An individual first aid kit, or IFAK, can give you the tools you need...
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One of the most frequently-neglected categories of every-day carry (EDC) gear is emergency trauma supplies. We tend to focus our EDC efforts on items like firearms, knives, flashlights, multi-tools, spare magazines, and perhaps some counter-custody tools. In our efforts to be prepared for a violent assault, we try to carry the tools that will help us answer the threat, but often overlook the necessity of having lifesaving tools that can keep someone alive until medical professionals arrive.
Whether one likes to admit it or not, we live in a hostile world with many bad people who would like nothing more than to deprive you of life. Aside from that nasty fact, injuries happen. Good people have accidents, nature strikes, and the laws of gravity and motion are constantly at work.
What happens when that active shooter walks into your church and gets off four or five shots before you can react? Or when that drunk driver runs into oncoming traffic? Or when a guy in a rented van plows through dozens of people on a public sidewalk? You must be prepared to render medical aid if you are going to save lives, lives that could include those of your dearest loved ones, or even your own. Being prepared means having the right mindset, the right training, and the right equipment for the task.
The battlefield is the proving ground for trauma management technology and techniques. The mid-‘90s brought about the introduction of Tactical Combat Casualty Care (TCCC). Originally designed for the Special Operations medical community, TCCC has become the standard model of care in prehospital battlefield medicine.
TCCC provides a set of evidence-based best-practices for battlefield trauma care with the objectives of providing lifesaving care to injured combatants, limiting the risk of further casualties, and achieving mission success. Prehospital battlefield care is divided into three phases:
Care-Under-Fire (CUF): In the CUF phase, combatants are under attack by effective enemy fire. The essential initial action during this phase is to return effective fire to neutralize the threat and prevent continued effective fire from the enemy. During this phase, medical actions are limited to movement to cover, self-aid, rapid assessment for massive extremity hemorrhage, and rapid tourniquet application if practical.
Tactical Field Care (TFC): TFC is rendered while still in the tactical environment, but not under effective enemy fire. This phase focuses on assessment and management of massive hemorrhage, airway, respirations and breathing, circulation, and hypothermia.
Tactical Evacuation Care (TACEVAC): This phase of care encompasses the same management and procedures included in TFC with the additional focus of advanced procedures that may be performed while en route to a medical treatment facility.
These TCCC protocols have proven extremely effective at reducing preventable death on the battlefield. The fatality rate in current combat operations has decreased to roughly half of the 15% fatality rate seen in Vietnam.
The proliferation of mass killing events in the United States over the past several years has demonstrated the need for a paradigm shift in civilian prehospital medicine. As a result, many of the lessons learned from the efficacy of TCCC protocols on the battlefield have been brought into civilian emergency medicine in the form of Tactical Emergency Casualty Care (TECC). Most law enforcement agencies are now training officers in TECC principles and outfitting them with tourniquets and individual first aid kits (IFAKs). Some even at the basic academy level.
In 2015, the Department of Homeland Security launched a national awareness campaign called Stop the Bleed to educate and encourage bystanders to respond to bleeding emergencies using direct pressure, pressure dressings, and tourniquets. Specialized TECC courses like the Dark Angel Medical Direct Action Response Training (DART) and the Independence Training IFAK Life Saver course are now commonplace within the tactical training community. With so much information and training available, it’s hard to have an excuse for not knowing what to do in a trauma situation.
Having established the need to carry medical supplies and the knowledge to use them, the question then becomes, “What should we carry?” From what we have learned from over 10 years of TCCC research, we know that the three most common causes of preventable death in combat are blood loss through extremity wounds, tension pneumothorax (build-up of air in the space between the lung and chest cavity wall), and airway problems. It would then stand to reason that we should carry items that would allow us to treat these injuries.
Tourniquet: A tourniquet is probably the absolute minimum piece of medical equipment you should carry on your person. It needs to be accessible with either hand and staged in a manner that allows it to be self-applied in less than 30 seconds. A severed femoral artery can lose 3 liters of blood (over half an adult’s total blood volume) in less than 120 seconds. The C-A-T and the SOFTT are the only compact tourniquets currently recommended by the Committee on Tactical Combat Casualty Care.
