First-Aid & Trauma Kits

Anyone who has spent significant time on the water will tell you that the success of a spearfishing trip turns on two factors: luck and preparation. Sometimes, no matter how well you dive or how good the conditions are, the fish just won’t show up to play. You have to get lucky. But experienced divers know that the right planning and preparation can often tip luck in your favor. Divers spend hours poring over bathymetric charts, painstakingly rigging gear, and training CO2 tables to maximize the chance that, when presented with the opportunity to put food on the table, they can successfully close the deal.

What a lot of divers don’t realize is that the same mentality and preparation that can make or break a dive can also make or break dive safety. We divers regularly place ourselves in situations with a higher-than-average risk of death or great bodily harm. Blackouts, biotoxins, and big, toothy critters are an ever-present threat. We try to mitigate that risk through freedive training and strict reliance on the buddy system, but sometimes emergencies happen. A trauma kit is a critical but often overlooked piece of dive gear that can literally save your life when things take a turn for the worse.

Before We Get Started

I am not a medical professional and cannot provide medical advice. The goal of this article is to show you how I personally set up my first aid / trauma kit for every-day carry and spearfishing. The gear identified below is gear that I am trained to use and that I feel comfortable carrying and employing in an emergency. Any commentary expressed below is my personal, non-professional opinion having carried and trained on this gear. It is not intended to be a recommendation or endorsement of any particular gear. If you’re not sure what’s right for you, ask a doctor, a paramedic, or another medical professional. Then, get professional training. The Red Cross, the American Heart Association, Divers Alert Network (DAN), and various other organizations offer training in first aid, CPR/AED, Stop the Bleed, O2 administration, and a whole host of related topics. Get equipped, get trained, and dive safe!

What to Plan For: Balancing Risk, Consequence, and Practicality

Any time you’re preparing for an unpredictable event—whether it’s building an earthquake kit for your home or trying to decide how many shafts you’ll bend in Baja—you have to balance the risk of the event occurring, the consequence of that risk occurring, and the practicality of preparing for that risk. If you’re out chasing dogtooth tuna in the south Pacific, there is a high risk that you will break or lose gear. Maximum preparation would dictate that you take an entire dive shop’s worth of guns, floats, and terminal tackle with you to buffer against any loss. Obviously, though, you can’t (or, at least, I wouldn’t want to) fly hundreds of pounds of gear half way around the world for a two-week vacation. You have to triage.

You identify those problems that are likely to happen and those problems that, if they happen, would end your trip early, and you plan accordingly. The risk that you’ll bend a shaft is high, so you pack five or six. Similarly, you know your shooting line will get chewed up on the reef, so you bring extra to re-rig. You get the picture.

The same principles apply when designing a trauma kit. For my kit, I planned around the MARCH protocol used by the Committee for Tactical Combat Casualty Care (TCCC). MARCH stands for:

M – Massive hemorrhage

A – Airway

R – Respiration

C – Circulation

H – Hypothermia & helicopter

The idea behind the MARCH protocol is that, assuming you can successfully manage each element, you can keep a patient alive long enough to be evacuated to a medical facility. You address each element in order, making sure each is managed before moving on to the next one.

Tourniquets

The “M” in MARCH stands for massive hemorrhage, and it is the most time-sensitive of the MARCH elements. To paraphrase Ted Danson in The Good Place, the easiest way to kill a person is to drain out all of their goo and juice. And the ocean is full of things that can drain that goo and juice quickly. Shark bites, dive knives, sharp coral heads, or even a speargun mishap (more on this later) can all cause severe arterial bleeding requiring immediate care.

Tourniquets work by clamping an arterial bleed shut. While tourniquets were considered a last line of defense in civilian first aid not that long ago, lessons learned from the US military’s experience in Iraq and Afghanistan have changed that calculus. The general consensus, supported by the TCCC, is that tourniquets should be the first line of defense for arterial bleeds on extremities (arms and legs) in a pre-hospital setting. They must be applied quickly, as an adult with a severe arterial wound can bleed out in a matter of minutes.

Because the first-aid kit will most likely be on the boat (or on the beach if shore diving), I feel most comfortable carrying a tourniquet on my person. My preferred tourniquet for this purpose is the SOFTT-Wide tourniquet from TacMed Solutions, because it folds flat and can be deployed one-handed. When diving, this tourniquet lives in a neoprene ankle holster sold by Rescue Essentials. I can apply this tourniquet to myself or my buddy in a matter of seconds, buying us time to retreat to the boat or the beach, call for help, and stabilize other injuries.

Another common tourniquet on the market is the CAT tourniquet by North American Rescue. Many people—myself included—prefer the CAT to the SOFTT-W in actual use because it is easier to apply one-handed. The CAT, however, is a little bulkier than the SOFTT-W when staged. For that reason, the SOFTT-W is my first line tourniquet and the CAT fills each of my supplemental kits.

