A multilevel approach to FAK for group support

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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A multilevel approach to FAK for group support

Post by TacAir » Wed Feb 02, 2011 2:58 pm

I have seen many fine FAKs posted on the ZS board - everything from a few bits in a Ziplock bag all the way to large STOMP series trauma kits. I am sure that the owners are certain that the kits will meet their needs as they see those needs.

In my experience, many first aid kits seem to have been built with either a limited vision or a lack of foresight regarding their use in a disaster situation. Of course, a "disaster" is in the eye of the beholder. I have rarely observed an off-the-shelf commercial kit that could really meet the needs of individuals or small group in a disaster situation.
For my planning, a "disaster" has been defined as the lack of access to professional medical care/facilities/medicine for an extended period of time - say upwards of 90 days. The kit set must be able to handle serious but non-life threatening injuries

I have often stated here - No first aid kit, no matter advanced, well stocked or massive is a substitute for training. Why my continued emphasis on professional training? It can save a life. If nothing else, it is easily as good an investment as freeze dried food or any other preparation items you might purchase.

Back on task - this post is to discuss the idea of building a multi-layer kit set and offer some of the reasoning behind this suggestion.

DISCLAIMER - Standard disclaimer applies.
Always seek consultation with a medical professional whenever possible.

Concept of layered kits-
This multilayer approach in building a kit set should be focused on supporting you, your family or any affiliated group in an abnormal situation, either long term or short term. This approach provides the means for escalating the support you can provide for different types of injury and illness likely found in a situation with limited or no routine medical care access - such is found in disaster areas. Each part of a multilayer kit should support or provide items that may be used with the next level kit. This approach is also designed to be modular in nature, allowing for your medical supplies to be carried by many members of a group, should forced displacement occur.

Multilayer Kit - Limiting Factors
Some injuries are so grievous that without surgery, drugs, specialized medical equipment and techniques, the odds of patient survival are extremely limited.
Likewise - some conditions, while non-emergent, require very specialized treatment - for example, a detached retina.
Finally, some diseases require special testing in a lab setting to determine the course of treatment.
For this discussion, I have assumed that all of these types of issues fall outside of what I and many others would consider “first aid”. YMMV.

You can, however, provide real care for an injured or sick person that will allow them to recover from their injury - with or without advanced medical intervention. You will find this the driving focus here. Items listed are *some* of the items I carry - based on my plans, training and the folks supported.
You must do your own planning and build accordingly. Some of these modules are large; I plan on supporting several adults and small children for up to 90 days. I also recognize that I will likely be short of some items and have 'overages' of other items.

Multi-layer - what does that mean? As discussed here - a series of medical resources (First Aid Kits) or modules if you would, each with different levels of items and equipment to match treatment of what condition is presented.
Most simply put, the modules are designed to support the treatment of different levels of injury.

For my planning track, I have defined the levels of injury that must be considered as:
* Minor injury, individual
* Minor trauma, individual with limited bleeding
* Expansion module for minor trauma kit to deal with significant bleeding
* Major trauma - as bad as it gets
* Clinical (follow-up) or *sick call* type issues

Minor injury, individual.
Failure to care for even a seemly minor injury can kill you. Failure to treat a minor injury can lead to infection, sepsis and at some point, death.
This would include minor cuts, scrapes, minor puncture wounds, small object/dirt in eye or headache/low fever.

A simple Individual First Aid Kit (IFAK) should be enough for an individual to properly treat themselves or another with a minor injury.
In a multi-layer system, the IFAK is the first of 4 layers - this kit should have something to clean an injury, some antibiotic ointment and something to cover the injury.

I keep one of several IFAKs at hand, work or play. The size factor is focused on something small enough so that you always have it hand - in a pocket, purse, briefcase, or tool bag.
You should have one per individual, extras for any common workspace.
Suggested contents: (you can have whatever you want, these are just suggestions)

The kit should fit into an identifiable case Anything from a glasses case to a small bag or pouch will work, so long as you/others can identify it as a IFAK. See image for some sample sized IFAKs in different cases.

