MEDICAL: The SOL-IFAK

James G’s SOL – IFAK

Over the past decade of working as a contractor in shit-holes around the world and living and traveling in the 3rd world one thing I have always learned to have close by is an IFAK.

Depending on what sort of gig I am on or where I happen to be traveling “IFAK” can mean anything from a backpack packed to the brim with medical kit to a cargo pocket with some QuikClot, some tissues and a Band-Aid.

Basically if you are an operator working in the worlds hot-spots you need to understand that your IFAK needs to be customized to whatever operation you happen to be on. That can be everything from looking from some rich guys missing kid in Bangkok to running PSD missions in Afghanistan.

The particular IFAK I am going to go over today is one of the ones I currently use as a TL running missions (everything from PSD to Convoy Security) for a private security contractor in Iraq.

This IFAK was put together by our Company Medic to be used in a very specific situation. Without giving away any OPSEC shit, lets just say we are way squared away when it comes to having the best medical supplies and highly trained US medics on our missions. So basically if someone (hopefully not the medic) is injured we have not only the medical kit to treat them but also a top tier medical professional on-board.

I call this particular IFAK the “SOL-IFAK” – meaning if I have to reach into it, it is because I am a combination of injured, unable to physically move from my position, cut off or pinned down and my teammates or medic can’t get to me and I have to treat myself ASAP.

It is not for helping others (but it still has the components to do so if necessary), not for treating myself quickly and running to our medic – it is a you are all alone and “Shit Out of Luck” with half your leg 4 feet away along with a few holes in ya type of IFAK.

Pretty much the only time the SOL-IFAK will get reached into is if I am lying on some shitty Iraqi highway, bleeding, pinned down behind some broken down eighteen wheeler that is 12 flatbeds away from my guntruck/teammates and I am not expecting medical assistance immediately.

The SOL-IFAK will keep me alive until my team kills everyone and the team medic is able to treat me and then gets my ass off the X and on DBA.

Note: All the items in my SOL-IFAK were selected by (Call Sign: KeyWest) a highly experienced PSD/CSD Civilian Security Contractor Combat Medic who is a former U.S. Army Medic, Civilian firefighter and EMT. Descriptions and why those items were chosen were written by him, so thanks to ‘KeyWest’ for helping me with this article.

SOL-IFAK Contents

Let’s start from the beginning… basic first aid. Apply manual pressure and elevate. Next dress wound. Next apply a pressure dressing. Next, apply a tourniquet. These have been the basics of first aid and how it has been taught from the beginning. However, there are now some different options to keep close.

Cravat

The first most basic part of this kit would be a cravat. This can be used as a sling, for a pressure dressing, to be used in conjunction with a splint, and as a tourniquet. We carry at least 2.

Field Dressing

The next most basic part is the field dressing -2. This can be used to be applied to stop bleeding, cover a wound, decrease chance of infection, and can also be used in conjunction with others at the same time.

One thought to keep in mind is that one field dressing will usually hold about little less than a pint of blood. This is important to understand because your blood will keep you alive. If your first field dressing has soaked all the way through it’s past time to move on to the next step.

Quick Clot (Two Types)

Now on to quick clot. This item comes in different styles. We carry 2. The quick clot combat gauze and the quick clot (ACS) Advanced Clotting Sponge. The regular quick clot combat gauze is for temporary use to control traumatic bleeding. This means major bleeding.Don’t use this if you scratch your knee, or scrape your elbow.

This is for major trauma. You would open the package and apply to open wound and apply pressure for at least 3 minutes. Sometimes you may have to use more than one. At this point you would wrap and tie the bandage to maintain pressure on the wound and evac as soon as possible.

Quick Clot (ACS

The quick clot (ACS) is for a little more traumatic wound and is used for emergency external use only. This package also reads “Do Not Eat”. I’m not even gonna ask why that is printed on this package.

You need to wipe away any excess blood around the wound then pack the wound with the mesh bag in the package. Sometimes it may require more than one. It’s important to remember that direct pressure over the wound is never forgotten. Apply pressure for at least 3 minutes. This product will produce heat to be aware.

Wrap and tie a pressure dressing over the wound and evac as soon as possible. It’s also important to put the package in a pocket or stuck on you somewhere so medical staff will act appropriately when you receive hospital care.

