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We’ve all heard the admonition: “You need to have a well-stocked first aid kit!” The first step to following that advice is an understanding exactly of what “well-stocked” means.

Recently, I read an article on SurvivalBlog about a man who treated his wife for a serious arm laceration during an ice storm. After running out of bandages, he was forced to drive to the store in dangerous weather conditions to get more supplies. I posted a response to the article that elicited an e-mail asking, “Well, what does a good first aid kit contain?”

Let me start with some background information. About six years ago, I started a company that supplies businesses with CPR training, first aid, and emergency products. This experience has taught me some valuable lessons. First, the number of bandages used in an average office is staggering. Either there must be a terrible problem with paper cuts and stapling accidents that I just didn’t know about, or workers choose to use their office’s first aid kit instead of the one at home (if they even have a kit at home). Second, some items that should only be used on rare occasions are disappearing from office kits needlessly. For example, alcohol prep wipes should primarily be used for cleaning the skin before injections or for eliminating the sticky residue after bandage removal (If you have a laceration or abrasion and use an alcohol prep wipe to clean it, you must be a masochist!). Third, and more to the point, I was surprised to learn that there is no such thing as a “standard” first aid kit. Although there are a few organizations that make recommendations or list minimum requirements (OSHA, AMA, ANSI, US Coast Guard, Red Cross), they refrain from using the word “standard.”

So there are guidelines to help us, but we often want additional advice. Indeed, when I am teaching my CPR/First Aid classes, I am often asked. “What kind of first aid kit should I have?” As a general rule, your kit should match your training, plus a little extra. When I sell first aid kits, I always ask the prospective purchaser two things. First, I want to know what kind of training they have received (and how long ago). Then I ask the big question….

“If someone were severely injured and or bleeding, would you come to their aid?”

If the answer to this question is no, or if they haven’t been trained in first-aid, then I sell them your basic over-the-counter 150-piece first aid kit. These kits are available anywhere and are little more than boo-boo kits, to fix life’s little cuts and scrapes. As an example of this type of kit is available from CVS Pharmacy and manufactured by Johnson and Johnson™; its self-described purpose is for the treatment of “Cuts & scrapes; Minor burns; Pain & swelling; Itch.” This 170-piece kit has 138 Band-Aids™, a few ointments, pads, wipes, and little else. If you were counting on this kit to save someone’s life in an emergency, then both you and the victim are in deep kimchee!

Preparedness and survival are our ultimate goals, so we need a larger variety of supplies that will actually be useful in a real life-or-death emergency. It is my hope that more people start investing in kits with more than just Band-Aids, and here’s why. If you’ve taken a first aid course in the last five years (and if you haven’t, shame on you), your instructor should have told you that after you’ve taken care of the victims’ primary needs (their ABCs – airway, breathing, and circulation), you need to look after their secondary needs (serious bleeding, shock, and spinal injuries). Your first aid instructor should have prepared you for the worst case scenario: when advanced emergency care is either delayed or unavailable, and you are the one who must provide extended care to the victim.

In addition to acknowledging what you know, consider where you live and what you do for recreational and vocational activities when gathering your supplies, a well stocked first aid kit should reflect your geographic region, activities, as well as, how many people you may need to treat. Of course there is a basic minimum for every occasion, but if it’s a kit you are building for a boat that sails off the coast of Florida, do you really need a “snake bite kit” or a “tick kit”? If you live in the desert southwest, do you really need vinegar for jellyfish stings? You wouldn’t take an eight pound “Mega Trauma” kit while backpacking, but you would certainly want a comprehensive kit at a survival retreat. A blister kit would be as out of place on a boat as an ice pack would be at the North Pole. Just as there is no single gun to fit all needs, so there is no one kit that will fill all medical necessities. But there is a place we can start. So let’s explore what an appropriate kit looks like.

I like to see these items in my ideal well-stocked first aid kit. Your kit may look different, but should generally include most of these items.

Note: With few exceptions, quantities are excluded because they will vary with the size of the kit, and people served. This list is not intended to be all inclusive, nor the only list should you consult.