Contents:
Inside are several adhesive bandages - both strip and ‘dot’
Providone-Iodine prep pads
Foil packets of Betadine antibiotic ointment
Foil packets of ‘triple antibiotic ointment’ - also sold as Neosporin
Individual doses of eye drops in individual ‘tear-off’ dispensers
Foil packet of lip balm (Blistex brand)
Packet of Aspirin (2 tablets in packet)
2x2 sterile gauze packet
2x3 no-stick gauze packet
Steel splinter tweezers
Small LED ‘squeeze’ light
Book of military waterproof (MRE) matches
A card with 5 ft of duck tape wound upon the card. - one ‘stripe’ of tape is 1/2 in wide, the other 1.5 in wide. The card itself is a old ‘credit card sized’ plastic card..
The kit also has a ‘manual pencil sharpener’ which looks, to me anyway, like a small folding barber razor. Small, it has a two inch ‘razor’ blade that folds into its handle for safety. Just the thing for scraping off cactus needles and the like.
There is room for a flat Fresnel lens to spot splinters. SinceI keep a lens in my wallet, it not shown in this kit.
The case is secured with a large rubber band, which helps keep the case inside of a pocket and can further be used as ‘tinder’ if a fire is needed.

The next level in the multi-layer approach is a minor trauma kit. The basis (container) for this is the well known military Individual First Aid Kit, Field (NSN 6545-01-521-8502). This would be carried in/on your BOB.

Minor trauma may be falls, twisted or sprained joints, cuts or minimal depth penetrating injury.
While not adequate for large lacerations, avulsions or deep penetrating injuries, it should do for the risk posed by your day to day outside activities. One per individual, extras for the work area or a BOB. This kit works with ‘expansion’ module listed next.

This kit is fairly small in size (4-3/4 inches high by 2-3/8 deep by 4-1/2 wide). The container was designed to accommodate a waterproof plastic insert box which contained the components of a military Individual First Aid Kit. The first pattern (preferred) has snaps to fasten the cover flap. The case can be attached to any belt via two ALICE clips. This makes a good platform to build upon. The nylon cover is larger than the ‘insert’ allowing for additional items to be added. This container is available from multiple sources on line for between 8 and 10 USD.

This module is designed for dealing with minor trauma with limited bleeding.
**Inside the nylon case we find:
Providone-Iodine prep pads
Hand wash packets (commercial - to clean your hands before or after)
Aluminized mylar ‘survival blanket’ - this to wrap the patient should shock or cold be an issue
Gauze eye pad
Latex or Nitrile gloves in Ziploc bag, not sterile, but clean
**Insert, First aid (plastic)
The plastic insert box holds:
Dressing, First aid, Field, Individual Troop, 4x7 inches (more than 1)
Bandage, muslin, compressed - a triangular bandage, or cravat
Band-Aid brand bandage 2x3 in (larger than the 1 x 2 in ones used in simple kits)
Band-Aid bandage, extra large
Adhesive bandages - 4 ‘normal’, 2 small
Foil packets, triple antibiotic
Foil packets, burn get (Lidocaine)
Large safety pins - for use with the cravat
Packet electrolyte tablets
Eye drops in tear-off dispenser
Book of waterproof (MRE) matches

If you plan on supporting an industrial type operation, you may wish to add a pair of tourniquets.
Note - Use of a tourniquet will require seeking advanced, professional medical care at a hospital or trauma center as soon as possible.

The expansion module for the above listed kit is for more extensive trauma, with bleeding. This would be carried in your BOB,
This module should be adequate for large lacerations, avulsions or deep penetrating injuries - but not penetrating chest injuries which result in a tension pneumothorax or those resulting in evisceration. Support for crushing injury is limited.
One per two group members involved in industrial or dangerous activity with a high risk of injury minimum - one per person is better.

For me, this module is housed in a soft-sided nylon case 8 x 6 x 3 in deep. Color is optional, mine happens to be bright red with a First Aid logo on the exterior, but almost any waterproof container will work.
I also have a heavily modified Adventure Medical Kits "Field Trauma" kit for use as a carry away kit if the ruck has to be dropped.

