ITS Tactical's Third Annual Muster Event AAR... sort of

By Caleb Causey, Lone Star Medics

            There is really no easy way of explaining what the Muster is all about with mere words.  I’ve had the privilege and honor of being part of all three Muster events and every year I am at a loss for words when trying to explain to my friends and family what I’ve been doing all weekend.  So if you wish to learn more about what goes on at this unique and skill set driven assembly, may I suggest you read Mr. Black’s (Bryan Black, owner and editor in chief of ITS Tactical) AAR (http://www.itstactical.com/centcom/its-information/its-muster-iii-after-action-report/), the actual Muster description as it is posted on the ITS Tactical’s website.  My goal for this article is to simply share with readers what I witnessed as a member of the cadre, as the event’s medic, and as a quasi-participant.

            Let’s start with the fun stuff… gear that worked and gear that did not.  Granted we weren’t HALO jumping out of airplanes nor did we come across too many “walkers” following the latest Ebola crisis.  Attendees and cadre alike however were walking through the mean, scary dark woods at night and setting up OP’s (observation points) and conducting both day and night land navigation training in thorn bush and prickly pear cactus infested fields and forests.  Attendees found themselves out in those fields and in those woods more often than not throughout Muster; sometimes for several hours or even throughout the night.  Unlike previous Muster events, what the event lacked in overall distance and road marching.  It was made up in terrain and environmental elements. 

            Over the years, alumni attendees have learned that no matter how “tacticool” a piece of equipment or clothing looks; if it doesn’t keep thorns, dirt, gravel, bugs, skin-irritating plants, or small mammals out… it ain’t all that cool.  The mentioning of thorns keeps coming up because after three Muster events, I’ve probably plucked hundreds of thorns out of attendees and cadre’s feet, hands, arms, legs, and one dude’s butt cheek.  Thorns ranged from itty bitty little bastards that burned like fire to the giant ¼” – 4” spikes that the top of your foot found as you dragged your foot across a prickly pear in the night and didn’t see it there.  I’ll go into what I used to remove said thorns later. 

