What's in your first-aid/medical kit?

scott.cr

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Something I realized recently is that I tend to compulsively browse the first-aid aisle as much as I do the flashlight aisle. Since age 15 or so I've always brought some sort of first-aid kit with me whenever leaving the house for anything other than the usual trip to school or work (but now there's always a kit in my car).

One of the first weekend trips I took after becoming a first-aid geek was to Las Vegas to watch the SCORE desert races with my dad and my uncle. Back then, it was a nylon "fanny pack" loaded with bandages that had the words FIRST AID and a red cross puff-painted onto it. Even back then I realized most of the store-bought kits were overpriced garbage.

When I was 17 I joined the Boy Scouts with my best friend Robert. (Tangent: Guess who the only two guys in the entire troop were that brought 3D Maglites on backpacking trips?) On our "10 Essentials" list, a list of 10 things every Scout MUST have on every outing, I managed to convince our Scout master to dump the original listed first-aid kit and replace it with our own DIY version, ooh-rah! Haha...

Some time ago I wanted to get Red Cross certification in first-aid, but all the courses were during my working hours. BUT! My local community college offered EMT training classes at nights, so that's what I opted for. GREAT, GREAT training. Same class professional EMTs take, except I didn't take the state test to become official. I learned a lot, but my main focus was to be protected by the Good Samaritan Act in case I ever get it in my head to render aid to a stranger. Cost of entry was only 50 bucks and a TB test.

Anyway. In addition to the usual "band-aid" type bandages, here are a few things I find to be helpful for the various summer road trips and such:

-OTC drugs, and lots of them. Tylenol, Benadryl, Claritin, Claritin-D, Gas-X, Kaopectate, Pepcid, Pepto, Tums and Zantac. It seems like overkill, but each one has seen use. Travel seems to expose people to a lot of unusual foods and dusts that cause discomfort, so I like to be prepared for all of them. Oh... don't tell anyone I said I carry this, but Midol (daytime use) and Pamprin (nighttime use).

-For gauze, I like Kling or Kerlix, the 3 to 4-inch wide variety... Kerlix rolls tend to be about 36 inches longer than the Kling equivalent.

-Mylar blanket, for protecting a victim that's about to go into shock. It can keep them warm (by covering) or keep them cool (shield them from strong sun, if outdoors).

-Disposable eyewash, which can double is irrigant and contact lens solution.

-Wound irrigant... best (imho) is Irrimax... difficult to buy, but easy to get free samples from their Web site. I also keep a bottle of Betadine as well as Betadine wipes.

-Tempanol temporary dental filling.

-Glucose gel (for diabetics having an insulin reaction)

-Rehydration salts (Cera-Lyte)

-Epi-pen anaphylaxis kit, and believe it or not, I had to use these once, on my friend's wife (she's allergic to garbanzo beans).

-Pupil dilation penlight... yeah yeah I know, I have like 50 other flashlights, but I don't want to burn anyone's eyes out. ;-)

-Water Jel burn dressing. HIGHLY recommended for anyone even considering going into the summer sun. With the UV index what it's been lately, 2nd degree burns are easy to come by. I prefer the 4x16-inch size.

-"Mirasorb" gauze sponges... great all-purpose gauze pad, and they're thick and cushy.

-I also have petroleum gauze and an Ascherman Chest Seal... these are for sucking chest wounds... God I hope to never have to use 'em.

-Syringes (no needles). These things have all kinds of useful purposes, medical and non. Good for precise dosing of liquid meds or to provide a stream of irrigation. I've also used them to hand-feed very small kittens that couldn't nurse or needed drugs administered orally.

-Needle-tip precision tweezers... have to spend $10+ to get good ones.

-Bandage scissors... these usually have blunt tips. And trauma shears. And small precision scissors. You can't have too many scissors.

-Oxygen, non-rebreathing masks and regulator... great to have if you know how to use it, but requires training since oxygen is a vasoconstrictor (constricts blood flow to extremities). Surprisingly inexpensive to buy, too.

-CPR microshields... they make these in keychain sizes, but I've never used one on a live person.

-Single-packed sterile surgical prep scrub brushes. I'm super-careful about infecting someone when treating even minor scrapes. Resistant microbes abound.

