How to set up a Medic Bag
28th March 2020
Having all of the equipment available to you is only part of the equation. How you lay out a medic bag can either help or hinder your ability to treat a casualty, especially in a high-stress environment.
If you are looking for a Medic Bag here are some simple guidelines:
30-40 Ltrs is more than enough for a dedicated Medic Bag for a Responder. A Paramedic with additional equipment and drugs may need more. No matter how big your bag is you will always fill it and you have to carry it.
Green is the standard colour for Medic Bags in the UK, elsewhere EMS services will use blue or red. It really does not matter. One benefit of green is that in a sea of kit bags it will stand out when you need it. Black is de rigueur for tactical teams but can look a little Rambo in a civilian environment, however, they won't look as tired and dirty as quickly as brightly coloured bags.
Pouches and pockets can be great for organising kit but more does not equal better. A 30L Carry-On suitcase sub-divided with Tupperware would look out of place but would be easier to organise and access equipment than an all-singing-all-dancing rucksack with a myriad of zips and straps.
Since 2019 we have been using and abusing the 5.11 Operator ALS backpack. We have played with pretty much make and model over the years and we wouldn’t go as far as to say it is perfect but the Operator ALS fits so many criteria.
At 35 ltrs it is a reasonable size for accommodate everything listed below. It can also be compressed down to reduce volume.
It is reasonable sleek with very few straps or buckles which tend to snag on things. The abundance of velcro and molle webbing, however, make it very easy to add additional for extra capacity.
It opens up fully to reveal everything and can be ‘laid out’ unlike the flippy-flappy middle divider sections with some medic bags.
The four internal modules can be removed or easily reconfigured.
The laptop sleeve at the rear can accommodate larger, flatter items such as a self-heating blanket or a Xcollar.
Larger items such as splints or laryngeal airways can be accommodated in the full-length internal side pockets.
The Operator ALS will take a small oxygen cylinder - something like the BOC “ZA” cylinder which holds 300 Ltrs of oxygen (providing 15 mins of oxygen at 15ltrs per minute) in a 2 Ltr physical form.
The Layout
Lay your bag out in the order of your Accident Procedure: Whether you follow <C>ABC or MARCH, the accident procedure focuses your attention on the most important issues first, as such when you need to treat something access to that particular equipment should mirror its position in the Accident Procedure in its position in the bag. Having a bag which can easily be laid out to support your algorithm means your medic bag also becomes a prompt.
Similarity between MARCH and <C>ABCD set-up.
The equipment listed below is merely guidance and does not in any way advocate the use by anyone without appropriate training. The necessary items are within the scope of anyone who has advanced First Aid training including our First Responder course and should be seen as a minimum for that level of training. Sometimes extra equipment is nice but not essential. These items should be considered by those with additional training.
Personal Protective Equipment
You are the most important person, then other people and finally the casualty. As such your PPE should be the first things you lay your hands on. It is very easy to associate the use of gloves in First Aid as simply a barrier against blood and the risk of HIV but universal precautions are intended to protect us against all body fluids and all communicable infections. Even if there is no blood, we still glove up.
Catastrophic Haemorrhage
Whether you follow <C>ABC or MARCH, Catastrophic Haemorrhage or Massive Haemorrhage is the first intervention for trauma casualties. Tourniquets and wound packing material should be immediately available. If the lid pocket of the bag can be accessed from both inside and out, it means that Cat Haem can be dealt with either immediately, or escalated to in <C>ABCD or MARCH
Necessary
Tourniquets x 2 (unwrapped and set-up ready to apply.)
Nice
Additional trauma dressings
Lid pocket accessed from the outside.
Lid pocket accessed from the inside.
Airway
If you have an airway problem, you have a problem now. Airway management should be at the top of the main compartment or just one zip away.
Necessary
Oral airways
Nasal airways and lube
Nice
Tape or laryngeal airway holder
Colourmetric capnography
Suction
Tape ‘bundles’ of kit that is to be used together.
A tube of aqueous lube is more economical than individual sachets but they are not as aseptic and they leak (especially in the luggage hold of a plane!) If you lose your only tube it’s not that economical after all. Use individual sachets.
If you have equipment which requires other equipment, tape everything together into ‘bunldes’ which are ready to deploy.