Emergency Wound Dressing

The next part of our kit is the Emergency Wound Dressing….its a hemorrhage control compression dressing. It has its own device that enables you to one handedly apply pressure to a wound while dressing the wound.

Abdominal Dressing

Our next part of the kit is a small abdominal dressing. This is used like any other field dressing except its bigger to cover those exposed guts. And at this point, you might as well kiss your ass good bye because you have a very short time to be at a hospital.

Wound Dressings

The next 2 wound dressings are elastic in nature and provide pressure when applied. However the sponge is not as thick so other dressing may be required. One thing I’d like to point out is that once a bandage is applied…. Never remove it. Just keep adding to it.

One Handed Tourniquet

The next hemorrhage control device we carry is the one handed tourniquet. It’s always nice to be able to stop a major blood flow in a second and stay alive, rather bleed out from a leg blown off. Tourniquets should be the last course of action.

Apply a T on your forehead and note the time if possible. At this point shock will start to come into play and you may be unable to function. But with training, focus, and determination you can apply a tourniquet to yourself.

ARS Needle Decompression

Another part of our kit is a ARS Needle decompression. Once you are shot in the chest you thoracic cavity (your chest will start to fill with air… maybe blood. The needle decompression can be used to expel the air and allow your lung to function as best it can.

Remember to roll to the injured side. This will allow your good lung to function as best it can for as long as it can.

HYFIN Chest Seal

The last part of our kit is a HYFIN Chest Seal. This is an occlusive dressing. It is placed over the wound and will not allow air to enter the chest cavity and will allow air in there to escape.

One point to examine here… many chest shots have exit wounds. You are not gonna be able to apply a chest seal to both. Its only if you have and entry point. At that point, lay with the injured side down and apply the resources you have.

Thanks again to my Team Medic for helping me with this article

If you have any questions please feel free to jump in on the comments

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~James G
Founder – Editor in Chief

James G is a Veteran Civilian Contractor who has worked in the Middle East and Southeast Asia for way too long. He spends his off time in Indonesia and Virginia getting drunk, shooting guns, writing poorly written articles and trying not to get shot, blown up by an IED or the clap

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21 thoughts on “MEDICAL: The SOL-IFAK”

  1. Great stuff James.

    I do keep several Quick Clots on hand in different bags, however, the HYFIN and the ARS will be something I will be adding to the kit.

    Question: I’ve been lugging around my “stitch-up” kit for years. Do you guys ever keep a personal one with you or just let the medic deal w/ it?

    Thanks again,

    D

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    1. Our Medic has a suture kit and enough other medical supplies in our mass-cas bag that he could pretty much do a heart transplant in the field if he had to – lol

      ~James G

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  2. This a good idea to have anywhere . Not just in a third world shit hole , there are plenty of shit holes here in the us . I carry a personal kit and a EMT roll out bag in the trunk where ever we go .

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    1. Sure – that SOL – IFAC would work just as well if you were hurt from chasing a skip and waiting for an ambulance and the cops

      ~James G

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      1. We also figure that if we injure some one and they are not dead that we will render aid . As much as I dont like the idea of some idiot shooting at me I return fire and have to the deal with them . But in todays world lawsuits are given .
        So plan for the worst and hope for the best .

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  3. James

    I wish you’d do a review on your HSGI chest rig.

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    1. I did a review on it way back in the day – but it could have been better, good idea – I’ll do another more comprehensive review on it.

      But the HSGI Warlord V-4 New Version with the Releasable H-Harness for Chestrigs is the best rig out there hands-down in my opinion

      ~James G

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  4. Hi James,

    As a medic myself I would like to comment on some points:

    – Tourniquets aren’t the devil they were, use on demand. You have up to 6 hours before bad things happen.

    – NPA airways are great to help with airway (facial trauma e.g.)

