Constructing a Trauma Kit

[GeneralWashington]

Trauma / First Aid Kit Construction

Note: While it is difficult to recommend specific medical courses, you should strongly consider finding and taking medical and/or trauma classes in your area; Stop The Bleed classes are a good foundational step for this and widely available.

Essential Components

Tourniquet: Tourniquets are one of the most important tools in preventing death from severe hemorrhages in the extremities. They all work by applying enough pressure to occlude blood flow to a wound and prevent blood loss. It is strongly recommended to use a CoTCCC (Committee on Tactical Casualty Care) recommended tourniquet as their efficacy has been backed by sound scientific studies. As of the writing of this document this list is as follows: CAT Tourniquet Generation 6 and 7 (North American Rescue), SOFT-T Wide Generation 3 (by Tactical Medical Solutions), RMT (Ratcheting Medical Tourniquet by m2 Inc), SAM-XT (Sam Extremity Tourniquet by SAM Medical), TMT (Tactical Mechanical Tourniquet by Combat Medical), and the TX2/TX3 Tourniquets (by Revx Medical). Newer versions of these tourniquets are likely also good to carry, but are not yet officially recommended.

Ensure that you purchase your tourniquets either from a respected medical supply store or directly from the manufacturers/distributors as third party marketplaces such as Amazon and eBay often have fakes that are inferior and not recommended.

Packing Gauze: Packing gauze is another crucial tool in preventing death from hemorrhages. Not every wound can be or needs to be treated with a tourniquet and in this case, packing the wound with gauze is the proper treatment. Almost any gauze can be used for this, but some gauzes are better than others for this purpose; some are packaged specifically for wound packing and quick deployment, some have X-Ray strips so that any gauze remnants can be found by an X-Ray scan and removed in a hospital setting, and some are infused with hemostatic agents to assist in bleeding control. Hemostatic agents including infused gauzes will be covered elsewhere in this document.

Z-folded or S-folded gauzes are preferred for rapid deployment. The most important thing for packing gauze is getting gauze that is sterile; some gauzes aren't meant for wound packing and thus aren’t packaged to be sterile. Recommended packing gauzes include, but are not limited to: Rescue Essentials Compressed Gauze, H&H Flat Compressed Gauze, NAR Wound Packing Gauze, NAR S-Rolled Gauze, Dynarex Compressed Krinkle Gauze, Mojo MARCH System Mojo Gauze, and Phokus Non-Woven Z-Fold Gauze.

Pressure Dressing: Pressure dressings are an important tool in providing care for hemorrhages, especially in conjunction with wound packing; these bandages provide pressure on a wound to stop bleeding and can be an excellent alternative to a tourniquet if the bleeding is not severe enough to require it. Different pressure dressings have different methods of applying pressure, but work on the same fundamental principle of wrapping around the wound and applying pressure over a wound pad on the wound. Quality pressure dressings often include packing gauze as one of their components, and there is one pressure dressing that includes hemostatic packing gauze.

Recommended pressure dressings that come with packing gauze include: Israeli T3 Bandage, OLAES Modular Bandage, OLAES Hemostatic Bandage, and the H&H H Bandage. Recommended pressure dressings that do not come with packing gauze include: NAR Emergency Trauma Dressing, NAR Responder Dressing, NAR Mini-Responder, Israeli Emergency Bandage, H&H Mini Compression Bandage, and the Battle Bandage.

Chest Seal: Chest seals are occlusive adhesive dressings that are used on any penetrating chest wound to prevent air from entering the chest and potentially causing a tension pneumothorax (lung collapse from air building up in the chest). Studies on how useful these are are currently divided, but they remain in the recommendations for trauma kits at this time. Chest seals typically come in two packs for entry and exit wounds and come in vented and non-vented varieties although this is no longer always the case; the vented kind is currently preferred as they allow air to exit the chest but not enter it which can be useful if the lung is leaking air into the chest cavity.

Recommended chest seals include: Hyfin Vent Compact Chest Seal Twin Pack, Hyfin Vent Chest Seal Twin Pack, Halo Vent Chest Seal, H*Vent Chest Seal Twin Pack, Russell Chest Seal, and the Beacon Pocket Vented Chest Seal.

