What to carry in a medical kit?

[abbadon101]

See, my biology tutor told me the opposite when we were doing diabetes.

 

He said that no matter what, give them a fruit juice as it will not be enough to induce a coma in a type 2, but will be enough to save a type 1.

 

That really depends on how close they are to a coma in a Type 2.

 

As has been said. Unless you are 100% certain they are a type 1 going into a Low, don't do anything other than sit them down and get them back to the safe zone.

[Reincarnation...]

I'm fairly certain it is hypoglycemia (which may lead to hypoglycemic crisis aka insulin shock) that resemble s&s of intoxication and not hyperglycemia (which may lead to diabetic coma).

 

I too have been told that when in doubt about the diagnosis, give glucose PO or get a medic to admin it via IV.

[Ginger Chris]

I'll defer to the medical professionals on what to do with type 2s, I'm not one so it's not my specialty area :L

 

 

Best thing to do is ask as hard as you can. You'll get three situations:

 

- They'll say they are a type 2 and something is wrong. You guys know better than me what to do here.

- They'll say they're a type 1 and they're running low and they need sugar now quickly quickly before they tear your face off (I am not kidding when I say type 1s hulk out and get nasty ) This is why the Lucozade tabs are a great thing to have in your med pouch, 3-4 of those will stabilise a tidal wave.

- They've no clue what's going on, at which point you might have an undiagnosed case and they'll be running ridiculously High OR they're so High/Low they're about to go into coma, get the medics ASAP.

 

 

 

I was diagnosed a type 1 diabetic March 2010 and have been taking injected insulin twice daily since then.

 

I have had high blood sugar when I was initially diagnosed and two days where my dosage was too low for the food I was eating. Hyperglycemia isn't that big of a problem for me.

 

On the other hand I've lost count of the amount of times I've gone low. I've never gone comatose, but I've gone low often enough to know when exactly the symptoms are coming on and when I should drop everything and go and get food NOW.

 

Seriously, I recently delayed court proceedings when I was on jury duty cos I went low. F**k your testimony I'm minutes from going unconcious here! :V

[Gentner91]

Diabetes and you, the airsoft medic.

 

Disclaimer:

WARNING: IF YOU ENCOUNTER AN ACTUAL MEDICAL EMERGENCY CONTACT 911 OR YOUR LOCAL EMS!!! The information contained in this post should not be looked at as medical advice or training!!! I take NO responsibility for your actions. DO NOT attempt to practice and medical techniques mentioned in these forums without being trained to do so.

 

The thing to remember with diabetics is that in both type 1 and type 2 diabetes, the patient can experience both hypoglycemic (Low sugar) and hyperglycemic (High sugar) events. The reason for this is because for some reason the pancreas isnt producing enough insulin (which facilitates the up take of glucose [sugar] to the brains cells for energy) or their is natural insulin that is being produced, but its being rejected by the body. With working as an EMT, this is one of the more common issues that we run into, at least within my township. The key is remembering the signs and symptoms and obtaining an accurate history of the event which will give you an understanding as to what is going on with the patient. By no means is this supposed to make you an expert in diabetes but to give the reader an idea of whats going on, sorta like a spoiler to a movie =P

 

Hypoglycemia (Low Sugar)

Causes: Little food intake, too much insulin/diabetes medicine or extra exercise.

Onset: Sudden. If left untreated, the patient can slip into a coma, begin to seize and experience brain damage and even die.

Signs/Symptoms: Anxious, Irritable, Altered Mental Status, Weak/Fatigued, Dizzyness, Headache, Impared Vision, Sweating, Shaking, Tachycardic (Fast Heart Rate), and Hunger.

