Subject: Extensive Medical Field Kit (16K long)

From: [email-masked] (Anonymous)
Date: 11 Apr 1995 01:32:16 -0400

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Introduction:
What follows is a listing of items for inclusion in an extensive
field medical kit.

It is assumed that the reader has at least a nodding familiarity with
advanced first aid principles and equipment.  It is regretted that some
of the items mentioned may be hard-to-obtain.  Substitute freely.
If you have a physician with whom you have a good working relationship,
ask him or her for guidance in obtaining the uncommon and prescription
items.  The "Sources" list periodically posted to misc.survivalism may
also provide pointers to companies (e.g., Moore Medical) that carry some
of the items listed.

Disclaimer:
Nothing in this text is to be construed as medical or legal advice.
Qualified professional assistance must be sought before medical
treatment is rendered.  This text serves only as a guide for discussion.
YOU ASSUME ALL RISKS AND FULL LEGAL RESPONSIBILITY FOR ANY AND ALL
                  APPLICATION OF THIS MATERIAL.
This text is not copyrighted and is to be distributed freely.  Modifications
will invalidate the PGP clearsigning.

Criteria:
This kit is designed to address an extensive variety of problems.  It is
therefore fairly large, although man-portable.

Author Notes:
I did not compile this list.  The author has a broad background
in treating field injuries and medical emergencies.  If you disagree with
the selections herein, change or substitute to suit your needs.

Like me, the author wishes to remain anonymous.

If there is sufficient interest, future posts may be made on
related topics.

Regards,
NEMO
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Emergency Medical Pack, Field, Comprehensive

Items marked with an asterisk (*) are optional,
depending on the user's needs and/or level of skill.

NOTE: It is prudent to familiarize oneself with the infectious
      diseases endemic to the area one expects to travel to or
      through and be immunized accordingly

     Pharmaceuticals:

          Analgesics

               Acetaminophen 500 mg gel-coated
               Aspirin (buffered) 500 mg
               Percocet
               Proparacaine, Ophthalmic solution
               Morphine, injectable (*)

          Anesthetics, local (*)

               Xylocaine, 1% 
               Xylocaine, 1% with epinephrine
               Marcaine
                    Longer acting than xylocaine

          Antimicrobials (*)

               Antifungal foot powder/liquid
                    Tinactin
                    Micatin
               Antimalarials (see note 01)
                    Prophylaxis: Chloroquine Phosphate 500 mg (zone A)
                                 Mefloquine 250mg (zones B & C)
                    Treatment:   Chloroquine Phosphate 500 mg (zone A)
                                 Quinine Sulfate 300 mg or Doxycyline 100 mg
                                 or Clindamycin 450 mg (zones B & C)

                    Consult local health department or "Sanford
                    Guide to Antimicrobial Therapy" to determine
                    which strains of malaria are endemic in the
                    region you expect to travel in/near, and the
                    recommended therapy.

               Bacitracin Ointment (single use foil packages)
                    Many are sensitive to ointments containing
                    neomycin. Single use foil packets are less
                    likely to rupture than a large tube, and if
                    one does, the mess will be much less.
               Biaxin 500 mg
                    Broad spectrum, useful for respiratory infections
               Flagyl 500 mg
                    Antiparasitic, and also effective against many
                    anaerobic bacteria.
               Keflex 500 mg
                    Broad spectrum, useful for wound and respiratory
                    infections.
               Polysporin Powder
                    May be sprinkled into a deep wound if definitive
                    medical care is going to be delayed.
               Rocephin 1000 mg for injection, lyophilized (*)
               Silvadine Ointment
                    Topical antimicrobial, useful for burns.
               Saline, sterile, for injection, 3 cc vials
                    Used to reconstitute rocephin.
               Septra DS
                    Useful for many forms of bacterial sinusitis,
                    as well as travellers' diarrhea.
               Water
                    Although not a pharmaceutical in the traditional
                    sense, potable water (disinfected with chlorine
                    or iodine tablets, or filtered) is the best way
                    to disinfect/clean a wound that extends below the
                    dermis. While sterile water intended for irrigation
                    is preferable, clean, disinfected water is preferable
                    to dirt, bugs, and leaves in a deep wound. Betadine
                    solution should not be used to irrigate a deep
                    wound in the field in the vast majority of cases.
               Water Purification Tablets