So let’s look at specifics…
Uniforms/clothing
- Shirts.  Those that wore long sleeved shirts didn’t seem to get that many small cuts and scrapes as those that strutted their favorite screen print T-shirt.  You take your pick; moisture wicking or thorn picking.  Don’t forget that in the field a simple minor cut can become infected and cause more severe problems a few days later.  Think about that if you get cut your first day on a three day weekend trip.  If you had to prone out or low crawl for any amount of time/distance, would your muscle-mapping t-shirt protect your arms and elbows? 
- Pants.  Thank goodness no one wore denim this year.  Denim stays wet when it gets wet and trust me you don’t want a wet crotch during a road march or simple day hike.  You’ll have some crotch-pot-cooking going on down there in no time at all.  There were a few folks that decided to wear cargo shorts out in the field.  Again, if you had to low crawl or prone out… just sayin’.  The most common name brand I saw out in the field and what seemed to work pretty well were Vertx pants (http://wearvertx.com/).  Crye Precision and a few “dead bird” pairs of pants were present too.  Again, those that wore pants saw less cuts and scrapes.  However, I will say that no matter what type of material or brand anyone was wearing; those itty bitty thorns still found their way into people’s legs sometimes.  But some folk’s pants dried out a lot quicker than other’s did after submerging neck deep in the lake. 
- Footwear… one of my favorite discussions to have with folks.  Not to be a hater, but those cool-kid, overpriced, “off-road” running shoes are worthless out in the woods.  Just speaking as the medic, I saw more twisted ankles (minor, but still…) and picked more thorns out of folk’s feet because they had those damn things on.  They may be great for running off-road, off-trail or out on the shooting range.  But they are not meant to be worn with a 25lb pack and protect you from the elements.  Sand, sweat, socks, feet, and heat don’t all go to well together.  You may only roll your ankle just enough to let it talk to you a bit, but that sucks if you just left the trail head five minutes ago. Now your day hike or bug-out plans have to change. 
Each year at Muster there is at least one or two classes on foot care or foot wear.  The Muster alumni have learned very quickly what works and what does not.  When you have to march six miles to and from chow every other meal, you learn real quick.  (Granted that was from past Musters.)  I’m pretty sure everyone had on wool socks and changed their socks at least twice a day.  After all, a typical Muster day is about 15-18 hours and on your feet for most of that time as well.  
I recommend that for tromping through the woods with all sorts of things out to attack your feet; wear either a pair of Danner Acadia’s (one of my all time favorites) or AKU NS564’s for light rucking (<25lb rucks) or if you’re carrying more weight go with the Pilgrim DS or GTX.  (Check out https://squareup.com/market/procurement-specialists-llc for purchasing, tell them Lone Star Medics sent ya.)
The idea is to have enough protection from the terrain as you do from weight of your ruck.  It is a balancing act, but I sure as heck didn’t pull thorns out of anyone’s feet that wore boots made with sturdy material.  I could go on and on about foot care and wear, but this ain’t what we’re talking about here.
- Gloves.  A lot of people had these thin lightweight “shooter” gloves on and I spent plenty of time digging in their hands looking for tiny stickers and thorns.  Leather!  Get yourself a pair of old school Army issue leather work gloves.  I’ve had the same pair from basic training for over 15 years.  They still protect my hands and fingers to this day.  Granted you lose dexterity with them.  So if you are roaming through the woods looking for bad guys with a rifle slung across your chest; you’ll need to find a happy medium.  I’ve gone through several pairs of the Nomex flight gloves that military pilots wear over the years.  They have a thin layer of leather on the palms and offer dexterity over abrasion protection than the bulkier full leather work gloves.
- Compass.  Let’s face it, you’re already lost because your GPS unit ran out of batteries, it is getting dark, and you figured you’d save a few bucks and purchase a cheap compass.  Folks, do you and your family a favor… spend more than $7.85 on your compass.  Get one from either Silva or Suunto over at REI.  And while you’re at it, get one for each member of the team or family.  No, that compass smartphone app that came free with the phone does not always work.  One thing I found out is that my bad ass Suunto Vector watch’s compass was constantly off by at least 15-25 degrees.  Which is horrible if that is your only means of direction or navigation.  The rest of the functions did pretty well.  But I’ll keep to my Suunto regular compass for navigating through the jungles of DFW and beyond.

Sick Call

            As far as being the primary medic, I saw the typical injuries and illnesses you’d most likely see when you have a group of about 50-60 people of various ages and physical capabilities roaming around the woods.  Nothing serious, but without simple medical attention things could have gotten worse. 

            This year there were a lot less foot care issues and more environmental related issues.  Meaning I tended to less friction blisters and more prickly pear thorns.  The alumni really have been instrumental at telling the newbies what to expect at Muster and what their lessons learned have been over the past few years.  Simple cuts and scrapes are expected while in the field and thankfully the facilities we were at had running potable water.  The ability to use running water and soap made things easier for me and the patients.  We went through a handful of band-aids and antibiotic ointment.  Even the experienced woodsman rubs up against unknown plants on occasion.  These unidentified plants caused localized pain or irritation and sometimes swelling of the affected area.  Washing the affected area with soap and water, changing out contaminated articles of clothing and sometimes a small dosage of Benadryl seemed to curb the signs and symptoms.  Bug bites ranged from mosquitos to small spider bites to who-knows-what.  Dehydration was an issue after the overnight OP mission.  The temperature changed a bit over 48 hours and with sleep deprivation naturally comes a little dehydration.  But for the most part, the alumni kept everyone in check.  I guess they have enjoyed my hydration lecture(s) over the years.  One thing I did notice with the slight sleep deprivation of both the attendees and cadre; there was a temporary loss of appetite.  Not a huge deal, but as the primary medic it was something to keep track of.  This was no longer an issue following an hour or two of sleep, a can of Kill Cliff, and some pogey bait (Army for snack food.)

