What is essential to add to an IFAK?

[Iraq Ninja]

Aramti,

I guess they replaced it with moxiflexacin which I think is still ok with the FDA, but reserved for specific treatments.
The Brits tend to take a different approach, using Pen G to target just the real nasty bugs.

[matt86]

Theres no drugs in the IFAK now. The NARP 14 g cath looks sweet, but really no need to get it. The ACS is garbage, i like the NARP hyfin chest seal,it adheres pretty well to moisture ie. sweat, blood etc. I was deployed 08-09, and we go HemCon bandages, probably due to the fact Quikclot has chitosan, which is a contra. for pt's with shellfish allergies. probably because its cheaper though. go army.

[Submariner]

The ACS is garbage, i like the NARP hyfin chest seal,it adheres pretty well to moisture ie. sweat, blood etc.

Does the Hyfin have a valve or valves? If not, how does air vent?

[matt86]

No, its just an occlusive dressing.

[Danny Boy]

HemCon bandages, probably due to the fact Quikclot has chitosan, which is a contra. for pt's with shellfish allergies. probably because its cheaper though. go army.

I'd say cheaper. The unlikely event of anaphalaxis seems a very distant secondary concern to bleeding out, so I wouldn't pay it any mind. I've also been told that Celox was tested on volunteers with known shellfish allergies and that they did not report any negative reactions. Whether it's down to the way they refine the ingredients, I have no idea.

I heard that the ACS has recently had the adhesive changed to something similar to the Hyfin. Anyone confirm that?

[Submariner]

I heard that the ACS has recently had the adhesive changed to something similar to the Hyfin. Anyone confirm that?

Mr. Market said the adhesive sucked, so from chinookmed.com's site:

Now with an improved military grade adhesive!

http://www.chinookmed.com/cgi-bin/it...--------------

More on ACS.

[Iraq Ninja]

Danny,

I have heard the same thing, but I wonder if people are confusing the Asherman with the new Bolin?

BTW, here is an interesting report that confirms in the lab what was learned in the sandbox...

Evaluation of chest seal performance in a swine modelComparison of Asherman vs. Bolin seal
Injury, Volume 39, Issue 9, Pages 1082-1088
F. Arnaud, T. Tomori, K. Teranishi, J. Yun, R. McCarron, R. Mahon

Abstract
Introduction

Chest seals are externally applied devices used to treat an open pneumothorax. There is concern that chest seals used for treatment of an open pneumothorax can fail due to coagulation or malfunction of the external vent and poor skin adherence. Chest seal failure may lead to respiratory compromise or the development of a tension pneumothorax. The objective of this project was to compare the efficacy and adhesive capacity of two chest seals: Asherman and Bolin.
Methods

An open pneumothorax model in the swine (30kg) was developed to test the performance of Asherman (n=8) and Bolin (n=8) seals based on haemodynamic and ultrasonographic changes following intrathoracic air and blood infusion. Seal adherence measured on a scale from 0 (poor) to 3 (good) was tested on dry skin and skin soiled with blood.

Results

After standardised perforation of the chest cavity and aperture blocking, an air infusion of 372 (S.D. 214ml) was sufficient to reduce mean arterial pressure (MAP) by 20%. Both chest seals prevented a significant fall in MAP after infusion of 1500ml air into the chest cavity, and had similar adherence scores (2.6 (S.D. 0.8) and 2.8 (S.D. 0.6)) on dry skin. However, on blood soiled skin the Bolin seal had a higher score (2.7 (S.D. 0.6) vs. 0.4 (S.D. 0.7); p<0.01). Ultrasound did not yield interpretable results to differentiate between Asherman and Bolin seals.

Conclusions

The Bolin and Asherman chest seals were equivalent in preventing the development of a tension pneumothorax in this open pneumothorax model. However, the Bolin chest seal demonstrated stronger adherence in blood soiled conditions.

[USAFPararescueDoc66]

We have had to evaluate and test different kit set ups, whilst I was in the military as well as being a civillian doctor working with the DOD on hemostatic agent. In your IFAK you want to address the three primary battlefield killers being: extremety bleeding, tension pneumothorax, and airway.
-Extremety Bleeders: Israeli Bandage 6" , Kyrlex (wound packing if needed) , Quick Clot Granual, Ace Wrap, and combat gauze. I always carried two SOFT-W torniquets , these have been evaluated as the best torniquets on the market (Make sure you write the time the torniquet was applied to the patient)
-Tensionpnuemothorax: carry a DART decompression needle . If this is unavailable we have had to "jimmy rig" a catheter and attach the finger of a latex glove creating a one way flutter valve. Also carry either a HALO Chest Seal or ACS Chest seal for sucking chest wounds.
-Airway NPA (your size is determined by the diameter of your pinky finger.. In most cases ) and surgilube.
-Extras: Trauma Sheers, BenchMade Life Hook, forceps, tape, a few diaper safety pins, casualty card, large sharpie (writing BP's , medication given, etc) I always kept a cheat sheet of 9 line MVAC information as well whilst in country.
This is what I carried in my IFAK and hope this helps.
Stay Safe.

[Vic303]

I'd say cheaper. The unlikely event of anaphalaxis seems a very distant secondary concern to bleeding out, so I wouldn't pay it any mind. I've also been told that Celox was tested on volunteers with known shellfish allergies and that they did not report any negative reactions. Whether it's down to the way they refine the ingredients, I have no idea.

And as a former paramedic once told me...you have to be ALIVE to have an allergic reaction!

[Todd00000]

Most meds aren't really going to be relevant if you intend on being close to medical support/care. Unless you have some opioids like fetanyl which might be useful but even then I wouldn't self-medicate.

I think a roll of regular gauze gets overlooked quite a bit...not to unroll but to use as a wipe to get rid of excess blood to see the wound. Similarly the whole role can be placed under a pressure dressing to apply a single point of pressure.

I agree, and there is usually room for an extra TQ. We also took a gallon ziplock bag cut down the sides, sometimes you need a large chest seal and it rolls up real small.