USE&E: The Most Important Skills and Gear Might Not Be What You’d Expect

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In prepping for an urban survival situation, there is a lot of misinformation. And it is all due to the fact that there are no easy answers. There is also a huge misunderstanding of what happens during these events. It is a popular trope that cities will turn into urban wastelands replete with Mad Max-style gangs rampaging and plundering. Or that the cities will become filled with government death squads, opposing militias battling it out in the streets, and poor huddled masses living in sewers eating rats.

Look at history

As a great eye-opener, I would recommend reading everything you can from Selco on this website. He gives an amazing breakdown of what really happens in a city during a war, ethnic struggle, and the aftermath.

But, barring some horrendous occurrences, it is highly doubtful that this will be the case everywhere in this country. It may come close in some areas, and other areas may not be challenged at all.

One of the measures I use to prepare and check my preps are family stories. My maternal grandmother (Oma), and her family grew up in Germany during the Third Reich. They underwent the wartime depredations, and Oma would tell me stories about that time. My maternal and paternal grandparents from the US also grew up during the Great Depression, and also would share stories and tips from then.

But we don’t even have to go that far back. I have been fortunate enough to communicate with people from Argentina during and after their financial crisis, as well as people from Venezuela, South Africa, and elsewhere undergoing hardships we haven’t been exposed to.

So, as I said in my last article, we have to best prepare for what is most likely to occur to us. In self-protection terms, one of my teachers uses the saying; “Train to handle what happens most, and you’ll be able to handle most of what happens”.

I take this and apply it to my Urban Survival Escape & Evasion (USE&E) training as well.

The most important urban survival issues may not be what you’d expect.

 In our first installment we will be looking at what I consider one of the top two issues we need to prepare for, not just for SHTF, but every day.

This may seem shocking, but I will not be addressing fighting or weapons as the most important thing. Not E&E or escape from restraint.

No, we will be addressing first aid, trauma care, the need for training, and a primer on gear to carry and stage to have in a life-threatening situation.

First off, you are more likely to use any first aid/trauma med skills and gear than any other skill you have. And far more than shooting or fighting. In my opinion, the only skill that gets used more is defensive/evasive driving.

Start with training

If you haven’t yet, I would highly recommend you start off with training from the Stop the Bleed program. This is free training usually provided by Emergency Responders/Firefighters in cities large and medium, as well as at hospitals or schools in smaller communities across the country. In these classes, you will be taught the basics of bleeding control using the established protocols of direct pressure, wound packing, and tourniquet use.

This training is gold. It is appropriate for young teens through senior citizens. The presentation is information-rich without being boring.

After taking the StB class, hell, take it a couple of times, I would then look into taking classes from the American Red Cross. They still offer training in a wide array of first aid skills, including basic and advanced first aid, water safety, CPR, AED, and much more.

After you take these classes and practice the skills you learned regularly, you will be a giant asset to any group you are in, and better equipped to help in a wide number of situations and emergencies that may occur.

If, after this basic training, you want to go further, there are several very good training courses for everything from austere long term medical care, trauma care, ditch dentistry, field surgery, and scenario training for care under fire. You can take this as far as you wish, depending on your interests, and what you foresee happening in the particular area you are living in.

Get the appropriate gear for your skillset.

Once you get training, then it is time to look for appropriate gear for your skillset. Kits come in all sorts and sizes, made for different applications.

A word of warning: this is an area where you do not want to cheap out. The number of times we have seen counterfeit TQs (tourniquets) fail in training or testing is frightening. Cheap first aid kits may include expired or inferior components. When dealing with an actual medical situation or life and death, you want your gear to be accessible and to work when needed.

There are three types of kits we need to look at, as they all cover different areas of use. These three types are Boo-Boo kits, First Aid kits, and Trauma kits.

Boo-Boo kits are for treating small wounds, cuts, minor burns, some minor ailments like diarrhea, motion sickness, headaches, blisters, etc… It is to make things more comfortable. These kits should include basic items such as a variety of band-aids, pain medications like acetaminophen and ibuprofen, Benadryl, burn gel, nausea relief, sting relief, moleskin, and things like this. As I said, it is more for comfort and treating of minor wounds and owies.

