Anyone been to a Stop the Bleed course?

[TheGerman]

I've been stacking as many certs as I can and came across this as it was attached to a DoD resource I was looking at. A lot of the medical/trauma related courses I've attended basically go over the same stuff CLS/TCCC does but ocassionally you learn something new, or something more specific to one piece of it all that comes in handy.

Came across this and seems they are nationwide, and its free. Was wondering if anyone has been and what they thought? Worst case, this gets a few of you off your asses to take a free 2 hour class.

STB Home Page

The American College of Surgeons Stop the Bleed program has prepared nearly 4 million people worldwide on how to stop bleeding in a severely injured person.

www.stopthebleed.org

I go to this stuff with an open mind and try not to have a seizure when they teach something differently. In the case of the site, I see they are trying to pack the wound before putting a TQ on it (assuming its a limb); which in the case of large venous or any arterial bleeding, good fucking luck with that idea.

Then you pack it, time the TQ and check for a distal to see if you push hexend or not. But anyways.

Has anyone gone?

 

[Bender]

So going.

 

[TheGerman]

So going.

It's free and for me there's one actually in the town where I live. No need to drive 2 hours or more like I usually have to.

 

[WaltHer]

Great civilian course. As you noted, based off TCCC guidelines. Most LEO/FD/EMS agencies use a slightly more industrial program TECC-tactical emergency casualty care. Almost identical to TCCC minus the colloid IV solutions, prophylactic antibiotics, etc. Every person in your family should attend STB. More and more workplaces, schools, etc. are stocking STB kits with their AED'S etc. And since we all like HS/LD kit: if you're still packing shitty Israeli bandages, consider upgrading or adding these:
they're very good. $7ish.

 

[Bender]

It's free and for me there's one actually in the town where I live. No need to drive 2 hours or more like I usually have to.

I need to find in in Denver

 

[2ndamendfan]

One 30 mins from me, in 6 months. Going sign up. Never hurts to learn something.

Thanks for the heads up.

 

[WaltHer]

A good resource especially because C-TECC is all open source, evidence based, and not profit motivated:http://www.c-tecc.org/

 

[Anb618]

We have a couple officers certified as STB instructors. They’ve been working their wait through the schools certifying teachers, just in case. Seems to be a good course from my understanding.

 

[TheGerman]

Great civilian course. As you noted, based off TCCC guidelines. Most LEO/FD/EMS agencies use a slightly more industrial program TECC-tactical emergency casualty care. Almost identical to TCCC minus the colloid IV solutions, prophylactic antibiotics, etc. Every person in your family should attend STB. More and more workplaces, schools, etc. are stocking STB kits with their AED'S etc. And since we all like HS/LD kit: if you're still packing shitty Israeli bandages, consider upgrading or adding these:
they're very good. $7ish.

Yep those are good. It's basically a pressure dressing with a free H&H inside.

Everyone needs to know how to use:

TQ
pressure dressing/wound pack with or without quikclot
Chest seal
Pneumo needle

 

[2aBaC̶a̶]

Meh, cant find anything in CA. Closest one is in Las Vegas. 9hrs away.

 

[clcustom1911]

I've been stacking as many certs as I can and came across this as it was attached to a DoD resource I was looking at. A lot of the medical/trauma related courses I've attended basically go over the same stuff CLS/TCCC does but ocassionally you learn something new, or something more specific to one piece of it all that comes in handy.

Came across this and seems they are nationwide, and its free. Was wondering if anyone has been and what they thought? Worst case, this gets a few of you off your asses to take a free 2 hour class.

STB Home Page

The American College of Surgeons Stop the Bleed program has prepared nearly 4 million people worldwide on how to stop bleeding in a severely injured person.

www.stopthebleed.org

I go to this stuff with an open mind and try not to have a seizure when they teach something differently. In the case of the site, I see they are trying to pack the wound before putting a TQ on it (assuming its a limb); which in the case of large venous or any arterial bleeding, good fucking luck with that idea.

Then you pack it, time the TQ and check for a distal to see if you push hexend or not. But anyways.

Has anyone gone?

You're on the right track, but the order in which you're packing/tying off is a bit askew.

Tourniquet is initial treatment for massive bleeders essentially from armpit to fingers and crotch to toes. If the bleeder isn't amenable with a TQ, like the neck, or in the arm pit, pack that fucker and hold pressure.

