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What should be in a contemporary IFAK?

Updated: Mar 13

“IFAK” stands for individual first aid kit and comprises a small pack of essential equipment that every soldier or civilian operating in close proximity to the front line should carry with them at all times. However there is no straightforward answer to what should be in an IFAK which will vary from the context of the theatre to the needs of the specific individual and those (s)he may find him(her)self treating. Nevertheless the contents of an IFAK are worth recalling because there is little point, as many soldiers and civilians alike find themselves doing, in carrying an IFAK only to have no idea what is in it and then when an emergency arises that necessitates immediate medical attention panicking and fumbling to search in the kit for something that might be appropriate. An IFAK carried on the front line of a war zone will typically be very different from one found in a workspace or a kitchen and prepared for civilian use, and you should be familiar with the distinctive equipment found in a military IFAK if you anticipate operating, for any purpose, in proximity to the front line of a war zone.

The first thing to be said about a contemporary IFAK is that it should be carried in an all-weather waterproof bag with straps that enable it easily to be attached to a jacket or a hook on a trouser belt or jacket. Each item in it should be individually sealed against the elements and sterilised so that if any specific item needs to be used then its packaging can be torn open and thrown away after use with the other individual elements of the IFAK preserved for future use. The principal light injuries for which IFAKs will be used are cuts and grazes which can be severe. With significant flesh wounds it is necessary to sterilise the wound and close the cut flesh as soon as possible to prevent gangrene (rotting of the flesh leading to loss of the flesh) in order to minimise disfigurement or infections which can spread to the rest of the body and kill. Modern sticking plasters now take the place of conventional sutures and only in the most exceptional of cases should stitching up of flesh take place with a needle and thread outside the context of a field hospital. Other gauzes, plasters, pads and bandages should be present in the iFAK to cover wounds of various kinds and tape should be available to hold wounds in place, particularly where there has been a gunshot wound with both entrance and exit holes. Both such holes should be secured and held together as best as possible to prevent blood loss pending transport to a field hospital. A bandage may be of a triangular type to hold a limb in place where it is suspected that the bone has been broken or there has been severance of muscles, so as to minimise the pain and damage incurred in further movement pending transfer to a place of more comprehensive medical treatment.

Where substantial blood loss is indicated, it is imperative that the limb be the subject of a tourniquet and every good IFAK contains a high quality tourniquet which will stem blood loss completely. There are several bad tourniquets and designs, many of which originate in China; a good tourniquet will typically cost around US$40 alone and this makes it the most expensive item in the IFAK. Then there should be a collection of medications for pain and to sterilise and to provide antiseptic treatment as it is best that infections upon injury are minimised.

Hemostatic agents, which typically come in the form of gauzes, powders and sponges, may contribute to blood clotting and therefore reduce blood loss. These can be used in conjunction with tourniquets where “bleeding out” (i.e. bleeding to death) is perceived as a real danger. An EpiPen administering epinephrine (adrenalin) is also useful where it is perceived that there is a risk of cardiac arrest. Other medications can also be useful depending on the identity of the patient, but it must be recalled that one of the largest killers as a result of acute trauma is shock and therefore consider ensuring that your IFAK contains psychiatric medications to secure the mental state of a patient who has fallen into shock. The standard paramedic treatment for shock is to lift the patient’s legs above his/her head but consider also carrying a short-acting benzodiazepine (anxiolytic) such as lorazepam or alprazolam - if you can get hold of it. These medications are highly addictive in ordinary medicinal contexts and their use by non-psychiatrically qualified personnel is often frowned upon. But if a patient is raving and screaming and this is hindering combat or other operations or the process of transferring them to a stabilisation point for onward medical treatment, then a short-acting psychiatric medication, if available, may be indicated.

For a decent IFAK, which may include regulated or prescribed medications, you are looking at paying well over US$100 but it is essential that all personnel and civilians working in the context of the front line carries one and familiarises themselves thoroughly with its contents. Just a few hours of training is sufficient to acquire essential paramedic skills that may save your life or that of others. It is also important to know how to undertake mouth-to-mouth resuscitation and how to take measures to restart the heart after there has been a cardiac arrest. In the aftermath of a mass casualty event such as an artillery or mortar round landing in the middle of a group of people or a strike upon an occupied building, it is also important to be able to prioritise medical cases because some people are more likely to die than others irrespective of the medical treatment they receive and you may only have finite medical resources if you are on site until an evacuation unit arrives. Therefore you must be focused upon assisting those with major but treatable injuries, disregarding albeit sadly those whose death is inevitable irrespective of treatment and leaving those with more minor injuries capable to self-treatment to lag behind the priority cases.

This sort of capacity to prioritise emergency medical cases under battlefield pressure in the aftermath of a major incident requires training and experience, as does the effective use of an IFAK particularly in multi-casualty cases. It is therefore worth spending an additional few hours acquainting oneself with an IFAK and its use before placing oneself in harm’s way in the context of a front line military operation.


The author trained as a civilian paramedic with 22 / 23 Regiment Special Air Service.

Following complaints received by the Lviv Herald about the accuracy of this article, an opportunity to respond was provided to the principal complainant which has not so far been availed of; and the accuracy of the contents was checked with a third party military expert in medical matters who confirmed its accuracy.


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