4x4Lamm

A few people have asked me for advice on what to carry as far as medical kits for off-road, camping and general use. You have to build your kit to your own specific needs but I think mine does a pretty good job of covering all the bases. Obviously you should have appropriate food/water and clothing for the trip so those are not included.

I have been doing fire and EMS since I was in high school and have worked/work in wilderness, rural and urban settings. Aside from being a paramedic I have ACLS, ITLS, PALS and BLS certs. I also used to teach first aid and survival courses too if any of that matters to you.

Here is my kit,

Airway Kit:
2 Magil forceps, 1 small, 1 large
1 pocket mask (high quality)
1 CPR mask, (low quality)
1 bulb syringe
1 manual suction device with catheter
1 Asherman chest seal
1 oral airway set
1 nasal airway set
Surgical lube packets
3 16 GA. IV catheters
1 pair sterile gloves

Tools:
Misc. sterile surgical blades
Misc. splinter removal needles
1 disposable body staple kit with remover (Adventure Medical)
1 Wound closure kit (Adventure Medical)
1 pair trauma sheers
1 pair bandage scissors
1 hemostat clamp
Misc. safety pins and small needles
1 BP cuff
1stethascope with spare parts kit
1 LED penlight
Misc. pens, sharpie marker
1 Paper pad
1 “Vital Stats” notebook
1 pediatric trauma/meds guide
1 magnifying glass
Misc. q-tips
1 small mirror
1 window punch
2 pair tweezers
1 N95 mask
1 thermometer with extra covers
1 space blanket
1 emergency poncho
Misc. tongue depressors

Medications/Ointments:
1 hydrogen peroxide gel
1 activated charcoal
2 instant glucose tubes
1 Vaseline lip balm
1 bottle Motrin
1 bottle Imodium
1 bottle ipecac syrup
1 bottle sterile eye wash
1 tube of Rolaids
1 Primatene mist inhaler
3 packets of oral hydration salts (Adventure Medical)
Misc. packets multi symptom cold medicine
Misc. packets nasal decongestant
Misc. packets aspirin
Misc. packets electrolyte tablets
Misc. antiseptic, alcohol, iodine wipes
Misc. packets orajel
Misc. packets loratadine tablets
Misc. Pepto Bismol tablets
Misc. packets cortisone cream
Misc. packets Technu ivy cleanser
Misc. Benadryl, tablets and strips
Misc. ammonia inhalants
Misc. packets burn gel
Misc. amps of sting relief
1 packet of cough suppressant strips (dextro)
Misc. packets Goody’s pain relief drink mix
Misc. packets antibiotic ointment/Neosporin
1 packet Stay Alert caffeine gum

Bandaging/Trauma:
1 large packet of Quick Clot
2 triangular bandages
1 tourniquet
2 finger splints, 1 small, 1 large
1 “Extractor” snake/insect bite kit
2 rolls of tape, ½” and 1” (waterproof)
Handful of 4x4s
1 ACE bandage
1 roll of 2” Kling
1 SAM splint
Handful of 2x2s
Dozen large Band-Aids
1 small baggie of Misc. small Band-Aids
1 2” roll gauze
1 4” roll gauze
Misc. Moleskin
Misc. occlusive dressings
2 small packets of Quick Clot
1 multi trauma dressing
Half dozen 3x5 ABD pads (can use sterile napkins too)
1 sterile burn sheet
Misc. rubber/latex gloves



Here are the two Pelican Cases everything is in.



The small case hold supplies for airway and breathing management.



This is the airway case opened and the equipment stored in it.



This is the main EMS case.



Here is what you see when you open it up.

Except for the burn sheet and multi trauma dressings it is 100% contained in 2 Pelican cases. The airway kit is in a 1200 series box and the rest rides in a 1500 EMS series case.

IMPORTANT NOTE: Some things can do more harm than good if you do not know what you are doing. Unless you are trained as EMS or military (combat lifesaver) please don't do a needle decompression on me or something like that If you are unsure of what something on the list is or what it's for chances are you don't need to be carrying it but that does not mean you can't save a life with other items. Also, training is more important than anything on this list, the best return you can get on your time and money is a good first aid and CPR or even EMT-B class. EMT-B is only a few hundred bucks and about 120 hours of class in most areas, a real bargin if you ask me.

