I was forwarded a great article in the Coast Guard’s On Scene Magazine a few weeks ago by a friend, which went into drowning and the Instinctive Drowning Response. With Summer in full effect, I thought it appropriate to share with everyone here on ITS.

While we’ll look at the signs of drowning below, it’s important to note that it’s not like the movies where people are screaming for help and violently splashing the water. It’s often an undramatic event that doesn’t resemble drowning at all.

My only encounters with drowning victims were during pool evolutions at BUD/s. These examples aren’t really what you’d often see in a public setting, as these were men who were “red lining” (the instructor’s terminology for someone passing out underwater) rather than giving on the evolution. Their signs were motionless and void of any struggling or screaming. They just simply passed out.

Being a Lifeguard for my son’s Boy Scout Troop, I’m always staying up to date on my Lifeguard Certifications and CPR/First Aid through the Red Cross, but I’ve never been exposed to anything on the Instinctive Drowning Response and the specific signs associated with it.

Instinctive Drowning Response

Dr. Francesco A. Pia coined the Instinctive Drowning Response, which ” represents a person’s attempts to avoid the actual or perceived suffocation in the water. The suffocation in water triggers a constellation of autonomic nervous system responses that result in external, unlearned, instinctive drowning movements that are easily recognizable by trained rescue crews.

This is not to say that a person in the water that is shouting and waving is fine and doesn’t need assistance. They are in what is known as aquatic distress. They are not drowning, but realize they are in trouble and still have the mental capacity (and lung capacity) to call for help.”

Characteristics of the Instinctive Drowning Response

1. Drowning people are physiologically unable to call out for help, except in rare circumstances. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.
2. Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
3. Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
4. Drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
5. People’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

(Source: Coast Guard On Scene Magazine)

What this all comes down to is staying vigilant while you’re out on the water, or even relaxing by the pool in the backyard. Learn to recognize the characteristics of the Instinctive Drowning Response so you can react quickly in an emergency.

We were recently sent a testimonial on the usage of our EDC Trauma Kit by a first responder to an accident, where a man jumped from a moving car on a Tulsa, OK expressway and was struck by two vehicles. Below is the write-up that he sent us, which is a not only a great recap of the incident, but also an honest evaluation of our kit with some lessons learned.

Recently I had placed an order for the ITS Tactical EDC Trauma Kit and got my “Box of Awesome” in the normal quick fashion. I wanted to be able to basically carry a blowout kit, but didn’t want to be the guy in the office that people whispered about. Having returned home from Afghanistan late last February, I’d gotten very used to having one readily available at all times.

Understanding that I now manage a retail store, there was the hesitation of having to explain it to someone. A full size blowout kit was a bit big to be carried in my work pants back pocket. I already have a decent EDC setup, but I really wanted to be able to carry some type of blowout kit, so I decided to give the ITS EDC Trauma Kit a shot.

ITS EDC Trauma Kit

The first few days it was bulky and uncomfortable, but no one noticed it, or at least no one said anything about it if they did. After about a week, my wife stopped giving me that look and I started popping it into my back pocket every morning. I felt better knowing I was discreetly soothing that little itch I get when the unprepared monster creeps in. The kit did smooth out and I can now put it in my pocket rather easily without issue. In fact, the coyote pouch actually looks like a wallet when it does pop up, so people have yet to say anything to me about it.

After work, two days a week I go to class until ten at night, after which I drag myself home and start over again. With the recent addition of another child to the family, sleep has been a commodity that would be easier to find than hot water in Afghanistan. Wash, rinse and repeat, the schedule goes with the occasional skydive to break the monotony when my wife thinks my eyes are just a bit glazed over. This has been my life while trying to finish my degree in between deployments.

Last week on my way home from class it looked like it was going to be just another tedious drive home to start the cycle over again. On my way home I noticed a vehicle at a strange angle on my way home. As lights flashed by from on coming vehicles, I could see a body in the middle of the highway. It had to be a body, I thought to myself, there’s nothing like the outline of a body of the ground. If you’ve ever been deployed or work in a line of work where you see that sort of thing, you know the feeling. I have a hard time explaining that to people who have never seen that sort of thing, but it’s just a shape you’d know.

