OSD 357: Putting your first aid kit to the test, holiday edition
You'll need bandaids a lot more often than you'll need a nasopharyngeal airway.
A few years ago, we wrote a piece about how focusing too much on having a cool EDC (everyday carry) can prevent you from having an effective EDC. Excerpting it in full because it’s useful context for discussing the same topic in your home first aid kit:
You all carry, right?
Why?
Generally it’s something like “Better to have it and not need it than to need it and not have it.” A gun can save your life in particular circumstances, and who wouldn’t want their life saved. And sure, that’s part of it, but it’s not quite a full explanation. Lots of things can save your life. Antibiotics have saved many more lives than Glocks have, but you don’t tuck a flask of amoxicillin in your waistband when you leave the house.
The items you carry fall into two categories:
Items that will save a life.
More-frequently-used conveniences.
Both categories have a tradeoff at the margin, where you weigh the value of the item against the hassle of carrying it. But the value on the positive side of the scale will always be in one of the two categories above. Category 2 is stuff like a pen, a flashlight, your wallet, your phone, a knife for opening boxes, etc. Category 1 is the uncharted one.
For most people who carry a category 1 item at all, their list is one item long: a gun. (That’s if we don’t count a phone, which is statistically the most important life-saving tool you carry. But you’d carry it for category 2 reasons anyway even if it had zero life-saving utility, so we won’t count it in category 1.) The reason boils down to the old chestnut that when seconds count the police are minutes away. Emergencies where you need a gun on you are emergencies where you need a gun on you — it can’t wait.
We can generalize that: a category 1 EDC item is any life-saver where, should the need for it arise, the only way you’ll have it quickly enough for it to make a difference is if it’s on your person. If you can wait for help to arrive with the item, then it’s not in category 1 and you don’t need to carry it.
So, a gun is a category 1 item. What are some others? An non-exhaustive list of items whose immediate presence can determine whether the victim lives long enough for the ambulance to arrive:
EpiPen
Tourniquet
Chest seal
AED
Training in CPR and first aid
Your EDC is a bet that the expected value of an item is bigger than the hassle of schlepping it. If you carry a gun, then you’ve taken that bet with the gun. And that’s great. But keep pulling on that thread, and think about the
probability x valueof the others. The odds that you’ll need to use a tourniquet are higher than the odds you’ll need to use a gun. The odds that you’ll need to use an AED are higher still. Statistically, the highest EV thing on this list is the one that doesn’t take any effort to carry — first aid training.A data-driven approach to these category 1 EDC items is to sort them by EV (highest first) and then walk down the list until you reach the limit of things you can comfortably carry. So for people reading this, that probably means carrying: first aid training, a tourniquet, a gun, and then tapping out somewhere around chest seal.
(Side note: in a world where AEDs were dirt cheap, it would be negligent to not have one at home and one in every car. In today’s world where they cost ~$1000, that’s a tougher sell. But you should consider it. How many people wouldn’t bat an eye at spending $1000 on their tenth gun, but haven’t bought one AED yet?)
If you’re carrying a gun without having any first aid training, there’s nothing wrong with that per se — you’ve got one category 1 item with you instead of zero. But it does suggest you have an opportunity to make your full EDC toolkit more effective.
Now, your home first aid kit.
Urgent cares and ERs see an increase in visits on/around most holidays. That implies that the average person is more likely to have an emergency at home around those times. How should you prepare for that?
First, consider the framework above. The same Category 1 and Category 2 groups still apply. There are three differences between carry and home:
At home, your limiting factors are budget and storage space, not portability.
Because of that, you can lean more heavily into Category 2 items than you would with your EDC.
With EDC, your goal is “get home or get to the hospital”, and in either case, the plan is to deal with the situation further once you get to your destination. At home, that changes a bit. Your goal is “deal with the problem fully at home, or buy enough time to get to the hospital”. Dealing with the problem fully requires some extra thought and equipment.
Let’s think through trauma vs. medical.
First, trauma. At home this will mostly mean cuts, burns, and falls. For each of those eventualities, your first aid kit — and your training — should either treat the cut/burn/fall fully or just patch things up enough to get to the hospital. Falls in particular are dicey since the damage can be non-obvious and slow to manifest. Certainly any non-trivial blow to the head warrants a visit to a doctor.
Second, medical. The definitely-serious versions of this are things like heart attacks, cardiac arrest, ventricular fibrillation, strokes, or choking. The unclear-in-the-moment-how-serious-it-is versions are fainting spells, exhaustion, dehydration, random pains, or unexplained confusion. Unhelpfully, sometimes the latter are signs of the former.
There’s a generalizable approach to all of the above: “Climb your way to certainty about what to do”. And you can think of your first aid kit as just a tool to help you do that. If you are uncertain about what to do next, cut down the scope: if you don’t know how to solve the problem all at once, what is an incremental step that you are certain about?
Take an easy example: a small papercut. What makes it an easy example is that you start out certain about what to do. Put on a bandaid. Done.
Take a less easy example: your wife slices her knuckle open on the edge of an empty can of beans. She’s bleeding a few cc’s of blood per minute, the cut is 15mm long and gapes open when she bends her finger, and she might have a little pinto bean juice in the wound. Grab the first aid kit and climb to certainty. First, gently clean the wound with soap and water. Ok, any pinto bean juice is taken care of. Now apply gauze and wrap tightly with tape. After 10-15 minutes, did the bleeding stop? If so, great, the only uncertainty left is closing the wound and immobilizing it for a few days so it’ll heal nicely. If not, you also have certainty about what to do next: go get stitches or some dermabond.
Take a hard example: Grandma traveled a long way to be at Christmas and didn’t get to nap in the afternoon like she normally does. At dinner, she seems confused, which happens occasionally, but this is much worse than in the past. Here you’re starting out with very little certainty about even what the first step should be. Learn to listen for that feeling. “I don’t even know the first step here” is a sure sign you need to escalate. So get a doctor involved.
If you’ve ever had to use your first aid kit for a non-trivial situation, you quickly realized what all of us do in that moment: you made some mistakes when putting it together! The classics are things like having three nasopharyngeal airways and decompression needles, but no scissors or bandaids. Prepare for the exotic, but only after you’ve also prepared for the mundane. And then train with your kit. It’s not crazy to do dry runs. Tell a family member to spring a rehearsal of “I’m choking!” (mimed, presumably) or “I just cut myself!” when you’re not expecting it. Then grab your first aid kit and treat it like it’s real. You’ll be surprised how quickly you generate a list of improvements, both to your kit and your training.
Merry Christmas, happy holidays, and watch out for those sharp cans of beans.
This week’s links
Medical Points Abroad
Speaking of first aid kits, we like these ones from our pals at Medical Points Abroad. Good gear from people who have used it for real, from combat to the backcountry to around the house.
Christopher Lee from Lord of the Rings on how to be stabbed convincingly
On film he was on the receiving end, but it appears that in real life the tables were turned.
The US government sues the US Virgin Islands for Second Amendment violations
The U.S. Virgin Islands requires that applicants demonstrate “good reason to fear death or great injury to his person or property,” and to have “two credible persons” to vouch for their need of a firearm. Local law also requires that someone have “good moral character” to obtain a gun permit, which is valid for up to three years and applies to a single weapon.
…
The lawsuit states that those in the U.S. territory also must “submit to intrusive and warrantless home searches” as one condition to obtain a gun permit. If an applicant refuses a home inspection, which takes “several months to a year to schedule and complete,” the government will not process their request, according to the lawsuit.
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