Saturday, 02 Apr 2005
I pitched five good questions to Kevin at The Smallest Minority and he knocked all of them out of the park. I gotta work on my fastball.
Anybody else want some of this? Just leave your URL in the comment section...
Tuesday, 22 Mar 2005
Thanks to XRLQ at DAMNUM ABSQUE INJURIA.
Leave your blog's URL in the comments section. I'll give it a couple of days, and pick somebody at random.
Fair warning - one of my five questions is going to be a hardball. Got to keep it interesting....!
Monday, 21 Mar 2005
Unless something went horribly wrong during my final exam, I'll soon be certified as one of New York state's newest EMT-Bs. As a graduation present to myself, I am assembling that hardcore first aid kit I've always wanted. And you? You get to hear all about it, and tell me what I've overlooked...
I've put together a few kits before, and I've learned that the selection of medical gear ought to be guided by a firm, central principle: first decide what you want to treat, and then make a list of what you'll need to do it. You can't just throw random stuff into a bag. Many people just seem to grab whatever seems handy, and either find they are missing some small thing they really need, or that they have cluttered their kit with lots of stuff they'll never use. You can't fix everything. What you leave out matters just as much as what you put in.
In my case, I want to be able to deal with a pretty wide range of situations. A car wreck, a heart attack, a diabetic emergency, an accidental poisoning; also the softer stuff that's not life-threatening, things like cuts and blisters and splinters. Then there's always that grey area in between, things that are not severe enough to warrant a ride in an ambulance but which do require a visit to the ER - a broken collarbone, a deep cut, a crushed finger.
There's also a lot I can't deal with. I can't prepare for a mass casualty incident, I don't want to carry an oxygen tank, I can't carry an epi-pen or albuterol. I won't try to package a patient on my own, or attempt more than the simplest rescue. I'm not trying to replace the local ambulance or rescue squad, I just want to be able to hold my ground for ten minutes or so until the calvary arrives.
I also don't want to get hurt. A tiny CPR mask and a pair of nitrile gloves now ride in my pockets alongside my wallet and my keys every day, and the first thing you'll see at the top of any kit that I assemble is another bag full of gloves and another face mask.
The bag itself matters, too. Your kit needs to be small enough to carry in your car so that it's actually there when you need it. It must be easy to get into, easy to carry, and what's inside ought to be dry and unbroken when you finally haul it out. (If you carry water, carry it in an outside pouch unless you can protect it from freezing). You'll need quick access to some items more than others, and you want to be ready and willing to unpack half your kit while kneeling in three inches of mud. Nothing should be loose in there; it should all be held together in little sub-assemblies inside of tough, clear ziplock bags. Each bag should provide everything you need for a specific situation, and if this means that some inexpensive items have to be duplicated so that they can be packed in more than one bag, so what? It beats digging through a ton of stuff, and besides, it's always nice to have spares.
So, let's get serious and cover all the bases. First, here's a list of tasks I'd like to be able to handle:
- Trauma emergencies:
- Support airway and breathing, treat for shock.
- Fix holes and flails.
- Control serious bleeding.
- Signal for help.
- Medical emergencies:
- Support airway and breathing, treat for shock.
- Assist with meds as directed by physician - patient-prescribed nitroglycerin, aspirin for cardiac, glucose for diabetics, activated charcoal for poisoning.
- Manage overexposure to heat or cold.
- Non-emergency trauma:
- Bandage wounds.
- Stabilize minor bone or joint injuries.
- Remove splinters, pad blisters, wash away debris from eyes.
- Non-emergency medical:
- Electrolyte replacement.
- OTC meds for headaches, allergies, etc (family use only9).
And here's the gear I'll need to do it:
- Top bag:
- Nitrile gloves (6 pair).
- Eye protection7.
- 'Blob' CPR mask.
- Assessment bag:
- BP cuff1 w/scope.
- A small flashlight, that works, that you can hold in your mouth.
- A fine sharpie pen and a pad.
- Airway Bag:
- Set of OPAs.
- Set of NPAs.
- Disposable BVM2.
- Portable suction unit with tips.
- Bulb syringe.
- Tongue depressors.
- 4x4s.
- Trauma bag:
- Ace bandage. (2)
- Cling. (2)
- Large trauma pad. (2)
- Medium trauma pad. (2)
- Occlusive dressings and aggressive, thick tape (duct tape?).
- Shears for cutting clothes.
- Tourniquet14
- Med Bag:
- Activated Charcoal.
- Glucose gel (cake icing11).
