MEDICAL KIT IDEAS
By: Mike the Medic
First off, the following are just some ideas on what to carry in, and how to carry your medical gear. This article is an idea on "a" way to carry and what to bring. It's not "the" way, remember that. Variation is good and improvisation is better.
The medic should have several delivery systems for his gear. The system: backpack, thigh rig, or vest, dictates the amounts and the types of gear the unit will take - different size kits for different jobs. The medic takes into consideration four things when planning what to bring and the amount of certain supplies:
Knowing the duration of the mission or the time expected to be out and about is important because it lets the medic know how long they will have to support the team members' medical needs. Being aware of the type of threat to the team, (if there is one), is important because it allows the medic to plan as to expected injuries. Knowing the number of people involved and their ages is pivotal. A group of three people is more than likely not going to need half the amount of supplies that a large party may need. If pediatric patients are to be expected then appropriate medical gear must be included. Always be aware of the environment as it can be your worst enemy, (hypothermia, heat stroke, dehydration, you get the picture).
We can set several criteria for the actual bag used to carry your medical gear. It must be subdued in color. Black or olive drab are the most common along with blue, (maybe), and orange, (NO WAY). The medical bag must be able to withstand reasonable mechanical trauma like being dropped over a fence, thrown into a car, stepped on, fallen on, and dragged. The bag or pack must be able to be accessed easily, while at strange angles and while still on the medic's back. It's got to be water-resistant and have strong zippers, YKK type and 1000-Denier nylon construction.
As for the contents of the bag itself, it should have the gear in it to handle common medical problems and serious advanced life support emergencies at your level of training or one above. There should be clear and concise instructions in the bag for basic life-threatening emergencies for those non-medical personnel or basic life support providers who may find themselves using the gear should the medic be suddenly unavailable. An easy technique for medics to use when packing their bag is to put everything in colored modules or bags. The gear must be packed the same way each time so as to be accessed easily in low light, sensory deprived conditions or when the medic is fatigued. The following is a list of some possible contents:
AIRWAY
The above items can be packed together in one small bag and are your initial means of airway control. An experienced EMT should most definitely be able to ventilate an unconscious unresponsive patient effectively with those items. If they can't, then they need some training.
The above list is for advanced life support personnel. BLS providers should ignore it for now and maintain ventilations with the first set of items. Advanced training can be conducted if there is an ALS provider available. I firmly believe that orotracheal intubation is one of the easier ALS skills to learn. The anatomy of the airway and what to recognize are important. Most important is the ability to recognize when the ET tube is incorrectly placed - that's the key.
This is my last ditch airway kit. I use this when all else fails or post-initial assessment when I've figured out nothing else will work. It's important that the medic customize this particular kit and be familiar with its use. By the time you've reached this point in your treatment, things are dire in deed.
The above gear should be enough to cover your emergency airway needs. I specifically grouped the gear together to illustrate the different levels of airway intervention. Every medic feels more secure with the airway properly managed. Become familiar with your gear. Pull it out of the bag and "fool around" with it.
BLEEDING
Remember this simple fact: pack as many BLS supplies into the pack as you can. I'm talking everything from abdominal pads to 2x2's. I like the Kendall conform rolled gauze as it comes in several widths. There is nothing better than being able to plug up holes in human tissue with some rolled gauze. I like the big trauma pads for the simple reason that you can always make up a smaller dressing from a bigger one, but try to make a bigger dressing from several smaller ones, (it's a pain and delays treatment). The military traumedic dressings are cool because they have the ties built into them. Cedderoth makes an ok dressing called The Bloodstopper.
As far as IV fluids, we have two choices: Ringers or Saline. I like to use Saline for all calls, period. It's the fluid advocated by the AHA for all cardiac arrests and it's the fluid used as a main line for blood transfusions. If you have ringers, don't sweat it. Just remember that it shouldn't be used for blood infusions.
I like the 3M Durapore or Johnson and Johnson Dermiform tape. I know the stuff sticks well even when damp. And if it doesn't, I wrap it around until it sticks on itself. There is the waterproof tape (I believe Johnson and Johnson put it out) but I don't have much experience with it. If you are really desperate, just use the Konform Kling to cover the area, then tear the end into two strips and tie them together. For immobilization or securing the bandage to the wound, you can also use Elasticon tape which is marketed by Johnson and Johnson, (go figure). I have used this tape to cover chest wounds on a regular basis and used it three days ago to cover a large evisceration from a .357 mag wound. It kinda looks like an ace bandage but is real stretchy and REAL sticky on one side. I covered and washed some exposed small bowel with Betadine and stuffed the intestines back in. I know what you are thinking and, yes, it was under the surgeon's direction post airlifting the patient to a level one trauma center.
To Control Bleeding
Again, I would pack as much of the BLS supplies as I could. In the case of fluids, (IV), I would just pack two 1000cc bags of .9 Normal Saline with drip macro drop drip sets. If possible, get Hespan, which is a true volume expander. You will need an appropriate amount of IV catheters with start kits. I personally do not put 16-gauges in anymore - haven't in several years. With 18-gauge catheters I have had almost total success in the last 6 months. You must remember that the key to saving a patient that is suffering from hemmorhagic shock is to stop the bleeding. If your medic thinks that the rapid infusion of fluid into the hypovolemic patient, (w/o stopping the bleeding first), will save the patient, have them contact me.
Miscellaneous Supplies
The question has arisen in other sites about splitting up the medic's main set of gear. I can only say: That's the most stupid thing I have ever heard! The original idea must have come from one with much book experience, for only someone with book experience and no field experience would suggest it.
Let me ask you some questions:
Why would you turn gear over to someone that has no idea how to use it?
Why would you divide your supplies and limit yourself?
Has anyone ever heard of a "break in contact" while patrolling (that means that the patrol has been split into at least half during the mission and you must return to your last rally point)?
What are you supposed to do when the other half of the patrol has your airway gear? Medications?
You mean to tell me that the team medic can't carry his main bag and his weapon?
What if the patrol comes under fire or experiences a similar problem, you gonna just yell over the noise for your gear?
Not all team members can do advanced procedures, so why are you giving your gear away?
Negative... you carry your own gear. Everyone will have his own full load of gear and anything else that has been given out by the patrol leader. If you need that much medical gear, at least think about caching some of it using a GPS or 10-digit grid square with landmarks.
Now, that doesn't mean the other people in the team shouldn't carry certain medical items that the medic has determined are mission specific. Each team member should carry at a minimum the following:
The above gear should be carried in a common area on your webbing.
The above info was taken from an article for done tactical teams. I realize that not all medics are geared towards treating such emergencies as may be encountered while operating in a hostile environment. Also, the above items are ones that I have found useful. You may not. Articles will follow that will be more in depth as far as gear selection and training are concerned.