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!

We’ve been working for some time on developing a secondary way to seal our popular ETA Trauma Kits that will allow them to fit in most double M4 magazine pouches and we’re stoked to show you what we’ve come up with!

While our standard size kits aren’t going away, starting soon you’ll be able to choose if you want a “slim fit” version or a regular version of either our Basic, Standard or MIL/LE ETA Trauma Kits.

This new “slim fit” version of our kits doesn’t sacrifice any of the lifesaving components you’re used to, it’s simply another option for those that need it.

ETA Trauma Kit (Slim Fit)

More details will follow on these kits and they’ll be available soon in the ITS Tactical Store with the same price point as our existing ETA Trauma Kits. For now, here’s some photos to check out.

These photos show the new “slim fit” kits in the Zulu Nylon Gear M4 Double pouch.

Don’t forget to check out the sneak peek of our new EDC Trauma Kit releasing soon too!

We’ve had our new EDC Trauma Kit in development for quite awhile now and we thought it was time to unveil what we’ve been working on.

The EDC Trauma Kit is a vacuum sealed trauma kit with the essentials to stop life threatening injuries. We wanted to develop a smaller version of our ETA Trauma Kits that would still contain the essentials, yet fit just about anywhere.

It’s literally the size of a wallet, can be stuffed in a back pocket and only weights 5 ounces! 

EDC Trauma Kit

The EDC Trauma Kit contains (1) Combat Gauze LE, (1) SWAT-T Tourniquet / Pressure Bandage and (1) Pair of OD Nitrile Gloves. The kit is also vacuum sealed and completely latex-free. Another added benefit of the EDC Trauma Kit is that it’s able to be carried on a plane without any trouble from TSA.

More details to follow on these kits and they’ll be available soon in the ITS Tactical Store. For now here’s some photos to check out.

Eric’s been out at the SOMA Convention (Special Operations Medical Association) this past weekend checking out the show and grabbed some photos of the new Combat Gauze XL by Combat Medical Systems.

Developed with feedback from the field, where medics were having to use more than one package of Combat Gauze in certain situations and wanted a larger version. The new XL contains 4″ x 4 yds. of Z-Folded Combat Gauze w/ x-ray detectable strip. The standard MIL/LE (green package) of Combat Gauze contains 3″ x 4 yds of Z-Folded Combat Gauze w/ x-ray detectable strip.

Despite the increased width of the XL, the vacuum sealed package is the same overall size as the standard MIL/LE package.

Combat Gauze XL

No word yet if Z-Medica will be producing an XL version of their Combat Gauze LE (for Law Enforcement and trained medical professionals). Something we commonly get asked about with our ETA Trauma Kits is what the difference is between the MIL/LE only version and the Standard version.

As the green package of Combat Gauze is to only be sold to Military and Law Enforcement per Combat Medical Systems requirement, we have to state that the MIL/LE ETA Kit is to be sold to Military and Law Enforcement only. The Standard ETA Kit is exactly the same as the MIL/LE kit, but utilizes the black package of Combat Gauze LE that can be sold to Law Enforcement AND trained medical professionals.

Combat Gauze LE is still Z-Folded, the only difference between the two is that there’s no X-Ray Detectable Strip in the Combat Gauze LE.

We just received an email this morning about our ETA Trauma Kits being used out in the field to save a life. Here’s the account of the incident from the first responder. As he states, certain details have been left off, including his name and location.

I’d like to apologize first for the lack of proper medical terminology as I’m only trained minimally and anything beyond that is self taught. Due to OPSEC I have to be brief on my story, sorry.

None the less, we were under fire, seconds felt like minutes and minutes felt like hours. Making use of rubble as cover during a rain of fire, I noticed my buddy next to me hit the ground, getting hit with what looked like two ricochet rounds. Making sure all the targets were neutralized and covered, I then rushed to my buddy to assess his injuries.