Gloves: Gloves are a crucial part of keeping yourself safe from bloodborne pathogens when treating serious wounds. Brands and sterility do not matter for this purpose, but they should be nitrile and any color other than black; it can be hard to see blood on black gloves when running your hand over a casualty to check for area of bleeding.

Shears: Shears are an important part of a kit with a few uses; one of the most important things they are used for is cutting/removing clothing to gain better access to a wound to administer treatment. There are a lot of shears on the market these days, and quality varies wildly. They range in price from a few dollars to over one hundred dollars depending on what, if any, added features you want on them.

Recommended shears include: Leatherman Raptors, X-Shears, Rip Shears, Madison Supply EMT Shears, and SOG Parashears.


Strongly Recommended Components

Hemostatic Agent: Hemostatic agents are used in bleeding control. They are capable of promoting homeostasis by clotting blood independently of the body’s mechanisms. Studies are currently divided on the effectiveness of these versus standard packing gauze when both are applied correctly, but it is always wise to take any advantage one can get in a life threatening situation so they are generally recommended.

The two main types of hemostatic agents on the market today use Chitosan and Kaolin respectively. Various studies have been inconclusive on the superiority of one over the other except in saltwater environments where Kaolin based hemostatics have an advantage. Chitosan is derived from shellfish but there is currently no evidence of adverse reactions in people who are allergic to shellfish.

Recommended hemostatics are: QuikClot (Kaolin), Celox (Chitosan), and HemCon Chitogauze (Chitosan). Based on current studies NuStat should be avoided at this time. The OLAES Hemostatic Bandage (pressure bandage with hemostatic packing gauze) uses Chitogauze. There are many varieties of QuikClot and Celox but they all work fundamentally the same; gauze is usually preferable to granules outside of a few specific situations.

Duct Tape: Duct tape may seem like an unusual addition to a trauma kit but it has a lot of potential uses including reinforcing bandages or dressings, improvising a splint, improvising an occlusive dressing, and more.

The most useful kinds are the mini rolls, some examples of which are: H&H Combat Reinforcement Tape, and SOL Duct Tape.

Nasopharyngeal Airway: NPA’s can be an important part of a trauma kit, but only if one knows how to use them. They are used to establish an alternate airway in the event of obstruction to the main airway or other situations where people can’t get air through their mouth. It is important to get one with lubrication included. They come in a variety of sizes but the most commonly used one is 28 fr. This is a product that requires proper training to use safely; if you do not have and/or cannot obtain this training, please see the alternative Oral Airways option listed further below.

There are no specific brand recommendations for this product, just ensure that your NPA includes lubrication and is sterile.

Head Lamp: Having appropriate light to apply first aid or others is important in any situation; having this light be from a hands free source is equally important.

Recommended brands include: Streamlight, Surefire, and Fenix, but there are other good lights out there, just ensure that you do research on one before you buy it.


Valuable But Situational

As a note, the following products are very useful but often more situational so one must decide how likely they are to need them and if they are worth including in a kit based on that, pricing, and space taken up.

Splints: Splints are very useful tools in any situation where you are treating a fracture of an extremity. They are used to stabilize a break, reduce pain, prevent more damage, and make a patient easier to move. The recommended splints can also be used with a tourniquet to improvise a pelvic binder to stabilize hip injuries. When adding a splint to your kit, you should also add cohesive wrap to make securing the splint easier.

Recommended splints are: SAM Splint and the RISE (Rigid Immobilization System for Extremities)

Burn Dressings: Burns can be extremely painful injuries that can easily give rise to infections; any non-cotton sterile dressing should be applied over a burn, but there are dressings specifically for burns that can reduce pain and cause less issues in the future, especially when removing the dressing.

There are two recommended burn dressings that will be listed separately as they are useful in different situations. Water-Jel dressings are sterile non-adherent dressings that are soaked in a gel solution designed to absorb heat and relieve pain with lidocaine. While effective in relieving pain, due to lack of studies, these can only be recommended for minor burns. They can also be difficult to store in a first aid kit for long periods of time due to the amount of liquid in the packaging.

