First Aid, where's the limit??

I noticed that a lot of commercially available medical kits in the US (and other country's) are stached with all sorts of things that I think aren't first-aid Item's

Examples (from the AMK Marine 3000 kit): Med's, sutures, Foley's, oral airways, staple-gun's, stetoscopes, hemostats, etc.

In Europe first-aid is first-aid. The only thing you find in a commercial kit in Europe (In Holland anyway) are wound-dressings, Betadine, alcohol preps and if you're lucky, some Acethaminophen.

My question is: where do you think that the limit should be? What items would you include in a commercial kit and what not? And why?

I think that it is a good think to have the items available so that you can order them if you're interested, but it shouldn't be standard in commercially-prepared ''First-Aid'' Kits.

I don't have anything against the way you build First-Aid kit's personally and for your own family use (I also keep 2 fully packed trauma backpacks standing-by), but if you can just buy those kit's of the internet, how are the manufactures and retailers gonna know if the purchaser is trained and has common sence about how to use the kits and their contents? Or do they just want to sell as many as they can.....

You ask a good question. I believe that MY first aid kit should contain items that I know how to use, and YOUR kit should contain items that you know how to use. For example, first responder first aid in my county includes inserting oral airways, so I have the training and experience. I would not know what to do with a suture, so I would not try. For the most part, meds are for me or those I know personally, not the general public. My first aid kit is not a commercial kit, but is put together based upon my training and experience. I know how my body will react to certain meds, but I have no idea how someone else will react, or what might already be in their system. I won't even give someone an over the counter med, but I will assist them in taking whatever they have and think that they need. IMHO, first aid is ABCSS--Airway, Breathing, Circulation, Stoping serious bleeding, and treating Shock. When someone comes along with more experience and education, they get to take over and do what they believe is appropriate. And since I am in the documentation business, I write a nice report about what I saw, what I did, and what was done by others. A first aid kit and some knowledge can save a life. A good incident report can save a lawsuit, or at least direct the lawsuit at the correct person (and not me).

Medical kits are designed for different environments and differences in time to definitive medical care. The more extensively equipped Marine Kits are designed for situations in which medical care may be days or weeks away. The makeup of FAKs and more elaborate medical kits are, as with many things a matter of personal choice and experience of the intended user. Education, training, experience and practice should be the foundation of any purchase.

Just my 2 cents-
Pete

Many mass produced FAKs are "feel good" products aimed at people who have no clue. They buy them, have no idea how to use them, but feel better because their family will be miraculously protected in the event of an emergency, just because the kit is in a closet somewhere. The media directs their lives, and every time there is some random scare, they'll buy a new, overpriced, incorrect product.

''ABCSS''

Wasn't it ABCDE?

Airway
Breathing
Circulation
Disablility (treating injuries/ stop bleeding)
Exposure (hypothermia-prevention)

''A good incident report can save a lawsuit, or at least direct the lawsuit at the correct person (and not me).''

Are you guy's really so afraid of a law-suit?? <img src="/images/graemlins/confused.gif" alt="" />

Here I learned:
doctor ABC

DANGER!!!
airway
breathing
circulation
cervical vertebrae
degree of injury (e.g.burns)
disability
(now exposure)
evacuation

<img src="/images/graemlins/cool.gif" alt="" />

I agree that for personal first aid kits, as others have indicated, it's always a good practice to actually know how to use the things you are carrying. Training is at least as important, if not more important, than the collection of "stuff" you have in the kit. Things are also tailored to the number of folks covered by the kit, duration of the trip, and how long before advanced help could reach you if needed. The basic day hike FAK I carry looks very spartan compared to the expedition kit we take when we're doing a long trek in the mountains.

In fact, your example of the AMK 3000 Marine kit is a good one for a situation where the normal EMS system isn't going to get to you for 24 hours or more. Imagine you have a bad accident on your fishing boat, for example. You're way offshore, and the weather has deteriorated to where the choppers aren't flying. You might be on one end of a marine radio conversation with someone at a Coast Guard station who has proper training, who says: "do you have ____ in your med kit?" If the answer is yes, you might find that you can be talked thru a procedure that might otherwise be impossible, or require some serious improvisation. I know we carry a pretty extensive set of supplies on my boat, even though quite frankly, most of the time we're just grabbing bandages and antiseptic! It's one of those "just in case" scenarios where I think the penalty of not being prepared is too high not to be well equipped. The other thing is, if you're taking people where you might be 24+ hours from the EMS system, land or sea, you better have some training, and have someone on your crew trained (in case you need the medical help).

Many of those Marine kits are also designed to meet certain USCG requirements for offshore vessels and liferafts. They must have certain items (including a decent handbook) to meet Coast Guard requirements.

Jim:

I always have heard the ABC's as

A = Airway
B = Breathing
C = Circulation

Through training you learn to expand upon the primary ABC’s.

