The First Aid Kit Part II: The truck kit
When I set out on putting together the this aid kit, I set these parameters: The kit should fit in a small gym bag or something about the size of a tacklebox (Hat tip: anonymous reader). The idea behind it is that it will be something that you have standing by in the trunk of your car, or wedged in behind the front seat in the cab of your truck (next to your truck gun). It is what you will have with you should you happen upon a car accident while driving along. You may also take it out of your truck and keep it by your side should you think it wise "just in case." It is also assumed that you already have packed in it the contents of an individual first aid kit, either as a stand alone kit, or divided up with the other stuff I will list here. The goal is to be able to provide a fairly high level of care for one patient, or, to be able to provide a moderate level of care for multiple casualties. It should be able to cover virtually all emergencies which do not require real surgical intervention, or very specific gear, or are chronic by nature. As always, one should tailor their kit to their needs and what would best suit them using their best judgement. I am going to leave out equipment which will deal with environmental, or long term care. Ideally, even if you have to wait for medivac, or for a storm to pass, you should not be caring for a patient for more than 24 hours with this kit.
Before I start, I would like to mention something that I have gotten a lot of eMail about:
TRAINING
Specifically, I am being asked about training for medical emergencies. PLease allow me to address this on two fronts. First, organized training; It is very useful. I suggest that one should look into going through a First Aid class, or First responder class. Ifyou have the time, money and motivation, you may want to look into becoming an EMT-I (Emergency Medical Technician- Intermediate). These course will greatly increase your ability to use more advanced equipment, and train you in how to approach patients. If you are interested in working the medical field one day, or want to earn a living doing this stuff, then I would suggest you become a pramedic. The kits I list will not include cardiac drugs. If you know about cardiac drugs, you damned sure don't need my advice on stocking a first-aid kit. If there is gear here that you do not know how to use, then do not take it. It will just be dead weight, and if you try to use it, you will find yourself doing much more harm than good. The other avenue is training manuals which I will start to use in this post. Always be sure to at least thumb through the manual before you pack it because the next time you read it will be when someone is in serious trauble and you will be relying upon it for their welfare. Reading comprehension tends to be inversely proportional to rate of blood loss. Also, some of the items listed require an MD to sign off on you having or using. Be aware of this before you score some morphine through your cousin Vito, and pack it in your kit under the auspices of "medicinal use."
It is also important to remember that the patient's outcome in any given situation is more dependant upon the skills, knowledge and abilities of the provider than it ever will be on the equipment. I had to put a tourniquet on someone the other day in a level IV trauma room. There was no tourniquet, so I improvised, adapted, and overcame; I used a yankauer, a roll of kerlix and some tape to make one, and it worked quite well. If you are on the scene of a medical emergency, it is your ability to think clearly, act quickly, and improvise in a fluid situation which will serve you and your patient best. No hi-tech doohicky is ever going to change that. This is why, while it will always have both to it, medicine will always be an art more than a science.
Alright; enough bantering on...down to business:
- Individual First aid kit
- Polysporin powder
- Silvadane (for burns, do not use if you have a known sulfa allergy)
- benedryl (for a wide variety of uses, not the least of which is to counter allergic reactions. It's not as efficacious as epinephrine, but it is available OTC. It can also be used with ethanol to ad insomnia)
- Normal Saline IV bags (use TKO for access, wide open for fluid resuscitation. Can also be used for irrigation and for dilution of IV/IM meds)
- IV Start Kit X2
- Intubation kit (Only if you know how to do it)
- Collapsed AMBU (This can be used with a CPR mask, even if you do not know how to intubate)
- NG tube & KY packets (easy to learn how to insert, and confirm placement. This will give you access to the stomach, which is handy if you need someone to take something, but they are unconscious).
- activated charcoal
- C-collar (take care on choosing sizes. You may want to err on the side of a smaller size and just improvise something if you need a bigger one, or vise versa)
- Burn dressing
- Chemical ice pack (sprains, strains, heat casualties)
- chemical heat pack (hypothermia; it happens in the summer, too)
- emergency blanket
- *Scalpel X2
- hemostat X5
- Adson's
- Kelly foreceps
- ring foreceps
- *Sutures
- Needle drivers
- *Medical staple gun
- *Cautery pen
- Surgical tubing (this can be used for tourniquets, or, if you hook it up to a large syringe, you can also use it for suctioning. In fact, surgical tubing has all kinds of uses)
- stethoscope (get a decent one)
- BP cuff (preferrably the one-handed type. You may also want to consider an electronic one to free yourself up for other things)
- *Angiocatheters 16ga, 24 ga.
- syringes 20cc & 60cc
- *needles 24ga, 18ga, hypodermic.
- Knowledge (This means a book on first aid, wilderness medicine, or Basic Life support (BLS). It also means you put together laminated cards with clear, easy-to-read instructions on anything which is at all complicated. Do not overestimate your ability to use abstract reasoning and recall detail in a crisis situation)
Again, especially in regards to the surgical tools(*); DO NOT TAKE IT IF YOU DO NOT KNOW HOW TO USE IT! You can really fuck someone up if you try to stitch them without sufficient training. The staples are easier to use, but even then, I would suggest avoiding their use without instruction or guidance. If you have some real bleeders, and you have virtually no training, flush the area with sterile water from the IV bags, under pressure. Use the Sterile 4X4 gauze to soak up fluids in the wound, and then with sterilized hemostats, clamp the vessel. If it is small enough, cauterize it. If that is not practical use some foreceps and surgical tubing to apply a tourniquet. Remember: life over limb, people. As bad as it would be to amputate someone's leg because you used a tourniquet, it would be far worse for you to introduce them to 24 hours of necrotizing fasciitis, or septicemia.
As a whole, This kit (including the individual kit),can address a whole host of medical problems. If anything, this kit contains a little too much stuff, but that will be mitigated by the fact that a lot of the stuff listed will not be used by people who do not know how. For instance, if you do not know how to intubate, then you will leave that gear out. If you do not know how to start IV lines, then you will leave all of that stuff out. Either of these areas will free up considerable room. For those of you who are concerned that your vehicular kit is not much of an upgrade, please be patient. I am planning on also doing a post on miscellaneous items which you may consider augmenting your kit with.
Please, feel free to eMail or comment with suggestions or gripes.
Up next: the expeditionary aid kit.
Respectfully Submitted,
doc Russia