Personal First Aid Kits Scotten W. Jones, WFR

Transcription

1 Personal First Aid Kits Scotten W. Jones, WFR Get Trained First Hopefully before reading this you have read our article on CPR/AED and First Aid Training Options and you have taken the time to get an appropriate level of training. If you haven t at least been CPR/AED and Basic First Aid trained yet, I recommend you read the training options article and start there. A first aid kit is only as good as the person using it. In fact a properly trained individual can often improvise solutions in an emergency and accomplish more than someone with no training and a first aid kit. One Size Does Not Fit All A lot of first aid kit recommendations are a sort of one size fits all approach whereas I believe a first aid kit needs to be more of a tailored solution based on several factors. Specifically: 1. What are you trained to do A kit full of first aid supplies you don t know how to properly use isn t very helpful. It can even be dangerous if you are trying to use equipment and or perform procedures you aren t properly trained for. 2. What are you going to use the kit for a first aid kit for hiking has very different requirements than a first aid kit for your car. The typical injuries you may see are going to be different in different situations. 3. Size and weight if you are going to carry a first aid kit in a backpack you are going to need to minimize the size and the weight. If you are going to carry it in your car, weight is likely not a concern and within reason size likely won t be either. 4. Cost while many basic first aid supplies aren t very expensive, some of the new cutting edge supplies that have come out of military applications can cost $20 to $40 per item. The other consideration to building a kit is what do you routinely carry on yourself or would you carry for other reasons when you have your kit. For example, if you carry a pocket knife you could use it to cut open clothes in an emergency and might not add trauma shears to your kit. A lot of people carry small pen lights on their key ring or with their hiking gear so you wouldn t need to consider adding one to the kit. Do It Yourself My personal opinion is I would rather build my own first aid kit than buy a pre made kit. Yes there are a number of reputable companies that make first aid kits but I believe that if you make your own it will be better tailored to your needs. You can also insure that your kit only includes quality items and you will know the exactly what is in it and how to find it. A lot of pre made first aid kits have low quality items or other items that just aren t very useful. Scene Safety In any quality first aid training course the first thing they will teach you to do in an emergency situation is to ensure scene safety. When someone is injured the worst thing that can happen is for more people to get injured trying to help the injured person. The rules are: 1. You first the most important person at the scene is you; make sure you are safe first. 2. Other rescuers and bystanders second the second most important person(s) are any other rescuers or bystanders. 3. The injured person comes last only once you have insured the safety of yourself and everyone else do you treat the injured person. As stated above, the worst thing that can happen is more people get injured.

2 The harsh reality of this is that you could possibly be in a situation where you have to watch someone die because you can t safely help them, although the better trained and prepared you are the less likely this is to be the case. This also plays a role in the next section on body substance isolation. Body Substance Isolation (BSI) Unless you are treating a family member or close friend you will likely have no idea what if any illnesses the injured person may be harboring in their body. During my Wilderness First Responder (WFR) recertification the instructor told us a story about a first responder who got sick and died from an infection they picked up treating someone. This is a key part of scene safety we discussed in the previous section. As an absolute minimum your first aid kit should include 2 pairs of gloves and a CPR mask. I recommend two pairs of gloves so if a glove tears or someone is helping you, you are prepared. Also, as discussed below, there are times when you may want to wear two pairs of gloves. Gloves There are three main types of gloves used for medical applications: 1. Nitrile Nitrile gloves are the gloves of choice for first aid use. Nitrile provides a good barrier to infectious agents, are relatively tear resistant, fit snugly (if properly sized) and are not allergenic. 2. Latex Latex gloves have fallen out of favor for first aid use because they can cause allergic reactions in some individuals. Latex does provide a good barrier to infectious agents, are relatively tear resistant and fit snugly (if properly sized). Due to the allergic concerns I do not recommend latex gloves unless you have no choice and or know the person you are treating isn t allergic to them. 3. Vinyl I do not recommend vinyl gloves unless you have no other choice. Vinyl gloves have tiny pores in them that can let viral agents penetrate the glove. Vinyl gloves also tear relatively easily. Vinyl is not allergenic and can fit snugly if molded properly although it lacks the elasticity of nitrile or latex. There is also a wide variety of weights and lengths in gloves. For a first aid kit where size and weight are a concern, Rescue Essential sells gloves that are paired up and wrapped with a paper band creating a small and light weight package. Rescue Essential wrapped gloves. The drawback to the Rescue Essential gloves is they are relatively light weight gloves and only come up to the wrist. Still, they are a good option for small light weight kits. If you can afford the size and weight, I prefer 8 mil thick gloves with a 12 extended cuff. These types of gloves are heavier duty, more

