I gave myself a nasty cut the other day and it led me to take another look at the medical kit that I carry with me. My kit was sufficient on the day but I identified a number of deficiencies and improvements that could be made.
Here is my cut, not the worst but it required attention, I could not just shrug it off and continue as it was producing a lot of blood and was somewhat open in nature and would needed to be closed.
To cut a long story short, I messed up, in-spite of years and years of using sharp tools to work with, I was sleepy and not feeling very well at the time and was complacent. I was working at an awkward angle the knife slipped out of the work piece that I was carving and into my hand. It didn’t hurt, at all in fact but I was aware that something had gone badly wrong. So with only one good hand and the other dripping blood at an alarming rate I fumbled around for my first aid kit that was close to hand thanks to a habit that I have formed of always having a first aid kit with me when working with sharp things.
It has to be said at this stage that I could not open and retrieve the items that I wanted to with one hand and when i used both hands, I got slippery blood on everything that made it even harder, you see, over the years several useful items have been added to my basic first aid kit, things that I have found useful and decided to carry around such as a small amount of pain medication, antihistamine cream for bad insect bites, Oral Rehydration salts, Sun Block, Lip Balm, Super Glue etc.. My First aid kit had become stuffed to bursting of useful things that can help with a wide range of scenarios from good health, pain management, blisters, small cuts, burns, and more serious bleeding and trauma wounds.
After it was all sorted out, I took a look at the bloody mess and wondered what I could have done better and if there were any improvements to be made. It also did not escape me that the cut was within 5cm (couple of inches) form the Radial Artery in my left wrist.
I identified some areas of concern.
- An easy way to get into this kit and find the items that I wanted
- Enough absorbent material to handle the large amount of blood being produced by the wound
- Too much other stuff getting in the way eg; plasters (band aids), ointments, pills and other general first aid related stuff that was not needed in this time critical moment.
- No way to close an open wound, certainly not one handed either
- The First Aid Kit bag (a small dry bag) was too tight fitting, I had to shake it all out onto the floor
Most, if not all, commercially available First Aid kit´s cater for very basic first aid scenario´s and not for minor or even major trauma.
When working with sharp knives, axes and saws we are now exposing ourselves and each other to a new risk that is outside the scope of a normal first aid kit. Those 9 triangular bandages and a packet of plasters (Band Aids) are not going to help much.
I already carried items designed to handle trauma but realised that it was too spread out and difficult to locate and use while under stress, in shock, bleeding and one handed, which is likely going to be the state that you are in should you also need to manage this scenario.
Let me just say that in all the years that I have been using knives, I have had 2 serious cuts, both of which were caused by my own complacency and both of which occurred on my left hand (I am right handed). Simply put, most of the time while using a knife, it is your off hand that is at the highest risk of being in the way when the knife slips.
So what changes did I make? All of my medical items were in one medium sized kit, stuff into a dry bag and often with an H bandage and Tourniquet attached to the outside as these are large items that will not fit inside.
I realised that I needed to separate those everyday first aid items and trauma kit items into two separate kits with the following philosophy in mind,
- Seconds count
- The kit must be able to treat minor and serious injuries in the absence of immediate evacuation to a hospital (in remote locations, this is not always possible)
- The main threat that the kit needs to address is knife, saw and axe wounds, not gunshots as this is not within our threat sphere
- It must be able to be opened and items retrieved one handed.
- It must be small enough that it can be carried readily without encumbrance .
- It must be light enough that it is not looked upon as an item to save weight on when there is a desire to reduce the overall weight of what I am carrying
When deciding which sized bag or pouch to use, it is helpful to first get together all of the items that you want to put in a bag and then buy a bag to meet that requirement. The danger is that if you buy a bag or pouch first then you will just fill that up no matter what and worse still it may not be big enough.
I found two decent quality pouches for this and choose in the end to go with the Maxpedtion FR-1 Medical Pouch. The other one that I tried was a One Tigress Admin Pouch. Both were good but the Maxpedition FR-1 was slightly bigger (deeper) and therefore less of a squeeze to put everything in although it does all fit in both of them. Another advantage of the FR-1 is that it has a grab handle at the top which is very useful when trying to get hold of it in an emergency.
