Anaesthesia, 1977, Volume 32, pages 179-188
Thoughts on immediate care Anaesthetists are being increasingly called upon to give immediate treatment for various life-threatening conditions. Thisfeature of short papers by invited experts is designed to facilitate the proper management of patients in such circumstances.
Medical equipment for an accident team R . W.GABRIEL
Medical equipment provided for emergency use outside the hospital should be easily portable. This imposes severe restrictions on the size and weight of each container in order that any doctor can carry one-if necessary over a long distance. Division into more than one pack will therefore be necessary but each must be selfsufficient for the initial management of a patient. For instance, the surgical pack should include intravenous giving sets, fluids, syringes and anaesthetic agents, e.g. ketamine. It is important that all categories of pack should be taken to the scene at the outset, including the surgical sets. A patient inextricably trapped in the presence of advancing fire or flood would have no hope if amputation could not be performed at once. Requirements for individual hospital teams will vary to some extent according to particular local hazards and also according to the speed of availability and the equipment of ambulance and fire services. For a scheme based on a hospital such as the Luton and Dunstable, serving an area of 10 miles radius, it is considered safest and quickest for the doctor(s) to be taken to the scene in a police car. Since the other rescue services would also arrive quickly the equipment described does not include oxygen, Entonox (BOC 50% nitrous oxide and 50% oxygen mixture), splints, spinal supports, blankets, cutting gear, fire extinguishers or flood lights.
Finch & Nancekievill proposed that protective clothing should be worn with some first aid items in the pockets,’ and where access is severely restricted (Moorgate, 1975) such a garment is clearly advantageous. The remaining equipment may be divided into resuscitation, surgical and drug packs-all light and easy to carry. Should there be larger numbers of casualties reserves of the commonly used items and intravenous fluids are provided in a larger container. The resuscitation pack is the only one required to be carried by a doctor all the time and there are therefore, more of these than the surgical and drug packs.
The Luton and Dunstable Hospital equipment Each pack is clearly labelled with its identifying letter, the name of the hospital, and the words ‘Medical Officer’ to aid recognition. The drugs case is thus rendered slightly anonymous to reduce the likelihood of theft (Fig. 1). There are two quite separate sets of equipment in case two accidents occur simultaneously or, in the event of a motorway pile-up, when two small groups would be more usefully employed than one larger group based at one point. Soft carrying bags were chosen for two of the units in the interest of lightness, but this does pose the problem of packing and of locating items near the bottom. Rigid cases may be used as an alternative to give more space and to prevent squeezing the contents.
Richard W. Gabriel, MB, BChir, FFARCS, Consultant Anaesthetist, Luton and Dunstable Hospital, Luton, Bedfordshire.
179
180
R. W. Gabriel
Fig. 1. The set of equipment.
The resuscitation bag Label letter: A . Weight: 6 kg. Size: 470 x 170 x 270 mm
This is essentially for dealing with airway problems and far setting up intravenous fluids (Fig. 2). The Laerdal ‘jet suction unit’ is efficient yet remarkably compact. Although an Ambu resuscitator is used the Laerdal ‘resusci folding bag’ would arguably be better owing to its size and ease of cleaning. A cervical collar is included for use if a neck injury is suspected.
Baxter intravenous giving sets with the ‘pumping’ type of drip chamber are supplied.’ The accessories needed for setting up an infusion are packed into the box of each set throughout this scheme. They are held onto the inner card with adhesive tape to prevent them scattering when the box is opened. There are two different cannulae familiar to the doctors involved. A syringe, container for blood for cross-matching, a Typenex identification wrist band label, swabs, adhesive tape and a venous tourniquet are also included. The
Fig. 2. View of Resuscitation bag shown after removing the Ambu resuscitator.
Medical equipment for an accident team
181
Flg. 3. The wallet with intubation items.
Fig. 4. View of Surgical bag after removing the polyfusor of Hartmann’s and one packet of syringes and needles.
182
R.
