# BLS/Trauma Kit Advice



## will (Aug 21, 2007)

Hopefully the right part of the forum to post this.

I've got a few smaller kits around, a minor personal Trauma kit I carry daily (Kerlix, Vaseline gauze, Abdominal pads, 4x4's, 3x3's, hemostatic gauze, an Israeli Emergency bandage, Military Sam Splint, and perhaps a few other knick nacks... all fits in a small bag on the side of my daily carried pack, also BP Cuff, Stethoscope, thermometer on the other side)

Most are your typical boo boo kits (first aid with band aids) or in the case of my daily carry pack enough to take care of a fairly major wound for a short duration (I hope, everyone that's experienced has told me it's a good setup)

Anyways, I have a friend bringing me a larger pack (Stat Packs Perfusion) to check out this weekend and if I like it, will buy it from him (likely at dealer cost). This pack will be my primary vehicle carried pack to remain in my car at all times, and will also be at close proximity when involved in backwoods, and other activities where injuries will likely be more sever than usual... also for any other emergencies I might encounter in daily life.

My current training thus far permits me the use of O2, Bag Valve mask, manual ventilator, CPR, First Aid, and AED (perhaps more other things mixed in there, I know the steps of taking BP but need more practice with actually doing it.)  Eventually it will gain equipment as I gain experience/knowledge (EMT-B and Intermediate Training)

I think I know the basics of what bandages to include, I've made up a list based off of 3 of Galls most popular pre-made kits on what's included and will utilize them for what to put into my kit.

My question is what above the standard band-aids/gauze, etc, would one suggest?  O2 is likely out at least for a while, due to it's higher cost, as well as an AED (just not practical, however useful)

Thus far I'm thinking basic BP (probably an digital/semi-auto, or full auto for this pack, my other is full manual so not to worry about batteries), stethoscope, thermometer (likely digital for this pack as well), and likely an Ambu-Bag (I feel they are worth having, even if most situations might make their use difficult for a single rescuer)

O2 and Bag Valve Mask are probably good ideas, since I am a certified Diver, O2 is a divers emergency must have.  Typically I do dive with folks who have O2 on site, however not sure any have the bag valve, which would deliver the highest O2 concentration aside from the manual ventilator (which seems higher risk for damage to me, even with it's over pressure relief)

I live and work in areas where EMS response times can be as low as a couple minutes (presumably, since I live next door), to upwards of 20-30minutes in Rural Volunteer only areas, to likely an hour or more in remote diving/camping locations.

So, this kit needs to be able to support the lay rescuer (with perhaps a bit more knowledge than the average First Aid/CPR trained person) for the typical emergencies one might encounter, and the possible more major traumas/emergencies... and also allow for the future use by an EMT-B/EMT-I as well as any RN's/Nurses/MD's etc. who may be in the same location but not prepared at all or very well.

Thanks all.


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## medic258 (Aug 21, 2007)

Will,

I guess my first question is why are you buying this kit. If you work or volunteer for an agency that does 1st responder shouldn't you get the supplies through them? I am sorry if I do not fully understand. Where I live and work most EMS is full-time. However, I would take a look at what you think you will use often. I do not have a kit of my own but if I did I would include necessities only. If you try to have everything you might as well purchase an ambulance as well. Sure a few bandaging supplies are definitely worth it. I wouldn't get too crazy. 4x4's and 5x9's would probably do. Maybe a trauma dressing. A couple rolls of Kling. I would stay away from the automated BP cuffs that you can get at a drug store. The cost and reliability seem to be too much. You can not go wrong with a good old fashioned BP cuff and stethoscope. I would always manually check the BP before trusting those machines anyway. The one thing I would definitely have is sterile water for flushing eyes and wounds. I probably leave out the thermometer as well but in my region we do not use them. I hope this helps. 

--Bryan


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## will (Aug 21, 2007)

Thanks Medic.

Let's see if I can answer.  I guess reason for having it, I can come up with more reasons to have one than not to... Only reason I can think of not to, is perhaps why spend the money, and EMS is quick to respond.  

Reasons to have it: Natural Disaster, Major Emergency/catastrophe (acts of terror, etc), Major Vehicular accident in rural area, Wilderness Emergency (do a considerable amount of backwoods camping, often near vehicles, but over 1hr from EMS services), and I assist with Firearms training (though we've not had an injury above minor cuts it could happen, EMS is approx 30mins out from the 
facility)

I'm not currently EMS (volunteer or otherwise, plan on attending EMT-B classes in the Winter.) So I don't get anything from anyone in that regard.

I currently carry the Thermometer as it was recommended for the Wilderness stuff (I think more for identifying Infection)

I'll have to see if I can find some sterile water, I looked for solutions such as plain saline before, but didn't realize it was an Rx, seems most irrigation solutions are... any suggestions on locating something non-Rx?

I just don't like not being prepared, I'd rather have someone look at me strange thinking I'm over prepared, than have something happen and be wishing I had something.  I drove Long-Haul Truck for a couple years, and saw enough accidents and such, to make me wish I had a fairly well equipped trauma kit...  In the scheme of things it's a small amount of time/energy/money to spend for a LOT of peace of mind.  I've seen enough things on TV/Life of people not prepared at all or well enough to make me not want to be that person.


