Friday, February 20, 2015

Building A Medic Kit

How to set up a Medic Bag
This article was not really written by me. I have a friend who is a EMT/Paramedic and was a combat medic. This information is for “Rule-of-law” situations. For the “Where there is no Doctor or hospital” times, a different approach will be needed.
Burn
This article is not about which medic bag to use - the choice of medic bags is astounding and the merits of each is beyond the scope of this article, besides, choice is a luxury and the bag you are issued with may not be your decision. This is about how to best set up your bag ready for use.
If you are looking for a Medic Bag here are some simple guidelines:
• Just because it is sold as a Medic Bag does not mean it is ideal, and if it is not sold as a Medic Bag does not mean it cannot be used as such. We use the 5.11 All Hazards Prime for both training and operational use simply because we like it. 5.11 have a vast range of medic bags and this is not sold as one of them
• Blue or red is the standard color for Medic Bags. It really does not matter. Black is the typical color for tactical teams but can look a little Rambo in a civilian environment, however, they won't look as tired and dirty as quickly as brightly colored bags.
• 1700 square inches is more than large enough for a dedicated Medic Bag for a Responder. A Paramedic with additional equipment and drugs may need more. No matter how big your bag is you will always fill it and you have to carry it.
• Pouches and pockets can be great for organizing kit but more does not equal better. A 1700 ci Carry-On suitcase sub-divided with Tupperware would look out of place but would be easier to organize and access equipment than an all-singing-all-dancing rucksack with a myriad of zips and straps.
The Layout
Lay your bag out in the order of your Accident Procedure: Whether you follow DRABC, (Danger, response, airway, breathing, circulation) or anything else, the accident procedure focuses your attention on the most important issues first, as such when you need to treat something access to that particular equipment should mirror its position in the Accident Procedure in its position in the bag

The equipment listed below is merely guidance and does not in any way advocate the use by anyone without appropriate training. The necessary items are within the scope of anyone who has advanced First Aid training such as First Person on Scene and should be seen as a minimum for that level of training. Sometimes extra equipment is nice but not essential. These items should be considered by those with additional training.
Danger
You are the most important person, then other people, and finally the casualty. As such your PPE should be the first things you lay your hands on. It is very easy to associate the use of gloves in First Aid as a barrier against blood and the risk of HIV but universal precautions are intended to protect us against all body fluids and all communicable infections. Even if there is no blood, we still glove up.
Necessary
• Gloves
• Hand sanitizer
Nice
• Goggles / safety glasses
• Clinical waste bags
• Sharps shuttle
Response
Once danger has been managed we are into the Vital Signs. If the casualty is unconscious we have to purposefully detect and monitor their vital signs. If the casualty is conscious we can begin to record our observations covertly as we talk to them. The next available equipment should be to help you detect and record these signs.
A benefit to having these easily accessible on the outside of the bag is that not everything will be IEDs and chainsaws. Trauma is only one aspect of casualty care, the other being illness and a guaranteed way to affect someone’s breathing, pulse and blood pressure is to immediately rip open a massive medic bag revealing a bewildering range or seemingly archaic torture devices.
The casualty will respond best to calm reassurance; being able to surreptitiously dip into your bag to access your pen and pulse oximeter without breaking your conversation looks slick to anyone watching and will be barely noticed by the casualty.
If the incidence of serious trauma is high in your working environment, shears and tourniquets should be on the outside of your bag and a trauma dressing always in your pocket.
Necessary
• Notebook
• Pen
• Pen light
• Pulse Oximeter
Nice
• Pre-formated observation chart or Casualty Cards
• Thermometer
• Blood Pressure Cuff
• Stethoscope
• Blood Glucose test kit
• Ophthalmoscope / Otoscope
'Clothes-pin' style fingertip pulse oximeters are now so cheap there is little excuse for not having one. Even if pulse oximetry is not within your training they will all show pulse rate. Checking for a carotid pulse is time consuming and not particularly accurate - a cheap pulse oximeter gives you a live feed.
Airway
If you have airway issues, you have issues now. Suction and airway adjuncts should be at the top of the main compartment or just one zip away.
Necessary
• Suction
• Oral airways
• Nasal Airways and Lube
Nice
• Laryngeal airways
• Tape or Laryngeal airway holder
• Colourmetric capnography
A tube of aqueous lube is more economical than individual packets but they are not as aseptic and they leak (especially in the luggage hold of a plane!) and if you lose your only tube it’s not that economical after all. Use individual packets.
Breathing
Face-shields are a bit of a token gesture; they usually are a simple gauze filter rather than a one way valve and make mouth-to-mouth harder. Pocket Masks are a far superior option but if you have anything larger than a butt-pack, you should have a Bag Valve Mask
Necessary
• Bag Valve Mask
Nice
• Oxygen
• Pulse Oximeter
• Non-rebreather Mask
• Nasal Cannula
If you are using oxygen you need to use pulse oximetry. Some medic bags will accommodate an O2 cylinder, if not, carry the O2 cylinder separately but together with a Non-Rebreather and Nasal cannula. A cheap fingertip model may not be as durable or take a reading as quickly as a clinical model but at these prices there is no excuse for not having two - one in the main bag and one in the oxygen bag.