W.Gabriel
Fig. 5. Amputation instruments.
intravenous solutions in the bag are Hartmann’s 500 ml and Haemaccel500 ml. A large padded wallet (Ambu ‘intubation insert’) contains all the intubation items (Fig. 3). Endotracheal tubes areeach cut to a standard length based on 15 cm for the 5.0 mm size, with increments of 1.0cm for each 0.5 mm difference in diameter and each is fitted with a connector. Malleable introducers (stilettes) are included for a difficult intubation and nasopharyngeal airways for any patient in whom the use of the oral type is impossible. An Abelson cricothyrotomy cannula is provided for any patient who would otherwise be considered for a tracheo~tomy.~ For the management of patients
who are found to be too restless without recourse to sedation of some kind there are ampoules of diazepam and pentazocine together with syringes, needles, adhesive strapping and swabs. These are provided in case the drug pack should not be immediately to hand. The surgical bag Label letter: B. Weight: 6 kg. Size: 470 x 170 x 270 mm Two plastic groundsheets are includedand those can be used for spreading out the equipment if the ground is wet or muddy. This bag (Fig. 4) contains instruments for amputation (Fig. 5 )
Fig. 6. Cut-down instruments.
Medical equipment for an accident team
183
Fig. 7. Drug case.
and intravenous cut-down (Fig. 6) which are packed separately. Each set is in a roll of material so thick that if opened on an uneven surface it will remain flat and the instruments will remain in their slots rather than collect into a central heap (Fig. 4). A dressing towel and swabs are included. After sterilising the roll, a pre-packed sterile disposable scalpel and sterile sutures are stuck onto the envelope with adhesive tape before placing in the outer wrapping. No skin sutures are needed as the operative site will require subsequent review under sterile conditions in hospital. For an intravenous cut-down one of the cannulae packed with the giving set would be used; additional types of cannulae are, therefore, not required. The use of a pneumatic tourniquet will control haemorrhage both during an amputa-
tion and during transport back to hospitalthe selection of surgical instruments is thus considerably r e d ~ c e d For . ~ situations in which a conventional amputation saw cannot be used it has been previously suggested that an osteotome and hammer be used.’ Alternatively a Gigli saw may be used, with cholecystectomy forceps to introduce the bladeS and these instruments are included in this scheme, plus some spare blades. To aid introduction of the chest drain, a scalpel is packed with the Heimlich valve, together with some swabs and adhesive tape. A sterile disposable urine bag may then be attached if desired. Two packs of abdominal swabs are included and for dressing the wound some ‘Surgipads’ are packed in an envelope with the bandages (Fig. 4).
184
R. W.Gabriel
Fig. 8. Spares box.
In order to make this bag independent for surgical procedures in the event of separation from the rest of the equipment the following are also included: 2 intravenous giving sets, intravenous fluids (Hartmanns 500 ml and Haemaccel 500 ml), drugs (diazepam, pentazocine, ketamine and atropine) syringes and needles and a cricothyrotomy cannula. Drug case
Label letter: D. Weight: 6 kg. Size: 420 x 305 x 210 mm
A general practitioner’s case is used for the drugs (Fig. 7). Syringes, needles, adhesive tape and labels are included. Tubunics of papaveretum are additional to those carried in the doctor’s pockets. Although a portable anaesthetic machine could be caUed for from the hospital it is not a part of this immediate scheme as there is a choice of intravenous agents plus lignocaine. Entonox would also be available from the ambulance service.
Medical equipment for an accident team
185
Fig. 9. Spares box shown after the top tray is removed.
Spares box
Label letter: S . Weight: 22 kg. Size: 460 x 350 x 410 mm This container is designed to provide reserves of the most commonly used items (Figs 8 & 9). It is thus larger and considerably heavier than the other units and an assistant may be required to help to carry it some distance. Lights
TWO Pifco Litemaster battery lanterns were chosen for night work. Summary
Equipment assembled for use by an accident
team is described. The aim is to provide independent lightweight units that a medical practitioner can easily carry yet which will contain the essential items which he may need. A complete list of equipment is included. Compromise is inevitable which makes planning difficult particularly if action is seldom needed. Some schemes may need alternative equipment and individual preferences must also be taken into account.
Key words
EQUIPMENT; emergency teams.
186
R.
W.Gabriel Acknowledgments
The author wishes to thank Dr P.O. Pyle, Consultant Anaesthetist, Luton and Dunstable Hospital, for his encouragement and many helpful ideas, Dr T.M. Moles, Consultant Anaesthetist, Southampton General Hospital, for his constructive suggestions and also Mr J. Harrison, ARPS, and the Department of Medical Illustration, Luton and Dunstable Hospital, and Mrs P. Tisbury for secretarial assistance.
