Trauma bag

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migm

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hi guys,

one of my lovely xmas presents is a first aid/first responder bag I can put in my car or take with me. What sortof things should be in there that would be actually helpful and not useless/flashy?

Merry xmas,
M
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http://forums.studentdoctor.net/showthread.php?t=115794

Edit:
That link is useful but be mindful of the sarcasm.

My jump bag is the free one they handed out first day of orientation (soft sideds work best).

Remember that some of this stuff is temp-sensitive.

Nitriles and mask on top

A few ziplock bags with Qs (bandaids antisep gauze tape hemostatics etc), a tube of denat alc for cleanups.

Spare steth, a notepad, epi pen, albut inhaler, flashlight.

And a plush toy for lil junior in the backseat. <--- Most used item on this list

I keep roadflares, triangles in the back of my truck. Prepare ahead of time for the (likely?) moment in your life when you are the first on scene of a MVA.
 
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migm said:
hi guys,

one of my lovely xmas presents is a first aid/first responder bag I can put in my car or take with me. What sortof things should be in there that would be actually helpful and not useless/flashy?

Merry xmas,
M
Click to expand...

You should carry equipment you know how to and are licensed to use. Anything else is, by definition "useless/flashy."

#1: cellphone.
 
A robust and efficient electronic medical record system ......


Otherwise, I'd say BVM, 14 gauge angiocath, some duct tape, and a blanket
 
A satellite phone so that you can call 911 from wherever, and get the patient transported somwhere where someone can actually help them....
 
racerwad said:
You should carry equipment you know how to and are licensed to use. Anything else is, by definition "useless/flashy."

#1: cellphone.
Click to expand...

Thanks for posting this useless tidbit!

Consider this a first aid bag - obviously any real trauma the answer is transport to a medical facility. I figured it didn't need to be said
 
migm said:
Thanks for posting this useless tidbit!

Consider this a first aid bag - obviously any real trauma the answer is transport to a medical facility. I figured it didn't need to be said
Click to expand...

Are you serious? You didn't know what "should be" inside and now you're saying you know enough to discern that my suggestion was a "useless tidbit"? Granted, there was some sarcasm, but I am serious. Any commercially available first aid kit will have more than enough supplies for you. Unless of course the bag is empty. Then, I'd look at some of the basic kits available from some more legit vendors and take into account the kinds of situations you're most likely to encounter. Get OTC "misery meds" for runny noses and headaches and consider it good.

As someone else suggested, PPE is also a good idea.
 
As a first responder?

c-collar and nitrile gloves (and maybe a stethoscope/BP cuff for VS)

most important = cell phone

>90% of the time that's all you'll ever need.
 
racerwad said:
Are you serious? You didn't know what "should be" inside and now you're saying you know enough to discern that my suggestion was a "useless tidbit"? Granted, there was some sarcasm, but I am serious. Any commercially available first aid kit will have more than enough supplies for you. Unless of course the bag is empty. Then, I'd look at some of the basic kits available from some more legit vendors and take into account the kinds of situations you're most likely to encounter. Get OTC "misery meds" for runny noses and headaches and consider it good.

As someone else suggested, PPE is also a good idea.
Click to expand...

I never said I didn't know what should be inside. I was a volunteer EMT-B for 3 years (but that was many years ago), I'll be an EM resident in 6 months. I wanted helpful suggestions for a currently empty first aid bag in case I'm not in the ER and I need to be handy (be it on a camping trip, at a minor accident scene or basic BLS equipment to maintain A's B's and C's while help is on the way), etc. In this way your comment about cell phones while significant, was presented in an unashamedly sarcastic, dismissive and unhelpful way and you shouldn't be surprised you got snark in return.

Anyway, PPE is always a good thought, and so is a BVM + oral airways and C-collar. Worth it to add suture/small suture kit, lidocaine, quick clot?
 
Don't forget to include a stamped and addressed envelope, writing utensil, and patient satisfaction survey.
 
