Updated: Dec 15, 2020
Despite the amount of material that is covered in our classes, there always seems to be one topic that generates the greatest number of questions- trauma gear. In this blog we are going to answer some of the more common questions that Penn Tactical Instructors get regarding trauma management gear.
1. What is the difference between a trauma kit and an Individual First Aid Kit (IFAK)?
The answer to this question is relatively simple. An IFAK is designed to be a kit that should not be used except to treat YOURSELF. A trauma kit is designed to treat other people. Typically, an IFAK contains enough equipment to treat one person. The purpose of an IFAK is to have lifesaving equipment easily accessible in a situation where you may not be able to get help immediately. It normally consists of a tourniquet, wound packing gauze, trauma dressing, nasal airway, chest seal and sometimes gloves and a chest decompression needle. A trauma kit often contains enough equipment to treat more than one person. Trauma kits will often contain equipment that are not necessarily immediate needs like eye shields, splints and more bandages.
2. Can I use an IFAK to treat other people?
The answer to this question really depends on your situation and your role. If you are asking if you can buy an IFAK and use it as a trauma kit, then the answer is YES. How a kit is marketed really has no bearing on how it can be used.
However, to truly answer this question you need to consider what your role is. If you are a tactical operator, in a combat setting or generally are in a role when you can become injured as the situation develops, then you should have a dedicated IFAK. There is nothing wrong with carrying 2 kits with one being designated as your IFAK. On my vest I have 2 kits one is my IFAK and one is used to treat anyone else that is injured and also includes some minor care items. The one designated as my IFAK is marked with a MED patch. The reason that one is marked is because if I become incapacitated my teammates know what pouch is my IFAK and contains only lifesaving, immediate need equipment. This is also a good time to mention that if someone becomes injured you should treat them using their IFAK first. If your casualty does not have their own IFAK you are going to need to make a decision if you should treat them from your IFAK. One of the main determining factors in this decision should be “Am I willing to give up equipment that can save my life to save someone else?”. You should also take into consideration the chance of you needing that equipment yourself.
3. What should be in an IFAK?
As I mentioned earlier an IFAK typically consists of tourniquet, wound packing gauze, trauma dressing, nasal airway, chest seal and sometimes gloves and a chest decompression needle. What you carry in your IFAK comes down to answering a few questions:
a. What is your level of training? Ideally you should be trained on the proper use of everything in your IFAK. Training for most items you can carry can be done in a Stop the Bleed Course. In 2020 there is not much of an excuse not to get trained in at least tourniquet use and wound packing. While these skills are simple and the devices are relatively intuitive to use, there are some steps that ensure that you can apply them to yourself in a high stress situation. Items like chest decompression needles require a higher level of training and their use may not be covered under local law and protocols. However, being that your IFAK is also for other people to treat you if you are injured, I do know some people that carry a decompression needle in their kit. The needle is in the kit with understanding that it is only to be used by a trained and qualified medical provider. Case in point, in Pennsylvania a paramedic unit is only required to have 2 chest decompression needles. If there is a mass casualty incident the medic now has access to the device by working out of your IFAK. I will add that some devices do require medical authorization and you should always check with agency, local and state laws/policies before adding any item to your kit that requires a prescription or medical authorization.
b. What “real estate” do you have available? What I mean by real estate is how much space do you have available. Can you carry a pouch on an external vest, or does it need to be carried in your pocket? It is human nature that if something is difficult to carry, takes up too much space or is too heavy that it will not be carried on your person. If you have the space, I would carry the standard items I mentioned earlier. If you have limited space to carry medical gear, you need to at least carry a tourniquet and then start looking for items that can be used for multiple treatment options. An example of this would be the Tactical Medical Solutions OLAES dressing. The OLAES is a trauma dressing that contains compressed gauze that can be used for wound packing and the pressure cup can be removed and used as an eye shield. It also contains a piece of plastic that can be used as a chest seal. Personally, I think the plastic is super thin and I would rather use the bandage’s packaging as an improvised chest seal. Another multiple use item is the Battle Wrap or Battle Bandage from Combat Medical Systems. This product is a roll of plastic-like material that is designed to allow you to monitor bleeding through the clear plastic. The Battle Bandage has a dressing attached while the Battle Bandage is just a roll of the plastic material. It’s also super strong, so you do need to use care and don’t apply it too tight or you may occlude all the blood flow (although it would probably make a decent improvised tourniquet for a K9). While it’s designed and approved as pressure dressing, in a pinch you may be able to use the material as an improvised chest seal. The short version is that if space is limited you may need to think outside of the box and carefully select equipment that can be used multiple ways.
