Featured Bloody Important – Cheetos and Duct Tape Recoil Staff September 10, 2016 Bloody Important is a recurring RECOILweb.com series about the oft-overlooked, occasionally even ignored, medical aspect of the responsible armed citizen or LEO's training. Carry something intended to put holes in people? Think there might be a chance someone could try to put holes in you? Best be prepared to plug them. Today's installment of Bloody Important comes to you courtesy of Kerry “Pocket Doc” Davis, co-founder and lead instructor of Dark Angel Medical. Bloody Important – Cheetos and Duct Tape A Sponsored Disquisition by Kerry Davis Let’s say that someone in your work environment is seriously injured and needs help. Someone is bleeding out or has suffered a sucking chest wound. Look around you. What do you have that could be used as a tourniquet, an occlusive dressing, a splint or a pressure bandage? What if you witness a multi-vehicle collision on the highway and you only have one med kit? What about a gas explosion in a crowded restaurant? These things can happen, have happened, will happen again, and you need to be prepared. The likelihood of you getting caught in the middle of a domestic terror attack is low — which will be little consolation if it does happen. Photo credit Boston Globe. Unfortunately, not everyone will have one of our D.A.R.K.’s (Direct Action Response Kit) with them, or any medical equipment with them, if something happens — though they should! Sometimes things happen that are beyond even the scope of the D.A.R.K. or other personal kit. These contain, ideally, sufficient trauma treatment kit for just one person. You can certainly stretch it out to more than that, depending on the injuries involved, but it’s designed with a single victim in mind. After all, that’s what the I stands for in IFAK. You can carry a tourniquet in a still maintain a slim profile. This isn't the height of fashion, obviously, but it does demonstrate the Dark Angel TQ holder. Let us say for the moment you do carry a kit, have somehow been involved in a Mass Casualty Incident (MCI), and have used everything in your kit— but there are still casualties to treat. What do you do now? The answer is, you must be prepared to utilize whatever is around you and on hand to deal with those a traumatic injuries. It can be done; field expedient first-aid items are all around us. Let's talk about hemorrhage control. You can bleed out pretty quickly, and blood belongs in the body. It’s science. Say you're at a parade where someone has careened through the crowd, leaving crushed and mangled would-be revelers behind, and you've already used the 2 tourniquets (TQs) that you (in stark contrast to so many of the folks you hit the range with) routinely carry in your day pack. Can you make one? Absolutely, if the right materials are on hand and you're savvy enough to use them. Will it be as good as a commercially-available one? No. That’s not what a belt, scarf or tie was designed for. However, so long as you have the right material available, and the knowledge to use it properly, you can still absolutely make a difference and save lives. What if you're the first person on scene at something like this, and there's toddler bleeding onto the highway — would you be able to help? It’s extremely important to remember that TQs work not only from the force of the compression but also from the surface area being compressed. The wider the band is, the more surface compressed. The more surface area compressed, the less compressive force you need to gain arterial occlusion. You'll need a compression band at least 1 in. wide so you don't cut into the tissue and create more trauma. You'll also need a windlass (the thing you turn to tighten the tourniquet), and you'll need something to secure the windlass. What can you use? Look around you. See that hipster's pashmina? Are you wearing a belts or bandanas? Scarves, shemaghs, backpack straps, rifle slings…the list of what might be used goes on and on. Note that you don’t want to use anything like paracord, wire, bootlaces, rope or anything small and narrow that can cut the tissue. Remember, wider is better. What about a field expedient windlass? Do you have (or do you see) a carabiner, pistol magazine, small EDC light, a tent stake, a damn stick?. At the risk of using a tired aphorism, think outside the box. Actually, think outside the med kit. Keep in mind while you're sorting through this, you don’t want to make it too complicated. You have only a short period of time to get that TQ on and get the vessel occluded before the victim loses too much blood and either goes into shock