Contact Medicine

Fact #1- If you’re planning on taking up arms, plan on getting hurt.

Fact #2- Statistically speaking, 10% of those injured will die from injuries sustained. Nothing you will do can change this. These casualties will be dead usually from first contact.

Fact #3- Of the 90% who don’t die, without a tiered response plan by trained and seasoned pros, many of them will die also.

Fact #4- In this era of government sponsored public endangerment, most public places are now an asymmetric battlefield.

Now that may not fit into your 3%er Rambo paradigm, but its the truth. So if you haven’t been a) networking, b) networking with the right people and c) training, you might just want to get on that. We are going to deal with how to stock a realistic personal kit that will actually save lives and won’t kill you or your patient in the process of using it. Simplicity is the watchword here.

Not long after I got out of the Army I was contacted by a local milita-type, who was a little too eager to show off his field kit seeking approval. What he called an ‘IFAK’ was stuffed to the gills with all sorts of crap that couldn’t be accessed when needed and was otherwise generally erroneous even if he could. This individual had no other training aside from a long out-of-date CPR course, which is to say, none at all. I tell you this story to illustrate a painful reality for many; not only is there little to no concept of what defines individual trauma response, but there’s even less of a concept of how to implement  a basic treatment plan. From here we will address what goes in a real Individual First Aid Kit (IFAK), how you implement it into your kit, and guidelines for use.

Keep It Simple, Stupid

The IFAK is not for treating others. It’s for others treating you. It is not for treating minor booboos and earaches, it’s for trauma that follows a strict definition based on the MARCH acronym, which we’ll talk about in a bit. The contents of the IFAK must be standardized across the board. We do this so that we know what’s in them, what each of those components do, and so that the next echelon of care can get a visual idea of the wounds by what items have been used. The IFAK is an immediate response to trauma in order to increase wound survival, hence it is very simply constructed and organized. This simplicity, like all things, is key to effectiveness under duress.

MARCH is the acronym to follow for treating trauma in order to save lives. CLS, or the Combat Lifesaver Course the Army teaches everyone in the Infantry (and probably everyone else too) is very outdated, or at least was according to the last doctrine I saw before I got out. The medics emphasized Responsiveness, Breathing, Bleeding, Fractures, Bruising/Contusions (as a sign of internal injury), and Head trauma, followed by treating for shock (which was very vaguely defined). The problem is that following that paradigm first takes too long and second is not placed in the order of what will kill you the fastest. MARCH is more logical and is as follows:

• Massive Bleeding: While you won’t bleed out quite as fast as what’s commonly thought Arterial wounds, while they do gush for the first bit, are marked by very bright red blood will clot faster and re-route themselves. I’ve actually seen arterial blood clot to itself on asphalt in a street. Venal wounds which are dark blood take much longer to clot but bleed slower. Despite this, blood loss is the fastest killer, especially when dealing with blast injuries. The primary item that belongs in your IFAK is a tourniquet. You should have one in the kit and two more on your your person. There are two types of tourniquets you should consider. I know there’s a bunch of other ones that I’m sure work just dandy, but these two I’ve used and it saved the respective lives of those casualties. Don’t ask me about the other tourniquets.

  

  CAT

  The first tourniquet is the Combat Application Tourniquet, or CAT for short. It’s a long strap of velcro with a plastic windlass for tension. Because it’s plastic, it works just fine for arms but I don’t trust it on legs. Muscles sometimes spasm uncontrollably from blood loss or shock, and plastic doesn’t give me a warm and fuzzy. That being said, the CAT is the fastest and simplest for self-aid, AKA putting it on yourself, so it’s likely the first one to be used.

  

  SOF-T

  The second design is the Special Operations Forces-Tourniquet, AKA SOF-T. It’s a little more complicated, being a thick strap of nylon with a screw down strap tension and metal windlass. This is the one you use on legs(ideally) because once it goes on it will not come off by accident. A note on using tourniquets- they do NOT go, as erroneously taught in Army CLS, two fingers above or below joints. They are placed on single bone structures as close to the top of the limb as possible (to use the single bone as a compression point) to immediately stop any bleeding. Conventional wisdom used to teach that everything below the tourniquet would get amputated, and this is 100% false. Arteries love to roll and move, and slip in between double bone structures of lower limbs.The higher you go, the better the tourniquet works, meaning as close as possible to armpits and crotches. Roger?

  

  Compression Bandage

  The second item to go in your kit also addresses bleeding. The Compression Bandage,seen above, sometimes also known as an Israeli Bandage, is the most versatile bandage on the market and allows for a high level of compression second only to a tourniquet. In addition to stopping the bleeding, it also covers wounds, can be used as a stabilizer for fractures, and be made into a sling if need be. These three items alone, if you have nothing else, are a huge step to saving lives.