 

[TheGerman]

You're on the right track, but the order in which you're packing/tying off is a bit askew.

Tourniquet is initial treatment for massive bleeders essentially from armpit to fingers and crotch to toes. If the bleeder isn't amenable with a TQ, like the neck, or in the arm pit, pack that fucker and hold pressure.

Isn't that what I said

I mentioned that on the Stop the Bleed site, they have pressure first and TQ second, which from my experience is backwards. Read my post again

 

[Matches Malone]

Constellis use to use JTM in Vegas to cert come dudes coming on to contract. You don’t need to be working in contracting to go.

 

[DustBun]

Thank you for this information. I have been working on getting some medical training.

 

[MarinePMI]

To go along with this topic is a reminder:

If you have residual funds on your Health Flex Spending Account that you’ll lose on Dec 31, mymedic.com has trauma kits of various sizes that are HSA/FSA approved. Not affiliated with them in any way, but have a few of their trauma kits (house, car, etc), and they’re fairly decent once you add some decent drugs to them. No sense in giving money back to the government.

Just an FYI...

 

[fdkay]

It's a watered down TCCC class.
It is geared towards folks that may be on scene (like school teachers) and covers the very basics of stopping blood loss

 

[Nik H]

Nice

There is one 20 miles from me. This is great! Thanks for posting

 

[pmclaine]

Trying to get my wife to schedule one of these at her Fed Department work.

Few weeks ago she was witness to a party getting T boned on a Motorcycle resulting in lower leg amputation.

All my wife could do was offer some Tshirts for bandages. Someone else showed up and used their belt to tie off the amputation.

I bought my wife a kit from Chinook that includes Soff-T wide, quick clot, and appropriate first aid for bleeds and other trauma.

Still hasn't taken the time to sit with me and learn how to use it.

Truth be told she would be better learning it from someone else. One of these Stop the Bleed classes is exactly the type of thing she should schedule through their training department.

Shit listening to the news over the last 24 hours seems every citizen should be issued an IFAK.

 

[Matches Malone]

Trying to get my wife to schedule one of these at her Fed Department work.

Few weeks ago she was witness to a party getting T boned on a Motorcycle resulting in lower leg amputation.

All my wife could do was offer some Tshirts for bandages. Someone else showed up and used their belt to tie off the amputation.

I bought my wife a kit from Chinook that includes Soff-T wide, quick clot, and appropriate first aid for bleeds and other trauma.

Still hasn't taken the time to sit with me and learn how to use it.

Truth be told she would be better learning it from someone else. One of these Stop the Bleed classes is exactly the type of thing she should schedule through their training department.

Shit listening to the news over the last 24 hours seems every citizen should be issued an IFAK.

She should of done what I did on my way to Del taco at 0100. Dude got got by a car while crossing the road, the car blocked the road as there was a curb center divide. Dude was on the ground dying. I popped my truck door and asked what happened, dude that hit him told me, I said “cool” and I put my truck into gear and gtfo’d over that center divide and made my way to Del taco. Med bag in truck and all. Not my problem, and I never claimed to be a hero. I hate people to much for that shit.

 

[pmclaine]

She should of done what I did on my way to Del taco at 0100. Dude got got by a car while crossing the road, the car blocked the road as there was a curb center divide. Dude was on the ground dying. I popped my truck door and asked what happened, dude that hit him told me, I said “cool” and I put my truck into gear and gtfo’d over that center divide and made my way to Del taco. Med bag in truck and all. Not my problem, and I never claimed to be a hero. I hate people to much for that shit.

Well that's one option.

If anyone in your family gets hit Im hoping someone doesn't make that same decision.

 

[Kamerad]

I took it through my local sportsmans club. A good refresher. I don’t get too fired up about which protocol is the high speed lo drag of the moment.

Get good reps.

 

[Anb618]

She should of done what I did on my way to Del taco at 0100. Dude got got by a car while crossing the road, the car blocked the road as there was a curb center divide. Dude was on the ground dying. I popped my truck door and asked what happened, dude that hit him told me, I said “cool” and I put my truck into gear and gtfo’d over that center divide and made my way to Del taco. Med bag in truck and all. Not my problem, and I never claimed to be a hero. I hate people to much for that shit.

Is it just me, or does this make anyone else fucking sick?