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I carry lots of stuff into the wilderness. I carry a cell phone in my car. Either it's not serious enough that you need to do anything immediately, or it's too serious for anything you have besides a cell phone and an AED to do any good. BVM? I guess I could justify that. An Epi-pen would go pretty high on my list. A C-collar? Give me a break. I've come upon several people who needed c-spine immobilization. Guess what I did? I held their head until the medics showed up in 5 minutes and then I put the collar on them. They have all kinds of fancy stuff in those ambulances.
 
migm said:
I never said I didn't know what should be inside. I was a volunteer EMT-B for 3 years (but that was many years ago), I'll be an EM resident in 6 months. I wanted helpful suggestions for a currently empty first aid bag in case I'm not in the ER and I need to be handy (be it on a camping trip, at a minor accident scene or basic BLS equipment to maintain A's B's and C's while help is on the way), etc. In this way your comment about cell phones while significant, was presented in an unashamedly sarcastic, dismissive and unhelpful way and you shouldn't be surprised you got snark in return.

Anyway, PPE is always a good thought, and so is a BVM + oral airways and C-collar. Worth it to add suture/small suture kit, lidocaine, quick clot?
Click to expand...

Trunk of the car and camping are pretty different scenarios. Lots of gloves and other protective equipment would probably be first on my list. Basic stuff like band-aids, 4x4's, a bottle of saline, bacitracin, etc. would be next. You don't need a BVM. A pocket rescue mask should be sufficient, smaller, and easier to use with one person anyway. OPA's are a good idea. If you are truly going to be in the wilderness and far from care, things like a basic suture set or rescue meds might come in handy. Then again, if you are truly in the wilderness I doubt you're going to want to lug that crap around. I can hardly imagine a scenario where you would need suture materials at a MVC scene. A tourniquet is a good idea. A decent flashlight, trauma shears, one of those foil blankets would all be good.
 
migm said:
I never said I didn't know what should be inside. I was a volunteer EMT-B for 3 years (but that was many years ago), I'll be an EM resident in 6 months. I wanted helpful suggestions for a currently empty first aid bag in case I'm not in the ER and I need to be handy (be it on a camping trip, at a minor accident scene or basic BLS equipment to maintain A's B's and C's while help is on the way), etc. In this way your comment about cell phones while significant, was presented in an unashamedly sarcastic, dismissive and unhelpful way and you shouldn't be surprised you got snark in return.

Anyway, PPE is always a good thought, and so is a BVM + oral airways and C-collar. Worth it to add suture/small suture kit, lidocaine, quick clot?
Click to expand...

Your original post made it seem like you were looking for suggestions for a list of Rescue Rickey stuff and lidocaine/suture kit, quick clot, etc in a "first aid/first responder" bag is definitely RR. If, as a physician, you want stuff for a backpacking/wilderness medicine/end of the world bug-out bag, that's different.

A standard BLS kit from Remote Medical would probably serve as the perfect guide for such a kit. A tourniquet (eg-SOF) and nasal (rather than only OPAs) airways, bandages, tape, and 4x4s are probably all you really need. A good headlamp so you can work hands-free is key. Once you have been on the job for a while, you can add/subtract to the kit as you see fit.

And, I don't think that suggesting that you only pack stuff you know how to use/licensed to use is all that useless or snarky. The subtext was: if you knew how to use it, then you'd know to pack it; if you didn't know it pack it, you probably don't need it because you probably shouldn't be using it. I wasn't trying to hurt your feelings ;)
 
Another thing would be to pre-load your iPhone or iPad with McGyver episodes in case you need to cric someone with a straw, retrograde intubate with fishing line or make fire for cautery by rubbing toothpicks together.

:)



(Sorry, not every post by me can be deadpan serious :p )
 
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All kidding aside though, once EMS gets to a scene you can supervise them. Although a basic first-aid kit can't hurt, I agree with the others, that if armed with a cellphone and ACLS skills, you bridge the 5-10 min gap with a phone call to 911 and good CPR (+defib if lucky enough to have available) until the meat wagon arrives.
 
Birdstrike said:
All kidding aside though, once EMS gets to a scene you can supervise them. Although a basic first-aid kit can't hurt, I agree with the others, that if armed with a cellphone and ACLS skills, you bridge the 5-10 min gap with a phone call to 911 and good CPR (+defib if lucky enough to have available) until the meat wagon arrives.
Click to expand...

I think what I bolded is what the OP was getting at originally; that is, what supplies would allow someone to use those skills in a pre-hospital setting. Did I get that right, OP?

The best ACLS/ALS skill for most situations is boring old BLS and that usually just means an OPA/NPA, tourniquet, and/or CPR.
 
