Disclaimer:
I am not a medical professional, however I have been studying emergency medicine for roughly 8 years, and consulted medical professionals when writing this article. Before attempting any medical interventions, you should seek proper training. Remember, if you don’t know what you are doing, you are more of a liability than a help.
What is a Trauma Kit?
First of all, what is a trauma kit and how does it differ from a standard first aid kit? First aid kits are designed with common, minor, injuries in mind and are primarily stocked with bandages, and maybe medications like Tylenol. Trauma kits on the other hand are built with immediate life saving in mind, like car crashes, gunshot wounds, and other traumatic injuries. As such, their focus is on the MARCH algorithm, which stands for Massive Hemorrhaging, Airway, Respiration, Circulation, and Hypothermia / Head Trauma. This is the standard assessment used when evaluating and treating traumatic wounds.
Choosing the Right Kit for You
What you carry in your trauma kit will primarily be based on your level of training. Keep in mind that without sufficient training, you are a liability, not a help.
Stop The Bleed Kits
Stop The Bleed education and kits are becoming increasingly popular and for good reason. Left unchecked, a casualty can bleed out in mere minutes, thus why controlling massive hemorrhaging is the most pressing step in MARCH. It also requires a minimal amount of training to become proficient in and is non-invasive, meaning it carries little risk of worsening injuries. Besides, bleeding is the #1 cause of preventable death after an injury.
First up, is something that deserves a place in any trauma kit – a good set of shears. You can’t treat what you can’t see, so your first step is going to be exposing the wound. There are a ton of trauma shears on the market and they vary wildly in price. While the Leatherman Raptors may be nice, if you are just a prepared citizen as opposed to a medical professional, I’d recommend something cheaper, like those made by Madison Supply. This will save you quite a bit of money, allowing you to either stock up on more kits, and stage them everywhere, or to treat the shears as disposable when working with potentially infectious patients.
Next are tourniquets – the first line of defense against massive hemorrhaging of the extremities, but they come with some risks when left on too long. For that reason you may want to mark “TQ” along with the time it was placed on the victim’s forehead.
There are a ton of tourniquets on the market, but they aren’t all created equally. Ensure that the tourniquets you purchase are approved by the CoTCCC. The SOF-T Wide is my preferred tourniquet, though I also have experience with the CATs.
Tourniquets should be placed at least two inches proximal (closer to the torso) to the wound, though there’s nothing wrong with the classic “high and tight” application. After looping the tourniquet around the injured limb, pull the excess webbing before rotating the windlass until the bleeding stops. If one tourniquet isn’t adequate, apply a second one proximal to the first.
Then there’s gauze, which is used to pack junctional wounds, such as the hips, shoulders, or wounds of the extremities that are too high up to place a tourniquet. They come in two varieties – traditional and hemostatic, yet both are used the same way. Simply pack the gauze inside the wound as tightly as possible, then cover the wound with a pressure dressing.
While most traditional gauze is more or less equal, you’ll want to be more careful when selecting hemostatic gauze. The two industry leaders for hemostatic gauze are QuickClot and Cellox, with similar efficacy for both. Hemostatic gauze may also become less effective with age, so keep an eye on the expiration dates and rotate as necessary.
Lastly, there are pressure dressings such as the Israeli bandage (also known as an emergency trauma dressing). With the wound packed, place the nonstick pad part of the dressing on top of it. Then, pulling the dressing tight, wrap the bandage once around the extremity and pass it through the pressure regulator, pulling it taut, before wrapping the bandage in the other direction. Finally use the locking bar to secure the end of the bandage to the wraps.
Traditional IFAKs
Military-style individual first aid kits are a favorite in the tactical industry, Minimalist, yet fairly well-rounded, these kits are designed to stop hemorrhaging and maintain airway patency. In them, you’ll usually find both hemostatic and traditional gauze, chest seals, tourniquets, pressure dressings, NPAs and sometimes shears as well. This covers the first two steps in MARCH, which are the most pressing. Besides Stop the Bleed gear, they also tend to have a couple items for maintaining an airway and preventing pnuemothorax.
