Technical

The Definitive IFAK Article

The one-stop-shop article for what you need and where to get it. No marketed or paid-for premade solutions here.

December 31, 2020
By:
J. Allen
Welcome to my basement photo studio. I hope you like Fallout chic.

THE IFAK

The IFAK stands for “Individual First Aid Kit,” and takes its roots from the early days of the Global War on Terror. The first few years of the American conflicts in the Middle East saw a rapid and dramatic shift in the mindsets of combat medicine, we had learned many lessons along the way. There was a great evolution from that single square snap pouch on the shoulder of some web gear to the many, many IFAK options out there today.

If you’re here, you likely know what an IFAK is. I’m not here to discuss how to use the components in this article, or even purely to just tell you what to stuff in it. What I find lacking in the several hundred other IFAK articles out in the world is the lack of specific recommendation. That is the square I’d like to circle with our version.

In this article you’ll find advice for the exact brand and style of equipment I would recommend, as well as a link for where to buy it, in stock, with peace of mind that you’re not getting a knock-off.  Only proven equipment from reputable dealers.

An IFAK can be for many situations. I would pack one differently for my car than I would my kit. For this article we will focus on what I think many come here for first. The range IFAK or IFAK for their duty kit. Meaning we'll be foremost concerned about gunshots and blast injuries.

The Pouch Itself

This is one of my Vanquest FATpacks and a 5.11 UCR. I have purchased multiples of these due to the rip-open design that they offer. Seen above are the large handles and dual zippers that make thes pouches such a hit for me.

The medical pouch is a piece of gear that has likely seen the most varied set of approaches to style and placement of anything out there. Holding a magazine is one thing, holding several pieces of shrink wrapped medical gear is another. Not all are created equal, and not all are immune from the pure force of preference. With preference as a variable in mind, here are the four criteria I look for when advising a bleeder kit purchase.

Quick Release: I prefer a pouch or attachment system that allows one to completely remove the pouch, without tether, from the belt/plate carrier/chest rig etc. Repositioning a patient is a reality of emergency care, and the ability to reposition a patient without also relocating your medical equipment is awfully convenient. Especially if you need to remove their gear in order to get to the injury site, you won’t want that pouch attached to 30 pounds of kit you need to wrangle every time you want another gauze.

Everything Gets Secured. I am not-at-all a fan of the styles in which the contents are placed into the pouch unsecured to float around. When you open that pouch it is just as often that you’ll pull out something you didn’t want as it is something you did. I like every last bit of gear to be secured in a zipper or by elastic in one fashion or another to ensure you’re able to keep tabs on where all your gear is. Loose items are lost items once that pouch opens.

Rip Open Design: This is perhaps my most critical criteria. I heavily prefer designs that allow for the user to grab a loop or handful at the top and “rip open” the pouch. This usually looks like a flap that has a zipper on either side that unfolds to show the bits inside. While I think we often make too much fuss about the idea of “fine motor skills vs gross motor skills” it’s not a completely irrelevant concept. I’ve seen a few flustered people become utterly befuddled by even the simplest of clasps once the “oh-shit” juices got flowing.

Layout Design: Once the pouch is opened, I like something that can open up so that it organizes the contents in a “layout” fashion. This is a pure convenience feature but one that can allow you to inventory items as you’re using them should the situation require you to do so.

There aren’t many pouches that will satisfy all four of these to the fullest degree of success, but there are quite a few out there that have some features of each and accomplish them to different levels.

Here is a list of IFAK Pouches I have used, owned, or reviewed that I would recommend.

  • Vanquest FATPack 5x8
  • TPG Black Slider IFAK
  • 5.11 UCR IFAK
  • HSGI Reflex
  • Army Issue IFAK 2nd Generation
  • Tactical Tailor 5.56 Mag Medical Insert

Tourniquets

Pictured above is the MilSpec Monkey TQ holster. It was under $20 and I've had it forever. This is a popular option for having a TQ ready to go at a moment's notice while still having peace of mind about retention. Plus, it holds a set of shears.