3 resistant to tearing and come up over the wrist for better protection. Your skin is a pretty good barrier to diseases but any cut or flaw in your skin can allow an infectious agent entry into your body. CPR Masks CPR masks include a one way valve and filter so that you are isolated from the injured party while performing mouth to mouth resuscitation. Masks come in full size masks that cover the injured parties mouth with a full mask, or tiny Res Cue Key masks. For a larger heavier kit the full mask is a good idea, for a smaller lighter kit, the Res Cue Key masks are a good alternative. If you don t have a CPR mask available, current CPR standards include the option to perform chest compressions without mouth to mouth resuscitation, but compressions with mouth to mouth are more effective. CPR Mask Options packaged Res Cue Key (left side) and full CPR mask (right side). Additional BSI Gear Unless a scene is highly contaminated with bodily fluids, gloves and a CPR mask are likely sufficient. If however the scene is highly contaminated you may need additional equipment. Infective agents can be present in any bodily fluid including: blood, mucous, saliva, vomit, urine, excrement, semen, vaginal secretions, tears, sweat, etc. Arterial bleeding, projectile vomiting, explosive diarrhea or even the injured party thrashing around can all spread infective agents around the site. There is also the possibility that an infective agent could be air borne. The following are further items of Personal Protective Equipment (PPE) that you might consider adding to larger kits. This list is in rough order that you would consider adding the gear: 1. Safety glasses 3M model Z87 safety glasses that are small and light and provide reasonable protection for your eyes. For more highly contaminated situations you may need a 3M TEKK goggles or even a full face shield. Any bodily fluids that get into your mucous membranes around your eyes, nose or mouth present a high hazard. For a medium size first aid kit the Z87 is a good choice. 2. Masks for airborne viral agents N95 or N100 masks are the minimum standard precaution. These masks are not liquid proof but will provide some protection against splashed or sprayed bodily fluids getting into you mouth or nose. In a situation where there is a lot of liquid being spread around you could wear a mask such as this underneath a full face shield or you could

4 switch to a full face shield respirator. 3M is a reputable manufacturer of N95 and N100 masks as well as respirators. Proper fit of a mask is essential to insure no air leaks around the filter. For a medium size first aid kit, a couple of N95 or N100 masks would be a good choice. 3. Liquid proof clothing if there is a lot of liquid exposure you may need to wear liquid proof clothing. In the wilderness a gore text rain suit provides some protection. First responders in highly contaminated environments wear special suits. When the concern is infectious agents a DuPont Tychem QC suit should be worn with integral boots and hood. Tychem provides a better barrier than a Tyvek suit, although Tyvek provides some protection and is better than nothing. Gloves should be taped to the sleeves of the suit with ChemTape or Duct tapes if you don t have ChemTape available. Rubber booties also taped to the suit and an apron may be worn as well. Tychem suits, boots and aprons are beyond what you would carry in any kind of personal first aid kit although they might be something you would carry in a truck or car if you were a first responder. Fire departments and other first responders may even have full space suit types of hazardous environment suit on their emergency vehicles. N95 mask (left side) and 3M Z87 safety glasses (right side). One critical issue with all PPE is how to take it off after providing aid to the injured party. Once the gear is contaminated with bodily fluids it can be very difficult to remove safely, for example if your gloves are covered in blood how do you take off a mask and goggles without getting blood on your face. PPE should be put on in the following order: 1. Gown or suit first if worn 2. Mask or respirator if worn 3. Goggles or face shield if worn 4. Gloves always worn PPE should be removed in the following order: 1. Gloves 2. Goggles or face shield 3. Gown or suit 4. Mask or respirator

