One of the most common questions that I am asked on a regular basis, is “What should I put in my first aid kit?”
The reality is there isn’t a direct or simple answer. First aid kits come in a variety of shapes and sizes – and not one size fits all. Before we can even think about what you’re going to put into a first aid kit, we need to think about three things: size/weight, training and needs.
One golden rule, is that if you don’t know how to use something, or are not authorised to use it, there is no point carrying it.
Before we delve in, let’s start by taking a look at the absolute minimum, and answering the question, “What can I carry that will directly save a life?”
The list is nowhere near as long as you would expect it to be. In fact, there are four items that will directly save a life, two of which you may not have in your kit, depending on cost and space sensitivities and laws in the country in which you operate.
In this first part, let’s explore those items that will help you save a life, and in a subsequent article, we will address everything else.
1) Disposable Examination Gloves
The first thing that will directly save a life is disposable examination gloves; and the life they may save is yours. One of the first things we talk about in first aid is assessing danger and the order of priorities in doing so. Keeping yourself safe is paramount and importantly, this includes keeping yourself safe from infection. A big part of our approach to this is BSI, or body substance isolation through the use of appropriate PPE, or personal protective equipment. Remember: if it’s wet or sticky and not yours, you don’t want it on your skin. There are several types of gloves that you can use for this purpose, most of which will do the job in some way, shape or form, but not all disposable gloves are equal.
First, consider material. There are three common materials from which disposable examination gloves are made: latex, vinyl and nitrile. Some patients can be allergic to latex, even to the point of anaphylaxis, so I recommend avoiding latex gloves. Nitrile gloves are made from a synthetic rubber and generally have a higher puncture resistance than latex or vinyl gloves, and also have better chemical resistance. The one downside of nitrile gloves is that they are a single use item, and very slow to biodegrade, and thus have an impact on the environment. That said, there are some companies who now make biodegradable versions of their nitrile gloves. As well as being less resistant to puncture and chemicals, latex gloves can also offer less dexterity due to a looser fit.
Disposable gloves come in both powdered and non-powdered varieties. Powdered gloves are quicker and easier to don and doff and are favoured in medical clinics and hospitals. Non-powdered gloves are favoured in environments such as operating theatres and when performing wound care, as the corn-starch powder can contribute to allergic reactions and also skin sensitivity for the wearer.
Consider the three gloves in the image below. The glove on the right is a common, thin, examination glove made from nitrile rubber. Whilst this glove might be light weight and suitable for clinical purposes, it is by far the thinnest of the three gloves pictured and most susceptible to self-destruction mid use. The glove in the middle is also made of nitrile rubber but is a sturdier (thicker) variety favoured by EMS personnel as it is far less prone to disintegrating whilst you’re in the middle of assisting a patient. The glove on the left, however, is a common dishwashing glove. Dishwashing gloves are generally made from a blend of latex, neoprene and nitrile; however, you can find latex free offerings if you hunt around. As with most things, horses for courses. I’d generally look for a sturdier nitrile glove as the default for my first aid kit, but in wilderness situations or the back country, would tend towards something a little sturdier, like a latex free dish glove. These give less dexterity but are going to be considerably hardier and more reliable in a more demanding situation.
2) CPR Barrier Device
In much the same vein as gloves, a CPR barrier device is designed to prevent infection from passing either from the rescuer to the patient, or vice versa.
There are four common varieties of device, with costs and benefits varying widely.
The face shield is a relatively simple, low-cost device that usually comes in a small pouch that hangs from your keychain. They are designed to be simple to use, affordable, lightweight and small. Studies have shown however far lower percentages of successful ventilation at first attempt with face shields than with pocket masks. A face shield is generally a clear plastic sheet, with a one-way valve to prevent any fluids from passing between the patient and rescuer. It should however be noted that these valves will not prevent pathogens (such as COVID) from passing between patient and rescuer, or vice versa.1 When using a face shield, you need to pinch the patient’s nose shut to create an effective seal.
Face shields are great for personal, every day carry for example on your car keys, but I’d recommend investing in one of the latter three types for inclusion in a first aid kit.
