Preparing For A Bad Day - A Medics Approach to First Aid Kits

Preparing For A bad Day – A Medics Approach To First Aid Kits

By Matt

A Medics approach to first aid and how to put a reliable first aid kit together to keep you safe wherever you may find yourself

​You Need A First Aid Kit!

​At some point in the not too distant future, you’ll definitely need a first aid kit.

Now is the time to act and do something about it. Before you are unexpectedly confronted with the scene of an accident or a shooting, or when one of your kids falls off the climbing frame at the playpark.

Hopefully, it’ll only be to treat something minor. But maybe more likely, you’ll find yourself as the only level headed guy in a situation where your skills and gear are needed fast.

What Makes a Good Med Kit? First The Why!

​I’ve worked as a Paramedic in some pretty austere/crappy environments, where having consistent, good quality, and reliable equipment is essential for the job.

Medical aid (or First Aid) is about knowing what to do, acting fast to address the problems and to do the simple things well. You often don’t need to complicate issues with loads of expensive additional medical equipment.

​​Ambulances are almost never the first at the scene of an accident.

The first people to arrive are people like you,
first responders who are forced to improvise with what limited equipment,
and the knowledge, they and others might have with them.

​Matt Garner


​You just need to know what to do and have the right equipment to help you do it.


​Knowledge is excellent and having medical gear that does what it needs to do without too much thinking, makes the situation easier to deal with also.

Gear that’s uncomplicated, intuitive to use and does what it says it will do!
First Aid Kit  that's specific to your environment.

Why?
In most workplace environments, city or government regulations dictate to some extent what a Medical kit should comprise of. A lot of this equipment will be surplus in situations you will possibly find yourself involved in.

Place yourself on a hunting trip in the mountains and these kits will be inadequate for the type of injuries that you will maybe be faced with, as well as full of extras you do not need.

A rafting trip down one of the great rivers will need a different kind of kit, definitely waterproof, and band-aids just won’t cut it.
What’s the worse thing that can happen on that sort of trip?

​The City

​In the city, you can reasonably expect an ambulance to turn up, soon after you’ve called by 911 (Or whatever your countries number is).
However, out in the countryside, away from roads and people, you are supported only by who you are with, and what you are able to carry.


​My Work Place

​In my own work environment, I expect to have to deal with significant trauma, high-velocity gunshot wounds, or even blast injuries.
These are, as well as the more routine coughs colds and sore bits.

My work kit is set up to help deal with this. It is heavyish, but for the most part, I can leave it in the truck, rather than having to hump it around all the time. I wouldn’t want to have to hike too far with it either.

I also carry an individual first aid kit (IFAK) ​ light, easily reached, essential items only. Quick “Save A Life” stuff.

What About You! What’s your likeliest emergency?

​Driving?

Do you make long road journeys in the car or truck? - Maybe encountering a road accident is most likely for you then?

​A small medical kit behind your seat might be the most useful and handy option there.

​Hunting?

​Hunting has its share of GSW, and although Hollywood will have you believe that “flesh wounds” are minor and easy to deal with, any wound caused by a hunting rifle is pretty full on

​First Aid kits equipped for the sort of injuries you could expect in a hunting worse case scenario will need to be carried as well as all your hunting gear.

​Hiking?

​Where carrying weight is going to be an issue, like hiking, biking, bugging out whatever, you'll need to pare it down to essential items only.

​You will need to justify everthing that you carry, sometime this will mean leaving behind comfort stuff, in favour of another dressing or splint. Getting the most ​protection, for the pounds you will need to carry!

​Supply:

​​There are a plethora of suppliers out there who put med kits together, and often they are bulked out with unnecessary items to give the illusion of value.
Some will be of little use in a real emergency and if your kit is poorly organised too, you’ll have to hunt through all the bag pockets to find what you need.
This will increase an already stressful situation.

