Hey Mags - thanks, as I said in PM I didn't want to comment on the medical kit without knowing your training - here's my take on your kit: note that ALL of this is strictly IMHO - I am open to anyone offering differing opinions.
First off: I'm using THIS
link to assume the contents of your Adventure Medical Kit Ultralight Pro - the contents may or may not be the same as your own, forgive me if that is the case...
Keep the 7.5" shears, ditch the 4" and add a Benchmade hook instead.
Since you seem to be gearing up expecting penetrating trauma I'd suggest CELOX-A, CELOX is, imho just all around a better product than QC (let the flames commence) and the -A applicator is extremely intuitive. If you wanna keep the QC-ACS, by all means do though, it has it's uses too of course.
Needle thoracostomy: normally I'd tell you to not fuck with it but you say you're up to speed so... the only thing I'd suggest is adding another needle, in case for some reason yours is damaged or contaminated when you come to need it.
Bolin chest seal. Almost completely retard proof.
Iodine. Alcohol is fine for boo boos but if you're going to carry stuff like IV kit and decompression needles I would strongly suggest some iodine prep pads. No need to carry a bottle though.
Tweezers - preferably a couple of different sets, if weight allows. Actually instruments in general seem lacking - no scissors, forceps etc - am I missing those?
In my very humble opinion no medical kit is complete without peroxide and vaseline. They may not be flashy and cool but fuck do they have a lot of uses.
Ditch the 10cc irrigation syringe and upgrade to a larger one.
Suction. Don't have to spend a bunch on a suction kit, you can cut down a turkey baster if you like.
Put one of these on your keychain: http://www.tacticalresponsegear.com/cat ... ts_id=2745
Add a couple of heavy cycle sanitary pads. They weigh nothing and are very useful - plus, you never know if you'll be bugging out during wifey's happy fun time.
I see 1" tape in your kit - may be missing it but do you have other widths?
Another tringular bandage wouldn't hurt. Plus an H-comp bandage.
ACE bandages. Various sizes.
More rehydration salts. Many more. You're 10,000 times more likely to need them than anything in your trauma section and they cost and weigh nothing.
Something to splint fingers. Your choice of SAM finger splints or just a bunch of tounge depressors and tape. Again, most folks are much more likely to have to splint a finger than a limb.
Instant hot and cold packs. They're bulky and obnoxious but well worth carrying even just one of each. Again, imho - some may disagree.
Any surgilube with your NPA?
Epinephrine if you can get it.
I know it's probably in your kit elsewhere but just in case (not reading the entire thread for a third time =p), you have survival blankets, hats and other shit for hypotheria right?
Other than that... all good. I don't mean to trash your medical kit at all, just thought I'd offer some suggestions as the major thing that struck me, personally, about your post was that you have a fucking TON of money and time invested in gear to cover every eventuality but your medical kit was kinda... I dunno, I don't wanna say 'light' but like - not in keeping with the levels of awesome in everything else you have here.