If you are an EM:RAP listener, you have probably heard Mel Herbert's story of 2 cars crashing right outside of his house. Mel realized he did not stock a medical kit in his house with the necessary crucial supplies for an emergency scene. I realized I don't either (there is one in my car). So, I reached out to the master of preparedness, Dr. Keith Conover.
Everyday Emergency Kit
We spend the 1st part of the show discussing the everyday kit which Dr. Conover has with him (or in eye shot) pretty much always. He carries it in a fanny pack–I'm not sure if I can be persuaded to do this, but you should probably keep a kit with at least these items in your car or house.
On the topic of fanny packs…
Well anyhooooo, here is the list
We also discussed the Daypack Medical Kit for your House/Car
Digital Intubation
- Rich Levitan has an amazing article on the topic of Digital Intubation (Note: I can't find this online anymore so this is a Crashing Pt Copy)
- Here is an amazing entry on the Life in the Fast Lane CCC
Equipment we Discussed
Tourniquet
The CAT Tourniquet is the best one yet
Disposable Laryngoscopes for Kits
- Surescope
- Truphatek Trulite (This one folds up and is Rich Levitan's Rec)
Headlamp
I recommend the Zebralights, this is the one I use:
SAM Splint
The SAM Splint is EMS standard stock
Trauma Bag
In his trunk, Dr. Conover has this prestocked trauma kit.
Pelvic Binder
Dr. Conover actually carries a pelvic binder in his trunk as well (no comment), he stocks the SAM II Pelvic Splint.
Other Crucial Links
Update – Stuff EMCrit Likes
The folks at microbvm
sent me their pocketbvm
this device fills a key role. It is the only BVM small enough to realistically keep in your car trunk. It unfolds to a perfect, usable BVM but takes up minimal space in storage.
Additional New Information
More on EMCrit
PEMED's Resus Kit(Opens in a new browser tab)
Additional Resources
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Hey Scott, good podcast with some good information. As a Paramedic who works in the urban and wilderness search and rescue capacity I think you and Keith missed a very important life saving, hard to improvise, piece of equipment. Granular Hemostatics! Quick Clot, Celox, or another manufacture’s. I don’t have to impress upon you or the other listeners about the benefits of abating massive hemorrhage and doing so quickly. Having another contingency to address massive hemorrhage for non extremity or an area that isn’t suitable for a tourniquet is paramount. I have a few CATs in my kits (love them!)… Read more »
nice!!
I was reading an interesting perspectives on use of tourniquet in this book:
http://www.twnside.org.sg/title/limb.htm
For urban/combat application make sense but for remote application may not be the best use.
Scott, I haven’t listened to the podcast yet so please disregard if you talk about it. What are your thoughts on the LifeStat keychain cric device? http://lifestatmedical.com/ It has a sharp trocar with an outer cannula that you use for cric puncture then the outer universal adapter screws onto the top of the cannula which can then attach to an ET tube adapter. Obviously having a scalpel and tube +/- a bougie in a kit would be ideal but this makes sure that an airway is never more than the distance away from your keys. My one concern would be… Read more »
looked at these when they first came out at a trade show–i would never touch one. Pretty much anything involving a trocar is a flail in my mindset. Trocars=evil
I can confirm this. I recently attempted a crich with a trochar-based QuickTrach device. You might as well try to puncture the membrane with a soup spoon. It’s a nice thought, but they just aren’t practical.
-Mike
Scott, you touched my heart with this podcast….I teach wilderness medicine and volunteer as a SAR medic. Couple of thoughts/suggestions: 1) If you want to use a standard laryngoscope, the pediatric handle accepts all sizes of blades and uses AA batteries, the same as most headlamps. 2) Bougies are great for digital intubation….I suck at them in mannequins, but I’ve found that using the bougie as an introducer increases my success rate. 3) A one-way valve for mouth-to-ET tube ventilation is definitely minimalist, but imagine bending over for hours to ventilate a patient while doing a litter evacuation…I assure you,… Read more »
^^^^I need to correct a major typo! I meant a Heimlich valve instead of one-way valve for the improvised chest tube. A one-way valve would be a horrible idea!