5 In a highly contaminated environment you may want to wear two sets of gloves so you can take off the contaminated outer gloves first and still have your hands protected against any possible contamination on the other items you still have to remove. You would then take the inner gloves off at the end. Another consideration is what to do with any contaminated PPE or medical supplies after treating an injured person. In a larger first aid kit you may want to include a red hazardous waste disposal bag. Once again, in a typical personal first aid kit you would likely just carry gloves and a CPR masks but it is important to understand the hazards you may face in serious emergency situation. For more information on PPE equipment and usage I recommend the CDC s Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Minor cuts and scrapes Minor cuts and scrapes will probably be the most common issues you will have to treat with your first aid kit. As a minimum your kit should contain 4 to 6 band aid strips. Personally I like Coverlet by BSN medical and carry the 1 x 3 strips. In a medium sized kit you may want to include fingertip bandages and possibly knuckle bandages. To prevent infections clean all wounds well (more on that later). Blisters Blisters are a common issue for hikers, runners or anyone playing a sport with a lot of running. The best way to deal with blisters is not to get them in the first place. Wear shoes that fit properly with socks that wick moisture away from your feet. Shoes should be well broken in before undertaking a long hike or run. When you start to feel a blister developing, cover the hot spot to prevent the friction that is creating the problem. Moleskin is a product specifically designed to cover hot spots and prevent blister formation. Moleskin comes in small sheets with one adhesive side that you stick to your skin over the hot spot and the other side is a fuzzy coating design to slide easily and prevent further friction against your skin. Mole skin is very useful but also represents something else to carry in a first aid kit. I have had good luck just putting a small piece of medical tape over a hot spot to prevent blisters and medical tape is useful for other things besides blisters. I would add moleskin to a medium first aid kit but skip it for a smaller kit. Bleeding control For cuts and wounds larger than can be covered with a band aid, 4 x 4 sterile gauze pads should be carried in even a small kit, for larger kits 5 x 9 gauze pads can also be added. In addition 3 x 75 sterile roll gauze and 1 silk medical tape should be included. The roll gauze and tape will allow you to secure the gauze over wounds anywhere on an injured person s body. 3 x 75 roll gauze are very small rolls and are long enough to warp a limb several times or go around the body of even a large person at least once. I would include 2 to 4 4 x 4 gauze pads plus 3 x 75 roll gauze and a 1 roll of tape in a small kit and add additional 4 x 4 pads, 5 x 9 pads and 3 x 75 roll gauze to larger kits. Additional specialized supplies for severe bleeding will be discussed later. Orthopedic Injuries During my WFR recertification someone asked the instructor what the most common wilderness injuries were. The list the instructor gave us in order was: 1. Ankle sprains 2. Wrist sprains 3. Simple fractures to the lower leg and arm

6 The problem with orthopedic injuries is that the supplies to treat them tend to be bulky and in some cases heavy. Leg splinting in particular requires large supplies. For a mild sprain it may be enough to simply wrap the injury to provide compression and support. A 4 elastic bandage is a good choice for sprains or 3 x 5yds Co Flex adhesive flexible bandage can be used. In either case a latex free bandage should be used. Some elastic bandages have Velcro closures instead of the little metal pieces included with some elastic bandages; I like the Velcro closures because you don t have worry about losing them. In a smaller kit I would chose the Co Flex over an elastic bandage because it is smaller and is also better for securing splints. Co Flex sticks to itself so you just wrap the injury to provide the desired level of compression. In a larger kit I would include an elastic bandage and Co Flex to have more flexibility. For an ankle injury I might just wrap Co Flex over a sock, for a knee I would be more likely to use an elastic bandage because it gives more and would move with the joint better. For treatment of sprains and strains the recommendation is RICE for Rest, Ice, Compression and Elevation. Rest doesn t need any supplies and we just covered compression. For a larger first aid kit, particularly one targeted at sporting events you may want to include instant ice packs. You simply squeeze the packs to break the internal seal, shake the pack and you have instant cold. The problem with instant cold packs is they are heavy and don t last very long. You can easily use 3 to 5 packs on a single injury. I have a first aid kit I take to my kids sporting events that has several instant ice packs in it but I wouldn t add them to a small kit for hiking because of the weight and size issues. For splinting there is an aluminized foam product called a Sam Splint (or generic equivalent) that makes it easy to quickly form a splint for a variety of orthopedic injuries. SAM splints are very flexible until formed into the proper shape and then provide good stability to injuries. SAM splints are light weight but take up a fair amount of room and are really only big enough for arm or neck injuries (you can make one into a cervical collar). I would include a SAM splint in a medium size first aid kit particularly for sporting events and hiking. Sam Splint One of the most useful items for treating orthopedic injuries is a triangle bandage. Triangle bandages can easily be used to create slings and can also be folded over to create cravats to secure splints. Triangle bandages are also useful for dressing head wounds, or creating figure of eight bandages for