He was bleeding from two areas, the first area was where he was holding his left side of his abdominal, which was a quarter sized hole about three inches above his pelvis. His second wound was to his left leg. Falling back on my training, I was taught that 90% of leg wounds need of a Tourniquet. At that point I made the decision to address his leg wound first, as it was bleeding a lot faster than his abdominal wound. Due to the location on his leg where he was hit, I was worried it might have been a major artery.

I grabbed my “blow out bag” which had one of your ETA Trauma Kits in it, as well as a SOF Tactical Tourniquet. I quickly put on the tourniquet to help stop the bleeding as much as possible. I then cut open his BDU’s and the blood came rushing out, in my mind I was saying “OH F**K” but the words that came out my mouth to my buddy were “Piece of cake buddy… your gonna be ok… stay with me.”

I ripped open the ETA Trauma Kit, grabbed the QuikClot Combat Gauze and packed it into his wound. Once I was done with that, I grabbed the Z-Pak Dressing and placed it on the top to make a seal; ensuring the QuikClot stayed in the wound. I then wrapped his leg with the Israeli Bandage to finish treating it, before moving on to his second wound.

As I was treating his leg, I was telling him to keep pressure on his other wound to his abdominal area. Maybe I should of put some gauze on it, but at the time I was worried about his leg and had to make a quick decision; I couldn’t waste time.

His abominable wound was a clean through shot and by the time I started to treat it the bleeding had pretty much stopped. I grabbed another ETA Trauma Kit out of my buddy’s backpack, placed some gauze on the exit wound and a HALO Seal over it. I then put some gauze and the other HALO over the entry wound. He was stable enough for our 75 mile ride to the nearest medical facility in our given area.

We made it to the medical facility where he was treated by higher echelon care and survived his wounds. Because of your ETA Trauma Kits I had what I needed to help my buddy survive. Even someone not as highly trained as myself was able to save a life! Your kits had everything and more that I needed for that particular scenario.

Thanks a lot guys, I didn’t personally buy your kits but I had the chance to use them in the field. I did just pick up your ETA Trauma Kit Pouch though, as we always need a good quickly accessible pouch.

I hope this info was helpful and I’ll be buying more from your company in the future!

Thanks,
***Name Withheld***

The suspense that’s been killing some of you is finally lifted! We’re stoked today to announce our ETA Trauma Kit Pouch made exclusively for us by Zulu Nylon Gear!

The ITS Tactical ETA Trauma Kit Pouch was born out of the necessity in developing both a pouch that could hold our Vacuum Sealed ETA Trauma Kit, as well as the individual components of the kit if the end user needs to break the seal, or wants faster access to certain items.

We worked with Zulu Nylon Gear for nearly a year to design what we feel is one of the best medical pouches on the market today. With a simple pull on the red handle, the pouch quickly filets open to provide immediate access to your medical components without delay.

ETA Trauma Kit Pouch

The main rear-most pocket of the ETA Trauma Kit Pouch provides space large enough to fit our Vacuum Sealed ETA Trauma Kit or a complement of other medical items. The two rear wing pockets are large enough to store Decompression Needles and NPAs or other Airway devices. The main flap panel design comes from our ITS Med Insert that’s included with our Discreet Messenger Bags and allows you to custom configure the shock cord loops to hold whatever you need it to.

In the video shown below, we’ll show you exactly how we configure the individual components from out ETA Kits and show you the kit in action!

The ETA Trauma Kit Pouch can also be expediently secured by simply pulling back up on the red handle and affixing the velcro when you have to quickly move out. Trauma shears can be tucked behind the PALS/MOLLE mounting at the rear of the pouch or attached to the single channel of PALS/MOLLE that run on either side of the exterior of the wings. This channel can also be used to secure a tourniquet, tourniquet pouch, or rescue hook pouches.

Something that we wanted when we designed this pouch was for all the items prone to wear to be user replaceable in the field. Rather than use elastic webbing, which is prone to stretching out, we used shock cord so that if for some reason it becomes worn or stretched out it can simply be replaced and not have to be sent back in to get elastic webbing retention re-sewn.