I would understand if doing so puts your health and safety in danger (active shooter in progress, etc...), but if you have the opportunity, training, and equipment to help save someone’s life and purposely choose not to out of convenience, you’re the lowest kind of human being...

 

[pmclaine]

Great company having a twenty percent off sale......

Chinook Medical Gear, Inc.

Chinook is a Veteran-Owned and Native American Minority-Owned 8(a) Small Business that provides custom medical solutions for the harshest environments

www.chinookmed.com

 

[Anb618]

Great company having a twenty percent off sale......

Chinook Medical Gear, Inc.

Chinook is a Veteran-Owned and Native American Minority-Owned 8(a) Small Business that provides custom medical solutions for the harshest environments

www.chinookmed.com

We use their Care Under Fire pouches strapped to the passenger headrests in our cars at work. I like them so much, I used them to build my own STB kits for mine and my wife’s personal vehicles. Good gear.

Chinook Medical Gear, Inc. Care Under Fire Pouch (TMK-CUF)

This compact tactical medical pouch has internal retention bands for trauma supplies, as well as an external band for optional tourniquet placement.

www.chinookmed.com

Been kicking around the idea of getting some hunting buddies each one of their BleederPAKs to throw in their hunting bags after seeing someone post a photo of a hunting arrow through their leg here last month...

 

[Switchblade]

Last major cert I had was ACLS, Advanced Course. Heavy bleeding was always tourniquet first, then pressure bandage(which packs the wound)

 

[pmclaine]

We use their Care Under Fire pouches strapped to the passenger headrests in our cars at work. I like them so much, I used them to build my own STB kits for mine and my wife’s personal vehicles. Good gear.

Chinook Medical Gear, Inc. Care Under Fire Pouch (TMK-CUF)

This compact tactical medical pouch has internal retention bands for trauma supplies, as well as an external band for optional tourniquet placement.

www.chinookmed.com

Been kicking around the idea of getting some hunting buddies each one of their BleederPAKs to throw in their hunting bags after seeing someone post a photo of a hunting arrow through their leg here last month...

Yep hit them up for a bunch of gear and made 5-6 kits for various places at home and the vehicles.

When I had my appendix out in July used the aspirin from my med pack to deal with post op pain.

They carry everyuthing you could possiboly need medically.

Be careful though.....most of the stuff is beyond my level of training.

Don't buy beyond what you know.

The kit I made for my wife........Im guessing Ill be putting it in her car and just telling her "Don't try to use it. Give it to someone that knows what they are doing."

 

[powdahound76]

I teach STB classes.

@Bender

Gimme a bit to sort through some crap at work (couple weeks) and we can schedule a class.

I could do one for Denver metro guys and one up your way for the WY contingent.

It is a good class.
I liken it to bystander CPR for life threatening bleeding.

Basic interventions save a lot of lives.

 

[TheGerman]

It's a watered down TCCC class.
It is geared towards folks that may be on scene (like school teachers) and covers the very basics of stopping blood loss

I'd still suggest to anyone that they go. Worst case you get a refresher on packing a wound for 2 hours and it was free.

I have CLS and TCCC and still go to these sort of things because you may just learn a trick to something, i.e. a better way to store or deploy a TQ, a better method of packing gauze, etc. Something.

Or you reinforce what you knew to begin with and go home with a free cookie.

I'm also constantly amazed at how many people have firearms and go shoot/plink/whatever and don't have an IFAK and/or any medical knowledge past 'keep pressure on the wound' because they saw it on an episode of Grey's Anatomy. You don't need to learn all of the intricate pieces of it all; you have to do everything to get the guy to the collection area, medvac or actual hospital. That's it.

The level of what I've been trained to do, and have had to utilize under less than fantastic conditions is basically:

- How to deploy and properly fit a TQ on both myself and someone else. Sharpie the time the TQ was put on once you're done with all of the immediate things you have to do.

- If you can't get a TQ on because of the wound area location (and its not a stomach wound) pack it and pressure dress it. If its a stomach wound, pressure dress only as packing will probably make it worse. If a chest wound, seal it. Look for an exit wound as well. Seal that too.

- On a chest wound watch for signs of pnuemothorax; administer needle as needed. I suck at finding the 3rd rib. Sit them up.

- Are they unconscious and/or have have something fucked up with their airway? Nose tube.