A = Airway, Open and Maintain an adequate Airway.
B = Breathing, Maintain adequate volume (respiration)
B = Bleeding, Control life-threatening bleeding (gross hemorrhaging)
C = Circulation, Maintain adequate circulation by controlling bleeding and CPR.
C = C-Spine, Maintain neutral alignment when indicated, which is learned through training.
D = Disability, Neurological involvement and Injuries causing impairment away from normal activities.
E = Exposure, what was the patient exposed to: Environmental (too hot, too cold) Chemical (hazardous materials) Thermal (burns) and finally you must uncover an injury (cut away clothes) to determine the extent of the injury.
F = Fractures, Any fracture which could potentially cause extensive bleeding (hip and long bone) is a life-threatening injury.

As you no doubt can see the ABC’s seem to cover quite a bit of BASIC information, but remember something our ambulance director has always said: “We are in the business of ABC’s, sometimes you DO NOT have time to do much else. Don’t stay and play, get the patient to the hospital. Remember your safety first, Always!” I believe this sums up the whole idea. If you fail at maintaining the airway (for example) then all other interventions are rather moot.

Lawsuit: Yes, they happen quite frequently here (in the States anyway) you should research things like negligence, scope of practice and duty to act. I cannot say if your country has it, but there is a common law here in the States called “the Good Samaritan act. I believe Canada has something very similar.

Finally about first aid kits: yes, they look nice, but if you have no training with a certain piece of equipment, then they are useless. I agree that some people buy them and throw them in a closet and promptly forget them. Some people will use a few Band-Aids and forget to restock them. The most important items you can have are, knowledge (training and experience) and equipment you carry that meets your level of training. Carrying equipment beyond what you have the training for is asking for trouble. Carry what will adequately help you maintain ABC’s.

What do I carry?

My FAK in an Altoids tin contents here
FAK Accessory module (stuff I could not fit into a Altoids tin)
1 pair Nitrile Gloves
1 CPR Mask
2 Purell Sanitizing Wipes
1 Tyvek Triangular Bandage
1 4” offset Bandage
1 24” x 72” Gauze Pad
1 Pair of Sliver Tweezers
1 Pair of Iris Forceps
1 small bottle Personal Meds
1 small bottle of Eye Drops for my contacts
1 pair of extra Contacts

I have other kits that contain more, but find the above to be very adequate. Someday, I'll post pictures of it all.

Conclusion: Training, training and even more training is the first priority.

I hope this helps, sorry for the long post.

Take care,

Stargazer, WEMT-CCP

ASAP = Always Suspicious, Always Prepared

The terms "First Aid" an d "First Aid Kit" have become a misnomer, especially on this forum. The kits most people carry and call their "First Aid" kits are actually much more, the term "First Aid" is used for a lack of a better term. The kit you mentioned, AMK's Marine 3000, is not a first aid kit, it is a multi-day/multi-person basic medical kit for a small vessel or station. It is a well put together kit. Most of the commercially avalible first aid kits on the market today not only provide supplies for "First Aid" but also basic supplies for less severe medical issues and emergencies.

While I no longer teach First Aid anymore, I do teach Paramedics and EMTs as well as an occasional First Responder course I teach my students that First Aid is the same for all providers, from the layperson to ED Doctor, manage the ABCs. The goal of the ABCs is to find and treat life treatening emergencies. The ABCs never change (Airway/Breathing/Circultion including bleeding control and initial treatment of shock) the tools do as a providers level of care increase.

So, for me, a "First Aid" kit is pretty basic:

• CPR Mask or Pocket Blue BVM & OPAs
• Surgical Cric Kit
• Israeli Dressing (or similar) & Quick Clot or Trauma Dex
• Nytrile Gloves
• Heat Sheet
• Trauma Shears

This allows me to manage the ABC's until I can get to a larger kit. These are the items I carry in an easy to access locations on my vest, in my search kit, etc. Typically, they are kept in a different pouch or pocket than the rest of my "First Aid" kit or medical gear.

So the limit? The limit is as much as you can justify carrying for your specific needs. left over space? Add medical gear or water... But then again, I am a Medic who live in Arizona... so I never feel like I have enough of either!

Don't most countries require some fairly high degree of first aid training for a merchant captain's or master's certification? I know it varies flagging nation to flagging nation.

Jim, you think this kit (which probably really wass designed situation mentioned, where the only medical back up you are going to get in 24 hours is an intercept with a warship or cruiseliner, or they jump a medical team in by parachute) is scary? Check out the suggested inventory list for a merchant marine medical chest.

''Jim, you think this kit is scary?''

Absolutely not, the more equipment the better. I also keep a pretty good assortiment of first-aid and A.L.S stuff in my 2 trauma-backpacks.(not for survival use)

But you don't know if the purchaser is trained to handle this stuff. If he is, it's a good addition, but if he doesn't he can make the situation so much worse.....

Purchasing of these Advanced Medical Kits (seems a good discibtion to me) should only be allowed if the guy who is going to use it, know's how to use it and can prove that to the retailer.

