Preparedness priorities: First aid, part II
Friday, November 9th, 2012This is another guest blog from Will Kone, aka BusyPoorDad. His first installment is here.
—–
What are the minimal items to have in a first aid kit?
We have all seen the ads, heard the sales pitches, wallowed in the fear-mongering marketing. “You MUST have this special kit! Your life depends on it!” Which is why companies who sell specialized first-aid kits feel they have to charge so much for stuff they sell. After all, it must be great, it costs a whole lot!
I have nothing against making money selling stuff. And there is value in having someone else doing the work of assembling it for you. But I’m not made of money and I doubt the person I am seeing when I write this is either. I’m a practical guy, and want the lowest price, but highest quality, goods. With that in mind, let’s look at the minimum you want when building a first-aid kit.
First off, what do you know? Are you Dr. Bones or Nurse Amy? A Paramedic? Boy Scout? A fan of House and Grey’s Anatomy? If you have never taken a first aid class, your kit should be a lot smaller than the kit for the ER Doctor. (If you have not taken a first aid class, do that. This assumes you know the very basics.)
Second, who is this kit for? Many commercial kits [Ed note: especially those intended for the SHTF prepper] seem to be marketed towards either the single warrior in the middle of a combat zone alone or the Special Forces Medic trying to care for a battalion from a back pack. This scares off the new prepper. Medical kits seem like some mystic bag of equipment that needs massive training to assemble and use.
They are not.
The most basic need for a kit is one that a person can use on someone else. My home has five people in it. The kit I have today is five times bigger than it was when I was single. Since you are going to use this kit, it should contain items you know how to use and you should have a good idea who you would most likely use it on.
Third, apply a risk assessment. The actual risk assessment is beyond this article, [Ed note: maybe medical risk assessment is a topic for another post; general disaster risk assessment MJR covered here recently]. Odds are, you will say to yourself, “Odds are I will most often need to deal with minor scrapes and cuts.” If you don’t cut your own wood, you are not likely to have a chainsaw accident. If you make your own soap, you are more likely to encounter burns or chemicals.
Lastly, you need to consider how available help is. First aid does not fix a major problem. If you cut off a hand, you are not going to pull something out of that expensive kit that will re-attach it. A large cut, cracked bone, some burns, heart attack, etc. can only be “fixed” by serious medical attention. First aid, and later emergency medical care, are aimed at keeping the problem from getting worse till you can get to a doctor or other medical provider.
Sure, there are people who can re-set that bone and cast it with a toothpick and duct tape. I’m not that person and have only heard about them.
Your starter kit should be enough to help you take care of an injury till help can arrive or you get to the help.
If you live in a big city, you have a larger amount of help that can get to you faster than a rural area. When I started out in upstate New York, the only Hospital for two counties was a 45 minute drive from the station. The district we covered was 23 square miles for 3,500 people. The average response time was 17 minutes after the call till the first responder arrived on scene — 22 minutes till the ambulance arrived. Critical transport was done by helicopter and sometimes by plane. (The nearest trauma center was a level two and 90 miles away, the Level one was 130 miles away — 100 straight line)
Today I have over 20 hospitals to go to in the county where I work, including level one trauma centers for pediatrics and geriatrics, as well as several level two and three trauma centers. Cardiac, burn, stroke, even emergency dental care are found in my county. The average response time is less than six minutes to arrival of EMS. We only fly someone if it is going to take a long time getting them out of an entrapment.
All jokes about “Larry the First Responder” aside, in both cases, the people who show up when you call will be professional, trained, and have more equipment than you — as well as having more backs and hands to help out.
For a basic starter kit, everything should be useful no matter where you are.
The kit
Top of the list goes to band-aids. Yup, adhesive bandages. The things you can get for fewer than two dollars at the big box. My kids are always scraping their legs, hands, arms and such. Your skin is the best defense against getting sick. Any break is an opening to diseases. You will want to cover these everyday damages as soon as possible. So more than one box, and a wide selection is good. (Little note here; a lot of advertised 300 piece first-aid kits are really 229 band aids.)
Next, something to clean up with. Alcohol wipes, cotton balls and hydrogen peroxide, Betadine, even the expensive Neosporin. (Do not use bleach wipes!) All these are cheap, last a long time and have uses beyond boo boo’s.