I really don't see myself intubating anyone in the field. The tools to do BLS while calling for help and also be able to not be useless out where supplies are lacking but I am present (first aid) is what I'm lookin for this bag to let me do.

Stickers, scanners, paramedic pants and other ridiculous stuff need not apply.
 
Have a look through here for a guide about what you could include: http://www.remotemedical.com/results#!Equipment-Supply_2&ea_c=wilderness-medical-kits

You mentioned that you're going to be an EM resident soon...you could look into your county's EMS protocols and see if they have a outline of what the minimum supplies are for a BLS ambulance and go from there. That can be handy. Usually the protocols are available online as a .pdf.
 
Trauma shears, a good knife, or something similar to cut seat belts are a must. My friend's baby daughter almost choked to death when she got tangled up in the seat belt of a car that wasn't even crashed. If there is a crash and a fire, you might need to get people out of the car in a hurry, and that will certainly mean cutting seat belts.

Oh, and a good bright flashlight. Replace the batteries every year or two whether you've used them or not. If you're the first on scene at an MVC, there's a good chance it's 2AM on a dark and stormy night.
 
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Birdstrike said:
All kidding aside though, once EMS gets to a scene you can supervise them. Although a basic first-aid kit can't hurt, I agree with the others, that if armed with a cellphone and ACLS skills, you bridge the 5-10 min gap with a phone call to 911 and good CPR (+defib if lucky enough to have available) until the meat wagon arrives.
Click to expand...

With all do respect, the above is a bit misinformed. I guess it depends on the state/local jurisdiction, but we're taught to respectfully ignore physicians, of any speciality, unless they're willing to ride along. Under state mandate they MUST assume ALL care and responsibility until transfer at the ED (that means ride in the back and do stuff). Once we inform them of this, all the help tends to disperse. Even then, we're encouraged to have them consult. EM physicians (you guys/gals understandably) are the only ones I would be comfortable listening to. Smile and nod, get in the back of the ambulance, and then follow protocol. Orders from a local FM/IM? Consult the EM base station or follow protocol. Even if a EM physician gives us an order that doesn't follow protocol it requires review by the local jurisdiction and state. Understandably we're hesitant to do anything out of the normal for fear of the potentially lengthy QA process. It's not that we don't respect physicians from other specialities, or that they're not capable of emergency care, but there can be serious consequences for us.

We're given a few reasons for this: A) It's too difficult for us to verify medical speciality. B) Non-EM physicians take control, get in over their head, and then bail out, essentially leaving us a mess. With this said, I have heard of local EM physicians performing skills in the field. One performed an emergency cricothyrotomy on a pediatric trauma and I've heard of difficult intubations. I know there is a reluctance to do too much due to malpractice concerns. I know a few former paramedics, who despite an itch to ride along, are worried about their livelihood.

In the end, this never happens. With respect to physicians, I feel there is a healthy respect that our field is unique and should be left to the experts (emergency med physicians and EM staff). Nurses are a different story. I feel like every home has an outspoken nurse around the corner waiting to yell at us.
 
migm said:
I never said I didn't know what should be inside. I was a volunteer EMT-B for 3 years (but that was many years ago), I'll be an EM resident in 6 months. I wanted helpful suggestions for a currently empty first aid bag in case I'm not in the ER and I need to be handy (be it on a camping trip, at a minor accident scene or basic BLS equipment to maintain A's B's and C's while help is on the way), etc. In this way your comment about cell phones while significant, was presented in an unashamedly sarcastic, dismissive and unhelpful way and you shouldn't be surprised you got snark in return.

Anyway, PPE is always a good thought, and so is a BVM + oral airways and C-collar. Worth it to add suture/small suture kit, lidocaine, quick clot?
Click to expand...

Sure, you can hold c-spine and wait for the medics. But you wont have any free hands to do a pt assessment, splint, control bleeding, administer epi, or make a phone call.

OP Keep it basic, a good start:
Pocket mask, OPA/NPA, SAM splint, Kerlix, 4x4s, tape, tourniquet, multitool/knife, blanket, road flares, flashlight.

I would only include a small suture kit in a wilderness med pack and tourniquets are far more effective and cheaper than quickclot.

If you really want to help, start carrying around an AED. The only prehospital intervention proven to make a difference.
 
