Some IFAK Facts, Part 1 by MtnDoc in Washington

Introductory Disclaimer: This article is about medical first aid care and should only be used in emergency situation. Apply them at your own risk. There is no substitute for hands-on training.

I am writing today to touch on a topic that I have seen some discussion in regards to related equipment but not the requisite training. I have heard it many places including on this page that without training, any equipment is useless. I would heartily agree with this sentiment. I would argue that this is particularly true when it comes to medical equipment, and especially with first aid equipment. This is what I will be discussing today.

I cannot tell you how many times I have been to the range and at shooting courses and have seen folks carrying their Individual First Aid Kits (IFAK) on their belts, vests, etc. who do not know how to use most of their contents. When I ask, I usually get a response similar to “I am sure someone else around will know how to use them all if I don’t.” To my way of thinking, this is a less than satisfactorily response. If you take the time to purchase and carry the equipment, you should know how to use the equipment. They obviously care enough about equipment training to be at the range or even in a firearms class.

There seems to be a gap in the civilian market for good training for things as simple yet possibly lifesaving as the contents in a simple IFAK. As I speak, I am coordinating with a local shop who sells first aid equipment along with offering firearms and training to use the firearms to develop and teach a class similar to what I am going to go over in this post.

First, a little bit of my background in this subject matter. I am a former Navy Corpsman with time spent in the field overseas shipboard and on the ground with the Marines. I served two deployments in support of Operation Iraqi Freedom/ Operation Enduring Freedom where I trained sailors and Marines how to render first aid/buddy aid as well as served their medical needs. I am now a civilian with more time spent treating patients in emergency rooms and urgent cares.

I have seen firsthand in combat situations what quality first aid can do for the seriously injured as well as back home in the civilian world. This is why I always carry a well-stocked first aid kit in my vehicles and on my person. One never knows when they may roll up to an accident on a country road, when something catastrophic happens at the range, or be around when an active shooter situation takes place. Now, my personal kits are a bit more well stocked than the average IFAK, but I have had the training to use them properly. What I will go over today is how to use the contents of a basic IFAK that are commercially available in many places that can be obtained without any credentialing required to use the contents.

Stop The Bleeding, Start The Breathing

Most IFAKs available are variations on a theme, based upon who is offering the kit. The contents will be branded differently and may look different cosmetically, but they all do the same job and should not be too difficult to figure out. I would still highly recommend in person training to use whatever your kit contains. There truly is no substitute for hands on training. The purpose of the average IFAK is to do two things: Stop the bleeding and start the breathing. It will take up your time to cover these two items in the time it will likely take first responders to get to you in the situations you will probably come across. And of course, this is assuming the 911 system is active and not a TEOTWAWKI situation.

I cannot stress this enough though, whatever the situation, your first step should always be to call 911 and get the Emergency Medical Service (EMS) system activated. The second step should be to check the situation and be absolutely sure it is safe for you to respond to the injured person, i.e. making sure the threat is neutralized, weapon is secured, or traffic is stopped, et cetera. You do not need to add to the chaos by becoming a casualty yourself.

IFAK Contents

A good basic IFAK will come with these items at a minimum:

    • Elastic bandage (ACE wrap)
    • Plain gauze
    • Hemostatic Gauze (Quikclot, HemCon, Celox)
    • Tourniquet (CAT, RATS, etc.)
    • Chest Seal (HyFin, Fox, Halo)
    • Trauma Shears
    • Gloves
    • CPR mask

Of these contents, the gloves, plain gauze, trauma shears, and elastic wrap are pretty common and self-explanatory to use. The CPR mask is also pretty self-explanatory. My only caveat with using a CPR mask is to make sure you tilt the casualty’s head back with use to help open the airway. I highly recommend attending CPR class for training in this. The Red Cross and American Heart Association both offer classes and certification for CPR that will cover how to use a mask in rescue breathing as well as chest compressions properly. These may be offered through your local hospital, CERT, or through private companies. Moving forward in this article, I will assume the patient is conscious and CPR is not needed. In practice, CPR would come first prior to any further life saving measures.

