Auto Crash Scenario -- What's in Your FAK?

Not really urban -- feel free to alter the scenario to answer the question you prefer, but...

You're driving along a lightly traveled back country road miles from nowhere and happen upon a head-on, one driver is already gone but the second unlike the first was strapped in and is still alive but in bad shape. You have a FAK in your trunk, and while calling 9-1-1 (you do have cell coverage) you get the FAK and prepare to assist the surviving driver.

You can define bad shape as you choose (considering the scope of injuries that could be sustained in the head-on collision), but besides a complete trauma center, what would realistically be in a good FAK designed for such a scenario? Realistically, how many 4x4's and 5x9's? Quick Clot? What else?

If you like pick a commercially available kit and mark it up to make it better.

The kit in my truck is really three kits:
- An AMK Comprehensive Medical Kit,
- An AMK Trauma Kit w/ QC, and
- a kit w/ additional 4x4's and 5x9's, plus multi-tool, knife, LED flashlight and 550 paracord.

What can a person w/ nowhere near EMT skill level do while waiting on real EMT's?

Outside those kits are also road flares, blankets, clean water...

Make sure the scene is reasonably safe for you to intervene; pay attention to ABCs, especially bleeding (be sure to scan the entire body); do not attempt to alter the victim,s body position (there are likely to be significant fractures, particularly of the neck and spinal column, and movement is not good before stabilization). If the patient is conscious, find out who his doctor is, what meds he might be taking;connect with him and offer realistic reassurance.

There should be some very good comments on this - good problem. How do we know the other victim is expired? Be sure you are not making a bad assumption on that person...

"What can a person w/ nowhere near EMT skill level do while waiting on real EMT's?"
You can make sure the victims have the basic Airway, Breathing, Circulation. If someone is bleeding, apply direct pressure. If the victim seems "shocky", keep them warm, raise the feet if possible. If the victim has broken bones, keep them still and splint the limb if feasible. If the victim is agitated, try to get them to sit quietly. Before the accident, it will help to have taken an ARC First Aid class.

mine is similar to Russ's kit... don't overlook several pairs of nitrile gloves and disinfectant wipes for any first responders, and some way to irrigate with clean water... chance of battery acid or glass in the face... a mylar blanket to cover the deceased

a note... if you need to use a dry chemical extinguisher on a vehicle fire, with others in attendance... give them a warning first... breathing the powder is not pleasant

I think it is worth emphasizing - do not move the victim at all, or as little as possible, and as gently and carefully as possible, paying particular attention to maintaining alignment of the neck and spine. It seems all too often that untrained bystanders will want to pull the victim out of the vehicle - an action that should occur only after thorough assessment.

This is the pure Oh Bleep kit that stays in the car trunk except when I've got it out for inventory. There are NO boo boo level items included unless you count the 2X2s.


EMT Shears
AMK CPR Medic
nitrile gloves - 2pr
latex gloves - 1pr
2 packs of 2X2s - 3
2 packs of 4ply 4X4s - 4
10 pack of 4ply 4X4s - 1
packs of 12ply 4X4s - 7
butterfly closures - 6
triangular bandage - 1
some 1" tape around part of a credit card

Scene management is a big one actually. Checking for safe conditions, no downed power lines, leaking gas tanks, precarious positions of vehicles, managing traffic around the scene, setting up road reflectors, checking for fire conditions.

If you aren't comfortable with performing first aid then one can always act as the "gopher" or communications relay for those with more experience. There is always something everyone can do at an accident scene, even hanging back in the car calling for the ambulance/fire/police and directing them to the scene.

While a kit is handy, emergency training is far more worthwhile. A little confidence and calmness from you will help calm those are involved in the accident and keep them from getting weirded out.

Thanks for the responses. Unfortunately, in this scenario there is no one with more experience until a second responder arrives; the solo responder is on his/her own until help arrives. But your point is well taken; in my quest to do no harm, securing the scene -- setting out my LED road flares and calling 9-1-1 would be the top priorities, followed by whatever the operator asks. They'll probably want to know status of the victims which I can do. I'm quite comfortable with DP and serious bleeding injuries, but I'm not moving anybody who's strapped into a car. I do have extra nitrile gloves and more than a few 5x9's.

My FA training dates to my active duty days and since I've never worked anything other than a friend's hand injury (cut to the bone but not life threatening), I'm a tad rusty. I may talk with my fireman neighbor and see what he recommends re local training; the topic has never come up.

Check out CERT opportunities; in my experience, worthwhile and realistic.

In this scenario the FIRST thing one should do is secure the scene. Look for other safety issues like the downed power lines like Roarmeister mentioned. Get flares out, block the scene with your vehicle far back as a buffer! (Leave a path for emergency vehicles to enter and exit) Make sure there isn't a subsequent accident into the first one. You don't want to be another casualty. Remember this is NOT your emergency. Protect yourself!

In the scenario try to stabilize their spine; DON'T move them unless absolutely necessary and even then stabilize their cervical spine. They may not bleed to death but won't be happy if you turn them a quadriplegic by moving them.