7 collar bone fractures. H&H Medical Corporation produces a triangle bandage called the Super Combat Cravat that is an oversized heavy duty triangle bandage. I have actually found standard triangle bandages to be too small for slings and cravats around the body of bigger people and really like the large size of the H&H product. The H&H product is also vacuum packed minimizing size and keeping it waterproof until use, and it is sterile (unlike most triangle bandages) providing a large sterile dressing ideal for large area burns. Items that can be used for multiple uses are great for minimizing size and weight in first aid kits. I never really understood the recommendation to have a triangle bandage in a first aid kit until I went through splinting exercises during first aid training. When splinting an arm you can easily use 3 to 5 triangle bandages as cravats and splinting a leg often requires 6 or more. In a smaller first aid kit for hiking I would rely on Co Flex to secure a splint and carry 2 of the H&H bandages to use for a sling and a cravat to secure the sling. The H&H product is more expensive than standard triangle bandages currently at $3.50 each on Amazon but is in my opinion well worth it. In summary a small(ish) first aid kit for hiking should include 1 4 elastic bandage, 1 3 x 5yd Co flex bandage, a SAM splint or equivalent, and 2 H&H Super Combat Cravats. For a larger kit such as I might take to a sporting event I would add an additional elastic bandage, 4 more H&H Super Combat Cravats and 4 to 6 instant cold packs. This kind of larger kit would be relatively heavy and large but really isn t hard to carry to a sporting event. Basic Supplies for Treating Orthopedic Injuries Burns When a burn occurs, burning continues in the deeper layers of the skin for a significant amount of time after a heat source is removed. It is therefore important to cool burns, ideally with copious amounts of cool (not cold) clean water. In the wilderness there is likely to be limited availability of clean water. Water Jel makes wet sterile dressings that do an excellent job of cooling and protecting burns. The drawback to the Water Jel dressings is they contain water and are relatively heavy, they are also packed in a plastic package that is easily punctured potentially leaking all over your first aid supplies and they need to be kept from freezing. I would generally not include any burn specific dressings in anything other than a very large first aid kit that was going to be stored in a temperature controlled environment (I do have a large kit at home in an EMT bag that includes some Water Jel dressings). Water Jel also makes a burn cream available in small foil packs that you could include in a smaller first aid kit but it includes lidocaine and some people have a reaction to lidocaine if it is applied to too large an area of their body. Generally I do not include any burn specific items in a small to medium first aid kit and rather

8 rely on cool water followed by sterile gauze dressings. I will discuss how to clean up water with your first aid kit supplies later in this document. Oral Medication The focus here is on over the counter medications (OTC) that anyone can buy at a pharmacy without a prescription. If you take prescription medications you should consider whether it is appropriate for you to include some in your first aid kit in addition to these medications. The first medication is included because it is likely to be used a lot, the rest are all medications that under certain circumstance could save your life. 1. Pain relief The OTC oral medications you are likely to use the most are pain medications to deal with minor aches and pains. In the case that someone has an injury such as a broken bone you are going to want the strongest OTC pain medication possible. For severe pain you can take up to 4 200mg Ibuprofen (brand name Advil or Motrin) and 2 extra strength acetaminophen (brand name Tylenol) at the same time. The two medications have different actions so you can take them together. 800mg of ibuprofen is a prescription does so you need to consider carefully whether you want to administer that. You also need to make sure that the person you are giving it to isn t allergic to aspirin as some people who are allergic to aspirin can react to ibuprofen as well. I recommend carrying 8 ibuprofen and 4 acetaminophen tablets so that you have 2 doses of maximum pain relief. Both ibuprofen and extra strength acetaminophen are available in individual foil packs with two pills per pack making them easy to add to a small kit. REI sells both in foil packs plus they are sometime available at drugs stores or you can purchase them online. 2. Allergies the second OTC medication to carry is Diphenhydramine (brand name Benadryl). Diphenhydramine is extremely versatile and can be used to relieve allergies including severe allergic reactions, coughs and congestion due to colds, muscle spasms, motion sickness, and itching due to mild skin irritation. If someone has an anaphylactic reaction (severe allergic reaction) they may need an Epi Pen to counteract the short term acute affects, but the Epi Pen needs to be followed by Diphenhydramine to continue to suppress the allergic reaction until you can get the person to a hospital. If someone is having an anaphylactic reaction and an Epi Pen isn t available Diphenhydramine may still help them survive the attack. I recommend carrying 4 25mg tablets. Diphenhydramine can often be purchased in flat cardboard boxes at the pharmacy that contain the medication as single pills inside little plastic bubbles on a cardboard backing. It is relatively easy to cut or break apart a pack like that into 4 still wrapped pills to include in a first aid kit. 3. Chewable Aspirin in the case of a heart attack, administering 4 85mg chewable aspirins significantly increases the heart attack victims chance of survival. The one difficulty is finding chewable aspirin in individually wrapped doses. I have found it on line at Moore Medical but you have to buy 750 doses at a time. 4. Anti Diarrhea Loperamide (brand name Imodium) is an OTC anti diarrhea medication. Diarrhea can lead to dehydration particularly if severe or the weather is hot. I recommend carrying at least 4 2mg doses. Loperamide is often available in the same type of packaging as Diphenhydramine. 5. Electrolytes as long as you carry drinks or snacks that can make up for lost electrolytes these may be unnecessary but if you drink a lot of water while sweating profusely without replenishing electrolytes you can get water poising which can be fatal (although it is really hard to get). REI sells individual does packs of electrolyte tabs and given the low cost and small size this is a good insurance policy to add to a kit.

