Today: alcohol wipes and things to take the grease off.

Everyone has band-aids in their First Aid Kit(FAK). Lots of people have butterfly strips or steri-strips for closing minor lacerations. Most everyone is planning on using tape or Kerlix, or similar products, to hold on gauze pads. The bad news: If you can't get the skin clean all those materials are going to fall off. They might be useless. I have seen Kerlix and other co-adhesive stretch wraps slide down a limb when the skin was oily.

But you have alcohol wipes you say. This isn't an issue. Really? How many do you have on hand? Given someone who hasn't bathed in a day, or five, skin that is coated with human grease, fat and oil from cooking, sunscreen, body lotion, mud, and crud your going to need a lot of this sort of thing if you want any adhesives to stick.

Given volume use how long are your skin cleaning supplies going to last? There is always soap and water. It is perhaps the best cleaning agent we have. But accidents don't always happen near municipal water. Away from water on tap I have used two or three of the small single-use swabs, commonly used for sterilizing the skin for a shot, to get a single band-aid to stick.

Most FAKs I have seen have only a half dozen of those alcohol swabs. Some commercial kits only three. You might be able to press hand sanitizer into service and use gauze, or your tee shirt, to scrub the grease and crud off. But don't count on it if it is one of the hand sanitizers with moisturizer in it. Nothing sticks to skin coated with moisturizer. The dry-touch moisturizers are even worse. They are like Teflon for skin.

Look critically at your FAK and what you have on hand. A large number of the single-use alcohol swabs might work, especially if they are not the smallest ones. Larger single-use swabs are better than the smallest. A bandanna wet with water from a canteen can remove a good bit of the worse of the crud. Moist towelettes can be good if they don't contain a moisturizer. Baby wipes might work but most of them have moisturizers or aloe in them and while you might be able to take off the worst of the mud and grease you might need to follow up with alcohol swabs to get down to bare skin that will take an adhesive to best effect.

A small bottle of rubbing alcohol is helpful and can do the work of dozens of the single-use swabs but you need to pack extra gauze or cotton balls to scrub the dirt off and for drying. I prefer gauze over the balls or bulk cotton. A clean bandanna is handy and can be reused after washing. Non-sterile gauze pads, about half the price and 99% of the sterility, work well for cleaning. Keep cleaning in mind when buying hand sanitizer and avoid any with moisturizers, aloe, or heavy perfumes.

Don't run out of cleaning supplies before you run out of dirt. Be generous in your estimates and have more than you need on hand. Both alcohol swabs and alcohol based hand cleaner, without moisturizer, have other uses beside cleaning the area around a wound.

But what happens if you run out of cleaning supplies. Or just don't have time to do the clean thing as well as you might. What then? There are two types of bandage that seem to work pretty well on dirty, greasy skin; triangular bandages and cloth elastic bandages, commonly called Ace bandages. They don't depend on any adhesive and are rough enough to 'bite through' a layer or two of human grease.

If you ever have to bandage a significant wound on someone who has applied any of the popular dry-touch moisturizers or sunscreens a triangular or elastic bandage may be your best bet.

If it is just to get a band-aide to stick I've scrubbed the area roughly several times with an alcohol swab to get he moisturizer off. There is a product, similar to a single-use, foil-wrapped, alcohol swab but wet with acetone. They strip off the dry-touch moisturizers quickly. They also dissolve leftover adhesive from tape, and soften superglue. Consider a short supply of these in your kit. They also take off nail polish so you can observe the nail bed, sometimes a helpful diagnostic clue, and work as fire starters. Used too aggressively they can de-fat the skin and cause it to redden, dry, and peel repeatedly. So use care.

I'm not sure I'd want to use anyhing with Acetone on my skin or anyone else's.

Link to the product ?

Hydrogen Peroxide! Cuts thru dirt,grease,oil Very well! & Is Dirt cheap! Can also be used to wash the mouth out,It is a Definite Multi-use Necessity for Everyone,& did I mention,Cheap?

