The Core Kit: First Aid and Beyond, by Jason J.

Sunday, Nov 11, 2012

Beans, bullets, and Band-Aids are the basics of prepping. Each has its own place, and they each lean on each other. Beans are pretty easy, but expensive. You spend the money, organize yourself and learn to use the food. There are more sources to learn about this than you could ever read, we all know about eating, and you are certain to need food in almost any situation you can imagine! Bullets are really not that complicated. We make it complicated, but as an Army Ranger that has been shot at countless times, I promise you will not question if that was a 5.56 or a 7.62 fired your way. I have hidden from a .22, because they all can kill you! The counter to being shot at has been addressed, mass. Have some weapons you can use, know how to use them, and then be prepared to use them. It is about that simple. About the only things I can think to say from my experience is that rookies practice shooting while pros practice correcting malfunctions and reloading and that two decent guns in two different pairs of hands are usually better than a great gun in one pair of hands. Band-Aids are where I think things get more difficult. We all eat, all can buy guns and practice basic marksmanship, but we do not all get a chance to learn professional medicine or practice the skills we have learned about in books! I suppose if you can find someone to let you practice suturing on them or practice a teach then you have a more committed prep group than I do and you need read no further!

I switched from Infantry to nursing when I realized that no one pays you [in the civilian world] to be infantry. While in the Infantry I did get a chance to learn some great emergency/trauma management. In fact, when I went to medic school there really wasn’t much new to me. Your typical American Infantryman has the skills to stabilize most pre-hospital trauma injuries. Basically, stop the blood, keep the wind going.

I want to address the typical person reading this. I bet the typical reader is most likely to start by going to Wal-Mart and buying a first aid kit, a few over the counter drugs, and learning CPR. This is great! If more Americans would do this it would provide quite a stable situation for us as a community. I also want to talk about the more advanced prepper and the things I bet I’d find in his stores.

I started by buying a typical kit for around $15. I chose it because it said “outdoor” on it (a marketing tool that appeals to preppers) and because is useful before the world ends. I plan to toss it in the wife’s car for the normal bumps and bruises my kids and I receive.

I chose a “Be Smart Get Prepared Outdoor First Aid Kit”. It caught my eye because of the eco-friendly packaging! Who brings a paper bag to the outdoors? The first thing I noticed when I opened it was that it had an anti-theft zip-tie on the zipper! That would have been a real pain for my wife to deal with while my son was screaming about his bleeding thumb on the tailgate. Upon opening it I did notice the sort of compartments I am used to in the emergency packaging I carry as a medic. The kit did not come separated into any real logical order. It looked like someone that had no idea what was what had put things shaped similarly together. This would be a pain.

The kit included:
    12 antiseptic towelettes
    12 alcohol prep pads
    3 antibiotic ointment packets
    2 lip ointment packets
    3 sunscreen lotion packets, SPF 30
    3 burn cream packets
    3 sting relief pads
    1 poison ivy cleanser towelette
    3 insect repellent packets
    4 aspirin tablets
    4 non-aspirin tablets
    2 electrolyte tablets
    15 adhesive bandages: 3/4" x 3" (1.91cm x 7.62cm)
    15 adhesive bandages 3/8" x 1-1/2" (0.95cm x 3.81cm)
    5 waterproof bandages: 1" x 3" (2.54cm x 7.62cm)
    5 butterfly closures
    2 moleskins: 2" x 2" (5.08cm x 5.08cm)
    1 waterproof adhesive tape: 1/2" x 2.5 yd (1.27cm x 2.29m)
    4 sterile gauze pads: 2" x 2" (5.08cm x 5.08cm)
    2 sterile gauze pads: 4" x 4" (10.16cm x 10.16cm)
    1 sterile gauze trauma pad: 5" x 9" (12.7cm x 22.9cm)
    10 cotton tip applicators
    1 instant cold pack: 5" x 6" (12.70cm x 15.24cm)
    2 examination gloves
    1 First Aid Guide
    1 pair of tweezers
    2 finger splints
    2 safety pins
    1 Brightstick: 12-hr
    1 outdoor emergency blanket

This looks like a bunch of really good stuff, and it is. There is a reason most kits include some combination of these things. Lets look at each one that is worth looking at. You may be surprised some additional and actual uses for each item and some considerations you should have before you use them:

Antiseptic wipes. These are not sterile! They are real good for cleaning. I find I use this sort of thing to clean my own hands when I work on another person. Realize that every person has unique blood. This includes pathogens. We all have something in our blood we should not pass around. Also, dirt has many, many pathogens in it you should either remove mechanically or deal with chemically. Think of antiseptic as killing most pathogens, not all.

