A quality first aid kit is an essential item for emergency preparedness. The well-designed first aid kit is a crucial component of initial emergency medical care along with First Aid or Emergency Medical Responder (EMR) training.
A Well-Stocked First Aid Kit May Save a Life
A quality first aid kit…nearby, available, and well stocked, can prove to be a true lifesaver. Critical issues with airway, breathing, circulation, and bleeding must be successfully managed within the first 3 to 4 minutes. Besides life-threatening conditions that may strike, minor injuries require proper care to prevent infection. Common illnesses that are acquired away from home need relief from pain, discomfort, and suffering.
Keep Your First Aid Kit Handy
A first aid kit must be close enough to provide first aid in order to treat critical conditions immediately. Medical emergencies occur significantly more frequently than fires; therefore, first aid kits should be readily available, just like fire extinguishers. For people who are away from the home or office, a first aid kit also needs to be portable, lightweight, and able to fit in a vehicle or backpack.
Designing a Small First Aid Kit (SFAK)
A Comprehensive First Aid Kit (CFAK) that meets ANSI Z308.1-2021 class A or B workplace standards is often of a size or cost that is impractical to strategically locate multiple units throughout a home or building. It may also prove too large, and cumbersome for a traveling person to carry. It may also prove too large to fit into other emergency kits such as a Basic Automotive Safety Kit (BASK).
The solution to this problem is the Small First Aid Kit (SFAK). The SFAK is designed to provide the necessary supplies for immediate first aid of critical injuries, and shock. It can also treat minor wounds and illnesses when away from home. The smaller size of the SFAK has adequate supplies to treat 1-2 people. The SFAK will prove invaluable when the situation dictates that a smaller size is required.
The SFAK is easier and less expensive to create and deploy in multiple locations than to deploy an equal number of Comprehensive First Aid Kits (CFAK). As a general-purpose first aid kit, the SFAK also provides more treatment options than a military-style Individual First Aid Kit (IFAK) or “stop the bleed” kit. The smaller size of an SFAK allows it to be kept in a backpack, desk drawer, BASK, or emergency station. An SFAK is ideal for individual persons hiking out in remote, austere environments. Several people, each carrying an SFAK, can achieve a combined value greater than one CFAK.
Major Objectives of a General-Purpose First Aid Kit
The 3 major objectives of a general-purpose first aid kit are to:
- Provide immediate first aid to life-threatening conditions
- Provide first aid, pain relief, and definitive care for minor injuries
- Provide a measure of relief from pain and discomfort caused by common illnesses
Most commercially developed first aid kits of a smaller size are not comprehensive enough to meet the 3 major objectives of a general-purpose first aid kit. These commercial kits either focus on minor wounds or major trauma. Kits that are comprehensive enough to be general-purpose tend to be too large for many applications, or of poor quality.
Therefore the best options for acquiring a quality SFAK is to either build one from scratch or greatly augment/upgrade an existing commercial kit. This asks the question of what items are needed to create a quality SFAK. This paper will discuss the minimum quantities of items needed to build a SFAK and their rationale for inclusion.
The Small First Aid Kit Case
The SFAK case should be constructed of high-quality material. If it is being carried, one should consider a soft case of ballistic nylon or similar construction. It should have a handle or otherwise be capable of being mounted to a wall or bracket. The case should have a way to attach the case to a belt or pack. It should have a strong closure system that can be manipulated easily under stressful conditions. If exposed to the elements, the case should be waterproof or have a waterproof outer case.
When the SFAK is opened it should have numerous clear or mesh pockets. These pockets allow for the organization of first aid supplies, and their rapid identification under stress. The pockets also prevent first aid supplies from falling out or blowing away.
The case should be of a size small enough to place in a top or side backpack pocket, BASK, desk drawer, locker, or glove box. The case should also have the ability to be attached to a belt or other pack. In order for the SFAK to be found quickly under stressful conditions, and by those who cannot read, it should be clearly labeled with the ISO-approved white cross on a green background or the Geneva Convention-approved red cross on a white background.
