Monday, 18 February 2013

The Gunfighter’s Guide to Medical Kit, Part 2

In The Gunfighter’s Guide to Medical Kit, Part 1, we looked at the personal tourniquet and its storage plus requirements for a rescue hook. In Part 2, we will discuss the IFAK, its placement , marking and requirements, some possible loadouts and other equipment required for the individual tactical operator in the field. 

Where ever you deploy, Whatever the gig,
you will need a basic level of medical kit


I have heard many different names, mostly for commercial branding reasons, for the Individual First Aid Kit (IFAK). CFAK or Combat First Aid Kit, BOK or Blow Out Kit, even the grotesque VOK or Ventilated Operator Kit; to name a few.  I prefer IFAK, as it not only describes its role; it clearly states its limitations.  An IFAK is not a treatment pouch. It is the basic medical gear used by a buddy, TCCC/CLS or medic on an individual casualty. There are few, if any, high speed interventions in this kit. It is, also, not a minor wound or injury kit. For more information on a minor wound kit, check out The HSLD ‘Owie’kit.

There are a few tenets that I postulate: IFAKs should be removable from the operator’s kit, standardized tagging system within an element is required, and uniform placement within the element would be ideal.

An IFAK needs to be removable.  An IFAK is used on the casualty carrying it. As a responder, constantly digging into a pouch on a casualties rig will hinder and slow lifesaving interventions. Fighting gear will be collected for ammunition and other mission specific items to be distributed between remaining team members.  The medical gear needs to stay with the casualty. Also, once the casualty has been treated, the remainder of the medical supplies can be cached in the Casualty Collection Point (CCP) for additional wounded, especially in a multiple casualty incident or even a MASCAL. An IFAK needs to be removable; either tearaway or pouch-in-pouch.  Pouch-in-pouch is easily accomplished by putting all your first aid gear in a zip lock bag and stashing it in your C9/SAW/Utility pouch. There are commercial versions of this style as well.

Pouch In Pouch IFAK

I have always preferred tearaway pouches.  I have play-tested many companies’ pouches. Most will be more than sufficient for the job.  My current tearaway IFAK is a CTOMS Slimline. This pouch can be freed from its mounting panel with one movement - a pull on the beaded handle. The CTOMS Slimline remains secure on its platform until the beaded pull is employed. The pouch is easily reattached with one hand and can be mounted horizontally or vertically. This pouch has many other excellent attributes but a full report will be another blog post. Whichever style, pouch in pouch or tear away, you choose ensure you practice with employing it from a self-aid and buddy aid perspective.

A CTOMS Slimline on Belt Kit

Within your element or patrol, come up with a standardized marking system for your IFAK. I have seen many styles and types of marking. I have always preferred a red tag, tape or handle. Red is Med! This goes for all medical kit including IFAKS, Aid Bags and Vehicle Kits. It really doesn’t matter what you decide on for marking as long as everyone you work closely with is identical. When under the stressors of combat, this will aid in rapid location of medical kit. A uniform placement of IFAKs within your element is the ideal. Simply, every one positions the pouch in the same spot on their fighting rig or belt kit. When combined with a standardized tagging system, this makes the IFAK very easy to locate under stress. I am a proponent of mounting IFAKs on belt kits. As belt kit is the minimum that you will wear during a deployment or call-out, you will always have medical gear on your person.

Marking your IFAK makes it easier to find
 under the stress of combat

How do you decide what you or your element packs in their Individual First Aid Kit (IFAK)?  On most deployments, units issue very basic first aid equipment.  Most of the time, it consists of a pressure dressing, tourniquet, and a hemostatic dressing. As a mechanized infantry company medic, this may be more than sufficient when you consider the combined organic assets of infantry company. When tasked to support a unit, I do a medical threat assessment. Taking into account, weight distribution, unit size, mission, evacuation times and medical capabilities of the unit members, I design a load out to meet those crucial criteria’s.

I have come up with a few basic loadouts which I fully expect to be modified to meet your medical assessment for your element, mission and location. Within my deployments, I have found that with a higher threat, medical assets kept closer to secure areas thus increasing evacuation times. The IFAK contents listed below have been devised with this reality in mind. Also, all the medical kit listed is approved by the Combat Casualty Care Working Group (CCCWG) in Canada or the Committee on Tactical Combat Casualty Care (CoTCCC) in the USA. Again, these are intended as a guideline for you to build on or deduct from based on your situation and level of training.

