Disclosure:
The guys at CRO gave me this unit, but did so without any expectations. I’ve been following them for a couple years from the early days when they made a few really great digital references. Since then I’ve stayed in regular contact as we work in some overlapping circles and I made an effort to include their references and physical goods in specialized classes I taught as they fit with the student body. When I accepted a new high threat contract I reached out to CRO to buy this IFAK as it was listed out of stock at the time and I had short notice to deploy. They hooked me up so that I could use the product, not to review or promote it. I have purchased their pelvic binder, three digital products, two tourniquet covers, and a t-shirt at full price.
While I do have a friendly relationship with Jeff at CRO, I have no financial connection to them and do not financially benefit from this review. Frankly, knowing some of the other people that are using this product, I’m small beans both in terms of spending budget and influence.
Overview
The Hybrid IFAK is a “fanny pack” style pouch with removable belt designed to carry trauma management supplies but easily reconfigured to different purposes. The most recent version is available in a few different colors/patterns and two different materials. The more expensive option is made from a proprietary material called “Ghost” that is basically woven in the Himalayas from unicorn fur giving it a remarkable strength to weight ratio. The model I have is made from a more standard nylon fabric and works great for me.
CRO Medical is a company comprised of guys still active in SOF medicine that found there were gaps in the equipment available for them. CRO has always been clear that their products are not for everyone. They make stuff they and the other folks like them need. I am not the intended audience, but I have still found the Hybrid IFAK to be a useful product.
Most of the stuff CRO makes is for guys doing overt assault medicine with an emphasis of being able to work off the body for immediate life threats.
The hybrid IFAK is designed to be worn in conjunction with a gun belt, armor, and possibly a back pack. It sits at the small of the back, close to the body, and normally would face backwards to keep it clear of your front. When needed the kit is easily rotated around the body to the front and all items quickly accessed.
The main pouch is completely reconfigurable and the wings on either side has two MOLLE columns. There’s a pouch in the front and the back which will accept thin items like chest seals, a note pad, or compressed gauze.
My use
I spent 2019 on a contract in an active conflict zone working as a remote paramedic supporting a multi-national security organization. I rode with our field teams to provide emergency response and sick call.
The organization I was contracted to is responsible for ceasefire monitoring and is not a peacekeeping or war fighting organization. The area I worked in is saturated with UXO, mines, and periodically experiences shelling. Through maintaining high visibility we were not accidentally targeted and our risk management policies reduce the likelihood we will encounter explosives. Generally we operated in armored vehicles and sometimes did foot patrols. Due to the nature of the area we wore soft and hard armor during most operations.
Technically the position I was in is considered high threat, but it is exceedingly rare to see a major trauma patient. I did not respond to attacks on the civilian or military population as those are handled by either local ambulance services or military medics. There has been one KIA on mission due a blast injury.
The role described is where I’ve carried this the most but I would have no issue carrying this kit if I was working in a professional capacity in a lower threat environment. The kit gives me rapid access to core trauma items and would work quite comfortably with a day pack. This would also serve great as a vehicle kit as it could be easily clipped to a seat and then removed quickly to move to a casualty.
Text content list at the end of the post.
Capabilities
Here’s an explanation of what I can do out of this kit organized via the MARCH mnemonic. This is largely to provide point of injury care for someone else as I have an IFAK on my armor for myself. For further care I have a MR RATS pack that is well stocked which I am either carrying or is in the vehicle near by.
Massive Hemorrhage
With four CoTCCC recommended extremity tourniquets (SOFTT-W Generation 4) I am able to address severe hemorrhage from several extremities depending on the size of the limb as larger limbs may require two tourniquets for hemorrhage control. Generally I recommend the CAT Generation 7 as the standard tourniquet for most people and it is my preference for self-application. The CAT G7 is what I have on my vest for my use on myself. There’s an argument to be made that only one type of tourniquet should be carried as maintaining proficiency is hard enough with a single device let alone two. Perhaps this is hubris, but I believe that I am able to maintain proficiency on both the SOFTT-W and CAT. I care a bit more about trauma medicine than the average person or the non-medics I work with and I practice a few times a month with both tourniquets. When instructing on a military contract for a year and for public safety in New York I have practiced quite a bit with the SOFTT-W G3. I intentionally purchased the orange version of the SOFTT-W G4 as I want the placed tourniquet to be highly visible. With an unconscious casualty it is possible to place a tourniquet and have it missed by other healthcare providers until the patient is completely undressed.
My rationale for having the SOFTT-W G4 on the Hybrid IFAK is that I find working in close quarters with fabric, debris, and blood to be easier with the SOFTT-W than the CAT. The most likely scenario I expected to be deploying a TQ in (for the particular contract described) is a motor vehicle accident or blast injury sustained inside an armored vehicle. In that scenario I may be applying the tourniquet inside the deformed vehicle prior to extrication.
