Today we’re excited to announce a couple of new morale products as well as a new color of our popular 550 Jute Paracord to the ITS Shop. The new ITS Bleeding Arm PVC Morale Patch sticks almost anywhere with its hook velcro backside and is a great way to show off your Texas pride. The design is modeled after Brown’s Flag of Independence which is said to have been flown by Capt. Brown and his men at the Battle of Bexar and accompanied him when he went to Goliad to sign the Goliad Declaration of Independence.
For those lucky enough to find the ITS Crew at Comic-Con this year, you can score a free ITS Logo Lanyard but if you can’t make it out, you can order one right from the ITS Shop. We also have our extremely versatile 550 Jute Paracord now available in Forest Green. Pick some up for your next adventure!
ITS Bleeding Arm PVC Morale Patch
The ITS Bleeding Arm PVC Morale Patch is an homage to Capt. William S. Brown’s 1835 flag of Independence. It takes the iconic image of the bloody arm on the deep blue field from Brown’s original flag which has a large deep blue field in the upper left corner and a white arm grasping a sword dripping blood from its point. The original flag has thirteen stripes, seven red and six white with the word INDEPENDENCE in the third white stripe from the top.
Perfect for displaying your next trade show badge in style, these ITS Logo Lanyards were developed to pass out at Comic-Con and are now offered here in the ITS Store. Each lanyard measures around 17” long on each side of the loop and features a lobster claw hook attachment. *Backstage pass not included.
We’ve taken the proven concept of Type III Paracord and put a multi-purpose twist on it. Our Jute Paracord is built to exceed the Mil-Spec 550+ lb. tensile strength and 7-strand kermantle construction, with one difference. We’ve replaced the 7th inner strand with Jute natural fiber for fire starting purposes.
Here on ITS Tactical, we follow the TCCC (Tactical Combat Casualty Care) Guidelines very closely and have even designed our ETA Kit around them.
Tactical Combat Casualty Care (Pronounced “T-Triple C”) is a set of guidelines developed by USSOCOM (United States Special Operations Command) to properly train non-medics to deal with the preventable causes of death in the field.
The latest updates for 2014 are out and we wanted to share them with you. We’ve posted the updated guidelines in their entirety here, but also have them available in .pdf format to download.
Tactical Combat Casualty Care Guidelines – 2 June 2014
* All changes to the guidelines made since those published in the 2010 Seventh Edition of the PHTLS Manual are shown in bold text. The most recent changes are shown in red text.
Basic Management Plan For Care Under Fire
Return fire and take cover.
Direct or expect casualty to remain engaged as a combatant if appropriate.
Direct casualty to move to cover and apply self-aid if able.
Try to keep the casualty from sustaining additional wounds.
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.
Airway management is generally best deferred until the Tactical Field Care phase.
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.
Basic Management Plan for Tactical Field Care
Casualties with an altered mental status should be disarmed immediately.
Airway Management
a. Unconscious casualty without airway obstruction:
– Chin lift or jaw thrust maneuver
– Nasopharyngeal airway
– Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
– Chin lift or jaw thrust maneuver
– Nasopharyngeal airway
– Allow casualty to assume any position that best protects the airway, to include sitting up.
– Place unconscious casualty in the recovery position.
– If previous measures unsuccessful:
– Surgical cricothyroidotomy (with lidocaine if conscious)
Breathing
a. In a casualty with progressive respiratory distress and known or suspected torso trauma, consider a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch needle/catheter unit inserted in the second intercostal space at the midclavicular line. Ensure that the needle entry into the chest is not medial to the nipple line and is not directed towards the heart. An acceptable alternate site is the 4th or 5th intercostal space at the anterior axillary line (AAL).
b. All open and/or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression. c. Casualties with moderate/severe TBI should be given supplemental oxygen when available to maintain an oxygen saturation > 90%.
Bleeding
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.
b. For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if evacuation time is anticipated to be longer than two hours), use Combat Gauze as the CoTCCC hemostatic dressing of choice. Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available. Hemostatic dressings should be applied with at least 3 minutes of direct pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no traumatic brain injury (TBI). If the bleeding site is appropriate for use of a junctional tourniquet, immediately apply a CoTCCC-recommended junctional tourniquet. Do not delay in the application of the junctional tourniquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional tourniquet is not available or while the junctional tourniquet is being readied for use.
c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, replace tourniquet over uniform with another applied directly to skin 2-3 inches above wound. If a tourniquet is not needed, use other techniques to control bleeding.
d. When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal pulse is still present, consider additional tightening of the tourniquet or the use of a second tourniquet, side by side and proximal to the first, to eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indelible marker.
Intravenous (IV) access
– Start an 18-gauge IV or saline lock if indicated.
– If resuscitation is required and IV access is not obtainable, use the intraosseous (IO) route.
Tranexamic Acid (TXA) If a casualty is anticipated to need significant blood transfusion (for example: presents with hemorrhagic shock, one or more major amputations, penetrating torso trauma, or evidence of severe bleeding) – Administer 1 gram of tranexamic acid in 100 cc Normal Saline or Lactated Ringers as soon as possible but NOT later than 3 hours after injury. – Begin second infusion of 1 gm TXA after Hextend or other fluid treatment.
Fluid resuscitation a. The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred, are: whole blood*; plasma, RBCs and platelets in 1:1:1 ratio*; plasma and RBCs in 1:1 ratio; plasma or RBCs alone; Hextend; and crystalloid (Lactated Ringers or Plasma-Lyte A).
b. Assess for hemorrhagic shock (altered mental status in the absence of brain injury and/or weak or absent radial pulse).
1. If not in shock:
– No IV fluids are immediately necessary.
– Fluids by mouth are permissible if the casualty is conscious and can swallow. 2. If in shock and blood products are available under an approved command or theater blood product administration protocol: – Resuscitate with whole blood*, or, if not available – Plasma, RBCs and platelets in a 1:1:1 ratio*, or, if not available – Plasma and RBCs in 1:1 ratio, or, if not available; – Reconstituted dried plasma, liquid plasma or thawed plasma alone or RBCs alone; – Reassess the casualty after each unit. Continue resuscitation until a palpable radial pulse, improved mental status or systolic BP of 80-90 mmHg is present. 3. If in shock and blood products are not available under an approved command or theater blood product administration protocol due to tactical or logistical constraints: – Resuscitate with Hextend, or if not available; – Lactated Ringers or Plasma-Lyte A; – Reassess the casualty after each 500 mL IV bolus; – Continue resuscitation until a palpable radial pulse, improved mental status, or systolic BP of 80-90 mmHg is present. – Discontinue fluid administration when one or more of the above end points has been achieved. 4. If a casualty with an altered mental status due to suspected TBI has a weak or absent peripheral pulse, resuscitate as necessary to restore and maintain a normal radial pulse. If BP monitoring is available, maintain a target systolic BP of at least 90 mmHg. 5. Reassess the casualty frequently to check for recurrence of shock. If shock recurs, recheck all external hemorrhage control measures to ensure that they are still effective and repeat the fluid resuscitation as outlined above.
* Neither whole blood nor apheresis platelets as these products are currently collected in theater are FDA-compliant. Consequently, whole blood and 1:1:1 resuscitation using apheresis platelets should be used only if all of the FDA-compliant blood products needed to support 1:1:1 resuscitation are not available, or if 1:1:1 resuscitation is not producing the desired clinical effect.”
Prevention of hypothermia
a. Minimize casualty’s exposure to the elements. Keep protective gear on or with the casualty if feasible.
b. Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as possible. c. Apply the Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to the casualty’s torso (not directly on the skin) and cover the casualty with the Heat-Reflective Shell (HRS). d. If an HRS is not available, the previously recommended combination of the Blizzard Survival Blanket and the Ready Heat blanket may also be used.
e. If the items mentioned above are not available, use dry blankets, poncho liners, sleeping bags, or anything that will retain heat and keep the casualty dry. f. Warm fluids are preferred if IV fluids are required.
Penetrating Eye Trauma
If a penetrating eye injury is noted or suspected:
a) Perform a rapid field test of visual acuity.
b) Cover the eye with a rigid eye shield (NOT a pressure patch.)
c) Ensure that the 400 mg moxifloxacin tablet in the combat pill pack is taken if possible and that IV/IM antibiotics are given as outlined below if oral moxifloxacin cannot be taken.