Alcohol pads. Know that there is a segment of our population that is allergic to these. Typically, it is not a huge issue, some redness, swelling, irritation, and minor pain. However, if you find yourself using them there is a reason and an allergic reaction may not help. You need to have another solution. Iodine is one, but the allergy is an even bigger concern. Consider chlorhexidine if you can afford or find it (additional use, extremely flammable, fire starter!).

Antibiotic ointment. This is Neosporin to most of us. I suspect this simple, cheap, and easy intervention can prevent a huge portion of the preventable discomfort many of us may experience. Use it! As I said before, dirt is full of bad stuff. To make my point, bacteria spores can live for decades. Small wounds can and do kill. Even if this were not the case, wounds healing faster and with less pain is a good thing. Buy more.

Lip ointment. I chuckled when I saw this on the Ranger packing list. Weeks later I was borrowing this from other guys. It was mostly a comfort issue. But, as my first Squad leader said, “When in the field; comfort, comfort, comfort!”
Sun screen. See above.

Burn cream. The rule of thumb for a burn is to not get infected! This ointment is not for that sort of burn. Really, if you have a burn that does not break the skin, don’t put ointment on it. Let the heat that has entered you leave. When you take a pot off the stove it is still hot for a while. Putting a cream on it will insulate it. The ointment is useful a bit later. A good way to think about it is how long does your steak take to cool down? In fact, it continues cooking for up to 10 minutes after taking it off the grill. If you have broken the skin barrier, dry sterile dressings are the best first response. Your body is going to be sending fluids to the area. The dry dressings allow the fluid, and the possible invectives, a place to go, away from your body. This prevents secondary complications. For burns that do not cause a breakdown of skin, the cream is really for comfort. Last, don’t pop a blister, that is Nature’s bandage. It is way better for protection and provides a better healing environment than anything you can buy.
Sting relief pad. Comfort issue.

Poison Ivy relief. I have had poison ivy. It is possible to do whatever you need to do with poison ivy. However, it is not fun. Extreme comfort!
Insect repellent. Comfort and prevention. Note that this stuff has an odor you can smell from farther away than you might think. I have noticed it on other people before from quite a distance after a while in the field. People have had infection from insect bites.  Ounce of prevention… Malaria has killed more humans than anything else in the history of humanity. There are seldom perfect answers for every problem.

Aspirin tablets. If the FDA were to consider Aspirin (ASA)[as a new drug] today, you would not find it available over the counter. Be aware that, by order, soldiers are not allowed to use ASA in theater unless there is a very good reason pre-approved by a provider. ASA does help with pain, but it is better understood as an anticoagulant. It does not thin your blood, but keeps you from forming or building clots (a clot on the outside of your skin is a scab). If you have ASA in your blood and suffer a wound, you will not stop bleeding very fast. Additionally, Aspirin has a very real chance to cause gastrointestinal bleeding if you take it often. Your guts will start bleeding! On a positive note, ASA can help reduce the damage from a heart attack and save a life. Aspirin should be kept around, but perhaps not in the field.

Non-Aspirin tablets.  Acetaminophen is the active ingredient you are after when you buy Tylenol. Note, print out or write down the doses for adults and children for all of your medicines. The active drug in all the different packages and forms of most drugs are the same, name brands are not important. The reason the drug looks different in children’s packages is that it is difficult to convince children of certain ages eat a tablet. Mortar and pestle will help here. Liquid medicine and capsules do not store long. Tablets are great. Look into survivalblog.com or any of the numerous sources concerning medication storage. Acetaminophen is not only a pain reliever, but also an antipyretic (fever reducer). Fever = acetaminophen. It will reduce pain, but is processed in the liver. Something to consider for that hangover since your liver is already stressed from the alcohol. Motrin, ibuprofen, is a good alternative. If you have any stomach issue ibuprofen should be the choice in the long term. Alternating is an even better idea. Acetaminophen will not address inflammation, a common reason discomfort is noted. If arthritis is the complaint, ibuprofen will do nothing.