Bleeding

Once you have activated EMS by calling 911 and have established scene safety, it is time to get to work on any casualties you have identified. The next step is to stop the bleeding. A tourniquet should NOT be the first step to control bleeding in an extremity, it should be absolutely the last resort. Once the tourniquet is applied, you are basically writing off the rest of the extremity that is farther away (distal) to the heart. Anything on the distal extremity will have decreased and possibly no blood circulation as well as the wound itself. You could be effectively be killing that extremity. The first steps to stop the bleeding should be elevation and direct pressure. Lifting the arm/leg or head and torso and using the gauze to apply direct pressure to the wounded are may be all that is needed to control bleeding.

Direct pressure should be attempted for a minute or two. If this does not stop or slow bleeding to a controllable level, the next step will be to apply hemostatic gauze. I am most familiar with the QuikClot brand hemostatic gauze, but all hemostatic gauze application is the same. Hemostatic gauze is a gauze pad that has been impregnated with hemostatic granules to promote rapid coagulation to control rapid arterial bleeding. It is important to cover all areas of the bleeding area with the hemostatic gauze, including the deep areas of a wound. The gauze needs to touch the entire wound surface area. This may mean you will need to spread open a wound that does not naturally lay open enough to apply the gauze to the deep areas of the wound. Once the gauze is in place, apply direct pressure again and see if this controls the bleeding. A second hemostatic gauze pad may be required as needed.

Once the bleeding is controlled with the hemostatic gauze, apply a pressure dressing with the Elastic bandage or similar. Another bandage that I would recommend augmenting any IFAK with is an Israeli Dressing. It is like an ACE wrap with a gauze pad attached as well as a plastic windlass to help create more pressure on the wound. With any dressing/tourniquet, it is recommended to monitor distal pulses as needed. This will be further discussed with tourniquets usage.

Another Gauze that is advisable to add to your IFAK is an ABD pad. It is similar to a female sanitary pad, just larger. Their purpose it to absorb more drainage/blood than a similar sized standard gauze pad. These can be placed over the hemostatic gauze prior to the ACE or Israeli Bandage to help add to the direct pressure to the wound.

If the hemostatic gauze is unable to adequately control the bleeding, pressure points or tourniquets may be your next move. I will discuss this topic with a major caveat: if EMS is available, I would advise against the use of tourniquets in all but most absolute traumatic injuries such as amputation or severe, uncontrollable arterial bleeding. You could likely open yourself up to litigation. If EMS is available, direct pressure and pressure points would be as far as I would likely go, even with my training.

(To be concluded tomorrow, in Part 2.)




32 Comments

  1. The Golden Rule when administering First Aid is: First – Do No Harm.
    On more than one occasion, I’ve witnessed the first people on the scene doing exactly that, not knowing what to do, but stating later “I had to do something.”
    Not even using common sense, actually making the situation worse than if they had done nothing.

  2. In my experience, there is a gap on civilian first aid training because of liability concerns. Skills I used to see taught as part of basic first aid (like stabilizing impalements and tourniquets) are now moved up to the first responder level and above.

    One fine day I’d love to sit for an EMT basic, until then I’ll just rub dirt in it.

  3. Regarding the CPR mask – I’ve taken two different courses over the last year (one wilderness first aid, one for CPR alone), and they both said the breathing portion of CPR is being de-emphasized for non-professionals.

    1. You are correct. Don’t even bother with ventilation. Just pump hard and pump fast (100 per min) and the compressions will provide more than adequate air movement. I am a practicing paramedic and could go into all of the latest data about why, but just be advised that we as EMS don’t even ventilate for the first 2 min of CPR. We use passive oxygenation.

  4. Agree with eliminating the breathing portion of CPR. At our Fire House the CPR trainer is telling us compressions are the most important aspect and breaths are
    being downplayed.

  5. If you have EMS on the way and a reasonable expectation of surgical intervention within six hours, a tourniquet is a FIRST LINE response. It unequivocally stops bleeding. NO damage will occur to the extremity due to loss of circulation for the time it takes to reach an emergency room. This frees up valuable time that can be more effectively used to treat other injuries or other victims.

    If you are shot in the leg, the first thing the medic will do is pull on a tourniquet.