Small First Aid Kit Recommended Contents
Since first aid kits are designed for laypersons to use with little to no medical training, the items in the SFAK must reflect this. SFAKS are designed primarily for initial first aid response. Serious illnesses and injuries will require additional professional medical care. Items in the SFAK should not require any significant training beyond what is taught in a first aid or “stop the bleed” course. The quantities listed below are minimum quantities.
Instruments Guides and Tools
First Aid Guide (1) – The SFAK First Aid Guide should be small and thin to allow as much room as possible for medical equipment. It should be roughly the size of a sheet of paper and easy to read. However, no guide is an adequate substitution for professional medical training. Every layperson should take a First Aid, CPR, AED, or Emergency Medical Responder (EMR) course. However, recognizing the fact that most people do not get training, and the stress response can impair memory recall, a small guide may prove very helpful.
Tweezers (1) – Tweezers are necessary to remove splinters, insects, and insect stingers. They should be made of high-quality stainless steel with a tapering pointed end. A smaller size will fit better in the SFAK while a wide base will allow for easier gripping. Tweezers that come with a case will protect the SFAK and help to keep them clean.
Trauma Shears (1) – Also known as EMT Shears, these robust scissors are designed to meet all of the needs of first aid and professional emergency care. Quality trauma shears will be able to easily cut clothes, cloth, bandages, and dressings. They can also cut metal items such as wire splints. Normal scissors are not robust enough for the demands of emergency care. Trauma shears come in a standard size and a smaller size. The smaller size will fit better in the SFAK.
Pen or Pencil (1)– A high-quality pen, such as a space pen, should be carried in the SFAK to document any necessary patient information or treatments performed. Fast-drying ink is preferred. Pens that are half-size will fit better in the SFAK. Black is the preferred ink color.
Permanent Marker (1) – A black permanent marker is very useful to mark that a tourniquet has been applied to a patient or any situation where a pen is insufficient. A smaller size marker fits better in the SFAK.
Water-resistant paper sheets – 3” x 5” (2) – Two sheets of water-resistant paper, such as from an all-weather notebook will be useful for recording patient information. The water-resistant paper will also help when documenting in rain or other damp environments. Regular paper can be substituted as well.
Personal Protective Equipment
Disposable Nitrile Gloves (2 pr.) – Nitrile gloves provide strong protection against biohazards without risking a Latex allergy for the patient or provider. Choose a “one size fits most” sizing to accommodate the largest number of users. Extra-strength nitrile gloves, such as the Venom brand, are recommended. Each pair can be vacuum-sealed with a hand sanitizer towelette to save space and have sanitizer at the ready.
Hand Sanitizer Towellete (2) – Hand sanitizer towellets provide strong cleaning agents against pathogens while still being small enough to fit easily in the SFAK. The active agent should be benzalkonium chloride or ethyl alcohol 70%. They should be washed thoroughly after every patient encounter.
Optional – Face Mask (2) – The recent COVID pandemic reintroduced the world to the use of facemasks to prevent airborne and droplet disease transmission. Cloth masks do not protect the user from airborne illnesses. Surgical masks and N95 masks are somewhat effective. N95 masks provide the most protection; but to truly be protective, one must use a N95 mask that has been properly fit tested and sized to the user. These masks, depending on their construction, may not fold or otherwise easily fit in the SFAK and may have to be carried separately.
Minor Wound Care
Cotton Applicator Swabs – 3” (4) – Applicator swabs are very useful to clean small wounds and apply antibiotic ointment. The swabs can be single or double-sided. Choose the shorter 3-inch length size for a better fit in the SFAK.
Gauze Pad – 3” x 3” (2) – A medium size gauze pad is used to clean and dress minor wounds. Choose 12-ply pads that are individually wrapped.
