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Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
Not all of these tools are carried by each tactical medic. Some of the equipment is reserved for training and standby events such as team selection tryouts, swim tests, physical training days or range days. Some might be kept available in the medic vehicle. Tactical teams can have an ambulance that is overt (it looks like an ambulance) or covert (a long-bed, covered pick-up truck).Besides the medical equipment, the tactical medic is already carrying about 25-50 pounds of other gear. Most of the weight is in body armor/ ballistic plates and helmet. Other non-medical equipment might include weapons, ammo, incapacitating agents, knife, multi-tool, collapsible baton, radio / headset, lighting systems (including infrared), gas mask, eye protection, and a hydration system.
Download the full "TCCC"
TACTICAL COMBAT CASUALTY CARE HANDBOOK here
Medical Equipment
A combat medic will typically carry a backpack styled bag known as a "Unit One Pack". Aid bags are available from many different manufacturers, in many different styles. Depending on the unit and their standard operating procedures, the medic may have to follow a strict packing list, or may have the liberty of choosing their kit depending on the mission at hand. A typical aid bag will include:
Fluid Resuscitation
- IV fluids and tubing. The amount will depend on the length of mission. Normal Saline/Sodium Chloride, Hetastarch/Hextend, and Lactated Ringers(LR) are usually carried.
- 18, 16, and 14 gauge IV catheters.
- FAST 1 intraosseous infusion kit. The FAST 1 is a quick way to administer fluids when peripheral and external jugular venous access is unavailable due to massive blood loss, burns, or loss of limbs.
Hemorrhage (blood loss) Control
- CAT, SOFT-T or improvised tourniquets. Tourniquets are used for the care under fire phase of tactical combat casualty care, to stop massive life-threatening hemorrhage.
- Emergency Trauma Bandages, a newer version of the first aid pressure dressing.
- Kerlix gauze, for stopping hemorrhage, or creating a bulky dressing.
- Hemostatic agents, such as Celox, Hemcon bandages, and others. Some hemostatic agents are controversial due to their thermodynamic nature, which causes collateral damage if the user is not properly trained. These have been mostly phased out with newer versions which do not cause burns.
Airway Management
- 14 gauge catheter, at least 3.25 inches long, for needle chest decompression.
- Asherman chest seal, Bolin chest seal or Hyfin chest seal, as an occlusive dressing for sucking chest wounds.
- Nasopharyngeal Airway (NPA)w/surgilube or "nasal trumpet." This flexible tube secures a nasal airway when the casualty does not have, or may lose their ability to keep their own airway open. Contraindicated by signs of skull fracture.
- Oropharyngeal Airway, a hard "J" shaped plastic device that secures an oral airway, and can also be used to keep the teeth open for a more permanent airway device.
- King LTD, a simple tube airway with an inflatable cuff to create a sealed airway.
- Combitube, like a King LTD, but designed to be able to function almost no matter how the tube is placed due to the dual lumen tube design.
- Surgical Cricothyrotomy kit. Many different styles and kits exist, the choice is up to the individual medic's supply or preference. The most simple is a scalpel to open an airway, and to use an NPA to keep the airway patent.
Assorted Equipment
- Alcohol or Providine/Iodine swabs
- Cravats (muslin bandages)
- Assorted gauze bandages
- Band-Aids
- Assorted sizes of tape
- Assorted hypodermic needles and syringes
- Water Jel burn dressing
- Small sharps shuttle
- Safety pins
Personal Protection
- Gloves Black Nitrile
- Gloves, Patient Examination
Triage Systems
- Tactical Combat Casualty Card
- Sharpie Fine Point Permanent Marker Black
- Combat Casualty Card
Diagnostic Equipment
- Onyx II 9550 finger Pulse oximeter
- A Combat Medic may also carry other supplies as the mission dictates. A stethoscope, blood pressure cuff, pulse oximeter, otoscope, ophthalmoscope, and thermometer may help the medic treat his/her soldiers or civilians on the battlefield (COBs) while on an extended mission, as space dictates.
Casualty Management
- Paramedic Trauma Shears
- Benchmade Model 8 Rescue Hook
Splinting and Immobilitation
- SAM Splint—a flexible, reusable splint with a metal core covered in closed cell foam.
- Ace Bandages
- Extrication Collar - C-Spine Immobilization
- Coban, a stretchy, self clinging wrap/gauze
Hypothermia Prevention
- Blizzard Survival Blanket OD Green
- Ready-Heat Disposable Heated Blanket
- Us Army Blanket, Combat Casualty
- Us Army Blanket, Combat Casualty Type 2
- NAR Hypothermia Prevention and Management Kit (HPMK)
- Combat Casualty Lightweight Blanket
Battlefield Medicine
- Morphine
- Antibiotics
- Narcan, a narcotics antagonist, to counter morphine's respiratory-depressing effects.
- Phenergan, an anti-nausea treatment, which also increases the pain-reducing effects of morphine.
- Epi-pen, epinephrine in an auto injecting "pen" to counter anaphylactic (severe allergic) reactions.
A combat medic is generally expected to care for the needs of the soldiers in his group, including their everyday ailments. A medic will usually carry a small amount of what are referred to as "snivel" or "sick call meds." These are common over-the-counter medications that do not require a prescription.
- acetaminophen (Tylenol), anti-pyretic and pain reducer.
- Naproxen and ibuprofen, different NSAIDs which reduce pain and inflammation.
