Building A Trauma Kit/IFAK

My IFAK in its current configuration

Even though we may never find ourselves in fighting similar to that in Fallujah or Helmund Province, as shooters, hunters or preppers we nevertheless need to be ready to treat a gunshot or other serious injury that might happen in the field. Fortunately, the military has learned a lot over the past two decades of war on how to provide first aid care in the field, and we have a multitude of new products that our predecessors didn't have to treat a traumatic injury. 

    I haven't been without first aid supplies--in fact, my wife and I probably are better outfitted than most people in that regard. But as I saw more and more violence and unrest this past year, as I read more about the topic of having a first aid kit capable of treating a gunshot injury, and I thought what could go wrong when shooting out in the desert miles from anyone else, my mind started to focus on putting together a trauma kit to treat a gun shot injury. 

    The model for a trauma kits is the soldier's Individual First Aid Kit (IFAK). Per the Handbook on Tactical Combat Casualty Care (download PDF), care in the field generally follows two different acronyms: MARCH and PAWS. 

    MARCH stands for massive hemorrhage, airway, respiration, circulation, head injury/hypothermia and is used to help remember the proper order of treatment. PAWS stands for pain, antibiotics, wounds, and splinting, and is used to help remember additional casualty care issues. For purposes of the IFAK, our primary concern will be the MARCH outline of treatment. The equipment and supplies in the IFAK should, therefore, address each of the MARCH points, even if the treatment (and equipment) may be minimal for certain types of injuries.

This is a standard type of first aid kit that you would find in a small office or business or even a home. It is designed to deal with minor injuries such as cuts, minor burns, abrasions, etc. It does not have the equipment or supplies to deal with severe trauma.

    The Handbook describes two types of IFAKs: an IFAK Generation I and the Generation II. The recommended contents of a Generation I kit are:

• (1) A utility pouch to carry the items in the kit;
• (1) Combat Application Tourniquet (CAT);
• (1) Elastic bandage;
• (1) Gauze bandage (4-1/2 inch);
• (1) Roll of surgical adhesive tape (2 inch wide);
• (1) Nasopharyngeal airway;
• (4) Patient exam gloves (i.e., two pair); and,
• (1) Combat gauze dressing.

The military also includes a list of contents and an insert to organize the kit. If we look at this kit, it really only hits the first two items on the MARCH list: treating massive hemorrhaging and an airway obstruction.

    The Generation II kit is a step up and probably what you should consider the minimum for your IFAK. It includes:

• A pouch specifically designed for the purpose;
• (2) Combat Application Tourniquets (CATs);
• (1) Elastic bandage kit;
• (1) Gauze bandage (4-1/2 inches wide);
• (1) Roll of surgical adhesive tape (2 inches wide);
• (1) Nasopharyngeal airway;
• (4) Patient exam gloves (i.e., two pair);
• (1) Combat gauze dressing (e.g., QuikClot);
• (1) Rescue strap cutter;
• (1) Valved/vented chest seal;
• (1) Eye shield; and
• (1) Marker.

The Handbook indicates that the Navy makes use of a kit with a needle (dart) for decompression of chest wounds. The Gen II is an improvement over the first generation IFAK because it also addresses respiration and one type of head injury—injury to the eye.

    The Handbook is from 2017, and there are a few things that have changed since it was published. First and foremost is that the CAT (and SOFT-T) are no longer the only tourniquets approved by the Committee on Tactical Combat Casualty Care (CoTCCC). Also, in studying the subject, I noted that most recommendations for the kit contents omitted a rescue strap cutter in favor of a pair of trauma sheers, recommended two vented chest seals, and seemed satisfied with just one tourniquet (although two are recommended for injuries to a thigh). The interest from the civilian market has also resulted in a larger number of different pouches being made available.

    As I looked at most pre-assembled kits for sale, the one thing I saw over and over was that they typically did not include the combat gauze (like QuikClot) or a CoTCCC approved tourniquet which are typically the two high cost items in such a kit.  And those that did typically seemed more expensive than what I thought I could do on my own. Plus, there seemed other items that I would like to include. For that reason I decided to put together my own kit.

MARCH Resupply Kit (Contents)

MARCH Resupply Kit in package

    I decided to start my kit by purchasing the NSN MARCH™ IFAK Resupply Kit from Kommando Store. (As of this writing, they are out of stock, but they do get restocked so check back). I think that I paid $60 or $70 for mine, but the current listed price is $54.99. The kit came with the following items:

• TMT™ Tourniquet 1 ea
• Celox® RAPID 1 ea
• Pre-Lubricated Nasal Airway 1 ea
• Sentinel Chest Seal 1 ea
• Dart 1 ea
• Battle Bandage 1 ea
• Battle Wrap 1 ea
• Rolled Gauze 1 ea
• Eye Shield w/ Garter – Polycarbonate 1 ea
• Gloves (pair) 1 ea
• TCCC Card DD-1380 1 ea
• Mini-Sharpie 1 ea
• Quick Start Guide 1 ea

Kommando Store noted two issues with the MARCH kit which was that the TMT tourniquet was not as good as other brands, even though it had military approval. The second was that the exam gloves were black, which makes it difficult to evaluate a patient for blood loss; they recommended getting lighter colored gloves so you can see the blood on the gloves as you run them over yourself or a patient. I have seen similar comments from many other writers and YouTubers discussing IFAKs.