Adhesive Bandages – A staple of any first aid kit, adhesive bandages cover and protect minor cuts and scrapes. Waterproof bandages are best for SFAKs that are to be used in wilderness or outdoor environments, while quality cloth bandages allow the skin to breathe. The SFAK should have the following sizes and quantities:
- 1” x 3” (4)
- Knuckle (4)
- 1 ¾” x 4” (3)
- 3” x 4” (2)
Compressed Rolled Gauze – 4.5” x 4.1 yds. (1) – A roll of quality gauze can be used to create a pressure bandage for active bleeding and to pack serious extremity wounds with active arterial bleeding. It can also be used to dress larger scrapes and hold splints in place. Choose high-quality gauze with adequate length. Excess gauze can be cut off after the dressing is applied. A compressed, vacuumed sealed gauze roll takes up less space in the SFAK.
Moleskin – 3” x 4” (2) – Moleskin is invaluable to preventing, covering, and treating blisters or raw skin. These bandages are to be custom-cut to size and shape and placed over the affected area.
Burn Dressing – 4” x 4” (1) – These bandages are infused with a hydrogel to cool the burn area, protect the burn, and reduce pain.
Sterile Splinter Needles (2) – Pre-sterilized splinter needles are designed to have a better grip over traditional sewing needles and are very useful in the removal of splinters.
Antibiotic Ointment 0.5 g (4) – AKA Neosporin. Antibiotic ointment is important to prevent minor wounds from developing an infection. This is especially important in austere environments where infection is more likely. A triple antibiotic formula is preferred over any single antibiotic. Some antibiotic ointments are also infused with an analgesic agent to reduce pain but are difficult to find in single-use packets.
Wound Closure Strips (5) – Wound closure strips will aid in the closing of lacerations. It is a temporary measure until the wound can be properly assessed and sutured by a medical professional.
Cloth Medical Tape – 1” x 2.5” – Cloth medical tape has numerous applications in a first aid setting. Cloth tape sticks to skin better than duct or electrical tape and is easier to use in the medical setting. Fold the end over the roll so it can be used quickly and easily when wearing gloves. Additionally, the tape can be compressed or excess tape removed to allow a better fit in the SFAK.
Antiseptic Towellets (2) – Similar to hand sanitizer towellets; they are used for the cleaning and disinfecting of minor wounds. Choose towellets with benzalkonium chloride, or isopropyl alcohol 70%. Larger-size towellets are easier to use than smaller ones.
Optional – Dental Injury Kit (1) – Although technically a minor injury, tooth pain can be severe. These will be especially invaluable in remote or austere environments. A small pre-made kit works best for the SFAK. It should include the following items:
- Temporary Filling – Wax
- Temporary Filling Mixture
- Cotton Pellets
- Cotton Rolls
- Dental Floss
- Tea Bag – Pekoe Tea
- Anbesol/Orasol, Benzocaine 20% packets
Optional – Eye/Skin Wash 1 oz. (1) – Eyewash can be used to irrigate eyes that have a foreign body or toxic substance. It can also be used to irrigate a cut or minor wound. The eyewash may not fit into the SFAK due to space restrictions. In this situation, irrigation can be improvised with a Camelbak or similar water container that has a long tubing system or by simply using copious amounts of water.
Triangle Bandage – 37” x 37” x 52” (1) – AKA cravat. A triangle bandage is one of the most versatile and useful items in the SFAK. They can be used as a sling, swath, clavicle splint, bandage, and to hold a splint in place. Unfortunately, triangle bandages are made with a variety of materials and thus have a wide varying of quality. Military-style triangle bandages are preferred because they are stronger and can be used as a bandage. Civilian-style triangle bandages are slightly larger at 40” x 40” x56” but often cannot be used as a bandage. Unless made of Tyvek, they are not as strong as the military bandage; however, Tyvek cravats are not suitable to use as a bandage. In order to meet ANSI standards, the civilian bandage must be added, as the better military bandages do not meet the ANSI minimum size requirement.
Optional – Elastic Bandage – 3” x 5.5’ (1) – Also known as an ACE wrap, they are a versatile bandage. The primary purpose of the elastic bandage is to wrap sprains and strains. They can also be used to create a pressure bandage for arterial bleeding and are frequently used to hold a splint in place. This bandage may be too large to fit in the SFAK and thus is optional. One can use an elastic trauma bandage, rolled gauze, or a triangle bandage in place of the elastic bandage. They can be unrolled and folded flat for a better fit in the SFAK if necessary.