I slammed on my breaks and ran around to the back of my jeep where I keep a limited med kit. Having an addiction to adrenalin as my wife loving calls it and the father of a 5-year-old, you just learn to keep that stuff around. I grabbed the bag and ran back to the shape I was praying wasn’t a body. After all, better to be the crazy vet guy than have to try and deal with the worst day of someone else’s life. Sad to say it was the later of the two options and the guy was in pretty bad shape.

Just like in most traumatic incidents, there were a few people milling around taking pictures and one guy a little closer, but not touching the guy bleeding out in the middle of the highway. It seems like that’s just the way the human tribe works, some people respond and others just don’t think of it.  It’s not that they don’t want to help and if you tell them to do something they will, but otherwise they’ll just watch. The actions I took, seemed like they just happened, it’s not that I thought of what to do, I just did it. I guess that saying about not rising to the occasion, but sinking to your lowest level of training is true.

When you get down on the ground with a person that’s bleeding heavily, you’re going to get dirty and that’s just a fact. The backup blowout kits we carried in our calf pocket in Afghanistan didn’t have gloves and the thought behind it was that they were for a last ditch effort or in the case something caught you so off guard, you didn’t have your kit on.  Turns out when I tore my kit open, I tossed those to the side somewhere and just got to work without thinking about it. The guy on the ground had severe head trauma and his most of his face was gone. His trachea was off to one side and his ankle was barely connected.

With a bit of yelling and stimulus, the guy on the ground moaned and gurgled which meant it’s time to get dirty. He was rapidly bleeding out from his head injuries with a compound fracture (mostly amputation) and no doubt internal bleeding since he was choking on blood. I grabbed the guy that was close enough, but not touching him and asked if he knew what happened. He said something about a motorcycle, but the important part was that he got close enough for me to ask him to maintain the victims airway so I could work. My kit was rather thin but then I remembered I had my EDC kit in my pocket and that compound fracture needed a tourniquet. To be honest, it was mostly an amputation but there was a bit of skin holding it all together.

I pulled out my EDC kit from my back pocket and tore it open looking for the tourniquet.  Well imagine my surprise when I pulled out something that didn’t look anything like what I was used to. You see, tourniquets have things you turn to make them tight. It’s kind of a rule and even when you pull one out of your fourth point of contact on an objective, you have to have a stick or something to twist until the blood stops squirting. It’s just something standard that comes with tourniquets, but this SWAT-T tourniquet didn’t even have a buckle.

To be honest, once I got it open I didn’t even take the time to read the illustration on how to turn shapes into other shapes, etc. I pulled that thing tight and just started wrapping till I couldn’t pull anymore. With the pressure from the wrapping holding it in place, it stayed tucked and I went back to check his airway and to try and get the people around to do other things that could actually help.  When I went back to check the bleeding on what was left of his lower leg it had stopped and I couldn’t find a pulse below the tourniquet. So score one for innovations, because otherwise I’m sure my improvisation would have resulted in jokes flying around for years.

To make a long story short we stopped the bleeding with the tourniquet successfully and managed to keep him breathing till emergency crews arrived.  The ending, as many of you know, isn’t always nice and in this case the gentleman only had a few hours left. The important thing to me was that I did the best I could to give him a chance. If I hadn’t had my EDC Kit on me, I have no doubt the process may not have even given him that. So if you ever have a doubt that you need to carry something on you for blowouts I can tell you that you do.

The kit paid for itself that night and looking back I have some training scars, like not putting gloves on and having no idea what the actual tourniquet looked like. I know what I need to work on now and to be honest if that was the worst thing I did wrong, I’ll take that. My kit worked and my training worked which is really what we all wonder sometimes when the heat kicks up. Bryan and ITS did a great job putting this kit together and I cannot endorse it enough!

Photo Credit: KTUL.com

We’ve now taken the proven design from our ETA Trauma Kits, along with feedback from our end users and created an inert version of our kits. The ETA Trauma Kit (INERT) was made with the sole purpose of providing a lower cost option of our kits to train with.

