First Aid - Critical Preparedness Planning

Discussion in 'Survival Medicine' started by melbo, Sep 30, 2006.


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  1. melbo

    melbo Hunter Gatherer Administrator Founding Member

    Special Report: First Aid, and Then Some

    by Jim Rawles

    Editor, www.SurvivalBlog.com

    Most of the advice found at disaster preparedness web sites emphasizes basic first aid. Mainly because of liability fears in our outrageously litigious society, most articles do not discuss more advanced techniques. While there is no substitute for proper training, I do recommend laying in the essentials for minor surgery. You never know when you will be forced by geography or circumstance to take on minor surgery. In most cases if you do so in extremis, you will be shielded from prosecution by Good Samaritan laws. (But be sure to research you state laws first!) Also, keep in mind that Good Samaritan laws are not sure protection from civil liability lawsuits.

    Important Disclaimer: All of the advice in this report applies only to worst case situations when there is no outside help available, and your choices are either watching someone slowly die, or trying to do something to prevent it. Always seek professional aid and do not act if you don't know what you are doing. Get the proper training!

    First Things First

    To start, get training in the first aid basics from The American Red Cross (www.arc.org). You need to know how to immediately react when you are faced with someone that is choking, someone having a heart attack, or someone that has trauma from an automobile accident or gunshot wound. Learn things like how to give CPR, how to recognize and treat for shock, how to recognize an epileptic seizure, how to apply direct pressure, and so on. Most community training, including that given by the Red Cross training is free or given "at cost.". Take advantage of it!

    Bandages

    It is important to stock up on bulk bandages and wound dressings, such as tape, gauze, non-stick pads, burn dressings, and so forth. Small commercially packaged bandages from your local drug store are grossly overpriced. For example 4"x4" gauze pads - buying those from your local pharmacy in the 10 to box quantities would bankrupt you. But if purchased as military surplus, they are available in 100 count sleeves for about the same cost as a single box of 10 commercial dressings.


    First aid items that have essentially unlimited shelf life (such as gauze and splints) can and should be bought in bulk. If you can buy those from surplus outlets for "pennies on the dollar" then don't hesitate to buy a lifetime supply. But keep in mind that items with adhesive (band-aids, bandage tape, butterfly closures, et cetera) have a limited shelf life, so don't go hog wild buying those. Otherwise, some will surely go to waste. Some items can be found on eBay at reasonable prices. A few dealers that I can recommend are: JRH Enterprises, Ready Made Resources, Safe Solutions, Sportsman's Guide, and Nitro-Pak. Other low cost U.S. military surplus sellers include Civil Defense Supplies and Spruce Mountain Surplus. (I haven't done business with either of the latter, so I can't vouch for them.) A vendor with a very wide selection of civilian wound dressings (albeit at slightly higher prices) is Quality Medical Supplies.

    Minor Surgery and Advanced Techniques


    This report is too brief to go into the details of minor surgery or procedures like an emergency field tracheostomy. (BTW, for the latter, see: http://www.emedicine.com/ent/topic356.htm )
    Take the time to read the following books. (For sources, see the References list, below.)


    Ditch Medicine: Advanced Field Procedures for Emergencies, by Hugh Coffey.

    Survival and Austere Medicine: An Introduction
    Emergency War Surgery

    If you are anticipating a disaster situation where you might not have access to modern medicine, or if you plan to travel to Third World countries, then these two books are "musts":

    Where There is No Doctor
    Where There is No Dentist

    Put It All In Kits

    First aid supplies and minor surgery instruments are useless unless you have them where and when you need them. Think in terms of putting all of your gear into specific kits. You should have a pocket size kit for day hikes, a slightly larger kit for backpacking trips, a car/truck kit for each of your vehicles (including your ATVs or snowmobiles), and a full blown at-home minor surgery kit. For details, see the excellent article "Getting Your Group to Buy In: The $20 Medical Kit, By EMT J.N.", which is included as an appendix to this report.

    Nursing Skills

    It has been said that one of the most important aspects of medicine is giving the human body the time it needs and a comfortable environment to heal itself. Learn how to be a good nurse and caregiver. The classic book "Red Cross Home Nursing" is a good general reference. Used copies are often available through Amazon.com or on eBay.

