Article written by Guest Blogger WillG, a CF Medic with multiple deployments.
For many of you, belt kit will seem like devolution back to the days of webbing. The concept of first line belt kit harkens back to the early days of David Stirling’s SAS and WWII Commandos. Early belt kit consisted of basic survival equipment for escape and evasion, should the mission go wrong. Web gear was a fighting rig, modular for the soldier’s task or mission. It was intended for 24 hour sustainment. With that said, modern belt kit is NOT a throwback to web gear.
Modern belt kit or 1st Line has taken root again with armed professionals. The loadout, while quite unique to the operator, consists of the basic requirements to sustain life. Common items within most belt kit setups include a couple primary mags, some secondary mags, secondary weapon in holster and usually an IFAK. With the advent of MOLLE systems, MOLLE belt systems have become quite prevalent within certain unconventional units and with many coalition countries.
The basis of my belt kit, or first line, is the CTOMS™ M-Harness™ QRPS-A. This acronym stands for Quick Release Padded System -Armoured. Simply put, it is a padded MOLLE battle belt with armour inserts and the added versatility of becoming a rated climbing harness by donning the M-Harness™ Leg Loop Assembly. The base of my platform is modular to the mission, modular to the loadout and adds a higher level of protection than an unarmoured belt. With one belt system, I can operate in mountains, helos, confined spaces, and high angle rescue, all the while maintaining a minimum loadout to be mission ready.
My first line base loadout includes my secondary weapon and holster, two secondary weapon magazines, two primary weapon magazines which are ready for easy access in FastMags™ and mounted on the CTOMS™ MOLLE Drop Extension Panel. I am a big believer in IFAKs on first lines, this way the operator always has critical medical supplies on their person at all times. I have made use of the CTOMS™ SlimLine™ as my IFAK. The SlimLine™ is a tear away combat first aid kit with an integrated TQ pouch that takes up only two MOLLE channels of real estate. As this is a MOLLE system, I can tailor it to the current mission and any pouches that fit on my fighting rig will fit on my belt. True modularity.
I train, like many others, to fight out of first line. This allows for a consistency in indexing for magazines during reloads or remedial actions. When there is a lull in the action, I perform a tactical reload of weapons AND belt kit, bumping forward and topping up from my fighting rig. I use my fighting rig primarily for load bearing and armour carriage, using it only for reloading when there is ample time or administratively.
As a tactical medical operator, there will be times when a full rig is impractical or counterproductive. A properly setup first line will allow you to carry enough ammunition for self-preservation, enough medical supplies to sustain your own life and enough real estate to carry critical mission specific gear on your person. Control the chaos by being prepared at all times.
Article written by Guest Blogger WillG, a CF Medic with multiple deployments.
Tactical Medicine is approached in three stages. Each stage’s medical interventions are tailored to the tactical problem, threat level and available equipment. As the tactical situation stabilizes, we have access to safer working areas, more complex interventions and more gear for those interventions. The layers that you plan and pack for your medical equipment must compliment this reality.
During Care under Fire (CuF), the tactical situation is still active, meaning you are engaged in combat or under an impending threat. Accurate fire superiority and simple quick medical interventions are the most viable forms of treatment at this time. The only equipment available to a responder, at this time, would be the casualty’s tourniquet and his or her own hands. Stopping life-threatening extremity bleeds with a tourniquet and use of recovery position are the only interventions done during this phase. These are simple and rapidly executed interventions that will save a good portion of battle casualties.
Soldiers should carry their tourniquets within the ‘Diver’s Triangle’. The diver’s triangle is the area between the shoulders to the belt buckle. That way, no matter what position the casualty is in, it is easily accessible for self-application. It should be stored ready for one-handed application in a dedicated marked tourniquet pouch that protects the tourniquet from the elements, UV degradation and dirt. This also ensures a standardized location and a viable tourniquet readily available for buddy application.
There is an oft-taught situation-dependent transient phase of care called ‘The Tactical Field Care Bubble’. The concept was first taught to me during TACMED instructed by CTOMS™. It is a controversial concept that requires more than a blog post to fully comprehend and implement. It also needs to be worked into SOPs at a team or element level, much like tactical rescue.
During this stage of care, the only gear available to the trained responder would be the casualty’s IFAK (CTOMS™ SlimLine™) and his dedicated treatment pouch. The 1st line treatment pouch, like the CTOMS™ FrontLine™, carries enough medical interventions for at least one serious patient. The interventions are usually limited to the MAR portions of the MARCHE casualty treatment protocol. Life-saving interventions only.
