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Equipping The Tactical Medic
What is the minimum amount of gear a tactical medic should carry?
Any medic working with a tactical team needs certain basics. The uniform should resemble the rest of the team as much as possible for a sense of team unity. Ballistic protection is also a priority. The medic should be wearing level IIIA or better.
One of the trends being seen in the military special operations world is the use of climbing helmets instead of Kevlar helmets. The reasoning behind this is that there was a greater risk of blunt trauma to the head than penetrating trauma. The climbing helmets are also lighter, more comfortable, and allow for better hearing. The argument has been that the military Kevlar helmets offer blunt AND ballistic trauma protection.
In fact, the military issue helmets, like many tactical officers wear, offer only fragmentation protection. They are not designed to stop a round, and in fact, a small caliber round has been known to penetrate if the helmet is shot straight on. There are new helmets out there that offer ballistic protection and are a better design than the old standard, but their cost is also an issue. A helmet of some type is required gear; the decision on what type is up for discussion.
The rest of the uniform should mimic the tactical team, boots, eye protection and Nomex hood. There have been issues with labeling medics with large placards on their backs/ vests that say “MEDIC.” The reason is more of a military mindset than anything. In combat, the enemy tries to take out medics because it would increase the casualty death rate, and it was a blow to the morale of the unit, so a recommendation is to limit labeling.
The medic will also need the same kind of communications gear as the rest of the team. The medic should also have a light-headlamp and/or pocket light in blue or green, Chemlights in white or yellow and red, 14 feet of flatrope, and either a fixed or folding knife. Chemlights are a cheap and easy way to mark casualty evacuation points, cleared rooms or signaling triage levels at night. (White means walking wounded, while Red means critical). The flatrope is good for tying open doors or dragging patients to a safe area without exposing the medic.
The best way to address the medical equipment needed is to divide the answer into two categories: urban and rural. Medics who work in an urban environment enjoy the close proximity of street medics with a rapid response time. There isn’t the same necessity to carry an ambulance on their backs like their rural brothers.
Urban Tactical Medics
A recommendation for urban tac-medics is to carry the majority of their equipment in a low-profile backpack or medic vest. This allows for greater ease of movement in cramped spaces, i.e., apartments, condominiums and tenement housing. The urban tac-medic can carry additional gear in a drop leg pouch (two if unarmed) or a fanny pack.
There are some good low profile bags on the market today. The Blackhawk “M7” medic bag or the PSP (Pacific Safety Products Inc.) “TacPack” are both good choices. Tactical Tailor and Londonbridge Trading Co. also have some good low-profile bags that would suit many urban missions. This is by no means the only options available, just a short list.
The basics are always the best; focus on Airway, Breathing and Circulation (ABCs). Medics should push to get team members to carry blowout kits on their vests. This allows the medic to carry less and treat more. The big trend in blowout kits seems to be an oral/nasal airway measured to the operator, some trauma dressings, a hemostatic (blood stopping) powder, such as “Quick Clot” or “Traumadex,” and a one-handed tourniquet.
The medic’s pack or vest should be set up to treat at least three trauma patients, with additional supplies carried in the thigh rig or fanny pack for the “Platinum 10 Minutes.” In trauma medicine, medics talk of the “Golden Hour”; this is the hour directly after a traumatic event occurs to the human body. If life-saving interventions are performed within this hour, the odds are in the patient’s favor for a healthy recovery.
This hour has been further broken down into a “Platinum 10 Minutes”; this is the first 10 minutes of the “Golden Hour” that ABCs must be corrected for the patient to survive. The focus again is treatment of Airway, Breathing and Circulation (bleeding).
First, for the airway, the pack/vest should have multiple-sized airways in either oral or nasal types. There are arguments made for using “tactical” laryngoscopes and carrying endotrachial tubes (this device holds open the mouth while a long tube is inserted into the airway). This type of airway is more secure and allows for better air exchange. There are other options that don’t require much equipment and provide a stable airway; they also are a basic life support skill. The use of a “Combi-tube” or Laryngeal Mask Airway is quick and carries little equipment, and those are two things tactical medics love.
