For years I have been buying the Total Resources International first aid kits from my local Sam's Club for $21.63, including tax, to modify for missionaries and church-sponsored mission trips. The plastic case is sturdy, with room for some modifications, and the quality of the components is acceptable.

http://www.samsclub.com/sams/first-aid-center-326-pieces/196928.ip?navAction=push

I have looked at other kits; this one still offers the best bang for the buck. Here are the contents of the kit, prior to modification:

21 Antiseptic Towelettes
36 Alcohol Pads
06 Sting Relief Pads
06 Antibiotic Ointment Packets
06 Burn Cream Packets
05 Antacid Packets
05 Aspirin Packets
05 Non-aspirin Packets
01 English First Aid Guide
01 Spanish First Aid Guide
01 Instant Cold Compress
20 Adhesive Bandages, 1 in x 3 in
60 Adhesive Bandages, ¾ in x 3 in
50 Adhesive bandages, 3/8 in x 1-1/2 in
10 Butterfly Bandages
18 Wound Closure Strips
02 Gauze Rolls, 2 in x 4 yd
02 Eye Pads
08 Sterile Gauze Pads, 2 in x 2in
04 Sterile Gauze Pads, 4 in x 4 in
01 Sterile Trauma Pad, 5 in x 9 in
30 Cotton Tip Applicators
01 Adhesive Tape Roll, 1 in x 5 yd
01 Triangular Bandage, 40 in x 40 in x 56 in
05 Finger Splints
04 Examination Gloves
01 Metal Scissors
01 Plastic Tweezers

This year I have modified kits for Guatemala, one for Africa and I will be modifying another one India later this year.

This year modifications I have made this year have included the following which I ordered from Chinook Medical Gear. For each kit I have included:

01 Irrigation Syringe, 60 cc
02 Benzoin Swabs
01 Povidone-Iodine 10% Solution
05 Diomode Packets
05 Diotame Packets
05 Diphenhydramine (Antihistamine) Packets
02 Oral Rehydration Salts
01 Elastic Bandage, 3 in
05 Knuckle Bandages

Including the Diotame is overkill but I will continue to use my supply until I run out and I am still undecided on the Oral Rehydration Salts.

The two first aid guides (one English, one Spanish) are one-sheet pieces of paper, printed front and back, with a place for emergency phone numbers. Though they take up almost no room, they are almost useless for a third-world country. If I replace them, it will be with a used copy of a real first aid book.

Ideas for future modifications include Non-Adherent Pads, safety pins, duct tape, moleskin, either a pencil or a fine-point Sharpie, patient assessment form, CPR shield, Digital Thermometer, an additional Trauma Pad and Triangular Bandage. If room will allow it, a SAM Splint as well.

I always tell the missionaries or mission group to leave what is left of the kit behind for a group that needs it. I want each kit to be able to provide for, at minimal, a group of ten.

Does anyone have ideas for how to build a better ten-person first aid kit for a third-world country, know of guidelines on how to do so, know of a good place to buy quality components on a budget or build a good kit on a budget?

Note: I am not associated with any of the companies I have mentioned.

Jeanette Isabelle

I think you are the queen of first aid kits. I belive it was you that posted a link to a nice FA kit on sale a few months back that I promptly bought for my daughter. Thanks! This one at Sam's looks like a good kit too.

One thing that I like in FA kits is "coflex". A very nice stretchable bandaging material. Much better than "gauze wrap" for holding on 4x4's etc. Don't buy it at a human medical supply place - it will cost a lot. Buy it at a horse supply place. Same stuff. Comes in more different colors (we all want snazzy looking horses!)

Example, $1.39 for 4"x5yards at a horse place:

http://www.drsfostersmith.com/product/pr...7&ProdTab=1

Example, $1.64 for the same size at a different horse place, a bit higher priced, but even more colors:

http://www.kvsupply.com/co-flex

Example, or $7.13 for the same size in boring colors at Amazon:

http://www.amazon.com/North-Honeywell-10...keywords=coflex

Another great thing to get for clearing up wounds and preventing/treating infection is "colloidal silver spray". Again, buy it at a horse place rather than a human place. Much cheaper. Same stuff. While it is cheaper at a horse place, it still might be too expensive for you to put into the kits that you are building. It works much better on my cuts than the more traditional ointments - neosporin, polysporin, etc.

er nurse for 37 years, off and on, and occasional medical missioner here: exquisite job on the kit. I would second the motion on coflex, aka coban and vet wrap. Might consider substitutability and re-useability in designing kits: gauze pads and wraps can be fabricated from clean rags, rehydration fluids fabricated from diluted fruit juice and salt: antibiotic ointment, anti-diarrheal meds, povidone and tape, not so much: might increase supplies of latter, decrease supplies of former. Include, if permissible, splinter forcep, hemostat, small scissors, thermometer, blood pressure cough/stethoscope if training of users supports such.all this imho, ymmv, and not to detract in any way from your efforts.

Thanks. This is an interest of mine and I am always looking for the best bang for the buck.


The kit already comes with two Gauze Rolls and there is a compartment in the kit just for them.

Can CoFlex be used in place of an elastic bandage? If so, which of the two should be used in a first aid kit?

Jeanette Isabelle

It would be a waste, I think, to throw out the gauze rolls and gauze pads, especially the gauze rolls as there is a compartment just for them.

As you see, I have six Antibiotic Ointment Packets for a ten-person kit and five packets of the medication. I have to consider the cost for additional Antibiotic Ointment Packets and the space for the medication. How much of each should I have for a ten-person kit?


Blood pressure cuff/stethoscope will not fit. Small scissors are included. Should a hemostat be included in a kit for non-professionals?

Jeanette Isabelle

I defer to the wisdom of others, with more experience than me on this subject, but did want to say - I think it is very cool that you do this, Jeanette Isabelle. What a great way to make the world a better place. Way to go!

Is water going to be an issue for th missionaries? It may be scope creep, and will certainly add to the kit costs, but a water filter, such as the Life Straw, could be beneficial when it comes to both hydration and sanitation.

Water is not an issue for the group in Guatemala; I don't know about Africa. Either way, space inside the first aid kit and cost are an issue.

Jeanette Isabelle

"The discovery that sodium transport and glucose transport are coupled in the small intestine so that glucose accelerates absorption of solute and water (is) potentially the most important medical advance this century."


British Scientific Journal
5th August, 1978"

The "Simple Solution" - Home made Oral Rehydration Salts (ORS) Recipe

Preparing 1 (one) Litre solution using Salt, Sugar and Water at Home

Mix an oral rehydration solution using the following recipe.