Deleted due to civil agreement between parties.
 
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Paratodoc said:
Oh, misinformed: "false or inaccurate information, especially that which is deliberately intended to deceive." (OED). Past participle. My point isn't that you're not informed at all,[/]
Click to expand...


I appreciate the clarification. Sorry for the rant which was overblown. If you've been on this forum a while you'll know I put a lot into my posts, and to put me on the "uninformed" end of the bell curve as far as posters go, I think is pretty unfair. I should also know enough not to let it get under my skin.
 
Birdstrike said:
I appreciate the clarification. Sorry for the rant which was overblown. If you've been on this forum a while you'll know I put a lot into my posts, and to put me on the "uninformed" end of the bell curve as far as posters go, I think is pretty unfair. I should also know enough not to let it get under my skin.
Click to expand...

::shakes hands::

Sometimes people talk past each other on SDN. Written communication is ripe for misunderstanding. No biggie. I enjoy reading these forums because I like to get an idea for your world as an EM physician. I only pipe up when I feel there is educational value. Sometimes it's controversial, but I feel that's what internet forums are for: honest exchange and cat memes. Well, mostly cat memes.
 
alpinism said:
Sure, you can hold c-spine and wait for the medics. But you wont have any free hands to do a pt assessment, splint, control bleeding, administer epi, or make a phone call.
.
Click to expand...

What exactly needs to be splinted in the next 5 minutes? When's the last time you gave epi (0.3 mg IM) on a patient that needed c-spine protection? What kind of an assessment do you expect is going to change this patient's life in the next 5 minutes? I'll give you the control bleeding, and perhaps even the make a phone call if you're really uncoordinated, but I'm pretty sure I can handle 911 with one hand. Heck, Siri can probably do it by herself.

Have you guys actually been on a scene? I mean, think about it. There is a large percentage that is going to be just fine for the next 5 minutes. There is a small percentage that is going to die no matter what you do. And there's a tiny percentage in which you doing something prior to medic arrival which will really make a big difference. We're talking about interventions that need to be done in the next 5 minutes that are going to save life or limb. Let's list them out:

1) Direct pressure on bleeding. (no equipment required.)
2) Open an airway with a jaw thrust (no equipment required.)
3) Some rescue breaths (no equipment required but if you're grossed out, well, I guess a BVM and an OPA is reasonable. A laryngoscope is not.)
4) Compressions (no equipment required.)
5) Epi-pen
6) AED
7) Oral glucose (well, that can probably wait 5 minutes)
8) A tourniquet
9) Needle a chest (14 g angiocath)
10) Remove from dangerous situation (no equipment required)
11) Spinal precautions (no equipment required)

Anything else? I'm sure there's a few I've missed. I also find it a little bizarre to see how much personal protective gear people like to throw into these things. How many of you have had patient blood all over you? That's what skin is for. Know anyone that's gotten Hep C or HIV from getting blood on their skin? Me neither. Even a needle stick has quite a low rate of transmission. If a guy's bleeding to death you're not going to put your hand over his wound? Bandaging? What- you don't wear clothes? Take your damn shirt off.

This crazy idea that you're going to be running some code on the side of the road is dumb. ACLS can wait for the medics.

So what's in this fancy kit? An AED, an epi-pen, some candy, a 14g angiocath, and maybe a BVM. You can slide all that into the AED bag pockets.

All that said, I carry a lot more than that with me into the wilderness on multi-day trips, but that isn't what we're discussing here.
 
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Good post, active. I actually am trying to discuss both the above and also things that might go in a wilderness bag
 
ActiveDutyMD said:
What exactly needs to be splinted in the next 5 minutes? When's the last time you gave epi (0.3 mg IM) on a patient that needed c-spine protection? What kind of an assessment do you expect is going to change this patient's life in the next 5 minutes? I'll give you the control bleeding, and perhaps even the make a phone call if you're really uncoordinated, but I'm pretty sure I can handle 911 with one hand. Heck, Siri can probably do it by herself.