The pocket masks also have a one-way valve, are a little bulkier and a little more expensive, but at least one study on the matter shows them to be over 400% more effective at facilitating successful ventilation at first attempt. Some pocket masks are single use, and others can be reprocessed in an autoclave. That said, circa $20 is not an expensive sum to potentially save a life. When using a pocket mask, the mask goes over the patient’s mouth and nose, meaning you do not need to pinch the patient’s nose shut in order to create a seal. You do however have to use a reasonable amount of downwards pressure on the mask to create an effective seal.
The intra-oral mask is somewhat obscure and far less popular than the traditional face mask, however studies have shown it to be more effective again. Intra-oral masks are fitted behind the gums of the patient in much the same manner as mouth guard, and have a one-way valve and tube which extends outwards, through which to provide ventilations. Because this device goes into the patient’s mouth and not across it, you will have to pinch the patient’s nose shut in order to create a seal. The intra-oral masks have been shown to provide a greater tidal volume (amount of air) with less leakage – meaning they are theoretically more effective. One common brand of intra-oral mask is NuMask. NuMask ships their intra-oral masks with a oropharyngeal airway, but if you haven’t been trained in OPAs, then you can use the mask without one.
The final variety of cpr barrier device is a bag valve mask. The mask itself works in the same manner as a pocket mask, but instead of breathing into the mask, it’s attached to a plastic chamber which when squeezed, delivers air through the mask to the patient. These can take some getting used to and require additional training. That said, if you’re out and about, and responsible for the provision of first aid, investing in this equipment and the requisite training will mean that should someone need CPR you can provide both compressions and ventilations without the risk of exposing the rescuer to pathogens such as covid.
1 See current recommendations from the Resus council in your country/region. Most are currently recommending hands-only CPR.
3) Automated External Defibrillator
An AED is an electronic device that can be attached to a patient’s chest in the event of cardiac arrest and will significantly increase the chances of the patient surviving. AEDs are becoming increasingly simple to use – you simply open the case, turn it on and follow the voice prompts. There are two common dysrhythmias of the heart, where CPR alone is far less likely to have a positive outcome, and what the patient really needs is defibrillation. When you attach the AED pads to the patient’s chest, the AED assesses the patient’s heart rhythm, more specifically looking for what’s known as a shockable rhythm (ventricular fibrillation or pulseless ventricular tachycardia). If one of these rhythms is present, the device issues a high-powered electric shock, which stops the heart in the hope that the heart will restart in a more organised and functional manner – not dissimilar to rebooting a computer. AEDs are becoming more affordable and really do make a difference. Whilst I might not choose to carry one on a lightweight expedition, I would certainly have one in my hut or in my provisions for a jamboree or large residential event.
Epinephrine is a natural substance which is produced in the body, and released in response to stressful stimuli, resulting in increased heart rate, muscle strength, blood pressure and sugar metabolism. Epinephrine is also known as adrenaline (one being Latin, the other Greek) and is the definitive treatment for anaphylaxis.
Anaphylaxis is a life-threatening allergic response caused by histamines, in which the airway swells shut, and the blood vessels become permeable, allowing fluids to migrate out of the vessels. Antihistamines alone will not reverse anaphylaxis, as they only target the excess histamines that have already been released. Epinephrine on the other hand, stabilises the mast cells, preventing them from producing more histamines, as well as working to reverse the other effects of anaphylaxis.
Epinephrine is a controlled substance in many countries, and available over the counter in others. It is most commonly sold in auto-injectors (EpiPen) and is usually prescribed by a physician. At the very least, you should be performing medical screening on your participants to identify allergies (amongst other things), and ensuring that where a history of anaphylaxis exists, appropriate risk management takes place, and Epinephrine is available. In some countries where this is a controlled substance, it will be provided by the participant or their parents, and in other countries where it is less controlled, it may be available either under medical control or directly from pharmacies. Epinephrine is also available in ampoules or vials at a miniscule fraction of the price of an EpiPen. Depending upon the regulations in your country, it may be worth considering investing in additional training to make this an option for your organisation. Programmes such as Wilderness Advanced First Aid and Wilderness First Responder, by Wilderness Medical Associates include training in the administration of intramuscular injections of epinephrine.