Next up the scale are first aid kits. These can have Boo-Boo items also, but will add on to that with things like rolled gauze, gauze pads, wound dressings, splints, some will include things like cervical collars and other more advanced gear, depending on the intended use of the kit. Some of mine include items that you should only use with proper training, like sutures, forceps, clamps, IV kits and other such things. These items are usually included in field surgery kits but can be useful after proper training.

Now, onto the meat of my daily prep/carry, and gaining in popularity in the gun/sd/prep/EDC crowd, trauma kits. These are small, purpose-driven kits that cover the most common causes of death in a trauma situation. The core of a good trauma kit will be blood loss stopping equipment, which is why I first recommended the Stop the Bleed classes. You will be much better prepared to use these items. First in these kits, we will discuss the TQ (tourniquet).

Please make sure that your tourniquet is a real, not counterfeit TQ, such as a CAT, SOFTT-W, or RMT. Avoid the bungee style wannabe TQs such as the RATs or STAT. They do not achieve good enough occlusion to count on. You only want the best when life depends on your gear.

Next will be compressed gauze of some sort, Kerlix or another variety, for use in wound packing, You want at least 4 yards of gauze, and as a little starter, it is good to tie a knot in the end before you start packing the wound. Some kits include one, or you can buy an individual Israeli Battle dressing or IzzyD, which is a pressure dressing/wrap. It can be used as a secondary TQ also and is a very versatile piece of gear.

Another item frequently included is a blood stopper gauze, the two most popular being QuikClot and Celox. Both are great for dealing with arterial bleeding in junctional areas that cannot be effectively TQd. Do not worry about the reports of exothermic reactions. That was earlier generations of the product, and besides, burns or death is a pretty easy choice for me to make.

The final item that should be in your trauma kit is chest seals to treat tension pneumothorax, or sucking chest wound.

Your mindset is the most important part of survival.

 As I said, the first part, the most important part, of this equation is the mindset to survive and prevail, second, training, and then the gear. This ties in with the Tactical Pyramid that we will touch on in future articles. And this is not an exhaustive list of the gear available, it is just a list of the most common, and necessary items for the kits involved.

As always, I welcome any questions or comments and can make better recommendations for training courses and specific gear if you would like.

Thanks for reading.

About Terry

Terry Trahan has been a long term martial artist and teacher of personal protection, as well as an author for numerous publications. His experiences from being a gang member, enforcer, protection specialist, and bouncer have given his teachings a strong bent towards the practical. Fighting his way out of extreme poverty and some unsavory environs also gives him insight into survival and everyday life not often commented on. He can be contacted at terry.trahan at

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Terry Trahan

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  • Great article, Terry! I took Selco and Toby’s Urban Survival Course for women in Croatia last year. I work in a manufacturing facility with lots of band saws and nail guns, and after I returned home from the course, I organized Stop the Bleed training with our local EMS for all of our employees. Every employee had an opportunity to practice packing wounds (pool noodles) and applying both Israeli bandages and tourniquets. I made sure that all our First Aid kits were supplied with all of the items you named above in the trauma kit area. My boss looked at me a little sideways when I bought the hyphin vents, but I’d rather have them and not need them than need need and not have them. We also offer free CPR, AED, and basic First Aid courses to all of our employees twice a year. I agree wholeheartedly that medical knowledge is a top priority. I have a LOT left to learn yet, but I’m working on it whenever I can.
    Looking forward to more articles from you in the future!

  • I was wondering if there were any books or online courses available. I know that wouldn’t take the place of hands on course but it would be a start for me.

  • Excellent summary on an overlooked area. There are a lot of resources these days for folks looking for medical knowledge, and the best part is this is directly applicable in everyday life. One of the first “saves” by local police when they received TQ training was not a shooting but a car accident victim. If you’re looking for training or equipment, anything vetted by the Committee on Tactical Emergency Casualty Care (for non-military) or Committee on Tactical Combat Casualty Care (military focus but the originators and worth following) is going to be good to go. They have websites with the latest updated protocols. Although nothing can replace in person training, if you are familiar with the basic protocols, or need a refresher since the last time you took a class, there are a number of sources of good training videos including the CoTECC and CoTCCC mentioned above, and North American Rescue, makers of the CAT. Please be careful when buying supplies, lots of counterfeits out there, check with the manufacturers to find authorized distributors. Finally, these interventions (indeed our modern emergency medical system) presuppose that you will be able to get the patient to a higher level of definitive care. If you’re out in the woods or in an area where public services have broken down, there may be an extended time until you can get your patient to a hospital, or maybe in a situation like Selco’s you can’t do that at all, so it would be good to take something like a wilderness first aid course where you can learn how to stabilize injuries for an extended period of time.

