First Aid Kit

Nickle,

Seriously if the kit contains sharp, pointy things it wouldn't surprise me at all if they refuse to ship here. I vaguely recall reading of this happening on a 1st aid kit that someone tried to mail-order to MA.

Problem is that everyone is scared shitless of the AG (justifiably so) and the companies set policies that over-react as a result.
 
Nickle, take a close look at the Glock items in the Sportsman Guide catalog. They won't sell a Glock holster or tool kit here!
 
I remember the first time I took a first aid course. I was working as an armored car guard, and the nice ladies teaching it got real flustered when I kept asking questions about treating gunshot wounds. [grin]

The state agency where I currently work put me through CPR and First Aid, and puts me through an annual one day refresher. The CPR is good, the first aid is something of a joke. Much of it is various ways to do splints and bandage various body parts, and we have nurses and physician's assistants on duty around the clock, so we know we'll never use that stuff, all we really have to do is keep the kid alive for the five minutes the professionals will need to reach him.

One of John Farnam's assistant instructors, Anthony Barerra, aka DocGunn, is an MD with twenty years of ER experience; and the two of them have put together a one day TACTICAL TRAETMENT OF GUNSHOT WOUNDS course.

(I think it is similar to one that Chris Dwiggins of Gunsite used to teach before his untimely death.)

Anyway, it's half shooting and half simple Tac-Med.

I took it last year, and it's AWESOME!

The Israeli Battle Dressing, with proper training, can be put on any part of the body, yours or someone elses, (one handed if necessary) and used to bring bleeding under control.

A Naseo-Pharyngial (sp?) Airway and a way of dealing with a Tension Pneumothorax (sp?) finish out the kit.

That's it. That's a Gunshot Wound Trauma Kit.

NESHooters should see if they can bring John and Tony up to Pelham to teach this.

Oh, the IBDs and Airway are available through Galls.
www.galls.com

Hope this helped.

Regards
John
 
sellscottsell said:
I found some great first aid supplies here

http://www.actiongear.com

You can order Quick Clot battlefield agents and more. This is serious stuff, but if needed, the real McCoy.
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Quick Clot has some serious drawbacks and should not be used in most cases. The biggest drawback is that it's exothermic and generates considerable heat. There is a serious risk of second or even third degree burns. It's not the cure all that some people think it is.

Gary
 
Optimistic Paranoid said:
Much of it is various ways to do splints and bandage various body parts, and we have nurses and physician's assistants on duty around the clock, so we know we'll never use that stuff, all we really have to do is keep the kid alive for the five minutes the professionals will need to reach him.
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You think so, huh? If the agency that you are referring to is involved in the business of keeping people in facilities where they don't want to be, those RNs and PAs are well trained in primary care. They are NOT, as most RNs and PAs are not, trained in emergency care. The professionals will be whatever EMS service is called to remove the kid and transport him/her to the hospital.
Chances are the PA or RN is going to be looking to you, I hope you paid attention during that joke training.

Treatment of trauma in out of the hospital is geared to one thing. That is keeping the person alive until they can get to an operating room. Notice, I said operating room, not emergency room. Surgeon's have a saying, "Nothing heals like cold steel". The treatment for most gunshot wounds is surgery. Not medications, except where they are supportive of surgery.

All that splinting and bandaging stuff, along with airway control and assisting breathing is what is going to keep the patient alive until someone with more training and equipment arrives.

Optimistic Paranoid said:
A Naseo-Pharyngial (sp?) Airway and a way of dealing with a Tension Pneumothorax (sp?) finish out the kit.
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If you plan to use either of those, I'd add the phone number of a good attorney. No, wait, make that two good attorney's. One criminal defense, one civil litigator. Nasopharyngeal Airways are beyond the scope of practice of first responders. Any sort of treatment of a Tension Pneumothorax is beyond the scope of practice of both a first responder OR basic level EMT. John and Tony may be wonderful instructors and the course may have been interesting, but I somehow doubt that it certified you to do any of the treatments they demonstrated. Decompressing a chest is not something for first responders to even contemplate. Speaking of Tension Pneumothorax, did they teach you how to determine if a patient has one? For that matter did they point out that the vast majority of them are caused by blunt, not penetrating trauma?

