by Reasonable Rascal

“Mommy! Mommy! Mommy!” You hear your 6 year old son Dustin screaming frantically as he comes running into the house. As he charges into the kitchen he sees you as you are turning to face the oncoming voice of terror and blurts out “Jackie got bit!”

Jackie is your 10 year-old daughter, and for your younger son to be the one coming to you rather than her indicates it must be something serious. Taking a quick second you take your son by the shoulders and ask him “Bit how?” His tearful reply is “The doggie! The bad doggie bit Jackie!”

Thinking quickly, you turn and grab the family medical emergency bag from a nearby shelf where it normally sits in open view, and run out the back door, your panicked son leading the way to his sister.

With the preceding tale of urgent crisis we begin yet another series of articles, the goal of which is to guide you through the process of building various medical aid kits intentionally designed for differing environments and situations, hopefully without breaking the bank or your back in the course of things. There are no “You NEED this” or “You have GOT to…” pronouncements.  Rather this will be a series of articles offered over time guiding you to the construction of medical bags, kits, chests, etc. to fulfill various functions ranging from a quick grab n’ go bag to suggestions for a modest surgical kit (assuming one has the skill set to make proper use of it) and various areas in between.

The lone traveler will want a kit far less complex and weighty than say, someone who operates from a fixed base as part of a large group that includes at least a medic. Likewise the rural homesteader will have differing needs than the team medic, both from the aspect of training and intended mission.

To use the EMS world as an example, we are faced with unknown and varied situations on a routine basis. One day may bring a call for illness that requires little more than assess and transport, the proverbial sick-and-care call. The next week may see a 3-vehicle accident with several victims ranging in age from 3 to 83 years of age. Yet a couple of weeks after that we may have an urban trail hiker with a possible ankle fracture complicated by concomitant heat exhaustion. All require a different approach as far the care required at the scene in order to stabilize the patient for transport. And each is going to call for a different bag, assuming the agency doesn’t still use the 1-size fits all approach. In a situation like that your crew needs to be a minimum of two medics and a caddy.

The Gold Standard

Checking inside the back of an average Paramedic-level ambulance and you will find a cardiac monitor/defibrillator, an airway/oxygen bag, a general first out bag that goes in to virtually every scene, a pediatric bag, a drug bag, and a trauma bag.  And that is just the general run-of-the-mill stuff. Splints, cervical collars, obstetrical gear, portable suction and other specialty items often comprise additional bags. Now add in cabinets full of additional supplies and equipment not intended to leave the vehicle for the most part, such as IV pumps, specialty administration sets and drug delivery systems, ventilators for transport use and more. We are talking about a literal mobile emergency room, one we could only wish we were able to keep in our garage, much less possess the proper knowledge to fully utilize.

But we aren’t operating a rescue service here. Our concern for today’s article is having available to us the proper tools for a home emergency kit that can be grabbed and carried to the back yard, the basement, the garage, the kitchen, or even the neighbor’s place two houses down. We aren’t talking about a Paramedic’s ALS (Advanced Life Support) bag. Nor is this isn’t your blow-out kit for the range, your truck kit for the highway, or even your family camping kit. Not that it can’t function as such if required, just that in the everyday world what you may need at home is likely to be different than what you are going to carry to the range or the job site.

The following recommendations are made with the idea in mind that you are a typical member of a nuclear family, albeit one who believes in making rational preparations for potential day-to-day emergencies. We are assuming for this article that the grid remains up and fully functional, that EMS is a phone call (and 10-30 minutes) away and the hospital across town or down in the valley is open and functioning as usual. In other words, so long as you do your part there is a comprehensive care system waiting to receive you or your family member, neighbor, etc.

I am also going to assume that your household membership includes Dad, Mom, and our aforementioned one each boy and girl ages 6 and 10 respectively. Thus we have two adults who can be basic rescuers, one child who can be taught to recognize an emergency and knows where and how to access the bag and perhaps use a few of the more simple contents – even a 6 year old can be taught to properly don a protective glove and apply direct pressure to a bleeding wound – and an older child who can be taught a modicum of first aid skills.

The list following is by no means exhaustive but intended to be food for thought, as individual situations will vary and may require much more or much less (example: due to budgetary limitations, or a known diabetic in the family). I will try my best to use real-world examples to illustrate key points.

Choosing a Bag    

The first step is deciding what you are going to use for a bag. There are literally hundreds of options, probably thousands if you really wish to argue the point, but we are building a home-use basic medical bag, not the ALS bag spoken of above. We don’t need a 3-D tacticool camo pattern, or 1,800 cubic inches of interior space plus external tie-downs, or a wheeled airline case or 56 separate compartments, elastic loops and gear pockets. Nor do we want a bag by 31 or Gucci.  We just want something easy to spot, grab and run with, which also organizes a few things for quick access without digging through a jumble of clutter as with a small duffle.