Safety Pins – 2” (4) – These versatile items aid in securing clothing, splints, slings, swaths, and blankets. They are often packaged with triangle bandages.
Bleeding Control, Major Trauma, and Shock
Trauma Bandage – 4” x 6 ¼” (1) – A trauma bandage is similar to a compress bandage but augmented with an attached tail of muslin or elastic bandage to hold the bandage in place. The military has used this size as the primary trauma bandage that soldiers carry for over 60 years. Newer versions of the trauma bandage such as the Israeli Bandage and the OLAES bandage are designed to be easier to be self-applied, but take up more space in the SFAK as a result. The OLAES bandage also has additional capabilities including an improvised occlusive dressing, wound packing gauze, and a pressure cup that doubles as an eye bandage. Choose the trauma bandage that works best for your situation. Consider carrying an additional trauma bandage on one’s person, a purse, or in an outside pack pocket.
Occlusive Bandage with Vented Chest Seal (1 pair) – These bandages are designed specifically for penetrating chest cavity wounds and sucking chest wounds. The word occlusive means that the bandage is airtight and does not allow air to enter the chest cavity from the wound when inhaling. This is critical to prevent the lung from collapsing and the development of a life-threatening tension pneumothorax. The vent allows air to escape out of the wound when exhaling, reducing the severity of the collapsed lung. Although commonly found in military IFAK kits, they are not a common addition to commercial first aid kits. Hyfin chest seals are preferred. A pair of compact-sized ones will work best in the SFAK.
Mylar Blanket – 54” x 84” (1) – AKA emergency blanket, space blanket, or casualty blanket. The Mylar blanket has one side of a reflective silver color, and the other side is silver, a high visibility color or an earth tone. The reflective side, when placed against the patient will reflect up to 90% of body heat back to the patient. Hypothermia was identified by the US military as a preventable cause of injured soldier death. This blanket is crucial whenever a patient is hypothermic or in shock.
Optional – Tourniquet with Windlass (1) – A tourniquet with a windlass is a proven lifesaver for arterial bleeding of an extremity that cannot be controlled with a trauma dressing or pressure bandage. The CAT tourniquet is the preferred commercial tourniquet. The size of the CAT tourniquet may be too large for the SFAK and thus optional. In that situation, an effective tourniquet with a windlass can be improvised from a triangle bandage, trauma shears, and tape roll, all of which should be in the SFAK.
Place the triangle bandage through the tape roll, tie the tourniquet to the extremity, and attach and tie the scissors to the bandage to use as a windlass. Once the shears are secured to the bandage, twist the scissors until the bleeding is controlled. To secure the shears in place, insert the end of the shears into the roll of tape. The excess tails can be cut off if desired.
Airway and Ventilation
Optional – Nasopharyngeal Airway – 28fr. – with lubricant packet (1) – Asphyxiation caused by airway occlusion of the tongue in unresponsive patients was identified by the US military as one of the leading causes of preventable death in combat. Their solution was both simple and ingenious: the 28 French nasopharyngeal airway (NPA). This device can be easily inserted through the nostril of the injured person with minimal training.
This device can be used on unconscious and semiconscious patients. The tube is designed to rest behind the tongue, allowing air to pass. The NPA is sized by finding the NPA size that fits from the tip of the nose to the earlobe and is inserted with the bevel side toward the nasal septum (middle). The US military determined that the 28 French size NPA would fit nearly all adults. This single size is now found in nearly every commercially produced IFAK kit and is issued to all military personnel. The airway is lubricated with a water-soluble lubricant prior to insertion.
The 28 Fr. NPA should not be used in children due to their smaller size. For children, a smaller size must be used and the proper size determined. They should also be avoided in patients with significant head injuries or basal skull fractures. The item is optional as it does require some minimum training to become familiar with its application. This is a proven lifesaver worth adding to the SFAK.