I will start at the top left and work my way across left to right.
- Small Petzle LED headlamp
- Small roll of flattened Gaffer Tape (Duct Tape)
- Pair of gloves
- 2 packets of Celox ¨quick clot¨ haemostatic clotting agent. Used for heavy arterial bleeding. Note the ¨Tabs¨ of gaffer tape that I have added to make them easier to pull out of the kit. When an artery has been cut, seconds really do count and fumbling around is a waste of time.
- Scalpel Blade + folding handle
- A selection of pre made suture kits. Each packet contains a length of silk or mono filament with a little curved needle pre threaded. These are for closing deep wounds.
- Needle nosed tweezers with an ear plug stuffed onto the end to stop them from piercing other things in the kit
- A cyalume stick for additional light when needed
- Tube of super glue, also used for closing wounds
- Big shears for cutting clothing away
- 2 H Bandages (Israeli bandages). Highly absorbent bandages with the ability to tighten down by means of an H shaped piece of plastic. I have two because if the wound is enough to need one of these then it will certainly need a second one soon afterwards.
- 2 gauze bandages
- 10 packets of steri strips. These adhesive strips that can be used for wound closures. I have so many as I found that they tend to come off quite easily and require replacing frequently
- A selection of different sized, low absorbent dressings. These are placed on the wound and bandaged over with item 13.
- A couple of butterfly stitches, similar in use to Steri Strips but a different size and shape which can be useful on different areas of the body where the other strips don’t work well
- A couple of antiseptic wipes. For cleaning.
- A couple of plasters, I don’t know for sure what these might be used for but it seemed like it wouldn’t hurt to throw these in.
- Large waterproof plasters
- Small Low Absorbent dressings
- An airways / breathing mask. Should this kit be used on somebody else, it is not unreasonable to foresee that they may, at some stage, stop breathing. People are more likely to offer ¨the Kiss of Life¨ if they won’t get blood or vomit and whatnot on them. I have so many of these things laying around that I threw one in, just in case.
- On the outside of the pouch, I have a CAT (Combat Application Tourniquet or TQ). These are bulky so putting them on the inside was not possible but also, if you need a TQ then you will need it very quickly indeed and having it attached with bungee cord to the outside means that it can be retrieved very quickly. There is some danger that it may be lost if attached to the outside so we must be mindful of this.
It all fit´s neatly inside and overall is a small package and is very light. It should be noted that this is not a First Aid KIt. It does not replace a First Aid Kit and complements my existing first aid kit. What this does is ensure that I have life saving items easily available and close at hand, that can be used one handed, is not too big or too heavy, is configured to meet the risks associated with sharp tools and can treat a nasty injury in the absence of a hospital or the means to travel to a hospital immediately.
My main First Aid Kit is still very useful and important but it does not need to be as readily accessible and easy to sort through as this Trauma Kit so it can stay in the top pocket of my rucksack where it always lives and I can take the Trauma Kit out when I start using sharp tools.
You probably know this already but just in case you don´t, having a medical kit with you, trauma or first aid, does not compensate for a lack of training or knowledge. It is extremely important that you know how to use the tools contained within this kit and indeed how to react to the things that the body does when injured. I consider medical training to right up there as one of the most important skill´s that we can have. It is my contention, that you should too
I often ask my students where their First Aid Kit´s are and invariably receive the same reply – ¨In my bag¨. Your first aid kit is no good in your bag, which is often back at camp or ¨over there somewhere¨. When you are working with sharp tools, you must have your kit close to hand so that when you or somebody else needs it, it is right there within arms reach so that no time is wasted while you search for it.
Get into the habit of picking up your first aid kit when you pick up that knife or axe. Eventually this will become second nature and it will be there when you need it most.
Finally, Do not skimp, your life could be at stake here and you want the very best quality that you can find. Your kit should be configured to meet the threats that you are most likely to face. This is for working around sharp tools, it is not a general first aid kit, I carry one of those too which will be covered in another post.