My wife is an ICU doc, but she maybe carries a spare set of gloves in her car. I’ve pressed her to carry something more than that, but she has been pretty reluctant. I’ve tried to put the fear into her- what if something happens and you could have saved us if you only had X with you. I don’t know what X is. I know docs are medically trained, but with out tools, knowledge is kind of wasted.
Any suggestions for commercially available kits to buy? Just a good trauma kit the right thing? Wife is supposed to be a witch when it comes to intubating.
It’s not like we go off-grid, but when we travel, I bring enough stuff for a mid-range action movie. I just want to cover the other part of contingencies.
When I was a tactical medic I worked with the medical director of a nearby city’s tactical team. He was a neurosurgeon in his day job. He had so much crap, he could have done surgery–brain surgery!!–in the field. Most of his crap is useless: if you are going to intubate, you need a BVM, if you have a BVM and an ETT, you need oxygen. Who is going to carry O2? No one.
Most things are common and average; horses, not zebras. A comprehensive first aid kit (I like Adventure Medical Kits) and a decent trauma-specific kit. Remember, an IFAK is supposed to be used on her, not others, so I’d get trauma stuff for more than ‘just’ one person, like a ‘squad’ kit or a ‘range’ kit.
Also, she is an ICU doc, not an EM or wilderness med doc. Have her read Tintinalli (the definitive EM book) and/or Auerback (Wilderness Medicine). She can blow the dust off her neurons for the things that happen ‘out there’ instead of ‘in here.’
Your wife is the doctor. Why are you trying to tell her what she needs, should have or should do?
As a practical matter, chuck is right. Anything too exotic is impractical.
If the person is so far from help that an ambulance or air evac can’t get there and so severely injured that they won’t survive without advanced life support, they’re not going to make it anyway.
You might be surprised at the disconnect some have with the pre-hospital environment, current standards of care in the field, TCCC/TECC concepts, scene safety and patient interaction, how to use an IFAK, etc. It can be profound.
If the person is so far from help that an ambulance or air evac can’t get there and so severely injured that they won’t survive without advanced life support, they’re not going to make it anyway.
That’s a maybe, but I understand what you’re saying.
When I lived in Oregon, an acquaintance of mine is a retired US Army doctor who treated combat casualties and also a teacher at a medical college. I showed him my “trauma kit” that I keep in my car for emergencies. Showed him the contents of the kit, TQs, pressure dressings, rolled gauze, gauze pads, tape, hemostatics, emergency blanket, gloves, large printed “Stop the Bleed” flow chart in sheet protectors. etc., etc. Asked him if there was anything he could recommend to be added and what he kept in his vehicle. His response was that my kit was good to go but he only kept a very basic first aid kit with band-aids, some OTC meds and wound wipes. I was surprised and asked why not have a more expansive kit. He said that he never gave it much thought after he retired and that medical help response was usually quick in his location.
Here in Wyoming, the distances between towns and cities that have medical facilities can be quite far. Response times could be prolonged. Figured anything I can do to extend life is moving in the right direction. I’m not a medical professional, but I did sleep at a Holiday Inn Express a few times.
She won’t engage on the issue. Like I said, she might have a pair of gloves. I’m not talking exotic, the intubating was just a skill that her co-workers bring up at dinners and I know that airway is important. Like I said, I just want what she could use and not look back and think that she could have saved one of us “if only”.
We spend gobs of money on security and insurance, I thought throwing a couple of hundred into this would be money well spent.
Why don’t you just put one together for her as a gift? Might be a fun project and be something she may appreciate and use at some point.
I’ve not found anything available that is better than the kit I assembled for my truck. Start with a good TQ, scissors and gloves and build from there.
My kit sits in the backpack I have permanently in my truck and is in this pouch.
“We” always think about TQs because “we” think in terms of penetrating/perforating trauma. For general trauma 1st aid and for wilderness medicine, it’s a tool to have but rarely a priority of care because P/P trauma isn’t as common. For OOC in general and ‘back country’ certainly it’s a balance between C-ABCDE and the probability matrix of events (injuries and illnesses). TQs are cheap and small, no reason to not have one or two, but also not a likely tool to need.
