What is in your medical/first aid kit, show and tell

[cbr6fs]

It's possible you have spoken to more than me but it may be you need to speak to more, or more regularly, they know that when they are used appropriately they are the difference between getting to A&E or the morgue. They are being taught for use by a lot of professionals these days in the UK and Europe. I am trained in their use and train others in their use (If a mod wants to PM me I will happily send an e-mail from my government work address to verify who I am and my qualifications, since that seems to be an issue for some), some of that training is working in casualty and on ambulances in the UK. if I didn't use them when they were appropriate then I would be criticised and would almost certainly find myself in court.

Some of all clots are removed with the dressing hemostatics are no worse in that regard.



If you have time to debride and clean a wound then you shouldn't be using hemostatics.



They are mechanism of injury, not the injury and I said SURVIVABLE fatal injuries which are the most worrying because those are ones where people died but would have lived if there had been appropriate early intervention (Or First aid as it's often known) It was part of a study carried out reviewing coroners courts a few years back it's quoted in a lot of text books and is known as the "Golden Hours study"


I am a professional I don't doubt what they said but I have needed and used them and tourniquets. If that professional works on an ambulance then the person has already survived long enough for the ambulance to get there and they are able to get that person to a hospital in minutes whilst being able to keep the pressure on for most of that time. A really good case scenario in a remote rural setting is 30 minutes from injury to ambulance medical professionals arriving and then much longer to hospital. Worse case is days. I can apply a tourniquet to myself, I can maintain pressure long enough for combat gauze to work, I can't put the kind of pressure on my own wound for long enough to have any chance of stemming an exsanguinating wound. Similarly if I have to do that for one casualty then that's all I can do, I can't treat other injuries or other casualties.

Elevation is being phased out; it's out of most curriculums now; we are no longer taught it or teach it for catastrophic injuries because, even if it does work, (And there is no evidence it does) it impairs the ability to apply direct pressure, transport the patient and carry out other procedures. Red cross and St johns are difficult because they need to reprint a lot of text books and retrain a lot of volunteers and trainers so they are glacially slow to change.



By taking what they say seriously and getting training then you have already done more than the vast majority. I applaud you for that.

No one recommends clotting "Powders" and hasn't for years, they have not been available for years and all have now passed their use by dates. As for recommending clotting "bandages", if it's part of your training and protocols, then when they are indicated you should use them. These are very rare, I don't carry one every day or even every trip but it's not uncommon, I always have one at work. If I or those I treat get handed over to a doctor in circumstances where I have used clotting agents then that's me definitely having a good day. Once again they are for when the alternative is dying not routinely to stop bleeding.

There are OTC clotting sponges which are designed for that (Quikclot sport etc) I got given some to take a look at. Personally I would never have used them and gave them away. I don't think they would do much harm but it is not designed for the same purpose as combat gauze etc.


I think I have covered this in terms of getting advice, I am mandated to carry them at work (Not just them) and I am encouraged to carry them when not at work.

Great post with with good points

You two should get a room.

Another thread killed

:vio:

Inspiring, helpful and brings nothing to the thread except more snide comments :togo:

I can understand that folks would get bored with the discussion, it has gone on a bit now, BUT it is sharing opinions which is exactly what a forum is for.
Lengthy disagreement = yes
But with good points from both sides certainly more helpful that trolling for reactions.

I do honestly think good points have been put across by both sides, and now anyone reading this thread has some good varied opinions to chose from, how is that a bad thing?

 

[Bluffer]

I can see each persons viewpoint and the delineation between each.

HSE stats are generally workplace injuries.

MRT/SAR stats are generally falls and acute injuries/illnesses in otherwise fit and healthy persons.

Paramedic/NHS staff stats are wide spectrum and from across the population.

Military medicine stats are battle injuries and travel health within specific sub-groups (expedition medicine may be similar in many ways).

In general, each individual or group should assess the risks they are likely to face (there, I've simultaneously pacified both the health and safety crowd and the preppers) and prepare accordingly.

For some, that will mean advanced remote area training and sourcing trauma kit.

For others that will mean minimal training and carrying band-aids and paracetamol.

 

[dwardo]

Besides all the usual dressings pain killers, antihistamines as above,
Decent plasters. Not the cheap useless ones from the supermarket that wouldnt stick to a hairy blanket but elastoplast fabric ones. Usually five times the price but they work unlike the former.

Clove oil. Toothache can ruin a trip away and this will give a little relief until you get to a proper dentist.

Micro-pore tape,

Tweezers and sterile pins for removing splinters.

 

[Gimli]

Ok thats fine. Im not going to explain. This seems to be turning into a bit of a pissing contest.

