This has been addressed many times on many different blogs, whether medical, military, or other high-speed-low-drag blogs such as ours. But I just this past week came across
yet another entry on a gun blog and realized it's never been covered here, and many of our audience may not be familiar with even what a blow-out kit is, much less what it should contain and why.
A blow-out kit can also be called a trauma kit. It's designed to contain the items a medic or someone acting as one would need to treat the most common causes of death for people in combat situations ("combat situations" could mean actual combat in Afghanistan or simply being shot by a gangbanger in South Central). Those causes are:
- bleeding
- tension pneumothorax
- obstructed airways
We'll get back to those.
Before I even begin to cover what the kit should contain, ask yourselves of what use is a piece of gear you don't know how to use? Basic first-aid training is easy and may be available for free in your area. Beyond that, tactical medical training can be found all over, at varying prices and levels of quality, I'm sure.
Here,
here, and
here are three examples (I'm not endorsing any of those, they're just the first three results on Google to illustrate how easy it is to find tac med training. Do the research.)
OK, so you went and got the training somewhere and you know at least the basics and want to be prepared to save your own life or someone else's. What do you need? Well, you can buy complete kits such as
this one,
this one, or
this one. Or you can save a little money at the expense of a lot of time by assembling your own from supplies you find other places.
So (you ask with bated breath) what do I really need? Well, look a couple of paragraphs up where I mentioned the three main causes of combat deaths. I'll wait. Back? Good. Pop quiz. What are they? No, don't look again, you were supposed to be paying attention!
OK, I'll tell you again. The three principle causes of combat deaths are bleeding, tension pneumothorax, and airway obstruction. So your blow-out kit (/trauma kit/Individual First Aid Kit) needs to contain the necessary items to deal with those three things until better-trained, better equipped medical personnel arrive on scene to take over and get the victim to an emergency room.
For bleeding, obviously what you want to do is make it stop. (Remember, all bleeding stops - eventually.) OK, smart ass, you want to make it stop
faster. There are three ways to do this. One is the old stand-by, gauze and a bandage. The blood soaks into the gauze and eventually enough of it builds up that it begins to clot. If the victim lives long enough the blood clots up completely and stops coming out.
The second way to make the blood stop coming out is what's called a hemostatic agent. All y'all nerds look at the word and explain to the rest of 'em what it means. "Hemo" for blood and "static" for "not coming out all over the interior of the HMMWV." Hemostatic agents basically make the blood clot a lot faster. There are two main brands available in the U.S.: Quick-Clot and Celox. Never mind what they are (Celox is made from Chitosan, which is made from shellfish shells, not the meat, and no, you aren't allergic to Celox. Really.), they both work pretty much the same way: they make the blood clot faster. The old versions were what is called thermogenic. Nerds? Yup, they created heat when exposed to water. Blood is mostly water. You do the math. The new versions don't do that. They are "non-thermogenic." I'm not providing training here, but basically what you do is sprinkle the stuff on. Yup, that's purt' near it. Or you pack the wound with gauze that has the hemostatic agent impregnated in it.
The third, and most drastic way to stop the bleeding is a tourniquet. Two main types of those, two: the
CAT and the
SWAT-T. I'm not going to go into the advantages and disadvantages of each, they both do the same thing. They squeeze a limb really tight until no blood gets through. This means two things: It can't leave the body and it can't get to the rest of the limb. So obviously you don't just put 'em on for every little scratch. Tourniquets are for the really REALLY bad wounds.
So, what do we have so far? One cause of death, two ways of dealing with it, 4 items.
- Gauze (preferably impregnated with a non-thermogenic hemostatic agent)
- bandages (to hold the gauze in place)
- non-thermogenic hemostatic agent
- tourniquet(s)
Now the second major cause of death, the tension pneumothorax. What's a tension pneumothorax? Well, I thought you'd never ask! See, it starts with a pneumothorax (wound). Nerds? Yup, right again! It's a wound that penetrates a lung and the thorax. A bit redundant, that. But no worries, it serves the purpose nicely. So once you have a pneumothorax, air can be drawn in from the hole rather than through the trachea. And that air can be trapped in the chest cavity and prevent the lung from expanding. That's when it's a tension pneumothorax.
