~agk: What Should I Put in My First Aid Kit?

I was recently involved in editing a book on medicine in resource-poor circumstances, and the discussion on the first aid chapter collapsed into a disagreement on the nature of first aid. Having worked both professionally on an ambulance, and as a volunteer street medic, and also having been the “hey, could you look at this?” person for a community, I have some fairly strong opinions on first aid, and apropos of that, I’m rarely happy with internet discussions of first aid kits.

What should I get with my first aid kit?

Nothing. A first aid kit is a bag, like a purse or that outer pocket on your backpack, for storing and organizing the items you use on a regular basis. Purses don’t come pre-loaded with two spare tampons, a date book, five packs of soy sauce and a plastic fork; “standard” pre-loaded first aid kits don’t make sense either. Lets look at a standard kit, say one from CampMor.

There are things to like about this kit, for instance it has three information sources – a guide to the pack itself, a first aid manual, and an “action card.” At seventeen dollars, it won’t break your budget, and it includes a few things – tweezers, for instance – that you can pretty much count on needing sooner or later.

On the other hand, its kind of silly and makes some obvious compromises to make “one size fit all.” It includes two ibuprofen. Two? I can get a generic bulk pack from the drug store and put as many in as I want. Or, maybe I’d like tylenol instead, or naproxen? Why waste time and money on an “included” two pack? Also, the kit contains a green soap sponge and steri-strips. Both potentially very useful, but only if you’re out on your own for a significant period of time, and if that were true and you had a wound requiring surgical scrubbing, you’d probably want more than two ibuprofen, right?

It doesn’t, however, contain my favorite bugbear of an “included” first aid supply, the abdominal bandage or “ABD Pad.”

In my time on the ambulance, I probably used five to seven ABD pads. Now, I needed every single one of them, but in the same period of time I probably used five to seven thousand glucometer test strips. What I’m getting at is that the contents of your first aid kit should be based on what you use the most, which in turn depend on the context in which you might end up needing them. If you’re going to an earthquake zone, a “first aid kit” could be a duffel bag full of ortho boots and collapsible crutches. If you’re an ultralight hiker in a temperate climate, you might prefer telfa for blisters, or sunburn ointment. If you’re a wildlife biologist in Minnesota, your first aid kit should include things like hand warmers and something for giardia. If you or your family or nine percent of the population in your country are diabetic, you should probably keep a glucometer and test strips handy.

But what if you don’t ever use first aid stuff to begin with? Well first of all you probably do- go to your medicine chest, pick the six least dusty items,¹ and put them in a bag, voila. But more importantly, maybe you don’t need a first aid kit right now- maybe you need first aid training instead. Its a little weird to be saying this about bandages, but extend the principle up the scale: it isn’t uncommon on the internet to come across people asking “what antibiotics should I keep on hand?” The answer is none. If you know how to use antibiotics safely, which ones to keep is a no-brainer, hardly worth asking in public. If you don’t know how to use them, you shouldn’t have them around. First aid, while less risky, isn’t too different- knowledge, not doo-dads, is what saves lives in an emergency.

So get some first aid training! If you live in the US, first aid and (better yet) first responder training is pretty much universally available through the Red Cross, American Heart Association, NOLS, even FEMA; I assume some similar opportunity exists in the rest of the developed world. If you have a few months, most community colleges offer EMT training, and you could gain all the experience you need to build your own perfect first aid kit with a mere year with your local Volunteer Fire Department.

Now, I’m the first person to agree that medicine isn’t nearly as hard as its made out to be. We live in a culture that makes medical school graduates seem near-godly, whereas physiologists, public health workers, physical anthropologists and, (duh) nurses all learn the same material without so much as a whicker. Plus, plenty of people take good care of sick or injured people without ever learning chemistry or optics or even what we think of as “modern medicine.” I don’t want to be accused of saying that you need some paper on your wall, or some letters after your name, to be able to provide really good health care, because I absolutely think that premise is bunkum. What I will say, though, is that there is absolutely no substitute, for you, for the aid worker with the copy of Where There Is No Doctor, or for the arrogant new doctor entering a residency, for personal hands-on experience. Whatever you’re doing, if you want to be good at it, you have to have done it before. If your mother was a traditional healer, and you can sit at her side for ten years, wonderful. For most people, the easiest way to get that experience is by jumping in on the citizen-participant level and keeping their eyes open.

No, no, I mean where there REALLY is no doctor!

But, of course, this is the internet and nobody’s happy with that. On my one side are people talking about “sustainability,” on my other side are people worried about the zombie apocalypse; both of these groups like to criticize standard first aid for being too much “first” and not enough “aid”- that is, for teaching providers to expect ambulances and emergency rooms will be available within no more than a day or so at most. These folks actively resist getting trained, for fear they’ll pick up too many bad habits and dependencies in the process. What about when there’s no good backup plan?

First, lets stop a minute and think about what you’re asking. You want to know how to provide definitive medical treatment with no outside resources whatsoever, in a life-threatening emergency, with no prior experience and no information beyond what you’ve read online or in a book. You aren’t asking about real life, you’re asking about a video game.

Are there emergency procedures that can work in crazily resource-isolated circumstances, that doctors generally don’t learn? Sure. Most of them have been abandoned for a reason, such as not comparing well to more resource-intensive modern alternatives, but there are a few forgotten gems out there. Unfortunately, in my experience, its predominantly formally-trained medical people who collect them- WALS classes tend to be taught by doctors, for instance. Plus, the value of experience applies here too: I’d definitely want to have a pretty solid understanding of what I was doing in non-crazy circumstances before heading off into the radioactive wasteland, and for that my earlier recommendation (join the VFD) works.

What should I put in my sustainable zombie apocalypse survival first aid kit?

Wait wait, I’m serious. Think about it. Wool can be knit into warm garments against cold exposure, or woven into steam-sterilizable bandages. Lanolin from raw fleece is good for a wide variety of skin complaints. Boiled sheep leather can be used to make a custom-formed splint. Sheep intestines are the traditional source of gut sutures, and the cecum can be made into a “lambskin” condom. The greenflies that infest sheep farms are the source of wound-debriding maggots, and in an emergency, a ram’s horn can be carved into a shofar to call for help. Sheep are self-reproducing, don’t compete with humans for food, and in a pinch are good against malnutrition as well!

In my case: tylenol, diaper lotion, bandaids, non-latex gloves, chapped-hand ointment I made myself a few years ago, and alcohol pads. My “medical bag” (which started as a craftsman tool bag that I kept my stethoscope in for clinicals) contains dental floss and sewing needles, wire cutters, and a tuning fork.↩