By: Friedrich Seiltgen
Disclaimer: The author of this article is not a medical doctor. The information provided here does not constitute medical advice.
With the threat of active shooter incidents, terrorist attacks, and accidents always on the horizon, more and more law enforcement agencies are providing basic traumatic medical training to their personnel. This training, combined with the issue of an Individual First Aid Kit (IFAK), has saved lives of first responders and civilians alike, and the knowledge and resources provided to law enforcers is something all citizens should have.
Learning from Experience
Prior to any formal training, I started carrying an older generation military tourniquet I picked up at an Army surplus store in a case on my duty belt and read up on the basics of applying a tourniquet. I also kept a chest seal and rubber gloves in the pocket of my Body Armor hard plate.
In June 1997, I responded to an anonymous call referencing a suspicious incident in a public housing complex. I found a mid-20s male lying on the ground with a gunshot wound to the chest. At that time, our only medical training was CPR. I took a towel we were issued and applied pressure to the wound. I asked the victim who shot him, but he just kept shaking his head “no.” He died about the time paramedics got there and took over. When they picked him up, we realized his gun had been lying underneath him the whole time. It was a 380 still in the holster. Apparently, somebody got the drop on him.
Basic Trauma Care Materials
Times, thank goodness, have changed.
Before retiring from Orlando Police, I attended a three-day Basic Tactical Medical Training Program, courtesy of FLETC (Federal Law Enforcement Training Center). Another name for this course is Tactical Combat Casualty Care. This training is extremely valuable and may save your life or someone else’s someday. The instructor cadre traveled from various FLETC locations to Orlando, Florida to train us in basic traumatic injury treatment. It was my first look at Basic Trauma Care and was quite eye-opening.
The IFAK issued to us by the FLETC team consisted of one CAT (Combat Application Tourniquet), one “Israeli” bandage, one “H” bandage, one package of Quik Clot gauze, 4” Trauma dressing, nasopharyngeal airway, chest seal, tape, and rubber gloves.
The Israeli bandage was invented by an Israeli soldier and put into service in 1995. It is a trauma dressing used by Special Forces units throughout the world. It is 6 inches wide and about 7 feet long with a sewn-in pad to absorb blood. It has a pressure bar built in that keeps direct pressure on the wound and enables a wounded person to apply it one-handed. After wrapping it around the wound, you use the closure bar to keep it wrapped tightly.
The H bandage has an h-shaped piece on the back of the pad that maintains pressure while allowing the user to wrap around the “H” and go back in the same direction. It’s easier to use on wounds other than a leg or arm.
The “CAT” tourniquet entered military service in 2004. After full implementation, the number of deaths from exsanguination (blood loss) dropped from 23.3 deaths per year to 3.5 a year, an 85 percent decrease!
Address the Bleeding
Keep in mind, the number one issue in any sort of traumatic injury is to address the bleeding! “Fill that hole,” whether it’s a bullet, knife, or impalement – the bleeding must be stopped. The average person has between 9 and 12 pints of blood in his body. The volume will vary according to the person’s size and other factors. The loss of 30-40 percent, or 3-4 pints, is a class 3 hemorrhage and usually requires a transfusion. Normally once you get over 40 percent loss, the result is death.
I know of patrol officers who keep three tourniquets handy: one in the IFAK, an extra in the patrol vehicle, and one on their person. One local deputy I know deployed a tourniquet on an accident victim’s leg and was told by the doctor that the tourniquet saved the victim’s life.
A Brief Overview of What to Do
What to do when you come upon a gunshot victim varies according to the situation.
In general, the first thing you should do is assess whether the victim is conscious or not. If he’s not breathing, administer CPR. If he is breathing, locate the gunshot wound(s) and any exit wound(s). Address entrance wounds and any wounds affecting the body cavity and/or arteries first, prior to moving to other, more minor wounds.
If the victim is suffering from a “sucking chest wound,” meaning air is entering the body through the wound, wipe the wound and clean up as much blood as possible, and apply the chest seal. If you don’t have a chest seal handy, you can use a hard piece of plastic, such as a driver’s license or credit card and tape.
For all other gunshot wounds to center mass, apply direct pressure with a bandage. Once you apply a bandage, do not remove it, because you’ll remove clotting. Stack bandages and wait for a medical professional to remove them.
Next, move to any exit wounds resulting from the center mass wounds. Apply a bandage and pressure to these to stop the bleeding.
For a wound to the extremities that involves major bleeding (arterial or venous), slide the tourniquet around the arm or leg, cinch the Velcro as tight as you can make it, then turn the windlass rod until the bleeding stops. When the bleeding stops, insert the windlass rod into the windlass clip and secure it with the windlass strap. Apply direct pressure and a dressing to the gunshot wound.
Assembling Your Everyday Carry IFAK
A tourniquet placed in the center console of your car may save your life in an incident or attempted crime, such as a failed carjacking or drive-by shooting. In North Carolina, a man wanted to store his pistol in his car before entering the mall and accidently shot himself in the leg, striking the femoral artery. The man’s life was saved by a police officer’s tourniquet.
Our IFAKs were assembled with the law enforcement officer (LEO) in mind. They are essentially a trauma kit designed for severe bleeding, as the job of an LEO gets more dangerous daily. For the hunter or hiker, adding a few items can turn this IFAK into an EDC (Everyday Carry) IFAK.
Your IFAK contents will vary depending on your level of training and what you’re doing, and it should be matched to the environment and types of injuries you will most likely treat. Your IFAK will also be packaged differently depending on how it will be carried.
The type of bag is important. Many new IFAKs are designed to “rip away.” These are attached to the user’s belt, and if necessary, can be detached and thrown to someone in need. Some suggest carrying just a tourniquet in a pouch on your ankle or in a cell phone pouch and leaving the rest of the IFAK in the car.
There are public and private entities where you can get this valuable professional training and the equipment to go with it. The Red Cross offers First Aid courses, and local fire departments often hold EMT classes.
Just do it already! Get trained, get equipped, and be safe!
Friedrich Seiltgen is a retired Master Police Officer with 20 years of service with the Orlando Police Department. He currently conducts training in Lone Wolf Terrorism, Firearms, First Aid, and Law Enforcement Vehicle Operations in Florida. Contact him at firstname.lastname@example.org.