Building Your Own IFAK - Total Urban Survival Style
It is better to have and not need than to need but not have
Author: Garland H. - (Silat Sharaf Practitioner, ER Nurse)
WHAT IS IT?
IFAK is the “tacticool” acronym for Individual First Aid Kit. The best IFAK is the one that you will carry, either in your vehicle, or in a bag on your person where it is easily accessible. There is no point in purchasing a ready-made kit or assembling one just to keep stashed away where you cannot get to it in an emergency. An IFAK, and the items in it, are only as good as your understanding and ability to apply them (more on this in future knowledge drops, stay tuned).
All the necessities that can be carried almost everywhere
WHAT’S IN IT?
A good way to assemble a kit is to pack according to the two extreme ends of the spectrum of injuries. An IFAK should be able to address common injuries and illnesses (minor cuts and abrasions, sun burns, traveler’s diarrhea, nausea, fevers, etc.) as well as truly emergent concerns such as uncontrollable bleeding, penetrating trauma, facial trauma (especially the eyes), airway issues, etc. I will break the contents into the following sub-sections:
PPE (Personal Protection and Equipment)
Protecting yourself first and foremost
Gloves: I particularly like thick nitrile. This helps prevent the transmission of blood and body fluid transmitted disease. I think it also provides a psychological buffer which allows you to step in and do things you may otherwise hesitate to do.
Facemasks/Eye Pro: keep stuff from splashing in your face. If the air quality is bad, an N95 is a good thing to pack, but even paper surgical masks do the trick. Goggles are great to prevent getting blood coughed into your eyes.
CPR Shield: This is a piece of personal protective equipment which allows a rescuer to provide mouth to mouth resuscitation without going raw dog on somebody else’s mouth. This helps to mitigate fluids from getting from their mouth into your mouth. Unless it is somebody you are particularly close to, you likely don’t want to be rewarded for your life saving and heroic efforts with a mouthful of blood, emesis (puke), or secretions.
For times when you want to be intimate but safe
AIRWAY
NPAs:
Nasal pharyngeal airways, these are sometimes referred to as “nasal trumpets.” Sometimes just placing one of these puppies will allow somebody to breathe effectively enough to get them to definitive care. These can be placed on conscious victims. Any time you are dealing with a person who doesn’t appear to be breathing effectively, you should consider if it is an airway issue or a ventilation issue. If they have an obstructed or ineffective airway, which sometimes presents as snoring, adjunctive airways are your go-to tool. In the absence of these, a jaw thrust is an excellent maneuver to learn. If somebody is.not.breathing…you need to immediately give rescue breaths either by mouth or via a BVM, and they will likely lose their pulse soon after so consider the possibility of needing to do chest compressions if you are trained in CPR/BLS- if you aren’t, take a class now.
Lube:
Carrying lube is a good idea for placing NPAs. Many things can be solved with a judicious application of lube.
OPAs:
Oral pharyngeal airways, a good way to create a patent airway in an unconscious person. It moves the tongue down and out of the way to allow for oxygen to be delivered through the mouth. If somebody is gagging or fighting you as you try to place this, they probably don’t need it. Use an NPA instead. If you have a BVM, “super plugging” a person by placing NPAs and an OPA is also an option.
BVM:
Bag valve mask, these work best if attached to oxygen. These are what professionals use to ventilate people who aren’t breathing. There is some risk of causing barotrauma (damage caused by overinflating the lungs) with these. These are also fairly large, which may or may not influence your decision to include one as part of your kit.
A more advanced kit for people who are trained in their use may include a scalpel for emergent crichothyrotomy- essentially creating a new airway. I’ve rarely heard of this being done successfully in the field by people who aren’t para-jumpers, emergency room MDs, trauma surgeons, anesthesiologists, etc.
BLEEDING
Tourniquet (TQ):
It will hurt like hell, but if it saves your ass, its worth the shot
Hemorrhage from the extremities is perhaps the number one cause of preventable death in trauma cases. Some algorithms have changed from the classic ABC (airway breathing circulation) to put massive visible bleeding at the very top. That massive bleeding wins king of the hill versus airway in some professionals’ eyes should underscore how important this is.