Ensure Airway, Breathing, Circulation, and control HEAVY bleeding. Most wounds can be treated while the person is still in the vehicle. Only worry about life threatening injuries like not breathing, cardiac arrest, or major bleeding. The others like broken bones and minor lacerations can wait for treatment.

If the person is conscious and talking find out about medical history, medications, and drug allergies. The rest isn't as important if they lose consciousness.

In the FAK I suggest a minimum of: 4 pair gloves, safety glasses, medical mask (again protect yourself!), Sharpie (write on your forearm pertinent information to pass on), a micro headlamp, shears, 6 Roller gauze, 8 4x4 & 4 5x10 gauze pads, 1-2 Ace wraps, Medical Tape, 2-3 Triangular bandages. With these supplies one can bandage just about anything on the human body. In my kit I've even got a 10x30 multi-trauma dressing and with that I CAN dress any significant wound. My kit is actually double the quantities in this kit, but these supplies are where I would start.

Have in vehicle saniwipes to clean up with afterwards.

One can add Quickclot, tourniquets, and Israeli dressings but they aren't needed in the majority of situations and are expensive comparatively. The Ace wrap, gauze pads, roller gauze, and triangular bandages can do the same thing. I've got them but already had everything else first.

The first thing one should do is get first aid training from a good source. If you've got equipment you should know how to use it!

Amen. Once you have training, the equipment list will come naturally, as you will want to have the gear that works with the interventions that you've been trained to perform.

Thanks, excellent list and while I don't have a 10x30, my truck kit should be good enough.

Re training -- one of the local REI stores has a Wilderness Medicine Institute (NOLS) Wilderness First Aid course scheduled in October; this is an infrequent training opportunity so I will be taking advantage.

This ^^^

The instinct to help others is awesome, but you can't help if you become injured too. I have stopped for accidents (or gotten out to help the guy that hit my car), and until the scene is secured there are people that will continue to move past the scene at normal speed even if this means driving close to the wreck. Especially at night, take steps to make the scene (and yourself!) visible. In addition to your gloves a cheap headlamp and cheap visibility vest are very handy and a good investment.

The WMI Wilderness First Aid course is an EXCELLENT one. Particularly for a problem like this one where the EMT's may be an hour or more away. The current ARC First Aid (not Wilderness First Aid) course is designed for urban situations where EMT's are minutes away.

I also agree with the recommendation for A type 2 or 3 vest or jacket in the car as well as flares (the traditional or LED type) to insure safety. The headlamp in my car has a flashing red light in the back and I carry other small flashers (EGear Guardian) to mark people and things that might be in the way.

The tourniquet has been discussed lots on this forum, and I for one carry one in my car kit, especially when I am out of the local area (built up).

Respectfully,

Jerry

I completed the NOLS WFA course this past weekend. Great course, highly recommended. If you have the opportunity, the course is well worth the time/$ invested.

As stated when I started this thread, I still have "nowhere near EMT skill level", but I should be a bit more useful while waiting.

A lot.

Other than some anatomy, splints and oxygen, I found my EMT training to be real close to first aid merit badge in boy scouts. Hold pressure is hold pressure. Bandages are the same. Don't move the person unless you have to.

My kit is pretty complete (there's a thread around here somewhere), but first thing is scene safety. Flare off the accident scene, use my truck as a barrier, etc.

+1 to the above. Securing the scene and stopping the bleeding is absolutely necessary and will facilitate later work immensely. Talk to the victim, reassure the victim,get the history of the accident, any allergies?,do you have a regular doctor? Taking any meds? Act confident, especially if you aren't.

Be prepared to accept failure, even if you do your best. But I was always surprised. If we delivered a victim with a heart beat, the miracle workers on up the line kept it going, almost always with good end results

Yep, that's what we practiced over the two day course although not with an automobile scenario -- mountain bike accidents, serious and not so serious falls et al. The point was always to run through an assessment to systematically determine the real situation. That process was repeatedly drilled in and donning gloves came before first contact. Sometimes the vic/patient was conscious and sometimes not so much. I would have been good before but may have hesitated. A lack of confidence can be contagious which is not good. The hands-on drills were very effective at building confidence.

As far as first aid kits go, the kit(s) in my truck will stay as they are (too much to carry but fine for a truck), but now I've actually practiced with a lot of that stuff and seen others demonstrated. I just finished tuning the kit I keep in my backpack; it's lighter and thinner now, and easier to find what I need not having to see through extra stuff.

One item we saw demonstrated is the WMI Wound Pack, which is fairly thin and easily packed in a small FAK. The pack is good for one serious laceration. Open the pack and use it up. I ordered a couple, just too convenient to pass up. YMMV

Let me "third" this thought (since Chaos already seconded it). For a long time I was confused about what should go in the FAK or what my medical gear should be for emergency situations. It wasn't until I got some training that I realized I should just equip myself for the things I know how to do. A disaster is a really bad time to do attempt brain surgery with a Doug Ritter knife and an instructional manual if all you've done in your life is putting a bandaid on.