            Most of these injuries and illnesses could have been prevented.  Not saying they could have been prevented 100%.  Just that if some simple precautions like using bug spray, wearing the correct type of footwear and clothing; could have helped out.  That being said, I don’t think there is anything that could prevent Brandon P.’s hands from finding every single thorn or sticker in Texas.

            In conclusion, wear appropriate clothing that protects your skin, wear sturdy well broken-in boots with wool socks, and as always… DRINK WATER!   

After Action Review - ECQC by Shivworks

AFTER ACTION REVIEW (AAR)… ECQC course by ShivWorks/SouthNarc
May 2-4, 2014
College Station, TX

            I was first introduced to SouthNarc (Craig) at the Rangemaster’s annual Tactical Conference several years ago by my dear friend, the late Paul Gomez.  Over the next few years I would hear of how awesome this course called “ECQC” was and how everyone that took it learned how much about gun fighting or self-defense they really did NOT know.  These buds of mine are some pretty tough hombres and are probably some of the most talented defensive/competitive shooters on the planet.  So after years of reading about it, months of my close friends (ECQC alumni) pleading with me to sign up for it, and SouthNarc personally giving me a big dose of reality during a private conversation last year; I decided to sign up and bite the bullet.

            I’m not gonna waste your time telling you about what the class teaches you, go check out the Shivworks’ website for that info or better yet… go sign up for a class.  I’m going to talk about what I learned during this 20+ hours of course work.  Let me tell ya, I went into this course with the mindset of “I don’t know what I don’t know” and by the end of the first 4hr training day/block… I knew I knew even less.  The class consisted of a couple of LEO’s, handful of PMC’s, and regular folks.  Some had a few years of experience in some sort of martial arts or combatives training in either MMA, Brazilian Jiu jitsu, or Krav Maga.  Then there were dudes like me with very little amount of training in any martial arts.  Yes I had some in the Army, but when was the last time you saw an MMA fighter win by using a bayonet or a thumb-strike to the throat?  I am what Craig refers to as a “gun-guy” or someone that believes a firearm will solve all their violent attacks/problems.  Admittedly, I am a gun-guy.  I’ve taken several pistol, carbine, shotgun, and precision rifle courses over the years.  I’m more than confident using a firearm to defend myself or my loved ones in various environments/scenarios… so I thought. 

            Training day 1 is a four hour block called Managing Unknown Contacts (MUC) and a lot of other subjects.  I’ve taken a condensed version of this several times in the past at the Rangemasters’ annual Tactical Conference and Paul-E-Palooza.  Each time I would pick up more and more and it was always a great refresher.  MUC teaches students how to keep bad guys at a distance when confronted.  We learned how to pick up on “cues” or traits that bad guys use right before they pounce on their prey.  One skill that I learned and will never forget is how to get a low center of gravity and that he who has the lowest hips wins.  This was explained, demonstrated, and driven home quickly by practicing “mountain goat drills”.  Which is nothing more than having two people place their foreheads together and with their hands down by their sides, try to move the other person.  I’m a big dude, 6’2” and about 250lbs and a couple of folks half my size and weight were pushing me around like a rag doll simply because they got their hips lower than mine and faster.  I learned quickly to correct this and started enjoying the results.  This skills practice would produce our “training certificate” for the course… a bruised and raw forehead.  But it began the foundation for stopping someone from trying to mow ya right on over.

            Training Day 2 started on the range with a safety brief which really shocked me.  Since 2003, I’ve been to several shooting competitions, firearms training courses for civilians/LEO/Military, range fun days, demo shoots, and conferences.  Craig did the most thorough and most effective range safety briefing that I’ve ever even heard of let alone personally witnessed.  If I’m lyin’ I’m dyin’… but I swear he stole it right out of our “Range Response” course and right out of our “LSM General Medical Site Survey” form; both we’ve been using since about 2010.  I’m gonna email it to him and get his two cents.

