What’s in an IFAK?
By Bear Independent
An IFAK or Individual First Aid Kit is designed to be worn by persons who may find themselves on either end of the two-way shooting range. These kits contain standardized medical components that allow the user to follow the MARCH-E algorithm and address battlefield casualties.
The IFAK is worn on the individual’s load-bearing equipment; typically a plate carrier, duty belt, chest rig, war belt, or other; and is designed to be used to treat the battlefield injuries *of the person possessing the kit*. Additional medical capabilities should exist within a group, unit, or team, to treat mass casualties (similar to a Combat Lifesaver kit or Mass Casualty Kit) or to refer to a higher level of care, like a Medic with a STOMP bag or similar.
So, within your individual first aid kit, there are some basic components that you will want to have; but first- let’s cover the MARCH-E algorithm. The MARCH-E algorithm is synonymous with Tactical Combat Casualty Care, or TCCC, and allows the caregiver to quickly and reliably assess and treat battlefield casualties under stress.
M- massive bleeding – tourniquet, wound packing, hemostatic agent, pressure dressings
A- airway – nasal pharyngeal airway, typically sized 28 French
R- respiration – occlusive dressings, chest seals, decompression needles
C- circulation – emergency blankets, fluids, check for pulse
H- head injuries AND hypothermia – emergency blankets, check eyes, nose, throat, stabilize patient
E- everything else – perform secondary analysis of the casualty, address any additional injuries
To handle things like massive bleeding, typically from an arterial bleed, we will be using a tourniquet; perhaps several. The tourniquet that I prefer, and include in all my kits, is a North American Rescue Gen7 CAT tourniquet, or TQ. There are many CoTCCC (Committee on Tactical Combat Casualty Care) approved TQs, including the SOFT-T and SOFT-T Wide, CAT, and others. The basics required to conform to CoTCCC TQ guidelines are that a) the TQ must be able to be applied with one hand, and b) it must be at least 1.5” in width.
While many LEOs appreciate the SOFT-T TQ, I personally do not prefer them for self-care. I *do* like the quick-detach buckle that the SOFT-T incorporates for dealing with impinged limbs or other extenuating circumstances, but the CAT TQ can perform the same functions as well; however, the CAT TQ is easier to apply to one’s self than the SOFT-T, generally costs less, and doesn’t pinch the skin nearly as badly when the SOFT-T is fully tightened. As a rule, TQ’s are applied high and tight, on the extremities (arms and legs), and can be kept in place for up to 12 hours. The old adage was “life over limb” concerning TQ application in the field, however, there has not been one documented instance of a limb being lost due to tourniquet application in the last 20 years of GWOT. So- if you see a shit-ton of blood, apply a TQ.
As a general rule, I like to have at least 2 CAT TQs on my person, plus 2 more on my kit, one for each limb. I highly recommend that you stay away from the cheap Chinesium knock-offs out there- the windlass breaks when the TQ is tightened, which means… you keep bleeding. And die. No fun. But at least we saved ten bucks…!
Also for massive bleeding, we need to have provisions for wound packing. Typically we will want to use hemostatic agents to speed the body’s clotting ability, like QuikClot. Remember, it’s quick-clot, not instant-clot; the body will need at least 3 minutes to form a clot with the application of hemostatic agents, versus as much as 10 minutes without it. Other provisions for wound packing, which is how we treat bullet holes and puncture wounds in our junctional areas such as the pelvic region, shoulders, and neck, include compressed or S-rolled gauze, and pressure dressings.
Pressure dressings are essentially large ACE bandages with a big gauze pad already applied to the bandage. We use these to cover the wound packing material, our QuikClot or compressed gauze, after we have packed the bullet hole with packing material. The pressure bandage holds the packing material in place, and the additional pressure encourages clotting, which is a good thing.
I prefer the NAR 6” Emergency Trauma Dressings, which we include in our kits, because they are easier to apply than most competitors, due to the sensibile incorporation of small hook-and-loop areas within the bandage; in short, when there’s blood all over your hands and your trying to pack a wound, the bandage doesn’t roll away and unfurl itself all over the ground/mud/blood/glass/asphalt/shit like most other bandages- definitely worth an extra buck or two.