Monitoring
Pulse oximetry should be available as an adjunct to clinical monitoring. All individuals with moderate/severe TBI should be monitored with pulse oximetry. Readings may be misleading in the settings of shock or marked hypothermia.
Inspect and dress known wounds.
Check for additional wounds.
Analgesia on the battlefield should generally be achieved using one of three options: Option 1 Mild to Moderate Pain Casualty is still able to fight – TCCC Combat pill pack:
– Tylenol – 650-mg bilayer caplet, 2 PO every 8 hours
– Meloxicam – 15 mg PO once a day Option 2 Moderate to Severe Pain Casualty IS NOT in shock or respiratory distress AND Casualty IS NOT at significant risk of developing either condition
– Oral transmucosal fentanyl citrate (OTFC) 800 ug – Place lozenge between the cheek and the gum – Do not chew the lozenge Option 3 Moderate to Severe Pain Casualty IS in hemorrhagic shock or respiratory distress OR Casualty IS at significant risk of developing either condition – Ketamine 50 mg IM or IN Or – Ketamine 20 mg slow IV or IO
* Repeat doses q30min prn for IM or IN * Repeat doses q20min prn for IV or IO * End points: Control of pain or development of nystagmus (rhythmic back-and-forth movement of the eyes) * Analgesia notes a. Casualties may need to be disarmed after being given OTFC or ketamine. b. Document a mental status exam using the AVPU method prior to administering opioids or ketamine. c. For all casualties given opiods or ketamine – monitor airway, breathing, and circulation closely d. Directions for administering OTFC:
– Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure OR utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patient’s uniform or plate carrier.
– Reassess in 15 minutes
– Add second lozenge, in other cheek, as necessary to control severe pain
– Monitor for respiratory depression e. IV Morphine is an alternative to OTFC if IV access has been obtained
– 5 mg IV/IO
– Reassess in 10 minutes.
– Repeat dose every 10 minutes as necessary to control severe pain.
– Monitor for respiratory depression f. Naloxone (0.4 mg IV or IM) should be available when using opioid analgesics. g. Both ketamine and OTFC have the potential to worsen severe TBI. The combat medic, corpsman, or PJ must consider this fact in his or her analgesic decision, but if the casualty is able to complain of pain, then the TBI is likely not severe enough to preclude the use of ketamine or OTFC. h. Eye injury does not preclude the use of ketamine. The risk of additional damage to the eye from using ketamine is low and maximizing the casualty’s chance for survival takes precedence if the casualty is in shock or respiratory distress or at significant risk for either. i. Ketamine may be a useful adjunct to reduce the amount of opioids required to provide effective pain relief. It is safe to give ketamine to a casualty who has previously received morphine or OTFC. IV Ketamine should be given over 1 minute. j. If respirations are noted to be reduced after using opioids or ketamine, provide ventilatory support with a bag-valve-mask or mouth-to-mask ventilations. k. Promethazine, 25 mg IV/IM/IO every 6 hours may be given as needed for nausea or vomiting. l. Reassess – reassess – reassess!
Splint fractures and recheck pulse.
Antibiotics: recommended for all open combat wounds
a. If able to take PO:
– Moxifloxacin, 400 mg PO one a day
b. If unable to take PO (shock, unconsciousness):
– Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM every 12 hours
or
– Ertapenem, 1 g IV/IM once a day
Burns
a. Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.
b. Estimate total body surface area (TBSA) burned to the nearest 10% using the Rule of Nines.
c. Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Blizzard Survival Blanket in the Hypothermia Prevention Kit in order to both cover the burned areas and prevent hypothermia.
d. Fluid resuscitation (USAISR Rule of Ten)
– If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000 ml should be given, followed by Lactated Ringer’s or normal saline as needed.
– Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40- 80 kg.
– For every 10 kg ABOVE 80 kg, increase initial rate by 100 ml/hr.
– If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over resuscitation for burn shock. Administer IV/IO fluids per the TCCC Guidelines in Section 6.
e. Analgesia in accordance with the TCCC Guidelines in Section 12 may be administered to treat burn pain.
f. Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per the TCCC guidelines in Section 14 if indicated to prevent infection in penetrating wounds.
g. All TCCC interventions can be performed on or through burned skin in a burn casualty.
Communicate with the casualty if possible.
– Encourage; reassure
– Explain care
Cardiopulmonary resuscitation (CPR)
Resuscitation on the battlefield for victims of blast or penetrating trauma who have no pulse, no ventilations, and no other signs of life will not be successful and should not be attempted. However, casualties with torso trauma or polytrauma who have no pulse or respirations during TFC should have bilateral needle decompression performed to ensure they do not have a tension pneumothorax prior to discontinuation of care. The procedure is the same as described in section 3 above.
Documentation of Care
Document clinical assessments, treatments rendered, and changes in the casualty’s status on a TCCC Casualty Card (DD Form 1380). Forward this information with the casualty to the next level of care.
Basic Management Plan for Tactical Evacuation Care
* The term “Tactical Evacuation” includes both Casualty Evacuation (CASEVAC) and Medical Evacuation (MEDEVAC) as defined in Joint Publication 4-02.
Airway Management
a. Unconscious casualty without airway obstruction:
– Chin lift or jaw thrust maneuver
– Nasopharyngeal airway
– Place casualty in the recovery position
b. Casualty with airway obstruction or impending airway obstruction:
– Chin lift or jaw thrust maneuver
– Nasopharyngeal airway
– Allow casualty to assume any position that best protects the airway, to include sitting up.
– Place unconscious casualty in the recovery position.
– If above measures unsuccessful:
— Supraglottic airway or
— Endotracheal intubation or
— Surgical cricothyroidotomy (with lidocaine if conscious).
c. Spinal immobilization is not necessary for casualties with penetrating trauma.
Breathing
a. In a casualty with progressive respiratory distress and known or suspected torso trauma, consider a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch needle/catheter unit inserted in the second intercostal space at the midclavicular line. Ensure that the needle entry into the chest is not medial to the nipple line and is not directed towards the heart. An acceptable alternate site is the 4th or 5th intercostal space at the anterior axillary line (AAL).
b. Consider chest tube insertion if no improvement and/or long transport is anticipated.
c. Most combat casualties do not require supplemental oxygen, but administration of oxygen may be of benefit for the following types of casualties:
– Low oxygen saturation by pulse oximetry
– Injuries associated with impaired oxygenation
– Unconscious casualty
– Casualty with TBI (maintain oxygen saturation > 90%)
– Casualty in shock
– Casualty at altitude
d. All open and/or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.
Bleeding
a. Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.
b. For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if anticipated evacuation time is longer than two hours), use Combat Gauze as the CoTCCC hemostatic dressing of choice. Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available. Hemostatic dressings should be applied with at least 3 minutes of direct pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no TBI.) If the bleeding site is appropriate for use of a junctional tourniquet, immediately apply a CoTCCC- recommended junctional tourniquet. Do not delay in the application of the junctional tourniquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional tourniquet is not available or while the junctional tourniquet is being readied for use.
c. Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, replace tourniquet over uniform with another applied directly to skin 2-3 inches above wound. If a tourniquet is not needed, use other techniques to control bleeding.
d. When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal pulse is still present, consider additional tightening of the tourniquet or the use of a second tourniquet, side by side and proximal to the first, to eliminate the distal pulse.
e. Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indelible marker.
Intravenous (IV) access
a. Reassess need for IV access.
– If indicated, start an 18-gauge IV or saline lock
– If resuscitation is required and IV access is not obtainable, use intraosseous (IO) route.
Tranexamic Acid (TXA) If a casualty is anticipated to need significant blood transfusion (for example: presents with hemorrhagic shock, one or more major amputations, penetrating torso trauma, or evidence of severe bleeding) – Administer 1 gram of tranexamic acid in 100 cc Normal Saline or Lactated Ringers as soon as possible but NOT later than 3 hours after injury. – Begin second infusion of 1 gm TXA after Hextend or other fluid treatment.
