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#146162 - 08/27/08 05:14 PM Re: The Official First Aid Kit Show-off Thread [Re: NightHiker]
Chris Kavanaugh Offline
Carpal Tunnel

Registered: 02/09/01
Posts: 3824
I'm going to tell you people a story. I maintain a pretty sophisticated equine first aid kit. I get similar arguments from people who don't even know what the California Veterinary Practice Act is, or, conversely think Nikon Magnets and telephone calls ( at $100 via MASTERCARD)to animal psychics are viable treatments for foundering horses.

During El Nino one of our local large animal DVMs found her supplies severely depleted and a rush shipment of fresh supplies wound up in an overturned FED EX truck.

I learned of her worries when she stopped at my coastal canyon ranch minutes ahead of the road being closed behind her and yet another emergency call coming in. We didn't even bother with formalities. My infamous kit, an old ammo can for rather LARGE military munitions was tossed onto the floor of the cab and her assistant braced her bootheals against it.

For three days my controversial kit/cornucopia supplied vetwrap ( bought super cheap in the unpopular ecru)disposable needles,saline packs and stuff I haf forgot was in there.
My ecru vetwrap went onto a famous stud of a rare breed after a storm damaged stall collaped and his leg was badly lacerated. His barn colours now sport a thin ecrue stripe, much like the 'thin red line' of a famous Balaclava regiment.

I would remnind thee forum of two things: A. the famous first aid caveat of 'Do no harm.' There is no evidence of this extensive kit having done so. B. This forum has rules and guidelines. I rdeally don't care what people post on other forums. You quote it here, clean it up.You make a comment, keep it clean.

This thread has generated a lot of interest.It is to valuable to lock. I have excised a few vulgarities and posts with a disposable blade. Do not presume a surgical kit for trauamtic amputation is not in my moderator's kit.

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#146180 - 08/27/08 05:55 PM Re: The Official First Aid Kit Show-off Thread [Re: Chris Kavanaugh]
Glock-A-Roo Offline
Old Hand

Registered: 04/16/03
Posts: 1076
Originally Posted By: Chris Kavanaugh
...You quote it here, clean it up. You make a comment, keep it clean.


10-4; sorry for the vocabulary problem.

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#146337 - 08/28/08 03:11 PM Re: The Official First Aid Kit Show-off Thread [Re: Glock-A-Roo]
Paragon Offline
Enthusiast

Registered: 10/21/07
Posts: 231
Loc: Greensboro, NC
At the risk of restarting heated discussions, I do want to at least address some of the recent questions/comments.

Originally Posted By: Greg_Sackett
If you don't mind my asking, how much did that kit cost to put together?

Someone on another board asked the same question, and the answer is I'm not exactly sure, as I haven't really kept track of that. I do keep all my receipts, so I could actually total it up if I ever needed to.

According to the excel sheet that I put together, the total is $4,561.54, but that figure does not account for any discounts. For example, the price I have listed in excel for the STOMP II is $334.99 (the price shown on Blackhawk's website) although I actually purchased it new off eBay for about $135 with shipping. My best guess is that I've probably spent somewhere around $3,500 for everything.

Originally Posted By: NightHiker
What an individual chooses to include in his/her FAK (whether it's individual, small group, expedition, or post-apocalyptic) should depend on what scenario they want to be prepared for. IMHO, Paragon's kit isn't for the weekend warrior or EMT wannabe, it's a serious kit for a very serious event.

Thanks for recognizing that fact. The items that I chose to include in my FAK may or may not reflect the same preparedness goals that someone else may have. Just because I have a particular item in my FAK should not imply that you should run out and buy the same, and likewise, your medical history may require specialty items that I have no need for (insulin, cholesterol or heart medications, etc.).

Originally Posted By: martinfocazio
OK, here's my opinion on this whole thing.
First of all, it's good to see some discussion here about the meds in the kit, and I'm not going to take sides in the debate of legality and usefulness of one med or another, that's the domain of people who are paid medical pros, not a volunteer firefighter or armchair expert.

It’s very unfortunate that a few people have choosen to steer much of the discussion around the meds that I maintain in my FAK. Some of the PM’s that I’ve received even suggest there is a bunch of wild speculation going on over on other boards – everything from implying that my doctor is irresponsible to having friends in the medical field stealing them for me.

I have an acquaintance on another forum that has publicly shared his story regarding chronic back pain that he suffers from as the result of a spinal cord injury that he sustained several years ago. The pain that he endures is such that his doctor has prescribed significant daily dosages of Fentanyl (an opiate considered to have approximately 80 times the analgesic strength of morphine).