    Conclusion

    Get the training. Buy the supplies and keep them handy (including, most importantly, a car kit.) Remember to rotate supplies that deteriorate with age. Get regular refresher training. And as always, keep in mind: "Do thy patient no harm."



    Resources:

    General:
    Survival Blog www.SurvivalBlog.com

    First Aid Training:
    The American Red Cross www.arc.org
    Wilderness Emergency Medicine Services Institute (WEMSI) http://www.wemsi.org/


    Advanced Lifesaving / Combat Medic Training for Civilians:
    JRH Enterprises http://www.jrhenterprises.com
    Wilderness Emergency Medicine Services Institute (WEMSI) http://www.wemsi.org/

    First Aid /and Wound Dressing Supplies: JRH Enterprises http://www.jrhenterprises.com
    Ready Made Resources http://www.ReadyMadeResources.com
    Safe Solutions http://www.SafeSolutions.net
    Sportsman's Guide http://www.sportsmansguide.com
    Nitro-Pak. http://www.nitro-pak.com
    Civil Defense Supplies http://www.civildefensesupplies.com
    Spruce Mountain Surplus http://www.sprucemtsurplus.com/justin.html
    Quality Medical Supplies http://www.qualitymedicalsupplies.com

    Clotting Agents:
    Quick Clot. See: www.z-medica.com)
    Traumadex. See: Ready Made Resources http://www.ReadyMadeResources.com

    Surgical Instruments/Supplies:

    Henry Schein Medical Catalog http://www.henryschein.com/medical-supply-catalog.asp?temp=1
    JRH Enterprises http://www.jrhenterprises.com

    Packing Lists:
    Doyle MacDonald on "Jump" Kits: http://www.sff.net/people/doylemacdonald/emerg_kit.htm

    References:
    Survival and Austere Medicine: An Introductionhttp://www.aussurvivalist.com/downloads/AM Final 2.pdf
    Ditch Medicine: Advanced Field Procedures for Emergencies, by Hugh Coffey.
    Emergency War Surgery. Reprint of the NATO manual. Available from Desert Publications, El Dorado AR 71731, ph. (501) 862-2077
    Where There is No Doctor http://www.hesperian.org/publications_download.php#wtnd
    Where There is No Dentist http://www.healthwrights.org/books/WTINDentistonline.htm

    Appendix:

    Getting Your Group to Buy In: The $20 Medical Kit, By EMT J.N.

    Overview
    After the Katrina fiasco, a lot of my friends started to get interested in preparedness. Having some experience as an EMT and SAR volunteer, I decided to take the initiative and organize a group buy on medical supplies. This article is intended to help others who would like to put together low-cost, practical medical kits, particularly for a group.
    For the short version, skip down to The Kit: Part I. Otherwise, read on.