Ingredients:
Six (6) level teaspoons of Sugar

Half (1/2) level teaspoon of Salt

One Litre of clean drinking or boiled water and then cooled - 5 cupfuls (each cup about 200 ml.)
Preparation Method:
Stir the mixture till the salt and sugar dissolve.

http://rehydrate.org/solutions/homemade.htm

It is reasonable not to discard stuff that's already there. OTOH, a 1 ounce tube of antibiotic ointment provides dozens of applications, and might fit into the space where the gauze is housed. Similar argument for diphenhydramine and loperamide. IIRC, Usual dose for antihistamine is 25-50 mg every 4 hours, antidiarrheal is 2 tabs after first episode and one after each succeeding episode to a max of 4 per day. You have about one days treatment for one patient in each category. Is that enough? depends on the severity of the illness, and if the patient can get to a definitive care provider within a few hours. May not be economically feasible to provide more than this in a first kit. Hemostats are useful for removing bigger splinters, and have a high general utility value: emts and nurses generally carry both, and it's probably hard to get into trouble with them. Understand that bp cuff/steth is too bulky, but a little digital thermometer is still a good idea, and quite small. Hard to reconcile the competition between cost and comprehensiveness: providers like me always want more stuff. If you are not getting complaints from the users, you are doing just fine.
Oh-coban/vet wrap is great for securing dressings, not so good for elastic bandage applications: hard to reuse coban, while an ace lasts a long time.

If something from the kit is to go, to make room for something else, I would vote to nuke the burn creme packets. You don't want to put that stuff on a second or third degree burn, although I guess it would be OK for a first degree one. But all-in-all, burn creme is pretty useless at best. A dry sterile dressing is what you want over a burn.

For attaching dressings: First there was tape. Then "roller gauze". Then "Kling" wrap. Then "Kerlix". Now there is "Coban" (a.k.a. "coflex"). I don't know if anything came between Kerlix and Coban. We were still using Kerlix when I was a paramedic. Now we're using Coban. But I've been out of the medical field since the Kerlix days. Kerlix definitely was better than either Kling or roller gauze, but it was also much bulkier, so didn't fit into FA kits as nicely. None of these substitute for an Ace Wrap (a.k.a. "elastic bandage").

Very nice work! If you have room and budget, I'd suggest more gloves.

Great thread and hugely informative. Like others, I thank J-I for putting her time and effort into this topic. But I do have a question. Isn't there a difference between the optimum kit for a wildern ess (roadless, natural setting)and third world (higher chance of infectious disease, lots of contact with strangers)? In wnat I define as wilderness, weight of items carried is always a consideration and your first aid kit contains a few core items (sterile dressings, Ace bandages) and knowledge of other items in your gear that can be converted to first aid applications (duct tape, stays from your baackpack = splints)

The packets of burn cream and packets of antibiotic ointment have their own compartments so removing them would not save space. The two compartments combined can easily hold twenty cream/ointment packets. The kit comes with a total of twelve cream/ointment packets.

Jeanette Isabelle

Thank you. The kit comes with a reorder form and what they charge for each pair of gloves in a bag, plus shipping, is ridiculous. Do you know where I can buy a pair of gloves in a bag for less?

The kit has room for more bagged pairs of gloves.

Jeanette Isabelle

Jeanette Isabelle,check out uniform rental places.Many also provide a service to stock first aid kits in factories.Tell them what you are providing and they may even donate to the cause.....

I should mention that the kit comes with compartments for medications which are the same size as the compartments for the alcohol pads and sting relief pads. The antiseptic towelettes would not practically fit in these compartments so they are located somewhere else.

Therefore, if I remove the alcohol pads (which takes up two compartments) and sting relief pads (which takes up one compartment), I would have room for a total of sixty packets of medications. The kit came with a total of fifteen packets of medication (Antacid Packets, Aspirin Packets and Non-aspirin Packets). If I do not remove the medication, the alcohol pads and sting relief pads the kit came with, I can add thirty more packets of medication. How much diphenhydramine and loperamide should I include for a ten-person kit?


I still have my doubts about using a hemostat. The kit comes with those cheap “plastic tweezers” which I have considered replacing with Uncle Bill's Tweezers. Should I have both the plastic tweezers (in case they provide some benefit) and Uncle Bill's Tweezers or completely remove the plastic tweezers?


I have space for one roll of CoFlex or one elastic bandage, not both. Removing the two gauze rolls the kit came with would not save space as the compartment for them is not much use for much of anything else. What small items that can fit in that space is likely to fit in other parts of the kit.

On the other hand, I have considered adding a 2” roll of duct tape. If I do not add the duct tape, I could put in a 2” elastic bandage in addition to the one roll of CoFlex. In short, I have a choice of duct tape, one roll of CoFlex and an elastic bandage: I can pick two.

Jeanette Isabelle

Thank you and you are right. There is a difference between a wilderness kit and what I'm building.

Jeanette Isabelle

I wouldn't bother bagging them. Or I'd buy the gloves in bulk and then put them in cheap sandwich bags.



I would definitely pitch the plastic tweezers and put in some metal ones, the Uncle Bill's are an excellent choice if a bit pricey.



Duct tape and elastic bandage. Here's why: Duct tape can do everything CoFlex can do and more. Nothing beats an elastic bandage for certain soft tissue injuries.

Jeanette_Isabelle, have you considered Pepto-Bismol (and generic) tablets as an alternate anti-diarrheal? My understanding is the bismuth salts have anti-microbial effects in the G.I. tract as well as mechanically slowing the movement of material in the tract. I made a half dozen missions trips to Peru amd Mexico 10+ years ago and had no G.I. problems while others in my group did. I made it a habit to take 2 tablets with each meal and 2 tablets upon retiring. I wouldn't call this proof, but if I ventured back to Peru I would certainly take my pepto with me.

I'm a little OCD so if I add more gloves, they would be bagged in groups of two.

Jeanette Isabelle

What you are referring to is Bismuth Subsalicytate (Diotame). So I should use that instead of Loperamide Hydrochloride (Diomode)? How many packets should I include for a ten-person kit?

By the way, the kit includes five packets of Calcium Carbonate.

Jeanette Isabelle

I'd add more information -- both in training the missionaries and adding a book in the appropriate languages. Basic first aid, hygiene and science info are lifesavers.

I would definitely keep the anti-diarrheal over the Pepto-Bismol. Actually, I'd keep both. The Benadryl in the kit can also be used as an anti-nauseant. And as a sleep aid too.

I have considered recycling the first aid “guide” and buying used copies of A Comprehensive Guide to Wilderness & Travel Medicine by Eric A. Weiss, M.D.

Jeanette Isabelle

I buy nitrile gloves 50 to a box at Rite Aid. Take those and package them two each in small ziplock bags. The ziplock bags can be reused for other things in the field. This is how I package gloves for various kits.

So add the following: Bismuth Subsalicytate (Diotame), Loperamide Hydrochloride (Diomode) and Diphenhydramine. If I do not remove the alcohol and sting relief pads, I would have space to add thirty packets of medication. When grouped in fives (the amount each compartment holds), how much of each goes into a ten-person kit?

I have been saying “a ten-person kit” because ten is the number I am shooting for.

Jeanette Isabelle

As many as will fit, equally divided: this is based on the notion of leaving the kit behind for use by the locals. Loperamide and diphenhydramine are very useful drugs. Bismuth subsalicylate is an older drug, and is less effective in some studies.

This is what I have so far.

Do NOT add the following:
Oral Rehydration Salts
Additional Sterile Gauze Pads

Add the following:
Digital thermometer
Duct tape
Elastic bandage
Additional pairs of gloves
Additional Antibiotic Ointment Packets [There have been no suggestions on how much to add.]
Splinter forceps to replace the plastic tweezers
A Comprehensive Guide to Wilderness & Travel Medicine by Eric A. Weiss, M.D. to replace the first aid guide
Equal amounts of Diomode, Diotame and Diphenhydramine Packets

I will consider adding more tape.