- Diphenhydramine (Benadryl), an antihistamine with a sedative side effect.
- Pseudoephedrine, a nasal decongestant.
- Guaifenesin, an expectorant.
- Loperamide (Imodium AD) an anti-diarrheal agent.
- Pepto Bismol tablets, to settle upset stomachs, treat diarrhea, and heartburn.
- Colace (docusate sodium), a medium strength stool softener.
What’s in your tactical medical kit?
When you’re on an operation and you can only take what you can carry, what do you choose?
Dec 9, 2013
Tactical medical equipment is an interesting and evolving topic area, with SWAT medics having as many opinions as there are vendors and products.
FIRST AID KIT WEIGHT CONSIDERATIONS
There are the “minimalists” out there and then there are the, “you never know, I better have everything” types. The general consensus is that the medic needs to have enough equipment and supplies to stabilize a critically injured patient in a tactical environment. This equipment should be on their person, or carried in a medical pack, or both.
Not all of these tools are carried by each tactical medic. Some of the equipment is reserved for training and standby events such as team selection tryouts, swim tests, physical training days or range days. Some might be kept available in the medic vehicle. Tactical teams can have an ambulance that is overt (it looks like an ambulance) or covert (a long-bed, covered pick-up truck).Besides the medical equipment, the tactical medic is already carrying about 25-50 pounds of other gear. Most of the weight is in body armor/ ballistic plates and helmet. Other non-medical equipment might include weapons, ammo, incapacitating agents, knife, multi-tool, collapsible baton, radio / headset, lighting systems (including infrared), gas mask, eye protection, and a hydration system.
Less commonly carried or worn items might include binoculars, camera, computer tablet, body-cooling system and night vision goggles. The operational environment will also dictate additional equipment needs, such as cold weather or a hazardous materials event like a meth lab.
TACTICAL MEDICAL EQUIPMENT
In general, the medical equipment that is carried by the tactical medic can be broken down into the following areas:
Personal protective equipment (PPE): This refers to medical PPE, not ballistic protection. PPE should include gloves, mask and eye protection.
Patient assessment tools: These tools needed to assess, visualize and measure vital functions include a stethoscope, blood pressure cuff, micro pulse oximeter, thermometer and CO2 monitor.
One high-caliber tactical team I know of keeps a lightweight, portable I-Stat machine on hand to analyze blood chemistry and electrolytes, especially during endurance training/ team selection events.
Trauma supplies: These are tools designed to stop bleeding or seal off penetrating trauma:
Airway/breathing management: These can range from a simple oropharyngeal airway to a full airway management pack. Equipment might include:
Routine medicines: Most EMS providers are not allowed to administer over the counter (OTC) medications, as it is not in their scope of practice. However, making OTC meds available to team members has largely been an acceptable alternative. In reality, this is by far the most common request by team members for medic services. The medic is the go-to guy or gal for just about anything related to the health and well-being of team members.
Having an assortment of commonly used OTC medications helps to keep minor ailments from progressing, and can help prevent an onset of problems such as allergies. Over the years, this part of my kit has expanded while the major trauma supplies have decreased. In my experience, it seems that ibuprofen, Pepto-Bismol, and allergy medications such as Claritin are most commonly requested.
Other common items include sunscreen, insect repellant, and Tecnu poison ivy/oak protection.
Routine materials for minor trauma, blisters and skin care: By far, the most commonly requested item is a Band-Aid. Minor wound care is a constant activity for the medic. Having a readily available supply of assorted sizes of adhesive bandages is a must. In addition, minor wound cleaning tools/wipes and topical antibiotic ointment are often needed. Have a good assortment of 1” and 2” breathable and non-breathable tape. Tools such as tweezers, forceps, small scissors, and wound/eye irrigation supplies are used often enough to have a place in the kit.
Ortho/sports medicine: Orthopedic injuries are common in training, and they happen on occasion during SWAT operations. Personnel can often have underlying orthopedic conditions that can be exacerbated during operations, and need evaluation by the medic. Having a background in sports medicine or orthopedic injuries is a plus.
Skills including taping, bracing and in-field stabilization of orthopedic injuries. SAM splints are pretty good for most splinting needs. Other items to consider might include cold packs and compression wraps.
ALS/prescription drugs: This area is a no-go zone for many teams for a variety of reasons. If the medic is authorized by a physician Medical Director, they may be authorized to be an ALS provider. Our team has an AED and first-line ACLS drugs. In addition we carry aspirin, nitroglycerin, albuterol (Proventil), ondansetron (Zofran) and ketorolac tromethamine (Toradol), a non-narcotic NSAID analgesic drug.
Patient transport system: As part of their standard operating procedures, many SWAT teams leave breaching gear and a med pack at the front door of the target location. This is called the “door pack.” This may include a collapsible / roll up stretcher such as a Sked. Oftentimes the medic will also carry a soft “roll up” stretcher on their person.
INDIVIDUAL FIRST AID KITS (IFAK)
In addition to what the tactical medic carries, each SWAT operator should carry, and be fully trained in the use of, their Individual First Aid Kit (IFAK). Operators should carry the IFAK on their vests. It should be accessible with either hand. Many operators will carry a second tourniquet that is also easily accessible on the tactical vest. Equipment might include:
As you can see, the medical equipment that is carried by the tactical medic is designed to cover the needs of the team. In the operational environment, that equipment will prove valuable in reducing the level of injury and stress — and promote a successful outcome.
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