            We knew we were going to be close to the targets (cardboard IPSC), but I didn’t know we’d be THAT close to the targets.  We were about two yards from the targets to start with, but quickly moved closer so that our foreheads stayed in constant contact of the cardboard.  We were shooting from “position 2” of a 4-position draw stroke.  Which from what I learned from Gomez’s RPM class; we called a high close compression position.  This is obviously for a close contact shooting position.  Craig says it is up to us to judge for ourselves how far to extend or not to extend to engage our target.  But if they are up on us or we’re tangled up with someone trying to kill us; it works pretty darn well.  The thing that surprised me the most about this position was how really compressed I could be with my pistol and still make good shots on my target.  Granted I’m not hitting or aiming for the cardiovascular triangle (high center chest), but that was not the point.  There are several pro’s to this position and why’s we shot low; but I’m not going to go into it here.  That’s SouthNarc’s job… go take the class.

            The afternoon was spent going over a lot more combative movements with our hands and arms; how to gain control of our opponent using various styles of wrestling and martial arts.  Then we put on the FIST helmets, groin protectors (cups), eye pro, and mouth guards and the Simunitions guns came out too.  Oh and literally BUCKETS of Simunition rounds.  We broke up into groups of 3-5 and started one-on-one evolutions.  And that is exactly what they were; evolutions.  This was the first of several evolutions.  And I got my ass handed to me each time.  In fact, I didn’t even get to draw my gun on the first few because I was busy trying to gain a better position than my attacker.  Needless to say, by about 16:00hrs I was on information overload; but in a good way.  I had a lot to process and think about.  I had to “think” while someone was smacking the side of my head, pinning me to the ground, trying to get MY gun out of MY holster, gaining better body position, locking my arms and hands up, and all while trying to just simply breathe.  Yes, I forgot to breathe.  The information given to me was still processing and was not being put to good use during the first few evolutions.  I did manage to keep my hips low and even though I technically lost the evolutions, the wheels were turning in my head.  Just not near quick enough.  Which when you think about it; isn’t that how it is going to be in real life when the bad guys jump you in the parking lot?  Nope, it will be faster, more violent, and you can end up a lot more banged up than five or six Sims rounds in your back and a few bruised arms.

            Day three (technically) started back out on the range with more live fire drills from literally face-distances.  We learned how not to look like Ricky Bobby from Talladega Nights and what to do with our support hand/arm while shooting from position two.  This was odd at first, because while using a horizontal spear/guard, you can’t see your firearm yet you learned from the day before it is all about feeling and really focusing on those details about position two.

            The rest of the day was a mix of blue guns, FIST helmets, mouth guards, eye pro, and Sim-rounds.  Which yes it was a butt whuppin’, however a lot of lessons were driven home pretty solid.  If your defensive firearms training doesn’t include some sort of force-on-force scenarios, you’re BS’ing yourself.  We started off with two on one scenarios where the initial attacker begins by interacting with you on their own.  Then when Craig feels it is time, he introduces the second attacker.  Now these scenarios are not scripted nor are students told what to do or how to act.  The only directions given were to stay safe, stay within the training circle (a 10-15yd wide circle made up of observing students waiting their turn), and be interactive with each other.  After your scenario, Craig picks your brain on what happened and why you did what you did… good or bad.  My scenario; I shot an overzealous fan trying to get my autograph for a SWAT magazine article LSM was recently in.  Long story short, I gave polite but firm verbal warnings and things escalated quickly.  Things got worse for me when a “bystander” showed up to intervene.  I almost shot him too.  Moral of the story is don’t shoot your fans… I like fans… I don’t have that many… I shouldn’t shoot all seven that are out there.  But seriously, I felt that the role player was getting too close, I gave several verbal warnings, performed finger flicks (don’t ask, take the course), and when we went to grappling and I felt in fear of my life I deployed my firearm and from position two…fired two or three rounds in the attacker’s belly and then one round to the high chest from position three.  Let’s just say that it is going to be a hard sell to the jury that deadly force was justified.  There was a lot more that I learned in that scenario, but I don’t have the time to list them all here right now.

