Thursday, March 15, 2012

First Aid Kit

It is that time of year when I break out my first aid kit (FAK) to check its expiration dates and to restock any miscellaneous items. So, while doing so I thought I'd snap a few shots and do a post on what I use and my thoughts on FAKs in general. As usual, take it for what it's worth, and the following is just my opinions and not medical advice.

We’ve all heard it before, and I will repeat it here: nothing takes the place of proper training. Like everything else in the field (from bushcraft to survival to you name it) knowledge is the most important and easiest to carry “tool” in your kit. Unfortunately it is also the hardest to “own.” Hands-on training is the best so I recommend that everybody takes an actual class… there are many resources available, including the American Red Cross, community colleges, local public services, and even CERT. I would also like to add that a solid understanding of the basics will get you a long way in an emergency, especially if you remain calm and are creative. 

General FAK Considerations
There are many first aid kits (FAKs) on the market… some are good, some are not so good. While any kit is better than nothing, ideally one’s first aid kit(s) should be tailored to his particular situation. On this topic I offer the following things to consider when building your kit:
  • Level of training and experience – only carry what you are trained to use and are proficient with.
  •   Remoteness/distance to hospital and trip duration – carry extra basic supplies (OTC medications, Band-Aids, etc.) on longer trips or in more isolated areas.
  • Number of people to be serviced by the kit – you may be the only person with a kit, so scale it appropriately.
  • Potential for serious injuries – certain activities, terrain and tools increase the potential for serious injuries. For example, lots of knife and axe use increases the chances of serious lacerations.
  • Pre-existing or chronic conditions – ask your doctor for extra prescription meds, inhalers, Epi-pens, etc. for any conditions or allergies you may have and stock your kit appropriately.
  • Environmental conditions – be prepared for environmental extremes (hot, cold, wet, dry, etc.).

Content Selection
First aid kits do not need to be so comprehensive that they treat almost any potential injury or illness. There is a name for such a kit: it’s called an ambulance. Instead, FAKs should be built to target just the likeliest injuries and the most life-threatening injuries.  Like survival kits, first aid kits are only useful if they are immediately available when needed, so they need to be lightweight and compact so they are easy to carry and therefore more likely to be included on every trip. Efficiency is key in selecting items for a FAK and compromises need to be made. Seek out and include multi-use items wherever possible. 

In an outdoors scenario there is a multitude of mundane injuries and illnesses to deal with, including but not limited to: small scratches, cuts and scrapes, insect bites, slivers, thorns, headaches and muscle pain, chapped lips and sunburn. A few basic items will treat a very wide range of these ailments. While they are minor and not life-threatening, being able to treat them easily sure makes for a better outing.

Unfortunately not all injuries and illnesses are minor. Being outdoors can be risky, especially on rough terrain or if one is using sharp tools. There are many life threatening injuries to consider, but again it is not realistic to try and equip yourself to deal with all of them. Fractures, dislocations, hemorrhage, environmental injuries (hot and cold injuries) and dehydration are likely cases to occur. A few basic items, used thoughtfully and creatively, will cover an acceptable array of serious injuries. 

My Kit
Firstly I need to mention that I have a fair amount of emergency medical training and experience. Secondly I need to mention that I personally only feel that covering the basics is realistic (and desirable), so there isn’t a lot of sexy high-speed gear here. This kit is designed to cover 2 people on a short (1 to 3 day) trip, and I do expect to use sharp tools. It will treat one trauma and a few small injuries with the included supplies. Anything else is beyond the practical scope of a small outdoors FAK in my opinion. This FAK weighs maybe a pound - likely less - and measures 7” x 7” x 2”. It started life as an AMK Ultralight .7 kit. The kit is modular and is broken down as follows:

The FAK unpacked to show the various modules (from L-R: gloves, meds, small, medium, major)

