Combat first aid kit placement on your gear

There are many dangers and potential hazards on the battlefields and without a good first aid kit you will die, so you should carry the right stuff among your combat gear. But what to carry and where? Let’s find out!

The IFAK (Individual First Aid Kit) is practically mandatory for all army reservists and practical shooters. You can select the contents based on your first aid know-how and wallet, as long as you take certain basic principles into account. Various armies also distribute these to their soldiers. In Finland, the first aid pouch is identical to the magazine pouch. If this is the case, you should mark the first aid pouch with e.g. red tape to avoid mistakes. One of the authors, Mika Mäenpää has put some red paracord on his. The main idea is not to treat other people with your IFAK, the wounded should be treated with their IFAK. That is why it is vital that everybody in the unit carries the same first aid gear and that they are all marked the same way.

What to carry in the IFAK?

Everybody should carry their IFAK in an IFAK pouch. These are usually easily detachable rip-off pouches or inserts for general-purpose/magazine pouches that you can quickly throw to your teammate when needed. The kit should include stuff for stopping bleeding, ensuring breathing, keeping the patient warm, and treating a tension pneumothorax. For this, you usually carry an emergency bandage, a hemostatic gauze or granules, nasopharyngeal airway, chest decompression needle, vent chest seal, survival blanket, as well as heavy painkillers, such as morphine, in autoinjectors on peacekeeping operations. Many also include rubber gloves, a burn dressing, and a second tourniquet in their IFAK. The Israeli Emergency Bandage is something of a standard in the industry, and this is what the Finnish Defence Forces also use.

Hemostatic gauzes, such as the Combat Gauze, have nowadays pretty much replaced the hemostatic granules. Their undisputed benefit is that unlike granules, they cannot easily go where they shouldn’t go and they don’t easily bugger off in the wind.

Don’t be an idiot, carry a vented chest seal with you. Making an improvised chest seal from scratch is difficult: why wouldn't you make things easier for the medic who comes to help you? It is possible to craft an emergency solution using duct tape and plastic wrap but you easily cause a tension pneumothorax with such a contraption. The improvised version doesn’t have a vent. And since the tape solution is so tight, accumulated pressure cannot be released.

It is worth remembering that a slightly lower body temperature is already serious hypothermia for a patient that has suffered a traumatic injury. Because of this, hypothermia is a serious risk in Finland even in summer but especially during the three other seasons. You should thus always try to keep the patient warm and therefore the Finnish combat first aid kit always has a space blanket. Instead of the shiny silvery blanket, the Finnish army distributes a version that is green on the other side, which is of course a more tactical choice. How about autoinjectors? They will teach you to use those when they give them out.

You should also carry along scissors or another safe cutting device because finding the shrapnel holes might require a very thorough inspection. A strap cutter is another good option and it also has many other uses, too. A knife can of course also be used to cut open the clothing but you can easily create more unnecessary holes in the patient with those when you are somewhat stressed.

Don't skip items in the recommended list even if you're not trained on how to use them. Remember: the contents of your kit are tools for the other, more qualified person, who comes to your help.

First aid gear placement

We explain the basic principles of gear placement in this article. The IFAK is usually placed on the second line, i.e. attached to the combat vest or plate carrier. This is when you wear both the vest and the battle belt. There are also situations when you don’t have a vest, only the belt. Then you should carry the IFAK on the belt or in your pocket. Then there is of course the option where you have two sets, one on the belt and one on the vest.

If the IFAK is placed on the vest, you should also carry at least a bleeder pouch on the belt. It is a separate, lighter first aid kit designed solely for stopping bleeding. It usually has a tourniquet, an emergency bandage, and a hemostatic gauze/granules. There is a saying in the USA that when you have a device designed for making holes in people, you should also always bring along something for fixing such holes. Many professionals that carry a pistol in civilian clothes also carry bleeder pouches in cargo pockets. When you have a bleeder pouch, you also always have a tourniquet, either in the pouch or separately.

Bandaids and mild painkillers don’t have a place among life-saving first aid gear in the IFAK or Bleeder pouch. This is because you don’t want to rummage through piles of crap during an emergency. You should carry these separately on the third line in a small BooBoo pouch. This is the place for bandaids, blister plaster, headache pills, and other prescription-free medicine.