This 'expansion' module contains:
2 sets of latex or nitrile gloves in Ziploc bag
Package of 10 cotton applicators (Q-tips)
5 x 9 sterile combination dressing
Dressings, First Aid, Field 4 x 7 in
3 x 4 in non-adhering sterile gauze pads
Tongue depressors/splits
Bandage compress, muslin - triangular bandage or cravat
Non-stick gauze pad, Adaptic
Eye patch
Band-Aid - extra large
Roll 2 in self adhering bandage
Roll 2 in bandage gauze with 2 safety pins
Tourniquet
Plastic ‘splinter’ tweezers
Steel tweezers
Travel sized’ vial of 200mg INN (Ibuprofen) 22 tablets, OTC
Vial of spray Neosporin
Swabs, tincture of benzoin for use with SteriStrips
Packages of ‘SteriStrip’ wound closure strips, butterfly bandages are a substitute
Providone-Iodine prep pads
Adhesive bandages (1x 2)
Plastic hard case insert (3.5 x 4 x 1 in deep)
2 x 3 non-stick gauze pads
3.5 x 5 in moleskin patch
Eye drop doses in ‘tear off’ dispensers
Tabs Imodium (OTC)
Large safety pins
#10 sterile scalpel blade
Foil packets triple antibiotic ointment
Foil packets ‘burn gel’ (lidocaine)
Packets electrolyte tablet ( 2 tabs per packet)

The next level module is for major trauma.
Housed in a surplus M-3 Medic bag, it has supplies for dealing with major trauma, heavy bleeding, crushing injury. At this stage any injury you treat will require professional medical care normally found at a hospital or trauma center.
Designed to provide pre-hospital treatment of large lacerations, avulsions or deep penetrating injuries which may result in a tension pneumothorax or those resulting in partial evisceration.
These kits are normally built based on the advice of a trauma physician and include items not covered in training at a level below P-EMT. As such, I will just list some items to provide an idea of the level of care that might be provided -
Latex or nitrile gloves
N-95 masks (PPE)
Eye protection (PPE)
SAM splint
Quick-clot gauze, large
Quick-clot gauze, small
5 x 9 sterile dressings
4 x 4 sterile non-stick pads
Hot packs (hand warmers are fine)
Cold packs
6 in Ace bandages
4 in Ace bandages
4 in self-adhering bandages
Rolls 4 in Kerlex
Israeli Emergency Bandage 6 in with slider
Israeli Abdominal Emergency Bandage - 12"
or
Silver "H" Compression Bandage (optional as it is specialized)
Set of OTC meds (ASA/INN/antacid/Sudafed) 10 packs of tablets in OTC doses
Headlamp - LED - stays in kit.

These listed items are a *sample* - I strongly suggest you discuss the items for this module with your own medical professional and factor in your level of training, location and risk exposure.
I don’t openly discourage the view that having more ‘advanced’ supplies is a good thing - for use by medical professionals to treat your group members in case the pros supplies are exhausted. Some items may require a prescription - keep a copy in the kit!

Consultation with a professional can save you money - by not purchasing unnecessary or overpriced items.

The final module is for what I will term clinical treatment.
Here is where most of the ‘hardware’ resides. For me - it is a two part setup. I use a large tackle box which provides water resistant protected storage and a means to organize the items.
The other is a commercial ‘first aid’ bag that folds out presenting many pockets to hold items. These are used to provide follow-on treatment and treat ‘sick call’ type complaints - earaches, foreign object in the eye, colds, hay fever and so on.

Typical contents are:
Box of latex or nitrile gloves
Surgical soap or Betadine or Hibiclens Soap for cleaning your hands and any wound areas that require cleaning. Check with your medical professional on cleaning tips.
Eye protection and masks
5 x 9 sterile pads for wound dressing changes
Adaptic pads for draining wounds or burn dressing changes
Steri-strips for reclosure of lacerations, if needed, when changing dressings
Multiple swabs, tincture of benzoin. for use with SteriStrips
Several oz of medical saline solution for wound cleaning, eye wash and so on.
Several 2 oz squeeze bottles of saline are better then one big container.
Commercial dental kit, with extra wax sticks and several teabags. Ask your dentist what is best for you.
Stethoscope and sphygmomanometer to monitor blood pressure in long term care, monitor for pulmonary sounds (like rales) and to check for distal pulse sounds.

A quality otoscope for ear examinations, important if your group includes children. Some are sold with booklets containing color photos of different conditions.