The components you’ll find in the inert kit are all the same items you’re used to seeing in our kits, with the exception of the Combat Gauze Inert Moulage Trainer. This blue packaged Combat Gauze is for simulated training only and not for medical use. It’s the same z-folded Combat Gauze in our ETA Trauma Kits, but it lacks the hemostatic agent necessary to stop real bleeding. The inert Combat Gauze also features a resealable closure, so you can repack it and train with it again.

With these Inert ETA Trauma Kits, there also may be expired components included. It’s important that this kit is not used to “refill” another of our ETA Trauma Kits, as this inert kit was designed with the sole purpose being used in a dedicated training environment. Along with the bright blue tell-tale pack of inert combat gauze, we’ve also stamped our insert card in blue with “INERT.” Again, this kit is for training ONLY!

The reason we’ve chosen to include an inert version of every component from our ETA Trauma Kits, is to ensure you’re training with the identical items you’ll be using in a real life situation. In the event you have to use an ETA Trauma Kit, you don’t want it being the first time you’ve ever had exposure to the components. Train like you fight.

Pick up an ETA Trauma Kit (INERT) in the ITS Tactical Store today!

I recently came across an article I’d downloaded from the Emergency Medical Journal online a few years back, entitled “Tourniquet Use in the Civilian Pre-Hospital Setting.”

My reasoning for bringing up this article is to turn it into a discussion and hear others opinions on the topic and hear from our medics out there. To summarize this EMJ article, which I’ve attached here (PDF), it’s focus goes into exploring the potential problems and mistrust of tourniquet use, why civilian pre-hospital tourniquet use may be necessary, define the indications for tourniquet use and provide practical information on tourniquet application and removal.

While I’d highly suggest you read the entire article yourself, I’ve highlighted some bullet points of the article below. All sources of the can be found within the original article.

Problems with Tourniquet Use

• The majority of external hemorrhage can be controlled by direct pressure.
• Previously tourniquets have been used inappropriately when not clinically indicated (for example, for all gunshot wounds of the limbs.)
• Preventing arterial blood flow to a limb with result in ischaemia (restriction in blood supply). Continuous application for longer than 2 hours can result in permanent nerve injury, muscle injury. Muscle damage is nearly complete by 6 hours, with likely required amputation. The general conclusion is that a tourniquet can be left in place for 2 hours with little risk of permanent ischaemic injury.
• An incorrectly applied tourniquet will actually cause increased bleeding from distal soft tissue injuries and damaged arteries if there is occlusion of the lower pressure venous outflow, but inadequate occlusion of arterial blood flow.
• A policy of periodic loosening of a tourniquet in an attempt to reduce limb ischaemia has often led to incremental exsanguination (bleeding out) and death.
• A properly applied tourniquet is painful and this has experientially led to inadequate tightening or inappropriate pre-hospital removal. The patient will require strong analgesia (pain killers) after stabilization of vital signs.

Reasons to Tourniquet in Civilian Practice

• Penetrating trauma from firearms and stabbings.
• Police Officers working in tactical environments who may benefit from a self-applied tourniquet for “care under fire.”
• Terrorist incidents with penetrating and/or blast injury to limbs.
• Rural incidents or wilderness medicine where there are limited resources and delayed, often unconventional, transport to definitive care.
• Industrial accidents. From personal communication there are a number of examples of tourniquet use to prevent hemorrhage from limbs following entrapment or shredding by industrial or farming machinery.

Indications for Use

• Extreme life-threatening limb hemorrhage, or limp amputation/mangled limb with multiple bleeding points, to allow immediate management of airway and breathing problems.
• Life threatening limb hemorrhage not controlled by simple methods.
• Point of significant hemorrhage from a limb is not peripherally accessible due to entrapment (unable to provide direct pressure.)
• Major incident or multiple casualties with extremity hemorrhage and lack of resources to maintain simple methods of hemorrhage control.

