Build an EMT & Paramedic First Aid Kit
Not too long ago I became an Nationally Registered Emergency Medical Technician. In case you don't know, those are the folks that ride on the ambulance or firetruck and show up to help you when you call 911 and need medical assistance.
Also on the rescue will be Paramedics. They can administer medications and do other things like EKG analysis and advanced airways. Medics go to school for a year or more, and is the gold standard for US based emergency field care.
That's simplifying it all a little bit but the point is this: emergency providers are trained to operate in the field, in all kinds of conditions, and to stabilize a patient long enough to get them to advanced care in a hospital.
This tutorial is designed to help both an EMS provider and lay person create a top notch First Aid kit, or to supplement one that you might already have.
If you are interested in emergency first aid at all, then using some of the same tried and true techniques that EMT's and Paramedics use to diagnose and treat medical conditions or injuries is the best approach for layperson study.
By treating certain conditions quickly you can save a life. Sometimes you only have minutes to perform an intervention before a patient moves past the point of being treatable - but that initial intervention might buy them another hour (or more) of time to fight so they can be treated in an ER.
The trick is to know the signs to look for, and have the tools handy to address them at hand.
Surprisingly, many of the devices I was trained to use are typically not offered in any of the first aid kits I see in the market.
And that is what this article is about - identifying those key items nearly no one has in their first aid kits, and the ways how to use them properly.
If you are looking for a smaller, portable IFAK which fits with the Tactical Combat Casualty Care protocol (meaning its designed for quick deployment for trauma) then check out our Tactical Combat Casualty Care (TCCC) for Civilians guide, which walks you through those kits.
Obligatory Disclaimer: I don't know all the laws where you live, and what might or might not be covered under any Good Samaritan laws, so this article is for informational use only and is not to be considered a formal training document. You are responsible for your own actions, I am merely explaining some of the tools and techniques used by EMS, not endorsing you to use them.
I Want One Now!
If you don't want to wait, or read all of this, and just want something that covers most of what we will outline below, there are a options out there. This kit provides you with about 90% of what you would need and what I would recommend having.
However I would prefer some of the elements in the bag be higher quality (stethoscope, shears, tourniquet) but you can always supplement this kit if you want.
Also make sure you can get the O2 tank filled where you live. You might need an Rx and O2 is hard to come by these days.
Lightning X Jumbo First Responder EMT Trauma Bag
Typical Price: $370
The Modular ALS Bag is an excellent size and layout for EMS agencies and first responders. It features a zippered compartment that holds one D sized oxygen cylinder including regulator that allows easy access to the cylinder without having to remove it from the bag or even open the main compartment.
The main hold has removable modular dividers that can be arranged in any order to fit the users’ needs. Also included are four color coded quick-grab pouches with a transparent window for often used items.
Fill kit includes the following supplies: Tweezers, Kelly Hemostats, Trauma Sheers, Bandage Sheers, LED Penlight, Am Ampules, Band-Aids (100), 4" x 4" Gauze Pads (25 packs of 2), 2" Roll Gauze (2), 3" Roll Gauze (2), 4" Roll Gauze (2), 2" Self-Adherent Bandage (2), 2" Elastic Ace Bandage (2), 5" x 9" ABD Pad (2), 8" x 10" ABD Pad (2), 1" Roll Cloth Tape, 2" Roll Cloth Tape, Iodine Wipes (10), Isopropyl Alcohol Wipes (10), Triple Antibiotic Ointment 1/2 oz, Instant Cold Packs (2), Eye Pads (2), Triangle Bandage (2) , Eye Wash, Nitrile Exam Gloves (4), Universal SAM Finger Splint, Glucose, Sting Pads (10), Adult BP Cuff, Sprague Stethoscope, CPR Barrier Mask w/ Case, OPA Kit (6 sizes), 10" x 30" Trauma Dressing, NC Tubing (2), NRB Mask (2), MPR Bag, 4-1/4" x 36" Roll Splint, Occlusive Chest Seal, Adjustable C-Collar, 2oz Burn Spray, 2oz First Aid Spray, Emergency Blanket, Quick Stop Hemostatic Blood Stop Spray, R.A.T.S. Tourniquet, First Aid Guide Booklet, 4" x 4" Burn Dressing (2), O2 Reg 0-15 lpm, Alum "D" Ox Cyl (empty), Color Coded Pouches (4)
Keep Yourself Safe First
The first and most important thing to do before treating a patient is to make sure the scene around you is safe: No downed power lines. No animals that might attack. No distracted drivers that will run you over. Those sorts of things.