We’re also not only using MALICE Clips from Tactical Tailor as a means to secure the pouch to PALS/MOLLE, but we include two of them with every pouch unlike some of the other gear you might have purchased. MALICE Clips are dependable and Tactical Tailor recently stated in a shop tour video that they’d only had 2-3 come back for warranty in the years they’ve been making them.

Everything in this pouch from the materials, craftsmanship, labor and MALICE Clips is 100% Made in the USA by Americans and Berry Amendment Compliant.

Features

• Lightweight 500d Cordura Construction with 420d Pack Cloth Interior
• Mil-Spec 550 Type III Paracord Zipper Pulls
• Color-Matched Velcro and Webbing, Including MultiCam Webbing and MultiCam Velcro
• All Edges Feature Binding Tape for Quality Construction
• Exterior Single Side Channels of PALS/MOLLE for Mounting Tourniquets, Tourniquet Pouches, Shear Pouches, or Rescue Hook Pouches
• 1″ Red Webbing Pull Handle Denoting Medical Supplies
• Reverse Zippers to Keep the Dirt and Grunge Out
• Exterior Loop Velcro Field for Medical, Blood Type or Unit Identifier Patches (2″ Tall x 4″ Wide)
• User Replaceable Shock Cord and ITW Nexus CordLoc
• Weight: 4.2 oz.
• Measurements: 7″ Tall x 5.25″ Wide x  2.5″ Deep
• Includes (2) Coyote Brown MALICE Clips for Mounting to PALS/MOLLE (3 Columns x 5 Channels PALS/MOLLE on Rear)
• Available in Coyote Brown and MultiCam with Color Matched Webbing and Velcro.
• Made in the USA (Berry Amendment Compliant)

Also check out the Haley Strategic Partners ETA Trauma Kit Pouch Sneak Peek Review and YouTube Video! Thanks for the great review guys!

Order your ETA Trauma Kit Pouch here TODAY!

To quote the late comedian Mitch Hedberg, “You know that Pepperidge Farm bread, that stuff is fancy. That stuff is wrapped twice. You open it, and it still ain’t open. That’s why I don’t buy it, I don’t need another step between me and toast.”

Well that’s exactly how an Israeli Bandage is wrapped. You may asking yourself why this is important, so allow me to elaborate and to also explain the new changes in the 4″ Israeli Bandages.

History

The Emergency Bandage, AKA Trauma Wound Dressing, AKA Hemorrhage Control Bandage, AKA Israeli Bandage, has quite a few names. It was invented by Bernard Bar-Natan, a Holocaust survivor, who immigrated to Israel in 1979 and was drafted into the military there in 1983. During his service he saw a need for a dressing that didn’t exist.

What he envisioned, was for medics like himself, to not have to create field expedient pressure dressings and for bandages to evolve like everything else in the military had been. With a loan from the government in the 90s, he turned his idea into a reality and The Emergency Bandage was born.

Bar-Natan’s company, First Care, introduced the bandages to the U.S. Military in 2000 at Ft. Sam Houston in San Antonio. It wasn’t much longer after that before elite units quickly adopted them for standard use. They were also know to have played a part in saving lives during the recent Tucson Tragedy in Arizona.

Israeli Bandage

While the technical name is The Emergency Bandage, it’s a bit of a misnomer, as the Israeli is really a pressure dressing. It combines a sterile dressing, elastic bandage and pressure applicator capable of exerting up to 30 lbs. of pressure on a wound. The closure bar, which secures the bandage at the end of wrapping, can also be used to exert additional pressure.

The Israeli is truly a multi-purpose bandage and can be used as a make-shift tourniquet, ACE Wrap, or even a sling to immobilize an appendage. It’s truly a versatile item to include in your trauma kit or first aid kit. It can also be self-applied, even one-handed.

Usage and Application

We’ve always thought highly of Israeli Bandages, which is why they’re included in every ETA Trauma Kit we make. The only downside to them is that they’re wrapped twice like that pesky Pepperidge Farm Bread!