Enjoy and feel free to ask questions.
4x4Lamm

Fink

I'm literally putting my kit together as we speak.
I've got the 1500EMS and the 1200.

The airway kit was easy and is already put together, I still need to get the manual suction.
I've already got three bulb syringes in various sizes.

Would you mind shooting a pic of the second layer of the plastic organizer in the 1500 case?
I'm trying to get everything organized and I can't decide how I want to arrange it all.

I'm about to make a run to Walgreens to get the band-aid and general bandaging/dressing stuff.

Mine will be strictly a BLS kit since I can't do all the cool stuff that Paramedics can.

I'll post mine up when I get done - it will be very similar to Lamm's though.

Thanks Lamm!

Fink

22RUCRAZY

Saftey first hell yah i would include a survival kit you know knife matches meals ready to eat that sort of thing oh and morphine

aviator

Morphine can be dangerous and AFAIK it's also a schedule 1 controlled narcotic. In other words unless you have a scrip. don't have it on you when the cops stop you 22R.

Hope everyone reads your note Lamm some of your goodies could do more harm then good if folks don't know what they're doing. I was trained to do some advanced things as an EMS Pilot so I could "assist the medic" in situations where the patient was going sour... [never had to us it yet] but I still would'nt try to use half those things.
If you're going into the serious back country take Lamm's advice and get some training.

Fink

You are absolutely right, Paul.

CPR is the most helpful thing a civilian can get trained on and perform when needed.
Fact is, in most situations you are just going to be rendering life-saving care (CPR/airway maintenance and maybe a severe bleed) until ALS arrives.
Secondary injuries (small abrasions, lacerations, minor fractures, etc...) will all be stabilized/assessed while en route to the hospital and may not even be messed with until the patient is transferred to definitive care depending on how critical the patient is.

It's as easy as ABC - airway, breathing, circulation.

CPR classes are often times free at local fire departments or community colleges, the more people we have effectively trained the better off each community will be.

I'm off my soapbox now.

Fink

muddpigg

iTrader: (1)

You guys ought to look into a BVM to throw into your kits. A face mask is good but can huff yourself to exhuastion quickly. I BVM w/o O2 is still 21%. Shoot if your offroad it may take quite a while for FD, EMS, or medivac to reach you.

I don't carry any meds other than topical.

Fink: your 100% right ACLS is pushing good CPR over any med.

I like the 60CC non luer loc syringe with an NPA placed on the end for suction. You can trim the ends to get better bore for the "chunky stuff"

Ya'll ought to look at the Isreali dressing, its like the trauma bandage attached to an acewrap. Awesome for pressure dressings and getting those hard to bandage wounds like ingenial and armpit, takes some creativity and practice but very doable.

They took the quick clot away from us and reissued another coag bandabe packed in gauze. Quick clot burns the tissue and can cause more damage. Plus the powder is great in the lab but has a tendency to blow in the wind. You don't want it in your eyes. I'd get rid of the stapler too, we don't want to close anything in the field that is what ER but perferribly ORs are for. I'd toss in another tournique too, as you know one is never released and occasions do arrise that ones just no enough. Though I am a fan of cravaets a CAT is so much easier. Ippecacc has fallen out of favor.

Its getting late and I'm tired. Don't intend on starting a firestorm but I see concerns in your kit. I don't work for you system. I didn't go into much of the med list, its late. I do agree that an EMT class is a good investment. If you feel you need me to post my acrynyms I will.

Fink

As far as a BVM goes, for your average urban application I don't see the need for it not to mention the probability of having O2 with you or finding somebody who does is next to none.
In a typical urban setting you're looking at a response time of 2-6mins - doing a breath every 6-8 seconds as you would with a BVM isn't going to kill you with a pocket mask until ALS arrives.

Plus, with a BVM in order to really utilize it you would need a second rescuer who is trained on it and the odds of that are next to none.

However, if the scenario only called for breathing for the patient then a BVM would be a good choice.
Or, if you mean after CPR has been done or an AED has been used and you have moved onto solely breathing then yes, I can see the BVM being a good choice.

