In this blog, we’re going to take a look at the medical tools for executive protection that I find are the most important. But before we get there, let me make an important point: emergency medicine is about much more than the gear.
Medical training and knowledge matter more than medical tools
This might bother some of the more “gear-oriented” people out there, but it can’t be emphasized enough: no gizmo, gadget or cool toy can ever replace appropriate training and experience. When I was doing paramedic schooling I was lucky enough to ride along with one of the most notable and experienced paramedics in the field of emergency medicine at the time. When we responded to a call, the paramedic stepped out of the ambulance carrying nothing more than a caring attitude and a smile. If and when he needed additional tools, he’d be as likely to ask for a pen as for some advanced piece of gear.
This example isn’t meant to dismiss the use or importance of proper equipment—of course not. But I’ve seen too many executive protection practitioners who have no problem packing and lugging a 40-pound medical kit around without being able to do basic CPR. On the other hand, I’ve watched a trauma surgeon save a guy’s life with a razor blade, a pair of desk scissors, a handful of paper clips and some duct tape. You’ll find the best medical kit ever invented right between a good practitioner’s ears.
You’ve got eight minutes to save the guy’s life. How are you going to use them?
You should also keep in mind that in most developed countries, the average ambulance response time is around eight minutes. In other areas of the world, you might have to wait much, much longer—if an appropriate ambulance is available at all.
But sometimes even if an ambulance is only a couple of minutes away, you just can’t afford to wait. The principal, or one of your team members, needs your help right now.
Of course, different patients, situations, locations, and injuries all call for different equipment, techniques and skill sets. But as an executive protection pro, you have a distinct advantage over other emergency medicine practitioners: you already know your potential patient. Because that’s your principal. You can prepare yourself using vital information such as medical history, allergies, current medications, insurance, next of kin/POC, company risk management POCs and much more.
Get good training
Where do you start with training, though? Regardless of your background, you’ll generally want to start with EMT-Basic. You can presume companies and organizations will recognize the standards behind an EMT-B certification, but you really shouldn’t expect them to understand or appreciate your hard work at the “Combat Lifesaver” course or other niche medical certifications such as “Billy Bob’s School of Ninja Medicine”.
Further training in areas such as Tactical Medicine or Wilderness Medicine can be helpful, but these more advanced disciplines and should not be your first foray into emergency medicine. If you haven’t mastered the basic skills, you sure as hell won’t be able to perform them under fire or on in the middle of ice field at night. At the end of the day, medicine is medicine—regardless of where you are.
Forget the idea of a “perfect” medical kit, and welcome to my kit dump
Medical tools are actually very personal, and every practitioner will have his or her own opinion of what constitutes the ideal kit. It’s just like asking armed executive protection professionals about what the best firearm for the job is: you’ll get plenty of informed but different opinions. So here’s my opinion on medical tools: there is no “best” kit that works across the board and applies to all situations. If it existed, everyone would already be using it, right?
Instead, I thought it would be interesting to do a quick “kit dump” with you, so we can have a look at the items in my bag, and I can tell you why I like them. I’ll add a few words for a few items in particular, then include a spreadsheet checklist for details and individual agents that I hope you’ll also find useful.
General Rule: I hate carrying stuff around, so I always look to lighten the load and ensure that I have all of the items I might need. It’s a trade off, and I think the best way to strike the balance is to make sure that everything in your bag serves more than one purpose. The worst items are those that are large and bulky and only have one, esoteric use.
Bags: As a rule, your medical bag should be able to hold everything you need – inside the bag. Nothing should be strapped to the outside. Why? You want something non-descript that doesn’t broadcast “medical bag”, because that’s what your principal would want if he or she bothered to think about it.
Imagine following a principal around with a big red bag with stethoscopes and trauma shears hanging out all over the place. What does imply about your principal? Does he or she have some life-threatening medical condition that requires constant attention? How would that perception affect the price of the company’s stock or the image of the principal? Personally, I like the black canvas STOMP bags because they look just like a backpack, but are well-organized inside. You can purchase fully stocked STOMP bags, but I recommend finding an empty bag for a fraction of the cost, and stocking it yourself with only those items that meet your approval.
Some practitioners pack their bags with great care – even to absolute perfection. That’s all nice and well. It even works for a while, but when it’s crunch time the contents of the bag most often get dumped out onto the floor or the ground. I like to put things in my bag so I generally know where they are, but don’t fixate too much over a specific load-plan. Your approach may vary.
A popular philosophy is to preposition several kits throughout the operational area, in other words, one for the car, one inside of the residence, or the boat or plane. To me, this is the “fire extinguisher” approach; trying to have medial bags around where you are likely to need them. As a medic, I strongly believe that it’s not how many different medical bags you can bring to bear on a sick client, but how much training and experience you can interject within a very short amount of time.
Finally, I maintain a log using an app called My Stuff Pro so I know what’s in my bag and when items expire. If I use an item, I can simply mark it in the app, and I will be reminded to replace it.