  6. My first experience as a first aider was Boy Scouts, 1975. Since then, I’ve seen torniquet and CPR regs. change every other year.
    After 25 years and several good samaritan law suits, they did away with basic first aid. ( except for Boy Scouts, who will always teach it.) The public wouldn’t accept the liability.
    Enter the first responder. Those jobs requiring first aid for their jobs would get professional training just short of EMT. They just wouldn’t get paid for it. Now with the addition of the AED, there’s no real reason for the breathing method. Sounds like prenatal class instead of CPR. There’s usually a paramedic or ambulance within a reasonable response time.
    Wilderness rangers have a greater need to do both 1 and 2 person CPR for the sheer distance away from an ambulance . They should also be EMT’s. That’s just my opinion.
    In addition, no standard military personnel (short of corpsmen) EFAK training or no should be considered a first responder. I have a lot of respect for corpsman, but the standard first aid training in the military is just medieval.

  7. Very nice article by a professional. Thank you. Some comments based upon my personal experience as a doctor.

    When we do angiography procedures, which entails a sizeable direct puncture to the artery, we typically achieved hemostasis by direct pressure. In general, we expected to hold pressure for 10 to 15 minutes in order to stop bleeding. It was not uncommon with patients who are on blood thinners to hold pressure for 30 to 60 minutes to achieve cessation of bleeding. I have seen quite significant bleeding stop with only direct pressure.

    In general, every time you take your hands off the wound and look, you are disrupting the forming clot and essentially starting over. Consequently, we were taught to hold pressure for at least 10 to 15 minutes before relieving pressure and looking, but this was in a hospital setting. I’ll defer to the expert with regard to management in a combat situation.

    Although it seems obvious and perhaps self evident, for a surface wound which is no longer bleeding while under direct compression, there is no reason to get “happy hands” and look. If the patient is hemodynamically stable (has normal blood pressure and pulse) and you see no active bleeding, continue to hold pressure as you are achieving the desired result . I would offer this last point simply because I regularly saw doctors in training who were uncomfortable standing by the bedside holding pressure for 30 minutes, wondering if something bad was happening when, in fact, they were managing the situation correctly by holding pressure, stopping the bleeding, and waiting for the clot to form.

    Again, very nice article.

  8. Our local FD just briefed us that they have experienced a 60 percent survival rate using compression-only CPR, compared to a 20 percent survival rate doing the CPR that incorporates both breathing and compression.

    They average 4 callouts per day here for all medical calls, so have a pretty good database for their analysis.

  9. As someone who does a lot of very remote dirt bike riding, I became very concerned about my first aid abilities as of late. I have searched and finding a place to do more than basic first aid training is very difficult and expensive. I have picked up some books but if anyone has any suggestions on where to seek additional training that would be great.

  10. With regard to local training: In addition to Red Cross first aid courses, there is also a course called “Stop the bleeding” that is being put on by many hospitals. It is well worth the time(usually an evening or two) and may also give an insite to any other programs available in your area.

  11. Great article to bring this issue to the forefront. As a volunteer for a SAR team we get more first aid/advanced first aid/wilderness first aid than most. Luckily we usually get a discount on the training.

    However, with so many ambulance chasers, we are taught not to provide any aid beyond what we are certified for even though we may know more. Other than immediate family members, what I am certified to provide is all that I will do. Those Good Samaritan lawsuits get expensive really quickly.

    I also agree that if you carry something, know how to use it, or do not carry it at all. Get the training you need, specially the low cost “Stop the Bleed” and CPR/First Aid/AED, the very basics. And remember, once you start CPR, you do not stop until you are relieved by another person or a professional.

    Looking forward to Part 2.

    @MtnDoc – Do you have a list of contents of an expanded IFAK?

    1. AnalogTechGuy, this is what I keep in the back of the cab of my truck. Again, I’ve been trained to use some of the more specialized gear, but most is self explanatory. I keep them in an old surplus M3 tri fold medics bag:

      Kit Contents:
      (1) M3 Medic Kit with strap
      (1) Ontario Knife Strap Cutter with Case
      (2) CAT Tourniquets
      (2) Sharpie Markers
      (2) Sam Splints
      (1) – baggie with packets of Povidone-Iodine Swabsticks, Alcohol Prep Pads and Surgical Lubricant Sterile Bacteriostatic
      (4) Sealed Bag of  Powederfree, LatexFree Vinyl Synthetic Exam Gloves in Sterile Sealed package
      (1) Nasopharyngeal airway
      (2) Double sets chest seals
      (1) Needle decompression kit (for collapsed lung)
      (3-4)View Guard Transparent Sterile Dressing 4 x 4 3/4″
      (3) ABD pads
      (2) 12 ply 4×4 sterile gauze packs
      (2) Fluff Roll Sterile 6 Ply Gauze 4.5″ x 4.1 yrds
      (2) Rolls surgical tape Assorted sizes
      (3) Isreali Trauma Wound Dressing Hemorrhage Control Compression Bandage
      (2) Oral Rehydration Salts Pack
      (1) Pair Paramdic Utlity Cutter/Scissors
      (1ea) 2″, 4″, 6″ ACE Bandage 
      (2) Penrose Drains
      (2) QikClot combat gauze
      (3) Petrolatum Gauze, U.S.P. Non-Adhering Dressing 3″ x 36″ Sterile

