# First Aid kits



## Jay Ashworth (Jul 9, 2022)

I'm rebuilding mine, since it's gonna be a REAL busy first-season-back-after-COVID... assuming BA.5 doesn't shut us all back down again. And as I go through everyone's "10 things", "20 things" and "30 things" lists (I hit about 90% without looking), it's occurred to me to wonder:

How does one go about getting naloxone and epipens to put in such a bag? Do you need a script? How would you get a script, if so?


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## Jay Ashworth (Jul 9, 2022)

In a related story: JEEZUS is that stuff expensive. $200-600 per dose?

Yeah, ok, I get it; the alternative is dying, but even so...


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## jtweigandt (Jul 9, 2022)

I'm sure the procedure for obtaining naloxone varies from locale to locale.. but google "Standing order naloxone"
it can be obtained otc without a prescription. Pretty sure epi pen also has a "standing order" provision, but it appears on quick perusal that most of that distribution is geared toward schools.
Most fire departments in many mid to large size metro the firefighters are also paramedics.. might be a good first ask.. the local firehouse How do I??
Naloxone carries less potential adverse effect than epi if you are wrong and the patient doesn't really need it. So I'm thinking the reins might be tigher on the epi.. ie first responders school nurse etc.


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## chausman (Jul 11, 2022)

It varies by state, but generally Epi pens are not widely available without specific medical licenses or a prescription. Narcan/Naloxone is generally easier to get OTC though.

Also a general word of caution. If you're going to be putting together a large trauma/first aid kit (especially one with medications in it), it's worth checking the relevant laws in your state/jurisdiction and being aware of if and how they might cover you in your situation. Not all state's Good Samaritan laws are the same.


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## Jay Ashworth (Jul 11, 2022)

chausman said:


> It varies by state, but generally Epi pens are not widely available without specific medical licenses or a prescription. Narcan/Naloxone is generally easier to get OTC though.
> 
> Also a general word of caution. If you're going to be putting together a large trauma/first aid kit (especially one with medications in it), it's worth checking the relevant laws in your state/jurisdiction and being aware of if and how they might cover you in your situation. Not all state's Good Samaritan laws are the same.


An excellent point, and one that will probably make me stop short of those two items. 

I don't think benadryl and loperamide can get me in too much trouble....


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## MRW Lights (Jul 11, 2022)

Jay Ashworth said:


> An excellent point, and one that will probably make me stop short of those two items.
> 
> I don't think benadryl and loperamide can get me in too much trouble....



I can't discourage this second statement enough and now you've put it on the internet forever...

Does it morally suck that the system makes it prohibitively dangerous to help another human in a time of need absolutely, but that's the rub...

most "Good Samaritan" laws are incredibly restrictive and cover the "victim" significantly more than you.

here's what YOU CAN DO...

Get training, especially for department heads, full timers and anyone with responsibility of Life/Safety. There should be a local Red Cross affiliate / American Heart Association that can provide appropriate first aid / CPR training. They can also cover local municipality and state laws that vary place to place.

You may also have laws that prohibit storing, distributing or providing things as simple as acetaminophen. It's a thing in NYC for most "venues". You can't have ibuprofen in a first aid kit. (does everyone do it? absolutely. Is it technically a violation? YES.)

Take the appropriate steps to be able to provide the appropriate help in a time of need.


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## Jay Ashworth (Jul 11, 2022)

This is, for the record, my personal bag, and I'm only barely a department head anywhere I work, and all of those as overhire. I simply got tired of it taking 15 minutes to hunt up a bandaid when I scraped up my own finger on a pipe.

As far as "you can't have analgesics in a first aid kit, well, that state government will look really foolish on the national news.

I don't propose, though, legally, to "dispense" any of these items.

They're just *there*, in the corner, in a box. If anyone sees fit to take something out of it, that's no nevermind to me...