Electrolyte tablets. These are like protein supplements in some ways. If you eat the right foods, they are useless. Drink water, eat food. *-- The kit I purchased came with a note inside asking me to request the tablets!! I plan to complain, it is unreasonable to sell an emergency kit and not indicate on the outside that everything on the list is already in the package. Another reason to put your hand on your equipment and know it. -- Your body needs electrolytes, you get them in food! Variety of diet prevents most nutrient deficiencies. I would say to eat variety, but I hate when people are redundant, because I do not like that people say the same thing they just said for the sake of saying things again, after saying what they just said, because they just mentioned it and it was already explained earlier... You need all your macro and micro nutrients. 8,000 pounds of wheat might feel good in the basement, but no teeth from scurvy bites better than you will, inability to stop bleeding is a real drain, muscle cramps and twitches turn you into a jerk!

Adhesive bandages. Band-Aids do a few things. One, they keep blood off your shirts and whatever you may brush against! Two, they help stop bleeding. Three, they keep pathogens out of the wound. The biggest thing, they keep stuff out of your wound. Your body will continue to bleed for a little while; this is how your body cleans an injury. The bandage keeps it clean. For my family, I use a bandage after I clean an injury and then put triple antibiotics on it. Usually it is a perfect answer to put the cream on the bandage. Practical point, joints bend. Flex or bend the joint so that movement does not create a limit to range of motion or large gap in coverage. A bandage is an artificial barrier. If you fail to create a clean wound you are creating a dirty, warm, wet, and isolated environment for any pathogen to proliferate.
Waterproof bandages. Want a bandage and be active? Try a waterproof bandage. Don’t jump into Staph creek and think you are good to hook. This is an active bandage. It is a little better. Think about it, do you trust this thing to keep every environmental factor out of your wound? I don’t, but it is better. I would buy more, they are cheap.

Butterfly closures. These are cheap, DIY, limited solutions to a wound an adhesive will not address. It can replace stitches in a few limited situations, but are not complete replacements. These serve to connect tissue. Have a cut on your skin a bandage won’t fix, use a butterfly. However, if the wound is deep enough to see muscle or anything under the skin you may not be fixing anything. You might be holding pathogens in the wound. If it is very deep you may want to consider a wet to dry dressing. This gets into a place where average people can understand and perform, but need to take time to really inform themselves and think about it a lot. I wish there was a class to take to learn these sorts of nursing things without going to nursing school. Many parents and family members get to learn this sort of thing when a family member has a particular need and hospitalization is not really cost effective. A nurse can teach you, at his/her level of comfort in doing so. Maybe volunteering at a hospital or nursing home would expose you to a few of these sorts of skills. At the very least, you would be familiar with more medical issues.

Sterile gauze pads,  2" x 2". Small sterile gauze pads are good for covering a small wound that is in a difficult position. Also, they can come into play with the wet to dry dressings. Bottom line, if you keep it so, it is a sterile cloth for putting on a wound. You can also use them to clean a wound; the only trouble is a sterile liquid for mobilizing dirt and debris in the wound. You only get two, use carefully!

Sterile gauze pads, 4" x 4". See above, only bigger.

Cotton tip applicators. Q-tips. These are good for cleaning difficult places. Be very careful you are not pushing things deeper in your attempt to clean. Your ears are a perfect example.

Instant cold pack. If you hurt a joint, RICE is a good thing to remember; Rest, Ice, Compression, and Elevation. In the first hours your body is sending fluids to the injury to help it heal. This fluid causes some discomfort. Cold decreases the fluid coming to the area. To let you know how well it works, Ice is the first thing they toss between a woman’s legs after giving birth. People often pass this sort of thing over because it is simple, and they are of course advanced!

Examination gloves. These protect the injured and the person helping. If there is any possibility of fluids getting on you then you should use the gloves. Remember, if I help you, the small cut on my hand could pass something to you while I dress your wound.

First Aid Guide. I always keep these references. I have not used one yet, but I figure it has two good uses. First, I know I am not perfect. If I have time, I look things up. Second, I imagine if I was working on my son while my wife was there, it could be useful to give her something to do. This is not patronizing. It is practical! She may remind me of something and she feels involved. Helplessness is a huge issue for parents.

