I have carried two 1990's era military field dressings and a triangular bandage (which I got when in the NG) with my items to go to the rifle range, just in case.

But after looking on the 'Net I see this is totally inadequate, and the technology and procedures have moved on considerably since my combat lifesaver training in the early 90's. Now that my children go with me to the range, I want to upgrade the kit.

The range I shoot at is at least 30 minutes from an emergency facility.

I thought of just buying a straight US Army IFAK, but I do no not know the proper use of all of the components, or the rationale for each, and so I'm not sure it is sufficient for my needs.

I know I want 1-2 First Care "Israeli" dressings (4", with mobile pad), a tourniquet (CAT-type), and something to stop heavy bleeding like QuikClot. I've also seen the wound covers for a sucking chest wound. (IIRC, we had something similar in the CLS bag.) I will also throw in some nitrile gloves.

Questions:

Is that all I need?

As to the QuikClot, it is sold in all sorts of sizes and flavors. "Sport", "Adventure", Trauma" - in 25g, 50g and 100g sponges, and a 4-yard combat gauze. I have never used it, so on this I am clueless. What and how many should I have? How is it used? Because I am on blood thinners, someone recommended I have some QuikClot anyway in case I have a bad cut in my workshop, as my meds make it hard for my blood to clot. Recommendations and insights?

The IFAK has a compressed gauze bandage. How is that used? Should I have one as well?

Any comments, hints, advice, help, etc., would be most appreciated.

And, Happy Thanksgiving to all!

.....CLIFF
(like, who else?)

The items in an IFAK is basic.

If you don't know how to use that, then you need to attend a basic First Aid Course and have a talk with the Instructor.

You should consider taking an Advanced First Aid Course as well.

Bring your FAK and tell him about going to the range and your concerns. They will show you how those bandages are used to control bleeding, to buy yourself time for the trip to the ER.

Wildman said it all. Training is more important than the gadgets.

What is the protocol at the range for injuries? Transport to a good ER is likely to be key in the event of a gunshot wound and time would be of the essence.

I've had basic first aid training through the Red Cross and Army, and I completed the CLS course while on the NG. But, that was almost 20 years ago, so my quandry is how to use the new products, like QuikClot. I have seen the YouTube vids, and read as much as I can, but what QuikClot product to buy? One 50g 'Trauma' sponge, or 2 25g 'Sport' sponge, or the 'Combat Gauze'? I can't seem to find anything telling me the difference. Is 2 25g equal to one 50g? Is 2 50g equal to one roll of the gauze?

The IFAK is indeed basic, but there is little on the web about training/use the components, and for what situation. When I was in, you were issued one field dressing, and the only treatment for blood loss was pressure.

Totally agree with Hikermor

It's not as if you are in the wilderness, you're 30 mins from a decent hospital you said.

I would apply pressure to any wounds and beat feet to the ER. Those old gauze bandages in your antique first aid pouch work fine - so do tampons.

Maybe apply a tourniquet if and only if pressure didn't stop/slow the bleeding. I wouldn't waste money on quikclot, heard some nasty stories about aftereffects, dunno if I would want to use it or not.

Don't get so wrapped up looking at the trees you miss the forest. Remember KISS - treat quick and beat feet to a doc.

Perhaps the most important question would be, "How long would it take for a capable paramedic to respond to your 911 call?" Transport in a private vehicle might or might not be a good idea. The paramedic will be in communication with the ER, and will have expanded capabilities over even a well trained layperson. They can best utilize the "Golden Hour."

Would love to hear comment from some of the PMs on this forum...

I'm taking a one-day course for firearms instructors on treating gunshot wounds in mid-December. I'll be sure to post something after the class.

Hikermor: Range we go to now is public (thank you, Louisiana DNR!), but 9 miles down a washboard dirt road. I would only consider moving a victim by POV as a last resort. I'd wait for EMS.

And yes, I'd like to hear from the vets and PMs about this, especially what they recommend as kit components.

Chaosmagnet: I would enjoy you sharing what you learn. Thanks!

for the good Samaritan.... add some nitrile gloves and Clorox... an acquaintance took a fragment to the scalp with a lot of blood loss... I was frist to get to him, and used a handkerchief to apply pressure...ended up with wrist deep blood on me... when I asked him if there was a possibility of AIDS/HepC and he replied " I DON'T think so" and I wanted to hear "definitely NO"... the range did not have anything other than soap/water to clean my hands...

IMO you're better off skipping the blood-clot and 4by4s.

A couple of field dressings, a couple tourniquets, maybe an airway if there is some present who can put one in, and 911 on speed dial. The priority is to keep the blood in, dirt out (as long as doing so doesn't slow down anything else), and transport are you're priorities.

