Something I’ve been interested for a while now is making order out of chaos. I’ve spoken to friends of mine who have been in combat – one a former Navy Seal Medic, and also emergency responders as well as two former homicide detectives. I’ve been working on combining the tips and tricks of what these seasoned professionals do when they are first faced with a traumatic chaotic event. What is the order of how to make sense of things when the shit has hit the fan and how to apply those steps to an event a civilian may face when an earthquake or other natural disaster has hit.
Most of the time the training these people have received is specific and tailored to their specific jobs – there were clear steps each would take. All be it these steps varied widely depending on the scenario there seemed to be a common thread among all of their methods. Each would peel one layer of the onion away at a time. None of them would take a knife an cut to the center. They all made it clear individual steps had to be taken – skipping steps caused harm to either oneself or the injured person or the chain of custody. Skipping steps caused either harm or death of a fellow team mate or bystanders.
The take away from all these conversations was the following:
- Stabilize the Environment – Make sure the structure is safe or stable enough to allow entry. Whether it be an Earthquake or a firefight, the structure you are entering must be taken in phases. Take it in small steps, get through the front door and analyze the threat. Either move on or stabilize this part of the structure then figure out if you can proceed. There are an incredible amount of variables but if you think about each step being a series of ‘Go’ / ‘No Go’ questions you will be able to make progress and get to the injured or the problem. Fools rush in.
- Stabilize any medical needs – Think about the ABC’s. I’ve written previously about the need to change this term to the CAB – Circulation, Airway, Breathing. Especially in a disaster situation bleeding will kill in 30 seconds so stabilizing a bleeding victim is priority one. Tend to the injured ASAP and get them out to a safe location.
- Secure the perimeter – Make sure you get everyone including the non injured to a safe place. Look for faults in structure, downed power lines, vulnerable lines of attack. Turn off utilities – power, gas, water. Again, this area is vast with it’s variables depending on what the specific situation is. If the event was large enough it could be several days or weeks till things begin to normalize so you must know your environment and what it will take to live within it and survive. If you are in a cold climate what will your plan be to keep people warm and sheltered through the night? Knowing in advance how to deal with these things will help you if and when an event happens. Along with securing your perimeter is checking on your neighbors. Are their elderly in the area who might need help? Is the neighbor down the street who always thought prepping was a waste of time hurt or displaced? Unfortunately, no matter how much you’d like to let them realize the hard way they were wrong and you were right – helping them now is the most important thing for securing your perimeter. Happy neighbors along your perimeter will create a buffer zone aid in keeping riff raff at a distance.
- Establish Communications – What are the ways you can communicate? Do you have your HAM radio? Cel phone? Painting SOS on your roof? What ever the lines of communication are, the sooner you can get them up the better. Sending and receiving intel about the event will allow professionals and other members of your family and community to assess the situation enabling them to send assets to the correct location.
- Recover Data – When the situation has stabilized recover data. If it is your home try to recover legal papers, pictures, computers, insurance policies. Hopefully you have organized these in advance and you know exactly where they are so even in rubble you should be able to locate the rough geography in the structure of where they should be.
Many of the people I spoke with had mission specific things they would do, but in the end the common thread which applies to civilians faced with a disaster was those steps. Many times in military or law enforcement situations these people would establish communications ASAP, but for a civilian tending to the injured will become a priority.
So after last weeks post I got a lot of questions about Trauma Kits, what should be in an Individual Trauma Kit and who should carry one. Well to answer the last question first I think everyone who lives any place where there is a chance that there will be a natural disaster should carry one at the very least in their 72 Hour Bag. If you are law enforcement or a person who goes to a shooting range then you should have one IN your leg pocket. This isn’t because we’re afraid you are going to shoot yourself… It’s because some knuckle head at the end of the range doesn’t know what they are doing. Here’s an image of a guy who was hit at the range through both legs. I can not begin to say how many things they’re doing wrong in this image but just know you need to have your own Trauma Kit for you – it just makes sense.