I’d like to suggest that without intimate knowledge of someone’s personal medical history, second guessing a doctor’s choice of prescribed medications is not only a sign of ignorance, but is quite irresponsible. While I don’t feel compelled to share every personal detail of my life on the internet in defense of my FAK, only a fool would not realize there are dozens, if not hundreds, of acute and chronic medical conditions ranging from LBP to breakthrough cancer pain management that warrant the occasional or even 'round-the-clock use of prescribed narcotics.

Without trying to single out anyone in particular, I would have thought that the mere fact that I haven’t deleted my post and run off to Mexico in fear of the DEA showing up at my house asking questions would have suggested that nothing illegal, immoral, or unethical has occurred regarding the prescription meds that I have. I guess George Carlin was right when he noted that when you consider the stupidity of the average person, it’s frightening to realize that half the population is actually dumber than that.

Originally Posted By: Chris Kavanaugh
I'm going to tell you people a story. I maintain a pretty sophisticated equine first aid kit. I get similar arguments from people who don't even know what the California Veterinary Practice Act is, or, conversely think Nikon Magnets and telephone calls (at $100 via MASTERCARD) to animal psychics are viable treatments for foundering horses.

I would remind thee forum of two things: A. the famous first aid caveat of 'Do no harm.' There is no evidence of this extensive kit having done so…

A fact that has apparently gone unrecognized by too many.

I find it somewhat ironic that we can post modifications of AR-15’s and pictures of caches of amour-piecing rounds in the attic without people jumping to the false conclusion that we’re a crazed maniac plotting the day we will take out the local post office, but post some medical items in your FAK beyond your stated training or experience level and these same people instantly deduce that your life’s goal is to perform a needle thoracostomy on the first stranger that we meet experiencing shortness of breath.

Jim
_________________________
My EDC and FAK


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#146342 - 08/28/08 03:46 PM Re: The Official First Aid Kit Show-off Thread [Re: Paragon]
kd7fqd Offline
Enthusiast

Registered: 08/07/05
Posts: 359
Loc: Saratoga Springs,Utah,USA
Jim
Major kudos for the FAK, one of my ER Docs helped with mine and I don't have near the stuff you do but, I'm aheaded that way.
He told me to add the intubation kit so in it went, he also told me to carry (2)250ml bags of saline and (1)250ml D5W.
I also carry IV tubing, sharps and claves.
My neighbors are sure glad to know I carry it. I also carry a letter from my doc stating I am qualified to use said equipment (In Utah you are only a Paramedic when you are working for an agency) my ER Docs will countersign anything I do.(as long as it's warranted)50-75 miles from help, in the mountains (I work for a mountain rescue team)

Mike

Again good job on the FAK
_________________________
EDC: Samsung Galaxy Note 2,DR PSK, Swiss Army Champ, Leatherman Blast
My Blog emergencybobs.wordpress.com


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#146388 - 08/28/08 07:50 PM Re: First Aid Kit Show-off - RANT [Re: NightHiker]
JIM Offline
Old Hand

Registered: 03/18/06
Posts: 1032
Loc: The Netherlands
Bravo Nighthiker, very well spoken!
_________________________
''It's time for Plan B...'' ''We have a Plan B?'' ''No, but it's time for one.'' -Stargate SG-1

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#146392 - 08/28/08 08:27 PM Re: First Aid Kit Show-off - RANT [Re: JIM]
falcon5000 Offline
Addict

Registered: 09/08/05
Posts: 662
Bravo Nighthiker and Paragon as well. Even if you look at how Paragon's kit is set up, it takes a person with a good amount of knowledge just to build this kit. I fall into the bandade class level, that's why my kit is an off the wall kit with a extractor and quick clot in it. If all heck broke loose, I would definitively hope that someone like Paragon would be around. When your choices are dieing of attempting anything, the attempting anything wins in my book because the worse case of that is dieing anyway.
_________________________
Failure is not an option!
USMC Jungle Environmental Survival Training PI 1985

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#147179 - 09/03/08 02:36 AM Re: The Official First Aid Kit Show-off Thread [Re: climberslacker]
Alan_Romania Offline

Addict

Registered: 06/29/05
Posts: 648
Loc: Arizona
It has been a few days since Doug emailed me the link to this thread. I have drafted a number of responses, but when I came back and reread them after being interrupted none of them seemed appropriate. What kept upsetting me was the viciousness of some of the responses. So, I figure I will address this first and then move on… One of my major dislikes of internet forums is how many people are willing to attack people for one reason or a number. Comfortably hidden behind the anonymity of the internet these individuals post comments that they would never say in person. I have left or avoided many forums because this behavior… Please don’t bring that behavior in here. I have been working with Doug for a few years now to know how much time and effort he puts into ETS and what the Foundation stands for, those few individuals that are posting that garbage are not only disrespecting the individual they are attacking or responding too but they are also disrespecting the others who post here, the moderators, Doug and ETSF.