Transport can be a bit of a trick. An EMT response and ambulance ride has advantages in that a good EMT has more options. And an ambulance arriving at an ER gets the fastest and most definitive response. Partly because stabilization and initial evaluation are done, partly because it is what the ER is used to, and partly because an EMT who works regularly with the ER is going to be more effective at communicating with the ER.

This can also speed response on the ER end of things because reporting by radio the EMTs can trigger the ER call list and crisis response protocols. This means that by the time the ambulance arrives the ER has a chance to have a trauma team (trauma surgeon, respiratory therapist, radiologist, etcetera) standing by.

On the other hand a lot depends on how fast EMTs can/will respond compared to how fast, and effectively, you can do the job. I've seen people bundled up and hauled off to the ER in the back of a truck in what seemed like two minutes compared to the rural FD response time north of twenty minutes. Good news is that someone got on the horn, this was before cell phones, and informed the ER, actually a full-on trauma center in this case, that they were coming and everything worked out swimmingly.

I go with all the gadgets I can...syringe for irrigation, Celox, Israeli dressing, Kerlix gauze and roll, stretch cling tape, Betadine, petroleum gauze for sucking chest wound... will add nasalpharangeal airway and something to reduce tension pneumothorax (I collapsed my own lung in a scooter accident)....I'm good at listen carefully to professionals when need be...can't think of a side effect worse than death....to aid aerial medevac a couple of chemlights and piece of weighted string to circle overhead to indicate a hazard clear LZ if needed....from previous post, nitrile gloves (3)pair, and small bottle of Clorox/water for me..

Just one thought. Be sure to include some band-aids along with the more serious items. You will probably see about two dozen bloody hangnails for every gunshot wound, even at the range.

We tend to keep our first aid kits for minor issues separate from the trauma kits, when on the range. I've treated any number of boo-boos on the range without ever once (thankfully) going into the trauma kit.

Skip the quick clot granules. The bandages are *probably* OK - it doesn't really matter which size, as long as you're comfortable with it. But if you're going to worry, just get "the biggest one." That being said, the military is going towards Combat Gauze, so that should tell you something. Pretty much it's like Kling or 4x4's, you shove it like crazy INTO the wound, then pressure on top. Don't ditch those 90's era bandages, since the Israeli bandage is just a fancier version of it.

Buy a dedicated tourniquet. It's been covered before on ETS fairly recently.

Buying one of those Asherman bandages is up to you. Personally, I've never seen one used - vaseline gauze and tape seems to be good enough still in the civilian EMS realm for chest wounds.

Which blood thinner are you on? Pretty much no matter what, it's going to be a PITA to stop your bleeding. But you should probably carry something in your kit about your meds, so if you're injured, those responding will know why you're bleeding so much. Plus, there are some ways to counter certain drugs that the ER can do.

I'd personally carry more supplies, including ALS level, but I have lots of medical training.... which is my subtle hint (like everyone else) that you should update your knowledge base!

This has been covered pretty well here, there are a couple points I would like to highlight or discuss more, in no particular order:

Training: Get some training and practice with the supplies you will have in your kits. Not all dressings or tourniquets are the same.

Occlusive Dressings:
Asherman chest seals are not worth it. There have been and continue to be serious issues with the adhesive, without backing them up with tape they are useless. The newer Bolin Chest seals are better, but for the money Halo Chest Seals are a much better choice. The Halo seals work better and the packaging is more robust.

For a simple and cheap occlusive dressing, I put 2 4"x4" gauze pads and 2' of 3" tape in a zip-lock bag. Place the gauze pads on the wound and tape the plastic bag over it to make an air tight seal.

Hemostatics

Like MDinana typed, if you do decided to carry a hemostatic the impregnated dressings are the way to go. While there is still a time and place for some of the loose granules or powdered hemostatics, their applications in both the civilian and military realm is limited significantly and should be used only by advanced providers. Both QuickClot and Celox have reasonably priced hemostatic dressings, the best bang for the buck is the rolled gauze hemostatic dressings.



In response to this question, the answer would have to be how close exactly are you to the ED? If you are across the street from a Hospital with a bleeding patient and there is no concern for neck/back or head injuries, then maybe it may not be bad idea to just get the patient to the ED as best as you can. In most other situations, it is probably best to call 911. One thing most don't consider; is the closest ED the right one? In the end, definitive care for significant trauma is SURGERY and not every hospital has the capability to get a patient in front of a surgeon quick enough.