• A durable case – preferably with compartments for storage and ease of access.
• A good First Aid reference manual – as a reminder of practices and protocols.
• A card with emergency numbers (Poison Control, out-of-state contacts, etc.)
• Gloves (latex or nitrile) – at least 2 pairs, to protect against contamination and pathogens.
• CPR barrier – to protect against disease transmission.
• Large absorbent dressings/AB pads (5”x9” or larger) – to stop or control bleeding.
• Sterile gauze pads, various sizes – to stop bleeding and dress wounds.
• Roll bandages, various sizes– to dress wounds.
• Ace™-type roll compression bandage – for sprains and strains.
• Self-adhesive bandages (Band-Aids™), various types and sizes – to dress minor wounds.
• Steri-strips (butterfly bandages) – for closing wounds.
• Adhesive tape – to dress wounds.
• Non-adherent pads, various sizes – for burn wounds
• Triangular bandages – for immobilization of dislocations and fractures.
• Cotton-tipped swabs – for cleaning wounds, applying saves and ointments.
• Bandage Sheers/EMT sheers – cutting bandages or victims’ clothing.
• Tongue depressors – for checking throat issues and as small splinting applications.
• Tweezers – for splinter removal.
• Needle – to assist in removing foreign material.
• Penlight – for emergency lighting and for examination.
• Oral thermometer (non-glass) – to check vital signs.
• Syringe or squeeze bottle – for irrigation of wounds.
• Splinting material – for dislocations and fractures.
• Emergency blanket – for warmth and treatment of shock.
• Instant cold pack – for treatment of hyperthermia, sprains, dislocations and fractures.
• Instant hot pack – for treatment of hypothermia and some stings and muscle strains.
• Bio bags – for disposal of gloves and medical waste.
• Eye cup – for aid in removal of foreign matter in the eye.
• Eye solution – for eye contamination and aid in removing foreign matter from the eye.
• Antibacterial soap – for cleaning wounds and hands after treatment.
• Antiseptic solution or wipes – to clean wounds.
• Antibiotic ointment – for wound treatment.
• Hydrocortisone cream – for stings and irritations.
• Burn gels and ointments – for treating burns.
• Burn pads – for treating larger burns.
• Ibuprofen – to reduce swelling and for patient comfort.
• Antihistamine tablets – for allergic reactions.
• Blood stopper powder – for stopping severe bleeding.
• Pen and index cards – for annotating victim’s vital signs.
• Hand sanitizer – when you can’t wash your hands with soap and water.
• Mole Skin – for treatment of blisters and abrasions.

In addition to the above items, there is a list of “add-ons” that could be added to your first aid kit. These can vary greatly depending on your needs, locations, and activities. Some of these may require additional cost, training, or certifications:

• Separate compete Burn Kit – for treating multiple or very serious burns.
• Snake bite kit – for treating snake bites.
• Israeli Battle Dressings – one of the best on the market for serious trauma.
• Stethoscope – for listening to breathing and heartbeats.
• Cervical collar – to immobilize the neck from possible further harm.
• Foldable stretcher – for carrying victims unable to walk on their own.
• Blood pressure cuff – to determine victim’s blood pressure.
• Sutures – to close serious wounds.
• Hemostats/Forceps – for closing major bleeding vessels or aid in suturing.
• Automated External Defibrillator (AED) – to help with sudden cardiac arrest.
• Scalpel – for removing tissue, minor surgery.
• Blood borne pathogen kit – to assist in cleaning up.
• Surgical masks – to prevent disease contamination and blood borne pathogens.
• Eye shields / goggles – for eye protection.

There are also items / medications your victim may need (some of these may require a doctor’s prescription):

• Asthma inhalers – for treatment of asthma.
• Nitroglycerin – for the treatment of heart patients.
• Aspirin – for treating heart patients.
• Sugar pills – for diabetic stabilization.
• Salt pills – for treatment of dehydration.
• Imodium – for treatment of diarrhea.
• TUMS – for gas and heartburn.
• Epi Pen – for treatment of severe allergic reactions.
• Eye drops – for tired or irritated eyes/contacts.

