First Aid and Medical - Guest Post: DK Richardson

 

First aid and medical

"Baby, you put me stitches..." The DKR Rockers

Summary -

As a former licensed EMT and having worked while in the Air Force as a military medic, the focus here should be on what training you have. I'll outline a basic First Aid Kit (FAK) and let you know why this is important. I describe an advanced FAK, one that is layered - so that the supplies you do buy are appropriate and inexpensive.

The types of injury you can treat with the FAK is discussed as is the issues of Over the Counter medicines. While you can make a very nice FAK for less than a commercial offering, training is one area where you are advised to obtain commercial training. I've listed sources for hands on training and give you sources on the 'Web for follow on and self-training.

Every first aid kit begins with TRAINING!

I find one of the better training providers here in South-Central Alaska is the American Red Cross - a National organization, they are a good first place to check for your training. I'm providing this listing of classes for your convenience. Currentinformation can always be found at www.redcross.org

Online Blended Learning

The American Red Cross program blends web-based technology with traditional classroom learning. Complete the online tutorial at your pace and the written test online. Then complete your skills session in two hours. all your local office for more information.

Wilderness First Aid - 2 Year Certification
This two-day class consists of hands-on activities about how to respond to emergencies when away from the EMS system. Co-developed by the Boy Scouts of America, students will learn a variety of topics including advanced wound care, head and spinal injuries, shock, environmental illnesses and winter survival. Includes free first aid kit. Wilderness First Aid is valid for two (2) years.

Adult CPR/AED with First Aid PLUS Child and Infant CPR
The CPR/ AED component of this class includes conscious and unconscious choking, rescue breathing, and CPR for adults, children, and infants, and AED . CPR/ AED certificate is valid for two (2) years. First Aid includes caring for sudden illnesses, bleeding control, caring for burns, etc. First Aid certificate is valid for two (2) years.

Adult CPR/AED with First Aid
The CPR/ AED component of this class includes conscious and unconscious choking, rescue breathing, and CPR/ AED for adults. CPR/ AED certificate is valid for two (2) years. First Aid includes caring for sudden illnesses, bleeding control, caring for burns, etc. First Aid certificate is valid for two (2) years.

Standard First Aid
First Aid includes care for sudden illness, bleeding control, care for burns, poisoning, allergic reactions, etc. First Aid certificate is valid for two (2) years.

Self-aid and Buddy Care

http://capnhq.custhelp.com/ci/fattach/get/399/0/filename/afh36-2218v2.pdf

The Red Cross recommends that all first aid kits for a family of four include the following:

• First Aid Manual - a must have.
• 2 absorbent compress dressings (5 x 9 inches)
• 25 adhesive bandages (assorted sizes)
• 1 adhesive cloth tape (10 yards x 1 inch)
• 5 antibiotic ointment packets (approximately 1 gram)
• 5 antiseptic wipe packets
• 2 packets of aspirin (81 mg each)
• 1 blanket (space blanket)
• 1 breathing barrier (with one-way valve)
• 1 instant cold compress
• 2 pair of nonlatex gloves (size: large)
• 2 hydrocortisone ointment packets (approximately 1 gram each)
• Scissors
• 1 roller bandage (3 inches wide)
• 1 roller bandage (4 inches wide)
• 5 sterile gauze pads (3 x 3 inches)
• 5 sterile gauze pads (4 x 4 inches)
• Oral thermometer (non-mercury/nonglass)
• 2 triangular bandages
• Tweezers

Okay, that covers the basics.

In my experience. many first aid kits seem to have been built with either a limited vision or a lack of foresight regarding their use in a disaster situation. Worse, some kits contain items that if misused or improperly used can further injure/permanently cripple/kill the‘patient’. Hence my emphasis on professional training - it is easily as good an investment as any you'll make.

I was fortunate enough to have had the opportunity to receive training from both the military and the EMT community to provide field medical support. and to work in military hospital ERs for several years. I was a State licensed and Nationally Registered EMT for many years as well.

Using this field and clinical experience, I have some ideas on First Aid Kits that I think amy be of use to you. I make suggestions on how to build a multi-layer kit, offer some specific advice on items not normally found in First Aid Kits and the reasoning behind the suggestions.