            The next evolution after learning to prevent gun grabs with more blue guns was a carjacking gone bad.  Good guy (armed, concealed) and bad guy (armed, concealed) start off sitting up front in an old junk car.  Story goes; bad guy is given a ride by good guy, bad guy pulls gun and robs good guy.  Good guy must survive.  Trust me folks, this sounds a lot more tame than what really happened.  Again, my ass was handed to me, learning was obtained.  Cool part was that no matter your environment you can still apply everything we learned over the past 2.5 days.  For me the wheels were turning and I was starting to “think” my way through some of the problems (evolutions) by the end of the class.

My take home from this course:
- The gun doesn’t solve all your problems.  Chances are I might not even have the opportunity to even draw it.
- AIWB (Appendix Inside the Waist Band) is the way to go for concealed carry.
- If a knife isn’t “fixed”, it’s broken.  Meaning folders are a much more pain in the butt to deploy and use while all tangled up in a fight.
- I’m not in perfect shape, but I managed to maintain.  But ya can’t “maintain” in a real fight.  Cardiovascular endurance, strength, and speed survives and wins!
- NEVER, NEVER, NEVER, NEVER, NEVER, NEVER get flat on your back!  I learned how to rotate my hips from under an opponent that is on top of me in a mounted position both full and from the side. 
- Learn position #2.  Learn it very well.
- I had a lot of fun.  I learned more about myself in 2.5 days than I have any other training except from my military training/service.
- I’m currently searching out BJJ and Krav Maga gyms locally with good reputations. 
- There is still so much to learn…    

Some of you may be asking what does this course have to do with field or tactical medicine.  Well, if you can’t stop the bad guys from producing more injuries to yourself or others; then medicine is the least of your worries.  Stop bullshitting yourself like I did and go take this course!

I’d like to thank my fellow classmates for being excellent training partners.  Without you, I would have been lost in all the info.  Thank you for being patient while I sorted things out.  It was awesome having each student NOT pretend they were the instructor and let the actual instructor do the teaching.  Big “Thanks” goes out to Cawthon Cartridge Club for hosting.  Craig, thank you for calling me out last year and telling me what I didn’t want to hear, but needed to.  Also thank you for calling me out this year and telling me what I didn’t want to hear, but needed to.  You truly are a great instructor.  You have my respect and it is an honor to call you “friend”.  You will see me in more of your classes so that I can continue to learn and think.   

You can find out more about ECQC and other courses that Shivworks has to offer at this website:  http://shivworks.com/    

Caleb Causey, Lone Star Medics

"Do you even TQ, bro...?"

           First off let’s get something straight; tourniquets (TQ) are your first line defense against major bleeding from the arms or legs.  If you don’t know why that is or if this is new information to you, no matter your occupation; you need to get trained up on current hemorrhage control practices.  We’ve got over a dozen years of war on two different fronts that proves the old saying “tourniquets are a last resort” is just not true.  For most of us, we know how important a TQ is to have strapped to the buttstock of your rifle, the first thing you see when you open your IFAK, or have stashed in your EDC med kit that you carry on you 24/7. 

          “You mean I have to carry a TQ “on” my body?”  Yes, cowboy, I sure do!  More importantly do you even know how and when to use that thing ya got stuffed in your back pocket?  A quality tourniquet should absolutely be part of your Every Day Carry kit.  Notice I said “quality”.  Before you ask, let me give you an example of what a quality tourniquet is; it’s a Combat Application Tourniquet (CAT) made by North American Rescue (narescue.com) or a Special Operations Forces Tactical Tourniquet-Wide (SOFT T-Wide) made by Tactical Medical Solutions (tacmedsolutions.com).  I’m not going to bash another manufacture’s product and this article isn’t a pissing match between tourniquet “X” and tourniquet “Y”.  What I’m ranting about here is that I want y’all to start thinking about your tourniquets like you do your defensive pistol that you carry concealed every day.