I’m going to write about tourniquets in a separate section because I don’t think a TQ should go inside your IFAK.

An IFAK is a pouch that goes on to overt gear. There are EDC IFAKs, but that’s not the focus of this article. The pouches we’re talking about end up on gun belts and chest rigs, and with use of that kind of gear as our context, we don’t have to worry about having our equipment remain unseen. This allows us to stage as many tourniquets as we want anywhere we want.

I firmly believe a tourniquet, if placed in a pocket or pouch, should be the only thing in that pocket or pouch. It’s not like the most popular brands and styles are easy to rip out of fabric enclosed spaces. I am a big fan of the rubber band method of attaching them to MOLLE gear. Even if a hasty tourniquet implies a conversion tourniquet later, why not have them both on your rig out and open? You wouldn’t put the handle to your reserve chute behind a clasp and zipper, so don’t do the same to your backup TQ should your first break or fail.

So do not place tourniquets inside your IFAK. Have multiples staged on your person and around your environment. They are faster to deploy that way, and when you need to deploy them you’ll need to be fast.

There are only two tourniquets I’m going to recommend: The North American Rescue CAT Gen 7, and the TacMedGear SOFF-T Gen 4. I do recommend the latest gen of any TQ you’re after, but if you find a Gen 6 CAT or Gen 3 SOFF-T you won’t be in the wrong. There are many counterfeits out there, so the easiest method to ensure you’re picking the correct items is to buy directly from the manufacturer.

NAR CAT Gen 7
https://www.narescue.com/combat-application-tourniquet-c-a-t.html

TacMedGear SOFTT-W
https://www.tacmedsolutions.com/SOF-Tourniquet-Gen-4

Please buy at least two. Tourniquets are one-time use and will break if used repeatedly. You will need a real-deal TQ to have staged and another to act as a trainer. Training versions are generally colored blue. They are identical to the other colors in every way, just clearly marked as trainer tourniquets so you know not to use your real-deal ones.

THE REST

Nasopharyngeal Airway

Also known as the NPA, it’s a tube that goes into the nostril and down into the oropharynx behind the tongue to ensure your patient has a good airway while unconscious. Positioning methods are not always effective. The NPA offers a bit more peace of mind than repeating the head-tilt-chin-lift periodically.

Recommendation: 28F is the sizing I recommend for most. It’s the one-size-fits-all diameter of NPA. I recommend you buy from TacMedGear as they get have quality examples and also provide the needed lubrication packets.

https://www.tacmedsolutions.com/NPA-28FR-w-Lube

Occlusive Dressings x2:

I recommend having two. An entrance wound to the thoracic cavity implies an exit wound. Don’t buy into the mentality of relying on improvised solutions such as using the wrapper of your dressing for the second chest opening. They’re so cheap that there’s no reason to not just have multiple examples of what works great for an injury that commonly features two holes to plug.

Recommendation: There are two brands I recommend here. H&H Wound Seal and HyFin Chest Seals. I prefer the versions without the vents. They’re of dubious effectiveness anyway, and I’d rather have more adhesive to stick over the blood, sweat, and hair.

H&H Wound Seal has my slight preference, as it’s very sticky.
https://buyhandh.com/products/wound-seal-kit

But I wouldn’t be disappointed with a HyFin at all. I’ve used many and know they work great.
https://www.narescue.com/hyfin-chest-seal.html

Combat Gauze and a pressure bandage. A match made in heaven. The newer shrink-wrapped version of Combat Gauze comes Z-folded, making it much easier to pack a wound.


Hemostatic Gauze

I need to emphasize here that I do mean the gauze and not the powder. The powders are harder to come by these days due to their obvious downsides. These are for all those life threatening bleeds a TQ can’t get to.