Finally, I posted an image of a multi-layered kit, just to you can see what I've been going on about.

DISCLAIMER - I am not a doctor, and I've never even played one on television.
Always seek consultation with a medical professional whenever possible.

If you have not been trained on certain procedures, do notattempt to perform the procedure - you can harm, permanently injure or worse, cause a lifelong disability.

This information is for educational purposes and for discussion.

It will hopefully get you started on your own training program and help you to build a First Aid Kits that will support your family or group.

No first aid kit, no matter advanced, well stocked or massive is a substitute for training.

Concept
The multilayer approach in building this resource is focused on supporting you, your family or small affiliated group in an abnormal situation, be it long term or short term. It provides the means for escalating support for different types of injury and illness found in a situation with limited or no routine medical care access - such is found in disaster areas.

Each kit supports or provides items to be used with the next level kit. Modular in nature, this allows for the medical supplies to be carried by many members of a group, should displacement occur.

Kit Limitations
Some injuries are so grievous that without surgery, drugs, specialized medical equipment and techniques, the odds of patient survival are extremely limited. Likewise, some injuries while non-emergent, require very specialized treatment - for example, a detached retina. Finally, some diseases require special testing in a lab setting to determine the course of treatment. All of these fall outside of what I and many others would consider “first aid”.

You can, however, provide real first aid care for an injured or sick person that will allow them to recover from their injury - with or without advanced medical intervention. You will find this the driving focus here. Items listed are suggestions, feel free to change or add as you see fit.

Multi-layer - what does that mean? It means you have a series of medical resources (First Aid Kits) or modules if you prefer, each with different levels of items and equipment to match treatment of what the patient is presenting to you, the care provider. Simply put, the modules are designed to support the treatment of different levels of injury.

These levels are:
Minor injury, individual
Minor trauma, individual with limited bleeding
Expansion module for minor trauma kit to deal with significant bleeding
Major trauma - as bad as it gets
Clinical or ‘sick call’’ type issues

Minor injury, individual.

Failure to care for even a seemly minor injury can kill you.

My Grandmother was very alert to minor problems - she often told me that “The Presidents son died from an untreated blister” just before dosing me with some noxious concoction. As it turns out - she remembered a tragic death in the Presidents family - that of Calvin Coolidge Jr in 1924 - from a infected toe blister.

I worked with a youngster in the ER who presented advanced sepsis (blood poisoning). His knee was swollen, with‘angry’ or bright red lines running up the leg. He was in pain with an elevated temperature. We used a large bore syringe to remove over 70cc of pus and cloudy liquid from the swollen knee, then a drain was installed. He was given IV antibiotics. After a hospital stay, he was released and made a full recovery.
What happened? He fell while playing, scraping his knee. His folks washed the area but did nothing further. Even as the child complained of pain in his knee, no further ‘first aid’was attempted. On the morning of the second day after injury, he presented a swollen knee - again, nothing was done until late that night, when he made it into the ER. A string of bad moves that could have easily killed the child.

A simple Individual First Aid Kit (IFAK) would have been enough to properly treat this child for what began as a minor injury. In a multi-layer system, the IFAK is the first of 4 layers - this kit should have something to:

-clean an injury,

-some antibiotic ointment and

-something to cover the injury.

I keep one of several IFAK at hand, work or play. The size factor is focused on something small enough so that you always have it hand - in a pocket, purse, briefcase, or toolbag. One per individual, extras for workspace.

Suggested contents: (you can have whatever you want, these are just suggestions)
Case, hard, designed for cigarettes. Splits in half and is pretty waterproof. The orange color is a plus. Anything from a glasses case to a small bag or pouch will work just as well.
Inside are

Several adhesive bandages - both strip and ‘dot’
4 Providone-Iodine prep pads
2 foil packets of Betadine antibiotic ointment
2 foil packets of ‘triple antibiotic ointment’ - also sold as Neosporin
2 individual doses of eye drops in individual ‘tear-off’ dispensers
1 foil packet of lip balm (Blistex brand)
1 packet of Aspirin (2 tablets in packet)
1 2x2 sterile gauze packet
1 2x3 no-stick gauze packet
1 steel splinter tweezers
1 small LED‘squeeze’ light
1 book of military waterproof MRE matches
1 card with 5 ft of duck tape wound upon the card. - one ‘stripe’of tape is 1/2 in wide, the other 1.5 in wide. The card itself is a old‘credit card sized’ plastic card

The kit also has a ‘manual pencil sharpener’ which looks like a small folding barber razor. Small, it has a two inch ‘razor’ blade that folds into its handle for safety. Just the thing for scraping off cactus needles and the like. There is room for a flat Fresnel lens to spot splinters. I keep one in my wallet, so not shown in this kit.

