Planning Your IFAK
One thing you figure out quickly in Army Special Forces is that if you get a bigger rucksack, you will always find something to put in it: Whether those things need to be there or not. The same thing happens if you buy a bag to use as an Individual First Aid Kit (IFAK) before planning what you will pack in it.
The best way to select an IFAK bag or any aid bag is to determine and plan the packing list first, then find a bag that will fit your thoughtfully selected packing list. To plan an IFAK, which by definition will be a small “personal” bag, you have to decide which injuries you are planning on managing and which you are not. It should be placed for easy access in an emergency and so where you store it is also important. Our IFAK plan is for managing immediately life-threatening injuries that can be handled with minimal equipment during an ongoing dangerous event.
What DOES go in an IFAK?
Management of Life-Saving Interventions: M-A-R-C-H
Life-Saving Interventions pertinent to an IFAK include the management of junctional and extremity haemorrhage, management of airway occlusion, decompression of tension pneumothorax, and prevention of hypothermia. Other more advanced interventions like IV access for shock require too much gear for an IFAK.
Massive Hemorrhage
Tourniquets
If you plan on managing massive haemorrhage from an extremity, you will be using tourniquets. In any study ever conducted on human thighs, verifying occlusion of arterial flow with Doppler ultrasound, the Combat Application Tourniquet always outperforms any competitors. Since one tourniquet high on a thigh may only occlude arterial flow 70% of the time, you need to have two available. If you have more than one casualty, you can quickly run out of commercial tourniquets: Having a plan to improvise isn’t poor planning, it’s professional.
Wound Packing
If two properly applied tourniquets placed side by side don’t control your massive extremity bleeding you will need to wound pack. Additionally, junctional hemorrhage, from necks, groins, armpits, and potentially subclavian vessels will not be amenable to tourniquet placement and also require skills and knowledge of wound packing.
The best way to pack a wound will be with gauze. In my Army Special Forces career, no advanced hemostatic-type agents existed, and we routinely packed significant junctional wounds with cotton compressed gauze. Unfortunately, you can go through a lot of gauze packing a wound. Studies show gauze works just as well as the current hemostatic gauzes if you know what you are doing. These items also go on our IFAK packing list.
Hemostatic Gauze
A hemostatic gauze with some scientific evidence it works may help less trained/experienced wound packers. Of the commercially available hemostatic gauzes, Rhino Rescue Soluble Hemostatic Gauze has strong evidence supporting its use. If you can afford to add it to your IFAK, that seems reasonable.
Unless you plan on continuing to hold pressure on a tightly packed wound until the casualty is taken to definitive care, you will need to know how to make a wound-packing bandage. The last thing you want is for the gauze in the tightly packed wound to work its way loose and have the person start bleeding to death all over again. Wound-packing bandages require a lot of materials.
Airway
Airway intervention is not terribly likely in combat casualties based on the WDMET data, accounting for about 1.6% of deaths. Half will only require simple positioning, think head-tilt chin-lift and the recovery position. In this situation, a nasal pharyngeal airway can be helpful. The other half of airway interventions statistically will be for direct airway injuries. In that instance, a surgical airway will frequently be the answer and is a paramedic-level skill.
Respiration
The minimal equipment needed to decompress a tension pneumothorax is something sharp to make a hole in the chest wall to let out the air under tension. Although you can do this with a knife (which is basically a finger thoracotomy), having a large needle and catheter can make it easier. This too is a paramedic-level skill in most countries.
Chest seals are a type of dressing used for deep puncture wounds to the chest. Chest seals are commonly used by first responders, paramedics and military field medics, but can be used by anyone. They are simple to use and are included in many IFAKs.
Circulation
More advanced interventions like IV/IO access require too much gear for an IFAK. Circulation management with an IFAK largely involves keeping the “red stuff in.” (By controlling haemorrhage).
Hypothermia
Prevention Equipment for the prevention of hypothermia isn’t especially IFAK-friendly. The NAR HPMK or PerSys Blizzard transport system are awesome options for a vehicle-mounted bag, but much too large for an IFAK. Having an inexpensive “space blanket” is the best option in a small kit.
Standardization of IFAKs
All of the IFAKs in my home, cars, and tactical gear are packed identically. They differ only in colour. IFAKs are not location-specific, they are casualty specific to deal with Life-Saving Interventions, so there is no reason to change what is in the IFAK. The plan for the IFAK remains consistent. Obviously, my medical skill set is more advanced than the average person or First Aider, but with the right training, yours should consist of the same items.
Keep your IFAK Separate
Bandaids/plasters, antiseptic wipes, and moleskin may be part of your first aid kit. However, we recommend your first aid kit be kept separate from your IFAK. The reason is this: much like scissors are never where you expect them to be because someone has “borrowed them,” if there are everyday items in your IFAK someone may need, like bandaids/plasters and pain relievers, they will likely trot off with your IFAK. It will never be where you expect it to be in an emergency. Similarly, we do not stock items typically referred to as the “12 essentials” (or however many are on your list) in our IFAK. That is also a separate kit.
All of your IFAKs should be identical so you know precisely what is in them and don’t have to expend additional mental effort during an emergency. If your IFAK is then attached to your larger bag/kit in a tear-away fashion, that’s the best bet.