Appendix of equipment lists One of each item is supplied unless otherwise indicated. Resuscitation bag Carrying bag (Ambu-ever ready pack, large). Laerdal ‘jet suction unit’ (Vickers Medical). Ambu resuscitator Ambu E valve (anaesthesia t~-22/15). Masks: size I and 4 (McKesson-flat rim type). ‘Quick-Clip’ cervical collar (Fermo Washington). Suction catheters: 2 x 12 FG, 2 x 8 FG (Portex): 2 x 5 FG (Warne). Pharyngeal suckers: 2 x intermediate size (Argyle). 2 x infusion sets with pumping chambers (Baxter) each containing: Medicut cannula 18 g (Sherwood), Venflon cannula 17 g (Everett), 10 ml syringe (Brunswick), 1 m of 25 mm adhesive tape (wound onto the syringe container), Blood group bottle, 2 x miniswabs, 5 x gauze swabs 100 x 100mm, Venous tourniquet (rubber tube +clamp) and a ’Typenex’ identification label (Fenwal). Hartmanns solution 500 ml (Boots, polyfusor) and Haemaccel solution 500 ml (Hoechst). 5 x record cards. 2 xpolythene bags (for dirty equipment). Inner intubation wallet: (Ambu ‘intubation insert’ without contents) containing: Adult laryngoscope (Penlon, plastic type), Infant laryngoscope(Penlon, plastic type), Endotracheal tubes (red rubber type-each fitted with 15 mm BOC connector). Cuffed: 9.5 mm, 8.0 mm and 6.0 mm. Uncuffed: 5.0 mm, 4.0 mm and neonatal (Warne 12 FG), 2xcatheter mounts (each fitted with 15 mm elbow and
+
22 mm BOC connector), Oral airways (sizes 1, 2 and 3), Nasopharyngeal airways (Goldman t y p e 4 . R . Bard,-26 FG and 30 FG), Lignocaine ointment, Magill’s intubatingforceps, Open-wove bandage (50 mm), Adhesiue tape* (1 m of 25 mm wound onto a suitable spool), Syringe (20 ml) with Record nozzle for use as cuff inflator, 2 x Plastic clamps (‘All-purpose clamp’ with ends cut o f f 4 . R . Bard), 20x Gauze swabs (100x 100 mm), Abelson cricothyrotomy cannula (Becton Dickinson), Malleable introducers (Adult Talley hardened type and M&IE Child type), 5 x Identification bracelets, Fibre tipped pen, 6 x Syringes (2 ml) and 21 g needle (Brunswick), 2xButterfly needles (21 INT Abbott), 10 x Miniswabs, Scissors (210 mm Ward Crank Bend, Rocket Instrument Co.), 10 x Diazepam (Valium) ampoules (10 mg/2 ml) and 1OxPentazocine (Fortral) ampoules 60 mg/2 ml. Surgical bag Carrying bag (Ambu-ever ready pack, large). Surgical sets (amputation set, cut-down set: see separate lists). Swabs and dressings (2 x 5 abdominal swabs, 5 x ‘Surgipad’ 200 x 200 mm (Johnson & Johnson), 2 x crepe bandage 150 nun and 2 x crepe bandage 100 mm). Pneumatic tourniquet with 865 mm Velcro cuff (Zimmer Orthopaedic). Trocur catheter 16 FG 255 mm long (Argyle). Heimlich valve (Becton Dickinson) with 5 x swabs 100x100 mm, scalpel + B blade and 1 m of adhesive tape. Uribag (Meredith). Abelson cricothyrotomy cannula (Becton Dickinson). Aneroid sphygmomanometer (Accoson, duplex model with Velcro cuff). 2 x Infusion sets and cannulae, etc. Hartmann’s 500 ml (Boot’s polyfusor) and Haemaccel 500 ml (Hoechst). 2 x Cannulae packs each containing: 2 x Venflon cannula 17 g, 2 xButterfly needle (21 INT Abbott), 2 x 2 ml syringes and needle (21 g Brunswick) and 1 m adhesive tape. Ampoule container containing: 5 x diazepam
* The adhesive tape used throughout is masking tape as it adheres well, yet can readily be torn without the need for scissors.
