Personal First Aid Kit for Hostile Environments

Hi Instructables Community,

this week I'm presenting you something quite different from my usual projects. A friend of mine suggested that I should share some of my experience from working abroad in usually hostile environments. A first step to do this was for me to re-create the personal first aid kit I used (carried) quite extensively during my time in Afghanistan from 2010 - 2014. Depending on the reception of this Ible I might decide to continue this with a few more items like EDC or Go Bag (Bug out Bag).

Please take the time to read the disclaimer and info in the second step as well as the last step if you are interested in my monthly giveaway.

Cheers Alex

PS: This Instructable has been approved for the Hack your day & Full Spectrum Laser contests. If you like it I would really appreciate if you would take the time to vote for me.

Step 1: Background & Disclaimer

I had a look around the internet and found that there are already a number of great projects on bug out bags (or go bags) and other things related to life in remote and hostile areas made by more or equally experienced folks. Usually however these are written from a military perspective or from someone working Personal Security Details (e.g. for the US State Department). The vast majority of civilians working in countries are in occupations that have little or nothing to do with security (e.g. engineers, aid workers, service & maintenance staff) and hence those working in those areas tend to neglect their personal security. I hope that there may be a few of those that are working already or going to work in hostile areas among the readers of this Instructable. If you are one of them I urge you to critically reflect upon your position, skills, training & equipment

From 2008 till 2014 I worked in Baghdad Iraq and various places of Afghanistan as a consultant/contractor for Aviation Security. From 2010-2014 I managed, coached, trained and mentored the security staff of the Airports in Kabul, Kandahar & Mazar-e-Sharif. I created the aviation security system, procedures & security culture from scratch for the newly build airport in Mazar-e-Sharif with the assistance of my american colleague (and friend) as well as my afghan team. During that time I lived & worked over long periods in what is known as "Outside the wire" with limited access to secure facilities controlled by the International Security Assistance Force (ISAF). Adventurous as it might sound it was also connected with a number of risks such as kidnapping, targeted assassinations, intimidation from criminal as well as insurgent elements. I know for a fact that there are many people working in these areas who wouldn't give the risks much thought since their approach might be that of an aid worker who is only there to help therefore they don't see themselves as a potential target.

The unfortunate truth is that everyone can become a target might it be as a victim of kidnapping for ransom or as the victim of a suicide bomber who strikes a target of opportunity. Due to the increased risks the preparation for worst case scenarios should be made on an individual basis regardless of the preparation the company or organisation one works for has made. You should however review and analyze what measures might be already in place and what you can do to enhance them.

One example for this is the personal first aid kit. Most organizations and companies will provide in house medical facilities or use the service of a medical provider. They should also provide basic first aid kits in the accommodation space as well as the work place and for the transportation in between. These first aid kits would have to cover the very basics from small cuts & injuries up to the initial treatment of traumatic injuries. Your own first aid kit should cover the same range and should be suited to your skills and level of training. I strongly suggest that you participate in advanced medical training such as the First Person on Scene (FPOS) and Medicine in Remote Areas (MiRA) before you deploy or in one of your vacations between deployments.

Disclaimer

1. I'm not a health care provider, paramedic nor do I pretend to work in this field of work. I'm a specialist with regards to physical security and aviation security and have over the course of the years participated in various medical training courses as part of my personal development and to increase my "particular set of skills"
2. Reading this Instructable will not be enough to increase someones skills I hope however to increase awareness. If you want to develop your skills I suggest you book yourself into specialized medical training courses.
3. Simply recreating the kit shown in the video and the following steps will not prepare you for anything if you do not have the skills to use the items contained in the kit.
4. This kit is a recreation of my original kit with some items (such as the bag) being original and some left out intentionally (e.g. prescription meds, smoke & pyrotechnics due to transportation safety regulations).
5. I suggest you add a standard travel pharmacy to your kit with basic meds for pain & fever relief, antihistamines, antidiarrheals, water purification and other medication you may require. Ensure that you'll carry enough for the duration of your stay and add at least another week worth of daily meds.
6. BE CAREFUL: Not all drugs that maybe legal or prescription free are so in the country you travel to or the the one you travel through. Especially the UAE are very strict on prescription medication (this would include antibiotics) let alone narcotics or other recreational drugs (Fun Fact: Poppy seeds and products such as pastry that uses them as ingredient are banned in the UAE). Check your itinerary and if you have doubts I suggest you conduct a thorough research on possible items you are not allowed to carry.
7. Some items in this Ible have been linked to my Amazon Affiliate Shop. Using these links supports this project and future ones!!!

Step 2: The Bag & External Items

The Bag

The bag is made by Tasmanian Tiger and is called the Small Medic Bag.

It weights empty 480g (Approx. 1lbs) and is approx. 26 x 14 x 11cm (approx. 10" x 6" x 4") with a volume of 3 Liters and is made from Cordura 700 DEN. It is MOLLE compatible and has MOLLE loops on the back, bottom and both sides.

I like this bag because it is small enough to carry it as an additional module for backpacks (Go Bags, Bug out bags) yet it is large enough to be used as a standalone medic bag.