          As someone that values their own life and their family’s lives; you carry a firearm on your body as part of your EDC kit.  You carry a solid, reliable, functioning pistol; right?  Then why for Odin’s sake, do you 1. Not carry a TQ at all or 2. You carry a weak, non-reliable, non-functioning tourniquet?  I want you all to start thinking about your tourniquet like you do your sidearm.  Stop thinking of your tourniquet like some red-headed step child piece of kit. 

          Ask yourself this; “If I was in a gunfight, would I want a cute little Kel-Tec .32 caliber that fits in my back pocket because it’s small & light and doesn’t take up much space in my skinny jeans?  Or do I want a Glock 19 hugging my body via Raven Concealment Systems with 16 rounds of “In Your FACE!”?   

Well, I see that SOFT T-Wide as a Glock… a reliable piece of kit that is going to do its job when I need it to.  Even if I’m upside-down in three feet of water with NVG’s on; they are going to work.  That small rolled up piece of bicycle-inner tube-like thing or that jock strap with two shower hooks ain’t gonna do much for controlling major bleeding… under stress… with one hand… in the dark… in the ditch on the side of the road.    

Some of you have spent thousands of dollars on firearms, defensive firearms training, and firearm accessories over the past several years.  Which I’m all for and as big, bearded, barreled chested freedom-loving patriots; we should.  But for those of us living stateside, when was the last gunfight you got into?  Now how many car wrecks did you see on your way to work this week?  Not taking away from firearms or training with them.  According to the stats from the CDC and American Heart Association, Americans are dying of cardiac related disease and receiving serious traumatic injuries from car wrecks a heck of a lot more than GSW’s from bad guys.  Just like all those shooting classes you took so you could master that skill and weapon when your life depended on it most; you should view medical gear and training the same.  I beg of you, please go get some medical training from a reputable instructor/company.      

So tomorrow when you start to throw all that gear on, make sure at a minimum you’ve got a TQ… a solid tourniquet, as part of your EDC.  You’ve taken the time to get yourself ready for what the day has planned, might as well be ready to beat death back with a stick.  Just like your firearm, a tourniquet could save your life or someone else’s.

Some questions for ya...

1. What does "tactical medicine" mean to you?

2. What is a tactical environment?

   I recently posted these two questions over on our Facebook page.  It was very cool to read everyone’s answers.  If you haven’t already done so, head on over there and post your own answer.  There are no “wrong” answers, but to be honest, I felt like there were some answers that were a little off target.  For some of those answers you could very easily chalked them up as perfect answers to the questions; “What is a field environment?” or “What does the term field medicine mean to you?”

   To me, “field medicine” is medicine outside a clinical setting.  For example; the type of medicine performed outside a doctor’s office or a hospital.  Notice I said nothing about it being “emergency medicine” or "tactical medicine".  As a medic in the US Army, I probably practiced more sports medicine and medicine you might find at your family physician’s office than a whole lot of trauma.           

These are just my thoughts & opinions…
1. Tactical medicine is a type of medicine performed in an environment that has an active threat(s), the high potential of a threat(s), or immediately following a violent act(s).  This type of medical care must provide the highest level or degree of mission success; no matter if that mission is to immediately stop the burglar from harming your family in your own home or a group of law enforcement officers serving a warrant or soldiers hunting terrorists up in the mountains.  Even with injuries and casualties; the mission comes first.  So therefore the medicine provided must cater to that mission’s goal. 

2. A tactical environment is an environment that has an active threat(s), the high potential of a threat(s), or immediately following a violent act(s).  The proper use of appropriate tactics in this environment will assist in the positive outcome of the mission. 

… Just my two cents.

   This was just to get your minds thinking and to see where your heads are at.  The reason for asking y’all these questions; was to make sure that the medicine applied is the correct medicine.  There are several different types of medicine; cardiology, podiatry, oncology, emergency medicine, pre-hospital medicine, etc.  There are also several different types of specific professionals for each of those types of medicine. 
To quote a mentor of mine when I was a young medic in the US Army; “Medicine is not a science.  Medicine is an art; and some artists’ art is better than other’s.”

