Oneof the things that has always driven me crazy about the commercial first aid kits that youfind in drugstores and pilot supply catalogs is that they’re filled with crap that istotally useless … and sometimes even harmful. Never one to be soft-spoken orunopinionated, I have tried to make my feelings known (vigorously) to variousmanufacturers of first aid kits, only to be ignored.
Even high-priced aviation-oriented medical kits aren’t well thought out, in myjudgment. Let me give you an example. MedAire, Inc.is a company that specializes in providing medical services to airlines and corporateflight departments, training their in-flight personnel and providing emergency”telemedicine” consultation by radio or flight phone in the event of medicalemergencies aloft. MedAire offers a series of
Remember that first aid kits are strictly for first aid in medical emergencies, not forongoing evaluation of medical conditions. In an emergency, it’s not important to know aperson’s precise blood pressure — all that’s important is whether it’s high, normal orlow. If you can feel a pulse in the wrist or groin, the systolic pressure (top number) isat least 90, which is adequate. If the pulse can only be felt in the neck and not in thewrist or groin, the pressure is low — probably in the 60 to 80 range (systolic). On theother hand, if a pulse is visible in the temple area or are very strong in the wrist –and especially if accompanied by headache — blood pressure is probably high. For firstaid purposes, a general determination of B.P. as being high, normal or low is all that isneeded. You don’t need a sphygmomanometer and stethoscope for that.
Another problem I have with most first aid kits is that they contain too muchspecial-purpose stuff and not enough multi-purpose stuff. The folks who design themapparently assume that the user cannot be creative. When I help mountain climbers createmedical kits for climbs in the third world, I know that weight and space are at a premium,so I try to give them medications and other items which can be used to deal with multipleproblems. For instance, acetaminophen (Tylenol) with codeine is great to treat pain, butis also good remedy for diarrhea, cough, headache and insomnia. Another example:antibiotic eye drops can be used in the ear, but eardrops cannot be used in the eye.
Yet another complaint I have about most first aid kits is the way they’re packaged –typically in a plastic or metal hinged-lid box that requires the user to dump most or allof the contents out to find a needed item. This makes the kits difficult to use, which inturn causes people to avoid using them in anything but the most dire emergency. If youcarry a first aid kit in your car or airplane or boat or backpack, think about when thelast time was that you actually opened the kit and made use of the contents. For mostpeople, the answer is “a long time ago” or “never.” To my way ofthinking, a medical kit should be designed to be useful and user-friendly, not a”break glass in case of emergency” affair.
With these concepts in mind, I have developed a first aid kit for my own use which cutsout all the B.S. and contains a host of useful items, most of which can be used for amultitude of purposes. It’s not the cheapest kit (we’ll talk about cost later), but itincludes stuff one is most likely to actually need, and I’ve tried to include the best andmost useful items available, packaged in a fashion that makes the kit truly useful.
What I Carry, and Why
My personal medical kit is packaged in a
professional-grade Cordura EMT bag.
Let me go over the key stuff I carry in my kit, and explain why I selected each item:
Band-Aid-type adhesive bandages
First, let me admit that I am not a big fan of Band-Aid-type strips. They occlude thewound and make it gooey. You know that white, wrinkly skin you find under a Band-Aid? Themedical term for that is “maceration,” and it not only impedes healing but alsopromotes infections.
But it’s hard to fight all that Johnson & Johnson advertising money. Seriously,adhesive bandage strips are great for bleeding wounds in order to stop the bleeding, but Irecommend that the strips be removed after a few hours … or immediately if they get wet.I prefer the fabric stretchy adhesive strip, particularly for fingertips and knuckles, butthe straight ones are great too. Most kits just don’t include enough. Mine has a lot.
Band-Aid decorated spots and strips
Okay, these are pretty useless, too, but I have a four-year-old son. Regardless of thesituation, a decorated strip or spot can cure a crying attack faster that an ice creamcone, and you can’t store ice cream in a first-aid kit (except for the freeze-dried stuffthe astronauts have never taken into space).
Conventional rubber gloves have their place, but I would not necessarily use them on myfamily. Paramedics around the country use the blue ones because they do not tear aseasily. These blue gloves are so good that I know paramedics who buy their own when theiremployers are too cheap to provide them. They also can be used to carry water in asurvival situation, and as a tourniquet.
