The primary focus of most tactical medical kits is traumatic injury. These lightweight kits usually include equipment to handle different forms of trauma, from specialized bandages to chest seals and tourniquets.
But the priority of any emergency treatment, whether trauma-related or medical, is securing the airway. So today we’ll discuss four airway tools to include in your tactical medical kit.
With any patient, your assessment must begin with the airway. Ensuring a patent airway is the best means of warding off hypoxia, so be alert for the signs, which include:
- Increased work of breathing—use of accessory muscles, belly-breathing (in children), nasal flaring, retractions
- Bradycardia (especially in children)
- Decreased level of consciousness
- Inadequate breath sounds
- Abnormal breath sounds (gurgling, wheezing, stridor)
Since most tactical scenes involve violence and your treatments will likely be trauma-related, you should maintain a high index of suspicion for respiratory distress if you notice any of the following chest injuries:
- Flail chest: multiple ribs fractured in two or more places
- Hemothorax: bleeding into the chest cavity
- Cardiac tamponade: bleeding into the pericardial sac
- Tension pneumothorax: buildup of pressure within the chest, causing a shift of the mediastinum to the unaffected side
- Aortic disruption: tearing or rupture of the aorta
Thoracic trauma can result in difficult breathing, hypoxia, and even respiratory arrest, so when assessing the chest, pay special attention to the following signs:
- Impalement (stabilize in place)
- Muffled heart tones
- Abnormal breath sounds (crackles, wheezing)
- Absent breath sounds
- Asymmetrical chest rise
- Subcutaneous emphysema
The rapid assessments that take place during tactical scenarios rely on minimal equipment—only what you can carry with you. To properly assess the airway, you will need at least the basics:
- BP cuff
- Pulse oximetry
Basic Airway Management Tools
The intense nature of tactical scenarios requires rapid assessment and intervention. Basic airway tools may suffice, providing a patent airway and allowing you to assist ventilations. Basic tools include:
- OPA (oral pharyngeal airway)—to properly size, measure from earlobe to angle of the jaw
- Collapsible bag valve—to assist ventilations and hyperventilate prior to suction and intubation
- Positioning/jaw thrust—requires no tools, but can open the airway in trauma patients
Applying basic airway management tools can ensure patency, stabilizing your patient until an advanced airway can be put in place or the patient is transported to an appropriate facility.
Advanced Airway Adjuncts
If the basic tools or techniques are inadequate, you may decide your patient requires an advanced airway. Endotracheal intubation, considered the most effective means of securing the airway, has many advantages, including:
- Isolating the airway from gastric contents and bodily fluids
- Allowing ventilation with 100 percent oxygen
- Decreasing the risk of aspiration pneumonia
- Facilitating tracheal suctioning
- Preventing gastric distention
- Providing an additional route for certain medications
Indications for placing an endotracheal tube are:
- The patient is unable to protect his or her airway.
- The patient has significant oxygenation problems, requiring high concentrations of oxygen.
- The patient has significant ventilatory impairment and requires assisted ventilations.
Your tactical kit should contain a range of advanced airway tools to choose from. These include:
- Endotracheal tubes of varying size
- Supraglottic airway—an alternative when unable to place an endotracheal tube (e.g., difficult intubation—short neck, obesity, anterior larynx)
- Surgical airway kit—for performing a cricothyrotomy
- Chest decompression kit—for decompressing tension pneumothoraxes
Having an assortment of advanced airway tools will enable you to treat any respiratory emergency.
Suction for Tactical Medicine
One of your most critical pieces of respiratory gear is your portable suction unit. This is especially important during tactical scenarios, since the patient will most likely suffer from trauma and may have profuse bleeding.
Manual, hand-operated suction units will not be able to keep up with copious blood or vomit. Using a battery-operated, lightweight suction unit, designed specifically for tactical medicine, will free up the hands of rescuers while providing continuous, efficient suction. This is especially important during intubation, when bleeding may impede visualization of the vocal cords. A battery-powered suction device will provide the necessary negative pressure to evacuate the oral cavity, allowing the placement of an endotracheal tube.
Consider including a hyper-curved catheter for difficult airways, which may present as:
- Receding chin
- Short neck
- Large tongue (especially in Down syndrome)
- Small oral cavity
- Cervical immobilization/limited neck mobility
- Facial trauma
- Active vomiting
Although your tactical medical kit must be small and easy to carry, it should still contain enough equipment to enable you to assess, stabilize, and correct a respiratory emergency. By including these four essential tools, you will be prepared to handle whatever tactical scenario comes your way.