There are also non-medical items that can work well in a first aid kit:

• Head lamp – for clearly seeing your work area.
• Instant (Super) glue – to close wounds.
• Tampons – for penetration or gunshots wounds and their primary function.
• Glasses repair kit – to repair broken eye glasses.
• Multi tool/Swiss Army knife– for multiple tasks.
• Insect repellant wipes – to keep the bugs away.
• Sun block – to prevent sunburn.
• Lip balm – to prevent chapped lips.
• Hand lotion – for dry and chapped hands and feet.
• Talcum powder – for treatment of rashes and foot care.
• Desitin™ ointment – for treatment of rashes and sore areas.
• Hair comb – for removing items from victim’s hair and for hygiene.
• Disposable razor – for cleaning treatment site or for personal hygiene.
• Duct Tape – who couldn’t find a use for it?
• Paracord 10’ – same as duct tape.

Now that we have everything and the kitchen sink, what items would I consider to be essential to any kit no matter what size?

• Triangle bandage – has so many uses that it is a must have!
• • Sling, bandage wrap, splinting wrap, bandana, hat, baby diaper, water filter,  sarong, halter top, face shield, shade covering, blindfold, dust mask, tourniquet, pressure bandage, ankle wrap, foot covering, gloves, handkerchief, washcloth, wet and use tie around neck, belt, tie up a pony tail, basket, cold compress…Why do you think every cowboy wore a bandana?
• Self adhesive bandages (Band-Aids™) in multiple sizes – there really is no good substitute.
• Antibiotic ointment – secondary infection of a wound can be fatal.
• Sterile gauze pads (various sizes) – many things can be improvised to slow or stop bleeding, but to properly dress a wound, a sterile covering is vital.

Now that you have gathered every conceivable medical essential, you will need a place to put it all. Ironically, your choice of container is almost as important as what goes into the kit. The size of the kit will be determined by several factors. Is it stationary, or will it be carried? Where will it be going? Where will it be stored? How much room do you have for the kit? Will its environment be wet or hot, or will it be jostled about? Here is a list of possible “non-standard” containers for your first aid kit.

• Fishing tackle box
• Tool kit
• School lunch box
• Electronics box
• Ziploc™ bag
• River rafting “Dry Bag”
• Pelican™ “type” waterproof container
• Rubbermaid™ “type” Storage container
• Plastic office drawers
• Zippered Nylon pouch/bag
• Army surplus bag
• Ammo can (painted with a big white cross so you don’t take the wrong can to the range)
• Tupperware™ type containers
• Cigar Box
• Fanny pack
• Small nylon/canvas backpack

A few final thoughts: Rotate, rotate, rotate! Just like food on your shelf, some of your first aid kit supplies have a “limited” shelf life. With frequently changing and expanding information on expiration dates, I will not advise you when to discard your “out of date” ointments, creams, and medicines. But what I would like to address are those items that people don’t often realize have a limited life span. Gloves are notoriously short lived, especially in hot environments like a car, RV, or boat. Check them at least once a year and replace when necessary. It is very frustrating to be half way through putting on a glove when it tears, and if you’ve done this a couple of times, the cut on your victims arm may be the least of his worries! Another item with a frustratingly short life time is the self-adhesive bandage. As Band-Aids™ get older, heat and age tends to breakdown the adhesive and it loses its cohesive strength. If a self-adhesive bandage can’t “stick,” it really serves no purpose.

Another consideration, your kit is as good as your training. If you haven’t taken a CPR/first aid course in a while, seek out a reputable instructor and take a comprehensive CPR/First Aid course. Also, once you assemble your kit, make sure it goes where you go. Like so many other aspects of preparedness, I follow the general rule, “It’s better to have it and not need it than to need it and not have it.” Now that you have a well-stocked first aid kit or two…or three, seek out opportunities to use it. If you show up to the company picnic or a family function carrying your first aid kit, there will be a few who ask sneeringly, “Hey are you expecting a disaster?” but when they need a bandage for a minor cut, or burn cream for a child’s finger, to whom do you think they will sheepishly turn to? They will turn to you, the nut that brought the first aid kit. And as you become more comfortable using your first aid kit in life’s little misadventures, you will be better suited to handle a big emergency if it is ever thrown at you.