Traumatic Brain Injury a. Casualties with moderate/severe TBI should be monitored for: 1. Decreases in level of consciousness 2. Pupillary dilation 3. SBP should be >90 mmHg 4. O2 sat > 90 5. Hypothermia 6. PCO2 (If capnography is available, maintain between 35-40 mmHg) 7. Penetrating head trauma (if present, administer antibiotics) 8. Assume a spinal (neck) injury until cleared. b. Unilateral pupillary dilation accompanied by a decreased level of consciousness may signify impending cerebral herniation; if these signs occur, take the following actions to decrease intracranial pressure: 1) Administer 250 cc of 3 or 5% hypertonic saline bolus. 2) Elevate the casualty’s head 30 degrees. 3) Hyperventilate the casualty. a) Respiratory rate 20 b) Capnography should be used to maintain the end-tidal CO2 between 30-35 c) The highest oxygen concentration (FIO2) possible should be used for hyperventilation. *Notes: – Do not hyperventilate unless signs of impending herniation are present. – Casualties may be hyperventilated with oxygen using the bag-valve-mask technique.
Fluid resuscitation a. The resuscitation fluids of choice for casualties in hemorrhagic shock, listed from most to least preferred, are: whole blood*; plasma, RBCs and platelets in 1:1:1 ratio*; plasma and RBCs in 1:1 ratio; plasma or RBCs alone; Hextend; and crystalloid (Lactated Ringers or Plasma-Lyte A).
b. Assess for hemorrhagic shock (altered mental status in the absence of brain injury and/or weak or absent radial pulse).
1. If not in shock:
– No IV fluids are immediately necessary.
– Fluids by mouth are permissible if the casualty is conscious and can swallow. 2. If in shock and blood products are available under an approved command or theater blood product administration protocol: – Resuscitate with whole blood*, or, if not available – Plasma, RBCs and platelets in a 1:1:1 ratio*, or, if not available – Plasma and RBCs in 1:1 ratio, or, if not available; – Reconstituted dried plasma, liquid plasma or thawed plasma alone or RBCs alone; – Reassess the casualty after each unit. Continue resuscitation until a palpable radial pulse, improved mental status or systolic BP of 80-90 mmHg is present. 3. If in shock and blood products are not available under an approved command or theater blood product administration protocol due to tactical or logistical constraints: – Resuscitate with Hextend, or if not available; – Lactated Ringers or Plasma-Lyte A; – Reassess the casualty after each 500 mL IV bolus; – Continue resuscitation until a palpable radial pulse, improved mental status, or systolic BP of 80-90 mmHg is present. – Discontinue fluid administration when one or more of the above end points has been achieved. 4. If a casualty with an altered mental status due to suspected TBI has a weak or absent peripheral pulse, resuscitate as necessary to restore and maintain a normal radial pulse. If BP monitoring is available, maintain a target systolic BP of at least 90 mmHg. 5. Reassess the casualty frequently to check for recurrence of shock. If shock recurs, recheck all external hemorrhage control measures to ensure that they are still effective and repeat the fluid resuscitation as outlined above. * Neither whole blood nor apheresis platelets as these products are currently collected in theater are FDA-compliant. Consequently, whole blood and 1:1:1 resuscitation using apheresis platelets should be used only if all of the FDA-compliant blood products needed to support 1:1:1 resuscitation are not available, or if 1:1:1 resuscitation is not producing the desired clinical effect.”
Prevention of hypothermia
a. Minimize casualty’s exposure to the elements. Keep protective gear on or with the casualty if feasible.
b. Replace wet clothing with dry if possible. Get the casualty onto an insulated surface as soon as possible. c. Apply the Ready-Heat Blanket from the Hypothermia Prevention and Management Kit (HPMK) to the casualty’s torso (not directly on the skin) and cover the casualty with the Heat-Reflective Shell (HRS). d. If an HRS is not available, the previously recommended combination of the Blizzard Survival Blanket and the Ready Heat blanket may also be used.
e. If the items mentioned above are not available, use poncho liners, sleeping bags, or anything that will retain heat and keep the casualty dry. f. Use a portable fluid warmer capable of warming all IV fluids including blood products.
g. Protect the casualty from wind if doors must be kept open.
Penetrating Eye Trauma
If a penetrating eye injury is noted or suspected:
a) Perform a rapid field test of visual acuity.
b) Cover the eye with a rigid eye shield (NOT a pressure patch).
c) Ensure that the 400 mg moxifloxacin tablet in the combat pill pack is taken if possible and that IV/IM antibiotics are given as outlined below if oral moxifloxacin cannot be taken.
Monitoring
Institute pulse oximetry and other electronic monitoring of vital signs, if indicated. All individuals with moderate/severe TBI should be monitored with pulse oximetry.
Inspect and dress known wounds if not already done.
Check for additional wounds.
Analgesia on the battlefield should generally be achieved using one of three options: Option 1 Mild to Moderate Pain Casualty is still able to fight
– TCCC Combat pill pack:
– Tylenol – 650-mg bilayer caplet, 2 PO every 8 hours
– Meloxicam – 15 mg PO once a day Option 2 Moderate to Severe Pain Casualty IS NOT in shock or respiratory distress AND Casualty IS NOT at significant risk of developing either condition
– Oral transmucosal fentanyl citrate (OTFC) 800 ug – Place lozenge between the cheek and the gum – Do not chew the lozenge Option 3 Moderate to Severe Pain Casualty IS in hemorrhagic shock or respiratory distress OR Casualty IS at significant risk of developing either condition – Ketamine 50 mg IM or IN Or – Ketamine 20 mg slow IV or IO
* Repeat doses q30min prn for IM or IN * Repeat doses q20min prn for IV or IO * End points: Control of pain or development of nystagmus (rhythmic back-and-forth movement of the eyes) * Analgesia notes a. Casualties may need to be disarmed after being given OTFC or ketamine. b. Document a mental status exam using the AVPU method prior to administering opioids or ketamine. c. For all casualties given opiods or ketamine – monitor airway, breathing, and circulation closely d. Directions for administering OTFC:
– Recommend taping lozenge-on-a-stick to casualty’s finger as an added safety measure OR utilizing a safety pin and rubber band to attach the lozenge (under tension) to the patients uniform or plate carrier.
– Reassess in 15 minutes
– Add second lozenge, in other cheek, as necessary to control severe pain
– Monitor for respiratory depression e. IV Morphine is an alternative to OTFC if IV access has been obtained
– 5 mg IV/IO – Reassess in 10 minutes.
– Repeat dose every 10 minutes as necessary to control severe pain.
– Monitor for respiratory depression f. Naloxone (0.4 mg IV or IM) should be available when using opioid analgesics. g. Both ketamine and OTFC have the potential to worsen severe TBI. The combat medic, corpsman, or PJ must consider this fact in his or her analgesic decision, but if the casualty is able to complain of pain, then the TBI is likely not severe enough to preclude the use of ketamine or OTFC. h. Eye injury does not preclude the use of ketamine. The risk of additional damage to the eye from using ketamine is low and maximizing the casualty’s chance for survival takes precedence if the casualty is in shock or respiratory distress or at significant risk for either. i. Ketamine may be a useful adjunct to reduce the amount of opioids required to provide effective pain relief. It is safe to give ketamine to a casualty who has previously received morphine or OTFC. IV Ketamine should be given over 1 minute. j. If respirations are noted to be reduced after using opioids or ketamine, provide ventilatory support with a bag-valve-mask or mouth-to-mask ventilations. k. Promethazine, 25 mg IV/IM/IO every 6 hours may be given as needed for nausea or vomiting. l. Reassess – reassess – reassess!
Reassess fractures and recheck pulses.
Antibiotics: recommended for all open combat wounds
a. If able to take PO:
– Moxifloxacin, 400 mg PO once a day
b. If unable to take PO (shock, unconsciousness):
– Cefotetan, 2 g IV (slow push over 3-5 minutes) or IM every 12 hours,
or
– Ertapenem, 1 g IV/IM once a day
Burns
a. Facial burns, especially those that occur in closed spaces, may be associated with inhalation injury. Aggressively monitor airway status and oxygen saturation in such patients and consider early surgical airway for respiratory distress or oxygen desaturation.
b. Estimate total body surface area (TBSA) burned to the nearest 10% using the Rule of Nines.
c. Cover the burn area with dry, sterile dressings. For extensive burns (>20%), consider placing the casualty in the Heat-Reflective Shell or Blizzard Survival Blanket from the Hypothermia Prevention Kit in order to both cover the burned areas and prevent hypothermia.
d. Fluid resuscitation (USAISR Rule of Ten)
– If burns are greater than 20% of Total Body Surface Area, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000 ml should be given, followed by Lactated Ringer’s or normal saline as needed.