Splints do several things. They provide a firm material that can be used on broken armsor legs. The purpose of splinting an injured extremity is threefold: to reduce bleeding,to decrease pain, and to reduce further injury. The splint material I use can be benteasily, can be reused, and does not age quickly. The SAM has detailed usage instructionsrolled up with it, but in general the splint should be unrolled, doubled and curved aroundthe extremity. Curving the splint material provides a great deal of rigidity and strength.The splint can be applied to the injured extremity with tape or gauze, or tied on withtriangular bandages secured with knots. Upper extremities should also be put in a slingwith a triangular bandage after splinting … the more elevation, the better.
God, I love provoiodine solution. Basically, Provoiodine sterilizes everything oncontact. It is great for cleaning abrasions (it does not sting like regular iodine) andsterilizing wounds. Any situation where a wound has occurred deserved to be wiped off withprovoiodine.
I first saw it used (later proven counterproductive) by the Chief of Surgery at mymedical school (I am not telling which one). The surgeon mixed the brown solution withperoxide and poured it into the belly of patients who had infections in their abdomen. Hecalled it “brown and bubbly.” You should have seen this combo start to bubbleout of a belly wound. Looked like Old Faithful or Mount Saint Helens erupting!
Antibacterial waterless soap is the best for prepping the hands for working with woundsor any other situation for sterilizing the skin.
Hand cleaner/prep pads
These are saturated with benzyl ammonia and packaged in individual tear-open packets.They’re non-sticky and do not require rinsing to clean up hands. I find them good foreverything from cleaning the relief tube to getting ready for dinner, but they’re reallygreat for washing off solid or liquid contaminants on the hands or skin.
Several pilot friends recommended towels. They do come in very handy for all sorts ofsituations, and take minimal space. I use disposable ones.
Earplugs are important. Hearing loss from loud sound is cumulative, and those of usfrom the rock-crazed 60s already have problems. Headphones are okay for flying, but thereare lots of times on the tarmac that earplugs come in handy. They are also good forpassengers (especially infants and small kids) who do not have headsets or do not want towear them. They also work great if you get stuck in a hotel room with a snoring copilot.
Antacid chewable tablets
These tablets can be lifesavers when dietary indiscretions get the best of you.Although the liquid is more effective, the tablets store better and do not spill. Two at atime is the minimum dose, and can be used as frequently as necessary.
Throat lozenges (eucalyptus or menthol)
These help with minor sore throats and coughs. Although they provide symptomatic helponly, this medication can really improve a sick person’s disposition.
Now available over-the-counter without prescription, hydrocortisone cream is the bestremedy available for dry skin, irritation, and most scaly rashes. It’s particularly goodfor contact dermatitis such as poison ivy or poison oak. A small amount applied frequentlyworks best — you do not need to goop it on.
The water-based children’s type is our favorite, since it doesn’t tend to blind youwhen you start to sweat and it drips into your eyes.
Citronella-based repellent is the best. It is non-toxic to children, smells okay, andwon’t melt plastic like DEET (which is also toxic to children). Citronella has one hugeadvantage in addition: It repels flies and other biting insects besides mosquitoes thatDEET does not.
Ibuprofen (Advil, Motrin)
Ibuprofen is one of the truly great drugs developed since aspirin, and is part of adrug family known as NSAIDs — non-steroidal anti-inflammatory drugs. Non-prescriptiondose is 400 mg (two tablets) every six hours, while the prescription strength is 800 mg(four tablets) every six hours. It is useful for headaches, sunburn, pain, muscle aches,and general soreness. The only downside is that it can cause stomach upset, so it shouldbe taken with food.
The acetaminophen dose for adults is 1000 mg every four hours for fever and pain.Acetaminophen differs from aspirin and ibuprofen in that it has no anti-inflammatoryeffect, but is much easier on the stomach.
Aspirin is similar in effect to ibuprofen, and has similar stomach side effects. Doseis two to three 325 mg tablets every four hours for fever, arthritis, headache, or otherpain.
Tee Tree Oil
Doug Ritter of Equipped To Survive turned me onto this stuff. It is the best thing I have found for insect bites (stinging ants, bees,mosquitos, etc.). The thick stuff should be dabbed (not rubbed) on the site on an “asnecessary” basis. It also works well for minor burns almost eliminating the painimmediately. Friends have reported to me that it also works well as an anti-fungal torelieve athlete’s foot and ringworm.