Please save me the argument about "Well if the guy was going to die it's what I would have to do", because the reality is that treatments of any type applied incorrectly can do way more harm than good.

Why do you think the first rule of medicine is "First, do no harm"?

Gary
 
I'll have to agree with Garys on this. The ONLY folks I know of that can do Advanced First Aid with out having serious Medical Training/Certification is the Military, and then ONLY under certain circumstances, like in a Combat Zone, and administered to a fellow soldier or a POW.

But, then, under those circumstances, we're exempt from Civil Litigation for any mistakes as well.

Bottom Line - If you're not Certified to do it, don't do it.
 
Gary brings up some very valid points. First, being that the number one rule is, First, do no harm. (The second is, if you drop the baby, pick it up. But that's another topic.)

There has long been the dispute between Paramedics, RN's, PA's, and even MD's. There has been more than one occassion in my 14 year stint as a Paramedic that I've had law enforcement physically remove an "MD" from my scene and my patient. RN's, PA's and MD's all have "specialties" as it relates to their primarmy functions in an institution. I've known, and worked with, some great ER nurses and Doc's. However, having an OB nurse (or Doc) on a trauma scene is quite annoying.

Again, Gary is correct when referring to the first priority of a true trauma patient is preserving the "Golden Hour" and delivering a viable patient to a trauma surgeon in a trauma facility.

Airway management is one of the most critical aspects of the first responder. OP / NP airways are a viable treatment for the certified first responder as they are non-invasive (they don't pass the pharynx and enter the cords). They are simple devices aimed at keeping the tongue from blocking the airway. Some of the blind esophageal tubes in conjuction with a bag valve mask can be used at the basic level in many areas.

Tension Pneumo / Hemothorax can be treated at the basic level as it relates to a sucking chest wound by having the abilty to recognize it, properly position the victim, and properly applying an occlusive dressing, maintaining an airway and artificial respirations if needed. Decompressing and intubating are ALS functions.

The attention to, and the splinting of, angulated extremity fractures often cost the life of the trauma patient. Simply because these are visuals that will often draw the attention of basic responders away from the ABC's - Airway, Breathing, and Circulation. Even the nastiest looking fracture bent seven ways from Sunday will rarely ever be life threatening. The two caveats to this is the case of a femur or pelvic fracture that compromises a great vessel.

The femur fracture that compromises the femoral artery will most times compartmentalize and not cause death (if that is the only trauma) but prolong treatment will cost the patient his limb. The pelvis, however, contains enough "hollow" space to allow exanguination. Again, these can only be treated definitively by a trauma surgeon.

Basic life-saving can be summed up, I believe, in being able to properly apply the ABC's, protect the C-Spine, and controlling massive external hemmorage while arranging for prompt professional intervention.

Hope this helps.
 
Yup, what Nickle said. When I took my basic EMT I already knew how to do more than most because of the training I got in the Army for first aid. Alot of what I learned in the Army I was not allowed to do As a basic EMT.
 
TonyD said:
Gary brings up some very valid points. First, being that the number one rule is, First, do no harm. (The second is, if you drop the baby, pick it up. But that's another topic.
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I thought the second rule was "All bleeing stops eventually".

There has long been the dispute between Paramedics, RN's, PA's, and even MD's. There has been more than one occassion in my 14 year stint as a Paramedic that I've had law enforcement physically remove an "MD" from my scene and my patient.
Click to expand...

Well, I could write a book about that. Maybe I will someday. There was this one time I asked a nurse about the patient's allergies and she told me to be sure not to give him any NKDA because he was allergic to it. No, I'm not kidding.