Sorry but how is this a pissing contest????? I only asked (and I appologise if I have worded it poorly) how you are diagnosing the conditions that you have the kit to deal with. As I have said in other posts. I am a reasonably well experienced Paramedic, having done solo work in cars and motorbikes, worked in Special Operations/HART and now on HEMS. I also hold the Dip IMC RCSEd but I am well aware that I don't know it all, far from it, and I was interested in what you are doing. I've never heard of the isolating the core thing even though I work with A+E and Anaesthetic Consultants every day and I wanted to know more. I also think it is important that the non health care professionals on this forum understand the difference between evidence based practice, experienced based improvisation and plain silly ideas. Therefore we should be explaining our reasoning behind our kit.

 

[rik_uk3]

Sorry but how is this a pissing contest????? I only asked (and I appologise if I have worded it poorly) how you are diagnosing the conditions that you have the kit to deal with. As I have said in other posts. I am a reasonably well experienced Paramedic, having done solo work in cars and motorbikes, worked in Special Operations/HART and now on HEMS. I also hold the Dip IMC RCSEd but I am well aware that I don't know it all, far from it, and I was interested in what you are doing. I've never heard of the isolating the core thing even though I work with A+E and Anaesthetic Consultants every day and I wanted to know more. I also think it is important that the non health care professionals on this forum understand the difference between evidence based practice, experienced based improvisation and plain silly ideas. Therefore we should be explaining our reasoning behind our kit.

Spot on chap, some of the kit on several forums I'm on is frightening...

 

[Quixoticgeek]

I do still stand by my opinion that pressure and elevation is a far far far better solution than either a tampon or celox.
To be honest i've yet to meet a combat medic that carries a tampon, discovery of a tampon in a combat medics kit would get them a right royal telling off.
So even in combat zones a tampon is useless compared to having the correct dressing.

My inner pedant says that tampons for their original use work where ever the user is... they don't stop functioning the moment you arrive in theatre... But I'm guessing that wasn't what you meant.

As i said earlier a combat medic has different priorities in treating a casualty than a civilian medic, if paramedics started using combat medic treatments and procedures folks would be dropping like rocks.

Not quite. The lessons learned about emergency care in Aghan are trickling down into the civilian services in the UK and US. The Boston marathon bombing there is a quote from an EMT that responded saying something along the lines of "we just grabbed the tourniquet's and ran" The Tourniquets in question I am lead to believe are the same as the CAT ones that were developed for Aghan[citation needed]

I recently had a UK paramedic show me how to use the orange CAT that they are issued with. He taught me one thing that I think is most important "If you are going as far as putting on a CAT, you are giving up on the limb" I asked in the context of sticking something into the big artery in the leg. Something that should never really happen in bushcraft unless you are either unlucky, or incompetent (note to self, stop using thigh as a chopping board when cooking dinner...).

If you are in a group and someone has a cut that causes major bleeding then pressure and elevation are a far better solution than either a tampon or celox.
You don't have to worry about moving the casualty, you are not under fire and apart from sending someone off to call the emergency services your main job right then is to keep applying pressure.

Couldn't agree more. This is why I carry the dressings I carry. Open, apply pressure, wait for the Calvary.

The reason i called it a fantasy is that i don't see a realistic civilian scenario where either a tampon or celox would be a better solution that pressure, elevation and a proper wound dressing.

I can, but it also tends to start to sound as a bit of a holywood film storyline...

When I say Celox, I mean a celox dressing not celox granules. When I've mentioned tampons I've meant them for female use primarily.
Celox dressings and tourniquets ARE being seriously considered for wide scale use within the arboriculture industry for chainsaw injury.

The main place I have seen Celox for sale has been forestry and arb suppliers. The only injuries I can envisage that would justify CAT or celox in civvie life tend to be chainsaw related. If a chainsaw was to kick into your inner thigh, and your trousers not do the job intended. What do you do? How effective with a large ambulance dressing applied with a lot of pressure be? Would using a CAT or Celox on the wound and risking sacrificing the leg to save the life of the rest of the body be justifiable? I would be very interested to hear peoples opinions on this one.

I think it's difficult to quantify or prove something is being considered by a industry as a whole, even then my main source would be the people that treat chainsaw injuries rather than lumberjacks.

The thing is, the first person on scene when out in the woods with a chainsaw is the buddy you have with you. They are the one that has to stop the catastrophic bleed. In the above case where the chain hits the big artery in the leg, is the large wound dressing the HSE requires all chainsaw wielders to carry at all times when using a chainsaw going to be enough?

Plus the problem there is you will not be treating chainsaw wounds when you are out with your groups.
Chainsaw wounds are open, messy, horrific injuries, you will be dealing with missing limbs or limbs hanging by a thread.

