Medical gear philosophy
A new private out of AIT wants to know: what’s the aid bag load plan? He gets great comfort in having a bag packed just like he was told to do. Much of the bag’s contents are high-tech gadgets that were placed in the bag not because they were needed, but to get funding. In order to hasten the procurement process an individual pushing for the new load plan only need add a few extra tidbits at the request of lobbyists for various manufacturers in order to get a few influential senators to back the bag. Hence we have the ubiquitous single purpose Benchmade hook knife in addition to scissors in every Combat ‘Lifetaker’ Bag (CLS), or the Asherman chest seal, never proven to have any benefit as a chest seal with a valve. How about the absolutely worthless Sawyer extractor? Millions sold, no value to the patient outcome.
Later our private becomes a SGT. Instead of tossing out gear, he gets more training and adds more high tech gadgets. His bag gets huge. He can’t do a push up with it, he can’t fire and maneuver, but by gosh he has separate solutions for IV, irrigation, and eyewash. Three pen lights, a flashlight with 2 colors of lightsaber attachments, and a headlamp. No one ever taught him about medicine, so he has lots of OTC meds like hydrocortisone, where the base petroleum jelly has more treatment value than the impotent steroid. He gets hot packs; comfortable, but will not change your core temp any more than it will change the temp of a 5 gal pail of water if you drop it in. He gets uncovered surgical tools ’cause they looked cool on Blackhawk Down, are as clean as the open sewer swamp he just set the bag down in, and sticks them in a nylon bag that he just contaminated with his first patients’ blood when he puts them back.
As he gets on in his training he learns to only carry items he needs. They must be multifunctional items. He learns to make an eye shield from stuff he already has, not a pre fab whiz bang one, etc. He learns how to make do with what he has as he discovers all the training on the CAT-T that every soldier carries (so he only needs 2) won’t help him when faced with 50 blast injured Iraqi policemen or Boston Marathon runners that don’t have them. He learns to improvise. He knows to cut the end off a SAM splint instead of carrying finger splints. A SAM splint becomes his extraction collar. You get the idea. Make the most with that you have.
The intellectually lazy want a set kit someone with great credentials “the Army” “SF” or “The Marines” put together for them.
Arguing about exact contents is a futile endeavor as it’s all based on a study of “what if?”
As environments and missions change so should your kit. The kit you take to war won’t be ideal for a camp trip by the river with your family.
As with any kit it starts with a medical assessment. In no particular order:
1. How many are in the group and what level of training do they have?
2. Budget and weight (if you don’t have SOCOM’s Budget and supply chain, your priorities may be different)
3. What are the top medical threats? Weather, terrain, wildlife, 2 legged varmints? For travel to new areas do your research. Use local docs, trauma pattern studies based on your activity, missionaries, news reports, CDC, expats, etc…
4. Which of those threats are time sensitive and fixable with what you can carry in an individual kit? If it does not fit that criteria it belongs in a main aid bag or somewhere else. Basically, how can you mitigate risk within your available resources?
5. What are the intrinsic medical problems within the group or individual the kit is for? ie. allergic to bees, heart problems, diabetes, etc…
6. What are the distances/obstacles, time, and availability of the next layer of care? Main aid bag or hospital or aid station?
As an example, I will load my pockets with items when providing coverage for a large group, for example, narcotic pain meds and antibiotics when working a community in the developing world. When moving with a Battalion on planes I will pack motion sickness, and sleepers and anxiety meds to manage inflight issues when separated from the main pharmacy bag. As the doc it’s your job to anticipate issues and worst case scenarios and plan ahead.
The modular, layered medical kit
In blatant violation of the training and experience centered philosophy above, this is how I set up my medical equipment on deployment. Again, don’t mistake gear for brains. This is broken into trauma and medical modules.
Layer 1 – what you carry on you
Unless you are like a certain paramedic I knew a few years ago, you likely do not have an aid bag on your back 24/7. Layer one is learning how to use the clothing and gear you already carry as an aid bag. I’m not talking about dependence on fancy EDC (Every day carry) micro pocket gadgets either. It’s t-shirts, pocket knives, keys, pens, and stuff in the environment you reside in. It includes an awareness of resources in your environment such as tap water, bottled water, etc. You may even cache some supplies in work areas. It includes equipment you may have in your pack or BOB (bug out bag) like sleeping mats, sleeping bag, water purification items, a bush knife, cordage, tarp, and so on.
It also includes cross training those around you in these same skills. The medicine they know is more valuable to you personally than the medicine you know yourself.
This class takes about 6-10 hours to teach. I have taught it in the western US and in 4 countries. It is particularly suitable to the developing world/grid down/resource poor environments. We will try to cover a lot of the material in ongoing posts on this site.
Layer 2 – blow out bag
This is a small bag that can manage a single patient due to a gunshot wound or other penetrating trauma. It does not contain sunburn cream. It is a single focus kit for combat.
There are various configurations of an Individual First aid kit IFAK or Blow out kit. They are basically a kit for an individual to carry based on a threat assessment of the environment you are in.
I have one on my armor, I also have a small one as a leg bag in the event I am not in an armored environment. BTW I hate leg bags hanging up so it’s usually riding somewhere else.
