Medical Aid Bag Considerations Jun 15,2017

Medical ( Trauma - What you need to know prior to treating your first patient )

Medical Aid Bag Considerations

By Patrick O'Neil, PA


So let's start off by saying that I really dislike this subject.  I mean, I REALLY dislike this subject.  It's not that I dislike Aid bags; for many years they were a constant companion by my side.  That is how I made my living as a medic and then as a PA.  The reason I dislike this subject is because everybody has an opinion on how big it should be, what needs to go in it, and how it should be packed.  Everybody is an expert and they all feel their way is the best way.  If I lined up 5 very competent medics, gave them all the same Mission Briefing; I would end up with 5 different aid bags, each one packed differently.  And each one of those medics would be able to defend their choice of bag and their choice of packing list that went into that bag.

The bottom line is this: There is no one perfect aid bag, packing list, or organizational technique for an aid bag.  The old adage, "There are a hundred ways to skin a cat" is very appropriate when discussing this subject.  There are, however, some basic considerations that do apply.  If you apply these considerations, this will greatly assist you in selecting the type of bag that you need, what needs to go inside that bag, and maybe how to pack it. With that being said, let’s start with the basics.

1.  Number of personnel to be treated?  Is the medical bag going to be for my own personal medical sustainment; or will the bag need to take care of a small group of people?  If it is for my own personal use, I may be able to get along with a small bag, like the military's Individual First Aid Kit (IFAK).  If I need to be prepared to treat more individuals, then the size of the kit will depend on the number of people I expect to treat.

2.  Purpose of the bag:  Major trauma, minor injuries, medical illnesses, etc.  Also think of "Most Probable and Most Dangerous."   In other words, “The things that I am most likely to see; and what is it that is most like likely to kill me?”  This can get a little complicated, so let me give you a few examples.

If I am going on a day hike, "Most Probable" and "Most Dangerous" are both forms of trauma.  I'm going to have a small first aid kit that is built entirely around sprains, fractures, bleeding, and hypothermia.  This is probably what I'm going to experience should I roll my ankle, slip off a ledge, fall as I am crossing a stream, or get attacked by an animal.  I'm not going to pack for vomiting, sniffles, sore throat, etc.  Same thing with my vehicle aid bag.  The purpose of the bags dictate that trauma will be my greatest concern.

For my home Aid Kit, that's a totally different matter.  My "Most Probable" will now be routine illnesses, common colds, simple cuts and scrapes.  My "Most Dangerous" will be major bleeding, possibly a burn from boiling water or grease, or a possible fracture from one of the kids playing outside.  In this situation, I will actually have two different kits:  One for common illnesses and another for trauma.  If you want to kill about 5 hours one day, start looking up the myriad of different home first aid kits available on the market.  Then take a couple of Tylenol when your head is ready to explode from looking at the plethora of different products available.  For those that want to skip that mess, I have a few sample packing lists available, and then you can customize it to your liking.

3.  Duration of treatment?  Do I need to sustain the patient for a few minutes, a few hours, or a few days?  If it is just for a few minutes, then I am going to prepare for life-saving, trauma management only.  Major Bleeding, Airway management, and respiratory emergencies.  These are "Load and Go" situations where you provide only the necessities of life sustainment and then the patient is off to the hospital. 

If we are talking about hours or days, now I will have to think about Hypothermia, infection, volume replacement, wound care, fracture management, etc.

4.  Do to I have any size limitations for the bag?  Obviously, if I'm going on a hike, I will need to be able to put that medical kit in a backpack or on my person.  Canoe?  Personal vehicle?  Or, is this a kit that will be maintained at my house? 

I have been on combat missions where the insertion technique did not permit me to carry more than a rudimentary Aid Bag and one small litter.  My planning indicated that we had the possibility of sustaining several casualties, but due to size limitations placed on me, I had to modify what I took along with me.  It would have been nice to have a Medical vehicle, but that's not an option sometimes. 

5.  Skill level of the person utilizing the bag?  The higher your medical skill set, the more medical items you are trained in using.  It also means the tendency will be to pack for everything you have been trained to do.  Avoid that thought like the plague. It is easy to over pack a bag and you will find yourself carrying 100 pounds of “lightweight” medical equipment.  Keep it basic.  Most of these items for home or field trauma use don’t need to be very complicated. 