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## medic258 (Aug 21, 2007)

I hope I did not offend you by asking the why question as it was not my intention. I just was not sure if you would be using this kit as part of a dispatched response. As far as the sterile water thing... it does require a prescription and I have no idea as an over the counter substitute. Good luck with your kit. I hope you never need to use it...especially at the range!


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## will (Aug 21, 2007)

No offense taken Medic,  I'm with you, I'd be happy to buy this up, and never need anything (small bandage for a cut aside, or a 4x4 for a scrape).  It's possible the kit could be later used as a dispatched response, as I may join the volunteer side of our FD once getting my EMT-B and not sure if they do dispatch volunteers or just allow them to respond if nearby (I've known guys in the past who were volunteers and were assigned either radios or receivers), in which case, if they provided a kit, I'd utilize it as needed, and either store mine, or just resupply my kit as needed with their supplies.

Yeah, we HOPE to never have an accident at the range, knock on wood, we take every precaution we can, unfortunately sometimes stuff does happen... The Sheriff's Office has had 1 or 2 Accidental shootings (upon holstering) despite their best efforts, all it takes is one person not paying attention and an instructor paying attention to something else and BAM!  But then we did have an instructor cut his finger open with a knife like a goof ball, but he's done it enough to know how to deal with it (he's cut himself many times)

As for sterile water, maybe my MD will give me an Rx, he's pretty cool guy and knows all about my upcoming EMT training and the other activities I'm involved with, and might write me up a single Rx for one small bottle or something.


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## medic258 (Aug 21, 2007)

will said:


> Yeah, we HOPE to never have an accident at the range, knock on wood, we take every precaution we can, unfortunately sometimes stuff does happen...



You can't cure stupid


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## firecoins (Aug 21, 2007)

I carry a box of non latex gloves, a couple of 4x4s, 5x9s, cling, tape, cpr mask, my stethescope, a normal bp cuff, glucose, a flashlight, a flourescent EMS vest for ID, pens and a notepad.  I have only come across MVAs and some diabetic problems.  Often i need just gloves, a flashlight and the vest for personal safety of being seen.


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## will (Aug 21, 2007)

medic258 said:


> You can't cure stupid



No, but you can kick them off the property 

Thanks guys... I guess I should have said my car normally has 2 (came across a spare recently) ANSI II vests, at least one flashlight (normally have about 3 more on my person), about 10-12 30min flares, 10 Turbo Flares (LED Flare Alternative) and already have about 2-3 blankets

Also I was at the Walmart (I hate that place) picking up the latest release of House MD (Love that show, Season 3) and came across some Wound Wash in a can, said contained .9% Sodium chloride, and was Saline, in the normal OTC section, think that is worth getting since is non-Rx or something else?  I seem to recall my Wilderness book suggesting provo-iodine or something similar diluted in clean water as a wound rinse alternative.  This is the same stuff here... http://www.brucemedical.com/wounwassalst.html


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## medic258 (Aug 21, 2007)

Very true :lol:


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## Flight-LP (Aug 21, 2007)

will said:


> As for sterile water, maybe my MD will give me an Rx, he's pretty cool guy and knows all about my upcoming EMT training and the other activities I'm involved with, and might write me up a single Rx for one small bottle or something.




Hey Will, after reading this thread and remembering the conversation from the previous one, I still think there is an aspect you are not grasping. You have to have physician medical direction. That means a continuous authorization by an MD to practice as an EMT. The "Rx" will not cut it. That prescription is for your use, not to be used on others. You also must have a physician authorization to administer oxygen regardless of what training you have. Perhaps you Dr. friend would be willing to put his license on the line and work as your medical director, but before buying anything and offering any level of care beyond that of a private citizen, I would secure this very important detail. You can and eventually will run into issues down the line...................


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## rgnoon (Aug 21, 2007)

Flight-LP said:


> Hey Will, after reading this thread and remembering the conversation from the previous one, I still think there is an aspect you are not grasping. You have to have physician medical direction. That means a continuous authorization by an MD to practice as an EMT. The "Rx" will not cut it. That prescription is for your use, not to be used on others. You also must have a physician authorization to administer oxygen regardless of what training you have. Perhaps you Dr. friend would be willing to put his license on the line and work as your medical director, but before buying anything and offering any level of care beyond that of a private citizen, I would secure this very important detail. You can and eventually will run into issues down the line...................



My intent on the other thread was to point this out. I apologize if I wasn't clear, but Flight-LP is right on the money. Just having an emt card doesn't allow you to provide all of the care you are trained for. Here in NJ we have standing orders at the basic level for things where most other states require on-line med. direction. I don't know what your situation is in Oregon, but you will still need to be operating under some form of med. direction to render care other than that which a private citizen would know. Depending on local protocols, you very well may need Med. Direction to obtain O2 as it is also an Rx. I only re-iterate this as it seems my last post didn't express what I was trying to say, and that is my fault.

BTW, way to go on the PPE!, I can almost see you from here. Seriously though, if you see yourself stopping for MVAs (when under med. dir), the vest and a few flairs are a good call.


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## medic258 (Aug 21, 2007)

I must have missed all of this stuff before I replied but these guys could not be more correct. I guess I just am naive to the way the rest of the country works.


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## will (Aug 21, 2007)

Well as far as O2 is concerned, I have already been able to obtain O2, without an Rx.  The rules changed on O2 back in I think 1992 or sometime after, PER federal regs, it is an Rx, to be administered as Prescribed by an MD, except in emergencies by someone trained in it's use.  I have that current training and was able to obtain O2 under that (the O2 is for use at my Dad's company)  In an emergency anyone trained in the admistration of O2 for emergencies may do so.