- Make sure they don't go into shock.

- Check for distal pulses. If no distal, administer or let whoever needs to know at handoff so you can get some hexend in them.

That's literally it. There's a ton of detail to this, but this is basically it. I'm mentioning this because again, going back to all the people out shooting, training, wanting body armor and shit yet couldn't even do this.

 

[AIAW]

And here I thought this thread was about getting your wife to shut the hell up for a few days out of every month...

On a serious note, good info in this thread. I need to "re-cert" myself when I can carve out some time.

 

[Slash0311]

Amazing! I attended a local TCCC course this week. I really liked the info however some of it was well beyond what I would have access to in my "kit". Such as IVs and meds.

My instructor also steered me toward "stop the bleed" to become an instructor to teach some of the TQ skills and things to my department. Im going to be looking into this more for a class in my area.

Thanks also guys for the links to the kits. Im going to be buying my own and options are always good. Im looking at the North American Rescue TORK kit which has almost everything I want in a more complete type kit.

 

[TheGerman]

Amazing! I attended a local TCCC course this week. I really liked the info however some of it was well beyond what I would have access to in my "kit". Such as IVs and meds.

My instructor also steered me toward "stop the bleed" to become an instructor to teach some of the TQ skills and things to my department. Im going to be looking into this more for a class in my area.

Thanks also guys for the links to the kits. Im going to be buying my own and options are always good. Im looking at the North American Rescue TORK kit which has almost everything I want in a more complete type kit.

From the words of an instructor I had, 'Fuck all that. You need to get there first'.

It's a bit overwhelming especially the terminology and just how over complicated it can make it. I forget what it is, but the medical jargon to find the space between the 2nd and 3rd rib in line with the nipple made it sound like you were about to perform 6-step brain surgery and my eyes just glazed over.

IV's are useful for after stabilization, but again, you gotta get there first and hopefully you/they are on the way to or at the hospital at that point. I'm annoyed that finding stuff like Hexend is basically impossible on the civi side seeing as how it doesn't contain a narcotic or anything weird.

 

[clcustom1911]

It's a bit overwhelming especially the terminology and just how over complicated it can make it. I forget what it is, but the medical jargon to find the space between the 2nd and 3rd rib in line with the nipple made it sound like you were about to perform 6-step brain surgery and my eyes just glazed over.

You mean the second intercostal space superior to the 3rd rib at the mid-clavicular line? ?

?

 

[powdahound76]

As a semi experienced person with sick and dying trauma patients, starting IVs and needling chests is not the best idea unless you have training, practice, experience, and are covered under a medical director or some kind of insurance (probably for PD working on your own folks). That stuff goes beyond the Good Samaritan laws of most states.

Also, getting IVs on a bleeding trauma patient isn't always easy. there is a reason the medics carry IO kits in the military world.

I still use them on occasion, surrounded by a large team of highly trained and experienced professionals.

I love STB as I believe it is the "everyman" training that can and will save lives in the event of an Mass Casualty Incident. Doesn't have to be shooting or terrorism like the Boston bombing. Could be a building collapse, multi car pile up, or natural disaster.

I wonder about teaching a class on video and posting to youtube? HMMMMM Not that I want to be out there. Perhaps plan it and make someone else teach the class?.....

and always use the line from one of my favorite trauma surgeons as she was putting a chest tube in a guy dying from a massive hemothorax. In a thick GA accent "My name is Dr. XXXXXX, This is gonna hurt like hell, but I am gonna save your life".
1.4L of blood out in about 90 seconds from his R chest from a stabbing wound. Dude did well, home 4-5 days later.

Anyways, off work with a sick kid today, have to go do some parenting stuff......

 

[powdahound76]

You mean the second intercostal space superior to the 3rd rib at the mid-clavicular line? ?

?

Or the 5th at mid axillary?

This is all I do, so I feel kinda in the know in this discussion.
Many reloading and fine points of shots at 1400 yds talks get my brain boggled.

Ok, really need to be a parent for a while. More later ladies

 

[clcustom1911]

Or the 5th at mid axillary?

This is all I do, so I feel kinda in the know in this discussion.
Many reloading and fine points of shots at 1400 yds talks get my brain boggled.

Ok, really need to be a parent for a while. More later ladies

Oh come on now!. 5th ICS at the midaxillary is the secondary spot. It should be primary because its easier to access, but that's above our heads.