Again, Gary is correct when referring to the first priority of a true trauma patient is preserving the "Golden Hour" and delivering a viable patient to a trauma surgeon in a trauma facility.
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Get used to it Tony, I usually am. <G>

Tension Pneumo / Hemothorax can be treated at the basic level as it relates to a sucking chest wound by having the abilty to recognize it, properly position the victim, and properly applying an occlusive dressing, maintaining an airway and artificial respirations if needed. Decompressing and intubating are ALS functions.
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The incidence of either is pretty rare in penetrating trauma. I should maybe say GSW, as I've seen way more sucking chest wounds from knives than guns. Bullet wounds seem to have a propensity to self seal. As a rule of thumb, the diameter of the wound has to be greater than the diameter of the patient's airway for it to make a sucking wound.

The attention to, and the splinting of, angulated extremity fractures often cost the life of the trauma patient.
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Yeah, what he said. Ugly wounds get a lot of attention because they are ugly.

The pelvis, however, contains enough "hollow" space to allow exanguination. Again, these can only be treated definitively by a trauma surgeon.
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And sometimes not even then. Of course the mortality for women from Pelvic Fx is higher than for men.

Basic life-saving can be summed up, I believe, in being able to properly apply the ABC's, protect the C-Spine, and controlling massive external hemmorage while arranging for prompt professional intervention.

Hope this helps.
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Pretty much. Which is why I get kick out of 20-40 hour first responder courses. Including CPR, a first responder course shouldn't take more than about 12 hours, even if you toss in Oxygen and taking BPs.

For Nickel and Mrs. Wildweasel, even though the military has adopted EMT style training, it's far different than what we see in the civilian world. I'm a bit rusty on it but don't they teach "Combat Life Saving" to all infantry now? The 91W MOS is supposed to be both primary care and combat medic, I think. In any case, what you can do under combat situations is far different than the constraints I face on a daily basis. Then again, if I deploy with FEMA it's a different situation 'cause it's likely to be a disaster. What we're responding too that it. <G>

Gary
 
From what Alan told us while they were getting ready to deploy. He learned alot more, and also how to do IV's since they are in a combat area.
 
TonyD said:
I'm allergic to NKDA! Does that come in ampules or multi-dose vials??
[rofl]
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I don't know, I can never find it in the PDR. I did once have a patient tell me he was allergic to Oxygen. THAT was intersting too.

Gary
 
Naw, psyche. COPDers usually know how much O2 they use. This guy was just a nut job. It's been so long, I don't remember why we were trying to give him O2. Then again, psyches get sick too.

We had one guy that was "allergic" to Albuterol. Not really, he just didn't like the side effects and wouldn't let us give it to him. Which wasn't a problem until we stopped using Alupent.

Gary
 
Hey, that's not an allergy! Any diver can tell you that Oxygen is poisonous. Breathing it under pressure can kill you. I know some people who are showing the symptoms, and if I were in the right location, would consider it my moral duty to stop them from consuming more of this deadly toxin. [rolleyes]

Ken
 
Garys said:
You think so, huh? If the agency that you are referring to is involved in the business of keeping people in facilities where they don't want to be, those RNs and PAs are well trained in primary care. They are NOT, as most RNs and PAs are not, trained in emergency care. The professionals will be whatever EMS service is called to remove the kid and transport him/her to the hospital.
Chances are the PA or RN is going to be looking to you, I hope you paid attention during that joke training.
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Hmmn. Looks like I kicked over a can of worms here with my post.

First, let me clarify one thing. I don't think the first aid training I receive is a joke. I think the joke is that the Dilbert's World Bureaucracy I work for mandates that I take training in techniques that the very policies they have put in place GUARANTEE that I will never be able to use on the job.

In the event that one of the kids in here is injured, I am required to IMMEDIATELY summon the medical staff and apply such first responder techniques as are needed to keep him alive until the medical staff arrives.

Which, for all practical purposes, means CPR and controlling bleeding by direct pressure

It's interesting that someone else here mentioned that they had had an MD or nurse led away in handcuffs by LE. That could never happen in here. From the instant Medical staff arrives at the scene, he or she is GOD. Not even my Facility Director can over rule them on a medical question. We do exactly what they tell us to, and ONLY what they tell us to do.

