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.
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
- 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.
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.)