Improved First Aid Kit

Army, Jun 2008 by Gourley, Scott R

In her March 2007 statement before the House Armed Services Committee, Maj. Gen. Gale S. Pollock, thenacting surgeon general of the U.S. Army and chief of the Army Nurse Corps, described the improved first aid kit (IFAK) as "the first major improvement in individual soldier care in the past 50 years," adding, "Today every soldier carries a first-aid kit that provides intervention for the leading causes of death on the battlefield."

Developed in response to the tactical combat casualty care doctrine, the IFAK is designed to increase an individual servicemember's capabilities to provide self-aid/buddy aid and provides interventions for two leading causes of death on the battlefield-severe hemorrhage and inadequate airway.

"The IFAK is an aid kit that is provided to every soldier deploying to theater. It contains medical items that are critical to assist in potentially preventable battlefield deaths," explained Steven Reichard, program manager for the kit at the U.S. Army Medical Research and Materiel Command (US-AMRMC).

Explaining how the kit was developed in concert with the tactical combat casualty care doctrine, Reichard said that the process examined "the leading causes of potentially preventable battlefield deaths. We looked at those and said, 'These are items that we can train the soldiers to use.' And we put those into the EFAK."

Reichard was quick to note the cooperative team-development arrangement among Program Executive Office (PEO) Soldier, the rapid fielding initiative (RFI) and the Army Medical Department (AMEDD).

Moreover, he noted that the development reflected a "building-block approach" to tactical casualty treatment, in which "the combat lifesaver can use the items that are in the IFAK to assist in his treatment. Likewise, the combat medic can use what the combat lifesaver has to assist in his treatments."

Weighing approximately 1 pound with a mass of approximately 128 cubic inches, IFAK is configured inside a modified ammunition pouch initially designed for the squad automatic weapon.

One of the significant items in the IFAK is the Combat Application Tourniquet (CAT). AMEDD backgrounders note that before 2005 the tourniquets available to the military included "a cravat-and-stick tourniquet that servicemembers used along with the strap-and-buckle tourniquet that dated back to the American Civil War. The latter item was largely believed to be ineffective and was removed from the military supply inventory. A third tourniquet, called the one-handed tourniquet, was also available; however, it worked on arms but failed to work on legs."

Based on an emergent need from operations in Iraq and Afghanistan, in the summer of 2004, the U.S. Army Institute of Surgical Research evaluated several commercially available tourniquet designs. The evaluation process led to selection of the CAT, from North American Rescue Inc., for inclusion in the kit.

"Prior to this, every soldier was issued a cravat," Reichard said. "And they would have to find a stick or pen or something and then use that to form a tourniquet. Now every soldier is issued a tourniquet in the IFAK. It is intentionally designed as a tourniquet. Soldiers have it. They know where it is. They are trained in how to use it. They can put it on quickly. And that alone has saved a significant number of lives."

"We've also got the nasopharyngeal airway," Reichard continued, "which is one of those little rubber tubes that you can stick up someone's nose that then goes back down the throat. Obviously that would help with a collapsed airway."

Another IFAK component highlighted by Reichard is the chitosan hemorrhage-control dressing. Also known as a HemCon bandage, the dressing is designed to control bleeding from locations like the neck, that cannot use tourniquets, or large abdominal wounds. While cotton gauze and bandages were the traditional means with which to treat these wounds, they frequently failed to quickly control severe, life-threatening bleeding. With the help of a research grant from USAMRMC, however, civilian researchers discovered that chitosan, a carbohydrate found in shrimp shells, helped stop severe bleeding.

According to USAMRMC research descriptions, a bandage based on chitosan, which carries a positive surface charge, when placed in contact with blood, which carries a negative surface charge, creates a powerful electrostatic bond between the bandage and the wound, quickly stopping severe bleeding. The technology was licensed to HemCon Medical Technologies for manufacturing; the company shipped its first bandages to the Army in 2003.

"We have other bandages in IFAK as well," Reichard said. "We also have gloves, tape and gauze. It's really a very robust trauma-care kit with the individual soldiers trained to use all of those items. ... Because everybody has these, lives are being saved and soldiers are able to treat injuries that before were untreatable."

Reichard was also quick to characterize IFAK as a developing capability. "When we say that IFAK is addressing a significant amount of the potentially preventable battlefield deaths," he said, "I'm afraid that someone will ask, 'Why aren't we addressing all of the causes of potentially preventable battlefield deaths?' Well, we are. It's just that these are the ones that we are able to influence right now. But we are doing more. We have ongoing research into areas like hemorrhage control. And that is a lot of what our science and tech base is working on."