    Background
    For any kind of preparedness project, it's best to have a set of goals in mind at the outset. The goals I came up with were to build a kit that:
    1. Is simple to use by lay people, with a maximum chance of helping in a crisis and a minimum chance of causing harm.
    2. Contains supplies for 2-3 people to take care of themselves for 1 week in the event of a crisis (earthquake, weather emergency, flu, etc) or for one major incident (car accident, work injury).
    3. Useful for the same 2-3 people during an average year of minor cuts, scrapes, and illnesses. Useful as a stand-alone kit or a module in a larger cache.
    4. Easy to obtain and replenish (no exotic meds or perishable items)
    5. Compact and easy to store (1 gallon Ziploc).
    6. The last, and most difficult: the kit must cost around $20.
    Based on experience, I felt that it would be unrealistic to expect friends and neighbors to spend $1,000 on a full-blown medic bag suitable for an expedition to Mt. Kenya, or to spend 100+ hours in EMT training. Someone who is dedicated can get to this level of preparedness, but those supplies do no good if they are locked up in your basement and not out where the hurt or sick people are.
    If you happen to be the sick person or away from your cache of gear, the same rule applies.
    So let's start with the assumption that our friends are be willing to put $20 towards their own safety and maintain something that fits inside of a 1 gallon Ziploc. If copies of that kit are distributed to all of your friends, neighbors, family, deer hunting buddies, etc then there is a better chance that:
    1. They will be able to take care of their immediate needs during the first critical hours of a disaster.
    2. They will be there to help you.
    3. As a group, you will collectively have enough supplies to stabilize someone who is really seriously hurt.
    The Kit Part I - what do we really need?
    A lot of papers have been written on the subject of first aid kits and what they should contain. What we're most interested in is being able to carry out a few basic interventions that can treat the small problems and buy us time to get to a real doctor for the big ones.
    So what can we reasonably do? A complete discussion of first aid measures could easily fill a book, but let's keep it simple.
    The basic things needed for a person to live are the ABCs:
    Airway
    Breathing
    Circulation
    Any major interruption to the above, and you're basically done for without immediate intervention. Going down the line, we have other common problems that can threaten our survival:
    Shock
    Hypothermia
    Dehydration
    Fever
    Infection
    Major Injury
    We also have a number of minor problems that can become major ones if we ignore them. A sprained ankle may keep you from being able to evacuate. A minor cut can lead to sepsis when you're in a dirty environment. Diarrhea is annoying, but can kill you if it goes on for longer than a couple of days.
    For the kit to be worthwhile, every item should be able to help us solve these problems, and preferably have multiple uses.
    After substantial research, the kit listed below was settled on as being a good compromise in terms of usefulness and cost. The supplies are grouped by categories.
    Personal protection
    (1) 2oz Bottle, hand sanitizer
    (4) Exam gloves, Nitrile
    (1) CPR shield
    Instruments
    (1) Splinter forceps, pair
    (1) EMT shears, pair
    (2) Disposable fever thermometers
    (1) Razor blade

    Bandaging
    :
    (20) 1" Band-aids, cloth
    (2) Roll, 4.5" Kling gauze
    (1) Small roll, medical tape
    (4) 4x4" gauze bandages
    (1) Triangular bandage
    (1) Ace elastic bandage, 3"
    (10) Steri-strips, 1/4x1.5"
    (2) Tincture of benzoin swabs
    (2) Instant Cold Packs


    Medications:
    (6) Packets, triple antibiotic ointment
    (20) Benadryl tablets
    (20) Ibuprofen tablets
    (18) Imodium tablets
    (15) Aspirin


    Other:
    (4) Plastic vials, 2 dram capacity
    (1) Bag, 1 gallon Ziploc freezer-type

    The Kit Part II - What can we do with these supplies?
    Here is a brief explanation of each group of items and what it might one day do for you.

    Personal protection - These items are there to help keep you, the rescuer from getting a disease or worse from someone you are trying to help.
    Gloves are a good precaution whenever bodily fluids (blood, vomit, etc) must be handled. The more expensive Nitrile gloves are better, as some people are allergic to latex. They are also more sturdy.
    A CPR shield is a must-have if you ever expect to perform CPR or rescue breathing - it could mean the difference between helping someone without hesitation and not being willing to risk it. Don't spend a lot of money here, as it's also one of the least-used items and the reusable models can be harder to use without practice.
    Hand sanitizer is always useful. Ask any nurse about the importance of washing up. The alcohol-based gel is not as good, but the best you can get when the hot, soapy stuff is unavailable.


    Instruments - Being able to dig a splinter out, cut away clothes, or take vital signs, is one heck of a lot easier with some basic tools. EMT shears are inexpensive, heavy-duty scissors that can even cut through a penny. These, along with the other items will find many uses to an imaginative person. The forceps (tweezers) can also be used to get the cotton out of the pill bottles.

    Bandaging
    - Bandages are used to stop bleeding and protect wounds. An assortment of cloth band-aids can help you deal with minor injuries, while the larger gauze pads and rolls can help with bigger lacerations (cuts) and abrasions. An Ace bandage can be used to treat a sprain, hold a makeshift splint onto a leg, or wrap up a severely bleeding wound that requires pressure. An additional item that might be added is one or more sanitary napkins. Aside from their feminine use, they are excellent for soaking up blood on large injuries.
    For major cuts, steri-strips are a way of closing up the skin without needing special equipment and training. Think of these as "band-aids on steroids." They are thin tape strips, 1/4" or so wide and 3-4" long, coated with a super-aggressive adhesive and reinforced with cloth fibers. After thoroughly cleaning a wound (a hole poked in the Ziploc can allow you to squirt clean water deep inside), the steri-strips are applied much like sutures (stitches), across the wound to close the edges up.
    Tincture of Benzoin (a sticky disinfectant swabbed on wounds) will make the steri-strips stick better. Properly applied, they will stay on for up to 2 weeks, even with showers. Don't waste your money on butterfly bandages - these are far superior.