A UV or Cobalt Blue light for in use in conjunction with orange dye (fluorescein)
to detect foreign bodies in the eye or damage to the surface of the eye.
Used with saline solution eye drops, it can be used to confirm all debris has been removed from the eye. Ask your medical professional to demonstrate correct use before you use these items.

I suggest adding a set of ‘hobby’ headband magnifying lenses - very handy in eye examinations - and allow hand-free use.

Some kind of notebook or other means of recording treatment. These records can be important in the long run, certainly valuable to medical professionals if you seek care after treatment.
Activated charcoal and syrup of ipecac are not included in any module. The American Academy of Pediatrics recommends that ipecac syrup not be stocked at home, the same for the charcoal. Activated charcoal can cause ‘concretions’ in the intestines, an often fatal condition.

You should closely examine those items your group will carry and consult with a poison control unit to determine risk and treatment if the substance is ingested, now. Examples include water treatment tablets, prescription medicines and so on.

A separate OTC carrier. These may hold:
Aspirin, 325 mg Tablet
Acetaminophen, 325 mg Tablet
Ibuprofen, 200 mg Tablet
Diphenhydramine, 25 mg Capsule
Diamode, 2 mg Tablet
Diotame Tablet
Alamag Tablet
Sudafed Tablet
Cera Lyte 70, 50 g Packet, Lemon
Loperamide tablets (Commercial name - Imodium)
Triple Antibiotic Ointment
Hydrocortisone Cream 1%
Printout - of all OTC meds, showing reactions, contraindications and save dose levels (see this site for good data or consult a PDR guide)
Checking with a medical professional on your selection of OTC meds is a good idea if you have members with prescription medicines or long term health issues.
Prescription drugs and antibiotics are best discussed and obtained from your health care professional.

In many jurisdictions possession of prescription items without the accompanying script is a felony.

Do not carry any medicines or pills in unmarked containers. Officer Friendly and his trusty canine companion Killer-Diller just may not understand. Avoid that dirty boot on the neck and those cold steel bracelets - ensure all items are in the original and marked containers.

I have covered a module based approach for first aid treatment of :
* Minor injury, individual
* Minor trauma, individual with limited bleeding
* Expansion module for minor trauma kit to deal with significant bleeding
* Major trauma - as bad as you can handle
* Clinical or ‘sick call’’ type issues
All layers that provide for mutual support, ease of carry and distributed carry - avoiding a ‘all eggs in one basket’ for medical support.

Each adult (or adult pairing) has an M-3 bag (and individual FAKs) for group support. Each BOB has an FAK and expansion module set. In my specific case, I and my wife have seperate sets of a BOB, IFAK, FAK, expansion module and carry away module.

Not everyone will agree or see the value of this approach, but for my plans and what I see as needed, with current training/certs/etc - this meets my plans.

I hope this will give you something to think about and perhaps include in your planning.

(ETA - photos removed)
Last edited by TacAir on Tue Feb 19, 2013 12:30 am, edited 1 time in total.
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Re: A multilevel approach to FAK for group support

Post by Hydrostatic » Wed Feb 02, 2011 4:28 pm

Nice post :D
I think I will apply this method of setting up the different levels of medical kits when I get further along in my preperations.
I have two questions for you; where do you purchase your supplies? and do you know a good way to get trained in basic trauma care?
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Re: A multilevel approach to FAK for group support

Post by Apache » Wed Feb 02, 2011 6:14 pm

I like your ideas. A couple of things pop into my head reading it. I would like to see a major dressing in the small kits that are carried at all times, as you can't always plan a major injury. Although a vital survival issue, not sure where matches come into play? Some small LED lights don't take up much more room and would be more useful.

There are a number of issues that you could treat quite well in your scenario of being 3 months from help. The problem is that a major wound, degloving injury that would heal with sufficient dressing changes would use 10X all the dressings you have in your group. I'm sorry, but I don't know your level of training, but patching people up is one thing, but keeping them going isn't the sort of supplies you can carry. You would need dozens of rolls of gauze, dressings, irrigation solutions etc etc.

What you want to achieve can't be achieved! I have given it serous thought and a lead bolus may be required in many cases that could be treated successfully now. :(
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Re: A multilevel approach to FAK for group support

Post by johndoe » Wed Feb 02, 2011 6:24 pm

As always, a great, informative post from you, Tacair. Thank you for taking the time to share. A couple questions came to mind.