– Initial IV/IO fluid rate is calculated as %TBSA x 10cc/hr for adults weighing 40-80 kg.
– For every 10 kg ABOVE 80 kg, increase initial rate by 100 ml/hr.
– If hemorrhagic shock is also present, resuscitation for hemorrhagic shock takes precedence over resuscitation for burn shock. Administer IV/IO fluids per the TCCC Guidelines in Section 5.
e. Analgesia in accordance with TCCC Guidelines in Section 11 may be administered to treat burn pain.
f. Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per TCCC guidelines in Section 13 if indicated to prevent infection in penetrating wounds.
g. All TCCC interventions can be performed on or through burned skin in a burn casualty.
h. Burn patients are particularly susceptible to hypothermia. Extra emphasis should be placed on barrier heat loss prevention methods and IV fluid warming in this phase.
The Pneumatic Antishock Garment (PASG) may be useful for stabilizing pelvic fractures and controlling pelvic and abdominal bleeding. Application and extended use must be carefully monitored. The PASG is contraindicated for casualties with thoracic or brain injuries.
CPR in TACEVAC Care a. Casualties with torso trauma or polytrauma who have no pulse or respirations during TACEVAC should have bilateral needle decompression performed to ensure they do not have a tension pneumothorax. The procedure is the same as described in section 2 above. b. CPR may be attempted during this phase of care if the casualty does not have obviously fatal wounds and will be arriving at a facility with a surgical capability within a short period of time. CPR should not be done at the expense of compromising the mission or denying lifesaving care to other casualties.
Documentation of Care
Document clinical assessments, treatments rendered, and changes in the casualty’s status on a TCCC Casualty Card (DD Form 1380). Forward this information with the casualty to the next level of care.
NEMO takes a lot of pride in their designs and how they come about. It all starts with the adventurous lifestyle of their staff and it’s often their experiences that allow the development of innovative solutions for common camping problems.
In 2004, NEMO debuted their first generation of AirSupported Technology tents and immediately got the attention of the outdoor industry. They’ve since refined that idea and added a lot to their tent lineup. In 2012, they launched another game changing design with their Spoon sleeping bags.
It’s been awhile since NEMO Equipment introduced the idea of tent topographic diagrams on their blog, but it’s certainly something the outdoor industry could benefit from.
If you’re in the market for a new tent, you’ll undoubtedly look over all of the specs, but will most likely make your purchase based on the floor dimensions and peak height. After all, you want to make sure you’ll fit when you lie down and be able to sit up without hitting your head on the roof of the tent.
The problem with basing your decision on those specs alone is that you don’t have the best idea of how much usable space there is internally without getting to see one of the tents in person. NEMO wants to change that.
For those unfamiliar, topographic maps or “topo” maps are used as a visual aid for terrain on a 2 dimensional map. Their primary purpose on a map is to accurately represent the shape of the Earth’s surface through the use of contour lines which will illustrate elevation. The key thing to remember about contour lines is this: The closer the spacing, the more rapid the change in elevation.
Along the same idea of getting the shape of a mountain from a topographic map and analyzing the steepness of the slope based on the contour lines of the map, with tent topos, you’re able to visualize the steepness of the walls of the tent your interested in.
”NEMO’s tent topos show you the contours of a tent at various heights so that at a glance, you can understand where in a tent you can sit up, sleep, and fit your shoulders. If you’re not able to set the tent up before buying, this is an easy and quick way to understand the livability of a tent.”
In this example, both tents have roughly the same floor area and height, but it’s obvious that the interior volume arrangement is completely different.
As a full example, here’s the tent topo diagram as seen on their award winning Losi 3P Backpacking Tent:
We’ve utilized NEMO’s tent topo overlays on a few of our NEMO tent reviews on ITS and have always loved this way of looking at the interior dimensions. Right now, it seems that only NEMO Equipment is using tent topographic diagrams but they have hopes others in the tent industry will adopt the visualization and it will become a standard practice. This will no doubt give customers a highly useful metric when selecting their next tent.
ITS Tactical has partnered with Huckberry to give away this Black Ops prize pack! With exclusive sales and original story-telling, Huckberry is our go-to online shop for awesome new gear and apparel, etc.
While members of ITS get a special deal of $10 free credit for their first purchase on Huckberry.com, we’re giving everyone a chance to get in on an awesome prize pack. Make sure you have your good luck charm handy!
What’s Up for Grabs?
One lucky individual will win the Black Ops Prize Pack from Huckberry that includes:
Congratulations to Conor A. for winning this latest contest and thanks to all who entered! In case you didn’t win this time, stay tuned to more contests in the future!
Contest Fine Print:
One winner will be selected at random and will receive prize pack listed above.
Winner will be notified by email. Once contacted, they have 24 hours to claim their prize. If we do not receive a response from within 24 hours, we will select a new winner.
The Internet is the single greatest information resource available to mankind today. Unfortunately, the Internet of today has become a minefield of data collection and tracking. From advertising companies, to hackers, to governments, the information about where people are going on the Internet is a hot commodity.
Vast numbers of Internet users often assume that no one is viewing their Internet traffic and often use the phrase, “What do I have to hide?” While they may not have any information to hide, they certainly have some that should be protected. In a world where Internet shopping dominates the economy, more and more financial and personal information is being stored on our computers. What steps can be taken to protect this information and is there truly a way to browse the web anonymously? First, we need to look at the methods used to collect all of this information.
As a note, this article is meant to provide a basic overview of online security and privacy. It’s not an all encompassing guide, but armed with these basics you’ll be able to understand the principles and develop a strategy to further protect yourself online.
Cookies
Ask an average person about Internet Security and at some point they’ll likely bring up the subject of cookies. A cookie is a piece of data from a website that’s stored in a web browser when a user browses that site. Cookies can offer useful features like remembering where you were on the page or what was in your shopping cart. Unfortunately, cookies can also provide information about your long term browsing habits, which enable web sites to see where you’ve been and allow them to more effectively target you with advertisements.
Social Media
Almost everyone has at least one social media account and most of us have many more. While these services are great for connecting with friends and family, they’re one of the biggest violators when it comes to privacy invasion. Sites like Facebook and Twitter use cookies to track your web history and use this data to push ads for things they think you’ll be likely to click on.
Sites like Facebook even offer compatibility with commenting systems so you can comment using your Facebook account. The ability to offer services like this comes from using data collection devices like cookies. The problem with these methods is that there’s no public log of exactly what information is being collected. When you browse the web with your social media accounts logged in, you’re potentially allowing those companies access to virtually all of your Internet browsing.
IP Tracking
Every Internet connection requires an IP (Internet Protocol) Address and these addresses are issued by ISPs (Internet Service Providers.) These addresses are unique and can be used to locate a user and where they’re browsing from. An IP Address is an Internet fingerprint of sorts, that leaves a trail of breadcrumbs for anyone following your browsing habits. While many ISPs claim they don’t track individual users IP addresses, there are several instances where IP information was turned over to Law Enforcement or private companies.
One of the biggest examples is IP information being tracked by movie studios to combat movie piracy. A user browsing the web downloads a copy of the latest summer blockbuster and several weeks later receives a letter from a movie studio or their Internet Provider warning them that they’ve violated copyright law. In several cases, users have received warnings from their ISP that a copyright holder has tracked a violation using their IP Address. While copyright infringement is definitely against the law, many people feel that it’s a large violation of their privacy to have their browsing information shared with a private company.
Can You Browse Anonymously?
After seeing some of the methods used to track your Internet browsing, you may be asking yourself “Is there any way to avoid sharing all of this information?” The good news is that using a variety of services and practices, you can severely limit the ability of third parties to track you and your information. The following are just some of the steps you can take to protect your information.
“Private” Browsing
Many people hide behind their browsers “Private Browsing” feature but that doesn’t completely remove you from what you’re doing online. In fact, all that’s needed to give you away is to log into your social network accounts. When you start a new Incognito window in Google Chrome, they make it clear as to what’s actually happening:
Pages you view in incognito tabs won’t stick around in your browser’s history, cookie store, or search history after you’ve closed all of your incognito tabs. Any files you download or bookmarks you create will be kept. Learn more about incognito browsing
Going incognito doesn’t hide your browsing from your employer, your internet service provider, or the websites you visit.