So what’s in a leg pocket Trauma Kit? Here’s the leg kit I carry in my 72 Hour Bag and is small enough to fit in my leg pouch when ever I go out and do things which are on the riskier side. Let me open it up and take you through the Items I keep in there. Most came from the Falcon Operations Group Tactical Medic class, but I’ve added a couple small items just to round it out.
When I unzip my kit I want the first two things that are available to be my tourniquet and my H bandage. The reasons are obvious, blood loss is the first priority in the new CAB methodology. From here I try to assemble things in order of importance, but really it’s how stuff fits into the pack.
Right below the H bandage are two rolls of tape. Nestled in one of the rolls of tape are nitrile gloves. If you are trying to save your own life don’t take the time to put these on. They are there to protect you from some one else’s blood.
Along with the immediate layer is my H and H Compressed Gauze, it’s a handle little bundle for plugging holes.
Next I have my package of Celox handy, it’s quick and simple to use.
Under the tourniquet and H and H Gauze is the Nasopharyngeal Airway. This is a device used to open an airway of a victim who may have had head trauma and they are having difficulty getting air through their mouth. The size I carry is a 28 French, which is the most common size for an adult. If you are taking care of kids you might want to get a smaller size.
Right after these items I have a trauma card. It’s some light reading when you have the time and can be tossed aside if you’re in a hurry.
Next is your Ascherman Chest Seal. This is used if a patient has a sucking chest wound, meaning there is a hole in the chest cavity which causes air to leak into the cavity collapsing the lung. The seal has a one way valve which allows the lung to build pressure back up and evacuate the air from between the lung and the cavity. Notice on the corners I’ve pre tabbed the package to allow easier opening when things might get slippery from blood.
Here is a package of Petroleum Gauze, this is good to use on things such as burns because it is non adhering to the wound. It’s to package em up and get them to a facility which can deal with a traumatic injury of this kind. This puppy also has an expiration date so be on top of it.
Tucked into a little pocket I have a zip lock baggy with a few items: Surgilube, surgical lubricant for the Nasopharyngeal Airway. In a pinch get a little tube of KY Jelly for your kit. I also have Antimicrobial wipes, two 2-0 sutures and a condom. If you are at the point where you need to start suturing a wound then you had better be on a deserted island in the middle of the Pacific Ocean after the plane has gone down or the ship has sank. The condom has many uses other than the preferred.
At the very back of my kit I have a couple of sleeves which allow me to tuck my tools neatly in a position which are easy to grab even though they are deepest in the kit. There is a large tube of Super Glue which you might want to try first before sewing your buddy up. I can tell you that if you have a wound on your arm and you’re alone I don’t care how good you are – you aren’t going to be able to tie a suture easily with your one good hand. Try the glue and save yourself a headache. Next are my Trauma Sheers, Forceps which act as a needle driver for the sutures and are a handy tool for a lot of other jobs. The next item is a Decompression Needle. This is if there has been trauma to the chest cavity causing a collapsed lung and pressure is building up inside the chest cavity – say from a broken rib puncturing the lung. This device is about the most advanced piece of gear in my kit and I’m not even going to describe how to use it. The decompression needle needs to be taught to you by a medical professional – PERIOD. Below this are two safety pins. they can be used for all sorts of reasons, one being in extreme cases to pin a persons tongue to their lip to prevent choking.
There are a couple on line sellers where you can get smaller IFAK kits, such as NARESCUE. This link leads to a kit which is $130 and requires a medical device authorization. Another site I like is ITS Tactical, they have a version of a personal trauma kit as well and ranges in price from $99-120. If you don’t want to get something as elaborate or as technical ITS also has an EDC kit which addresses blood loss only, but it’s a kit small enough to fit in your back pocket and it on;y about $70. Once again, you might want to take a class in all this stuff. It’s nothing to sneeze at, but knowledge is power, you can take it with you and it weighs nothing so knowing is better than not knowing.