Drink Water,

Caleb Causey,
Lone Star Medics

“What should I pack in my med kit?”

I get asked that question more than any other throughout my day.  Usually I tell them to just come take one of my classes and not only will you answer your own question… ya’ just might learn how to use the stuff too.  How cool would that be!  Alas, I have a hard enough time getting people to be properly hydrated (i.e. drink water); let alone carry a tourniquet (TQ) and learn how to use it effectively.  So I figured that I would answer this objectively and without any “sales pitches”.

First off, there are a couple of factors that you should consider either when purchasing or building your Individual First Aid Kit (IFAK), Blow-Out Kit, Aid Bag, or Med Kit.  These factors/considerations may change throughout the day, month, or year.  The idea is to “... be like water” as Bruce Lee would say.  Create options for yourself.  There is no, “Do All, Cure All” med kit.  The aid bag I carried as an OPFOR medic in the Army, ranged between 25-55lbs depending on these factors and it still didn’t have everything I needed/wanted.  No, it wasn’t 45lbs of Motrin® and moleskin.  I did have some pretty cool flashlights in there though. 

Here are the considerations I feel you need to ask/answer yourself when selecting medical equipment for a med kit, aid bag, or IFAK.  These are great for both the layperson and the medic alike: 

1. Mission.

What are you going to be doing?  

What is your mission, in general?  Meaning, what do you find yourself doing on a typical day.  Are you the type of person that sits in a cubical freaking out because you forgot the cover sheet on your TPS Report or are you hunting down terrorists & shooting them in the face?  There are several of us that are somewhere between those two options.  For me, wearing my plate carrier with an IFAK pouch via MOLLE attachments is not a great option when picking up chicks at my local Wally-World. 

Seriously though, think about what your daily routine is on a normal day.  Remember “how” we    carry this med kit is just as important as “what’s in it”.  If you’re heading out to the range for the day with your shootin’ buds, then an IFAK and a general purpose med kit may be in order.  A med kit with “booboo” supplies like Band-Aids, Aspirin, antacids and an IFAK for serious life threatening injuries should be carried to the firing line.  Notice I said “carried to the firing line” and not just left in the car, back up by the club/range house!  

You need to carry & pack your med kit so that it is an asset to your mission, not a detriment.  (Yes, you can use that line in one of your books, S.A. Bailey.)

2. Environment.

Where are you going to be while doing your mission?

What type of environment are you in?  This may sound repetitive and similar to “Mission”; but it’s not.  In regards to “Environment”, I’m talking about what type of actual environment you’re working in.  You could be in a desert, jungle, urban/rural setting, or maybe in the mountains.  My students are often surprised how much effect the weather has on your patient and your treatment plan.   In the mountains, you might want to throw in a foil space blanket into your med kit to help with shock.  A wool stocking cap is not necessarily on my med kit’s packing list, but it sure is a quick and effective tool to have on hand when combating shock.  Are you working in extreme temperatures?  If it’s cold out and lots of snow, simply performing a two- man drag/carry in three feet of snow is going to be tough.  If it’s hotter ‘en hell, don’t forget that while you’re dragging that patient behind you on a litter/stretcher, they’re cooking directly under that sun.  For some of us living in town, leaving a patient (pt.) lying on that blistering hot concrete may produce second-degree burns.  See where we’re going with this?  

Don’t forget that having access to professional rescuers is also part of your environment.  We’ll talk about that detail in a minute, but for now just remember that there’s not always a Level I Trauma Center (big freaking hospital with literally every kind of doctor and medicine available, 24/7… sort of) right down the street like some high-end coffee shops are.  You may have to drive a couple of miles down a dirt road just to get to a hard-ball road (Army talk for an asphalt or paved road).  Then it may be a 45 minute drive to a local clinic… that closes in 5 minutes… but they left early because it’s Friday… and a thunderstorm just blew in. 

