Med Kit for EMERGENCIES

Of course any serious discussion of emergency preparations must include some thought of medical supplies and medicines for trauma and illness. It is in fact one of the most important preparedness considerations. One can write whole books on what supplies are vital and how they may be used.

As I finally get around to tackling this subject, I am actually very torn along multiple axis about how I should proceed with this subject here. Should I assume that readers are completely untrained novices? moreover, do I stick strictly to established medical guidelines for medical training and standards of care (what the law allows) or do I assume that all bets are off during a survival emergency? also, I know from experience that there is not a more contentious and opiniated group in the medical community than emergency responders. Everyone seems to have an unwavering opinion on what's right and useful, and if you wait around long enough, there will be someone who has a "valid" counter-argument against everything (from CPR to C-spine precautions). I see it every time I go to a training class or re-cert. Inevitably, the various highly trained debaters will start to "pull rank" and start whipping out their level of qualification and years of experience to support their position and to see who has the biggest "cert" in the room.... LOL. Seriously, I've seen medics almost come to blows over proper strapping procedures for a backboard, or how to figure the rule of 9s.

Personally, I am of the school of thought that what is most important is the knowledge (and later, experience) that a medical responder carries in his/her head. Bags full of nice shiny medical gear would be great to have on hand in case of emergency, but, really, most of the emergency techniques and gear can be improvised (especially in an urban disaster setting). Those really effective and helpful pieces of equipment or medicines are expensive, hard to get and harder to carry (and have on hand) i.e. AEDs, O2 tank, IVs, and perishable, controlled meds like Epi or morphine. Secondly, I am greatly disappointed at what is generally sold in the civilian world as so-called First Aid Kits. Even the largest and most extensive kits are really not good for much more than lacerations and maybe some splinting. What I think of when I speak of Medical Kits are for major trauma (battlefield/disaster wounds, burns, fractures) or life threatening illness (cardiac arrest, diabetic shock, aniphyllactic reactions). One will not die (immediately) from minor cuts and scrapes. Also, related to this, is the fact that no matter how well supplied one is, many medical supplies and medicines have a finite shelf life or expire rapidly without refrigeration. Thirdly, and perhaps most controversially, though I do believe in proper training, certifications, continuing education, and following current standards of care, I also believe that in an emergency situation, whatever you do for a patient (with consent) in a good faith attempt to help (as opposed to doing nothing) is all good. In other words, I will do what has to be done to the best of my knowledge.

A decent, practical medical kit IMO should have those band-aids, antiseptics and aspirins that store-bought kits have, but then you should have at least enough bulky dressings for 2 serious hemorrhages (like two GSWs or stab wounds), plus enough tape or bandages to hold them on. Ten 4 x 4 dressings will do. Or two US military field first aid dressings. Cloth medical tape is good multi-purpose tape (but don't forget duct tape which works just as well and can even be an occlusive dressing!). Roller gauze, Kerlex or even an ace bandage will suffice for holding dressings on. A pair of scissors (bandage scissors or medic shears) would be handy (but remember anything sharp can cut bandages and tape). If you don't have the training or the means to get sutures, adhesive steri-strips and/or butterflies are the next best thing. In fact, skillfull use of steri-strips can leave lacerations healing with no scars (don't forget super-glue, originally invented for surgical purposes!). A small bottle of beta-dyne or hydrogen peroxide is good for general anti-septic use and even irrigation (don't forget the other uses of iodine and H2O2 for water purification, dyeing and incendiaries).

My personal medical kit for emergencies has about 7 "modules". You can buy a handy medic pouch (stocked or unstocked) or a nice commercially available FAK with multiple pockets, or, you can place your medical supplies in clear Zip-loc bags and just carry them around in a paper sack for all it matters. As I said, the container that you carry your medical supplies is not terribly important, but that is not to say there are not certain desirable features. Waterproof or water resistant is good. Organized into separate pockets, pouches or sections is helpful for quickly accessing the requisite module, and labeled or colour coded (ROYGBIV) is further advantageous. Clear see through plastic windows or mesh screens are helpful seeing the contents of each module at a glance.

The first and perhaps the most important module is the (black) first responder kit. This module is usually on my belt or separate from the rest of my medical bag. It basically contains the Universal Precautions, and the most basic tools to assist with the initial assessment, gain access, and conduct a head to toe survey. Universal precautions are the gear that protect the medic from the patient... nitrile glove (not latex), mouth barrier breathing device, safety glasses, and liquid hand sanitizer. Basic assessment tools include a reliable penlight, EMT shears, pen (for field notes on glove, tape, or notebook), and a small prying tool of some kind (for light rescue). Though not necessary, intermediate level diagnostic tools like a stethoscope, sphygmomanometer, and are useful. Actually this module can be quite small (about the size of a small belt pouch) but of course if you included everything (like translation book, pediatric conversion wheel) then it can get to be a sizeable pouch (perhaps like a fanny pack in size). I will mention that for most urban medical emergencies (99%), merely this first module is often sufficient... to do the ABCs, get a history, quick survey, and to stabilize (c-spine or control bleeding).... until someone calls 911 and paramedics arrive.