Using a leg bag or vest mounted 1st Line pouch allows the rescuer to make prompt limited interventions within ‘The Tactical Field Care Bubble’ and still is able to defend himself and the casualty or make movement in a rapid military manner.
Tactical Field Care (TFC) is the conventional concept of casualty care. A Casualty Collection Point (CCP) is secured, casualties are brought there where medics and other responders set to work treating them in priority. During TFC, the medic or responder has much more gear available to them. The most important of which is the 2nd Line™ Med Bag. A properly packed 2nd Line™ will have enough interventions and supplies to treat the entire MARCHE protocol including analgesic, antibiotics, vascular/intraosseous access and fluids.
2nd Line Bags should be pack with more hardware than software, meaning hard interventions not bandages and packing. IFAKs and TCCC kits carry more than enough hemorrhage control equipment especially with proper mission medical planning.
2nd Line packing needs to match the threat and the mission. An armoured company medic will carry more burn dressings and airway interventions due to the threat of burning vehicles and inhalation injury from chemicals burning. An infantry dismounted medic will pack lighter with multi-purpose equipment than a mechanized infantry medic. I have used both the CTOMS™ 2nd Line™ Main Pack and the CTOMS™ 2nd Line™ Assault Pack Module in this role. Their modular internals allow the contents to be easily tailored to the mission and the gear available.
Fourth Layer: Follow on Kit
Unless there is a gunfight in a surgical suite, all combat casualties will require evacuation to a surgery capable hospital or trauma centre. Thus, Tactical Evacuation Care (TEC) is the final stage of tactical medicine. During the TEC, the responder not only has more gear available to him, but there will be more hands to help. Evacuation platforms, be it armoured ambulance or helicopter, bring trained medical personnel to the fight. They will be able to maintain all interventions and possibly have a higher level of medical training.
Sometimes units must clear casualties with organic vehicles to the helicopter landing zone or a link up point for ground evac. This is a scenario when a properly packed 3rd line bag will be important. A 3rd Line Bag will include equipment primarily for evac, patient stabilization and to support previous interventions done during the TFC phase. Traction splints, C-Collars, larger volumes of fluid and packaging materials are examples of gear that should go into your 3rd Line or vehicle kit.
A 3rd line med bag should also have stores and gear to support MASCALs. A good triage kit and extra hemorrhage control are always welcome when dealing with multiple casualties. This is also the bag were you stash your sick parade bundle, unless on extended dismounted operations. A vehicle kit or 3rd Line can be packed heavy as it is follow-on kit and is not carried.
In the past, I have set up my CTOMS™ 2nd Line™ External Module to fulfill this duty. It worked out well as I could run my CTOMS™ 2nd Line™ Main Pack as my med bag for dismounted work. But when mounted, I made use of both modules as a complete compact package.
The Full Layer Cake:
The Tourniquet Pouch Care Under Fire
1st Line Treatment Pouch Tactical Field Care Bubble
2nd Line™ Med Bag Tactical Field Care
3rd Line Med Bag or Vehicle Kit Tactical Evacuation Care, MASCAL
Layering your medical responses to the harsh realities of combat and other tactical operations keeps you light, mobile and an effective medical operator. It ensures that you will have the right intervention at the right time.
Article written by Guest Blogger WillG, a CF Medic with multiple deployments.
I was having the ultimate male bonding experience. My best friend, an infantry senior NCO, and I were packing our fighting rigs in his garage for deployment to Kandahar in 2006. I notice a small white plastic case he had in his admin pouch. I asked him ‘What is that?’
“It is my High Speed, Low Drag Owie kit. ‘Cause nothing slows down an operator like an owie!!”
I was sold on the concept immediately. We all wear gloves, eye pro and other forms of PPE when operating in hazardous environments, but everyone still get scratches and scrapes. Even the most disciplined operator comes close to dehydration during dynamic operations. We have all had minor, but nagging, bruises and bumps that slow us down. A little self –reliance goes a long way when working within a tactical environment.
From a practical standpoint, this is a small first aid kit for minor wounds, infection prevention and dehydration treatment. This gear does not belong in your IFAK or treatment kit as those are for life-threatening injuries. Imagine, rummaging through a casualty’s IFAK in adverse lighting conditions, you grab a package that feels like your issued hemostatic dressing. You pull it out and it is an oral re-hydrant powder. Lost time equals blood in the sand; not kept within the body!!