9 In addition to these core five OTC medications you may also consider Loratadine (brand name Claritin) if you have allergies (causes less drowsiness for regular use than Diphenhydramine although not as versatile or useful for severe allergic reactions) and also Bisacodyl if you are prone to constipation. A small tube of glucose gel or cake frosting is also useful in case someone is in a diabetic coma (although I typically carry food items I can use in this situation). Oral Medications Topical Medication A lot of pre made first aid kits are loaded with lots of topical medications many of which aren t very useful. Hydrocortisone cream is often included but in OTC doses is not strong enough to be effective against things like poison ivy. Burn creams such as Water Jel are worth considering but you need to be careful using them due to the possible reaction to Lidocaine discussed previously. They are helpful on sun burn as well as thermal burns and can even be used on skinned knees. Things I would include are: 1. Antibiotic Ointment it is hard to properly clean wounds in the wilderness and hard to keep them clean as well. Antibiotic ointment can help prevent infection although as one of my instructors noted creams in dirty environments can encourage the trapping of dirt and grit. 2. Povodine Iodine Povodine Iodine (brand name Betadine) is the antiseptic of choice for cleaning wounds in first aid treatment. It is available in individually foil wrapped prep pads making it easy to carry in even a small first aid kit. If you need clean water to cool a burn or rinse out a wound, drop the pads into a bottle of water and let them soak until the water is the color of weak tea. It should then be sufficiently free of pathogens to safely use on a wound. Those are the only two OTC topical medications I would include in a small first aid kit. Some people carry an anti fungal for athlete s foot and jock itch but I wouldn t unless it was a medium size or larger kit. You might want to carry hydrocortisone cream in a larger kit for mild skin irritations although once again the usefulness is somewhat limited. If you are going to go somewhere where poison ivy is likely you may want to consider carrying Technu soap, a special soap that can remove the poison ivy sap and prevent you from getting poison ivy if used quickly after exposure. Technu soap is available in small foil packs and I literally saved someone from poison ivy one time at Crane s beach when they came back from a walk in the brush and said they had accidently ended up in poison ivy. They were very surprised and also relieved when I pulled a packet of Technu out of a first aid kit I had in my back pack.

10 Miscellaneous Items Other items to include or at least consider: SOAP note I always include copies of a SOAP note form in any first aid kit. I recommend the SOAP note form available on the same resource page as this list. Not only does the form have room for the critical patient information you need to collect but it also provides a check list to make sure you don t forget an important step during the stress of an emergency. Sharpie I like to include a Sharpie pen to fill out the SOAP note and to write on the patient if needed (more on that later). Sharpies are available with a fine tip on one end and a medium on the other. The fine tip is good for filling out the SOAP note and the medium tip for writing on the patient. Penlight if you don t carry any type of light, a penlight of some kind is a useful addition. I carry a AAA LED light on my key ring so I don t add one to a small kit but do to larger kits. Tweezers I carry tweezers even in small kits. There are very small tweezers made for first aid kits available that aren t very heavy and take up almost no space. Trauma Sheers I carry a pocket knife so I don t add trauma shears to small kits but for larger kits I would add a 6 1/4 pair. Magnifier the older I get the worse my eye sight gets so I include a credit card sizes magnifier in even a small kit. Thermometer thermometers can be helpful to have. I generally don t put them in smaller kits but will add them to medium or larger kits. The glass thermometers are good because they never need batteries but are a breakage risk. I have small battery powered digital thermometers with extra batteries in some medium size kits. Dental Kit A lost filling can be incredibly painful. A small dental kit as part of a first aid kit takes up very little space and is easy to add. Oil of clove on a small cotton ball can help reduce the pain and Dentemp temporary fillings can be used to fill the space left by the missing filling until you can get to the dentist. CVS sells Red Cross Toothache kits with oil of cloves, some cotton balls and a small pair of forceps. Add to that Dentemp (also available at CVS) that comes with a small spatula for applying the filling material and you have a small dental emergency kit. I would add this even to a relatively small first aid kit. Emergency Dental Kit