Truthfully, this isn’t really a downside, as the double packaging ensures their sterility. Although, if you haven’t been trained on using an Israeli and opening it from the package, you can be setting yourself up for failure and wasting precious seconds in a life-threatening situation.

Hopefully you’ve all heard the phrase “seconds count,” this is no joke when you’re talking about stopping a severe hemorrhage and having to open a pressure dressing like the Israeli Bandage twice isn’t practical.

I’ll let the video explain the instructions for applying the bandage and just what the packaging looks like when they’re opened. We’ve also got step-by-step photos below.

Storage

We recommend storing them out of the outer vacuum sealed wrapper (still wrapped in the inner vacuum sealed wrapper).

The outer wrapper is clearly marked on the new Israelis with tear marks, but if you don’t know what you’re looking for on the interior wrapper you may waste precious time. With the added potential of having gloves on and slippery hands, this is no time to be wildly tearing at a plastic wrapper to get to the bandage.

The inner wrapper is clear and has a small pre-cut tear mark on the very top of the bandage, but both the top and bottom of the bandage’s long side look the same. You’ll have to pull on it slightly to loosen up the side with the slack (top) to find the pre-cut tear mark to open it.

Additions

Something new on the Israeli is the addition of a small tied string that runs throughout the bandage called the “Stop and Go Release.” One of the issues with the past version of the Israeli was that if you dropped them while wrapping, the bandage could potentially hit the dirt and lose it’s sterility. You certainly don’t want to be wrapping dirt into an open wound, that’s just asking for an infection.

We’ve also noticed that the entire Israeli is now vacuum packed even smaller in the 4″ size. They’re also available in a 6″ size if desired.

Another thing to note is that you should save the packaging from the dressing. A large piece of plastic can be used as a make-shift occlusive dressing to treat a pneumothorax aka sucking chest wound. For more on this, check out our article on Developing a Blow Out Kit.

Hopefully this article has given you a glimpse of how effective and versatile the Israeli Bandages can be. It’s definitely a must to have in your kits and keep in your vehicle and the office. They’re available here on Amazon and at many medical distributors as well.

Have you ever heard of mountain sickness? Altitude illness is very real, and effects even those who live at altitude. Mountain sickness is a direct result of lower barometric pressure and concentration of oxygen in the air. The lower pressure makes air less dense so your body gets fewer oxygen molecules with each breath.

It’s pretty rare to feel the effects of altitude below 6000 ft. Living, working, training or vacationing at altitude doesn’t happen overnight. It takes a period of time to become accustomed to it. If you’re used to sea level, chances are you’ll even feel the effects of altitude if you decide to fly in to the “Mile High” city for a Broncos football game.

Altitude Defined

So what’s considered high altitude? For the purposes of this article, we’ll use the following commonly accepted elevations.

Moderate Altitude

8,000ft to 12,000ft

High Altitude

12,000ft to 18,000ft

Extreme Altitude

over 18,000ft

The Golden Rules of Altitude Illness

These general rules, taken from A Comprehensive Guide to Wilderness & Travel Medicine by Eric A. Weiss, MD, can help you to stay safe in the mountains.

1. Above 8,000ft, headache, nausea, shortness of breath, and vomiting should be considered to be altitude illness until proven otherwise.
2. No one with mild symptoms of altitude illness should ascend any higher until symptoms have resolved.
3. Anyone with worsening symptoms or severe symptoms of altitude illness should descend immediately to a lower altitude.

Mild Altitude Illness

Acute mountain sickness (AMS) is common for travelers that quickly ascend above 7,000ft. Typical symptoms include headaches, difficulty sleeping, nausea, and perhaps a loss of appetite. Swelling in the face and hands may be an early sign. Children are more susceptible than adults. Sleep becomes fitful and you may awaken frequently.

You may experience an irregular pattern of breathing while sleeping — periods of rapid breathing alternating with periods of no breathing (apnea). The typical treatment is to avoid going any higher in altitude until symptoms have completely resolved, usually a day or two. Symptoms will resolve more rapidly by descending a few thousand feet.