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## Morte615 (Jul 11, 2022)

Yeah an amusement park I used to work at had a "weird" rule for Aspirin and other pain killers.
They could sell it to you in the gift shop but they were not allowed to hand it to you in first aid, even by the registered nurses they had working.
But they also had a container of pre-packed dosages (same they sold in the gift shop) sitting on the counter of first aid. You could grab one yourself but they were not allowed to hand it to you. I am guessing (though don't know for sure) that the moment it was handed to you it was dispensing, but if you grabbed it yourself it was fine.


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## Jay Ashworth (Jul 11, 2022)

Morte615 said:


> Yeah an amusement park I used to work at had a "weird" rule for Aspirin and other pain killers.
> They could sell it to you in the gift shop but they were not allowed to hand it to you in first aid, even by the registered nurses they had working.
> But they also had a container of pre-packed dosages (same they sold in the gift shop) sitting on the counter of first aid. You could grab one yourself but they were not allowed to hand it to you. I am guessing (though don't know for sure) that the moment it was handed to you it was dispensing, but if you grabbed it yourself it was fine.


I'm inferring such a legality, yes. Lawyers... <sheesh>


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## jtweigandt (Jul 12, 2022)

Good sam talk reminds me. I once witnessed an older patron step backwards off a step at a local barn theater, just a few feet from me. It was the whole time slows down slo mo.... ohhhh nooooooooo. Couldn't get to her, and she hit back of the head first. I made her stay down, got someone on the cell phone to call the para meds. Family got her up to a seat but paramedics arrived. She checked out basically ok.. was mobile and lucid.... I really pushed the family hard into having her take the ambulance ride, because I saw the head strike and no one else did. Few months later she literally charged up to me in the church parking lot to thank me. She had CT.. sub dural hematoma.. they drilled and drained. Without the ride and the check, she would have gone home laid down and never gotten up again. So yes I was pushy and a busy body... and someone probably could have sued me if everything checked out OK for an un necessary ambulance ride. But sometimes lawyers be damned, you have to do the right thing. I probably am in a more precarious liability situation being a Veterinarian, but you'd probably rather be shipwrecked with me than your dentist.


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## SteveB (Jul 12, 2022)

MRW Lights said:


> .
> 
> You may also have laws that prohibit storing, distributing or providing things as simple as acetaminophen. It's a thing in NYC for most "venues". You can't have ibuprofen in a first aid kit. (does everyone do it? absolutely. Is it technically a violation? YES.)
> 
> Thats fascinatiing as we had a contract first aid kit contractor at Brooklyn, would come in periodicaly and re-stock the first aid kit, which had acetaminophen in it. I assume he was unaware of that particular NYC law.


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## Jay Ashworth (Jul 12, 2022)

jtweigandt said:


> Good sam talk reminds me. I once witnessed an older patron step backwards off a step at a local barn theater, just a few feet from me. It was the whole time slows down slo mo.... ohhhh nooooooooo. Couldn't get to her, and she hit back of the head first. I made her stay down, got someone on the cell phone to call the para meds. Family got her up to a seat but paramedics arrived. She checked out basically ok.. was mobile and lucid.... I really pushed the family hard into having her take the ambulance ride, because I saw the head strike and no one else did. Few months later she literally charged up to me in the church parking lot to thank me. She had CT.. sub dural hematoma.. they drilled and drained. Without the ride and the check, she would have gone home laid down and never gotten up again. So yes I was pushy and a busy body... and someone probably could have sued me if everything checked out OK for an un necessary ambulance ride. But sometimes lawyers be damned, you have to do the right thing. I probably am in a more precarious liability situation being a Veterinarian, but you'd probably rather be shipwrecked with me than your dentist.


Nice.

And yes, in the lifeboat, the *person who read the medical textbook* does the emergency appy.


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## ZHamm (Jul 13, 2022)

One other resource that may be useful to you or others who want to carry Naloxone. Try your county (or other municipal) health department. In our area in western NY there is an effort to provide training and free doses to the public. You show up for the training and leave with a dose. One thing to note is that storage temperature for Naloxone is recommended 68 degrees F to 77F with occasional exposure of up to 104F. Depending upon the season and geography it probably shouldn't live in a car based kit all the time.


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## jad17555 (Jul 13, 2022)

As a Paramedic who dabbles in stagecraft, here's my $0.02. 