Second, for treatment for breathing once the airway is secured, the medic needs to ensure that the patient is receiving oxygen. If the patient can’t breathe for himself, the medic must take over. The pocket mask is a good tool to have, preferably with an oxygen inlet and one-way valve.
I don’t recommend urban medics to carry oxygen or bag valve masks because of the weight and space each takes up on their kits and the time used. The amount of time for a patient to receive advanced care from a street medic is usually short. A chest decompression kit is included as a breathing treatment, and all tac medics should be encouraged to carry them in some form or another.
Last, treatment for circulation should include trauma dressings of various sizes. The military field dressings are handy and designed for the tactical environment, with ties attached so no tape is needed. Other options such as the “Israeli Dressing” combines an elastic trauma dressing with a one-handed pressure dressing and are great solutions for moderate to severe bleeding. There are many forms of vacuum-packed elastic bandages that conserve space, yet perform well.
Another option that is new to the field include hemostatics (blood stoppers). These powders and gels are in use by different types of tactical and military units with varying degrees of success. The big issue for a lot of medics who would like to use them are the ER docs and trauma surgeons who have to deal with the cleanup. This issue can often be solved through education.
Tourniquets are also an issue of contention that really are imperative for a medic to have available if the need arises because of severe bleeding. In the past, tourniquets were viewed as a last resort and only to be used if the other option is bleeding to death. Today, that stigma has been replaced with a better understanding of the importance tourniquet use plays in severe trauma and patient survival.
The last item of importance when dealing with circulation compromise is fluid replacement. The medic should have an adequate number of intravenous fluid replacement setups. The solution of choice seems to be normal saline as opposed to Ringer’s Lactate or other solutions. These setups should also include several sizes of catheters (always trying for the largest bore), tubing and tape. The urban environment may not have as great a need for this type of fluid replacement as the rural environment, but better to have and not need, than need and not have.
There are, of course, many other items that are important for urban medics to have in their kits. These discussed are considered some of the basics.
Rural Tactical Medics
The definition of a rural area in regards to tactical medicine is a 15-minute or greater response time for backup medical units. This category would also include medics who work with a regional tactical unit. Medics for regional teams must be prepared for anything and count on nothing. Once again the basics are the main focus: A=Airway, B=Breathing, and C=Circulation. Blowout kits for team members are a must in the rural environment. Rural medics could be called upon to “hump” their gear long distances (2 to 3 miles or more) to a target location; backup, if available, would have an extended response time.
Therefore, the recommendation would be a sturdy, comfortable pack that would be capable of carrying enough equipment to treat three patients for at least 30 minutes (or more depending on the operation). Conterra makes a good bag for those medics who travel long distances and work on extended operations.
The “Tac-ALS Extreme Pack” is designed like a sturdy mountain pack with a good suspension system and has more than adequate storage. NARP (North American Rescue Products) also has a large bag available for extended operations. The “Casevac Bag” is designed to carry a litter and first-aid supplies. Smaller bags such as the Blackhawk “STOMP 2 Bag” are good for standard operations. Standard military rucksacks are also a good, less expensive alternative.
The equipment list is the same as the Urban Tactical Medic with additions. The Rural Medic needs to increase the amounts previously stated and add some longer-term care equipment. The “long-term” care equipment includes Oxygen, stethoscope, BP cuff, OTC (over-the-counter) medications, and possibly a suturing kit. This list is, of course, a basic list and can be adjusted as the medic sees fit.
The environment in which a tactical medic works is the determining factor as to what and how much of any given item he carries. The rural tactical medic is very similar to the military medic or wilderness medic because they all need to determine if an item is worth its weight, literally.
Tactical medicine, like any form of prehospital care, is constantly changing and progressing. The greatest tool available to the tactical medic is knowledge. A good Tac-medic is constantly reworking his equipment, learning new “tricks,” how to adapt his equipment to more varying situations, and always learning/training.
Matthew Watson, EMT-Cardiac, is a police officer with the Winchester, VA Police and operates as a medic/operator on the department SWAT team. He teaches a tactical medic course for the Virginia Office of EMS and SWAT basic for the Department of Criminal Justice Services. He can be reached at firstname.lastname@example.org.
Published in Tactical Response, May/Jun 2006
Rating : 10.0
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