Part 2 -
Training in use of a BVM will be part of the EMT class I mentioned earlier. I'll wait here while you go find out when your local community college or rescue squad will be having their next class. Plan on being a part of that class. You will be making your community, and thereby your family, safer.
You can buy your own, and Gall's will ding your for around $15 for a disposable model. In the hospital, we use these once and discard them. You might choose to meticulously clean yours and re-use it. Your local rescue squad or ambulance may shop locally, and you might want to do likewise. Ya know, if you were to volunteer with your local rescue squad, you might be able to obtain things like this at your agency's cost. All this on top of the good karma from helping to provide a necessary community service. And,, besides, becoming known to the locals (police included) as one of “the good guys”. Your phone book likely will provide the contact information you require. I'll still be here when you get back.
One of the adjuncts to using a BVM is called an oral airway. Oral airways come in sizes, which may be selected according to the size of the patient. Their purpose is to hold the flaccid tongue of a profoundly unconscious patient forward, so that it does not sag against the rear of the throat and thereby block the passage of air into and out of the lungs. The problem it may trigger is, should your patient be other than profoundly unconscious, he or she will vomit. Among other disasters this may cause, the enzymes from the stomach, designed to digest proteins, will (unsurprisingly) begin to digest the proteins found in the delicate tissues of the air sacs (alveoli) of the lungs, with effects you are likely to be able to imagine on your own. Very Bad Thing. [JWR Adds: Plastic airways usually come in sets of six sizes, and usually color-coded these days, available for less than $5 per set on eBay. Buy a couple of sets. Someday you may be very glad that you did!]
Another way to fail when employing an oral airway is to bunch up the patient's tongue in the rear of the throat. This blocks air flow, strangling your patient. This device must be restricted to only profoundly unconscious patients, and only if you are schooled in its use. You can buy them individually, or in sets. Before shipping, they go for around $5.00/set. You might elect to buy them one at a time, but at $5 a pop, they aren't a particularly major investment.
When I'm confronted by an actively bleeding patient, I reach for a Carlyle dressing. Mine are the old style The Carlyle iteration includes muslin (cloth) ties to secure as any other tied bandage. The 21st century version is called an Israeli Dressing, and is available from various sources. (see my shopping list/spreadsheet for representative sources) It consists of a sterile dressing incorporating an elastic bandage to secure the dressing to the wound. Should you shop gun shows or surplus stores for your equipment, be wary of old dressings. They present potential issues of failed sterility as well as mustiness or mildew occasioned by improper storage or imperfect packaging. The contemporary Israeli Battle Dressings are available from Cheaper Than Dirt or from Gall's for $9.00 or $10.00 each.
Another wound care product is QuikClot . This is a mineral product, bound to a dressing, which enhances clotting, and thereby slows and limits blood loss in the bleeding patient (common in trauma, surprisingly enough!) One article (QuikClot Use in Trauma for Hemorrhage Control: Case Series of 103 Documented Uses. Journal of Trauma-Injury Infection & Critical Care. 64(4):1093-1099, April 2008.) reflected the occurrence of burns in several patients, but the manufacturer's web site reports that changes in packaging and delivery system have addressed this issue.
An alternative you might consider is Celox. It appears perhaps to be a reasonable alternative to QuikClot. It is derived from shrimp shells, although it seems to not produce allergic reactions in folks otherwise allergic to seafood. I have no personal experience with either product, but the reports are interesting. This goes on my “further research” list!
The preceding items are to be found in the outside pocket or very top of my jump kit. I don't want to be searching for them when I feel the need for them Right Freaking Now. Beneath the don't-wanna-wait-for-them items, I have supplies of somewhat lesser immediacy. These allow me to assess the situation in greater detail, or address issues that may come to light that are of less time sensitivity.
Triangular Bandages are useful for slings of injured arms, or may be folded into narrow strips and then used as a means to secure splints or dressings (as “cravat bandages”). If we were to consider them as a backpacker might, they may be used as expedient dust masks, bandannas, head coverings, or washcloths. I buy muslin by the yard at Wal-Mart, and cut it from one corner to the other, forming (surprise!) 2 triangles approximately a yard on a side. I keep 6 to 8 in my kit.
Bandage shears are the most obvious of the prehospital medic's tools. You can go with Lister style bandage scissors, often found as “nurse's scissors”, or the plastic and steel “super shears”. Prices range from $4.00 and up. Frequently employed to trim dressings to the proper size, cut away clothing from wounds, and to cut bandages.
Did you ever notice that a tongue blade/tongue depressor is almost exactly the width of a finger? And just a bit longer than your Mark 1, Mod 0 finger? Exactly like it were designed to be a finger splint, isn't it? In addition, should you tape three of them together one on top of the other, you have a dandy tool for tightening that “Spanish windlass” you are going to learn about, when your EMT class teaches you how to apply and improvise a traction splint for a fractured femur (thighbone). Finally, if you are unhappy at the thought of wiggling somebody's fractured femur (broken thighbone) so you may place ties (cravats: remember them?) for a splint, tongue blades are thin, stiff, and very helpful at limiting the wiggling as you place ties beneath the broken bone of your choice. I keep a handful handy.