Finger splints. The big thing to remember is ensuring you do not limit circulation. To keep a digit from moving does not require much. It is really a bit more of a reminder and protector from bumping it against things than keeping the patient from moving it. If the end of the finger feels cold, it may be too tight. Additional note, the finger next to the injured finger provides a decent splint. This leaves your wood splint for additional uses like examination and manipulation.

Brightstick. Chem lights work. It is hard to see things with the light they emit. Practice with the light. It is a great signal device. Make a “buzz saw” by tying the light to the end of two feet of string. Spin it around, very easy to see at night. Remember, once it is on, you cannot turn it off. Bury it, if you must. I can vouch that these are visible while in your pocket.

Outdoor emergency blanket. This is another of those things people do not realize is very useful. You can carry a person with one of these, as long as you do not brush against anything! This thing is a good reflective surface for heat! This is the final step in packaging a person for transport. Do what you can, and then put this on the patient, you just cut all their clothes off! If they say they don’t need it, I bet they don’t.

This sums up what I thought about the kit. Next, I want to talk about other items that the advanced prepper has:

Tourniquet. This is a lifesaver. It is the number one intervention for soldiers! Modern medicine can preserve a limb longer than we used to think. You do not need the expensive ones available for purchase. I have them because I got them for free. For the general public they are expensive. The things to really know is that string will not do. If you have a 550 survival bracelet and that is your plan, you are planning on having no tourniquet and additional injury! You need a wide strap, one inch at least, that compresses the tissue around the vessel. Keep it off the joint. The fast rule, if you are not sure where to put it, put it as high as you can. Make it as tight as possible. The first one I ever put on was interesting. I placed it on an Iraqi soldier. My training had not mentioned that a conscious person may really dislike the tourniquet! It was something of an argument I am amused with now. This was an easy situation where I was able to see when the blood was spilling from his leg, and when it was not. He was in pain from the gunshot. Despite the language barrier, I can tell you the tourniquet seemed worse to him. I kept it on because that is the way to save his life. I have one question for the grid-down prepper; if there is no “next level” of care, what next? Some things are just beyond what we can do without years of school. This is a reality to deal with. I would rather die from hemorrhage than sepsis. This is only an honest consideration to have if you claim any integrity. A book and a surgical kit will not work 99 out of 100 times if you have no real training.

Israeli Dressing/Trauma Bandage. These are great options for dressing a wound fast and tight. They are clean, wrap hard and tight, secure well, and cost a lot. If you got a line on some, go for it, great. If not, there are better things to spend your money on. Cheap gauze and tape can do fine with some practice. The goal with this thing is pressure. We all know pressure helps stop bleeding. The Trauma Bandage keeps the pressure on. If you bleed through it, add more. Do not remove the original material, you may be ripping some of the clot off and starting over again.

Combat gauze/Quik-clot. This falls into the tourniquet area. Great, you stopped the bleeding. If the grid is down and you do not have a medical professional, what next, sepsis? There is also an allergy issue. Shellfish allergy indicates an allergy to many of these options.

SAM splint. These are a bit costly. There are cheaper ways to secure and splint an injury, but these things are awesome! You can immobilize almost any body part, even the neck! Do not play around with them too much. They are just thin aluminum covered in thin foam. Playing with it will create sharp edges and exposed metal. If you have a choice, go for the thin packed ones. They are much easier to stow away than the rolled up sort.

Surgical kit. When you buy these things at a surplus store, know they usually are not sterile. Options to make them sterile can be found on the internet. My wife had the idea to find a tattoo shop willing to help us out. For those not sure of the sort of people working in a tattoo shop realize that they are very regulated and physics works pretty much the same everywhere! Many of these places have an autoclave for their instruments. These machines are very user friendly. I used one in a hospital after a 10 minute class. The wrapper has an ink in it that indicates the correct conditions were met to be considered sterile. Additionally, many of the people that include themselves as preppers have tattoos!

I would also say that surgery is a risk in the best of conditions! This is certainly a time where there can be too many cooks in the kitchen because each cook has his/her own ability to infect the patient. Forget your Rambo illusions and think about being clean. Think stitches, object removal, wound healing, and cleaning. It has been said the reason to have a surgical kit is to have something to put into capable hands. Very true!