Have you guys actually been on a scene? I mean, think about it. There is a large percentage that is going to be just fine for the next 5 minutes. There is a small percentage that is going to die no matter what you do. And there's a tiny percentage in which you doing something prior to medic arrival which will really make a big difference. We're talking about interventions that need to be done in the next 5 minutes that are going to save life or limb. Let's list them out:

1) Direct pressure on bleeding. (no equipment required.)
2) Open an airway with a jaw thrust (no equipment required.)
3) Some rescue breaths (no equipment required but if you're grossed out, well, I guess a BVM and an OPA is reasonable. A laryngoscope is not.)
4) Compressions (no equipment required.)
5) Epi-pen
6) AED
7) Oral glucose (well, that can probably wait 5 minutes)
8) A tourniquet
9) Needle a chest (14 g angiocath)
10) Remove from dangerous situation (no equipment required)
11) Spinal precautions (no equipment required)

Anything else? I'm sure there's a few I've missed. I also find it a little bizarre to see how much personal protective gear people like to throw into these things. How many of you have had patient blood all over you? That's what skin is for. Know anyone that's gotten Hep C or HIV from getting blood on their skin? Me neither. Even a needle stick has quite a low rate of transmission. If a guy's bleeding to death you're not going to put your hand over his wound? Bandaging? What- you don't wear clothes? Take your damn shirt off.

This crazy idea that you're going to be running some code on the side of the road is dumb. ACLS can wait for the medics.

So what's in this fancy kit? An AED, an epi-pen, some candy, a 14g angiocath, and maybe a BVM. You can slide all that into the AED bag pockets.

All that said, I carry a lot more than that with me into the wilderness on multi-day trips, but that isn't what we're discussing here.
Click to expand...

I see your point. I was just throwing out random examples w/ the epi. My whole reasoning is that even w/ limited time, if the trauma is severe enough (multiple injuries), you might need to immobilize the spine and deal w/ bleeding, collapsed lung, etc...

The above list is good. Like you said most stuff is unnecessary and can wait till the ambulance arrives.

Wilderness is a whole other animal. Here's a very detailed list from Paul Auerbach:
(prob the world's leading expert on the subject)

http://www.outdoored.com/community/risk_management/b/wildmed/archive/2011/04/18/first-aid-kit.aspx
 
I don't care who makes fun of me, but I've unashamedly gone on record stating that the day I get to perform a field appendectomy, splenectomy or amputation is the day I retire and go focus on my other two dreams. Being the world's coolest physics teacher and running a good and honest mechanic shop.

You are free to crap all over my secret squirrel dreams, but one day I'll be clamping a splenic artery on a highway with a smile and satisfaction of knowing my future jail time was worth it.

I had cool surgery attendings who let me have so much fun doing things i probably shouldn't be doing, but doing it in a field is a whole other level of manic kiddishness.
 
Everyone's got a bucket list. Some of them just might include things that lead up to jail time.
 
ActiveDutyMD said:
I also find it a little bizarre to see how much personal protective gear people like to throw into these things. How many of you have had patient blood all over you? That's what skin is for. Know anyone that's gotten Hep C or HIV from getting blood on their skin? Me neither. Even a needle stick has quite a low rate of transmission.
Click to expand...

Anyone carrying an angiocath around but not bothering to throw in a few gloves is a *****...
 
DeadCactus said:
Anyone carrying an angiocath around but not bothering to throw in a few gloves is a *****...
Click to expand...

Why the insults? You probably already know this but the vast majority of needle sticks (or scalpel stab by an attending in the OR in my case) happen through PPE's. Even those magic ortho gloves that sucked to suture in, wont protect you from a good ol'fashion needle jab.

Granted it is still silly not to use gloves. Hell my hands are permanently chapped anyway.
 
ActiveDutyMD said:
Have you guys actually been on a scene?
Click to expand...

Though not as a civvie, plenty of times as a medic, sure.

ActiveDutyMD said:
1) Direct pressure on bleeding. (no equipment required.)
2) Open an airway with a jaw thrust (no equipment required.)
3) Some rescue breaths (no equipment required but if you're grossed out, well, I guess a BVM and an OPA is reasonable. A laryngoscope is not.)
Click to expand...

I would say that I would never lip-lock anyone except my immediate family. Sorry. The BVM is an absolute. Even the CPR face masks would be too close and personal for people I don't know.


