2011-06-20_23-22-43_805

Yesterday I talked about a med kit that’s being offered for sale that isn’t up to my standards. What followed in the comments was a pretty good conversation about the benefits of clotting agents, the appropriateness of duct tape and some really good suggestions as to what makes an “ideal” med kit for every day carry or to take to the range. Wanting to capitalize on that discussion, Dan asked me to write a quick article about what I’d include in a small, medium and large first aid kit. Here we go . . .

The basic concept behind different sized kits is that you want to start with the worst case scenario, include the items required to deal with that situation, then add additional items as space allows to deal with more minor situations. The same interventions that work well on major trauma tend to also be effective for minor injuries as well, but not the other way around. An Israeli bandage will work fine on smaller cuts, but a 2×2 piece of gauze isn’t going to work very well when you’ve sliced your leg open. So, when you’re making your kit, just remember to start from the top of the list and work your way down.

Minimalist (EDC) Kit:

  • Triangle Bandage – $1
    There are very few things in the medical world more useful than a triangle bandage. Tourniquet? Sling? Pressure dressing? A triangle bandage is all these things and more. I’d recommend grabbing two for your EDC kit, one for a TK and one for a pressure dressing, should the worst happen.
  • Quick Clot Dressing – $15
    My earlier suggestion of Celox over Quick Clot was based on my memory of how much the old version burned like a motherf***er, but I’ve been assured that the problem has since been fixed. Clotting agents are great for getting control of moderate to severe bleeding, as the blood is typically flowing too fast to clot effectively on its own. This gauze pad has been soaked in quick clot, making it an ideal tool for stopping leaks in humans.

Small (“Operator Level”) Kit:

  • Include all of the previous items, but add:
  • Combat Application Tourniquet – $28.99
    Triangle bandages work, but if you have more room than just a pocket in your trousers to store the gear, this is the first thing that should be on your list.
  • 4×4 Sterile Gauze – $6
    Not every leak requires the “big guns” and clotting agents. Most of the time, direct pressure and a little gauze is good enough. This, plus a triangle bandage, will fix just about every non life-threatening bleeding issue.

Medium Kit:

  • Include all of the previous items, plus:
  • Kerlix Rolled Gauze – $4
    Burns, large superficial lacerations, cuts in odd places… Kerlix does it all. A general purpose bandage that works in a wide range of situations.
  • 3M Coban Adhesive Wrap – $4
    I freaking LOVE this stuff. Never use glue-based tape again to wrap your wounds, this stuff is designed to stick to itself without any glue or other sticky agents. Added bonus: it won’t stick to all the stuff in your pack.

Large Kit:

  • Include all of the previous items, plus:
  • Oral Glucose – $13
    I’m a fan of the strawberry flavor myself, but it looks like Amazon doesn’t stock that. Oral glucose is used for diabetic emergencies where the patient’s blood glucose level drops too low. Or, it can be a delightful snack while you’re sitting around bored in the ambulance. Low glucose levels are a more immediate emergency than high glucose levels, so having a tube on hand makes sense.
  • NPA Kit – $18
    This is the level at which I would include the nasopharyngeal airways, and I would include the full kit and not just the “one size fits all” version. If you’re going to use one, you should have enough training to know how to properly size it to the patient as well.
  • SAM Splint – $7
    Helpful in immobilizing broken limbs or bad cuts. Use with the triangle bandages and self-adhesive wrap for best results.
  • Flares – $156
    Getting the patient to definitive care is the most important thing in emergency medicine. And if you’re in the middle of the woods, the fastest way might be setting up a landing zone for a helicopter and airlifting the injured person out. Four flares work wonders in that capacity.

[Email your firearms-related questions to “Ask Foghorn” via guntruth@me.com. Click here to browse previous posts]

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32 Responses to Ask Foghorn: Medical Kits for the Firing Range

  1. Nice follow up. Any thoughts on the Quickclot sponge you recommended vs the impregnated gauze?

  2. Nice kit.
    Being a former paramedic, I always have at least one kit similar to the above in my range bag. It also has a good set of shears and a fresh tube of super glue for those annoying cuts.

  3. The only public range in my area is at least an hour from a hospital, I never go without a buddy than can drive me there and a some Quick Clot and some gauze. I will be looking for triangle bandages now.

  4. Holy Cow! $155 for 4 flares? S***, we had better quit firing off all the FIL’s signal flares on his fishing boat after a few bevvies then.

    • The same flares can be bought at Walmart. Not sure how much they cost, but Amazon is gouging due to the added cost to ship hazardous freight

  5. LOL…flares??? Gotta think after watching the news this morning that being burned alive in a forest fire caused by a flare might be considered as a downside to using them. Maybe want to consider using glow sticks, eye safe laser, strobe.

    • You’d probably be charged with a felony if you lit off a flare to facilitate a wilderness evac here in CA. For good reason, too — seems like every summer about 10% of the state is on fire at one point or another.

      Exaggerating a little. But not much.

  6. Gloves should be on everyone of those kits. I would also include medical shears and a CPR barrier.

  7. This is a good kit, I will be using it as a guide in august when i put my hunting gear pack together again.

  8. “If you’re going to use one, you should have enough training to know how to properly size it to the patient as well.” Well yes, that goes for a lot of things. For example, yesterday you mentioned a “flutter valve”. I think I know what that is, but I would be guessing trying to put it together. Is there a go-to manual for this kind of emergency response? A military field manual? A thee-fold pamphlet? Tools are one thing, knowing what needs to be done with them is far more important.

    Secondly, I too would like to know your opinion on comparing and contrasting the Quick Clot you promoted today, and the Celox gauze you held up yesterday. What is the practical difference?