I personally favor orange or red for such a bag as the colors catch the eye more easily when you are frantically looking for the emergency bag because your husband has fallen off the roof, or your daughter was just mauled by a stray dog in the front yard.

I have purchased or been given various and sundry bags over the decades and each has their individual merits and drawbacks. Presently my house uses a Nexpak model TF 115 bag in a high visibility orange.  It is inexpensive, durable enough for the intended purpose and offers enough compartments for the items that need to be sorted without being overwhelming as would be a Knickerbocker-style EMS bag with its multiple internal dividers that do as much to hide smaller items as they do to separate them. Depending on what you choose to stock the bag with you may be able to get by for as little as $20 for a similar bag based on needed size, though $30-35 would be more reasonable. For that matter you might find a suitable container for a buck at a garage sale. I have built several such kits for people using such ‘found’ items that are well suited to their individual purposes.

Regardless of what you end up choosing/using there are some common design features you want to stay with:

  • You want a bag that can be tossed. Think down the stairs, up to the roof, or across a fence. This is going to preclude a hard shell case for reasons of weight and the potential for causing harm should someone be hit by it.
  • It should be able to be hand carried, or slung over a shoulder to leave both hands free to climb. Emergencies do not always occur on the kitchen floor of a ranch-style house.
  • It should hold everything carried either with secure outside pockets or firm loops such as MOLLE straps, and/or inside in a non-spill sealed enclosure. Zippers with pull cords work very well in this latter regard. Note that elastic loops are not given preference as they loosen with time and use – MOLLE straps do not.

Inside the Bag

As to the contents here is a rough guideline based in part on what we stock:

  • Airway: channeled bite stick, CPR barrier mask, disposable Ambu Spur resuscitator bag with mask
  • Bleeding: Bulkee Gauze rollers, 4.5” x 4 yds., 4×4 gauze pads – 6-8 individual packs of 2 each, 8” x 9” ABD dressings – 4 each, 4” elastic rollers (Ace type), a few simple Band-Aids, Combat Application Tourniquet (CAT-type), CoFlex UMAFD (Universal Medic Absorbent Foam Dressing) – 2
  • Medications: Baby Aspirin, Benadryl
  • Patient Assessment: BP cuff (adult), Stethoscope, Pulse Oximeter
  • Personal Protection: Nitrile Gloves, Disposable Face Masks, HEPA Masks
  • Splinting: SAM-type roller splint – 36”, SAM forearm splint – 9”, C-Collar – Adult Adjustable, Triangular Bandages
  • Miscellaneous: Chemical Cold Packs, Penlight, Documentation Materials, Emesis Bags, Tape, Trauma Shears, Burn Free Gel, Gelled Alcohol Hand Wash

Why These Items Were Selected

I am a Paramedic and Registered Nurse with decades of practice. My wife is trained as a Wilderness First Responder. Needless to say our skills differ – though her training is ‘enhanced’ – it took place in the Central American jungles of Belize and includes IV skills, suturing, etc.

I also have a more advanced bag I carry at times depending on the circumstances, what my Scouts used to refer to as my ‘portable ambulance.’ But spending a week camped in the mountain wilds vs. being at home with access to everything from a cardiac monitor to portable oxygen equipment and a small clinic’s worth of goods is a horse of a different breed. What we aimed for in our bag was the basic essentials for carrying quickly to the yard or the neighbor’s house. I have what I need quickly, and the lovely bride can also make good use of every item. These are not SHTF bags – they are our everyday common emergency bags, enough to get us by until the local vollie squad arrives, if required.

Airway: the channeled bite stick functions as a tongue blade for examination, and a bite block if necessary though contrary to popular belief they are not intended for seizure cases. It can also be used as a finger splint. The pocket mask, of course, is to provide personal protection when performing mouth-to-mouth and also to help secure a good seal so that such efforts are not wasted. It is simple, very fast to deploy and resides in the right hand end pocket for fast access.

The Ambu Spur is intended to provide qualified ventilation during an emergency. I am well acquainted with the use of same and the wife is also trained, and yes, I have had need when responding as a civilian. The bags are large enough to hold a collapsed ambu with everything else, and if we had children they could also hold a pediatric model as well.

Bleeding: the most likely need for such a bag is going to be an injury that involves bleeding: a shop accident, perhaps with the lawnmower, or a knife slip in the kitchen. If you manage to saw off a couple of fingers using the band saw the contents can address that, and should you run over your foot with the lawnmower the ABD pads come into play. Even minor cuts are covered by the Band-Aids, with a piece of tape over that to help them stay in place.