I have not received feedback regarding the following:
Non-Adherent Pads
Moleskin or other blister treatment
Patient assessment form
CPR shield
Additional Trauma Pad
Additional Triangular Bandage
SAM Splint, if space will allow it

I have considered putting in one Pocket Medic per kit. A Pocket Medic provides splinter forceps, moleskin, two safety pins and an extra Antibiotic Ointment Packet at a reasonable price.

Edit: If I don't need moleskin, it would be cheaper to only get the splinter forceps.

Thank you for your help.

Jeanette Isabelle

For an inexpensive, lightweight and small trauma kit, I strongly recommend the "Patrol Officer's Pocket Trauma Kit" from Rescue Essentials (order either from http://www.rescue-essentials.com/ or from Amazon, especially if you're a Prime member). It's far from complete and it's not what I carry on the range, but for the price point it can't be beat.

It contains a SWAT-T tourniquet, Z-Pack Dressing, a pair of gloves, and three feet of duct tape. If you have a sharp with you, the plastic bag containing it can be used with the duct tape to create a field-expedient chest seal.

The SWAT-T isn't the best tourniquet out there -- I'd hate to be applying it to my own arm -- but it's inexpensive, easy to use, and can double as a pressure dressing with the Z-Pack. The preferred tourniquets (CAT-T, SOFTT-W) are far more expensive.

I have no connection to Rescue Essentials or Amazon other than as a customer.

Or a box of feminine hygene pads (the large bulky style) and an Ace wrap.

For leave behind books; 'Where there is no doctor'- useful, though badly out of date. is there something newer?

"Bismuth subsalicylate is an older drug, and is less effective in some studies."
I don't argue with RN's or Physicians, both have different training than I do. My only argument with Loperamide is, as I understand it, it effectively paralyses the G.I. tract; trapping any microbes in the gut. Pepto Bismol slows but doesn't stop peristalsis. If a person has food poisoning or some similar problem, they may continue to feel sick until the causitive agent is expelled from the body. That may take longer if the person has taken Loperamide. But I don't argue with R.N.'s

NurseMike, Thanks for that PubMed link. I hadn't seen that one before.

These kits are going to third-world countries, not to a war zone.

Jeanette Isabelle

These kits come with a trauma pad, triangular bandage and two gauze rolls. I'm adding duct tape and an elastic bandage. Space and cost are an issue. Besides what I have mentioned, what do I need?

Jeanette Isabelle

Add a second 5” x 9” trauma pad? Noted.

The two gauze rolls included are 2” x 4 yards. As I said, I'm adding an elastic bandage and duct tape.


What would you recommend?

Jeanette Isabelle

Oh, you are referring to prescription medications. I don't know how practical that would be in a kit modified for missionaries.

Jeanette Isabelle

An inexpensive alternate for trauma pads are womens maxipads.They are sterile and work just as good....

BOATMAN
John

Nothing inspirers confidence like using a maxi pad. A 5” x 9” trauma pad is only $0.19.

Jeanette Isabelle

Not sure why you are leaving out the oral rehydration salts? Are local salt and sugar available? Check out the Zinc Supplements too. Treatment for dysentery requires plenty of ORS. Just stopping someone up with Lomotil can be a hazard, especially in children. You will notice no Lomotil or Pepto in the WHO treatment below.


"Diarrhoeal disease is the second leading cause of death in children under five years old, and is responsible for killing around 760 000 children every year. "


"Key measures to treat diarrhoea include the following:

Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. It costs a few cents per treatment. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.
Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
Rehydration: with intravenous fluids in case of severe dehydration or shock.
Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well.
Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.


http://www.who.int/mediacentre/factsheets/fs330/en/

Just curious, what is the level of first aid training of the recipients of this kit? That is the most important component of any FAK.

As you read in Nurse Mike's post, “rehydration fluids [can be] fabricated from diluted fruit juice and salt.”

You said:

The "Simple Solution" - Home made Oral Rehydration Salts (ORS) Recipe

Preparing 1 (one) Litre solution using Salt, Sugar and Water at Home

Mix an oral rehydration solution using the following recipe.

Ingredients:
Six (6) level teaspoons of Sugar

Half (1/2) level teaspoon of Salt

One Litre of clean drinking or boiled water and then cooled - 5 cupfuls (each cup about 200 ml.)
Preparation Method:
Stir the mixture till the salt and sugar dissolve.

While I do take what the World Health Organization says seriously, putting a bottle of zinc tablets in the first aid kit may not be an option. If we agree that including Oral Rehydration Salts in the kit is better than making something with what is on hand in a village, this is what I consider using:

http://www.chinookmed.com/cgi-bin/item/1...---------------

I can put two of these packets in a kit without removing anything. If I need more, I can remove the instant cold compress. At least six ORS packets can fit into that compartment, likely more. If diarrhea is a problem, I believe this would be a good tradeoff.

Jeanette Isabelle

Sometimes there is a nurse but most of the times there has been no medical professionals so include gear a layman can use.

Jeanette Isabelle

I've known a lot of people on "water pills" due to heart failure. They all require supplementation with potassium. The DIY formula does not include potassium, but the Chinook packets linked to do. Lack of potassium can cause serious heart problems.

We use "salt substitute" which is potassium chloride, for our "table salt." Bananas (I know, not packable, but may be locally available) are a super source of potassium. Something to be kept in mind.

It seem to me that it would be simple to add the salt substitute/potassium chloride to the DIY formula, but in what amount is slightly confusing--- I think a bit less than 1/2 the amount of salt.

Note: standard sugar is 50% glucose, and the Chinook mix has 20 grams of glucose, so you would need 40 grams of table sugar to equal it. Glucose tablets (in the diabetic section at the pharmacy) typically have 4 grams of glucose per tablet. This might be another option to include in your considerations.

It might be a good thing to do. Salt substitute is not expensive, and small packets of the proper amounts of salt, sugar and potassium could be made up at home and sealed with a small vacuum sealer.

Another (or additional option) is to include several "recipes" for rehydration fluids. If it a problem, even for one person, they are going to need more than a few packets. Use of locally available DIY ORS components seems the best long term solution.

Hi Jeanette .... sorry I'm late to this party! Some thoughts from reading the thread.

Coban isn't really interchangable with ACE wraps. There's just not enough tension in the coban. Though arguably, it's not all that useful if you already have ACE wraps, or some tape. Think of it more as gauze with a little stretch (like the elastic in underwear) - snug, but not tight. I'd say use either coban or gauze rolls, but leave the ACE wraps. One thing about coban - it can't pull double duty as a bandage, like a gauze roll could do.

For space concerns, not sure your budget or time frame, but you can buy compressed gauze rolls. or, if you have access to a Food Saver, potentially vacuum wrap the gauze and gauze rolls. That might buy you some space.

I'd ditch all the packets of antibiotic ointment and just throw a tube of neosporin or bacitracin in, and call it good. If needed, it can be applied with a clean rag, bandage, finger, etc, and rubbed onto the wound. Plus it'll probably have more applications per unit size.

