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.
You’re on an active shooter case and your partner has taken a shot to the leg. The shooter is not yet contained and you have to handle this situation as quickly, but carefully, as possible. Your partner is in need of a tourniquet but you have to keep your guard up and keep your eye out for the threat all at the same time.
Remaining focused and staying calm is key in this situation because incorrectly applying a tourniquet could potentially make the bleeding worse. In some cases, you may have a third officer there to guard your back, other times you may need to call for back-up. Being able to quickly assess the situation and then find the solution are the most important parts in assuring the safety of everyone involved, including yourself.
It goes without saying that officers can’t be expected to walk onto a live scene knowing exactly how to respond without being trained. For example, in a case like this, tourniquet application under threat is extremely valuable knowledge for officers. That is where our scenario-based training comes into play.
The scenarios for this topic include teaching officers how to apply a tourniquet on themselves in some cases and someone else in others, while simultaneously protecting everybody from the threat. It also educates officers on the different types of tourniquets (R.A.T.S, C-A-T, and SOF-T) and even covers ways to reduce blood loss in the moment.
Officers are able to fully immerse into our tourniquet application scenarios as if the scene described above was actually happening to them. They also are able to explore the different branching options and see the results of the different actions that they take. This helps them learn exactly what to or what not to do in that situation.
We are committed to helping officers get home safely every day and we developed our immersive law enforcement scenarios in order to play our part in making that happen. Our tourniquet application scenario is just one of many that we have created to help officers in their training.
Including our curriculum into your department’s training regimens would help ensure that your officers show up ready for anything and are fully equipped with all of the knowledge they need to keep your community and themselves safe.
To hear more about the training we offer, contact a VirTra specialist.
It pays to be prepared. Since the goal is to increase safety for all, officers need to know how to perform first aid not only on others, but also themselves, should an emergency arise.
To help officers in this endeavor, VirTra created the nationally-certified curricula “Tourniquet Application Under Threat”. Essentially, this course teaches officers how to best apply a tourniquet, depending on injury location. Officers are able to practice this potentially life-saving skill first in the classroom, under a trainer’s instruction, then in the real-life environment of the simulator.
The reason behind two-fold training is simple. Practicing in the classroom makes it easier to understand the basics, whereas practicing in the simulator is a test to see if trainees can perform the same function in a high-stress situation. It is only through constant practice in a high-stress, real-life environment that officers can improve stress inoculation, skill building and moving this information to long-term memory. Long-term memory is what will allow the trainee to quickly access the information when in the field.
Since life in the field is unpredictable, “Tourniquet Application Under Threat” covers a variety of lesson topics. This includes: general tourniquet uses, what to do when direct pressure and elevation cannot be maintained, tourniquet myths, the application process and so much more. To help with training, certain VirTra scenarios have an instructor appear on the screen and guide trainees step-by-step in applying the tourniquet while the scenario is ongoing.
You can get a sneak-peek into the tourniquet curriculum in this video:
Whether it’s applying a tourniquet to yourself or a partner, the tourniquet is a vital lifesaving tool that officers must master. The recommended tourniquets are designed to apply pressure above the wound to stop a person from bleeding out in the event of an injury. VirTra recommends all officers to not only understand how to use a tourniquet, but to also carry one. They have been proven to save lives and limbs over the years and in various disasters, including the Boston Marathon Bombing.
Tourniquets are applied when bleeding cannot be stopped with direct pressure or elevation, or when both are applied simultaneously. Sometimes there is a reason direct pressure and elevation cannot be maintained, such as an ongoing threat that requires the use of at least one arm to fight. It is also possible that the injured and/or their partner must flee the area quickly, again, making it impossible to apply pressure and elevation.
It is imperative that tourniquet application is done correctly or additional injuries may occur. When applying a tourniquet to yourself or a partner while a threat is still active, multi-tasking and stress levels should not affect how the tourniquet is applied, as cutting corners could cause more harm than good.
VirTra’s IADLEST-certified Tourniquet Application Under Threat curriculum is designed as a walkthrough that can be done alone or with a buddy. It accounts for long gun considerations, injuries to different limbs (arm, lower leg, thigh, etc.) and more. This curriculum falls under VirTra’s V-VICTA—Virtual Interactive Coursework Academy—program and includes a lesson plan with testing materials, scoring rubric, class roster and class survey.
The 27-page lesson plan walks officers and trainees through the application of C-A-T and SOFT-T tourniquets through the use of images and step-by-step instructions. There are also tips on how to slow your heart rate using controlled breathing and finding cover. By using this lesson plan in conjunction with VirTra’s immersive simulations, officers become prepared to treat their own injuries or the injuries of others while a threat is still active.
To see this intense, heart-racing training in action, watch this video showing an officer applying a tourniquet after being injured, then getting back in the fight.
Train hard and stay safe!