1. Any medical provider other than a physician is governed by a scope of practice and set of protocols that are established by state and local authorities. Anything we do requires a standing or direct order from a physician. Hence the reason I cannot carry common OTC pain relievers or other meds and give them out. I can, however, leave them on the table for a person to self-medicate.

2. As stated above, Narcan and EPI have very specific temperature ranges and shelf life. In most states, Narcan has a standing order for general public administration, Epi does not. In most EMS systems anyone other than a paramedic can assist a person to take their own EPI Pen (though that is changing to allow EMT's to use their own)

3. When you build your kit, there are 2 scenarios to plan for - Bo-Bo's and trauma. For Bo-Bo's the usual stuff - BandAids, Gauze, splints, etc. For Trauma, add a Stop the Bleed Kit (https://www.bleedingkits.org/all-products/personal-stop-the-bleed-kits.html) that contains a tourniquet, Chest Seals, Wound packing gauze, and pressure bandage. Buy these kits from a reputable supplier - NOT Amazon!! The $19.99 tourniquets are not of high quality or tested and will fail. Spend the extra $10 and go to a vendor like North American Rescue for a COTCCC approved device.

4. In addition to a CPR, AED, and First Aid Course, take a Stop-The-Bleed course to learn and practice using the kit contents. There are other courses such as Trauma First Responder that go into more depth.

You are working on stage with power tools and working at heights so the risk of major lacerations and falls is always there. That is what the second part of the kit is for.

John D


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## Jay Ashworth (Jul 14, 2022)

On point 1, *you* have a license to lift, which, presumably, I don't. This matters? "There's probably some helpful stuff in my bag" was my planned stance; I *know* my limits in First Aid.  

3. Thanks for the link.
4. I gotta check if my new house has AEDs; it's gotta for $15M, right? 

My older house does.


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## jad17555 (Jul 15, 2022)

Jay Ashworth said:


> On point 1, *you* have a license to lift, which, presumably, I don't. This matters? "There's probably some helpful stuff in my bag" was my planned stance; I *know* my limits in First Aid.
> 
> 3. Thanks for the link.
> 4. I gotta check if my new house has AEDs; it's gotta for $15M, right?
> ...


Jay:

Agreed. when i am away from my department, i function as an overqualified standard first-aider, 

If your house has an AED, get them to add a Stop the Bleed kit to it as well. (and take the course)

To answer your first question - the reason for the post, after many years of traveling with small children, Scout troops, Marching bands, and youth groups I developed a small hip sack that serves as a walking first aid kit. Contents are as follows:

Front compartment - small flashlight, whistle, and compass (also space for keys, etc.) Also, an energy gel can be useful

Rear compartment 
2x Nitrile gloves (your size, NOT black)​Tourniquet​Chest Seals​4x4 Gauze pads​5x9 gauze pad​3" Kling (self-adhering gauze)​3" Ace bandage​Triangle bandage​Ziplock bag for bo-bos with various forms of Band-Aids, Benzalkonium Chloride wipes, and Triple antibiotic ointment​Ziplock bag with unit dose packs of common meds (Advil, Tylenol, Benadryl, Imodium, and Rolaids) to be made available for self-administration ​Tools - small bandage scissors, tweezer, safety pins, tick remover​​If I carry tape, it needs to be replaced frequently. I would add a small knife but it needs to be TSA compliant.​​Obviously, I have other kits built for other purposes, but this is the minimalist one.


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## Jay Ashworth (Jul 15, 2022)

jad17555 said:


> Jay:
> 
> Agreed. when i am away from my department, i function as an overqualified standard first-aider,
> 
> ...


Unsurprisingly, that's a pretty big IFAK. 

I don't do things by half-measures, and I had some free cash; my bag is the big orange Damero (https://www.amazon.com/gp/product/B09FZ7J29R/?tag=controlbooth-20) with no big silly cross or labelling. I picked it because of the flip up and flip down lids -- the competition didn't have those -- and a couple other things. It's almost full, and almost at maximum load (I suspect); I'll post an inventory here in the next day or two; been out sick most of the week.