Ditch the burn cream. Nothing bacitracin or neosporin doesn't cover. If the burn is bad enough, cover with a dry bandage and evac.

Use a manual thermometer. Digital things have a tendency to break or have batteries die or be misplaced. Or honestly, skip it. You can tell if someone is febrile by touch, and really, does the number matter much in the middle of no where?

I tend to agree with some others on skipping Imodium/loperamide. If you're holding in the GI bug causing diarrhea, you potentially worsen the disease process. As long as a person can keep up with hydration, diarrhea isn't usually life threatening. Just really inconvenient.

Ditch the alcohol pads. 1, you're not giving shots, and 2, they're not anything that soap and water won't do. Consider ditching the sting relief pads. Not sure what's their active ingredient, but a tube of After Bite should work for most folks (available at most grocery stores). I think it's essentially vinegar.

I would hesitate to bag gloves. You can roll them up and make little "burritos" of them. Lie 2 gloves on each other, one slightly higher. Rolle from the fingers to the cuff. The slightly "higher" cuff can fold over and hold the roll together. Slightly faster, and less material/bulk, than bags.

Why medicine packets, instead of a bottle? a 50-pack of benadryl in a small bottle doesn't take much room, versus 25 2-packs of benadryl. Ditto other meds.

CPR Shield is nice, but honestly if someone dies out there, they're likely to stay dead out there. Save the space, but if it makes people feel like they 'tried everything,' then go ahead and put it in.

As for bleeding control, quick clot, TQ's, etc. If there's a bad bleed, you can never have enough gauze. A few 4x4's, 2 gauze rolls, and 1 or 2 5x9's will be gone in a heartbeat. It may be worthwhile to have a small trauma kit set aside, but again, may be budget prohibitive.

have your missionaries ask their docs for prescription meds. I assume most of them will be needing anti malarial drugs, right? You can also talk to the local Public Health dept about vaccines/meds that would be needed.

The gauze rolls have a compartment just for them. Compressing the rolls will not save space. The gauze pads can be compressed if I had access to a food saver; how much space am I saving if I did?


There are compartments just for cream/ointment packets. Removing packets and replacing them with a tube would not save space, it would reduce space. The only purpose I see in removing burn cream packets is to make room for more antibiotic ointment packets.


What about Diotame (Bismuth Subsalicytate)? Does it stay or go? If it stays, how many packets do I include in relation to other packets of medication?


There are only twenty-one antiseptic towelettes. Thirty-six alcohol pads fit into two compartments. Those two compartments can be used to hold ten more packets of medication if I go that direction. Are there situations in which alcohol pads can be used in place of antiseptic towelettes to stretch out the limited supply of towelettes?


The only purpose in removing the sting relief pads is to make room for five more packets of medication.


There are compartments which only hold medication packets, alcohol pads or sting relief pads. Antiseptic towelettes are too big for these compartments. Therefore, removing packets and replacing them with a bottle would not save space, it would reduce space.


What is a TQ? What would you suggest with space and budget in mind? If I do not add the thermometer as you have suggested, I will save $4.51. That $4.51 can be applied to trauma supplies.

Jeanette Isabelle

TQ= tourniquet.

I would think a 3" Ace bandage would be cheaper and more versatile than a TQ. TQs are fairly easy to improvise. Again, this all leads back to the level of training of the end users.

While Tums has some antimicrobial properties, it is NOT considered an antibiotic. So, it's good for heartburn, and might help a little for diarrhea, but I'd just as soon take it out and leave it up to each traveler to get their own prescriptions. Don't think Tums will cure an E coli or cholera infection.

Re alcohol and antiseptic towlettes. I'd take out both. While they have their place, I don't know that they aren't more useful than soap and water for the things you'll be doing. "The solution to pollution is dilution," so don't be afraid to copiously irrigate wounds, assuming blood loss is controlled. Add in more benadryl or tums or something. Tylenol, motrin, butterfly bandages, something.

TQ's are easy to improvise, as Hikermor said, if you know what you're doing. If not, the CAT-T and SOF-T are the current recommended ones by the US military, but they're pricey. I don't have experienc with other brands.

Do those medication compartments come out? Or are they permanently molded? Can you cut the dividers with a pair of scissors? I know that some meds can come in very small bottles, but you're right in that it's probably easier just to stick with individual packets if you're stuck with a pre-mold box. That's why I prefer a bag

Compressing gauze can save a LOT of room, particularly if you have Kerlix brand gauze rolls. Think of going from roughly 2 inch diameter to 1 inch diameter, and a little loss of height. It can probably double your supply, possibly triple if you really pack it tight. Same for the gauze pads.

BTW, I don't know if you mentioned, are the gauze pads individually wrapped? If so, I recommend swapping out for bulk pads. Relatively clean (shrink wrap or throw in a sandwich ziplock to keep clean), and sterility doesn't matter much for bleeding control; it's more a concern afterwards. You can fit more for the space that way. Kind of hard to describe, but I found this picture to show the relative size of 2 compressed rolls: http://i30.tinypic.com/w7fpde.jpg

The active ingredient in the five antacid packets included in the kit is calcium carbonate. What I was asking is, do I include Diotame (Bismuth Subsalicytate)?

Approximately half the kits I put together each year go to Guatemala where the water is not even safe to drink. Should that be used in place of the antiseptic towelettes? One kit a year goes to villages in Africa where there is no running water.

The entire organizer can be removed. Then everything is disorganized. Ziplock bags can be used; even then, the untrained caregiver has has to hunt for what she needs.

As I said, the gauze rolls are in their own compartment so removing, altering or replacing them will save no space unless, of course, I remove the organizer.

The four 4” x 4” gauze pads are individually wrapped and together are 3 cm thick when compressed. These kits are designed for nonprofessionals. Therefore, I need to make this as easy for them as possible, another reason for leaving the organizer in.

This is a passion of mine but I only have a part-time job. The kits I am starting out with represent the best bang for the buck I have seen so far. I'm having to do budget triage. That means, use what was included as much as possible. The first aid guide included in the kit is almost useless for this environment. Therefore I have to include a used copy of A Comprehensive Guide to Wilderness & Travel Medicine.

Not including additional medication, this is what I have so far. Areas in bold represent what I will add.

21 Antiseptic Towelettes
36 Alcohol Pads
06 Sting Relief Pads
06 Antibiotic Ointment Packets
06 Burn Cream Packets
05 Antacid Packets
05 Aspirin Packets
05 Non-aspirin Packets
01 Elastic Bandage, 2 in
01 Duct Tape
01 A Comprehensive Guide to Wilderness & Travel Medicine
01 Instant Cold Compress
20 Adhesive Bandages, 1 in x 3 in
60 Adhesive Bandages, ¾ in x 3 in
50 Adhesive bandages, 3/8 in x 1-1/2 in
10 Butterfly Bandages
18 Wound Closure Strips
01 Irrigation Syringe
01 Povidone-Iodine 10% Solution
02 Benzoin Swabs
02 Gauze Rolls, 2 in x 4 yd
02 Eye Pads
08 Sterile Gauze Pads, 2 in x 2in
04 Sterile Gauze Pads, 4 in x 4 in
01 Sterile Trauma Pad, 5 in x 9 in
30 Cotton Tip Applicators
01 Adhesive Tape Roll, 1 in x 5 yd
01 Triangular Bandage, 40 in x 40 in x 56 in
05 Finger Splints
02 Pairs Examination Gloves
01 Small Scissors
01 Plastic Tweezers

This is what everything I have listed will cost me. Some items listed do not include the cost of shipping.