          Emergency Drugs

               Epinephrine Injector (1:1000)
                    Essential for treatment of anaphylactic reactions
                    to poisonous bites/stings.
               Charcoal, activated, suspension
               Ipecac, Syrup
                     Never induce vomiting in cases of poisoning due
                     to caustic substances or petroleum distillates.
               Glucose concentrate, oral
               Inhalants, ammonia

          Gastrointestinal

               Levsin SL 0.25 mg
                    An excellent treatment for cramps associated with
                    gastroenteritis.

          Intravenous Solutions (*)
                  
               Ringer's Solution, Lactated
               5% Dextrose in Water (D5W)
               Normal Saline

          Other

               DEET (At least 30% concentration) insect repellant.

     Consumables

          Bandages, adhesive, butterfly
               Useful to close minor lacerations. Steri-strips
               are a good alternative, but tend not to stick well
               without benzoin skin prep.

          Bandages, adhesive, fabric
               Carry assorted sizes, including 2x3" and finger tip.

          Bandage, self-adherent (Coban)
               2" rolls make an excellent replacement for adhesive
               tape to secure a dressing.

          Bandages, triangular
               Useful for cravats, slings, and tourniquets

          Benzoin Applicator Ampules
               Skin prep ampules to ensure adhesive dressings stick.
               This can be very useful in a field setting.

          Blanket, emergency, aluminized

          Cautery unit, battery-powered, disposable (*)
               A quick way to stop bleeders that are too small 
               to ligate and too large to stop quickly under
               direct pressure. This device is about the size of a
               disposable pen-light.

          Cervical collar, disposable

          Cotton, absorbant, sterile
               Can be used for extra packing in a wound dressing
               or to cushion a splint. Also useful to fashion a
               temporary dental filling, soaked with eugenol

          Dressings, field, battle-type
               Military issue field dressings, if in undamaged
               packages, are excellent, compact dressings.

          Dressings, burn, gel, hydrophillic
               Minimizes contamination and fluid loss.

          Dressings, burn, sheet-type
               Allows coverage of large areas, and is permeable to
               aqueous irrigants.
          
          Dressings, eye patch, with metal shield

          Dressings, gauze, sterile
               2x3" & 4x4"

          Dressings, occlusive
               Tegaderm
               Xeroform

          Eugenol (*)
               Soak cotton pledget to temporarily replace lost dental
               filling.

          Gloves, latex

          Ice pack, chemical
               Useful to minimize pain/swelling of sprains and
               poisonous bites/stings.

          Moleskin
               Packages of 3x6" sheets. Use BEFORE blisters appear.

          Prep pads, Alcohol
               Useful for cleaning instrument tips and injection sites.
               Also useful to clean the edges of a wound prior to
               applying steri-strips or butterfly bandages.

          Scrub, surgical, Phisohex
               An antimicrobial cleaner that is a good alternative
               to Betadine. It is less likely to cause a skin reaction.
               I do not recommend the use of topical disinfectants to
               clean/irrigate a deep (below the dermis) wound.

          Splint, wire mesh
               This is excellent for arm/wrist splinting. It is
               unit-packaged the size of a deck of cards.

          Sutures, individually packaged, with needle (*)
               3-0 and 4-0 Nylon
               3-0 Vicryl/Dexon

          Tape, adhesive, cloth
               A 2" roll is useful for dressings where Coban cannot
               be used, also to temporarily stabilize a sprained
               extremity.

          Towel, cleaning, moistened (Wash 'n' Dry or baby wipes)
               Many contain antimicrobials and are useful to
               clean abrasions.

          Zinc Oxide Powder (*)
               This can be made into a paste with eugenol to form a
               temporary filling.

     Equipment

          Airways, oropharyngeal, disposable

          Blades, scalpel, #11 and #15

          Clamp, hemostatic

          Dowel, wood, 1/4" x 6"
               Used to make "Spanish Windlass" tourniquet with a
               cravat bandage.

