What should go in a First Aid Kit?

3rd April 2009. Updated 23rd February 2021

One of the most commonly asked questions we receive from candidates is “What should be in our First Aid Kit?”

Whilst the HSE provide guidance on the minimum contents of First Aid Kits for the workplace, the contents of any First Aid Kit should be based upon a First Aid Needs Assessment.

Who is this intended to treat?

• How you treat yourself, your friends or family may be different from how you treat colleagues or people in your care, especially children or vulnerable adults.

• Are there many people in your care or do you work on your own or with small groups?

What am I likely to encounter?

• The most common injuries are often the simplest: cuts, grazes, sprains and strains. Stock your kit accordingly.

• In an office setting these injuries are less common although you are statistically more likely to encounter more chest pain and breathing difficulties.

• In the outdoors the injuries can be more environmentally specific; Walkers will invariably get blisters. Paddlers are likely to become sunburned. Cavers are likely to encounter grit and foreign bodies in their eye and open wounds.

• In industry, you may be more at risk from poisons or chemical burns.

What is the environment I am in?

• In hot environments you want to be prepared for heat illness and dehydration.

• In the cold you will need to prepare for hypothermia.

• Abroad you may consider diarrhoea and vomiting to be the most likely ailment.

• Will your kit need to be waterproof or crushproof?

A First Aid Kit Decision Matrix

In the same way that we might perform a Risk Assessment by examining the Hazards versus the relative Risks, a First Aid Kit can be tailored to the Hazards versus the Distance to Definitive Care:

• More hazardous activities are more likely to require more comprehensive, life-saving interventions compared to low-risk settings which are more likely to require minor treatment and therefore less equipment.

• The further one is from definitive care, the longer one has to care for the casualty which also dictates the contents and size of the First Aid kit.

Despite 20 years of working in a pre-hospital setting, I do not carry a First Aid kit everywhere I go, in the same way that a plumber is unlikely to always carry a pipe-bender wherever they travel.

As a minimum, I usually have a pair of cheap 'Tuff Cut' EMT shears in a jacket pocket or glove box as well as a pair of gloves. In an emergency the shears will allow me to make as much bandaging material as I need from the casualty’s clothing and the gloves are not just a barrier to infection, they are also part of my thinking time.

However, if I have a day bag with me, I will always bring the Ouch Pouch.

The Ouch Pouch is simply a small container that sits in the bottom of my day bag to the point that it is unnoticeable. Having a large, cumbersome, fully stocked medic bag may be seen as extremely diligent but its size and weight are detractors to always having it with you and the necessity is not there to warrant it.

The Ouch Pouch is for those everyday issues which are not life-threatening but simply…unpleasant. This represents the very lowest level of Hazard on the Decision Matrix

Contents:

1. Tape - You can improvise bandages and splints but you can’t improvise adhesive tape, Its usefulness, size and weight make it an essential item. A roll of 25mm tape can be cut down to make wound closure strips, individual plasters or to strap minor joint injuries.

2. Medications - contrary to popular belief it is entirely safe, legal and appropriate to provide people in your care with over-the-counter (or General Sales) medications. as long as it is done diligently by asking appropriate questions, such as allergies or any known reactions and following the directions included on the packaging.

   • Analgesia - Paracetamol is vastly underrated and the analgesia of choice for musculoskeletal injuries such as sprains and strains. Ibuprofen is recommended for a hangover rather than paracetamol as your liver has already had a good kicking. A combination of ibuprofen and paracetamol has the same analgesic effect as 2mg intramuscular morphine in some cases. (1-4)

   • Indigestion - A simple antacid such as Rennie or Gaviscon as well as Ranitidine for more stubborn cases.

   • Anti-Diarrhoeal - Diarrhoea is not usually life-threatening, but it is inconvenient and unpleasant, yet easily managed with Loperamide (“Immodium”).

     • Further Reading: Vomiting and Diarrhoea

   • Allergies - Whilst Piriton (chlorphenamine) is the most widely known antihistamine in the UK it is not as effective as 2nd generation antihistamines such a cetirizine which is also less likely to cause drowsiness which is of particular importance to anyone driving or operating machinery.

     If medications are removed from the original packaging, clearly label the name of the medication and recommended dosage.

3. Bite and sting cream - Most bite and sting relief creams consist of antihistamine and / or corticosteroids such as hydrocortisone yet there is surprisingly little evidence of their efficacy in reducing the symptoms. (5) An anaesthetic cream such a Lanacane will not deal with the inflammation but will reduce the pain and, in turn, break the itch-scratch cycle.

4. Alcohol wipes - The best thing to clean a wound with is clean water as alcohol and other antiseptics can actually delay wound healing (6-8). Isopropyl alcohol wipes are included purely for the relief of nausea which can be achieved by sniffing them (9-11). Nausea is not life-threatening, it’s just unpleasant which is exactly what the Ouch Pouch is designed for.