Considerations: The brain needs glucose to survive. As stated before, insulin transports glucose to the brains cells to provide energy. If their is sufficient insulin within the body, but not enough glucose, then the brain will begin to malfunction and ultimatley die without treatment. Insulin dependant diabetics usually have a schedule to which they follow on a daily basis, injecting their insulin an hour or so before they plan to eat, so their is enough insulin to transport the glucose of the food they are eating to the brain. If the diabetic takes their insulin on their regular schedule, but forgets to eat, the body becomes hypoglycemic. The same can be said for a diabetic who takes too much of their medication. In the airsoft setting, this is they type of person you'll expect to see due to the amount of physical activity that the body is going through. (More activity = more fuel [Glucose] used) Another thing to look out for is that a hypoglycemic patient can appear as though they are drunk and can also be very combative. Again, remembering the signs and symptoms, along with the sudden onset, will help give you an idea of what is going on. Although some of these signs and symptoms can also be seen in patients experiencing shock, heat exhaustion and with patients experiencing acute myocardial infarctions/angina attacks. The key is connecting the dots and obtaining an accurate history of what has happend and getting the person to the appropriate medical personnel before their condition gets worse.

Treatment: In the EMS setting, my local protocals tell me that if I come across a patient that is showing no signs of trauma, alcohol/drug use, poisonings etc. but have an altered mental status and are showing signs and symptoms of hypoglycemia, should have their blood sugar levels checked via a glucometer. The normal glucose ranges are between 70mg-115mg. If they are below 70mg, they are considered hypoglycemic. Again, in the EMS setting, we would give an alert hypoglycemic patient glucose tablets or have them drink orange juice or eat half a peanut butter sandwich to bring their glucose up. The tablets are nice, but if the patient presents with an altered level of consciousness or unconscious, then we cant give them the tablets or have them drink due to the risk of inducing an airway obstruction. So for the patient with an altered level of consciousness or one who is unconscious, we give them one tube of oral glucose in small amounts. I DO NOT suggest that anyone attempt this unless properly trained to do so as oral glucose, if aspirated (breathed in), can be VERY damaging to the lungs. Again, if you see anyone showing any of these signs and symptoms, call EMS immediatley. As an airsofter, I would not suggest trying to treat these patients. As Ginger has stated, you dont want to load the patient up on sugar if they turn out to be hyperglycemic. As a concerned airsofter, your priorities should lay with getting the person to safety and stopping the game, noting when the patient began showing the signs and symptoms and asking the person if he or she is insulin dependant, if and when they took their medication and if they had eaten. These will help the arriving EMT's/Paramedics in terms of whats going on before they even get to the scene. Also look for medical alert tags and bracelets as this will help you figure out any medical conditions they may have.

 

Hyperglycemia (High Sugar)

Causes: Too much food, too little insulin, illness or stress

Onset: Gradual, 12 to 48 hours. Can progress to diabetic coma if left untreated.

Signs/Symptoms: Extreme Thirst, Frequent Urination, Dry Skin, Blurred Vision, Drowsiness, Nausea, Hunger

Considerations: If their is not enough insulin in the body to take the glucose to the brains cells, then the brain will begin to shut down, just like in hypoglycemic patients, with the exception of the onset and low amounts of insulin. Hyperglycemic events occur over an extended period of time, usually between 12 to 48 hours. As sugar levels begin to build, the brain begins to starve for glucose and resorts to plan B; which is to metabolize fat to produce energy. This method is a last ditch effort for the brain to stay energized but in the process, the metabolized fat creates a harmful byproduct known as ketones. If excessive amounts of fat are metabolized it creates a condition known as diabetic ketoacidosis. As the amount ketones rise, the body begins to attempt to burn off the ketones by excessive urination and with rapid/deep "sighing" breathing known as Kussmauls respirations, which smells like juicy fruit. The metabolization of fat, DKA and Kussmaul Respirations are ineffective to support the brain and body and if left untreated, the patient will slip into a coma and die.

Treatment: Outside of maintaining the patients airway, breathing and circulation, their is little an EMT or Paramedic can do outside of rapid transportation for the hyperglycemic patient. The patient needs insulin and only the hospital can adminsiter it. Again, recognition and calling EMS are key to their survival.