The combat tourniquet is a given in this day and age. They have been proven time and again on the battlefield and now in the civilian world. These devices are a far cry from what I was initially trained with decades ago. Don’t get me wrong, a belt and a stick will work if called for as a fellow Scout back in 1974 proved to his younger brother’s benefit. The odd thing he did it again almost exactly 5 years later, this time at college. I would hope he carries a CAT with him these days.

I should also add that a Qwik-Clot is not a bad idea either. I know readers here would never make the mistake of cleaning a loaded weapon but there is no accounting for the neighbor. But for your range bag….

Medications: Baby aspirin is to address a heart attack. It can be literally life-saving, and the 10-30 minutes gained before the ambulance arrives can make all the difference. 4 baby aspirin (81 mg each for 324 mgs total) chewed. Baby aspirin is selected because by chewing it gets into the bloodstream faster, and frankly it tastes much better than Bayer adult aspirin. The problem with children is they need to be taught that it is not candy, lest they be tempted to help themselves, as might the 6 year-old example from above. A 10 year-old can be taught to safely discern the need for same.

Benadryl is of course for an allergic reaction. 25 or 50 mg depending on whether we are talking of a child or an adult. Needless to say having an Epi-Pen would be preferable but that requires a prescription, on top of being extremely expensive to acquire and replace as needed the past few years.

Patient Assessment: Normally an adult BP is enough. If BP determination is a concern for a pediatric patient EMS needs to be on the way. Because it is important to have a properly fitting cuff to obtain an accurate reading keeping several sizes is not practical. The decision to do so would be highly individualized and depend strongly on extenuating circumstance. An adult cuff can be successfully used on the forearm should the patient otherwise require a large adult or even obese cuff. Battery-operated wrist cuffs can be useful for routine monitoring but make poor choices for emergency use when low pressures might be an issue.

Stethoscopes are used in conjunction with the BP cuff to auscultate (listen to) the Karotkoff  sounds. Learning to use it for this purpose if no other is a very useful skill, and a 10 year old can be taught to do so successfully. Even a basic provider can also learn to auscultate heart sounds to determine a regular or irregular rhythm, and gross lung sounds such as wheezing that can signal distress.

The pulse oximeter is easily used, simply slipping it onto a finger, hitting the button, and waiting a few seconds for a pulse rate and expressed percentage of oxygen saturation. Other than situations where the blood pressure is very low (poor perfusion) or the extremity is very chilled there is little than can go wrong, though it is potentially useless in cases of carbon monoxide poisoning for reasons best left for another discussion. The maximum perfusion is 100%. Anything at 90% or below is concerning.

If someone has a history of say childhood asthma having an oximeter can make the difference between determining whether an attack is only mildly concerning or instead cause for serious alarm. An oximeter can signal grave concern long before blue lips appear. The price on these devices has dropped significantly such that aside from severe poverty there is no reason not to have one when they cost as little as $14. The pulse ox, as it is commonly called, has become widely regarded as essential to a comprehensive set of vital signs as is determining the rate of breathing.

Personal Protection: Gloves are of course the most commonly used personal barrier device used by everyone nursing aides to surgeons. I strongly recommended nitrile compound over latex or vinyl owing to their lifespan in storage without deteriorating. I have personally tested this to exceed 15 years through temp extremes of 130+ to below zero. Latex becomes a gluey mess and vinyl also has the disadvantage of being slightly porous and becoming sticky with age. Vinyl tears easily and latex more so with age.

Face masks are for instances where blood or other spray (vomitus, for instance) is of concern. There is also a psychological advantage as people tend to assume such items some degree of competency in western culture. Finally, it conceals facial expression such as grimace that is an involuntary response to situations such as vomiting, profound bleeding, etc. Not to mention they can just plain look cool.

HEPA masks are for the rare occasion when actual isolation from infectious cough may be called for (flu, etc.) or perhaps fumes such as smoke, etc. They are of limited use in such cases but are the best that can be had given the circumstances. In my view using less-than-fully-adequate protection is better than none at all. Unless you are trying to perform mouth-to-mouth they will not hinder your efforts.

Splinting: a 36” SAM splint offers a lot of versatility for the buck: upper and lower arms, lower leg and ankle, neck, wrist, etc. SAM splints can be fashioned in various and sundry fashion to fit the situation, and if you are willing can be cut to fit as needed to address a finger fracture, etc.

The 9” SAM is carried precisely so I do not have to cut down the 36” splint. It is also handier for a pediatric splint than trying to manhandle the 36” splint. In actual practice I would rather cut 2” off the 36” splint than the shorter one. The short splint can also be used for the family dog, the same one that saved Jackie from the “bad” dog earlier.