Often over looked is gloves. Sure, you most likely are treating yourself or family, but non-latex gloves do more than protect you from other people’s blood. They help reduce the spread of germs from you to them. (And you can also use them to pick up that slimy gross stuff the dog dragged in.) You can find gloves at most drug stores, but really cheep ones can be found in restaurant supply stores, called food handler gloves. Try to avoid the one-size-fits-all floppy kind; you want to be able to hold things somewhat.
Bulky dressing. This can be strips of old, well washed, cloth diapers. You want thick, clean, and at least the size of a page of paper. You will be stacking them four or five high in some cases.
Cotton gauze. Rolls or pre-cut, both are a multi-use item. You can have too many, but they compress well. I take bundles of ten pre-cuts and put them in ziplock baggies and squeeze out the air.
Elastic wraps, ACE bandages. I love the kind with the Velcro-like ends. They are not much more expensive than the clip kind, but well worth it. Have different sizes, both in length and in width. That gives you lots of versatility with treatment.
Large freezer-type ziplock bags. These can hold stuff and keep the wet out. They can hold stuff and keep the wet in. In a pinch you can use them as gloves.
Pad of paper, pen, Sharpie. Anything beyond a boo boo, you are going to want to write something down, and a Sharpie writes on most things. Like where under the dressing is that gaping wound, what was the victim’s pulse, what allergies do they have, what medications do they take.
Large squares of sheet cloth. Two foot square with some three and one four. Fold into a triangle and you have a sling. Roll up that triangle and you have something to tie with. You can fold these for padding between something hard and a soft body, like a splint. Use old sheets; don’t buy brand new, your patient won’t be offended.
Duct tape. Really, any adhesive tape will work, but duct tape sticks better to lots of things. You should have some medical tape. It should stick to dry skin well, but not so well that it pulls off skin taking it off.
Scissors. You can get those EMT shears, which cost around $10. Don’t pay more for them. Regular scissors used for cutting cloth will be good, but keep them short. Long tailor’s shears are better as a weapon than for the close to body cutting you will do.
Tweezers. Overlooked often. Great for getting out splinters or bee stings, or for picking up small objects. I’ve never said, “Gosh, I wish I had not put these in my kit”.
Pocket mask. This can be any device that allows you to do rescue breathing and acts as a barrier between your mouth and a victim’s. These can be as small as something that fits on your key ring, or as big as a softball. [Ed note: Amazon has a number of varieties, specially designed for CPR.] The price is higher than free, but one of these is worth getting. If you’re doing mouth-to-mouth, unless you’re married to the person, do you really want to swap spit with them? (Besides, regurgitation is a common result of mouth-to-mouth they don’t show you on TV.)
I would call this the minimum you should have in a first-aid kit. There are lots of other things I’ve got in mine as a paramedic-trained person. But many of those extras are not in the kit my wife keeps in her car. (She is a highly trained minister, not a medical professional.)
Nothing says you have to only have these things. I just argue that they are the minimum you should have. With a basic first aid class, and/or cpr class, you would be able to use all these things to provide first aid till the EMS system is able to put responders on the scene.
Where to keep your kit
Ok, now you have the stuff for the kit, but what to do with it? You went through all the effort to put this together, then why would you put it someplace you can’t get to it?
The beauty of this list is that everything in this minimal kit will fit nicely in small, kiddy sized back packs. If you place each item in its own ziplock bag and press out the air, it will take up less space, and it’ll have a better chance of remaining dry if you drop it in a puddle.
I put a kit containing these items into a 12-inch by 8-inch by 4-inch Tupperware-type container. This fits nicely in the car, van, an office desk, or bathroom closet.
Think about where you will be in the course of a day. In your car, in your office, at home, visiting a friend, in a store. What would you do if you’re in your office and a sectary has an accident running with scissors if your kit is at home? Does your office have cravats and bulky dressings? Or is your office first aid kit one with 400 small band aids? Likely the later. This is when you would want to have something in the desk drawer that you know has what you need (and know how to use).
But, hey, I have a kit in my car, why do I need one in the office? Like answers to most of life, that would depend. It would depend on where your office is vs your car. If your desk is right by the front door and you park three steps from the door, maybe not. But if your desk is on the 42nd floor and you park two blocks away … well you get the idea. Which would you rather, having to pull open a draw in your desk and going to help or getting up, going out the door, opening the car, getting the kit, closing the car, going back in the door and then going to help?
Having a kit in your car means you’re taking it with you. Having more than one at home helps too. Why have to run up stairs to find the kit when you have on each floor. Having one at Grandma’s is a good idea too. You visit her (right? Maybe not often enough) and it’s likely she has not put a kit of her own together. Be nice to Grandma and make one or more for her. Maybe make one for her bug-out bag (BOB).