Now with that off my chest.

Paragon,
As others have said, you have put together a very comprehensive kit. I can see a few things I would add, but in the end those items wouldn’t really “improve” the kit just make it more suitable for me wink. It is obvious that you put considerable time and money into making it and for that I give you Kudos! Extra Kudos for the outstanding time and effort that you put into an exceptional series of posts!

As I understand your purpose for this kit, you built as a SHTF huge FAK that would allow a more experience/trained provider to provide more than basic first aid. It should suit that purpose very well. Just to reiterate what Chris reminded everyone, “Do No Harm” is the cardinal rule of patient care… just because you have something doesn’t mean you can or should use it if you don’t know how, especially on others (that wasn’t directed at Paragon, but the forum as a whole…).

The first bit of advice I have for you is to add a manual suction device ASAP, that is an important airway management device. The Res-Q-Vac you mentioned is a good device, I carry one in my aid station and truck kits, but you might also want to look at the Squid suction device (I believe NARP carries them).

Next I would reorganize your kit into two or three smaller kits. You already have the IFAK on the outside of the kit, but I would organize the rest into two other kits, or even three. The main problem I see with your kit is that it would be difficult to work out of. While it is really neat and organized, it is organized like it would be used as an aid-station kit vs. a field trauma kit. While this will work, it will become frustrating when working on a crappy patient in less than ideal conditions. A common mistake when less experienced providers build a kit is they tend to put as much stuff anywhere it can fit, rather than organizing it so that the items you will need NOW are easy to access. I would arrange the kit so that everything you need to manage your ABC’s are quickly accessible, everything else can wait. While the IFAK on the front is a good start the rest of the kit is kind of scattered. An example of this would be the Endotracheal tube (more on that later) in one spot while your Laryngoscope is in another. What you may want to do is find someone to help you rearrange your kit, someone with experience in provide care in the field like an EMS provider or military provider. A Doctor or nurse that has only worked in the hospital, even the ED, won’t have the experience to help you organize a kit like this. Even if you intend to use one of the other, smaller kits you mentioned for immediate care I would still reorganize this kit to make working out of it easier and quicker.
I would like to mention a few things about the medications in the kit. First, I do know of more than one MD who has written prescriptions for some of the items and medications that are in this kit. Typically these kits are for travelers, expeditions, sailing, etc. where medical facilities and/or supplies may be hours away if they are even available… On the assumption that you have a prescription for all these medications my second medication comment is in reference to the Morphine and Narcan… Paragon, you have 300mg or Morphine and only 0.4mg of Narcan. I would suggest at a minimum 10mg of Narcan. On an adult we typically use 2mg as the FIRST dose of Narcan and have had more than one patient that have required 6mg or more before their respirator effort returned to adequate.

Switching the topic to airway management, you have only a 9.0mm endotracheal tube. That is a big tube, and it would be unusable on many adults. In my wilderness kit, where space and weight are an issue I carry a 6.0, 7.0 and 8.0 tubes for adults. These three sizes are useable on all but a small population of adults. Personally, I would dump your intubation equipment and simply carry the King airway devices in more sizes. The Kings are simpler, safer and quicker to use and are pretty darn effective in the emergency setting (especially for lesser experienced providers).

Without repeating others, that is about all I have. The last bit of advice I have is get some more training… it can only help! Even a 40hr first responder course or wilderness first responder course would be a great addition to your toolbox of education.

Now, where did you get those iGo boxes? My Google-fu is weak today!
_________________________
"Trust in God --and press-check. You cannot ignore danger and call it faith." -Duke

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#147237 - 09/03/08 03:22 PM Re: The Official First Aid Kit Show-off Thread [Re: Alan_Romania]
Paragon Offline
Enthusiast

Registered: 10/21/07
Posts: 231
Loc: Greensboro, NC
Originally Posted By: Alan_Romania
It has been a few days since Doug emailed me the link to this thread. I have drafted a number of responses, but when I came back and reread them after being interrupted none of them seemed appropriate.

Alan,

I greatly appreciate you taking the time to look things over, as well as providing your professional opinion.

Originally Posted By: Alan_Romania
The first bit of advice I have for you is to add a manual suction device ASAP, that is an important airway management device. The Res-Q-Vac you mentioned is a good device, I carry one in my aid station and truck kits, but you might also want to look at the Squid suction device (I believe NARP carries them).