Pack only CCCWG or CoTCCC
 approved medical supplies

Low Threat with integral medical assets or fast evacuation times:

1 x Roll of 1” or 3” Gorilla tape or GeckoGrip tape
1 x Casualty Tag with your identification (patient ID), medical history (Hx), allergies (ALG) and prescription medications (Rx) filled out.

Medium Threat with medical assets close or normal evacuation times

1 x Roll of 1” or 3” Gorilla tape or Gecko Grip tape
1 x Casualty Tag with your identification (patient ID), medical history (Hx), allergies (ALG) and prescription medications (Rx) filled out.

High Threat with medical assets on call or delayed evacuation times

1 x Roll of 1” or 3” Gorilla tape or Gecko Grip tape
1 xPill Pack for Pain Management & Infection Control (consult your Task Force Surgeon or Agency Medical Director)
1 x Casualty Tag with your identification (patient ID), medical history (Hx), allergies (ALG) and prescription medications (Rx) filled out.

Some people think that storing your casualty tag in your IFAK  with your identification (patient ID), medical history (Hx), allergies (ALG) and prescription medications (Rx) filled out is ‘bad mojo’.   I do not prescribe to superstitious nonsense like this. It is your IFAK and the kit carried for use on you! Having the critical information filled out prior while hasten your casualty documentation, speed up your evacuation time and assist treatment at a trauma center or Role 3.

As you can see, the higher the threat, the farther away from medical assets and the length of evacuation times increases the quantity of medical equipment required. This is all moot without proper training and clearly established and practiced Standard Operating Procedures (SOPs).

Other Required Kit

Unless the gunfight takes place in a hospital emergency room, casualties will require evacuation. It is likely that the evacuation platform, whether helo, armored ambulance or even civilian wheel ambulance, will not reach the point of wounding. Collecting wounded to a secure Casualty Collection Point (CCP) indicates casualty movement. Casualty movement is not ‘one size fits all’. An improperly chosen technique can increase hemorrhage and reduce the long term recover of casualties. Traditional Litters are bulky for light work thus usually relegated to evac platforms or assault vehicles.

The Foxtrot Litter is an effective roll litter. It is compact enough to attach to your day pack, but is still very practical in a tactical setting. Casualties can be dragged or carried off target without wasting valuable time rigging and securing.

Both the CTOMS Pocket FX Litter and the Tactical Medical Solutions Phantom Litter represent excellent examples of modern pole-less assault litters. Both are ultra-light and compact so they can easily be carried in a pocket or pouch. They both also operate as a casualty equipment bag once the casualty has been loaded onto a proper litter. Both these litters are so light and compact; there is no justifiable reason not to carry a few within your team.

To go with the theme of casualty evacuation, ensuring that there is a complete Helicopter Landing Zone (HLZ) marking kit available. Contents of a proper kit should include: Chemlights  (IR and regular), 550 Cord ( Pre-cut  and attached to chemlight for signaling) MS 2000 Strobe, , VS 17 Panel, and colored smoke grenades.

A few of pieces of gear that I carry on my belt kit and day pack, at all times, are a whistle and a signalling mirror. A good whistle can be separated from the sounds of battle when signalling for assistance. It takes significantly less wind to blow a whistle than to yell or scream for help. A signalling mirror can be used for inspecting under and around furniture and boxes, peering around corners, applying cam paint, shaving and signalling for help.

In the The Gunfighter’s Guide to Medical Kit Part 1 and Part 2, we have covered the base medical equipment that should be carried by all. This is a living concept as technology, equipment and techniques will change and expand as science and end-user improve them. The doctrine provided is based on my operational experiences and training.

Every operator should carry, at a minimum:
  • A personal tourniquet
  • A rescue hook or similar rescue tool
  • An Individual First Aid Kit or IFAK
  • A whistle and signalling mirror
  • A practical means to perform casualty movement


  1. What would you recommend for a North american range situation where one is taking more advanced courses?

    Many ranges in Canada are a good distance from Emergency room level care. Can you outline a good kit from this article that would be appropriate for a gunshot wound in those conditions?

  2. A Level 1 kit would appropriate for most square range activities combined with knowledge of civic address, routes to range and emergency contact info. Ranges in Canada are required to keep a Aid Kit in their range stores as well.

    Knowledge is more important than gear.