THEY decide whether to summon the Rescue Squad, Transport to a hospital, etc. There is exactly a 0% chance - INSIDE THESE FENCES - that I will ever have to splint some kids broken leg or bandage around an impaled object or stuff like that.

Nevertheless, the bureaucracy here requires that I take an annual refresher in such techniques, just so they can check off a box on a form somewhere. And that's what I find funny.


Garys said:
If you plan to use either of those, I'd add the phone number of a good attorney. No, wait, make that two good attorney's. One criminal defense, one civil litigator. Nasopharyngeal Airways are beyond the scope of practice of first responders. Any sort of treatment of a Tension Pneumothorax is beyond the scope of practice of both a first responder OR basic level EMT. John and Tony may be wonderful instructors and the course may have been interesting, but I somehow doubt that it certified you to do any of the treatments they demonstrated.
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One of the more interesting aspects about training with different people is when highly qualified people disagree.

A couple of years ago I took a handgun course with John Farnam. John raves about the usefulness of OC ("pepper") spray in general, and FOX brand in particular, and recommends we all carry it.

A couple of months later, I took a course with Louis Awerback . (Whom Jeff Cooper has publicly referred to as a "Master Trainer") Louis thinks OC spray is useless, doesn't work, and we shouldn't waste our time with it.

Hmmn..


Now, I don't know you, but it appears that you are a highly trained paramedic or EMT with many years of experience, and you're telling me that - in your opinion - this naseo-pharyngial airway thing is way too complicated for an uncertified person like myself to do, and I better have a good lawyer if I try it.

On the other hand, I've taken a course with an MD with twenty years of ER experience, and he tells me that I not only CAN do it - IF I HAVE TO - but that if circumstances warrant it and I DON'T do it, then my loved one will die while I stand around helplessly waiting for you professionals to show up.

Hmmn

Believe me, under those circumstances, my lack of a properly signed and notarized permission slip from the proper state bureaucrat will be the LEAST of my concerns. But I do understand why YOU have to be concerned with it in YOUR life

Finally, not to put too fine a point on it, I appreciate where you're coming from as far as NORMAL circumstances go, but isn't this a SURVIVAL forum, where we also consider situations so screwed up that no help will be available and we'll be thrown totally on our own resources?

Regards
John
 
Optimistic Paranoid said:
Hmmn. Looks like I kicked over a can of worms here with my post.

First, let me clarify one thing. I don't think the first aid training I receive is a joke. I think the joke is that the Dilbert's World Bureaucracy I work for mandates that I take training in techniques that the very policies they have put in place GUARANTEE that I will never be able to use on the job.
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It might just be that state law requires that you have the training. MA requires all police officer and fire fighters be trained as first responders. CO's don't fall under that law, but I think they still have to be trained. It's overkill as there is a lot of stuff in the FR curriculum that they are never going to use.

Which, for all practical purposes, means CPR and controlling bleeding by direct pressure
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Which is about all that a first responder should need.

It's interesting that someone else here mentioned that they had had an MD or nurse led away in handcuffs by LE. That could never happen in here.
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Totally different set of circumstances. Presumably TonyD was talking about the same type of situation that I was. Someone walks up during the middle of a call and identifies themselves as a doctor. Then they try to take over. The first problem is actually knowing if they are a doctor or not. The second is knowing if they are willing to take responsibility for the patient. Generally when we explain that first we have to get authorization from our medical control doctor to allow them to takeover AND that they have to go to th hospital with the patient AND that we have to see a copy of their wallet card, they generally leave. This is a different situation than if we are called to a doctor's office or clinic. Then we just take the patient and leave.

Nevertheless, the bureaucracy here requires that I take an annual refresher in such techniques, just so they can check off a box on a form somewhere. And that's what I find funny.
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Reading the forms and checking the boxes is someone's job security. <G>

On the other hand, I've taken a course with an MD with twenty years of ER experience, and he tells me that I not only CAN do it - IF I HAVE TO - but that if circumstances warrant it and I DON'T do it, then my loved one will die while I stand around helplessly waiting for you professionals to show up.
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Generally if it's a family member no one is going to say boo. If it's someone that you know really well, you're fine. If it's someone you know less well or a stranger, you can run into trouble. From your original post, it seemed that the advice you got was unclear on the distinctions.