$21.63 First Aid Kit
$03.96 A Comprehensive Guide to Wilderness & Travel Medicine
$00.82 Elastic Bandage
$02.71 Duct Tape
$00.56 Irrigation Syringe
$00.47 Povidone-Iodine 10% Solution
$00.80 Benzoin Swabs
$30.95 Subtotal

I have two packets of Oral Rehydration Salts. They will be included in the next kit which is going to India later this year. If I buy them in bulk, I can get packets of Oral Rehydration Salts at $0.80 each.

Does anyone have experience with a first aid kit that offers a better bang for the buck then this one?

http://www.samsclub.com/sams/first-aid-center-326-pieces/196928.ip?navAction=push

Also, does anyone actually know a place where I can get quality supplies at a lower price than at Chinook Medical Gear?

Jeanette Isabelle

Update: The India mission has been postponed to January.

I talked to a missionary who went to Africa about what is being discussed here. Do not remove the organizer.

I did not catch everything said; two ladies going to Guatemala talked about how useful alcohol pads are. Something about how useful they are when something else is not available. I did not catch what that something else is. Also, all medications need to be in their original packaging. If I had arrived earlier, I may have gleamed more information. That is all I got.

Jeanette Isabelle

For some reason I kept thinking Tums (Calcium carbonate), not bismuth (aka Pepto). If you're going to take one, take the bismuth - it can be used for upset stomach as well as tums, but has the additional anti microbrial properties. Like I said, it's not a "cure" medicine, but may help reduce the amount of bacteria causing illness. FYI, being a salicylate, people with allergies to aspirin/motrin/naproxen/NSAID's or stomach ulcers should avoid it.

Given that the water "isn't safe to drink" (Which, really, it probably is - given that the locals drink it, right? Just us tender Americanos have wimpy stomachs), how do you plan on treating it? You can use treated water with soap for cleaning. Antiseptic towlettes are OK for a quick and dirty clean, but they don't actually remove dirt or much particulate matter, they just kill whatever it touches. So you essentially have really germ free hands with dirt on them. Once that dirt dislodges, germs get exposed. Soap/water moves all that away. Better if you use hibiclens (or similar) or one of the anti-bacterial soaps. But even your basic 69-cent soap will clean better than a towlette, you just have to scrub.

The calcium carbonate will remain because it came with the kit. I was wondering if I should add the Bismuth Subsalicytate. You answered my question. Thanks.


For treating water to clean a wound, I included Povidone-Iodine.


Oh. I think I know where we got lost. I did not mean to imply that towelettes were meant to clean the hands of the caregiver, unless there's nothing else available, but for treating a patient for minor things like cuts.

Thank you for your help.

Jeanette Isabelle

As you read in yesterday's post, I went into why I need to keep what was included in the kit as much as possible and a breakdown of the cost of the kit and some added items. Are there situations in which burn cream can be used in place of antibiotic ointment? If so, what are they?

After crunching the numbers, it appears the best option is to leave in the packets and add a tube antibiotic ointment.


After including the cost of the tube of antibiotic ointment, the cost per kit is $34.95. If I add a second 5” x 9” trauma pad, the cost is $35.14. If I add QuikClot Sport, 25gr instead of a 5” x 9” trauma pad, the cost is $47.94. If I add a SWAT-T Tourniquet instead of the 5” x 9” or QuikClot, the cost is $44.63. Both put me past $40 and QuikClot is approaching $50 and I have yet to include the cost of the medications or the shipping of some items. Something has to go.

In the order of most to least important, what are the priorities?

Jeanette Isabelle

I have nothing to add, but wanted to say this is a great thread. The discussion on trade-offs -- including some items and dropping others, while keeping to a physical size limit, constraints of the physical kit (dividers, et al) and overall cost is an excellent cost/benefit exercise. Thanks to all.

In a two-year period, I build ten first aid kits, give or take. Bismuth Subsalicytate, 250 packets per box, has a shelf life of two years. Diphenhydramine, 200 packets per box, also has a shelf life of two years. To avoid waste, I can add twenty-five packets of Bismuth Subsalicytate or twenty packets of Diphenhydramine but not both unless I take stuff out which I prefer not to do.

Which do I add, the twenty packets of Diphenhydramine or twenty-five packets of Bismuth Subsalicytate?

Edit: If both are equally needed, I can play “musical chairs” with the medication packets and alcohol pads resulting in the kits not being identical, meaning one kit would have more of one item than another with the removed items going into kits used for other purposes.

Edit: I was off on my calculations making it more difficult to play “musical chairs” with the medications. I'm leading toward Diphenhydramine. The kit already has five packets of calcium carbonate.

Jeanette Isabelle

In the way adding to the conversation - I have nothing. What I want to say is this: Thank you Jeanette for having a passion for something and benefiting others with it. I am humbled by your graciousness and willingness to answer a call to help.

I have stopped lots of bleeding without Quik Clot. Given its high cost, it would be the first thing out of the kit IMO.

This is a very interesting and productive thread, but we haven't discussed the most important component of any kit - the level of training of those receiving and using the kit. that would be a good place for any extra finances you might have lying around.....

Recommendations for a good lightweight texts for travelers should be handed out
too. I liked the medicine for mountaineering. There may be better ones depending
on travel location.

QuikClot costs too much. Other than adding a second 5” x 9” trauma pad, is there a wound treatment item for non-professional caregivers?

Who has experiences with using a surgical scrub brush to clean wounds, more specifically abrasions? What is your opinion on using a scrub brush and recommendations on cleaning abrasions?

I want to thank everyone for their suggestions, even for the ones I will not be using, and for your kind words.

Jeanette Isabelle

A wonderful idea, it has inspired me to write about long term planning for a 3rd world community.

band aid solutions?


Respectfully,

teacher

Teacher, your "Band Aid Solutions" thread is beyond to the scope of what JI is doing. In the comment above you say JI has a wonderful idea but in your thread you basically say that her efforts are pointless. It's belittling and insulting to do that and posting a link to it here isn't right or fair, and could derail what is a very interesting and informative thread.

My point is - its a great idea, how can you better serve your goal?

help the missionaries while they are there - done and done

or is it to have a lasting affect on the communities?

I agree with both goals - just that the second is harder and longer lasting

On my phone, so will try to be quick. I'd skip quick clot similar. For bad bleeds, sterile bandage next to wound, rags/clothes/etc on top of them, and LOTS of pressure. If you can't afford a TQ, maybe a n additional triangle bandage and something sturdy to use as a windlass to make an expedient TQ.

How far are you from civilization? Benadryl is only a stop gap for anaphylaxis, so it's overall utility ai would put below bismuth. Folks are likely to get diarrhea, not likely to become anaphylactic (and if they do, oral benadryl is a poor choice for treatment). If it's just for regular allergies, so what if you have a runny nose? This goes back to people bringing their own prescriptions. I would say maybe 5- 10 packs of benadrly and the rest bismuth.