So there are two items that deal with this. One is to prevent it, the other is to fix it. The first is called, imaginatively enough, a chest seal. It seals the opening of the wound on the chest (you may need another one on the exit wound) so the air won't be drawn in. Two common types of chest seals are the
HALO and the
Asherman. There are others, as well as a few ways to make a field-expedient (that means DIY) chest seal, although you may have a hard time making it actually seal when the chest is covered with blood. Keeping in mind that I'm not intending to actually train you here, you basically slap a chest seal on and make sure one corner of it doesn't seal. That way it seals under a vacuum (like, ya know, when the diaphragm lowers to try to draw air into the lungs) but allows air to escape (like, ya know, maybe air that escaped from the lung into the chest cavity).
The second item is a decompression needle. And I'm not even going to
begin to tell you, on a blog, how to stick a needle in someone. But if you've had the proper training you insert a thick needle at a particular place and it allows any air that has already built up in the chest cavity to exit through the needle, allowing the victim to breathe again. You've probably seen this done in a movie. If you haven't had the training, you want this item anyway. Why? Well, that leads me to another subject I was gonna save for the end, but here we go:
YOUR BLOW-OUT KIT IS FOR YOU.
Here's what I mean by that. The blow-out kit
you carry is intended to save
your life. That means if
you have a hole in you,
someone else will be treating it. And that someone else, if they know what they're doing, is going to try to use your blow-out kit to do so. Why? So they still have theirs for themselves. So even if you don't know how to use that needle, you want it to be there for someone else to use.
OK, back to stuff. What we have so far is two ways to die and six items to deal with them:
- Gauze (preferably impregnated with a non-thermogenic hemostatic agent)
- bandages (to hold the gauze in place)
- non-thermogenic hemostatic agent
- tourniquet(s)
- chest seal(s)
- decompression needle
The third and final major cause of death is an obstructed airway. Makes sense, right, that if air can't get to the lung the body can't use it for anything? So what you have to do then is open that airway up. That generally means sticking something in there that will hold it open enough for air to get through. There are two main things you stick in there. Both of them (to no-one's great surprise, I'm sure) are called airways. One is an
oropharyngeal airway and the other is a
nasopharyngeal airway. Nerds? Last time I'll call on you, I promise! Yep, one goes through the mouth, the other through the nose, and into the pharnyx. I'm still not training you here, so I'm not gonna tell you how to use these either. But you want to include one of them in your blow-out kit.
Now, we've covered the three main causes of combat deaths and the 7 items you need to include in your blow-out kit to deal with them. But we're not finished, Dear Reader. Oh no we're not, because there are other things you really want to have in there.
Shears, for example. Even the good ones are pretty cheap, so don't skimp. The really cheap ones bend rather than cut. You need shears to cut away clothing or gear that might be in the way.
And
gloves. Nitrile (rubber), not latex, 'cause some people have an allergy to latex. But you need them to protect the victim (even if it's you) from whatever might be on the responder's hands, and the responder from whatever infectious diseases the victim might have.
And that's pretty much a barebones blow-out kit.
- Gauze (preferably impregnated with a non-thermogenic hemostatic agent)
- bandages (to hold the gauze in place)
- non-thermogenic hemostatic agent
- tourniquet(s)
- chest seal(s)
- decompression needle
- airway
- shears
- nitrile gloves
Does that mean that's all a blow-out kit should contain? No. That's the very very basic version. If you're going to carry supplies to help other people, why not throw in some other things? Like glucose tablets to help diabetics, or quick-release aspirin to help heart-attack victims. Don't lard it up too much, though, since the more stuff you have the harder it is to find what's necessary. The blow-out kit is supposed to be pretty much just the basics.
Now, how to contain all this stuff? Well, if you're just putting it in the trunk of your car, pretty much any good, durable pouch will do. If you're going to be wearing it, you definitely want something removable.
ITS Tactical has one that attaches to MOLLE vests by a pair of quickly-removable sticks.
Here's another way to do it. It's held on by Velcro and you simply pull it off. Either way, a kit on someone's back or side isn't easy to access when they're lying on their back.
And that pretty much covers it. Any questions?
P.S. In another post we'll have our team medic address in a little more detail how to use some of this stuff.