General Items
  •  Nitrile Gloves (3 pairs)
  •  Small Shears

  •  Diamode – (Loreramide, an antidiarrheal)
  •  Motrin – (Ibuprofen, a pain reliever, antiinflammatory, and fever reducer)
  • Benadryl – (Diphenhydramine, an antihistamine)
  •  Ivy-X – (wipe that mitigates poison ivy exposure… supposedly)
  •  Micro Pur tablets (for purifying drinking or irrigation water)

Little “boo-boos” module
  •  Bandages (cloth type, various)
  •  Cleansing wipes
  •  Alcohol swabs
  •  Antibiotic ointment
  • 23 gauge needle
  • Sliver tweezers
  •   AfterBite wipes
Medium “owies” module
  • Gauze (2x2, 3x3 and 4x4)
  • Gauze rolls (2” and 3”)
  •  Duct tape
  • Cloth Medical Tape
  • Wound closure strips (Steri-Strips)
  •   Moleskin

Major “uh-ohs” module
  • Israeli Dressing, 4”
  • Cravat
  • Mylar Blanket

Medium "owie" module

Following are some specific items that I feel individually deserve a brief discussion.

Israeli Dressing -This pressure bandage is a military design that is intended to stop major hemorrhage. The bandage pad  is held in place by elastic that similar to an Ace bandage. It is possible to apply this bandage to an extremity one-handed if self aid is required. Beyond bleeding control it can be used to stabilize fractures, as a sling, to support strains and sprains, to cover an eye, etc. The plastic packaging can be used to improvise an occlusive dressing for an open (sucking) chest wound. I removed the outer packaging to reduce bulk but I didn’t consider that the instructions are on that outer package in case a person unfamiliar with the design needs to use it, so I will swap it out soon.

Cravat - A standard cravat can be used for almost anything. It can augment a pressure dressing, be used sling a fractured arm, stabilize leg fractures, to protect against sunburn… the uses are only limited by your imagination. It can also be used to pre-filter water or to make charred cloth for fires. It comes with 2 safety pins, but I added 2 more because their use is as limitless as the cravat’s.

Duct Tape - Duct tape has stronger adhesive, is less affected by moister (blood, sweat and tears), and is stronger than most all medical tape. Of course duct tape has a ton of uses outside of medical emergencies.

Gloves - Many people do not include gloves, but I think they are very important. Firstly, they protect you, the rescuer, from blood-born nastiest the victim may have. Secondly, gloves help keep the wound from getting contaminated from the dirt, bacteria, food, feces, etc. that may be on your hands. I prefer nitrile gloves because of the increasing prevalence of latex allergies today.

Shears - Again an item often omitted. Why carry a scissors when you already have plenty of sharp cutting tools on hand? Well, there are several reasons. Your tools are likely contaminated from using them, setting them on the ground, putting them into the sheath wet or dirty, etc. Also, they are dangerous… it is way too easy, when things get dicey, to exacerbate a situation by trying to cut clothes, tape, or anything else with a knife. Trauma shears can be gotten for a couple of bucks, they will cut through virtually anything, are very safe for the rescuer and the victim, and weigh very little. Of course they have a ton of other uses besides first aid, but remember to clean them as close to sterile before returning them to your kit any time you use them for anything. 

Items Not in My Kit
There are a few things not included in my kit that some may feel are necessary. As stated earlier, each individual’s kit should be tailored to his needs, and there is nothing wrong with including additional items so long as they do not make it less likely that you do not pack it. I will briefly touch on a couple of items that I do not include in my wilderness kit (although they are, mostly, included in home, car and range FAKs).

Tourniquets - tourniquets are life savers, no doubt, and I have several. But I do not include one in this kit as a calculated risk; I am betting on handling a trauma with items in the kit or making a field expedient tourniquet if the need arises. As stated earlier, there are compromises to make.

CPR Mask - compression only CPR is the layman’s standard now, but likely I’ll just take my chances with old fashioned mouth-to-mouth and chest compressions. In a pinch I can rig a barrier out of some plastic wrapping or similar item.

Hemostatics – these are another modern battlefield life-saver. There are a bunch of different types on the market now, from granulars to pads to rolled gauze, but the cost is high and the shelf life is relatively short. These are also single use items and relatively bulky.

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