    – Shears are needed to access injury

    ps: one hand tourniquets are great but kinda useless if you need both hands to open the packaging ;-)

    Stay safe

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    1. .
      -I will have our medic chime in on why an NPA was not included

      -And EMT Shears are such a “no shit” item we didn’t list them, but everyone on the team has a pair at the ready

      ps: one hand tourniquets are great but kinda useless if you need both hands to open the packaging

      That’s why god gave me teeth

      -But our Team Medic and I actually had a conversation about adding something for a tracheotomy for if my face got blown off and our determination was if I was that fucked-up in the face I most likely would not be able to use one on myself so we skipped it

      Some dudes are just hard enough to trache themselves when there face is laying on the pavement, I am not quite sure if I am in that category lol

      ~James G

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    2. .
      My name is ‘Key West’ and am the team medic for this private contracting team.

      Shears are needed to access injury

      I personally assure you my guys have trauma shears like they would have ammo.

      NPA airways are great to help with airway (facial trauma e.g.)

      I have personally seen people try and administer a NPA to themselves. It never works. I didnt include this item because there is no way under this amount of stress, trauma, and shock that someone could possibly correctly administer this to themselves under these circumstances.

      Tourniquets aren’t the devil they were, use on demand. You have up to 6 hours before bad things happen.

      I never said tourniquets were the devil. They actually save lives. I just said it would be a last resort in certain situations. But thanks for putting words in my mouth.

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      1. Hey mate,

        no critics intended.

        My comments weren’t for you or the team but more for the readers (shears)

        Same with the tourniquet comment: I still see a lot of guys spreading rumors about them.

        I never had issue using NPA on myself (in training) or others (including a facial trauma on a kid) so I really like them but that just me.

        My take on the IFAK: I have the guys carrying what they know how to use even if they don’t master it: when moving to an injured partner struggling, I’ll use his IFAK, so if he carries a NPA, I’ll use it first saving some seconds maybe. Same with the ARS: never used one but we still carry it, cost/benefit are big enough ;-)

        Again, none of my remarks were against you or your procedures, just my POV.

        Cheers

        Over and Out

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        1. .
          Quotes by “Nick”:

          “when moving to an injured partner struggling, I’ll use his IFAK”

          “I’ll use it first”

          Nick,

          This IFAK does not have items in it for other People to help you – that’s why it I called it a “SOL – IFAK” – It is to be used when NO ONE can help you.

          It is a Mission Specific IFAK

          I think maybe you missed the point of its use and the reasoning behind the items chosen bro

          ~James G

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        2. When was the last time you were being shot at, mortared, or had an IED hit your convoy?

          This article is about SELF AID when pinned down by suppressing fire.

          There is no way in Gods green earth that a guy who just got his bell rung and has been shot or has his face half way blown off can administer a NPA on themselves.

          Plus, if you need a NPA that means your air way is compromised. That means you cant breathe so good, or at all.

          But I’ll always remember to pull out my NPA before I pass out from not breathing. (being condensing here)

          You do realize that there are only seconds before you lose consciousness?

          Who the fuck would carry a NPA in there IFAC for self AID?

          Just sayin….

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  5. While having a NPA might be a good thing to have in a vehicle’s medkit or trauma pack…

    Self administering one when your lower jaw has left your face at high velocity is not going to work. Like James said… I am sure there are guys out there hard enough to maintain composure and run one themselves while bleeding out on the side of the road while several hundred incoming rounds of .30 caliber hate are skipping off the roadway- but I haven’t run into any of them in my career.

    Even if you can self administer a NPA under classroom conditions… doing so while suffering from massive facial trauma, TBI induced from the round’s impact, blood loss, a heavy adrenaline dump and loss of fine motor skill that accompanies all of that is a non-starter.

    The point of this piece of kit is it is to be broken out if there is no assistance coming in for the foreseeable future. Hospitals aren’t 15 minutes away- they are 2-3 hours away. There is no EMS to call to come put you in an ambulance- and even if that option did exist you’d be getting scooped up by hajji- not something I’d allow even if I was bleeding out (I don’t look good in orange).

    If half your face is gone, you’re going to die on the side of the road anyway. Period. Full stop. End of story.

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    1. But Zero, What if there were jack-booted thugs between you and home and you had to take the long way or go to sooemne else’s home. :)

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  6. Good write up on a realistic bag without all the tacticool gayness.

    NPA’s in your own nose are a cool party trick, not something I have ever seen in the field. Anyone who is bad ass enough to dart their own chest is a fucking rockstar. The ACS packing does not just generate heat, it burns like shit and works like magic.

