****EDIT 3**** Article posted. MODS: STICKY?
***EDIT 2*** Done writing the article. Working with the editor to get it online.
**EDIT 1** Pictures done. Compiling contents lists. Progress is being made. Updated kit list also.

BLOW OUT KITS
Concepts and tools for Law Enforcement Tactical Medicine.
By Kevin McAvenia, NREMT, CEM

10 years ago, tactical medicine in a domestic law enforcement setting did not exist. During tactical deployments, at best most teams got a standard ambulance and a few EMS workers staging a few blocks away with standard, conventional equipment and training. If an officer went down in a structure, it was up to fellow officers to pull the downed operator to a safe location, and await the ambulance to arrive, which might have taken 30 minutes or more depending on location and available resources. If the operator was seriously injured, there was a very small chance for survival. In 1996, a landmark paper appeared in an issue of Military Medicine, The US Special Operations Command (USSOCOM) outlined new strategies for trauma management and decreasing Preventable Combat Death at the point of wounding.

The strategies were based on historical wound patterns and preventing the 3 leading causes of death on the battlefield, which are extremity hemorrhage (60%), tension pneumothorax (33%) and airway obstruction (6%). Collectively, the guidelines and strategies were referred to as Tactical Casualty Combat Care (TCCC, or TC3). Today, TCCC is the standard of care for the tactical management of combat casualties within the Department of Defense and is the sole standard of care dually endorsed by both the American College of Surgeons and the National Association of EMT’s for casualty management in tactical environments. The 2010 guidelines are available here.

TCCC is built around three definitive phases of casualty care:
Care Under Fire:
Care rendered at the point of wounding while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic.

Tactical Field Care:
Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours.

Casualty Evacuation Care (CASEVAC)
Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.

Over the past few years, there has been a huge increase in available products on the market to augment and facilitate TCCC by operators of all skill and training levels. Unfortunately, many departments do not have the budget to train or equip operators to handle a downed operator scenario, so many choose to get trained and equipped out of their own pocket. Thankfully, there are cost-effective options on the market. This article will discuss kits available for use, however it will not discuss treatment modalities; do not use these items without proper training, and the best tools are only as good as the training the operator has received to use them. The kits I have reviewed are intended mostly for use by patrol officers and tactical operators when a medic is not readily available. With that being said, a concept often followed is to have all the tools possible to save your life, in the event that someone ELSE is trained to use them. Maybe a backup officer responding is a paramedic, but the department does not issue him any equipment, wouldn’t it be great if you had the tools needed for him to help you?

Lastly, before I begin reviewing the kits, I will note that before you purchase or use anything; consult all local laws regarding possession of medical items, and all laws regarding providing emergency care and lifesaving measures. Furthermore, many items are “controlled” and require a physician’s license to purchase. While it may not be possible to carry everything, anything is better than nothing!

I will not be comparing these kits head-to-head, nor will I give an opinion as to which one is “the best” or which are better than others, I will simply be laying out what they are, what they have, and important points to consider for each. Without further delay;

North American Rescue “IPOK” (Individual Patrol Officer Kit) FIG 1, 2. – $44.98

IPOK (1) by grfallen, on Flickr

1. 2 x Black Talon® Nitrile Trauma Gloves (1 pr.)
2. 1 x C-A-T® (Combat Application Tourniquet®)
3. 1 x S-Rolled Gauze™
4. 1 x ETD™ 4 in. Emergency Trauma Dressing

IPOK Contents (2) by grfallen, on Flickr

The IPOK is one of 3 in North American Rescue’s arsenal. It is a great basic kit to provide cost-effective bleeding control to an officer in a compact simple design. As with all NARP products, it has large pull tabs, a rugged vacuum-sealed design and will stand up to abuse. Lack of a hemostatic agent limits treatment of severe hemorrhage. No treatment options for airway-related injuries. At 7.7oz and only 4×6.5×2.75 it can fit practically anywhere. This is a great option for a patrol officer on a tight budget that only has basic treatment concepts.
North American Rescue “IPOK-CG” (Individual Patrol Officer Kit-Combat Gauze) FIG 3- $74.98

IPOK CombatGauze (3) by grfallen, on Flickr

1. 2 x Black Talon® Nitrile Trauma Gloves (1 pr.)
2. 1 x C-A-T® (Combat Application Tourniquet®)
3. 1 x QuikClot® Combat Gauze™ Hemostatic Bandage
4. 1 x ETD™ 4 in. Emergency Trauma Dressing

The IPOK-CG provides the same foundation as the standard IPOK with the addition of the QuickClot Combat Gauze for enhanced treatment of severe hemorrhage. For 30$ more it may be a viable option as from first-hand experience, I can tell you the Combat Gauze works, very well. It is the widely-used standard for hemostatic agents in tactical scenarios.