          Eye Magnet/Foreign body loop
               To lift foreign objects off of eye
               Never remove a foreign object that penetrates
               the globe of the eye.

          Flashlight, AA size, Mini Maglight

          Forceps, fine tip (tweezers)

          Forceps, Adson (fine tip with teeth)

          Hypodermic needles
               25 ga. x 1" 

          Intravenous infusion sets (*)

          Intravenous needles, angiocath (*) 
               I recommend 20 ga. 1 1/2" and 18 ga. 1 1/2"

          Intravenous needle, angiocath, 16 ga. (*)
               For emergency cricothyrotomy

          Intravenous needle, butterfly, 18 ga. (*)
               For rapid IV access when an indwelling IV catheter is
               not needed.

          Mask, bag-valve type (ambu-bag), single patient use (*)
               Useful for resuscitating respiratory arrest

          Mask, pocket, with one-way valve
               For administering CPR

          Needle Holder

          Oxygen, USP (*)
               As large a cylinder as practical to carry

          Ring cutter

          Scalpel handle, #3 or #7 type

          Scissors, bandage, 4"

          Scissors, "paramedic" type

          Syringes (*)
               5 cc for local infiltration
               60 cc for emergency thoracentesis

          Sphygmomanometer

          Stethoscope
               Littman Classic II or Cardiology II

Miscellaneous Survival

          Dental Floss
               This is an excellent lashing material, takes up little
               room, and has tremendous tensile strength.

          Entrenching Tool

          Fire starting equipment
               Magnesium bar with striker
               Matches, waterproof

          Hatchet 

          Ice Axe

          Knife
               High quality rugged knife (with sharpening steel or
               stone); Examples (in no particular order):
                 Cold Steel "Recon" series (SRK, Tanto, Scout)
                 Buck models 119, Nighthawk
                 Randall models 1, 14, 15, 16
                 Gerber models LMF, BMF
                 Busse Steel Heart II
                 SOG models Seal 2000, SF Bowie

               A back up knife is also recommended, such as:
                 Spyderco Clipit Series
                 Benchmade AFCK
                 Swiss Army Knife

               Multi-Tool
                 Leatherman
                 Gerber Multi-Plier

          Paracord
               Useful for lashing poles for a shelter, or fixing a
               blade to a pole for a spear.

          Radio, two-way
               Lap top computers with PGP and ham radios that are
               packet-capable are a relatively inexpensive method
               of secure, near real-time communication. Many VHF
               ham hand radios also receive NOAA weather frequencies.

          Rope
               200' Climbers' rope
               Figure 8 descender

          Saw, wire

          Signaling Devices
               Aerial flares
               Signal mirror (Gerber)
               Smoke Grenades
               Strobe, battery powered
               Whistle

          Survival Rations
               MREs, dehydrated "backpacking" food.
               Potable water, and/or a means to filter/disinfect water

Useful References:

          Advanced First Aid
            American Red Cross

          Advanced Trauma Life Support
            American College of Surgeons

          Emergency War Surgery
            US Government Printing Office

          Flint's Emergency Treatment and Management
            Harvey D. Cain, M.D.

          Medicine For Mountaineering
            James A. Wilkerson, M.D.

          The Merck Manual

          Sanford Guide to Antimicrobial Therapy
            Jay P. Sanford, M.D.

          US Army Special Forces Medical Handbook
            United Stated Army Institute for Military Assistance

  Notes:

    01   Zone A includes Central America, Carribean Islands, Middle
         East (not including North & South Yemen), the Northwest
         part of Afhganistan, and Northeastern China

         Zone B includes India and all countries on its northern
         borders, North & South Yemen, Northwest Afghanistan, 
         Southeast Iran, Sumatra, parts of Borneo and Malasia.

         Zone C includes All of Africa south of 20 degrees north
         latitude plus Madigascar, all of Southeast Asia except as
         otherwise indicated, New Guinea (and islands in the 
         immediate vicinity), plus parts of Borneo and Malasia.