The second recommendation is a hydrogel dressing; while any hydrogel dressing can be effective, the NAR BurnTec dressing has been over designed for this purpose and thus is the recommendation of this document. Hydrogel dressings are the only field burn treatment currently backed by studies that show they can reduce pain, promote healing, and maintain the wound in an optimal environment. They are suitable to be applied to first, second, or third degree burns.

Abdominal/Stump Bandage: Abdominal or Stump bandages are pressure dressings with large wound pads; they are typically used either in major abdominal injuries to cover severe penetrating, blast, or shrapnel wounds and when used with the occlusive layer can be used to cover any abdominal contents that are protruding from the skin to prevent them from drying out and protect them. They can also be used to cover the remnants of a limb in the event of a spontaneous traumatic amputation to protect it and the remnants.

Recommendations include: TacMed Blast Bandage, Israeli Abdominal Emergency Bandage, NAR Emergency Trauma Dressing Abdominal/Stump, and the H&H Big Cinch Bandage.

Cohesive Wrap: Cohesive wrap is a versatile component that can have a variety of uses including: securing a splint, improvising a compression bandage, wrapping joint sprains, secure other dressings, and more. There are no specific recommendations for this product.

Triangular Bandage: Triangular bandages are useful items in their versatility. Potential uses of triangular bandages include: improvised sling, wrap for minor head injuries, ankle sprains, wrap for eye injuries, immobilizing a fractured jaw, bandaging a shoulder injury, a hip wrap, and more. There are no specific brand recommendations for this product.

Saline Rinse Jet: Saline rinse jets have several potential uses, the main ones are flushing a wound and flushing the eyes in the event of exposure to chemicals. There are no specific brand recommendations for this product.

Oral Airways: Oral airways are a less versatile but still useful alternative to NPAs for maintaining an airway for people who do not have the training to use an NPA. These airways prevent the tongue from blocking the patient from breathing. There are no specific brand recommendations for this product, but one should have a variety of sizes for different potential patients.

Aspirin: Aspirin has two main uses in a first aid kit; the first is simple pain relief. The second is in the treatment of heart attacks. Studies have shown that taking aspirin during a heart attack may reduce damage and severity. There are no specific brand recommendations for this product, but the dose should be at least 325mg.

Minor Wound Treatments: Having ways to treat minor wounds can be useful in a variety of situations. Recommended items include: Triple Antibiotic Ointment, Butterfly Closures, Benzalkonium Chloride Wipes, Povidone Iodine, ABD Combine Pads, Adhesive Bandages, Fingertip Bandages, Knuckle Bandages, Non-Adhesive Pad, Moleskin, non-sterile Gauze, and other similar items.

Naloxone/Narcan: This is a crucial item to have for opioid overdoses. It is typically available for free from either local overdose prevention organizations or government offices, but can also be obtained from any pharmacy for a fee. Ensure you watch an appropriate training video on how to administer whichever type you get; the nasal spray version is currently the most common in the US.

Ammonia Inhalant/Smelling Salts: These inhalants can be used to wake up an unconscious person if they are not unconscious due to an opioid overdose. There are no specific recommendations for specific brands as all ammonia will have this effect.

N95 Mask: N95 masks can be a valuable response tool if you or a casualty is in any area with any type of contamination by reducing the amount that you inhale.

Due to the current pandemic, as of this writing, there are no specific brand recommendations, but one should ensure that their mask of choice is certified by NIOSH as N95 (or higher) rated.

Other OTC Medicine: Other OTC medicines which may be useful include, but are not limited to: ibuprofen, antihistamines, poison ivy pre and post exposure towelettes, burnjel, acetaminophen, activated charcoal, and others. Don’t be afraid to include them if you have room and think they may be valuable.

Pepper Spray/CS Decontamination Wipes: Pepper spray/CS decontamination wipes are perhaps the most situational items included on this list. If you feel that you are at risk of being in situations where these agents are deployed against you, they should be included to reduce incapacitation time.

The only recommended brand currently is the Fox Labs Sudecon Decontamination Wipes as these are the only ones that the author has had first hand experience with and can verify to work effectively.


Please note that all recommendations, other than the Tourniquet CoTCCC recommendations, are made by the author only and, while often supported by studies, are ultimately an opinion and should be supplemented by your own research into the topic and/or the recommendations of a medical professional.


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