    Medications - These are inexpensive drugs that can be bought (at least in the U.S.) without a prescription.



    Antibiotic ointment (i.e. Neosporin) should be applied to cuts to reduce the chance of infection, particularly in dirty environments.
    Benadryl (Diphenhydramine) is an antihistamine (anti-allergy) medication that can help treat cold and flu symptoms (runny nose, congestion), make allergies less severe, and aid sleep. (Many OTC sleeping pills contain Diphenhydramine.)



    In addition, taking Benadryl early could help save your life if you suffer anaphylactic shock (i.e. a severe allergic reaction, such as from a bee sting
    Ibuprofen is a pain reliever, anti-inflammatory and fever reducer. In a survival situation, being able to carry out important tasks without the pain from a headache or sports injury could be critical, as could reducing a life-threatening fever.



    Aspirin is also a pain reliever, and has fever reducing effects, although Aspirin should never be administered to children with fevers, due to the possibility of a life-threatening complication known as Reye's syndrome. Aspirin is also often given at the first signs of a heart attack in many EMS protocols.


    Imodium (Loperamide) is the last OTC drug included, and it is used to control diarrhea. Diarrhea can interfere with your ability to perform tasks, but it can also be life threatening if it causes dehydration. A 2-3 day course could be life saving in an emergency.


    With any medication, it is important that the full instructions be included in your kit. Make photocopies of the drug labels and warnings, and include with your other documentation. Be sure to write down the drug expiration dates as well.
    All of these meds should be good for at least 1 year after purchase, but check first.


    Plastic dram vials are good for packaging drugs purchased in bulk. Add a small amount of cotton if you need to protect the pills from being crushed by vibration and shaking. And don't forget to print labels for each bottle.
    In addition to the four above, you might want to pack an extra vial for your personal medications.


    The Kit Part III - Being a savvy shopper!
    Assembling all of this and keeping the price under $20 is difficult unless you buy in bulk.



    From our research, we found that Costco had hands-down the best prices on medications. You will need to buy the large, bulk bottles and repackage them.



    For bandages and related first-aid supplies, buy quantities mail-order from an EMS or medical company such as Emergency Medical Products.
    Many supplies are available locally. Wal-Mart often has 2oz bottles of hand sanitizer for U.S.$0.99. The plastic vials can be purchased in packs of 25 or 100 from several eBay vendors. The razor blades can be had in 100-packs at any hardware store.



    Some of the "Big Lots" type discount stores also have first aid supplies. I recently found 2-packs of Ace bandages for U.S.$0.99. But be wary of buying medications at these places, as you may find that they are close to their expiration dates.





    Conclusion - Putting it all together
    Once you have orders from all of your group members (20-25 kits seems to work out well on quantities for the first order) and you've received your supplies, you'll need to pack them. I've found that the best way to do this is to have each group member come and pack their own kit. This way, everyone will be familiar with the contents and will know where everything is.


    The first time you do this, you will probably lose money, owing to the odd quantities that some products must be purchased in, and occasional hidden tax or shipping charges. Think of it as a charity (or charge a bit more than you think you need to up front!)

    And remember, the best survival kit is the on you keep inside your head, in the form of training. Go sign up for Red Cross First Aid/CPR training, take a First Responder, Wilderness First Responder (WFR), or EMT class. Read books, or take on-line lessons. There are several excellent, free resources on-line.


