Transcript of Get Ready Report Podcast, Episode 25

Tips for creating a useful first-aid kit

Interview with Richard Bradley, MD, associate professor of emergency medicine at the University of Texas Health Science Center at Houston. Bradley is a member of the American Red Cross Scientific Advisory Council and chair of the CPR Subcouncil of that group.

Dr. Bradley, thank you for being with us today.
My pleasure. It’s good to be here.

Let’s talk about first-aid kits. Why is it important to have a first-aid kit in your home?
First-aid kits are important because in some injuries, time is really of the essence. If someone is bleeding or if someone is not breathing, you want to be able to start treatment right away. We also want to remember that we have to be prepared for disasters and the emergency medical services that we expect to be there in just a few minutes during normal conditions may take a lot longer or may not be able to come at all if there’s an injury after a disaster.

What items should we stock in our first-aid kits?
Break down the items into the types of emergencies that you expect to face. The first thing that we would always say is, if you are going to help somebody, first of all, take care of yourself. Because we are always worried about the possibility of disease transmission from blood and body fluid, think about having a pair of disposable gloves. And if you are going to possibly do mouth-to-mouth rescue breathing, then have a barrier device, such as a pocket mask, in your kit. The next thing to think about is controlling severe bleeding. Some things to think about for controlling severe bleeding, most importantly, (are) some gauze, dressings. And then also think about less serious bleeding but still things that are important to make somebody comfortable or stabilized when you are transporting them or taking them to medical care. So of course, bandages, adhesives, gauze, also some roller gauze. My particular favorite is sterile triangular bandages, because those have so many uses.

Why are triangular bandages important?
Triangular bandages are great. If you know a little bit about first aid you can do a lot of things with them. If you have the kind that are sterile, you can take them out of the package. You don’t have to unfold them, you can put them right on a wound and you can use them as a dressing to control bleeding. If bleeding is severe and if you’ve been trained, you can use a triangular bandage as a cravat and from that you can make a tourniquet for life-threatening bleeding that’s not controlled by other means. And then also you can unfold a triangular bandage and you can use it as an arm sling. So they have a number of purposes.

How about first-aid creams, such as Neosporin?
In the (American Red Cross) Scientific Advisory Council, our review of the scientific literature has failed to show a benefit from any first-aid cream. So we do not have a recommendation that would endorse the use of any type of first-aid cream in a home first-aid kit. A lot of the discomfort that first-aid creams relieve, it is simply a matter of getting the air off the wound and you can achieve the same effect by putting a dressing and bandage over an injury and that will take a lot of the pain away. There is no good literature that we have assessed that shows conclusively that any of the first-aid creams make the difference in terms of outcome or reduced rates of infection. What is important to reduced rate of infection for wounds is to make sure that you flush the wound really well with plenty of tap water. If you don’t have tap water available, (use) the cleanest water you have, like water from a bottle. Two really important things in terms of saving a life are making sure that somebody is breathing, or you can support their breathing if they’re not breathing. And second, to stop any life-threatening bleeding, and so that would be in the bandage category, and not to do mouth-to mouth-directly. It’s a lot more hygienic to use a barrier device.

A child falls down and gets a scrapes and headaches, what would you recommend for those kinds of situations for your kit?
Those are a lot more common first-aid emergencies, scrapes and headaches, and again the first step in a scrape or an abrasion is to try to clean it, and so that is tap water or bottled water. When we talk about our disaster preparedness guidelines we always say you want to make sure you’ve got water with you. You can always take a bottle of water from a store if you don’t have water with you and clean the abrasion off and then dry it off with a clean dressing or paper towel, it doesn’t leave a lot of lint behind, and then just put a dressing on it. For minor scrapes and abrasions, adhesive dressings work fine, the brand name of course we associate with that is Band-Aid, but there are a lot of other brands available And it’s nice to have a variety of sizes of adhesive dressings, whether you have the small one-inch by one-inch pads up to the larger two-inch by three-inch pads or four-inch by four-inch pads, it just depends upon what types of abrasion or what size of scrapes you think you might have to take care of.

In terms of medications, what would you recommend for a common first-aid kit that isn’t associated with a disaster?
Common medications — we have medications for pain and fever, and that would be acetaminophen, which we all know by the trade name Tylenol and ibuprofen — medications that have lots of uses that are good for pain and good for fever.