North American Rescue “IPOK-CG” (Individual Patrol Officer Kit-ChitoGauze) FIG 4, 5. – $76.48

IPOK ChitoGauze (4) by grfallen, on Flickr

1. 2 x Black Talon® Nitrile Trauma Gloves (1 pr.)
2. 1 x C-A-T® (Combat Application Tourniquet®)
3. 1 x ChitoGauze™
4. 1 x ETD™ 4 in. Emergency Trauma Dressing

IPOK ChitoGauze Contents (5) by grfallen, on Flickr

The IPOK-CG is identical to the previous CG, with the exception of the ChitoGauze in place of the Combat Gauze. Many say it is the “next generation” treatment to the Combat Gauze, however either will work just fine, with a 2$ difference in price it is truly personal preference.

North American Rescue “SIRK” (Supplemental IFAK Replacement Kit) FIG 6, 7. – $TBA

SIRK (6) by grfallen, on Flickr

1. 2 x Black Talon® Nitrile Trauma Gloves (1 pr.)
2. 1 x C-A-T® (Combat Application Tourniquet®)
3. 1 x ChitoGauze™
4. 1 x ETD™ 4 in. Emergency Trauma Dressing
5. 1x 14g ARS
6. 1x Nasopharyngeal Airway 28F w/ Lubricant
7. 1x 2” roll NAR Surgical Tape
8. 1 x S-Rolled Gauze™
9. 1x Hyfin™ Chest Seal

SIRK Contents (7) by grfallen, on Flickr

I have the great pleasure of being one of the first to review the SIRK from North American Rescue Products. NARP has not yet released this kit to the public. It is intended to be an enhanced replacement to the US Army standard issue Individual First Aid Kit (IFAK). The SIRK is TCCC-compliant, and contains all the items needed to treat the 3 leading causes of battlefield death. This is a fantastic kit with robust capabilities and it is one of the only TRUE TCCC-compliant kit to contain both a hemostatic agent AND a tourniquet. The Hyfin chest seal is not the greatest on the market, but it will get the job done. I hope to see this kit available soon as I feel it will be a great addition to the market.

Chinook Medical “LEMM-SW” (Law Enforcement Medical Module-SWAT) FIG 8, 9 – $40.58

LEMM-SW (8) by grfallen, on Flickr

1. 1x QuickClot 1st Response 25g
2. 1x SWAT-T Tourniquet
3. 1x HALO Chest Seal
4. 1x 4”x7” Field Dressing
5. 2x Gloves

LEMM-SW Contents (9) by grfallen, on Flickr

Chinook Medical has put together a very cost-effective kit with rather impressive treatment capabilities. At 5.5”x 3”x1.5 and only 8oz, it can go just about anywhere. I carried it for 6-12 hour tours in my right calf pocket on my work BDUs and completely forgot it was there. While it may not be the best TQ on the market, the SWAT-T will do its job rather well, especially for what it is. I find it takes a bit more practice to apply than a CAT or similar TQ, however it is hard to beat for the price. The HALO chest seal is the latest and greatest on the market, 2 seals are in every pack, they can be used for more than just sealing chest wounds. They are very durable, and without a doubt the best on the market. This is one of my favorite kits on the market.

