Editors note: Beyond our skills and knowledge, some of the most important assets of the EMT are the collection of tools and supplies they carry. But how often do we really consider the container in which we carry these critical items? The following post is from an invited guest author on the subject of EMS bags. Sam Distefano works with Fieldtex Products, Inc., a supplier and manufacturer of quality custom EMS carrying cases, and a Medical Division that stocks them with life-saving supplies. He shares his insight on what to consider when evaluating and acquiring new bags for the working EMS professional.
The Anatomy of an EMS Kit: The Importance of Case Design and Contents
The well-trained medic or First Responder has so much more to offer than what is stocked in their kit, but a well-stocked and intuitively organized kit can make any responder more effective. There are innumerable First Responder, Trauma, and Professional First Aid Kits on the market in all shapes and sizes, boasting selections of supplies and tools that vary from kit to kit. Whether built, bought, or borrowed, you become acclimated to your kit layout and its supplies, and can feel confidence in your ability to utilize the kit in an emergency situation. However, the vast and varying selection of cases raises several questions: what features should your carrying case have, and what supplies will be stocked inside?
The most effective carrying cases for EMS have been designed with input from field providers in the very early stages of development, starting with the Prototype and Design phases. Oftentimes, the greatest innovation stems from these fundamental conversations. Without this input, the kits may be aesthetically well designed, but rendered useless if there is a negative impact on your effectiveness or efficiency due to any design flaw that was overlooked due to lack of field experience.
There are a few key features that should be consistent throughout all EMS Cases. We will discuss their Durability and Material Quality, Convenience of Transport, Ease of EMS recognition, and (most importantly) the Organization of your contents.
Durability and Material Quality: The use of durable textiles for an EMS carrying case should be obvious you and your kit must be prepared to face some of the harshest elements in the field while safely transporting your supplies to any scene. The use of Cordura (nylon), or other comparable tough woven materials, is the foundation throughout the EMS carrying case industry, and undoubtedly remains the optimal choice for durability. This material is abrasion resistant even after numerous washes (which will be necessary) and continuous uses, providing you with mil-spec durability you can rely on. Other common material alternatives that are frequently used include vinyl and tarpaulin, synthetic non-woven textiles. While not as durable as a woven nylon, these are primarily useful in instances when water and fluid resistance are vital to the design. For example, a case including any sterile items or products that could be water damaged must be kept dry at all costs. Ultimately, there are pros and cons to any textile choices, but Cordura seems to be the most universally utilized and with good reason.
Closures and other hardware are also a core element of a durable carrying case. YKK zippers are the most durable and reliable choice for zippers. This coil style zipper with plastic teeth prevents rust and corrosion even after extensive use, and every coil size (especially the #10 Heavy Duty) provides a secure and fail-proof closure. While there are other options for zipper brands, YKK is the leading brand in terms of long-lasting performance (theres a reason you see it on most clothing and bag zippers). Alternatively, opting for durable plastic side-release buckles or high-performance hook-and-loop closures (Velcro being the most widely utilized brand) also provide adequately secure closure, and is simply a matter of personal preference. Some responders will argue these closures grant quicker accessibility than a zipper.
Still, a collection of durable materials and hardware are only the beginning. They must be put together with quality stitching. If you have the opportunity to build your own cases, seek a company with experience in manufacturing for the First Responder community. If you do not have someone that will ensure industrial-strength construction, the most durable fabric wont matter much when you have missed or broken stitches. Look specifically for mil-spec and industrial sewn cases which will help reduce the likelihood of failure in the field and will extend the useful life of whatever case you choose. Looking for carrying cases made domestically will also ensure a quality-controlled and durability tested bag that supports American workers.
Convenience of Transport: Getting from your truck to the patient while having everything you need in one trip starts the scene off right. A system that offers more than one transport option (i.e. backpack straps, an adjustable shoulder strap, or handles) assures that your movement wont be inhibited in any setting whether running through an open space or moving through a crowd. It also allows additional items to be carried separately as needed. Transport options also provide a critical backup in the event that one of the carrying methods may fail on the scene.
Due to the comparative size of some people to the bag they carry, struggling to a patient without being beaten up by your bag can be a genuine challenge. Designing cases with different transport methods also allows you to carry it in a way that wont inhibit your effective movement or lead to discomfort. Ideally, you should not have to provide different bags based on staff height, strength, or other human variables. While shoulder straps and handles are more common transportation methods for EMS cases, backpack straps allow you to travel without the case bumping against your legs, to distribute the weight evenly across your back, and to keep both of your hands free from the first moment on the scene.
Ease of EMS Recognition: Use of bright colors, reflective straps/stripes or the universal Star of Life logo make it easy for people to quickly recognize you as EMS. Working with a custom case designer and manufacturer that additionally offers private label and branding services also allows you to brand your cases with your county logo, unit icon, or any other recognizable symbol to bystanders on the scene. This is especially important in the event of a motor vehicle accident in a busy intersection or a medical call on a crowded plaza. High visibility not only identifies you and lets people know youre there to provide professional medical services, but also protects you both indoors and outdoors at any time of day or in situations of low visibility and high risk. Choosing a case that will allow you to easily access and integrate your identification can help expedite access to the scene and effectively reduce response time.
Organization: Last, but certainly not least, is organization of the contents. This is potentially the single most influential aspect of any EMS case in the moment. You never want your supplies to just knock around in the large open space of a duffle bag where they could be damaged. Further, having to dig through dozens of bandages, gauzes, and tapes to find the supply youre actually looking for leads to delayed action and increased frustration. Buying bags with interior and exterior pockets, or sections, allows the user to organize the case in a way that will increase their efficiency and categorize their supplies in a way that is intuitive. Some bags on the market contain individual modules that can be removed. Each component should logically contain products to treat a specific kind of injury or support a unique procedure. Modularization, say for burns or advanced airways, allows these supplies to be quickly accessed and the bags to be easily customized for new situations you may face.