Recommendation: QuikClot Combat Gauze is my heavy preference. It works phenomenally and has been proven in clinical testing and in practical use over and over.

https://www.narescue.com/combat-gauze-z-fold-hemostatic.html

Celox Rapid is another solid choice that is a little more available and affordable for some.
https://www.chinookmed.com/05214/celox-rapid-gauze-z-fold.html

Rolled Gauze

3” rolled gauze is my preference here. Combat Gauze is not usually enough to fill an entire wound cavity sufficiently. Likewise, it is dependent on good pressure to work properly. Having another roll of gauze to push in behind the hemostatic gauze isn’t just helpful, it’s something I would consider required.

I heavily prefer rolled gauze to compressed gauze or z-fold as it’s easier to pack into a wound little-by-little. You do not want to just shove a whole roll in, you need to use your fingers to fill every nook and cranny. That’s how blood likes to clot.

Recommendation You can buy them in bulk for very cheap.
https://www.rescue-essentials.com/gauze-rolls-3-pack/

Pressure Bandage

These come in a lot of flavors and it’s something that’s hard to go wrong with. Choose whatever you’re comfortable using competently. However, I do have a couple favorites.

Recommendation: The Israeli Bandage is cheap, available, and proven. It’s my preference for a pressure dressing.

https://www.chinookmed.com/05130/israeli-emergency-bandage-4.html

For those without a lot of training, the H&H Compressing Dressing with the H handle can be a bit more intuitive for a first time user in a pinch.
https://buyhandh.com/products/h-bandage-compression-dressing

A quick shot if the inside of a pair of spare IFAKs I had hanging around in my basement.

Tape

Everyone forgets this and it infuriates me. Moving a patient is the best way to dislodge your life-saving interventions. A tourniquet isn’t properly placed until it’s taped in my book. Blood is a slippery devil and will make a mockery of many of your bandage attempts if you don’t wrap it up securely. Any duct tape works, but there is one ultimate choice.

Recommendation: For medical purposes it’s hard to beat 3M’s Durapore Surgical tape in either the 2” or 3” persuasion. This is a very adhesive cloth-based tape that tears easily and sticks over blood. Military medics would trade away cigarettes and booze for the large rolls of this stuff.

https://www.rescue-essentials.com/3m-durapore-tape-1-2-or-3-x-10-yds/

Trauma Shears

You can’t treat wounds you can’t see. True trauma patients get stripped naked to account for all injuries. DO NOT USE A SEATBELT CUTTER. This is a cool-guy trope that’s led to a lot of lacerations caused by men trying to be slicker than they are smart. Trauma shears are designed to not fuck up your patient while you fuck up their clothes.

Recommendation: The NAR shears are affordable and work very well

https://www.rescue-essentials.com/nar-trauma-shears/

Space Blanket

Hypothermia is the last part of MARCH and if you’re using a bleeder kit for it’s namesake purpose, it’s going to be a problem you’ll have to contend with. These days you can get mylar blankets that fold up so small you can nearly fit them in your wallet. There’s no excuse to not have one, hypothermia is a condition just as critical as a gunshot wound.

Recommendation: Here’s one that’s compact and affordable.

https://combatmedical.com/product/emergency-blanket/

A Sharpie

This is for marking your tourniquets and recording patient information. You can buy these name-brand most anywhere you want.

Reputable Dealers

Please sponsor me.

But seriously note, I buy most of my items through here. You know you're not getting the knockoffs.

If you want to shop for deals, that’s fine, but if you want to make sure you’re getting the real deal equipment, you can be sure you’re getting it from the following sites:

  • Chinook Medical
  • Tac Med Gear
  • North American Rescue
  • Combat Medical
  • Rescue Essentials
  • Buy H&H

Operational Ideas

Placement: There will be a lot of conjecture on the perfect place to place your IFAK, and for the most part that will be dependent on exactly what kind of gear you’re wearing, but the only large rule of thumb I would give is to make sure you can reach it with both hands.