Or maybe it should only be possible to get special stuff like sutures,hemostats etc. on prescription and not from the (anonymous) internet?

What do you think?

Jim, I do not mean to knock your commitment and enthusiasm. But if I remember correctly you are 16, at such an age, at least hear in the US, you would not even be eligible to take ALS training, no less carry ALS equipment. Are the laws in Holland different? If not, how did you get ALS training and experience to carry ALS equipment. Depending on the state, here in the US, it is not even legal for Paramedics to carry personal ALS equipment.

Just some thoughts-
Pete

I dislike people telling me what I can buy, what I can own. I think that if tools are usedirresponsibly (by the untrained and cause harm, used incorrectly) that the user should be held criminally responsible. If the user was trained and had proof, no criminal charges could be brought and the user would be protected by the good samaritan act.

Maybe I just hate to be told what I can and can not do.

Well it's like this: My father is a fireman with a compagnie that makes ALS-equipment, so I can get the equipment.

I'm now also a nurse in training (finally), so I can get things like ALS equipment and of course also the ALS training.

And I'usually don't carry it with me (to much stuff). It's just a hobby.
I learn a lot about ALS from my dad, family (medics), my work and of course books and manuals.
I don't know it all (you never know it all), but I'm a fast learner and at the very least I know the basics and how to use the equipment that I have.

(sounds a bit over-confident, doesn't it?)


<img src="/images/graemlins/grin.gif" alt="" />

I got the impression from the start of this thread that your position was that it was not a good idea for companies to sell to individuals advance medical kits without the appropriate training. It seems to me that while you believe that you either have or may have the training, if I were selling comprehensive medical kits, based upon your initial assumption, you would be ineligible to purchase said kits. It seems to me somewhat hypocritical to carry or even posses ALS equipment for which at best I suspect is limited training.

As I am unfamiliar with schooling in Holland, my assumptions may be all wrong. In the US generally 18 years old-post high school is the age at which an individual would be a nursing student at the Registered Nurse (RN) level and where ALS intervention would be taught. While many US high schools have vocational-educational programs of which nursing may be a program, to the best of my knowledge these are all at the Licensed Practical Nursing (LPN) level. ALS techniques are, again to the best of my knowledge not taught at this level.

Pete

Sutures- it's a very fine leather working needle. As I've said other places, I don't want to stitch someone. But if I have, absolutlely no other choice, I will, and if they hold still, it will be a pretty stitch. I started working with light leathers fairly young- taxidermy.

Hemostats- Jim, if you got these regulated, I know a lot of fly fishermen and electronics geeks who would have your head on a pig pole in thier front yard. I use them in tool kits when I don't have room for pliers, or need a heat sink or a fine clamp. Hemos are very precise, very small, all metal clamping pliers, there is no special magic to them.

So on and so forth, ad nasua, until you get to the meds. Tools should never be regulated, just thier possession by stupid people.

Pete, in lot (all?) of Europe, they don't do high school as we do in the States. As I understand it large number of younge people have a tech school education, basically a standardised pre-apprenticeship. High school as we think of it in the US, with almost pure academics, is a route to the university tryouts.

For those in Europe, is that assessment about right?

If I had to guess, Jim, by our standards, you're training for an LNA or something similiar with EMS. And Pete's right- by your proposal, your hobby would be illegal. Regulation rarely solves problems, but frequently makes new ones.

Ironraven, your assesment is about right.

Well, you can start your training as a nurse when you're 16 in Holland.
In takes 4 years, and you spent a lot of this on work-practices. During those, you are supervised by a qualified nurse and get basic training in school, but you'll be encouraged to learn and preform new prodedures. So you will learn on the job.
And you can aks for aditional specific subjects that you want to train for. I chose technical/medical subjects.

My position is that in isn't a good idea for some A.L.S PRODUCTS to be sold in FIRST-AID KITS. And especially not from the anonymous internet because the retailers and manufacturers can't know if the person know's what to do with it.

A good idea would be: Only be able to buy basic FAK's on the internet and a special store for those that are interested in additional equipment. (A.L.S. or other)

Another question: what do you think is A.L.S. equipment and what can be listed as B.L.S./ First-aid?

My idea is that A.L.S. equipment is upgrade stuff for maintaining the ABC and D.
That means in my case: Ambu-bag, Blood-pressure meter, IV's, oral airways, o2, c-collar, and some common meds. And some basic surgical stuff.

I don't carry ET Tubes, defibrilators, Epi and all that. Those item's I believe are in the category A.T.L.S. , very hard to get and very, very expensive.

When you start saying "some", you are on a slippery slope. Laws must be very precise, or they will mutate on you. You're right, the airways might make some of us a little nervous, but I've never known anyone who knew what they were who was unable to make the go/no-go call on thier own. BP cuffs, unless you try to use one as cervical collar or to control the bleeding of a head wound, really are pretty much harmless. Everything else you can get without an Rx is dual use stuff, as I said before.

Jim, I think you are seeing problem where they really don't exist.