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Complete Medical bags

40calgal

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What about a small flask of whiskey, or brandy? Helps with pain and sleep right? Maybe even some B12 drops (instant absorption) to help with energy and nerves. I use this when my legs get real restless. Aer these good things or I am wastin time and moola?
 

gunplumber

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As to vitamins, thats a whole 'nother subject - vitmains and herbs in long term care of course have value. I have vitamins in my food storage, but I don't see a need for it to be in a trauma kit.

As for alcohol - while I don't deny that it has a physiological effect, often including relaxation and numbing, its volume to effect is much larger than meds designed for pain relief. I think its a poor choice just based on size and weight. I suspect that the CNS and nephritic effects (bradycardia too?) may contraindicate it in trauma.

As for walking wounded, "relaxed" or not, the last thing I want in a crisis is a bunch of drunks, which (forgive my pessimism) is what I suspect would happen.
 

gunplumber

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If this is going to be made a sticky, can I have moderator priviledges in this forum? With thanks to 40 cal Gal for starting the thread, I think I can keep it more streamlined if I can add people's suggestions to the list, rather than making each one a seperate post.
 

shogan

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Howdy and welcome 40calgal! I just ran into this thread out of curiosity. There are about as many ways to make up a medical kit/bag/chest/truck load as there are folks who want them. I certainly believe in borrowing ideas etc. Mark, great list!.

I think medical supplies need to stocked to the level of the mission and the abilities of the user. But more is generally better than less!
With a TEOTWAWKI scenerio I would be be adding surgical tools and ether to my list. The SF Field Medic Guide is a supurb guide to have in the kit.

My medical background is mostly in the Army as a Medic and then a PA. I 've been the defacto medical officer and platoon leader for several Leg Infantry, Arty and Armor Batalions during training and real world Ops. No biggy. Learned alot. My specialty is emergency medicine.

There are a lot of little details when dealing with oral/injectable meds. You won't usually find them in a PDR. Vet meds are definately doable. Ask your local veterinarian for advice. Buy stuff wholesale and split the cost with like minded friends. A lot of country veterinarians have treated the rancher/dairyman and family as well as the sick or injured animal stock. Shoot, I learned how to do IM injections and wound treatment on my Dad's horses way before I treated folks. So, I'll be glad to answer any medical related questions. Oh yeah, Cotex pads make great cheap combat dressings. Use with ace wraps.
:biggrin:
 

Flanigan

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For prescription drugs like antibiotics, a good alternate source is your good 'ol farm store. Bear in mind that this should be your last avenue since this stuff might not be as refined (read "pure") as the stuff for humans and could also be more potent. Then again, you don't need a prescription either.

A relation of mine uses livestock injectables on his family with no complications aside from the braying laugh they have now.

Did a little searching awhile back on Atrophine and it seems that civilian posession is illegal - at least here in the PRI.

:rofl: Just recalled a story from a friend that worked for AFaRTS. They were doing a film on Vx and its effects using goats as test subjects. The entire crew was issued several injectors each (just in case). Friend saved one for himself, and gave one of the goats 4 without being noticed!! They laughed their asses off when the lab boys couldn't figure out why that one goat didn't drop when exposed, then dropped dead hours later for no apparent reason!
 

g5

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Silvadine is very good for burns unless you are allergic to it's components, which includes SULFA medication.
And an interesting story on Veterinary meds: a friend was visiting a pharmaceutical plant where pills were rolling out and there was a divider sending some one way and some another. He asked why and was told "these are for humans and those are for animals". I don't know how far that applies but it was interesting.
 

davestarbuck

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sulfamylon 8.5% cream burns
ampicillin broad spectrum antibiotic
gentamycin broad spectrum antibiotic
metronidazole broad spectrum antibiotic
clindamycine broad spectrum antibiotic
cefoxtin broad spectrum antibiotic
ketorolac injectable NSAID
Tequin, Avelox


Good set of antibotics but I'd eliminate the gentamycin. Gentamycin/Vancomycin require certain labs (creatine clearance) to be dosed correctly. The other meds cover the organisms these would cover quite well, except Methacillin Resistant Staph Aureus (MSRA). The chances of picking up MSRA outside of a hospital are rare, but unfortunatley becoming less rare every year.