-Disposable razor. We've all stuck a Band-Aid over a patch of body hair.

-SAM splint variety pack.

-Disposable thermometers... I could only find a box of 100. Anyone need a few???

-Oral airways... keeps the tongue out of the way to make sure casualties keep breathing.

-I also really like the vacuum-packed military bandages, ie. "Cinch-Tight" for mobile use. They're strongly packed and a huge bandage doesn't take much space in your kit bag.

-Speaking of kit bag, all that gear fits in an Uncle Mike's police duty bag, AND!! It has an external dedicated flashlight pouch. :)

-I get most of my supplies from chinookmed.com. Great customer service, and an unbelievable selection of hard-to-get and military items.
 

Oddjob

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Very comprehensive list! I'm sure there are many around that can give suggestion on what to add. My suggestion (unless you already have them but forget to type them out) would be to add ASA to your OTC drugs for people with chest pain/possible heart attacks and some sort of antbiotic ointment (unless my knowledge has become outdated) And of course the very best thing you can take with you is your own good sense to help avoid ever having to use your kit.
 

coontai

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I'm an active EMT and I have to say WHY DIDN'T YOU TAKE THE STATE TEST!!!!!!!!!!!!!!! Being state certified will put the Good Samaritan Act on steroids for you. I was a little concerned with your epi kit. Although I don't what kind of kit you have, those are often Rx could easily be the source of legal woes. Trauma shears are great and sooo cheap these days so you can toss them. Throw in a water bottle or two for the oral rehydration salts. Also, I found it peculiar that you carry O2 and airway adjuncts but no bp cuffs and stethoscopes. Yeah I know they are pricey, but it is counterintuitive not carry them in your bag.
 

coontai

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Oh almost forgot. I love SAM splints they are great for backpackers, but my dep. doesn't stock them...
 

coontai

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Oh also throw in a couple bottles of water for dehydration and for taking pills with.
 

Raven

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Can anyone offer some insight on whether bandages or tape is best for securing pads?

Both seem equally expensive.
 
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scott.cr

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coontai said:
I'm an active EMT and I have to say WHY DIDN'T YOU TAKE THE STATE TEST!

LOL. Thanks for the advice all around. I didn't list all the gear in my kit (BP cuff, stethoscope); just the stuff I thought CPFers might find interesting. Can you give me some insight to the state test? And... I'll be throwing some clear bottled water into my kit!

BTW, the epinephrine is for people who I know may need it... not something I'd use on strangers...
 

coontai

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I took my state test last august. There is a lot of hype and stress about it, but it was not honestly bad. I'm no genius, but at the end of it you feel like "that's it that is all I had to prove to the state?" I passed and my results came in the mail in less then a week. The test was three clinicals and a written. The clinicals were kind of awkward because over half the instructors I had for the course were the people who graded you on your clinicals. Some people fail for the stupidest things like not saying "scene safety bsl." On the other hand I guess "scene safety bsl" and I have heard some crazy stories about both. I hope I didn't scare you with the legal woes spiel. During my training one of my instructors told me that it had been over 3 years since there was a successful case in my state because the "Good Samaritan act" is incredibly generous to providers. Basically if you do something and you are not being 'compensated' for it you are in the clear unless there is GROSS I mean GROSS negligence. Though the reality is most people don't want your help, which feels like a stab in the back.


PS $50 for emt training is nothing short of a bargain. I shelled out $700 to be a volunteer.
 

daloosh

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Wow, in our state, if you join a volunteer corps, you get covered for the training by your agency, thru state funds. Good on ya, coontai, fer going the extra mile.

Good list Scott! And chinook's got good stuff.

Pupil dilation light - you mean a Streamlight Stylus? Those darn AAAAs...