  • As a retired ER nurse, I can’t emphasize how spot on this post is! (I personallly have a trauma kit and a small surgical kit.) Getting even basic first aid/CPR training is the base knowledge one should have.

    May I also suggest that even if you have no desire to get any medical training, that you still consider having a trauma kit. A person who does know how to properly use it may come along and be able to help.

  • Early on I recognized my lack of medical training. Found a night EMT-B course at a local community college’s adult continuing education center.
    2 nights a week for 6 months, mandatory ride along/hands on, and then took the state boards, passed and certified.

    Took it a step further and took the Wilderness EMT course offered by NOLS. That course really brought it home of how to deal with medical issues, in a remote area, with only what you have in the patients pack or yours.

  • 1) You mentioned having 4-yd rolls of Kerlix gauze in your First Aid Kit, that’s good; but you can never have too many rolls. If your bandaged wound has blood bleeding through, you should NOT start over–you should continue to wrap additional layers of gauze around the wound until the bleeding finally clots (stops). If you watch some of the news interviews with the fire dept. emergency responders, you see them re-stocking their BIG BAGS of gauze rolls!!
    2) You should include a box of each size of Tampons in your First Aid Bag–for the purpose of bullet wounds that are difficult to stop bleeding, and stopping the bleeding of nose bleeds (along with a little granular Quit-clot already mentioned).

  • I am sorry to say that you are wrong.
    You, like many others, have no clue as to what SHTF really means: It is the absence of Any government, or Normal rule of Law.
    The one that is coming next is world wide.
    So that removes the Balkans war, Venezuela or most any others from having much in common with SHTF. They all still had a semi functioning Government, they received help from foreign nation to supply food, medicine and stability, to help the crises.
    Another difference was the Family / societal structure. They had far more and closer ties with friend and family (locally), than we do in the US. They also were far less diverse politically, racially and in all other categories.

    In a World wide SHTF, there will be no outside help, coming in to rescue you. So it will be far worse, much more of an ” every man(or woman) for themselves” scenario. When people are starving they will do anything for food. The total lack of food, they had scarcity yes, but not a true lack. So that problem makes the scenarios you read about different, than what a US urban environment would face in SHTF.

    So the biggest Issue in urban areas, will be real world, self defense training. Hand to hand combat and weapons training, As much more of it will be up close and personal attacks. you will be fighting to keep what you have. (BTW gasoline will be gone in a matter of a month or so, after world wide SHTF. So defensive driving will be worthless skills. Cars won’t be running. And if they are, they will have to be converted into home made APC’s.)

    Why? Because people will take all those medical supplies and much more from you. That might include your life or your freedom.
    I suspect in SHTF, Urban environments, human slavery will be a gigantic problem. The US is far more diverse in races and cultures than any of those other countries. Diversity usually brings discrimination and separation of groups, usually by the strong enslaving the weak, in one form or another.

    Historically, human slavery has always been the way to build or rebuild a society or an Empire.. Criminal Gangs will run urban areas. Most are already involved with human trafficking, slavery( i.e. sweat shops), and sexual slavery. So that is not a far stretch of the imagination.

    If you look at the State of Mogadishu, Somalia, with the War Lords and how they divided up the city, the poverty, the oppression, enslavement( i.e. child soldiers), etc., you will see a far different picture of “urban survival”. Not a pretty one, that is for sure.

    The next item on the list would be Bush craft, which would include Escape and Evasion techniques.
    If you can not purify your water, build a shelter or fix one, build a fire, escape and evade, then you will not survive, regardless of your medical equipment or expertise.

    Then after those two things, then Medical is next on the list.
    Unless your priorities are right, you will not have ability to use your medical stuff.

    Tourniquets, Battle dressings and Quick clot are great, but it is better if you can avoid those injuries.
    Injuries on that level usually require advanced medical care and anti biotics in the long term, in order for you to survive, things will probably be absent in a True SHTF scenario..
    Which is why Escape and Evasion skills need to come first, to try to avoid such injuries.

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