Severe Altitude Illness

High altitude cerebral edema (HACE), will develop if you continue to ascend after experiencing AMS. Your headache may worsen and not respond to typical treatment with Tylenol or Motrin. You may start to vomit, develop a loss of coordination, become confused, experience hallucinations, stupor or coma. You may also experience a seizure or develop transient blindness, partial paralysis or loss of sensation on one side of the body. Sounds like a great time doesn’t it? You must immediately descend at least 3,000ft. Waiting could prove fatal.

High Altitude Pulmonary Edema (HAPE) usually begins within the first two to four days of ascent, most commonly during the second night. You may have marked breathlessness even during minor exertion, and develop a dry, hacking cough. As the fluid collects in your lungs you will develop increasing shortness of breath, even while you rest. Your cough may produce frothy sputum. You may start to develop a bluish color of lips and nails. Immediately descend at least 3000 ft and administer oxygen if available.

Medications

The best treatment is always to descend to a lower elevation, but some medications might help treat the symptoms of mild altitude illness. 100mg of Ginkgo Biloba may be taken twice a day starting two to three days before you reach altitude and continued while you are there. It will not help with HAPE or HACE (see below).

Tylenol or Motrin can help with the headaches. Acetazolamide (Diamox) and Dexamethasone (Decadron), Nifedipine (Procardia) are prescription medicines that may be used. A portable hyperbaric chamber may also be helpful in treating some cases.

Prevention and Mountain Safety

Prevention is possible by avoiding an abrupt ascent. You want to avoid ascents to altitudes above 10,000ft where you plan to spend the night. You should average no more than 1,000ft of elevation gain a day when above 10,000ft. Day trips to higher elevation with a return to lower altitude to sleep will aid in your acclimatization. Eating foods high in carbohydrates and low in fat and staying hydrated will help; avoid sleeping pills.

Loss of coordination and other symptoms of illness can progress quickly. Someone who could have walked down under their own power can easily require to be carried or evacuated by litter in just 12 hours. Never take a trip alone, even with cell phones and hand held radios. Always take a friend (or friends) and ensure that others know where you are going and when to expect you back. Rescues at altitude can become a tedious, difficult task depending on weather and location. Search and Rescue teams will have an easier time finding you if you prepare and plan ahead and someone knows what area you were heading to. Signaling devices and bright colors will also help identify you for daylight rescue; fires, chem. lights, strobes will help for a night time rescue.

Despite the dangers, the young and the old can have a great time at altitude. I climbed Pikes Peak with some friends a few months back and during my descent I saw several families climbing with their children. Many of the trails required no special equipment other then perhaps some gloves and a wind breaker. Temperatures will drop the higher you go, so even during the hot summer months you may experience chilly winds or hike through snow.

Symptoms and treatments listed in this article are by no means all inclusive. I am not a doctor. When in doubt, consult a physician. I’ve lived for two plus years at altitude and conducted several training classes for Medical Boot Camp, LLC at elevations over 9,000ft as well as mountain biking and hikes in the Colorado area including hiking up Pikes Peak.

If you are planning a trip, try to go with someone that has experience. Plan to give yourself some time to acclimatize, and don’t rush your ascent or you’ll have a terrible experience. I definitely recommend A Comprehensive Guide to Wilderness & Travel Medicine by Eric A. Weiss, MD. It is a handy pocket book, and easy to carry.

Don’t forget to take pictures wherever the altitude takes you. Bring your ITS Tactical challenge coin and show the ITS love! Post your photos on the ITS Facebook page, ITS Flickr Reader Photos Group or geocache some neat stuff like ITS stickers!

Editor’s Note: Cory is an Active Duty Sergeant First Class and has been a U.S. Army Medic for 19 years with multiple deployments overseas. Cory has over 13 years as an EMT-B and grew up hunting and fishing in the outdoors of North Dakota and enjoys outdoor sports as well as teaching wilderness and tactical medicine and First Responder courses for Medical Boot Camp, LLC. based out of Colorado Springs, CO. Cory is also a Plank Owner of ITS Tactical.

