Two Letters Re: First Aid Kits Are Not Enough

I very much appreciated reading the recent article about an adventure in wound care during a blizzard. It was chilling! Hope your wife has made a complete recovery! In my many defensive firearms classes with John Farnam, he has held forth the many virtues of the Israeli Battle Dressing (IBD) and its fantastic ability to control hemorrhaging. Had your wife severed an artery, the IBD may have been to only thing that would have saved her, at least would have been the best solution. The IBD has the ability to quickly apply a lot of preferential pressure on a wound and maintain it without further attention from the caregiver or the patient. Additional pressure is available by using the closure bar as a windlass to crank down even harder over the wound.

It is available in four inch and six inch pad sizes, and features a six foot long ace bandage securely attached to it. It also features a pressure bar that is used to focus direct pressure onto the wound as the Ace bandage is wrapped around the whole affair. The price, if you shop around, is about $6 each. I recommend that each family buy 50 of them. Have a half dozen in each vehicle you own. A half dozen in each kit. Can be used especially well on head wounds, chest, abdominal, and on extremities! If it bleeds through, apply another one on top! Do not remove the original.

That article, I hope, will jolt many out of their complacency and get them to realize that the vast majority of first aid kits out there are useless snivel kits. One needs a really serious trauma kit to fair well in any serious circumstance as you found yourself in!

Interestingly, during my five day stay in a hospital for open heart valve surgery, I spent my free time teaching staff and doctors how to use the IBD. They had never seen one! It was all new to them. Imagine, a really sore and hurting patient with tubes, wires, etc all over him wrapping the arms and heads of the nurses and surgeons who were caring for him. For a while, it took my mind off my own problems. Most cops have never seen one. I find no end of willing students who want to know about this truly amazing bandage.

You do a lot of good on your site and post a lot of useful information not available anywhere else. Even is some of it is not the best information (can’t think of anything that falls in that category), it gets people thinking! God Bless You. Best Regards, – Paul S.


Dear JWR:
I have been wondering why the writer kept changing bandages.  Particularly with a clean cut, as with a knife vs. a jagged vessel tear, most bleeding will stop within 10 minutes.  However, you should apply pressure for those ten minutes as measured by the clock, and not by how much time you think has passed.  Every time you remove the bandage to “check” the wound, you remove part of the clot.  Always add to your dressing, rather than change it (acutely) for this reason.  The dressing should be removed slowly and carefully for the same reason.  There is no rush to remove the dressing unless you are prepared to definitively clean and close the wound or some hours have passed and you want to minimize infection by gentle cleaning and replacing the dressing with something more sterile.

Once a clean or sterile dressing or sanitary napkin has been applied on the wound (to reduce infection), you may use towels over them if necessary for additional absorption and to maintain a dry outer surface for applying pressure.

Exceptions to the general rule about clotting may occur if someone has a coagulation disorder, whether inherent (liver disease, blood disorders) or secondary to medication (aspirin, warfarin, calcium channel blockers in high doses).

I can think of only about four times in the last 40 years as a lifeguard, firefighter, paramedic, and physician that I have faced uncontrollable bleeding.  Twice from severe liver disease (sick livers don’t make the proteins necessary for clotting), and twice from disseminated intravascular coagulation (before a strategy became widely known to address it).  I have had others bleed out, but those were from massive trauma causing quick death, generally secondary to internal bleeding that would have required immediate trauma surgery to address.

Regards, – K.N.