First aid supplies that belong in an ‘Owie’ kit:
Chlorhexidine/ Providone-Iodine prep pads – for minor wound disinfection
Antibiotic Ointment- for topical prophylactic infection control
Various adhesive bandages- prevent wound infiltration
Oral Rehydrant- not a sugary sports drink
4 tabs of 500mg Acetaminophen – half the daily maximum dosage
Any prescription medication required
Anaphylaxis kit, if indicated
This can be stored in a ziplock bag and stuffed into an admin pouch. It can be carried in the CTOMS™ GP Pouch (small) on your belt kit or rig or in your arm pocket in the CTOMS™ Small Wound Pouch. Incidentally, the latter is how I carry my owie kit.
How do you decide between an auto-lock or a screw gate carabiner? Generally speaking, I choose auto-locking carabiners for use on helicopters. They don’t vibrate open, and noise signature isn’t as big a deal. Auto-locks have a tendency to make a loud noise as they are released to close and spin into the lock position. I use screw gates for tactical ground rope work, be it urban or mountain. It is much easier to control the gate close, reducing the sound signature, and they are lighter weight, less prone to failure from corrosion and dirt, and less expensive. A few things to ponder the next time you’re buying and packing carabiners for a task. Keep in mind, this is for tactical applications, and is not a hard rule. For aid climbing, I’ll usually use twist locks on my daisy chains.
We’d like to welcome back our Guest Blogger: Article written by WillG, a CF Medic with multiple deployments.
How do you decide what your element packs in their Individual First Aid Kit (IFAK)? On most deployments, units issue very basic first aid equipment. Most of the time, it consists of a pressure dressing, tourniquet, and a hemostatic dressing. As a mechanized infantry company medic, this may be more than sufficient when you consider the combined organic assets of infantry company. Would that be enough in a small unit embedded with LN security forces?
When tasked in that role, I did a medical threat assessment. Taking into account, weight distribution, unit size, insurgent tactics, evacuation times and medical capabilities of the unit members, I came up with a more robust kit list for unit members. It basically amounted to the soldiers carrying a mini TCCC (CLS) kit. This allowed me to carry more hard interventions and medications than first aid gear. This was an effective solution; we were never short on gear.
An IFAK is not a treatment pouch. It is the basic medical gear used by a buddy, TCCC (CLS) or medic on a casualty. Therefore, it needs to be removable; either tearaway or pouch-in-pouch. This becomes self-evident when you try to treat a 200lbs soldier with 35lbs of gear and all you need is one small pouch. Pouch-in-pouch is easily accomplished by putting all your first aid gear in a zip lock bag and stashing it in your C9 (M249) pouch. There are commercial versions of this style as well. I have always preferred tearaway pouches. I have play-tested many companies’ pouches. Most will be more than sufficient for the job. My current tearaway IFAK is a CTOMS™ SlimLine™. The MAR system internals, intrinsic tourniquet storage and beaded pull tab make it easy to access and modular for any load out. The side MOLLE allows for cutting tools, trauma shears, permanent markers, glowsticks or buzzsaw to be stored with the medical gear. This IFAK can be mounted on your rig or belt kit both vertically or horizontally.
IFAKs should be indicated with a standardized tag within your element. This allows the IFAK to be quick identified when under stress. I have seen many different tagging systems used by many units. As long as everyone in your element has the same identifier, that is all that matters. Some units have a standardized location for mounting the IFAK on their rigs. This idea has merit as well especially in adverse lighting conditions.
IFAK load out must address the mission and threat
Should be removable
Standardized tagging system
Standardized placement would be ideal
A closing shot, try to get the operators within your element to inspect their first aid gear as often as they clean their weapons. They will have a habit of putting this life-saving equipment away and not inspecting until they turn it in, months later. The constant up-down, wear and tear of combat operations can damage even the most durable packaging. Bandages and dressing with worn out packaging make great training supplies. Fresh dressings belong in IFAKs…..
I’ve been asked “what is the best one-handed bandage?” or variations thereof, and I even see discussions about it online. Apparently there are even people instructing the importance of a one-handed bandage on courses that others pay money to take. Here’s my opinion on the matter.
Fact: Tourniquets are contextually safe and save lives. That data is plentiful and widely available, so there are no excuses left to poo poo tourniquets.
Fact: Wound packing will effectively stop life threatening hemorrhage if performed correctly. We don’t coat bandages with hemostatic compounds, we make then into gauze that can be packed into wounds instead, so we can get to where the actual bleeding is and work to effectively plug the leak. Even if you only have regular gauze…even if you only have a dirty T-shirt, for a penetrating wound with associated arterial bleeding, pack it deep and tight and hold the pressure. That is effective hemorrhage control.