HK and Chuck, that’s what I was thinking, but just don’t know what put in it. I agree on the TQs, but we are around guns so good to have a couple. Loooking at the kits, I see a lot of cleaning and wipes, and frankly, my thought was how to keep someone alive for 30min to a couple of hours- let the hospital juice them with miracle antibiotics to fix things. Gunshot wound, a nasty knife cut/stabbing, birthing a baby. Work a chest wound. Car accident where you might not be able to get the person out. Broken bones and burns- stabilize?
Retractors, clamps, couple of scalpels. Tubing?.
In her residency she was at one of the busiest ERs in the country, and I mention the ICU just because she isn’t just a pill pushing diagnostician - but yes, she isn’t a ER doc or a trauma surgeon- but she can use her hands and get medieval on things if needed.
But like I said, hard to get her to engage. Might use Father’s Day to get her to play along.
THX
You can be a trauma surgeon, EM doc, 18D, PJ, or whatever…all the ‘higher’ speed stuff isn’t worth a damn if you don’t have the logistics to back it up: advanced airway; OK, but with what do you ventilate? Are you going to use room air (21% oxygen)?
The goal of OOH care is to keep the person alive, to which you alluded. The brilliance is in the basics. Catch a baby? Two clamps, scissors, blankies, bulb suction. Keeps someone’s guts on the inside? ABD dressings, saran wrap, foil. Sick people–especially trauma–die from hypothermia, so some mylar blankets.
If you want something more-than-basic, with her license she can buy IV solutions; always good for heat casualties, hypovolemia. A basic surgical airway kit (a 11 blade, a Trousseau dilator, a tracheal hook, and a 6.5 ETT–KISS applies here). A suture kit with lidocaine.
Basic splints for fractures. She can purchase epi pen for anaphylaxis. Basic meds like benadryl, zantac, a broad spectrum antibiotic for open wounds.
All that said, 99% of her effectiveness is in a basic kit + her knowledge.
I don’t think telling you what is in my kit would be as useful. I’m not a Dr. and most of my kit is centered around first aid and is a combo medical / survival kit for a SHTF scenario.
I could ask my PA daughter and MD son in law what they would put in a vehicle kit, but I’d probably get 50 questions back because they’ll both want to over analyze it.
My Kit:
TQ - Surgical scissors (Large & Small) - thin and heavy nitrile gloves - N95 Mask - Burn Free Burn ointment - Liquid bandage - Band aids of various size - tweezers - clot packs - Gauze - Anti-biotics - surgical tape - Advil - Signal Mirror - various small tools, including a mini socket kit - Emergency blankie.
The burn ointment has found the most use of the items in my kit.
I like Chuckster’s idea of an EPI but don’t have any allergies in my family so it probably isn’t worth the bother for me.
Thanks guys. Good stuff that I hope will move the conversation forward and get her to do it as a ‘Father’s Day present’, and I’ll buy the smoker I want myself.
…and those two texts I mentioned. Even if she doesn’t ‘carry’ a band aid, the wilderness med text and EM text will be a paradigm shift in how the professions approach OOH care and treatment; the wilderness med book times a million.
Thanks guys. Was watching one of her med/drama shows with her last night and a guy had a pneumothorax. I got her to engage on doing them (yes) and what she would need to do one. Didn’t know that Heimlich had some many claims to fame, though even with out a valve or suction she said just getting the air out can help a lot.
I’m curious about her legal exposure if she’s “treating” or helping those other than family members who are significantly injured. I’m in anesthesia and this crosses my mind constantly being that live in such a litigious society.
It doesn’t matter if you are a ARC First Aid-trained do-gooder or chief of medicine at Prestigious Hospital, if you ‘practice’ outside of your lane you are at risk. Even the Good Samaritan laws offer very limited protection, and that’s for people with no training. I do think the higher up the medical food chain the higher the liability, for sure.
I think the ‘reasonable standard’ is applied in any situation: what would any other provider reasonably do? Splint a fracture, yes. Sew up open wounds, no. Of course this is my understanding, and I’d love to know what legal beagles would have to say.
Nice area, I know the hospital. Old buddy is in EM there (I think his wife is still there, too). I am in Big Blue in Durham, clinical nurse educator for trauma education. If you ever get this way give me a shout.
To risk sounding callous and uncaring, I will not render aid to strangers or get involved in any trauma that does not involve family. Harsh? Cruel? Evil sub human monster? Maybe, perhaps but not really. An ER nurse I know rendered aid to a gentleman who collapsed at a mall some time ago and was subsequently sued for her efforts. I’ll call 911 for someone or to report an incident but will not get personally involved for the most part.