Also very important to have with your BOB, after all, if you’re bugging out, odds are you or someone you know will need some form of first aid. Don’t be slapping your head going “I could have brought my kit with me.”
—–
“Who am I? Why am I here?” The immortal words of admiral Stockdale are best answered like this: I’m William V Kone, a First Sergeant, Paramedic, Emergency Manager, and a “Busy Poor Dad.” I’m 23 years into the Army Reserves, currently the interim Company Commander of an HHC for an Engineer Battalion. I work for an Ambulance Company and have been with EMS since 1997, and with Fire Service since 1996. I have been with rural districts in upstate New York, a Suburban district in Maryland, and currently work the City of Cleveland and Cleveland Metro area. I also work with the Emergency Management Agency in the small city I live in, have a BSc in Emergency Management and Homeland Security, level 1 Continuity Of Operations Planning certification, and am working towards my CEM.
November 9th, 2012
Will, after a long career in nursing, wound care being a specialty at one point, I’d suggest that warm water and plain soap are superior to any kind of alcohol or betadine swabs. Those would be useful in a situation where soap and water are not available, of course, but not a first line option otherwise.
Another suggestion for wound dressings is plain old kotex. They are becoming difficult to find these days, but the newer and more expensive feminine hygiene pads are even better for absorbing blood and other body fluids, applying pressure to bleeds, and as cushions for splints, etc. I carry several different sizes and kinds in my trauma packs.
Another good place for a first aid kit is the diaper bag, the range bag and even a very small one for any purse or fanny pack. Even a zip bag with a pair of gloves, a few bandaids and baby wipes could make a tremendous difference.
Great series of articles, and lots of good reminders for everyone. :)
November 9th, 2012
MamaLiberty — Good stuff. I told Will yesterday that he should brace himself for dozens of suggestions on items to add or alter. Nice, basic ones there.
One of the things that makes this series so good is the comments. If this ever becomes a book or booklet, comments will help make it.
November 9th, 2012
A good basic list, BPDad. I’d add some tongue blades and finger cots for splinting and general protection of fingers. Also a couple of ammonia vials.
And, though usually found at a medical supply but may be found at some health/sports shops, I think a pair of forceps (straight works better than curved) is a good addition. It can be used as an emergency mini-vise or a fulcrum, in addition to holding or picking up medical nasties. (I’ve known one person to use it for holding a hot dog over the fire, but I wouldn’t recommend that if you value your instrument.)
November 9th, 2012
“Tweezers. Overlooked often.”
Amen. I don’t think I ever bought a first aid kit that I didn’t have to add a pair of tweezers. And they get used ALL THE TIME.
Also second MamaLiberty on the feminine pads.
1. Excellent bandage, etc.
2. If they have a plastic wrap it will seal a sucking chest wound. (Inside out, covered by the pad that came in it.)
3. Never will a guy be more studly than when he produces a sanitary pad for a woman who wasn’t expecting to need one.
November 9th, 2012
Okay, 2-parter here (yes, I’m being wordy).
I can claim studly status then. I remember back in Jr. High, uh many years ago, the local fire / rescue folks came by to show off their truck and equipment — it was supposed to be educational, and they were going over their inventory, which included tampons. Yes, there was a little juvenile sniggering. I bought (I mean now, not back in Jr. High) what seemed to be the best value with the least amount of extra flappery. I mostly figured that with an ace bandage and some tape, they’re a cheaper substitute for the vaunted (at least in the tacticool circles) Israeli Military Bandage.
BPD, thanks for the post. With all due regard for improper use doing more damage than doing nothing, I will say that having some of the more advanced stuff can be justified. I always think in worst case, or almost worst case scenarios, and one of them is that there’s someone who know how to use thing X, but there isn’t any thing X around, for whatever reason — maybe she ran out with all the zombies wreaking havoc or whatever. Well, there are people dumb enough to attempt an intubation without training, but I’m not one of them. Yes, I want to be that studly guy, not just with my Maxi-Pads, but with my trach tube too. ;) I also have a ‘Combat Application Tourniquet’ and plan to get either Celox or Quikclot.
