Tactical Paramedic Loadout 1: Essentials

This is the first of four parts on the topic of tactical medic loadout.

When I joined the tactical team, I was given a great degree of autonomy over how I would organize my personal equipment and even what equipment I would carry. “Set it up however you want” was the order. While I appreciated this unprecedented freedom, I only had a vague idea of where to start. After getting some quality training under my belt, talking to and observing other tactical medics and operators, and a fair amount of direct experience in the field, I have arrived at a relatively simple system that works well for my needs. As we have added personnel to the team, I have seen them struggle with the same issues that I faced. The purpose of this series is primarily to assist these people. It may or may not work well for others, and undoubtedly each operator will change and tweak it to meet his own needs—this is entirely appropriate and I hope only to give some guidance and points of consideration for those of you that find yourselves in similar circumstances. We are, as one of my colleagues has said, “creatures of autonomy,” and it is very likely that your situation and mission differ significantly from mine.

My method is simply this: I look to the principles of tactical combat casualty care (TCCC) to guide the organization of my loadout, and correlate gear lines to the phases of care.

The concept of “gear lines” is a hierarchal system of arranging tactical equipment according to how it is carried. My system designates first line gear as essential gear that the tactical medic should never be without, whether operational or in training. Second line gear is carried on the armor, and medical supplies in this line focus primarily on care under fire. Third line gear is carried in an individual pack and correlates to tactical field care. Finally, I designate fourth line gear as those supplies that are vehicle-borne and correlate to the tactical evacuation phase of care. Paul Howe discusses a similar concept regarding weapon systems in Leadership and Training for the Fight. He calls this concept “layered offense.” We are going to apply the concept of a layered offense to medical supplies and equipment.

1st Line: Essentials

First Line gear consists of those things that are carried in the pockets and on the belt. I include drop leg pouches in this category, and a battle belt may or may not be included, depending on when it is worn. The key concept here is that these are things carried on the person whenever operating in the tactical environment, in both operational and training capacities.

One concept that is important to me is the idea of consistency in the “manual of arms” for my loadout. By this I mean the highly trained and programmed motions that guide how we interact with our equipment, whether it be a weapon or otherwise. Under stress, the operator reverts to those behaviors that are most strongly trained and ingrained in muscle memory. Because of this, my tactical first line gear correlates strongly to those things I carry every day on the street. If you carry your shears in a thigh pocket and are accustomed to reaching for them there every day, don’t carry your only pair in your vest in the tactical loadout. You will reach for them in your thigh pocket when you need them, so leave them there.

With that said, my first line gear consists of a good folding knife, shears, a rescue-hook type cutter, multitool, pen, small light, exam gloves, and tactical gloves (An aside here: I often cut the first finger and the thumb off of my tactical gloves. This allows them to be layered over exam gloves for hand protection, but allows me the dexterity and sensation required for fine motor skills such as IV cannulation). Eye and ear protection are included here. Inside a drop leg pouch I carry what is essentially an IFAK. It contains one tourniquet, hemostatic gauze, two pressure dressings, one NPA, chest seals, two decompression needles, a sharpie, and tape. This small kit contains everything required to treat the three primary preventable causes of combat death, and ensures that I am always able to treat critical trauma even in the event that I am without my armor. The final piece of essential first line gear is a smart phone with GPS and satellite mapping capability.

Other items that might be included in the first line that are not strictly essential include a small wound kit, stethoscope, and narcotics, depending on agency policy.

For armed personnel, the handgun and magazines are included in first line gear.

In the next entry in this series, we’ll examine second line equipment and the fighting load.