If you have to cover a wound, this is probably the stuff you want to use. The Telfa padsupposedly keeps it from sticking, but sometimes you have to soak it off a crusted wound.
Unstarched roll gauze
This unstarched gauze is great for wrapping large wounds. It is not elastic so it willnot go on too tight (unintentionally). It conforms to the area it is placed and tends tostay there.
Cohesive compression bandage
Although this stuff looks like an Ace bandage, it is not. The material sticks toitself, is waterproof, and can be reused to some extent. It’s great for wrapping wounds,especially over unstarched gauze, and eliminates the need for securing clips or tape. It’simportant to note that it is elastic, so take care not to wrap it so tight that it impedescirculation. Although it’s intended for dressings, it’s also perfect for splintapplications, creating a makeshift sling, and all sorts other uses. Think of it as theduct tape of first aid kits.
Ace elastic bandages
Ace bandages are for general support of joints and for compression dressings. Supportof ankles, knees, wrists, and elbows are the most frequent use, but Ace bandages can alsobe used with gauze pads and or unstarched gauze rolls for keeping a wound from bleeding.Ace elastic wraps can be dangerous if wrapped too tight, causing a tourniquet effect andcutting off circulation. If used to stop bleeding, an Ace bandage must be loosenedperiodically (every 30 minutes is fine) until bleeding is controlled, and then reappliedless tightly for gentle pressure. They can be washed, re-rolled, and reused.
Gauze pads are good for cleaning and dressing wounds, and are better than plain cottondressings since they do not leave fibers in the wound. They’re also great for applyingprovoiodine, etc.
Tape (zinc and plastic)
Zinc tape is more conforming, but plastic tape does not absorb water. Only experiencewith use will help you decide which tape is the best for each job. I carry a roll of eachin my medical kit.
Mastisol tape-skin adhesive
This stuff is the Crazy Glue of first aid kits. Put this on the skin and tape willstick forever, even in water! Great for steri-strips (see below).
Steri-strips are modern day butterfly bandages. They will aid closing and/or keeping awound closed (especially when used with Mastisol). However, I have concerns about puttingsteri-stips into a first aid kit, because wounds are very difficult to keep sterile whenclosed in the field. It is essential to remember this caveat: Open wounds rarely getinfected, and when they do it is usually minor. Closing a wound, however, creates thepotential for an abscess and blood poisoning that can create a disaster. The scarring froma wound that is not closed might be greater than one that is closed, but that can be dealtwith later by a plastic surgeon. Blood poisoning or abscess formation while camping can belethal, especially if it occurs in a survival situation or a third-world country. In mostcases, it’s better to leave the wound open.
General wound care should start with cleaning with soap and lots of water. Paintingwith provoiodine completes the cleaning. If soap and water are not readily available,irrigating with the provoiodine is best alternative. For a dressing, I am personally fondof using gauze lightly wetted with provoiodine directly on the wound, with a layer of drygauze on top — a so-called provoiodine wet-to-dry dressing. A few studies have shownprovoiodine to be irritating and destructive to live cells, but my personal experience isthat the wet-to-dry dressing works extremely well for sterilizing wounds and preventinginfections.
There are good for making slings and tying extremities to splint material forstabilization. They can also be used as a tourniquet as a last resort for uncontrollablebleeding.
Mosquito hemostat with fine nose
These are the surgical equivalent of needle-nose pliers, but made of springy steelalloy and with a self-locking feature. They are great for removing splinters, fishhooks,and a variety of other missions. (If you were around in the 60s, you’ll remember that theywere popular as roach clips.).
These are small scissors with one blunt blade, allowing bandages to be cut off withoutinjuring the bandagee. (I also carry a Robin Safety Boy Rescue Cutter for heavy-duty jobslike cutting seatbelts and breaking out windows, but it’s too big and heavy to includeinside the medical kit, and should be stored within easy reach in the event of a crash.)
Diphenolhydramamine 25 mg chewable (Benadryl)
Benadryl is good for allergic reactions, itching, and insomnia. Adult dose is one ortwo tablets every six hours, or half that for children.