Medical equipment for an accident team ampoules (10 mg/2 ml) and 5 xpentazocine ampoules (60 mg/2 mi). Ampoule container containing: 2 x ketamine 5 ml (100 mglml) and 2 x atropine 0.6 mg. 5 x Record cards. Fibre tipped pen. Scissors. 2 x Plastic groundsheets 6 m square.
187
5 x Swabs (100 x 100 mm). Inner wrap: small ‘Sterifield’ 600 x 600 mm. Outer wrap: bag, Code K. Protective wrap: bag, Code K. Disposable Gillette scalpel with D blade. Plain No. 2/0 catgut (No. 103).
Drug case Amputation set Amputation saw-Army pattern (Down Bros GT630-01-R). Gigli saw: 1 pair handles (Down Bros 5351). 3 blades-Swedish model (Down Bros 5350-01). Amputation knife with 150 mm blade (Rocket R3.700). Moynihan’s cholecystectomy forceps (Rocket R2.782). 2 x KeIly Halstead curved artery forceps (Rocket R1.605). 2 x Miles Phillips curved artery forceps (Rocket R1.659). 2 x Spencer Wells artery forceps (Rocket R1.860). Bonney’s toothed dissecting forceps (Rocket R1.446). Mayo Hegar needle holder (Rocket R2.274). Mayo straight scissors (Rocket Rl.161). Green dressing towel (900 x 900 mm). 10 x Swabs (150 x 100 mm). Inner wrap: small ‘Sterifield’ 600 x 600 mm. Outer wrap: bag, Code H . Protective wrap: bag, Code H. 2 x Disposable Gillette scalpels with B blade. 2 x Chromic No. I catgut (No. 115) and 2 x chromic No. 0 catgut on round body needle (No. 450). Cut-down set Halstead non-toothed straighl mosquito jorceps (Rocket R1.594). Halstead non-toothed curved mosquito forceps (Rocket R1.595). Treves jine-toothed dissecting forceps (Rocket R1.487). Blunt single hook (Rocket R2.001). Aneurysm needle (Rocket R2.410). Fine pointed straight iris scissors (Rocket R1.102). Green dressing towel (600 x 600 mm).
Carrying case: ‘Beaumont’ doctor’s bag (Down Bros.). Drugs: 10 xpethidine 50 mg, 10 xpethidine 100 mg, 20 xpapaveretum 20 mg, 12 xpapaveretum 30 mg/ml (‘Tubunic’), 10xatropine 0.6 mg, 5 x ketamine 5 ml(100 mg/ml), 5 x aminophylline 10 ml, 5 x lignocaine 1% 20 ml, 10 x diazepam 10 mg, 5 x methohexitone 100 mg, 5 xsuxamethonium 2 ml, 10xpancuronium 2 ml, 2 x dextrose 50% 20 ml, 2 x hydrocortisone 100 mg, 5 x naloxone 0.4 mg and 10 x water 10 ml. 10 x Ampoule files. 5 x Chloromycetin eye ointment tubes. Syringes: 2 x 20 ml, 5 x 10 ml, 10 x 5 ml and 30 x 2 ml. Needles: 50 x21 g, 1 0 x 2 3 g, 5 xmixing, 5 xAbbott Butterfly needle (21 INT) and 5 x Venflon cannula 17 g. 20 x Tie-on labels. 2 x Indelible pencils. 5 x 25 mm Adhesive tape. 50 x Gauze swabs 100 x 100 mm. 50 x Miniswabs. Spares box Container = Pharmacy transit box (W.C.B. Containers Lt d .). Jet suction unit. Laryngoscope (adult). 2 x Masks, size 4. Oral airways ( 5 x size 3 and 5 x size 2). Nasopharyngeal airways ( 2 x 26 FG and 2 x 30 FG). Endotracheal tubes with connectors (cuffed : 3 ~ 9 . 5 ,3 x 8.0 and 2 x 6.0 mm, uncuffed: 1 x 5.0, 1 x 4.0, 1 x neonate). 5 x Catheter mounts. Cuffinflating syringe. 6 x Plastic clamps. 6 x Cotton bandages. 2 x Spare cannisters for suction unit. 20 x Syringes (2 ml) with 21 g needle.
