What to put in a Good First Aid kit for my vehicles?

[duckknot]

nice catch. The only thing I would administer is a epi-pen.

Only if you are trained to do so, if you are not either guide the person to do it themselves or have one of their family members (if available) do it!

#1 is PPE for YOURSELF this means gloves, masks, CPR masks, etc.

I second the ABCs comment as well as blankets to help reduce shock!

Take a class where they teach you how to stabilize the spine!

Broken bones will (usually) not kill you so splints aren't necessary IMO however compromised airway, excessive bleeding and shock will kill you so know how to recognize and treat these things and what equipment you will need to do so!

Keep the kit simple....so many people want one with everything then can't find anything when they need it!

 

[TX69]

IF you're really into making a complete FA pack I would include a couple glucose gel packs. There are over 30 million in the US with some form of diabetes and if someone needs a quick dose of sugar (glucose) to get their sugars back up those can save a life.

 

[Mreed911]

Not sure about now, but Red Cross was saying no to tourniquets when I took their first aid/CPR about 6 years ago. I was surprised.

They're the standard now for bleeding control when pressure dressings fail.

 

[diveRN]

Not sure about now, but Red Cross was saying no to tourniquets when I took their first aid/CPR about 6 years ago. I was surprised.

My guess is too many people are using tourniquets when unnecessary.

If a victim has had a whole hand, foot, arm, or leg chopped off then they are going to exsanguinate before help arrives.

I just took a first aid class last weekend with an army medic, and he was saying that tourniquets aren't as devastating as they used to be known to be.... l

The notion of not using a tourniquet came and went pretty quickly. Like using a firearm in self defense though, it should be a last resort.

Even bleeding at the stump of a missing hand might be stopped by direct pressure and elevation above the heart. Remember, pretty much everything south of a tourniquet site is going to be surgically removed later so do whatever you can to save as much of the limb as possible for either reattachment of the severed extremity or consideration of a prosthetic later on. If you apply a tourniquet, reattachment isn't possible.

 

[Mreed911]

Remember, pretty much everything south of a tourniquet site is going to be surgically removed later... f you apply a tourniquet, reattachment isn't possible.

False, false, false. Wive's tale.

You have HOURS before any kind of damage like that is done. NEVER let concern for limbs stop you from fixing lethal bleeding, but also know that it's much less "risky" now that we have good data on the lack of negative effects in most urban/suburban cases.

 

[Shotgun Jeremy]

Thankyou for clearing that up. I don't know why he cut out the part of my post where I talked about that being the latest info as well as ignore your post about it.

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[nlam01]

I'm definitely going to say a tourniquet, compression bandages, gauze, wraps, ace bandages, scissors (in case you need to cut a seat belt off or restricted clothing causing more damage), quick clot, CPR masks (because you don't know what the person may have), splints, etc.......
As a trained professional, I always have an oximeter, blood pressure cuff and stethoscope handy. I always carry a notepad and pen, because when responders do finally arrive, it's super helpful to hand over this info. I also carry a stitching pack in case help is too far out and the person is in need of stitches.
It's also a good idea to have flares in case this happens at night away from any good source of light.
My truck is packed with so much more.

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[txinvestigator]

False, false, false. Wive's tale.

You have HOURS before any kind of damage like that is done. NEVER let concern for limbs stop you from fixing lethal bleeding, but also know that it's much less "risky" now that we have good data on the lack of negative effects in most urban/suburban cases.

This.

 

[TX69]

Is there a ready made kit good for the Texas heat available?

 

[Shotgun Jeremy]

Yea, it's called bottled water.

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[diveRN]

False, false, false. Wive's tale.

You have HOURS before any kind of damage like that is done. NEVER let concern for limbs stop you from fixing lethal bleeding, but also know that it's much less "risky" now that we have good data on the lack of negative effects in most urban/suburban cases.

In an urban/suburban setting applied by a professional like a medic or EMT-B and hospital care is close by, I'll agree. On the flip side, the ATLS (Advanced Trauma Life Support for non-medical folks) course I took in 2009 discouraged their use by untrained lay people because they were often applied too tightly and caused tissue injury that ultimately led to necrosis and eventual amputation or other complications including emboli, nerve damage, and systemic reperfusion injuries. Admittedly, I don't maintain this cert anymore so I don't know what they're teaching nowadays. When I worked at UC Davis in California back in 2007, the ED director (an army combat surgeon who spent time in the sand box) hated them because in ~50% of the cases where they were applied, they weren't indicated and the medteams were left to clean up the mess created by untrained folks.

