Cross-loading Medical Supplies

A medic’s bag is never big enough, but it’s always too big. There is no way for you to carry enough medical equipment in your bag to treat every possible injury. If you over pack your bag, it makes it difficult to work out of, it slows you down and it limits your ability to maneuver through the battlespace. If you under pack, you might not have the items you need to treat a serious casualty.

One way to maximize the medical supplies on the objective while minimizing the burden on the medic is to cross-load supplies. Medics carry ammunition for their weapon; operators should carry supplies for their wounds. This has been practiced for quite some time in the military, but it is just making its way into the civilian/ Law Enforcement sector. Soldiers are issued individual first-aid kits containing the essential items for initial care on the battlefield. The majority of what is needed for self-aid and/or buddy-aid is contained in these kits, and they are a great example of cross-loading on a massive scale.

When considering items for cross-loading, look at items individuals are actually trained to use and that take-up a lot of space in your bag. Bandages and tourniquets are good examples of items that are high-volume items in both use and consumption of space. Spreading these items throughout your element will be a major help in a few ways. For example:

1. It reduces the medic’s load
2. It spreads medical assets across the team reducing treatment times.
3. Increases the amount of medical supplies on the objective

Items recommended for cross-loading:

1. Bandages
2. Tourniquets
3. Chest-seals
4. Snivel meds (OTC Drugs)
5. IV fluids

Specialty items that are medic-specific tools should not be cross-loaded. These are items you want to protect and have at your immediate disposal if required. Some of those items include:

1. Advanced airway management
2. Special diagnostics
3. Pain-control meds (this is unit dependent)
4. Surgical instruments

What you decide to cross-load should be based on mission requirements, level of your teams’ medical training, medical director’s guidance, and local protocols. Every organization will have different requirements based on the above factors. It’s up to you to develop your plan.

Hypothermia: Is It a Valid Concern in a Hot Enviroment?

According to information published in the latest “Lessons Learned” from Iraq it is one of the most important variables concerning the survivability of casualties. Hypothermia, as our readers know, is one of the three components of the lethal triad–acidosis and coagulopathy being the other two. Even if it is hot outside, care must be taken to ensure casualties do not loose heat. Below you will find an abstract from an article that speaks to the importance of preventing hypothermia.

The impact of hypothermia on trauma care at the 31st combat support hospital.
The American Journal of Surgery, Volume 191, Issue 5, Pages 610-614
Z. Arthurs, D. Cuadrado, A. Beekley, K. Grathwohl, J. Perkins, R. Rush, J. Sebesta


BACKGROUND: The primary objective of this study was to review the incidence of hypothermia, and its effect on surgical management, resource utilization, and survival at the 31st Combat Support Hospital (CSH). METHODS: This study was a retrospective analysis of all combat trauma injuries treated at the 31st CSH over a 12-month period. All trauma admissions were included. Descriptive and inferential analysis were performed using SPSS 11.0 software package (SPSS Inc., Chicago, IL). RESULTS: A cohort of 2848 patients was identified; 18% were hypothermic (temperature <36 degrees C). Hypothermia was significantly (P < .05) correlated with admission Glasgow Coma Scale (GCS), tachycardia, hypotension, lower hematocrit, and acidosis. Hypothermic patients had a significantly higher blood product and factor VIIa requirement. Hypothermia was an independent predictor of operative management of injuries, damage control laparotomy, factor VIIa use, and overall mortality (P < .05). CONCLUSION: Combat trauma patients have a high percentage of penetrating injuries with variable evacuation times. Hypothermia was a pre-hospital physiologic marker, and independent contributor to overall mortality. Prevention of hypothermia could reduce resource utilization and improve survival in the combat setting.