      Assorted elastic adhesive bandages (band-aids)

      North American Rescue sells some pretty comprehensive kits as well.

  12. “A tourniquet should NOT be the first step to control bleeding in an extremity, it should be absolutely the last resort.”

    This is outdated information, especially in the face of bleeding, massive or otherwise.
    You are usually going to be unable to apply sufficient pressure yourself in many types of injuries to your limbs due to their location. TQ’s alleviate that issue. Tourniquets are used routinely in the operating room setting and are left in place up to 2 hours before releasing gradually for reperfusion of the affected limb for 10 minuted before
    reinstating their use, as noted above, without loss of the distal limb. Always note the time when applied, learn how to properly apply them as well. Also learn how to apply a TQ to yourself, one handed. You may be your only hope until help arrives. Look up the acronym MARCH, used in the miltary arena for folks injured in the war zones. Direct pressure is still very effective in other scenarios, with or without the use of hemostatic agents i.e. quikclot, celox. Prioritize the problems, massive bleeding is first, people can exsanguinate literally in a minute. Other than obvious fatal injuries to the chest, or head, bleeding number one cause of death on the battlefield. Go to such sites that teach TCCC, tactical combat casualty care, such as http://www.deployedmedicine.com, http://www.nextgencombatmedic.com and similar. Loads of info to assimilate. Too much info to cover in detail here. Otherwise good basic info in the article.

    1. I forget where I read this (some TCCC article), but in the case of self applied tourniquets, they told soldiers NOT to release the pressure because the loss of blood could cause them to lose consciousness and bleed out. Better to lose a limb than a life.

  13. Direct pressure for 15 to 30 min. does work. A nurse gave me personal demonstration when she removed a cath out of my right femoral artery. Fortunately she had a small round bag of sand ( about 10 pounds) that was placed directly on top, and then she put as much of her body weight on the bag as she could. She stayed there for about 5 to 10 minutes, then took a look, and seeing more blood, repeated the procedure for another 5 to 10 min. I believe the bag of sand was necessary to focus pressure where it was needed. A tool was required (bag of sand), including body weight. She knew what she was doing, but should have stayed on it longer before inspecting. I do not know if a tourniquet would have done the job, because of the location of the cath (bleeding) was high on the inner leg. And because the bleeding was stopped, one could say that a tourniquet would not have done a better job. And she was able to stop the bleeding, even though I was on blood thinners. I cannot afford quick clot, or other clotting agents, but I do know that pressure works, and that this knowledge is always with me. I also know that I can improvise on the spot with material I wear everyday to perform the most important action, and that is to stop the bleeding with pressure. A femoral artery can bleed someone out in minutes.

    Sadly I must also report that immediately after stopping the bleeding, the hospital kicked me out, and let me drive myself home. I was en-route home is less than 30 min. and could have sprung a leak, and been unable to stop it myself. I suppose I could have rolled up a t- shirt. and used my belt to apply pressure on the roll of t-shirt to slow the bleeding, and bought some time….

    1. What a learning experience! Thanks for sharing. My middle son was inspired by Jim Elliott and would often quote him to me:
      “Mom, I am immortal as long as God has work for me to do.”
      This article and whole thread has been an awesome learning tool. God bless each of you!

  14. I agree with Mark W a tourniquet is the first line in saving the patient, also helpful if you can distinguish between a bad wound and an arterial bleed. If you waste several minutes trying to stop the bleed, and it’s arterial, your patient just died. Recent research from combat missions have shown great success with fast use of a tourniquet. And has shown even hours with a tourniquet in place the limb is saved, and if not you have saved the patient, maybe not their arm or leg, but alive to go home to their families.

    Proper training is what everyone needs and often, many people can find basic CPR classes given for free. Take one EVERY 2 years!