Hemostatic Gauze: Hemostatic gauze like the QuikClot Combat Gauze is a wound dressing treated with a blood-clotting agent. It can be used to pack penetrating wounds after the initial tourniquet application or at the junctions of the body where a tourniquet is not effective.
Pressure Bandage: A pressure bandage is used to provide direct pressure to a bleeding injury while covering the wound. This can be used on less severe bleeds that do not warrant the use of a tourniquet, or in conjunction with a tourniquet or hemostatic gauze.
Occlusive Dressings: Penetrating chest trauma must be covered with an occlusive dressing to prevent air from entering the plural space of the chest cavity, which can result in a tension pneumothorax. You should carry at least two occlusive dressings, one for an entrance wound and one for an exit wound. Chest wound kits like the HALO Chest Seal usually include two seals for this reason.
Nasal Airway: A nasal airway (NPA) is the most versatile airway device you can add to your kit, because it is light, compact, and can be used on either a conscious or an unconscious patient. Your personal kit should contain an NPA sized for you. The most common sizes are 8.0mm for males and 7.0mm for females, which should serve as a good starting point.
These items provide the basis of a good minimalist trauma kit. Of course, having several pairs of medical exam glove on hand is also a good idea for body substance isolation (BSI).
Unless you’re running around in full battle rattle every day, finding room for emergency medical supplies on your person can be very challenging. Sure, it’s a good idea to throw some of these items in your car, but in a tactical trauma situation, seconds count. You need these items with you.
The most obvious place to stash your IFAK is in a pocket, but this may be problematic. Wearing tactical cargo pants 24/7 isn’t exactly discreet, and the pockets on a pair of regular jeans or shorts are likely to bulge uncomfortably with your kit inside. Anyone who has carried a concealed handgun with an ill-fitting holster or belt knows how irritating this sort of continuous discomfort can be, and how it can lead to excuses about leaving important gear at home.
Just like a CCW, your IFAK needs to be easily-accessible, discreet, and comfortable enough to wear every day. So, if pocket carry isn’t feasible, you’ll need to consider an alternative carry method.
One excellent solution to this carry space conundrum is the Ryker Nylon Gear Ankle First Aid Kit (AFAK). The AFAK is a lightweight (2.3 ounces) ankle system for carrying essential medical items. The three vertical pockets will easily hold a tourniquet, hemostatic gauze, mini pressure bandage, NPA, and trauma shears. An internal horizontal pocket is perfectly sized to fit a HALO chest seal or other occlusive dressing. MSRP is $55, and the system is available in four colors — black, ranger green, grey, and coyote. All Ryker Nylon AFAKs are made in the USA.
While wearing the AFAK, we found it to be surprisingly comfortable and concealable under long pants. The divided pockets tend to mold the contents around your leg, locking the AFAK in place and preventing shifting. Even without high boots (an elastic boot extension piece is included) or long socks, the AFAK is comfortable to wear and easy to forget about. It is an outstanding solution for on-body transport of trauma supplies.
Even if you’ve already found a carry solution for your medical gear, Ryker says the AFAK can be used to carry other items. The AFAK provides an excellent carry solution for a spare pistol magazine, flashlight, knife, or other EDC gear that you might not have room for in your pockets or around your waistline.
An IFAK can be carried even when law prohibits the carrying of a firearm. Most IFAK items are TSA compliant as well, so there is little excuse not to have one at all times. Even when your wardrobe makes carrying an IFAK challenging, the Ryker Nylon AFAK offers a viable option to limited cargo space.
A recent study of the tragic Pulse Nightclub Shooting that claimed 49 lives found that almost one-third (16) of the victims had potentially survivable wounds had immediate prehospital trauma care been provided. These findings further illustrate the importance of carrying an IFAK and having the knowledge to identify and treat casualties with preventable causes of death and keep them alive long enough to reach definitive care.
Chad McBroom is a 21-year veteran law enforcement officer with most of his time spent in the tactical unit. He has also served as Tactical Emergency Medical Technician within that unit. Chad McBroom is the owner of Comprehensive Fighting Systems and offers training in empty-hand tactics, edged weapons, impact weapons, and firearms tactics. Follow him on Instagram: @cfs_combat.