5. Plasters - Plasters create a wonderful moist humid environment for bacteria to breed so we do not recommend them for automatic, constant use for all cuts and grazes. Once cleaned, it is recommended to leave the wound exposed if the environment is clean. However, plasters have their place when you need to perform a dirty job (such as changing a car tyre) or a clean job (such as cooking) and want to place a barrier between the wound and the task.

   And sometimes, even the most hardened of alpha-males just want a plaster and to be told “It’s going to be OK”.

6. Pulse Oximeter - There are many medics that turn their nose up at a cheap fingertip pulse oximeter due to their questionable accuracy. I include one for the following reasons:

   1. Finding a pulse manually is hard enough, especially when you are flapping (6-15) to the point that a manual check for pulse was removed from the requirements of the lay-responder and de-emphasized for the requirements of healthcare professionals from resuscitation guidelines back in 2010.

   2. If a pulse can be detected manually, determining strength and regularity is even harder, especially if the casualty is poorly perfused. The pulse rate is just one aspect but the waveform is really useful as a pictorial representation of strength and regularity of the casualty's pulse.

   3. Pulse in isolation is not a particularly useful vital sign - how the casualty appears will tell you more but with more information your picture is not necessarily different but 'higher definition'. Having more information can help confirm or challenge your diagnosis or decision making.

   4. A poorly perfusing casualty will be obvious before the Sp02 drops but....if you can quantify it you can see the rate of change. A 3% drop in SpO2 is a cause for concern but what does that look like in terms of colour or Level of Response? What does that look like on a casualty with a dark skin tone?

   5. Pulse oximtery is essential for the delivery of oxygen but if you are not carrying oxygen, why carry a pulse oximeter? You may have O2 available e.g. onboard an aircraft or at a swimming pool. They almost certainly won't have a pulse oximeter.

   6. Some people just need reassurance. I have put a pulse oximeter on many 'casualties' who are just a little upset; you've introduced a bit of esoteric kit which makes the casualty think 'this person knows what they're doing'. Give it a hard stare, look reassuringly at the casualty and say "This is fine...you're going to be OK". Sometimes this is all people need. An arm around their shoulder, tea and cuddles.

For the size and weight, why not? At less than £20.00 and about the size of two boxes of matches there is little reason not to have one.  

Note: The Ouch Pouch is considered for all Low Hazard settings in the Decision Matrix, regardless of time to definitive care. Most injuries and illnesses we can expect to encounter are minor, so having the Ouch Pouch available - or ensuring each member of your group has their own Ouch Pouch - negates the need for the higher-order medical kit being utilised and depleted for minor issues. The dedicated Trauma Bag or Medic Bag should be preserved for more significant issues.

The Immediate Aid Bag

As the nature of one’s activities increase both the likelihood and severity of injury, the contents of one’s First Aid kit should reflect those increased demands.

The Immediate Aid Kit (more commonly known as an IFAK - Individual First Aid Kit) is a small, unobtrusive bag or pouch that should be carried on the person (such as the thigh pocket of a tree surgeon or plate carrier or duty belt of military and law enforcement personnel) or kept within arms reach so that it can be immediately deployed to deal with life-threatening injuries.

From high-hazard incidents such as vehicle or industrial accidents or hostile / terror events, the immediately life-threatening injuries we can reasonably expect are catastrophic haemorrhage and open chest injury.

In these scenarios where we have moved up the Y Axis into the territory of increased hazards, but are still within the same comfortable area of the X Axis where definitive care is not too far away.

The kit should be small enough to be deployed within minutes. This enables the responder to administer life-saving interventions but does not consider the scope of longer-term casualty care which is not an immediate priority.

The kit should also contain an aide-memoir and a Casualty Reporting Card to provide clarity and guidance in a stressful environment and also facilitate the accurate reporting or the incident to the emergency services rather than relying on memory alone.

Contents

• Nitrile Gloves x 2 pairs

• Trauma bandages x 2

• Tuff-Cutt EMT shears x 1

• Casualty Card x 1

• Aide-memoire x 1

• Permanent marker x 1

• Zinc oxide tape x 1

The kit could be augmented where the risk of catastrophic haemorrhage is increased with the inclusion of:

• At least one tourniquet

• Haemostatic agent or gauze for wound packing

• Chest seal

Trauma Grab Bag

Where the incidence of serious injury, the distance to definitive care and one’s capacity to carry equipment is increased (such as vehicles or distributed amongst a team), a more comprehensive first aid kit should be considered which should also focus on trauma but with greater scope for managing a wider range of injuries and with at least some element of protecting the injured or ill casualty.

Where the Immediate Aid Kit would be carried on the person a Grab Bag is typically vehicle-based or packed alongside other equipment.