    Glad to see DVM back on the net

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  7. fascinating, looks practical.
    @Keywest would love to hear what you carry in your kit

    I’d be interested to hear how often and how well the ARS gets used in real life. In my experience as a trauma surgeon the majority of field needle decompressions in the civilian world were unnecessary and failed anyway, e.g., there was no ptx to begin with and the needle didn’t enter the chest cavity. I’ve also seen a lot of caths bend and fail to work.

    Of course, the gang bangers are not good at getting on center mass and they use lower energy weapons, so YMMV.

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  8. Carry what you like do what you like makes no diference to me. However, if you put your shit out there with the intent off teaching others you should do your homework and be prepped for questions. You seem a little defensive to me, maybe you aren’t that sure of your skills? (That shit was rhetorical I already know the answer). Your article clearly states TQ’S should be the last course of action and that is absolutely false. If this is a true SOL kit then you are rendering self aid during Care Under Fire. In that case TQ’s are the first choice for hemorage control on an extremety. That is day 1 hour 1 TCCC bro. Also, if this is a true SOL kit then TQ’s should always be prepped and packed for the worst case scenario. That is “one handed self application with the non dominant hand under simulated combat conditions” in case you didn’t know the standard. So yours is in a wrapper in a pouch on the back of your vest? No gunfighter does that. Hope the hajis dont shoot you in the wrong arm, you may be SOL. By the way there are much better hemostatics out there than the ones you mentioned. So, I doubt you have the best training and kit as your article states. Hey you have to work with what you’ve got but just thought you might like to know. You have no airway device in your kit but death from airway obstruction is the only thing other than massive hemorage that kills POTENTIALLY SURVIVABLE combat casulties in the first hour. I put that in caps hoping that you know why those two words are signifigant, but you probably don’t. Who says an SOL kit shouldn’t have some buddy aid items? So the only guy who is trained and equiped to treat airway injuries on the team is you? Hope you aren’t the casulty. Hope you get to him quick. Most combat casualties have good airways but the ones who don’t need help right away. So wait, help me understand, you can’t put an NPA in yourself but you can needle decompress yourself? I’m not saying you could get either done well with your bell rung but you imply that the NPA is absent because self application isn’t realistic. So is self decompression realistic? is it necessary during CUF? Facts say no but you say yes? How do you confirm placement when you needle decompress anyway? Don’t tell me you listen for the “whoosh” of air exiting the cath right after a gun fight, IED or during vehicle transport, that’s bad medicine bro. How do you Rule out a false negative decompression? You do know what that is right? TENSIONpx never develops in less than two hours and bad lung down is incorrect. (When I do the caps thing I am trying to tell you that word is important. You get to figure out why). Bad lung up increases blood flow to the good lung and bad lung up does not reduce ventilation. You need to keep up with effin science bro. Your shit is way out of date and your kit is too. The Hyphen is junk it only sticks to manikins. Makes me wonder when you did your last real casualty and last real training. This article is full of inaccurate medical advice. Carry what you want, do what you want but at least be able to explain what you do and why clearly. Don’t be too hard on yourself, I guess you don’t know what you don’t know and somehow that makes this article OK right? You should be open to criticism though that’s how real gunfighters build a team and improve themselves. Before you make some lame comment I’ll tell you this much, OPSEC and all, I’m there now and my last real casualty was yesterday. So DX the attitude and get your shit wired tight because someday you might have to treat a real CAT A. Peace In The Kingdom bitches.

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  9. Great list. My kits are very similar but vary from your by quantity. My personal kit has only one of most of the above, if I need more than one abdominal pad for self injury I just consider myself fucked. The kit I carried for three years as a swat medic had the same but high quantities to deal with the team. Since I was on the entry team having these essentials keeps it light and low profile. The big bag is for the obese medic sitting in the truck. I used to get crap from new guys (and pussies on the team) about not carrying what they wanted because I only kept a ziplock bag with band aids, and otc\’s. We called this the “booboo bag”, if you came asking for it you were going to get heckled by the guys who were in my squad.

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  10. Also have to agree about the NPA. If you need it, you can\’t breathe and you aren\’t giving it to yourself- therefore not SOL-IFAK gear. Already to late. Great to have in my bag for the team, or in the small bag with a TQ and QC that I keep in every vehicle for coming up on wrecks.

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