​​You'll need to be familiar with your ​first aid kit, what to use when, and where things are.

​First Aid Kits Need To Address Only A Few Things:

​Airway And Breathing


​Assist with keeping a good flow of air in and out of the lungs by keeping the airway open using simple airways or positioning 

​Keeping Blood Circulating


​Keeping existing blood circulating inside the body by stopping it leaking out of where it should be and keeping the pump (heart) doing its job.

​​Prevent Further Harm


​Helping ​prevent Injuries that contribute to breathing and bleeding getting worse by immobilising and treating other injuries​ and protecting the airway

“​Trauma is the number one killer of people under 46”

Keeping A Constant Supply Of Air Going In And Out
AKA Breathing


When someone is unconscious, all the muscles in the body relax, including the tongue and if they are lying on their back, this will fall to the rear of the throat, blocking the flow of air.
It only takes a short time, for the body to starved of oxygen. The heart will soon stop, followed by rapid death.

We can use three things to keep the airway open,  two known as simple or basic airways, the other requires nothing, except knowing how to use proper positioning.

​1) Positioning

​If someone is unconscious and lying on their back, you can tilt the head back and lift the chin, which will pull the tongue away from the rear of the throat, allowing the proper flow of air in and out.
The downside is you have to keep holding their head back, because as soon as you let go, the head slumps forwards, blocking the throat and airway.

One of the best way to overcome this is to roll the person over onto their side into what used to be known as the recovery position. (AKA - HAS - The High Arm Side position)
It is easy to do, and when the person is lying correctly, the head will be held in the correct position, keeping the airway open.

​2) Simple Airways

We can also use simple airway devices. These are plastic tube devices that keep the airway open, allowing air to pass through to the lungs and back out again.
1) Oral (OP) airway which goes into the mouth and keeps the tongue out of the back of the throat,
2) Nasal (NP) airway, which is a tube that goes into the nostril and extends into the back part of the throat.

Both of these are straightforward to use and will help significantly in maintaining an open airway so there is no interuption of airflow.
​They take up minimal space in a medical kit, and whilst there is a skill involved in their use, this can easily be learnt.

​3) Advanced Airways

​​More advanced airways techniques, including Intubation and LMA’s, require significant training to be able to use them safely and correctly and are better suited by people with the necessary skills and equipment. (Paramedics)

Unless you are specifically trained in their use, it is better to maintain an open airway by doing the simple things well for example head positioning - (head tilt, chin lift)

Sandra Bullock as the uptight FBI Special Agent Sarah Ashburn in the film “The Heat”,  used a knife and a pen to make a hole in someone who was choking’s, throat.

​The Penknife and Ballpoint Pen Trick!


​Sandra Bullock as the uptight FBI Special Agent Sarah Ashburn in the film “The Heat”,  used a knife and a ​straw to make a hole (Cricothyrotomy) in someone who was choking’s, throat.
It didn’t turn out well for her, and unless you have been trained and have the skill, don’t even attempt it.
In my experience it’s messy, you’ll only get one shot, and you can cause untold damage if you get it wrong.


​Keeping A Constant Supply of Blood IN the body.
AKA How to Stop Bleeding.

​Blood needs to go around the body, Pumped by the heart under pressure through arteries - (these are the most prominent blood vessels) - and into capillaries where they pass on oxygen and pick up waste like carbon dioxide from the body organs.

The deoxygenated blood then moves more passively through the veins, back to the heart and on its journey through the lungs and around the body again.

​It needs to happen consistently​ to sustain life!

If an injury happens where tissue damage and bleeding occurs, then the blood is likely to flow or pump out, until it is either stopped by someone’s actions, (yours) or until there is no more blood left to lose.