My comments weren't exactly accurate, but they're not a wives' tale, as you put it... but they were inaccurate for a reason. That reason is for the layman, a tourniquet should be an absolute last resort because direct pressure can often control even the most persistent arterial bleeders.

 

[Mreed911]

In an urban/suburban setting applied by a professional like a medic or EMT-B and hospital care is close by, I'll agree. On the flip side, the ATLS (Advanced Trauma Life Support for non-medical folks) course I took in 2009 discouraged their use by untrained lay people because they were often applied too tightly and caused tissue injury that ultimately led to necrosis and eventual amputation or other complications including emboli, nerve damage, and systemic reperfusion injuries. ... That reason is for the layman, a tourniquet should be an absolute last resort because direct pressure can often control even the most persistent arterial bleeders.

We'll agree to disagree on this one. Most laypeople are bad at direct pressure, especially for the kind of trauma it would be indicated for (and is relevant here) gunshots and IED blasts. A C-A-T (combat application tourniquet) can be applied by anyone with minimal training (i'd argue Youtube would work), can be applied one-handed, and should be carried by every police officer on duty... and any civilian with a med kit.

There's simply no excuse NOT to have a tourniquet ready.

As for the doc griping about the 50% not needed? So what. Unwind them and quit bitching. It's far superior to the alternative.

The other thing to consider is time and self-application. Alone, one can use a tourniquet faster and for longer than pressure, and in the field where you'd need it, freeing up a hand is almost more valuable.

Better yet, combine the two and place dressings under the tourniquet and use IT for pressure, as well.

As always: see red, add more white.

 

[Mexican_Hippie]

Um, I'd rather lose a limb than bleed to death, but I am not an expert. Maybe the experts recommend bleeding to death?




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[txinvestigator]

In an urban/suburban setting applied by a professional like a medic or EMT-B and hospital care is close by, I'll agree. On the flip side, the ATLS (Advanced Trauma Life Support for non-medical folks) course I took in 2009 discouraged their use by untrained lay people because they were often applied too tightly and caused tissue injury that ultimately led to necrosis and eventual amputation or other complications including emboli, nerve damage, and systemic reperfusion injuries. Admittedly, I don't maintain this cert anymore so I don't know what they're teaching nowadays. When I worked at UC Davis in California back in 2007, the ED director (an army combat surgeon who spent time in the sand box) hated them because in ~50% of the cases where they were applied, they weren't indicated and the medteams were left to clean up the mess created by untrained folks.

My comments weren't exactly accurate, but they're not a wives' tale, as you put it... but they were inaccurate for a reason. That reason is for the layman, a tourniquet should be an absolute last resort because direct pressure can often control even the most persistent arterial bleeders.

Things have changed since 09.


For serious bleeders I will go straight to a tourniquet.

 

[txinvestigator]

Um, I'd rather lose a limb than bleed to death, but I am not an expert. Maybe the experts recommend bleeding to death?




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The facts is that it is highly unlikely a tourniquet will cause you to lose a limb.

 

[matefrio]

Simple. If you don't know how to use it keep it out of your kit. :-)

CERT gave me a nice backpack full of stuff I keep in the car along with the training to use most of it.

 

[ZX9RCAM]

Simple. If you don't know how to use it keep it out of your kit. :-)

CERT gave me a nice backpack full of stuff I keep in the car along with the training to use most of it.

While this is sound advice, what if one of your passengers, or a passenger in another vehicle WAS certified, but did not have the item with them as they were a "passenger" in a vehicle.

 

[diveRN]

So this discussion got me to thinking, reading up on current literature, and reevaluating my position. I'll be discussing this for sure with the various ED physicians I'll be working with later today, one of whom is the EMS medical director for our county here in North Texas.

...There's simply no excuse NOT to have a tourniquet ready. ...