The case is secured with a large rubber band, which helps keep the case inside of a pocket and can further be used as‘tinder’ if a fire is needed.

The next level in the multi-layer approach is a Minor Trauma kit.

The basis (container) for this is the well known military Individual First Aid Kit, Field (NSN 6545-01-521-8502).

Minor trauma may be falls, twisted or sprained joints, cuts or minimal depth penetrating injury. While not adequate for large lacerations, avulsions or deep penetrating injuries, it should do for the risk posed by your day to day outside activities. One per individual, extras for the work area. Works with ‘expansion’ module listed next.

On summer break from college, I worked for a geophysical exploration company. In remote Montana , one of our field crew was struck just below the knee with a chainsaw in a brush cutting operation. The saw cut deep, into the bone. The location of the injury allowed us to treat and self-evacuate while treating. The crew person required surgery and a hospital stay but thanks to the care given in the field, was able to fully recover with no permanent loss of mobility. The module described here would meet the needs of this type of accident.

Still small in size (4-3/4 inches high by 2-3/8 deep by 4-1/2 wide) the kit was designed to accommodate a waterproof plastic insert box which contained the components of the military Individual First Aid Kit. The first pattern (preferred) has snaps to fasten the cover flap. The case can be attached to any belt via two ALICE clips. This makes a good platform to build upon. The nylon cover is larger than the ‘insert’ allowing for additional items to be added. This container is available from multiple sources on line.

This is for dealing with minor trauma with limited bleeding. Inside the nylon case we find:

8 Providone-Iodine prep pads
2 hand wash packets (commercial - to clean your hands before or after)
1 aluminized mylar ‘survival blanket’ - this to wrap the patient should shock or cold be an issue
1 gauze eye pad
1 set (or more) latex or Nitrile gloves in Ziploc bag, not sterile, but clean
1 Insert, First aid (plastic)
The plastic insert box holds:
3 Dressing, First aid, Field, Individual Troop, 4x7 inches
1 Bandage, muslin, compressed - a triangular bandage, or cravat
2 Band-Aid brand bandage 2x3 in (larger than the 1 x 2 in ones used in simple kits)
1 Band-Aid bandage, extra large
6 adhesive bandages - 4 ‘normal’, 2 small
2 foil packets, triple antibiotic
2 foil packets, burn get (Lidocaine)
4 large safety pins - for use with the cravat
1 packet electrolyte tablets
1 eye drops in tear-off dispenser
1 book of waterproof MRE matches

If you will support an industrial type operation, you may wish to add a pair of tourniquets. Keep in mind, use of a tourniquet will require you to seek advanced, professional medical care at a hospital or trauma centeras soon as possible.

The “expansion” module for the above listed kit is for more extensive trauma, with bleeding. This should be adequate for large lacerations, avulsions or deep penetrating injuries - but not penetrating chest injuries which result in a tension pneumothorax or those resulting in evisceration. One per two group members involved in industrial or dangerous activity with a high risk of injury minimum - one per person is better.

For me, this module is housed in a soft-sided nylon case 8 x 6 x 3 in deep. It has a strap handle and a steel clip similar to a carabiner to hold the case, should that be required. Color is optional, mine happens to be bright red with a First Aid logo on the exterior, but almost any waterproof container will work.

We had a call to respond to where a person had pushed their hand through a plate glass window. The person had severe and deep lacerations to the hand, with soft tissue avulsion (‘meaty’ parts of one finger removed to the bone). This kit would be adequate to deal with this level of injury.