The second most important thing is to keep yourself from being contaminated from bodily fluids, should your patient have any diseases.
This concept is called Body Substance Isolation (BSI) using Personal Protective Equipment (PPE.)
At the very least you need to have in your kit:
- Non-Latex Rubber Gloves sized to fit your hands
- Goggles to protect your eyes from substances or aerosols
- An N95 mask - a real one from 3M, not some fake no-name face diaper
- Disposable gown if you expect to get dirty or exposed to very contagious diseases
This is for fun of course, find middle ground. Don't be Tyler Durden...(or admit to it anyway.)
Basic Concepts
EMT's have to asses a patient quickly, to identify any immediate life threats and treat them.
The method for this is the ABC's: Airway, Breathing, Circulation
Airway: This is the pathway from the nose and mouth to the lungs. If there are any obstructions or blockages they need to be handled first and foremost.
Breathing: Next we need to make sure that the patient is breathing adequately enough to maintain themselves. If not then we need to assist their breathing, either with oxygen or positive pressure ventilation.
Circulation: what is the heart doing? Is there a pulse? If yes, what is the rate, rhythm and quality? Is there any bleeding we need to be aware of?
There is one exception to this rule, and that is if you see life threatening bleeding that needs to be treated immediately or the patient will die. This is typically bright red, spurting arterial bleeds.
In those cases, you switch to CAB: Circulation, Airway, Breathing. Get a tourniquet or pressure bandage on, then repeat your assessment.
C-Spine Immobilization
There is one quick assessment you need to do prior to any other intervention for a patient, and that is to immobilize the neck if there is a suspected neck injury or if you feel anything along the mid-line of the spine that feels dislocated or is tender.
This is because cervical injuries can cause your patient to become permanently paralyzed or and even stop breathing.
If the injuries from the patient are from obvious trauma that could have impacted the cervical area, then you should immobilize the neck as a precautionary measure, in addition to using a back board to minimize movement while transporting.
Have one person hold the neck in a neutral (natural) position, and apply a C-Collar.
Laerdel Stifneck Select Adult Adjustable Collar
Typical Price: $11
The Stifneck Select Collar simplifies your job, saves space and provides outstanding immobilization.
All you have to do is measure the patient, select the size, adjust and lock.
This collar fits all adult patients.
Here's a video of how to size and apply the collar:
Airway Management & Adjuncts
Now that we know that airways are important, what can we do to ensure we have a patent (open and clear) airway?
There are 2 moves to learn first which you need to master: the head tilt and chin lift (no neck c-spine trauma suspected) or the jaw thrust (neck c-spine trauma suspected.)
This one minute video will demonstrate both:
There are devices you can use to make sure that an airway stays open. Two of the most prevalent airway "adjuncts" are the OPA and the NPA.
The Oropharyngeal Airways (OPA) go into the mouth and hold the tongue in place. The Nasopharyngeal Airways (NPA) go into the nose and down the back of the nasopharynx.
An adjunct is always married to the use of a Bag Valve Mask (BVM), meaning you will always use an airway device with a BVM, but we'll discuss those more in a bit.
OPA's only work for people without a gag reflex. If you try it and the patient gags, pull it out and switch to an NPA.
NPA's are good for people who still have a gag reflex, but might be unconscious, i.e. an someone who overdosed on opioids.
Both need to be measured against the patient to make sure you have the right size. You also need to know how to insert them.
Here's how to correctly size and insert an OPA:
Here's how to correctly size and insert an NPA:
You can grab them from Amazon and figure out what sizes you might need for you and your family members, so you don't have to guess should you ever need to use them.
Oropharyngeal Airways
Typical Price: $6
Oropharyngeal airways are only used on unconscious people, because of the likelihood that the device would stimulate a gag reflex in conscious or semi-conscious persons.
These triple function airways serves as a bite block, a tongue depressor to avoid crimping and protects the teeth. They automatically curve to the contour of the pharynx and are disposable for single-patient use.