Here's a few additions:
AMK personal survival kit (mirror, whistle, firestarter, foil, etc)
duct tape - not necessarily for wound closure, but all kinds of uses
scalpel and/or blades
hand warmers
Quikclot (talk about going outside your protocols, I would only use this on a family member, cuz what's the point suing me for something they'll get later anyways...)
Moleskin - handy for ladies in heels, and other blisters

Dude you have so much in there it must weigh a ton. And since it's so heavy, you might as well toss the microshields (you have a regular mask anyways) and add a BVM.

daloosh
 

coldsolderjoint

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*Take this advice at your own risk, I am not a lawyer or legal counsel, and can only offer my opinion. I am also not familiar with your local/state EMS protocols, or legality regarding good sumaritan laws*

As an EMT of 5 years, I would caution you to be very careful as to what care you render to people you do not know. At least in my state, several of those items you have in your kit would be a huge liability issue if administered to an injured civilian. Depending on your state, the "EMT" class, could be considered pretty much basic first aid, and without a comprehensive degree in pharmacology and online medical direction, I would caution you to re-think the intentions of your kit. I would read up on the medical/legal issues, and what kind of liabilities you could be opening yourself up to.

I'm not attacking you or your first aid skills, as such a subject is largely subject to the situation at hand and usually cannot be judged on a comparison basis but rather over a series of time and repeated evaluations.

IMHO, taking an EMT class, but not the test, is worse then taking anything at all. "A little knowledge" is sometimes worse then too much. And, now, you have created an "electronic papertrail" so to speak, of intentions, and blah blah blah subject to lawyer's interpretation.

I'm not saying that I do not have a few OTC drugs in my medical kit in my car, but those are resevered strickly for my own personal use, or some close friends and families.

And actually, as a helpful hint, throw out the pocket masks, get a BVM. Your kit is big enough as it is, and I don't want to be any where near someone's stomach contents. Conterra-inc sells one that claims to be the size of a burrito when folded, although i never personally used or handled one. But on the other hand, you have to worry about your good summaritan law regarding training.

It's kind of sad that medical personal have to concentrate on the "grey area" and "CYA'ing" before they can administer care, but in the same sense, I think a highly efficient regulated system does provide better healthcare in the long run.

Raven said:
Can anyone offer some insight on whether bandages or tape is best for securing pads?

Both seem equally expensive.

I think the Traditional Way is the pad is called the dressing, and then the bandage is wrapped around to hold the pad on. There are also bandages like co-flex (or generics) which offer a little more water resistance, and actually stick to themselves, unlike most "Kling".
 
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4sevens

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scott.cr said:
-Epi-pen anaphylaxis kit, and believe it or not, I had to use these once, on my friend's wife (she's allergic to garbanzo beans).
I have to vouch for the epi-pen. If someone didn't have one of these
when we were in poland in the tatra mountains she would have died from
a bee sting. She pretty much had passed out by the time she got the
shot. She was then airlifted out of the mountains. Scary stuff.
We try to carry one now not just for her sake for anyone else who
might have anaphylaxic shock.

As for legal issues - we were in europe so things are different there.
But if someone is going through shock and you had an epi-pen would you
withhold it based on legal liability? I think I would rather take the risk
than watch someone die when I knew I could have prevented it.
 
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Mike Painter

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coontai said:
I'm an active EMT and I have to say WHY DIDN'T YOU TAKE THE STATE TEST!!!!!!!!!!!!!!! Being state certified will put the Good Samaritan
Act on steroids for you.

Note that the good samaritan act has no provisions at all for what level of provider you are. In fact you have FAR GREATER liability as an EMT than as a first aider. This is considered a professional level and as such you will be held to a higher standard.
Legal action against first aid providers is unheard of. It's not unheard of as an EMT and is heard of quite a bit at the paramedic level.
(An epi-pen without a prescription for the person it will be administered to and without checking other requirements *will* be gross negligence.)

California has never had a state test and local authorities are all switching to the NREMT (National Registry EMT) standards.
1. Just taking the written does not make you an EMT as there are clinical hours and skills testing that must be signed off.
2. 3. You must work under medical medical guidelines that vary from place to place. In my area there are things that a first aider is allowed to do that the EMT is not allowed to do (yet). This means that you could be found grossly neligent for doing something in one county and would not be found liable for in the next county if working as an EMT.