Keep the BVM in the medic bag because it can be used with or without O2. A non-rebreather mask and nasal cannula are useless without the O2.

Circulation
Signs of circulation will have been checked and recorded with the diagnostic sections - here it is all about stopping blood loss.
Again, if you operate in a high-risk area using ABC or MARCH as a standard, keep shears and tourniquets on the outside of the bag for ease or access, or preferably on you person.
For non-catastrophic bleeding, your equipment should take the same hierarchical approach as your treatment. Direct pressure will stop the majority of bleeds so have more pressure dressings than tourniquets.
Necessary
• Pressure bandages
• Gauze
• Tourniquet
• Tape
Nice
• Spare tourniquet
• Haemostatic Agents
• Chest seal
Israeli or Trauma bandages are ideas for applying pressure to serious bleeding wounds but sometimes we just need a bandage. Traditional First Aid bandages and gauze are not only very often insufficient in size they are also packaged poorly in fragile wrappers. H&H Compressed Gauze is vacuum wrapped, taking up less space and in more durable packaging.
Damage
Or Deformity or Disability or Dysfunction or whatever. That's the life threatening stuff dealt with so we can afford to pack the stuff for all other injuries a little deeper in the bag.

Splintag
Necessary
• SAM Splint
• Stretch Wrap
Nice
• Elasticated bandages
• Inflatable splints
• Cervical Collar
• Hot and Cold Packs
Burns
Necessary
• Stretch Wrap
Nice
• Water soluble burns dressings e.g. Water-jel / Burn Shield
• Eye wash
The best treatment for any burn is cold running water but invariably running water is not always immediately available and this is where burns dressings have value. If your budget or pack size is limited to one dressing, get the Face Dressing - it has holes cut out for eyes, nose and mouth but can be used anywhere. A facial burn dressing is the most valuable because running water for 10 minutes over someone’s face is just like waterboarding.
Environment
Environmental conditions can themselves be the cause of problems. If not the cause, they can make them worse. The treatment for heat illness is simply fluid and rest; very little equipment is needed. For cold illness we can provide shelter or protection.


Necessary
• Foil blanket (emergency blanket)
Nice
• Hat
• Blizzard Bag
• Group Shelter
• Chemical heat packs
Accessories
It’s very easy to go over the top with gadgets and accessories but a few well chosen supplementary extras will prove themselves invaluable:
• Head lamp
• Ski-Pass holder - keep your trauma shears on your belt connected with a retractable ski-pass holder. They will then always be where you left them.
• Scissors - blunt/sharp are best for bursting open difficult packaging and not accidentally bursting open the casualty's skin
• Chemical light sticks
• Duct Tape
• Magill forceps
• Tweezers
• Tape - you can never have enough tape
A Modular Approach
There is no such thing as an Ideal set up as it depends on so many factors including, but not limited to, your budget, your skillset, kit availability, the number of casualties you are expected to treat, the distance from definitive care and the activities potential casualties are involved in.
Organizing the main compartment using bags or mesh boxes not only simplifies the layout of the bag but gives you some flexibility without having to completely repack when the situation changes.
• In a high-risk environment you might choose to double up your Circulation module.
• In an industrial environment you may choose to combine the Circulation module with Splinting equipment in order to make space for a dedicated burns module.
• At a community event it will be either cuts and grazes or cardiac arrest so you may remove the burns module in favor of a defib.
• In a remote environment a defib on its own might not be warranted so you may make space for high energy food and a group shelter.
Team Bags
If you are working in a team, ensure that every bag is packed identically, this means that whichever bag you grab you know where everything is.
If you are lucky enough to benefit from regular training, dedicate one bag specifically for scenario training. A Training Bag builds muscle memory in terms of locating and assembling equipment as well as gaining familiarity with the use of the equipment. A Training Bag can be used and re-used and ripped apart and restocked with expired consumables without having to worry about Live Bags being damaged, contents not being replaced or sterile packaging compromised.
The Training Bag should be identical to the Live bags but...
If you are using identical equipment for training, make sure it is clearly labelled and stored separately.
Above all, get trained and practice. Know how to use everything you have, but you can include some things you’re not sure of. You may be with someone who has the knowledge to use that item. But don’t fool yourself into thinking in your time of need you will magically know what to do. You may not panic, but you’ll be useless without training.
Semper Paratus
Check 6
Burn
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