c. What is your role? Are you a police officer, in the military or a prepared citizen? Looking at what injuries tend to kill people in your role may be a factor in deciding if there is any additional equipment you want to carry. For instance, police officers have their chest covered by body armor so the exposed areas are limbs and the junctional areas. A person that wears body armor may want to consider carrying additional wound packing material in their IFAK. In a civilian setting, most intentional injuries are to the center mass, aka the chest and back. If someone is shot in the torso (especially multiple times) a single chest seal may not be enough to treat entrance and exit wounds without improvising. While improvising can be effective, commercial devices are much easier to apply in periods of high stress. The last thing you want after being injured is having to be creative to save your life.
d. How much can you afford? This is a huge reality when it comes to choosing medical gear. While all of us would love to have hundreds of dollars to spend on medical gear, this is rarely a reality. If you want to save money, the first place to start is with how you carry your IFAK. You may want to consider a vacuum-packed kit or even a sealable plastic. Nylon pouches are durable and look good, but they definitely add to the cost of your kit. The one place you don’t want to cut corners is your medical equipment. Many people are tempted to shop on sites like Amazon, Wish and eBay. These sites have become flooded with counterfeit medical devices. While a $6 tourniquets sounds appealing, chances are it’s a cheap knock off with a high likelihood of failing when you need it. It’s important to remember that medical devices are regulated and legitimate manufacturers are held to high standards by multiple regulatory bodies and agencies. There are also other companies selling 50 piece IFAKs at what looks like an incredible price. You need to make sure that these kits have the items you actually need.. Some of the kits have non-recommended tourniquets and the majority of the 50 pieces are alcohol wipes, safety pins and adhesive bandages. While some of these items may be great in a “boo boo” kit, an IFAK should be limited to proven life-saving equipment.
4. Where should I carry my IFAK? First consideration is can you get to it easily if you are injured? You need to remember that you should be able to reach it with either hand should one limb become unusable. SCUBA divers use a rule of thumb called the “Golden Triangle”. The Golden Triangle is an imaginary footprint is the space where you can easily reach with either hand in an emergency. It can also be worn between the 10 o’clock and 2 o’clock position on your belt. When deciding on where to carry your IFAK, I would suggest some practice gaining access to it. This also applies to opening your kit. Can you grab small zippers, or should you make pull tabs? (Note: if your IFAK has pull tabs or you need to add pull tabs, you should make sure they are durable enough to be pulled forcefully and enough of a grip that you can still grab it with injured, wet or bloody fingers) Should the IFAK open from the front or from the top? Make sure you can access it with both hands. If you carry a tourniquet outside of a case, make sure that you regularly inspect it for wear and damage and replace it if needed. It’s also important to remember that exposure to the sun’s UV rays may degrade the materials.
If you carry an IFAK for work, you may be required to carry it in a standard location. If this is the case, you still need to make sure that it is accessible with either hand. If you are functioning as part of a team or unit, your IFAK should be in a relatively standard location. Every person on that team should know where you carry your IFAK or be able to easily identify it as medical gear.
5. What should I carry in a trauma kit? This question also depends on a variety of factors but before we discuss the variables, I’m going to discuss the main goal of a trauma kit. The goal of any trauma kit should be that a person is able to manage a trauma casualty based on our skill level and training. In our classes we teach the mnemonic MARCH for trauma assessment and treatment priorities. Your trauma kit should be able to get you through this algorithm until you either get the casualty to a higher level of care or someone with more training and equipment can get to your casualty.
Massive Hemorrhage. This typically applies to life threatening bleeding from an extremity. Amputations, Severe Lacerations, Gunshot Wounds can all be treated quickly and effectively using a tourniquet. This is the only medical treatment performed if there is still a threat present. If there is no threat present junctional wounds can be packed with gauze or a hemostatic agent to control bleeding.