No Offense Intended to the Original post!Acetone does a Damn good job of cleaning dryed paint,caulking,silicone sealant,& even cured JB Weld from,just about any surface.It has an Extremely LOW Flash-point,making it Extremely Volatile.The pores of your skin will Readily absorb this Chemical,It is basically made from Ultra-Refined Wood Alcohol,& It is Toxic!It melts most plastics,& Stinks to High Heaven!I'm fairly certain it is the main Ingedient of Nail Polish remover,check the ladies stash,open it up & That smell will tell you,Right away!I would call it a Multi-use chemical for sure,but the only skin one would care to contact this with would be that of The Common Zombie!I use this stuff on a daily basis,at work, with gloves,Mask,& Lotsa' Ventilation!

I keep collodion
http://www.newskinproducts.com/liquid-bandage.htm
in my FAK. It covers small cuts and abrasions without a bandage. It makes tape/bandages adhere to dirty-greasy skin if you paint it freely around the borders of the wound. It is volatile enough to enable a scrap of cloth to catch a spark as a fire-starting aid.

...and it stings like heck, by the way.

I keep at least one good size bottle of Betadine and Betadine scrub on hand in both the house and barn. Both can be found in feed stores in larger bottles and for less money than drug stores. In my car kit it's in smaller bottles.

Not sure this has been a big issue in real world situations (mine, at least). I tend to bring lots of sanitizer (double use as fire starter) and use Ace bandages a lot. I am not a fan of alcohol preps because their wrappers tend to micropuncture and dry out.....

Agree. I also use acetone a fair amount , only with gloves and good ventilation.

I've got to say, cleaning the skin around any sort of a major cut with rubbing alcohol sounds like it has the potential to be extremely painful.

Most of the cuts / scrapes I wind up cleaning up are on my two kids. They would allow me to clean the area with alcohol exactly once (if I'm lucky). They would never let me near their broken skin ever again.

Sepsis is not a joke and cleanliness can be important.

However, I have a problem with lotions and potions in first aid.
The people who trained me told me to put nothing on a wound.
Not even iodine or weak peroxide.
If all I am trying to do is keep them breathing until they can get to a doctor's care then I am not going to worry much about infection or even about cleaning the wound.
Most of the time attempts to clean wounds in the field cause more harm than good.

Wound closure is the doctor's job, so I am really just going to use bandages that I can tie on and pressure pads to stop the bleeding if I have to. Sticky stuff just has to be removed when the doctor gets to it anyway and often means more damage when it is pulled off.
Wounds with big pieces of junk (glass, wood, metal) in them just get padded and immobilized until a doctor can deal with removing whatever it is that is stuck in the wound.
There is too much risk of me causing even more damage by trying to remove it at the scene.

If the wound is a minor boo-boo cut and I am closing it with a bandaid then a bit of soap and water goes a long way.
Try to keep soap out of cuts but irrigate with clean water to remove anything foreign like dirt or glass. (saline is nice but not required)
Pieces of junk in the wound cause more trouble than you might expect because the body must work on rejecting them, plus they provide a site for bacteria to grow on inside the wound.

Again, infections are for the doctors to treat with proper drugs and are not (in my opinion) my problem as a first aider.

If we are talking about long term bush medicine that becomes a different game entirely and I am not qualified.

There's more than one way to skin a cat.

I've cut my finger at Burning Man while taking down our shade structure - 8 days on the playa without a bath. My skin was coated in playa powder, sun block, and skin moisturizer. The key was to use a band-aid big enough to wrap around my finger and stick to itself. shrug - cleaning the area around the skin would have been preferable, but I wouldn't use alcohol for that. Soap and water works fine, if you've got it.

If you have a wound on an area the band aid won't reach around, and you're out of ways to clean the skin, either run a piece of tape around the limb (I've got yards of surgical tape in my kit), or put a gauze pad on the wound and tie it with fabric.

Oh, and crazy glue works, too. Just glue the cut shut.