This past weekend I had awesome experience of attending the ITS Tactical hosted Lone Star Medics Medicine X Course, which as the name implies, means to get yourself and any injury out of harms way and off the “X”.

Remaining static on a line at your local range can build bad training scars in my humble opinion. Training like Lone Star Medics provides not only gets you moving, shooting, communicating and thinking, but also throws in a surprise element not found in many tactical training scenarios; unforeseen care under fire.

TCCC

Based largely on TCCC (Tactical Combat Casualty Care), Medicine X is solely focused on the first phase of treatment, Care Under Fire. This can be summed up in the short list below taken from the 2010 TCCC guidelines, but it’s so much more complex than it sounds when negotiating the stress of unknown scenarios and having to return fire.

1. Return fire and take cover.
2. Direct or expect casualty to remain engaged as a combatant if appropriate.
3. Direct casualty to move to cover and apply self-aid if able.
4. Try to keep the casualty from sustaining additional wounds.
5. Casualties should be extricated from burning vehicles or buildings and moved to places of relative safety. Do what is necessary to stop the burning process.
6. Airway management is generally best deferred until the Tactical Field Care phase.
7. Stop life-threatening external hemorrhage if tactically feasible:
   - Direct casualty to control hemorrhage by self-aid if able.
   - Use a CoTCCC-recommended tourniquet for hemorrhage that is anatomically amenable to tourniquet application.
   - Apply the tourniquet proximal to the bleeding site, over the uniform, tighten, and move the casualty to cover.

I’d urge everyone to familiarize yourself with TCCC if you haven’t yet. This military methodology for dealing with the treatment of life threatening injuries is becoming more widely adopted every day. Not just military wide, but Police Departments are starting to take these guidelines on board as well as evidenced by the recent Tuscon Tragedy. TCCC is also constantly evolving as tactical medicine should.

Self Aid = Self Sufficiency

Where I feel that TCCC is largely needed right now is with Police Departments. Something that has always struck a chord with me is how more often than not, departments are requiring their officers to rely solely on EMS to get treatment during a life threatening emergency, just as most civilians do. I’ve always know not to count on EMS to save my life and that of my loved ones in certain situations, especially during a national disaster or state of emergency when local resources will be otherwise occupied and stretched to capacity.

Let’s face it, that’s why ITS Tactical is here too, to provide a resource for learning skill-set information and practical applications that could one day save your life! It’s all about self-sufficiency. As Caleb Causey, the founder of Lone Star Medics, quoted in our Medicine X class, 9-12 minutes is the national average for EMS response time and you need 4 out of the 6 liters of your blood in your body to get to the OR not just the ER!

How long do you think it takes for a 2 Liter bottle full of blood to leave your body? Of course that depends on the injury, but suffice to say it will happen in a lot less than 9 minutes in any situation that deals with the first out of the three leading causes of death in the field; extremity hemorrhage, tension pneumothorax and airway obstruction! Considering that extremity hemorrhage is the number one killer, how do you keep that precious blood in your body?

Priority #1

Engage the threat. Going off of Care Under Fire, the first priority taught by Lone Star Medics is to return fire. This means not running right up to your injured buddy until the scene is safe and the threat is neutralized. Casualties are expensive! For every casualty it takes an average of 1 1/2 guys to take their guns out of the fight and render aid. If the most effective medicine in combat is superior firepower, how effective is it if you’re having to pull guns off the fight to render aid?

When dealing with casualties during a firefight first find out if they’re responsive by verbally calling out to them. If they are responsive and can hear you, direct them to continue to engage the threat, move to cover and render self-aid. If they’re unresponsive, you don’t just run out into the fight to pull them out. Remember how expensive casualties are? You don’t want to be the next one! Use your situational awareness and best judgement on when the right time is to get them. You don’t want to put yourself on the X any longer than you have to be.

