The following information on first aid and medical kits is excerpted from the Survival & Austere Medicine manual. It reproduces in part the section on medical kits based on increasing comprehensiveness. Minor changes have been made in order and figure numbering. The manual goes into additional detail about each of the categories of kit contents, and what you want to look for in those products. This high-level overview leans more toward supplying the list of contents for each kit type in a more condensed format. The Survival & Austere Medicine manual is a free resource with much good information. Please consult it for more detail.
Personal bag/blow out kit: Carry this with you at all times. It contains basic first aid gear or in a tactical situation the equipment to deal with injuries from a gunshot wound or explosion (figure 1). This includes things to immediately render aid – it’s almost like a pre-first aid, first aid kit!
A list might include:
Combat dressings/Israeli dressings
A hemostatic gauze compound
Chest seals – Asherman chest seals stick poorly on wet, hairy chests despite being relatively common place. Hyfin or Halo seals or even a rat glue trap works better. Studies have shown no advantage to vented dressing chest dressings vs. not vented.
Long IV cannula or specific pneumothorax decompression needle
Tourniquets x2
Oral and/or nasal airways
Figure 1 Blowout bag: Personal medical equipment for a tactical situation (dressings, HemCon bandages, Chest seals, oral and nasal airways, IV cannula and a tourniquet
First response bag: Carry this in your car; take it with you when you go camping, family trips to the river, etc. It contains more advanced first aid gear and some medical items than a basic level medical kit.
Large kit bag: This is your home/retreat/bugging out medical kit. It contains your medical kit as opposed to simple first aid supplies.
Storage area: In your home/retreat. It contains duplicate and bulk supplies. Large plastic storage bins are ideal for this.
First Aid Kit
A comprehensive basic first aid kit is the building block of any medical preparations. With relatively simple equipment and supplies you can stop bleeding, splint a fracture, and provide basic patient assessment. Figure 2 lists the suggested contents for a basic first aid kit.
Figure 2 Basic First Aid Kit
Basic Medical Kit
The basic medical kit is the next step you take from a basic first aid kit. The example here is designed for someone with a basic medical knowledge and a couple of good books (figure 3). A lot of common problems can be managed with it; minor trauma (cuts and minor fractures), simple infections, and medical problems. Between this and the larger more comprehensive advanced kit there is a wide spectrum depending on knowledge or experience. Most begin with a first aid kit and expand as knowledge and finances allow.
A smaller medical kit for your bug-out bag could be made up from the above by adding some medications (such as acetaminophen, Benadryl, and some Loperimide) and some instruments to a small first aid kit.
Figure 3 Basic Medical Kit
Advanced Medical Kit
This is designed for someone with extensive medical training and would allow one to cope with 90% of common medical problems including some surgery, spinal and regional anesthesia, and general anesthesia with ketamine, treating most common infections and medical problems, and moderate trauma (figure 4). This list may seem extreme, but is designed for a well-trained person in a worst-case scenario. Even though it is a long list, it all packs down. This sort of amount of equipment packs into two medium size nylon multi-compartment bags and a Plano rigid 747 box.
Figure 4 Advanced Medical Kit
Notes:
1) We’ve tried to use the international generic names for drugs. However, there are some differences between the British and the US pharmacopoeias and where possible we have tried to include both, e.g. Lignocaine (US & Oz/NZ) = Lidocaine (US).
2) We have not included any quantities. This is dependent on what you are planning for and what you can afford. Unfortunately, most medications require rotation with 1-5 year shelf lives, making this a costly exercise, as they are not like food you can rotate into the kitchen.
3) Always store a supply of any medicines you take regularly. These do not feature on the packing-lists. However, it is vital to remember the blood pressure pills, thyroid hormones, allergy pills, contraceptive pills, asthma inhalers, or whatever you take regularly. Most doctors will issue additional prescriptions for regular mediation to allow an extra supply at a holiday home or to leave a supply at work. The main problem likely to arise is covering the cost of the extra medication which may be expensive and not covered by insurance. If you have previously had severe allergic reactions consider having a supply of Epi-pens.
Components
Dressings – Small gauze squares/large squares/combined dressings/battle dressings/non-adhesive dressings. There is a vast range. They serve two functions: -to cover and stop bleeding and to protect a wound. Exactly what you need is to a large degree personal preference – but whatever you buy you need small and large sizes, and they need to be absorbent.
Roller/Crepe Bandages – These go by various names (Crepe, Kerlix) – but what we are talking about is some form of elasticized roller bandage. These are required to hold dressings in place, apply pressure to bleeding wounds, to help splint fractures, and to strap and support joint sprains. They come in a variety of sizes from 3 cm to 15 cm (1-4”) and you should stock a variety of sizes.
Triangular Bandages – These are triangular shapes of material which can be used for making slings, and splinting fractures, and sprains.
Band-Aids – Lots of them and in multiple sizes. They are useful for protecting minor wounds and skin damage. Small sheets of Tegaderm (transparent/adhesive dressings) are useful as an alternative and provide a clear view of the wound.
Oral or nasal airways – We have already discussed supplies for airway management. Oral or nasal airways are the basics for assisting with airway management. Often when combined with basic airway opening manoeuvres these are sufficient to maintain the airway of an unconscious person.
The face shields are recommended if you need to perform mouth-to-mouth on someone. The practical reality is the commercial face shields on the market to do not work effectively.