11 Severe Trauma and Bleeding The single biggest cause of loss of life on the battlefield is blood loss. In the wars in Iraq and Afghanistan the US military has pioneered technologies that routinely save injured soldiers who would have died in previous wars. The same first aid items the military uses are now available to the public. In most cases these are expensive and specialty items you are unlikely to ever need unless you spend time in environments where you may be shot or blown up (although some of this has applications in car accidents). Tourniquets historically tourniquets were used to stop severe bleeding in extremities (arms and legs). Concerns about loss of a limb due to loss of blood flow led to the practice of releasing the tourniquet periodically to restore some blood flow. Unfortunately this practice basically bled the injured person to death over time. For many years tourniquets were completely out of favor with the medical establishment. At some point during the wars the military realized that surgeons clamp off arteries during surgery up to 8 hours without people losing a limb and the use of tourniquets gradually returned. The military now routinely issues tourniquets to their personal and even have special clothing with tourniquets built in. If a limb is partially or fully amputated severing an artery, it is extremely difficult to stop the bleeding. The artery tends to pull back up into the remaining part of the limb making it very difficult to clamp off. A tourniquet placed a few inched closer to the body than the severed artery can stop the bleeding and save the injured person s life. The tourniquet should not be placed directly over a joint and it needs to be wide enough not to cause tissue or nerve damage. The military issued CAT tourniquets are approximately one inch wide straps with Velcro to adjust them to the limb diameter and include a small plastic bar used to tighten the tourniquet until blood flow stops. Tourniquets are incredibly painful to the injured party but can save someone s life. When a tourniquet is applied the standard practice is to write TQ on the injured parties forehead with the time the tourniquet was applied. This is often done with the injured parties blood but the sharpie discussed above would provide a more reliable method (blood can easily wash off or become smeared). During my WFR recertification the instructor was a very experienced paramedic who also knows and works with dozens of other paramedics. He said he only knew one paramedic who ever used a tourniquet. The only time I am aware of tourniquets being used in a civilian situations beside the case he mentioned, was after the Boston Marathon bombing where people improvised tourniquets to help some of the victims. The other thing to be aware of about tourniquets is if you really need one you only have a very short time window to put it to use because people with arterial bleeding bleed out so quickly. The tourniquet needs to be somewhere you can very quickly access it. The military has found tourniquets can be left in place for up to eight hours without loss of a limb. In the wilderness if you apply a tourniquet and a hospital is more than eight hours away you will have to make the difficult decision about when to try loosening the tourniquet. After a sufficient period of time blood will clot even in an artery and the tourniquet will be safe to remove but how long that time will be depends on a number of factors and you won t know for sure unless you try it and the injured party could bleed to death while you are checking. The CAT Tourniquet is currently around $25 each on Amazon. If you are going to buy one you should also buy the trainer and practice with it. Trauma Gauze while tourniquets are old technology reborn and perfected, trauma gauze is a whole new invention. During the wars the military pioneered the use of chemical clotting agents that could be poured into wounds to increase clotting. The early versions had several drawbacks around heat generation and difficulty cleaning them out of wounds after they were used, but newer solutions impregnate gauze with the clotting agent and are easier to use. Combat trauma gauze and things like quick clot sponges are now available to the public and can be placed on or in severely bleeding wounds to rapidly stop the flow of blood. Trauma gauze

