The Second “Most Important” Medical Device to Carry

There are four primary tools in trauma medicine that the average civilian, with some medical training, should prioritize for stopping life-threatening bleeding (these four tools omit protective gloves and shears); the tourniquet, packing gauze, the pressure bandage, and chest seals.  Of the four, I have submitted the opinion that the tourniquet is the single most important to carry, as accidents are more likely to cause injury than is violence, and machine related accidents most often lacerate the appendages.  Usually, life-threatening bleeding happens from the limbs due to worksite or machinery accidents.  Also, the tourniquet is the hardest of these four tools to properly improvise. 

If on-person space allows and you are inclined to carry a second of these four items, I am quite convinced that hemostatic packing gauze is the way to go.  I say this because packing gauze is primarily used to pack a wound in a junctional area on the body, and in this capacity, the gauze is the direct means of slowing or stopping that bleeding.  While other cloth, such as a shirt, can be used to pack a wound, ripping open a pack of gauze is faster and using it is more efficient.  For a wound in a junctional area, this tool is the best option we have for on-scene treatment.

Standard training suggests packing a wound with gauze and keeping direct pressure on it for several minutes, then applying a pressure dressing to maintain the pressure on the packed wound.  So, while a pressure dressing is important for moving a patient and the like, I would argue that there is more time to retrieve a pressure dressing, or improvise one, once the wound is packed.  Likewise, chest seals are intended to mitigate the development of tension-pneumothorax (a collapsed lung) due to an open chest cavity.  This condition, however, takes time to develop.  Also, chest seals can be improvised with plastic packaging and duct tape, though that is not as good as dedicated tools, obviously. 

So, the pressure dressing and chest seals are certainly important, but there is more time available, whereas an arterial bleed from a limb must receive a tourniquet immediately, and an arterial bleed in a junction must be packed immediately, so the tool for stopping the bleeding needs to be on you.  Is it not reasonable to prioritize the most essential and time sensitive items?  In the wake of an accident or violence in a public place, packing a wound and enlisting someone there to hold pressure until help arrives, or until a pressure dressing can be brought from a vehicle, seems reasonable. Now, if in the wilderness and far from help, you should have all four tools with you, obviously, but when out and about in public, I think there is an argument to be made for having the immediate tools on person rather than the tools that are not as critically needed within an instantaneous time frame. 

Carrying a full trauma kit with all four tools in an ankle cuff is feasible, and if you have a bag with you, having all four tools is a no-brainer.  But, if you can only accommodate a couple items in your pockets, I would suggest that a tourniquet and a pack of hemostatic gauze would cover most wound issues you may encounter.  Also, similar to a carry gun, you are better off carrying a smaller tool ALL THE TIME than a larger tool only some of the time.  If you carry a tourniquet and gauze in a pocket, all the time, that is much better than carrying a full trauma kit on your ankle only some of the time, and while some do, most do not wear an ankle IFAK all the time. 

Personally, I carry a tourniquet and hemostatic packing gauze on-person, all the time.  I have full trauma kits in my vehicles, in my home, and in my EDC sling bag, which often goes everywhere with me.  For on-person, however, I have these two items, and I am good with that.  I don’t feel a compelling need to carry more on-body, and if I want more, I just carry the bag.  If in the woods or anywhere afield, I always carry a pack that has a full trauma kit.  When on the shooting range I keep a full-size trauma kit in my range bag and, when teaching, I wear a kit on my belt.  However, for EDC, I think having the two most critical items on-person is sufficient.  Concealed carry is a compromise, and we need to prioritize the absolute necessities.