You can facilitate how quickly EMS crews can find you: know the address of where you are. Seriously, we have been dispatched to 2 calls today where the caller didn't know the address of where they were. For more remote locations, GPS coordinates are very helpful.

What I carry in my Range Kit

This kit fits in a 8"x4"x14" pouch that can fit in my range bag, it is for just BAD stuff. A modified AMK 0.5 lightweight kit is also in my range bag for boo-boo stuff.

2- "H" Compression Bandages
2- Halo Bandages
2- Z-PAK Gauze Dressing
1- Celox Trauma Gauze (3"x6')
2- Halo Seals
1- 30fr NPA
1- 28fr NPA
1- Surgical Airway Kit
1- Needle Chest Decompression Kit
1- Trauma Shears
4- sets of EMS gloves
2- TK4 Tourniquets
1- small roll duct tape
1- Pocket BVM

I do carry an IFAK on my belt when using firearms in remote areas and for some classes etc. This kit I carry in a small IFAK pouch made by High Speed Gear. I keep this kit simple and carry:

1- "H" Compression Bandages
1- 14g IV cath for chest decompression
1- 30fr NPA
1- Pair EMS gloves
1- Trauma Shears
1- McMillian Tourniquet (attached to the outside)
1- 24" duct tape

Keep you IFAKs simple, clean and streamlined. It will make it easier to find what you need when you need it.

About Bleeding Control

Stop profuse bleeding first. A patent airway is useless if the patients ability to carry oxygen to their cells is a sticky messy puddle on the ground.

Commercial military style compression bandages and tourniquets are you best investments. Hemostatics do work, but pressure dressings and tourniquets are more durable and more likely to be what you'll need. For the cost of 1 Celox Trauma Gauze you can get 2 - Compressions Dressings AND 2 - TK4 tourniquets.

For extremity wounds, if pressure doesn't stop the bleeding use the tourniquet. If the limb was savable prior to tourniquet application it still will be for HOURS after application.

Commercial tourniquets work better and are simpler (i.e. quicker) to apply. You don't need the most expensive models, the $5 TK4 work well. If you do want a more robust tourniquet, stick with models that don't have ratchets or cranks that could easily break. In my opnion, besides the TK4, CAT, SOF-T or the McMillian Tourniquet are the only decent tourniquets on the market. BE WARY of knockoffs!

Thank you very much, AR. Just the kind of comment I was hoping for.

Really appreciate the comment about knowing the address of your location. Simple, elementary, and obviously true.

One further question. For backwoods locations, what system do agencies prefer? Is there a standard? I use UTM routinely, but here in coastal Southern California and on the islands, the Coast Guard prefers decimal lat/lon. What do they use in Minnesota and elsewhere?

AR makes some good points. His IFAK list is pretty spot on, and what I'd carry if deployed (and essentially all of which is in my trauma kits). Though I'd add a couple extra supplies to start IV locks. Something that can be connected to an IV fluid if needed. The rationale being, it's easier to get a line in someone when they've got more blood in them. 30 minutes of blood loss can seriously diminish your chances for a good line, and most civilian EMS places aren't trained up on using interosseous lines in adults. (Just one more thing the military's been trying lately - better medicine through death)

The CAT and the SOF-T are the ones that the US military uses. Both one-handed and fairly easy to apply. The SOF-T are preferred but apparently harder to find (the metal bar makes it slightly more robust).

GPS Coordinates

The "standard" for emergency response is supposed to be Degrees Decimal Minutes (ddd mm.mmm"). But, and Degrees format should be fine. I know I can put ant Decimal Format into the MCT (Mobile Computer Terminal) on my Engine. I have setup my GPS handhelds to display this format and UTM (which I prefer to use with paper maps).

Obviously, you want the Datum set to the paper map you are using but the responding units may be on a different Datum. WGS84 is the Datum to use when given GPS coordinates to Aircraft.

IV start Stuff

Mdiananna is correct, it is much easier to get IV access early in a patient with significant trauma. In my range bag, I didn't add IV start stuff due to a space/room requirement I set for my self (wanting the kit to fit in my range bag). I decided that with the urban ranges I shoot at being very close to paramedic units (3-5 minutes if they are in quarters) and since I would typically be on scene at the time of injury by the time I was at the point I would be getting ready to start an IV help would be arriving.

In the remote setting, I carry much more including IV supplies. I have the luxury of being able to be bring a full complement of advanced life support equipment including a medications, ECG/defibrillator or AED. However, I typically stick to a larger version of my Range Kit that adds more advanced airway management, IV supplies, basic complement of medications and larger quantities of bleeding control stuff. This kit also includes a cheap GPS (an old eTrex) with spare batteries and set to the right coordinate system and datum, signal gear (a strobe, smoke and signal panel) and stuff to keep a patient warm.