Ben–Heimlich is just a one-way valve so you were good the first time. Amazing comments! As to bougie for digital–this is the way I learned on corpses–totally agree Can you send a picture of your vent tubing one-way valve set-up? (easiest to tweet to @emcrit) SOFT-T looks very nice As to ETT for chest tube, that’s exactly what I was thinking when Keith talked about it and I stock 3ETTs in my car kit rather than chest tube. If you don’t have the one-way, just use the glove tip with a slit (old school) #7 is a frigging amazing tip–I… Read more »
GDay Scott,
Haven’t listened to all of podcast – but thanks for the words of warning/words of advice regarding fanny packs and bum bags from Kieth. Priceless.
yes, very important distinction
Bringing upstairs care everywhere on your person at all times?
In all seriousness do you carry any self created literature or Tarascan pocket books printed on digital during your shifts? Such as Drug/Drip dosages, protocols, various scoring parameters (besides your LLS Looks like shit score respectively).
there are computers EVERYWHERE in my dept, so I don’t carry anything anymore.
Trauma kit link is dead!
fixed! thanks, Paul
Daypack Med Kit link broken
Missing hand/portable suction. I carry NAR suction. cheap and small. http://www.rescue-essentials.com/nar-suction-device/
nice
As an improvised alternative, use your 60mL syringe and shove it into the bevel end of an NPA for a mechanical suction device. A Leur lock syringe works well for blood/water/runny vomit, but for slightly chunkier stuff a catheter tip is needed. Bonus for the catheter tip; you can pull off the 15/22 adapter to your ET tube, attach the syringe to the end of the ET tube and suction the trachea directly. I love the “squid” type suction devices though, I have one in my SAR kit!
Haven’t tried it, but I’ve used a V-Vac with good success multiple times. Allegheny Mountain Rescue Group has one with the litter, it turns out with a little adapter it works great for pumping out our full-body vacuum splint.
Hi Scott,
Really love your podcasts despite coming on board only late last year. This one particularly impressed me as I teach austere environments emergency medicine in South Africa especially wilderness emergency medicine. I have several versions of packs that I use for various situations which I would like to submit. Perhaps you could use it somewhere. We in SA do not have the luxury of most things you guys talk about so we have to make do with what we have. Guess the whole of SA can sometimes be a remote site, austere environment.
I’d love to post them. Shoot me an email on the contact page.
Love EMCrit coming outside the hospital! Two things I thought of while listening were AcademicLifeinEM’s post about a good penlight (http://academiclifeinem.com/trick-of-the-trade-my-new-penlight/), which led me to getting my own that I’m very pleased with (http://www.foursevens.com/products/PP-AA). It serves dual purposes as an EDC (everyday carry) item and as a medical tool while at work. Another product that a few agencies in my area have started to stock for active-shooter scenarios is the SWAT-T tourniquet (http://www.swattourniquet.com/). I have no first hand experience with them outside of training, but there seems to be decent support from the military community (http://www.ncbi.nlm.nih.gov/pubmed/23198515, http://www.ncbi.nlm.nih.gov/pubmed/23032323). Also, they’re cheap… Read more »
great additions. I’ll post my flashlight of choice in a couple of days–the 4 sevens stuff is great.
I have many different “favorite penlights.” On both my keychain and my Swiss Army Knife I have a PhotonLight II: http://www.photonlight.com/led-flashlights/photon-micro-light-ii-led-keychain-flashlight/ There are newer and supposedly waterproof PhotonLights but I find these turn on in my pocket and are dead when you need them. So to waterproof my PhotonLight IIs, I open then up with a tiny screwdriver, and then fill them with Vaseline. Works fine as waterproofing, I’ve used these caving for years. But for a “real” headlight I use a Petzl Nao, which I just love for caving and SAR and night hiking. Expensive, but works very, very… Read more »
I work for an EMS agency that uses the SWAT-T and it is an excellent pressure dressing but gets very slippery when covered with blood and makes for a less than desirable tourniquet. The CAT is far superior.