At the expense of increased size and weight, it affords the responder greater scope of treatment which should be built around your DRABCD Accident Procedure

Contents

• Catastrophic Haemorrhage

  • Trauma dressings

  • Tourniquets

  • Wound packing gauze or haemostatic agent

  • Chest Seal

• Airway

  • No equipment needed

• Breathing

  • No equipment needed

• Circulation

  • Pulse Oximeter

• Damage

  • Stretch wrap

  • SAM Splints

  • Burns dressing

  • Tape

• Environment

  • Space blanket and / or blizzard blanket

  • Digital fridge thermometer

• Everything else

  • Casualty Card

  • Permanent pen

Medic Bag

For more hazardous activities and when further from help a complete medic bag is warranted.

We have written in detail about developing a Medic Bag here.

Modular Upgrades

For particular environments and appropriate situations, it is worth considering additional modular upgrades which can be added or removed from the Medic Bag or Trauma Grab Bag as the situation dictates.

Wound Care Kit

For low-severity injuries which require long term care, such as cuts and grazes, tropical ulcers, blisters or bites, it is worth having extra capacity to manage these issues to prevent them from becoming high-severity injuries due, principally, to infection.

A small pouch, such as this, that contains essential items for wound cleaning, closure and covering as well as the skills to utilise them would be equally suited alongside the Ouch Pouch for minor issues as it would inside the Medic Bag.

Medications

When far from help, basic over-the-counter medications are far from life-saving but in a camp setting or other scenario where groups are living in close proximity a casualty in pain will have a tangible effect on not just their own psychological wellbeing but also on those around them. Being able to diagnose and treat minor ailments increases the group’s effectiveness on the ground, enhances their productivity and enjoyment, reduces lost time and reduces the burden on outside assistance.

Read more about over-the-counter medications which should be considered in a remote setting here.

Diagnostics

Diagnostic equipment - along with gathering an effective history - allows the responder to gain a better assessment of the situation as well as an understanding of what may be going on.

Whilst the Responder will be limited in their treatment by their scope of practice, effective diagnostics enhance the possibilities of telemedicine when working in remote areas; a clinical practitioner can only provide advice based on the information they have, in turn, received from you.

Dental equipment

Whilst not life-threatening, dental issues can be activity-threatening; a casualty who is debilitated by pain or who has the potential for serious infection becomes a liability to any planned activities in a remote environment, be that an expedition, activity holiday, film production crew or security team.

A simple dental kit with basic tools and temporary fillings can deal with the most common, simple issues.

For further training in remote dental skills in emergency settings, Wilderness Dentristry are subject matter experts in this area.

Conclusions

• There is no ‘definitive’ First Aid kit.

• The contents of your First Aid kit should be based on your Needs Analysis; considering the hazards and relative risks, tailored to the environment, activity, time of year and number of people within the group.

• Regularly revisit your First Aid kit: Double up on items you regularly use and remove or reduce items you rarely use.

• Less is more. Carrying lots of everything in a ‘better safe than sorry’ approach means you are going to resent your equipment and are more likely to not bring it with you because of it’s bulk. And that will be the time you need it.

• Only incorporate items you are trained and proficient in using. If you do not know how to use a BVM or how to suture, do not include these items.

A safe pair of hands with no kit can do far more good and much less harm than someone with all of the kit but no idea of what they are doing.

References

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2. Kelly LE, Sommer DD, Ramakrishna J, Hoffbauer S, Arbab-Tafti S, Reid D, Maclean J, Koren G. (2015) “Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial”. Pediatrics. 135(2):307-13.

3. Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J. (2017) "Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department - A Randomized Clinical Trial". Journal of the American Medical Association. 318(17):1661–1667.

4. Mehlisch DR, Aspley S, Daniels SE, Southerden KA, Christensen KS. (2010) “A single-tablet fixed-dose combination of racemic ibuprofen/paracetamol in the management of moderate to severe postoperative dental pain in adult and adolescent patients: a multicenter, two-stage, randomized, double-blind, parallel-group, placebo-controlled, factorial study”. Clinical Therapeutics. 32(6):1033-49

5. “Management of simple insect bites: where's the evidence?” Drug and Therapeutics Bulletin. 2012;50:45-48.

6. Bhandari M, Schemitsch EH, Adili A, Lachowki R, Shaughnessy SG.  (1999)  “High and low pressure pulsatile lavage of contaminated tibial fractures: an invitro study of bacterial adherence and bone damage”.  Journal of Orthopaedic Trauma.  13:526–533.

7. Longmire AW, Broom LA, Burch J.  (1987)  “Wound infection following high pressure syringe and needle irrigation”.  American Journal of Emergency Medicine.  5:179–181.

8. FLOW Investigators.  Petrisor B, Sun X, Bhandari M, et al.  (2011)  “Fluid lavage of open wounds (FLOW): a multi-center, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures”.  Journal of Trauma.  71:596–606.

9. Lindblad AJ, Ting R, Harris K. (2018) “Inhaled isopropyl alcohol for nausea and vomiting in the emergency department”. Canadian Family Physician. 2018;64(8):580.

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