Alan!!

Long time! You going to be there in January again?

.....CLIFF
(like, who else?)

Interesting point. Many of the topo maps in my area are NAD27. It makes about an 80 meter difference, which good signaling ought to be able to overcome

I carry both the old US bandage and Israeli battle bandage in my range bag and in my war bag. Just make sure you buy an extra one to play with and try out. Also a quick Google search a few years back when I bought my first Israeli battle bandage I found several good company video clips on how to use it. Here's one link to get you started:

http://www.firstcareproducts.com/apage/2123.php

It can be up to 400m in some areas.

I am hoping for a day or two, but the beginning of January is looking pretty ugly this year...

Don't forget an Umbrella

The class was extremely interesting. It wasn't a general first aid course, and while there was some overlap with what I learned in the CERT first aid module, this class was focused on traumatic injury. While other students had CPR certification I was the only CERT member and clearly had the most first aid training going in.

I'll try to hit the high spots of the class and then talk about equipment.

Our lead instructor was an Army combat medic in Iraq, a civilian paramedic, and is now a police officer. Our training was based on his practical experiences as well as the evidence-based medicine learned by the Army and the hospital systems he worked in as a civilian. He covered far more than I can put into this post, with excellent slides and some good hands-on drills.

Most important is the combat mindset. I won't talk about it here other than to say that complacency kills.

Next most important are tactics -- knowing what interventions to use for a given situation.

After tactics come skills -- practicing those interventions so that you can perform them correctly under stress.

Last and least is gear. Gear, he said, is "the weak person's crutch." He believes in having the right gear but the best gear is worthless unless you train and practice with it. If you don't have it with you, it's worthless. Even fifty yards away in the parking lot is too far.

There are three kinds of casualties: People who will live if you do nothing, people who will die no matter what you do, and people who will live if you apply the correct interventions immediately. We focused on that last category.

Getting to definitive care as quickly as possible with a live patient is the goal. As firearms instructors we should know about the local hospitals, know where the nearest trauma center is, and liase appropriately with the local EMS, before holding a class. If the local EMS is professional and nearby, you're probably best off calling an ambulance. If the trauma center is ten minutes away but the volunteer FD ambulance is thirty minutes away, you're probably best off transporting the casualty yourself.

The three most common killers for casualties who could otherwise be saved are loss of blood, tension pneumothorax, and airway issues. We learned interventions designed to keep casualties alive long enough to get to definitive care.

For loss of blood, we learned about direct pressure, packing wounds (gauze is good, tampons work but are invasive and can cause us liability problems) pressure dressings, tourniquets, and hemostatic agents, with good drills on applying them.

For tension pneumothorax, we learned about occlusive dressings, both pre-made ones (and like MDinana says, avoid the Asherman), petrolatum gauze with tape, and "ghetto-fabulous" field-expedient dressings made out of a plastic bag and tape. We learned about needle decompression but were told very sternly that it is too invasive and out of our scope of practice. If we use needle decompression we'll face significant civil liability.

For airway issues, we learned how to use a nasopharyngeal airway (NPA) and an oropharyngeal airway.

We all had questions about gear. Since we were all firearms instructors, RSOs, or LEOs, we were focused on equipment we could carry with us to treat a single wound in the field. For that purpose he recommends the Army issue IFAK. The IFAK contains:

• CAT Tourniquet
• Compressed gauze
• Compression bandage
• Gloves
• Tape
• NPA

With an Army IFAK I can do almost everything he taught us to do, using the package for the compression bandage as an occlusive dressing. He says that the issue tape is crap and should be replaced with duct tape. His favorite compression bandage is the Israeli Battle Dressing. His favorite tourniquet is the CAT, with the SOFTT being a close second. His favorite hemostatic agent for deep wounds that can't be addressed with a tourniquet is CELOX-A, with QuickClot Combat Gauze highly recommended as well.

I have what North American Rescue calls a USCG IFAK coming. I consider the it to be pretty complete. I'll be adding the following to it:

• another pair of gloves
• duct tape
• shears
• Laerdal CPR face shield
• a travel package of aspirin
• a travel package of Benadryl
• CELOX-A

I'm considering this a supplement to my regular first aid kit and it's going to be on my person when I'm on the firing line. The aspirin and Benadryl will be reserved for cardiac issues and anaphylactic shock, respectively. Running back to the car when someone is bleeding is not an option.

It can't be said too often or too forcefully: If you want to be able to help people who are hurt at the range, get some training.