    I made several long comments in a recent post on “Family Medical Preps” by Dr. Dan on July 18th this month on why I would not want CPR done on me without rescue breathing (read the July 18th if you want to know).
    Wheatley, I challenge your Fire Chief and yourself to do about a one year follow up study on the cardiac arrests you believe have a 60% survival rate doing just chest compressions without rescue breathing in your area. I’m sure those statistics mean getting to the ER alive. This must absolutely include what their down time was before someone started only chest compressions and what their overall down time was to the hospital with only chest compressions being done. See if these patients had a successful brain recovery with more than 5 – 8 min of just chest compressions, or if they did not even survive their hospital stay. It sounds good in theory, especially trying to get bystanders to do SOMETHING, but the results are usually not good. My statement of not wanting someone to do just chest compressions is I want to live with intact brain function, people really need to get over their fear of breathing for somebody, if you want to help save a life then get the proper training and save the whole person. I’ve been doing this for 30 years in an ICU and ER, and I can tell you with a lot of experience, the overall survival is not good. The American Heart Assoc. changes things up about every 5 – 10 years based on what outcomes show. Their decision to get people to get more involved was the just compressions scenarios, and I believe after much data they will find brain survivability is way down, most untrained (and even trained) people don’t even do good chest compressions.

    One final comment to the guy who said “don’t stop CPR until EMS gets there” may be setting someone up with a lot of guilt if they cannot provide that. In real life, doing CPR in the hospital and once outside of the hospital too many times to count, I can honestly state even the youngest, most in shape person you know cannot carry on with CPR properly more than about 5 min. (in hospital we change out every 2 min.). Depending on where you are when a situation happens, you could be 10min to who knows when help may arrive, so, do the best you can until you can’t any longer, and don’t beat yourself up over it.
    Training, training, training, and I just don’t mean watching you tube (unless that’s all you can do/afford). I hope most of you never have to be in that situation.

  15. While I, myself, have tourniquets in my jump kit and IFAK, I packed them realizing that I am very, very unlikely to require them.

    My backstory is 6 + years on a big city’s third service EMS, running, at that time, 120,000 runs with 16 ambulances. And 30 + years as an ER RN in small as well as large ERs. And 12 years as a PA in ERs and urgent cares.

    Yet, just as I have never required a firearm for self defense, in the same manner I do/will pack a tourniquet as well as a sidearm every day.

    Because, to paraphrase Bat Masterson’s line, when I need a tourniquet, I really, really need a tourniquet!

  16. AnalogTechGuy,
    Here is my list of expanded IFAK kit I carry:
    First off in my purse which is always with me I carry 2 CAT tourniquets, glucose tabs and an EPI Pen (I’m not diabetic), I also carry ibuprofen and Benadryl.

    In my car I carry a small IFak kit with:
    nitrile gloves
    2 more CAT tourniquets
    2 chest decompression needles
    2 Quik Clot sponges
    2 HyFin Vent chest seals
    2 Israeli Bandages
    several compression gauzes
    several sizes of oral airways
    a nasal trumpet
    a flash light
    trauma sissors
    eye protection
    several simple surgical masks
    small pad of paper and marker

    In my extended bag which I carry If I go further than 20 miles from home I carry
    all of the above plus:

    a selection of bandaids
    different sizes of dressings/abdominal/petroleum gauze/telfa
    steri strips
    LiquiBand
    Bacitracin ointment
    burn gel
    alcohol pads
    povidone iodine swabs
    coban and other tapes
    nasal bulb syringe
    60cc irrigation syringe
    a scapel
    finger tip oxygen monitor
    stethoscope/blood pressure cuff
    a wide range of OTC meds
    ace wrap
    medium arm sling

    I still have 2 progressively larger bags at home for the neighborhood ( we live rurally)
    Don’t even get me started on what’s in those!

    You absolutely need to know how to use these items, that’s why training is so important.
    Hope this helps, Montana Doc probably even has better ideas!