[ On reflection, that's one notch up from an IFAK, isn't it? ]


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## jad17555 (Jul 15, 2022)

Jay Ashworth said:


> Unsurprisingly, that's a pretty big IFAK.
> 
> I don't do things by half-measures, and I had some free cash; my bag is the big orange Damero (https://www.amazon.com/gp/product/B09FZ7J29R/?tag=controlbooth-20) with no big silly cross or labelling. I picked it because of the flip up and flip down lids -- the competition didn't have those -- and a couple other things. It's almost full, and almost at maximum load (I suspect); I'll post an inventory here in the next day or two; been out sick most of the week.
> 
> [ On reflection, that's one notch up from an IFAK, isn't it? ]


Jay - that's a nice looking bag - similar to what we use as a "first In" bag. I will be interested in your inventory


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## gafftaper (Jul 27, 2022)

A really important thing to consider in this discussion is the respomse time of EMS in your area. In my case the fire department is about 2 minutes away. I need to call 911 and keep the victim alive 3 minutes until the professionals can take over. So my primary 1st aid kit is just an AED and a bleeding kit. In the back, I have an extensive minor injury kit (ace bandages, ice packs, band aids, gauze pads and tape, etc). 

Also remember if you are working in a school or around children you probably should never give them any medication. Check into the local rules carefully.


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## Footer (Jul 27, 2022)

So, probably outside the realm for most... but we pay a service to do this for us. We have 5 kits throughout the building, all very well stocked and checked quarterly. Takes care of the OSHA requirement and requires no staff interact. Costs about 2 grand a year to do all in. 





Workplace First Aid and Safety Services | Cintas

-


www.cintas.com


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## gafftaper (Aug 1, 2022)

Also, if you work in the education world you should discuss this with your school medical staff. So that your kit fits into the overall campus emergency plans and so that your medical staff knows what's in your kit and where to find it.


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## Jay Ashworth (Dec 1, 2022)

Ok, it's been a day or two or 45, and so here is the pictorial version of that inventory I promised.

I may get back to it to itemize in text, or not...



Front drop, compartment 2; this usually also contains an IR forehead thermometer, but it was in my bedroom at the time.



The main top compartment has 4 slices, a wide one across the back, 1A contains bandaids and related stuff. Apologies; Xen apparently ignores camera orientation, and also appears not to provide manual controls for editing...



Front left is 1B; cold packs (and I have heat packs to go in there), plus Curad spray bandage, which I like better, it turns out than...



Center is 1C; assorted OTC... including NuSkin, which oversprays even more, doesn't set as fast, and flakes off when it does. Where possible I've chosen either non-contact or individually-packed items, except where that ran the cost up unreasonable; sometimes, that multiplier is *six* to one or even higher.

Right is 1D; gloves and some cohesive bandages. Gloves are an example of the price multiplier which I remember: 10 pair in sterile envelopes cost about 4 times as much as 25 pair in a bulk box, like these.



Compartment 4; cough drops and Sucrets.



This should be 3, unless I've screwed up.  Half a dozen magic mylar blankets (cause they're disposable), a couple prism paks of temp-stable Instant Breakfast. And a few gallon freezer slider ziplocs, for utility, including disposing of medical waste -- which means anyone's bodily fluids that aren't *yours*. 



In compartment 6 (yeah, I don't know how we got here either, and the actual bag's in the car and I don't have the energy to go haul it inside right now...) lots of rolls of gauze.

Items I am still contemplating include folding splints, tourniquets, and an airway set. Not sure they carry enough utility for their potential risk, as discussed above. Plus, I personally am not trained in using any of them -- that doesn't make them useless to pack, but...


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## jad17555 (Dec 1, 2022)

Jay Ashworth said:


> Ok, it's been a day or two or 45, and so here is the pictorial version of that inventory I promised.
> 
> I may get back to it to itemize in text, or not...
> View attachment 23698
> ...


Jay - the kit looks great and should cover anything but the really big stuff. If you add a tourniquet and pressure dressing to it (part of the STB kit) it will help with that. I would forget the airway kit (very limited use) but add a pocket mask for your protection. Hopefully you won't need to use any of it!