The NREMT requirement will improve EMT's a lot. No more good old boy standards and no more teaching to the test. All testing is done on computer and nobody in a room is likely to see the same test. If you fail, you will not be told what you missed but will be told what areas you missed questions in.
In my opinion the test questions are far better than what I've seen locally.
 

coldsolderjoint

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Mike Painter said:
Note that the good samaritan act has no provisions at all for what level of provider you are. In fact you have FAR GREATER liability as an EMT than as a first aider. This is considered a professional level and as such you will be held to a higher standard.
Legal action against first aid providers is unheard of. It's not unheard of as an EMT and is heard of quite a bit at the paramedic level.
(An epi-pen without a prescription for the person it will be administered to and without checking other requirements *will* be gross negligence.)

+1


The NREMT requirement will improve EMT's a lot. No more good old boy standards and no more teaching to the test. All testing is done on computer and nobody in a room is likely to see the same test. If you fail, you will not be told what you missed but will be told what areas you missed questions in.
In my opinion the test questions are far better than what I've seen locally.

Mike, I think thats probably one of the worst things that EMS has going for it today, the discontinuity of testing/levels of care, for instance, in NJ we only have EMT-B's and Paramedics (EMT-P's). As B's, we arent allowed to intubate, or do any cardiac monitoring, or anything "advanced". But yet, in New York, they have B's, I's, and P's. The I's can do pretty much everythng that our NJ P's do on a regular basis. Their standing protocols are also much different then ours.

We need a standard exam for all the states. Or perhaps go to a federal system. NJ used the national exam for a few years, and then recently, just dropped it to go back to a state test. We have one of the largest volunteer EMS population percentage in the nation, or so I hear, and while there are good and bad things about this, I think the "lower level" test, is a bad thing.

I do understand that there are regional differences, for instance, somewhere out in the midwest, you are likely to have very long transport times, and different interventions could be required. Were as, we are 10 minutes from our local hospitals and 20 minutes from our trauma center. And honestly, I couldnt tell you the correct dosage of activated charcoal for an adult/child, we dont have the stuff, its not in our protocol. I've never put on a pair of MAST pants outside of my intial EMT training, my service doesnt carry them, I'm not sure if anyone else does either. I'd say 80% of our calls, are "taxi rides". There was no reason why they couldnt just drive themselves to the hospital and wait for hours to get treated.

The recent federal NIMS 700 class (ICS on drugs) was supposed to be a step in the right direction for ensuring quality mutal aid with the correct level of care, and I'd be all for that, but just like leading any large group of people, there are going to be those that resist and resist and resist.
 

coontai

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Mike Painter said:
Note that the good samaritan act has no provisions at all for what level of provider you are. In fact you have FAR GREATER liability as an EMT than as a first aider. This is considered a professional level and as such you will be held to a higher standard.
Legal action against first aid providers is unheard of. It's not unheard of as an EMT and is heard of quite a bit at the paramedic level.
(An epi-pen without a prescription for the person it will be administered to and without checking other requirements *will* be gross negligence.)

I to absolutely agree with this statement, but my context was different. To my understanding if you are going illegally to administer a prescription drug I think being legal trained to administer it will be beneficial in this (scott's) case. I still understand this situation is debatable, and I don't believe your opinion is wrong or incorrect by any means. But if I was the judge and a licensed emt administered an epi-pen vs. an unlicensed civilian and there were complications in both cases I would go easier on the emt. Yes the even the Good Samaritan Act allows room for interpretation. I am currently undertaking ALS training (albeit in an unconventional yet state recognized route) and understand the simple equation that more training=more responsibility=more liability. More medical training is simply a double edged sword…
 

coldsolderjoint

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coontai said:
To my understanding if you are going illegally to administer a prescription drug I think being legal trained to administer it will be beneficial in this (scott's) case.

Part of the training is to make sure that the medication is prescriped to THAT patient, it is within its expiration period, and not cloudy. And the patient is exhibiting signs of Anaphilaxis. By jamming it into someone's leg who it is NOT prescribed, you just went against the first thing you were taught. Thats a lawsuit waiting to happen.

coontai said:

But if I was the judge and a licensed emt administered an epi-pen vs. an unlicensed civilian and there were complications in both cases I would go easier on the emt.

Unfortunatley, I do not think you are a judge.. and unfortunatley, I will continue to practice exactly as I have been trained.
 