I'm in scafool's camp - for mass casualties its triage, stop bleeding, bandage, move on to next case. When you have time (and in a really bad situation you have 24 hours or more before patients can reach medical assistance), go back, and inspect the wound, clean, probably with ordinary water and the big bottle of betadine in the mass casualty bag. You may need to irrigate a wound before you close and bandage it, but as long as you aren't introducing new sources of infection most folks will be fine if you bandage them and have the next level of medical assistance deal with possible infection.

fwiw I keep 2 L of water in my car with my casualty bag (which has irrigation syringes), and an 8 oz bottle of betadine.

An endorsment for scafool: anything that kills microbes kills the healthy tissue at the margins of the wound, slowing healing and speading infection: saline, soap and water work fine. If I cannot get the wound and edges clean, then I do not want to close the wound, cuz a closed wound with an infection in it is an abscess, and lots harder to treat. If the wound and margins are clean, and I want the steri-strips to stay on for awhile, I coat the intact skin that will receive the adhesive with tincture of benzoin, and then apply another coat of benoin on top of the steristrips. Keep it out of the wound. Hurts. Izzy: avoid nosebleeds by coating the inside of the nose with petroleum jelly-antibiotic ointment, chapstick, carmex and vicks all work well, tho the latter two choices are sort of exciting.

A bit off topic here, but everyone that's carrying around betadine realizes that it needs to DRY before it's actually sterilized anything, right?

I also agree with scafool. I have been certified in First Aid, my training can be summed up as this, "I am not a doctor, but I can help you get help." immobilization and not causing further harm are the two big ideas that I took away from it. Just because I have a needle and thread, or superglue, does not mean I should attempt to sew/glue someone else together, and i would be LIABLE if i did. Good samaritian laws protect people giving first aid but they do not cover "I saw this on ER last night...." or "I have read about this in an old army manual so I must be a medic" type stuff. First aid is about keeping a person alive, intact, and not getting further hurt. Its not about being a superman. I am qualified for rescue breathing, not intubating. I can splint a broken bone, not set and cast it. (only if there is a need. If the paramedics are in route I wait and monitor) My number one priority is to get help.

I agree with the OP pretty well, I figured out with my last busted knuckle at work that 4 iodine wipes are just about useless. (I was changing the oil on a car so i had oil and grease on my hands it sure did make opening the foil package fun too!) simple soap and water is a much better choice. I mean simple soap, we also have the soap that has grit in it which is a really bad idea to clean a wound with.

for minor scrapes and cuts usually I make sure the cut site gets flushed by blood, then bandage with a little triple A. No washing or alcohol or iodine. the bandaid sticks, I dont kill extra cells, the triple A keeps the cut clean and non-sticking. I understand many will not approve, but think back to when you were a kid.

Wrapping the bandage completely around the digit, limb, or trunk certainly helps keep any pad in place. It works really well if the person isn't all that greasy or active. But I've a;so seen bandages simply slide off if they aren't attached to skin by adhesive or substantial friction. Fingers are possibly the worse for this. they tend to be grimier, greasier and more mobile than other parts.

Of course we are talking about seriously grimy and greasy folks here. Your average well-cleaned 8 to 5 office worker is a suitable target for bandaging without a whole lot of preparation.

On the other end of the scale is what you see around major disasters. Earthquakes, mudslides, wildfires, even some vehicular accidents, can have people covered in nearly unimaginable layers of sweat, grease, dust, blood, crud, you name it. Even experienced EMTs have been caught flat footed. Some resorting to using NS from IV bags, drinking water, or water from nearby fire trucks after the normal supplies and bottled NS ran out.

Superglue is good stuff, within its limits, but it doesn't work well on greasy skin. On the other hand a small drop of glue between bandage and relatively clean skin will keep a simple wrap of gauze from sliding or rotating.

The acetone pads are sold as 'tape remover'. The cheap ones are, as I understand it, mostly acetone.

http://www.cnmtstore.com/index.php?itm=76441

Just a few drops per pad. No worries. Most cheap nail polish remover is mainly acetone. Used in tiny amounts it isn't really an issue. If you scrub and use several pads in on spot you might de-fat the skin and cause some damage. So gentle, gentle.

In recent years many hospitals have gone to less aggressive chemical compounds.

http://www.homecaredelivered.com/professionals/pc_product_detail.php?intItemID=4901

I don't know if they are as good for what I use them for. Worth a shot but they don't go into my kit without some experimentation.