    Appendix I:
    Spreadsheet with kit contents. Includes a worksheet help figure out quantities to order, total cost, etc.
    http://23.org/~arclight/firstaid/medical_kit_worksheet.xls
    Sample Avery labels (Avery #8257) for pill bottles.
    http://23.org/~arclight/firstaid/drug_labels.doc

    Appendix II:
    Optional Items:

    Rehydration Mix
    If you should come down with severe diarrhea, you can die from dehydration and loss of electrolytes. Stocking some Pedialyte, Gatorade (dilute to 50% with water) or the homemade equivalent could be a life saver. The basic recipe is 1 teaspoon (5ml) salt, 8 teaspoons sugar and 1 liter of water.

    SAM Splint (or imitation)
    These are very versatile split devices, which consist of thin aluminum on a foam backing. You can bend and use as-is, for splint arms, wrists, legs, etc or cut up with your EMT shears to make finger splints.


    N95 HEPA Masks
    If you're worried about airborne pathogens, this is a good thing to have. Most hardware stores sell masks with an N95 or higher rating, and small, collapsible masks are available from medical outlets.


    Upgraded CPR Mask
    The $1, disposable shield will serve, but a better shield, with a one-way valve will make things easier. The CPR Microshield from MDI is good compromise, as it is superior to the thin plastic shield, has a one-way valve, and comes on a keychain.

    Suction
    Keeping the airway clear is critically important when someone has experienced trauma or is severely ill. Commercial suction devices are available, but a cheap, improvised solution is a standard turkey baster. For less than $2, this could be a useful addition to a kit.


    Thin Sharpie Marker and paper
    Useful for recording vital signs. (You do have a watch, right?) With a Sharpie marker, you can also write the numbers on the patient's hand, so that there is no chance of the paper being lost during transport/evacuation.

    Better Packaging
    The 1-gallon Ziploc bag was chosen as the least costly option for getting the kit out there. You will probably want to find a better container to package it in if you expect it to last in a vehicle or other harsh environment. The basic kit can fit into a 30 caliber ammo can, a small Pelican box (1300 series or larger) or a soft bag. Harbor Freight offers a low-cost canvas or nylon bag that will neatly hold the kit. Check out items #40727-3VG, item #38167-0VGA, and item #32282-7VGA
    If you really want a top-of-the-line, well organized packaging system, look at the compartment cases from L.A. Rescue, Outdoor Research, or Atwater-Carey. A search through most EMS catalogs, or a Google inquiry should turn these up.

    Useful Web Sites:

    Wilderness Emergency Medicine Services Institute (WEMSI)
    Lots of good materials, including the full text of their training manuals
    http://www.wemsi.org/

    Where there is No Doctor (Now available on-line)
    http://www.healthwrights.org/books/WTINDonline.htm

    Free First Aid Guide (From SciVolutions, a medical manufacturer)
    http://www.firstaidguide.net/

    Emergency Medical Products
    Sells a full line of EMS supplies
    http://www.buyemp.com

    Allegro Medical
    Generic Medical catalog, offer smaller quantities of similar items
    http://www.allegromedical.comBooks

    Wilderness Medicine (Great reference, previously recommended here on SurvivalBlog.com)
    Paul W. Auerbach
    (1,910 pages, hardcover)
    ISBN: 0323009506

    98.6 Degrees: The Art of Keeping Your Ass Alive
    Cody Lundin
    (240 pages, soft cover)
    ISBN:1586852345



    Again, if you would like to take real steps to get prepared, then you can simply order nowHERE (www.readyfortheworst.com), and get started. Best,
    Jake Stafford

    Arbogast Publishing LLC

    PO Box 759
    Genoa, NV
    89411
    US
     
  2. phishi

    phishi Psy-Ops Moderator Emeritus Founding Member

    I read this last night, and again this morning in an attempt to organize my thoughts on this matter. Of the two articles, the second is better. It presents a realistic approach to a large first aid kit that is cost affective. It does have a few issues that I would like to mention, but I'll get to that later.

    The first article is the one that I have the largest problem with. It, to me at least, implies that general surgery is a walk in the park and, in certain circumstances, should be attempted, even with little to no medical training. I disagree with this idea, for the most part at least, unless the surgery results will meet the three following criteria.

    -1: The surgery will save the life of the patient.

    -2: The surgery will not stress the resources of the group.

    -3: The surgery is not beyond the skill level of the individual performing the surgery.