Last, but certainly not least, is backing up your supplies. I keep large quantities on hand of most of the supplies I listed (Okay, well I sell first aid kits and supplies for a living, so I’d better have a few extra). If you have followed my advice and used your kits often, then you will occasionally need to re-stock. Having a larder somewhere to draw from makes the whole process easier. About once a year (more often if I’ve had a medium or large need), I will gather all of my kits into one place and do an inventory and re-stock my kits as needed. I gather them from my family’s cars, the BOB, the 72-hour kit, the range bag, the RV, and anywhere else I have them, and re-inventory, re-stock, and rotate out long expired meds and non-sticky bandages.

Many people assume that in a panic they may forget what they have learned and not be able to rise to the occasion if an emergency occurs. One of the things that I teach each of my classes is the Emergency First Response (EFR) axiom: “Adequate care provided is better than perfect care withheld.”  If that is a little too esoteric for you, then how about a quote attributed to General Patton: “A bad plan today is better than a perfect plan tomorrow.”  Or if that’s still above your level of understanding, I like Larry the Cable Guy’s “Git ‘Er Done!”  Truer words have never been spoken.

References:
Emergency First Response Corp.  – Rancho Santa Margarita, CA
Occupational Safety and Health Administration (OSHA) – Washington, DC
American National Standards Institute – Washington, DC
International Liaison Committee on Resuscitation  (ILCOR)

Thyroid disease, diabetes, heart disease, back pain, asthma, COPD.
If you suffer from any of these chronic illnesses, you may be medication dependent.  What will you do when the supply of pharmaceuticals dries up?  Do you have enough medication stockpiled for the rest of your life?  What are the consequences of doing without?  Will you die or merely suffer?  Is there any way to prevent what appears to be inevitable?
And if not you, what about your parents, grandparents, and other loved ones?
Although complete answers to these questions would require hundreds of pages and perhaps years of study, here are 10 tips to help medication dependent persons survive TEOTWAWKI.