12 can be used in some situations on extremities instead of a tourniquet and can also be used on the torso of the body, neck and head where tourniquets can t be used. Quick clot sponges are available at camping stores such as REI or on line (combat gauze comes in a z fold that is easy to pack into a wound versus a thicker one piece sponge). This is an item you may want to consider for a first aid kit that you keep in your car where highly traumatic injuries can occur due to the energy of high speed car crashes. The full Z fold combat trauma gauze is currently around $45 on Amazon although the civilian gauze and sponges are only around $20. Trauma Dressing trauma dressing are basically large sterile gauze dressings sown onto an elastic bandage. The sterile gauze is placed against the wound and the elastic bandage is wrapped around to maintain pressure on the wound. The application of a dressing like this immediately frees up your hands to attend to other issues because you don t have to keep pressing on the wound. You do need to be careful not to apply a dressing like this so tightly on an extremity that it ends up acting more like a tourniquet. These dressing typically come vacuum packed to minimize the size and to protect them from the wet until they are used. I personally like the North American Rescue dressings because they are packaged in such a way that the package can be quickly and easily opened with just your hands. North American Rescue makes the dressing in both 4 and 6 sizes. Once again this is an item to consider for car first aid kits. Chest Seal in order to breathe our bodies create a vacuum in our chest cavity between the lungs and the ribs causing the lungs to expand and fill the space. In the event of an open chest wound air can get into the chest cavity and cause the lung(s) to collapse making it impossible to breathe. An open chest wound that is causing a lung or lungs to collapse will typically bubble and appear as what is a called a sucking chest wound. The treatment is to cover the wound with an occlusive (air tight) dressing with a one way valve to allow air to escape from the chest cavity but no air to get back in. there are several companies that make occlusive dressings with oneway valves. My current favorite is the HyFin Vent by North American Rescue that is once again vacuum packaged in an easy to open package and sold in pairs so that if you have an entry and exit would to treat (from a gunshot for example) you have the two dressings required. The two packs are currently around $17 on Amazon. I am not sure how likely an open chest wound is from a car accident but you could consider adding this to a car first aid kit. Nasopharyngeal Airway when someone is unconscious (as opposed to sleeping) they may not properly guard their airway and their tongue can close off the airway and suffocate them. One way to prevent this is to insert a Nasopharyngeal Airway to keep their airway open. A Nasopharyngeal Airway is basically a tube with a wide flange on one end and you insert the tube in the injured party s nostril and insert it in all the way so the tube extends down into their throat. The wide flange on the end stops the outside end of the tube from going into the injured person s nose. As long as the person doesn t have major trauma to their nose a Nasopharyngeal Airway is safe and effective. Before inserting it the end should be lubricated with Surgilube. The airway also needs to be properly sized and anyone using one needs to be properly trained. Once again if you know how to use one you might consider adding this to a car first aid kit. The five items discussed in this section are all discussed in more detail in Trauma Care for the Worst Case Scenario and Building a Trauma Kit by Gunner Morgan.

13 Trauma Kit Supplies trauma dressing (upper left), vented chest seal (upper middle), CAT tourniquet (upper right), nasopharyngeal airway (lower left), clotting sponge (lower right). Training Tourniquet Things Not To Bring You can buy an amazing variety of first aid supplies on line now many of which you are unlikely to be able to use safely (or legally) and many of which really add no value. The following are a few prime examples: Snake bite kits the old Cutter snake bite kits with the small scalpel and suction cups are no longer considered an effective treatment for snake bite. The whole idea of sucking out the venom is no longer recommended. This brings us to the next item. Sawyer extractor this was a first aid kit staple for years. The sawyer extractor is used to suck out venom from bites and stings but is not considered to be effective by experts (although many non medical personal still swear by these). Steri strips it is not recommended that you completely close up a wound in the wilderness because of the risk of infection. Suturing, stapling and even closing a wound with steri strips should be left for a cleaner setting. You might use Steri Strips at home after thoroughly washing out a wound with clean water although going to the doctor would still be a better choice.

14 Example of Kits By Use Minimalist first aid kit This is a minimal kit for when weight and space are at a premium x 3 band aid strips x 4 gauze pads x 75 roll gauze medical tape 5. 1 pair of Rescue Essentials gloves 6. 1 SOAP note form 7. 2 Povodine Iodine pads 8. 1 set of oral meds Minimalist First Aid Kit in 5 x 7 flat poly bag. The minimalist kit in the poly bags weighs only 3.8 ounces. The poly bag has the advantage of being clear so you can easily see the contents and also being water proof as long as the zip closure is securely closed.

15 Small first aid kit This is the kit I would carry on a long hiking trip for myself and one other person. It has the same supplies as the minimalist kit and adds a triangle bandage and cohesive wrap for orthopedic injuries, plus the triangle bandage (H&H Super Combat Cravat) is also a large sterile dressing, plus antibiotic ointment, tweezers and a sharpie pen. It also increases the quantity of SOAP notes to 2, glove pairs to 2 and band aid strips to x 3 band aid strips x 4 gauze pads x 75 roll gauze medical tape 5. 2 pairs of Rescue Essentials gloves 6. 1 Res Cue Key CPR mask 7. 2 SOAP note forms 8. 1 Sarpie pen 9. 1 mini tweezers Povodine Iodine pads antibiotic ointment packs set of oral meds x 5yd Co Flex cohesive wrap H&H Super Combat Cravet Small First Aid Kit Supplies Small First Aid Kit Bag Options Eagle Creek bag (left), plastic bag (right)