 

As for what to carry in an "Airsoft based" first aid kit, my personal opinion would be as followed:

x2 Pairs, Latex Free Gloves

x2 Ace Bandages (Can be used for sprains, pressure bandages etc)

x2 H&H/NAR S Rolled Compressed Gauze Rolls

x4 4x4 Gauze Pads

x4 2x2 Gauze Pads

x1 Box of Bandaids (Vary the sizes and place in zip lock bag)

x2 Triangle Bandages (Sling/Swathe)

x4 Alcohol Pads

 

I advise not to use burn jel/oientments as these have been known to continue the burning process. I ran across this twice in my life, once during my ER clinicals and about 6 years ago on a family vacation to Florida when my sister decided to go sunbathing instead of going with us to Universal =P

 

Also, some of you have expressed your concerns about being sued for rendering aid to an injured person. As long as you act within reasonable limits, obtain consent and act to which you are trained, you are covered under the Good Samaritan Law. If you live in the United States, you will have to look at your state in particular to see the extent that you are covered. As an EMT, this only covers my *albatross* half of the time. Since I am "employed" as an EMT in my township, I have to follow my protocals to the "T" and I have to work as I have been trained, otherwise I can be sued because I "know better" in the courts mind. Now, if Im out of the township that I work for and I witness a cardiac arrest and start CPR and something goes wrong, then I would be covered under the Good Samaritan law...but if I screw up while Im in my township, its on me. For you guys without any training, use common sense. Dont try to decomress a chest, jab a pen in someones throat to open an airway or help the Paramedic intubate the unconscious dood in the corner. If you keep within your training and use common sense, you should be good. Again, check your local laws.

[Ginger Chris]

^^^ This is a great post and everyone needs to read this.

[celbii]

Moleskin for blisters.

[RockerMan]

I've been a paramedic for a little over 2 years now, and I would have to agree with gisburn20, every sittuation is totaly diffrent and depending upon the site, equipment carried would vary from that. As far as a basic all round kit:

 

 

Assorted Adhesive Dressings

Sterile Eye Pads with Bandage

Non-Woven Triangular Bandage

Safety Pins - Assorted Sizes

Medium Sterile Dressing

Large Sterile Dressing

Individually Wrapped Wipes

Sterile Saline

Disposable Gloves (pair)

Foil Blanket

CPR Shield

Steri-Strips may aloso be hand to carry about with you..

 

People may frown upon a few of the items above, but trust me every one of them is essential.

 

I don't know how many of you on this forums are site owners, but if possible a AED would be a great idea if your marshalls have had the training, same goes for a small oxygen tank and some variable maks. More so if your more than around 15 minutes from the station and are on hard to get to land.

 

During the briefing, tell all people who need meds to keep them in a specific place and then as others have said here, the marshalls can easily have access.

 

A - Airways

B - Breathing

C - Circulation

D - Danger

 

 

So, how I know all this stuff?

 

Well first of 3 years at uni studying Paramedic Science

2 Years been a paramedic

PTLLS certified

Just a few of what I've done, also completed combat medic courses.

[TheFull9]

A - Airways

B - Breathing

C - Circulation

D - Danger

Could you explain this a bit more please? Only the rest of the post makes a lot of sense, but this part comes across to me as both entirely backwards and out of date. Hazard/Danger should certainly be first; there's no point trying to treat a casualty while all the other players on the field are still running around shooting.

[RockerMan]

I know that, but DABC does not make sense, yes you should always but danger first, asses the scene if there is an element of danger. IF possible handle the danger, then treat the patient. We already have one patient we don't want another. If you can't deal with the danger wait for the emergency services, but try and keep the patient as calm as possible. Try and help them from the sidelines. Take an severe cut to the arm, and there's a big danger. You can tell the patient to lift the arm above the heart, to press on an artery to slow down the bleeding you can be a big help from sidelines.

 

What I meant if possible handdle the danger, I mean something minor like stop the game, I don't want you running around grabbing people from a 10ft hole with the possibility of you getting stuck down there with the patient.