Breathing
Face-shields are a bit of a token gesture; they usually are a simple gauze filter rather than a one way valve and make mouth-to-mouth harder. Pocket Masks are a far superior option but if you have anything larger than a bum-bag, you should have a Bag Valve Mask
Necessary
A selection of different sized masks.
Nice
Non-rebreather Mask
If you are using oxygen you need to use pulse oximetry. Some medic bags will accommodate an O2 cylinder, if not, carry the O2 cylinder separately but together with a Non-Rebreather and Nasal cannula.
Keep the BVM in the medic bag because it can be used with or without O2. A non-rebreather mask and nasal cannula are useless without the O2.
Circulation
For non-catastrophic bleeding, your equipment should take the same hierarchical approach as your treatment. Direct pressure will stop the majority of bleeds so have more pressure dressings than tourniquets and haemostatics.
Necessary
Pressure bandages
Nice
Spare tourniquets
Haemostatic Agents
Some medical equipment is desperately expensive. But that doesn’t mean it is the best. Isreali (£9 approx) and Olaes (£10 approx) bandages have an almost cult following with tactical medics but we think you will not find a better trauma bandage than the TraumaFix - double bagged, vacuum packed, large, stretchy and super quick to apply with just velcro. No fiddly plastic clips or intricate mechanisms. And approx £3.50 rrp.
Damage
With immediately life threatening issues dealt with we can afford to pack the stuff for all other injuries a little deeper in the bag.
Necessary
Nice
Elasticated bandages
Eye wash
The best treatment for any burn is cold running water but invariably running water is not always immediately available and this is where burns dressings have value. If your budget or pack size is limited to one dressing, get the Face Dressing - it has holes cut out for eyes, nose and mouth but can be used anywhere. A facial burn dressing is the most valuable because running water for 20 minutes over someone's face is akin to waterboarding.
Environment
Environmental conditions can either be the cause of problem or they can exacerbate them. All trauma casualties should be treated to prevent hypothermia.
Necessary
Nice
Hat
Group Shelter
The management of heat illness is generally straightforward and requires very little equipment. The management of cold illness can be more intense and whilst we can improvise many items you cannot improvise heat. Foil blankets can best be described as homeopathic; a self-heating blanket with blizzard bag (ideally a sleeping bag) is the gold standard for pre-hospital hypothermia at Responder level.
Accessories & Admin
Its very easy to go over the top with gadgets and accessories but a few well chosen supplementary extras will prove themselves invaluable:
Necessary
Pen
Head torch
Shears
Spare pulse oximeter
Nice
Ski-Pass holder - keep your trauma shears on your belt connected with a retractable ski-pass holder. They will then always be where you left them.
Scissors - blunt/sharp are best for bursting open difficult packaging and not accidentally bursting open the casualty's skin
Chemical light sticks
Duck Tape - "If you can't Duck it..."
Magill forceps
Tweezers
Spare batteries - Storacell is a great way to keep batteries together rather than rattling around in your bag.
A Modular Approach
There is no such thing as an Ideal set up as it depends on so many factors including, but not limited to, your budget, your skillset, kit availability, the number of casualties you are expected to treat, the distance from definitive care and the activities potential casualties are involved in.
Organising the main compartment using removable compartments not only simplifies the layout of the bag but gives you some flexibility without having having to completely repack when the situation changes.
In a high-risk environment you might choose to double up your Circulation module.
In an industrial environment you may choose to combine the Circulation module with Splinting equipment in order to make space for a dedicated burns module.
At a community event it will be either cuts and grazes or cardiac arrest so you may remove the burns module in favour of a defib.
In a remote environment a defib on its own might not be warranted so you may make space for high energy food and a group shelter.
Team Bags
If you are working in a team, ensure that every bag is packed identically, this means that whichever bag you grab you know where everything is.
If you are lucky enough to benefit from regular training, dedicate one bag specifically for scenario training. A Training Bag builds muscle memory in terms of locating and assembling equipments as well as gaining familiarity with the use of equipment. A Training Bag can be used and re-used and ripped apart and restocked with expired consumables without having to worry about Live Bags being damaged, contents not replaced or sterile packaging compromised.
The Training Bag should be identical to the Live bags but...
If you are using identical equipment for training, make sure it is clearly labelled and stored separately.