Oh BTW I'm a pharmacist, feel free to ask me questions about meds :) .

-Dave
 

gunplumber

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Oh BTW I'm a pharmacist, feel free to ask me questions about meds :) .

-Dave [/B]


Couple questions. Since many antibiotics deteriorate in effectiveness with time, and some I understand become dangerous to use, is there a way of determining just how important an "expiration date" is? How many expiration dates are just a manufacturer ploy to get you to buy more?

Since many of us only have sporadic access to antibiotics, it pays to stock up while we can - but not if the stuff isn't going to last.

Also, there seems to be a shift due to poor Pt compliance, in large short term dosages versus smaller doses over a 7-10 day period. Any comments? In a survival situation - one may not have continued access for a long period of time . ..

Also - tetanus toxoid - there seems to also be a lot of new information on effectiveness and duration since last booster. Any contraindications of a booster every so often needed or not? I'd rather have had a booster a year before needing it than search for one when I do need it and its not accessible . . . .
 

davestarbuck

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gunplumber said:


Couple questions. Since many antibiotics deteriorate in effectiveness with time, and some I understand become dangerous to use, is there a way of determining just how important an "expiration date" is? How many expiration dates are just a manufacturer ploy to get you to buy more?

Since many of us only have sporadic access to antibiotics, it pays to stock up while we can - but not if the stuff isn't going to last.

Also, there seems to be a shift due to poor Pt compliance, in large short term dosages versus smaller doses over a 7-10 day period. Any comments? In a survival situation - one may not have continued access for a long period of time . ..

Also - tetanus toxoid - there seems to also be a lot of new information on effectiveness and duration since last booster. Any contraindications of a booster every so often needed or not? I'd rather have had a booster a year before needing it than search for one when I do need it and its not accessible . . . .

1. Product exp. dates: Actually the expiration dates are not a ploy to get you to buy more, the manufacturers are required to put them on there by the FDA, to insure our drug supply is up to standards. Standard is 90% to 110% of drug activity based on stated amount of active ingrediant(s). But most drug companies put an arbitrary date on the bottle, because it costs too much to do degradation studies.
There is no predicatable way of ensuring product saftey
because each drug reacts very differently to temputature, humidity, UV light, etc . Titrating doses in a survival situation would be mostly a wild guess.

2. Dose/Duration of treatment: It depends on the antibotic actually. Some antibotics are not at all effective if given in large quantitys for a short period of time. The cephlosporin and penicillin class antibotics are good examples of this. There mechanism of action requires that blood levels of the drug have to reach a certain level for a certain period of time. Other classes of antibotics such as the flouroquinolones (Cipro,Levaquin,etc) and Macrolides (Erythromycin,Biaxin,Zithromax), can be given in large doses for a short period of time and are effective. These are examples of course and are not all inclusive. But in a live or die scenario some would be better than none.

3. No complications with Tetnus innocluations more often than every 5 years or so that I'm aware of.

Good questions sir!!!!:)

-Dave
 
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nhcruffler

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Well, I guess I have to ask this one. Dave, your'e the professional. What about mail order from Mexico? I understand that the Doctor / pharmasist there will even give you a prescription over the phone. Is this a viable ( and legal ) way to fill the med bag ?
 

DigitalNY

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Although I'm not a RN, PA or MD I can give some info from the perspective of a former USAF medic / civilian emergency medical technician. First of all, even if you choose not to undergo the training necessary to become an EMT or Paramedic the national association of emts (www.naemt.org) offers a class that is invaluable in providing some of the training necessary to manage trauma in the pre-hospital setting. The course is PHTLS (Pre-Hospital Trauma Life Support) and more information can be found at: http://www.naemt.org/PHTLS Even if your not a certified EMT, Nurse or other medical professional you can take the course, you just won't receive the certificate.

Much of this training is stuff you would want to know in a SHTF scenario and will give you the basic training (or a refresher in the training) to start iv's, manage traumatic injuries, perform cricothyrotomies, needle decompressions, etc.. It also goes into more detail regarding specific traumatic injuries such as abdominal injuries, head injuries, etc..