Priority #2

Get the casualty off the “X” using drags or carries. The next critical step in Care Under Fire is to get your casualty somewhere where they can be further evaluated to address any life-threatening bleeding with a tourniquet if they haven’t already themselves using self-aid. As the TCCC guidelines mention, this is IF it’s tactically feasible. If the bullets are flying and you’re negotiating threats you definitely don’t have the time to try and treat a casualty. This may seem simple, but as I experienced first hand in our scenarios, it can be challenging to do the right thing under the stress of rounds flying.

The first thing we were taught is to approach the casualty from their feet if possible, so as to be visually recognized as a non-threat. We went over a slew of different drags and carries and the positives and negatives of each. We even got into using different commercially available products to aid in dragging and carrying, but remember, time is of the essence and attaching devices to your casualty is only going to cost you more time! You can argue this fact if you’d like, but I’d urge you to practice and find out what works for you. For me, even the thought of using these devices adds one more step to the equation, more time and one more piece of equipment that can fail.

That Hollywood method of hooking someone up to your Rigger’s Belt and dragging them as you move backwards while firing, is crap. Not only is it hard to even negotiate threats moving backwards like that, but guess where your barrel is pointed when you trip and fall? Yep, at your casualty. The Lone Star Medics mission statement is “To cause no further injury to my patient…” This method doesn’t really fall in line with that.

What I found worked the best when working alone on an unconscious casualty was a technique taught in class. It’s to sling your rifle, sit the casualty up, squat while facing the casualty’s back with your toes near their tailbone, lock your arms under their armpits and stand up. You then move backwards to safety. As a team of at least two, the best method for us was for one man to move the casualty using the aforementioned method while the other provided cover fire. If we weren’t taking fire it was for both to hook an arm under an armpit and pull, or to grab a shoulder strap from their rig and pull them.

Working with “Rescue Randy,” our 180+ lb. dummy wearing a flack jacket and LBE was challenging to say the least. I did however like how realistic his weight was, as it brought even more realism to the course. One last thing to mention here is that in any drag/carry method employed, the goal is to get your casualty up as high as possible. Think about that for a second and what muscle group you’re using when you’re bent over dragging something vs. standing up dragging something. There are some that think you need to keep a low profile, but as Caleb noted, you need to keep a FAST profile when you’re moving off the X! Use the larger muscle group to get the casualty to safety, i.e. your legs, not your back.

Priority # 3

Buy back seconds. We’ve all heard of the ABC’s, right? Airway, Breathing, Circulation. The first thing that Medicine X teaches is to put circulation first on your patient in a tactical environment, above airway and breathing. This is done through the use of a Tourniquet first and foremost if extremity hemorrhage is a factor. In a normal setting you’d start with a pressure dressing like an Israeli Bandage, but when time is of the essence you don’t have time to wait and see if a pressure dressing is going to be enough. The TCCC recommends a tourniquet is applied first and foremost in situations that would cause you to question a pressure dressing over a tourniquet.

Currently the TCCC recommends either the TacMed Solutions SOFTT or NARP CAT. There’s been a long debate over the merits of each and with the introduction of the SOFTT-W (wide) and removal of the set screw, I feel the SOFTT-W is superior in many ways. While I’ll leave this comparison for a future article, I will say that there’s positives and negatives of each, but I found the SOFTT-W to be faster and more user friendly when seconds count.

When placing a Tourniquet the important things to note are to put it up as high as possible on the extremity, never place it on a joint, keep the windlass inboard or towards the body and turn it until ALL BLEEDING STOPS. Not just the bright red blood! Also make sure nothing is in a pocket that lies underneath where you may be placing a tourniquet.

As far as removing a tourniquet, that’s hopefully something you won’t have to deal with as the person making that decision will be higher echelon care. Anything over 6 hours is going to require amputation and loosening a tourniquet can be dangerous as you have the potential to recirculate blood clots.

For bleeding that doesn’t warrant a tourniquet, or even as a backup to a tourniquet, a pressure dressing can be applied if time permits. None of the compact pressure dressings easily carried in a Blow Out Kit or IFAK are perfect, but the one I had the best success with in a training environment is the Israeli Dressing, this is also the dressing of choice in our ETA Kit designed by an 18D Corpsman. Again, I’ll save the comparison for a future article.