Browser Extensions
Browser extensions are a great first step towards protecting your privacy. Disconnect stops third party tracking and encrypts the data you share with websites. Not only does this increase privacy, it increases your browsing speed since the pages aren’t loading all of the tracking information. Disconnect also advertises that pages can load up to 27% faster than browsing without the extension.
Adblock Plus can be used to hide multiple types of advertising on sites you frequent and can really speed up your browsing experience. By collecting a database of advertising locations on popular sites, Adblock can choose not to display those ads, giving you a faster and cleaner experience. However, since many sites rely on advertising revenue it’s recommended that you whitelist any sites where advertisements are unobtrusive and simple.
Both of these examples are completely free and easy to install in most popular web browsers.
Tor/VPN’s
For the ultimate in privacy protection, you’ll want to use software that is designed to be anonymous. A Virtual Private Network (VPN) offers a user the ability to connect to the Internet publicly from behind a private network. This severely limits the ability of anyone to track information, as all information in a VPN is encrypted and IP addresses can be re-routed through different servers to avoid tracing. While you can configure your own VPN, there are many services that can provide one for a monthly charge. Services like BT Guard allow you to use their VPN connection for $9.95 a month to encrypt all of your browsing including email and web browsing.
Another great privacy option is Tor, a free software that directs your traffic through a volunteer network with over five thousand relays. These relays allow Tor to conceal browsing information from those attempting to track it. Browsing with Tor offers onion routing, a name derived from the many layers of encryption used, much like the layers of an onion. A request is sent from your computer and then routed through multiple relays disguising the origin of the request and IP address information. This makes it almost impossible to track the traffic as no one relay contains all of the browsing information.
A Few Tips
While using these services and methods mentioned above, you’ll still need to keep in mind that there are always failure points in our systems, the largest of which is the end user. The best rule of thumb for browsing the web is if you don’t want the information getting out, don’t post it.
Always be aware of the information you’re giving out and don’t volunteer information unless you know what it’s being used for. With the tips above and a bit more research, users can limit the amount of information they share and improve their ability to truly become anonymous.
While it may be a confusing title, you’ll know all about it after listening to Episode #4 of Ridiculous Dialogue. The title comes from a story Kelly tells about her summer vacation growing up that we dare you not to laugh at!
Lang continues on his streak of hilariously unplanned one-liners and we cover some favorite summer treats, pranks and also clubs we formed as kids.
Ridiculous Dialogue was created to share the banter that takes place at Imminent Threat Solutions on a daily basis. It’s us; candid, unedited and talking about everything from what movies we’re watching to the general geekiness that keeps us laughing here at ITS HQ.
While we generally keep the vibe in our articles PG rated, be warned, it may not be safe to blast over your speakers at work. We hope you enjoy the insight into ITS and who we are behind the scenes as a company; pull up a chair and tune in to Radio ITS.
The Obama Administration quietly published Executive Order 13662 yesterday, which specifically addresses Ukraine-related sanctions. Amongst the entities that the US is now prohibited to deal with is Kalashnikov Concern.
Formerly known as Izhmash, Kalashnikov Concern manufactures the modern AK-100 series rifles, the Saiga sporting line of rifles, as well as shotguns.
Keep in mind that this isn’t an outright ban on Kalashnikov Concern products or Russian-made AKs. According to the FAQs about the Executive Order, any Kalashnikov Concern products that you already have are good to keep, or even sell on the secondary market as long as Kalashnikov Concern doesn’t have an interest in your sale. However, the prohibition for companies to do business with Kalashnikov Concern, or any of its interests monetarily, will definitely cut off the supply chain.
Our friends at Rifle Dynamics issued a statement on their Facebook page addressing the new Executive Order and what effect it will have on their business:
“We build our gun from surplus parts not imported guns, honestly we saw this coming and moved away from Saiga conversions a while back. While this is not good news, it does open doors. When the barrel ban happened, everybody said “there goes the AK, no more barrels,” but American companies stepped up and now we have decent quality barrels. At Rifle Dynamics we’re dedicated to making the AK a US gun, while there have previously been “all US made AK’s” advertised, the truth is that the main parts are complicated and expensive to make. Most guns claiming to be “US” are not all US made parts. People have always considered the AK to be cheaply made and for years it has been made by cheap labor in foreign countries. We are currently building/testing US made AK parts and hope to bring them to market soon.”
While this is a blow to the availability of quality-made AKs from Russia, there are also other manufacturers of AKs like Bulgaria, Romania, Yugoslavia/Serbia and Poland. We can only hope that other Russian firearms manufacturers aren’t added to this sanctions list.
The keen-eyed reader will no doubt see that the AK pictured in the photo above wasn’t manufactured by Izhmash, but it was the only Russian made AK we had to take a photo of around HQ.
Since the first article in this series, Modifying an FJ Cruiser for Overlanding, Toyota has announced that they’ll be discontinuing the FJ after 2014. According to Jalopnik, Toyota has sold more than 200,000 of them since debuting in 2006 and needless to say there’s enough of them out there if you still want to find one.
The large user base has also given companies the justification to create aftermarket parts for the FJ and there’s quite a few options out there. I’m still loving my FJ and continue to modify it frequently, in fact it just came back from stretching its legs a few months back at the 2014 Overland Expo. Today’s article will focus on security and the things I’ve done to my FJ to not necessarily make it bulletproof, but to increase what every security measure accomplishes; buying time.
Security
Take household security for instance, your alarm system (complete with yard sign and window stickers) is a deterrent in itself. You hope that it makes would-be thieves look elsewhere, but it’s truly only going to slow down a determined thief, i.e., buying time.
I’ve talked a lot about the security here on ITS and take it pretty seriously when it comes to my home as well as my vehicle. What I’ve tried to do with my FJ is install some things that aren’t necessarily fool-proof or completely burglar-proof, but that does buy me some time and peace of mind knowing that my valuables are better secured and harder to get to than simply leaving them in my seat.
All a thief needs is time and opportunity, the more you can do to increase that time needed and take away the opportunity, the better off you’ll be. Your vehicle, like your home, should appear to be a hard target, which will in turn cause criminals to look elsewhere for a softer target.
Firearms
I wanted to address firearms first and foremost, as many of you probably carry them in your vehicles. Whether this is just temporary when going to and from the range, or stowing a concealed carry sidearm if you’re going into a government building, etc.
Securing firearms properly is paramount, I don’t think any of us could live with ourselves if a firearm was stolen as a result of our negligence and used in a crime. That or being accessible to a child.
So what can be done? There’s no excuse for not buying the right equipment to secure your firearm, even if it winds up being just as expensive as the firearm itself. This is of course not to say it is, but I know the security box I’m about to talk about was equivalent to the cost of buying another gun and I was glad to make the purchase.
Security Drawer
A few years back, when I knew I wanted to start modifying my vehicle, one of my first purchases was a Tuffy Security Cargo Drawer. Shipping was a bit pricey, but in all I think I spent around $750. I installed the drawer myself in the span of an evening and it was relatively painless.
Something I’d tell anyone if asked about the install, is that during the last step of sliding the drawer in onto the sliders, while following the instructions carefully I might add, the slide rail was bent causing the ball bearings to spill out. After some back and forth with the company they eventually agreed to send me a new slider out and I finished the install.
The drawer has operated well since then and I’m continually impressed with what can fit inside. Primarily I keep firearms here when transporting them, but also have recovery equipment, lock picking equipment, camping equipment, food, water and spare clothing. There’s a whole separate article I could write on what I carry in the drawer and perhaps I’ll get into that one of these days. Needless to say, I can get lost in the backcountry and be ok with all the equipment stored in there, even if it took me a few days to find my way back to civilization.
A few security features on the Tuffy Security Cargo Drawer really sold me on it. These consist of a pry-guard locking system, anti-twist push button lock system complete with weather seals and a 10 tumbler double-sided security key. There was also the 16 gauge steel construction, internal divider kit (optional), powder coat finish and having around 12,500 cubic inches of storage space that sealed the deal. I have sacrificed storage space for the drawer, but the organization and lock-ability has more than made up for the space I gave up.
Portable Lock Box
Another item I have in the cab of my FJ is a small portable lock box. This is a key-based lockbox design that also has a double-bit security key like the Tuffy Security Cargo Drawer. I honestly have no idea where I purchased it from, but I have three others that are all keyed the same around my home and in another vehicle. Here’s a similar box on Amazon.
