Let us discuss medkits. Just like your pack, the less stuff in the smallest area for the biggest capability is your goal. When buying or assembling a medkit people have this amazing capability to both under-prepare and over pack. The assembled kits that are for sale are partly at fault; the vast bulk are just terrible, mostly trying to put in lots of low value items to justify the cost. Let us then assume that you’ll be assembling your own.
Remember the goal here is to cover items that enable skills to allow you to stave off death long enough to reach definitive care. Anything else is for a booboo kit, and I suggest that being a separate section of the medkit or its own.
Originally when I wrote this it had a lot more biomed knowledge to justify the choices, and more the don’t bother. I’ve narrowed that down a lot. Need to be humble about what you can do even in the perfect, understand what you can do reasonably, and accept that sometimes you actually are mostly helpless.
What do you know?
There is no point in having things in your medkit that you are not certain you know how to use or when. First item to put in your medkit is your brain. I think this is part of why so many medkits end up really being booboo bags. Don’t get me wrong, booboo kit is a very nice thing, just understand that’s what it is. The level and power of your medkit is based on the level and power of your knowledge and training. The gear won’t save you, the gear is to enable what you know. I’m being a bit vague on purpose to cause you to evaluate your knowledge to know what you need to enable your skills, or seek those skills so you know exactly what kind of equipment you need and what’s good.
What are you doing? What’s likely to happen?
Assembling an absolutely everything kit to go with you everywhere is folly. My hiking kit looks more like a booboo kit with some severe trauma items for problems I’m likely to encounter. This is also the place to consider probabilities. The kit has items that must be present to delay death until EMS arrives based on my level of knowledge. I’m not running around with a bag-valve mask. I don’t have a tube kit. I don’t have a bunch of drugs. I’m not likely to need it. The more medical gear you have, the more you have to maintain and replace. Slim it down to something manageable. Stuff you really know how to use and is indispensable if something of reasonable probability occurs and that you can use to actually make a difference. Don’t overdo this minimal approach and decide to rely on on the spot improvised supplies. Note on improvisation that knowing how to use something that way and having practiced and proven is different, as is using a more general purpose item rather than a specialized one. My experience has most improvisation is about not wanting to spend money, or, “just do this” thinking… belt as a TQ I’m looking at you.
I’m not really a fan of “someone that does know how might not have one and need it”. Don’t put things in that you don’t know how to use.
The kit you’ll reasonably carry hiking every time you go out is probably insufficient for a bear mauling. The one you need for that you sure don’t want to carry every single time. Still what do you do about that, reasonably? Consider… I’ve seen a half dozen bears in my life. Not close calls. Seen. Single digit numbers of people get mauled in America and they usually participate in that happening.
You cannot fix anything in the field your body is incapable of handling on its own. Anything you’re “fixing” without a hospital trip is comfort related or allowing the body to fix itself faster or reduce chances of infection. Something life and limb threatening is a non-negotiable hospital trip.
MARCH
Massive Hemorrhage
Your kit absolutely must include items that will allow you do deal with a massive bleed. You need something you can use to apply and maintain direct pressure as this is your first go-to. You need a tourniquet you know how to use (I suggest NAEMT and/or TCCC approved), gauze you can pack with, and pressure bandage to hold it together. Do be thinking about how these can be multi purpose items. The gauze can be used for wrapping as a regular bandage, not just packing.
If you need to or want to deploy an item do it. You don’t need to save it for later, especially if its something low-cost. If it’s small and lightweight include a low-cost one to augment a high cost one - hemostatic gauze I’m looking at you. You’ll likely be able to replace it before you need it again. Don’t hesitate to deal with a significant bleed.
The pouch used for the med kit should unfold to have the items to deal with significant bleeds visible and accessible quickly. Don’t bury the gauze and TQ somewhere in your pack that requires digging. Often I have the TQ out on its own so it’s more accessible. The most compact bags have ribbons you pull that dump the contents everywhere, gets out fast but my opinion is this is less than ideal.
Airway
This second part of MARCH-PAWS and first part of ABC is tricky for citizens. For self-care there’s not much you can do here. If you can’t breathe due to compromised airway you’ll have an extremely limited time to fix that or rely on a buddy that knows what they’re doing to save you. NPAs are generally the item that goes in an IFAK to cover this, recovery position also generally works (no item needed!). If the patient can breathe on their own they should, so make sure they can.