    Kommando Store even offers an upgraded version for $80 that includes blue exam gloves and a CAT tourniquet (again, they are out of stock at the time of this writing, but check back periodically). They didn't offer the updated kit when I was assembling mine, but it wouldn't have mattered because I had some other items I wanted to change or add, and a whole box of grey exam gloves at home.

    For a pouch, I initially turned to a medical pouch that came with a surplus British military load bearing vest made by Osprey. Unfortunately, the pouch was too small to fit all of the items in the MARCH kit, and it was a simple open utility pouch that did not provide for organizing your supplies.

    In the videos I watched about putting together an IFAK and using one, I noticed that several of the EMTs/Paramedics were using and/or recommended the Condor Rip-Away EMT Pouch. It comes in several colors, and is a tri-fold pouch with multiple pockets and loops for holding supplies. It is attached via hook and loop to a MOLLE panel, allowing it to be ripped loose from the panel. It also has PALS loops on the front as well as a loop panel to attach a patch or other item. And, it is available for a reasonable cost--approximately $25 from Amazon. I picked the Coyote Brown color so that it would at least kind of work with my camouflage patterns. 

Condor Rip Away Pouch (front) with a patch I added to identify it as a medical kit

Condor Rip Away Pouch (back)

Condor Rip Away Pouch with the backing partially detached from the pouch.

    Some other items I decided to add or change to the basic kit was to purchase a pair of 7.5-inch trauma shears, upgrade the tourniquet to a M2 2" Ratcheting Medical Tourniquet (RMT) from Rescue Essentials (which is CoTCCC approved--now available at Amazon if you prefer), included a small pen light for checking pupil dilation or to help with seeing, and threw in a space blanket for keeping a patient (or myself) warm to prevent hypothermia. The TMT tourniquet that came with the MARCH kit went into my home first aid supplies.

    The MARCH kit came with a basic, non-vented chest seal, but included a dart for doing a needle decompression of a tension pneumothorax (i.e., when excess air is introduced into the pleural space surrounding the lung that actually puts pressure on the lung impeding the ability to breath). That's all well and good, but I haven't had training for it, and with the obesity epidemic, the standard insertion point may not work on large people (or women with large breasts) and an alternate insertion point might be needed. Accordingly, I upgraded to a two-pack of the North American Rescue Hyfin Vent Chest Seal. I kept the non-vented chest seal just in case I needed more, and I have kept the dart for use by a professional should one be available.

    Finally, my wife has some severe allergies and it is possible that I might encounter someone going into anaphylactic shock--the local news recently reported of the death of girl at a party due to a food allergy--and so, with her permission, I took one of her extra Epi-Pens and included it in my kit.

Tourniquet, shears, and Voodoo Tactical pouch

    Unfortunately, the RMT tourniquet is larger and bulkier than other CoTCCC approved tourniquets, and I wasn't able to fit it into my pouch. I wound up purchasing a VooDoo Tactical Tourniquet Pouch with Medical Shears Slot which I could attach to the outside of the medical pouch or to a load bearing vest. I picked that brand and model because it was larger than many of the other tourniquet pouches. The RMT fit (barely) and it gave me a better place to store my trauma shears. It comes in colors other than the OD, but I didn't want black or red, so OD it was.

My medical kit in its current configuration.

Contents of upper section. I know that it is advised to get rid of the instructions cards to save space and weight, but I don't know if someone else will be needing to use the items on me.

Contents of middle section. These fit in the smaller elastic loops. There is still an area behind the loops and a pocket to store other items if necessary.

Contents of lower pouch. I plan on adding surgical tape and some other boo-boo type items.

    Moving forward, I plan to add tape, a triangle bandage, and some "boo-boo" type stuff such as adhesive bandages and antibiotic ointments. I have suffered some minor cuts to my fingers in the field that have bled profusely, and so smaller adhesive bandages are a necessity unless you don't mind bleeding all over your self or your firearm. I also plan on adding more gauze or other bandaging materials.

    Another project I have is to build a more basic kit. Earlier this year I purchased a surplus British military plate carrier in their Multi-Terrain Pattern (MTP)--basically Multi-Cam--and among the pouches was a medical pouch updated over what had come with my earlier load bearing vest in that it was actually designed to zip open and organize your medical supplies. 

Upgraded British military IFAK pouch (front)

Upgraded British military IFAK pouch (back)

Upgraded British military IFAK pouch (open)

    And that, dear reader, is the evolution of my trauma kit to date. As noted, I have plans to update it further. I also plan on getting a MOLLE panel I can attach to the back of a seat in my vehicle to which I can attach the kit when I'm out and about. As always, any comments, suggestions, and critiques are welcome. My choice of tourniquet was based on a recommendation from a long-time reader, and so I appreciate any other ideas.