Bandaging: Gunshot Trauma and Your IFAK

Disclaimer: I really hate it when a subject is this spot-on.

Prior to this past Sunday night about 11PM, I would have happily postponed this sort of thing in favor of more likely problems. But some folks might live in Chicongo, or be at a country music festival in Las Vegas, or something equally unfortunate on the day, so...

There's nothing terribly complicated about the Army's IFAK, or the one you should have handy, and the contents are rather basic.

Peter at Bayou Renaissance Man linked earlier today to the Army's IFAK packing list (pdf), which reveals nothing requiring much more than common sense to use:

8465-01-531-3647 100 Round SAW/Utility 1 Pouch, MOLLE II
6515-01-521-7976 Tourniquet, Combat Application 1
6510-01-492-2275 Bandage Kit, Elastic 1
OR
6510-01-460-0849 Bandage Kit, Elastic 1
6510-01-503-2117 Bandage GA4-1/2" 100’s 1
6510-00-926-8883 Adhesive Tape Surg 2" 6’s PG 1
6515-01-180-0467 Airway, Nasopharyngeal 1
6515-01-519-9161 Glove, Patient Exam 100’s 4
6545-01-586-7691 Contents Kit, IFAK Resupply Kit 1
6545-01-531-3147 Insert (folding panels with cord) 1
6510-01-562-3325 Dressing, Combat Gauze 1*

Let's break it down, then talk about using it.
First, for the non-military, those thirteen-digit numbers are NSNs (National Stock Numbers) for the items in question. If all you put in the address bar of Google, Bing, or whatever engine you're using, the first fifty hits will be the exact item you're looking for, in case you weren't sure.
Followed by the military nomenclature for the items.
Want it in civilianese? No problem.

Bag for the stuff
CAT-T tourniquet
ACE bandage or 4" Israeli Bandage
Band-aids
2" first aid tape
nasopharyngeal airway
Nitrile exam gloves (2 pair)
a card with the military item list, above
inner pouch to hold the stuff organized inside the big outer pouch
QuikClot Combat Gauze

And for the really thick or lazy, I linked every item possible to Amazon.

So, 2000 rounds have just been pumped into various folks around you, one of whom is yourself, or a loved one. Now what?

1) Try to get behind something bulletproof ASAP (unlike 15,000 people Sunday night, unfortunately), WITH your patient(s), any way possible.
Because if you get shot while tending to yourself or someone else, then what good are you?

2) Put on a pair of the gloves. Keeps your cooties off the patient, and their blood off you.

3) Find the most serious wound(s). (You might deduce that a set of EMT shears, not included on the IFAK list, would be handy for cutting clothes to expose the wounds, as we've noted in prior posts on this topic. That would be wise.) If the wounds in question are in arms or legs, and they're spurting bright red (arterial) blood up and clear of the wound, grab that CAT-T tourniquet, put it on, and tighten it and twist the windlass bar until the spurting stops.
How do you do that?

As I told you earlier, get an extra CAT-T, open it up, play with it, practice with it, and learn WTF you're doing now, while you're not spurting arterial blood.

Patients have four limbs. So do you. This would lead the brighter folks to note that there may be more than one seriously bleeding extremity, and therefore think that more than one such CAT-T might not be a bad idea. That would be correct.

4) Find the next most serious wound(s). These will generally be either the head, neck, or torso. You should have already dealt with serious extremity wounds, but non-spurting wounds not requiring a tourniquet would qualify.

5) In all of those cases, apply the combat gauze to the wound(s). Then wrap either ACE wrap or the Israeli bandage over that wound, until you have applied enough pressure and bandage material to the wound to cover it, and stop bleeding.
How do you do that?

Once again, get an extra, and practice using it before you need it.

 

6) If your victim has been wounded in the mouth/face, and may be having difficulty breathing or swallowing/aspirating blood, that's what that NP airway is for. It's also known as a "nose hose" or "nasal trumpet" both because that's what it look like, and it's also what it sounds like when an unconscious patient is breathing through it. To insert it, you need a surgical lubricant (think medical K-Y) to help you slide the tube into either nostril. (The one I linked to includes one packet (!), but you might want refills). Skipping the lubrication step will be like trying to stick sandpaper inside a sweater sleeve, with the rough side out: it ain't gonna go. So lube it, and insert it, gently rotating it until it's fully inserted.

How do you do that?

 

And yet again: Get an extra, see how it works. If you practice it, manikins are better than people, because manikins won't struggle and try to claw your eyes out. but if you find a willing volunteer, well...

7) If you place a tourniquet, mark a "T" on the patient's forehead, and the time it was placed, in military time (e.g. 2230 is 10:30PM). This is because tourniquets, per medical trauma studies, can remain in place for up to 6 hours with no or minimal damage to limbs, but that assumes someone later on knows when you put it on, and that you put it on, because they saw that "T". So a laundry pen or Sharpie pen in that IFAK? Yet another good idea not on the kit list.

8) There's one more good idea not on the list. Someone shot in the chest, between the top of their shoulders and the bottom of their ribs (where the diaphragm lives) may be leaking air or bloody bubbles out their new hole(s). So having a chest seal (there are several types) is a good idea to place over that hole to let air out, but not in. Because air where it's not supposed to be in the chest makes breathing not work, and allows one or both lungs to collapse. If this happens, after about 5 minutes, it's known by the medical term "dying". Also, bullets may go in on one side, and come out somewhere else. So you may have more than one chest hole letting air in with a gunshot. Or there might be multiple gunshot wounds. Thus you may deduce that more than one chest seal is also a good idea. Once again, you'd be very bright. If you have a chest wound, and you aren't sure about needing a chest seal, better safe than sorry. It won't hurt, and might save a life.
How do you do that?

9) The band-aids? Troops always break into their first aid kit for boo-boo band-aids. You can too. No video for this one. If you aren't sure how to use it, beat your head against the keyboard until you bleed, get a Band-Aid, go to the bathroom mirror, and practice putting one on correctly. (My lawyer says to tell you I was just kidding about beating your head bloody on the keyboard. My inner NCO voice thinks if you're that stupid that you'd do it, learning to put one on is good training. Now you're covered either way, and so am I.)

10) The tape can be used like tape is used, including to secure the NP airway in place, or reinforce the tourniquet or elastic bandages, and twenty other things, including something to stick to the forehead of a person with darker skin, and write that "T" and time on with the sharpie. The contents card is to see what you need to restock your kit when you use stuff, and make sure it's all there each time you check it (annually is a good idea).

You now have in one post the entire first aid course you need to do everything you're liable to be able to do between the time someone (including yourself) gets shot, and 911 arrives, and/or someone with more stuff and more training takes over.

ADDENDUM: Not covered in this, nor contained in the IFAK, is any mention of eye protection. That's because before the end of the first year in the Sandbox, every Swinging Richard in the .Mil was wearing either ballistic goggles, or shades, 24/7/365. Where spurting arterial bleeding is a factor, something as simple as an $9 pair of chemical splash goggles or clear eyewear is a great help to keep blood (and ricocheting bullet fragments, etc.) out of your eyes. You don't have to walk around looking like Tactical Timmy at all times, but splash goggles or safety glasses are mandatory PPE in both EMS and the ER, for a reason. I keep a set in my kit, and you should too. Didn't mention it, because it's not part of the IFAK load-out.
Wear your gloves, and protect your eyes. If you aren't doing it, you're doing it wrong. Period.


Here's hoping you die of old age, and never need to break it out and use it.