A word of caution on compartmentalization – there is a fine line between organization actually helping and it possibly hindering access. Sectioning products down too much can lead to further stress or added confusion in an emergency situation. Focus on making the case intuitive, not sectioning off products for the sake of sectioning off products. A general rule is that if you have multiple sections containing the same items, you probably have too many compartments. Larger sections should hold bulkier supplies, or supplies that require multiple pieces. While bandages may not be your go to on every call, you should always stock several of them in different sizes and compositions – because when you need them, you need them quickly. Storing them in a large compartment near the bag opening ensures easy access on any scene.
If items are placed on top other small equipment, the compartments may be too deep or too few. Another way to store items that need to be accessed quickly could be by attaching them to internal lanyards. One very new idea comes from Stethosafe, a new manufacturer that offers a rigid plastic cover with small lanyard to protect the bell of your stethoscope while also keeping it handy for immediate access.
Another great aspect of teaming up with a contract manufacturer and designing your teams carrying cases from scratch is that you can control the amount and size of compartments based on the inventory that your team regularly stocks. Carrying cases with interior movable/removable dividers (usually fixed with heavy-duty Velcro) also helps with organization and modification of supply compartments as needs change. Your supply stock could be changing as often as the seasons based on accident frequency and type, and your bag should be able to accommodate that. Generally speaking, designing from scratch is more expensive than off the shelf due to prototyping, sampling, and production costs. There could also be production lead times, making it a longer process even after the design is approved. However, designing from scratch is the way to go if you want a bag that is true to the contents your team carries and organization methods.
If you are limited to buying off the shelf, seek cases that can accommodate your recurring inventory and have adequate sections. Features like elastic bands to hold smaller items in place can also be an effectual interior design if it is practical and intuitive for the user.
Thoughts on Contents
The old adage that BLS comes before ALS points out the nature of the type of incidents that most First Responders face. Basic Life Support Kits are stocked with supplies to treat victims on the scene who have sustained life-threatening injuries. In other instances, these cases can be called upon to treat patients while in transit to the hospital. How your kit will be used will determine what supplies are required. Our stocked BLS Kits are designed to manage traumatic injuries (lacerations, burns, other severe wounds), choking, drowning, and other bodily insults that can be treated non-invasively. BLS training is the most common among EMS and Fire personnel, but is also common in lifeguards, police officers, and even teachers. Advanced Life Support requires further training and certification as Paramedics who may utilize different medical equipment and procedures. These kits are designed to treat underlying medical conditions more invasively. In the case of cardiac arrest, an IV Kit with syringes, and a sharps shuttle allow medications to be administered safely and disposable supplies to be controlled.
It is likely that your organization has a checklist of required items to be stocked some lists are even dictated by the state or other accreditation agency. While there is no universal regulation of what goes in a particular kit, at a minimum, you should stock sufficient supplies to provide life support in the event of an anticipated type of trauma given your location, training and certification level. The amount of supplies is also determined by the number of calls you expect and the length of time away from your base without being resupplied. That being said, there are some things that can be commonly found in these standardized kits:
Wound Dressings: Burn Dressings, Combine Pads, Gauze Pads and Rolls in Various Sizes (2 and 4 rolls are most common), Trauma Dressings, and (a lot of) Bandages of various sizes.
Wound Treatment/Cleaning: Irrigation Solution (normal saline), Hydrogen Peroxide, Alcohol (usually beneficial in a wipe/prep-pad), Antibiotic Ointment, Povidone Iodine solution/wipes, Instant Ice Packs, Pain Management Medication (Ibuprofen, Acetaminophen, Naproxen, and in the event of serious injury, Morphine, etc.). Be aware that while some of these items may be useful, there application may have legal implications. As always, please consult with your local protocols about administration restrictions. Good Samaritans who supply themselves and act according to general knowledge in good faith for the best interest of the patient may be held to different standards than certified individuals.
Tape: Transparent, Paper, or Cloth tape
Splints/Collars: Stock Various Size Splints and Cervical Collars (at least 1 child size and 1 adult size)
Personal Protection: Safety Glasses, N95 Face Masks, several pairs of medical gloves, emesis or Biohazard Waste Bags
Tools and Equipment: Utility Shears, BP Cuff, Stethoscope, Flashlight, Nasal Cannulas, Non-rebreather masks, pulse oximeters, Tactical Tourniquet, Thermometer
Drugs: Oral glucose (for diabetics), naloxone (for opioid overdoses), epinephrine auto-injectors (for anaphylactic reactions), or activated charcoal (for accidental poisonings) may also be added based on need and training.
At some point, its more likely than not that you will be on the scene of an accident and think I could really use an (insert medical product here) right now! Your personal experiences responding to calls in your region will aid in determining recurrent emergencies, therefore helping you stock enough of a frequently used product so you wont run out prior to resupply. The ability to enhance a common kit with additional supplies gives you the opportunity to further improve your ability to provide emergency First Aid in a crisis situation.
While case design and contents are simply tools, there is no substitution for a well-trained medic. A First Responder or EMT Carrying Case should be designed to help provide the most efficient and effective care, and all play an important role in the layout and organization of supplies on hand.
To learn more about Custom Design and Manufacturing Capabilities, visit FieldtexCases.com.
To learn more about how we can help you Restock and Refill your EMS Kit, visit e-firstaidsupplies.com.