Features you want to see in a tourniquet are a wide band with a windlass and a good method of securement. The idea is that you want to crank this fucker down hard enough to stop the circulation to the injured limb. Think about cranking the windlass as turning off a faucet. Personally, in the absence of one of these (such as a SOF-T or a CAT, both of which you can place on yourself…very useful) I would pick a hastily fashioned fabric and stick/pen/etc. versus some of the thin tourniquets seen on the market. The only use those have would be in placing IVs, phlebotomy, or illicit IV drug use. Apply the tourniquet at least two inches proximal (closer to the body, upstream) to the injured site.
Used correctly, tourniquets hurt. In order to tell whether or not one is working in practice, try feeling for the obliteration of your pulse distal to the device. You shouldn’t be able to feel a pulse. Don’t undo the tourniquet for comfort or to “check” if the bleeding has stopped. Let the doctors in a trauma bay do that.
Permanent marker / sharpie:
write down the time the tourniquet was applied. Some devices have a place for this, if not…write on the victim’s forehead like they passed out at a party. Seriously. Knowing when the thing went on is very important. A lot of research is saying 3-4 hours is fine without lasting neurological or tissue damage from the ischemia (lack of blood flow) to the limb. Even so…life OR limb. If you are far enough away from help and/or have no way of reaching help…be willing to make that call.
Hemostatic Agents:
Quick clot. Usually sold as a gauze, these are great for packing bleeding wounds.
Long cotton tip applicators:
so you aren’t packing wounds with your fingers and potentially running the risk of shredding your digits on bone fragments or shrapnel.
Gauze:
Regular gauze pads and rolls can be fashioned into pressure dressings.
Band-Aide type bandages:
For small cuts.
Superglue:
can be used like medical dermabond for cuts that don’t require sutures but may be too much for a bandaide.
Sutures and a driver:
Sutures come in varying thicknesses and in a variety of materials. Naturally this takes some know how and practice. A driver is something like a hemostat which you can use to pull the needle through skin and sew up a wound. I wouldn’t recommend trying this unless you are trained to do so.
CHEST WALL TRAUMA
Chest Seal:
this prevents air from being trapped and causing further injury. An occlusive (water proof) dressing can also be applied, but leave a side open to allow for some gas exchange. This prevents a tension pneumothorax which can lead to a mediastinal shift which can lead to death. If you applied a dressing and the victim’s trachea shifts over from midline and they start looking grey, this is what’s happening. More advanced tools (speaking of pneumos) would be a decompression needle. Again, this is only to be done by trained professionals.
BONEY INJURIES
Splints: pre-fabricated splints are relatively cheap and can be found online.
Elastic Bandages and Triangular Bandages: can be used to fashion splints and slings.
SPINE:
C-Collar: know how to place these because you have the potential to really hurt someone if it is placed ineffectively or if you turn move somebody’s neck who has had spinal trauma. These are large and may be worth carrying in a car kit rather than one that is more portable.
MEDICATION & NIC-NAKS
(these are all over-the-counter)
OTC nic-nacks
· Antibiotic ointment
· Isopropyl Alcohol
· Sterile Saline (great for irrigating and washing out wounds, especially under pressure- a 5-10cc syringe and an angiocath from an IV work awesome)
· Aspirin
· Tylenol
· Benadryl
· Pepto-bismol
· Ibuprofen
· Dramamine
· Caffeine
· Sunscreen
· Aloe Vera
· Hydrogen peroxide
· Betasept/Hibiclens
· Petroleum jelly (lube)
· Eye wash
· Moist towelettes
· Hand sanitizer
· Anti-itch cream
(if you can acquire it, Narcan/naloxone and epinephrine/epi-pen are VERY handy)
ASSESSMENT
(for people who are trained in their use)
- Disposable stethoscope
- BP Cuff/Sphingomenometer
- Penlight/flashlight (these days a phone works)
- Shears- Leatherman Raptors can also cut off rings and such.
WHY?
I strongly encourage people to carry one in case of an emergency situation, because you never know how far out help is. Circumstances such as natural disasters and mass casualty incidents (read mass shooting) may preclude emergency personnel from reaching you or your families. Accidents in remote locales or life threating injuries which require immediate interventions are also very good reasons to carry an IFAK.
You don’t need a super elaborate rig to be effective. My personal IFAK includes: CPR face shield, nitrile gloves, N95 mask, a knife, trauma shears, a SOF-T tourniquet, quick clot gauze, hemostats, my stethoscope, and a HALO chest seal. It’s not the definitive kit which covers all potential contingencies, but it can help me potentially save a life, and it is reasonable enough to carry with me in my backpack.