The other author Hemmo Päiveröinen uses a wide padded battle belt with a compact rip-off IFAK that is placed on the back in a way that it is accessible with both hands. Furthermore, he has a rip-off IFAK pouch on the left backside of the vest that carries a full set. Because it is designed for other people that treat him, he doesn’t need to be able to access it. So, it can be placed wherever it isn’t in the way as long as other people easily identify it and the contents are identical with the rest of the unit.

Tourniquet placement

The tourniquet (TQ) is a device that stops bleeding. Nowadays many of them can be used with just one hand. It can be placed on both the first and the second line, preferably several on both. Combat Application Tourniquet (C.A.T.) and SOF Tourniquet (SOF-T) are the current market leaders. Both of these are used by various armies and both of them work. Which one you use, depends on your preference. Mäenpää has the CAT because it can be used with one hand. However, he also carries a SOFT in his IFAK in case one tourniquet doesn’t stop the bleeding since SOFT is more efficient.

The tourniquet placement is always a compromise. The most important thing is that you can access it with either hand and with all your gear on. Secondly, it should stay out of the line of fire. However, since the gear placement is always a compromise, you should acknowledge the threats, possibilities, and risks. Sometime in 2012 in Afghanistan, British soldiers started carrying the tourniquet in the left elbow pocket of the combat shirt in such a manner that it attaches to the velcro surface of the pocket. This method is nowadays also used by many Finnish professional soldiers. It is quite efficient but a downside is that it is impossible to get the tourniquet from the left sleeve with the left hand. That is why many carry a second one in the right sleeve. Another problem with the sleeve carry is that if the arm takes a bigger hit, there goes the sleeve, arm, and the tourniquet. Therefore it is good to carry several tourniquets.

Some people carry the first line tourniquet in a separate pouch, attached to the battle belt or the utility belt. Even though the tourniquet can take a pounding and it doesn’t need to be sterile, you should still consider getting a pouch so that the tourniquet doesn’t get tangled everywhere, and the Velcro doesn’t gather all sorts of crap. There are several small pouches available, both vertical and horizontal. You should mark the pouch with ”TQ” or +, so it can be easily found during an emergency.

You should have another tourniquet or two on the second line. If you have two, one could be in the IFAK but the other one must be easily accessible with either hand. Many people attach the tourniquet horizontally e.g. with a bungee cord in the top center of the plate carrier. The first aid kit of the Finnish army has a tourniquet pouch that many people carry on the shoulder of the M17 vest on the support arm side. It is a good place as long as you can access it.

Mäenpää carries four tourniquets. Two of them on the first line (inside the sleeve of the combat shirt and in the bleeder pouch on the battle belt) and two on the second line (on the centerline of the vest and inside the IFAK). Päiveröinen carries three. One on the belt, one on the vest, and one in the IFAK. The one on the vest is placed in a separate pouch on the right side next to the rifle mag pouch so that it doesn’t interfere with pistol handling.

Golden rules

To sum everything up, here are a few important rules of thumb:

• Win the battle before treating people. The best combat first aid is supreme firepower.
• Don’t treat anybody in open terrain. With stupid aid, you get two wounded instead of one!
• The principle ”One is none, two is one, three is two…” also applies to first aid gear.
• Always use the first aid kit of the wounded. Your kit is for yourself.
• Place the first aid stuff on your combat gear so that you can access them in all positions, with either hand. Agree in advance, where everybody in your unit carries the first aid gear, and have everyone mark the pouches clearly so that the person coming to help the wounded will quickly find what they need.
• Understand the principles of cABCD and learn to use a tourniquet and other items in the IFAK on e.g. a TCCC course.

Authors

Major Mika Mäenpää has served in the Finnish military for 20 years and has participated in operations in Afghanistan and Africa and in the development of tactics and infantry gear. He trains CrossFit and shooting, possessing a gold medal in the Finnish Sniper competition and has represented Finnish Defence Forces in international sniper competitions.

Hemmo Päiveröinen is the lead designer of Särmä TST and Terävä brands at Varusteleka. Hemmo has also worked in various security duties both in Finland and abroad for over ten years and worked as a full-time firearm and security instructor for seven years. He has trained more than a thousand professionals and hobbyists and has undertaken more than 50 security training programs in Europe and the USA.