Vicks has some uses but I don't think I would put it up my nose. Too close to delicate membranes. And don't get it in your eyes.

Also most commercial bottle water bottles can be used to irrigate a wound if you use the tip of a knife, or the awl on a SAK, to open a pinhole in the top of the cap. Good for irrigation, metering out water, and an effective squirt gun. Even better than the old standby trick of poking a hole in a plastic bag for irrigation because you can squeeze harder.

Why in the world are any of you using alcohol wipes for cleaning wounds?

They're not designed for that purpose, they burn, are painful on an open wound, can destroy or damage living tissue.

Use Benzalkonium Chloride wipes, they cost about 3 bucks for a hundred of them from any number of mailorder/website sources. They're usually larger than any alcohol wipe, they don't sting at all and they don't affect living tissue. Soap and water are even better or diluted iodine/betadine or some of the commercially available "wound washes" but if you're gonna carry something small in a FAK, do yourself a favor and get BZK wipes and leave the alcohol alone.

Alcohol wipes are meant to be used to disinfect unbroken skin prior to giving an injection, taking a blood sample or getting a blood glucose level.

As for making bandaids stick, after you clean the wound use some basic iodine or betadine either a swab or using a gauze pad or cotton ball and wipe it where you're going to put the bandaid, LET IT DRY, the adhesive will stick about a thousand percent better to skin treated with either iodine or betadine first.

Uh oh. I have been scrubbing my hands with betadine before surgery for years and never let it dry. I rinse my hands with water (tap water at that!), dry them, and then don gloves and gown.

Letting it dry is good because it leaves a bacteria resistant area, for lack of a better description, for hours, but iodine, wet or dry, will kill bugs.

A lot of this is all dependant on the question

"what do I intend this first aid kit for"

There is a HUGE difference between a "after disaster" kit, a "trauma" kit, a workshop kit (even a home workshop) and the classic "Mom with kids" kit - LOTS of overlap, and the bigger kits will be able to handle the lesser stuff, but

The other question is - How far/long (distance way less important than TIME) are you from regular medical care?

Many times when I was younger, I was a GOOD 12-14 hours walk without injury to the first telephone, and there was no such thing as a cell phone. Get hurt back were we used to go, and you were going to have fun. We "what if'd" some really possible scenarios like a broken leg/arm, and which way we would decide to go to get out. The real issue was the shortest HEALTHY way out would require two good arms, or some what to get someone up a 15-16ft rock face - You had to toe walk on a 4 inch or so wide ledge that went up this face, and you NEEDED to hold on - NOT something I'd want to do with an injured person. The problem is, the OTHER way out, without packs/packs stripped was about 25% longer time wise, and a LOT further distance wise

Our general conclusion was "stablize, and send team to get people to help" - the shorter way (the way with the rock face and a few other scrambles) could have a ATV/SUV get about 75% of that 12 hour walk distance - that first 25% though would probably require a litter, and some rope work to get a person with a broken leg out

So, the first aid kit for that would have to be "You better figure on 3/4 day or better before you get outside aid" - way different than when I gashed open my finger last year, and it was' OK, let's control the bleeding till I can get driven to the hospital 15 minutes away" - (4 stiches later...)

Your a little confused as to what I was getting at. I'm not talking about cleaning the wound. I'm talking about cleaning the skin around the wound so the bandage will stay put. Granted there is some overlap, soap and water is generally used to clean both wound and the surrounding area.

As you point out alcohol is justifiably restricted to the area surrounding the wound. It hurts like hell and damages the tissue. The later potentially slowing healing and increasing the chances of infection.

Benzalkonium chloride solution is, IMHO, fine for the surrounding area but used directly on the wound it might be less benign. Recent evidence suggests that the compound may not be entirely benign. Being both a potentially toxic and allergen. Simple soap and water is far safer.

Unfortunately tap water, or sterile water, and a little soap, is fine but in short supply in the field. Which is where the alcohol swabs, baby wipes, towelettes, and mommy spit come in.

