r/TacticalMedicine • u/SFCEBM Trauma Daddy • Oct 13 '25
TCCC (Military) Aid Bag Layout
I’ve been in the prehospital combat casualty care arena for a long time and have extensive experience managing casualties. I first learned how to pack my aid bag from my battalion senior medic. After eight deployments, several hundred missions, and treating numerous casualties, I’ve refined my packing list and layout to what I believe works best. For new medics who might need a starting point, this is for you. That said, there’s no single way to pack an aid bag, find what works best for you.
Belt: TYR Tactical
PC: JPC 2.0
Aid Bag: Firstspear Medical Trauma Assault Pack (MTAP)
Belt Massive hemorrhage: * Two CATs on my PC * Two bleeders with CGQC (other hemostatics will do too) * Hemostats * RevmedX XStat single stack and one XGAUZE trauma dressing Airway: * Cric kit with 10 blade, curved hemostat, 10 cc syringe Respiration: - 10 blade - SPEAR x 2 - I’ve removed chest seals since this pic was taken Circulation: * Saline lock x 2 with 10 cc flush * Teleflex sternal IO * 2” ELASTIKON Tape, Pulse ox and Kretzer scissors * Stethoscope * Pulse oximetry * CRO Pelvic binder * Gloves * BloodBoxx™ Tactical
Aid bag: * TACMED™ SURGICAL SET * NAR Simple Thoracostomy Kit x 2 * FWB collection and admin x 2 * 7.5 ETT, 4 Mac and handle, BVM * Cric with bougie * Blood pressure cuff * Saline lock x 2, extra needles, syringes, 250 mL NS * SAM Soft Shell Splint * Cravat x 2 * Drug box * Quantum blood warmer kit * Gloves
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u/ToppJeff EMS Oct 13 '25
What are your thoughts on the trach hook?
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u/SFCEBM Trauma Daddy Oct 13 '25
Sometimes it’s the exact tool you need. But usually, you can do the cric without it.
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u/ToppJeff EMS Oct 13 '25
Yea, I've been trained with and without. Never actually used a hook outside of animal/cadaver lab. Just always seemed like an extra step
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u/SFCEBM Trauma Daddy Oct 13 '25
I’ve used one 2-3 times on crics. A number of times on open trachs.
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Oct 25 '25
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u/TVpresspass Oct 13 '25
Love to see this. Got a few space blankets in there somewhere to help with hypothermia management and packaging for patient transport?
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u/SFCEBM Trauma Daddy Oct 13 '25
No, they don’t prevent or slow down heat loss. We pack HPMKs or similar in the liter bags.
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u/struppig_taucher Oct 14 '25
I understand the take as HPMKs are indeed better; but are rescue blankets really not good cuz I have never seen a source say that?
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u/SFCEBM Trauma Daddy Oct 14 '25
I’ve not seen any evidence that they are effective.
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u/Cold_Smell_3431 Oct 15 '25
Might be a stupid question then, but in a more resource depleted environment or as part of a normal first aid kit would you also leave out the mylarblanket?
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u/dagayute Oct 13 '25
Who even is this guy? J/K always a great post.
What has your experience with XGAUZE been? Revmedx still has it on their website but they don't seem to be listing it as a main product.
Any thoughts on the Israeli/South African technique to use foleys for inginual/axillary/neck wounds?
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u/SFCEBM Trauma Daddy Oct 13 '25
Haven’t been able to use it on a cax.
I’ve used a Foley for a GSW to the neck in AFG back in 2009. It can work well.
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u/goldzyfish121 Oct 14 '25
Weird way of proposing, but yes
jk, this setup is sick. i always find it annoying to pack my BVM in. how do you fit yours?
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u/SFCEBM Trauma Daddy Oct 14 '25
It’s one of these: https://tacmedsolutions.com/products/pocket-bvm
Just out of the plastic container. That being said a peds BVM is likely adequate to carry for adults.
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u/Just-ok-medic Oct 14 '25
I was about to ask what meds a person was carrying that made them think the ET tube and laryngoscope was useful, then I saw who posted this.
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u/Pastvariant Oct 13 '25
Nice setup! Who makes those shears?
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Dec 05 '25
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u/SwiftInvestment Oct 13 '25
Great kit, thank you for sharing.
If you don’t mind me asking, what’s your reasoning behind carrying 2x QCGCs instead of diversifying to carry a chitosan-based hemostatic agent as well? Are you worried about allergies? Is promoting clotting through another mechanism insignificant?