In Australia emergency medications can be ordered from a selected ‘doctors bag list’ through pharmacies without needing it to be prescribed for a particular patient. Not sure if this exists elsewhere…
great tip
I’m a mere IT grunt working round the edges of healthcare but as a migraine sufferer the moment I heard compazine I was waiting to hear the diphenhydramine chaser. Nothing I’ve ever been through sucked more than akathisia from a high dose of compazine. Ondansetron has come down from its arm, leg, and firstborn pricing it started at and might be a second agent to consider. And personally it feels much nicer. Compazine was like a cork in the throat vs ondansetron’s removing the stomach churning need to vomit. Sorry for the graphic description but its the only way I… Read more »
for the reasons mentioned above as well, diphenhydramine seems an essential addition
I learned this from an old ER nurse. If you put your 10 mg of Compazine into a liter bag (I prefer LR) and if you do that, instead of giving it IV push, there is never akathisia. And, I’ve never seen akathisia with oral Compazine. But if you do see akathisia from IV-push Compazine, Versed works better than anything else.
Great cast as always. Def in the Bum Bag bucket! Any MD can order Rx for themselves through Moore or Boundtree. Boundtree (I will disclose I work for them) has a great back order report that’s updated weekly and suggest alternatives. http://www.boundtree.com/data/default/productattachments/BTM_Pharmaceutical_Back_Order_Report.pdf I can tell you that I am seeing a lot of agencies adopt the Israeli Bandage as dual tourniquet and absorbing bandage. Cheaper than the CAT/SOF and can double up. Obviously hard to self administer. I carry a few rolls of duct tape round my pocket knife handle that’s in my bag. Duct tape has million uses and… Read more »
yep, love it. Have a round of gorilla tape wrapped around an industrial sharpie in my kit as we speak
If you are space limited you can give these a try for oral medications: http://www.walmart.com/ip/iGo-Just-in-Case-6-Space-Travel-Case/21832545.
I carry two in my medications bag, one for the general PO meds, and another for NSAIDs (including ASA) and acetaminophen.
can’t quite picture how big this is from the walmart shots
Here you go! I personally love these things, especially for the OTC or basic Rx meds.
The other good thing for parentral (or PO) meds are those small plano tackle organizers.
——
Another thing to mention is that one can purchase inexpensive fingertip “spot check” pulse oximeters from several online sources these days that are a great addition to a kit -> they are small enough that they don’t take up much space.
I’d probably shy away from eBay, but there are suppliers (at least in Canada) that sell similar units for approximately $80 (CAD) [sands.ca].
excellent!
The other thing to not for any Canadians on here is that several common emergency meds are otc up here. Obviously a physican can obtain Rx meds, but this is an easy way to get the basics without having to do nasty stuff like raid the med cart (DON’T do it, not a good idea)… —— NAPRA schedule II “OTC” meds All local anaesthetics (topical, parentral and opthalmic) Dimenhydrinate-parentral Diphenhydramine-parentral Nitro spray Epinephrine autoinjectors (no ampules/vials) Glucagon Tylenol #1 300 mg acetaminophen/8mg of codeine) Activated charcoal Look up napra sch 2 for the full list. Another note is that stuff… Read more »
I would shy away from any $80 pulse ox. I spend half my time returning them, the quality is very poor. If you think you need one spend the money, def worth it.
Or wait for the iWatch, Masimo just got raided by Apple!
I would just add the reminder that, in a field setting, the fact that you CAN perform an intervention (i.e. you have the training) and you’re now EQUIPPED for it (with your kit) and even that it’s INDICATED (for the relevant pathology), doesn’t mean it needs to be done IN THE FIELD. I expect there’s a wonderful feeling of preparedness that sweeps in when something happens in your presence and you realize you can perform many of your ED measures right now — but if they’re not time-sensitive on the scale you’re dealing with (e.g. a brief urban EMS response… Read more »
Makes total sense in the theoretical. Any example you can come up with?