Lemme share a couple pics.
med supplies
med kit
November 9th, 2012
I can claim studly status then. I remember back in Jr. High, uh many years ago, the local fire / rescue folks came by to show off their truck and equipment — it was supposed to be educational, and they were going over their inventory, which included tampons. Yes, there was a little juvenile sniggering. I bought (I mean now, not back in Jr. High) what seemed to be the best value with the least amount of extra flappery. I mostly figured that with an ace bandage and some tape, they’re a cheaper substitute for the vaunted (at least in the tacticool circles) Israeli Military Bandage.
BPD, thanks for the post. With all due regard for improper use doing more damage than doing nothing, I will say that having some of the more advanced stuff can be justified. I always think in worst case, or almost worst case scenarios, and one of them is that there’s someone who know how to use thing X, but there isn’t any thing X around, for whatever reason — maybe she ran out with all the zombies wreaking havoc or whatever. Well, there are people dumb enough to attempt an intubation without training, but I’m not one of them. Yes, I want to be that studly guy, not just with my Maxi-Pads, but with my trach tube too. ;) I also have a ‘Combat Application Tourniquet’ and plan to get either Celox or Quikclot.
Lemme share a couple pics.
med supplies
November 9th, 2012
med kit
I have a bit of stuff, not as well organized as I’d like, and there’s more that isn’t in the pics. But I really like those Sterilite bins. What I really want to find is a bag like the one pictured, but a bit larger. REI doesn’t carry them any more, and the “EMS Bags” I can find come fully stocked, or are too expensive even empty. Here’s what I like — when you open it up and lay it out, everything is right there in front of you. I keep looking, but I haven’t found one, and I’m about to just sew one myself. Anyone ever seen anything like that for sale — I don’t mean something like the camp / travel shower organizers.
But, thanks to BPD, I can see I’m lacking a few things, and I’ll get right on those, since they’re easy stuff to come up with. I also highly recommend that brown crinkly tape — self-adhesive elastic bandage, is what it’s called, and comes in lots of colors. Best stuff I’ve ever used for attaching gauze, splints, etc.
Some of the stuff I have, e.g. various splints, are stuff the docs taped onto me, and I just tossed ’em in the bin when I wasn’t using them anymore. I have gauze pads acquired that way too — well, the docs just handed me a bunch and said to change my dressing at whatever interval, and I had leftovers.
I also recomment surgical tubing. Even if you never use it for a field expedient tourniquet, you can build a slingshot!
BTW, I do intend to get some training. And my range bag will have kit for dealing with a gunshot wound. And I no longer like Carmex, so I’ll be pitching that. Probably replacing with Burt’s Bees.
(Dang, I’m wordy tonight.)
November 9th, 2012
To even a basic kit, I would add a roll of Kerlix, and some butterfly closures. Probably a mylar space blanket too. Well, those cloth sheets can do a lot of what you’d use a roll of Kerlix for, but when I had a use for it (holding a dressing in place on my knee) it sure worked well. And Sting-Eze, or it’s moral equivalent.
November 9th, 2012
My normal kit included duct tape and brown tri-fold paper towels for many years. It is amazing how many applications there are for those two basic items.
In April I put a Cold Steel Tanto Voyager mostly through my had. Fortunately the knuckle prevented complete penetration. Bled quite a bit. Used cayenne pepper to staunch the bleeding with compression provided by a cut up sanitary knapkin and the whole thing secured with duct tape. Got a few laughs but it worked quite well and sealed a wound in a difficult spot.
I keep small packets of cayenne pepper and honey in my first aid kit for wound care as well.
November 9th, 2012
Just a quick pointer about the tweezers. You mentioned they are good at taking out a bee’s stinger. You should really avoid using the tweezers if you can as they might squeeze more of the bee’s venom into the victim increasing the reaction. It is better to take a credit card, driver’s license or something to try to “brush” the stinger out.
November 10th, 2012
I hope people are reading the comments. Some great things to add to any kit have been posted. I know this is not a complete list, had not tried to make it one either. I had looked at my kits and tried to pick out the free or really cheep to get items that had the most versatile use. And no, I did not have tampons. I know they are useful, and when I was a Drill Sergeant use to keep some of the ultra-thin’s on hand to put inside my hat to absorb the sweat to keep it from staining. Several times I did use them for bleeding control.
One thing to consider, is that tampons are designed to absorb, not to apply pressure. The body’s coagulation process works best when you can block the flow of blood so that the platelets can bind. Just putting a tampon on a wound won’t do it. A tampon with pressure will be better. (working on the understanding that you’re using a tampon for major cuts/bleeds, not a paper cut)
Now, I am going to have to do another post called “the minimum first aid kit plus” that includes these suggestions and a few more things that are less versatile and cost a slight bit more.
