I am an ER doc, former paramedic and have volunteered internationally practicing medicine in several different countries in Africa, Asia and the Caribbean.

I recently put together a first aid kit for my daughter to take on a trip to Nicaragua and thought I would create a post for anyone who is interested.  This isn’t actually my first aid kit, it was designed for my daughter. Mine has a bunch of medications and suturing material as well as the things listed below.

I am not making a recommendation for anyone else, merely showing you what I provided for my daughter. I am sure that there are those who will disagree with my choices.  I would love to hear from others who have knowledge or experience in hopes that this thread can become a resource for anyone who is interested.  

I started with a dyneema dopp bag from CountyComm, found here
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I will go through the contents in “ABC” order although the current teaching is “CAB”:

Airway:

I included two NP airways as well as some lube.  I went with 26 French as they are small enough they will likely fit a small woman or teen, but still may be useful for a full size male, everything in a kit this size is a compromise. You might want to go with one smaller and one larger airway, the choice is yours:

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I purchased them here although it appears 26 French is not currently available.

The length is important as the goal is for the airway to extend beyond the tongue in the pharynx in order to allow air to travel past it for respiration.  The 26 may be too short to function in a large male.    Here is a picture of sizes for comparison/ decision making purposes:

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Something like this in a 28 Fr might be a better option.

Video on use:



Breathing:

There are several different versions of CPR masksavailable on Amazon.

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We could have a discussion about the utility of rescue breathing during CPR. Let’s just say that if you’re doing CPR, there’s a high 90%s chance the patient is going to die.  However, if the patient still has a pulse and has an airway or respiratory problem, rescue breaths can make a difference. For this reason, I consider some form of mask useful.

Circulation:

I purchased some combat gauze online.  You can find combat gauze in multiple places online  or expired packages on eBay.  I am of the opinion that since it is inert, likely the expiration date  is not a big deal, but feel free to buy whatever you desire.

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I also included an Oales Bandage as I think they give you a lot of options in a small package.



I am a huge fan of Coban wrap for first aid and I included two 4 inch rolls.  Coban is a 3M brand name.  Similar stuff can be found at tractor supply as “vet wrap”.  I like the 4” stuff.  If wrapped loosely it works to hold 4x4 gauze over a wound.  If wrapped tighter it forms a pressure dressing, or could be used to support a joint similar to an ace wrap. If wrapped very tightly it forms an excellent tourniquet.  I have seen several arterial bleeds stopped with coban, and didn’t include a tourniquet in the kit because I believe that it is adequate for this purpose, often working better in very proximal wounds.  The one situation where a commercial tourniquet may be better is if you are applying it to yourself one handed.  As was noted below, it is possible that this would be inadequate for a proximal thigh wound in a large person, so you may want to include a commercial TQ.

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On the bottom of the bag is a 36” Sam Splint.

These are amazing in terms of what they can do for the amount of space they take up.  The coban above is the best material to wrap around the Sam splint to secure it, so it performs quadruple duty- splinting, dressing, pressure dressing and tourniquet.

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I also included a cheap Pulse oximeter
as well as some EMT shears

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Using a pulse ox takes some judgment. One could argue that without experience using them, they likely will cause more issues than they provide information. If the pulse ox is not correctly sensing a heart rate, the saturation is likely not correct either. Also, you have to look at the patient, not the pulse oximeter when making decisions.

You can break down first aid kits into “boo boo kits” and life saving supplies.  The above supplies are oriented toward life saving stuff.  For boo boos, I just went to Walmart and bought their smallest first aid kit for $6.  I took out the cold pack and threw in some hydrocortisone cream and moleskin instead.

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Also throw in some Nitrile gloves in a ziplock bag.
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That is it for tonight. I might do some stuff on medications later.

Tylenol, ibuprofen, Benadryl, Zofran, loperamide, Cipro, Keflex, Bactrim, augmentin all have their uses.

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Awesome thread idea, can't wait to see it! Thanks for sharing.

Tag

OST.

Interested

My man! love the olaes. I have a few and keep one in my work van.

Really surprised you didn't include a TQ.  Granted I'm not a MD like you, but is Coban going to be enough to shut down a femoral cut in the thigh, or a brachial in a larger arm ??