 

If you need help with anything just ask, I'll be happy to help

 

As I said in a lfe threatening situation you'd be assisting 'with best intention' so your safe there ( am talking about UK liability) but the point I was making was to general cuts and abrasions and especially if the other person is under 18 . obviously your going to ask for consent to help (some ones just gashed there head and laying there all stunned , you come hurling out of the bushes band aid in hand and slap it on there head like a ninja nurse ! ) no the point I was making was best to leave it for the marshals to deal with it . I'm an A&E nurse and once had a kid brought in to the dept by his mother after he'd cut his head at a football summer school and some one had dressed it for him at the event and she wanted it re-dressed ( little cut centre of his forehead) she was jabbering on about would he have a scar , we said "yes probably" few days later she turns up again with a load of legal paper work she wanted to try and sue the person who'd put the plaster on for scaring her son ! we told her no chance and sent her on her way .

As to a Personal first aid kit I quite often am asked to put one together for team mates and friends , this what I always use ;

2 x pairs non sterile laytex gloves

Assorted sized sticking plasters x 3 of each size

1 x L , M , S sized bandage

1 x L , M , S sized non adherent dressing

2 x packets sterile saline

Several alcohol wipes

1 x M sized pressure pad

1 x triangular bandage

Several safety pins

I also recommend sticking a strip of paracetamol and anti-histamines in as well but i never put them in my self . I also recommend trying to do a basic first aid course if they can ( tell everyone this , less people turning up at A&E makes my job easier ! ) but if you can't then get a copy of the red cross first aid manual , really good first aid book .

 

@druid799 - Non sterile gloves? What it the patient has an open wound? EVERYTHING has to be sterile. Also, I would not go around saying to give paracetamol and anti-histamines to people as this is against the law unless your licenced!

 

and your a nurse?!

[Reincarnation...]

Is the safety pins for managing the tongue? I would imagine it would produce a large amount of blood and require active suctioning to maintain a patent airway. Or are the pins used to produce slings, swathes and whatnot?

 

Would oxygen be considered a drug and require the license to administer also? In addition, how well does pressure point work as a method to control bleeding (I was told: pressure, elevation, tourniquet)?

 

RE:"Sterile vs Non sterile gloves". The only place with sterile gloves on the buses I been on are in the OB kits.

 

BSI,ENAMES,GI,AO,A,B,C,D,SP-LG. Acryonms ftw.

[druid799]

@druid799 - Non sterile gloves? What it the patient has an open wound? EVERYTHING has to be sterile. Also, I would not go around saying to give paracetamol and anti-histamines to people as this is against the law unless your licenced!

 

and your a nurse?!

right the guys asking what to put in a first aid kit for his rig .

Sterile gloves , where not performing surgery the gloves are for protection for your self from contact with bodily fluid IF you help some one else .

You say your a paramedic so were do you carry your golves in work ? In a pouch on your belt ? and were do you get those gloves from ? The box of non sterile gloves in the back of your ambulance .(or from A&E when you drop a patient off because there's non left on the wagon ) I've never ever seen a paramedic use or carry sterile gloves .

And as to the paracetamol and anti-histamines as I stated I put the kits together for FRIENDS and TEAM MATES not some random I've met on a skirmish site , so I'd know if they had any risk from taking either , And did not say YOU MUST CARRY THEM I recommended you do there Not prescription grade medications , you buy them in tesco's for god sake .

And yes I AM a nurse and a former member of the RAMC .

[RockerMan]

OK, so lets say we bring in a patient in to you, he has a large cash on his upper arm and you using non-sterile glove, you then go prodding around with your hand to inspect the wound. That wound now become infected with germs from Mr.Kajhdgt in china who sneezed all over them when packing. Hence why we use sterile dressings...

 

As for my work, No I don't carry glove on the belt, all that’s on the belt is tuff scissors, pen, and Stethoscope. The gloves are in the back of the wagon when I'm in there, im mainly FR, as far as never seen any paramedic carry sterile, must be different in Wales then...