That is non-professional Medical training, it's is lay rescuer training, and is allowed under Federal Law (I've checked into it considerably, and was confirmed by the gas supplier when I went to get a fill without Rx)

I totally got what you guys were saying in the previous post, I am only asking for advice on what is worth having given my current level of training... If there was anything beyond the basics of 4x4's 5x9's standard gauze, etc... that was recomended.

One suggestion was the sterile water, which as I stated I actually found .9% Sodium Choloride wound rinse in the over the counter section, and wondered if that was worth having.

I understand the Med. Directive, etc.. and have no intention of doing anything I would/could get in trouble for.

Given my current level of Normal Citizen training (non-professional) I have been trained in the use of BLS (CPR/First Aid) as well as AED, O2, Manual ventilator (with O2), and Bag-Valve Mask with/out O2.  I can legally obtian and use O2 in an Emergency (i.e. respritory distress/near drowning/decomression sickness/CPR/diving emergencies/etc)


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## rgnoon (Aug 21, 2007)

Will, I apologize for repeating myself like that. I was just afraid that I hadn't made my point effectively (I do that sometimes). We really are just trying to help. It sounds like you've got a pretty good idea of what you want in a jump kit. 

One good thing to keep in mind, and its been pointed out on this forum in the past, is that many items that are regularly carried in trauma kits and BLS bags have expiration dates (i.e. occlusive dressings). If it were found that a pt were treated expired supplies, there lies potential for accusations of negligence. This is just something that we have to keep an eye on in our personal gear.


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## firecoins (Aug 21, 2007)

rgnoon said:


> One good thing to keep in mind, and its been pointed out on this forum in the past, is that many items that are regularly carried in trauma kits and BLS bags have expiration dates (i.e. occlusive dressings). If it were found that a pt were treated expired supplies, there lies potential for accusations of negligence. This is just something that we have to keep an eye on in our personal gear.



I doubt that if you stop someone's bleeding with an "expired" bandage, you will get sued.  If your equipment works, your fine.  If it doesn't work and serious harm is caused, there is a case reguadless of the expiration date.


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## rgnoon (Aug 21, 2007)

firecoins said:


> I doubt that if you stop someone's bleeding with an "expired" bandage, you will get sued.  If your equipment works, your fine.  If it doesn't work and serious harm is caused, there is a case reguadless of the expiration date.



You're definatley right about that brian.
The main concern is just that allot of it has expiration dates for a reason. For example, we had some occlusive dressings that were WAY past their expiration date. The vaseline managed to "clump", for lack of a better word, and leave dry spots. I don't have to tell you brian that this part of the country especially can be so incredibly over-litigious, it can't hurt to have a healthy concern about this trend. We obviously can't let it get in the way of exceptional patient care, but I think it is something that we need to be aware of. 

I've hijacked this thread, sorry Will. I'm done.


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## VentMedic (Aug 21, 2007)

There have been a lot of different interpretations for the "emergency O2" OTC use.  The exemptions have been for airlines, schools, athletic clubs, LEOs, dive boats and various practitioners' offices including Chiropractors.  Using their exemption approval to obtain O2 for purposes outside of their premises/purposes may not necessarily be part of the exemption.  My health club has  "public access" O2 tanks and most of the employees have had the National Safety Council training. However, these employees can not take the O2 off the premises with the chance of seeing a cardiac arrest on the way home if they are not acting on behalf of the healthclub.  

http://www.lifecorporation.com/fda-gif.html

http://www.lifecorporation.com/cder.html

*Fresh Air "2000" - A look at FDA's Medical Gas Requirements
(excerpted summary)*
Fresh Air "2000" provides FDA's interpretation of how the minimum current good manufacturing practice (CGMPs) regulations apply to the manufacturing, filling, transfilling cascading, etc. of medical gases compressed and cryogenic. Please note this presentation is not all-inclusive.

(Edit. Note The following paragraph on page 13 provides the exemption for emergency oxygen from prescription RX requirements . Please read the "--- or for emergency use,..." phrase. It is not easy to interpret but the FDA does confirm therein that Emergency Oxygen remains Non-Prescription.
However, if a firm sells Oxygen U.S.P. to emergency medical services, i.e.' fire departments, rescue squads, ambulance companies, etc. or for emergency use, then the label is required to contain the statement: "For emergency use only when administered by properly trained personnel for oxygen deficiency and resuscitation. For all other medical applications, Rx Only."

(Edit. Note The following paragraph does appear on page 1 of 32, and it causes much confusion in the Emergency Oxygen industry, because you have to read page 13 to find the exemption.
Medical gases are prescription drugs that must be dispensed by prescription only. *Each firm has a responsibility to determine if its consignee, not the patient is authorized to purchase the drug gas, and if required, is registered with FDA, and properly licensed with the state, where required prior to selling them medical gas.*

http://www.lifecorporation.com/cder.html 
another Quote:



> (Edit. Note The following further clarifies the present policy above, in an often quoted FDA policy letter.
> In a letter dated 19 September, 1996 to the Compressed Gas Association from the FDA administration regarding the use and labeling of emergency oxygen, the FDA states: "FDA recognizes that there are medical emergencies in which there is not sufficient time to seek the assistance of a physician or hospital before the administration of medical oxygen may be necessary. In such emergencies, it is desirable that properly trained personnel ... be prepared and equipped to administer oxygen to persons in immediate need of oxygen. In these situations, the FDA believes that medical oxygen should be available. This has been the agency's position for more than 40 years."