If you anticipate vehicles being an aspect of your situation, I would recommend going with a flatter design if you belt mount. The new Army IFAK 2.0 has adopted this method and it works out much better than the old jungle pouch for sitting in vehicles for a long time. Especially in the modern era of minimalist plate carriers and chest rigs, the bleeder kit is more popularly being found on a belt. Right in the middle over your spine as flat as you can get it is a great spot for most any kit.

Designation: I am a fan of very obviously marking a medical pouch as a medical pouch in the event you are incapacitated and someone else needs to make use of it on you. This is often accomplished with a little patch with a medical cross on it, or may be sewn on to the pouch itself. You can fix any pouch that is unmarked with a black or red sharpie if need be. Just do something to let everyone and their mother know that what is in that pouch is what they’ll need to bring you back from the brink.

Standardization: If you are working with a team, it may cross your mind to standardize the IFAK contents and packing procedures across the team. That way everyone is trained on the exact same gear packed into the pouch in the exact same way. It helps streamline training and instills confidence across the board. Some teams even standardize the placement of an IFAK so lifesaving materials can be found quickly and without confusion.

CONCLUSION

Hopefully you learned something from this article, we wanted this to be more than just a pure components list. If you have thoughts or questions about the view that tourniquets should be staged around your kit and not in the IFAK, I’d love to hear them. You can contact us via email or join the Discord for the ongoing discussions.

All the resources listed in this article are proven both clinically and in practice. Likewise, they’re all items I’ve used in real situations or very heavy training scenarios. When the blood gets pumping, this is all gear that will still work well, verified by thousands of dudes who have scraped litters across the bottoms of Blackhawk floors.

Disclaimer on Training and Scope: If you don’t know much about how to use the equipment, please get training. Any Stop the Bleed course is a phenomenal class to attend and will take you through most of what I recommend you pack. Triad Medical is also a great company to get medical training through.

If you are a first responder or EMT, please remember your scope, but also know your local laws and how much the Good Samaritan law will cover you.

Yet to come, I’ll start tackling the subjects of medical gear for everyday carry, car kits, and other specifically non-tactical but daily applicable needs. Until then, stay safe and change your socks.


UPDATE:

Previously this article included the following passage:

Decompression Needles

There are a lot of tentative feelings about decompression needles. Why someone who is comfortable carrying a Glock in their pants on the daily gets wigged out about placing a needle in terms of capacity for comparative catastrophe I have no clue. It’s a fear I hope we can all collectively get over, it’s not rocket surgery. This can be any 3.5” 14g catheter, but I do have a favorite:

Recommendation: The ARS NCD comes in a protective shell that keeps the catheter and needle safe inside pouches.

https://www.rescue-essentials.com/nar-ars-for-needle-decompression/

However, we received a comment on our facebook page. It reads as such:

Needle Decompression (NCDs)
Why they are considered ATLS, and if you do not have the necessary training you should not be carrying one with the intent to perform the procedure.
(This is with consideration to a stateside environment with ready access to Level I trauma centers)

Far too often I see individuals carrying a decompression needle, and when asked they explain an intent to use it. This is typically (in my experience, so anecdotal data here) from individuals that are prior service, LE, or previously attended TCCC classes and have not practiced the procedure beyond this.
YOUR CLS CLASS FROM 8 YEARS AGO IS NOT QUALIFYING ATLS LEVEL EDUCATION.


First, let’s go over the use of a decompression needle. It is used to treat a tension pneumothorax in a procedure called a Needle Thoracostomy or Needle Thoracentesis. Traditional placement is a 14 or 10 gauge needle in the 2nd intercostal space, mid clavicular line (2IC-MCL)- or alternatively the 4th or 5th intercostal space, in the mid axillary line (4/5IC-AAL). The actual placement is the subject of some debate, but that isn’t the topic at hand here.
To dispel some of the bad knowledge, let’s go over when an NCD is appropriate. A large majority of sucking chest wounds are typically an Open Pneumothorax (Pneumothorax meaning air in the chest cavity). This does not typically require an NCD, but instead is treated with a vented chest seal (which are often effective at preventing the progression to a tension pneumothorax)


Provided a vented chest seal is applied quickly and effectively, the odds of an open pneumothorax developing into tension are relatively low (looking at Eastridge et al. 1.1%) and to add to this, it takes a moderate amount of time for an open pneumothorax to develop into a tension- as well as being exceedingly difficult for untrained individuals to ascertain a tension pneumothorax with surety.