It is possible that the coban would be inadequate for a person with a large thigh, I would encourage you to try it and make your own decision.  As I said, I am not giving advice, merely sharing opinions.  Adding a commercial tourniquet would not take up much room.  I modified my OP to reflect this.

I mean not many people in this thread besides the Op is gonna be doing a femoral cut down

Coban is good, but it can be iffy in high temps

I have ace wraps as well in my kit to bandage dressings

EMT/Paramedic here for 14 yrs. This kit is almost exact to what I have packed away in the truck and house, with the exception of a TQ and some different medical tapes. Good post.

What's the point of the oximeter? How will it change treatment?

What’s the ballpark total cost of what you have assembled?

A pulse ox measures o2 saturation and gives a pulse rate. Having diagnostic instruments on hand to obtain vitals helps alot.
With those instruments they can guide you towards treatment in the not so obvious medical emergencies, and help track improvement or decline after treatment.

Example one: You come across a teen girl seated on the ground stating shes having trouble breathing, with your stethoscope you hear clear lung sounds, your pulse ox reads 98% SPO2, breathing rate is rapid, heart rate is up and she complains of tingling and cramping in the hands.

With prior training, pt presentation, and vitals you dig alittle and ask if she has a history of anxiety and panic attacks. She admits to panic attacks in the past but nothing like this. You try to calm her, coach her to slow her breathing, and in time the tingling cramping and shortness of breath subsides.

You didn't cover the pill box... what's in the pill box man?

Nm


V

Tagging. Excellent post. Thanks for taking the time and sharing!

I get what you're saying, but how would treatment differ with same patient, situation and symptoms, just without an O2 sat? Maybe I'm a dinosaur, having run calls before these were available. Just strikes me as a bit...advanced?...for a first-aid kit?

The question points out the value of customizing your first aid kit to where and how you may use it as well as your level of training.


You have to think about the context in which the kit was created. My daughter in Nicaragua in a tiny town with an inreach satellite  device. If she develops a cough, chest pain or shortness of breath, she can put it on and we can text back-and-forth and make decisions about whether or not she needs to seek additional medical care.  Heart rate over 120?  O2 sat less than 90?  She needs to get somewhere to someone who knows what they are doing.  Normal heart rate and sat?  Maybe some Sudafed, ibuprofen and see how it goes.

Her odds of significant trauma are low, although she did have a 10 hour bus trip, statistically probably the riskiest thing she will do the whole time she is there.

When I volunteer in Africa or Haiti I have a month’s worth of HIV antiretrovirals in case of a needle stick.  It all depends on where you are and what the risks are.

If you are putting together a kit for when you go to the range, a tourniquet definitely belongs in it, and if you have the training perhaps some 10 or 14 gauge needles for chest decompression.  International travel?  Different considerations.

OST. Thanks, Doc.

Thanks, great information!

Nice job, Sir!  Thank you!

Great post.

Good post, thanks Doc. I’ll add as a 10 year paramedic in a busy urban area with an active knife and gun club, I put a huge personal emphasis on a purpose built quality TQ.

I also spend a lot of time hunting in the backcountry. When people ask me how to build their kits, I always say, “Your either trying to keep yourself alive until you can get to a trauma center, or keep minor symptoms minor to save the trip, the rest is just fluff.”

Gotta stick with band aids only.  

Great info Doc. I just made kits for my family.
My post about an incident with my grandson.
I guess I should look into airway stuff.

You goddamned class act.

I've talked to a small town ER doc who treats gunshots and other impalement-type injuries regularly. He was a big fan of Israeli bandages since they're cheap and quick and easy to use. Having had to use one, I am in agreement, and have a bunch in my med bag. I don't have experience with the OLAES, though this is one area where I don't want/need a bandage with multifunctionality since I have plenty of room for both bandages and gauze in my M5 pack. If the OLAES works for some, I see no reason not to pack it.

Nice post, OP. Question...Are NPA's really worth a damn? I've never had the need to use one, and never heard a medic actually use one.

What would be a scenario where an NPA would work? I was a medic many years ago, but have forgotten most of what I learned.

Thanks!

No sticky sheets for a sucking chest wound?