16 In the Eagle Creek bag, the small first aid kit weighs 8.7 ounces. Medium first aid kit This is the small first aid kit with additional orthopedic supplies added, a dental kit, heavier longer gloves, 5 x 9 gauze and a 2 nd 3 x 75 roll gauze. The medium kit is better equipped for more serious bleeding, orthopedic and dental emergencies. Ironically I actually carry this kit on day hikes but it is too big for solo overnight hikes. I would carry this on an overnight group hike if I was the medical person x 3 band aid strips x 4 gauze pads x 9 gauze pad 4. 1 clotting sponge x 75 roll gauze medical tape 7. 2 pairs of 8 mil 12 long gloves 8. 1 Res Cue Key CPR mask 9. 2 SOAP note forms Sarpie pen mini tweezers Povodine Iodine pads antibiotic ointment packs Water Jel burn ointment set of oral meds dental emergency kit x 5yd Co Flex cohesive wrap elastic bandage H&H Super Combat Cravets Sam splint Medium Size First Aid Kit Supplies. In the larger Eagle Creek bag the medium size first aid kit weighs 25.5 ounces, a significant jump up from the small first aid kits 8.7 ounces.

17 Medium Size First Aid Kit Bag Sports first aid kit This is the kit I carry when I go to sporting events my kids are involved in. I was at a flag football game once and a player broke his arm, all the coaches were looking at each other asking if anyone had an ice pack. I have used this kit multiple times since I started bringing it to games. This kit is focused on orthopedic injuries with basic scraped knee and bleeding capabilities as well: 1. 2 pairs of 8 mil 12 long gloves x 4 gauze pads x 9 gauze pads x 75 roll gauze medical tape 6. 1 Sam finger splint 7. 1 Sam splint (full size) 8. 3 instant cold packs (I usually have several more in my truck as well) 9. 2 H&H Super Combat Cravats triangle bandages (these are standard ones to use for securing splints) x 5yd Co Flex cohesive wrap elastic bandages pair trauma shears Sports First Aid Kit Supplies

18 Sports First Aid Kit Bag Automotive first aid kit First aid kits for cars or trucks need to be designed to deal with the substantial injuries that can result from a high speed crash. Also weight and size within reason are not constraints. This kit is focused on traumatic injuries with major bleeding. I also carry band aid strips in the glove compartment along with an OTC medication pack (see the write up on our first aid resource page). The automotive kit contents are: 1. 1 Cinch Tight Big Cinch trauma bandage 2. 1 North American Rescue 6 trauma dressing 3. 2 North American Rescue Hyfin vented chest seals 4. 2 SOAP Note forms (see our SOAP note article on our first aid resource page) 5. 1 Sharpie pen, medium tip on one end and fine tip on the other end H&H Compressed Gauze 7. 2 H&H Super Combat Cravats 8. 1 CAT Tourniquet 9. 1 Quick Clot Clotting Sponge pair Trauma shears x 9 Sterile Gauze x 4 Sterile Gauze pairs of 8 mil 12 long gloves full size CPR mask Kerlex Roll Guaze silk medical tape Nasopharyngeal Airway with Surgi lube Medical waste disposal bags M N95 masks I am generally not a fan of Adventure Medicals bags for homemade first aid kits because their bags are designed to organize their supplies, but I had one of their Comprehensive kit bags and this all fit (barely).

19 Automotive First Aid Kit Supplies Briefcase First Aid Kit This is a kit for treating minor cuts and scrapes that you could carry in a briefcase or computer backpack. You could add the medication packs discussed along with previous kits, but I prefer to carry an Over The Counter Medication Pack described elsewhere on our First Aid Resource Page. The brief case kit supplies are: x 4 sterile gauze pads silk medical tape x 75 sterile roll gauze band aid strips 5. 1 pair Rescue Essentials Gloves 6. 2 Triple antibiotic ointments 7. 1 Water Jel Burn Jel 8. 1 mini Tweezer You might also consider a small digital thermometer and 1 or 2 Povodine Iodine pads. Briefcase First Aid Kit

20 Briefcase First Aid Kit in a 5 x 7 poly bag. Maintaining Your Kits In addition to building good first aid kits you need to maintain them. At least once each year you should go through your kits and replace any expiring supplies.