Moving Paramedicine Forward
by Nicholas Miller
09/22/2015

Why police need to train to use and carry an IFAK


The modern Individual First Aid Kit or IFAK was developed as a result of research performed into the causes of preventable deaths in combat during Operation Enduring Freedom (OEF) in 2003-2004 and Operation Iraqi Freedom (OIF) in 2006.[1] The findings were sobering. The number of preventable deaths in combat accounted for 7.8 percent of total combat deaths.[2] This significant number had remained essentially unchanged since the Vietnam War.

Military officials felt that these were unacceptable losses and developed a new system of medical training for non-medical military personnel, Tactical Combat Casualty Care (TCCC).[1, 2] Along with TCCC training, every soldier would also be provided an IFAK. This kit would be worn by every soldier in combat operations for immediate self-aid or buddy aid.

The first IFAK’s were simple in design. The equipment was selected for its ease of use by non-medical personnel and to address the two major causes of preventable deaths in combat, uncontrolled hemorrhage and airway obstruction. This rapid response by the military paid off, and by 2011, the percentage of preventable deaths in combat in was significantly reduced to 2.6 percent.[3] The IFAK, combined with TCCC training, has saved thousands of lives.

The need for civilian law enforcement IFAKS

Recent events, such as the Boston Marathon bombing, the Fort Hood shooting, and several other mass casualty shootings have made it clear that law enforcement officers, like the military, must be prepared to provide immediate life-saving first aid. This need is especially important as civilian paramedics are traditionally staged away from the scene until it is safe or mostly safe to enter. This time delay can prove deadly when rapid bleeding or airway obstruction is present.

In the Fort Hood shooting incident, the officer who stopped the assailant was shot through both thighs. She did not have an IFAK. Off duty physicians on the scene applied improvised tourniquets, but they were not effective. Her life was saved when a military medic applied a C-A-T tourniquet similar to the ones found in military IFAKs.[3]

During the Boston Marathon bombings response 27 tourniquets were applied in the prehospital setting.[1] They were all improvised tourniquets and many of them required replacement with a C-A-T tourniquet to prevent ongoing extremity exsanguination.

In 2015, department issued IFAKs were successfully used by law enforcement officers at a mass shooting incident at a movie theater in Lafayette, Louisiana.[4] These cases demonstrate the need for IFAKs for law enforcement and how IFAKs can save lives in the civilian setting.

In June 2015, the United States InterAgency Board (IAB) released a white paper on Tactical Emergency Casualty Care (TECC) and IFAKs for law enforcement. This paper, referencing the concepts of TCCC and the military IFAK, established recommendations for Tactical Emergency Casualty Care (TECC) training and IFAKs for law enforcement officers. The IAB recommendations, along with a description of each item, are listed below.[5]

Law Enforcement Officer (LEO) IFAK – essential equipment

Windlass Style Tourniquet (1)

The tourniquet is essential to control external hemorrhage to extremities. The reintroduction of the tourniquet to emergency care has demonstrated a significant improvement in the number of lives saved without the feared loss of limb amputation from prolonged restriction of blood flow.[6] After-action analysis of the Fort Hood shootings and the Boston Marathon shootings have demonstrated that improvised tourniquets are often inadequate in controlling severe extremity hemorrhage.

Hemostatic Gauze (1)

Hemostatic gauze is a gauze roll coated with a hemostatic agent that helps to stop bleeding faster and more effectively than gauze alone. It can be used in conjunction with tourniquets or by itself. This is especially useful for wounds to the head, neck or torso where tourniquets cannot be applied.

Mechanical Pressure Bandage (1)

Also known as an Israeli Bandage, a pressure bandage is designed to stop hemorrhage by the application of direct venous pressure at the site of injury. It is usually 4-6 inches in length and has an attached cravat made of elastic ace bandage style material. Many brands also have a device attached to the bandage that allows it to be self-applied using only one hand.

Compressed Gauze (1)

Compressed gauze is traditional rolled gauze that is 4.5 inches by 4.1 yards long that has been vacuum-sealed into a smaller compressed package. This makes the gauze easier to pack than regular rolled gauze. Compressed rolled gauze can be used in a variety of ways to control hemorrhage or bandage wounds.

Chest Seal – Vented (1)

The vented chest seal is designed to prevent penetrating chest trauma wounds from developing into a fatal tension pneumothorax. The vent on the chest seal allows air to escape the thorax while preventing outside air from entering. 

