Some IFAK Facts, Part 2 by MtnDoc in Washington

(Continued from Part 1. This concludes the article.)

Pressure points are areas where major arteries are closer to the surface of the skin than normal and utypically over hard/boney areas of the anatomy. Pressure points are areas of the body where arteries come close enough to the surface for pressure points to work. They are common areas where pulses are felt as well. You can practice locating them by feeling for the pulse on friends or family members, using your index and middle fingers together. I will be discussing the easiest points to identify and have labelled their general location with blue dots on the attached picture.

Working down the body, the first pressure point is where the brachial artery transits past the armpit (axilla) and down the arm over the humerus/biceps area. The pressure point is located on the inside of the arm over the area where the bicep muscle and humerus (upper arm bone) meet. The second point is also the brachial artery, but further down the arm. It is typically very visible in healthy, well hydrated individuals at the crease of the elbow, or antecubital area of the arm. This is the area that is commonly accessed for IV access.

The next point is the Radial artery, probably the most recognizable pressure point. The Radial pressure point is on the underside of the wrist on the thumb side, where the pulse is felt and measured most frequently. The next point down the body is the Femoral artery. The easiest way to identify Femoral Pressure Point is in the area where the leg meets abdomen close to the genitalia. To access the pressure point, you may need to cut away the clothing to expose the area to properly feel for the pressure point. This is where trauma shears would come in handy. When accessing the femoral pressure point, do not be shy. To reach the pressure point you will need to get close to the genitalia. I made sure to tell my sailors and Marines this, and in a life and death situation where there is a legitimate chance of bleeding out, the patient will not care.

The final pressure point to cover today is the Popliteal Pressure Point located behind the knee. This pressure point can be difficult to find due to the anatomy of the area. You will need to apply pressure with significant force to ascertain the location and to restrict blood flow to control bleeding. To control bleeding with a pressure point, you will need to apply significant enough force to slow or stop bleeding enough to apply further measures like applying gauze and pressure dressings. You will want to monitor bleeding while applying pressure as another responder applies and dressing and then slowly remove pressure and watch for bleeding through the dressing and add more as needed.

Tourniquets?

In a situation where EMS is not readily available, like possibly backcountry hiking or TEOTWAWKI scenario, the procedure for applying a tourniquet is very specific to help save as much of the limb as possible. Again, I will reiterate this point, DO NOT use a tourniquet in any but the most emergent situations where there is a significant time before EMS will be able to reach you or there is no longer any Emergency Medical Services, WROL situation.

Of the many commercially available tourniquets available, I prefer tourniquets with a windlass to apply the pressure. With a windlass, you can adjust the tension on the tourniquet without needing to completely remove and reapply it. My other criteria I look for is a large enough surface area for adequate pressure to the large arteries to control bleeding. With these criteria in mind, my go to tourniquet is the tried and true Combat Application Tourniquet (CAT). There are plenty of others available, and I have put hands on most. The CAT is still my go to, but it is a bit bulky in a pouch. If storage space is an issue, my second choice would be the Rapid Application Tourniquet (RATs).

The CAT is currently on its seventh generation, but the design has not changed drastically since it was first fielded to me in the early 2000s. The changes of the generations have been improvements on the basic design to make them easier to use, especially for use by the injured personnel by themselves. These instructions should work for any of the generations. Slide the extremity through the loop of the hook and loop (Velcro type) band or wrap the hook and loop band around the extremity and re-route through friction adapter buckle. Position the CAT above the wound; leave at least 2-3 inches of uninjured skin between the CAT and the wound. This is will help leave enough tissue for the tourniquet to apply pressure to underlying arteries and not slide off as well as leave enough tissue for repair in the case of amputation.

To secure, pull the free running end of the hook and loop band tight and securely fasten it back on itself (if applying to an arm wound). Note: All the slack must be removed from the hook and loop band before tightening the Windlass Rod. Do not adhere the band past the Windlass Clip. If applying to a leg wound, the hook and loop band must be routed through both sides of the friction adapter buckle and fastened back on itself. This will prevent it from loosening when twisting the Windlass Clip. Twist the Windlass Rod until the bleeding stops. When the tactical situation permits insure the distal pulse is no longer palpable. Lock the rod in place with the Windlass Clip.

NOTE: For added security (and always before moving the casualty), secure the Windlass Rod with the Windlass Strap. For smaller extremities, continue to wind the hook and loop band across the Windlass Clip and secure it under the Windlass Strap. Grasp the Windlass Strap, pull it tight and adhere it to the hook and loop band on the Windlass Clip. Release and remove the tourniquet. Note that on a real casualty, the date and time the CAT was applied would be recorded when tactically feasible.

The RATs tourniquet has a metal cleat at one end and a long, elastic band attached to it. Start by holding the metal cleat in one hand. At the end with the cleat, the elastic band should be threaded through to form what they refer to as a three finger loop. Your limb does NOT go through the three finger loop. Place the cleat on the limb requiring a tourniquet and wrap the long length of rubber around the limb. Thread the long end of the rubber band through the three finger loop and pull until snug. Wrap the long length of rubber back on itself and continue wrapping the limb until the elastic is used up or the blood flow has stopped. With every wrap you should be stretching the rubber so that the band pulls tight and cuts off blood flow.