4) Compressions (no equipment required.)
5) Epi-pen
6) AED
7) Oral glucose (well, that can probably wait 5 minutes)
8) A tourniquet
9) Needle a chest (14 g angiocath)
10) Remove from dangerous situation (no equipment required)
11) Spinal precautions (no equipment required)

Anything else? I'm sure there's a few I've missed. I also find it a little bizarre to see how much personal protective gear people like to throw into these things. How many of you have had patient blood all over you? That's what skin is for. Know anyone that's gotten Hep C or HIV from getting blood on their skin? Me neither. Even a needle stick has quite a low rate of transmission. If a guy's bleeding to death you're not going to put your hand over his wound? Bandaging? What- you don't wear clothes? Take your damn shirt off.
Click to expand...

If you've decided to include a BVM as a must have in your jump kit, then minimalist space-saving goes out the window. That being said, wouldn't be too crazy to throw in some ABD or trauma dressings, Ace or Kling bandages, tape.

If a guy's bleeding to death, you can certainly take 5 seconds to throw on a pair of gloves before you treat them, so you don't get blood over yourself, your clothes, and everything else you touch. Gloves are another absolute.

This crazy idea that you're going to be running some code on the side of the road is dumb. ACLS can wait for the medics.

So what's in this fancy kit? An AED, an epi-pen, some candy, a 14g angiocath, and maybe a BVM. You can slide all that into the AED bag pockets.

All that said, I carry a lot more than that with me into the wilderness on multi-day trips, but that isn't what we're discussing here.
Click to expand...

Yeah, I'm not sure I'd bring an AED with me. But if that's a must have, then you can certainly throw some bandages and gloves in there.
 
AED is probably out of the question economically speaking unless I can get one for 200$ or less?
 
Gloves, bandages, bvm would be nice (but at least a pocket mask). Opa's, npa's. more gloves. Definitely an epipen. Gloves, and cell phone. And gloves.
 
It is fantastic you have advanced medical training but you will be limited without the resources afforded to ambulances and hospitals.

Keep it simple with bandages, gauze, gloves, BVM, trauma shears, and a few other simple things. Remember ABC and BLS before ALS. Activate EMS immediately. Little reason to have an arsenal of IV equipment, medications, etc.

Caveat: I am assuming this is just a bag for your car or something that you have should you roll up on an MVC or arrest or something similar. But if you are preparing a kit for a week long camping trip fifty miles from the nearest town, then you can prepare a bag with an AED, intubation kit, meds, and portable CT scanner.
 
bad virus said:
Why the insults? You probably already know this but the vast majority of needle sticks (or scalpel stab by an attending in the OR in my case) happen through PPE's. Even those magic ortho gloves that sucked to suture in, wont protect you from a good ol'fashion needle jab.

Granted it is still silly not to use gloves. Hell my hands are permanently chapped anyway.
Click to expand...

Fair enough, let me rephrase that to something more accurate. Carrying around an angiocath without bothering to pack some gloves is *****ic.

Accidental sharps sticks is one thing. Coming up on a scene with no equipment and choosing to do your best is one thing. Specifically packing a kit to intervene in an emergency and not including the most basic PPE is a completely separate issue...

In revisiting the post, it has occurred to me that it may come across as my objection being to handling a sharp without gloves. That wasn't the point. The argument is against preparing a kit that to deal with a pneumothorax but leaves you under-prepared for the far more common issue of bleeding.

Yes, the risk is practically negligible. But gloves are cheap and I doubt statistics will be a comfort if you end up the anomaly.
 
DeadCactus said:
Yes, the risk is practically negligible. But gloves are cheap and I doubt statistics will be a comfort if you end up the anomaly.
Click to expand...

Ever tried to use gloves that have been in your trunk for three months? Let's just say it's no different than not having gloves.

PPE is overblown. Skin is darn good PPE.
 
If you really want the deluxe package here I've heard good things about the stat kit line of products. Here's how they market it...

"Banyan Stat Kits are designed for the medical
practitioner. The primary objective is to provide
the necessary equipment needed to handle
most life threatening emergencies that might
occur in your office. The kits are designed to
provide approximately 30 minutes of
emergency equipment. This is intended to
sustain the patient until the paramedics arrive
and the patient can be transported to the
hospital."

and here's the pdf of the 800 series... http://www.statkit.com/files/pdfs/800_Dlr.pdf
 
These are the kits that the airlines carry on their planes, if you ever are called upon to use one...

The kit that you posted is out of date and has prefilled syringes not consistent with ACLS guidelines. I wouldn't recommend buying that particular model.
 
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