​Shock - How The Body Copes With Losing Blood

​The human body contains about 8 Pints of blood. So there’s plenty there, to begin with. It can cope with losing some blood by compensating.
The heart beats faster to pump less blood around, and the breathing increases to get more air and hence oxygen, in and around the lungs where it’s needed to oxygenate fresh blood.
The extremity blood vessels also constrict, so that as much blood as possible stays in the major organs of the body.
This is known as “Compensated Shock”

At this point with a loss of blood of up to approx 20%, it’s known as a compensating shock - the body is hanging in there, managing to cope, hopefully with no more problems.

Via Pinterest

​Via Pinterest.com

​Further Blood Loss

​If bleeding continues, then the body is increasingly unable to deal with further loss. The compensation mechanism begins to fail!
The casualty needs IV fluids and a transfusion of blood to survive. The shock rapidly progresses further, and now you are up against a tough situation with a rapidly deteriorating casualty.
It's now De-compensating Shock​

It’s hard, even with the best medical care, to save people when they have de-compensated for a prolonged period, and death from organ failure can soon follow.

​So you know now, that it’s so much better to work on stopping it getting to this point, by doing your best to stop bleeding.

​Stop Bleeding - The How We Do It

1

​Expose The Wound #1

​Sweep for blood using a gloved hand to find where the blood is coming from. Expose the area around the wound by cutting away clothing using shears, so you can get to it properly , be careful using a knife although there are some designed for just this purpose.

2

​Direct Pressure #2

Use a dressing to apply direct pressure to the wound. ​Block the hole where ​the blood's leaking out by using dressings pushed into the wound and held on top with another. This applies direct pressure that's needed deep in the wound where the blood vessels are damaged and bleeding from

​3

​Restrict Blood Flow #3

​With extremity wounds you can ​restrict the blood vessels so that blood can’t go down them - Use tourniquets. Apply the tourniquet high and tight if you can​'t find where the injury is. It will save time and blood trying to find it. ​Otherwise apply the touniquet a hands width above the wound.

​Wound Dressings

​Dressings that contain blood clotting agents like Quick Clot or Chitosan, will also help if they are pressed into the hole (wound) These are known as Blood Stoppers or Bleeding Stoppers.

These will need to be pushed deep into the wound and held firmly in place with dressings as well. The benefit of this type of dressing material is that it accelerates the clot-forming process in the injury.


​If you don’t have any of these dressings, you can use an ordinary bandage and feed it firmly into the wound, bit by bit, and bandage another one over the top to hold it in place.

Medical kits will need to have a range of dressings that are easy and intuitive to use. Essential too, in my view, are dressings that contain Blood clotting Agents (Blood Stoppers or hemostats)

​Blood Stoppers - Clotting Dressings and Hemostats


​When clotting agents first hit the scene several years ago, they were mainly powders or granules you poured into a wound to stop it bleeding.
Unfortunately, many of these new concoctions set off an undesired thermic reaction too.
Painful!
Yes, they did stop bleeding, but they also sometimes damaged the surrounding tissues, causing other complications. These agents were also tricky to remove from wounds during surgery.

Recent Developments:
The ongoing development of hemostatic dressings has evolved exponentially, and now the actual clotting agent is impregnated into gauze dressings so that they can be applied to wounds more easily.
Even some dressings for minor injuries contain these blood clotting compounds, and you can also get band-aids with the hemostatic agent in them now.
​The undesirable side effects of earlier compounds (heat Generation) have now all but been eliminated

​Whatever type you decide to use, do it quickly and get a bandage on over the top of the dressing material to hold it in place. Use firm pressure and if necessary, apply another dressing and bandage over the top of this one.

​Tourniquets

​Restrict The Flow Of Blood Using Tourniquets


​If blood is pumping out from a wounded artery, it can be controlled by compressing the blood vessel closed. Sometimes this is the ONLY way to stop massive bleeding.
Wrap a tourniquet around the limb, a hand width above the wound and tighten it until the bleeding stops.


​Tourniquets work by compressing the blood vessel with its surrounding muscle against the bones within the limb. It can be excruciating, but this stops the blood flowing past the site of the Tourniquet, so there is no further blood loss from there.