or, worse, dies. Direct pressure remains king in non-life threatening hemorrhages. Try to find some sort of material which can cover your hands to prevent blood or other body fluids from reaching your skin, grab some absorbent material (t-shirt, gym towel, that other hipster's pashmina), hold pressure and keep the bleed controlled. Place a golf ball, smooth rock or anything of similar size underneath a layer of material as you compress it to focus pressure down into the wound. Such materials can also be used as expedient packing into a wound. Don’t worry about giving them an infection by using unsanitary materials. This is the least of your worries right now. Antibiotics will come in copious quantities later at a definitive care facility. You're more likely to be the first person upon a scene like this than you are to find yourself caught in the middle of a convenience store robbery — don't train with your weapon without giving thought to the medical side. Just like with a commercial TQ, and especially with a field expedient one, you must constantly reassess for any loosening of your make-shift TQ and re-bleeding. It is vital to watch for signs and symptoms of shock and constantly monitor the Level of Consciousness (LOC) of the victim. If one dressing becomes saturated, place another over it and continue to put the pressure on it. Don't pull the old one off — and remember, as much as possible, keep them warm and dry. As with virtually any skill, proper training is more important than fancy, high end gear. Knowing the rationale behind and mechanics of using a pressure bandage will be far more valuable in an austere environment than the bestest, mostest expensive IFAK back in your vehicle, your dorm room, or you range bag. Finally, and this is important — you will cause the victim discomfort. Perhaps sufficient discomfort that they'll resist your efforts to treat them. Just remember there is a difference between causing discomfort and causing further injury. What you've read here addresses bleeding specifically, but proper knowledge, prior training and a preparedness to use field expedient materials will help address a wide range of injuries. Stay calm. Think outside the med kit. Don't discount the lifesaving potential of that empty Cheetos bag and half roll of duct tape when someone has a sucking chest wound. The time chooses you. Will you be ready? Think about it. Regular old Band-Aids won't avail you much in a Mass Cas Incident, but sometimes they're all you need. If you're already carrying sufficient trauma kit to assist one victim, might as well throw in some basic incidentals or, just pick up one of Dark Angel Medical's Ouch Pouch. Cover image unknown photo credit — everyone thinks weird, improbable and injurious events happen to someone else…which is true, until you are someone else. Why is medical training so Bloody Important? Even the American Medical Association thinks you should know how to use a tourniquet and stop bleeding. Think about it, and be honest — what are you more likely to use in your everyday life? Will it be your tricked out, stipple-gripped, laser etched Gucciblaster with the Kung-Fu Magwell? Or will it be the IFAK in your glove box and pressure dressing you (thankfully) remembered to throw in your back pocket? Wondering why you should be carrying something? Here's why right here. Some information about wounds and injuries from mass shootings here. Dark Angel Medical is headquartered in the formerly free state of Colorado. They can found online here; locate their training schedule and secure a slot in class right here. Dark Angel produces the Direct Action Response Kit (D.A.R.K., now on Gen. 4), the D.A.R.K. Lite trauma kit, the Pocket D.A.R.K. individual trauma kit, the larger scale St. Mike Trauma Kit, and many other trauma kits. They even have a low profile IFAK for your K9. Dark Angel Medical can be found both on Facebook (DarkAngelMedical) and on Instagram, @darkangelmedical. Co-Founder and lead instructor Kerry Davis has been channeling Johnny Cage and Roy DeSoto for over a quarter century. He is a former flight medic with a decade and a half's service turned paramedic, then critical care and Emergency Room RN (Registered Nurse). In addition to his work for Dark Angel, he teaches periodically for the Sig Academy and Magpul Dynamics. Subscribe to them on YouTube, follow them on Pinterest or stalk them on Twitter (@Dark_Angel_Medical) as you prefer. Davis frequently appears on Trigger Time TV both as a host and a Subject Matter Expert, and also occasionally weighs in on Practically Tactical. 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