Skip the surgical scrub, it's redundant and rather bulky. How do you clean abrasions here in the US? I hope not with a surgical scrub! Soap/water or diluted peroxide works just fine

Add a second trauma pad and add a second triangular bandage. Got it. Thank you.

Originally I was going to add one foil package of Povidone-Iodine 10% Solution. Nurse Mike said to increase the Povidone-Iodine. Yesterday I was thinking of putting in two foil packages of Povidone-Iodine instead of one.

I have no experience with specifically abrasions hence why I asked who has experience. Thanks again.

Jeanette Isabelle

True. A triangular bandage can be easily improvised. When I put everything together and it looks like I am running low on space, I will stay with one.

Jeanette Isabelle

I read the first fifty-nine pages of Where There is No Doctor because Teacher recommended this book. This book is about healthy lifestyle changes, which certainly has its place.

A guide in a first aid kit has to cover the situation and be organized so a layperson can quickly find what she needs.

Something Izzy said inspired an idea. For those who have copies of A Comprehensive Guide to Wilderness & Travel Medicine by Eric A. Weiss, M.D. you are not using, I can put them to use. Send them to this address:

Jeanette Isabelle
C/O Southwest Harvest Church
201 W. Center St.
Duncanville, TX 75116

Getting both presents a problem. Since Bismuth Subsalicytate is more important than Diphenhydramine, I will fill the kits with Bismuth Subsalicytate.

Edit: I won't attempt to explain why. The bottom back compartments can't be used to hold medication packets; it can hold alcohol pads. One compartment is for sting relief pads so that leaves eight compartments which hold five packets of medication each. The Bismuth Subsalicytate will replace the five packets of Calcium Carbonate. The kit comes with five packets of Aspirin and five packets of Acetaminophen. I can afford to buy two boxes of medication packets. If the second box I buy is Diphenhydramine, this is what I propose:

Twenty packets of Bismuth Subsalicytate, ten packets of Diphenhydramine, five packets of Aspirin and five packets of Acetaminophen.

An alternative is to skip the Diphenhydramine and buy a box of one of the following: Ibuprofen, Acetaminophen or Aspirin.

Jeanette Isabelle

I won't be able to use the CoFlex; I found Telfa Pads at good prices:

http://www.kvsupply.com/telfa-pads-2-x-3-strip-100-count
http://www.kvsupply.com/telfa-pads-3-x-4-100-count

Jeanette Isabelle

You've never skinned your knee?!?

I have; I was under the impression an abrasion is worse than what I had experienced, as painful as it was.

Jeanette Isabelle

Nope, an abrasion is just scraped sking. Granted, you can scrape a lot of it (see "road rash"), but it's superficial.

You're probably thinking lacerations, avulsions, amputations....

Abrasions suck, but rarely need more than a quick scrub and keeping it clean.

I was thinking of road rash.

Jeanette Isabelle

After that incident, how have you treated road rash?

Edit: I know MDinana has said soap and water; there are situations in which running water may not available. I am including a 60 cc irrigation syringe and thus far two ¾ oz foil packets of Povidone-Iodine to treat the water.

Jeanette Isabelle

For what it's worth here is a link to the first aid kits the US Embassy's are procuring. It gives you an idea as to what they stock. However; they are very pricey.

http://www.progressivemed.com/estylez_ps.aspx?searchmode=keyword&searchkeyword=us+embassy

Stargazer

Probably not planning to treat anaphylaxis with this kit. Probably trying to keep some nice folks from the first world comfortable in a third world setting. Benadryl is fine treatment for insect bites, mild allergic skin and respiratory symptoms, and for folks who are sleeping poorly in an exotic location. For anaphylaxis et al., contact local authorities and hope for the best.

"first aid kits the US Embassy's are procuring. It gives you an idea as to what they stock. However; they are very pricey"
But these are the people who pay 400 dollars for a hammer and 800 dollars for a toilet seat.

Well, the $399 kit DOES include one #2 pencil. And one whistle.

Make that twenty packets of Bismuth Subsalicytate, ten packets of Diphenhydramine, five packets of Aspirin and five packets of Acetaminophen? Hydrocortisone 1% Cream packets are good for skin reactions. Include them?

Jeanette Isabelle

cortisone is a safe, effective topical medicine, seems like an excellent choice. Once again, excellent project, well-conceived and well-executed. Might be useful to get some end-user missioner feedback on what was actually used and useful, since much of the effectiveness of the kit is related to the conditions on the ground and the level of training and preparedness of the missioners.

Thank you. I gleam what information I can; I'm talking with non-medical personnel.

Jeanette Isabelle

JI... transferred here per your request from the critique thread.... for those looking at how to organize your FAKs, the videos on YouTube by USNERDOC are excellent tutorials... he goes over the top on individual packaging and labeling.... variety of levels of care in his series... link is for the basic kit....

http://www.youtube.com/watch?v=P60_sELRkqw

Thank you for the link. Is there a video on how to build a kit for large groups?

Jeanette Isabelle

I really like this kit set-up , Jeanette Isabelle. It seems really comprehensive to me. I agree with haertig, that you're probably the queen of FAKs. And I'll say it again, I think it's a really great thing you're doing.

If it was my personal kit, I'd add a little LED penlight or key chain light, or better yet, a headlamp, but I don't know how these kits fit into the bigger picture of the missionaries supplies.

I also carry a Mylar or Heatsheets blanket in mine, but I deal with the threat of cold injuries here that might not be issue in Gutamala, Africa or India. I don't know enough about those environments to wager an opinion, but if there's a chance it could get cold at night, or a cold rain could roll in, etc. It might be worth considering. Then again, it goes back to the big picture of their other supplies, cost and space.

I also keep some water purification tabs in my kit, for sanitation and hydration, but you said that running water isn't an issue for them.

Would you suggest penlights like there? One should fit in the instrument compartment.

http://www.chinookmed.com/cgi-bin/item/3...---------------

These kits are going to warm climates so I don't perceive hypothermia being a problem.

Edit: It does rain in the mountains of Guatemala; I still don't know if a space blanket would be beneficial or fit in the kit.

There is running water in Guatemala but it is not safe for those of us in industrialized nations to drink so bottled water is used.

Jeanette Isabelle

That one looks great. I like to have a little light in case I need to do first aid in the dark, not mention that patient monitoring can be a nightly affair too, and things like pupil dilation and skin tonne can be important assessment factors that are hard gauge without light. A pen light can be held in the mouth for hands free use, making it a good alternative to a headlamp IMO.

Keeping warm a patient who is in shock is something to consider. I've never really thought about not needing a blanket of some sort for that, even a Mylar one, but that could be the Canuckian in me speaking from my Northern experience. I will say this though, when I shattered my shoulder at the end of July a few years ago, I went into shock and was shivering because I was so cold, even though the temp was still in the the 30Cs. Could have been the shock, the sun exposure, or a combination.

Thanks for the link to the pen lights, btw. I need a few more and that's an a smoking good deal compared to what I've seen around here.

Question- I have not looked at those style lights in a while- maybe they have upgraded them- They used to last an hour, have bad batteries, and no throw whatsoever.