In reality though, it's a royal PITA to maintain a patent airway (head-tilt or jaw-thrust) while also getting a good seal on the mask and breathing adequately without a second rescuer there.

As far as the Israeli bandage goes, I have a 6" one in my kit as we speak and a 4" that is on backorder and should be here Monday.
Only downside is they are very bulky and not easily stored in a case that is already stuffed full with other goodies.

I'll be making a trip to my local drug store today, as soon as my check clears, to get the other odds and ends stuff that I need.
I may also get enough to stock my Adventure Medical Weekender kit as a quick jump kit in addition to the main BLS kit - we'll see what I find at the med store today.

Time for sleep - just got off work an hour ago...I need my beauty rest.

Fink

22RUCRAZY

When your really in the middle of no where like 6 hours from help youll be glad youv got some morphine (pill form) I dont recomend this for the mall type city trucks that never see the trail but in the real world away from the city we dont have shiny fire trucks to come help you . Be prepared or die

muddpigg

iTrader: (1)

I disagree, a bvm is a lifesaver. No you do not have to have O2 to operate it. If your talking trauma and trying to rescue solo wouldn't want to be that guy. As for size the it is colapsable. No if it is at the point of injury huffing on someone till EMS gets there in 4-8min is doable. But for an offroad situation where you my have to render aide and sustain it for any length of time. No. The reason we place NPA is provide a passage for air to pass through, shoot I'm going to place two one in each nostril. Once an airway is placed an you get go raise and fall the need for holding chin lift jaw thrust is not as important as C-spine. Believe me this is an item that I'll carry in an aide bag that is smaller that those pelican cases.

22ru- I've heard this aurgument from people before " its a good thing that I had (vicodin/percocet/diluadid/morphine/etc) cause I fell and it hurt. I couldn't have done it without whatever pain med" I really think it is an excuse to pop pills. There are several instances were pain meds are going to worsen or mask life threatening conditions. Besides if your pateint is complaining of pain it gives you a good assessment tool.

aviator

Exactly one of my points mudd... if you do need to carry a pain killer you are generally far better off with plain old ASA [aspirin] or Tylenol just remember each has it's own problems. Tylenol is very hard on the liver and may have allergy issues. ASA is generally not an issue allergy wise but is a blood thinner and so may cause problems with blood clotting but on the other hand it is also an anti-inflammatory and may aid recovery from sprains/strains and other soft tissue injuries. While both of these OTC drugs may have side effect/drug interaction/reaction issues either of them would be a better choice then the hard scrip pain killers. In a survival situation another option you can try is a placebo [ie sugar pill] tell the patient it is {morphine/vicodin/percocet/ whatever} and really "sell it" and you may be surprised what the human mind can do.
In any case if you are in an urban/rural setting where EMS services are available within say... an hour response time you should not administer any drugs unless advised to do so by a doc./medic/poison control centre... concentrate on the ABCs, and try to control any bleeding and wait for trained EMS to arrive. If you do give any kind of drug make a note of what, how much, and when you gave it EMS will need this info to prevent over dosing and to aid treatment.

If you are in the back country or a disaster situation [ie Katrina] and EMS may be several hours or even days away you may need to do more but again avoid giving meds unless advised to do so by a competent professional. Remember if you act on your own and give the wrong drug/treatment you can be successfully sued no matter what the outcome, if you are acting on the direction of a medical professional you have a defense, without it you are SOL.

Also don't forget CPR certs. need to be renewed once a year to stay current.
Make First Aid/CPR training part of your seasonal preparation the same as getting the rig ready for the trail.

Fink

Again, morphine is considered a narcotic and you cannot get it unless you have a prescription for it.
Even then, that prescription would be in your name - as soon as you administer or let somebody else take that drug you have then committed a crime.
Rules like that can vary state-to-state however I don't see it being legal in many.

Similar to carrying O2, some states are more lax about it than others - in some you have to have a script or medical direction.

If you're talking about a lengthy response time then yes, a BVM would be a good choice.
I was merely saying that your average Joe, 9-5'er going to and from work that may or may not roll up on a wreck once a year does not need to carry one.