You mention not stocking activated charcoal in any of the kits. There are obvious risks, of course, but it's still being actively used by EMS services and is still part of the DOT curriculum. Obviously, you wouldn't want to use it indiscriminately, but it seems like there are cases when it would be beneficial. Is not including it done with the thought that there may not be access to medical direction?

Second, where do you generally keep the kits (apart from the IFAK, obviously)? When I think modular my first thought is that they're generally going to be stored in the home, though of course I could be wrong on this. The reason I ask is, in my case, I'm usually either at home with my vehicle, or I'm out with my vehicle. My initial thought is that this makes vehicle storage a good solution, especially if theft risk is relatively low. I suspect that since most of us in the US rely on our vehicles for primary transportation, were there ever a local medical emergency the chances are that we're going to be near our vehicles, and thus near our supplies. If this is the case, doesn't it make sense to consolidate into a large vehicle borne kit as opposed to modules that you may not have access to if you're away from home? Thoughts?

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Re: A multilevel approach to FAK for group support

Post by johndoe » Wed Feb 02, 2011 6:27 pm

Apache wrote: The problem is that a major wound, degloving injury that would heal with sufficient dressing changes would use 10X all the dressings you have in your group. I'm sorry, but I don't know your level of training, but patching people up is one thing, but keeping them going isn't the sort of supplies you can carry. You would need dozens of rolls of gauze, dressings, irrigation solutions etc etc.
I guess at some level you can never stock enough supplies for a long-term situation, but couldn't many of the supplies for long term wound care be improvised? Bandages are easy enough. Sterile water for irrigation isn't too difficult. The bigger issue I suppose would be medications for a long term situation.

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Re: A multilevel approach to FAK for group support

Post by TacAir » Wed Feb 02, 2011 9:22 pm

Hydrostatic wrote:Nice post :D
I think I will apply this method of setting up the different levels of medical kits when I get further along in my preperations.
I have two questions for you; where do you purchase your supplies? and do you know a good way to get trained in basic trauma care?
THank you for the kind words.

I purchase my supplies from different sources, price being the driver. For example, the M-3 bags were had from a local surplus dealer, the headlight - HD and so on. I have found that REI carries a good specturm of supplies at reasonable cost - no need to buy a box of 250 Providine wipes, when you can buy (and only need) 10.

Given your local location, the local Jr College could be a good vendor for an First Responder class. Check with your State licensing office or the 'net.
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Re: A multilevel approach to FAK for group support

Post by TacAir » Wed Feb 02, 2011 9:28 pm

Apache wrote:I like your ideas. A couple of things pop into my head reading it. I would like to see a major dressing in the small kits that are carried at all times, as you can't always plan a major injury. Although a vital survival issue, not sure where matches come into play? Some small LED lights don't take up much more room and would be more useful.

There are a number of issues that you could treat quite well in your scenario of being 3 months from help. The problem is that a major wound, degloving injury that would heal with sufficient dressing changes would use 10X all the dressings you have in your group. I'm sorry, but I don't know your level of training, but patching people up is one thing, but keeping them going isn't the sort of supplies you can carry. You would need dozens of rolls of gauze, dressings, irrigation solutions etc etc.

What you want to achieve can't be achieved! I have given it serous thought and a lead bolus may be required in many cases that could be treated successfully now. :(
In my planning the one thing I have never considered is shooting someone due to lack of treatment options - it is considered oh so very rude in many parts of the world.

If I have 7 adults (and 7x the supplies shown in the photo set) I suspect we will find some way to get by. As we plan on bugging in (possibly aggregating at a alternate location) - the one area I do get nervous about is meds.
Expensive to purchase and fussy to store, they are the one weak spot in this plan set - but as noted, at some point an injury will force you to seek professional help.

We don't plan on disappearing, just not being a burden to any existing services. If we have to seek additional care, we will - I can only hope something is 'there' to seek.

I do have lights, there was room for the matches, so why not?
: )
Last edited by TacAir on Thu Feb 03, 2011 12:52 am, edited 2 times in total.
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Re: A multilevel approach to FAK for group support

Post by wagdhead » Wed Feb 02, 2011 9:33 pm

You sir are a gentleman and a scholar for putting this together. I plan to borrow heavily from you work, I will call it flattery instead of plagerism :D
The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.
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Re: A multilevel approach to FAK for group support

Post by TacAir » Wed Feb 02, 2011 9:48 pm

johndoe wrote:As always, a great, informative post from you, Tacair. Thank you for taking the time to share. A couple questions came to mind.

You mention not stocking activated charcoal in any of the kits. There are obvious risks, of course, but it's still being actively used by EMS services and is still part of the DOT curriculum. Obviously, you wouldn't want to use it indiscriminately, but it seems like there are cases when it would be beneficial. Is not including it done with the thought that there may not be access to medical direction?

Second, where do you generally keep the kits (apart from the IFAK, obviously)? When I think modular my first thought is that they're generally going to be stored in the home, though of course I could be wrong on this. The reason I ask is, in my case, I'm usually either at home with my vehicle, or I'm out with my vehicle. My initial thought is that this makes vehicle storage a good solution, especially if theft risk is relatively low. I suspect that since most of us in the US rely on our vehicles for primary transportation, were there ever a local medical emergency the chances are that we're going to be near our vehicles, and thus near our supplies. If this is the case, doesn't it make sense to consolidate into a large vehicle borne kit as opposed to modules that you may not have access to if you're away from home? Thoughts?
The kits are part of our overall "bad things have happened, over a wide area" and we are cut off from normal services - for ~about 90 days preps.
If we are out motoring, I plan on calling 911. The auto has a basic kit - weather extremes here in Alaska can kill a FAK as fast as anything - short of storing it in a bucket of water...
If we are out in the RV, I carry one Major kit, a FAK and the snivel bag. If we do see an accident, and can offer some assitance, we will. It hasn't come up in the last 20+ years here in AK. This, in part, due to so many jobs that require FA training and annual refresher training as a condition of employment.

As far as the other. They were left out as the risks outweigh any benefit we can reasonably see. YMMV.
While those treatment options are still in use, the pt is carried by your EMS to a treatment center that may offer aqueous cathartic solution, gastric lavage or other advanced treament we do not support - by plan.

When I do my camp support thing, I have a pair of RNs that call those cases - and evacuation of anything even remotely serious is Plan A - after stablization. The nice part is I get refresher training at no cost to me.

Storage of the kits is 'near' our carry out bags (BOB) in a controled environment - this allows each of us to be mutually supporting, but have a 'somewhat' large amount of supplies for each of us. As I noted, all adults have the same or nearly the same kit set. Again, not all the eggs are in one basket so to speak.

Thank you for your thoughtful reply.
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Re: A multilevel approach to FAK for group support

Post by TacAir » Wed Feb 02, 2011 9:53 pm

wagdhead wrote:You sir are a gentleman and a scholar for putting this together. I plan to borrow heavily from you work, I will call it flattery instead of plagerism :D
It was my hope when I posted this that others would find some of it useful for their planning.

Thank you for the kind words.
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Re: A multilevel approach to FAK for group support

Post by johndoe » Fri Feb 04, 2011 6:05 pm

TacAir wrote:
As far as the other. They were left out as the risks outweigh any benefit we can reasonably see. YMMV.
While those treatment options are still in use, the pt is carried by your EMS to a treatment center that may offer aqueous cathartic solution, gastric lavage or other advanced treament we do not support - by plan.
This makes sense. Thanks for responding.


Storage of the kits is 'near' our carry out bags (BOB) in a controled environment - this allows each of us to be mutually supporting, but have a 'somewhat' large amount of supplies for each of us. As I noted, all adults have the same or nearly the same kit set. Again, not all the eggs are in one basket so to speak.
Understood. That's the one concern I have myself. Due to the RV living thing, we're extremely limited in storage. In our car (our main around town vehicle, the truck is rarely driven) we keep both our BOBs and our main aid bag, partly due to the reason mentioned above, but also due to the practical reality of a lack of space. It is sort of an all eggs in one basket approach that makes me a bit nervous, but there's little to be done except keep secondary BOBs (our hiking gear, and another, smaller FAK, in the RV or the truck.

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