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When was the last time you learned to stop a serious bleed? If you’re like most people, especially outside of the tactical enthusiast community, that answer is probably a deafening, “Never.” At some point, everyone has probably heard the basics such as direct pressure, and knows that bandages & tourniquets are things. However, there’s a significant difference between knowing that a thing exists and actually knowing how to use it in a real emergency.
A while back, I talked to Doc Larsen of One Shepherd about building a minimum capable skillset for prepared citizens. As we got into the conversation, the very first thing that he thought everyone should learn was first aid.
His reasoning was sound. We are all far more likely to have use first aid skills in an emergency than we are shooting skills. That might look like an accident in the kitchen, a car crash, natural disaster, or a camping trip gone wrong. None of those immediately require care under fire, but you still have the opportunity to save someone’s life.
More recently, I established the Everyday Marksman gear acquisition hierarchy. The point was establishing a general order of purchase for equipment. Along with that came several suggestions for training.
In that lowest level of the pyramid, I mentioned a basic first aid kit and training to go along with it. My suggestion was starting with a Stop the Bleed Course, offered all over the country. That course is enough to teach anyone the bare basics and point them in the right direction of equipment they should also keep on hand.
But, then what comes next? To me, the next obvious answer is diving into Tactical Combat Casualty Care (TCCC). Many training organizations around the country offer Combat Lifesaver courses to civilians as well as law enforcement and military.
As an additional suggestion, I also think it’s worthwhile to look into various Wilderness First Aid courses, as they have an emphasis on treatment when emergency medical care isn’t immediately available. You’ll find that this also informs different set of medical equipment beyond what’s in the typical “blowout kit.”
So What Goes in the First Aid Kit?
Let’s divide first aid for prepared civilians into two categories. The first is the most severe, and that includes traumatic injury like gunshots, impalement, massive hemorrhage, or other items we typically think of as “tactical first aid.” This is what most of us build our IFAKs around.
Since I’m not an expert here, I talked to my friend Justin of Swift Silent Deadly. He’s a former special operations member with a variety of skills, and currently spends time working as an emergency medical technician.
He boiled down the bare essentials to only a few items:
- Chest seals
- Hemostatic agent
- Compression bandage (optional, but good to have)
In his words, the general sequence of events looks something like this:
If it’s bleed on an extremity, then put a tourniquet on it. Bleeds from the body cavity, such as the chest or torso, get a “sticker” (aka chest seals), and junctional wounds like the armpit or hip get packed with hemostatic agent.
To this minimalist kit, I would also add a pair of nitrile gloves. This minimalist kit, not including the TQ, should fit in even the smallest first aid pouches.
If you have a bit more room, though, there are a few more items that are helpful to have:
- Trauma dressing (if not already in kit)
- Compressed gauze
- Triangle bandage
- Medical tape
- Nasopharyngeal airway (NPA) + lubricant
- Chest decompression needle
- Trauma shears
- Casualty card
There are, of course, more items you could pack away than this, but at some point we must find a balance between how much stuff we want to keep at the ready, and how much space it takes up on our gear. With the notable exception of the Minuteman Harness, I try to keep my emergency first aid kits to no more than two columns of MOLLE, which naturally limits the space and capacity. Even the flat IFAK of the Minuteman doesn’t hold a huge excess, though, as I need it to remain flat.
That gets me to the other first aid kit.
Don’t Forget the Booboo Kit
While talking, Justin mentioned that he had cut himself with a saw about 10 days before the conversation. He irrigated it the wound and sealed it up, but 10 day slater was starting to show signs of infection.
The emergency IFAK should not be the only first aid kit available on your gear. While getting shot or stabbed is certainly an emergency that needs dealing with right now, there are plenty of other things that can kill you just as dead, like infections from small wounds, if you aren’t prepared to deal with them.
For this reason, you should also carry a small secondary first aid kit with non-emergency supplies. Commonly called a “booboo kit,” this contains the typical household or outdoors first aid supplies you would expect.
- Antiseptic wipes
- Antibacterial ointment
- Assorted fabric badges
- Butterfly closures
- Gauze pads
- Additional medical tape
- Moleskin and other blister treatment
- Insect sting & bite kits
- Safety pins
- Antihistamines & anti-inflammatory
- Anti-diarrhea meds (remember, dehydration kills)
- Mylar survival blanket
- Hand warmer with lighter fluid
By the way, that last item comes as a suggestion from community member Jelle. He discusses something called the “triangle of death.” It’s sometimes known as the triad of trauma as well. In short, it’s a combination of hypothermia, acidosis, and coagulopathy stemming from too much blood loss. The basic sequence is loss of blood leads to hypothermia (lowered body temperature), which leads to acidity in the blood plasma, which leads to metabolic issues that prevent clotting.
Jelle mentioned that most medics will use the mylar survival blanket to help combat this, but it’s not enough by itself. If the body has lost enough blood, it cannot produce enough heat to warm the inside of the blanket. So enter the hand warmer to help supplement the heat.
Carry First Aid Supplies
In military units, where SOPs and issued gear rule the day, the perfect pouch isn’t really a question. You use what you’re given and put it where you’re told. On the outside, though, we’ve got a lot of options. Over the last several months, with your support through ko-fi and affiliate links, I’ve been able to test many IFAK pouch designs to figure out what works best for me.
Along the way, I’ve learned about a few preferences. First, I much prefer pouches that have some kind of module that comes out or tears away. This goes hand in hand with keeping the kit accessible to either arm. If you have a pouch attached to one side of your gear and have to fish around in it with the opposite arm, it’s a pain in the butt. It’s so much easier to remove the module and work with it right in front of you.