• Airway: The second fastest killer is blocked airways, common in blast injuries and other facial trauma. There’s two steps to address this- lifting the chin of a casualty in the supine position (on their back) while clearing the lower airway (throat). Next you’ll insert a nasopharyngeal airway, or NPA for short. It’s a small green or blue rubber tube that goes up the nasal cavity and and into the throat, creating a clear artificial airway from an otherwise damaged path. (Yes, it sucks. BAD. Every CLS trained Infantryman knows, because they all had to do it. If you’re prone to fighting, like I am, and have a deviated septum from a broken nose they suck that much worse. They universally suck so bad, that I had a SGM that loved to give them to soldiers who fell out of formation runs and ceremonies. He kept it in his pocket and made that soldier’s NCO put it him in as a sweet reminder to not do that again.) This being said, an NPA needs to be in your kit. It WILL save a life.

With these two areas addressed we’ve increased the odds of a casualty surviving many times over. Even if you forget the rest, a casualty stands a good chance of survival with the appropriate follow-on care. An additional note on hemostatic agents (such as Celox and Quik-Clot) because I know someone is going to ask- I don’t recommend using them unless you’ve been trained on their use by a professional. I have, and I don’t tell you carry them individually without training. Do they work? Yes, and quite well. But there’s a caveat. First, the untrained go for them primarily whenever they see blood. Wrong. That should be the tourniquet. Second, Celox is made of shrimp shell, so if your casualty is allergic to shellfish, guess what- you just killed him. Third, and this has to do more with Celox than the others (when used improperly) it can break off and cause an internal blood clot killing your patient sometime down the road. It is only used as a LAST RESORT in places a tourniquet cannot otherwise go, such as groins or necks. Last, higher echelon care now must take it off, causing more problems. So in short, use the tourniquet. Its simple. It will do what it’s supposed to, and let those with more training take it from there. 

• Respiration: This is where CPR comes in. Get them breathing.
• Circulation: We’re looking for swollen limbs, which indicate internal trauma. You’ll want the follow on medical aid to know about this, but there’s little you can do as a primary responder.
• Head Trauma (H1): For head trauma, like circulation, you’ll want to make a note of it, then cover any open wounds to the head to prevent possible encephalitis. Further, upon recognition of head injuries, prevent the casualty from moving around. I’ve been that guy (catastrophic IED, I was in the turret nearly completely exposed) as well as treated that guy and he’s gonna say and do some strange things. Keep them as calm as possible if they’re awake.
• Hypothermia (H2): The injured get cold FAST. It’s something we don’t think about, but open trauma causes the body to lose heat at an expedited rate which will kill an otherwise stable casualty very quick. The easiest way to address this is with a simple space blanket, available pretty much anywhere that has a sporting goods section.

So as a recap, our new acronym for treating casualties is MARCH- Massive bleeding, Airway, Respiration, Circulation, and Head Trauma/Hypothermia.

But wait- you didn’t talk about abdominal injuries- gunshots, sucking chest wounds, etc? No, I didn’t. The reason why is that there’s not that much without extensive training you can do for this type of injury. You can pack it with gauze (or a tampon) to keep it from getting worse, but the best thing to do is close it with a safety pin. You should not consider a needle decompression for a sucking chest wound if you have little medical training either. Doing so incorrectly or overestimating your skill can cause many more problems than it solves, possibly killing your casualty. Understand? Extremity wounds are the ones you can treat the easiest and also kill the fastest if untreated. So focus on what you can do (unless you’re trained in advanced medicine by an accredited institution) and leave the rest to people who know what they’re doing. I also didn’t reference pushing fluids- that’s left to those with training for not only administering fluids but for monitoring the patient for shock possibly induced by those fluids.

Your IFAK is built along this paradigm, stocked with a CAT and SOF-T Tourniquet, a Compression Bandage, a NPA, medical tape (to better secure the tourniquet and NPA- make sure it’s 3M and not the cheap crap), space blanket and a safety pin. It’s not expensive, the equipment is available on Amazon and should be on the hip (or accessible in a standard place) of every person on your patrol. Ideally it should be on your belt and not your kit (because your kit might come off of you, your IFAK is Line 1) and in the same position on each person, so they can each be accessed without searching for it.

You’ll never know these days when just a tourniquet and an NPA might come in handy. I bet Boston’s responders would’ve greatly appreciated a few more among the crowd.

Since apparently everywhere is a potential battlefield in this era of government sponsored public endangerment, these basic techniques will be likely be needed in the near future. Act accordingly.