Probably the Foley in most cases… or converting a needle thoracostomy to a chest tube if it’s not necessary (just a general example, I know you have your own views on needle decompression!) The fact that it may need to be done eventually doesn’t mean it needs to be done now. Trauma in an urban setting is the ultimate example, since of course anything that’s not immediately life-saving probably shouldn’t be done by anybody (bystanders, EMS, or frankly the ED) if it’s going to delay surgery. I’d always keep in mind the final disposition. Obviously your first aid may be… Read more »
First off- Scott, GREAT podcasts and website. Just discovered it a few couple months ago and can’t stop listening/reading. I rotated at Shock Trauma just last year, and had the privilege to round with Dr. Scalea for a week or so; amazing! I’m a primary care Doctor in the military, and I usually end up deploying to areas where these sort of kits are essential. One huge aspect of all this ‘field medicine’ is planning for DISPO/DOCUMENTATION. Initial evaluation/stabilization/resuscitation only goes so far with regard to a severely injured patient. In the developed world, you can expect the cavalry to… Read more »
beautiful, John
Really enjoyed this podcast, I have carried around a kit in my vehicle for years but I think it needs some updating! I do have a question regarding liability, I am a flight paramedic who works under guidelines signed off by a medical director and when I am at work I fall under this umbrella. So here’s a scenario: If I’m outside of work (either in the area I am certified in or not) and I find myself in a situation where I can render care aside from BLS care i.e. CPR, bandaging, etc, how do I do so without… Read more »
Varies by state, but if your actions were within the realm of good judgment, I think you would be all right. For instance, you have no standing orders to adminster subq epi b/c you are not on the job, but a friend was having anaphylaxis in front of you and you gave it–I think you’d be ok. Disclaimer: EMCrit ain’t no lawyer
Primum non nocere and justify what you did…
Again absolutely not a lawyer, but keeping it to friends gamily may also be a good way.
My understanding at the base the major that ” protect” people that help is: http://en.m.wikipedia.org/wiki/Good_Samaritan_law It varies little by place mostly the same. Like in Quebec it is MANDATORY to provide help to others, even if only calling 911. My understanding is only doctor can practice as they have a license. As a flight nurse i have knowledge but not the right to do so unless under an md. That said would you be convicted? That’s another question. If you proof that there was no other options, that you did exactly what was right maybe. It come down to convincing… Read more »
I buy a lot of my gear there. As a nurse I am limited what I have access but they have a lot of selection:
http://www.chinookmed.com/cgi-bin/category.cgi?category=s-prescription
For my home kit, i found this at REI. It become a portable clinic. I have ,made the blue bag my airway bag, the red trauma/bleeding and green obstetrics.:
http://gizzardstone.com/dad-gear-rei-camp-pack-n-prep-totetable/
also if you like a good read kind of evidence base, that book is awesome:
http://www.healthline.com/health-blogs/outdoor-medicine/improvised-medicine-book-review
thanks for those links, Daniel
Wilderness medical associates offers wilderness ALS courses, as well as wilderness fr, w-emt b) and w-emt i.
Also a two-week wilderness medicine elective for medical students (disclosure; I’m an instructor for WMA).
Could you post which loupes/telescopes/magnifying glasses you and Dr Conover are carrying around? I know there are many quite cheap options now available that are not specifically medical, sourced from hobby/impairment compensation sources. They seem to be one of the less sexy items, but useful in many circumstances starting at removing splinters…
Hi Scott,
I asked my wife, a community pharmacist and pharmacy owner, how docs in our community get meds for “office” practice. Anything that isn’t a C2 can be prescribed using a standard prescription with the patients name being “for office use” and the directions also listed as “for office use.” Pretty easy way to get standard meds.
For Australian doctors, they can get medications including all the ones listed in PDF for free from the government, through a scheme called PBS Prescriber’s Bag. Methoxyflurane is one I commonly use in my out of hospital work.
Hey guys. As always – love this post.