Nasopharyngeal Airways
Typical Price: $18
Nasopharyngeal Airway Kits include multiple soft, latex-free and sterile airways that not only ensure an open airway but also prevent damages in the nasal passage.
Used by emergency care such as EMTs and paramedics in situations where an artificial form of airway maintenance is necessary but it is impossible or inadvisable to use an OPA (the preferred type of airway adjunct) or to intubate (considered the most certain way to secure a patent airway but the most medically invasive.)
Suction
There is always the possibility of there being fluids or debris in the airway that could compromise its patency. Vomit or other things could be breathed or pushed into the lungs and now you have a real problem on your hands.
This is why having a suction device is also a smart idea, since you will need to get that stuff our of there before you can start positive pressure ventilation with a BVM.
EM Innovations Suction Easy Pump
Typical Price: $39
The Suction-Easy Emergency Suction Pump is a simple aspirator, inexpensive solution to facilitate training and use for this aspect of airway management. It also provides you with the quickest, safest and most effective form of emergency suction.
The Suction Easy Pump features a unique double-valved design that allows continuous operation with one hand, while the other hand directs the suction tip through your patient's oropharynx. A consistent vacuum force is applied with each squeeze of the bulb and the material drawn into the bulb is expelled into an attached collection bag.
Breathing & Ventilation
If you need to provide breathing assistance aka positive pressure ventilation, then you will want either a Bag Valve Mask (BVM) or a Pocket Mask.
A BVM, properly used, can push much needed oxygen into the lungs, which will perfuse throughout the body (as long as the heart is pumping, something we will discuss later.)
First you make sure the airway is positioned properly, and clear (suction) then you insert an adjunct (OPA or NPA) before you begin the process of positive pressure ventilation with the Bag Valve Mask.
A BVM on its own will deliver 21% oxygen (on "room air") but can be connected to an oxygen tank to deliver 100%.
Read this important article on the Do's and Dont's of BVM ventilation.
Pocket Mask
MCR Medical CPR Rescue Mask
Typical Price: $9
Easy enough to use for any rescuer, this latex free rescue mask makes resuscitation safer for the responder and more efficient for the patient.
By using this type of mask, rescue breathing is more efficient. Supplemental oxygen, connected by way of the mask's oxygen inlet, increases concentrations of organ-sustaining oxygen by 50%. Remove the included valve, and the mask can be connected to a BVM.
The quality transparent mask features a one-way filter valve and elastic head strap to facilitate hands-free operation. A pair of gloves, antiseptic wipe, and instruction card completes the set.
Bag Valve Masks
I especially like this type of BVM for a portable kit. You can get less expensive ones for around $20 each, but they don't pack very well and take up a lot of room in a kit. This Pocket BVM from Persys solves that problem.
Persys Medical Pocket BVM Clear w/O2 Tube
Typical Price: $49
Hand-held disposable device for manual resuscitation and emergency respiratory support. The Pocket BVM with O2 Tubing has become the BVM of choice amongst military units and has been adopted by the U.S. and German militaries, NATO forces, and other armies.
The Pocket BVM with O2 Tubing contains a bag, mask, patient valve, reservoir bag, 2cm oxygen drive lines, and a 167mm (6ft 6in) oxygen tube, all within a single compact unit.
Here is a video showing how to pack and unpack the BVM.
Circulation & Bleeding
Once you've established a patent airway, you next need to assess the circulation of the patient. This typically means measuring both Pulse and Blood Pressure.
There is one exception to the ABC rule, and that is if you see large amounts of life threatening bleeding, you need to address that right away. That changes your rule to CAB: Circulation, Airway, Breathing.
Let's look at dealing with bleeding first. Spend 17 minutes and watch this video, it's very well done and is a complete walk-thru of a Stop The Bleed course, which I have taken and recommend to everyone.
I wont get into all of the techniques here, but there are three methods to stop bleeding: pressure, packing, and tourniquets.
Pressure is just that, applying pressure with the hands using a towel, or shirt, anything which can slow the bleed and absorb some blood.
Packing is primarily used for junctional injuries: the armpits, groin and neck area. You can use Sterile Kerlix Gauze or anything else that you have handy (like a t-shirt, no it isn't sterile, but you don't have time to worry about that), but the best items to have is a hemostatic gauze.