What is causing the airway to be compromised and why? Does it need to be secured? NPAs don’t secure an airway you need a tube for that. As a citizen you’re not going to do this due to lack of training and practice, nor carry all of the items. In addition use of intubation is coming into question as a generalized practice. NAEMT-PHTLS 8th edition recommends avoiding intubation whenever possible.
So, what would cause an airway to become compromised in a general situation that you can do something about? Anaphylaxis. For a citizen kit the answer is probably epi-pen. That gets into some logistical concerns with cost and getting an MD that will go with it. But, I’m increasingly thinking some kind of epi in a med kit is very wise if you can get it. Possibly it would be a boon on society to normalize epi-pens in most well equipped kits for people who know what they’re doing but still aren’t EMTs. Having at least 50mg of benadryl (diphenhydramine) on hand is a good idea too. Do know that diphenhydramine does actually degrade over about 2 years so be ready to replace this with freshly produced medication frequently.
Respiration
Respiration will get us to chest seals and dealing with impalement and other penetrating trauma of the thorax. This is the stage of making sure respiration (as in use of oxygen) is happening. Need oxygen available to the blood (lungs) and the blood able to attach and carry it, so it goes a bit further than the lungs and starts into the next category.
If something penetrates the body it should stay put if it can - this is true with extremity impalements too. If there’s a hole because it has to be removed, was removed, or is a gunshot or animal related puncture then you’re going to need an occlusive dressing. This is where the chest seals come in. They’re super handy, but you can make one too with some plastic and tape. The real ones are better though, they seal better, are easier to burp or self burping, and stick much harder.
Needle decompression is a what you know thing. Probability you’ll need to do this is vanishingly low. The fad of ALS needles comes from the military where this is a “why not” type treatment for a gunshot wound to the chest. There’s already a hole, so let’s make another one just in case. For the rest of respiration it is doubtful you’ll be carrying around bag-valve mask, stethoscopes, and other such gear you’d find in an ambulance or ER. Remember, it’s about the most you can do for the most likely severe things you can deal with with what you know and is reasonable to carry. If it’s not absolutely necessary, especially if you don’t really know how or when to use it, it’s not necessary.
Another what you know is CPR. Do you know current best practices with CPR? Is it reasonable to do this while awaiting rescue?
Circulation / Shock
First the part you can do something about: this is where to address non life threatening bleeding and that blood is getting to the tissues it should and can. More gauze and steri-strips. The more blood you can keep in the circulatory system the less likely you’ll have to deal with a shock situation. Shock is dealt with by fluid resuscitation, keeping as many red-blood cells in the circulatory system as possible, and controlling & preventing pneumo/hemo-thorax. In your kit you can reasonably do 2; 1 with a normal level of training and you already have that covered.
Hypothermia & Head
Put a survival blanket or wrap in your medkit. They’re tiny, lightweight, and cheap. There is no reason to not have one. Keeping someone warm will keep their blood clotting properly and prevent all sorts of metabolic problems. If someone has lost any significant amount of blood they will be cold. The shock above can also be reduced increasing the survivability chances of your patient until you can get them to definitive care. Put a survival wrap or blanket in all of your kits.
Do you know the symptoms of traumatic brain injury (TBI)? Again, not really a medkit thing, but sure will alter how you handle your patient. Again, what you know vs what you have.
PAWS the booboo kit
Pain
A small amount of your favorite analgesic is a good idea. I’d say maybe a dose or two. There is no reason to carry around a whole bottle of acetaminophen in your pack. If you’re prone to kidney stones, maybe, maybe, it’s worth having something better in there. Pain is a good place to think about bug bites, tick keys, hydrocortizone, chapstick, and sunburns.
Antibiotics
Antibiotics for this context will be your triple antibiotic ointment. If you are to the point you need something more severe it’s extract and hospital time. May want to think about water filtration/purification here too if on a long trek.
Wounds
The most used things in my medkit involve treating my feet. Moleskin and heavy fabric bandiads. Blisters are the most common wound I deal with. Treating these early prevents further injury by reducing fatigue and soreness, which leads to stumbles, falls, and joint pain due to odd gait. Tincture of benzoin will make bandaids stick better for sweaty feet some swabs of this can be nice.
Splinting
If you have room some kind of splinting device is nice to have. There are other uses besides use as a splint as well. With tape, gauze, and things lying around splints can be improvised. Have in mind what you might do with a severe joint injury or bone break.