Practical Exercises and Scenarios

What’s truly remarkable about the experience at Lone Star Medics is how we not only went into classroom discussion with all the Care Under Fire procedures (without death by powerpoint), but actually had to put them into play while shooting, moving and communicating to locate a casualty. Rescue Randy was our objective in all our exercises which ranged from hanging out in a local Wal-Mart with a concealed carry, when your buddy Randy takes fire and becomes a casualty, to a bad day in Baghdad working as a team to move a casualty to safety and properly treating them.

Adding live-fire into any training scenario just makes sense, especially doing so out of the confines of a static range. Yes, safety is always the number one concern and as you’ll see on the video below, there were times the action stopped when the RSOs Caleb and Andrew saw any potential of a questionable situation. Safety is always paramount, but I’m a big believer in training like you fight. Moving dynamically on a range with others is something I’d highly recommend everyone works into their training regimen. When you throw in the extra stressors of having to communicate with a casualty, dynamically assessing them and moving them to safety, it’s a whole different ballgame!

Our FTX consisted of locating our injured teammate Rescue Randy on foot and humping him out with a Med Sled VLR litter to be MEDEVAC’d. We lucked out in getting to T&E the Med Sled VLR during the class and it’s 6 lb. weight was a welcome change to other heavier flexible litters I’ve seen. Throughout our transition to extract Randy, we had to engage threats, cross streams and work as a team. We got thrown curve balls along the way as members of our team received injuries that required self-aid and buddy aid.

Wrap-up

We also went in to many other topics outside of Care Under Fire such as the use of hemostatic agents like QuickClot Combat Gauze, treating Tension Pneumothorax, airway adjuncts like an NPA (Nasopharyngeal Airway), wound packing and treating for shock. Although these are all used outside of the Care Under Fire phase of TCCC, it was great that we covered them and got a chance to hear Caleb’s knowledge on the subjects.

Lone Star Medics put on a fantastic course of instruction with Medicine X. I truly feel that the professionalism and knowledge that Caleb, Andrew and the crew of Lone Star Medics brought to the table was delivered in a way that allowed everyone to learn on an equal footing. Our class was largely made up of prior military guys, which I feel contributed to the ease of working together as a team, but Lone Star Medics classes are open to all qualified trainees.

The information was presented in a very practical manner of learning the skills and ingraining them with practical application scenarios. While already having some medical experience and knowledge I felt this class to be a even better than what I’d expected. I’m a strong believer in being a student for life and learning from every opportunity. These scenarios were a perfect opportunity to put my new and past knowledge into practice and find out what worked.

I wholeheartedly recommend Lone Star Medics’ Medicine X course for everyone that carries a gun and takes their life and those around them seriously. Do yourself a favor and learn what to do when EMS is 9-12 minutes away! As a final note, I want to recommend to everyone that at the very least you buy extras of the medical supplies you carry and practice with it prior to using it in a real situation. Your speed and familiarity with a product’s uses and limitations could mean the difference between life and death.

Thank You’s

Of course a huge thank you to Caleb and Lone Star Medics for allowing me the opportunity to organize and host this Medicine X class for ITS Tactical. I’d also like to thank Andrew of Lone Star Armory for his instruction, providing lunch on Saturday and helping out as RSO during the class. You should really check out some of the awesomeness that Andrew produces over at Lone Star Armory, he had a sick 300 Blackout he was shooting that made me pretty jealous. He did want my Mayflower R&C Lo-Pro Carrier I was wearing though, so maybe we make a deal! Hah!

I’d also like to thank Kyle of Fire Fight Underwater Recovery for personally cooking an outstanding lunch on Sunday, TacMed Solutions and JBC Corp for providing training equipment, XS Sight Systems and to Quail Creek Shooting Range for allowing us the use of their classroom and police range for the course. A huge thank you to all those that came out and attended the course and for taking time out of your Mother’s Day Weekend to learn skills that might save mom one day!