Nasopharyngeal Airways, or NPAs, are used to maintain airway patency in a patient with a compromised airway. Able to be used on conscious patients, and are straight forward to use. However, due to the vascular nature of the nose, there is a bleeding risk. Additionally, NPAs are contraindicated when there is facial trauma, or the patient has polyps of the nasal cavity.
To use, simply apply lubricant to the NPA, face the bevel towards the septum of the nose, and insert it until only the flange is protruding.
Chest seals are used to prevent and mitigate tension pneumothorax, which is when air becomes trapped between the lungs and the chest wall. As more air finds its way into the chest cavity, pressure increases, straining the heart and lungs. Chest seals, as the name implies, are designed to prevent air from making its way into the chest cavity.
There are two types of chest seals – vented and non-vented. There is a debate in the medical industry over which is better to use, however, the effectiveness of them are similar. Vented chest seals allow the built up air in the chest cavity to escape. Non Vented chest seals provide a tight seal that prevents air from escaping or entering the body, however, one can always “burp” the chest seal to help allow this air to escape.
Adhesive backed, simply remove the backer and center the chest seal over the wound.
While chest seals may help prevent pneumothorax from developing or getting worse, but they don’t correct it. For this, you’ll need a decompression needle. Traditionally, ARS needles are 14ga x 3.25″, the trend is starting to shift towards 10ga x 3.75″ as these have higher reliability and allow air to escape the chest cavity much faster.
To use a decompression needle, you’ll either want to locate the anterior 2nd intercostal space, or the lateral 3rd & 4th intercostal space depending on which method makes the most sense for the situation. Then, keeping the needle perpendicular to the body, insert the needle all the way to the flange. After waiting five seconds, pull out the needle leaving just the plastic tube in the body.
Airway and Ventilation Kits
Unless you are a medic, EMT, or other medical professional, you probably won’t be carrying a dedicated Airway and Ventilation kit, but there are certainly some things you can learn from how these professionals set up their equipment and why.
NPAs may be ideal in some situations, the nasal passages are very vascular, they do carry a bleeding risk. As such, they shouldn’t be used on a casualty with facial trauma or nasal polyps. This is where OPAs come in. Oropharyngeal Airways can’t be administered on conscious patients due to gag reflex, but don’t carry the bleeding risk of an NPA. As such, they can be used when there is facial trauma or suspected fractures.
To place an OPA, first you’ll want to size the airway. With the flange at the patient’s teeth, the tip of the OPA should reach the angle of the jaw. Then, perform a head-tilt, chin-lift to open the airway. Begin inserting the OPA upside-down until it won’t go any further (do not force the OPA). Lastly, twist the OPA and insert it the rest of the way before using tape to secure the airway from being dislodged while transporting the casualty.
While mouth to mouth is no longer recommended for CPR, there are still times when you may need to breathe for your patient. In these cases, rather than risking disease transmission or providing less than ideal breaths, a bag valve mask is the way to go. A Pocket BVM, such as this one from Rescue Essentials, is ideal in most non-hospital settings as they are compact enough to take just about anywhere. Some BVMs are O2 tubing compatible, which is a great capability for those working in a hospital or ambulance setting, while others do not. BVMs provide better ventilation, and don’t carry the same risks to the provider as rescue breaths. They also help prevent aspiration by keeping excess air from being pushed into the stomach. However, one must always be vigilant for over-ventilation, as this can be extremely dangerous to the casualty. Remember, on an adult patient, the goal is to make the chest rise roughly 2 inches and to allow the chest to fall back to its natural position between each breath, which should be administered roughly once every second.
Sometimes, foreign objects lodged in the mouth are the reason behind an obstructed airway. To remove these objects, one could perform a finger sweep, but this can pose a risk to the responder as the patient’s jaw could clamp down on your finger. Because of this, I carry a Kelly Clamp (hemostat) for use in these situations.
Conclusion
Trauma kits come in a wide variety of configurations for a variety of use cases. Which trauma kit is right for you? Let us know what you carry in the comments below. If you liked this week’s content, don’t forget to sign up for our newsletter and check out our social media to be the first to know when we release new content.