6.  Refrain from items that have only one purpose:   I dislike ready-made kits that only have one function.  A good example would be a Cric Kit that has everything I need to place a temporary airway through the skin of the neck and into the trachea; allowing the patient to breathe when his own airway is closed.  Now, don’t get me wrong, it’s a great kit….if I have enough room for it.  When weight and size limitations are placed on me, however, this is the first thing staying behind. Instead of a Cric Kit, I will carry a couple of Endotracheal Tubes that if need be, I can cut down and fabricate my own little Cric Kit.  Specialized bandages, eye patches, and things that have only one function are rarely ever found in my own personal Aid Bag.  Always ask yourself, “Can I do the required task with an item I already have?”  If the answer is “Yes” then you can do without the single purpose item.

7.  Compartmentalize:  When possible, you want to keep like items together.  I try to maintain all my Airway items in one area, Breathing supplies in another, Circulation in another, etc.  You can do this by placing the items in small bags, or pouches, and labeling them.  You are probably asking yourself, “Now, Pat, why in the world do I need to put all my like items in compartmentalized bags, or areas?”  Good question!  Because I can almost guarantee you, that when the excrement hits the oscillating wind blower…..most people are going to absolutely lose their minds.  They start to go into sensory overload and cannot think straight.  They start fumbling around, losing their train of thought, losing their treatment sequence, etc.  Compartmentalization not only keeps things organized, but it organizes things in a pre-determined manner within the bag.  The first pouch you come to should have all the immediate lifesaving items of massive hemorrhage.  Second pouch is all your airway items.  Third pouch is your Breathing/Respiration bag. Fourth should be minor bleeding.  Fifth is for hypothermia prevention.  (We will get to the treatment sequence in other articles).

I have seen Combat Medics with 20 weeks of trauma training lose their minds when faced with major trauma for the very first time.  It happens to a lot of folks.  It will happen to even seasoned professionals once in a while.  You will temporarily lose your train of thought and start second guessing, “OK, where in the hell am I at?”  “What is the next step I should be looking at?”  That’s OK.  Don’t worry about it.  If you have all your stuff compartmentalized, look at what bag you were using…..see if you still need to continue utilizing it.  If you were working on Airway and you now have that secured and under control; well, time to move on to the next pouch/bag….Breathing. 

This concept is so important that entire products have been designed to incorporate it.  They come with ready-made pouches that Velcro right into a Trauma Roll or Aid Bag.  Or, you can simply make your own pouches out of Ziploc bags and pack them however you want to.

8.  Rotate your stock annually:  Supplies wear out.  That is a fact that you cannot ignore. This is especially true if your aid bag is subject to temperature and humidity changes.  Vehicle Aid Bags are subject to incredible temperature changes that can occur within a 24 hour period.  These temperature changes lead to condensation on the inside of most of the packages.  Adhesives stop working, bandages will start to dry rot and experience failure, etc. I vividly remember a training scenario where my equipment was failing as I tried to apply the bandages.  The tails of the dressing were ripping when I applied even minimal amounts of pressure, all because of dry rot from condensation. Luckily, it was a training event, and I learned a valuable lesson.  If it had been actual trauma, well, the ending of that story may not have turned out well.

Don’t look at replacing your stock as if you are wasting money.  I like to look at this with a lot of gratitude.  I’m very thankful that I did not have to actually use those supplies on a family member or a close friend.  I also look at stock rotation as a training opportunity.  It is a great time to practice trauma scenarios, refresh your memory, and get your hands accustomed to using the actual supplies you will have available in a real world event.  I don’t care who you are… never have enough training.  I train until I can use that bag in the dark, no light source available; and I know where every piece of equipment is and how to use it.  It’s on autopilot.  It has become second nature.  I’ve practiced it so many times, I don’t even need to wonder if I am doing it right or not.  You should strive for the same thing.  Practice DOES make perfect

If you apply these considerations, you should be in pretty good shape for most events.  Make sure you have the proper equipment, the proper training and skill set, and the proper mentality.   

Always Remember:

► Bad things can happen to good people

► Preparation can lessen the bad effects on good people

► Amateurs train until they get it right.  Professionals train until they can’t get it wrong

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