Wound Packing
There are 2 go-to brands when it comes to hemostatic gauze: Celox and QuikClot.
We prefer Celox, because it works on patients who are using anti-coagulant medication like Warfarin (Coumadin) or Heparin. QuikClot does not. QuikClot is less expensive but doesn't work against blood thinners.
Celox Rapid Z-Folded Gauze
Typical Price: $49
Pack the gauze directly on to the bleeding source and hold pressure for three minutes to stop bleeding from arterial injuries, gunshot wounds, road traffic accidents and other severe bleeding injuries.
Celox works independently of the body’s clotting mechanism unlike Combat Gauze* and other inorganic mineral based gauze products. It works on hypothermic blood that does not clot normally, often found in serious casualties.
Here is a video about how it works and how to use it properly. Contains some graphic images which might be unsuitable for some viewers.
QuikClot Advanced Clotting Gauze - 3 x 24 in
Typical Price: $15
QuikClot hemostatic gauze works on contact to stop bleeding by accelerating your body’s natural clotting process, clotting blood five times faster. This pack contains one clotting gauze pad impregnated with kaolin. Kaolin activates fibers in the blood plasma, makes them sticky, traps platelets and stops bleeding fast! Inorganic and inert, kaolin is non-allergenic, making it safe and effective to use.
QuikClot’s extremely absorbent combat gauze is flexible and pliable, easily contouring to wounds and allowing you to get them to the nearest medical center.
Tourniquets
There are several types of tourniquets out there and it comes down to personal preference mostly, but there are those that are held in higher regard than others.
To learn more, please spend a minute to read our article: The Best Tourniquets.
But the one you will see out there the most is the North American Rescue Combat Application Tourniquet (CAT) - Generation 7.
CAT Combat Application Tourniquet - GEN7
Typical Price: $25
The CAT Tourniquet (Combat Application Tourniquet) utilizes a durable windlass system with a patented free-moving internal band providing true circumferential pressure to the extremity. Once adequately tightened, bleeding will cease and the windlass is locked into place.
A hook and loop windlass retention strap is then applied, securing the windlass to maintain pressure during casualty evacuation.
Stop the bleed! CAT Gen 7's are the gold standard. Official Tourniquet of the US Military. Beware of counterfeits out there, only purchase them from the source at North American Rescue or accredited dealers like LA Police Gear.
A must have addition to any emergency first aid kit.
Sucking Chest Wounds
For penetrating injuries into the lungs, you'll need an occlusive dressing.
Sucking chest wounds (open pnuemothorax) are holes in a patient's chest (such as punctures via knife or gun shot) which have created new pathways for air. Occlusive wounds can be utilized to block and treat the puncture.
Having a few of these available in your kit is a smart idea, they are the best way to handle these not-uncommon wounds.
North American Rescue Hyfin Vent Chest Seal
Typical Price: $17
The HyFin Vent Chest Seal Twin Pack from North American Rescue sets the standard for the prevention, management and treatment of an open and/or tension pneumothorax potentially caused by a penetrating chest trauma.
Two seals, each individually packaged, are designed to allow the user to apply a seal to both an entry or an exit wound while also giving the option to only apply one and store the other until needed as the situation requires. This innovative design provides 3-vented channels designed to prevent airflow into the chest cavity during inhalation while allowing air to escape through the vent channels during exhalation.
The 3-vent channels are designed to allow blood to escape and also provide a backup fail-safe system, as even if two of the three channels become obstructed, the vent is designed to remain fully operational.
Pulse & Blood Pressure
To further diagnose a patients current state of circulation, you'll want to know what their Blood Pressure and Pulse rate, quality, and rhythm are like.
You'll want to know if someones Blood Pressure is hypotensive (too-low) hypertensive (too-high) or in a normal range. It's how you can identify if a patient is going into shock, or if you can perform certain medical interventions (like nitroglycerine administration).
There are three very important tools you'll want to have in your kit: a sphygmomanometer (blood pressure cuff), a stethoscope, and a pulse oximeter.
Don't cheap out on the stethoscope, you'll use it for more than just taking blood pressure, you'll use it to listen to the lungs (for blockages or fluid collection) and to the heart for pulse rate and quality.