Airway. This refers to the upper part of our respiratory system. The most common airway issue is if a casualty is unconscious the tongue falls into the throat and blocks the airway. The airway can also be damaged by trauma. These issues can often be treated through positioning the airway by using the recovery position or jaw thrust. You can also use a Nasopharyngeal Airway that creates a passage for air behind the tongue.
Respiratory System- Typically refers to chest and upper back trauma or lung injuries. If there is an injury to the chest wall, air can get into the chest cavity and increase the pressure. If there is an open injury to the chest wall, we want to seal the exterior with a chest seal or occlusive dressing. If the pressure continues to build up inside the chest cavity, the lungs can collapse, and the pressure can prevent the heart from pumping effectively. If this happens, we need to decrease the pressure. This can be done by either “burping” the chest seal or using a decompression needle.
Circulation- In this stage we address shock and any bleeding not addressed under Massive hemorrhage. To treat for shock, we keep the casualty warm (more on that under H) and advanced life support will use fluids or blood.
Hypothermia- When a casualty goes into shock, they lose the ability to generate heat and become hypothermic (low body temperature). When a patient becomes hypothermic it starts a cascade effect that includes decreased ability to clot blood. This cascade will continue until medical treatment stops the cycle or the casualty dies. The goal in this phase is to keep the patient warm. Ideally this would be managing the patient’s temperature through active warming devices like heat packs or maintaining the casualty’s body temperature using a device like a survival blanket. This step is often ignored or forgotten about but is extremely important.
After we get through MARCH, we should have all the life-threatening injuries we can treat taken care of. Now we can assess for other injuries that need to be treated. We can move on to injuries like eye injuries, fractures, minor wounds etc.
Now that we have a very BASIC understanding of what our goals are, we decide what to carry. A trauma kit should have enough equipment to get you through the MARCH algorithm. At a minimum you should have a tourniquet, nasal airway, chest seals, trauma dressings, heat retention/survival blanket, PPE, a small flashlight and trauma shears. Your role, space limitations, skill set and training will help you decide what additional equipment you should carry.
A. What is your role? Are you a police officer, military, first responder or just want to be prepared? This has a lot to do with what injuries you can anticipate and what you should carry. Here are a few examples:
i. Police Officer- Even this depends on your primary job function. One of our instructors is a city police officer in a high crime area. Most of the shooting victims he deals with have multiple gunshot wounds to the torso. Because of this he carries a bunch of extra chest seals. He uses more chest seals than other items. If you are responding to more motor vehicle accidents, you may want to consider more trauma dressings. Don’t forget about minor care items. Anyone that is the “go to” guy for equipment has run into the case where you have 10 tourniquets but no adhesive bandage (like a Band-Aid dressing) when someone asks.
ii. Tactical Team Member/Military- Given the risk of being involved in a shooting and the use of heavier body armor the vulnerable areas are extremities and junctional areas. A trauma kit for this role may include additional packing gauze, hemostatic dressings and tourniquets. You may also want to include some minor care items to keep you and your team operational. A common injury in a tactical setting is finger injuries, while not life-threatening can affect operational readiness. I carry the T-Ring Finger cut kit that stops the bleeding long enough to clean up the injury and dress it. Another common ailment that affects operational status is blisters. Small blister dressings or moleskin can keep someone operational. You may also want to consider some OTC medications for minor pain & allergic reactions (ALWAYS check with a medical professional before giving anyone medications. Some medications can cause adverse effects and affect the body’s ability to clot blood)
iii. Search and Rescue- In most cases, SAR involves minor injuries but extended time to definitive care. If this is your case hypothermia management becomes a huge concern. An active warming system would be better than just heat retention methods. Environment injuries, stings and animal bites can also be a factor. Also, given the fact I have taken a tree branch to the eye, carrying items like eyes shield to treat eye injuries is a good idea. Weight is a huge issue in SAR and you should focus on items that can be used to treat multiple injuries.
iv. Firefighter- Firefighters most often suffer either blunt trauma or burns. You may want to consider burn treatments or at least extra dressings that can be applied loosely.
v. Office worker- Consider adding OTC medications and more minor injury care.