    Taken seperately these do not seem to be in conflict. Taken together however and we have a different senario. In theory, a tracheotomy will save the patient's life, and can be done by an individual with limited medical training. However, it will stress the resources of the group. You will now be responsible for breathing for the patient, maintaining the airway, monitoring for infection, and the chance of a full recovery is low. You will need an individual who can go one on one with this patient concerning care, meaning that you have now lost not one, but two strong backs to work in the fields. You will need some high end medical equipment, possibly a vent, and the ability to use it. In other words, this surgery has led to an increased burden on the group.

    That is not to say that the three criteria can not be met. Some examples might include debridement in conjunction with wound closure, debridement with an infected wound, amputations due to infection or crushed/mangled extremity, taking out a tooth, chest decompression, and foriegn body removal and dealing with hemorrhage that results. Most of these can be done with minimal training, will not stress the resources of a prepared group, and may save the patients life. (Note: This is not to be entered into lightly. Get the most amount of medical training that you can NOW. This will tell you your limitations as well as what you will need to stock.)

    Some basic equipment that you would need would include suction, sutures, surgical instruments, other wound closure methods (derma bond, staples, steri-strips), wound cleaning set ups, pressure cooker for sterilization, gloves, gowns, masks, multiple sets of clean linen, a way to wash the linen on a daily basis, light sources, bandges, antibiotics, pain meds, splints, IV setups, beds, tables for surgery, and more. I am sure that I have only scratched the surface, but the more you have, the better your patient's odds at survival. I estimate that to run a small aid station with surgery suite you could easily spend as much as you have already spent on food, guns, and gear, and still not be ready for everything. The idea is to stock what you know how to use, plus a little that you don't (In case you find a Doc wandering about ;) ), and make due with the rest.

    That brings us to the second article. Medical supplies and training are usually at the bottom of everyones list. They aren't sexy, it isn't fun, and they aren't cheap. The list provided in this article however does a great job of helping you to get a small kit together for a great price.

    There are a few points that the author makes that I would like to elaborate on. First, I would not even include a CPR shield, unless you believe that medical help will still be available. By that I mean EMS or a hospital. CPR is a stop gap measure that does save lives, but only if there is a higher level of medical care that can be reached quickly. If you are going to start CPR, in the middle of the woods, with a 2 hour walk back to the trail head and an hour drive to a hospital, you are possibly going to exhaust yourself and the odds are against the patient surviving. I would lose the shield and place some extra bandages in the now open space.

    Second, add some Tylenol, some Pepto tablets, and a SAM splint to your load. The meds will give you more flexibility in what you can treat. The splint will make your life easier when treating sprains, strains, and broken bones. Add an extra ACE wrap or two also.

    Third, warm weather injuries are discussed, but not cold. I would add a space blanket and two or three instant heat packs if you are in cold weather country. These will help warm someone who is pre-hypothermic. They don't add much weight and take up little space. (Note: Always rely on your training concerning cold weather injuries and how to deal with them.)

    Four, Benadryl should not be used as the primary drug for an anaphylactic reaction. Epi pens, if available, are the first drug on board. They react much faster with what is going on in the human body. Benadryl is loaded second because it takes longer to work, but will also stay in the system after the body has used up the Epi. If Benadryl is all that you have, get it on board, and start looking for a higher level of medical care. (Note: Same should be done if you have put both Epi and Benadryl into the system. The combo might not work as well as you hope and by moving towards help you can get the patient stabilized for what could be a rough 24-48 hours.)

    Finally, the purchase of large amount of meds. The author is correct, if you are building multiple kits, then Costco or Sam's club is probably the way to go. If you are only building a couple, or are keeping all of the kits for yourself, you may want to think about buying small amounts of meds at different times. I say this because I purchased large 500 count bottles for Y2K. I figured that they would be needed. They were never used, and when time came for their replacement, I was out the money, plus all of my stash at the same time. By purchasing these seperately, in small batches, I feel that I don't lose all of my stash at the same time (expiration dates will be different) and I can spread the cost over different paychecks. YMMV.

    Just my .02,
    phishi
     
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    Survival First Aid
    Thread by: melbo, Aug 9, 2005, 44 replies, in forum: Survival Medicine
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