If your squeamish and needle-shy you may want to consider calling the local training center or college that handles EMS training in your area. Most of them are always looking for "patients" to use in class as IV stick dummies or to be used as patients for the student's practical exams. Being stuck a few times tends to get people more used to needles and in turn tends to make you calmer when it comes to performing the skill on someone else. Of course it's no substitute for training.

As far as the scenario that was posted goes the first course of action before the patient is moved any substantial distance would be to control the bleeding and ensure patency of the airway. If the S really has HTF and I'm going to be caring for the victim for 5-7 days before proper medical attention then I must assume that I am going to end up being the victim's primary care.

You have to consider that in normal times a patient with a gut wound if uncomplicated with minimal damage to GI tract and vital organs could 2/3's of the time be discharged from the hospital and well on his way to recovery within that 5-7 day period.

If the victim has a patent airway which is self-maintained then the next course of action would be inspection of the wound site and the surrounding area. Is the abdomen unusually firm or soft? Is there extensive bleeding as if from a major vein, an artery or the liver? If the wound site is substantial and there is free-flowing blood is there foreign matter in the blood that I'd really prefer not to be present? Such as stomach contents, bile, excrement, etc.. Is there an exit wound? Visually retracing the path in my mind between entrance and exit if it's a straight path, soft tissue shot what major organs may have been affected?

Alot of the above information would dictate what the overall course of action would be. As harsh as it sounds, pain management would fairly low on the priorities list. The next steps I would take would be starting 2 IV's, one large bore 14ga or 16ga and a second that although it may never be used I would at least keep as a saline lock and mantain a scheduled flush. Hang a bag of normal saline on the primary IV line and if bleeding is slight to moderate and uncontrolled run it open, if bleeding is heavy and uncontrolled hang a second bag on the second line and run it open also.

Now comes the hard part, If the bleeding is moderate to heavy after attempts to control it then I'd need someone to assist me in rudimentary battlefield surgery. Even with fluid replacement if the bleeding is left uncontrolled the victim will eventually come to a point where the blood circulating is so dilute that it can no longer carry oxygen and death will be forthcoming.

Uncontrolled bleeding in this context includes internal bleeding. The placement of pressure bandages or clotting agents such as the powders of miscellaneous brands that are available do a good job of controlling bleeding in the near term but in a gut shot type wound the bleeding may continue unabated internally.

Scalpels, betadine surgical scrub, sutures, suction and basic surgical equipment should be in every group's inventory of medical supplies. It doesn't necessarily have to be in a person's kit that they carry in the field unless that person is comfortable using it in the field. If something like this were to occur in the field I'd pray for a couple of litter bearers, a litter and that my camp is close.

I'd proceed with very minimal pain management, the administration of narcotic analgesics such as nubain or hypnotic sedatives such as versed would depend greatly on vital signs and patient condition. Field surgery would be focused on finding bleeders and either tying them off or suturing larger bleeders back to restore bloodflow. Once bleeding is controlled then I'd make a survey for lacerations / ruptures to the GI tract and organs and suture the affected areas if I felt comfortable with it and there were an actual need. The thing to keep in mind is that this surgery is not meant to be a long drawn out exploratory surgery but an expedient bleeding control exercise. I'd end the surgery by suturing up the incision except for a 1/2"-3/4" section left as a drain.

Once the bleeding was controlled I'd convert the second IV line to a saline lock, consider placement of a foley cath, and begin administration of IV antibiotics until such time that the patient was capable of receiving oral antibiotics. My choice of antibiotics would probably be doxycycline & pcn by IV if available to cover both anaerobic & aerobic bacteria, IV Cipro could also be considered.

At this point I'd be searching for a physician in the local area that could do a consult and possibly perform a more complete and competent surgery to repair any other damage.

If during the initial treatment it had been a slight to moderate bleed that could be at least partially controlled I would opt for continual fluid replacement and basic medical care to maintain the patient until a more advanced level of provider were available. IV antibiotics would of course still be called for as well as pain management dependent upon pt condition. I really don't consider field surgery to be a minor affair, in fact when you consider the time that it ties up the healthcare provider, the people assisting him / her and the continued need for guards to maintain security in the area it's a huge resource hog.

Everyone should consider getting to know a couple of professional healthcare providers (MD's, RN's, PA's, etc.) in your local area or at the very least keeping a list of healthcare providers that reside in the immediate area of your home or the area you plan to bug out to in a SHTF scenario.

