How long will you be treating a patient/patients?
So one thing to consider when building a kit is what kind of time frame are you going to consider? I think of things in four time frames.
Minutes. If this is the focus, I need to be able to address life threats, and quickly. The speed that I’m able to access my treatment options may also be of consideration. By TCCC/TECC guidelines, my focus is going to be on massive extremity hemorrhage because that will be what can kill a patient the quickest (3 minutes for arterial hemorrhage). My next focus might be airway (NPA) and respiration concerns (Chest seal/Needle). I’m probably operating in or close to the Direct Threat Care/Care Under Fire/Hot Zone. If that’s the case, I’ll be wearing armor and my medical supplies may be attached to the front of my plate carrier, in a drop leg pouch or something else that’s easily accessible. I probably won’t be digging around in a backpack for supplies as I want them fast. Triage tools may also be relevant in this time frame. This focus in the MARCH assessment is on the MAR portion. If I’m tasked with operating in this time frame, the mission details for the kit becomes less important. I’ll be working right after a lethal injury, so where it came from is a little less important than how I’ll treat it.
Hours. This basically starts from a ½ hour and works up to around 12 hours. Will a kit that operates in this time frame be in conjunction with a kit that operates in the minutes after the injury? If this kit is a stand alone kit and I’m going to be operating in the minutes after injury, I will need to ensure there are supplies to treat those life threats. I’m going to utilize this kit as the phase transitions to the Indirect Threat Care/Tactical Field Care/Warm Zone, I will add on options to escalate treatment for hemorrhage control, airway and respiratory management. I should never ignore those tools that occur in the “minutes” time frame, it’s just that my kit may have less of those. That treatment is done by someone else or from another kit. IV supplies and medications will come into this realm as well. Hypothermia prevention is something that gets overlooked often, but I definitely need to have something to manage this problem. When thinking about the MARCH assessment, I’ll be adding in options for the entire assessment. As we start to extend our time frame some, we are going to have to start adding in additional tools. Basic diagnostic tools of a stethoscope, BP cuff and SpO2 monitor may come into play here, depending on the environment I plan on working in. If I plan on managing a patient for a few hours, additional information from these tools can help me make informed decisions. Further tailoring of this kit relies on what my mission profile will be.
Days. Usually between ½ day to 3 days. This will probably be a regional disaster. This could result in a ‘shelter in place’ situation. Utilities could be affected, cell phone service could be affected, and chances are most people won’t be worried about the morning commute tomorrow. I have moved into the Prolonged Field Care or Evacuation Care phase. Luckily, I’m either in a fixed place or in transportation of some sort working my way to definitive care, so I can pack more things in this kit without worrying about carrying them everywhere I’m going. This kit will probably be separated from a kit that works in the minutes/hours after an injury. Specialized equipment that is designed to help manage a patient that long would be included in this kit. Transportation equipment/platform may also be a consideration if you are transporting the patient out to definitive care. I should have enough to manage the MARCH needs long term. A ventilator can be a big keystone here when it comes to equipment. Another thing to consider in this realm is that more often than not, primary care and ortho becomes a focus. If you are the team medic, you’ll have people coming to you asking for tylenol and motrin for aches and sprains more often than you’ll need a tourniquet. Mission planning is critical in this realm. Specifically, my major factor is the medical threat assessment. Also, what is the composition of the team? I need to know my team well enough to be able to pack specific treatments for medical conditions they may have. Diabetic team member? Adding oral glucose or D50 for that member is important.
Weeks. This is going to be a larger scale disaster or remote posting. If there is a problem where things won’t return to normal in less than 7 days, it may be every man (or woman) for themselves. Evacuations should have taken place already. Even if things aren’t at disaster level, and you just happen to be remote, typical resources are not available. An evacuation platform will be necessary to move patients to definitive care from your remote post. There is going to be a huge range of needs here, and it may be everything from those life saving treatment options to sutures and antibiotics. A wider range of drug choices is going to be important as well. You will absolutely be a stand-in primary care provider in addition to emergency treatment. The medic may also be in charge of determining a water supply and food options, so some equipment and planning in that direction can be helpful. Hopefully if you have to address medical needs for week(s), the single most important thing you’ll have is another medical provider. While mission planning and medical threat assessment are important here, extra consideration needs to be made to the unplanned scenario. There may not be a diabetic on the team, but I may want to consider treatments for those medical conditions as someone’s first episode of hypoglycemia may occur while on the mission.
Time frame planning is just one of many tools that can be utilized to outfit a medical kit. Additional tools would be the mission profile, medical threat assessment, and the composition of the team. Each of these different planning tools helps create a tailored kit that can address the needs you’ll face.
The clock is ticking!