Ouch?

In my experience the most common injuries i've seen while out hiking, camping are:
Sprained, broken ankle
Knee injuries
Burns (fire, stoves, hot pots etc)
Cuts (knifes and the like)
Concussion (falling over)
Broken wrist, fingers/thumbs, arm, collar bone (mainly mountain biking)
Heart attack
Asthma attack

A useful side effect of my recent research survey, is I have actual data on this sort of thing. Small cuts and grazes account for the large majority of all injuries received by BCUK users when out in bushcrafting. (Usual statements regarding sample size, representivity etc... apply).

Followed by burns, then sprains/strains.

These are the injuries i've either sustained personally or i've treated while being out.
I know Julia has done a survey on the most common injuries, be interesting to see how many of those would require celox or a tampon to treat.

If you assume that it celox or a tampon can be used to treat all wounds classed as "Large wound ­ I.e. deep knife cut or axe cut with substantial bleeding", then 19% of those who responded said they had one of those injuries. Compared to 95.96% for small cuts/grazes.

Should us blokes start carrying tampons in case we come across a damsel in distress needing one?
How would we know they need one, would they just come up and ask?
Or should we start asking females we come across on the trail if they "need anything"? *wink, wink*

Personally I would rather you carried a supply of chocolate you are willing to share... but that's just me...

All received mate; I'll double check again when on shift down the ambulance station tomorrow and I'll ask the relevant questions when I re validate my rescue medic, cas carer and wemt quals for other work I do in REMOTE areas where the 'golden hour' is not really applicable. I have already registered for the emergency SMS service thank you.

With genuine curiosity, can you clarify what CAS carer and WEMT mean please?

Cheers

Julia

 

[Quixoticgeek]

Clawing back to the start, have you thought about what you've used in the past and why? I stopped carrying topical antihistamine for a while but with the current weather bringing out the bugs more so, and the nature of bushcraft, it's relevant?!

I used to carry a topical antihistamine for years, it lived in my pack from spring till autumn. But recently after receiving bites to the middle of my back in that one square inch you can't get to with your own arms, and after getting board trying to apply the cream to every one of the 20+ bites I got, I switched to carrying Loratadine tablets, as an easier solution to multiple bites.

True enough, you can only carry so much. If you only travel to locations close to a road then a basic off the shelf kit is probably enough alongside a reliable signal on the phone

And yet my data suggests that only 12% of respondants to my survey carry an off the shelf kit unaltered. 2% didn't carry any kit, and the remainder either customise an off the shelf kit, or created their own from scratch.

I can't find burn gel? Any ideas where to buy?

Amazon and ebay sell it, as does Spservices, st johns supplies, and many others. Try searching for "burn blot" or "burn jel" or similar. They all sell it in 3.5ml sachets, a bit like the ketchup sachets you get in the chippy. Great stuff.

Yea, I do know that and none of those lessons has included the use of a tampon.

Out of interest, am I the only one now having the image of a group of grizzled combat medics having to attend a course on the correct use of a tampon ?

Ok, heres my 2p. In 10yrs prehospital medicine i have never been to a bleed that wasnt controled by primary means (pressure and elevation), this has included open long bone fractures, truamatic amputations,direct artery dissecting wounds and dialysis patients whos av shunts have haemmorhaged.

These are pretty substantial injuries. When you say traumatic amputations, are you referring to where a whole limb has gone missing? Is pressure and elevation really enough to save them in that situation?

Yes. Specialist para in urgent care. Aka paramedic practitioner. Working for secamb.

Where abouts in secamb are you? at risk of a slight tangent from the thread, are you aware of the BCUK Kent group?

J

 

[Quixoticgeek]

I do honestly think good points have been put across by both sides, and now anyone reading this thread has some good varied opinions to chose from, how is that a bad thing?

Even this far down the thread I am still learning new things and finding the thread interesting. Not everyone do, and noone has to read all the way to the end. I'm just a first aider, so to be able to effectively pick the brains of people who have far more experience than I will ever get is useful.

how you are diagnosing the conditions that you have the kit to deal with. As I have said in other posts. I am a reasonably well experienced Paramedic, having done solo work in cars and motorbikes, worked in Special Operations/HART and now on HEMS. I also hold the Dip IMC RCSEd but I am well aware that I don't know it all, far from it, and I was interested in what you are doing. I've never heard of the isolating the core thing even though I work with A+E and Anaesthetic Consultants every day and I wanted to know more. I also think it is important that the non health care professionals on this forum understand the difference between evidence based practice, experienced based improvisation and plain silly ideas. Therefore we should be explaining our reasoning behind our kit.