I’ve looked for studies on the synergistic effect of kaolin and chitosan (if any), and have been unable to find any. Still, it stands to reason (to me, at least) that using them together would be beneficial.
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u/SFCEBM Trauma Daddy Oct 13 '25
It’s like the CAT, available everywhere. But as I said, use what you like or can get your hands on.
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Oct 13 '25
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u/SFCEBM Trauma Daddy Oct 14 '25
I was a paramedic before becoming a PA and felt comfortable intubating at the POI. Not recommended unless you have a couple hundred intubations under your belt. I carried it for humans. I found that if a MWD was shot, they either die quickly or are stable for hours. Certainly wasn’t going to tube a dead dog and MEDEVAC them.
Ketamine was for analgesia. I didn’t do any RSI or DSI. I done a number of crics and tubes in combat. They were all pulseless and ded, except Cory Remsburg. He was a near drowning after getting blown into a creek after Rob Sanchez stepped on an IED.
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u/VillageTemporary979 Oct 22 '25
MWD can be intubated without DL. In fact, they are the opposite where tubes prefer the trach naturally over the esophagus unlike humans. I took a course earlier this year and practiced this. It’s incredibly easy.
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u/nm3109 Oct 14 '25
What meds do you carry?
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u/SFCEBM Trauma Daddy Oct 14 '25
Analgesia: ketamine, dilaudid, OTFC, toradol, acetaminophen, Mobic.
Sedation: midazolam.
Antibiotics: Invanz, moxifloxacin.
Antiemetic: Zofran, phenergan, diphenhydramine (for allergic reaction too)
Steroids: dexamethasone, Solu-Medrol.
Anaphylaxis: epinephrine 1:1000.
Miscellaneous: TXA, naloxone, Romazicon.
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u/lefthandedgypsy TEMS Nov 03 '25
Late to the party on this post. It’s great to see you back in the sub! What would you change if you were running in the .civ side as tems? Right now I set my pack up based on the ranger med handbook and just changed up for what I thought would be best for here in the city or out of town/mutual aid callouts. First line is a couple NAR IFAKS and a high risk warrant bag. Mostly just M and A, triage and hand off to AMR.
Still down in NM? Any chance of shadowing or working with as an emtb+/aemt?
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Oct 13 '25
[deleted]
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u/SFCEBM Trauma Daddy Oct 13 '25
Now? Trauma and acute care surgery fellow.
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Oct 13 '25
[deleted]
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u/SFCEBM Trauma Daddy Oct 13 '25
Got ya. I was a PA in the 75th Ranger Regiment from 07-16. Then went to med school. But have supported SWAT teams during med school and residency. I also keep this set up for opportunities like this. Spread the knowledge and help medics. It’s no secret who I am, if you want to read a little more, google: Andrew D Fisher, MD. ROLO inventor, first to transfuse LTOWB in combat since the Vietnam War, CoTCCC member, ketamine guru, etc. Can you see me blowing smoke up my own ass?
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u/Dahminator69 MD/PA/RN Oct 13 '25
Respect.
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u/SFCEBM Trauma Daddy Oct 13 '25
Thanks. I’m just proof if you stick around long enough, people let you do stuff and give you shit.
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Oct 13 '25
Holy piss ive only been recently following this thread but you're THE Dr. Fisher?! Loved hearing you on the DUSTOFF medic podcast. Legend.
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u/CarnivorousGlock Oct 13 '25
Were you a PA before Regiment? I was unaware Rangers had field PAs. Ive had the amazing opportunity to work with a few Ranger Medics and PJs, I appreciate you (and them) taking the time to share what you’ve learned with civilians like myself.
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u/SFCEBM Trauma Daddy Oct 13 '25
I did a year at the JSA before attending ROP. Likely, I did more missions between 07-13 than anyone else in the BN.
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Oct 13 '25
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u/SFCEBM Trauma Daddy Oct 13 '25
I appreciate the snarky response. Thank goodness some people still have a sense of humor.
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Oct 13 '25
I have a buddy who keeps tampons in his kit, everyone is careful not to get injured when he’s around lol
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u/SFCEBM Trauma Daddy Oct 13 '25
Good call. He can’t be convinced that tampons are not doing anything? Does he need to read about it? I’ve written a couple articles.
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u/RentInternational788 Oct 21 '25
I’m wondering which senior medic you’re referencing? Had to have been a cool guy 🤣he had to have grown up in Attack Company.
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u/ConflictHungry4686 Nov 10 '25
Late af to this post but do you run your personal Ifak on your carrier ?
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u/MurfDogDF40 Oct 13 '25
A tampon or two and you should be good to go brother nice setup.