  17. Thanks so much to MtnDoc for taking the time to address this important matter! I wish MDs in all locals would dust off their basics and offer classes. Just one comment that I can’t resist:

    I’m with TXnurse when it comes to CPR chest compressions PLUS appropriate rescue breathing. While it is true that blood with normal oxygen saturation carries more than enough oxygen to support tissue function for multiple circulations; however, without re-oxygenation, it is only a matter of time until saturation declines. Of course, residual air in the lungs may support re-oxygenation for several passes, but the very delivery of “high quality compressions” pushes air out of the lungs. Though I am a clinical pharmacist of 38 years practice, and lean heavily on evidence, some things require some common sense. Learn to do it right. If you can find one, take a “BLS (basic life support) for medical professionals” course – it’s really not that technical. While a “compressions only” approach may be better than nothing for short term support (maybe less than 10 minutes) until EMS arrives, you’ll have to show me a LOT of validated data to convince me that it is preferential to full BLS! After all, I haven’t attended a cardiac arrest in my hospital lately where the respiratory therapist stood by and watched!

    1. The instructor in the last CPR class I took, basically told us that rescue breathing was “optional” (meaning, optional for you, not for the patient. Only do it if you want to). Apparently a lot of non-professionals are reluctant to go mouth to mouth, especially with a stranger, in this age of AIDS, and other serious communicable diseases. So they basically told us to concentrate on the compressions. She also said the patient WILL almost always vomit.

      I take it back, my last refresher class was with my boss. Having worked in the DEA he had occasion to actually use CPR, etc. to save lives. He basically said, if you don’t want to go mouth to mouth, and don’t have a mask/appliance, just do this: he cupped his hands around the mouth of the dummy.

  18. I recently took an excellent 2-day Trauma First Aid course through Sheepdog Response. Look them up. The trainer was a Special Forces Medic who was a tremendous teacher. I cannot recommend this course highly enough.

  19. I am a little taken back by the differences in opinion voiced by seeming professionals here on important items like compressions, tourniquets, etc. Seems about an even split of opinion.

    Is this due to regional or organizational differences in training? Is American Red Cross teaching something different than American Heart Association? Are different Fire Departments or hospitals using different policies?

    Regarding the comment that military first aid was medieval, every first aid class I received in 23 years in the military was taught with American Red Cross and/or American Heart Association curriculum and testing. I am now a Navy civil servant and just received updated CPR training from an active duty sailor last week and he was a certified Red Cross trainer and taught standard Red Cross curriculum and tested with a Red Cross test.

    We only did CPR last week so I cannot speak to the tourniquets. They taught 30/2 just like last time emphasising compressions. They taught that if you did not feel comfortable with giving breaths due to fear of personally catching a disease from a victim to just give compressions. They taught to get an AED ready as fast as possible by either having a second person get it ready while you are giving compressions or stopping at 5 cycles and applying the AED. They advised quickly opening the AED immediately and pressing the power button ASAP even while doing compressions. They stressed to do your initial evaluation of airway and pulse in less than 10 second and then get compressions going fast.

    Regarding Good Samaritan lawsuits, when I was active duty they claimed that non-medically trained people were protected. In other words non-EMT/nurse/PA/doctor were covered by Good Samaritan laws. Medical professionals were not and could be sued for malpractice although it was rare in a field situation. Has this changed? Can someone link me to any hard reference to a lawsuit against a non-medical-professional person who had only basic first aid training and was sued? I have personally known non-medical-professional people who have treated up to sucking chest wounds and none were sued.

  20. Another great option for training, especially if you spend a lot of time in the Great Outdoors, is the NOLS Wilderness First Aid class. It’s a 2-day hands-on course that costs around $250. I signed up for it through my local REI store.

  21. I have taken NOLS Wilderness First Aid 3 times (the certification is only good for 2 years and a combination of updated methods and need for a refresher made it worth repeating). The course is excellent, but focused on using what is at hand in the back country which is often little and then improvising rather than using a robust IFAK. It also aims to stabilize a patient who likely has to walk out of the back country which is quite different from stopping the bleed and enabling breathing long enough for an ambulance crew to arrive. It is NOT a course that deals with gun shots or knife wounds nor does it cover nasal pharangel tubes or chest seals for sucking chest wounds. I recommend a good Stop the Bleed class plus WFA plus a CPR/AED class as good basic first aid preparation for a SHTF situation.

  22. I know a man who had a heart attack on the golf course. Complete failure, lying basically dead on the ground. But one of his golfing buddies was a doctor and he kept him alive until the EMT & ambulance got their. A couple years later he was on a plane and the same thing happened, heart just stopped, he was good as dead. But his doctor buddy was with him and saved his life again. So I’m tossing my IFAK and hanging around the golf club trying to make friends with doctors. I think I’m onto something here. I think one doctor buddy is worth 100 IFAKs.

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