Principles of Tourniquet Application

• Be familiar with a tourniquet that has been proven in studies to be effective, rather than using an improvised device.
• Tourniquet must completely and consistently occlude arterial blood flow (both in legs and arms.)
• There is an inverse relationship between tourniquet width and the minimal pressure required to occlude blood flow. As width increases, the amount of tissue that must be compressed increases, requiring an increased effort to produce tension.
• As the width increases, the strap tends to bow, transmitting more pressure to the center rather than the edges and therefore reducing functional width.
• If the tourniquet is ineffective it should be tightened or repositioned. If still ineffective (unlikely) the health care provider my consider a second tourniquet placed proximal to the first.
• The time of application should be recorded and handed over to the receiving emergency department staff.

Notes

Again these are just highlights from the article, read through it yourself and let us all know in the comments what you think about tourniquet use in the civilian pre-hospital setting.

We’re excited to release our Every Day Carry Trauma Kit today and feel it’s truly something you’ll never leave home without. No longer will you have the excuse of not being able to carry lifesaving equipment with you wherever you go!

We wanted to design a minimum bare-bones trauma kit, smaller than our ETA Trauma Kits, that would not only be comfortable enough to throw in a back pocket, but also be capable of treating the number one preventable cause of death in the field according to the TCCC; extremity hemorrhage AKA bleeding out.

The EDC Trauma Kit is literally the size of an average wallet and even smaller in some instances, especially if you carry a Costanza. It can be stuffed in a back pocket and only weights 6 ounces with the included pouch!

EDC Trauma Kit

The EDC Trauma Kit contains (1) Combat Gauze LE, (1) SWAT-T Tourniquet / Pressure Bandage, (1) Pair of OD Nitrile Gloves and your choice of a Coyote Brown or Black EDC Trauma Kit Pouch. The kit is also vacuum sealed and completely latex-free. Our EDC Trauma Kit Pouch is nothing more than a lightweight slip cover to protect your EDC Kit against damage and puncturing the vacuum seal while being carried in your pocket or bag.

Included with every EDC Trauma Kit is our insert card which lists the contents on the front and includes the directions for using the SWAT-T on the reverse. These directions come directly from the manufacturer and are also printed on the bag that we’ve left on each SWAT-T we seal in a kit. We’ve also taken the time to cut a large slit on the bottom of each wrapped SWAT-T we use so that it’s easier to open when seconds count!

Please keep in mind that while the SWAT-T is described as a Tourniquet and Pressure Bandage, we’ve found its use better for a pressure dressing to wrap over a packed wound then for a dedicated tourniquet. Can it be used as a field expedient TQ? Absolutely, but if you have the option to carry a dedicated tourniquet like the SOFTT-W, we highly recommend it. The purpose of this kit is every day carry and the components in the EDC Trauma Kit are certainly suited for that.

Click here to purchase your EDC Trauma Kit!

Manufacturing

The pouches for our EDC Trauma Kits are sewn in Chicago by Zulu Nylon Gear, making them completely made in the USA. The EDC Trauma Kits are hand assembled by ITS Tactical in Fort Worth, TX using nearly all made in the USA components.

The Combat Gauze, SWAT-T, glove wraps, vacuum seal bags and insert cards are all made in the USA. The gloves are the only component made overseas, which we’re working to change.

Pick up your EDC Trauma Kit today and don’t let the excuse of not having the room to carry life-saving equipment ever happen again!

We’ve been eagerly awaiting the return of the Mojo Medical Shears to the ITS Store and we’re excited to announce some new changes.

Combat Medical Systems has retooled the Mojo Medical Shears and removed a few of the previous dummy cord attachment points in the handles and colored them coyote brown.

They’re now also made in Germany, a trade compliant country, rather than the prior manufacturer in Pakistan. If you know medical instruments, you’ll know that many high-quality surgical-grade tools come from Germany.

Mojo Medical Shears

As the previous version, they’re still made in stainless steel and retain the features that put them above all the other cheap shears on the market. I’ve linked to the video below where we demonstrate the way that other shears can bind up while cutting. The industry standard seems to be to think of shears as disposable, but investing in a good pair of shears is definitely worth it in our opinion.

We also have the Mojo Retractors back in stock as well, these make a great companion to the shears or to just about any sensitive equipment you want to lanyard in.

Click here to purchase your Mojo Medical Shears or Mojo Retractors today!