What to carry in your EMS tactical medical kit

Tactical EMS

When you’re on an operation and you can only take what you can carry, what do you choose?

Tactical medical equipment is an interesting and evolving topic area, with SWAT medics having as many opinions as there are vendors and products. [At the end of this article, find a downloadable list for reference when putting together your own tactical medical kit]

There are the minimalists out there and then there are the, "you never know, I better have everything" types. The general consensus is that the medic needs to have enough equipment and supplies to stabilize a critically injured patient in a tactical environment. This equipment should be on their person, or carried in a medical pack, or both.

On- or off-duty EMS personnel need to be on the lookout for hazards and ready to operate in the warm zone

Besides the medical equipment, the tactical medic is already carrying about 25-50 pounds of other gear. Most of the weight is in body armor/ballistic plates and helmet. Other non-medical equipment might include weapons, ammo, incapacitating agents, knife, multi-tool, collapsible baton, radio/headset, lighting systems (including infrared), gas mask, eye protection and a hydration system.

Less commonly carried or worn items might include binoculars, camera, computer tablet, body-cooling system and night vision goggles. The operational environment will also dictate additional equipment needs, such as cold weather or a hazardous materials event like a meth lab.

Not all of these tools are carried by each tactical medic. Some of the equipment is reserved for training and standby events such as team selection tryouts, swim tests, physical training days or range days. Some might be kept available in the medic vehicle. Tactical teams can have an ambulance that is overt (it looks like an ambulance) or covert (a long-bed, covered pick-up truck).

In general, the medical equipment that is carried by the tactical medic can be broken down into the following areas:

Personal protective equipment (PPE). This refers to medical PPE, not ballistic protection. PPE should include gloves, mask and eye protection.

Patient assessment tools. These tools needed to assess, visualize and measure vital functions include a stethoscope, blood pressure cuff, micro pulse oximeter, thermometer and CO2 monitor.

One high-caliber tactical team I know of keeps a lightweight, portable I-Stat machine on hand to analyze blood chemistry and electrolytes, especially during endurance training/ team selection events.

Trauma supplies These are tools designed to stop bleeding or seal off penetrating trauma:

Airway/breathing management. These can range from a simple oropharyngeal airway to a full airway management pack. Equipment might include:

Routine medicines. Most EMS providers are not allowed to administer over-the-counter (OTC) medications, as it is not in their scope of practice. However, making OTC meds available to team members has largely been an acceptable alternative. In reality, this is by far the most common request by team members for medic services. The medic is the go-to for just about anything related to the health and wellbeing of team members.

Having an assortment of commonly used OTC medications helps to keep minor ailments from progressing, and can help prevent an onset of problems such as allergies. Over the years, this part of my kit has expanded while the major trauma supplies have decreased. In my experience, it seems that ibuprofen, Pepto-Bismol, and allergy medications such as Claritin are most commonly requested.

Other common items include sunscreen, insect repellant, and Tecnu poison ivy/oak protection.

Routine materials for minor trauma, blisters and skin care. By far, the most commonly requested item is a Band-Aid. Minor wound care is a constant activity for the medic. Having a readily available supply of assorted sizes of adhesive bandages is a must. In addition, minor wound cleaning tools/wipes and topical antibiotic ointment are often needed. Have a good assortment of 1" and 2" breathable and non-breathable tape. Tools such as tweezers, forceps, small scissors, and wound/eye irrigation supplies are used often enough to have a place in the kit.

Ortho/sports medicine. Orthopedic injuries are common in training, and they happen on occasion during SWAT operations. Personnel can often have underlying orthopedic conditions that can be exacerbated during operations, and need evaluation by the medic. Having a background in sports medicine or orthopedic injuries is a plus.

Skills including taping, bracing and in-field stabilization of orthopedic injuries. SAM splints are pretty good for most splinting needs. Other items to consider might include cold packs and compression wraps.

ALS/prescription drugs. This area is a no-go zone for many teams for a variety of reasons. If the medic is authorized by a physician medical director, they may be authorized to be an ALS provider. Our team has an AED and first-line ACLS drugs. In addition we carry aspirin, nitroglycerin, albuterol (Proventil), ondansetron (Zofran) and ketorolac tromethamine (Toradol), a non-narcotic NSAID analgesic drug.

Patient transport system. As part of their standard operating procedures, many SWAT teams leave breaching gear and a med pack at the front door of the target location. This is called the "door pack." This may include a collapsible/roll-up stretcher such as a Sked. Oftentimes the medic will also carry a soft "roll up" stretcher on their person.

In addition to what the tactical medic carries, each SWAT operator should carry, and be fully trained in the use of, their Individual First Aid Kit (IFAK). Operators should carry the IFAK on their vests. It should be accessible with either hand. Many operators will carry a second tourniquet that is also easily accessible on the tactical vest. Equipment might include:

As you can see, the medical equipment that is carried by the tactical medic is designed to cover the needs of the team. In the operational environment, that equipment will prove valuable in reducing the level of injury and stress – and promote a successful outcome.

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This article was originally published Dec. 9, 2013. It has been updated

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WHAT EVERY TACTICAL MEDICAL KIT NEEDS

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Jim Morrissey is the tactical medical program director for the Alameda County EMS Agency and a former FBI SWAT tactical paramedic. He has a Master's Degree in Homeland Security from the Naval Postgraduate School. He is an internationally recognized expert in the field of the multi-discipline response to active shooter incidents. He can be reached at [email protected].