Pulse Oximeters: These are small devices that attach to the tip of a finger and give instantaneous readings of heart rate and blood oxygen saturation. Both of these readings are vital to understanding the patient’s condition. Pulse oximeters have their limitations, but a skilled practitioner will understand these and take the limitations into account when caring for the patient. I attach a very colorful lanyard to mine so that when I turn the patient over to higher care, I don’t forget to collect the device on my way out. (Link)
Stethoscopes: I carry a 3M Littmann, Master Cardiology, 27” (Black Edition) stethoscope. I’ve had this for many years and it has held up very well. I’ve taken a piece of medical tape and wrapped it a few times around the right ear-branch, so that in the dark I can ensure that I’m wearing the stethoscope the correct way around. Few things are more embarrassing than putting a stethoscope on backwards; nevertheless, I’ve seen all levels of clinicians do it. The other modification I make is to tape (the cap of) a black Sharpie Pen to the upper-portion of the central tube. The pen will stay inside of the cap, and I will always have something to write with. (Link)
3×5 Cards: While pretty low-tech, a stack of 3×5 cards held together with a small clip is invaluable. You can take notes on the cards, and then simply hand them off to the next level of care as needed. I’ve seen people scribble on gloves with a Sharpie, which seems silly when your gloves get covered with all sorts of, ahem, stuff. What are you going to do, hand a blood-covered glove to the nurse, and go, “Hey, my notes are on there somewhere”?
Headlamp: This is an invaluable piece of equipment that lets you provide care with two hands instead of trying to hold a penlight in your mouth and carry on a conversation. I used to have the biggest, “baddest”, brightest lamp that I could find; then I realized that it’s outrageously uncomfortable for a conscious patient to have such a thing shining in their eyes. Instead, go for something that’s bright enough for care—but not so bright that you could land a helicopter with it.
Triangular Bandages: These are good for slings, tourniquets, hand-ties (to stop a patient’s hands and arms from flopping around during CPR on a gurney). They make pretty good bandages as well. I have about 10 of these in my bag. I’ve seen guys pre-tie a stack of Popsicle sticks in one or two of the bandages to use as a windlass for a tourniquet. Some guys color-code the ends so that when they pass a handful of them under a leg to secure a splint, they know which ends get tied to which.
Trauma Shears: Go for anything that works and that you’re willing to lose, because these are the first things to get left behind on a trauma scene. Don’t invest in a $70 pair of “crew-served” shears unless you’re happy to repeat such an investment every month.
Apps and Books: There are a ton of emergency medicine apps out there, and they are changing all of the time. Medicine is not a dark art, it’s a science, and like all sciences information is readily available in all sorts of forms. As a general rule, I recommend reference material that is designed for one or two levels above your current level of practice. I like to understand what the ER Physician is going to be immediately concerned with, so that I can have that information or procedure well at-hand.
The general references that I use are:
- Pharmacopeia: These give the clinician access to a ton of drug information, including trade and generic names, recommended dosages, interactions, etc. Every emergency medicine resident in the Emergency Department has this at their fingertips. I personally use Tarascon’s Pharmacopeia edited by Richard J. Hamilton, MD. (Link)
- Pediatric Information: “Broselow-like” apps that take the age or weight of the pediatric patient and calculate device sizes, drug dosages, vital signs, etc.
- Pocket Reference: No matter what your experience level, you’ll always be glad to have quick access to some pocket emergency medicine reference. I use Tarascon’s Adult Emergency Pocketbook by Dr. Steven G. Rothrock, MD. I’m unsure if it comes in an app version. I carry the actual book, and often add notes to it. (Link)
- Anatomy and Physiology: Netter’s Atlas of Human Anatomy is hard to beat. It’s a classic, it has an app, that lets you review specific anatomy when you have some time to spare. (Link)
- Pathophysiology: Pathophysiology by McCance and Huether is a really good place to start. It’s a pretty weighty tome, but if you need to know the “pathophys” of a respiratory disease, that’s the place to start. (Link)
- EKG Interpretation: 12-Lead ECG, The Art of Interpretation by Garcia and Holtz. Admittedly this is an advance skill if you’re an EMT-B, but if you’re considering delving into the ALS world, this is the best I’ve seen. (Link). Alternately, your first foray into EKGs should be Dubin’s seminal book Rapid Interpretation of EKG’s (Link)
Make sure medical issues are part of your RTVA
When most people think of corporate executive protection agents, their understanding is informed by images of bodyguards ready to thwart physical attacks. Understandably, risk, threat and vulnerability assessments (RTVAs) tend to focus on external factors, and there is no doubt that we must be trained and ready to handle physical threats and defuse aggressive confrontations.
But real protection focuses on mitigating risk to the principal in all forms: from the immediate to the probable to the possible. Whether you do the math like an insurance actuarial pro or just use common sense, you’ll soon find that a handful of medical emergencies are far more likely to befall most principals than terrorist or active shooter attacks. That’s why it’s critical that executive protection professionals have solid skills and appropriate tools for first aid and medical assistance.
I look forward to your comments!
Example of a medical kit