“When seconds count”
Last month we started off our TacMed series with a quick low down on tourniquets. We discussed their applications, uses, and benefits for extremity gunshot wounds (GSWs). We talked briefly about the Care Under Fire phase of care as it pertains to Tactical Combat Causality Care (TCCC) doctrine. Stopping life threatening bleeds is our priority in the Care Under Fire phase and the CAT tourniquet was our go to tool in our toolbox.
This month let’s cover the toolbox and the other handy tools that make up its contents. The toolbox that I am referring to is called a blow out kit. A blow out kit is an immediate action, Individual First Aid Kit (IFAK) that is small in size and can be worn on the gear of anyone shooting at the range, hunting, on your home defense gear, or concealed if so desired. Its purpose is to give the individual the necessary medical gear to handle life threatening penetrating trauma wounds. It is designed to allow the individual to perform immediate medical interventions on the level of self-aid or buddy-aid at the time of the incident. The blow out kit will be set up to primarily cover the TCCC acronym MARCH as listed below:
M – Massive Hemorrhage
A – Airway
R – Respiration
C – Circulation
H – Hypothermia
With the threats currently facing US Citizens, the need for basic tactical emergency medical skills and equipment cannot be overstated. Having the basic skills and necessary equipment to treat a life-threatening penetrating injury such as a gunshot wound is crucial. It only takes between two and four minutes to bleed to death from an injury to a major artery. Even EMTs and paramedics with the best intentions (and skills) may not be able to render aid in time. For an unspecified amount of time, you will be on your own. It will be your personal skills and available equipment that will likely be the difference between life and death. You must be mentally prepared to come out of a critical incident with a life worth living mindset, not a mere survival mindset where your quality of life has been irreparably damaged. Training and preparing to prevail and not merely survive is a responsibility that falls squarely on each of us.
Numerous companies offer high-quality individual immediate action medical kits (or blow out kits as the military calls them), many of which are offered preloaded or can be loaded to suit your own specifications. Because some kits can be prohibitively costly for many civilians, an alternative is to build your own blow out kit. We will focus on building our own in this article and keep it as simple as possible but effective. I have yet to be issued a fully stocked blow out kit. Building my own with the components that work best for the mission tempo have always suited my needs well. I will stick to equipment that can mostly be purchased online and we will keep cost to a minimum.
Assembly of the Blow Out Kit
Assembling your own blow out kit is relatively simple and inexpensive, and should include (as a minimum) all of the items necessary to treat life threatening injuries caused by penetrating trauma such as gunshot or stab wounds.
Items Required for the Blow Out Kit
• One compression dressing, Israeli style preferred, 4”to 6” (approx. cost $5-6). There are currently a variety of emergency compression dressings on the market that work very well to control hemorrhaging and are suitable for the tactical environment. The OLAES Modular Bandage, the emergency compression dressing commonly referred to as the Israeli Battle Dressing, the “H” Bandage, and the Cinchtight bandage are examples of some of the most popular compression bandages available for tactical use.
• One pair of small trauma shears (approx. cost $6-8)
• Two pairs of nitrile gloves
• One Sharpie marker (preferably a mini-Sharpie)
• One small Ziploc bag
• One tactical tourniquet, CAT or SOFTT (approx. cost $18-25)
• Eight strips of 2” or 3” Tape (100 mile an hour, duct, or equivalent)
• One small roll of Cloth Medical Tape 1”-2”
• One small, compact solar survival space blanket. Comes pre-packed about the size of a credit card and is silver in color. *not a necessity to have unless you are in an area that EMS response will be delayed several minutes*
• Two 14-gauge Angiocath Needles (3” or greater in length)
• One (size 26-28) French Nasopharyngeal Airway w/small pack of surgical gel (NPA)
• Two Hemostatic Agent, Combat Gauze preferred (Celox or QuikClot will suffice)
• Two Chest Seals such as Asherman or Hyfin
*you can save some money by supplementing a few of these items.*
1. The only tactical tourniquets currently approved for military issue are the Special Operations Forces Tactical Tourniquet (SOFTT) and the Combat Application Tourniquet (CAT). A military triangular bandage and tongue depressors (6” x 1” tongue depressors taped together to create a windlass) can be substituted as an improvised tourniquet to reduce cost. The materials used in the production of some civilian triangular bandages may not be strong enough to function effectively as an improvised tourniquet. They will tear before adequate pressure can be applied. In addition, an improvised tourniquet will generally take more time to properly apply which could be critical. The CAT and SOFTT are reliable and fail safe compared to improvised TQs.
