Category Archives: - MEDICAL

broken ankle

MEDICAL: Ottowa Ankle Rules – Are you hurt or injured?

Dude, Just walk it off its not that bad

In a wilderness survival or tactical environment how can you tell if you’ve sprained or broken an ankle?  The distinction may seem minor, but the implications are dramatic.

In a wilderness environment it means the difference between wrapping the ankle and the patient can walk out, or immobilizing the limb and carrying the patient out.

Tactically, the distinction is the same, but instead of having another shooter, you have a casualty.

So here is a field expedient method to determine if an ankle is broken or sprained.  It called the Ottowa Ankle Rules.

(This isn’t completely fool-proof, so use some common sense.  If the patient’s foot/ankle is obviously deformed then it’s safe to assume it’s broken and don’t let the patient put any weight on the foot.)

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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.

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MEDICAL: Ditch Dentistry

I do my own dentistry

First the disclaimer.  What follows is for informational purposes only.  Nothing should be construed as dental advice.  Without a proper diagnosis by a qualified dentist, appropriate treatment cannot be recommended.  If you find yourself in the midst of a dental emergency/urgency, seek care from a qualified dentist as soon as possible.  If you read this and then think you are an expert, you are the author of your own demise and it’s not my fault.

No one wants to think about dental emergencies when “out and about” but emergencies happen nonetheless.  There are many possible scenarios that qualify as dental emergencies, and unfortunately, there are some things that just simply can’t be properly treated in the field.  There are other occurences, however, that do lend themselves to “ditch dentistry” to hold you together until you get back to a dentist.

Prevention is easier – “Going For The Gold”:

I have accepted the fact that no one likes to go to the dentist, I don’t even like to go to the dentist.  When working/living/traveling in hot zones, the open ocean, jungles, or other far away places, however, it is far better to have definitive dentistry completed prior going to your gig.  The last thing you want to deal with is a dental problem especially a dental problem that could have been prevented.

Definitive dentistry does not necessarily mean that you don’t have any new cavities and you’ve had your teeth cleaned.  Definitive dentistry means utilizing crowns, inlays, onlays, bridges, etc. to treat the teeth as comprehensively as possible to get the longest lifespan possible out of the teeth and the restorations.  This treatment is more expensive and more extensive than simple fillings, but if it is done properly, it will be worth the investment.

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ADVENTURE JOBS: Medic 101 – How to Become a Medic

A lot of people have asked me over the years; “Hey doc, how do I, an average Joe, become a high speed medic much like yourself?”  After I stop blushing, I tell them, “It’s really pretty easy, there are basically two ways. The first is the civilian route and the second is the military route.”

Let’s talk about the civilian route first. This is how I initially got involved with pre-hospital Para-medicine way back in 1986.  First off, a little background, there’s an organization called the (NREMT) National Registry of Emergency Medical Technicians ( that has, in conjunction with the Department of Transportation, set national standards for emergency medical responders.

The four levels of certification are; First Responder (FR), EMT-Basic (EMT-B, “basic”), EMT-Intermediate (EMT-I, “intermediate”) and EMT-Paramedic (AKA EMT-P, EMT-Advanced, paramedic, (“paramagic”, “medic”, etc).  These certifications are recognized by a majority of the United States (right now there are five states that do not recognize NREMT certification.  As of 31 Dec 2009 they are NY, MA, NC, IL, and WY.  When in doubt, check with your state health department to find out which certification is required.

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MEDICAL: Safety Pin Airway

The Safety pin airway – Iraqi style! (Sweet unibrow dude!)

Read THIS so you can’t sue us

Treating a trauma casualty was briefly mentioned in Andrew R.’s First Aid Kit article, and we’ll make sure to post more thorough discussions here in the future on how to treat all things trauma.

In Andrew’s article he introduced EABC (exsanguinations, airway, breathing, circulation), and briefly discussed treating life-threatening bleeding. The next step in the trauma assessment is ensuring the patient has a patent airway.

Unless the airway is blocked due to a foreign object (debris, broken teeth etc), the main cause of an airway blockage is the tongue relaxing and blocking the airway. So opening an airway simply involves removing any object that is blocking the airway and making sure the tongue is out of the way.

Oral pharyngeal airways are designed to pull the tongue up and towards the front of the mouth, ensuring it doesn’t slip back and obstruct the airway. The downside with oral pharyngeal airways is that they have to be sized correctly to the patient, so you have to carry a half-dozen or so.  In addition, if the patient should regain consciousness or is semi-conscious, they can trigger the gag reflex.

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MEDICAL: Putting Together a First Aid kit

Authors FAK

I started thinking, as summer is coming up, just what I want in my first aid kit for the range and any firearms classes I will be attending. Then I tried to decide what would be a good kit for just about anything I would do outdoors that might cause a traumatic injury. I thought about what we had at work (local fire/EMS department) and what changes have come along since the wars in Iraq and Afghanistan.

With the wars in Iraq and Afghanistan we have revamped a number of things we do in treating traumatic injuries. Probably the most significant change in this care has been the reintroduction of tourniquets. What for well over 20 years had been a major No-No is now initial care. In the “old days”, care was done by ABC; Air way, Breathing, Circulation.

Now the standard is EABC. The E, standing for Exsanguination or better known as “bleeding out”, is the number one killer on the battlefield. So our first step is to stop the bleeding with direct pressure. If direct pressure will not stop the bleeding we then can go to a tourniquet. Just to clarify, we do not use tourniquets for bleeding on one’s neck, ok people.

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MEDICAL: Ditch Medicine – Wound and Infection Management

Dude, No amount of Cipro is going to fix this


Wound care away from the hospital is always a problem.  And thanks to Bear Grylls, everyone thinks that any cut or scrape is going to lead to gangrene and amputation.

While antibiotics are often tough to acquire in any decent amount to treat a seriously infected wound outside of a licensed medical facility, here are some steps that you can use to prevent that field amputation.

First, wash the crap out of the wound.

Sounds easy, but a serious laceration or puncture is tougher to wash out than just using a bottle of hand sanitizer.  You need to pressure wash the wound to make sure that anything embedded (debris or bacteria) has been removed.

Two easy ways:

1: Take a standard average plastic bottle, poke a hole in the cap and squeeze.  Creates a jet of water that you can use to wash the wound

2: Take a Ziploc bag filled with water, cut a small bit of the corner off, and again squeeze to create a jet of water.

Adding some salt in the water will help to create a more aseptic solution.

Now that the wound is clean, here’s an easy Ditch medicine step to keep it from getting infected:

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MEDICAL: How a Tactical Enema Could Save Your Life

The Tactical Enema – Just like maximum security prison but without the sporks

Anyone who has ever broken a sweat knows how important it is to stay hydrated. Dehydration of just 2-3% will decrease your endurance capacity by a whopping 25%.

Just sitting in front of the Xbox will cause you to lose dehydrate (mainly through respiration), and sit somewhere cold, you’ll dehydrate quickly as your body converts stored energy into free energy to shiver (plain old metabolism uses 1.5-2L of water a day, figure 2x-3x if you’re in a cold environment).

And all bets are off if you’re playing in the sandbox.

To rehydrate properly, you need a mix of salt and water, preferably in the same concentration that your body normally is – and if you can throw some glucose (sugar) in the mix for energy it’s a bonus, plus sugar makes a salt/water mix not taste like shit (actually glucose has some good hydration properties in itself and should be added in appropriate amounts, but that’s a different article).

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