As far as everything else in a trauma kit, I think every household should have one especially if you live in a disaster prone area or have kids. The EMS supply magazines give many good examples of a fully stocked trauma/BLS bags. You could use one of them as a model.  The earthquake and hurricane survival sites also offer examples of trauma bags.


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## will (Aug 21, 2007)

No worries, good point about the date... I got some stuff recently from a Nurse Family member, who pointed out the expiration date on much of this stuff is kinda silly (gauze for example) and much other items are still good for some time after that date (the items they gave me were close to date, but are used to send to 3rd world countries as they are still good but the hospital can no longer use them due to the date issue)

Some items, such as hemostatic gauze, occlusives, meds (antibiotics, etc) are well worth chucking after thier date... We recently bought new hydrogen peroxide as the bottle we had, had no visible date, and we thought was probably 10 years old at least... it still appeared to work, and upon purchase of a new bottle, wasn't appearing to work any better...

Based on my limited knowledge I don't think I'd see much issue with gauze/bandages past thier date.. I'm guessing they are still likely sterile... plus it's been proven from good samaritan laws, etc.. that the use of a dirty shirt is better than nothing at all, given it's all you have available.

Anyways, no problem on the repeating.. I'm sure I am a little (how to say) overly ambitious anyways about what can/can't be done.  In this instance I was just looking for advice on gear that could be used by anyone, but also have friends/family who are RN's etc... who have told me what they carry and suggest I might want to have, which is inline with my current thoughts.

 My personal belief has been for many years that there is a serious lack of pre-ems (ie professional) care in the US... we are all used to there being rapid response times, which isn't always the case, given some remote areas (much of Oregon has areas of greater than 30min response times, ie. mountains, wilderness, etc) but there is a signifigant lack of "layperson" care IMHO... CPR/First Aid Classes teach CPR (important) and then touch on basically sticking a bandaid on anything bleeding... beyond that, nada...  It seems to me simple things such as how to help someone administer thier own EPI Pen, more hands on with bandaging, shock, and likely things where EMS maybe delayed by more than 10minutes should be taught somewhere... perhaps an Advanced Layperson First Aid, or ???  There seems to be a huge gap (IMO) between CPR/First Aid and First Responder (difficult to find a course around here) or EMT-B


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## will (Aug 21, 2007)

VentMedic said:


> There have been a lot of different interpretations for the "emergency O2" OTC use....



VentMedic, that's the reason I got the O2 filled I did...  Both as training specifically to provide O2 in an Emergency, and as a CPR Instructor able to train others in much more basic use than what I've been trained to do.

The Gas filler filled a bottle owned by a company I work with for me, and other than one former Combat Medic who is now an RN I don't know of anyone at the company trained in it's use.  O2 is just too expensive to have anyways... I wouldn't mind having it in my Kit, but not about to shell out the $300 or so to get a cylinder, regulator, etc...

Sorry to create all the arguing/hardships... guess I'm good at starting topics on controversial subjects   It's my curse...  Guess I'm always a bit too gung-ho for my own good


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## VentMedic (Aug 21, 2007)

will, you have some good ideas and a lot of ambition. Get back to me in about 20 years with that same ambition and I'll put you up for Sainthood.

Again, EMS supply magazines, websites have many, many examples for trauma bags at every level and need. You could design one for yourself using them as a model. My home hurricane survival kit is probably better stocked than any trauma bag I had working Rescue.  

Good Luck!


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## medicdan (Aug 21, 2007)

will said:


> VentMedic, that's the reason I got the O2 filled I did...  Both as training specifically to provide O2 in an Emergency, and as a CPR Instructor able to train others in much more basic use than what I've been trained to do.
> 
> The Gas filler filled a bottle owned by a company I work with for me, and other than one former Combat Medic who is now an RN I don't know of anyone at the company trained in it's use.  O2 is just too expensive to have anyways... I wouldn't mind having it in my Kit, but not about to shell out the $300 or so to get a cylinder, regulator, etc...
> 
> Sorry to create all the arguing/hardships... guess I'm good at starting topics on controversial subjects   It's my curse...  Guess I'm always a bit too gung-ho for my own good



I understand where you are coming from, and I have a similar background. I am a DAN O2 instructor, and I used to be an EFR instructor (long story, for another post). I know what DAN O2 teaches in terms of the cert card being a license to carry O2, but I think that there are mitigating factors. 

My understanding is, if you want to carry O2 in your car (for diving emergencies), you need to placard your car as carrying a hazardous material, and, depending on the region, may need to secure it in specific ways. As well as DAN O2 cert, other localities may require owner/operators of O2 to hold a Rescue Diver level cert (whatever the agency). I will look into the details of this-- I remember a conversation about this on another forum (PM me and I will look for it).

Good Luck, and go for EMT training (and consider DAN's DEMT add-on program),

DES


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## rgnoon (Aug 21, 2007)

will;55684
Sorry to create all the arguing/hardships... guess I'm good at starting topics on controversial subjects :)  It's my curse...  Guess I'm always a bit too gung-ho for my own good ;)[/QUOTE said:
			
		

> No worries!! An about the expiring gauze...I agree it's ridiculous. It was just the other stuff that I was pointing out that is easy to forget about.