1. Understand what your medications are actually accomplishing for your disease and the consequences of doing without. In my experience, few patients understand the physiology of their particular disease and the purpose of their medicine.  If you are on heart medicine, ask your doctor why.  Is it to control the heart rate or make the heart pump stronger?  Is it meant to limit chest pain or decrease the likelihood of a heart attack?  If a certain medicine is unavailable, is there an older (less expensive) generic?  Will you likely die without nitroglycerin? For COPD patients, will you suffocate without your inhalers? Diabetics, will you dehydrate without insulin or metformin? For thyroid patients, without Synthroid will you develop a goiter?  Or will you grow sluggish, gain weight, and end up in a coma?  (For thyroid patients, these questions are answered in detail in my new self-study course “Hypothyroidism – Answers for the End of the World” . Armed with a better understanding of your disease, you’ll be better able to evaluate your options.
2. Understand your treatment goals.  For the atrial fibrillation patient, do you understand why you’re on Coumadin rather than aspirin?  If you’re also on a beta-blocker, do you know why?  As a heart patient, what is the purpose of your nitroglycerin patch?  Is avoiding chest pain the same as avoiding a heart attack?  For diabetics, what is your current goal of therapy?  How will this change when home blood sugar monitoring is unavailable?  Is the aim of thyroid replacement therapy to lower your TSH or make you feel better?  Are pain meds to help your back feel better or allow you to work harder? Ask your doctor the specific purpose of each medication you’re taking.  Just knowing “it’s for my heart” isn’t enough to plan your future.
3. Research treatment options beyond pharmaceuticals and try them out now.  It amazes me when an asthmatic chooses to sleep with their cat and wheeze, rather than ban the cat and breathe.  If medication weren’t available to open the airways, would they make the same choice?  Or, if you’re allergic to the world and can’t escape, would rinsing your nose with saline work as well as medicine?  It often does.  Or, ever wonder if eating half as much would cure your diabetes?  (If you don’t find out now, you may when the food’s gone.) Can’t live without Prilosec?  GERD (acid reflux) would be markedly reduced if people would elevate the head of their bed, eat less, limit spicy, fatty, and acid foods, and avoid alcohol and tobacco.  Narcotics aren’t the only option for a bad back.  Heat, exercise, and massage can work wonders in a motivated patient.  Medicine is not the answer for everything, though it often seems simpler to pop a pill than to make lifestyle changes.
4. Research over-the-counter alternatives to the prescription medication you’re on now.  OTC drugs can be stockpiled much more easily than prescription drugs.  Excellent OTC meds that could easily be substituted for certain prescription medications include Prilosec OTC, Prevacid, ranitidine, topical antifungals, meclizine, Azo, naproxen sodium, ibuprofen, cetirizine, diphenhydramine, bacitracin, and pseudoephedrine, among others.  Asthmatics may want to purchase Primatene Mist (which may be unavailable after 12/31/11) for emergency use in case their albuterol runs out.  Anyone taking Plavix should have a back-up supply of aspirin. Don’t forget to ask your physician if an OTC might substitute for your prescription medication.
5. Consider substituting an older drug for a newer medication too expensive to stockpile.  Since your insurance will not cover medications beyond three months in advance, how will you afford them (assuming your doctor is willing to prescribe them)? Many of these drugs are $200 a month, which most people find unaffordable.  Though not every drug has a $4/month alternative, many of them do so, or at least a generic form that doesn’t cost an arm and a leg.
6. Ask your doctor about vaccines that may improve your condition or prevent future problems.  Anyone with a heart, lung, or immune problem should certainly have a pneumonia vaccine and the newer TDAP vaccine, which includes a booster for pertussis (whooping cough).  Though the annual flu vaccine is aimed at the current year’s expected strain, there is also a cumulative effect, so receiving the vaccine annually may help not only in the short run, but in the long run as well.  Consider vaccines to hepatitis A and B if you haven’t yet had them. Also, make sure your family is up-to-date on their own immunizations, for their personal protection as well as your own.  Infections uncommon today will re-emerge when the number of unvaccinated individuals increases.   
7. Seek a permanent remedy now if one is available.  Atrial fibrillation patients may want to consider radioablation.  Spinal stenosis sufferers may choose to undergo surgery now, while it is an option.  It only makes sense for every asthma and COPD patient to quit smoking immediately.  Hyperthyroid patients may want to consider surgery or radioactive iodine treatment sooner rather than later.  Physical therapy (or manipulation under anesthesia) may resolve a frozen shoulder that otherwise might plague you the rest of your life.  Allergy desensitization shots may enable you to get off allergy or asthma medications altogether. If you suffer from any chronic condition, ask your doctor if a cure exists, no matter how involved.
8. Acquire supplies you may need in the future.  A COPD patient should consider purchasing a nebulizer.  An arthritis or back pain sufferer may be wise to find a used wheelchair or walker.  A diabetic may want to buy additional needles and lancets for future use.  Think about your environment and what accommodations you would need if electricity, heat, light, or running water were unavailable.
9. Try a dry run.  Ask your physician if it would be safe for you to do without your medication while being monitored medically.  Do not try this on your own!  As a COPD patient, do you really need three inhalers, or would a single inhaler work as well?  If so, which one? Can you monitor yourself using a peak flow meter? As a heart patient, will you develop chest pain or become short of breath without nitroglycerin? For back pain or arthritis patients, since doctors won’t prescribe a lifetime supply of narcotics, can you get off them now or try an alternate therapy?  For thyroid patients, will your TSH climb 10 points or 100 if you discontinue your medication? Don’t try this experiment without your doctor’s approval and understanding, but do express your concerns.  The doctors I know don’t envision the world as a permanently stable environment.  Your questions may take additional time with your physician, so make the receptionist aware when you schedule.  Please don’t tack these questions on as your doctor is heading for the door.  Your doctor will feel rushed and the questions won’t receive the attention they deserve.
10. Consult with a fellow prepper health professional, or perhaps a seasoned physician.  Treatments come and go, and newer is not always better.  Older treatments (such as Armour thyroid) do work, but may require a modified approach for optimum treatment.  Switching now, when monitoring is readily available, may be easier than later, when guesswork will replace laboratory testing. Younger doctors may have head knowledge but no practical knowledge of older treatments.  A retired physician may be a gold mine of information.