….On practical IFAKs

There is a dearth of useful information out there on practical useful IFAKs(Individual First Aid Kit). Most of what is offered amount to a “Boo-Boo” kit. They do not remotely address the most common of life threatening wounds encountered in a combat situation.

Outside of EMS/EMT training there is minimal information on the use and application of the equipment and materials required to address these wounds. There are a few DVDs available (Doc Spears) and some equipment manufacturers have made some useful you-tube videos on the use of their equipment (NARP, ARS).

A list of mandatory supplies:(most purchased IFAKS have few of these.)

Chest seal (Bolin, Halo, Hyfin, ARS, Asherman)

Chest decompression needle, 14ga, 3.25” (NAR ARS)

Tourniquet (CAT, NARP)

Battle dressing (OLAES, ISRAELI, H&H)

Hemostatic Z fold gauze (Celox, Quick clot)

Powdered Quick clot or Celox

Naso-Pharyngeal tube w/lube (RUSCH)

Nitrile gloves

Bandage scissors

Scalpel w/blade

Hemostat

Pen light

Beta-dine wipes

Waterproof marker

Tourniquets can be improvised from belts, straps etc, and compression bandages can be made from Kotex pads and ace bandages in a pinch.

These are the minimum of supplies needed to address the wounds discussed below. Proper use of these items with training, will allow you to:

Stop extremity arterial bleeding

Relieve a tension pneumo-thorax (collapsed lung, pressure on heart)

Seal a chest wound to prevent lung collapse

Provide a clear airway

Evaluate, stop bleeding and pack/bandage most other wounds

Cut away clothing and clean the site.

Debride the wound if necessary

Mark the casualty with time of tourniquet placement or other vital information

The following is informational only and is not to be taken as medical training, seek out a qualified medical instructor.

The below listed wounds are the top 4 combat wound killers if not treated in a timely manner. These wounds should be addressed by yourself or another, AFTER you have gained fire superiority or can be removed to a safe area. Other wise continue the fight.

Rule #1 is scene safety. Do not become a casualty yourself. Best way to do that is to return fire and and eliminate the threats to safety. Do not begin casualty care until you can do it safely.

There have been changes to the ABCs of wound care. Now it’s Circulation, Airway, Breathing, Circulation. Stop all major bleeding first and foremost as that is what is going to kill folks after a firefight.

Wound: Sucking chest wound [Tension pneumo-thorax (collapsed lung)]

Presents as: Entry hole the size of projectile in lung. May or may not also have a larger exit wound. Wound will make a sucking sound and/or blow blood bubbles. Look for Tracheal deviation, hyper- expanded chest, bulging neck veins. Patient in respiratory distress.

Treatment:Inspect for exit wound. Treat for shock if indicated. Clean wound(s) with beta-dine wipe, Place chest seal on entrance and exit wound per package instructions. Monitor for pneumo-thorax. If indicated, clean area in line with nipple vertically and between the 2^nd and third rib down from the clavicle (collar bone) with beta-dine. Feeling for the top of the 3^rd rib with your weak hand, place the decompression needle vertically just above the rib. If resistance is felt, angle the needle slightly away from the rib and fully insert flush. You should feel and or hear air escape. The wounded party should experience almost immediate improvement in breathing. Treat for shock. Monitor for blockage of needle. An additional needle may need to be placed next to the first one.

Wound: Arterial bleeding of extremities (arm/leg)

Presents as: Bright red pulsing, forceful bleeding. Elevated pulse.

Treatment: Apply CAT (combat application tourniquet) two inches above the wound. Apply Celox or quik clot granules. Tighten tourniquet until bleeding stops.(this will hurt, that is natural). If bleeding does not stop, apply an additional tourniquet above the first. Write time on injured forehead or tourniquet. Remove any visible debris and clean with beta-dine.(follow this treatment up with the next wound treatment.)

Wound: Puncture, stab, projectile penetration (single or thru and thru)

Presents as: wound smaller than two fingers, no arterial bleeding or has been addressed above.

Treatment: clean wound with beta-dine and bandage with gauze compress and tape. If excessive bleeding apply celox/quikclot and compression bandage.

Presents as: wound the size of two fingers. Moderate bleeding or arterial bleeding has been addressed

Treatment: Clean with beta-dine. Wrap a couple turns of Z-fold celox/quick clot gauze around two fingers and start packing gauze at the bleed site. Continue to feed in gauze working around the wound until full. Ball up additional gauze atop the wound and then apply a compression bandage.

Wound: Injured is unconscious and not breathing.

Presents as: Air way blocked for one reason or another. Difficulty breathing, unconscious.

Treatment: With injured on back , head supported, lubricate nasopharyngeal tube. Place the tube with the bevel against the inside wall of the nose and insert straight in (not up toward the eyes) It should follow the path of the hard palate. Twist up, with the bevel to the rear to clear the back of the tongue. If resistance is felt try the other nostril. (some people have one occluded nostril, but not both) Push the airway flush. Injured should start breathing through the tube. Place injured on his side in the recovery position.

This article has very briefly covered the skills and tools required to be a “combat lifesaver”. This is not in any way training to be a corpsman or EMT. Its intention is to allow basic, emergency, in the field, temporary, self or buddy treatment of the most statistically deadly combat wounds in a SHTF situation.

In the interest of correctness I submitted this article to an active duty LTC. medical combat, surgical nurse for review. I have added his few recommendations.

Please follow this up with additional study and training, if you feel that you or yours life is worth the additional skill set. What I have presented here are the mere basics and should not be construed as medical training, only advice in an area that you may not know, but should.

The life you save may be mine.

Included below is my outline for the CLS class I teach my Tactical Carbine students. It may be of use to you in training your friends and family.

CLS TRAINING MODULE FOR RANGE EMERGENCIES

Teaching aids:

Bolin chest seal

ARS decompression needle

Z-fold gauze

Israeli battle dressing

CAT

Naso tube

IFAK contents

alcohol wipes

Denim wrapped raw pork loin with gunshot wound,.223

Denim wrapped raw pork loin with large gunshot wound.

Denim wrapped raw slab of ribs with gunshot wound, .223

DECOMPRESSION NEEDLE (see ….on IFAKS notes)

Demonstration and then student practice of placement of chest decompression needle on a raw slab of ribs contained in saran wrap.

Use of volunteer to show correct location of needle placement.

Have students find location. And simulate with marker pen.

CHEST SEAL(S) (see notes)

Demonstration and then student practice of placement of chest seal on

slab of ribs with gunshot wound.

CELOX Z-FOLD GAUZE (see notes)

Demonstration and then student practice of packing and compression bandaging of pork loin with large gunshot wound.

CAT (see notes)

Demonstrate application of CAT.

Pair up students and have them apply CAT and check pulse to determine effectiveness of CAT and also experience the pain of a proper CAT application while monitored.

ISRAELI BATTLE DRESSING

Demonstrate and then student practice of application of compression bandage.

NASOPHRENGEAL TUBE (see notes)

Perform a non-invasive demo of tube placement.

Have students talk through a non invasive explanation of insertion.

BUDDY SIMULATION SCENARIOS

Set up scenarios and have buddied students simulate and explain the various treatments.

Regards, D.

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