ITS Tactical “ETA Kit” FIG 10, 11 – $119.99

ETA KIt (10) by grfallen, on Flickr

1. 1x QuikClot® Combat Gauze™ Hemostatic
2. 1x HALO Chest Seal
3. 1x 14G Decompression needle
4. 1x Nasopharyngeal Airway 28F w/ Lubricant
5. 1x Israeli Bandage 4”
6. 1x Ace Bandage 4”
7. 1x Z-Pack gauze
8. 1x Combat Casualty Card
9. 1x Pencil
10. 2x Gloves

ETA Contents (11) by grfallen, on Flickr

ITS tactical created the ETA kit to respond to the growing market of blow out kits. Each kit is constructed on an order-by-order basis to guarantee a 3 year shelf life and superb quality control. ITS uses top quality items, such as the HALO chest seal, which is certainly the best on the market. While there are a few other “all in one” bandages on the market aside from the Israeli bandage, it is a tried and true system that works. Note however the kit does NOT come with a tourniquet, ITS has left it out in order to save on cost to the end user. It is highly recommended that you supplement this kit with a TQ such as a CAT or SOFT-T, however a TK4 or SWAT-T are certainly better than not having one. The packaging is very durable, small cube and is capable of handling a broad range of injuries. The ETA kit is a very solid choice to carry, and it is my personal kit that I carry every day.

Rescue Essentials “Tactical Medic Kit” FIG 12, 13 – $110.99

Tactical Medic Kit (12) by grfallen, on Flickr

1. 1x 14G ARS Decompression needle
2. 1x Petrolatum Gauze Dressing 3”x9”
3. 1x Nasopharyngeal Airway 28F w/ Lubricant
4. 1x C-A-T® (Combat Application Tourniquet®)
5. 1x ETD™ 4 in. Emergency Trauma Dressing
6. 1x 2”x10yds tape
7. 2x Light sticks (Green)
8. 1x 15g Celox Hemostatic Agent
9. 2x Gloves

Tactical Medic Kit Contents (13) by grfallen, on Flickr

The Tactical Medic Kit from Rescue Essentials is a TCCC-compliant kit that can handle all the major injuries associated with battlefield wound patterns. In order to save costs Rescue Essentials choose to use a generic Petrolatum Gauze Dressing for use to treat a sucking chest wound rather than a specifically designed dressing, such as the HALO or Hyfin. The dressing is still a viable treatment option, however not my first choice. The addition of the light sticks is good for marking casualties or treatment in low-light conditions. Also contained in the kit is a single 15g pack or Celox. Again I would go with something more robust such as the Combat Gauze or ChitoGauze, the Celox is a granular material and can be difficult to use during high-stress situations, but it will get the job done. One of the first points I noticed is the kit is not vacuum sealed, and the packaging is a bit “brittle”, I would be hesitant to throw it around in a bag a lot or keep it under a car seat as the packaging may be easily damaged. At $110.99 it holds a slightly high price tag, for $10 more I would personally go with the ITS ETA kit, which has some higher quality components and packaging, however for a tight budget this is still a complete TCCC-compliant kit.

Tactical Response “VOK” (Ventilated Operator Kit) FIG 14, 15 – $40.00

VOK (14) by grfallen, on Flickr

1. 1x Cinch Tight Compression “H” Bandage
2. 1x TK-4 Tourni-Kwik (3” wide 40″ long Rugged Combat Tourniquet)
3. 1x Primed Gauze (crinkle cotton)
4. 1x Nasopharyngeal Airway 30F
5. 1x 14ga Decompression needle
6. 1x Alcohol Prep Pad
7. 2x Safety Pins
8. 1x Duct Tape (2”x100”)
9. 2x Gloves

VOK Contents (15) by grfallen, on Flickr

The VOK from Tactical Response is one of the oldest kits on the market. This kit was first available in 2006, and was created by James Jeager , a former high threat civilian contractor in the Middle East. This kit can handle all the leading causes of death with some improvisation, such as utilizing the duct tape to create a chest seal. Some feel that the “H Bandage” is the best bandage system on the market, I feel it is a good choice however I feel that the bandages are purely personal preference, I do not prefer one over the other. Next, the TK-4 is a very simple tourniquet design that works, however I personally prefer one of the windlass-type designs such as a CAT. I do own several TK-4’s and I feel they are great to stash all over your gear as “back ups” should something happen to your primary TQ’s. The kit does lack a hemostatic agent, however at $40, the kit is another solid choice. I personally keep one in my “trunk kit” and one in my home, they are great to stash all over the place for the price, however as my “first line” kit, I personally go with other options.

These are not the only kits on the market, there are literally dozens out there. As you can see there are choices for every training level and budget. If nothing else, take ideas from these kits and by all means put together your own! With all the threats faced daily, from traffic stops to active shooters and everything in between, not having basic life saving items is an unnecessary risk that should not be taken.