Do not pull the band as tight as it can go because it can cause permanent neurovascular damage if tightened too much. Hook the end of the rubber band into the cleat to secure the tourniquet in place. When using the RATs tourniquet, the elastic material is relatively thin when compared to the CAT, you will therefore need to make sure to wrap the elastic multiple times to adequately control blood flow as well as prevent nerve damage by using a thinner band. The band should be relatively close together, approximately half an inch between passes but not overlapping either. More practice will be required to be proficient with this tourniquet.

Once bleeding is controlled, finish dressing any wounds with gauze pads and ACE wrap as needed and ready to casualty for transport. Reassess casualty approximately every 5 minutes for increasing bleeding. With severe trauma and especially with traumatic amputation, the body will involuntarily contract muscles which will help constrict blood vessels. Over time, the muscles will relax and may cause an increase in bleeding once again. This may require tightening of the tourniquet. This is why I prefer a tourniquet that has a windlass to avoid either reapplying a tourniquet or having to add a second tourniquet above the first. With a windlass equipped tourniquet all that is required is to tighten the windlass and leave the tourniquet in place. Once the tourniquet is in place, it should not be removed until the casualty is in a place for definitive trauma intervention where physicians are present to preform any interventions as needed when the tourniquet is removed.

Breathing

Bleeding is a pretty easy topic to conceptualize for the layperson. A sucking chest wound is not as obvious, but emergency treatment is a fairly simple process. A little bit of anatomy first, before delving in to treatment of sucking chest wounds. In an uninjured person, air has only one way in or out of the lungs, the trachea leading to the nose and mouth. As long as there is only one way in and out, breathing is an automatic behavior with the lungs filling and emptying as designed. If an extra hole is made into the lung, say by knife or bullet wound, it will make breathing very difficult and could lead to other issues. This wound is called a sucking chest wound. Symptoms of a sucking chest wound will include difficulty breathing or rapid/ shallow breathing, pain, and gurgling sounds possibly with frothy blood coming from the wound.

Note: Not every penetrating chest wound will cause a sucking chest wound. Treatment is based on symptoms and not the presence of a penetrating wound to the chest. A sucking chest wound will allow air into the chest in the area between the chest wall and the lining of the lungs which will in turn cause a pneumothorax: collapsed lung. Emergency treatment for a penetrating wound caused pneumothorax is a relatively simple process using a chest seal. A chest seal will likely be a thin, flat package. It is basically a sterile, thin plastic round or square shaped film with adhesive on one side. The seals will either have vents or not. A vent is not required to treat a penetrating chest wound/pneumothorax, but they do help the casualty breathe better by creating a one way valve that will allow blood to drain out as well of allow some air to escape without allowing air in.

Vents also allow air to escape through the wound and prevent it from collecting once again in the space between the lungs and chest wall. To use a chest seal, you will need to clean and dry the wounded area of any blood and debris to allow the seal to adhere properly. Once cleaned, simply apply the adhesive end of the chest seal to the wound and monitor the casualty. Do not forget to check for exit wounds and treat the same way. Some chest seals will come in packages of two for this reason. As with tourniquets, the chest seal should not be removed without physician supervision.

Now that you have had a good primer in how to use your IFAK, I recommend practicing with the items in your kit. You do not need to practice on a living person for risky procedures like tourniquet application, a small sandbag would suffice. Practicing finding pressure points is difficult to do on yourself because your pulse is the same in your fingers as well as at your pressure point, so I recommend using a partner to find them. Please do not wait to practice these skills until you are in a situation, it will be exceptionally difficult to complete with adrenalin pumping and distractions around.

God Bless and Semper Fi




6 Comments

  1. Regarding Good Samaritan laws/lawsuits:

    I was trained in CPR and first aid multiple times over the years and was specifically taught that a non-medical-professional was protected by Good Samaritan laws with an unresponsive or willing victim in an emergency situation. Yesterday people said this was not true.

    Can anyone give me an example of a lawsuit recorded against anyone rendering first aid who did not fall into one of these categories.

    Police officer
    Fireman
    First Responder/EMT/Nurse/PA/MD
    Person in a public position who might be trained and expected to render aid. (Maybe flight attendant or ???)

    I am looking for Joe Carpenter/Janitor/Computer Programmer/non-medical military member/etc. who was sued for botching the rendering of aid at a car crash/heart attack scene/fall scene/etc. that they happen upon on the way home from work or something.

    First hand accounts or specific reputable online sources please. No brothers, cousins or friends. No vague article about the rise of lawsuits unless they include specific cases. I would like to read about solid evidence that a rank “civilian” (for lack of a better term) is putting themselves at legal risk rendering aid.

    I ask this because in the training I have received they specifically stated that there were none that the instructors were aware of and that this should not deter a person from rendering aid should they be willing. They also said it was a different story for medical personnel or others listed above who may be expected to render aid in their “day jobs”.

    Thing could have changed of course and I would like to know.