Can you explain the acronyms for us lay persons please?

I to would be interested what happened, how you diagnosed it and how you treated it, mainly as I am curious. The most exciting injury I've had to treat recently was cut on my finger.

Julia

 

[Bluffer]

Not quite. The lessons learned about emergency care in Aghan are trickling down into the civilian services in the UK and US.

I think he was referring to the actual drills and logistical procedures rather than items of equipment.

The first casualty drill taught is 'win the firefight' which has nothing to do with first aid, medicine or medical treatment.

The battle does not stop just because you've incurred a casualty, in fact it usually indicates that they fancy a scrap and that you'll have more casualties if you don't fight back.

We also have blood transfusion protocols that are unheard of in UK and we can take the surgery forward onto the battlefield.

I think that is why anyone with battlefield experience is not automatically going to be the expert in other scenarios

 

[Gimli]

Even this far down the thread I am still learning new things and finding the thread interesting. Not everyone do, and noone has to read all the way to the end. I'm just a first aider, so to be able to effectively pick the brains of people who have far more experience than I will ever get is useful.



Can you explain the acronyms for us lay persons please?


I to would be interested what happened, how you diagnosed it and how you treated it, mainly as I am curious. The most exciting injury I've had to treat recently was cut on my finger.

Julia

Sure.

Special Operations/HART - The Civil Contingencies Act requires ambulance services to not only be able to respond to Major Incidents but plan and be involved in multi agency training for such incidents. In Scotland the ambulance service created Special Operations Response Teams (locally known as SORT), in England and Wales the ambulance services called their teams Hazardous Area Response Teams (HART). In Scotland our teams usually respond to all declared major incidents, any chemical incidents as well as other multi casualty incidents i.e. big road traffic accidents. They also have off road capabilities in order to reach casualties in the more remote places.

HEMS - Civil aviation regulations call emergency ambulance work done by helicopters, "Helicopter Emergency Medical Service", HEMS. There are other types of air ambulance work that is non-emergency, esp up here in Scotland as we move a lot of patients from the islands to the mainland who are not emergencies. When on an emergency flight, a HEMS flight the pilot can claim exemptions from some of the more restrictive parts of civil aviation legislation.

Dip IMC RCSEd - this is the Diploma in Immediate Medical Care from the Royal College of Surgeons of Edinburgh. I hope this explains better than I can, http://www.rcsed.ac.uk/media/133320/dimc web version.pdf, and this thread from another forum may give an independant view, http://www.closeprotectionworld.com/medical-training/18621-rcsed-dip-courses.html.

I hope this helps. Happy to answer more if needed.

 

[BlueTrain]

I have probably put more thought into my first aid gear (and with no regard to what any army, doctor or hospital does) in spite of the fact that it doesn't really get used very much. However, I always take it with me, including when I travel. It has undergone considerable variation over the years, years being something like 40 years now.

I hate to admit it but what was included was partly based on what I carried it in, which was a zipper-closed nylon pouch that I also used for "spare" like an extra flashlight, batteries and so on. It had multiple compartments. It finally wore out. After that, I went through a year, at least, experimenting with various watertight boxes. They were never quite right. They wouldn't always fit in the place I wanted to put them, they were difficult to pack just so and there was the temptation to use the next larger box. But the fact that the boxes were rigid and watertight was good, just not really necessary. So what do I use now?

I use a nylon drawstring bag. It allows me to carry more things, which seems to be what you always want to do, and it fits in more places with less trouble. It's red, too, the only red thing I have. In theory, it should contain everything I want and it should always be complete. I know from experience that it may not. So it actually seems to need more maintenance than other components of my outdoor gear, chiefly because (contrary to what I've already suggested) it actually gets used and everything there is a one-time use sort of thing.

Using an ordinary bag allows me to put everything in one place, too. Before, some things were counted as part of something else, which was cheating in a way, or not included anywhere. A couple of things I wonder if I'll ever have a use for, like a so-called space blanket, but at least I have the space for it. Likewise I do include a first aid dressing because I can see the possibility of a serious puncture wound, more so than a knife cut.

Otherwise, everything has been chosen based on my own experiences over the last 50 years, starting with no first aid kit at all. In a way, that's not the way to do it because there's a first time for everything. But nothing dreadfully serious has happened to me in the woods, although plenty of things have at home. At the same time, most of the stuff is only there more for convenience rather than as a life-saving measure. Band-aids, hand ointment, aspirin, tweezers, things like that are not really essential but they'll certainly find their uses and will probably be used more than a first aid field dressing. I'm sure something essential has been left out. I just don't know what is essential and what isn't.