Patroller Advice Request: What to put in a 1st Aid Kit

[time2clmb]

Now according to (COTACS):
1. Direct Pressure/Pressure Dressing
2. Tourniquet
3. (Hemostatics in certain circumstances)

Did you leave out pressure point on purpose or was it left out for a reason?

As for giving drugs out please know the drug and the contraindications before arbitrarily handing this stuff out, or you could potentially make the problem worse. Even some thing as simple as A.S.A. has contraindications. It's simple to get this info from google for the drugs you will be carrying. Think of it this way, you give some one in pain morphine and they react bad to it, or you gave them too much or some thing like that. Now you have to breath for them too, turning a semi bad situation in to a really bad one.

[summit]

Did you leave out pressure point on purpose or was it left out for a reason?

THEY, (they being Comitte of Trauma / American College of Surgeons) left it out. I have not read all of the research or reasoning but would PRESUME that it is because the cons of a tourniquet have been found to be lower than previously though versus its effectiveness (which is higher than pressure point, they do do essentially the same thing, and tourniquets are more reliable and give the provider free hands). That presumption could be way wrong.

Again, 6th edition seemed to be a progression and things were changing. I think 7th edition will have clearer recommendations for prehospital providers.

As for giving drugs out please know the drug and the contraindications before arbitrarily handing this stuff out, or you could potentially make the problem worse. Even some thing as simple as A.S.A. has contraindications. It's simple to get this info from google for the drugs you will be carrying. Think of it this way, you give some one in pain morphine and they react bad to it, or you gave them too much or some thing like that. Now you have to breath for them too, turning a semi bad situation in to a really bad one.

I agree 100%.

(If you were referring to the hemostatics, most OTC hemostatics have no contraindications other than presence of infection.)

[likwid]

Summit, stick with paracord.
Spectra/Technora doesn't hold knots worth a damn unless you're stacking/lashing and it'll be under load.

Dyneema is just as strong and knots a little better as an alternate.

[strum]

this is in my east coast kit, some of the thins are issued by the area and I otherwise wouldn't carry (i.e. airsplint and ski pole traction)
Gloves - nitrile 6 pairs (keep 2 pairs in my pants pocket as well)
3 cravats
bandaids
saline
Gause (sterile)- lots, 3X3 nonstick: 8, 3X3 norm:8, 4x4 norm:8, 2" roller-2, 3" roller-2
abdominal: 1, eyeshape: 1
Gause (non sterile) couple rollers
pupil light
CPR mask
Trauma sheers
moist towelettes
glucose (I usually carry sugared jello, easier, and tastes better)
spare knife
sam splint (or equivalent)
air splint
ski pole traction kit
zip locs
biohazard bag
safety pins
tape, lots of tape (athletic, duct, vinal)
all fits with room in a "mini" aid belt

[time2clmb]

THEY, (they being Comitte of Trauma / American College of Surgeons) left it out. I have not read all of the research or reasoning but would PRESUME that it is because the cons of a tourniquet have been found to be lower than previously though versus its effectiveness (which is higher than pressure point, they do do essentially the same thing, and tourniquets are more reliable and give the provider free hands). That presumption could be way wrong.

Again, 6th edition seemed to be a progression and things were changing. I think 7th edition will have clearer recommendations for prehospital providers.


I agree 100%.

(If you were referring to the hemostatics, most OTC hemostatics have no contraindications other than presence of infection.)

I wasn't talking about the hemostatics. That comment on the drugs wasn't directed at you it was more of a general comment to all.

Should be interesting to find out if they eventually get rid of the pressure point thing, I can't really see it happening though. Then again, they got rid of the pulse check in the standard CPR course. They figured that people are too stupid to do such a simple check. The instructor was saying that the majority of people could either not remember where to check, or were doing it wrong, so they got rid of it for the standard course all together. Studies showed that doing compressions on a person that still had a regular beat, really didn't affect it, so they axed it. I don't know man, but if I was just passed out with a pulse and some randy rescue started pumping my chest breaking my ribs, I would be pretty pissed off. Anyways...off topic now.

My kit:
- Emergency blanket
- gloves
- face shield ..there's no way I want to taste some ones lunch or get puked on
- roller gauze
- some sterile 4x4's
- 1 pressure dressing
- knuckle bandaids *I climb alot*
- duct tape around my pole

For longer trips I add some drugs. Some times I add a SAM splint, but my partner or I have poles I don't bother.

Anything else can be improvised for the most part. You have lots of stuff usually. Pack straps ect ect ect...

[skinnyskier]

Save your tourniquet time for the OR. It's hard to imagine a survivable backcountry wound which could not be controlled with direct pressure. After an angiogram, patients have a good-sized hole in the femoral artery which closes with 10-15 minutes of direct pressure. My wife the trauma surgeon can only remember one wound which needed more than direct pressure, in a patient who was run over by a ski boat.

The best tool in your first aid kit might just be someone with strong fingers and a strong stomach. Paramedic students work particularly well for this purpose in the ER.

[summit]

OK, I researched this some time ago and I am loathe to argue the subject of medicine with people who have MD after their name, but here's my counterpoint:

Yes, most bleeding can be stopped by direct pressure alone. But how long does it take and how much blood is lost in the process? I guess it doesn't matter as much if you have bright lights, cold steel, MDs RNs PAs RTs and also paramedic students standing around and a huge storeroom and extra units of warm blood to run in.
But on the street with a medic and a basic with 4x4s, kerlex, and some NS 2 hours out?
One EMT on the side of a mountain with only what he carried 6 hours out?
Johnny first aid in the same situation?

Wounds *needing* more than simply direct pressure, tend to be large areas of soft tissue damage to the extremities or penetrating injuries. Why does the military have such good luck with hemostatics and tourniquets? Multiple shrapnel wounds to the limbs while the core is protected by armor. While this is seen not so often in civilian EMS (and we hope it stays that way), there are still penetrating injuries and incidents of massive trauma to extremities that could benefit from tourniquets and hemostatics, which is why COTACS presumably made such a recommendation. Also hypothermia and clotting deficiencies (natural or due to medication) can be addressed by these treatments as well. And different treatments were recommended for different transport times.

I can think of more one patient I had in my relatively short career who probably would have lived with hemostatics. They weren't in the hospital when they coded.