- Aspirin (80mg chewable).
- Benedril.
- Bone Bag:
- Cravats. (4)
- Tongue depressors.
- Tape.
- Cling.
- Cardboard and/or wire mesh5 for splints; whatever fits in the base of the bag.
- Enviro Bag:
- Hot packs.
- Cold packs.
- Gatoraide mix.
- Little Stuff Bag:
- Advil.
- Tweezers.
- Foreceps.
- Needle.
- Eye cup.
- Small squirt bottle of eye wash.
- Moleskin.
- Bandaids.
- Bacitracin12.
- 4x4s, mild tape.
- Kotex.
- Tincture of benzoin - to hold moleskin and bandaids in place8.
- Ring cutter13.
- Superglue.
- Misc Bag:
- Plastic bags.
- Thick plastic sheet6.
- Waterless hand wash.
- Translation card.
- Emergency blanket3.
- Cash (quarters and small bills).
- Whistle.
- Tiny toy bear4.
- Outside Pocket:
- 1 liter potable water.
Things I intentionally overlooked:
NPAs10Contraindicated by head trauma, and not really necessary for short-term medical care.- Cervical collars, backboards, large splints, oxygen
- That's what the ambulance is for.
- Window punch, seatbelt cutter
- I already carry a sharp knife and a leatherman tool.
- A watch
- My cell phone has one, and it's always on time.
OK, now it's your turn. What did I miss?
1 That BP cuff is a valuable tool - it can help you distinguish between indigestion and a true emergency. You'll also need it before assisting with nitro.
2 The BVM may seem a bit excessive, but disposable units are surprisingly cheap (under $12) and are far better than a face mask when assisting the ventilations of a conscious patient, or the driver of a car when you are in the back seat.
3 For shock.
4 Bravery award for toddlers.
5 Added 3/22. Can be formed into various shapes; tape edges. (Thanks, Joey)
6 Added 3/22. Sometimes, people go down outside on the ground and you need to get them as warm and dry as you can. Also makes it easier to drag them, if necessary. (Thanks, Mom!)
7, 8 Added 3/22. (Thanks, Robert)
9 There are serious liability issues if any meds (even over-the-counter stuff) are given without explicit medical direction. I can still give an Advil to my wife, but not to a stranger!
13 Added 3/30. (Thanks, bjbarron)
14 Added 4/05. (Thanks, Heartless Libertarian)
Okay, pretty good list for an EMT for general care. There is a good reason to carry anything from super-glue to a piano, you just have to pick what you're willing to carry. The following are trimmings, not criticism.
I'd add the c-collar, because you're more likely to run across an MVA with a good airway than need a BVM in trauma, and you'll need a c-collar. You don't need every size, just pick a medium, and live with it.
11Cake icing is cheaper than 'glucose paste' and works just as well. And is probably better packaged.
You aren't carrying Duct tape and safety pins. More lives saved with those in the 'Wilderness' with these than anything else.
IMHO: things to leave behind: cold packs (exposure in the key usually for that). If you really think this is a problem, just use your water, sprinkled, and fan like mad. Gatorade Mix: water is cheaper. If the patient needs more than that, to the ED, drinking water! Eye cup: silly that we teach that. Have never used one professinally, and don't intend to. Eye irrigation is a direct, hands-on thing. Pry and squirt. Moleskin? If you're accompanying a Marine BN on a hump OK, otherwise a nice thing to have at home for the family, but not useful on the street. Ditto, Benzoin. Benzoin is just going to leak all over the rest of your kit and make it sticky and useless. If it needs to be taped, and the patient cannot be taped due to sweat, either go around (cricumferential), or use the duct tape.
12Neosporin isn't a bad choice, though I prefer regular Bacitracin, as it's less antigenic (fewer allergic reactions). However, price and personal preference rule here.
As for the rest: thick plastic sheet=space blanket, or heavy trash bags. You'll have more use for the trash bags.
I like the cash, though you should limit it to about a buck in quarters. With cell phones and calling cards, you'll be lucky to find a phone to drop your change into.
Bottled water: up to you. Leave it in the car, though. Heavy.
10You should reconsider the NPA's. They are much better tolerated than the OPA's in the people you need to use them in, and weigh nothing.
Carry a lot of tongue depressors: they weigh nothing and have a million splinting uses, and others you've never considered.
Lastly: A BP cuff? Unless you can do somthing with the data you collect (IV fluids, etc,) it's just extra weight and complexity.
My two cents. Void where prohibited, etc.