The box features a security cable that runs around the base of my seat and reattaches to itself before getting locked into the box. It can be a pain to manage on occasion, but it does the job. I’ve been wanting to upgrade to a Tuffy Portable Safe, but haven’t been convinced that a combination lock is just as secure as a double-sided key. Don’t get me wrong, even the self-described “security” key on the Tuffy box is pickable, the double-sided keys just increase that critical “buying time” factor I’ve been mentioning.
Other than the application of the lock box for its primary purpose of locking up a handgun, it’s also great to utilize when traveling. It can be cabled into a suitcase and used as the required locking case necessary for airline travel.
Security Cables and More
Another element to the security on my FJ is the combination lock security cable routed through my gas tanks, that prevents them from walking away. It’s a thick gauge steel cable that would certainly take some time to cut through for the willing thief.
I also have small padlocks on the posts of my Hi-Lift Jack mounting brackets and the posts of my shovel/axe combo mounting brackets. These, along with the gas tank mounts are made by Baja Rack, the manufacturer of my roof rack. I’ll have another article where I talk about the roof rack in detail too.
Something that I’ve considered adding to my security is The Club. It wouldn’t be an all the time device, but would go on when I need the extra visible security. Additionally, I utilize what amounts to wheel locks on lugs of my wheels. They’re not wheel locks in the traditional sense, but they do take a special deep socket to turn. It’s deeper than a standard deep socket, which as mentioned, effectively make them like a wheel lock. I always have to provide the special socket to Discount Tire when I’m there getting a tire rotation, etc.
Most modern vehicles, my FJ included, have some kind of engine immobilizer system that corresponds to a chip in the key. This electronic security device prevents the vehicle from starting if the correct key isn’t inserted, or if a thief attempts to bypass (hot wire) your ignition. My FJ has a flashing red LED on the stereo that blinks when the immobilizer is activated and is another theft deterrent. An alarm system could be a useful upgrade, but in my opinion they’re overrated. When’s the last time you cared that a car alarm was going off and actually took the time to look into what might be going on, rather than just get annoyed.
A small detail, but important one I’d like to add here is window tint. If a would-be criminal can’t see what valuables you might have in your vehicle, they’ll be less likely to break in to find out. I recommend going as dark as the law allows with your tinting an even carrying a dark blanket to cover up anything during a shopping trip, etc.
When I was talking to Mike about this article, he said that in D.C. where he used to live, cars were getting broken into that just had the residue from a suction cup mounting bracket on their front windshield. This was a sign that the driver used a GPS and just took it off when they parked. Thieves were breaking in and finding them in glove boxes. Just a tip if that sounds like something you’re doing.
Vehicle Security Tips for Everyone
Now that I’ve gone over my security precautions, I’d like to wrap this article up with a list of not only what I went over, but of some additional tips to keep in mind that don’t necessarily pertain to a vehicle set up for overlanding.
Park in well-lit areas, roll up your windows and lock your doors.
Don’t leave valuables, shopping bags, backpacks, purses, etc. in plain sight. Having these visible through your windows is just asking for a smash and grab.
Invest in dark window tinting, but be sure to check your local laws on the legal percentage. Out of sight, out of mind.
At the minimum, carry a blanket in your vehicle for covering up shopping bags and valuables.
Don’t leave mail with your address on it in your vehicle.
Take the original vehicle registration form out of your vehicle, if you legally have to keep it in the vehicle, black out your address.
Use The Club to lock your steering wheel and add another layer of security if your vehicle doesn’t have an engine immobilizer feature.
If you’ve upgraded your wheels, purchase wheel locks.
Don’t use magnetic key hiders, they can be found, especially if you’re spotted using it.
Cable lock anything on the exterior of your vehicle that can be easily removed.
Invest in a lock box that can be cabled in underneath your seat, or a larger drawer system that can be bolted down in the trunk. These are made for many different vehicles, so do some digging.
Research options like iTunes in the Cloud, Spotify or Pandora for Music to take your music with you. Or have a portable method for storing your music so you’re not leaving it in your vehicle.
Remove your garage door opener from your vehicle if you don’t park in the garage.
Don’t have personal information on your keys, if they’re lost or stolen, someone now has your name to look up where you live and probably now has a key to the front door.
Invest in a car alarm if this seems logical in your area of town, engine immobilizers are common now in newer vehicles and you might already have one installed.
When was the last time you were traveling and looked up only to realize that your real and perceived locations no longer matched? It’s a common and unsettling experience to say the least. In these moments, humans tend to use a combination of observational, logical and investigative techniques to reorient themselves and get back on track. However, any combination of factors can undermine a person’s chances for success:
Lack of familiarity with the environment (causing perception error)
Decreased cognitive capability (due to medical issues, environment, panic, exhaustion, etc.)
Inability to use key skills and techniques (due to training, experience, lack of awareness, etc.)
Equipment failure, physical disability or an overwhelming dose of Murphy’s Law.
The result is being lost, which can be a terrifying and life threatening experience. One of the most dangerous environments in which this can happen is the rural/wilderness areas that surround our familiar man-made environments. Since most people aren’t trained or equipped to survive in these circumstances indefinitely, a key part of survival for the lost person is being found.
In this article, we’ll examine what the average hiker/camper/outdoor enthusiast can do to increase their chances of being found by examining how Wilderness Search and Rescue Personnel approach the missing person incident.
The Searcher’s Perspective
In the United States, search managers are frequently taught that the missing person incident is “the classic mystery.” This is because finding a person involves bringing together a variety of clues, indicators and theories to narrow down where a person is located. This is achieved by using investigation, lost person behavior analysis, terrain analysis, specialized search resources and brute force grid searching to find “the subject.” This effort can be complex and is as much an art as a science. Some fundamentals:
Information We Want To Know
Geographic Information
Where was the person last seen? What was the person’s last known location?
Was there a plan of movement, direction of travel or destination?
Where have people previously gotten lost in the area?
Are there any tricky decision points along the route where a person may get off course?
Is there any indication that the missing person is not in the area being searched?
Lost Person Information (abbreviated)
Name, age, sex, physical description, medical history
Skill-set, experience, knowledge of area and equipment
Known activities or plans
Events leading up to disappearance; time since last contact.
Characteristic behaviors and traits
Actions We Will Take
Immediate
Begin investigative activities and determine where to start search operations.
Establish containment around the search area at a distance that matches the behavior profile and terrain. Set up methods for attracting the lost person (sirens, fires, flashing lights, etc) or detecting if they leave the search area (track traps, motion sensors, etc).
Search the immediate area around the place last seen/last known point to find the subject/and or determine a direction of travel.
Search routes of travel and linear features that speed movement from the search area.
Search locations of interest, such as destinations, hazards or natural attractors.
Long Term
Investigation activities, in concert with local law enforcement, will be used to develop a detailed picture of the missing person, the events surrounding their disappearance, probable behavioral patterns, likely scenarios of events and narrow down probable locations where the person may be.
Search resources will be applied in a combined manner to search high probability areas, eliminate areas the subject is not at, locate specific sign/indications of the subject’s presence and follow up on pertinent clues and indicators. Multiple types of resources will be moved through search areas in order to increase the likelihood of detecting the missing person.
How We Search
Ground Units (walkers)
Foot patrol styled searching involves a variety of tactics including grid searching, purposeful wandering (going to notable points) and surveying (observation post work). These personnel depend on the use of their senses, teamwork and attraction methods.
Mounted Units
Mounted personnel are able to search areas rapidly. The riders benefit from their raised perspective for general observation and sign-cutting. The horses themselves, when trained, can be as active in searching as their riders. Trained horses will alert to both visual clues and smell (which has been shown to be as good, if not better, than most dogs).
Dog Units
Dogs and their handlers work in small teams to either search large areas or seek and follow a specific scent trail. Different dogs are trained in different methods. Not all dogs are “scent specific.” Those that aren’t scent specific will search for human scent versus a specific person. Knowing the dog’s training and its handler’s experience is key to effective use by a search manager.
Sign-Cutters/Trackers
Trained to various levels of proficiency in detecting, identifying and following disturbances in an environment made by humans or animals. These personnel depend on keenly honed observational and analytical abilities to understand their environment. Frequently used to determine route of travel and analyze clues. Extremely versatile and frequently combined with other units as force multipliers (especially alongside dog units).