This module contains:

2 sets of latex or nitrile gloves in Ziploc bag
1 package of 10 cotton applicators (Q-tips)
3 5 x 9 sterile combination dressing
2 Dressings, First Aid, Field 4 x 7 in
5 3 x 4 in non-adhering sterile gauze pads
2 tongue depressors/splits
1 bandage compress, muslin - also called triangular bandage or cravat
1 non-stick gauze pad
1 eye patch
1 Band-Aid - extra large
1 roll 2 in self adhering bandage
1 roll 2 in bandage gauze with 2 safety pins
1 tourniquet
1 set plastic ‘splinter’ tweezers
1 set steel tweezers
1 ‘travel sized’ vial of 200mg INN (Ibuprofen) 22 tablets

1 vial of spray Neosporin
3 swabs, tincture of benzoin for use with SteriStrips
2 packages of ‘SteriStrip’ wound closure strips, butterfly bandages are a substitute
15 Providone-Iodine prep pads
30 adhesive bandages (1x 2)
I plastic hard case insert (3.5 x 4 x 1 in deep)
5 2 x 3 non-stick gauze pads
1 3.5 x 5 in moleskin patch
5 eye drop doses in ‘tear off’ dispensers
6 tabs Imodium (OTC)
4 large safety pins
1 #10 sterile scalpel blade
2 foil packets triple antibiotic ointment
2 foil packets ‘burn gel’ (lidocaine)
2 packets electrolyte tablet (2 tabs per packet)

The next level module is for major trauma.

Housed in a surplus M-3 Medic bag, it has supplies for dealing with major trauma, heavy bleeding, crushing injury. At this stage any injury you treat will require professional medical care found at a hospital or trauma center. Designed to provide pre-hospital treatment of large lacerations, avulsions or deep penetrating injuries which may result in a tension pneumothorax or those resulting in evisceration.

These kits are normally built based on the advice of a trauma physician and include items not covered in training at a level below P-EMT. As such, I will just list some items to provide an idea of the level of care that might be provided -

4 sets latex or nitrile gloves

2 N-95 masks
1 set eye protection
1 SAM brand splint
2 Quick-clot gauze, large
2 Quick-clot gauze, small
20 5 x 9 sterile dressings
20 4 x 4 sterile non-stick pads
2 hot packs (hand warmers are fine)
2 cold packs
2 6 in Ace bandages
2 4 in Ace bandages
2 4 in self-adhering bandages
4 rolls 4 in Kale
2 Israeli Emergency Bandage 6 in with slider
1 Israeli Abdominal Emergency Bandage - 12"

or
1 Silver "H" Compression Bandage (optional as it is specialized)
1 set of OTC meds (ASA/INN/antacid/Sudafed) 10 packs of tablets in OTC doses
1 headlamp - LED - stays in kit.

This is a sample- I strongly suggest you discuss the items for this module with your own medical professional and factor in your level of training, location and risk exposure. I don’t discourage the view that having more‘advanced’ supplies is a good thing - for use by medical professionals to treat your group members in case the pros supplies are exhausted. I will caution you however.

About those 'advanced' supplies - in some States suturing, for example, is considered surgery - and requires professional licensing to perform. If all goes well, fine. If things go badly, you can expect trouble on many fronts. The Good Samaritan laws I am familiar with do not cover you if you perform advanced medical procedures without the documented training and licensing required by the local authorities. If society collapses, this is most likely not going to be an issue. If this ‘system’ is for disaster support - it will become an issue. You can make that decision for yourself.

Both so-called M-3 and M17 based “Medic kits” are offered online. The M3 bags are far smaller and easier to carry and work with in the field.
Prices range from under $30 to over $300.

You must examine the offered contents closely! The “trauma items” offered by some vendors includes such items as a 100 ct package of Q-Tips, 100 adhesive strips (Band-Aids) and so on. These items are quite useful, but are not normally considered in the same class as pressure dressings or tourniquets.

Other vendors offer the “Medic kits” as surplus and may include IV setups, IV bags, and other advanced treatment items. All of these advanced items have “use by” or expiration dates and may have issues with packaging that has not kept the items sterile. Use common sense or ask a professional. The medic bags may be purchased empty and filled as you deem appropriate, this is usually the best option. Consultation with a professional can save you money - by not purchasing unnecessary, outdated or overpriced items.

The final module is for what I will term clinical treatment.

