The Monkey on Your Back...

    PJ Medical Ruck :

I've heard a ton of debate over the years about what to carry in an aid-bag for the various combat mission sets.  Sometimes it's a debate over the weight, other times it a discussion of what is practical for the prehospital, austere environment. The ultimate goal is always the same: to carry the right amount of gear to perform at our highest level of training and ability, without carrying extraneous weight. 

    In almost every one of these conversations I'm considered the "over-packer".  There is a common myth that your bag has to be the size of a refrigerator box and twice as heavy to carry everything you may need, and that simply isn't true. I feel as though I have been trained to a very high level and my experience supports the need to have the full gambit of equipment.  Additionally, I've never failed to keep-up with the group on account of my bag being to heavy or large.  Bottom line, last thing that I ever want is to be standing over a patient with the team looking to me to save his life, knowing that I don't have the tools required to do my job because I chose to be light and fast.  Getting to a casualty quickly does no good if I’m not equipped to help. I've heard it said time and time again: "I'm a shooter first and a medic second".  Look, I get the sentiment but I hate the mindset.  How about: "I'm ALL shooter, until someone is hurt and then I'm 100% medic and fully prepared to save a life... or three".

    I'll share a secret with you since it turned out ok and the shame has diminished with time.  A few years ago, while attached to "a group of people", I forgot to bring my aid bag on a mission.  I was tired, it was dark, I was hungry... (you can insert whatever lame excuse here that you are willing to let me get away with), but I didn't have it.  I did my standard pre mission run down in my head, "helmet, nods, gloves, guns, bullets, radio, .... and I feel like I'm missing something but I'm sure it's nothing".  We rolled out the gate and a couple of miles down the road it hit me, "oh yeah, med ruck... OH SH!#%!!!! MED RUCK!" I sat there sweating bullets and running through my head what gear was on my first-line (in my pockets), what was pre-staged on the vehicles, and what other people may have on them.  From Advil to IVs, I was screwed. I considered coming clean but I decided that their was no turning around and I would only succeed in losing their confidence.  So I kept my mouth shut and prayed.  When we arrived at our "place of work" I got out and It felt as though everyone was staring at me.  Clearly they had to see that I had nothing on my back.  It's like when you have a new pair of shoes on and you're feeling super cool and you’re just sure that everyone is noticing your awesome new footwear and are keenly aware that you can now run faster and jump twice as high. In reality, no one notices your new kicks, and no one noticed the fact that I was without my Med Ruck. 

  Fortunately the night went on and we did what we do with no issues. Thank God the mission went without a hitch that night and that I work with some amazing professionals.  Not even so much as a headache or a sprained ankle, and while we didn't win the war that night, I did walk away with a lesson I'll never forget about being prepared.  Mistakes are made and we can't save everyone unfortunately, but we can avoid risking peoples lives by being unprepared.  Or as grandpa would say, "Proper prior planning prevents piss poor performance".

                              Arctyrex Khard 30

                              Arctyrex Khard 30



This is my "large" ruck, (Arctyrex Khard 30) packing list and the one that I carry for dismounted, extended operations, and most everything that we do.  Using the Khard 30 bag with it fully loaded only weighs approx. 21.5lbs





                    First Spear Multipurpose Pack

                    First Spear Multipurpose Pack



     I will post a second packing list of a smaller ruck that I use for specific operations that require me to be smaller and lighter, for shorter faster movements.  The reasoning behind the smaller bag is that I'm 215lbs before I kit-up and I have been jammed up in hallways by the Khard because I can be to big.  The small bag is a supplement to this bag and I try to make sure the full bag isn't far away (on a vehicle or in the bird). For the small ruck I use the First Spear Multipurpose Pack and I'll post some videos soon showing some reasons why. 






***Keep in mind that this is augmented by the gear on my first line. In a normal patient scenario, all major hemorrhage should be controlled before my bag is opened.

Medical Ruck Contents: 

Ruck Packing List:  (Roughly in order of use per TCCC)


Hemorrhage kit:  

  • Compressed Gauze x4
  • Combat Gauze x3 (would prefer Celox Rapid)
  • Elastic wraps (Ace wraps) x2
  • Pressure Dressing x1 (preferably the Olaes 6")



Airway and Respiratory


  • Cric Kit x1
  • NPA x2
  • 4"x4" gauze x3
  • Chest seal x4 packs 
  • Hydrogel x1
  • Decompression Needle x3 (14g x 3.25")
  • Chest Tube kit x1
  • Suction
  • Bag Value Mask (BVM)







  • Sodium Chloride 0.9% (NS) 500mL 
  • 6% Hetastarch 500mL 
  • IV Administration Kit x2 
  • IO gun and 3 needles
  • Basic Blood Transfusion Kit 
  • Sharps Shuttle










  • Helos Hypothermia Kit x 2
  • Fleece Beanie













  • Blood Pressure Cuff
  • Pulse Ox
  • Thermometer 
  • Stethoscope
  • Note book w/Marker
  • 4"x4" gauze (for going pt to pt)





Wound care and Closure:



  • Skin Stapler
  • Alcohol/Providone Iodine Swabs
  • 2"x2" Gauze
  • 4"x4" Gauze
  • Durmabond
  • 0.0 silk x2 
  • Steri-strips
  • Assorted Band-aids
  • Dental Repair kit 








  • Elastic wrap 6" x1
  • Sam Splint
  • Finger splint x2 








  • Sunsceen
  • Eye cover
  • Bio Freeze
  • Batteries (AA, AAA, 123)
  • Duct Tape
  • Trauma Sheers 
  • Hand Sanitizer






Anaphylaxis Kit:




  • Epi-pen x2
  • Benadryl (50mg vital x2)





  • Ibuprofen
  • Mobic
  • Tramadol 
  • Prednisone 
  • Cipro 
  • Azithromycin
  • Cyclobenzaprine
  • Cough Drops
  • Pepto Bismuth
  • Loperimide (Imodium)
  • Mucinex
  • Ondansetron (Zofran)
  • Benadryl
  • Antacids
  • Caffeine
  • Meclizine 
  • Tylenol Cold and Allergy
  • Hydrocortisone (topical) 
  • Cefazolin
  • DiazepamMorphine x2 
  • Invanz (ertapenem)
  • Marcaine 
  • Promethazine x2
  • Diphenhydramine
  • Ketorolac x2
  • Naloxone (Narcan)
  • Ketamine
  • Lidocaine
  • Midazolam

Extensive Video of ruck setup coming soon as well as permission med-checklist: