Lesson Nine: Ortho

Lesson Nine: Sprains, Fractures, and RICE

You or someone else has suffered the dreaded FDGB. (Fall Down, Go Boom!)

There was a "pop" sound. It really hurts.
Did you sprain something, or break a bone, and what should you do?

Use RICE.

No, not Uncle Ben's, or Mahatma, or any other starchy food product.
This is an acronym. We'll get to it in a minute.

Let's work backwards. From the ER, I tell patients the following when they come in with a possible sprain/fracture:

If you sprained (Generic Body Part), we're going to X-ray it, wrap it, tell you not to use it, and give you prescriptions for pain medication.

If you fractured (Generic Body Part), we're going to X-ray it, wrap it, tell you not to use it, and give you prescriptions for pain medication.

Then splint it, and refer you to an orthopedic specialist for a cast in 2-3 days, after the swelling is minimal.

 What I hope they (and you) learn from this is that in almost all cases in the short term, whether you sprained something or fractured it doesn't realy matter. And the treatment is nearly identical. Before, and after. Now, back to RICE.

R: Rest

Don't use it. Courtesy of the Groucho Marx School of Medicine, "If it hurts to go like that, don't go like that."

Immobilize it. You can make splints out of scrap cardboard, rolled up magazines, bedsheets, duct tape, or darn near anything. (I'm going to cover improvisation in the near future.) And, if you have them, you can use purpose-designed splinting equipment. The key to remember is that you're trying to prevent movement of the joint above and the joint below the injury. The point is, make it so the part doesn't move much, if it all, and the patient shouldn't be using it. Period.

I: Ice.

See Lesson Eight, above. Whatever you smacked, ice it. Go big. Unless hypothermia is a problem, cover that injury site in ice, and keep it on for 20 minutes. You'll stop a HUGE amount of swelling today, which means you've stopped pain for the whole week. Remove the ice for 1 to 1.5 hours, then re-apply ice. Ice, not heat. And you can continue cold therapy for 3-4 days. At that point, you've probably maxxed out on stopping swelling. (Down the road, if it's a sprain, at 4 days or more you can switch to heat therapy, on the theory that it will help increase circulation and thus speed healing. It also relaxes muscles and feels good.)

C: Compression

Short of making it a tourniquet, preventing injured parts from swelling can also be aided by something tight around it. In the hospital, we may do a padded splint, a neoprene sleeve, or an ACE bandage wrap. Having a couple of the last-mentioned in your kit is probably a great idea. Put the ACE wrap on from the farthest point of injury on an extremity, and roll it on going toward the heart (e.g. from the wrist toward the elbow, or from the toes towards the calf). No ACE wraps for neck injuries, please. And don't wrap torso/rib injuries. We want our patients to breathe, okay?

Check after you apply it. If things are suddenly numb/tingly after it's applied, or if you squeeze a fingernail/toenail lightly, and it stays white, or returns to normal pinkness s-l-o-w-l-y (like more than 2 seconds) you've wrapped too tight. Remove, and try again. Re-check frequently until your patient gets to medical care to make sure your wrap hasn't become a tourniquet due to swelling. And remove anything else like bracelets or rings on fingers/toes that might do the same thing. Do it early, before you need to cut the jewelry off. If it's already too late, cut the jewelry off. Jewelers can fix rings much cheaper than hand surgeons can fix fingers.

 E: Elevation

Elevate the part. It doesn't have to be strung up like those old hospital beds in Three Stooges films. The level of your heart will do. For a lower extremity, any elevation above the floor will be an improvement. Sitting sideways on a car seat or couch is tons better (and, you'll notice, less painful) than putting it down on the floor. Why?

Because gravity works. The fluids in your body move to the dependent (that means lower) parts. Fluids mean swelling. Swelling means pain. Raise things up, they don't swell, they don't throb, and you're happier. That's why you don't walk with an injured leg other than necessities (like bathroom trips), because even if you're using crutches and not walking on that leg, it's hanging down low, and swelling, and throbbing, and it's no fun. Stay off it and get it elevated.

When you go to your doctor, or the ER, you'll get similar instructions. Along with prescriptions for (usually) narcotic pain relievers, and an NSAID - non-steroidal anti-inflammatory drugs.

The typical NSAIDs are aspirin, ibuprofen, and naproxen.

The Rx won't be for aspirin, because it "thins your blood" (technically, decreases clotting) which makes you more likely to bleed. If tissue was bruised, you've damaged some small blood vessels, so aspirin would only make that leakage worse, and increase swelling and pain.

The Rx will probably be for ibuprofen (think Motrin/Advil/any generic brand). It doesn't affect clotting, unlike aspirin. But it does do two things we really like: it relieves pain (just like aspirin or Tylenol would); and it decreases swelling (UNlike aspirin or Tylenol). This is what makes ibuprofen better in most cases, and why doctors recommend you take it to prevent swelling, even if you're not in pain.

{Obligatory advisory:Read and follow all label directions. Consult your doctor before taking any medication. Ibuprofen may be contraindicated in persons with kidney or liver diseases. Void where prohibited by law. Post no bills. Etc. Etc.

Naproxen (e.g. Aleve) may be selected because you're allergic to ibuprofen, have one of the contra-indicating conditions, or because you've found it works better and told the doctor that before he wrote the Rx. It acts like ibuprofen, except in ways too technical to worry about here. The important thing is it doesn't have the blood-thinning effects of aspirin either.

 

Sprain or fracture, remember RICE, before and after you get your patient to the ER. It's free, and it works.

Lesson Eight: Cryotherapy

Lesson Eight: Ice works

Ever since (insert Deity of your choice) gave us the recipe for ice, its usefulness for all manner of things has been well-known. Its medical utility, contrary to what you might think about your Aunt Hilda’s Home Remedies, is pretty phenomenal—and usually overlooked.

In fact, other than snakebite and frostbite, there’s not really many common injuries you shouldn’t put it on.

Contusion? Ice it.
Laceration? Ice it.
Abrasion? Ice it.
Puncture? Ice.
Sprain? ICE.
Fracture? Ice too.
Sunburn? Ice works.
Thermal burn? Ice. Possibly in some water. Poured on a dressing if necessary.
Dental abscess/toothache? Ice, or even ice water.
(I know someone who held off a dentist visit until the office opened on Monday for a day and a half by drinking ice water. He peed a lot, but said it beat ripping his face off with a crowbar from the pain.)

And so on. Now I’m sure someone, if they tried hard, could find a couple of more things where it’d be a bad idea. Chemical burns, especially dry ones, would fit that profile. Stingray stings too - those are actually inactivated by WARM water. But seriously, how many stingrays are there in, say, Nebraska or Vermont?

So, what makes ice so spiffy?
Two things:
1) It forces small and large vessels to contract, reducing blood flow. If they’ve been lacerated/punctured/etc., this reduces bleeding. If not, it reduces swelling.
Swelling is the body’s natural response to traumatic injury. It’s also the cause of a lot of the pain subsequent to the injury. Trust me when I tell you that having your knee balloon up to the size of a football even without a separarte injury would be quite painful. Ice decreases that. Which not only saves you pain today, but also tomorrow, and the next day, because the swelling which never happened doesn’t have to dissipate. Remember that if you’re days from help and/or short on medications.

2) It numbs peripheral nerves, thus deadening your perceived pain. In other words, ice is FREE DRUGS, without any of those annoying narcotic side effects (like nausea, drug allergies, drowsiness, decreased breathing, etc.).

At home, a large bag of frozen peas (which, I confess, is the only reason you’d find peas in my house) works great.
In urban situations, ice can be had anywhere there’s a fast food restaurant. Bring your own ziplock baggie, and you’re set. In 20 years, I’ve never had anyone at any such establishment deny me a bag of ice for an injury.
Off the beaten path, you MAY have access to snow, or snowmelt running water. If not, you have to bring or find what you can. Party coolers or full cold drink cans are better than nothing.
“Break n Shake” first aid kit ice packs are okay, but it’s amazing how briefly they work on a hot day. The original product is far superior if there’s ANY way you can get some.

Caveats: Don’t put open wounds in running streams. The fish don’t want your blood, and you don’t want the bacterial paradise in your cut.
Don’t leave ice on for more than 20 minutes at a time. We don’t want to CREATE frostbite on top of your other distress. 20 minutes on, 40-90 minutes off, depending on circulation.
Don’t use chemical “blue ice” packs, or (please God, NO!) “dry” ice (CO2) [b]ever[/b] on bare skin. Wrap them thick enough to get the “coolth” through, without being cold enough to rip skin off if applied. Better yet, get frozen H20.

First aid kit ice packs can be pricey, and as I said they don’t last as long as real ice. I carry a bunch of sandwich-sized and quart-sized ziploc freezer baggies. When needed, I put ice inside one, then I put it in another one. I’ve had few leaks in 10 years with this double-bag arrangement, and when the ice melts, you can dump the water out and refill it, over and over.
On a planned outting or event, you can even pre-fill and freeze a few, and throw them in the cooler, on the theory that someone is going to do something and you’ll need it.

For a day-hike or car kit, a single break-n-shake ice bag is a justifiable luxury. For almost anywhere else, I heartily recommend multiple baggies. If you’re going somewhere with an ice chest, pre-fill and freeze a few.

At the best, you’ll have something to keep your food cold longer. At the worst, you can treat a host of minor injuries quicker, safer, and cheaper than any other way.

Lesson Seven: Allergies

Lesson Seven: Do NOT flirt with Anna Falacksis

Or, as medical dabblers know her better, anaphylaxis.
Anaphylaxis is the body’s sudden allergic reaction which leads to disseminated (that means all over) swelling, redness, and itching. If the “all-over” part includes in your airway, you’ll feel a tightening in your throat, maybe a tickle, you might be coughing for no reason, wheezing, and eventually, it’ll swell up to the point where you can’t breathe.

Untreated, you will die. As my gunnery sergeant used to say, remember this, you’ll see this material again.

What’s happening is, your body has just come into contact with some substance (in, say, peanuts, strawberries, shellfish, or bee venom, for example) that it really doesn’t like.

A host of things happen. I’ll spare you the medicalese long explanation, but remember that this chain of events is all part of what’s known as “the histamine response” your body goes through. It makes the cell walls of your blood vessels more fluid-permeable. When blood and fluid leave the blood stream and soak into surrounding tissues, those tissues get swollen and red. Other mechanisms take place which leads to itchiness.

The swelling around your airway can shut down your trachea worse than Christmas traffic at the international airport, and the loss of circulating volume of fluids (i.e. blood) can be so sudden and severe that you go into shock. One or both of these will activate your life insurance policy if you don’t get to a hospital, preferably via 9-1-1 ambulance.

Okay, allergies “BAD”, but what am *I* supposed to do?

Well, since you asked:
1) KNOW WHAT YOU’RE ALLERGIC TO.
Not “some antibiotic, I can’t remember the name...” Find out the name. See an allergist to do a sensitivity panel to check for specifics. Memorize it. Write it down. Wear it on an MedicAlert bracelet or neckchain. Write in on a Post-It you stick to the back of your driver’s license.

2) With food items, be an SS Camp Guard about not eating it. We’re talking about your life, after all.
I once dated a girl who was allergic to MSG. We were getting dinner at a Chinese restaurant (her choice) which advertised “No MSG.” She asked when ordering, and was again assured “No MSG.” She then said, “Well, if there is, I’ll die right here on the dining room floor.” Whereupon the waiter hemmed and thought, and suggested she might want to try something far less likely to contain the offending substance. That’s the level of persistence I’m talking about.

3) CARRY APPROPRIATE MEDICATIONS.
I’m not a pharmacist nor a doctor. Consult yours. Many people are in the habit of carrying Benadryl (diphenhydramine) along with either an Ana-kit or an EpiPen. Many ERs give OTC H₂ blockers like Zantac, Pepcid, etc. as well. I repeat for the record I’m not prescribing anything here. But let’s go over why you, in consultation with your doctor, might decide some or all of these things are a good idea.

Benadryl is an antihistamine. Remember that “histamine response” involved in anaphylaxis? Well, there you go. It can decrease the speed or severity of the response.

Zantac/Pepcid/etc.? Guess what...Zantac etc. blocks certain body processes which release acid into your digestion. But wonder of wonders, it (and similar-family OTC drugs) also block the same allergic response cycle that’s possibly trying to kill you.

Ana-Kits and EpiPens are both injected forms of Epinephrine (that’s adrenaline, in other words) which can also help with things, especially if airway swelling is involved. Both require a prescription to have and carry.
The Anakit is a small kit with syringe which contains two doses, that you inject yourself with. You push one dose, and if necessary, twist the plunger and push the second dose.
The EpiPen is modeled on the military’s Chemical Warfare injectors. It’s the size of a Magic Marker pen. You pop off the cap, press the “hot” end to a large muscle, like your thigh, and it auto-injects you.

Both from familiarity with the idea from my military days, and the fact that most people won’t be able to inject themselves, the EpiPen is probably a better idea for most folks. YMMV.

So?
* If you have potentially life-threatening allergies, consult your doctor and carry the medicines agreed upon, at all times and places. And replace them when they expire. No excuses.

* Use of any medications will not “cure” you. It ONLY BUYS YOU TIME TO GET TO THE ER.

If you’ve used Benadryl, Zantac, and/or prescription epinephrine, and have any doubt about or reason to suspect that you may continue to have an allergic response, your next step is either to a friend/relative’s ER-bound car seat, or to the phone to dial 9-1-1 for an ambulance ride.

Also, be aware that everyone is different. To get an allergy generally requires sensitization. That could be the first time you ate shellfish, or got stung. Subsequent re-exposure to the offending substance can produce increased responses, in both speed and severity. It can be gradual. Or the second one could kill you.

The speed of the response in subsequent cases may give you an idea of what to expect. Some people may be allergic to certain seafoods, but the response may be so mild that it’s worth the discomfort, and slow enough that they needn’t take any measures other than an OTC med. Other people might turn lobster-red in a few minutes, be coughing and wheezing, and need immediate emergency care. Still others may pass out within minutes from airway swelling, require immediate paramedic response and field airway support and medication, just to survive.

I don’t know which type you are, and you probably don’t either. Which is why you should take the precautions listed, and not flirt with sudden death, whether it’s you, a loved one, or a friend.

If you’re going to ignore this, I can send you my info to be listed as your life insurance beneficiary.

Lesson Six: Your ER Visit

Lesson Six: Preparing For Your Emergency Room Visit

We’re talking medical preparedness, and let’s be serious: there are only two types of people—those that have been to the ER, and those that are going to go.

And since, by virtue of my hospital’s estimation of my skills, *I* (or someone very like me) is who you’re going to see first, I’d be seriously remiss if I didn’t give you a little coaching to make an unpleasant experience for you go a little easier. Pay no attention to the fact that it’ll make my night a little smoother too.

There are a number of informational tidbits I’m going to want from you, as rapidly as you can supply them. This will be true whether you’ve been to the ER once, never, or a hundred times. It will be true if it’s your infant child or senile great-granduncle. And if the patient is actually unconscious, not breathing, or has no heartbeat, at some point after we take care of those important little details, I’m STILL going to want this information.

First, what to bring. (BTW, 10,000 of my colleagues agree on this, so don’t think you can pull one over on us. We’re pretty cliqueish about this stuff, and you won’t be the exception that proves the rule. Trust me.)

1. Why are you here?
No, not in a college philosophy metaphysical sense, but rather ”Why are you darkening MY hospital doorstep right this minute? If it’s 4 AM, especially.
I don’t want to know the history of your internal organs, the strange things that went on since 1962, or the comments from the 5 people that finally chivvied you into coming. What I’m digging for, and usually none too subtlely - is an explanation in 10 words or less for why you’re in my assessment room chair this minute.

Good examples:
This crushing chest pain since 20 minutes ago.
The arm bone poking out of my lower arm after I fell.
This swelling in my throat since we ate the crab stew.

Bad examples:
I’ve had this headache for 14 years.
It’s Friday night at 2 AM, and I decided to detox from alcohol and drugs just now.
My arm hurts and I have this sore on my toe and I’m coughing and I’m tired all the time and once in 4th grade I think I might have had a stroke and…

Try to remember, it’s the Emergency Room. If there isn’t some pressing reason you’re here right frickin’ NOW that you or an immediately accompanying friend or relative can elucidate, no amount of college essay exam b.s. will conceal that fact from me. I will screen you, and send you back out to the Siberian Winter of the Waiting Room while I attend to more pressing concerns. I swear to God. You’ll get seen, but not until we’ve taken in all the more serious patients.

2. What medical conditions do you have?
We’re talking real, serious, known, pre-existing and which have been diagnosed by someone with a medical LICENSE conditions.

Good examples:
Hypertension (or high blood pressure - English is fine if you don’t speak medicalese)
Diabetes
High cholesterol
They took out my (appendix, gall bladder, female plumbing, etc.) in year XXXX

Bad examples:
Freckles
Gonasyphaherpaloids
Inability to answer direct questions
“I think I had a heart attack once” (Either you did, or you didn’t; if you don’t know, you just lost 10 points with me as a personal historian.)

3.What medicines do you take?
Good answers:
None
Lasix, Plavix, Lovenox, Librium, etc.
furosemide, aspirin, amoxicillin, etc.

Tolerable answers:
blood pressure pills
heart pills
cholesterol pills

Really sucky dumb@$$ answers:
A little white one
A big yellow one
Those two tiny ones

Know your medications, by name (Trade or generic name) and WHAT THEY’RE FOR, or understand why you’ll lose 10 points with me for being a bad historian and making my job more like being a vet than helping people.
If all else fails, bring me the pill bottles, if necessary, in an empty pillowcase, just like the paramedics do when they pick up grandpa with 47 bottles on the nightstand.

And BTW, if you have a condition, and you've been prescribed medication, but for whatever fill-in-the-blank excuse you have, you aren't taking the meds, own up to it and say so. 

4. What are you allergic to?
I don’t care about cats and dogs—I’m not going to hand you anything to pet.
I want to know about food, and particularly, DRUG allergies.

Good answers:
None
Iodine
Shellfish
Eggs
penicillin
latex

Bad answers:
all antibiotics
all pain medicines
that one that starts with “D”

And BTW, getting nauseated isn’t an ALLERGY, it’s a side-effect. Turning red, getting itchy, swollen all over or hives, or not being able to breathe is an ALLERGIC reaction. If you’re really allergic and you don’t know this, -5 points.

But how in heck can I remember all this stuff? I’m DYING here? It’s IN MY CHART! Etc. etc.
Thanks for asking.
A) I don’t expect you to memorize it, though it’ll impress me.
B) I don’t have your chart, and I can’t get it. I don’t ask these questions for my amusement, I ask them to save your life. So kindly cut the crap and whining, and answer them, please, now.
C) You’re reading this on a computer, so you have no excuse for not for not doing the following:
Put this info into a word processor file, and print out a copy before you need it. Update it when you need to, and always have a copy in your wallet or purse. Bring it with you to the ER.
If you don’t have a printer, I’ll accept an index card, or even a folded napkin. And I promise, you’ll get 10 bonus points with me for being smart and prepared.
And don’t think you get an excuse for being on vacation, out of town on business, at DisneyWorld, blah blah blah. THIS INFO IS LIKE AMERICAN EXPRESS - DON’T LEAVE HOME WITHOUT IT.

If you’d like to also list your doctor or doctors’ name(s), their telephone numbers, and perhaps your blood type, knock yourself out.

And the same goes for all your kids, your wife’s father, or your crazy Uncle Tim if you take care of them or bring them to the doctor.

If you have this info on a sheet of paper, I’ll photocopy it, and learn enough about your medical history to make a far better and quicker decision on how serious your emergency is than if I first have to play “20 Questions” to puzzle it out. Work with me, and I’ll work with you, and we can get you in, seen, and hopefully treated or home a lot faster. That’s what you want too, right?

And lastly, a few insights to my job for you to remember:

EVERYBODY on your side of the desk “doesn’t feel good.”
EVERYBODY on your side of the desk is “in pain.”
EVERYBODY on your side of the desk is “having an emergency.”

I don’t sort people by the amount of blood on their face, the amount of panic in their parents’ eyes, or the volume with which they holler. Take this as gospel.
I also don’t care who got here first, unless we’re down to the minor complaints (by which I mean, you aren’t dying any faster than the rest of the planet).

I’m an experienced professional. I’m also human. I expect that when you (or your child or relative) is in pain, you’re going to be testy and a bit distressed. That’s normal.
But if you insult me and go above and beyond the call to piss me off, AND I determine that you aren’t a priority patient, consider the likely results for your plans for the evening. It’s my house, my rules, and I can count my mistakes at sorting people in the last 10 years on my thumbs. If you want to count the times I erred on the over-cautious side, I’d need my fingers and toes. I almost always err on the cautious side, BTW. The same will generally be true for any of my colleagues you meet in YOUR town’s ER. Think well before you test this.

I don’t know “how long the wait is.” This isn’t the [i]Chez FouFou[/i].
Your doctor didn’t call ahead and make a reservation for you.
It is a Jewish proverb that “The more you complain about life, the longer God lets you live.”
It is an ER proverb that the Triage Nurse is godlike, and the more you complain, the longer you will wait. (In fact, if you’re frisky enough to get up and whine, we generally know you aren’t that serious. That quiet guy in agony in the corner is the one I’m keeping one eye on.)

On a typical night in my house, I sort through 50-200 people. I ask enough questions to determine how serious they are, and how quickly they need to be seen. And if there’s an empty bed, I put as many of them back with my fellow nurses and the doctors as quickly as I can. And if you thought that calling 9-1-1 for your week-long flu-like symptoms or back pain will spare you any waiting...think again. My boss will meet you at the back door, and tell the medics to bring you to me. Then you’ll answer the same questions, and go wait with everyone else. And get a $500 ambulance bill that your insurance probably won’t cover. Save 9-1-1 for real emergencies.

If you’re having a serious or life-threatening emergency, I will get you in very quickly. If you doubt this, get in my way when I’m trying to get that old guy with the chest pain into a wheelchair and back to the cardiac room.
If you’re not serious, but you’re still in pain, distress, or just having a lousy night, I’ll get you in as fast as tonight’s patient load will allow.
And if you or your child are there “just to be safe”, I’ll respect that concern, and get you in too.

The more prepared you are to help deal with what brought you to us, by giving us the key information I asked for, the simpler and quicker your night will be. That, I can absolutely guarantee.

Lesson Five: Medical Reference Books

(Note: All references updated to 2012.)



The following was one response to the prior article, when it was posted:

   "Unfortunately most folks aren't going to dedicate that much time, or be able to for that matter.    The new “first responder" training is useful, but the medical portion is so basic (less than the basic first aid courses) that it absolutely must be supplemented with the basic and advanced first aid courses at a minimum.

The problem is, there aren’t a lot of programs in between the advanced first aid course, and the EMT course; except as you said putting it all together yourself; and without direct knowledge and experience of what's going to be covered that can be difficult.

 

For years I've been wishing for a program that covered basic and advanced first aid, as well as emergency response, basic emergency diagnostics, and basic trauma care; in a way comprehensive enough to be meaningful; but that could be covered with a few weekends of instruction plus home study."

I’ve known active-duty combat arms Marines who managed to squeeze in an EMT course, but I understand those who can’t. That’s why I hinted that you can do the work piecemeal—it’s better than nothing.

If you can't do an EMT course, do the Red Cross Basic First Aid & CPR.
Then take their 4 hour How To Measure Blood Pressure module.
Volunteer with Ski Patrol, or at a local ER one or two nights a month for several months, and do or see as much as they’ll let you.
Get your lifeguard card and do that for a season.
Take any wilderness first aid classes you can at the local hiking stores, or diver first aid/Dive Medic/Rescue Diver courses.
Bit by bit you’ll be a first-class responder.
I worked with an ER senior Resident instructor doctor who could literally dump out a walletful of 140 certifications.
He’d invariably start a lecture, even to other doctors and nurses with that trick, followed by his own, “SO WHAT? Either I know what I’m talking about, or I’m full of crap. Alphabet soup and wall plaques don’t save lives. That’s what your BRAIN is for.”

With that in mind, Lesson Five: Books Are Your Friends

I learned that from the daycare lady who took care of me at 4 years of age. I blame her for the fact that I’ve got cartons of the things around, because the spare bedroom/library is overflowing.

But with medical books, it’s a gold mine. Dig in, friends.

As a start, begin with the highly readable (i.e. dumbed down but basic and accurate) Red Cross Basic First Aid, Advanced First Aid, and CPR for the Professional Rescuer texts. Ideally, get them because you took the classes.
Then, add on the flyers, handouts, and pamphlets from any other training you receive.

Even if you never take the class (and yet again, you should) to be an EMT, there’s no law against getting and working through a good EMT text on your own. Get through a chapter a week, especially if you can find one with a companion workbook, and you’ll be miles ahead of people who do nothing. Mosby and other publishers make good ones, or you can check your local CC/Occ. Ctr. student bookstore to see what they use.

Lacking that, I can’t recommend anything more highly than the most recent edition (10th, currently)of Emergency Care and Transportation of the Sick and Injured by the American Academy of Orthopedic Surgeons. It’s the gold standard, IMHO, and if you passed high school English, you’ll “get” it.

Another must-have is Wilderness Medicine: Beyond First Aid by Dr. William Forgey. It’s a fabulous comprehensive handbook for anyone who’s concerned about medical help in the great outback anywhere in the world, and Dr. Forgey (I met him once) is great doc and a prince of a man in getting the information to the average person. Buy this book!

The current Special Operations Forces Medical Handbook is also quite valuable. Unlike 18D training, I do not recommend shooting and treating your own goat, however. And the now prehistoric (30 years out of date) edition of SF Medical Handbook ST 31-91B should be saved as a historical reference, not so much used as a medical one. Unfortunately, the ancient text is the one of which every table at a gunshow has a stack, but the up to date version has to be obtained either from the GPO, or Amazon. A more basic first aid overview is in the Air Force’s Aircrew Survival, AF 64-5.

Another text I’d heartily recommend is Where There Is No Doctor. It was written by tofu-eating tree-hugging Leftists doing Peace Corps-type work in Third World $#!^holes, but nonetheless the text is informative, readable, and very useful, especially from a preparedness standpoint.
The companion book Where There Is No Dentist is less useful, but still of value.

As noted in the previous post, for setting up shop in austere circumstances, two books are worthwhile. Survival Nurse by Ragnar Benson, is a good basic overview of running a care station in either the Third World, or after the Third World War. And for a book geared specifically for making do in such circumstances, Improvised Medicine: Providing Care In Extreme Environments by Iverson, 2011, is very worthwhile.

If you can find the old olive colored texts, get a pre-1970 Red Cross Advanced First Aid textbook at a secondhand bookstore. {Nota bene, some things, like prehistoric CPR, and cutting on snakebites, are obsolete and verboten.} But they contain a lot of skills and ideas, particularly for bandaging and splinting that are still dead-on, and it’s more knowledge in your head.

If you get to where you’re ready for the big leagues, Lange’s Current Emergency Diagnosis & Treatment, or the Emergency Medicine textbook by Tintinalli et al are the bibles of current ER physicians. 90% of the information is mentally accessible and useable to someone with a good lay knowledge, and I’ve seen both at Barnes & Noble or Borders. Consider adding the current Merck Manual, Taber’s Medical Dictionary, to explain some things you might not understand, and any current one of the various Nursing Drug Handbooks (Lippincott's version is my personal preference). And of course, Amazon can get you almost anything.

If you get that far, even with no diploma, you’re a frickin’ medical supergenius, and will be very handy in an emergency.

My library would break an elephant’s back. But my brain only weighs 3 pounds or so, and I take it with me almost everywhere (occasionally it seems to go missing, but it usually turns up by suppertime). Get as much knowledge out of the books and into your brain as you can to be truly prepared. That’s true with every subject, but doubly so with medical knowledge. It’ll even make you a better patient when you see your doctor. (Trust me, medical professionals appreciate smart patients.)

Don’t worry about not knowing all the high-tech modern medical stuff. Any modern nurse probably knows more about medical “stuff” than a doctor did near the turn of the last century and then some. It’s kind of frightening, but 1900-era medicine didn’t do too badly at preserving the human race. Most of that modern knowledge is still found in books. They’re lightweight, require no batteries, and work anywhere there’s enough light to read.

So get some, read them, and improve your odds of survival.

Lesson Four: Training

Lesson Four: If You Aren’t TRAINED, You Aren’t Prepared

Being trained and without a kit is dumb. A kit without training is a paperweight.

You can stockpile water, food, guns, ammunition, fuel, and all other type of survival/preparedness gear, including medical supplies.
But if you don’t know what to get, or how to use it, you’re approaching udders on a bull in terms of functional utility or general preparedness.

So until they sell freeze-dried dehydrated Doctor-In-A-Box, or someone invents a real medical hologram doctor like the one on Star Trek Spinoff 23, you’d better get some training.

In virtually any kind of disaster or emergency, untrained people are generally part of the problem, not part of the solution. At best, they’re what a friend described once as WIRIBs: Well-Intentioned, Reasonably Intelligent Bystanders. You hope. At worst, they’re a PITA (look that one up yourself).

But you want to be more than that, you want to be trained. Excellent! Now what?

Bare minimum should be taking the Red Cross’ Basic First Aid and CPR class, which takes one whole Saturday. It’s geared for a 5th grader with a room temperature IQ, and the book has lots of pictures. But it’s far better than nothing, if only to whet your appetite. The other downside is it relies a lot on “activating 9-1-1”. The whole problem is there may not be any 9-1-1 to activate after...Katrina, Mississippi floods, the Northridge Earthquake, the L.A. riots, or a mishap 2 days on foot from the nearest road in Yellowstone National Park, let alone anything far worse.

Where they offer it, their advanced class is a step up. But only just a step.

To really get some horsepower, find the local community college or occupational program EMT class for EMT-1. (Forget the other levels unless you’re looking for a job.) It’s 110 hours, give or take, which is a one-semester college class. If I were Emperor, it would be required training for everyone to graduate from high school, or at least to enter college. Period. That’s where I’d recommend you start. And check around for the best class and instructors you can find, if there’s a choice. Come the day when you need the training, you can’t call them up and ask them about the stuff they glossed over, so find a class with well-qualified and enthusiastic instructors. It makes a big difference, and it’s your time and money.

Now I’m going to brag a little on my instructors. I had the great good fortune to get into a one-of-a-kind Red Cross first aid class that’s no longer offered, geared precisely toward backcountry/disaster medical care. It was taught by thorough professionals, and approximately twice as long and ten times as intense as any EMT course you’ll find. I lucked out. In fact, when I and two friends from the first class took an EMT class after this gem of preparation, we not only aced it, but ended up helping the under-prepared staff teach it, and we set up one doozy of a practical experience for our other classmates. In fact, nursing school was easier than my advanced first aid class. No, I’m not kidding.

So what? You already said that class doesn’t exist anymore...?

True. But what does exist are most of the components my instructors utilized to teach us so well.
1) Wilderness modules from local or national sports chain stores, dive shops, or the local hiking/mountaineering group. There isn’t much difference between backcountry first aid considerations and disaster first aid concerns, except the scenery is prettier. Take the scenic route.
2) Volunteer for health fairs, etc. When your first practice in taking blood pressures is doing it in a noisy mall, with disco/Elvis muzak playing overhead, on 150 elderly folks with thread little pulses, you’ll never forget how to do it right the rest of your life. There’s also helpful, experienced coworkers, and nobody’s life is at stake.
3) Other volunteer opportunities. I can’t say enough about Paying It Forward. Before I ever got through nursing school, I’d done 2 marathons, including the L.A. one, 20 walkathons, 3 bike races, 8 rodeos and related horsey events (barrel races etc.), 3 Rose Parades, 4 Hollywood Christmas Parades, 6 annual airshows (with 100,000+ attendees in 100 degree heat), karate tournaments, numerous community parades and events, 2 brushfires, 1 World Cup Soccer series, a major earthquake - including a week running 4 shelter aid stations with 20 people working for moi, and the L.A. Riots. All for free. Such a deal!
Both subsequent schooling and paid employment were nothing to worry about after that. And I got to practice the trade on real patients!
Things I didn’t do, but which are equally valuable, are local search and rescue teams (the ones that actually get out there and do stuff, not the chair and EazyUp commandos) , Ski Patrol, lifeguarding, and probably 20 other regular or occasional things you could find in your local area.
Get as trained as you can, and avail yourself of the opportunities for hands-on practice before it’s you or your family that needs the help.

I started out to get trained for general preparedness reasons. I ended up with a new career that’s kept food in the fridge and a roof over my head the last 12 years, and it’s never boring. So if EMT and volunteer work aren’t enough for you, the sky is the limit. Of the people I first trained with at the Red Cross, 2 are now M.D.s, 3 are P.A.s, 3 others are nurses, 6 are firefighter/EMT/paramedics, and several more have found ways to get paid for what we used to do for free.

Even if that’s got nothing to do with your plans, the rewards I get (other than monetary) are the exact same ones I got for free the first time someone needed help, and I was there, ready to go to work. To say nothing of the personal peace of mind in knowing what to do, how to avoid a trip to the ER, or know when it’s absolutely vital to get someone there, and how to care for them until it happens.

That’s trained.

Lesson Three: Basic Kit

(Note: This was originally written circa 2005, with regard to a basic minimum kit for all purposes. I'll be updating it with a list of TC3 considerations/additions in the near future. For anything from under your carseat to next to your workshop bench, this is still the go-to kit I would recommend.)


Lesson Three: Have a good basic first aid kit

The first rule of a gunfight is “Bring a gun.” George S. Patton used to say that “A good plan NOW is better than a perfect plan later.”

In exactly the same measure, the first rule of being a prepared human is: Bring a first aid kit. And a good first aid kit NOW is better than a perfect one somewhere ELSE.

Example of reader-submitted First Aid Kit:

“My Travelling first aid kit is pretty basic.
Various sized Bandaids
4X4 Gauze pads
adhesive tape
Hydrogen peroxide- A debrider, not a disinfectant. I use it to clean wounds.
Neosporin/Bacitracin- Antibiotic cream for wounds after being cleaned by soap and water or Hydrogen peroxide…
2 ace bandages- 1 narrow, one wide. Good for slight sprains.
Ibuprofen tablets- My favorite pain reliever after Demerol…
Eyedrops
Imodium (Liquid) A good plugger upper when Montezuma gets his revenge.

This covers most of the emergencies that you can self remedy. It all fits in a small plastic container that can be put in a backpack, carry-on luggage or even a tackle box...If these items can’t help, you probably should head for an Emergency Room."

The exemplar travelling kit just listed is a pretty good start. Personal preference, but I’d dump the peroxide, trade it for a bottle of Bactine—see Lesson One—and add four small things:

• a pair of latex/non-latex exam gloves
• a small pair of SHARP bandage scissors
• a couple of ABD large wound dressings
• and instead of eye drops, a 99-cent 4 oz. bottle of generic brand sterile non-preserved saline for contact lenses.

It’s sealed until you pierce the cap, it’s an instant sterile water wound cleaner; you can get some darn good pressure squirting it into wounds to blast the gunk out of a cut, scrape, puncture, etc. when you’re far away from running water. And that stuff is made to use for contact lenses, so it happens to be great for getting stuff out of your EYES. With those minor changes, the kit would be pretty decent.

What would make that kit, or virtually ANY kit you may favor, MILES ahead of ANY OTHER KIT IN THE WORLD, would be actually having it whenever you need it.

My day job (actually, my night job) is in one of the busiest ERs in the country. We see 300-500 patients a day, 24/7/365. And the reality is, there, or at the trauma center I used to work at—busiest on the planet!—almost 95% of EVERYTHING I needed for any patient I took care of in 15 years would fit inside the lunch pail I carried in 4th grade. (For those who’re wondering, the other 5% would be the prescription drugs by the ton, plus defibrillators, chest trays, CAT scanners, etc. A bit large for the personal kit, not including doctors. And for those wondering about the lunch pail, it was The Man From U.N.C.L.E. And you’re really weird for wondering!)

The example kit would be that small, or smaller. But you gotta bring a first aid kit to the accident. Without it, you’re not doing First Aid, you’re doing Last Aid, i.e. holding someone’s hand as they potentially expire. And we’re better people than that.

Another War Story: A friend of mine, one of my earliest medical instructors, was a well-known Disaster Magnet. Chad could be on a hike across Death Valley miles from anyone, and you could bet money he’d come upon a newly crash-landed 747 with 400 fresh patients. Probably before the FAA even knew it had gone down. And what made it funny rather than tragic was that he always carried his kit.
He was driving on the I-405 in the middle of L.A. one Saturday afternoon (way back in the pre-cell phone era), when he came upon two car loads of large families that had collided and crashed. It couldn’t have happened 5 seconds before he pulled up. With 14 patients, from 3 years old to 80. The paramedics/fire engine company arrived in 12 minutes. Which had given Chad an 11+ minute head start, which didn’t even work him into a good sweat. He had found, assessed, and recorded names and vital signs (yes, he even carried pediatric blood pressure cuffs) on every patient, written the info down, done the ABCs, hastily bandaged the wounds, sorted them by priority, and was waiting for the fire captain with a full report when the first engine and ambulance pulled up.
He proceeded to give his full report to the fire captain, whose men tagged along, and when he finished, Chad asked, “So, you guys got all that?”
The fire captain looked at him and replied “Yeah. But who ARE you?!”
Chad said, “Oh, just a first aid instructor.” And got in his car, got back on the road, and made it to that night’s first aid lecture, where he shared the story.
(He was subsequently invited by one of the fire department’s asst. chiefs to regularly assist in teaching their paramedics about accident scene management.)

A first aid kit can save a picnic, a day, or a life. Perhaps of YOUR loved one. But it can’t do any of those things if it’s sitting in the pack in the back closet of the bedroom 20 miles away.

So come up with a bare minimum, as suggested above or slightly different, pack it in whatever suits your fancy and will protect it and make it easy to find, and make sure it, or an expanded, enlarged, upgraded version of it—but NEVER less than that minimum—goes with you, on you, or close enough to get quickly, everywhere you go.

Remember, in a world where s#^t happens, the person with the roll of toilet paper is King.

Lesson Two: Snakebite Kits

Lesson Two: Most ALL "snake bite kits" are a waste of space, time, and money.

(Nota bene: I’m writing this from the U.S. If you’re out playing anywhere else, some or all of it may not apply. Now you’re warned.)

Bold words, I know. Allow me to try some math on you.

I’m assuming most prepared people won’t be wearing an anti-lightning strike rod on their gear. Why? Because dying from a lightning strike in the U.S. is about a 6,000,000:1 occurence, in terms of likelihood. Your chances of dying from a venomous snakebite in the U.S. are 25,000,000:1. So unless you're in charge of feeding the rodents at the zoo's reptile house, or you regularly go to brushy canyons and stick your arm armpit deep into holes in the ground to collect field mice, or you're trying to perfect a new act to get on the Tonight Show, you probably have a higher risk of being trampled to death by rogue mimes than of getting snakebit. QED.

If you’re a white male, 15 to 35 or so, your odds go up somewhat. If you’ve also had a couple of beers, they go up a bit more. If all the above is true, AND your last words before reaching down to play with Mr. Reptile are “Hey guys, watch this!”, your odds of being bitten approach the actual need for a snakebite kit. On the other hand, you’re probably too stupid to use one, and probably not reading this either.

If you’re out hiking around, some common sense, heavy footfalls, looking where you put your body parts, and a good walking stick will warn snakes of your approach, and you’ll never see them. And if you do cross paths, they aren’t going to chase after you. They’ll recognize you’re too big to eat, and as long as they aren’t cornered or pestered, they’re not interested in biting you either.

And 5-8 months out of the year, depending on where you are, it’s probably too cold for them to be out playing anyway.

There are always a few (in this case - very few) exceptions. Maybe you’re out in the spring, sneaking around, and manage to step over a log right next to a nest of younglings who don’t know the rules I just laid out. It happened to a know-it-all college biology grad student on Camp Pendleton, even though we’d warned him the years’ hatch of rattlesnakes was wildly high. He made it about 20 yards across a grassy meadow before he got nailed - half a dozen bites on both legs, right above his Birkenstocks. Effing stupid hippie was too smart to listen to a bunch of dumbass Marines. 

So maybe you’re with him, or your friend was the one who said said “Hey, watch this!” So now what?

Get out that snake bite kit you had to have, because you’re mega-prepared. Open it up. Is it one of those little  rubber green Cutter’s/yellow Coghlan's kits, with a skinny dark string, an X-acto blade, etc.? Perfect!

Grasp it firmly in your dominant hand, take careful aim, and throw it at the offending snake, just as hard as you possibly can. That’s the best use you can ever make of it. Don’t ever use it on anyone, unless you really, really don’t like them. If you have one now, and you haven't used it yet, go down to a local lake or river, and practice this drill, imagining the snake was floating on a log offshore. Never buy another one.

But why?

1. The little halves provide less suction than your 5 year old’s dart gun tips.
2. The constricting band they supply will cost you a body part.
3. We don’t slice open bites.

But I saw in this movie where...

No! Bad doggie!
1)First, 25-33%  of all venomous snakebites are “dry”, i.e. no poison was injected.
2)Second, the “wet” bites won’t respond to most suction devices, except right away, and it has to be very strong.
3) Third, your bite is very likely on an extremity, esp. a hand or a foot. Note the amount of extra space in your hand or foot. There isn’t any. It’s pretty much all important stuff—blood vessels, tendons, ligaments, and nerves in amongst a lot of bones. The last thing you ought to be doing is trying to sever important machinery in your limbs. That’s about as sensible as blowing a finger off with a 12 gauge. Cutting on it is mutilation. Technically, it’s “practicing surgery without a license”. Resist the urge.
4)Fourth, that tiny string will become a drastically too-tight band, cutting off blood flow as the bitten part swells. We can work with envenomization in the ER, but cutting off the blood flow is going to cost you your digit or limb. And seriously, wouldn’t you rather dilute that venom with your big body, rather than concentrate it in a part of your body loaded with pain receptors, like a hand or a foot? Of course you would.

And if you were really going to help yourself or your buddy out by sucking the poison out with your mouth...just don’t. Be smarter than that, please?

If you’re bound and determined that you’ve gotta have something just in case, pay attention. The only device I’m aware of that might, just possibly, do any good, is the Sawyer Extractor. If you have it, if you whip it out and slap it on within a few seconds, you might manage to draw out some fraction of the venom. And it won’t hurt to try, or do any demonstrable harm in the first few minutes you use it.
Other positive reasons are that 1) it’ll keep you from doing anything stupid like trying to catch, kill, or further piss off or annoy the snake; 2) using it forces you to stop, slow down, calm down, and concentrate on doing something deliberate, rather than panic or run around. Best evidence from actual medical journals is that it's a total waste of time and money, and may cause harm, making it too a no-go.

I've thrown mine away for that exact reason: weight and space in a kit that could be used for useful, productive items.

Okay, what next?
Stay calm. If Mr. McFang is still nearby, and probably trying his best to retreat, observing the snake, with a view to giving a species ID to medical professionals later on, is acceptable. But the priority is treating and evacuating the patient, not apprehending the suspect.
Clean the bite wounds. (Snakes eat rodents and such, and they don’t brush after meals. Thus they have nasty cooties in their mouths. The bite WILL get infected.) The better you clean it the less worries about that later on.
Remove everything (tight bootlaces on a foot, rings, watches, etc. on a hand, and any constricting clothing) that might be a problem after things swell up. Because if it was a venomous bite, things WILL swell up. Possibly a lot. If you’re with someone, let them help you out to civilization. If you’re alone, call someone, or as a last resort, get yourself back to the World (assuming this is an option, and not during your escape from TEOTWAWKI). Ideally, you want to immobilize the extremity, at the heart level, and carry the victim to transport and evacuate them to definitive medical care.
In North America, your odds of dying from a snakebite are very, very low. That doesn’t mean it’s not gonna hurt, or that you won’t need medical help. But you probably aren’t going to die, and if you get to help in a timely fashion, you’ll do fine.

The best snakebite kit in the world is a cell phone and an ambulance to the hospital.

 

What about carrying antivenom?

You aren’t going to fix it by carrying antivenom. The last guy I treated in the ER* for snakebite needed 20 vials of the stuff for a bite on a finger, it’s a cast-iron b###h to re-constitute even under hospital conditions, and you won’t likely have nor find that much of it. That’s assuming you even know what kind of snake bit you. You sure aren’t going to carry 20 vials of antivenom, sterile equipment, syringes, etc. for every venomous snake in the continent, or even your area. So get thee to a hospital.

Ice, stun guns, etc.
And for the inevitable "I read this on the Internet" questions: Using ice on a bite that may cause decreased circulation isn't just worthless, it's jackassically stupid.

And using stun guns on the pt. has no - as in nada, zip, zero, zilch - demonstrable positive effects on the injury whatsoever.
That said however, if the guy who got bitten was the biggest dickhead in your group, I can understand the urge to try it out on him a few times, just because watching him flop around is kind of funny. But be advised, it doesn't have any therapeutic effects, except to your own twisted sense of humor.

Hopefully, this info will either save you $10 and a few ounces of dead weight, or if the worst happens, keep you from doing more harm than good.

 

 

*(Brilliant guy, classic snakebite victim: 30 y.o. WM, found a nest of baby rattlesnakes, likely Western Diamondbacks (Crotalus atrox sp.), freshly hatched on spring day behind a Wal-Mart - I can't make this stuff up - and decided that he could catch them all and sell them to friends for a few bucks. Somewhere in the process Huey, Dewey, or Louie chomped on his right ring finger about halfway up, and probably gave him the full bag o' nasty juice. When I got him, 24 hrs. later from a local smaller hospital, his right arm from fingertips to upper bicep was discolored and about the size of a thigh. Because of the time passed from the initial injury to my receipt of pt., I can't tell you if he'd been drinking any adult beverages prior to the bite. Hmm, catching rattlesnakes in the open field behind a Wal-Mart to sell to his buddies...you do the math on that. He didn't lose any body parts, but his right arm was in severe pain, the specialists standing at bedside were discussing the possible necessity of doing long-direction relief cuts on his entire arm to keep the internal pressure from giving him permanent nerve damage from compartment syndrome, and when I rolled him up to the inpatient ward, I'm betting the pain he was experiencing, despite quite a quantity of IV pain meds, was enough to bump his IQ up a solid 10 points over what it was 48 hours earlier. Don't be that guy.)

Twenty Lessons On First Aid Preparedness: Antiseptics

After the recent post on supplying oneself for austere conditions, a couple of questions have made it obvious that I should dredge up a series of posts I contributed on the subject. I wrote these originally and they were posted for pretty much the same reason, i.e. personal preparedness, for "The Other Side Of Kim", the then-regular blog of Kim DuToit. The loss of the contributions of that crusty, cranky genius to the internet has been notable, but he moved on to other things, and thus the content there is no longer available. I'll pop them up one-a-day until they're all up.

So for general edification, reviewed, proofread, MSWord-edition and content updated as appropriate, here are the lessons:

Lesson One: BACTINE IS YOUR FRIEND

I’ve noticed in kit lists and after-action reports, quite a number of people here (just like everywhere else) always want to fling alcohol, hydrogen peroxide, or povidone iodine in/on/all over wounds. (Not to mention pee on them, or smear in butter, mayonaise, or Aunt Hilda’s Secret Recipe. We’ll ignore those for now.)
Pro: That’s better than rubbing dog doo on them. And it’s usually better than nothing.
Con: Didja ever notice most of that stuff stings like ####??

There’s a reason it hurts. It’s killing healthy tissue. Along with the germs.

Isopropyl alcohol
War story: I was working the 20-Mile Aid Station at the LA Marathon back in the day, when some Poor Guy shuffled in, both knees a bloody mess. He’d fallen, and been trampled by the pack, who couldn’t stop or avoid him in time.
Old School Nurse decided that two big kerfluffs of gauze soaked in isopropyl alcohol would clean those hamburger knees right up! Being a mere EMT, I bit my tongue and averted my eyes. The bloodcurdling screams could be heard for blocks.
And Poor Guy finished the last 6 miles—on a massive adrenaline and endorphin high induced by the screaming agony.

Consequently, as I tell friendly Teamsters on movie sets, I only use alcohol on people I don’t like.
It's also flammable, and setting your pt. on fire is rather inconvenient.

If you want to use it to soak a hemostat, knife blade, needle or what-have-you in, for 15 or 20 minutes, that’s a much better use for it.

Hydrogen peroxide
Peroxide hurts too, and for the same reason. And it only works where it hits, so you’re missing a lot of germs with it as it bubbles up. It also does nothing to disinfect inanimate stuff.
It is great for getting blood out of your hospital scrubs, socks, t-shirts, wife’s towels, or carpets after you move the body.
But it’s less than optimum for disinfecting wounds. You also have to keep it in that dark bottle, because heat and sunlight will turn it into H2O, instead of H2O2. This also makes it a poor choice for car/travel/backpack kits.

Povidone Iodine
Great stuff.
10,000 hospital ORs can’t be wrong.
Unless you or your patient are allergic to iodine.
Treating anaphylactic shock, in addition to a minor puncture, especially in the field, is a serious bummer. Trust me.
If you’re patient isn’t allergic to it, and you know that, g’ahead with it. It does also stain everything, so be careful. It also makes a great topical smear on the OUTSIDE. Like on skin around a blister on your foot, BEFORE you use that sterile needle to drain it, if you must. Or to mix with clean water to soak a cut finger or infected toe in to help heal and kill the cooties.
So of the three, other than potentially life-threatening allergies, it’s not bad.

Bactine
is the king for a first aid kit.(and I hold no stock nor receive any royalties from its maker).
Why is it so good?
It uses benzylkonium chloride to kill germs. That stuff kills darn near EVERYTHING, and without stinging like ####. Not having your patient take a swing at you is always better than having them do it.
Bactine also has a tiny amount of lidocaine, which is a painkiller. The risk of allergies to that is far smaller than for iodine (unless YOU are allergic — caveat emptor) and the lidocaine helps numb your own “Ouch!” or that of someone you’re helping when you accidentally poke holes in your people-cover.

So as you pack your first aid kits, perhaps you’ll keep this advice in mind.