The old standard red cross on white background arm band does still have it's uses. Keep it out of sight in your inventory somewhere but if you end up going to medical professional's homes in an attempt to get aid put it on prior to approaching the house, if their hiding inside glancing out curtain slits it will make them more likely to answer the door. :wink:

What do you think? Am I completely flippin psycho?

DigitalNY
 

gunplumber

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The next steps I would take would be starting 2 IV's, one large bore 14ga or 16ga and a second that although it may never be used I would at least keep as a saline lock and mantain a scheduled flush. Hang a bag of normal saline on the primary IV line and if bleeding is slight to moderate and uncontrolled run it open, if bleeding is heavy and uncontrolled hang a second bag on the second line and run it open also.

I disagree slightly here. I say bolus 2 IVs of RL or NS (bolus = squeeze bags to empty them faster). Then reload both and get a BP assessment before deciding to bolus, normal load, or slow drip the next two.

Burn injuries the treatment is changing a bit - the brooke and modified brooke formula for calculating fluid replacement is maybe in conflict with new developments on fluid overload on burn injuries. I'm locked out of the navy research on this at this time as you have to be active duty.

(jury is out on RL or NS - some schools differentiate - RL for spinal trauma, shock, and NS for vulume replacement - chances are, you'll have to use whatever you've got - consider also saline enema in dehydration injuries)
 

DigitalNY

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gunplumber,

Of course the infusion of fluids would really depend on bp & rate of loss. It's amazing how fast you can infuse fluids when you run it wide open and throw a spare bp cuff around the iv bag and pump it up. :wink:

Although RL is great in burn cases I think my first choice of fluids would be NS in this scenario.

Ideally, every patrol that is leaving your "I'm already bugged out camp" to go out into the field to do recon, forage for food or supplies and the like should have at least one person that is trained to the national registry EMT-I/85 with PHTLS level of training or to the current standards of the US Army Combat Life Saver program.

Another thing that people can do now to prepare is to put up medical texts. Once the SHTF the designated medical guy / gal for your group can read up and expand his / her knowledge during their down time. Although medical texts aren't exactly relaxing reading they can come in handy.

DigitalNY
 

GUN SNOB

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So should I feel bad that most of that last was over my head? Looks like I have some catching up to do, till then nobody get shot around me that dident understand the last two post.

Thanks for the info every one lots to think about, lots to learn.
 

gunplumber

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Jargon. Every field has it.

It was a pleasure reading "Where there is no doctor" because it was written with no jargon. It wasn't as precise, but it worked.

Anyway, when someone loses blood, it does two things of immediate concern.

Red blood cells carry oxygen. Losing red blood cells reduces oxygen, even when lungs are working fine.

Loss of blood volume makes the whole circulatory "pump" work less efficiently. Just like a loss of freon in the air conditioner - it will still cool, but not very well. In body terms, this is called "shock".

the majority of blood volume is not blood cells, but clear fluid the blood cells float around in.

We cannot replace blood cells in the field because of blood type compatability.

We can replace the "interstitial" fluid between cells.

Two common substances for fluid replacement ar .9% sodium chloride, or "normal saline" or "NS" - called "Normal" because it duplicates the salt content of your body.

The other is "RL" or Ringer's Lactate, or Lactated Ringers. This is another clear fluid, and I really don't know whats in it, but its a more complicated mixture than just salt water.

NS is a good fluid to use for trauma, and for heat injuries and for burns. Some medical professionals believe that RL has benefits in spinal injury, and burns that NS doesn't. In a well stocked hospital, they can choose. In the field, its whatever you've got.

Burns cause massive fluid loss by the cell walls rupturing . Replacing fluids in burns is important.

But its possible to overload a system with fluid, which will cause additional problems.

This dude named Brooke developed a formula for determining how much fluid to replace in burn victims. Brooke Army Medical Center at Ft Sam Houstan is known internationally as one of the best burn centers. I trained there, although not specifically in burns, about 15 years ago.

a "Bolus" is "a whole bunch really fast".