These are just a few examples of how you can use your role and primary use for your kit to decide what additional items you can add. The environment and situation you are most likely to find yourself in is also a huge consideration.
B. What is your available space and what is your budget? We will never have enough space or money to carry enough gear to treat every injury you may encounter. When prioritizing what you should carry consider the following:
i. Carry the essential MARCH gear to address life-threatening injuries.
ii. Consider the most common injuries you are likely to encounter. Add the basic items you would need to treat these injuries.
iii. Consider what items can be used for multiple treatments.
iv. If an item takes up a lot of space in your kit, see if you have other product options that can provide the same capabilities or that allow you to substitute two items for a single item that can fill both roles. of if chances are help would arrive before you use it.
v. Avoid gimmicky products that you would never use.
6. How should I organize my trauma kit? I have found the easiest way to organize my trauma kit is keep the “MARCH” immediate need items in the most accessible location. For example, the trauma kit I keep in my vehicle is a STOMP II bag. In order to keep the MARCH equipment separate and easy to access, I’ve repurposed a chest rig and attached it to the exterior of the STOMP II. This would also work if your bag has an outside pouch. Moving to the inside of the bag, I try to organize it into the smaller pouches by function. Even inside the bag I try to keep things organized by the MARCH algorithm. Low priority items are located deeper in the bag. I try not to have items floating around my bag and use pouches and plastic bags to keep things together.
7. What equipment do you recommend? The good news is that most of the hard work is done on this question. The Committee on Tactical Combat Casualty Care evaluates trauma equipment and makes recommendations based on both ease of use and clinical effectiveness. Currently (as of 10 DEC 2020) the recommended equipment list is:
A. Limb Tourniquets (Non-Pneumatic)
a. Combat Application Tourniquet (CAT) Gen 7 (North American Rescue)
b. Combat Application Tourniquet (CAT) Gen 6 (North American Rescue)
c. Ratcheting Medical Tourniquet -Tactical (RMT-T) (M2 Inc.) (NOTE: The RMT Civilian models are not CoTCCC-recommended for military use.)
d. SAM Extremity Tourniquet (SAM-XT) (SAM Medical)
e. SOF Tactical Tourniquet – Wide (SOFTT-W) (Tactical Medical Solutions) (NOTE: The original 1” SOFTT is removed from the CoTCCC Recommendations.)
f. Tactical Mechanical Tourniquet (TMT) (Combat Medical Systems)
g. TX2” Tourniquet (TX2) (RevMedx)
h. TX3” Tourniquet (TX3) (RevMedx)
B. Limb Tourniquets (Pneumatic) (NOTE: Not recommended for JFAK, but considered for medics, evacuation platforms and Role I/II/III teams primarily for TQ-replacement, conversion, or prolonged application.)
a. Emergency & Military Tourniquet (EMT) (Delphi Systems)
b. Tactical Pneumatic Tourniquet 2” (TPT2) (Combat Medical Systems)
C. Hemostatic Dressings and Devices
a. Combat Gauze (CG) Z-Fold (QuikClot Combat Gauze) (Z-Medica)
b. Celox Gauze, Z-Fold 5' (Celox Medical)
c. ChitoGauze (HemCon)
d. X-Stat, Single Applicator (RevMedx)
e. iTClamp (Innovative Trauma Care)
D. Junctional Tourniquets and Devices
a. Combat Ready Clamp (CRoC)
b. SAM Junctional Tourniquet (SAM-JT) (SAM Medical)
c. Junctional Emergency Treatment Tool (JETT) (North American Rescue)
E. Airway Management
a. CricKey (Control Cric) *This NSN set includes the Cric-Key and Cric-Knife with an integrated sliding tracheal hook. However, only the Cric-Key device is CoTCCC-Recommended; the Cric-Knife and tracheal hook are not specifically recommended.
b. iGel Extraglottic Airway Sz 4
c. iGel Extraglottic Airway Sz 5 (Size 5 is for patients >90kg)
Items like trauma dressings, trauma shears and miscellaneous treatment products so we will work on a list of what our instructors like to use (Including CoTCCC recommended products).
I hope this clears up some questions. We will make another blog with recommendations of specific equipment you may want to consider.