They have proven to be very useful with limb wounds that have suffered quite horrifying injury. They can stop major bleeding from arms and legs fast!

​The military uses them in combat zones. We see their use more and more in mainstream urban trauma care too, with the “Stop The Bleed” program, rolling out in the US and hopefully we’ll see this expand worldwide soon also.

Heaven knows it’s where it’s needed!

​Improvised Tourniquets

​Its worth noting that at the Boston Bombing on April 15th 2013, that of the 243 people injured there were 27 Tourniquets applied. None of these was a commercially ​made one. They were all improvised.

​Stop The Bleed Initiative Factoid

Stop The Bleed - A response by the Obama Government to lessen deaths from massive bleeding in MASCAL/active shooter events,
Rolled out worldwide - aim to have bleed kits in community areas and people knowing how to use them.
Hartford consensus - Medical professionals and govt working towards common aim - saving lives from bleeding wounds.

​Commercially Available Tourniquets - CAT, SOF-T And More

Med Kits NEED to have tourniquets. Anyone doing high-risk activities should especially have them available.
They work, and it’s easy to train people how to use them. There are a few recommended tourniquets available

You can read more about Tourniquets in my article here.

Minor Wounds

​Most minor wounds can be dealt with quickly and easily.
Cleaning them out with mild soap and water or irrigating with a mild antiseptic solution, then drying with a clean gauze pad is generally sufficient. A fresh dry dressing applied over the top finishes the job and will protect the wound from dirt.

Some more extensive wounds will require quite invasive stitches, and I don’t advocate using the fishing line in the handle of a Rambo knife to do this.

​Better to stop the bleeding using dressings and get to the nearest hospital emergency department as soon as you can!
Clean small cuts, can be closed quickly with medical superglue or strips specifically designed for the job like steri-strip or similar.
Thin strips of duct tape will do the business too! (temporarily till you can get to proper medical attention)

​Guarding Against Infection

​​
Once bleeding from all wounds has been tackled and stopped, then dressings are about keeping out contaminants or foreign materials that leads to infections. Closing cuts and wounds that are not immaculately clean risks infections developing so really work hard cleaning out any foreign material from wounds before applying dressings.

Blisters and other abrasions will need cleaning, and protective dressings applied. ​Dog and other animal bites can become infected quickly and should be cleaned well with antiseptic solution and checked out by your local emergency department.


Bad Breaks - Broken Bones and Taking
Care Of The Pain

​Minor Breaks


​Minor bone fractures can often be cared for until you can get the casualty to a hospital, with simple splinting and pain relief.
These are known as simple fractures and include the likes of fingers and wrists. Sometimes You can see that something is bent the wrong way.


​Immobilising the break decreases the pain and the risk of further injury. You can use really good splints made of aluminium (SAM Splints) if you have them.  Or you can improvise using cardboard or rolled up magazines, slings and duct tape.

It really doesn’t need to look pretty. 


​Sam splints are malleable aluminium that can be moulded into shape and bandaged or taped to limbs to hold breaks in place. They can also be cut to size easily with shears.


​Big (Long) Bone Breaks

​It takes a great deal of force to break the major long bones, so there is going to be damage to the surrounding fleshy body structures.
These will almost always need a lot of pain relief before moving them.

​Robust and professional splinting devices are more than likely required here too. Although improvised splinting works well if you are in the situation that needs it. Ski poles, camera tripod poles and tree branches are all materials that have been used successfully to splint broken limbs.

Blood loss into the surrounding tissue complicates things though, and if the bone is sticking through the skin, you will need to stop the bleeding by whatever means you can, often aggressively with dressings and possibly tourniquets.
It is challenging to pack dressings into a wound with bone poking out, so you may need to apply dressings around the wound to avoid further damage to the bone and wound area.