My training recommended in any case involving fluid replacement, to give the first two liters as fast as possible. Someone actually squeezes the IV bags to pump the fluids in faster. I assumed this was to fight off shock, it may also have been because of the difficulty in the field of assessing internal bleeding extent. Even on a healthy person, 2 liters of IV fluid is going to have no ill effect other than "I have to pee". as a "patient" I've had 2-4 IVs every day or so . OTher than railroad tracks on my forearms, it was no big deal.

Anyway, I ramble. The point - or question rather - is how much of what fluides to pump into a victim in what circumstances.

Giving IVs is not difficult, although it does take practice. A piece of moleskin over a very small tube is one way to practice. NOthing beats the real thing. After this one corpman missed my vein 3 times, I got the catheter in with one hand the first try, upside down. Pain is a great motivator for success.. I think its basic first-responder stuff, but there is a potential of some dimwit screwing things up with a needle and causeing more harm, so typicaly its not taught at the basic emt level.
 

deepcharge41

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Survival Medicine

Myself was so tuned in with the Fal File's Survival Forum, it so wonderful to learn more things even in our small ways how to save lives in any scenarios like, survival, war, or just the daily way of life, no matter if it is for human or pets. I wish I am a doctor and be sent into remote areas where immediate medical needs are needed in lack of immediate real medical availability is present, but I can't afford the medical university course. I am a volunteer American Red Cross in one part of the Pittsburgh, PA area as a disaster response personell, I learned first aid CPR too, but I'd like to learn more than this alone in case we needed it in the family or friends. I have also saved about 4 or 5 human lives in form of resucitations caused by heart, chocking, drowning and wound, and also one small puppy who accidentally chocked himself with his dog lease and was hanging by the house stair. I am 65 years old now but i don't want to stop from what I love doing...."Saving Lives" that is why I would like to learn more mostly in prepairing emergency medicine that are more complete in a bag.i need to know where to find a supply or distributor.
Thank you.
 

thexrayboy

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Very intersting thread. It has much usefull info. However I can say first hand that knowing how to do something from reading about it or taking a class is not the same as doing it in the real world. If you are serious about taking on the role of healthcare provider in a SHTF scenario you should consider not just acquiring skills but the ongoing practice of these skills. Working in a local ER as an EMT or with the FD as a volunteer are ways to help maintain these skills.
This is important because all the knowledge in the world helps little if you don't have the experience that goes with it. One of the reasons that real world experience is usefull is that it helps people cope with the "deer in headlights"
reaction when bad things happen. If you take EMT and other courses up the wazoo but never really see the real world uses up close you might freeze up or lose it the first time it happens. If this happens during a time of widespread trouble this could be a fatal problem. So get some exposure to it now to see
if you can handle it and also to help advance clinical skills. Real world practice has its benefits. It does not pay to know how to deal with a theoretical ailment if you do not have the experience to know the ailment when it presents to you.

One of the best methods of preparing for TEOTWAWKI/TSHTF futures is the teamwork approach. No one person can be everything. It doesn't matter what aspect of post disaster survival is being discussed. Whatever the issue multiple people with broad skill sets will survive and thrive much better than individual or family size groups. The time to build these teams is now, before things get out of hand. Yes we should all broaden our skills as best we can and I also know what Robert Heinlein said about specialization being for insects. However
it simply is not possible at the individual level to acquire, maintain and adequately utilize the complex technologies we have. This applies not just to medical care but all areas. We need to be able to function at the community level in a disaster. Groups smaller than this may not have the skills or resources to continue. Groups larger than this can succumb to the problems seen at large population levels such as elitism, welfare mentality etc. For centuries homo sapiens funcioned well surviving at a tribal level. We can do it again if need be.
 

nomadcrna

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quote :We can replace the "interstitial" fluid between cells."
Actually you replace the intravascular fluid. Fluid may or may not move interstitially depending on injury. This is called "3rd spacing" and does the patient no good at all.
The intravascular fluid replacement is what helps your BP. Giving rbc, replaces lost rbc.
You can replace blood loss by giving 3cc crystoloid per cc blood lost. Give 1cc of colloid or blood per cc blood lost. You make the decision on when to switch to blood products on patient history and either h&h or by however amount you feel comfortable with losing.
Either RL or NS is fine. If you have Hypertonic saline, some studies show it is superior to rl or ns in acute, severe blood loss.

