QuikClot is ideal for wounds that are not tenable via tourniquet: Axillary wounds, proximal leg wounds such as inguinal or groin region, subclavian (shoulder region) wounds and the like. It is proven in these applications and can often accompany a patient to a receiving facility and continue to provide bleeding control while in the receiving facility until an actual surgeon can provide the definitive care to control the impacted vessels.
The ideal IFAK is one that can address the most common preventable causes of death that result from the injuries we would commonly expect in a gunfight.
Have a tourniquet, have Quikclot, have an Olaes or Israeli bandage. Remember this is all hardware, without the training and “software” download into the end users brain having the IFAK is just belt decoration.
Remember, just because you pass through ER doors does not mean you magically stop hemorrhaging. I have rolled many a patient through ER doors where due to patient load and wait times, field interventions were relied upon to maintain homeostasis. At one time our cardiac monitor, while pacing an unstable symptomatic bradycardia patient, remained with the patient in the ER, through to the cath lab and through the duration of surgery.
I think simple adages and memory aids go a long way when executing decisions in the hostile and disruptive environment. One of my respected instructors for “unconventional medicine” as he termed it at times had some good key points to drive home. Some of this will not pertain to those in the civilian side as much, however if you are in the midst of an active shooter encounter, it very much just might:
“Good medicine can equal bad tactics, and bad tactics gets everyone killed” This is a key point I took home from my first TCCC-week back in 2007. What this means, is that sometimes doing the best medical procedures, the most life saving interventions can result in a BAD tactical situation in the gunfight/scenario. The bad tactics can cause more casualties (team guys), hostage deaths and a compounding problem. An example often given is the raid on Entebbe where the IDF were rescuing Israeli hostages in Uganda and the Team Leader was struck by a soon to be lethal round only moments into the raid. Had the team stopped to render aid and provide for his care, there would have been a major change in the tactics (for the worse), slowing momentum, speed, and surprise likely resulting in the terrorists killing many hostages and more rescuers. Instead of providing good medicine, the train kept rolling into the airport and annihilated the terrorists by harvesting their souls. This truth of good medicine equaling bad tactics covers many areas. There are times where instead of retrieving a casualty, team members need to shout instructions to them to get them to cover or concealment, locate the shooter, encourage the casualty to stay low, rather than run to retrieve them and become a casualty themselves.
“The best medicine is fire superiority It kind of speaks for itself. Another key point. The best medicine is prevention. Prevent further hits on good guys by neutralizing the bad guy. In the CUF – care under fire phase of TCCC the only thing a casualty should do is get down, get cover, and place a tourniquet on the limb of injury. The team, and the casualty (if he can) need to focus on staying on gun and putting rounds on the bad guys. The days of screaming for a doc are over. That as one instructor put it, “Is straight out of hollywood and needs to stop”.
Self Care – Get your kit out and work on yourself. Sooner than later. Practice and be able to access your kit, especially your tourniquet with either arm, one handed, and applying the TQ to each limb (DO NOT USE YOUR REAL TQ, GET A TRAINER). You need to do this in a minute. Casualties are their own first line of care. After the point of injury, any capable casualty needs to focus on surviving and be the first link in the chain of survival in a series of links …..
Buddy Care – Don’t use your kit on your buddy. USE HIS. If he treated himself, continue using his kit. After the casualty’s “self care” and the care under fire phase has progressed to TFC – tactical field care, (care in a more controlled/protected area e.g. like a room off of a hall) or it is otherwise safe to do so (neutralized the threat) a buddy can provide the necessary additional aid to the casualty. You need to stay alert and be prepared to react and move back into care under fire, should a new threat present or the situation change where you begin taking fire again. At that point you must abandon buddy aid and return fire protecting the casualty and YOU.
Team/Doc Care – As it states, this is where the team provides a team effort of care. In using communication, and reverting to the proper training, the team will be a major link in the casualties survival. It takes a team to often times move and evacuate an injured or incapacitated member. Often times it takes a team to provide interventions on a critical difficult to manage patient. It takes a team.
“Prevent additional casualties, complete the mission.”
MARCH and THREAT
I teach my team members MARCH-
R – RESPIRATIONS
CH- CONTROL HYPOTHERMIA
Civilian classes more often get THREAT-
RE-RAPID EXTRICATION TO SAFETY
A-ASSESSMENT BY MEDICAL PROVIDERS
T-TRANSPORT TO DEFINITIVE CARE
Of course there is more we could add and discuss here. My hope is that some of this helps some of you guys out there. Stay safe. Carry a kit. Know how to use it. Without the “Software” the “Hardware” is useless.