This is my personal preference and I am not aware of any research that supports my preference. What is not personal preference is that the SOFTT-W is a reliable and well studied tourniquet. If a tourniquet isn’t recommended by the CoTCCC I don’t want to trust my life or someone else’s to it. I’m looking at you bungee cord and zip tie “tourniquets”.
For a junctional hemorrhage I have the ability to pack wounds with hemostatic (2) and non-hemostatic gauze (1) then create a pressure dressing with the elastic bandages (3). In training I’ve also practiced using a CAT G7 or SOFTT-W G3 as part of an improvised junctional tourniquet.
With this quantity of supplies I should be able to do a stump wrap. I might need to grab more gauze or use improvised materials to build up the area around the stump.
Airway
In addition to upright positioning, use of the recovery position, or instructing someone else on how to maintain a head tilt chin lift or jaw thrust I have two NPAs for a single patient or a single one for two patients. My primary patient population did not include any pediatric patients hence the single size.
With inclusion of the scalpel, bougie, and 6.0 tracheostomy tube (packaged with 5 mL syringe) I have the ability to do a surgical cricothyroidotomy. When packing stateside I failed to include a means to clean the site. Certainly gaining a patent airway is a higher priority than infection control, but we should still strive for a close to sterile as possible which means prepping the site prior to an incision. When laying out the items for the pictures I recognized this deficiency and have since added two Povidone-Iodine swabsticks. When I get back to the US I’ll probably swap out the swabsticks for Povidone-Iodine wipes as they are more compact and in my experience, less likely to rupture when carried in a pack.
Respiration
With the two Hyfin Vent Twin Chest seals I have 2 vented chest seals plus gorilla tape that can be used with the packaging for some improvised ones.
The two 10g ARS needles give me a quick option to release a tension pneumothorax. Additionally, with the scalpel and hemostat I can do a finger thoracostomy. If available, sterile gloves would be preferred for a finger thoracostomy.
Circulation
No means of IV access, med admin, or medication is carried. This kit focuses on point of injury care and will be used in conjunction with a MR RATS pack that has adequate IV and IO access supplies. For an entrapped patient the RATS pack can be brought to the patient’s side.
Head Injury/Hypothermia
This is another area largely not addressed by the kit. With the pen light I can check pupils. The EMMA Capnograph gives me the ability to monitor ETCO2 while using a BVM so that PPV rate may be adjusted to maintain a normal ETCO2 or intentionally hyperventilate in the setting of herniation to keep ETCO2 between 30 and 35.
My vehicle had hypothermia management supplies including tarps, survival blankets, and sleeping bags.
Diagnostics/Misc
The pulse ox is a handy tool for trending when paired with a quick feel for the radial.
Triage cards can make communicating with other responders a bit easier and allows for a simple way to record injuries found and interventions done.
Sharpie for for triage card or using a chest seal as a means of documentation.
Leather gloves to minimize the hazards associated with wrecked vehicles and ease a litter carry over distance. The Benchmade Rescue Hook allows me to quickly and safely cut clothing away to expose injuries.
Carrying
Without armor the kit is comfortable and easy to move from front to back. With a climbing harness this setup might be harder to use. Strictly speculation on my part, I’m sure the CRO folks have tried that and can speak to how it fits with climbing gear.
When worn with armor and a large medical pack, in this case the MR RATS pack, the Hybrid IFAK is great. Doesn’t get in the way at all and is comfortable. When seated in a vehicle with armor the Hybrid IFAK actually provides some lumbar support making the ride a little more comfortable.
Summary
I won’t be bringing the Hybrid IFAK on every trip with me, but some certain missions it makes a lot of sense and is a really well designed and constructed product.
Contents List
Left of IFAK
1 – Benchmade Model 5
1 – Nite Ize S-Biner #4 with gorilla tape
2 – Tactical Medical Solutions Phantom TQ Pouch w/
2 – SOFTT-W Gen 4 Orange
Hybrid IFAK
Front Pouch
2 – Triage & Treatment Cards
Front Velcro
1 – Reflective “Trauma” name tape
Main compartment
Fold down lid
3 – Nitrile Gloves (light blue)
1 – #11 Safety Scalpel
1 – Tracheostomy Tube 6.0
1 – Hemostat
2 – 10g ARS
2 – 28 Fr NPA
1 – Sharpie
1 – Streamlight Stylus*
2 – Hyfin Vented Chest Seal
1 – Bougie
2 – Povidone – Iodine swab sticks
Main compartment body
2 – Flat fold elastic bandage
2 – QuikClot Combat Gauze
1 – Nonin Onyx II*
1 – Masimo EMMA* and BVM adaptor
Back Pouch
1 – Flat fold elastic bandage
1 – Non-hemostatic compressed gauze
Right of IFAK
2 – Tactical Medical Solutions Phantom TQ Pouch w/
2 – SOFTT-W Gen 4 Orange
1 – Nite Ize Slide Lock #4
1 – Pair, Outdoor Research Direct Route leather gloves
*Dummy corded