 

[Slash0311]

I am so glad Im not the only one that the medical jargon goes over on. It made me feel as tho I was drunk in a bar trying to pick up the hottest gal in there not knowing she was out of my league...

 

[Downtown]

I was trained to start IV, insert oropharyngeal and nasophargeal airways and decompress a tension Pneumothorax many years ago. Not confident with my skill level, nor covered under a medical director any longer. However, my kit still contains gear above my skill level. My reasoning is that at a accident scene, it's not uncommon to meet another responder who might be a nurse or doctor. Once stopped at a MVA where a person was being treated by a ER doctor who had no kit and I did. My point is to go ahead and pack needle and nasopharyngeal airway/lube. Someone might be able to use them.

I could not possibly not stop and offer any aid I could, especially if I was trained and equipped. Seems a basic tenet of humanity. Even if I really wanted a taco.

 

[pmclaine]

For my wifes kit, knowing her lack of training, I gave her the following

1. TQ
1. 4x6 pressure dress.
1. Big abdominal dress.
1. Roll of gauze
1. Compressed gauze
1. Z Fold Quick clot
1. Foil emergency blanket
1. Sharpie

Pretty much I intend to gear it toward the incident she came upon and if she can understand how to deal with an extremity amputation she can likely do no harm with other injuries.

TQ the limb, Sharpie the time, Pack with Quick clot/gauze, apply pressure dressing, further protect with large abdominal gauze, treat for shock by maintaining heat, elevate wound, monitor for bleed through, pressure on artery to bone, you have done all that can be expected.

 

[pmclaine]

Fuck, just spent more ammo money on a blue training TQ from Chinook.

Well at least it wasnt 35 Lancer mags or something.

 

[Matches Malone]

Is it just me, or does this make anyone else fucking sick?

I would understand if doing so puts your health and safety in danger (active shooter in progress, etc...), but if you have the opportunity, training, and equipment to help save someone’s life and purposely choose not to out of convenience, you’re the lowest kind of human being...

Good. It’s that feeling that made me this way. I don’t know what kind of fucking dick sucking asshole is going to put a lawsuit on me. And laying in the road? Common, those little shit kids in Afghanistan use to lay in the road to slow your vic’s down just before you get ambushed. Fuck no. I’m going to dell taco, package acquired and I’m RTB.

EMS gets paid to deal with that. They wanted to be the hero’s, let them do that shit. I’ll keep driving 97.3% of the time if it ain’t my business. You think I’m low, but I think your stupid, or at least not as experienced.

 

[Downtown]

Well, you'll probably be lucky. If you're ever seriously injured and in desperate need of trauma care, chances are very good that there will be somebody that does not feel the way you do. Hope you're appreciative and don't sue them.

 

[isofahunter]

You have a rifle, pistol, knife and sunglasses in arms reach. Which sends you to ER?
Everyone in your circle needs BASIC skills to stop bleeding, and know WHERE the FUCK they are so they can call for help and get someone there ASAP.

The answer is sunglasses.

When they opened it up the every time my son's heart beat he painted the wall red. Had tools and mind set to manage the bleeding until someone could get him to ER.

 

[MarinePMI]

Good. It’s that feeling that made me this way. I don’t know what kind of fucking dick sucking asshole is going to put a lawsuit on me. And laying in the road? Common, those little shit kids in Afghanistan use to lay in the road to slow your vic’s down just before you get ambushed. Fuck no. I’m going to dell taco, package acquired and I’m RTB.

EMS gets paid to deal with that. They wanted to be the hero’s, let them do that shit. I’ll keep driving 97.3% of the time if it ain’t my business. You think I’m low, but I think your stupid, or at least not as experienced.

That's some serious Blue Falcon shit right there...smh. Semper I brah...

 

[Sean the Nailer]

I'd still suggest to anyone that they go. Worst case you get a refresher on packing a wound for 2 hours and it was free.

I have CLS and TCCC and still go to these sort of things because you may just learn a trick to something, i.e. a better way to store or deploy a TQ, a better method of packing gauze, etc. Something.

Or you reinforce what you knew to begin with and go home with a free cookie.