Here is where most of the ‘hardware’resides. For me - it is a two part setup. I use a large tackle box which provides water resistant protected storage and a means to organize the items. The other is a commercial ‘first aid’ bag that folds out presenting many pockets to hold items. These are used to provide follow-on treatment and treat ‘sick call’ type complaints - earaches, foreign object in the eye, colds, hay fever and so on.

Typical contents are:

1 box of latex or nitrile gloves
Surgical soap or Betadine or Hibiclens Soap for cleaning your hands and any wound areas that require cleaning. Check with your medical professional on cleaning tips.
Eye protection and masks
5 x 9 sterile pads for wound dressing changes
Adaptic pads for still draining wounds or burn dressing changes
Steri-strips for reclosure of lacerations, if needed, when changing dressings
Multiple swabs, tincture of benzoin. for use with SteriStrips
Several oz of medical saline solution for wound cleaning, eye wash and so on. Several 2 oz squeeze bottles of saline are better then one big container.
Commercial dental kit + several teabags. Ask your dentist what is best for you.
Stethoscope and sphygmomanometer to monitor blood pressure in long term care, monitor for pulmonary sounds (like rales) and to check for distal pulse sounds.

Note - while the simple ‘nurse’ type stethoscope is just fine, the slightly more expensive Rappaport (two headed) type, with changeable diaphragms, offers better sensitivity.

A quality otoscope for ear examinations, an important item if your group includes small children. Some are sold with booklets containing color photos of different conditions.

A UV or Cobalt Blue light for in use in conjunction with orange dye (fluorescein)
to detect foreign bodies in the eye or damage to the surface of the eye.
Used with saline solution eye drops, it can be used to confirm all debris has been removed from the eye. Ask your medical professional to demonstrate correct use before you use these items.

I suggest adding a set of ‘hobby’headband magnifying lenses - very handy in eye examinations - and allow hand-free use.

Some kind of notebook or other means of recording treatment. These records can be important in the long run, certainly valuable to medical professionals if you seek care after treatment.

Activated charcoal and syrup of ipecac are not included in this module. The American Academy of Pediatrics recommends that ipecac syrup not be stocked at home, the same for the charcoal. Activated charcoal can cause‘concretions’ in the intestines, an often fatal condition.
You should closely examine those items your group will carry and consult with a poison control unit to determine risk and treatment if the substance is ingested, now. Examples include water treatment tablets, prescription medicines and so on.

A separate OTC carrier. These may hold:

24 Aspirin, 325 mg Tablet
24 Acetaminophen, 325 mg Tablet
24 Ibuprofen, 200 mg Tablet
24 Diphenhydramine, 25 mg Capsule
24 Diamode, 2 mg Tablet
24 Diotame Tablet
24 Alamag Tablet
24 Sudafed Tablet
3 Cera Lyte 70, 50 g Packet, Lemon
24 Loperamide tablets (Commercial name - Imodium)
12 Triple Antibiotic Ointment
12 Hydrocortisone Cream 1%
Printout - of all OTC meds, showing reactions, contraindications and save dose levels

(Consult a PDR guide IF UNSURE ON OTC MEDS AND INTERACTIONS)

Checking with a medical professional on your selection of OTC meds is a good idea if you have members with prescription medicines or long term health issues.
Prescription drugs and antibiotics are best discussed and obtained from your health care professional. In many jurisdictions possession of prescription items without the accompanying script is a felony.

Do not carry any medicines or pills in unmarked containers. Period.

Officer Friendly and his trusty canine companion just may not understand. Avoid that dirty boot on the neck and those cold steel bracelets - ensure all items are in the original and marked containers.

I have covered a module based approach for first aid treatment of :
*Minor injury, individual
*Minor trauma, individual with limited bleeding
*Expansion module for minor trauma kit to deal with significant bleeding
*Major trauma - as bad as it gets
*Clinical or ‘sick call’’ type issues
In layers that provide for mutual support, ease of carry and distributed carry - avoiding a ‘all eggs in one basket’ for medical support.

 

A milti-layered kit does not need to be expensive or massive - it does need to be tailored to you, your family or group. Check with your local health provider and get that training beforeyou need a FAK.

Good luck.

DKR/dkr

Thank you, Mr. Richardson, for this excellent post. 

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