If you're looking at a 10min+ ALS response time then yeah, you're going to be hurting.

Also, I agree that I would not want to be a sole rescuer on a trauma patient.
However, I'm not going to assume that there will be other people around that are willing to help, much less be trained or have the know-how to.

I'm not saying it's a bad idea to carry one, ask anybody that knows me, I carry way more than I need to and I am all about preparedness.
If you have the room and the funds to buy it, why not?
I will carry one eventually I'm sure.

I also completely agree with you about the medications.
Medications being administered or "offered" by somebody who is not a licensed Paramedic is a very bad idea.

In most states the "Good Samaritan" act/law will protect you but you have to be very careful with it.
Don't just rip open some Benadryl and offer it to somebody because they are swelling up a little bit and might have been bitten by something or eaten something they're allergic to.
There could be a million different variables that you are simply not aware of.

Sure, if you gave them the drug and they instantly felt better and they were back to normal they will give you some respect and a pat on the back.
But, if you gave them the drug and they had a violent reaction or it made their condition worse and they died you might be getting a, "You got a purty mouth..." in jail versus the pat on the back.

You hit the nail on the head Paul and beat me to it - an attempt at a placebo is a fantastic idea.
The mind, as Paul said is an amazingly powerful thing and can have a bigger impact on a patients status than any medication you can buy other than maybe anesthesia.

Feeling pain is a good thing, in moderation.
If you can see that they have a severe arterial bleed in their leg due to a bad laceration and they can't feel it, you may have a much bigger problem on your hands than just bleed control.

Remember the ABC's and focus on that - that is what saves lives.

Fink

muddpigg

iTrader: (1)

tickticktick I'd like to say holy . Oops I said it.

Fink

muddpigg

iTrader: (1)

If someone can verbalize their pain or lack of it. You assessed the airway and breathing (airway has to open to speack and air movement over the vocal cord produce sound). If their speech is apropriate then thein mentating meaning the brain is getting oxygen so circulation is assess. But if you don't stop arterial bleeding you are not going to have to worry about the ABC's.

I can make an airway
I can breath for them
I can circulate their blood
but I can not put blood they've lost back into the body.
I can save a life without pain meds

Pain doesn't kill people but it does become a distraction to us and not having the expereince to not be distracted cause life threatening injuries to do get overlooked. our equipment can become a distraction so keep it simple. As far as meds go, only a provider can prescribe them (DR, PA Nurse practicioner). I paramedic is not a provider so they are acting under a providers licence, thats why they are protocals and directives.

As long as they are complaining about pain they're making my job easier as I can constantly assess the ABC's without touching them. Its when they are not complaining that things get hairy.

I don't give a damn it you carry an intire trauma bay in the back of your truck. If you lack the basic skills and expereince its all useless. Text book answers are great for test.

aviator

What????

muddpigg this is aviator actual your communication received but not understood please clarify and re-transmit...

aviator

Good points on the ABC assessment mudd... if they're complaining they're breathing ok... aside from controlling bleeding another thing that needs to be watched for that has'nt come up yet is shock.
Shock needs to be watched for because it can kill. Even with a relatively minor injury. Management and prevention can be a simple as keeping the victim calm and wrapped or covered with a blanket. If you don't have a blanket you can use a coat or a tarp or even an unrolled tent.
Try to keep the victim conscious and awake by talking to them, any topic is good... cheating F1 teams, football, weather, family, anything.

Fink

These are all good points but I just realized how far off-topic we have taken Lamm's thread.

Lamm, if you want any of our discussion deleted or taken out of view to clean up your thread just ask and I'll do it.
It's a good discussion regardless.

Fink

muddpigg

iTrader: (1)

X2 on the off topic.

Aviator, I was shaking my head at the example given.

aviator

x3 on the off topic

at least us perps are fessin' up

mudd thanks for the clarification... I figured it was something like that or else you had a sudden case of daddy brain...

muddpigg

iTrader: (1)

I can come across much more harsh on this subject than what is needed. I'm still toned down from some that taught me. I have had some unique expereinces and been very fortunate to have worked along side trauma surgeons and ER docs on a first name basis, though the NCO in me would not let me do such madness Perhaps we should start a new thread on this or similar subject.