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.
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.
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.
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).
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.
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.
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
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