I don't see NEARLY ENOUGH tape there.

Bandage aint gonna stay on unless you tape the bejeezus out of it.

I can certainly see reason to lay in a supply of oral antibiotic like Cipro. But a first-aid situation aint where you're gonna use it.

Avoid administering ANYTHING oral if you can avoid it. Patients are worth crap as far as telling you what meds they are already on. So you can't judge interactions in the field. Once you take custody of the patient, you are responsible for any extra bad stuff that happens to them. Including allergies and reactions (including aspiration) to oral medications. So you might end up needing that N/P airway after all if they aspirate. Good luck getting it in without doing more harm.

As for mouth-to-mouth, I'm not doing it on anyone except close kin. And maybe not even then. But once I commit to it, I'm not gonna compromise the effort by trying to use some weird prophylactic gasket thing. Chest compressions move air anyway if there is not blockage preventing movement of air. And remember, we only do chest compressions on DEAD PEOPLE. If they are able to move any air on their own, we don't do compressions.

What did she go to Nica for?

My son is going hiking out West with my MIL / BIL. He will be gone for 18 days. Scares the crap out of me. But he is 14 and will be a trip of a life time. I did the following;

Cat TQ’
Quick Clot gauze
2 X Chest seal
2 X compressed gauze
3" compressed trauma dressing
EMT sheers
Silk tape
Vaseline gauze
4 x4” Tesla pads

I did a small boo boo kit with bandaids, neosporin, oral gel, butterfly’s, mole skin, Aleive, Benadryl, etc. He knows how to apply TQ / chest seal. Also have the Garmin InReach Mini II.

Subbed - love these threads as they are super high value.  Thanks!

For a boo-boo kit, I really like to add a small bottle of super glue.

Yeah, some people are ALLERGIC to super glue. So be aware.

But for small cuts in places that are not going to be amenable to a big clumsy band-aid, and if the situation is low-key enough that you have time to allow the glue to actually dry, it really is superior to any bandage (which will probably fall right off) you might try to splap on there. Cuts on finger-tips being the prime example.

As for band-aids, always carry only the largest size you think you might use. You can always cut-down a large band-aid. You cannot make a small one larger. Use the scissors. Or your knife.

Speaking of cutting, if your knife isn't crap or some weirdo thing that looks like it belongs in a Grade B movie, the trauma shears are redundant. You do carry a knife don't you?
I mean they aren't going to let you bring the scissors in anywhere that they don't allow knives for the most part. The knife just needs to be decent. It doesn't have to be Gucci or expensive. The lightweight Buck 112, is inexpensive and excellent for workaday use. https://smile.amazon.com/gp/product/B07H33X8B1/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&th=1
And if you're the sort of responder who can't cut a piece of clothing with a sharp knife, to expose an injury, without further injuring the patient, should you really be attempting to treat the type of trauma that involves cutting-off clothes?

great thread.  Thanks.

Lol.  

I have plenty of love to spread around.  Don't be jealous.  

I have used npa's numerous times in the last year.  Havent used an opa yet. Do I want to toss in an opa and discover they have a gag reflex? Nope.

Scenario would be an unconscious patient that is unresponsive to painful stimuli in respiratory distress like my father in law who is not compliant with his meds and accidently takes too many oxy's.

In your last post you mention being worried about causing more issues using an NPA and now you are advocating ditching shears to use a knife.  Having used a knife to get clothes off a patient before an ambulance showed up I can say 100% I would rather have shears especially on a scene with people that don't know what they are doing.  Last thing I want is someone running into me because they lost their mind after almost stepping in blood.

Wut?

This is one of the weirdest things I’ve read here, advocating for cutting a patient’s clothes off with a knife.

How many patients have you cut the clothes off with a knife?

Does your employer approve of this?

Most trauma shears suck and jam up on denim.


I’ve cut clothing with a knife multiple times and was issued a specific benchmade for the purpose.  


Nothing wrong with it if it’s what you have.  


We are talking about exposing a wound, not getting naked here…

10 out of 10

I’ve used ~99 cent trauma shears to cut denim.

Never seen anyone whip out a pocket knife and go to town.

I would be genuinely curious to see where some of these folks work or if they are in the medical/EMS field to start with.