​Medications

​Unless you are a physician, you are not allowed to prescribe medications, so any commercially supplied first aid kits can only stock what you can legally buy over the counter at a pharmacy with Over The Counter - OTC - meds!
The responsibility lies with you to read the manufacturers instructions on the packet so that you take it for what it’s intended and you don’t take more than you should.

When stocking your kit with meds, consider what you are most likely to need. You don’t need to carry the large quantities that you might like to have stocked in a medicine cabinet at home.
It’s useful to have a selection of meds to treat minor ailments. There’s no point in suffering, when a couple of pills can possibly sort it or make it bearable for a while.

The meds you’ll see here, are what I feel represent the right balance of what you can easily buy without a prescription.
It's not an exhaustive list, and your own needs and preferences may vary.​

​The only person qualified to give YOU advice on meds is YOUR physician, face to face.
 
This section is for information only. It is NOT advice.
While medications are readily available in pharmacies and supermarkets, it is up to YOU to read the labels and take as directed on the packet.

​Matt

Pain Relief Medication

​If you carry no other meds in your kit, make sure you have something that can help deal with pain.
There are a few groups of pain medications that work on relieving mild to moderate pain.

Non-Steroidal Anti Inflammatories - (NSAIDS) - this includes Ibuprofen, Aspirin and Naproxen.

​All three are readily available, and all have been known to cause gastric upsets for some people.  These are best taken with food.​
Caution for those with Asthma

  • Ibuprofen - various trade names abound - (Advil, Motrin,) including own brand supermarket variants.
    Probably the safest of the three and can be used for all age groups. Beware - there are different strengths of this drug, so read the instructions on the packet carefully. - Used for treating muscle aches and pains and for reducing fever.
  • A​spirin - also known as Acetylsalicylic Acid (Aspro, Disprin) this drug has been around for a long time and is also widely effective at treating inflammation, pain and fever. ​Its a particularly useful Med to have in your kit, as it also inhibits the clotting process and is known to increase survival rates when given following heart attacks. (Best chewed for this)
  • ​Acetaminophen - also known as Paracetamol (Tylenol, Calpol and Panadol) - sits in a group of its own and can be used in conjunction with NSAIDS for a combined effect. 

​It’s essential though, to stick with the dosage on the packet, as these are very hard on the liver. Even minor overdoses can cause liver damage. I​ts often marketed in combinations with codeine, caffeine and also, Hydrocodone (Vicodin)

​Decongestants


​The common cold, bunged up noses, and hay fever, causes you misery and discomfort and messes with your breathing, so medications that can help deal with this are useful to have in your kit.

Pseudoephedrine (Sudafed) (generally now Phenylephrine is used as you can’t turn it into amphetamines) dries up the mucus in your nasal cavities by shrinking the blood vessels. Some variants contain all sorts of combinations of ingredients and some for slow release over more extended periods.


Anti Histamines

Diphenhydramine (Benadryl) - Is excellent for the treatment of the effects of allergic reactions like sneezing, itching, watery eyes and nose.
Warnings on the packet are usually against driving or operating machinery because of this side effect. There are other brands of Antihistamines that don’t cause drowsiness such as Loratadine (Claritin)

Diarrhoea - And The Relief From Travellers Gut
While it’s sometimes best to hydrate and allow stomach upsets to pass through, often you will need something to bung you up so that you can, at least function. Loperamide (Imodium) is one such drug. It works by slowing down the gut and reducing the bowel movements.

Multiple bowel movements will also very quickly dehydrate you, so It’s important to keep taking in fluids regularly. You can supplement these with Oral Rehydration Salts.
Bismuth Subsalicylate (Pepto Bismol) is also used to treat diarrhoea, but will also help with nausea, heartburn and indigestion discomfort.

Remember that slick gear is no substitute for good relevant training. Get some first aid training done as part of your preps.

Keep Safe,
Matt

​Be Ready For A Bad Day

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