A c-collar is used to immobilize as much as practical the neck following a potential injury that may have damaged the cervical (neck) spine. Even the best are only 65-70% effective, and the soft foam ‘insurance collars’ only rate about 10% effective. Despite the cautions taught for years in EMS classes a lay person can be taught how to properly apply a cervical collar very quickly and easily. The potential benefit is in my opinion far in excess of the potential danger. Even an insurance collar can be used with effectiveness if a SAM is added around the outside to stiffen it (the foam collar serves to protect from the SAM itself in this instance).

Triangular bandages are used to improvise arm slings, tie on leg and arm splints, and make constrictive bandages and much more. They are cheap and versatile.  Think of a Boy Scout neckerchief – the older larger versions and not the more modern semi-mini versions and you can easily see what we are talking about. If you have a choice always select the 36” version triangular over a shorter one. Otherwise your arm sling/upper arm splint won’t fit anyone over 4’ 6”.

Miscellaneous: Here are the various and sundry subjective items that always seem to find their way into any first aid bag.

Pen and Paper: you might want to make some notes while you await the local vollie squad, like name, age, medications, important medical history, and phone numbers for the family who will be following later, ad nauseum.

Chemical cold packs are cheap and quite useful for sprains, bumps and bruises, etc. Use a gauze roller to hold them in place if needs be.

Penlights are useful for the obvious reasons, and people like me have this obsession with checking pupils. Special note applicable in today’s world: if both pupils are widely dilated in the presence of bright light marijuana may be involved.

Emesis bags are a handy thing if you have them. If not a small plastic waste basket liner can be used. Believe it or not sometimes puke needs to be sent with the patient for inspection and perhaps even testing.

I use Burn-Free gel by preference. Burn creams, on the other hand, are useless and can actually worsen a burn by retaining heat. Burn-Free provides nearly instant relief. The gelled alcohol could also be used though I would not apply it to more than a 1st degree burn – alcohol and broken skin do not get along. It is otherwise used to clean potentially infectious material such as blood from the hands until a proper hand washing can be accomplished. And sometimes you may wish to wash before dressing a wound, assuming the need is not urgent.

Trauma shears: Paramedic scissors is another name. Even the cheap $2 pairs can cut thin sheet metal so clothing, belts and certainly gauze are no match. Personal preference will dictate whether you select a 5” or 7” pair. I personally prefer the larger size for my car kit, and use the smaller one at home or in scrub pockets.

Scenario Conclusion:  Upon reaching your daughter you find her sobbing almost inconsolably, with obvious injuries to one leg and her right hand. The family canine protection unit – Bowser – is standing by defensively. The leg looks to have taken the brunt of things and the hand wounds appear to be more defensive in nature. It is messy looking but not serious. She is bleeding in what appears to be a very significant fashion from her left lower leg, though there does not appear to be anything arterial.

You are going to need a trip to the Urgent Care clinic 5 miles away – the local hospital is closer to 12 miles – and you need to control the bleeding. Using 6 year old Dustin as your assistant – partly because you also need to get him less than also panicked  – you first rip open several packs of 4×4 sponges and hold them while he digs out a couple of the ABD dressings, which are applied over the top of the gauze pads to increase absorbency.

You then direct him to dig out the 9” SAM splint and coach him through forming a trough down its length and then placing it against the ABDs, after which you can remove your hands and have Dustin hold the splint while you dig out and make use of a pair of 4” gauze rollers to secure the bandages and splint. The splint will keep the now-bloody bandages from being too obvious and also allow direct pressure to be maintained to the ABDs. You need to drive, after all, and making a 6 year old responsible for his older sister in such a situation may not be the wisest choice.

Yes, you could have called the ambulance, and would have if needed, but they are easily 15 minutes away and your hands were a bit busy for the first while. But the bleeding seems to be under control and Jackie is calming now that she knows she isn’t going to bleed to death. She remains well awake and alert and we aren’t concerned with blood pressures and the like, just getting her to the Urgent Care, and the Sheriff’s office  looking for the stray dog that your family protection dog – Bowser – successfully chased on. You make a mental note to have your husband pick up a couple of cheddar wurst for Bowser on the way home, once you have time to call him, that is. Dustin carried the bag, you help Jackie limp to the garage, and Bowser plays tail gunner, almost daring that stray to reappear.

Now, for the sake of argument, replay this scenario without the house emergency medical bag. Did I mention that during this entire time your cellphone was on the kitchen counter? Without your bag you could only wish that ambulance would be there in a mere 15 minutes.

And because I know it would otherwise come up in the comments we didn’t bother with gloves in this scenario because it was family and we know what they don’t have. 10 year old girls are not likely to be infected with bloodborne pathogens that wouldn’t otherwise require some measure of isolation in their daily life. Had it been anyone outside the family I would expect that we would all have taken a moment to don a pair of gloves easily accessed in the outside Velcro-secured pocket.

Discussion is invited. We’ll build on this in future articles to address family diabetics or epileptic cases, or as applies.

 

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