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## will (Aug 21, 2007)

EMT-Student, Not sure about placarding... Typically that refers to Commercial Vehicles... The DOT also has a quantity specified on items before they have to be placarded... I'll try and look it up tonight (I have the Hazmat Pocket Book) I am a Class A licensed Driver with Hazmat Endorsement... in fact my previous job was hauling welding cylinder (glad I don't do that anymore)

Anyways, I'll try and look it up. It's likely a single cylinder M size or smaller is not placarded (in fact it might have to be a 125cf or even larger to require it)... it's just like the scuba cylinders themselves... compressed air in large enough quatities is Hazmat, because it could explode in a fire, etc... but you don't have to placard your car with a compressed air sticker.

It's possible, but I've never heard of anyone needing a placard for a single O2 cylinder.  Think about all the people using it for Rx who carry it in thier car.


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## ffemt8978 (Aug 21, 2007)

Something that I think you should really consider before doing this is how much good are you really going to do on scene before an ambulance arrives?

First aid is exactly that...first aid until other resources arrive.  ABC's, C-spine, and basic wound care are about the extent of what you are going to be able to do (and should be doing) before an ambulance arrives.

There are very few items in the EMT-B's/MFR/FA certification that will actually save a life outside of the basics of ABC's, C-spine, and wound care (notice a theme here?)  At this level, all we are doing is stabilizing the patient for transport to definitive treatment.

As far as the oxygen cylinder goes, you may want to check out this thread.

POV Issues


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## will (Aug 21, 2007)

Yeah, I've hijacked my own thread DOH!.

For the O2, I found something about 1001lbs or more to placard, don't recall if that's correct or not, will have to see if I find more at home... but that's quite a bit of O2 even compressed, an 80CF cylinder won't be more than 100lbs

If youre bit about the basics is in regard to my saying I think we have a lack in training in the US...  I have no doubt the basic are the core...  Looking forward to actually learning more about them... I only see a lack in the training in the basics at a First Aid level. They cover the ABC's farily well in CPR I think but wound care usually just covers bandaging of one or 2 different wounds, and doesn't even do them justice... I've seen many people get out of a FA class and you show them something like a 4x4 and they say "I wouldn't even know what to do with that" I don't like that after FA training, you can go buy any sized first aid kit and not know what over 1/2 the items are for... most people don't know what the diferences or use of each bandage is, or the medications provided in your typical drug store first aid kit.


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## medicdan (Aug 21, 2007)

will said:


> Yeah, I've hijacked my own thread DOH!.
> 
> For the O2, I found something about 1001lbs or more to placard, don't recall if that's correct or not, will have to see if I find more at home... but that's quite a bit of O2 even compressed, an 80CF cylinder won't be more than 100lbs
> 
> If youre bit about the basics is in regard to my saying I think we have a lack in training in the US...  I have no doubt the basic are the core...  Looking forward to actually learning more about them... I only see a lack in the training in the basics at a First Aid level. They cover the ABC's farily well in CPR I think but wound care usually just covers bandaging of one or 2 different wounds, and doesn't even do them justice... I've seen many people get out of a FA class and you show them something like a 4x4 and they say "I wouldn't even know what to do with that" I don't like that after FA training, you can go buy any sized first aid kit and not know what over 1/2 the items are for... most people don't know what the differences or use of each bandage is, or the medications provided in your typical drug store first aid kit.



I understand, and agree. I carry O2 in my car when I dive (I do/did a lot of shore diving), but wasn't transporting it on a regular basis. I have the cheap DAN "Oxygen on board" sticker on my O2 box (visible from outside) because of a horror story I heard from one of my FF friends about an O2 fire in a car. 
In fact, unsecured compressed air (in SCUBA cylinders) is very dangerous and I remember reading something a few years ago about someone who transported their tanks valve-in, and ended up getting killed by a projectile when they stopped short and the valve shot off... but I digress. 

FFEMT, I also understand and agree with what you are saying, but want to disagree with one statement. I agree that in general, we should be waiting for a full ambulance and the equipment that comes with it, and that stabilization is key pre-hospital, in the specific case of SCUBA related injuries, it has been proved that the earlier O2 has been applied, the better the end result, because pre-decompression chamber, O2 is the best (and only) treatment for suspected decompression illness/sickness.


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## ffemt8978 (Aug 22, 2007)

emt-student said:


> FFEMT, I also understand and agree with what you are saying, but want to disagree with one statement. I agree that in general, we should be waiting for a full ambulance and the equipment that comes with it, and that stabilization is key pre-hospital, in the specific case of SCUBA related injuries, it has been proved that the earlier O2 has been applied, the better the end result, because pre-decompression chamber, O2 is the best (and only) treatment for suspected decompression illness/sickness.



A lot of things have better end result when the proper and appropriate treatment is given sooner, that's a given.  The point is where do you draw the line between first aid and providing medical care?  

From a first aid stand point, and please remember that is what Will (the OP) would be without an agency affiliation, carrying O2 may not be worth the liability.  

From a post by akflightmedic in the POV Issues thread:


> I was just reiterating the fact the O2 is a drug as so many people forget that and believe it is totally harmless to handle, transport or administer.
> 
> If anyone is going to carry any drug in their POV, they better have medical directors approval and also have a plan in place per OSHA guidelines (if you are OSHA state) on the storage, maintenance and care of such cylinder.
> 
> ...