Now bandages on the other hand. I’ve never heard of a bandage to ‘save a life’. Bandages by themselves are used to threat non-life threatening hemorrhage, or to hold gauze in place and provide pressure on a packed wound. Remember, a bandage is not a tourniquet. The force applied wrapping a bandage tightly is not enough to stop arterial blood flow. It is intended for non-life threatening venous bleeding. In reality, it may actually stop all venous flow, but still allow arterial flow causing a compartment syndrome and if there is a wound distal to the tightly wrapped bandage on the arm, cause even worse bleeding! Blood goes past the wrapped bandage at high arterial pressure, but can’t get back into the core under the low venous pressure. Nowhere to go but out the wound and or backup into the cells.
So here’s the punchline you’ve all been waiting for. That damn logic:
If you have life threatening hemorrhage to your arm (hence why you need to apply treatment one handed) then apply a tourniquet because a bandage will not stop life threatening hemorrhage!
And if it’s non-life threatening bleeding, then don’t waste a perfectly good bandage! But seriously, then brace it against the floor, door, wall, wrap it up and carry on camping. So the bottom line “what is the best one-handed bandage?”. Who care’s! Stop making this difficult.
Now I want to hear the other side of the this debate from you. If you disagree, please post a comment.
Disclaimer: The views and opinions expressed herein are those of the author and the voices in his head and are not necessarily those of CTOMS or necessarily necessary at all.
We’d like to welcome a Guest Blogger: Article written by WillG, a CF Medic with multiple deployments.
When it comes to Junior Medics setting up their rig, one of the things that I see regularly is emulation of the infantry or gunfighters that they are teamed with. Weapon magazines, comms gear and illumination systems are important to all in tactical environments. Modern modular fighting rigs are to be tailored to the mission and to the soldier’s role. Our primary role as tactical medical operators is treatment of casualties, friendly or enemy.
There are a few principles that I adhere to as when setting up my fighting gear, be it chest rig, plate carrier or belt kit.
Two is one, one is none: Critical equipment, such as lights, strobes, and gear cutters, requires redundancy. A flashlight with built in IR strobe functions can fulfill two roles thus allowing necessary redundancy while saving space and weight.
If it is important, it gets a string: This is a principle from mountaineering that has crossed over into tactical gear. No longer do we need to use 550 or paracord. High quality gear retractors and military lanyards are commonplace now.
Thirty Second Rule: If you do not need it within thirty seconds to save your life, a fireteam partner’s or a casualty life, it doesn’t belong in a fighting rig. This goes from primary ammo to first aid supplies to IFF systems. Reaching into a pouch during contact pulling out a Twinkie when you need a primary magazine or tourniquet could be deadly. A properly selected modular aid bag can have pouches or divisions set up for mission critical gear such as food, water and batteries. The CTOMS™ External Module for the CTOMS™ 2nd Line™ Bag can be set up for long term missions and still satisfying the thirty second principle.
The Diver’s Triangle: A technique from SCUBA diving. The diver’s triangle is the area between the shoulders to the belt buckle. Gear stored in this region can be accessed quickly and easily.One critical piece of kit that must be stored in the diver’s triangle is your personal tourniquet. It should be stored ready for one handed application in a tourniquet pouch that protects the tourniquet from the elements, UV degradation and dirt.
A Dedicated Treatment Kit: This is the core of a tactical medic’s gear. This can be a sub load of the medic’s belt or vest mounted. It is fastened to the platform, not tear away like an IFAK. From experience in training, instructing and combat, what goes on the ground; stays on the ground. I have a preference for vest mounted treatment kits and belt mounted IFAKs. This way personal medical equipment is on my person at all times in a tactical environment. Also, it keeps my legs clear of gear which is important in vehicles and building entries. The CTOMS™ FrontLine™ pouch is my current treatment pouch. With its three magazine capacity and modular MARS™ system, I can carry enough medical supplies for use in a Tactical Field Care Bubble without getting into my med bag. This way I can make tactical movement or engagement quickly, should the bubble get popped.
This is not a definitive article on medical fighting rig setup. It is merely the observations and guidance that I follow and mentor Junior Medical Operators when they set up their gear. A final point, before your deployment, train with gear you are planning to deploy with. Run it hard before you go. I am pretty sure the initial setup will change as you gain experience.
Do no Harm; Do Know Harm.
A MFR setup following the principles laid out in this post. This rig is setup for use in a specific vehicle type. Keep in mind mission type, duration, and vehicle used when approaching rig setup.