Optional – Breathing Barrier (1) – This item is required for first aid kits that need to meet minimum ANSI standards. The breathing barrier is either a specialty sheet of plastic or a pocket mask with a one-way valve. The valve allows for rescue breaths to be administered to the patient but prevents any bodily fluids to come up to the user. CPR and rescue breath training is required for correct use. The pocket mask, although better, is too large to fit in most SFAKs. Perform compression-only CPR when indicated if leaving this item behind.
Over-the-Counter (OTC) Medications
The addition of OTC medications to an SFAK will increase the value of the kit greatly. OTC medications can provide relief from many of the most common aches and illnesses. Some OTC medications, in the right setting, can even be lifesaving.
The decision to add medications to a SFAK is dependent on several factors.
- Location is an important consideration when determining if medications should be added to an SFAK. SFAKs used for hiking, camping, bug-out bags, or used in remote environments will be greatly enhanced with the addition of medications. The longer and further away from civilization, the more important medications will be. SFAKs that are stored in the home, and meant for home use only, do not require the addition of medications. SFAKs in commercial buildings or schools should be decided on a case-by-case basis for the inclusion of OTC medications.
- Temperature is another factor in deciding whether to add medications to SFAKs. Most medications come with instructions to store within a specific temperature range, usually 59-86 degrees Fahrenheit. Medications should be a solid tablet or powder whenever possible to minimize melting and damage from heat or cold. Medications stored outside this range will lose their potency faster. SFAKs stored in higher temperature areas such as vehicles or non-climate controlled buildings will need a more frequent rotation of medications to ensure potency. Plastic or foil-lined packets will help to mitigate damage from humidity.
- First Aid Kits are designed for laypersons with little or no medical training. Therefore, only OTC medications should be included in the SFAK. The medications should be in individual packets with the medication information and warnings printed on each packet. These individual packets also make it more difficult to cross-contaminate medications and provide additional protection against accidental consumption by young children. SFAKs with OTC medications will need to be stored in a location and manner to prevent young children from accessing them. Personal or prescription medications should not be kept in a first aid kit.
OTC medications are not danger-free. Many medications can be lethal when taken in large enough doses. Follow the dosing instructions provided by the manufacturer. Confirm that the person is not allergic to the medication or has contradictions to its administration. Pregnant patients are further limited in what OTCs are safe for them to take. Consult a physician if necessary prior to taking any OTC medications.
Generic OTC medications, when compared to brand-name medications, are a cost-effective choice. Generic medications are used by medical facilities all over the globe to reduce costs. Generic medications contain the same quantity and efficacy of the medication as brand-name medications. They also undergo the same mandatory quality control requirements. The only difference between generic and brand-name medications is the dyes and binding agents that are used to make them (i.e. the actual pill).
Over-the-Counter Medications to Include in a Small First Aid Kit
Oral Glucose – 15 g powder or gel (1) – Oral glucose is used to treat hypoglycemia or low blood sugar. Also known as “the sugar shakes”, hypoglycemia occurs when a Type I diabetic patient takes insulin without eating or too much insulin for the amount of food consumed. It also occurs in any person who has a mismatch between their level of exertion and their food intake. This sugar prevents a hypoglycemic person from becoming unresponsive. Care must be taken to make sure the patient is conscious enough to swallow and protect his or her own airway before administering it. It is safe to administer and effective.
Topical Diphenhydramine 2% – 1.17g packets (4) – AKA Benadryl, Calagel. This medication works to relieve itching or rashes caused by an allergic reaction, insect bites, or plants. It works by blocking the histamine that is released during an allergic reaction. It can be used in conjunction with hydrocortisone cream and oral diphenhydramine for increased effect.
Topical Lidocaine 2% (4) – Used in burn cream, burn gel, and insect sting relief medication; Lidocaine is a numbing agent that can reduce pain and discomfort for minor burns or insect stings.
Topical Hydrocortisone 1% (4) – this medication works to relieve itching or rashes caused by an allergic reaction, insect bites, or plants. It is a corticosteroid that works by reducing the inflammation of the affected area. It can be used in conjunction with diphenhydramine cream or oral diphenhydramine for increased effect.