You can pay a couple of bucks for them at the corner pharmacy, or you might be able to talk your way into several for free, like when you are volunteering at some public service event with your local volunteer fire department, emergency medical service, or amateur radio club.
Stethoscope/Blood Pressure Cuff. A stethoscope allows you to hear the sounds made as air moves into and out of the lungs, and note changes from normal. These changes might occur because your patient has a collapsed lung, or has pneumonia, or heart failure. When you get that far into your EMT class (hint, hint), you will learn how to evaluate these changes, and what sort of treatment decisions you ought to consider when you notice them. In addition, you will learn how to measure, and interpret, your patient's blood pressure.
I am certain you will know somebody who will go out and get the cardiology deluxe stethoscope, with the multi disc cd player, mag wheels, and gold trim. Do not join them in this folly. Spend $10-40 at the same place the local student nurses get their stethoscopes, and spend the difference on your spouse, whose enthusiastic support you will require, anyhow. If you can show your spouse how your expenditure of family money and time on supplies, education, and volunteering promote values that you both agree upon, the both of you will thereby make your family more crisis resistant. If your family is more crisis resistant, then you are not only NOT a drag on community emergency services during an emergency, you all might even be an affirmative community asset during bad times. That cannot fail to be a Good Thing when you get to explain yourself to The Jewish Carpenter. Me, I'm going to require all the help I can get. I'm volunteering!
Adhesive tape (1 inch, 2 inch) secures dressings, holds loose ends of bandages, and provides a single use notepad (tear off a length, tape it to your thigh, and jot notes. You will not lay it down somewhere to be forgotten). If you listen to some friendly and knowledgeable athletic trainer, you can learn how to use it to support sprained ankles or knees if the preferred treatment (rest, ice, elevation) is not possible. Before you employ these tricks, bear in mind that physicians frequently cannot differentiate a sprain from a fracture, even after an x-ray. In my view, except under the most dire possible circumstances, walking on a fractured (or sprained) extremity is a Very Bad Thing. Two rolls each are at hand when I open my green bag.
I keep 12 to 15 Gauze pad, sterile, 4x4 in my kit. I employ them as eye pads, padding beneath splints, or as (oddly enough) dressing for wounds. Occasionally I encounter a wound bleeding so enthusiastically that a couple of gauze pads will be overwhelmed. Fortunately, I haven't come across such a wound off duty, but in the hospital we use a “boat” of sterile gauze. This is a plastic tray of ten sponges in one pack. The tray also may be used as a clean basin for wound irrigation/cleansing solution. In the hospital we use sterile saline, you may elect to use the water from your retort pouch, or fresh from the bottle as you purchased it for storage. I would certainly give it some thought.
If you happen to be the purchasing agent for your entire survival community, ambulance service, or the entire Boy Scout Council, you might find the case price from Galls to be a useful bit of information. 1200 sterile 4x4 pads for $89.99 works out to around 7.5 cents each.
Triple padding/ABD padding, sterile, 5x9 inch. These multiple layer absorbent dressings are designed for wounds producing a lot of drainage of either blood or other fluid. They are my first choice for a bulky dressing or splint padding. I keep 6 in my kit. The frugally minded may note that “sanitary napkins” are designed to absorb drainage, are “medically aseptic”, and are available nearly everywhere.
And, on a related note, tampons from the “feminine hygiene” shelf at your local store are also constructed to absorb fluids, and contain them. Should you confront a penetrating wound, “tamponading” a wound is a widely known concept among inhabitants of the medical world. Packing such a wound with a tampon using sterile technique might prove to be life saving, and provide hemorrhage control options not otherwise available. (
http://snopes.com/military/tampon.asp)
Roller Gauze, 4 inch is typically used to secure a dressing (see Gauze Sponge, above) to the wound. I pack 6 in my kit, and they have “found careers” as bandages to secure dressings, securing splints when I run out of triangular bandages, and upon occasion as packing/dressings for vigorously bleeding wounds. In fact, when one is employed as the dressing, and another as the bandage, I can not only dress the wound, but also (since the bulky roll provides a pressure point) apply direct pressure to the bleeding site. This provides an alternative to the Carlyle or Israeli Dressing, cited above
Vaseline Gauze (sterile, 3x9 inch) is intended to seal wounds penetrating the chest, in order to prevent collapse of your patient's lung(s). When you seal the defect in the chest wall, your patient will not draw in air through the wound when s/he inhales, and thereby not fill the space between the lung and the chest wall (the pleural space) with air. When you can avoid this, inhaling draws in air through the mouth, trachea and bronchi, and that inflates your lungs, and we think that is a good thing. Myself, I pitch the gauze and tape three sides of the foil package, sterile side towards the wound, forming a flutter valve sort of effect. In this way I allow excess pressure in the pleural space to vent to atmosphere (stopping further lung collapse, I hope), and seal the hole when the pressure inside the chest is less than atmospheric pressure (like when the patient inhales). The only way left to equalize that pressure is by inflating the lungs, already described with approval above.