If you are into a massive blood loss situation and give 10u or more of prbc then you might have problems with a dilutional coagulopathy. You might consider giving FFP and platelets.

Quote "Anyway, I ramble. The point - or question rather - is how much of what fluides to pump into a victim in what circumstances."
If you have normal vs and no clinical signs of bleeding then you can go easy on the fluids. If you have a hypotensive patient and/or continued blood loss then keep giving fluids. Use either LR or NS.

One note: giving all those fluids along with the blood loss, nekkid patients and such, you really need to think about keeping the patient warm as you are able. Hypothermia can cause major problems.[

Obviously care and treatment will vary depending on skill level and whether you are in the boonies or at a treatment facility.

quote"Scalpels, betadine surgical scrub, sutures, suction and basic surgical equipment should be in every group's inventory of medical supplies. It doesn't necessarily have to be in a person's kit that they carry in the field unless that person is comfortable using it in the field. If something like this were to occur in the field I'd pray for a couple of litter bearers, a litter and that my camp is close.

I'd proceed with very minimal pain management, the administration of narcotic analgesics such as nubain or hypnotic sedatives such as versed would depend greatly on vital signs and patient condition. Field surgery would be focused on finding bleeders and either tying them off or suturing larger bleeders back to restore bloodflow. Once bleeding is controlled then I'd make a survey for lacerations / ruptures to the GI tract and organs and suture the affected areas if I felt comfortable with it and there were an actual need. The thing to keep in mind is that this surgery is not meant to be a long drawn out exploratory surgery but an expedient bleeding control exercise. I'd end the surgery by suturing up the incision except for a 1/2"-3/4" section left as a drain."

I would not recommend the above unless you are a skilled professional and have had training. You will only succeed in killing the patient quicker if you open him him to "fix the bleeding." It sounds easy but withough experience, suction and such your chances of fixing the problem are nil. If you have an open abdominal wound then packing would be the thing to do until you can get the patient to a higher level of care

Note: the above was off the top of my head between cases so please excuse typos, spelling errors or minor/old information.

Ron Ray CRNA, MS
 
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cliffy109

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I realize this discussion focuses on complete medical kits, but I thought I'd bring up the issue of a blowout kit. This is meant as an emergency kit that has everything to field treat a gunshot wound before professional help arrives.

Ventilated Operator Kit

It includes the following:

1) Cinch Tight Compression "H" Bandage
(1) TK-4 Tourni-Kwik (3” wide 40" long Rugged Combat Tourniquet)
(1) Primed Gauze (crinkle cotton)
(1) Nasopharyngeal Airway (30FR Robertazzi Style)
(1) 14ga x 3 ¼ Catheter (sterile)
(1) Alcohol Prep Pad
(2) Safety Pins (2”) multipurpose
(1) Duct Tape (2”x100” roll)
(1) Set Nitrile N-Dex Gloves
(1) Three gram tube of Surgilube

The same company also made a DVD with instructions on how to use every piece of equipment in this kit. It is NOT a substitute for real medical training, but is enough to get the average layman by in an extreme emergency.

VOK video
 

WolfBrother

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cliffy109 said:
I realize this discussion focuses on complete medical kits, but I thought I'd bring up the issue of a blowout kit. This is meant as an emergency kit that has everything to field treat a gunshot wound before professional help arrives.

Ventilated Operator Kit

It includes the following:

1) Cinch Tight Compression "H" Bandage
(1) TK-4 Tourni-Kwik (3” wide 40" long Rugged Combat Tourniquet)
(1) Primed Gauze (crinkle cotton)
(1) Nasopharyngeal Airway (30FR Robertazzi Style)
(1) 14ga x 3 ¼ Catheter (sterile)
(1) Alcohol Prep Pad
(2) Safety Pins (2”) multipurpose
(1) Duct Tape (2”x100” roll)
(1) Set Nitrile N-Dex Gloves
(1) Three gram tube of Surgilube

The same company also made a DVD with instructions on how to use every piece of equipment in this kit. It is NOT a substitute for real medical training, but is enough to get the average layman by in an extreme emergency.

VOK video
Nothing but high praise for the company that sells this kit. I bought 5. One for me, one for each vehicle, one for my Cruiser Bag, one for a spare.
 
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