The same is true of many "prep" areas. Guns, for example. All the time people ask on the internet: "What's a good carry pistol?" "What's a good home defense shotgun"? "What rifle for SHTF?" If you need to ask, you probably should sign up for some classes. (Unfortunately, much of the time the people who respond to such inquiries also need to take classes themselves.)

Of course, from that perspective I am woefully underprepared in some areas. My bushcraft skills are basically non-existant. But it's surprisingly hard to find classes, and they're frequently expensive to take. The same is true of emergency medicine. There isn't much out there for us weekend warriors. But the biggest cost factor is the travel involved. If every city had a competent instructor in each of the areas we want to study, we can probably do it. If we have to take five days off from work to fly somewhere in order to learn a skill that we may never get to use, we may not be able to make that sacrifice.

In Germany you are obligated to carry a first aid kit in your car, and you also have to take a first aid course (or "basic life support at the scene of an accident") to get your drivers license.

The contents of the first aid kit are even regulated in a norm (DIN 13164):

1x role of tape (2.5 cm x 5 m)
8x bandaid (10 x 6 cm)
3x sterile gauze bandage with smaller dressing (8 x 10 cm)
1x sterile gauze bandage with larger dressing (10 x 12 cm)
2x sterile dressing (40 x 60 cm)
1x sterile dressing (60 x 80 cm)
6x sterile dressing (10 x 10 cm)
2x gauze bandage (6 cm x 4 m)
3x gauze bandage (8 cm x 4 m)
2x triangular bandage
1x emergency blanket
1x pair of EMT scissors
4x gloves
1x first aid brochure

You also have to carry a reflecting warning triangle to secure the scene of the accident as well as at least one reflecting vest in your car to guarantee your own safety when walking along the road.

This thread came at a nice time, making me check my gear. I just recently replaced my vehicle, and moved some of my kit from my old Envoy to the new Grand Cherokee. I've always tried to have some "permanent" gear in my vehicle in storage compartments, so it's always there. Sometimes the gear bags with supplemental gear get moved out of the car for various reasons, so I always want a set of basic gear with me. What that means is sometimes cramming a lot into the nooks and crannies of the vehicle. I've learned to always have a couple of heavy duty contractor trash bags in the kit, so if I need to remove the gear (to change a tire, for example) I can do it quickly, and keep it dry. I can always then throw the bag in the back, and repack it when I'm home. This is some of the "stuff" in the wheel well of the new Jeep, as an example. I need to make a list of everything in the various compartments, and expiration info.

I didn't mention this in my earlier reply, but I'll throw in a real-world example.

Driving up I-5 between LA and San Fransisco, I saw a large cloud of dust appear about 1-1.5 miles ahead. Pulling closer I saw a vehicle in the center median (2 lanes on either side, dirt patch down the center). Pulled over, and a car behind me did as well. She was a nurse, at the time I was just and EMT.

Go over to the car, one of the passengers is standing up, walking around, dazed, freaking out. Glance at her and walk to the one still on teh ground. Vehicle is upright, damage on sides and bottom, obvious roll-over. Patient on the ground is on her back, staring straight up, blood from nose/mouth, non responsive.

Crowd gathering from other vehicles. Eventually a doc and a few firefighters show up before the local cops and about 30 min later, EMS.

But in that time, the nurse and I gloved up, I had a gown on, used an ambu bag, c-collar, oropharyngeal airway, and did CPR for about 15 minutes til one of those FF's came and switched out. Blood spraying every time we squeezed the bag, got everywhere. Used my suction device (a turkey baster, works OK and costs a ton less than real medical supply) numerous times. We ended up working on her about 40 minutes til EMS got there, at which time they hooked up the EKG and the medics, along with the off-duty physician, called the code.

Someone at some point started to help the passenger, but I really didn't pay much attention.

So, my first aid kit has a LOT. But, all of it is EMT-B level. I do have an IV now, but don't really anticipate using it (heck, it might be expired).

back in the old days, it was not uncommon for battery acid and glass fragments to pose a threat, especially to eyes... still keep a 1L bottle of sterile water for irrigation....

i will give you my own thoughts about that scenario.

1. A head-on poses a risk of very serious injuries. And since one driver is already dead, the other can possibly be critical. One of the biggest risks is the arrival of overly-enthusiastic third parties who try to move the victim who is still alive ... because of the problem of possible neck/spine damage. It is not uncommon to see well-meaning responders do some very risky things (for the victim) while trying to "help". I am not against immediate critical first-aid. But definitely make sure you have immobilization devices like C-collar and a spine board would be excellent (but highly impractical for the average person to have a spine board).

2. Otherwise, how about good old-fashioned oxygen? It's one of the few things an EMT can administer that has a definite shot at really saving life! People never talk about oxygen, but getting someone on O2 might be a lifesaver while the ambulance is coming.

3. Be prepared for the victim to vomit. You will need to clean the mouth, maintain the airway, and ensure they are breathing.

4. Yes, some bandages for serious bleeding.

5. Small flashlight to check eyes and ears for brain damage & head injuries.

cheers, Pete2