Prescription Drugs. I figure there are two main things here, sedation/anesthesia and antibiotics.
I have read about all manner of anesthesia. They all look dangerous. Drinking yourself into a state may have worked a few times in the past, but carries some real consequences. I would love someone to offer a real solution. I doubt there is one because if there was it would be logical to assume that solution would be used today. Playing with consciences is always dangerous. Anesthesiologist/Nurse Anesthetist are very highly trained and have years of school. Do you really think you can mimic this after reading an article online and mixing some solvents from the auto shop? Even if you could do this correctly, you need a very clean room, a plan, a correct diagnosis, good assistance, and many other things. And, you still need to remember antibiotics!

Antibiotics are a more reasonable pursuit. Preppers go for antibiotics sold for fish, find doctors that are ok with their license being on the line with your preps, and some try to keep their past drugs after they feel better, figuring it will help them later. The latter is a very bad idea. First, using only a portion of a prescription leaves the bacteria in your system. You could get sick again, or pass is on as stronger bug for the next person. This means that over time you get super-bugs that are very difficult to treat. The antibiotics we are using for some people now have huge problems and side effects. According to many sources antibiotics for animals are good to hook. However, this is only when you apply the correct antibiotic for a given situation. Penicillin is not going to work for all bacteria. Doctors know which drugs to give based on the location of the infection and the current trends in their area and experience. Your animal drugs are not as specific or broad. I am not saying this is necessarily a bad idea, but that you certainly need to have a hard copy explanation of what you have, when to use it and how to recognize it in simple and reasonable ways. Know how to dose your drug and what a common dose for a child or adult is. Go to the book store and get a nursing drug guide. This will tell you what to look out for while using the antibiotic, possible negative effects, common dose, and when not to use the drug. For the most part, an older used book is fine. The drugs you get from a vet do not change so rapidly that a drug guide from 2005 will be out of date. I strongly suggest a drug guide if you do or do not have prescription drugs.

Some things people don’t think about that are worth having are ways to transport patients, palliative measures/pillows, N95 masks, gloves, sterile blades, Netti-pot, and vitamins. Transporting people correctly limits additional injury and stress.  Pillows can help limit pressure sores after being in the same position for a long time. Palliative measures make people more comfortable, reduces stress, and even help those not injured feel better. If the world ended and you were going to die, being comfortable would be nice. Rotate people’s position every few hours. Just a bit to place pressure on a different spot, this reduces skin breakdown. N95 masks and gloves protect everyone! Sterile blades to cut the umbilical cord are the number one intervention to reduce infection and death after a “normal” birth. A shard of obsidian is not a good answer! A Netti-pot keeps a sinus infection from becoming a bigger problem. Vitamins can help the body heal its self. If you have variety in your diet you should not normally need supplements. If your body has an increased need from injury or illness vitamins can play a big part.

Herbs are an interesting topic and very worth investigating. Mid-level providers are increasingly turning to this old wisdom. However, like any drug there can be consequences and contraindications. You need to know what you are doing before you use your friend or family as an experiment.
Training and knowledge are the biggest part of the puzzle. All the cool, expensive equipment in the world is useless and dangerous in the wrong hands. In some cases, it may even be useless in the right hands. A well-stocked bookshelf is certainly indicated for the prepper, but you actually have to read and consider the information. You will not rise to a medical emergency! You need to have a plan first. Seek out people with the knowledge you want. My experience is that people are happy to share what they know and are interested in.

Some closing food for thought: I attended the survival/preparedness expo in Spokane, WA a few weeks ago. There were many people there spending large amounts of money on preps. In truth, many of them would be better off spending that money on a gym membership to be prepared for TEOTWAWKI! What is the logic of $1,000 worth of gear when you are 50 pounds overweight, pre-diabetic, have decreased cardiac output, decreased mobility, reduced cardiovascular potential, and any host of other problems that come with the sedentary American lifestyle?. Sometimes the answer you have heard all along is the best answer. There are few short-cuts to health and fitness. I question the motivation of a person worried about TEOTWAWKI when they do nothing to prep for the world as we do know.


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