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## VentMedic (Aug 22, 2007)

emt-student said:


> and that stabilization is key pre-hospital, in the specific case of SCUBA related injuries, it has been proved that the earlier O2 has been applied, the better the end result, because pre-decompression chamber, O2 is the best (and only) treatment for suspected decompression illness/sickness.



And, that is why so many organizations lobbied to get oxygen for dive companies. UHMS, AARC, FSRC, DAN and others all recognized that importance.  The dive industry as well as several other providers, including miners, needed access to emergency oxygen.

However, it was not meant for every well (or not) intentioned citizen to take a short class and then carry an O2 tank around with them in their POV.  There is so much more to learn about being a First Responder/EMT when the cause of or the injuries are not obvious.  The greater picture of scene and patient stabilization should also be appreciated.  As you know in diving, trauma, MI, CVA, just to name a few, occur frequently. Look at the diving deaths in the Florida Keys for the last 2 years. Decompression sickness actually is on the rare side compared to all the other possibilities.  But, it was a battle worth winning to get the oxygen on the dive boats. Unfortunately, the dive industry still has a ways to go in some of its other safety regulations but they are making the effort for improvement.


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## Jay114 (Aug 22, 2007)

will said:


> One suggestion was the sterile water, which as I stated I actually found .9% Sodium Choloride wound rinse in the over the counter section, and wondered if that was worth having.



Anyone have any thoughts as to the usefulness of this wound rinse? I like the idea of having something in my personal kit to irrigate with.


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## BossyCow (Aug 22, 2007)

Since I do quite a bit of backcountry stuff, I do like something for wound irrigation.  I have a small sterile water and a syringe. 

And on the first aid kit thing.  As the years go by, most EMT's personal kits get smaller, not bigger.  A lot of stuff sounds like a great idea until you have to rummage through all that 'maybe someday' stuff for the 8 - 10 things you need all the time.


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## will (Aug 22, 2007)

So bosssycow, you think that wound wash I found at the Wal-Mart is a decent one?  Seems funny that you goto an EMS supplier and Sterile water or .9% Sodium Chloride is Rx, but yet Walmart and other online sources are selling .9% sodium chloride in this bottle OTC... perhaps the FDA approved it differently due to the packaging.

As for the rummaging... I actually had a friend make a good suggestion about the rummaging bit (since he knew I had the equipment to do it)

He suggested pre-packaging mini-kits inside the larger kit using a food saver (vacuum sealer) and then write on the outside what they are for... examples were such as minor trauma, major trauma, broken bone, etc...  Not a bad idea... his reasoning was 1) no rummaging through to find certain items, they should be in the pack they would be utilized in, and 2) that if you get blood on things you don't have to throw out a bunch of unused bandages you got blood on, just wash the sealed packs off... pretty good idea I thought... now whether I'll use it or not, who knows... I might make a couple up that are generic just to keep things tidy, say 5-10 4x4's, 2 gauze rolls per package and 3-4 packs of those, or something to that effect.


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## BossyCow (Aug 23, 2007)

I know nothing about the WalMart product so I can't comment one way or another on that.  I do know that most packaging not designed specifically for EMS tends to disintegrate when you need it most.  

I think that most of the pre-packing and creating of bundles of stuff to go into kits and designing kits and thinking about what to put into kits and rearranging of kits is a nice hobby if you have the time and inclination.  I mean, they look pretty and really make you feel comfortable and prepared and everything.

You will find, if you start going on calls where you actually use the stuff, that you will be tearing into the pre-packaged stuff to get 'just one more of those' and the rest of it ends up in the mud. 

I keep a ziplock baggy with an assortment of dressings and another with an assortment of bandaging material.  To be reading the labels, with a flashlight, in the rain, the mud, on a hillside is not practical.  At least not for me.  I look, I grab, I use.


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## emtwacker710 (Jan 20, 2008)

Ive got a nice compact jump kit in my car, I've got 2 hot packs, 2 cold packs, 2 bottles of sterile water, lots of 4x4's, 3x3's 2x2's etc. a few different sizes of sterile kling, 3 sizes of OPA's, 3 sizes of NPA's (and packets of water based lube), BP cuff and scope, latex free gloves, a few different sizes of tape, emergency blanket, shears, insta-glucose, an adult BVM, a pocketmask and I can't really think of anything else, (any suggestions of anything I'm missing btw)


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## Ridryder911 (Jan 20, 2008)

emtwacker710 said:


> I can't really think of anything else, (any suggestions of anything I'm missing btw)



Yeah, a cell phone to call 911 and leave it to the responding units...

R/r 911


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## SwissEMT (Jan 21, 2008)

Okay, time for your much needed reality check and you'll have to excuse me if I'm a little harsh but there are times where it's needed.

You are not MFR, WFR, EMT, BLS nor ALS. You are no different than your next door neighbor. You operate at the same level and protocols as Bill Clinton does. You lack the knowledge of anatomy, physiology or pathophysiology and most importantly, you are not a certified healthcare provider. Whatever "training" you've received means jack @#!* because they don't need your rescue ranger doodads, they need an ambulance 5 minutes ago.

Unless you have an ambulance with you, you can bring no more to the table in an emergency than J Edgar Hoover could.
How can you save a life? Whip out your damn phone and dial 911 and let them do it. 
You're talking about carrying all this junk in some high-speed low-drag bag with fancy names yet all of it is worth absolutely nothing if you don't have the knowledge to use it and AN AMBULANCE TO TRANSPORT IN.