Helicopters
Though their effectiveness varies according to the environment and skill of the crew, these units are often able to bring sophisticated imaging technology into play. Forward Looking Infra-Red (or FLIR) in dense environments and active visual observation in open areas can yield good results. These units depend on visual cues. They’re also immensely helpful in raising the morale of the missing person (since they tend to hear or see the helicopter, even if it does not see them).
What You Can Do
Pre-Plan
The best way to speed your rescue is to tell the authorities where you are. When you make a plan for your trip, document your intended route of travel, planned activities, timetable, how you can be communicated with and key information about your travel group. Leave this information with a person you trust and establish an emergency plan: When will you be back? How long should they wait before calling authorities? Will you be checking in regularly? Oh yeah… and stick to your plan. If you do make a change, communicate those changes before you act on them. Sending rescue to the wrong location can be as bad as sending them on a wild goose chase.
Get The Right Equipment and Training
Buy yourself and your rescuers time by equipping to survive for at least 48 hours on your own. Train and practice survival and basic wilderness medicine. Equip to fill skill-deficits and meet the demands of your environment. If you’re out hunting, bring some flashy clothing alongside your camo or consider carrying an MPIL.
Be Honest With Yourself – Realize When You are Lost
People in denial get themselves into deeper trouble. Be honest with yourself and acknowledge if you’re lost. Move to the next step.
Stay Put
If you’ve done the above and ended up in a bad circumstance, STAY PUT. Find a safe location to set up camp and stay there. This is one of the most effective plans if you have a reasonable expectation that someone will come to find you. People tend to get themselves more lost when they move or take themselves out of the search area before there’s time for rescue resources to respond. SAR teams using the data provided and effective tactics will narrow down your location.
Burn the Camouflage
Make yourself and your location as detectible as possible. Think in terms of sight, smell and sound from all angles. Match your methods to the resources that may be used to find you. Your nice leaf-shelter may be warm, but a searcher may walk right past it if it isn’t distinctly marked.
Establish Communications
More and more of the country is covered by cell phone communication technology and satellite communications are becoming increasingly affordable. Even if you don’t know where you are, trained SAR and Law Enforcement personnel can use the device’s signal to narrow down your location. Personal locator beacons can help immensely as well. As with all technology, have backups and know how to use it properly.
Be Ready For Variable Responses
There’s not a single standard for Wilderness Search and Rescue methodology. Availability and quality of Wilderness Search and Rescue varies widely across the nation. Know the organizations that are responsible for missing person incidents, how they operate and who the right points of contact are. Be very wary of any private search and rescue organization that isn’t integrated into official emergency management or Law Enforcement systems.
Don’t Get Lost
While every Search and Rescue Responder loves to get into the field and apply their skills, they also know they’re taking a tremendous risk. Remember that every mission involves putting numerous people, animals and resources in harm’s way. All will push the limits “That Others May Live.” Respect their dedication and sacrifice by taking every effort to prevent an emergency before it happens.
Special Considerations for Children
A lost child is a terrifying experience for parents and an incident of greatest urgency for rescuers. Given the limited mental development of children, especially at younger ages, it can be extremely hard to prepare them for being “lost.” The National Association for Search and Rescue (NASAR) developed an educational program called “Hug-A-Tree” in the 1980’s to combat this challenge. Designed for children between the ages of 7 and 11, it teaches basic survival principles and how to appropriately respond to being “lost”, as well as being “found” (which can be an issue all its own). This highly effective program can be taught by anyone with adequate preparation. All training materials are available for affordable purchase or download from the NASAR Website.
To Learn More
If you’re interested in learning more about Search and Rescue, contact your local search and rescue team or look into the following organizations:
Editor-in-Chief’s Note: Please join us in welcoming Evan Koepke as a contributor on ITS Tactical. Evan is the former chairman of the Blue Ridge Mountain Rescue Group and the Appalachian Search and Rescue Conference. His training and experience includes wilderness search management, lost person behavior, sign-cutting, technical rescue and wilderness medicine. He currently works as the Operations Planning Associate for Team Rubicon, a veterans-based international disaster response organization.
It’s the 1970s. A 30-something man makes his way across the Golden Gate Bridge. He’s passed by pedestrians and cyclists, and steps around tourists taking pictures of Alcatraz, Angel Island, and the channel of water below that runs between San Francisco Bay and the Pacific Ocean. He gazes up at the reddish-orange towers soaring above, and then climbs over the bridge’s four-foot safety railing. He steps out onto a 32-inch wide beam known as “the chord,” pauses, takes one last long look out at the bay, and then jumps. His body plummets 220 feet and violently hits the water at 75 mph. The impact breaks his ribs, snaps his vertebrae, and pulverizes his internal organs and brain. The Coast Guard soon arrives to recover his limp, lifeless body.
When the medical examiner later located and searched the jumper’s sparse apartment, he found a note the man had written and left on his bureau. It read:
“I’m going to walk to the bridge. If one person smiles at me on the way, I will not jump.”
What Good Shall I Do This Day?
Benjamin Franklin was a moral pragmatist who had little patience for theology and preaching that didn’t encourage a man to become an upstanding citizen and do some good in the world. As he couldn’t find a sect he felt sufficiently espoused these pragmatic ideals, he eschewed church attendance and came up with his own program of self-improvement. Franklin set out to live a set of 13 virtues, a challenge designed to push himself to become as morally perfect as possible. Each week he picked one of the virtues to concentrate on and kept track of his failures in a notebook dedicated to that purpose.
Of the 13 virtues, Franklin found it most difficult to implement the principle of Order into his life. As an aid in doing so, he created a daily schedule for himself:
To begin his day on the right foot, not only in regards to Order, but living virtuously in general, he would ask himself this question:
What good shall I do this day?
Reflecting on this question helped him think about what opportunities for serving his fellow man might arise during the day.
In the evening, he would return to the question by asking himself: “What good have I done today?” He examined how he had spent his hours and whether he had done the good deeds he had planned on doing, as well as taken action when unforeseen opportunities to serve others had arisen.
In his virtue notebook, Franklin also inscribed a prayer that helped him remember the purpose of this exercise:
“O powerful Goodness! Bountiful Father! Merciful Guide! Increase in me that wisdom which discovers my truest interest. Strengthen my resolutions to perform what that wisdom dictates. Accept my kind offices to thy other children as the only return in my power for thy continual favors to me.”
But What Good Can I Do?
“Loving-kindness is the better part of goodness. It lends grace to the sterner qualities of which this consists and makes it a little less difficult to practice those minor virtues of self-control and self-restraint, patience, discipline and tolerance, which are the passive and not very exhilarating elements of goodness. Goodness is the only value that seems in this world of appearances to have any claim to be an end in itself. Virtue is its own reward.” -W. Somerset Maugham
Many of us want to be like Franklin and do good in our lives. But what does doing good even mean?
74% of Millenials believe they can make a difference in the world. But if pressed, most aren’t sure what that difference will entail.
I was talking to a 20-something friend of mine the other day, and he said, “I feel everyone in my generation wants to change the world, but if you ask them how, nobody knows. They have this restless urge to do something important, but all they ever actually do is buy products designed to ‘build awareness’ or tweet out a certain hashtag to show their support for some cause.”
It’s great to have big, idealistic plans to build wells in Africa or change the whole political process. But oftentimes we only associate doing good with doing something big, and since we don’t know how to get started on a huge project, we end up doing….nothing at all.
Might I suggest we aim simultaneously lower and higher?
Society has any number of pressing needs that are crying out to be tackled. But there’s a need that everyone can start addressing immediately — no experience or Kickstarter campaign required: regularly showing more human kindness.
I know, I know. Talking about kindness can seem cheesy. It isn’t cool. Doesn’t have much currency in our cynical age. Kindness doesn’t scream “manly” either. But I truly believe that helping our brothers and sisters along the way is what this life’s journey is all about, for men and women alike. At the same time, this service is the surest path to finding our own happiness.
Showing kindness doesn’t have to involve Mother Theresa-like dedication. It’s the small things that often not only make the most difference, but also most test our character.