Don't get me wrong, I'm not saying don't have one in the bag or never use one, they definitely have a place in achieving hemostasis. I have one in my bag and have for years. What I'm saying don't immediately take txi's approach below and go straight to it unless applying direct pressure is going to put the rescuer and the patient at further risk such as in a battlefield scenario. Though rare, complications do happen and are life-threatingly serious, even from properly applied, commercially available tourniquets in place only for short periods. Cases are documented. Yeah, crews got the patient to the hospital and they lived, but the long-term cost was high for some.

... For serious bleeders I will go straight to a tourniquet. ...

This is the wrong approach and is the basis of my ENTIRE argument with their use.

The facts is that it is highly unlikely a tourniquet will cause you to loose a limb.

You're not counting the long-term cost of use. Yeah, you may save their life and their limb will probably make it too, but there are other serious complications you obviously know little about. Battlefield evidence is great and all and many good things come from it, but it has to be tempered with the fact that we're generally NOT under fire here stateside with med-teams sometimes hours away. If the "facts" support first line use, why has tourniquet use, even among medical professionals today, been so controversial? The evidence just isn't there for it being the first line choice to control bleeding.

Here is the AHA's position on their use.

We suggest first aid providers use a tourniquet when standard first aid hemorrhage control (including direct pressure with or without a dressing) cannot control severe external limb bleeding. ...

The cost of the intervention is moderate. ...

The literature search was rerun in January 2015, and 2 additional studies were added to the consensus on science and GRADE table, 1 from the military setting(Kragh JF Jr 2015, 290-296) and 1 from the civilian EMS setting,(Kue 2015, 399-404) both supporting our treatment recommendation. ...

However, we did not find a relationship between the application of tourniquet and improved survival.

The last sentence is telling. Point is, it should be a last resort, especially for the untrained.

Edit to add: If a tourniquet is applied, even for a short time, chances of successfully reattaching a severed limb drop precipitously. Life over limb certainly applies here.

Sources:
Gross KR, Collier BR, Riordan WP Jr, Morris JA Jr. Wilderness trauma and surgical emergencies. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 21.

Moorell D. Management of amputations. In: Roberts JR, Hedges JR, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 47.

 

[txinvestigator]

So this discussion got me to thinking, reading up on current literature, and reevaluating my position. I'll be discussing this for sure with the various ED physicians I'll be working with later today, one of whom is the EMS medical director for our county here in North Texas.



Don't get me wrong, I'm not saying don't have one in the bag or never use one, they definitely have a place in achieving hemostasis. I have one in my bag and have for years. What I'm saying don't immediately take txi's approach below and go straight to it unless applying direct pressure is going to put the rescuer and the patient at further risk such as in a battlefield scenario. Though rare, complications do happen and are life-threatingly serious, even from properly applied, commercially available tourniquets in place only for short periods. Cases are documented. Yeah, crews got the patient to the hospital and they lived, but the long-term cost was high for some.



This is the wrong approach and is the basis of my ENTIRE argument with their use.



You're not counting the long-term cost of use. Yeah, you may save their life and their limb will probably make it too, but there are other serious complications you obviously know little about. Battlefield evidence is great and all and many good things come from it, but it has to be tempered with the fact that we're generally NOT under fire here stateside with med-teams sometimes hours away. If the "facts" support first line use, why has tourniquet use, even among medical professionals today, been so controversial? The evidence just isn't there for it being the first line choice to control bleeding.

Here is the AHA's position on their use.



The last sentence is telling. Point is, it should be a last resort, especially for the untrained.

Edit to add: If a tourniquet is applied, even for a short time, chances of successfully reattaching a severed limb drop precipitously. Life over limb certainly applies here.

Sources:
Gross KR, Collier BR, Riordan WP Jr, Morris JA Jr. Wilderness trauma and surgical emergencies. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, PA: Elsevier Mosby; 2011:chap 21.

Moorell D. Management of amputations. In: Roberts JR, Hedges JR, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 47.

I have been to several "field trauma" type schools recently. You do what you want, I'll use the tourniquet. Of course, since you object I won't on you.

 

[Mreed911]

I have been to several "field trauma" type schools recently. You do what you want, I'll use the tourniquet. Of course, since you object I won't on you.

Yep. TCCC was my last training. Tourniquet = time.