- Kerlix wrap
- Combat gauze
- 3.5 in 14 gauge catheter
- Combat Application Tourniquet x2
- Scissors (on a lanyard)
- 3 inch silk tape (on a lanyard)
- Coban or Vet wrap
- HALO dressing (heck a sticky mouse trap works just fine here)
- Tylenol, Meloxicam* (NSAID), Gatifloxacin*, Ketamine*, Fentanyl pop* and patch*
- Other items as needed, based on medical needs assessment
Layer 3 – main trauma aid bag and sub kits
- 0.9% Normal Saline solution
- Hespan / Hextend
- IV start kits, with 3-way stopcock and 30cc syringe
- IO cath kit, (or the EZ IO drill)
- Sam splints
- Duct tape and plastic bags
- Airway kit
- Sedation kit
- Gel hand wash
- Gloves – Black nitrile gloves are Alpha-male tough, but their darkness makes it difficult to see things that may get on them. Get in the habit of rubbing fingers together to feel for blood or fluids.
- Extraction kit may include Ropes, chain, pry bars, Hi-Lift jack, shovel, fire suppression, cut off saw, blocks for cribbing,
- Sked stretcher – always make sure to pack lots of blankets / clothing between your patient and the Sked. You don’t want to create a burn patient from pulling someone around in one. If you think I’m kidding, have someone drag you on the ground for a minute in one while wearing a t-shirt and pants.
- Oregon spine splint – Fire and EMS guys, this is a KED, and it can be packed and used with the sked for extraction.
- Mass casualty bag, this is basically a big bag with 1 gallon ziplocks filled with blow out bags, one per casualty. When medics move forward they can resupply by taking a whole bag instead of individual items. It’s faster.
- Cold weather kit-
- NBC kit
Layer 4- ICU bag.
This bag in my kit is bright orange. The color is a reminder that if it’s a tactical environment it’s not to be used. Also I can say to anyone, “Go get the orange bag!” and it’s easily found in the sea of green ones.
The contents include a full assortment of high end airway stuff, portable vent, meds for a code and trauma, IV pump, chest tube, The details are not important as if you get to this level you need to pack it yourself. The load plan shifts a lot here and overlaps with the surgical sets in other kits.
Layered medicine bag
Layer 1: Portable bag
It’s hard to improvise medicines, especially since the number one killer in the woods is the bee sting. We need to be able to manage stuff like that, so here are some suggestions. Keep in mind we are still talking austere care and not definitive care with air conditioning, 378 channels of TV, and a nurse call button every time you have to poop.
Please also remember the Medical Assesment above, and specifically focus on #5, the intrinsic and known medical problems of those in your group.
I use a series of small aluminum sealed keychain fobs of different colors that contain medicines focused on a particular body system or emergency.
For example, my cardiac fob is red and contains a nitroglycerin patch, aspirin and/or Plavix, and metoprolol or other beta blockers . .
Anaphylaxis, (fits in a sharps shuttle) diphenhydramine, prednisone, albuterol MDI (on a seperate ring) EPI 1:1000 vial with a 1cc syringe (you can use the syringe multiple times on the same patient). Prednisone PO (by mouth) has rapid onset in under 10 minutes so I don’t carry IV or IM steroid anymore. It may need to be crushed and made liquid to swallow however. Zantac, Allegra.
Pain, tylenol, meloxicam, oxycodone, fent pop, fent patch,
GI, pepto bismol, immodium, Cipro, flagyl,
And etc. As many systems as you need. The keychain fobs force you to keep it small.
I have a knife that unscrews to open on a sealed kubotan handle that is filled with Hibiclense. The back side of the baton is a blunt trochar.
Small tweezers are also usually on the ring. You might add a magnifying glass if needed, or a small light.
That’s the small med kit. It can ride in small bag with other medical-related items or in a large pocket.
Large Med Bag
For bigger groups I use Ziplock pill bags in insulated soft boxes, think canvas with zippers with ensolite pad foam. You can make these yourself with your leftover pouches in your kit for cheap. Keep these out of the sun, and don’t let folks sit on them unless you want them to snort their medications. This bag is about the size of a suitcase with straps and treats very large groups.
Even though the following are not meds, the large med bag is where they lived: a stethoscope, ENT scope with tools and diagnostic bedside test cards. It just seemed to work out that way.
Derm, diflucan, tegaderm, high potency topical steroid, silver sulfadiazine, etc.
EENT, otoscope, ear loop, olive oil, silver nitrate stick, tetracane, flourecin, cortisporin ear drops, ear forceps. Also a small meconium trap with a small suction cath, mouth operated for clearing ears.
And so forth.
Basically what I did when setting up sections was go through the Tarriscon Pharmacopoeia by system and select a few important drugs from each section that I was setting up. Each section became a pouch with some smaller ones combined.
I also carried a Tarriscon pharmacopoeia, Sanford antibiotic guide, and a small netbook running old windows XP. On the laptop, I had:
Illiad 4.5 is a diagnostic program that takes data and give a list of differential diagnosis.
MAXX contains 26 medical specialty references and is searchable
5 Minunte Medical Consult was also an old good one.
All of the above are references from the late 90’s when software was on disk and did not require internet to function. This requires power but also can run digital ham programs and mapping software. It never goes online to prevent malware.
That should get you started.