As for Airway, the “A:” in our MARCH-E algorithm, we’re going to need a nasal pharygeal airway in our IFAK. The reason we use a nasal airway is because it does not induce the gag reflex, like oral airways aka J-tubes, which means that they can be used on both unconscious and conscious patients. As a general rule of thumb, we’re going to apply an airway whenever there has been concussive (i.e. explosive) force, head injury, or the patient is unconscious. We want to avoid installing the airway, though, if the patient has suffered trauma to the face and/or nose; if the internal structure of the nose has been damaged, you don’t want to be poking your airway into the casualty’s brain…
The respiratory portion of your IFAK should definitely include chest seals. There are many commercially available chest seals on the market, and they are all basically the same concept, however I prefer the HyFin chest seals. Because, they are sticky as hell. Which is good.
Now, chest seals can be made with any occlusive materials and tape, however it us much more expedient in the field to simply open up a package of HyFins and slap one or two on the patient. Yes, you *can* improvise, but in trauma medicine, if you’re planning to improvise, you’re planning to fail. People die, and quickly, in many of the scenarios that our MARCH-E algorithm is designed to address; don’t try to McGuyver shit to save a few bucks.
In addition to chest seals, you may want to source a decompression needle for tension pneumothorax; the proper use of a needle for decompression is outside the scope of this article, but you can check out Skinny Medic on youtube for a bit of instruction. However, if you stick a needle in your buddy’s heart, not my problem… 🙂 Legit decompression needles will be either 14 or 10 gauge and at least 3.25” long, like the ones we source from North American Rescue for our kits. Again, avoid the stuff from China- they’re not sharp and not long enough anyway.
As for circulation, with battlefield casualties what we’re really talking about is shock mitigation and keeping the patient warm. Shock results from loss of blood- we want to mitigate that as much as possible, through application of tourniquets and wound packing. Additionally, we want to keep the patient warm. The clotting ability of the blood halves for every 1 degree of core temperature drop- meaning that the colder the patient gets, the harder it is for them to form clots, which exacerbates bleeding, causing shock… a dangerous spiraling of the drain. So, while a cheap little mylar blanket seems like an afterthought, they can and do literally save lives by mitigating shock effects and keeping the patient’s core body temperature as close to 98.6 degrees as possible.
The “H” in our MARCH-E algorithm is for head injuries AND hypothermia. We will mitigate hypothermia with the same techniques as shock- keep the body warm through use of emergency blankets. Additionally, we want to assess the casualty for head injuries- perform a visual check, looking for blood ,trauma, debris, and abrasions. If you see any clear fluid coming from the nose, this is an indication that the casualty has suffered a serious head injury and we need to elevate care to a more experienced care provider.
For eye injuries, we’re simply going cover the injury with gauze and tape it down. Most head wounds will bleed like a stuck pig, and all we can really do is cover the wound and induce clotting; head injuries should pretty much always be looked at by a professional.
The E in our algorithm is for “everything else”- cuts, scrapes, burns, etc. It is a good idea to have a couple of burn dressings available on the squad level, as well as provisions for broken bones like splints and cervical collars. A litter, like the NAR Quick Litter would be good to have on a squad level as well.
So, essentially what we’re going to be dealing with in an individual first aid kit is the MAR or our MARCH-E algorithm; massive bleeding, airway management, and respiratory management. To accomplish this, we want to have multiple CoTCCC-approved tourniquets, hemostatic agents for wound packing, compressed gauze, pressure dressings, chest seals, a nasal pharangeal airway, perhaps a decompression needle, some good shears, and gauze and tape.
Here’s a quick list of what we include in our kits:
Gen 7 CAT TQ
QuickClot gauze
7 1/4″ Shears
Twin Pack Hyfin Chest Seals
14g Decompression needle
Nasal Pharyngeal Airway 28g
6″ Emergency Trauma dressing
5×9 combine pad x 2
Compressed gauze
Emergency blanket
4×4 gauze x 2
2×2 gauze x 2
3″ Rolled gauze
Triangle bandage
Duct tape 2” x 26”
Medical tape 1” x 10 yards
Nitrile gloves
Disinfectant wipes x 4
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-Bear