Crozet Annals of Medicine: Your First Aid Bag

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The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases. 

William Osler

A friend asked me recently to put together a first aid kit for use at the private school he works at. He is a teacher and a coach and he wanted something to cover sports meets and field trips and hikes. This didn’t seem like a tall order; after all I specialize in the treatment of emergencies, and first aid should be child’s play. I told him I would be happy to do it. 

Another teacher at the school apparently has some experience in a previous career as a Special Forces soldier and passed on his wish list for my first aid kit.

Med supply wish list

  • First aid bag 
  • CPR/ AED manikin 
  • Portable AED 
  • Endotracheal tubes 
  • Optic (light) laryngoscope 
  • Oropharyngeal tubes 
  • Assorted nasopharyngeal tubes 
  • Assorted coagulant powder/ spray 
  • Chest tubes with valves 
  • Oximeter 
  • BP cuff 
  • Stethoscope
  • Minor surgical kit (scalpel blade, curved kelly’s, suture, various hemostats etc) 
  • Otoscope Ophthalmoscope
  • U/A test strips 
  • Guaiac test kit 
  • 2×2, 4×4 Curlex (2in, 4in)
  • Ace wrap (1in, 2in, 3in, 6in) 
  • Surgical tape (various) 1in, 2in, 4in, 6in; micropore, durapore, etc.
  • Steri-strips
  • Band-Aids (various)
  • Petrolatum gauze
  • IV solutions (1liter) ringers, NACL, D5w
  • IV starters Iv catheters 14, 16, 18. 20 gauge 
  • Suture (nylon/ silk) 2-0, 3-0, 6-0) 
  • Scalp catheters (infant)
  • Bulb syringe 
  • Cricothyroidotomy set/kit 
  • Sterile suture instrument pack
  • Sterile surgical gloves 7’s and 7½ 
  • Sterile towel pack 
  • Malleable emergency splint (various)
  • Space blankets 
  • Pneumatic splints (Leg and arm) 
  • Assorted needles 8, 10, 12, 18, 16 and syringes 10cc- 50cc
  • Sterile scrub brushes (betadine) 
  • Finger splints
  • Tourniquets
  • Portable/ collapsible stretcher
  • Eye flush set/ kit 
  • First aid bandages small through abdomen sized
  • Headlamp/ magnifier glass 
  • Used microscope strong enough to do gram stains
  • Gram stain reagents
  • Glucometer
  • And finally, a Hemoglobinometer

“Wow, what kind of hikes do you guys go on? “ I asked him. 

“It is good to be prepared,” he replied. True.

Over the years I have talked with many of my ER colleagues about the ideal emergency first aid kit and most of us seem to have some sort of supplies in our autos and our homes. They range from a pair of gloves to full-on trauma immobilization and resuscitation gear.  

As I thought about it, I thought it brought up an interesting topic. What should a basic first aid kit contain? 

The biggest issue of course is who will be using it. A cricothyroidotomy kit  as requested above is a set of surgical instruments used to cut a hole in the neck into the trachea to ventilate a dead or dying person. It is not useful for the average first responder. A bag valve mask on the other hand can be used to ventilate a patient if the first responder has Basic Life Support (BLS) training, which is widely obtainable. So a bag valve mask is the first thing I recommend for a commonly shared first aid kit for a school group (with a strong recommendation for as many people trained in BLS as possible).

Those BLS-trained people would also benefit from a stethoscope and a blood pressure (BP) cuff.  Not everyone can reliably measure a blood pressure with a cuff and stethoscope but an inflated blood pressure cuff makes a handy tourniquet to control severe bleeding.   UVA offers a free Advanced Bleeding Control course for those interested.  A sign of the times I suppose. Here is the website. They also offer BLS courses. 

 Blood pressure is actually relatively easy to estimate without directly measuring. If the patient is mentating  (she can talk and think) then she has enough blood pressure to supply blood flow to her brain. That’s important to me (and her) without having a number as in a blood pressure reading.

 I am also informed by the presence and the strength of pulses.  If you still have a pulse on the top of your foot, for example, that tells me your blood pressure is normal and your arteries are not clamped down in some kind of shock syndrome. 

My complete recommendations for a commonly shared first aid kit for a school or group would be for several pairs of disposable non-latex surgical gloves, a stethoscope, a BP cuff mostly as a tourniquet, Bag valve mask, a two-pack of epi pens (need to be replaced yearly) lots of dressings and Ace wraps, aspirin, an albuterol inhaler (also replaced yearly or every other year), and a cell phone to call 911.

Oh, yes, and an AED, of course. This is an Automated External Defibrillator. Simple to use and lifesaving in sudden cardiac arrest.  

Epi pens not only treat anaphylaxis but severe asthma and most kinds of shock and cardiac arrest, depending.

In this kit should be a simple set of instructions. The simpler the better.

  • Call 911.
  • Put on gloves
  • If it is bleeding, apply pressure over a gauze dressing. If it is still bleeding, apply more pressure and gauze.
  • If they can’t breathe, give albuterol puff or epi pen injection.
  • If they still can’t breathe,  use bag valve mask to breathe for them.
  • If you lose a pulse, give epi pen injection and apply AED. The machine will decide if a shock is indicated.
  • Chest pain or stroke symptoms—give aspirin.
  • Fractures or deformities—splint with your ace wraps and any stiff, straight thing. Cardboard works in a pinch.

I have an old leather doctor bag with most of these things (except  the directions)  that I use for the occasional house call, but I no longer carry it routinely in my car as I did early in my career. But I always have gloves (in the glove compartment of course) and a stethoscope. These two items have seen me through multiple emergencies and are usually enough to stabilize any patients till 911 can respond and bring more elaborate equipment that they often let me use. 

And the gloves are handy for keeping my hands clean if I ever have to change a tire. 

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