    1. JBH, I have been trained that Good Samaritan laws vary greatly by state. There have been recent lawsuits earlier this year in the California (UGH) supreme court that required a change in the good samaritan law. In the case, the good samaritan moved an injured person from a vehicle they were worried might catch fire and resulted in the victim becoming paralyzed. According to the original law, as determined by the court, moving the victim was not “medical care” and therefore not covered under the good samaritan law. Now, depending on the situation I might have done something similar. I was trained to establish scene safety prior to working on a patient. Apparently in Commie-fornia, this could open me up to lawsuit. Luckily, I don’t go there very often.

      https://www.verywellhealth.com/no-good-samaritan-1298834

      1. Interesting article.

        Several thoughts.

        1. Apparently I was trained incorrectly regarding Good Samaritan protection. It looks as if the law spoken of was probably in effect when I was taught that but then later modified to provide more but not universal protection.

        2. Apparently I was trained correctly about moving people. All of my training has always said to not move anyone unless they are in imminent danger and you absolutely have to. This woman apparently thought the victim was in imminent danger when she was not. Hard to judge if this was a reasonable call or not. Why did she think a car fire was imminent? Was her concern reasonable or not? What kind of training had she received? Was the victim conscious and protesting or approving the movement? Lots of unanswered questions that would tell you if this woman acted reasonably or stupidly. Should the law protect the stupid Good Samaritan? That is a hard call, because who determines who is stupid? But you don’t want people running around doing stupid things and harming people. But you don’t want to dissuade people from helping others. But…UGH!

        3. I notice it was a split decision with the judges. Hard to say why on that issue. They came down on the technicality that the movement was not an act of medical aid but was that the real reason? Were they really just supporting some ambulance chaser? Or did they think a wantonly stupid act harmed someone unnecessarily and it had to be addressed? Or did they really get wrapped around the axle on the technicality?

        4. It says the victim sued. But did they really? Or did the victims insurance company sue? Sometimes that is the case. Happened to my sister and brother-in-law years ago when two motorcyclists rear ended them and one died. They were husband and wife. The wife died after racking up nearly a million in medical bills. The husband testified for my sister and brother-in-law at trial when the insurance company sued but they still lost. My sister and brother-in-law actually just went bankrupt and in the end lost no money, but then the insurance company could write off the loss was my understanding.

        I also have heard that lawsuits that do not seem reasonable in the news are sometimes reasonable when you have the details. The infamous McDonalds spilled hot coffee lawsuit of several years back was supposedly one. (This is hearsay from a friend.) Reportedly the woman was given the coffee in a cold drink cup instead of a coffee cup, which then disintegrated in her hand and lap and really did burn her pretty good. Then she was reportedly treated very badly by McDonalds (corporate or local I don’t know) when she complained which then prompted her to sue. When the suit was complete her share of the multimillion dollar award was in the tens of thousands I believe. So I have heard anyway.

        I think this incident would make me very careful about rendering aid but I don’t know if it would stop me or not. It would sure make me think. It does heavily emphasize that you need to be very careful to be trained well and follow your training to the letter.

        Thanks for the info.

  2. Unfortunately, an EMT course is expensive and far away. I have sucessfully performed CPR on my dog after he had what I believe was a heart attack. He lived almost another year after that. Chest compressions is all it took to bring him back. This stuff works!

  3. Splurge $.50 at the next yard sale, and pick up a pre-1972 Boy Scout Handbook, and study the first aid instructions and pictures.

    1) Before the Scouts turned “faaaaaaaaaaaaaaaaaaaaaaabulous” :roll:, they actually knew what they were doing back in the day. The handbook editions of the 1960’s were printed in the 4 million + copy range, as the baby boomers came through the program. A “serviceably used” copy could still be had for $.50 in recent years. Fork over an extra buck or two if necessary because…

    2) They are written and illustrated so a 12 year old boy could understand them. Granted, a 12 yo in the ’60’s, was smarter than a 32 yo Anqueefa living in mommy’s basement TODAY… but you get the picture, which therefore makes them…

    3) Suitable for the WHOLE family to learn first aid from! Splurge another buck, and pick up a Boy Scout Fieldbook from that same era while you’re at it. Printed in slightly fewer copies than the Handbook, these are ALSO useful for learning/teaching fieldcraft, edible wild plants, learning basic weather patterns, animal tracking, etc. In fact…

    4) I keep a copy of each in my BoB(s). In those long, lonely, weeks in-between fighting off the golden horde, & chopping firewood (ALWAYS chopping firewood…), the skills taught in both can make for a basic child primer, and give them TONS of activities to keep busy, that are a) GOOD to know b) helpful to the household, & c) exciting, stimulating, & good exercise for growing, inquisitive, little ones, post-SHTF.

    Since 1960’s era Scouts couldn’t go on-line, and order their pre-fab IFAK from Amazon, you’ll find out just HOW simply and inexpensively an effective first aid kit can be built, from rudimentary household items.

    And give thanks, that our fathers and grandfathers were more interested in teaching self-reliance and basic preparedness, than political… “correctness”… 🙄

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