The other use for Vaseline gauze is when my lips or hands are dry, in which case I use the Vaseline to remedy that little problem.
We all can think of uses for the common elastic bandage, 4 inch and 2 inch. Two inch is useful for sprains of your wrist or thumb, and the 4 inch is used for an ankle twist/sprain. In addition, I can use them to secure a splint (there is that rule of threes, seen in other posts on this blog, again!), as the “swathe” part of a sling-and-swathe to immobilize an injured shoulder, or as part of a pressure bandage over a dressed wound that does not want to stop bleeding.
Large Bulb Syringe (for which you can substitute a turkey baster) functions as an expedient means of removing fluids from the airway of someone who is not managing to do so effectively on their own. It will not work nearly as well as a battery powered or pump action suction, such as you might find on your local rescue squad rig, but it won't cost you $50-$60 (for the manually pumped version) either. Second best is superior to nothing.
Mylar “Space blankets” protect you or your patient from the hypothermia-inducing effects of the wind, slowing heat loss. Generally colored bright orange on one side and silver on the other, there are signaling opportunities as well. In a pinch, you can improvise shelter from one or two. Amazon sells the "Space Brand" blanket inexpensively. Equip your jump kits, and each member of your family with one or two.
Any accident so severe as to convince suspicious old me (alumnus of Detroit's EMS) to stop and offer assistance will not be fixed with a couple of Adhesive Bandages (aka “Band Aids”). I have six in my jump kit, two entire boxes at home (and parceled out among my camper, car, and household kits).
I keep a couple of Ice Packs around, as assorted adventures may bring on modest orthopedic injuries. Ice is helpful for strains, sprains, or overuse of an over aged joint (...not that I would know anything, firsthand, about that...). Choices include “instant cold packs”, or that old picnicker's standby, a zip lock bag full of ice from the cooler.
Either option has drawbacks. I do not generally drive about with a cooler of ice at hand, although when camping I am likely to do so. Instant cold packs are kind of fragile, and you might find, when you go to place one in service, that you have a leaking mess on your hands. On the other hand, they are more likely to be there when you want one.
The foregoing lists the contents of my “jump kit”. I keep one kit in my vehicle, and another at home. In addition, there are Subordinate Kits, kept in camper, car and home, for lesser sorts of occasions. I have customized each by adding more dressings, triangular bandages, roller gauze, and gloves. In addition, I improved over the baseline “Wally World” $15 first aid kit, by adding zip lock bags of various household medications. I labeled each bag with the name of the med, the out date of that particular bottle, directions for use, and date of packing. I made my selections by inspecting my own medicine cabinet, and pondering which meds I had wished I had kept handy the last time I was out camping, for example. Most everything commonly needed is therefore in the Camper Kit, Car Kit, or House Kit.
The jump kits are reserved for “Holy Fertilizer!” sorts of events. They are not mere “boo-boo boxes”. Reserved in this way, I will not find myself hunting (and swearing) in crisis, as I need this or that widget, which some child (or adult) has used, and not restocked.
LONGER TERM CONSIDERATIONS
Some of us might contemplate longer term medical preparations. For those, I recommend Dr. Jane Orient's article. Once I get beyond the 20 year old pricing, the are only a couple of improvements I could suggest. One is in the arena of recently developed antibiotics (as in quinolones). Even in that light, it seems to me to be a very good basis for developing a longer term medical kit (and training plan) for your particular circumstances.
Another substitution I would make, is to delete surgical masks, and substitute NIOSH N-95 masks. I found a carton of MSA Safety Works No. 10005403, Pack of 20 Harmful Dust Respirator Model 10005043 for $18.97/each carton at Home Depot. You may find similar products locally.
Additionally, I would add loratidine (you may recognize the brand of Claritin) as a non-sedating antihistamine. (Personally, I would prefer my personnel pulling OP duty to be non-sedated.) I'd also add the most frugal of the following : ranitidine, famotidine, cimetidine, in lots of 1,000 tabs, as a superior stomach acid blocking medication, to supplement the antacid Dr. Orient suggested over 20 years ago. As the “big gun” for acid stomach problems or GERD, I'd lay in a supply of Prilosec OTC. This class of stomach medication is the yardstick against which all others are presently measured.
If you are planning establishing a longer term medical cache, it is imperative that you do so only in concert with a physician, or other personnel licensed to prescribe. The guidance you will receive will help you avoid causing more illness than you relieve. Medications are a double bitted axe, and may cut on the upstroke as well as on the downstroke. Be aware.
