While Individual First Aid Kits (IFAK) are increasingly popular among law enforcement personnel, they have been popular in the military since the late 1990s. The increase in popularity comes as a result of lessons learned during the Global War on Terror. As a young EMT, I can remember a time when it was a common belief that the tourniquet should only be used as a last resort. Those beliefs no longer stand among the military and first responder medical communities. So many lessons have been learned and lives have been saved due to new technologies and interventions.
The purpose of this article is to discuss some of the new interventions and protocols and provide a list of items that are important to me as a first responder. My personal list of items which I keep in my IFAK is not comprehensive, but it’s meant to provide a jumping-off spot for further discussion in your agency. A couple points to make before we start:
Having an IFAK on you is as important as your duty sidearm. Personally, I’d rather have it and not need it, than need it and not have it. Oftentimes, the best medicine on the battlefield is fire superiority. If you find yourself in a situation where you are operating as a solo unit having an IFAK on you increases your survivability. Once the deadly force threat has been dealt with, you can begin administering lifesaving treatments to yourself while you wait for responding units to arrive. If your agency allows you to wear an IFAK on your outer vest it is important to place your IFAK in a place that is easily accessible with either hand. Remember, your IFAK is for you. It is not intended to be used to treat others – that is what your first responder bag is for.
Remember the old military first aid adage: “Start the Breathing, Stop the Bleeding, Protect the Wound, Treat for Shock”? That was a pretty solid assessment protocol, and although it’s been replaced with the M.A.R.C.H. acronym, it still stands as a good standard for what we should consider our priorities for building our IFAK.
Breathing is self-explanatory, realizing that “shot ain’t dead” is an important part of any good battle plan. Autogenic training is often utilized in sport psychology, in particular, but it can benefit people in a wide range of stressful situations. It uses the body’s natural relaxation response to counteract unwanted mental and physical stimuli. Through the use of breathing techniques, and positive self-talk, autogenic breathing can help to reduce stress allowing injured officers to slow their heartrates down, decrease blood pressure and enables them to think more clearly.
While nothing in your IFAK can stimulate you to spontaneously begin autogenic breathing it is important to train in this technique. In our training room at VirTra, often times our trainers will train students to begin autogenic breathing as part of the draw stroke during deadly force encounters.
Another important item to keep in your IFAK is a Nasopharyngeal Airway (NPA). If you are unconscious and unable to protect your own airway, it is quick and easy way for arriving officers to secure your airway. Funny story – in IFAK training we learned how to insert an NPA by doing it on ourselves. It was uncomfortable to say the least, but provided a ton of comic relief as we watched our partners with watering eyes, sneezing and gagging.
An adult human body carries 1.2 and 1.5 gallons of blood. Generally speaking, hypovolemic shock can occur when individuals lose 20% or more of their total blood volume. Depending on where an individual is bleeding from indicates how you can stop the bleeding.
Tourniquets are a great way to stop heavy blood flow from the extremities. There are some rules for applying them, however. If you are not able to control blood flow with direct pressure and elevation simultaneously applied, a tourniquet is needed. “High and tight” is a good principle to apply when placing a tourniquet. Tourniquets should not be placed in double bone areas like the lower leg or forearms. If an arterial bleed happens in those areas a tourniquet can be placed above the knee or elbow. I carry two tourniquets in my IFAK for two reasons. First, we have two Femoral Arteries. Second, if the first tourniquet is failing to control the bleeding, another tourniquet can be placed higher up on the limb (proximal) above the first one.
In areas of the body where a tourniquet cannot be applied, it is important to be able to pack the wound. Penetrating injuries in areas like the inguinal region are difficult to treat. First responders must be able to pack the wound to control bleeding. For this, I like to use Quick Clot gauze or Celox gauze. While packing a wound is difficult is important to remember that the femoral artery runs through the inguinal region. Proper packing techniques must be employed keeping direct pressure on the artery while “plugging the hole.” I keep two packs of quick clot gauze in my IFAK in the event that additional packing is required.
A sucking chest wound can lead to a collapsed lung pretty quickly. For penetrating wounds to the chest, I like to use the Hyfin Chest seal. This chest seal provides 3-vented channels designed to prevent airflow into the chest cavity during inhalation while allowing air to escape through the vent channels during exhalation. I like to keep two seals in my IFAK in the event I need plug an exit wound as well as an entry wound. Don’t forget to do your blood sweeps looking for indications of an exit wound.
To protect the wound, it is important to have a good trauma dressing. My preference is the Israeli trauma dressing because the design contains a plastic clamp that if applied correctly applies additional direct pressure to the wound. There is other dressing available such as cravat triangular bandage, sterile gauze or a 4×4 pad. With the exception of the chest seal, it’s important to remember that no bandage is complete until it’s dressed. The wound needs to be protected and simply applying a tourniquet is not the end of the intervention. I carry two Israeli Trauma Dressings because I was taught that “Two is One, and One is None.” Medical tape is another item that is extremely useful for protecting the wound. It is used to secure the dressing.
Without going into a discussion about the four types of shock, it’s important to understand that keeping our patient warm and comfortable until the bus arrives is vital. I don’t carry a Mylar blanket in my IFAK, but this another good place to begin autogenic breathing to lower your heartrate and decrease stress and lower your blood pressure.
At VirTra our system includes several scenarios that would lend themselves to IFAK training. Take for example the Scenario titled “Nightmare Alley” – a good practice would be as the cover officer quickly ending the threat, then turning to see your partner laying on the ground with his IFAK on. You would quickly assess his injuries and begin proper interventions. We have several scenarios that can be used to sharpen your medical first responder skills.
If you need assistance coming up with training ideas, feel free to contact VirTra SMEs for any suggestions on what scenarios will fit your needs.