Second, I don’t want my pouches to be very bulky. Typically that means I only want them taking up no more than two columns of MOLLE, shouldn’t be more than a magazine tall, and no more than three magazines deep.
Lastly, I want my IFAK to be obvious. Based on the second point, it’s easy to use an existing magazine pouch as an IFAK. In fact, that’s a great idea and there are many medical modules that fit into double and triple mag pouches. With that, I want some kind of obvious marking for others to know what’s in that pouch.
So what are my favorite IFAK pouches?
ATS Tactical Slimline Micro
I now have two of the ATS Slimline Micro kits. One on my primary battle belt, and the other on my “General Purpose Patrol” harness. It’s a two-part system with an outer zippered pouch and an inner folding module. When you need to access the contents, you zip open the pouch and yank out the inner module by an easy grab handle.
The module holds everything I need as well as a few extras. As a bonus, I also discovered that it fits well inside a Velocity Systems Jungle 5.56 magazine pouch.
ATS Small Medical Pouch – Narrow
Also from ATS is their Small Medical Pouch Narrow. I have one of these, as well as the older (and larger) small medical pouch. The narrow model is sightly smaller by consuming only two columns of MOLLE, yet holds nearly as much stuff. I currently have it mounted to my Velocity Systems Jungle Harness. The larger “small” pouch is in the spare gear bin, but sometimes rides on my backpack for range trips.
This pouch is a clam shell design consisting of two parts. The first is the pouch itself, the second is the base. The base attaches to the MOLLE surface, while the pouch attaches to the base via a combination of hook and loop and a fastex buckle. When you need to access it, you undo the buckle and rip the pouch away via the attached handle.
SO Tech Viper Flat IFAK Mini
This pouch breaks the mold by violating my earlier preferences. I have both the Mini as well as the full-sized Viper A1. The Mini consumes three columns of MOLLE while the A1 uses four. The mini holds less, but it holds everything I need plus a few extras. I would rather save the space on my gear, honestly.
The reason I like this pouch is that it makes a great option for putting the IFAK out of the way. For most of my gear, I put the IFAK on my right side at about 3 to 4 o’clock. Since my “heavy” harnesses all have buttpacks or similar pouches on the rear, that made the most sense.
On my light belt and minuteman harness, I have no such constraint. The Viper IFAK sits right on the small of the back and is accessible with either hand. It’s also a two-part system, with an outer sleeve and an inner holder that holds the contents. Removing the contents consists of reaching to either side of the pouch and finding the large grab handle on either side. Yank it firmly to release from the hook and loop, and the contents slips out of the sleeve and is ready for use.
The main downside to this position is that it’s not obvious to anyone who might have to treat you. If you’re a casualty and laying on your back, there really isn’t any good indicator that you’re laying on top of your IFAK.
Booboo kits don’t need to be as accessible, so I suggest keeping them packaged in a freezer bag and stuffed in a separate pocket, pouch or backpack. You want to keep them protected from the elements, but not inconvenient to get to during a pause.
Also, let’s touch on tourniquets. You should have at least one, but preferably two. I like to carry a primary TQ in a protective pouch that keeps it out of the elements. That doesn’t just mean dirt and mud, but also sunlight. Over time, UV rays will weaken the materials. My preference here is the T3 Gear TQ pouch, as it fully encloses the TQ like a burrito.
For secondary TQ’s, I’m perfectly fine with more field expedient methods like rubber bands or elastic loops. You might have noticed that in at least one of my kits, I have a SWAT-T TQ.
This is really a glorified large rubber band, and it’s not deemed as effective as a classic windlass style model. However, it works in a pinch, and also doubles for adding compression. As an EDC item, it’s small and light. Should you come across a dire emergency, the SWAT-T is easier to use on children than an adult-sized CAT.
In this post, we’ve discussed some baseline medical training that all prepared citizens should seek out. I covered the minimum, and not-so-minimum contents of an IFAK, and my three favorite pouches for carrying emergency supplies.
To wrap this up, I just want to remind you that having the “best” gear doesn’t mean anything if you don’t know how to use it. On the scale of bad things that might happen to you, a loved one, or just some random person around you, the opportunity to save someone’s life with good medical intervention is far more likely than shooting someone with your rifle. So with that, I think that learning and practicing medical skills is more important than small unit tactics or other fancy shooting techniques.
Thanks for another informative, though-provoking post, Matt. Two things I’d consider adding are a tick key (if you live in an area where ticks are a problem) and an instant cold pack. Granted, neither is a life-saving tool, but I’ve been happy to have them when I’ve needed them.
Thanks for commenting! A tick removal tool is definitely a plus. I was kinda counting it under the insect/sting kit. Living in VA, ticks are something I hate having to deal with.
Great article! Med training is overlooked far too often. Luckily my family and I live 30 minutes away from Mike Glover’s Fieldcraft Survival. We’ve taken multiple classes there including Stop the Bleed.
I spent over four years as a medic with 34 months as a line medic, so I always love to see people thinking about medical. I taught a lot of CLS classes and helped train the IA medics. I miss teaching those courses, it was fun. In my experience I would say, if you’re on a budget, compressed or roller gauze is a better buy than hemostatic gauze. I’ve packed a handful of inguinal and axillary bleeds and found that the pressure is the more important factor when stopping a bleed. Hemostatic agents are nice but not absolutely necessary. I… Read more »
NICE Matt……pics to point! I need to upgrade my IFAK NOW!
Have carried a sling ‘med bag’ on range/hunting/camping trips for years – used aspirin, Neosporin and an Israeli bandage most often – keep fresh and trained – never know……keep multitool clean and close.