Recently, we presented you with a first aid kit, and asked how you would improve it. We got a lot of great responses, but this one was so good we decided to make it a post of its own.
See the original post here.
OK, Lets get the credentials out of the way... (skip the first paragraph if you don't care) I am a paramedic. I work in a county with both dense metropolitan, and very rural, districts. I have been working in emergency medicine for my entire adult life, and have responded to thousands of emergencies. I teach prehospital trauma life support, among several other "merit badge" classes. The hospitals in some of our service areas have about the same capability as your pocket first aid kit, so I frequently find myself taking care of patients for well over an hour through traffic to the nearest trauma center. I load people into helicopters fairly often, but they aren't always available due to weather. I spent my youth on a skateboard, riding motorcycles and ATVs, hiking, camping, climbing, surfing, etc... I have injured myself more times than I care to admit.
I've been injured far from help and with nothing, and made it work. I know from reading your blog that you are aware of the limitations of a "pocket" first aid kit, so I'll spare you the criticism. I got about half way through the replies to this before becoming frustrated enough to respond. You asked about what fits in a pocket, and got generic "wisdom" about what belongs in a much larger kit. I'm not going to remind you to carry a cell phone, or pack a hospital. I get what you're asking, and here are my suggestions:
Z-folded impregnated gauze is the best option currently available for control of arterial bleeding in a groin, axilla, or buttocks. Those who mentioned it are spot on... To place it correctly requires that both hands alternate to maintain constant pressure directly over the compromised artery. This would be VERY difficult to do on yourself. The z-fold is superior to rolled gauze because it is much less likely to roll onto the ground and become contaminated while you're packing a wound.
A commercially manufactured tourniquet, that you are able to reliably apply with one hand, belongs in EVERY kit. If you need to apply a tourniquet to yourself it needs to be prepped and ready and within reach. Using torn clothing is an OK fallback plan if a competent person is applying it for you. If you truly intend to be "self-reliant", you'll want to buy at least one tourniquet. I like the CAT, but brands don't matter. Just make sure its wide, easy to tighten, and that you know how to use it.
Those two things will be enough to control most bleeding to a groin, axilla, or extremity. Unfortunately treating significant hemorrhage to any other part of your body will require bulkier stuff than you're looking to carry. I was once given an OLAES bandage by a supply rep, and I'm a fan. They're not unlike other "do it all" bandage designs, but they are better than the others I've used. They have a large enough quantity of gauze to wrap a head. The elastic wrap is long enough to wrap all but the largest torso, and easily immobilize wrists and ankles. The pad can soak up quite a bit of blood. The plastic cup can apply pointed pressure to an artery and free up your hands. Don't underestimate how important that is. I've been stuck holding an artery for over an hour. If you're also tasked with getting yourself back to civilisation you'll need your hands. The plastic piece will also suffice as an eye cup. To top it off there is a large occlusive (plastic) sheet inside that can be used to cover exposed guts, plug a sucking wound, etc... This bandage, and others like it, are not small. They definitely will not fit comfortably in a pocket. It would be a good idea to keep one on your motorcycle, or in a backpack nearby.
For small but deep cuts, super glue is great. This isn't about holding yourself together till you get to a hospital either. I've used super glue on my self a definitive treatment. Hold it together, apply and let dry. A few people mentioned that your tube will be dried out when you need it, and they're right. I buy 5 packs of single use tubes, and leave the original seal intact till I need it. Cyanoacrylate sold as " derma-bond" is not special, and not worth extra money. The gel is easier to apply than the standard liquid. Glue works MUCH better than adhesive strips. Alternatively, proper sutures are not difficult to obtain or use. They're cheap, and a couple sets easily fit in a pocket. Suturing is not common practice in civilian prehospital medicine, but with all the time I've spent in hospitals I've helped with miles of stitches. You'll want two hemostats to alternate while making each stitch. Get a piece of flesh from a hunt, or your butcher and practice. I'm sure a quick google search will yield plenty of videos. Staples work well, but sutures work better and take up less space.
Improvising various splints and bandages with sticks and clothing will require tools. I have tens of thousands of dollars in medical supplies at my disposal, and still frequently find myself fabricating something during an emergency. Sometimes improvised stuff just works better. At work I carried absolutely nothing on my person for years... that is until the Leatherman Raptor came out. I'm not one to endorse anything, but I love this tool. I've cut off boots, wetsuits, riding gear, and countless pairs of jeans. It is still sharp as new and in great shape. I've passed it to other medics, firefighters, ER docs, and nurses, and ALWAYS remembered to get it back. That says something. After using mine people generally inquire about it and have one in their pocket the next time I see them.
Gloves are a good idea. Sterile gloves are in sterile packaging, and must be applied with sterile technique in a sterile environment to stay that way. More realistically, just keep a few pairs of nitrile gloves in a clean bag. If a wound is bad enough to need gloves, you'll also be receiving antibiotics in the hospital. That's not to say infection prevention is not important, just that the benefit you'll get from sterile vs regular gloves is minimized by the place you're using them.
Something to keep warm is necessary. A space blanket is better than nothing, and worth the space in your backpack. Blood does not clot properly if you fail to maintain your body temperature. If you expect to have a long trip to a hospital with nothing but small bandages over serious wounds, you'll need to maintain your ability to clot. This doesn't need to be a first aid kit item. Pack clothing in layers and always bring enough to stay warm.
Benadryl is a must. It's not about snake bites... The world is full of things that you MIGHT be allergic to. If you are far from help and find out the hard way, a little Benadryl can save your life. If you have a severe allergy that you're aware of, carry an epi pen. Benadryl won't stop the most severe reactions, but should be taken at the onset of symptoms anyway. It may hold you over until help arrives.
Aspirin is small, and easy to add to your kit, so carry it. It sounds like you are mostly with young healthy people, and not likely to drop from a heart attack. If, however, you happen to run across someone who is having a heart attack... Aspirin can reduce the effects of a heart attack even after the onset of symptoms. I buy the powdered kind, cause it dissolves quickly and works faster.
Tylenol is better for reducing fever than ibuprofen, and if you're far enough from civilisation you may need it. That said, I prefer ibuprofen as a pain medicine. If you're more than 8 hours away from help, it would be wise to carry both. They can be alternated to control fever/pain much more effectively than carrying just one.
Water treatment, and basic (non life saving) over the counter medications should be on your list, but you shouldn't need anyone's advice. If you prefer Pepto Bismol to Imodium, thats what you should use. I'm sure you didn't make it to adulthood without learning what basic medications work for you.
That is pretty much all I'd suggest carrying in a "pocket" kit. To address other comments regarding "knowledge"... I would never recommend against taking medical classes, but it would be unwise for someone to consider themselves proficient in providing emergency medical care after taking a class. Common sense is much more important, and if you spend your time with people who have it, you may never need all this stuff. Also, be vaccinated. Stay up to date on your tetanus shots (every 5 years). Start your trips well fed and well hydrated, and stay that way. Know your limitations. If you're riding motorcycles, a riding class is a better investment than a first aid class. If you're looking to learn first aid, go ride out with your local emergency medical service and get your hands bloody. That's how you really learn. You'll never fit a sufficient quantity of medical supplies in a single pocket, but the above mentioned items are a good start. I hope you don't need them... Be safe out there.