The pulse oximeter serves 2 purposes: it's a quick way to get the pulse rate of someone, and to see their blood oxygen level. (Under 94% and you'll want to start assisting with O2 supplementation or a bag valve mask.)
3M Littmann Classic III Monitoring Stethoscope
Typical Price: $89
Pricey, but this is the one of the best available for professional day-to-day use. You'll want a good one, this is one of the main tools in your arsenal.
The compact 3M Littmann Classic III Stethoscope is perfect for monitoring and assessing children or adults in non-critical settings. The versatile stethoscope offers high acoustic sensitivity for exceptional performance, hours of comfortable use and comes in a variety of vibrant colors to reflect your personal style.
Sphygmomanometer – Manual Blood Pressure Cuff
Typical Price: $20
Universal cuff (size 22-42cm, 8.7 - 16.5") that is made of extra durable nylon, comfortable velcro strip that allows for easy one hand self measuring.
This is an adult size, for the average adult. There are childrens sizes and plus (aka bariatric) sizes as well.
Fingertip Pulse Oximeter Blood Oxygen Saturation Monitor
Typical Price: $19
Measures your blood oxygen levels and pulse strength in 10 seconds. Taking a reading is easy, just clip it on to your finger and turn it on at the press of a button. The large LED display makes viewing the results a snap. Its small size and lanyard makes it convenient and easy to carry around.
Other First Aid Diagnostic Tools
There are a few other things you'll want to round out your kit.
One important item to have is a blood glucose meter.
Many symptoms a patient might present (like an altered mental status) can be attributed to low blood sugar levels, but look like more serious conditions (like stroke) so you will want to rule those out asap.
Low blood sugar (from too much insulin) can be fixed with orange juice or honey, or any simple carbohydrate.
Care Touch Diabetes Testing Kit
Typical Price: $30
Keep track of your blood using the new, state-of-the-art Care Touch monitoring system, featuring: Fast Test Results in 5 Seconds or Less, Hygienic Test Strip Release Ejector, Small Blood Sample Size – 0.5µL, 14-Day Averaging, Pre/Post Meal Flagging, 300 Memory, Alternative Site Testing, and Automatic Off.
Kit includes: One Care Touch Monitor, 100 Care Touch Test Strips, 3-Volt Lithium Battery (Cr2032), 1 Lancing Device, 30 gauge lancets - 100 count, and 1 Compact Carrying Bag.
You can usually tell if a patient has a temperature just be feeling them with the back of your hand, but get more accurate results with a dedicated non-touch thermometer.
Touchless Forehead Thermometer
Typical Price: $20
No Contact Thermometer: The infrared thermometer will get the temperature reading without body or object contact. Move the thermometer close to the forehead and press the button, you will get the accurate temperature readings.
Best First Aid Kit Bags
There are a lot of brands and choices out there for your first aid kit. Depending on how much you want to carry and what you plan to do with it determines the size you want.
For my full rollout kit, I use the Omni Pro X from Meret. It's everything you would ever want in an EMT / Paramedic kit. If you aren't familiar with it you should check it out.
It might be too much for your needs, but I want the best products I can get, especially when it applies to my medical supplies for myself and my family.
MERET Omni PRO X
Typical Price: $260
The OMNI PRO X is the perfect BLS/ ALS Emergency Response System for the first responder who wants an organized solution for their equipment.
The main internal compartment can be completely customized to efficiently organize large and small items by using the innovative slider divider system. Overlapping panels secure internal contents while providing easy access to DEEP STUFF Pockets and STICKIT STRIPS. Outside pockets and pouches offer additional quick-access storage.
Using OneView technology, the bag opens completely facing one direction, providing fast access to all compartments without moving the bag. A large front pocket offers space for longer items such as intubation aids.
A system of grommet holes allows all compartments to be air dried while the bag is completely closed.
The bag is ergonomically designed for use as a backpack, shoulder bag, can be carried briefcase style, or can be grabbed from any position using a system of light weight comfort-grip side handles. The OMNI PRO X uses a hideaway, mountaineering style backpack harness that provides a snug and secure fit. Walk, run, climb, or descend, this backpack system keeps the entire bag close to your body with a comfortable fit, including padded lumbar support. The entire harness system hides away in a zippered pocket in the back of the bag when not in use.
All sides of the bag that touch the ground are reinforced to ensure durability and water resistant.