Last year, the writer George Saunders gave a commencement address on the subject of kindness to the graduates of Syracuse University. In the speech, he recalls some of the bigger mistakes and mishaps of his life, and notes that despite their negative consequences, he regrets none of them. Instead, it is a small moment from his youth, a foible of omission rather than commission, that still niggles at him:
“In seventh grade, this new kid joined our class. In the interest of confidentiality, her Convocation Speech name will be “ELLEN.” ELLEN was small, shy. She wore these blue cat’s-eye glasses that, at the time, only old ladies wore. When nervous, which was pretty much always, she had a habit of taking a strand of hair into her mouth and chewing on it.
So she came to our school and our neighborhood, and was mostly ignored, occasionally teased (“Your hair taste good?” — that sort of thing). I could see this hurt her. I still remember the way she’d look after such an insult: eyes cast down, a little gut-kicked, as if, having just been reminded of her place in things, she was trying, as much as possible, to disappear. After awhile she’d drift away, hair-strand still in her mouth. At home, I imagined, after school, her mother would say, you know: “How was your day, sweetie?” and she’d say, “Oh, fine.” And her mother would say, “Making any friends?” and she’d go, “Sure, lots.”
Sometimes I’d see her hanging around alone in her front yard, as if afraid to leave it.
And then — they moved. That was it. No tragedy, no big final hazing.
One day she was there, next day she wasn’t.
End of story.
Now, why do I regret that? Why, forty-two years later, am I still thinking about it? Relative to most of the other kids, I was actually pretty nice to her. I never said an unkind word to her. In fact, I sometimes even (mildly) defended her.
But still. It bothers me. So here’s something I know to be true, although it’s a little corny, and I don’t quite know what to do with it:
What I regret most in my life are failures of kindness.
Those moments when another human being was there, in front of me, suffering, and I responded . . . sensibly. Reservedly. Mildly.”
After Saunders gave his address, he said that many people came up to him to share their regret over a very similar episode – a lonely classmate they thought about befriending, but didn’t.
I have the very same regret myself. There was a girl in my high school – new, very shy, not as affluent as the other students. Often when I would come out of my last class before lunch and start heading over towards the cafeteria, I would see her sitting alone, eating her lunch in an empty part of the building. Each time I saw her, I would think about inviting her to eat lunch at my table. But what would my friends think? And maybe it would be weird to try to talk to her. So I did nothing. And I still think about her sometimes. The things we regret most in life surely are our failures of kindness.
You don’t still need to be in school to find opportunities for doing good. Every day there are so many little things you can do to ease another’s burden just a bit.
Awhile back I came across a really uplifting thread on Reddit (I know, it happens occasionally). The question posed was, “How did a non-sexual, random encounter with a complete stranger, completely change your life?” I’d like to share just a few of the responses that show the power of small acts of kindness:
“6 years ago my wife and I had just had our first child. He was born through emergency c-section because he wasn’t responding to labor. He went straight to the neonatal intensive care unit due to rapid breathing problems. My wife and I were only allowed to see him at certain times of the day after we had spent 20 minutes scrubbing up. We were allowed to feed him but not hold him. After 3 days of staying at the hospital we were extremely tired, frustrated, scared, and unsure of what would happen next. The doctor gave my wife a Rx and I volunteered to head out and pick it up. I hadn’t showered in a couple days and I imagine I looked somewhat like a zombie.
I walked in to the nearest drug store and gave the clerk at the pharmacy the paperwork. He was a 20-something guy working the night shift. He must have noticed I was a little down and he asked how things were going. I told him that we had just had our first son but that there were complications and that he was in the NICU. He asked my son’s name and I told him. He repeated the name back to me and said thoughtfully, “That’s a strong name, sounds like a Heisman trophy winner…I’m sure he’s gonna be just fine.” He smiled and I teared up. He handed me the medicine and told me to make sure I got some rest and I thanked him and went back to the hospital to stay with my wife. 2 days later on Christmas Day we went home as a family with a healthy baby. It may have not changed my life but I will never forget the kind words he spoke…it gave me a glimmer of hope in the middle of a hard circumstance. Never underestimate the power of a kind word to a stranger.”
“I was having a bad day and was traveling by Greyhound from my friend’s city back to mine. I had to transfer and ended up seated next to a guy with a laptop. I don’t know if he could tell that I was upset or not, but he asked me if I wanted to watch something with him. We ended up sharing headphones and watching Where the Wild Things Are. I was pretty shy back then but if I could meet him again today I would thank him for cheering me up.
I know it’s not a life-changing story, but it’s a little thing that made a big difference back then.”
“When I first started trying to run, I couldn’t even jog a mile. I could barely jog a quarter mile.
One day, I was jogging on a very popular jogging trail near my campus and was basically dragging my feet, sweating like a pig, and wheezing like crazy. Of course the seasoned runners pass me by without so much of a glance but I always remembered this one old man who slowed down to tell me,
“Keep it up, you’re almost there!”
His smile and encouragement is something I remember now every time I’m struggling during a workout. Fast forward a few years and I am much healthier and fitter. One of my favorite things to do is offer kind words of encouragement to strangers I see at the gym or anyone struggling on the jogging path. Exercise is easy – it’s the motivation that’s hard.”
Stepping out of your comfort zone to show another person a bit of human kindness can be surprisingly challenging. But the effort it takes to swallow our shyness to talk to another, and/or to put aside our impatience to spend some extra time with someone who looks in need of comfort can end up meaning the world to them. Doing good isn’t limited to helping strangers, either. It can mean choosing to greet your children with warmth when you come through the door despite your hard day or staying up late to help your stressed girlfriend study for a test.
Something I’ve come to understand quite profoundly as I’ve grown older is that folks who are struggling – strangers and friends alike – frequently do not advertise their pain. I cannot count the times I’ve thought another person had it all together – the perfect job, the perfect family, the perfect life – only to have them later reveal some incredibly painful death, disease, or crisis they were grappling with. Every man really is fighting a hard battle. Thus, kindness is something you shouldn’t reserve and only dole out when you see an acute need, but something you embody in your day-to-day life. Your inherent warmth may bring someone comfort without your ever knowing it.
Seeking to do good each day weaves rich threads of integrity into our life, so that when we reach the end of our mortal existence, we can be proud of the tapestry of our actions and have few regrets for the things we should have done, but didn’t.
One of my favorite old hymns is “Have I Done Any Good?” It was written in the latter part of the 19th century by Will L.Thompson, a member of the Churches of Christ, but its message cuts across religious lines. Singing and listening to it is a reminder to me of the path I want to take in life:
1. Have I done any good in the world today?
Have I helped anyone in need?
Have I cheered up the sad and made someone feel glad?
If not, I have failed indeed.
Has anyone’s burden been lighter today
Because I was willing to share?
Have the sick and the weary been helped on their way?
When they needed my help was I there?
2. There are chances for work all around just now,
Opportunities right in our way.
Do not let them pass by, saying, “Sometime I’ll try,”
But go and do something today.
‘Tis noble of man to work and to give;
Love’s labor has merit alone.
Only he who does something helps others to live.
To God each good work will be known.
(Chorus)
Then wake up and do something more
Than dream of your mansion above.
Doing good is a pleasure, a joy beyond measure,
A blessing of duty and love.
It’s 2008 and 20-year-old Johnny Benjamin is standing on the edge of Waterloo Bridge in London. He’s lost in his own world of psychic pain, trying to figure out the right time to jump and end it all.
Then he hears a voice call to him. A voice that penetrates his bubble. Another 20-something, Neil Laybourn, very calmly says, “Please don’t do this, I’ve been where you are and you can get better. Let’s have a coffee and we can talk about this.” He begins asking Benjamin about himself, and the two discover they had grown up just 10 minutes from each other. After they chat for a bit, Benjamin climbs off the bridge.
Laybourn’s simple words saved his life.
“He reminded me of what people do every day so the normality of it was really inviting,” Benjamin later recalled. “His act of kindness changed my outlook on life.”
For his part, Laybourn doesn’t think of himself as a hero – it was just a matter of stepping up instead of turning his back:
“Maybe it was fate, it was easy to make a connection. There are people who would walk past and there are those who would have taken action. I am proud that I was in the crowd that took action.”
What good will you do this day?
Editor-in-Chief’s Note:This post was written by Brett and Kate McKay of The Art of Manliness. The Art of Manliness is a fantastic Website dedicated to uncovering the lost art of being a man. It features articles on helping men be better husbands, better fathers and better men. Check them out and be sure to subscribe!
