Trauma kits often referred to as IFAKS ( Individual First Aid Kits ) come in many different shapes and sizes and can vary in cost from $30 to upwards of $300. IFAKS come in a broad range of shapes and sizes, and every color imaginable from multi-cam to blacktical, all with a laundry list of interchangeable components. It can be very confusing even for those of us who work in and around these items everyday to decide on what to spend our hard earned dollar on.
It is not the intent of this post to get into the different manufactures or the wide range of mounting options, or even to compare one to the other. The goal is to discuss and make recommendations on the absolute essential items you must have to render aid to a trauma victim.
These are the items a good kit must have and the list is a great starting point, it's always better when you can add additional tools to get the job done but adding more to a kit or bag means additional weight and additional costs. Ounces make pounds, and pounds equal pain. Use this reference when your considering purchasing a pre-made kit or whether your creating your own kit or adding items to your first aid kit or bug out bag.
This is the number one absolute must have item.
Limbs make up about 50% of the body surface area and commercial tourniquets are a proven, safe, and effective means of stopping a life threatening bleed. Military personnel and Law Enforcement officers often carry their tourniquets on their body armor or duty belt, within arms reach as opposed to inside a kit. They do this to save precious seconds and avoid having to fumble through the kit to locate the tourniquet in an emergency situation. Tourniquets are no longer a LAST RESORT item, they should be a First Resort consideration. Tourniquets have been around for hundreds of years, new commercial tourniquets have expelled the myth that placing a tourniquet will resort in an amputation, read some other common myths here.
- Can't I just improvise a tourniquet ?
The answer to this question is a resounding YES you can, but it's important to understand that improvised tourniquets are ineffective about 75% of the time. It's always a better solution to use the right tool for the job then to try to use stick & rags and wing it.
- How many Tourniquets should I carry ?
Unfortunately there isn't a right answer to that question. If you are stocking a trauma bag for your vehicle and happen upon an accident with three people involved, mathematically speaking that's twelve limbs. I realize the likelihood of that many bleeding extremities is slim to none, that being said in 2004 military personnel deployed in Iraq carried just one tourniquet. Nowadays most are carrying one on the outside and one or two more in a pocket or IFAK. You can purchase a CAT tourniquet or SOFT-W for about $30 or a SWAT-T tourniquet for $15 and they take up very little space. I'd recommend at least on tourniquet as part of your everyday carry and at least one more in a go-bag or IFAK.
- Which Tourniquet should I buy ?
People always ask what is the best tourniquet. The simple answer is the one that your carrying. I am far less concerned with the specific tourniquet that you purchase and far more concerned about your level of training. As a professional instructor that's trained thousands of people, I cannot stress how important quality training and practice is, when it comes to performance in a real life situations.
Pressure dressings or bandages are a multi-use items that are extremely useful when rendering aid to a trauma victim.
These are not tourniquets however if placed effectively, in conjunction with wound packing they do a fabulous job at applying pressure and stopping blood loss. We train medics to do just that when the time & place are right so that they can consider reducing or removing a tourniquets. The most important factor when choosing a pressure bandage is that it must have elasticity in order to create pressure.
- bandage to provide direct pressure
- pressure device for junctional wounds
Center mass is where we teach shooters to aim. A thorough examination and exposing of the chest is key part of examining a patient that has suspected penetrating trauma. Gunshot wounds can often be through & through, secondary injuries from a blast are caused by projectiles flying into the body with a high level of kinetic energy. There is not much treatment that can be provided on scene for internal injuries or internal bleeding, the best option is to seal all holes in the chest, abdomen, and back with an occlusive dressing to prevent air from entering or exiting the chest. Seal every hole from the belly button to the neck 360 degrees around the torso.
- Seal the biggest scariest hole first or the one most likely to be pulling in air.
- Rake the chest with a monkey claw technique, it's not uncommon to miss large holes because the skin can move and rescuers often develop tunnel vision. Rely on more then on sense.
- Don't forget to check the downside, roll or sit up the victim to inspect the back.
- Holes in the armpit are commonly missed, get in there and look.
- You can fashion an improvised chest seal with plastic and or tape. Tape all 4 sides (3 is no longer recommended). Commercial chest seals are tested and designed to stick to despite blood, sweat, and hair and they are a far better option then arts & crafts.
Wound Packing is typically sterile (moot point) kerlix gauze that's intended to plug holes in the body. Hemostatic dressings are impregnated with substances that aid the bodies natural clotting process. Studies show a slightly greater chance of stopping the bleed when using hemostatics correctly. Theses advanced types of gauze cost about $35 which is about ten times the price of regular kerlex. The emphasis is on proper use, again I want to stress the importance of a reputable training program and practice. Packing an injury that's below a tourniquet shouldn't be a matter of life & death because a properly applied tourniquet will stop bleeding. The leading cause of preventable death in combat is junctional hemorrhage (It has surpassed extremity bleeding due to training and availability of tourniquets). The neck, groin, and armpit area all have large blood vessels that lie close to the surface of the skin. When these sites are injured, a victim can bleed to death in a matter of minutes. With a basic understanding of anatomy and an aggressive approach it is possible to stop bleeding in these areas of the body. To control a bleeding vessel in a junctional area, wound packing must be placed directly on top of the damaged blood vessel along with sustained pressure.
- Wound packing is intended to be placed inside the cavities created by the trauma and or over the top of lacerations, it not meant to be circumferentially wrapped around limbs like a pressure dressing.
- Hemostatics will only help with clotting if they come in direct contact with the bleeding vessel.
- Packing material is intended to go inside the hole not cover it.
- Towels and large absorbent bandages DO NOT stop bleeding.
- In the absence of wound packing material, your fingers may suffice or some t-shirt like material may be stuffed into the wound, sterility is not a primary concern.
Hypothermia can be the kiss of death for a trauma patient, it's part of the lethal triad in trauma. Loss of blood innevitabely results in shock, which simply means the body is unable to provide oxygen to the cells. The process of delivering oxygen and removing carbon dioxide is how the body creates heat and maintains a core temperature of 98.6 degrees. A drop in core temperature leads to a cascade of problems for an injured person. The most concerning is a loss of clotting ability. Hypothermic patients will continue to bleed externally and internally which leads to more hypothermia and eventually death. Here's another Trauma Monkeys blog post on Hypothermia myths.
- Trauma patients are at risk of becoming hypothermic regardless of the outside temperature.
- It's much easier to prevent hypothermia then it is to treat it. Good hemorrhage control and stopping the bleed as quickly as possible is crucial.
- Mylar blankets will not be very effective for hypothermic patients without the use of an external heat source. Trauma victims make poor heat sources, there isn't any heat to reflect.
- One of the ways we lose heat is through conduction, get victims off the cold floor / ground or put some insulation between them and the ground.
- It's important to remove wet clothing, its contact with the skin will expedite a drop in core temperature.
This is by no means an all inclusive list. I plan to do additional posts with detailed packing list of all the items needed for an IFAk or a trauma bag.