How about cough and cold medications?
Cough and cold medications are interesting. Now, when I get a cold and I feel chest congestion or nasal congestion, I use them, lots of people do. But there is no hard evidence that they really help. So we did not have a specific recommendation for any cough and cold medicine because there is no good evidence that any of them really make a difference. In fact, for children we recommend that children not get cough and cold medication because they actually have been associated with worse outcomes. So really, the thing to stick with if you’ve got a cold or flu-like symptoms or aches, pains, fever, the best thing to stick with is acetaminophen and ibuprofen.

How about thermometers, petroleum jelly, calamine lotion, those sorts of things?
We certainly do recommend a thermometer for determining when someone has a fever and there are some great thermometers available. We do not have a recommendation for any one type of technique for measuring temperature that I am aware of, so whether it is on your forehead or on your arm or in your mouth, those are all fairly reasonable techniques to take a temperature as long as you don’t care about being exactly accurate. But the main idea is “Do I, or does somebody in my family, have a fever?” Petroleum jelly has a few uses: If you have some chafing or if you have a child with a diaper rash it can be a great barrier. Calamine provides a little bit of relief but we don’t actually recommend it because there is not a lot of evidence that says it really makes a difference. If somebody is really itching a lot because they’ve been exposed to something like poison oak or poison ivy and it’s really bothering them, then we recommend you give your doctor a call because your doctor can give you some great medication to take care of itching after a contact such as it causes a reaction in the skin.

If you have children or elderly people in your home, how does that guide what goes in your first-aid kit?
If you’ve got children in the home you’ll notice one of the things I didn’t recommend in general is aspirin. I don’t think anyone is using it anymore, but you need to remember now that there is a strong recommendation that aspirin not be used for children with flu-like illnesses because of its association with Reye’s syndrome. But otherwise, same recommendations in general for children, with the caveat that if you’re going to have acetaminophen or ibuprofen that you get the children’s suspension or syrup. Both of these medications are available in both a liquid form for children and in liquid drops for infants. The instructions are on the bottle based on the child’s age, but it’s always good to talk with your health care provider about what dose of acetaminophen or what dose of ibuprofen you should give to your child if he’s got a fever or feels crummy.

So how about for elderly people?
For elderly people, much the same. We do recommend that you keep some aspirin available if there’s a risk of someone having a heart attack. If somebody develops chest pain, it’s always good to consider, especially if you’ve talked to your doctor in the past, about the possibility of giving somebody one tablet of adult-strength aspirin to chew and swallow if they’re having chest pain that could be a heart attack, as long as they’re not allergic to aspirin. The other thing to think about, some of the concerns, we don’t want to give acetaminophen, brand-name Tylenol, to anyone with liver disease, and we try to avoid ibuprofen in anyone with kidney disease. Otherwise, not a lot significantly different with the exception, of course, that if a patient takes chronic medication, we always want to make sure that they have some of their medication available. If you have someone who has heart disease and uses the medication known as nitroglycerin, it might be a good idea to put an extra bottle of nitroglycerin in your first-aid kit so that you’ve always got that available. Same with someone who has severe allergic reactions whose been given an auto injector of epinephrine by their physician. You may want to keep an epinephrine auto injector in your first-aid kit if it’s been prescribed by your doctor.

What if your child ingests something that is poison? In the old days they would give ipecac. Is that still recommended?
We do not recommend ipecac for children that have ingested. Ipecac has been shown to have more hazards and more adverse affects than it does benefits. So the first thing to do if your child eats or swallows something that might be poison is call the poison center. Make sure that you know the number for the poison center in your area and be ready to give them a call and follow their directions and advice. Calling a poison center will never be seen as anything that you should hesitate on. Just because you call a poison control center it doesn't mean that anybody is going to come out to you. It doesn’t mean that you’ve done anything wrong and a lot of times the poison control center will just reassure you and say there’s nothing you need to do, just watch the person and then let us know (inaudible) but they’re a good source for advice after something has been ingested.