Finally, not to put too fine a point on it, I appreciate where you're coming from as far as NORMAL circumstances go, but isn't this a SURVIVAL forum, where we also consider situations so screwed up that no help will be available and we'll be thrown totally on our own resources?

Regards
John
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Yeah, probably. In which case there won't be too many bureaucrats looking over forms. The problem is that some people, and I'm not saying you're one of them, can't tell the difference between the two sets of circumstances. File under "A little knowledge is a dangerous thing".

Gary
 
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I found a serious kit that's just great.

Hi all,

I haven't posted here much at all but have been poking around the different forums from time to time. This subject caught my eye, however.

My wife and I travel to very remote destinations for fishing or camping. Many times we are completely isolated and must call a plane to be extracted should an emergency occur. So, I decided to invest in an authentic EMT kit and learn how to use it.

I purchased one from here. Scroll down to the bright orange "first responders" kit.

http://www.imsplus.com/ims24.html

I wanted something that included sutures and splints along with all the other bits and pieces found in exotic kits. It even includes a stethoscope. I've also "beefed" it up by adding a large assortment of meds like aspirin, peroxide, soaps, non-aspirin, water purification tablets, assorted salves and balms and ointments, heart-burn stuff, bandages, alcohol, and a bunch of other similar items. Plus, I've even got a few items like antibiotics and codeine from our home med cabinet. They are dated so I keep them current. I’ve explained to my physician our situation and he’s been helpful with that. We’re only taking very small amounts with no refills. Basically, I'm good to go for just about anything that might happen when we're so isolated.

I also got this bag just in case there was another emergency that would hamper getting to a physician or hospital. I live in rural CT and if we headed to the hills, I'd be comfortable knowing that I could deal with incidents that a more meager kit would not be able to handle. I also travel with this bag in the trunk knowing that I can always find some Tums if I need 'em. LOL

On our last wilderness trip, I actually found a use for some of this. My wife broke her foot 36 hours before our float plane was to arrive to extract us. It was a 4mm break in her 5th metatarsal and very painful. I was able to use the chemical cold packs to address the swelling and fixed her up so she was comfortable until the next morning. She was on crutches when we left the hospital in Millinocket Maine that morning and remained that way for 8 weeks. That put a damper on further trips last summer! Even if it had been a compound fracture, however, we would have been prepared. We keep up on our training (I'm an old Eagle Scout) and I truly believe in the motto "be prepared"!

The next thing I'm going to do is sit down with someone who knows their stuff and pare through this kit, adding what might be missing and removing things that won't really be needed or can be replaced locally. It's a bit of a chore but being able to be reliably comfortable knowing that I'm self-sufficient is quite comforting.

Just thought I'd share.

Rome
 
Cabinetman, that is one of the reasons Glenn and I have a very extensive first aid kit. Mainly because of all the 4 wheeling we have done, and we realize that the places we go someone would have to be lifeflighted out for someting serious. One thing you might want to concider is epi-pens. Our doc gives us yearly refills on them. We knock on wood we have never had to use them, but we have had some of the guys get really badly stung. We had the benadryl.
In all the years we have been wheeling we have not had anything major happen.
 
Thanks for that suggestion but believe it or not, we include at least one of them, too! In her last year of college, our daughter developed a HUGE seafood allergy (probably because of all the lobster she was injesting up in Maine!) and now has to carry an epi-pen herself no matter where she goes. Fortunately, she has not had to use it but has come close. So, when she recycles them, they come to me. And I could get "new" ones by simply asking.

Doctors are very forthcoming with good things if you simply ask and explain why you might need them. We're not going to become druggies, after all, but having important things like the epi-pen and some codine can be crucial in the wilderness when you can' get out.......or are hiding in the hills. Thanks for the reply.

Rome
 

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