My only real hesitance with the commercially available suction devices that I've looked at is the size of the suction tube. Both the Res-Q-Vac and Squid seem limited in their ability to handle chunks (sorry for the gross-out factor) whereas clear fluids could be suctioned effectively by improvising existing items in my FAK (bulb syringe, 60cc irrigation syringe w/ an NPA, etc.).

The one significant advantage both of these devices seem to offer over most improvised methods is one-handed operation. That fact, along with the suggestions of several professionals like yourself, is enough reason for me to pick one up.

Originally Posted By: Alan_Romania
I would suggest at a minimum 10mg of Narcan. On an adult we typically use 2mg as the FIRST dose of Narcan and have had more than one patient that have required 6mg or more before their respirator effort returned to adequate.

Agreed. Having never experienced any respiratory depression in the past I didn't originally feel that more Narcan was necessary, although should a physician ever need to use my kit in a non-EOTWAWKI scenario on another PT, it would be wise to have 10mg of Narcan available.

I would also like to swap out the MS MDV for fentanyl amps when the MS that I have approaches expiration. There appears to be wide-spread consensus that fentanyl offers less risk of respiratory sedation in non-opiate tolerant individuals, as well as reduced hypotension and mental status depression.

Originally Posted By: Alan_Romania
Switching the topic to airway management, you have only a 9.0mm endotracheal tube. That is a big tube, and it would be unusable on many adults. In my wilderness kit, where space and weight are an issue I carry a 6.0, 7.0 and 8.0 tubes for adults. These three sizes are useable on all but a small population of adults.

Actually there are six (6) ET tubes in the FAK. You're not the first to miss the others, so I'm guessing you were probably looking at the photos more than reading the contents list.

I have 6.0, 7.5, and 9.0 Rusch ET tubes located in the (blue handled) airway accessory kit, along with a single King LT-D (size 4). In the supplemental airway pack I have an additional 9.0mm Endotrol and a size 4 King LT-D, along with the remaining airway items that are simply too large for the standard airway kit (3 x stylets, 3 x oxygen cannula, non-rebreather mask, and BVM).

Originally Posted By: Alan_Romania
Next I would reorganize your kit into two or three smaller kits. While it is really neat and organized, it is organized like it would be used as an aid-station kit vs. a field trauma kit. While this will work, it will become frustrating when working on a crappy patient in less than ideal conditions. I would arrange the kit so that everything you need to manage your ABC’s are quickly accessible, everything else can wait.

With the exception of storing the Epi-pens in the first section, all the potential ABC items are actually grouped together. This is the primary reason that I keep additional gloves and a second CPR mask in this section (to avoid having to go into the 1st/2nd panel to perform a primary ABC survey). It's important to note that when the pack is opened up to the 3rd/4th panels, the supplemental airway items (stylets, BVM, etc.) are literally two inches to the right of the primary airway kit. Likewise, the stethoscope is so close it actually has to be removed from the 4th panel storage location in order to access the primary airway kit.

Originally Posted By: Alan_Romania
The last bit of advice I have is get some more training… it can only help! Even a 40hr first responder course or wilderness first responder course would be a great addition to your toolbox of education.

Perhaps you may not have seen where I was originally scheduled to attend the 180 hour NOLS/WMI Wilderness EMT course last fall, although a last minute business trip to Germany conflicted with my selected course date. I hope to attend this course this winter if my work schedule allows, although despite my obvious interest in wilderness medicine, it is not my career (nor do I ever intend for it to be) so I don't feel that I've been a slacker when it comes to training.

Originally Posted By: Alan_Romania
Now, where did you get those iGo boxes? My Google-fu is weak today!

Walmart, in the travel size/product sample aisle, although that was probably eight months ago, so they may no longer have them.

Again, I really appreciate your review and input, and would welcome any additional comments/suggestions that you may have to help me improve the functionality of the kit.

Jim
_________________________
My EDC and FAK


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#217109 - 02/15/11 04:48 AM Re: The Official First Aid Kit Show-off Thread [Re: climberslacker]
beyondsundaymorning Offline
Stranger

Registered: 02/14/11
Posts: 1
You can get the Igo containers/boxes at:

http://www.nancysknitknacks.com/perfect_notion_case.htm

Hope this helps anyone.

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#217208 - 02/16/11 06:15 PM Re: The Official First Aid Kit Show-off Thread [Re: climberslacker]
PureSurvival Offline
Member

Registered: 02/21/09
Posts: 149
Loc: UK
Paragon that FAK is a wet dream come true.

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