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## Jay Ashworth (Dec 1, 2022)

jad17555 said:


> Jay - the kit looks great and should cover anything but the really big stuff. If you add a tourniquet and pressure dressing to it (part of the STB kit) it will help with that. I would forget the airway kit (very limited use) but add a pocket mask for your protection. Hopefully you won't need to use any of it!


There are half a dozen KN94s in a bag in there somewhere; I dunno why they didn't show up here...

And there are 2 or 3 sealed 4 oz bottles of eyewash (among other things) that didn't get listed here, so clearly I missed a pic, probably 1D.


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## seanandkate (Dec 2, 2022)

That's a pretty epic kit Jay.


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## jtweigandt (Dec 2, 2022)

You need to enclose the Regulatory disclaimer card... "This is the Jay Ashworth personal first aid kit. All items contained within are for my personal use and protection only. Feel free to use any of the contents to save my life and my life exclusively. Use for any other patient human or animal is not encouraged, nor condoned by me (Jay Ashworth) and would be considered theft at best." 

"So your honor.. I had my personal kit along.. and what was I to do? let the victim suffer and die?"


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## Calc (Dec 2, 2022)

When Jad mentions a 'Pocket Mask', he might be talking about something like this, not a KN95. Intended so you can do CPR without kissing strangers.


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## Jay Ashworth (Dec 3, 2022)

Calc said:


> When Jad mentions a 'Pocket Mask', he might be talking about something like this, not a KN95. Intended so you can do CPR without kissing strangers.


Possibly. 

That said, I've been told that two-component CPR is denigrated these days; compressions only is the current recommendation (assuming you aren't an EMT...)


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## RonaldBeal (Dec 4, 2022)

Jay Ashworth said:


> Possibly.
> 
> That said, I've been told that two-component CPR is denigrated these days; compressions only is the current recommendation (assuming you aren't an EMT...)


Reasons for the best efficacy of chest compression-only CPR include a better willingness to start CPR by bystanders, the low quality of mouth-to-mouth ventilation and a detrimental effect of too long interruptions of chest compressions during ventilation. Based on our findings, compression-only CPR should be recommended as the preferred CPR technique performed by untrained bystander.

from: https://www.ncbi.nlm.nih.gov/pmc/ar...cacy,of chest compressions during ventilation.


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## Jay Ashworth (Dec 4, 2022)

RonaldBeal said:


> Reasons for the best efficacy of chest compression-only CPR include a better willingness to start CPR by bystanders, the low quality of mouth-to-mouth ventilation and a detrimental effect of too long interruptions of chest compressions during ventilation. Based on our findings, compression-only CPR should be recommended as the preferred CPR technique performed by untrained bystander.
> 
> from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484593/#:~:text=Reasons for the best efficacy,of chest compressions during ventilation.


So in short, the Assumption I made in my last clause is pretty close to accurate: compression only CPR is better up at 40,000 ft, where there's likely to be more of it, but two component CPR is actually still better, *assuming it's being done properly*.


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## Benjamin Fink (Dec 5, 2022)

I just purchased this book from Lost Art Press and would highly recommend it. Jeffrey Hill (the author) is an ER physician and woodworker, and it's specifically focused on first aid for workshop accidents. The book has a list of recommended supplies as well as instructions to deal with a wide variety of injuries (cuts, punctures, amputations, etc.) It's also small enough to easily fit in a first aid kit and is sold by a small independent publisher and bound in the US.


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## Jay Ashworth (Dec 5, 2022)

Benjamin Fink said:


> I just purchased this book from Lost Art Press and would highly recommend it. Jeffrey Hill (the author) is an ER physician and woodworker, and it's specifically focused on first aid for workshop accidents. The book has a list of recommended supplies as well as instructions to deal with a wide variety of injuries (cuts, punctures, amputations, etc.) It's also small enough to easily fit in a first aid kit and is sold by a small independent publisher and bound in the US.


I have—it is in the top lid and I forgot to photograph it—a little general first aid kit that folds out from something the size of a business card. I'll look at this one too, thanks.


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