I hope you got a chance to read the blog posted by Chris July 12, 2012 titled “Kits of Convenience” because it has an excellent description of the SAS™ Kit. If you haven’t read it yet, check it out here. In the blog, Chris describes the many advantages to having Health Canada Licensed sterile prepackaged kits. When the time comes to perform a procedure you won’t have to search for components or remember the checklist of items you need for the procedure.
The Tactical Vascular Access Kit, or TVAK™ (pictured below), is another example of a Kit of Convenience that sets you up for success and is available from CTOMS™ in either 18 gauge or 22 gauge.
A video of the TVAK™ in use is shown below as well as a trick-of-the-trade in setting up the administration set and uncapping the Luer-Lok.
Medicine never stops evolving and neither do you. Contact CTOMS™ for training and products and don’t just take our word for it, try one of our kits of convenience for yourself.
When we first started teaching surgical airways to Canadian Forces Medics, they were expected to make their own kits. A #6 ETT was cut down to the point just above the inflation balloon tube, and all the other components were gathered and stored in a baggy. This worked fine other than the fact that it wasn’t sterile and the onus was on the medic to create and maintain the kit. Then they noticed that in real world use, those tubes found their way in too deep, into the right mainstem. That, and many other small issues, drove the need for a Health Canada Licensed, open technique, surgical airway set – the right tool for the right job.
The SAS™ Kit solved that problem with a 6.0 cuffed trach tube. It’s sterile and Health Canada Licensed, and it solved a lot of other problems too, including ones not even necessarily noticed by the medics.
The medics would now notice that instead of having to take the time to create their own kits, the kit is prepackaged. There is no labor involved. All the components are removed from their packaging and then repackaged to fill the needs of the medic in the field. This reduces the amount of garbage, bulk or the kit and, to a lesser extent, weight. From a supply chain logistical perspective, it also reduces the number of SKU’s that supply has to order, which reduces the amount of man hours that the supply chain has to work making the logistics a much more efficient system. Industry created ‘procedure kits’ streamline things for the end user.
Now from a practical perspective, in the back of an ambulance, it might not make sense to stock TVAK™’s for example. You have a lot of cabinet space and require multiple gauges of angiocatheters. But from a field medic’s perspective, it makes perfect sense. All the components, and only the components for a procedure are in one convenient location. No searching for components, or remembering the checklist of items you need for the procedure – it’s all right there. In fact, the presence of all the items in the kit prompt the medic to perform the procedure correctly.
There are numerous advantages to procedural kits of convenience. If you have any questions or comments on them, we encourage you to post. CTOMS™ can produce custom procedure kits of convenience to customer specs, including sterile kits that are all Health Canada Licensed.
Believe it or not! The preliminary drop tests were successful and promising. A 100kg load was dropped onto a Quickie Descender™ (QD) in belay configuration. Peak force and slip distances were measured. And theoretically, the system is safe employed within certain parameters. Now that the testing was done, only one thing to do: get onto the sharp end!
Typically, when you lead climb, it is done on dynamic rope (stretches), usually single 9-11mm or double or twin rope systems as small as 7.5mm (2 x 7.5mm ropes). If a lead fall occurs, the energy created in the fall is absorbed by the stretch in the rope. Imagine climbing on a wire cable, essentially what you’re doing with static rope (though even static ropes have some stretch), and falling onto it. Not only is it going to hurt, it’s going to impose extreme forces on your protection and potentially cause it to fail. This’s why static rope is not used in lead climbing. But there are exceptions to every rule!
Lead climbing trials on 6mm static with TRACE™ Systems
The key component is the QD used as a belay device. When excessive forces are applied to it, it slips under friction. That slippage has been fine tuned through design, to start slipping, when exposed to a dynamic force above 4kN. That means that instead of the energy being absorbed by rope stretch, it is being absorbed by rope slippage. A fall that generates more than 4kN will cause the device to slip, and when the friction of the slippage is reduced to around 4kN, it will bring the climber to a stop. Percentage of slippage is actually similar to percentage of stretch.
But there are caveats. This is a highly specialized system, intended for expert use only. TRACE™ Systems are for use in lead climbing tactical operations and are NOT for use on hard routes, or ‘working’ a sport route, or any recreational climbing. The easiest line should be taken, and a unique belay technique is required, including mandatory wear of gloves. It has been designed specifically to significantly reduce the amount of bulk and weight a soldier or specialized law enforcement officers have to carry on operations in technical terrain.
If you have a requirement for ultra light-weight, comprehensive capability rope systems, please contact us.