Have they improved?

would a cheap throwaway LED be better/worse?
I pick up one of this style for a 8 year old- 1.25 at Walmart. It was still working a year later... Lithium button cell battery, store forever, cheap, small....

http://www.beepbee.com/assorted-colors-p...ml#.UfJzVG_vseE

What is the quality of these lights? I do not know the quality of the lights I linked; I have done business with this company. So far I've been a happy customer.

Jeanette Isabelle

Why does choosing the right flashlight seem to be the most frustrating part of any project?

Jeanette Isabelle

Agree, a reliable 15 lumen light that takes a (relatively) common AAA battery is the way to go. You'll essentially be getting a Fenix E01 clone -- kinda sorta. I may need to swing by Wal-Mart ...

The inclusion of a space blanket/heatsheet is not a bad idea. If a person "goes down" and it is not advisable to move them, a hasty shade could be rigged. Just a thought.

Excellent point, MoBOB. A hasty shelter could be invaluable, if you can't move a victim and have to wait for help. Shade from the sun, cover from the rain or wind...

I while I don't think we need to make our FAKs full on PSKs, I like mine to be minimally stand alone, including a little shelter, water and fire. When doing something like canoeing, for example, I put mine in a cargo pocket in my pants, so I have it in the event of a bailout. Having a few essentials could be a lifesaver if I'm away from the rest of my gear.

I guess it goes back to the bigger picture of what else the missionaries will be carrying, and how.

Hmmm, IMO shelter is beyond the scope of an FAK -- First Aid, not extended care. That said, I hope they do carry PSK's which do cover shelter requirements in whatever climate they happen to find themselves.

Hi....I didn't read through the posts. If it wasn't mentioned....source for travel/individual items.... www.minmus.biz Standard disclaimer. Like the selection.

Does anyone have experience with the Adventure First Aid 2.0?

http://www.adventuremedicalkits.com/prod...amp;product=228

Jeanette Isabelle

A 2" elastic bandage is pretty wimpy. I much prefer a 3" or 4", and at least two. You can probably do better.

A two inch elastic bandage is all I can put in the current kits also.

Jeanette Isabelle

Only my large bulk supplies FAK has a 4" wrap. The AMK Comprehensive Kit has a 3" elastic wrap and a SAM splint, but no 4" wrap. Really, most FAK's are designed to size/cost constraints much as JI is doing with her's, and you must make-do until better can be found.

Jeannette, you might like to check the inventory on the AMK Fundamentals kit as a point of departure -- add/trim/delete as required for your size/cost constraints.

I have been looking for an alternative to the bulky kits, with the hard case, I have been using. Other kits made by AMK are too expensive but what if I am able to modify this one?

Jeanette Isabelle

I wasn't clear but wasn't implying you should buy AMK's Fundamental kit, it's not cheap even at Campmor. I was just thinking it probably has a good inventory to consider in building your kits. That said, using the discussion in this thread you may have arrived at a better inventory list. FWIW

I have abandoned most of my commercially made kits in favor of a big zip-lock bag filled with smaller zip-locks for organization. Next step might be to contact local hospitals, ambulance services or clinics for donations of sterile packaged supplies. Some supplies still have expiration stamps, meaningless in the case of packaged dry goods: loss of sterility is event-related, not time related: take any outdates that they cull from their supplies. Alternatively you might get donations cuz places like that support mission work and enjoy the publicity. Create a list of the items that you seek, collect the donations, and fabricate zip lock kits that mirror your existing kit. Lots more labor intensive than your current practice, but perhaps less costly. Schools and churches might donate, too.

Thus far in my research I find it more cost-effective to buy a low-cost kit and modify it because I have an organized case and some supplies already. People I have talked to want organization. Empty organized cases I have seen so far cost more than a low-cost first aid kits.

Jeanette Isabelle

Organization can come in the form of ziploc bags such as Nursemike is using. The bulk kit I referred to is essentially a few gallon ziploc bags inside a small cooler in which I received some food stuff (sausage mustard yada yada yada) for Christmas years back. For more organization than that then you probably already have the best solution. For that I really like the AMK FAK soft cases. They hold up well, but they are not cheap to buy retail.

That said, I wonder if one of AMK's custom kit would be cost effective. You might want to call them and see if they can help with this project. I wonder how many bags you'd need to order to get a significant break on price?? They're in business to make $$ but they may be able to assist -- maybe not.

I'll skip the soft case and work on the bulk issue by stuffing the hard cases as much as I can and reduce the number of cases.

I checked the folded dimensions of the SAM Splint. It should fit. Should I include the SAM Splint?

Jeanette Isabelle

I have a SAM splint and find it be be a very effective item. In my situation, weight and bulk are factors that influence my gear choices. Splints are easily improvised and I usually leave SAM at home or in the car.

Let your cost considerations influence your choice.

What is a rule of thumb for knowing how much supplies to provide per person?

Sometimes we may have as many as thirty people going to Guatemala. To reduce bulk, it would be better to send two 15-person kits rather than three 10-person kits.

I have looked at Adventure Medical Kits to get ideas but what I got out of this thread is that it is better to not make clones of their kits. What do I need to aim for in building a 15-person kit?

Jeanette Isabelle

Interesting question. I am always amused at descriptions like "suitable for four people for two to three days." You don't consume the contents of a FAK in the same predictable way you can meter out cooking fuel or water or oatmeal. You can go months with no appreciable use of a FAK and then rum into an incident which will exhaust all or nearly all of its contents. I think it would be more realistic to rate a FAK in terms of incidents - "This kit can handle two or three serious incidents" or something similar. Depending upon the environment - battlefields will see more incidents per day than libraries, for instance - that kit might be good for a year or two days. So much depends upon the environment and the enterprise. What has been the history of your folks? What kind of feedback have they provided. That should be enormously important.

I would argue that a large number of medium bandaids is actually worthwhile. In my experience, you will use about fifteen to twenty band aids for every large gauze pad applied. When I had the task of stocking the FAKs in our office, I kept a box of bandaids (and a bottle of aspirin) right next to the FAK,so that people could get what they needed to treat the more typical booboo without rummaging around in the FAK and disorganizing everything.

Check with your missionary clients. I'll bet their experience and feedback will be highly worthwhile

I figure most commercial kits are rated for at most two or three booboos and MAYBE a good start on a serious incident. (usually about 8 4x4's and A 5x9 ABD pad)

The AMK kits are well orgainized, but the X people over Y time rating system breaks down when it encounters that first major trauma. Hikermore has a valid point in that a serious incident can use up that entire 3x3 in a single use leaving nothing but the small bandaids.

For that reason I have added additional 4x4's to the larger kits. There will always be a trade-off in size vs utility vs portability and you need to remember that these are First Aid kits, not trauma centers.

In light of the recent response, perhaps Jeanette should consider building a trauma kit (many 4x4's and so forth). Then she could possibly adjust the individual FAKs to suit "normal" booboos and minor accidents.

I like it because it agrees with what I'm doing . Like I said earlier, my pocket boo boo kit gets the most use but all it will cover is cleaning and bandaging (bandaids) small cuts. Anything major and we go to one of the bigger kits. I can imagine that in some 3rd world locales preventing a small cut/abrasion from becoming infected could be a serious concern; hence small kits on person to clean and cover those small cuts. Meanwhile a larger kit focused on bigger issues (call it a trauma kit) would be available on the (hopefully rare) occasions it is needed.