2. You can supplement the two chest seals with two pieces of plastic wrapping cut in 8”x8” squares. Plastic wrap works well in place of a manufactured chest seal. Instead of having an adhesive backing you will have to tape three sides down with some pieces of your duct tape from your Blow Out Kit. You need two chest seals (1) one for your entry wound, (2) one for your exit wound if present. *Any penetrating wound from the base of the neck down to navel gets an occlusive dressing.*
As with any piece of gear, each of these items have particular advantages and disadvantages, the decision on which components to carry/use are best left up to the individual/operator. Whichever items you choose, make sure you train regularly with them. A compression dressing and TQ can be used many times for training purposes. However, items used for training should be from a blow out kit dedicated to training only. Do not use items from your duty blow out kit for training. Make friends with your local EMTs, paramedics, and hospital emergency room personnel. They may have items available to support your operations that will further reduce the cost of your blow out kit.
Be very careful when buying off-the-shelf first aid kits that are not designed for tactical applications. Often, these kits will list the necessary components, but upon examination many of the components are less than adequate for tactical operations. I recommend sticking with a kit that you assemble yourself comprised of components that meet or exceed the criteria for tactical applications or purchase a pre-loaded kit from a reputable tactical medical supplier. There are many companies out there producing/selling quality products.
Assembling the Blow Out Kit
Cut eight strips of 100 mile an hour or duct tape long enough to run the length of the compression dressing package. Fold about ¼ to ½ inch of one end of each strip under. Take the compression dressing or chest seal package (preferably a 6” dressing, but a 4” will suffice) and apply 4 strips of tape the length of the dressing package on each side. Each of the four strips should be placed on top of each other with all of the pre-folded ends located at the same end of the dressing. The fold will permit the removal of each strip when needed without the strips sticking together. This technique is known as “buddy taping.” The tape can be used for any number of things in an emergency such as securing a three-sided occlusive dressing over a chest wound.
Put the Sharpie and the Nitrile gloves into the small Ziploc bag. Carry two pairs of gloves so that you have a pair to offer someone that may be available to assist you, or in the event you rip a pair while trying to don them (which is quite common under stress), you have an extra pair immediately accessible.
Bundle the dressing, shears, Ziploc bag, and tourniquet together and bind them all together with paper masking tape. Using paper masking tape will keep all of the necessary items of your blow out kit together and still allow for the easy separation of the items when needed.
Advanced Blow Out Kit
Provided you have the required training, add the NPA, 14g angiocath needles, and hemostatic agent to the bundle. There are many training facilities that offer TCCC based training out there. Attend a class and educate yourself on the subject. You can also purchase books on the subject that can further your knowledge base as well as training videos that can be found on youtube.
You’re done…it is that simple!
Keep the kit in a cargo pocket or in an easily accessible place in your vehicle, such as the side pouch on your driver’s side door or center console. Keep in mind that there is a considerable compromise in choosing to position the kit in your vehicle and not on your person as conflict will likely take you away from your vehicle making it difficult if not impossible to get to it in the event of an emergency. In Afghanistan we position extra blow out kits throughout our vehicles that are accessible no matter which side we have to bail out of. Each operator also has their personal kit on their gear where it can accessed with either hand at all times. You could position an identical kit in each side door of your vehicle and add another in the trunk or attached to the tailgate of your truck. This makes a blow out kit available from three sides of the vehicle which could be critical in the event of an attack while in or near your vehicle. Under fire, you might not be able to get to one kit placed in the driver’s door, but having at least one other blow out kit placed elsewhere increases your chances of accessing life-saving equipment if/when needed. You can also break your blow out kit down into two very small kits and place them in your jacket or suit coat if you are a licensed CHL carrier. We do this regularly when operating in low-pro environments to conceal our gear and weapon systems. I have my kit divided into two small kits that I carry in both breast pockets of my sport coat while conducting low-pro missions. It works well and does not print my concealed gear when distributed in this manner. The only thing that I tend to change is that I move my TQ to my belt in the small of my back where it can be accessed by either hand.
I hope this information was useful to you readers. Train with your gear as much as you do your firearms. Set your gear up to be functional and simple because under stress your fine motor skills are diminished big time. Stay safe, train hard, train how you fight, and develop your warrior mindset.
Next month we will get into specific injuries and how to use your blow out kit to perform needed medical interventions to sustain life. Until then, be safe, and happy shooting. This is “Doc” Mac from the front lines where democracy never sleeps………I’m Oscar Mike.