Nice run down ChaosMagnet. I think there are two things worth highlighting in your post. The first is you listed out the instructor's "favorites." In my experience, it seems like every instructor has their own. So it goes without saying that students' preferences might differ too. It's always good to see what your options are, and see if something works better for you. Which comes to my second part, make sure you get training / practice using the stuff you have.

Great synopsis.

I'd hesitate about giving benadryl. It can be fine for mild problems, but if the person's airway is truly closing off, shoving something down it and trying to get them to swallow may be the proverbial "straw that broke the horse's back," and occlude that last little space they're breathing down.

If the trauma center is 10 minutes away, and you're transporting by car, for the love of everything holy, CALL and let them know you're en route. 2 minutes of controlled prep will help a lot better than the catastrophic chaos of a "homeboy ambulance" delivery. Get the direct number if you can, even if it's to the charge nurse.

Some things he probably didn't add:
- keep the patient warm. Even in Iraq they should be keeping a blanket on folks Cooling off weakens blood clotting and jacks up the blood pH, making it easier to bleed.
- I also like athletic tape. ANY plastic can work - bandage wrapper, sandwich bag, spare latex glove, 55-gal drum bag (probably should cut off the slack). You can seal the wound with a gloved hand while you get the bandage ready; ideally you'd have someone helping you.
- The 'flutter valve' concept is nice, but may not work. I've heard good and bad about it, and "tape on three sides" versus "tape all 4 sides" of a bandage arguments. Do whatever your local area EMS does.
-maybe add something to your liability waivers about the lack of immediate EMS, allowing you to perform basic first aid?

A couple of things with occlusive dressings:

Keep the occlusive dressing just slightly larger than the wound. If the occlusive dressing is too large, you essentially create a secondary pleural space.

Check for exit wounds. If found, apply an occlusive dressing to any additional sites.

Try to apply and seal the occlusive dressing when the patient exhales.

If possible transport with the injured side down, but monitor patient’s condition constantly.

If the patient complains of an increase in difficultly to breath, a decrease in the level of conscious and/or distension (enlargement/engorgement) of the jugular veins (large veins in the neck), you may have “burp” the occlusive dressing to relive trapped air and/or blood.

Pete

That's a great point. I'd never give someone a pill to swallow if they were having breathing problems.



This was addressed at length in class. Ideally (assuming transport by private car) we have one person driving, one person treating the casualty, and one person navigating and being on the phone with the ER.



This was covered briefly in class.



I hadn't thought or heard of using athletic tape in this capacity, thank you.



For myself, I'm not enough in their confidence to know that. I'll have to see if I can find out.



That's a very good idea.

Are you sure you weren't in my class :-) ? Our instructor said this to us almost word-for-word. For myself, I agree wholeheartedly.

This wasn't mentioned in our class but makes perfect sense to me.



We covered this well, although the CERT first aid module did a better job of teaching us to assess the patient.



We weren't taught this but it now seems obvious.



This was covered.



We were taught to use three sides of tape or a pre-made occlusive dressing, but this makes perfect sense to me.

Nah, I just know the drill.

All,

Being a civilian contractor in Afghanistan I am not allowed to carry a weapon, so having a well stocked kit and good training (Combat Life Saver, CPR for the Professional, and EMT-B course taken in country) gives me something to bring to the party. Still tinkering with the contents trying to fit in a CPR pocket mask. This bag, as its name implies, is for the first 5 or 10 minutes of an emergency until the real medics or EMS arrives. Everybody have a great Christmas!

Cheers,
W-W



Tactical Tailor First Responder Bag (CLOSED)


Tactical Tailor First Responder Bag (OPEN)


Contents of Tactical Tailor Bag

x1 SAM Splint
6” Elastic Bandage
x1 Israeli Abdominal Combat Dressing
x2 6” Israeli Combat Dressing
X2 HyFin Chest Seals
X2 Vaseline Gauze
x2 Compressed Gauze
x2 Combat Gauze
x2 CAT Tourniquets
3” Roll of Tape
x3 Triangular Dressings
x5 Nitrile Gloves (in top pocket)
x1 Nasal Pharyngeal Airway 28 FR with surgical lube
x2 14 GA Thorax Decompression Catheters
x6 Alcohol Pads
x2 Eye Shields

Glad to see you are Handling things,Despite the Restrictions!In lieu of a frag in the bag,May I suggest, a Couple Shooter bottles of Jagermeister,Might be in Good order,If obtainable! I Bid you a Most Decent as Possible-Merry Christmas & New Year!& As it should be,Thanx for Being There!