What kind of kit do you recommend for the actual storage unit?
What works is whatever is good for the individual who is maintaining the first-aid kit. So there certainly are lots of kits that can be purchased. I like buying pre-made kits. You want to make sure that you’re looking at a kit that has good ingredients. Not every premade kit has good things that are really helpful…things that are recommended based on the guidelines. We would like to say that one of the things that we do in the Scientific Advisory Council of the American Red Cross is that we do on occasion review some products and say “Yes, this particular kit meets our guidelines.” One place you can go, there are lots of places you can go, but one place you can go is to our Red Cross website where we do offer first-aid kits for purchase. That website is www.redcross.org and there’s a link on the home page that takes you to a place on the site where you can purchase first-aid kits that have approved contents.

If you’re putting a kit together yourself, what kind of box should you choose to put your supplies in?
Any kind of box that’s going to be stable, that you’re going to be able to find and grab in a hurry. Some people use a fishing-tackle box. That’s great. That’s probably one of the best ways to go. But any container…it can even be a small portfolio if you’ve got some room to put supplies in. It can even be a plastic bag as long as it’s sturdy and you can find it. The key is that it’s not going to fall apart with time, because these (kits) will sit around, hopefully, and not be used too much. But (it should) also be something that you can find quickly and can easily carry it to the place that you need it when there’s an emergency.

How often should you rotate the supplies in your kit?
You should look at your kit at least once a year. If you have anything in your kit that has an expiration date, like acetaminophen or ibuprofen or any medications that have been prescribed, you should make sure you note the date that those medications expire and then replace those medications as they expire. Otherwise for most of the other things, such as a barrier device for CPR, gloves, dressings and bandages, most of those don’t expire. If you look at your kit once a year, the thing to look at is to make sure that the packages are all intact, that nothing has broken down; that packages have not ripped open that might compromise things that are supposed to be sterile. And make sure that none of the bandages are falling apart or losing their stick.

Should you keep a kit in your car as well?
Absolutely. There are several countries where having a first-aid kit in your car is the law. We don’t have that in this country. I know in Germany you are required to have a first-aid kit in your car. I think there are some other (countries) as well. But I think it’s a great idea. We see a lot of injuries and fatalities due to vehicular accidents and we certainly recommend that if there’s anybody on the scene who has stopped, that people stop and render assistance, if they can do so safely and if they have the knowledge of what to do. And of course, in order to be able to render assistance if you stop, you want to have your first-aid kit with you. Again, even if it’s nothing more than to just put on a pair of gloves to protect yourself from blood or body fluids, and also something like a dressing and a bandage to stop life-threatening bleeding.

I suppose if you have little ones and you’re on a little outing that day and somebody gets a boo-boo or something like that, that would also be handy?
Absolutely. That’s the non-lifesaving, but the more typical first-aid components like water, as we said, to clean a wound, and some dressings to dry the wound and put over the wound and keep the air off the wound. Again, covering a scrape to keep the air off will go a long way toward relieving the pain and also our other goal of course is keep the skin clean that is scraped up to reduce the risk of infections.

So you recommend water to reduce the risk of infection?
Water is best, yes. Water and lots of it. When you first clean the wound with water, expect it to hurt. Water does hurt a little bit, it’s stinging discomfort, but it’s usually discomfort that people can make it through. I don’t recommend, in most cases, scrubbing the scraped up skin but at least rinse it well to get the dirt off and when you rinse it there’s some good scientific evidence that shows that rinsing the wound removes the large majority of bacteria that is in the wound. Alcohol wipes and betadine are good on intact skin. Let’s say you decide to try to take out a splinter, which we don’t really necessarily recommend, then you can use your alcohol or your betadine over the intact skin before you go to work trying to dig a splinter out. But if you’ve got an open wound or scraped skin, we do not recommend putting any antiseptic on an open wound, such as betadine or alcohol. The reason why is because in addition to killing bacteria, they also kill healthy skin and in particular, they kill the types of cells that fight infection. So you do as much harm or more harm than you do good if you put antiseptic into a wound.

That’s very interesting. Is there anything else you would like to add?
We just want everybody to be prepared for all types of emergencies. As an emergency physician, my life, my job, is seeing people who have unexpected emergencies and I can tell you anyone who I see who comes into my emergency department never planned, when they woke up that morning, that they were going to have an emergency that day. So you will never know when the day will come when something will happen when you’ll need to respond. So that’s why we, at the American Red Cross, want all Americans to be ready all the time for emergencies — for times when they need to provide first aid and for times when they need to be prepared for an unexpected disaster.

Thank you so much for sharing all this great information.
My pleasure. I’m glad I had the opportunity.

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