You find yourself encountering a person injured, but what do you know that others around you dont? 
If there's lots of red stuff coming out, stop it. If they're pulseless/apneic, do CPR. Great, my 7 year old cousin can do that. 
So what the hell makes you think you need a 200 dollar go bag with a BVM and BP cuff?? And you're talking about having oxygen too? Dude, you've got to be kidding me.
Let's say, somehow you end up carrying a D-cylinder in your kit. You have 1000psi. Want to know what that'll bring you? 8 minutes of oxygen at 15lpm. If your patient is alive for 8 minutes, chances are you probably shouldn't have touched him, since he could have made it fine without you.

I'll say it again, HE NEEDS AN AMBULANCE.
You'll say "hey a$$hole, what do they do that I can't do?"
One word: *MOVE*
They're actually going in the right direction, that being an ED or an OR.

Keep a cellphone, a pair of gloves and a CPR mask with you and stay in your lane.
Sure, call me the a$$hole of the site, but someone needs to say it. You need to understand that you're not gonna save a life with any of this stuff. A patient who is circling the drain isn't in need of what you've got, he's in need of someone who knows how to stop it all.


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## emtwacker710 (Jan 21, 2008)

well I don't really need to call 911 as I am one of the units that respond when they call my FD for 1st responders, or on my duty night at the squad I go directly to the scene, and since we are all vol. some nights it can take 10 minutes to get a crew for the rig and to get to the scene


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## emtwacker710 (Jan 21, 2008)

SwissEMT said:


> Okay, time for your much needed reality check and you'll have to excuse me if I'm a little harsh but there are times where it's needed.
> 
> You are not MFR, WFR, EMT, BLS nor ALS. You are no different than your next door neighbor. You operate at the same level and protocols as Bill Clinton does. You lack the knowledge of anatomy, physiology or pathophysiology and most importantly, you are not a certified healthcare provider. Whatever "training" you've received means jack @#!* because they don't need your rescue ranger doodads, they need an ambulance 5 minutes ago.



actually I am a NYS certified EMT-D thank you very much


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## SwissEMT (Jan 21, 2008)

emtwacker710 said:


> actually I am a NYS certified EMT-D thank you very much


My reply isn't directed towards you.


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## ffemt8978 (Jan 21, 2008)

I think everyone should take a deep breath and relax a little bit.


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## emtwacker710 (Jan 21, 2008)

SwissEMT said:


> My reply isn't directed towards you.




ok, I apoligize, the way I read it I thought it was, sorry..


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## daedalus (Jan 21, 2008)

Personal jumps kit: Cell phone, pocket mask, common sense.

Need to be fancy; your hypoglycemic friend could also drink a soda instead of a tube of glucose from a bag in your car.

All you need until an ambulance arrives is those three things: cell, pocket mask, common sense.

If your in a very remote area or backpacking/camping: throw in some OTC medications and some bandages/dressing. Whats a bag of airways and BVMs going to do in a remote area? By the time a defibrillator gets there your guy is gonna be dead and asystole anyways.


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## daedalus (Jan 21, 2008)

will said:


> VentMedic, that's the reason I got the O2 filled I did...  Both as training specifically to provide O2 in an Emergency, and as a CPR Instructor able to train others in much more basic use than what I've been trained to do.
> 
> The Gas filler filled a bottle owned by a company I work with for me, and other than one former Combat Medic who is now an RN I don't know of anyone at the company trained in it's use.  O2 is just too expensive to have anyways... I wouldn't mind having it in my Kit, but not about to shell out the $300 or so to get a cylinder, regulator, etc...
> 
> Sorry to create all the arguing/hardships... guess I'm good at starting topics on controversial subjects   It's my curse...  Guess I'm always a bit too gung-ho for my own good



Do you know what hypoxic drive is? How about what COPD is? The difference between hypoxia and hypoxemia? What oxygen toxicity is? Why oil is dangerous around o2 bottles? The indications for o2 therapy and the rates in LPM to use for specific complaints from the patient? Do you know at what point to take off the NR mask and use positive pressure ventilation? If not, please don't carry an o2 bottle around with you.


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## laina66 (Jan 22, 2008)

Hey,
I have a personal bag..it includes all the things one would generally need for trauma or medical assessment. It's really only importnt to have things such as gauze, tape, bp cuff, steth, survival blanket, centerpunch/seatbelt cutter, trauma shears, kelly forceps, bandages, rubbing alcohol/ peroxide, alcohol swabs, a notepad, and PPE. Mainly, if you are driving down the road and you see someone hit a tree and star their windshield, you will be able to care for them until further help arrives. If your area also allows, you can carry baby aspirin or low-dose aspirin if someone is experiencing chest pain...although you would have to have a standing order in your area and notify the EMS agency when they arrive that you administered such and suc a drug at such and such a time...and supply them with your EMT #, etc.
Don't go all out on the bag because chances are...you're not going to need all the extras. Basics, basics, basics.

Good luck...Stat Packs are awesome. B)
-L


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## TKO (Jan 22, 2008)

daedalus said:


> Do you know what hypoxic drive is? How about what COPD is? The difference between hypoxia and hypoxemia? What oxygen toxicity is? Why oil is dangerous around o2 bottles? The indications for o2 therapy and the rates in LPM to use for specific complaints from the patient? Do you know at what point to take off the NR mask and use positive pressure ventilation? If not, please don't carry an o2 bottle around with you.