Thought I’d share a gear bag system I’ve found optimal (the three bags total ~ $100):
Cool, Compact, Functional, Tricked-out Bag: http://www.walmart.com/ip/Fieldline-Tactical-Roe-Sling-Pack-Black/26357370
-Which nicely holds this inside as an airway module (although it’s a pretty tight fit): http://www.amazon.com/gp/product/B00AB3GUMS/ref=oh_details_o09_s00_i00?ie=UTF8&psc=1
-Plus this, attached via the molle system on the outside: http://www.amazon.com/gp/product/B008XO9U0Q/ref=oh_details_o03_s01_i00?ie=UTF8&psc=1
-if you prefer to make it look official, with EMS insignia add this velcro patch: http://www.amazon.com/gp/product/B00C0JVWIS/ref=oh_details_o01_s00_i00?ie=UTF8&psc=1
Many moons ago when the concept of a pocket mask was introduced to our regular training I decided to see about carrying one with me at all times. I got the idea because I was talking with a company firefighter about CPR and masks and asked her where her mask was. She said it was in her turnout coat which was in the squad room across the courtyard. I than asked what she would do if I dropped in front of her and needed rescue. She was a bit stumped by that because she had not thought about responding to… Read more »
To buy Cii drugs, all you need (besides a willing seller) is DEA form #222! The department of justice will ship you a bunch of forms for free: https://www.deadiversion.usdoj.gov/webforms/orderFormsRequest.jsp
That said– I’m sure morphine is still more trouble than it’s worth for most peoples’ personal kits….
Kyle Pharmd
A car emergency kit is important too.. Something that you can use when caught in a snowstorm while traveling. Be sure that you got all the basics covered or you will have a hard time stuck in the middle of nowhere.
Good morning, great podcast! I just finished listening to 117 and thought I would chime in. If any of the listeners do not have the time or resources to build out the kit themselves Remote Medical International has kits that are pre-made as well as sell individual items. They also have training classes for those interested in wilderness medicine.. All of the items in their kits come vacuum sealed to protect from the elements, individually labeled for easy identification.
Another two cents worth. Just to keep in mind with the commercial tourniquets, both the CAT and the SOFT-T, is that they really dont work in pediatrics. The tourniquets are specifically designed for circumferential pressure in an adult sized extremity and in very small adults and pediatric patients they won’t work effectively. For pediatric patients what works best is a homemade tourniquet usually a cravat (triangular cloth) with some sort of wooden or metal dowel as a windlass. I’ve seen SOFT-Ts parted out for exactly this purpose. Also the “Combat Guaze” works great as a field hemostatic agent and doesn’t… Read more »
Hey Scott,
Did you ever find more information on the liability aspect of this? I’m an ER physician and keep a bag in my truck but I always wondered how far this “good sam” coverage would extend for some of the more invasive interventions like a cric/chest tube or even an intubation or administering IV meds.
Hey Scott, There are some regulatory issues with writing prescriptions for one’s self if they are C-II (narcotics) medications. Most pharmacy legal texts, as well as the FDA regs, define prescriptions for “medical bag” use as being not valid – so if it is filled by a pharmacy, it is done so erroneously. Now, if you have another physician partner write a script for you and use that stock to fill your kit – that’s done so on your professional opinion for ‘legitimate medical use.’ But, if you’re seeking the most appropriate way of going about this – any physician… Read more »
Craig, Great information! Thanks so much for sharing.
I know this thread is over a year old but I was looking up improvising a chest tube with an ETT and was brought here by Google. Just wanted to throw out (military special operations medic here for background/experience) a tip for including the EZ Suction especially in the austere remote setting. IF (big IF) your going to choose to insert a chest tube in the field the EZ Suction fits into the end of a heimlich valve perfectly. You can keep it attached, squeeze it till it remains deflated (great easy visual reference that you still have negative pressure… Read more »
This is great info. I love the daypack and contents. Is there anywhere to get a kit like this (similar) as an all in one buy rather than piecemealing it together?
Any updates on airway recommendations? Looks like the Truphatek Trulite might be discontinued
Can’t emphasize the ZebraLight purchase enough. I bought one in med school. Use it all the time now in the ED (as a resident). It’s a top-tier piece of gear for the discerning type. Also uses the 18650 Li Ion battery, so you can interchange batteries/chargers between the head lamps and hand-held flashlights. Great investment!