Chaos Magnet did recommend this trauma kit.

http://www.rescue-essentials.com/patrol-officers-pocket-trauma-kit/

Jeanette Isabelle

Haven't seen or worked with that kit; but it looks from here to be directed to penetrating (ie gunshot) wounds of the thorax-abdomen and extremities. I went on a number of missions trips, primarily to Peru and Mexico. Never came across a gun-shot wound. Being the only trip member with any formal medical training I handled cuts, bruises, abrasions, colds, asthma, diarrhea and food-born diseases. Had anything more serious turned up, I would have asked the local missionaries for a referal to the local medical sources they relied on year round. YMMV

What are "EMS" community thoughts on Quikclot? I see that AMK has a 25g Quikclot application pad in their trauma kit. As I recall there were some negatives on the clotting powder (can't recall the name); does that apply to the Quikclot dressing or is the dressing the way to go?

I like the idea of a separate trauma kit so people will know what it is specifically for, use it only for that purpose and not try to use items from the general kit. If I build my own trauma kit, I would need a case and instructions for it. Are there recommendations as to what to include including case and instructions? I believe the right instructions is the most critical aspect of a trauma kit. Without it, the trauma kit would not be used or if used, more blood is lost as the provider figures what everything is and how to use it.

Jeanette Isabelle

JI... I'm no means a medical professional, but carry two small trauma kits... one in my car, and one in the off body carry bag I carry a pistol in...the carry bag has a small outer pocket, and the following articles are included

1. couple of pairs of nitrile gloves, and clean up towelettes for first responder to help prevent transfer of blood borne pathogens

2. for severe extremity bleeding, a self application tourniquet

3. for bleeding a self application pressure dressing (Israeli bandage)

4. for bleeding a small pack of Quick Clot

5. for bleeding a Kerlix gauze to pack off the wound

6. for penetrating chest wound, petroleum gauze, and tape 3 sides to help prevent air to enter chest

7. irrigation syringe, electrician scissors, duct tape to go around a person's chest

not shown a Surefire 6P LED light

I was not able to include abdominal pads to this kit, but a couple are in the larger range trauma kit

I have a question on blisters as I have not dealt with them since I was little. Do I use mole skin or upgrade to Blist-O-Ban?

Jeanette Isabelle

Health insurance? You mean a healthy dose of OCD when handling firearms to include a compulsive application of the 4 Rules? Yeah, I have that health insurance too...

While I was sitting in my dentists chair today we had a short discussion on trauma kits. He's a dentist not a trauma surgeon, but we decided the AMK Tactical Field/Trauma with QuikClot was a not bad deal at Amazon's $33.68 so I ordered a couple. I'll see how many add'l 4x4's I can get in the pouch. One will go in my truck kit and the second in my EDC backpack. If a need for one of these kits arises the cost will be like pocket change.

Unfortunately, for Jeanette's requirement to build many kits she'll need a source to make the QC affordable. It's one thing to buy these for personal use knowing that because we're bulletproof we'll never need them anyway -- something else to buy the contents of a large number to donate to folks going down-range.

I can understand including Quick Clot in a kit designed for range use, or any situation where deep penetrating wounds are likely (like battlefields), but is it really necessary in a general purpose kit? I have treated,or been on scene in many trauma incidents,some of which involved firearms,and direct pressure always worked. If you are bleeding out, and I come upon you, expect DP, not QC.

If as the AMK literature indicates QC stops bleeding faster, that's probably a good thing on a serious bleed injury. DP may work and I see no reason to not use it. OTOH, if I'm out solo and despite being bulletproof I find myself bleeding profusely, I may have more success controlling blood loss with QC. When the blood is mine I take a personal interest to keep more of it inside. Are there any reasons to not use Quickclot? Obviously not for a small superficial cut/scrape, but for a serious laceration where DP would work, is there a reason to avoid QC?

Quickclot


That said, the only serious bleeder I've treated was a "broken glass while washing dishes incident" (cut to the bone); we rinsed it, used direct pressure and found the nearest clinic. A few stitches later and all was good.

My reservations about QC stem from experience in successfully controlling bleeding with DP, up to and including a limb amputation (victim walked into the rear rotor of a helicopter) and thus it seems to me that QC is a solution looking for a problem - for most of us, that is. Battlefield medicine is a different breed of cat,about which I know nothing, and there indeed, QC seems to be useful.

But I dubious about including QC in a general purpose FAK, when the money and space could be used for more generally useful items. You always run into this issue - what to leave in and what to leave out of the FAK. The answers should be conditioned by the level of training of the users and the injury profile typical of the situations they will be facing.

Yep, those trade-offs are really what this thread is about. For Jeanette's purposes, QC may not be a cost effective addition to the main kit. OTOH, a single trauma kit with QC to supplement the primary kit may be a good alternative -- her call.

In my opinion, take it for what it's worth, direct pressure with a 4x4 or gauze should stop most bleeding problems. If DP alone doesn't work, I would apply pressure points and elevate the wound. If I'm alone and I'm the one bleeding, I may use quick-clot if I have it; since the wound may be in an inconvenient place for DP to be effective. The advantage of DP is I always have a palm handy. QC may not always be handy.

I am considering QuickClot for future kits, after I use up my surplus trauma pads. Is there a difference between QuickClot Sport and QuickClock 1st Response? QuickClot 1st Response is significantly lower.

http://www.rescue-essentials.com/quikclot-25-gram-sponges-5-per-box/

Jeanette Isabelle

Hemostatic agents have their place. I come at this as a firearms instructor and thinking about accidental gunshot wounds, but I've thought about it for wilderness use too. If you're by yourself or far from definitive care with a big bleed, a hemostatic agent can make things a lot easier for you.

Combat Gauze and similar products are more flexible (work in more situations) than the Quik Clot sponge products. They're also less bulky to carry.

My last experience with significant bleeding was when I split the side of my thumb beside the nail. It was deep enough that DP worked WHILE IT WAS APPLIED. Held pressure on it until I reached the ER (about 20min.) At that point, If I released pressure, it would shortly start bleeding again.

You were in the ER, right? Mission accomplished!

I suppose QC would be useful in mass casualty scenes, simply so that one could attend to multiple situations without being focused on one wound, applying pressure.

Absolutely. Christmas Eve 2004 knife slipped while opening thick clam shell packaging.

Slice.

Close & drop knife.

Grip thumb with other hand

"Grab your keys & pocketbook, we're going to ER."

One look, grab paper towel & deathgrip on thumb with other hand.

Next time I let go was at the ER triage station.

I've figured out that stuff is safer opened with a knife cutting toward your body. Brace it between one hand and your chest and cut away from your hand (yes, this is toward your body). Holding the knife in a full fist grip means even if it slips you get at most a minor cut. Your thumb on the hand holding the knife will hit your chest before the blade.

I've been cut with both dull & sharp knives. Sharp hurts less & heals faster.

The kit I am modifying comes with ten butterfly bandages. Would closure strips have a significant advantage?

Jeanette Isabelle

A lot of people in my age group are on "blood thinner" medication so Quick Clot maybe be useful even in a general use kit. I have it in my BOB.