Mike Painter

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coontai said:
I to absolutely agree with this statement, but my context was different. To my understanding if you are going illegally to administer a prescription drug I think being legal trained to administer it will be beneficial in this (scott's) case. I still understand this situation is debatable, and I don't believe your opinion is wrong or incorrect by any means. But if I was the judge and a licensed emt administered an epi-pen vs. an unlicensed civilian and there were complications in both cases I would go easier on the emt. Yes the even the Good Samaritan Act allows room for interpretation. I am currently undertaking ALS training (albeit in an unconventional yet state recognized route) and understand the simple equation that more training=more responsibility=more liability. More medical training is simply a double edged sword…

That's not how the law works and the judge would absolutely have to go harder on the EMT.
The standard that applies is that of the "Reasonably Prudent Person". An RPP is the person with all the knowledge, training, and experience that the defendant has but the RPP always does the right thing.
A RPP that is a first aider might not know what is needed to administer an epi-pen. The EMT RPP does know that there must be a prescription, that it must be for the person needing it, and that it must be current.

We can do the combi-tube here as EMTB and a lot of places are starting to use using this over other methods.
 

coontai

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Coldersolderjoint:
We are talking about an off duty situation here. In my jurisdiction if you are off duty you are simply out of uniform. On duty of course I would do the 5 rights and go 'online,' but this discussion is referring to a hypothetical off duty situation. I do respect you sticking your training and protocol. However, I like 4sevens and scott am willing to risk legal repercussions in administering a drug like an epi pen in a situation when I cannot go online though I would not administer it if the 5 rights were not checked. That is just way too risky.


Mike:
Of course a judge will go harder on anyone who has more formal and recognized medical training in a court of law. This discussion is about scott. He will be less likely to be sued if he was licensed EMT vs. not one. That is why I am a proponent of state testing. I am not debating how much more liable he would be in the court of law as I have previously stated "more training=more responsibility=more liability. More medical training is simply a double edged sword…" (this statement I stand by strongly and almost always generally true).

EMTs in my jurisdiction are not allowed to do nearly anything ie. No drugs, no combitube. However, they are trained to administer it because the state requires it. So, there is a lot of stuff I could do that I could not do in uniform.
 

Mike Painter

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coontai said:
Mike:
Of course a judge will go harder on anyone who has more formal and recognized medical training in a court of law. This discussion is about scott. He will be less likely to be sued if he was licensed EMT vs. not one.
None of my training and education in any situation where negligance is involved supports this.
"The Law and the Diving Professional' is the only referene I have here that goes into detail about the subject but it is covered in every First Responder and EMT book I've gone through including the latest edition from Mosby Jems.
As a professional you are held to higher standards and even if he was not on-duty, acting only as a first aider, he is far more liable than if he did not, or may not have had the training needed.
An EMT is taught about the medical authority he or she acts under and the rules governing use of an epi-pen and other meds.
It would be a deliberate willful violation of those laws and he would have no defense against any action.
If your EMT class did not include a lawyer making a fool of someone for much less and legal actions, you missed out on what it would be like in court.
 

coontai

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Mike

I am a bit confused by your last post. On one hand you say "None of my training and education in any situation where negligence is involved supports this. None of my training and education in any situation where negligence is involved supports this." "This" being people who have more advance medical training are more liable then those who have less. On the other hand, you say "As a professional you are held to higher standards," and previously you state "the judge would absolutely have to go harder on the EMT" which is more similar to my train of thought. Doctors have more responsibilities then nurses. ALS providers have more responsibility then BLS providers. There is a reason why doctors are constantly sued for millions (for pain and suffering) and EMTs are not sued for as much (although it is common for them to be sued). On an ems side this dichotomy may not be so apparent but as I previously stated this generally true. These days there are a wide variety of "professional" positions.

I do not understand what you are saying here: "he is far more liable than if he did not." Are you saying that if he did not help a bystander he would be liable? There are no duty to act laws that I am aware of. Nothing that I know of legally forces bystanders to helps others.



Finally, I hope no one takes any of these comments personally, but I am interested in this discussion because I am in these situations on a daily basis. Oh and sorry scott for thread jacking.
 
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