 

I had to work a rotation in A&E for uni, we also had to use sterile gloves there too...

 

 

 

 

 

 

[druid799]

OK, so lets say we bring in a patient in to you, he has a large cash on his upper arm and you using non-sterile glove, you then go prodding around with your hand to inspect the wound. That wound now become infected with germs from Mr.Kajhdgt in china who sneezed all over them when packing. Hence why we use sterile dressings...

 

As for my work, No I don't carry glove on the belt, all that’s on the belt is tuff scissors, pen, and Stethoscope. The gloves are in the back of the wagon when I'm in there, im mainly FR, as far as never seen any paramedic carry sterile, must be different in Wales then...

 

I had to work a rotation in A&E for uni, we also had to use sterile gloves there too...

Ok your scenario , some one has gashed his arm on the skirmish site , hes more than likely cut him self on a bit of glass or metal in or around a derelict building so it's going to be covered in rust/mould/dirt and god knows what else the wound's already grossly contaminated from contact with what ever caused it in the first place and he's wearing clothing that's sweaty and dirty , and your jipping on about me wearing a pair of socially clean gloves to protect my self when place a dressing over the wound when he first cut him self ?

When he arrives in A&E I would wear sterile gloves to clean the wound then change my gloves for a fresh pair to "to prod around" the wound as you put it because he's now in a clinical environment and we can maintain a clinically clean environment there, I would NOT go "prodding around" his wound on a skirmish field .

So you don't carry gloves on you , there only on the wagon ? Well your the first paramedic I've ever come across in 18yrs of nursing who doesn't carry gloves on him well done .

Yea we do thing different in Wales .

[RockerMan]

I never said that you prod around on the field, exactly the point the wound is already contaminated with germs and you would like to multiply that by 10? That’s what you're doing...

 

Nope, we arrive at a scene put gloves on then treat, however we are looking at getting a cheap little system from SP (I'm sure you've heard of them) to hold sterile on the belt. Admitted, sterile is not needed for everything, but as far as cuts and what not goes, sterile is probably best. I don't want to start an argument or anything I'm just saying what I've been trained to do in ALL my courses, I have the upper most respect for ALL medical staff including my fellow paramedics, ambulance drivers, nurses, doctors etc...

 

 

 

 

 

[Jimmypie]

If you two must bicker/rant at each other, at least use a spell checker.

[RockerMan]

Woops, my mistake I misspelled one word. People who go around on forums and/or blogs and check every spelling need to get a life!

[abbadon101]

Would oxygen be considered a drug and require the license to administer also?

 

In the UK it is classified as a drug yes and you have to have legal documentation to say you are allowed to administer it.

[Leon Kennedy]

Hey guys can you shut it with the bickering and stay on topic? Neither of you are going to magically agree with the other, so take it to PM if you want to just argue back and forth. Thanks.

 

My gloves are sterile and prepackaged and my medicines are all for personal use or friendly use only. I'm the regular guy building a regular guy kit.

[RockerMan]

In the UK it is classified as a drug yes and you have to have legal documentation to say you are allowed to administer it.

 

Thanks, forgot to add that Just a short course in Oxygen Therapy and Airways Managment should do ya

 

 

 

 

as for the safety pins, no they used for bandages. We use guedel airways for keeping the tounge out the way...

[demon.b]

 

Something I do wonder about, does anyone else sometimes struggle to keep up with the latest revisions of the CPR routine?

 

Current recommendation for 'best practice' basic life support using CPR;

 

http://www.resus.org.uk/pages/bls.pdf

 

If you follow the algorithm you will be doing the best you can for the casualty.

The important thing to remember is that you start with chest compressions, 30 at a time at a rate of about 100-120 a minute (sing the Beegees' song 'Staying Alive' in your head, it gives you a perfect 'beat' to keep time. I kid you not!)