If and when the open pneumothorax does progress to tension, it causes various issues; the most notable of which is decreased venous return with a drop in cardiac output- leading to tachycardia (rapid heart rate) and can lead to cardiac arrest. This is due to the collapse of the lung from the influx of air into the pleural (sac around each lung) cavity. This is when a needle decompression is appropriate.


Now. Complications from doing this INCORRECTLY. Attempting this procedure without, or with improper training, poses serious patient risk. The most notable of which are; damage to a pulmonary artery causing pneumothorax to develop into a hemothorax (INTERNAL BLEEDS ARE STILL BLEEDS), cardiac tamponade (compression of the heart by surrounding fluids, dangerously effecting blood pressure), or ineffective application. Below is an article that explains all of these and more in detail.
https://www.ncbi.nlm.nih .gov/pmc/articles/PMC4613415/


Other considerations to carrying a decompression needle. I understand that some individuals carry an additional needle in kit for EMS use should they need arise. That is understandable. But if you are carrying with intent to perform the procedure, and your most recent, relevant, and applicable medical training was at “your old unit” in 2009, perhaps consider taking some modern medical classes at an ATLS level, or if you do not want to train to that standard, relegate your needle to carrying for supplemental EMS use. Learn how to use chest seals, and apply them quickly and effectively.


-Eli Patten, with suggested edits from Dr. Andrew Fisher (https://stfisherchurchofebm.com)

Response: I've read Dr. Fisher's work before and an admirer. Him suggesting otherwise on NCD's definitely has me taking note.

The idea that my NCD feelings come from my military time is absolutely correct. It's where I learned the procedure and where I've taught the procedure almost entirely. My thoughts are pretty steeped in personal experience, just as anyone else's. I've had a CLS student identify and treat a closed PTN before off my instruction and that's always been a pride point for me. As such, I'm pretty enthusiastic for as many folks having that skill, and the tool to employ that skill, as possible.

But there is fair criticism here. The comment above talks very much about Open PTN concerns and how many of them preclude the need for an NCD. Reflecting on my experiences, I've utilized them or been a part of utilizing them almost entirely with closed PTN's. The context of this article is an IFAK for dudes who are wearing an IFAK because they're doing gun-guy activities. Ergo, the injuries we're anticipating lend themselves much more to open PTNs than closed. The points above explain clearly why an NCD is mostly unnecessary there. Likewise, if properly treated with a chest seal, respiratory distress that requires an NCD does take a while to develop. Medical response times in the US are generally going be well within the window of worry for such things.

And so I'll amend my recommendation to match theirs. If you want it for EMS to use on you, power to you. If you want to carry it in order to use it on someone, you bear that onus to not only get trained, but refresh and maintain that training. They make the point about "My old unit from 2009," and it's correct. To drive that point home, "My old unit" was teaching TCCC as recently as 2019. My EMT license from when I was in and teaching is still valid, in fact. But even so recently removed as I am those changing bits of medical information can really shift under you faster than you can realize.

Thank you, Eli and Doc Fisher, for helping set things straight. The team talked about how we wanted to handle this and being open with the retraction was an easy and unanimous decision. It would have been easy to edit the article or delete the comment, but we sure as hell like to preach about reconsidering positions and being open to the crucible of discussion. I hope this shows that we indeed value accuracy over ego.

Perhaps serendipitously, I recently did a solo podcast titled "Skills Regressions," in which I talked about the expiration date on which I'd feel comfortable covering medical topics now that I'm out of that world. We'd appreciate if you checked it out, and thanks for reading.

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