Because of its immediate relation to the basic ABC steps, the next (green for 02) module is primarily about supporting respiration. If I had my druthers, I'd of course like to have an O2 bottle. Oxygen is a treatment that is indicated in a large range of medical and trauma emergencies, if for nothing else to prevent shock. Unfortunately, O2 bottles are heavy, bulky, and not always practical to carry around in a portable med kit. Additionally, they require certification (license or prescription), servicing (refills), and maintenance (annual corrosion check). My recommendation is if you have the time and the means, by all means get O2. Get lots of O2. Probably the main thing that I keep in this module is an Ambu-bag and pocket mask with 02 adapter. This allows rescue breathing without direct contact. I also have an NRM and nasal cannula. The rest of this module is airways, nasal-pharyngeal and a complete set of oral-pharyngeal.

Probably the most conventional and recognized module of a medical kit is (red) for bleeding/hemorrhaging control. Indeed, this is what most commercial/civilian first aid kits concentrate on. This includes lots of 4 x 4 sterile gauze dressings, bulkier abdominal dressings, rolled bandages, rolled Kerlex, and perhaps some occlusive dressings (with petroleum jelly) for pneumothorax. A pair of bandage scissors and first aid tape would normally complete this part of the kit. Now I always like to point out at this point that (sterility aside) direct pressure, dressings, pressure points, and even tourniquets do not really require special equipment or supplies. I will improvise and use whatever materials are on hand (sheets, towels, napkins, feminine products, t-shirt, a belt, a necktie, power cord, plastic sandwich bag). The military designs neatly compacted, sterile, camoufluaged dressings of various sizes, specifically for various battlefield wounds (such as GSW), so if you can secure a source, military dressings and bandages will save lots of time, space, and have proven effectiveness. The core of my hemorrhage control measures are military dressings and surgical dressings. I would like to briefly mention two highly effective military products for controlling bleeding. One is the so-called "Israeli" bandage which is a field first aid dressing that a wounded soldier can deploy by oneself, even one handed! very useful. And two, there is a current wave of popularity of this coagulant powder called Quik Clot. Quik Clot can be very effective for certain types of wounds (like penetrative trauma where arterial bleeding is not involved), but should be used with caution by the untrained because of the hazard of doing more harm than good by using it inappropriately.

I don't mean this to be a field first aid training class, but I think it is worth mentioning that although stopping ex-sanguination is a medical priority, a human can bleed out quite a bit before it becomes life threatening. One good training exercise is to pour out some water and actually "see" for oneself what a cup of water looks like poured out onto the ground or soaked into clothes. One may be surprised how big a puddle a small volume of water can make. About 4 to 5 cups is when the danger of hypo-volemic shock (reaction to life threatening blood loss)sets in. Even in the case of amputations, the human body reacts rapidly to shunt blood flow to the core and not as much blood as one might expect gets lost after the initial hemorrhaging. And finally, because humans are such brain-intensive animals, head wounds tend to bleed profusely and always look horrible and serious even from small lacerations. I mention all of these things perhaps to bring calm and comfort to the emergency responder and victim, that bleeding, though serious, is not always critical (say, within 10-20 mins) and rudimentary measures, like simply slapping your hand over a wound firmly, greatly extends that time. The main exception is arterial bleeding or major organs. True story, during training we saw video footage of Oakland paramedics saving a gunshot victim hit 9 times with a 9mm pistol. The GSW victim survived because no major arteries or organs (except one punctured lung) were hit, medics immediately supported volume and a vascular surgeon repaired all the tiny punctures.

Probably the last "conventional" (as in, might be found in standard first aid kits) module is my (orange for) ortho kit which might be the largest in my med kit, containing supplies for C-spine immobilization, splinting, taping, and cold-packs. An adjustable cervical spine collar is the main piece of gear in this category. Generally, I would rely on improvising for splints, but I do stock a couple of compact, versatile Sam Splints which are like these fully padded rolled pieces of metal mesh which can be extended, folded and shaped into adequate splints for any extremity. The rest of the kit is medical tape, elastic bandages, velcro strapping, and instant chemical cold packs, for sprains, strains, and reducing swelling. Now in my bigger "battlefield" kit, which is a big backpack, I would also carry a KED and KED Sled which is another immobilization device and a sort of drag sled/emergency stretcher.