November 10th, 2012
MamaLiberty: Any particular soap you’d recommend? There’s too many out there, and I bet some are more suitable, or more unsuitable, than others. I assume that the soaps targeted more towards rejuvenation, etc. would be less suitable, besides being more expensive. There’s a hardware store nearby that carries lye soap, and I always have Bronner’s on hand. But it seems easier to store a chunk from a bar soap in the kit.
November 10th, 2012
For carrying things, try a fishing tackle box. They are full of trays to seperate things and can be simple or very complex, cheap on up to expensive.
November 10th, 2012
This is my version of what a Dr. friend from the philipines calls a 3rd world blow out kit. It is in place of the expensive kits that are issued to some military forces. It will pack into a 1 quart ziploc bag.
Matt’s version of the Third World Blow Out Kit.
Inspired by friend .
1 x Reinforced Quart Size ziploc bag
1 x U.S. Army Battle Dressing
1 x Cravat (home made)
1 x Ace Bandage
1 x Dowel (short piece)
1 x Boot Lace (from discard)
1 x Cable Tie
1 x Duct Tape (2 meters)
2 xFeminime knapkin
2 x Bread Tie (around shoe lace)
2 x Nytril Gloves
1 x cayenne pepper straw
Slightly more robust then recommended , but my most likely need in this area will be from a dynamic traffic accident or shotgun wound.
November 10th, 2012
Jed, any soap will do nicely, but I much prefer those without fancy additives – especially the “anti-bacterial” kind.
Soap and water clean wounds by creating a space between the dirt/bacteria/etc. and the wound itself – lifting the bad stuff off the tissues. It’s the surfactant feature that does the job. When you rinse – an important step – the dirt/germs/etc. are flushed from the wound without doing any further damage to the tissues. Alcohol actually works the same way and doesn’t really kill the germs itself, for the most part.
Unfortunately, alcohol, betadine and many other chemicals used for wound cleaning actually irritate the tissues and may damage them further – without providing any mechanism for removing the dirt/germs and dead tissue!
If plain soap and water are available, it seems a shame not to use them. Even before major surgery… the soap and water come before the betadine and other things used to prep the incision site… and for very good reasons.
I carry a small bottle of ordinary, plain dish soap – and have for more than 40 years. A few drops of that and some clean water are best for first aid wound care. Just don’t forget to rinse well too.
November 10th, 2012
Thanks, ML. I hadn’t considered that the surfactant qualities would apply below the particulate level, but it makes complete sense. I was wondering about dish soap too. It’s too easy, in these days of purpose-built cleansers for everything from soup to nuts, to forget that plain old soap can work for a lot of things.
November 10th, 2012
OK – more basics in my kit: include a couple of needles – which work better for me than tweezers on splinters and can be sterilized; a small magnifying glass & mirror, safety pins for securing cloth slings, ace bandages when the clips are lost… they’re useful for many things.
And the whole batch gets organized into waterproof containers or ziplocks, contained in one good sized, waterproof tote. It’s wet a lot here and water is the enemy of the supplies contained inside. And yes, we have smaller packs in vehicles, on the boat, etc. This is the “home kit” which can be quickly loaded into a BOV.
For BOBs, I pared down the packaging – except when it contained dosage information – included a ziplock and then vacumn sealed the whole thing. I separated stuff into Level 1, 2, 3 — based on the probability of needing the contents: bandaids & aspirin/ibuprofen & allergy meds, etc in Level 1, laxatives, immodium, cold/flu meds… Level 2, etc. Saved weight and kept things I wouldn’t likely use waterproof. OH… and you can pack a whole bunch of ziplocks of different sizes into a gal. ziplock and roll it small.
Yes, I have been called OCD and overly organized. Yes, there are knives and scissors for opening the packs. There is redundancy between the packs – in case one is lost or compromised in some way.
November 11th, 2012
I have to clarify that what I meant by ‘Kerlix’ was Kendall brand Kerlix 4″ roll gauze. It’s just that the term is stuck in my head from when I gouged my knee. Went to my regular doc a couple days after visiting the ER, and he told me to use “Kerlix” to hold the dressing in place, just like the ER had done. I didn’t realize that that was a trade name, and it’s just stuck in my head now for that type of gauze. I do know that it’s good stuff, but I don’t know how other brands compare to it.