Make the compressions effective; don't pat them on the chest, push the sternum down. A common error is keeping the palm of the lower hand flat on the chest; use the interlaced fingers of the top hand to lift the palm of the lower hand so you are only pressing with the heel of your hand on the sternum and not the ribs. (although some regard rib injury as a sign of effective CPR, and there are circumstances where rib injury is unavoidable, especially with thin, frail older people).

Current evidence indicates that the time spent 'off the chest' ie; not performing compressions, should be kept to a minimum, so don't faff about when trying to ventilate, be positve and prompt. Or if you are uncomfortable with the personal risks of performing mouth to mouth, there is an allowance of upto five minutes without ventilating within the guidance so long as effective compressions are maintained.

[abbadon101]

sing the Beegees' song 'Staying Alive' in your head, it gives you a perfect 'beat' to keep time. I kid you not!

 

However if some one hears you singing it out loud you are screwed

 

I was taught to use Nelly the elephant by my instructor.

[demon.b]

Yep.

Dancing Queen works as well.

Mind you, the way some resus jobs can turn to chaos and carnage, a bit of a sing-song might lighten the mood.

[Arghoslent93]

However if some one hears you singing it out loud you are screwed

 

I was taught to use Nelly the elephant by my instructor.

An ML-qualified leader in our Scout group was taught CPR to this tune too. The BMJ advises against it however, because while the rate of compressions whilst listening to Nellie is close to the optimum amount, the depth of each compression was inadequate, because of the brief time spent on each one.

 

Have a listen:

 

 

And a read:

 

http://www.bmj.com/content/339/bmj.b4707.full

 

I must admit, I still use the Nellie rhythm when I practice CPR.

 

The argument/discussion earlier about sterile and non-sterile gloves (in an airsofting context at least) seemed a bit.. pointless? If someone gashes their arm on some wire poking out of some broken concrete on an urban site, then it's a pretty safe bet that there's going to be dirt (and who knows what else, faeces, dog urine, blood even) on that wire, which will undoubtedly have found its' way into the resulting wound.

 

In such a case, the priority of the first responder would be to stop the bleeding. That means pressure. If you don't have gauze or dressings to necessitate this, then you use what you have near you. Take off your BDU shirt and get that pressed onto the wound if you have to, anything to suppress the bleeding. A bit more dirt in the wound isn't going to have a massive effect on whether he dies or not.

 

If the bloke is unlucky enough to have fallen on an artery in his leg, or caught his neck on some glass in a window frame, then if your first consideration is to whether or not the wound is going to be free from infection, you probably shouldn't be treating them in the first place. Step aside and let someone else do the job.

 

Infections can be dealt with at the hospital. Let's face it, if the gash is that bad and they need to be taken to hospital, the time between the incident taking place and them arriving in A&E isn't going to be massive, so the patient's chance of losing a limb as a result of gangrene is ridiculously small.

[demon.b]

An ML-qualified leader in our Scout group was taught CPR to this tune too. The BMJ advises against it however, because while the rate of compressions whilst listening to Nellie is close to the optimum amount, the depth of each compression was inadequate, because of the brief time spent on each one.

 

I think that BMJ article highlights a recurrent problem with the teaching of CPR that the latest guidelines tries to address; the need to emphasize the depth of compressions as well as the rate. It's necessary to push down a significant amount to be effective and this is quite off-putting, both for first-aiders and health care professionals who don't do CPR regularly because it can feel like you are doing harm, but if someones heart isn't beating, they are dead, so a couple of cracked ribs is a small price to pay for a sucessful resuscitation.

 

 

The argument/discussion earlier about sterile and non-sterile gloves (in an airsofting context at least) seemed a bit.. pointless?

 

It seems people are at crossed purposes between initial wound management, ie; cover/direct pressure and basic dressing prior to moving the casualty to a safer environment, for which non-sterile gloves are sufficient for barrier purposes, and the requirements of wound closure, ie; sterile proceedures and appropriate qualifications.