The final three modules are generally beyond the scope of basic first aid, and most people are not trained in the use of this equipment. Nevertheless, I'm going to mention them here perhaps as suggestions as to what you might consider supplying yourself with just in case (as in just in case a medic or someone more highly trained becomes part of your survival group).

The obstetrics kit (actually sold in complete kit form) is obviously for delivering babies in the field. It contains drapes, swabs, sterile gloves, scalpel, bulb suction device, umbilical clamps, surgical mask, and pads. Once again, I will mention that there is nothing "special" about this gear in particular. Everything can fairly easily be improvised or fabricated with some imagination, and when it comes right down to it, women have been successfully giving birth without assistance for many millenia (so when it comes right down to it, birth is not necessarily a medical emergency unless there is some complication). That's why it's yellow and bright (yellow and mellow).

Probably my most controversial module as far as course and scope (legally) is my (surgical blue) surgical kit. Yes, I said surgical. I have not been formally trained as a surgeon and I hold no medical license. However, through my science education (dissections, anatomy and physiology, pre-med training), private studies, life experiences, and on the job training, I have amassed knowledge in certain basic surgical procedures such as suturing, phlebotomy, administering IVs, and emergency procedures like crichs and needle thoracostomy. I would not presume to do any surgery on anyone else (I might on a family member in a dire, dire emergency when there is no other alternative). However, I can aver that I have sutured myself, I have surgically removed foreign objects from myself, I have drained and debrided my own wounds, and I have even extracted my own teeth (plural)so far without ill effects. Basically, I just bought this ready-made Surgical Kit from a mail order source. It contains needles/sutures, syringes, scalpels, hemostats, forceps (kelly, metzenbaums, banjo), surgical scissors, and beta-dyne swabs. It also comes with Catheters for IVs. IV bags of NS, D5W and LR are great to have (for supporting volume, administering drugs, rehydration/nourishment), however, they are bulky, heavy, fragile, and perishable, so unless someone is financing me, I don't carry them with the exception of a small 250 ml plastic bottle of normal saline for irrigation. The other plastic bottle that I carry in my kit is Beta-dyne (staining iodine solution) for use as a topical anti-septic.

Lastly, my (magical purple) module is for my medications. One can get all the basic medications over the counter. Analgesics (pain killers), anti-pyretics (fever reducers), and anti-inflammatories (relaxants) are the core meds... i.e. acetominophen, aspirin, ibuprofen and anaprosyn. Next come meds for specific maladies... decongenstants, anti-allergy, anti-diarrheal, anti-emetics (stopping nausea and vomiting). Most of these are most commonly in pill or capsule form. Whenever possible, I like liqui-gels, or liquid forms of these meds because I think they are faster acting and more absorbable. I like fast acting and multi-use meds like Alka-Seltzer with Aspirin, or Sudafed PE (allergy medicine with decongestant). I also prefer medicines sealed in individual single dose packages or blister packs (rather than bottles full of pills). There are common OTC meds available for just about every symptom from acid reflux to toothache so what you choose to stock is up to your medical needs and concerns. Some good readily available specialty meds to have on hand are Insta-glucose (for insulin shock), activated charcoal (for poisoning) and Ipecac (for inducing vomiting). Certain controlled or prescription drugs are very useful to have on hand, most importantly, a good general anti-biotic. I prefer Amoxycillin, however, be aware that some people are allergic to penicillin compounds. I suppose it's no big secret that meds like anti-biotics are readily available without much hassle online or mail order. Another handy source if you happen to live near the border is foreign pharmacies. The last few meds that I will mention are genuinely hard to get (legally) but I consider them essential if you are going to travel to an area where you might be separated from modern medical facilities or might be in imminent danger of serious injury (like a conflict zone).
Epinephrine in a convenient auto-injector pen mainly for allergic reactions, Atropine also in an auto-injector (used to re-start the heart), and Morphine Sulfate in pill form for moderate to severe pain. These are powerful and potentially dangerous medicines which unfortunately have recreational allure. I have possessed all three of these important medications legally and extra-legally, but again, they are tightly controlled, expire rapidly, and are expensive to obtain, so I will put out the recommendation but the practicality of actually getting them are problematic at best.

All of these supplies are stored in one of my waterproof "disaster" tubs and are logically divided into a large (backpack), medium (medic shoulder bag), and small (belt pouch-fanny pack). My medical bags are military OD green, advantageous if the situation is tactical, but I have reflective emblems and panels attached with velcro for highway safety and identification. I used to have bright safety orange bags, but found them too... gaudy... and attention/curiosity attracting.