Benzocaine 7.5% / Dextromethorphan 5 mg Lozenge (6) – AKA Cepacol Extra Strength. This lozenge works to reduce the discomfort of coughing and/or a sore throat. Benzocaine is similar to Lidocaine in structure and is a numbing agent. Dextromethorphan is a cough suppressant.
Acetaminophen Tablet 500 mg. (6) – AKA Tylenol, APAP. Acetaminophen is a proven pain and fever reducer. It can be used for various types of pain management. Acetaminophen can be used in conjunction with ibuprofen for improved pain relief. Great care must be taken when using acetaminophen as too much can permanently damage the liver causing serious illness and death. Care must be taken to identify any prescription medications the patient is taking that may contain acetaminophen to avoid a potential overdose. Look for “APAP” on the prescription bottle
Aspirin Tablet 81 mg (8) or 325 mg (2) – Aspirin has been used for over 100 years for general pain management. It is a non-steroidal anti-inflammatory drug (NSAID) that makes it useful against pain caused by inflammation. Aspirin also has anti-platelet properties that make it a lifesaver for a patient who is experiencing an acute myocardial infarction or other acute coronary syndrome. Patients who take aspirin while having an MI or ACS have clinically demonstrated reduced mortality and morbidity rates. Baby or low-dose aspirin of 81 mg is preferred because it is chewable and does not require water to take. However low dose aspirin is very difficult to find in individual packets.
Bismuth Salicylate Tablet 262 mg (8) – AKA Pepto-Bismol, Diotame. This medication works to reduce many common gastrointestinal symptoms including heartburn, gas, indigestion, diarrhea, and nausea. It works by protecting the stomach lining from excess stomach acid and is a mild antacid. As this medication is a salicylate, care should be taken not to use it if the patient has an allergy to aspirin.
Diphenhydramine Tablet 25 mg (6) AKA Benadryl. This medication is an antihistamine that helps to reduce the histamine response in an allergic reaction, anaphylactic reaction, and seasonal allergies. This medication may prove to be a lifesaver if one is in a remote area and experiencing a severe allergic or anaphylactic reaction. It is also the active ingredient in many OTC sleep aids and helps with insomnia.
Ibuprofen Tablet 200 mg (12). AKA Advil, Motrin, IBU. This NSAID is one of the most commonly used medications for general pain management, inflammation, and fever reduction. It can be used in conjunction with acetaminophen to enhance its pain and fever-reducing effects. As an NSAID, it is helpful to reduce pain caused by muscle aches, cramps, or inflammation.
Loperamide Tablet 2 mg (4) – AKA Imodium AD, Diamode. This medication is a proven anti-diarrheal medication. This medicine is essential if one is suddenly stricken with diarrhea and staying home is not an option. Patients experiencing acute diarrhea will need to drink plenty of fluids and consider electrolyte replacement drinks.
Meclizine Tablet 25 mg (4) – AKA Dramamine Less Drowsy. This anti-nausea medication is very helpful when suffering from motion sickness or seasickness. It can be used as either a preventative or treatment measure.
Phenylephrine Tablet 10 mg (6) – This vasoconstrictor is used in many cough and cold medicines including the current formulation of Dayquil and Nyquil. It works by helping to shrink and clear sinus congestion that comes with a sinus infection or head cold.
Small First Aid Kit Maintenance
Once the SFAK has been built and deployed, it will need to be inspected regularly. The SFAK should be routinely examined to ensure all equipment is present and available. Consider having a list of items on hand to verify that all items are present. Items that have expiration dates should be replaced as needed. Each time the SFAK is used, it should be:
- Inspected for any potential biohazard contamination
- Cleaned as needed
- Have all used or contaminated items replaced.
- Have all items confirmed as present in the SFAK
- Returned to its original deployment location
This will ensure the SFAK is always ready to go when it is needed most.
Start Today and Make Sure You Have What You Need in an Emergency
A Small First Aid Kit (Small First Aid Kit) is a critical piece of a comprehensive emergency response plan. The SFAK will provide the user with the ability to provide first aid for the majority of issues that may occur. An investment in a well-stocked, well-maintained SFAK takes up little room and ensures life-saving first aid equipment is close at hand.