I carry several hollow bevel-point hypodermic-type needles in my kit. They’re the bestthing I’ve found for digging out small splinters and making small incisions. They’re notrecommended for draining abscesses, since a needle-punctured abscess will reseal and formagain. (An abscess should be lanced with a scalpel blade.)
This is incredibly sharp, good for large splinters and incising (making a large cut in)an abscess for drainage. Also good for cutting thread. The blade can be clamped in thehemostat.
Dramamine works as well as any other over-the-counter drug for motion sickness (whichis not particularly well). The tablets are chewable and the dose is on the packet. (The
These are good for everything from transporting water to ice packs to disposing of useddressing material. They have zillions of uses, and are invaluable.
Used to secure triangular bandages, replacing lost buttons, and a variety of otheruseful applications.
Folding paper cups
I find them handy.
Cotton-tip applicators (Q-Tips)
These applicators can be used to apply medications, clean the external part of the ear,cleanse wounds, and remove foreign bodies from the eye.
This stuff is used to protect the feet and take pressure off of blisters.Self-adhesive, but best used with Mastisol. To take pressure off a sore area of the foot,cut Moleskin in the shape of a donut with the central hole slightly bigger than theblister or other lesion.
These chemical cold-packs can be used on a contusion, sprain, strain, or othertraumatic injury. The cold reduces bleeding and swelling. They will not last long, butwill help immediately and are better than nothing while you find some ice. Heat should notbe applied for 72 hours.
Use this for washing out contaminants (battery acid, chemicals, dirt, etc.) from theeye. The eye must be held open for this to work.
This is particularly good for fluid replacement for diarrhea, and for treatingdehydration due to heat exhaustion or heatstroke. Plain water is next best choice.Remember that hot dry climates may precipitate dehydration more suddenly than you mightexpect. My physiologic rule is that if you are drinking enough to have tourinate every three hours, your tank is full.
Good lubrication for irritated eyes of any cause. Not for washing out a foreign body orchemical unless nothing else is available. Eye wash or even plain water is better forirrigation of contamination.
Always handy for routine use.
Good for everything from trash to holding ice for ice packs.
Also can be used for holding pressure on bleeding wounds.
Can be used as finger splints, looking down the throat, or toys for kids. Cansupplement large splints.
The #1 TravelJohn is the best ofthe products we have tested. The internal polymer absorbent material gels any liquid,making it spill-proof, and neutralizes odor. These cannot be used for water storage ortransport because it cannot be recovered from the gel. Can be used for ice or cool packswhen placed in a freezer or filled with cold water.
How I Package My Medical Kit
This Cordura EMT bag is rugged, and
organizes all the contents in a logical,
easy-to-find and easy-to-use fashion.
It’s expensive, but worth it.
(Click on photo for larger image.)
To my way of thinking, packaging of a medical kit is almost as important as what itcontains. The contents do you no good if you can’t find what you need when you need it.Furthermore, a kit that is a pain to unpack and repack is unlikely to be used very often.My kit is designed for frequent use and rough handling. I take it wherever I go — flying,hiking, skiing, camping at Oshkosh — and use it often.
After surveying a wide range of boxes and bags, I finally settled on aprofessional-quality urethane-coated Dupont Cordura bag manufactured by
If you carry a first aid kit in your car or airplane, it’s also important to make sureit’s mounted in a location that’s easy to access in the event of an accident. You shouldalso check your kit periodically for replacement of used or depleted supplies. Most of themedications I carry are long-lived, but a few expire and should be replaced periodically.
Assembling Your Own Medical Kit
To assist you in putting together your own medical kit, here’s a detailed listing ofexactly what I carry in mine:
In preparing this article, I tried to price out what all this stuff would cost if youbought it at retail (including the fancy bag, but excluding a few hard-to-find orphysician-only items), and came up with a total of a bit over $500. You could obviouslyshave a little off that figure by reducing the quantities, and shave a fair amount off byusing less sophisticated packaging than the $100 Cordura EMT bag that I chose. Basically,you get what you pay for.
|NOTE: For those who may be interested, I’ve made up some medical kits substantially identical to the one I use (including the fancy Cordura bag), and made them available on the Aeromedix.com Web site for $350. (As an emergency room doc, I can buy most of the stuff in the kit in bulk and/or at discount.) If you’re interested in one of these kits, you can order it online or phone Aeromedix.com at 888-362-7123.