I'm also constantly amazed at how many people have firearms and go shoot/plink/whatever and don't have an IFAK and/or any medical knowledge past 'keep pressure on the wound' because they saw it on an episode of Grey's Anatomy. You don't need to learn all of the intricate pieces of it all; you have to do everything to get the guy to the collection area, medvac or actual hospital. That's it.

The level of what I've been trained to do, and have had to utilize under less than fantastic conditions is basically:

- How to deploy and properly fit a TQ on both myself and someone else. Sharpie the time the TQ was put on once you're done with all of the immediate things you have to do.

- If you can't get a TQ on because of the wound area location (and its not a stomach wound) pack it and pressure dress it. If its a stomach wound, pressure dress only as packing will probably make it worse. If a chest wound, seal it. Look for an exit wound as well. Seal that too.

- On a chest wound watch for signs of pnuemothorax; administer needle as needed. I suck at finding the 3rd rib. Sit them up.

- Are they unconscious and/or have have something fucked up with their airway? Nose tube.

- Make sure they don't go into shock.

- Check for distal pulses. If no distal, administer or let whoever needs to know at handoff so you can get some hexend in them.

That's literally it. There's a ton of detail to this, but this is basically it. I'm mentioning this because again, going back to all the people out shooting, training, wanting body armor and shit yet couldn't even do this.

You obviously don't know what you're talking about. EVERYBODY that has watched Greys Anatomy AND Code Black knows that the very first thing you do, is cut the wound larger so that you can fit your whole hand (up to the wrist) into the chest cavity. This way, you can use all your fingers to pinch off the artery's, right then and there. So that stops the bleeding, and whilst you're sitting there 'holding the patients life in your fingers' then others can suture-off whatever offending tumor happens to be found whilst using the portable 'back-pack MRI'. In an elevator.

With the power off.

During and earthquake.

Everything else you said though, seems pretty spot-on to me. It has been too many years since I've taken "Industrial First Aid" (don't even know if they call it that anymore) as I had needed it for completion of the ERT training. Alas, too many have been practicing their lessons on me, in the past 15 years. Maybe it's time I get back into the 'giving' instead of the 'getting'.

Excellent thread. Seriously.

 

[Matches Malone]

That's some serious Blue Falcon shit right there...smh. Semper I brah...

Only a blue falcon if I was buddy fucking. The stiff on the ground with his agonal breathing wasn’t my buddy. Semper Gumby. Here take some of these.

 

[pmclaine]

You obviously don't know what you're talking about. EVERYBODY that has watched Greys Anatomy AND Code Black knows that the very first thing you do, is cut the wound larger so that you can fit your whole hand (up to the wrist) into the chest cavity. This way, you can use all your fingers to pinch off the artery's, right then and there. So that stops the bleeding, and whilst you're sitting there 'holding the patients life in your fingers' then others can suture-off whatever offending tumor happens to be found whilst using the portable 'back-pack MRI'. In an elevator.

With the power off.

During and earthquake.

Everything else you said though, seems pretty spot-on to me. It has been too many years since I've taken "Industrial First Aid" (don't even know if they call it that anymore) as I had needed it for completion of the ERT training. Alas, too many have been practicing their lessons on me, in the past 15 years. Maybe it's time I get back into the 'giving' instead of the 'getting'.

Excellent thread. Seriously.

Someońe should be banging somebody in the midst of it also

 

[Ravenworks]

Good. It’s that feeling that made me this way. I don’t know what kind of fucking dick sucking asshole is going to put a lawsuit on me. And laying in the road? Common, those little shit kids in Afghanistan use to lay in the road to slow your vic’s down just before you get ambushed. Fuck no. I’m going to dell taco, package acquired and I’m RTB.

EMS gets paid to deal with that. They wanted to be the hero’s, let them do that shit. I’ll keep driving 97.3% of the time if it ain’t my business. You think I’m low, but I think your stupid, or at least not as experienced.

I think you're an asshole, but you're entitled

 

[powdahound76]

LDMF. Nuff said

 

[Keel Haul]

I need to find in in Denver

5.11 in town was doing them. I’ve been checking there now and then to see when they were going to have another one but haven’t seen anything yet.

 

[Doc68]

Oh come on now!. 5th ICS at the midaxillary is the secondary spot. It should be primary because its easier to access, but that's above our heads.

Actually that is the new standard for the army. The old secondary position due to 83% of the old primary site not working. We also now use a 10ga needle instead of 14 and it's still 3.25" in length.