Phht!  I'm sorry but that's just elitist rant.  Better questions are "Do you know the indications for supplemental oxygen?" and "Do you know of any contraindications for supplemental oxygen?".  O2 is fine for the most simple of people to administer safely.

Give O2 by low-flow when there is a serious injury, internal pain, head injury, and inadequate respirations or cyanosis.  Low flow isn't going to be harmful to anyone and is safe for all first-aid uses until EMS arrives.  

When giving low-flow O2 by nasal, there is only one contradiction that I can think of and that is around open flame.


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## laina66 (Jan 22, 2008)

Carrying O2 and such is a bit much...but a little bag of some gauze and stuff isn't a bad thng to have in your car...And actually we are trained more than the average bystander...and we would know to record :censored::censored::censored::censored: that goes on and relay it to the frst to respond...time is really all that matters...so if u call the FD/ambulance and in the mean time hod a wound with gauze and get any info you can from them its a big help---not to mention that if they're losing a :censored::censored::censored::censored:load of blood theres a chance of them not being able to answer these qustions in the 10 minutes it could take EMS to respond...
Basics only...but they are a good tool.
Plus...I like to have my own BP cuff and Steth b/c a litmann is a hell of a lot better han the :censored::censored::censored::censored: they carry on the bus and if theres more than one thing going on...guess what...theres only one regular cuff in the bag.

I dont know why poeple are getting so annoyed by this. If one wants to carry stuff, let them.


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## TKO (Jan 22, 2008)

That's my point.  If you want to carry everything possible, go hard.  Someone may one day appreciate it.  But just remember that no matter what your certification, after work we are all first-aiders and don't go too beyond that (unless you are allowed....I am, but I don't carry any IV equip around with me, for example).  And I am not going to.

Dressings and pocket mask with a stethoscope.  That's all I really need (tho I do have a full 1st aid kit) because I just need to manage the life threats on the spot, the rest can and should be managed by EMS.  I know I hate to have to undo some first-responders bandaging to get a look at a wound and then be sure it was properly cleaned and wrapped, etc.  That's just too much discomfort for a pt to have to go through.  The responder feels good about their skills until I have to undo it.  

Don't try to fix everything; just control the problem until I get there, and I'll do the same for you.


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## Ridryder911 (Jan 22, 2008)

Couple of things... If one is carrying a oxygen and administers it, one better have either standing orders from a licensed physician to administer it. It is a *drug and medication* (medical gas) and even carrying it is a Federal violation without a prescription. Yes, it is that serious! 

The same with any medical device.. cervical collars, etc.. they are prescribed devices, to be used per service protocols and if one reads the label will find out it requires a licensed physician to authorize it. 

Be sure to know things before one assumes anything...

R/r 911


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## TKO (Jan 23, 2008)

Well, I know better than to argue c Rid.  He knows the American system better than I ever will.

For Canuckians, never fear!  Our system protects good samaritans c training.  And in BC, we can practice as good sams the same as we can on car.


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## daedalus (Jan 23, 2008)

TKO said:


> Phht!  I'm sorry but that's just elitist rant.  Better questions are "Do you know the indications for supplemental oxygen?" and "Do you know of any contraindications for supplemental oxygen?".  O2 is fine for the most simple of people to administer safely.
> 
> Give O2 by low-flow when there is a serious injury, internal pain, head injury, and inadequate respirations or cyanosis.  Low flow isn't going to be harmful to anyone and is safe for all first-aid uses until EMS arrives.
> 
> When giving low-flow O2 by nasal, there is only one contradiction that I can think of and that is around open flame.



Pardon me, TKO, but I disagree. You should know what your doing before you treat somebody with something. I have no sense of being better than anyone else.


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## VentMedic (Jan 23, 2008)

Let me repeat the rules for Emergency Oxygen use in the U.S.  Oxygen of Emergency use can be located in many non-medical places for use in an emergency by a lay person who hopefully has taken a basic O2 delivery course.  O2 is considered non-perscription in an emergency but that does not mean just anyone can purchase O2 and use it for whatever.  I am also an RRT as well as a Paramedic for many years and have yet to take Oxygen home with me.  



VentMedic said:


> There have been a lot of different interpretations for the "emergency O2" OTC use.  The exemptions have been for airlines, schools, athletic clubs, LEOs, dive boats and various practitioners' offices including Chiropractors.  Using their exemption approval to obtain O2 for purposes outside of their premises/purposes may not necessarily be part of the exemption.  My health club has  "public access" O2 tanks and most of the employees have had the National Safety Council training. However, these employees can not take the O2 off the premises with the chance of seeing a cardiac arrest on the way home if they are not acting on behalf of the healthclub.
> 
> http://www.lifecorporation.com/fda-gif.html
> 
> ...


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## daedalus (Jan 24, 2008)

Its not the toys that make an EMT but her/his knowledge. This is a whole other topic, but make yourself better, read into things above your level and learn. If someone is in distress, you just may be able to figure out whats wrong, call for help, and support that person until help arrives. Thats the best thing you could possibly do for someone.


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## BossyCow (Jan 24, 2008)

I've said it before and I'll say it again, carry as little as possible (Gloves is my big must-have) and stand next to a fully stocked newbie who has every gizmo known to Galls.


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