    • Take an Immediate Action Medical course.

      Yes, the internet and forums are great for gleaning free information, but there is no substitute for the actual practical application and experience.

  9. +1 on the SAM splints. I carry a 36″ in my truck and when hiking along with a couple of the finger splints. If you have a good pair of medical sheers in your kit, you can also cut strips off the larger SAM splints to make smaller ones. Those are all great recommendations and I carry all of them, plus some a bunch of other items. The Combat Application Tourniquet works great. However, on my backpacking trips, weight is a big deal and so multi-use items are a big plus. So, when hiking, I carry the SWAT-T Tourniquet, seen here:

    http://swattourniquet.com/

    It can be used as a tourniquet, pressure bandage, or just an elastic wrap. Plus it doesn’t take up much room. It also only costs a third of the CAT if you order from the right place. I got mine from a vendor through Amazon that included free shipping, so I only paid $9.45 a piece. I keep a CAT in my truck, but favor the SWAT-T for hiking since it is light wight, simple, and multi-use. It also works great with the SAM splints.

  10. The USMC removed quick clot from their first aid kits several years ago. I don’t know exactly why, but I think they were sing used Inappropriately and did more harm than good.

  11. HEY NICK! 30 years as a EMT and (mostly) ER Trauma Nurse. Really, really, like your ideas about first aid kits. Best I’ve seen. Just one thing, tourniquets? Really? Glamorous, rarely needed with correct first aid. If you must apply one on a limb (arms and legs, never on the neck unless pt is a gun grabber) note the time. All should take a Red Cross first aid course. For a few dollars you can save a life. It’s a great feeling!
    With the proper knowledge there’s little that can’t be done with a triangle bandage. I would add a pencil and paper. Get what history you can, name, time of injury, current medical problems, medication allergies, drugs they take. Phone number for family. If patient becomes unable to talk this will be invaluable.

    • I keep a mini sharpie tucked inside my tourniquet so I always have a way to write the time of application on the victim’s limb.

    • Yeah…good point, but with this audience treating a wound from a high powered hunting rifle to a limb petty high on the list of possible scenarios.

      Just like the clot agent…a tournaquet is something not found in most kits.

    • With tourniquets, I see it as “Why not”? Just a few extra bucks and ya never know when you may need it. Kind of like having extra guns around the house. Better have it and not need it, than to need it and get screwed.

    • As we saw in Boston, there is a time and a place for tourniquets, and I’d rather have a proper one rather than improvising one from a belt or t-shirt.

  12. i’m sure this has already been touched on, but training is KEY. knowing WHEN and HOW to use a tourniquet (or any of the items listed here for that matter) can’t be stressed enough. there are all kinds of basic and and advanced first-aid training classes out there. this is probably more important than anything else.

    some other things i’d add to the more advanced kits would be:
    – burn gel
    – occlusive dressing for sucking chest wounds (assuming you have the training to ID them)
    – adaptic dressings (or other non-stick dressings)
    – trauma shears
    – a long 14g angiocath for needle decompressions (assuming you have the training and can actually legally get your hands on one that is… they don’t just let anybody buy intravenous needles for some odd reason… lol)
    – don’t forget latex (or non-latex if there are allergies at play) gloves. LOTS. can’t tell you how many times i’ve gone to put a glove on before an EMS run at work and the dang thing rips right apart.
    – and MORE DRESSINGS. you can never have too many 4x4s, abd pads, multi-trauma dressings and kerlix! 🙂

    as for tourniquets, it’s true that they’re not AS useful for gunshots as they are for blast and crush type injuries. *most* of the time, direct pressure, elevation and arterial pressure points will work fine – ESPECIALLY if you don’t have major arterial bleeding. can’t hurt to have one available though because ONCE in a blue moon it’ll come in handy.

    our local protocols just recently began allowing us to use hemostatic dressings – specifically the z-fold-type dressings that are designed to pack wounds. however we were told to never use them in the chest or abdominal cavity but they didn’t ever say why NOT. seems to me like those would be two of the most useful places for it! anybody have any idea on this?

    • I was glad to see someone mention a dressing for sucking chest wounds. My training calls for using the cellophane from a cigarette pack or even the plastic envelope from an MRE (either with a bandage to secure it).

    • Yes, I’ll second that.

      I will definitely be making a few adjustments to my medical kits after reading this, especially my large (SAR backpack) and small (24-hour bag) trauma kits.

      I’ve also found it helpful to have topical lidocaine, disposable surgical stapler, and superglue in my kits. Especially the superglue.

    • Yes. 100%. I have used it personally. Also, we have a sterile version in the ER called Dermabond. Not for deep lacerations that you would normally repair with sutures, but for skin deep cuts it works very well. Also great for that kid who is terrified of the ER to start with and has been taught to be afraid of needles.

    • I’ll second Max and tell you that I also keep it in all of my med kits. Unlike the disposable surgical stapler, which is a definite “just in case” item, the superglue gets used and replaced on a fairly regular basis.

      It’s especially good for shallow-angle lacerations resulting in skin flaps, which hurt like crazy every time the skin flap drags across the exposed nerve endings. Superglue is great for both stopping the bleeding AND immobilizing the skin to prevent pain.

  13. I have a couple QuikClot sponges which are nearing expiration, does anyone know what happens to QuikClot after it expires? Is it just a legal thing since the glue on the package to keep it sterile might go bad, or does it really become ineffective afterwards?

  14. You forgot (seriously) tampons. You can put clotting agent in a bullet hole and jam a tampon in there with an applicator to stop the bleeding.

    • That’s what the kerlix if for Don. It’s the medically approved version of a tampon, sort of what durmabond is for superglue.

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