Sterile normal saline (salt water) or water – You don’t need expensive antiseptic solutions for cleaning wounds. Sterile saline or water (and to be honest – even tap water is fine for most wound cleaning) is all that’s required to irrigate or clean contaminated wounds. There is no clear evidence that using antisectics over sterile water in traumatic (as opposed to surgical) cuts or abrasions reduces the incidence of infection. The best way to clean a wound is with copious amounts of water or saline. It is also useful for irrigating eyes which have been exposed to chemicals, dust, or other foreign bodies.
Tape – You can never have too much tape. It has hundreds of uses. We recommend a strong sticky tape like Sleektm or Elastoplasttm. There are many other paper or plastic based tapes around – the main criterion is that it always sticks when required.
Gloves – Needed for two reasons. First, you should assume that everyone you deal with has a blood borne disease. When you are dealing with family members in an austere situation this isn’t so important. The second reason is to try and reduce infection from the bacteria you have on your hands when dealing with wounds. In the same way that using antiseptics over sterile water for irrigation of wounds has minimal impact on the incidence of infection – the same is true for sterile vs. non-sterile gloves. When managing traumatic wounds (again this isn’t true for surgical incisions and operations) there appears to be minimal difference in infection rates between wound management with sterile or non-sterile gloves. Exam gloves are not sterile, can be used on either hand, and are just casually sized (small, mediu, large, etc.). They come in boxes of 50 or 100. Nitrile gloves are more than latex. Sterile gloves are packed individually and have specific sizes – 7.0, 7.5, 8.0, etc. Size is important – know your size.
Soap – The ability to wash your hands is so vital. You can also wash a wound or a whole body to help clean it. Hygiene will prevent a vast number of diseases.
Providone solution (iodine solution) – You can clean and disinfect wounds and at a pinch, do the same for water. A big risk of infection is potentially fatal so you really need the ability to clean. You can do almost the same with clean water in terms of cleaning wounds, but iodine just helps that little bit more.
Cotton-tips – Handy for cleaning small wounds and removing foreign bodies from eyes.
LT-king or I-gel – Easy insert devices offering a degree of airway protection in patients who are deeply unconscious.
Superglue – Close small wounds, glue splinting and wires of teeth to splint dental fractures and loose teeth.
Suture material – 2/0 is the most versatile size. Nylon is probably most useful for general work and external skin closure – although not absorbable and needs to be removed. Vicryl (synthetic absorbable) is also very useful and mid-size and can be used for most suturing you would need to do and while absorbable, it does have reasonable initial strength.
Scissors/Needle holder/Dissecting forceps/several small clips – We are cheating by only counting as one item, but they go together generally. You need all to suture properly but they do enable you, when combined with a scalpel blade, to do most minor surgery.
SAM splint – Useful for so many different splints – splinting c-spine, splinting an arm or a leg. They can be used as a short-term device or potentially in the longer term if required.
10ml syringes – Can be used to give smaller volumes from 0.5 to 10 mls safely and enable IM or IV administration of some of the drugs in our drug list. They and also be used to irrigate a wound.
22g needles – Can be used for injections but also splinter and tick removal, also be used attached to the syringe above to create a high-pressure irrigation device.
Scalpel blade – You can cut things – trim skin, open abscesses, work out foreign bodies.
Dent-temp filling paste, an emery board, and a couple of spare tooth brushes – Can replace a lost filling, file a broken tooth edge, and you also have the superglue to help stick everything back together. The extra tooth bruses are for any cases of gingivitis. Oil of clove is also useful for direct application to a sore tooth.
Quality head flashlight – For looking in cavities and wounds. Emergencies at night are common and good lighting is vital. Being able to focus the light beam helps. Consider adding a battery charger and solar panel to maintain this capability – it’s vital. It must be water proof and rugged.
Extas that may be useful, but only after your kit in every other way is complete include:
Tourniquets – I love my CAT – but it’s very much a nice to have not a must-have and is most suitable for mangled or shot limbs, and in civilian practice you don’t see many of those, and, despite the opinions of some, we personally don’t think you will see many post-shtf either.
Hemostatic compounds – Quick Clot, etc. – Must the same as for tourniquets. 95% of wounds we deal with, direct pressure does the trick and for the 5% it doesn’t they are likely dead in an austere environment.
IV giving sets and fluids – Oral rehydration powder/formula is featured in the drug list and for many patients you deal with dehydration or mild to moderate shock it is adequate. It takes knowledge and skills to use IV fluids safely and you can be resuscitated by the oral route with ORT.
Pulse-oximetry, blood pressure cuffs, thermometers and stethoscopes – all useful and worth having, but not vital if they fall in the top twenty. It is possible to assess someone adequately using only your hands and eyes and get a very good impression of their condition and vital signs. The gadgets help, but are not vital.
Prescription medications
Lignocaine 1% (Lidocaine) (local anaesthetic)
Augmentin (amoxicillin) (broad spectrum antibiotic)
Adrenaline auto injector (Epicene) (USA = epinephrine)
Morphine Sulphate (strong pain killer) if available
Co-trimoxazole (trimethoprim/sulfamethoxazole) (antibiotic)
Ciprofloxacin (antibiotic)
Over-the-counter medications
Acetaminophen (Tylenol) (mild analgesic)
Diclofenac (Voltaren) (mod analgesic/anti-inflammatory)
Oral Rehydration powder
Loperamide (Imodium) (antidiarrhoeal)
Benadryl &/or Claritin (antihistamines, short + long acting)
Cotrimazole (Lotrimin) (anti-fungal)
Gamma benzene hexachloride (body lice and scabies treatment – usually a body wash or shampoo)
Contraceptive pills/condoms
Lower Valley Assembly 