Carry methods

I used to carry this kit attached to my body armor (as you can see on the pic on the previous step) and also with a shoulder strap separated from the plate carrier. The bag comes with a waist strap which I found uncomfortable when travelling in a vehicle. I used the shoulder strap from a good quality laptop bag and after reinforcing the seams attached it with some carabiners to the bag. I left the waist strap on the bag but also added carabiners and tucked it into the MOLLE loops on the back.

I have also wound a roll of 2" olive duct tape into the shoulder strap which can be used for a million things (e.g. improvising splints, immobilize limbs or build a canoe). Do not use duct tape directly as a bandage on bare or injured skin.

Left Side

On the left side of the bag I have attached a belt cutter made by Benchmade to cut through a safety belt in an emergency. The second tool is a Smith & Wesson First Response Knife (I believe that they do not produce this particular model any longer) which combines a pry bar blade which can be used to cut/saw safety glass with a spring-loaded glass breaker. (I currently try to get permission to shoot a video in a junk yard trying the tools out on a proper car). Both tools can be accessed quickly and easily.

Right Side

On the right side I have attached a Combat Application Tourniquet with some rubber bands which allow for quick and easy access. This tourniquet has been prepared for one handed use.

Bottom

I have attached a rolled up afghan scarf (From the bazaar not the PX) with some rubber bands. The primary use was simply to cover this gear when travelling low profile so a person looking into the car wouldn't notice the high profile gear right away (Needles to say that the occupants would also travel low profile trying to blend in).

Latch

The latch has a double zipper which opened with a single handle. I would attach a Nite Ize SpotLit on each pull tab. When possible I would chose Red/Green, Red/White or Red/IR depending on which lights I had at the time.

The latch also has a small pocket which I would use for a small flashlight such as my Surefire G2 with either the white LED or Infrared LED bulb.

Patches

The front face also features a small Velcro loop area which is where I attached by Blood group and NKDA (No Known Drug Allergies) patches as well as my nationality patch.

Step 3: Combat Application Tourniquet C-A-T

As mentioned before I used to carry one Combat Application Tourniquet on the outside of the bag for quick and easy access. There is a second C-A-T inside the bag as well as a third one attached to my body armor or go-bag.

Tourniquets are used to stop the blood flow in arms or legs in case of otherwise uncontrollable blood loss. Tourniquets should however only be used if other methods (e.g. pressure bandages) fail to stop the bleeding due to the risks that are involved with the use of tourniquets.

I urge you that you seek professional training in the use of tourniquets if you plan to purchase and add them to your kit.

Step 4: 9-Line MedEvac Request & Contact Sheet

Another item I would also carry a number of would be a laminated contact sheet & 9-Line MedEvac Request smart card.

The contact sheet should have the contact details for:

Coalition Force CIMIC (Civilian/Military Cooperation) Liaison Officer - This is someone you should try to get to know in person as they are most often the key to gettin Access ID cards, medical assistance & intel.

Coalition Force Operations Center (SAROC,CJOC, BDOC or whatever they may call it at the time and place)- These can usually be contacted via local mobile phone networks, via Iridium and/or Thuraya satellite phones, military radio frequencies are another option but chances are that you won't be allowed in that loop.

Your companies/organisations Security/Risk Manager - Your company or organisation should be able to provide you with these details. These might be the contact details for a private security company your company has hired.

Local Security Forces - It could also pay off if you have a contact to an influential person within the local security apparatus. This however brings certain incalculable risks such as conflicts of interest, reliability & trust with it which one must be aware of.

Last but not least I have attached a few printable versions of MedEvac Requests that you can download.

As things are at the moment in Afghanistan your chances of a successful MedEvac request are slim at best due to the shifted focus and transition from ISAF to RSM Resolute Support Mission. The coalition most probably doesn't have the resources to aid civilians and even if they do they still have to weight the risks for their own personnel.

Line 1:	Location of the pick-up site
Line 2:	Radio frequency, call sign, and suffix
Line 3:	Number of patients by precedence and type: A - Urgent B - Urgent Surgical C - Priority D - Routine E - Convenience
Line 4:	Special equipment required: A - None B - Hoist C - Extraction equipment D - Ventilator
Line 5:	Number of patients: A - Litter B - Ambulatory
Line 6:	Security at pick-up site: N - No enemy troops in area P - Possible enemy troops in area (approach with caution) E - Enemy troops in area (approach with caution) X - Enemy troops in area (armed escort required) * In peacetime - number and types of wounds, injuries, and illnesses
Line 7:	Method of marking pick-up site: A - Panels B - Pyrotechnic signal C - Smoke signal D - None E - Other
Line 8:	Patient nationality and status: A - US Military B - US Civilian C - Non-US Military D - Non-US Civilian E - EPW
Line 9:	NBC Contamination: N - Nuclear B - Biological C - Chemical * In peacetime - terrain description of pick-up site

Step 5: Signalling and Pick-up Zone Marking

Included are a small selection of light sources both in the visible and infrared spectrum. I usually combined visible white and red lights with a source of infrared light to gain the flexibility to signal coalition forces in a tactical scenario where visible light would be disadvantageous for me.