I've run into the 'let it dry' approach before, usually applied to alcohol products. Would it be more palatable to assert that most disinfectants require some dwell time , wet or dry, to croak the more resistant organisms? probably more accurate, anyway. Regarding disinfection of intact skin, CDC research seems to identify chlorhexidine and povidone iodine (betadine) as the leading contenders. Quaternary ammonium salts like zephiran, were in vogue for this application in the seventies, not so much now.
Or there is the Arkansas orthopedics approach: make a paste of plaster dust and bourbon, and smear it on the infected part-the bacteria get drunk and stone each other to death.

I'm glad I was only "a little confused" but I'll stick to using my BZK wipes and skip the alcohol wipes for any sort of cleaning in or near a wound and iodine or betadine for use in helping to keep bandaids stuck.

Getting back to 'what can I expect to run out of first', based on exercises and feedback from folks who have been there patching others up from a kit post-earthquake, besides water I'll run out of burn dressings or anything to cover severe burns. And it doesn't fit in a FAQ, but I can also expect to run out of ground insulation below patients, ground around the PNW tends to be cool enough most of the year that if you can't get them up off the cold, wet moss, they will lose body heat. No solution for that so far, just scrounge what you can find.

No... you've been using the Betadine surgical scrub. Real/normal betadine you need to let dry (read the fine print in the instructions)

http://www.betadine.com/for_hospitals.aspx

Click the links for the package info - you'll see that the 10% solution they tell you to let dry; the scrub solution they say to keep wet. In fact, the last line in the scrub solution is essentially "if you add betadine, let it dry."

If you scrub an area with Betadine you're going to have to remove the Betadine before tape will stick. Or at least you will if you want it to stick for any period of time.

Try this experiment: Wipe some Betadine on your arm. Let it dry. Apply a band-aid over top of the dried Betadine. Betadine dries slightly tacky so it might feel like it is stuck on pretty well. Now try a little light exercise. Get out of the AC. Walk around the block a few times. Let it ride the rest of the day.

In my experience the dried Betadine absorbs sweat and softens. Band-aids and tape tend to fall off in a short time.

This may, or may not, be a consideration. If you're bandaging people up just to get them to a hospital a few minutes away it really doesn't matter what you do. You want to make a professional job of it but it is mainly out of pride instead of necessity. In short order the docs will remove the bandage. A carefully made field dressing is wasted if they are on their way to an ER or trauma center.

On the other hand, in a disaster, or austere field conditions, and certainly for minor injuries that won't see a doctor, wounds that account for the majority of what a FAK is used for, people will be wearing that bandage for a day or more. If you don't want to blow the contents of your FAK redoing one small injury you need to get it right the first time.

It also has to be noted that that time honored stickum, tincture of benzoin, is not entirely foolproof. I happen to love the smell. But I'm also mildly allergic to it. Anywhere it dries on my skin blisters in 24 hours. I had it used on me to anchor the ends of three Steri-strips. Next day I had six tight and round little blisters located directly under the ends of the strips. The laceration healed long before the six spots stopped their cycles of cracking and peeling. I now avoid the stuff.

Band aids falling off is a good thing; wearing a bandage after it is wet, or soiled, or more than 24 hours old, I would assert, is a bad thing. Bacteria thrive in warm, dark moist environments-it is wise to get the dressing off once or twice each day to allow the wound to dry, check for infection, and change the layer of antibiotic ointment. Bad things happen under dressings: bad things I have found under older dressings include infection, tissue necrosis (destruction of tissue due to excessive tightness/compromised circulation), and maggots...tho the maggots did clean up the dead tissue quite admirably, the patient seemed offended by their presence. Dandy little protein source, too, I am told, tho the efficiencies involved in dining on something that is dining on you is problematical.
I understand that the problems of wound care in primitive circumstances requires compromise, but I'm just sayin'...

Good link-thanks. I am not quite sure that they are saying that it is not bactericidal until it dries; they might be saying that, if it hangs around on your skin too long in solution, you will absorb it and suffer sensitivity and allergic reactions-then again, they might not mean that either: these words may have been written by marketers and lawyers, rather than pharmacologists and physicians,