While there are many other tourniquets on the market, experts recommend sticking to TCCC-approved tourniquets (the CAT and SOFTT-W are both TCCC approved) and buying them either direct from the manufacturer or from a trusted source. While it is tempting to save a few bucks on Amazon, lucrative government contracts have generated a market for knock-off tourniquets that often fail when needed most.

Finally, don’t practice with the same tourniquet you deploy in the field! Most TCCC-approved manufacturers make blue training tourniquets to practice with. If you can’t find one, buy a second regular tourniquet to train with and clearly mark it for training only. Tourniquets are designed to be single-use items, and repeated tightening and loosening can weaken them.

The Ouch Pouch

The meat of my trauma kit lives in a combination trauma / first-aid kit affectionately known as the Ouch Pouch. When diving, the Ouch Pouch lives in a dry bag on my kayak (or on the beach if I’m shore diving).

The Ouch Pouch is my everyday carry first-aid kit and needs to address a wide range of injuries. To that end, it includes classic “boo-boo kit” components like Band-Aids, duct tape, Neosporin, ibuprofen, allergy medication, small gauze pads, non-latex gloves, and needle-sharp tweezers (which, it turns out, are excellent at removing urchin spines). These items are all staged on one side of the kit so as to be out of the way of more critical gear.

On the other side, I have another tourniquet (this one is a CAT by North American Rescue), a pressure dressing (6-inch Emergency Trauma Dressing (“ETD”) by North American Rescue), and two chest seals for penetrating chest trauma (compact HyFin Vent by North American Rescue).

Mixed in throughout the kit, I also include a pre-lubricated nasopharyngeal airway from Rescue Essentials, a 4.5-inch by 4-yard roll of compressed gauze, and a 3-inch by 4-yard roll of Combat Gauze. Combat Gauze is gauze impregnated with Quik-Clot, a hemostatic agent that promotes clotting. Both Combat Gauze and regular gauze can be packed into junctional injuries (wounds in the groin or armpit) to stop arterial bleeds that a tourniquet cannot effectively address.

Remember that speargun mishap I mentioned earlier? Years ago, a diver on a local spearfishing forum told a story about a blue water dive. While he was loading his speargun on his hip, the butt pad slipped, and the speargun’s line release cut into his groin and almost severed his femoral artery. A junctional bleed cannot be stopped with a tourniquet (because you can’t place the tourniquet above it), so wound packing would have been his only option.

The general consensus is that Combat Gauze works marginally better than plain gauze for this purpose, but it is also significantly more expensive—about $45 per roll rather than $3 per roll—and you can go through a lot when packing a wound. Quik-Clot also expires and must be replaced regularly. Many professionals agree that if you cannot afford a hemostatic agent, normal gauze will work just fine.

Also note that Quik-Clot has gone through a series of developmental changes over the years. Old versions came in powder form and relied on an exothermic reaction to cauterize the wound. Emergency room doctors often hated this product because they had to scrape it out in the ER, and first responders occasional ended up with wounds of their own because the reaction was activated by water (so it would burn if it got in your eye or on wet skin). The newest version of Quik-Clot does not have these issues, but Combat Gauze is still considered preferable to the powders.

North American Rescue ROO MFAK, unpacked

Altogether the Ouch Pouch is a relatively compact kit. Still, there are times when space is tight and a smaller kit is a little handier. In those situations, I sometimes leave the Ouch Pouch at home and bring a modified ROO MFAK by North American Rescue. My ROO MFAK includes a CAT tourniquet, a 4-inch pressure dressing, 4.5-inch by 4-yard S-rolled gauze, two compact chest seals, non-latex gloves, and a pre-lubricated nasopharyngeal airway (essentially the “major trauma” half of the Ouch Pouch).

Additional Kit

The Ouch Pouch and ROO MFAK cover the vast majority of injuries that are likely to occur on a dive trip and that I am trained to handle. If you’ve been keeping track, though, you’ll note that neither covers the full range of MARCH elements. To supplement these kits and cover the “H” (hypothermia / helicopter), my dry sack also contains (1) a space blanket and (2) a cell phone or VHF marine radio. Maintaining body temperature is critical in an emergency, and it can be especially difficult in a marine environment. A space blanket is a cheap and compact tool to keep a patient warm until help arrives.

Speaking of help, no one will arrive to save you unless you have a way to call them. I typically dive within eyesight of shore, so I feel comfortable with a cell phone in my dry bag. However, VHF marine radios are often a better solution. Most modern VHF radios include an “SOS” function that will automatically send an SOS message on the appropriate channel and broadcast your GPS coordinates to rescuers.

Finally, when I have space and am diving in an area that I know is frequented by sharks, I will sometimes bring an extra-large pressure dressing (specifically, an abdominal ETD by North American Rescue). This dressing is made for battlefield eviscerations and large surface-area injuries, and can help cover and keep sand out of large wounds.

What do you include in your dive first-aid kit, and what training have you found helpful? Shoot us a message and let us know!

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