Non-Latex Gloves

Gloves provide protection from potentially infectious body substances

Optional LEO IFAK Equipment

Nasopharyngeal Airway (NPA) (1)

An NPA is a basic life support airway adjunct that is inserted through either nostril and into the nasopharynx. It rests behind the tongue, preventing it from occluding the airway in a semi-conscious or unresponsive patient. An individual pack of water-soluble lubricant (KY) is also needed to facilitate the insertion of the airway. The 28 fr. size will fit most adults.

Duct Tape – Roll - Small (1)

Trauma Shears (1)

Equipment Bag (1)

The bag should be zippered, with multiple attachment points.

IFAK ergonomics

The original military IFAK case was a squad automatic weapon (SAW) ammunition pouch that was retrofitted with an insert and attached to a belt or vest. This concept was chosen because of the need to rapidly deploy IFAK kits in the field.

However, it was discovered that the pouch was bulky and would often get in the soldier’s way. Current military IFAK pouch design calls for a longer and thinner pouch that is worn on the back of the plate carrier. This design allows the user to be able to sit in vehicles or chairs, wear a backpack, and access the pouch from either hand (7). 

For tactical law enforcement officers wearing military grade body armor, the LEO IFAK placement can be essentially identical to the current military style. However, most conventional uniformed officers will be wearing a traditional duty belt. In this case, the wearing of the IFAK will require a different approach. Most officers already have a glove pouch on the duty belt. Small, commercially available tourniquet holders specifically designed for law enforcement belts are currently available. Distribute the remaining equipment in one or possibly two pouches attached to the duty belt. 

Care should be taken to learn from the military and consider ergonomic factors when selecting IFAK pouches. The IFAK components should be accessible with either hand in the event one arm is injured and unable to function.

IFAK deployment

Many law enforcement agencies elect to keep the IFAK kit in the vehicle instead of being worn by the officer. Although this provides a marked improvement over no IFAK at all, it may cause unacceptable delays in deployment when the IFAK is needed and time is critical. An officer that needs to retrieve an IFAK from a vehicle may be delayed by the time it takes to attach the IFAK on their duty belt before engaging the threat or the incident may cover a large area that is too far from the vehicle to make IFAK retrieval practical. Also, the officer may be wounded and unable to retrieve their IFAK from the vehicle. IFAKs that are always physically on the law enforcement officer offer the best chance for successful utilization when needed.

Case after case has demonstrated the need for law enforcement officers to have TECC training and an IFAK immediately available to save lives when time is critical. An IFAK should contain all IAB recommended essential supplies, be of ergonomic design for easy carrying and worn by the law enforcement officer whenever possible. 

References

1. Butler, Frank. "Hartford III Consensus - Trauma Kits." Hartford III Consensus. 2015.

2. Butler, Frank K, and Lorne H Blackbourne. "Battlefield trauma care then and now: A decade of Tactical Combat Casualty Care." Journal of Trauma Acute Care Surgery (Lippincott Williams and WIlkins) 73, no. 6 (2012): S395-S402.

3. Jacobs, Lenworth M, et al. "The Hartford Consensus: THREAT, A Medical Disaster Preparedness Concept." Journal of the American College of Surgeons (Elsevier) 217, no. 5 (November 2013): 947-953.

4. KLFY. "Trauma Kits Played Big Role in Lafayette Theater Shooting Response." KLFY, July 2015.

5. Interagency Board - Health Medical & Responder Safety Subgroup. "Law Enforcement Tactical Emergency Casualty Care (TECC) Training and Individual First Aid Kits (IFAK) White Paper." United States Government, June 2015.

6. Butler, Frank K, John B Holcomb, Stephen D Giebner, Norman E McSwain, and James Bagian. "Tactical Combat Casualty Care 2007: Evolving Concepts and Battlefield Experience." Military Medicine 172, no. 11 (November 2007).

7. Reinert, Bob. "New first aid kit being developed at Natick." United States Army. USAG - Natick Public Affairs. February 2, 2012. www.army.mil (accessed August 2015).

Nick is a nationally recognized expert in paramedic education, military medic to paramedic transition programs and paramedic simulation training. He is a national conference speaker, published simulation author and recipient of the EMS 10 international award for innovation. He is also a member of the NAEMT Military Relations Committee. He can be reached at nmiller@emedconsultants.com.

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