Part of your environment is in fact “available resources”.  Does your environment have EMS available for you to call?  If you’re out hunting with uncle Bob and his heart starts acting up again, it sure would be nice if the ambulance you had called did in fact have not just an EMT, but a Paramedic with drugs & gadgets specific for treating cardiac related illness/disease.  As a medic/EMS; what sort of assets are immediately (respectfully) available?  Calling medical control is a little different while on scene in some apartment complex, than on the side of some Taliban infested mountain.    

3. Level of training.

What is your current level of training?  

As medics, we have extensive training in using some pretty sexy equipment.  A lot of laypersons ask me if I’ll teach them how to start I.V.’s on each other.  I tell them if they pay attention on how to use a SOFT-T Wide and QuickClot Combat Gauze, they probably won’t need an IV.  Let me rephrase it for you thick-headed types; we start with the most minimally invasive procedure/treatment plan first.  Then if that doesn’t work, we bump it up a notch or two.  The body does a pretty good job of taking care of its self.  Most the time it is ourselves that get in the way, believe it or not.  The body also responds better sometimes with the least amount of help in the form of medicines, surgeries, etc.       

Your level of training also includes knowing how to utilize those little bits and pieces in your med kit and maximizing their potential.  Meaning I don’t care how “James Bond” something is or looks; if you don’t have a clue how to make it work effectively, then either learn how BEFORE carrying it or pass it along to someone that does.  Now I’m not expecting you to be psychic and pack your med kit in anticipation of what some random medic may or may not want in that IFAK pouch,  if in fact you two end up treating the same patient.  I’m saying that you should probably carry medical equipment you are familiar with and know how to use that equipment efficiently.         

4. Number of people you’re responsible for.

How many people are you immediately responsible for or that you plan on having to treat?

For some of us crusin’ around town, this could mean that we’re just responsible for ourselves and our significant hottie.  For some, it could be a small platoon-sized family that you have to keep track of.  My point is that what we in the industry call an “IFAK”; is just that… an “INDIVIDUAL First Aid Kit”.  Key word being there, “individual”.  Those sexy little pouches filled with magical potions that the troops wear on their plate carriers and body armor are not there to treat some random dude.  They are there to treat themselves first, their battle buddy second, and non-combatants/the enemy/whoever else they want to last.  But it is not intended to treat five or six folks.  

Medical equipment/kit should work in tiers or levels.  For example; if we’ve got a group of 10 soldiers and one medic with an aid bag.  Each troop has on them their own IFAK.  Then let’s say their protocols call for every 6^th troop to be trained as an assistant for the medic and they carry a small supply of medical kit.  Then the medic has their own IFAK for themselves AND carries their aid bag with enough medical equipment to sustain that many people for that particular mission/environment.  Then that group of 10 report back to a larger group with more supplies & personnel… and so on.  Well, as civilians it works the same way.  We carry on our person just enough med kit to survive until the “… folks in funny little white shirts driving funny looking trucks” come and pick us up and take us to the hospital.  (I’m paraphrasing there what my dear friend Paul Gomez told me once.)

So just to recap; there are no “cure-all” med kits out there.  There are tools available and you need to make sure you pick the right tool for the right job.  Also, it sure is nice if you know how and when to use that appropriate tool correctly.  I’m not going to tell you specifically what products you need to have in your med kit.  To learn that, go out and get some training first.  That alone will answer more questions about med kit than anything else.  No, that’s not a ploy to sell more seats in my classes.  It’s just the hard truth.  For example; before I took my first defensive firearms course many years ago, I went out and purchased a pistol I thought was super-duper cool.  After that three-day class, I sold it and bought a Glock 19.  I had to learn why & how to accomplish a skill with sub-par equipment.  It was effective, but not near as efficient as the Glock.  And folks, let me tell you; after taking more classes, learning more about self-defense techniques/tactics, & taking a force on force class… you want both, effectiveness and efficiency.  Well, medicine is the same way.  When your buddy is laying there bleeding out of holes in their chest and legs; medical equipment needs to be effective and efficient.

Drink Water!

Caleb Causey
Lone Star Medics