Chem Lights

There is a wide range of products on the market with visible and infrared options. My preferred brand are Cyalume SnapLights but to be honest I didn't really test many other brands so far.

Chemical lights have the advantage of a long shelf life and the independence from external power sources which makes them a good contingency for battery powered devices.

I have wrapped a length (1m/3Ft.) of cord around both Chemlights to be used to create a visible/infrared "Halo" aerial signal.

Battery Powered Lights

In addition to the above mentioned chemical light sources I have a number of battery powered lights both in the visible and infrared spectrum at my disposal for varying tasks. From the evaluation of a patient to the illumination of the work area to signalling friendly forces there are plenty of uses for good flash lights. Currently I have a Glo-Toob Infrared Multi-Purpose Light and my Surefire G2 (White LED) as main light sources and signalling devices. In addition I have attached two Nite Ize SpotLits to the zipper pull tabs.

Pyrotechnics (Not included)

At the time I would also have pyrotechnical devices for smoke and flare signals available in my vehicle/Go Bag. Due to the dangerous goods regulations however I wasn't able to take them home with me and left them with my team in Afghanistan.

Step 6: Other Tools

Medical Shears

Nothing overly fancy here just some regular medical shears to cut off clothes or seat belts. The blunt tip is designed to avoid injuries when removing clothing to gain access to an injury.

Pincers & tick removal forceps

Nothing fancy or expensive here. These can be used to remove small splinters, insect stingers or foreign objects from a wound.

Sharpie

This permanent marker pen works on most surfaces including skin.

ARS for Needle Decompression (14 gauge x 3.25 in.)

This needle decompression kit is used to treat tension pneumothorax. Only use this if you have received appropriate training.

Scalpel and scalpel blades

All sterile & disposable for various uses.

Step 7: Haemostatic Agents

Before you crucify my for the above picture let me clarify that this is just for illustration & training purposes since I do not have access to other products at this time.Since I figured that my team in Afghanistan would be more likely to need it I left my stock of celox gauze there when I left.

Haemostatic agents work by rapidly decreasing the time it takes for blood to coagulate and are therefore used for the control of heavy bleeding wounds.

The trend/development has been in past years from simple powders (like the one shown in the pic) which are difficult to apply & remove and have unwanted exothermic side effects towards bandages & gauze that contain the coagulant or have been infused with it.

Recommendable products are Celox Z-Fold Gauze, QuickClot Combat Gauze and CELOX Gauze Roll.

Again I urge you that you take appropriate training for the use of these products before you consider buying them.

Step 8: Personal Protection Equipment & Sanitation

When treating someone you should consider you safety as a first priority. Ensure that you include plenty of sterile gloves as well as a few CPR Masks (Or resuscitation mask) for your own protection.

Also included are a number of alcohol and iodine prep pads as well as some cleansing wipes and a tube of hand sanitizer.

Step 9: Bandages and Dressings

I have included a variety of Compression Bandages, fixation bandages and dressings for a multitude of applications. From stopping bleeding, immobilization of broken bones, covering of lacerations there are plenty of uses.

Another type of dressing is the Water Jel Burn Dressing which is used for the treatment of smaller burns.

Step 10: Triangular Bandages and Tampons

There are a number of applications for triangular bandages from support, immobilization to covering larger surface areas of an injury.

Tampons can be used mainly as a method to stop bleeding (e.g. for gunshot wounds) or as an assistance for a compression bandage.

Step 11: Wound Closure

For the treatment of smaller and medium injuries such as cuts and lacerations I have included a variety of adhesive bandages for different applications, two packages of wound closure strips as well as some cyanoacrylate (Super glue). Of course there also a few band-aids in there for when you cut yourself again with that new knife you just bought in the PX ;).

Step 12: Emergency Blankets

Also going by the name space blanket or Mylar blanket or thermal blanket or first aid blanket. These are made of very lightweight heat-reflective material and is used to reduce the heat loss. The mechanism at work here are reflection of thermal radiation coming from a body and reduction of convection since the foil is airtight...blah...blah...it'll keep you warm if you're at risk of losing too much heat.

There are also other uses for such a blanket, due to its reflective surface you could use one for signalling for example or to hide your heat signature if you ever end up on the wrong side of a set of thermal imaging device...

Step 13: Single Use Thermometer

This small thermometer can be used to verify the temperature of a patient.

Step 14: Monthly Giveaway

Starting from this project I'm switching to a monthly giveaway.

You can win a Let's Prep Mini Surprise Pack including a 3-Month Instructables Pro Account. All you have to do is to subscribe to my YouTube channel and leave me a comment at this video and include "I want one!" & your Instructables username.

The winner will be announced on Feb 29th 2016 1800hrs GMT on my FB, Twitter & Blog.

(Only entries from the EU, Norway, Switzerland, USA & Canada are eligible to get the full package mailed (please understand that I pay for this myself), residents of other countries may only receive the Pro-Account).