188
R. W.Gabriel
10 xButterfly needles (21 INT). 20 x Miniswabs. 20 x Adhesive tape. 20 x Diazepam ampoules 10 mg/2 ml. 20 xpentazocine ampoules 60 mg/2 ml. 50 x Gauze swabs. Scissors. 2 x Lignocaine ointment. 10 x Polythene bags. Abelson cricothyrotomy cannula. 20 x Record cards. 20 x Identification bracelets. 2 x Fibre tipped pens. 5 x Pharyngeal suckers. Suction Catheters (10 x 12 FG and 5 x 8 FG). 5 x Trocar Catheters 16 FG 255 mm. 5 x Heimlich valves with 5 x swabs (100 x 100 mm) scalpel with B blade and 1 m adhesive tape. 5 x Uribags.
10 x Infusion sets. Each containing cannulae, syringe, etc. 10 x Hartmann’s 500 ml (Baxter, viaflex). 8 x Haemaccel 500 ml (Hoechst).
Lights 2 x Pifco Litemaster battery lanterns (Halfords).
References 1 . FINCH,P., NANCEKIEVILL, D. (1975) The role of
2. 3.
4. 5.
hospital mobile medical teams at a major accident. British Journal of Hospital Medicine, 13, 601. SNOOK,R. (1973) Medical aid at road accidentsequipment. U p h t e , 6, 916. ABELSON, L. (1959) Cricothyrotomy needle for the prevention of obstructive asphyxia (preliminary report). The Jewish Memorial Hospital Bulletin, 4.52. HINDLE, J.F. (1972) Personal communication. MOLES, T.M.(1975) Personal communication.
Thoughts on immediate care Anaesthetists are being increasingly called upon to give immediate treatment for various life-threatening conditions. Thisfeature of short papers by invited experts is designed to facilitate the proper management of patients in such circumstances.
Medical equipment for an accident team R . W.GABRIEL
Medical equipment provided for emergency use outside the hospital should be easily portable. This imposes severe restrictions on the size and weight of each container in order that any doctor can carry one-if necessary over a long distance. Division into more than one pack will therefore be necessary but each must be selfsufficient for the initial management of a patient. For instance, the surgical pack should include intravenous giving sets, fluids, syringes and anaesthetic agents, e.g. ketamine. It is important that all categories of pack should be taken to the scene at the outset, including the surgical sets. A patient inextricably trapped in the presence of advancing fire or flood would have no hope if amputation could not be performed at once. Requirements for individual hospital teams will vary to some extent according to particular local hazards and also according to the speed of availability and the equipment of ambulance and fire services. For a scheme based on a hospital such as the Luton and Dunstable, serving an area of 10 miles radius, it is considered safest and quickest for the doctor(s) to be taken to the scene in a police car. Since the other rescue services would also arrive quickly the equipment described does not include oxygen, Entonox (BOC 50% nitrous oxide and 50% oxygen mixture), splints, spinal supports, blankets, cutting gear, fire extinguishers or flood lights.
Finch & Nancekievill proposed that protective clothing should be worn with some first aid items in the pockets,’ and where access is severely restricted (Moorgate, 1975) such a garment is clearly advantageous. The remaining equipment may be divided into resuscitation, surgical and drug packs-all light and easy to carry. Should there be larger numbers of casualties reserves of the commonly used items and intravenous fluids are provided in a larger container. The resuscitation pack is the only one required to be carried by a doctor all the time and there are therefore, more of these than the surgical and drug packs.
The Luton and Dunstable Hospital equipment Each pack is clearly labelled with its identifying letter, the name of the hospital, and the words ‘Medical Officer’ to aid recognition. The drugs case is thus rendered slightly anonymous to reduce the likelihood of theft (Fig. 1). There are two quite separate sets of equipment in case two accidents occur simultaneously or, in the event of a motorway pile-up, when two small groups would be more usefully employed than one larger group based at one point. Soft carrying bags were chosen for two of the units in the interest of lightness, but this does pose the problem of packing and of locating items near the bottom. Rigid cases may be used as an alternative to give more space and to prevent squeezing the contents.
Richard W. Gabriel, MB, BChir, FFARCS, Consultant Anaesthetist, Luton and Dunstable Hospital, Luton, Bedfordshire.
179
180
R. W. Gabriel
Fig. 1. The set of equipment.
The resuscitation bag Label letter: A . Weight: 6 kg. Size: 470 x 170 x 270 mm
This is essentially for dealing with airway problems and far setting up intravenous fluids (Fig. 2). The Laerdal ‘jet suction unit’ is efficient yet remarkably compact. Although an Ambu resuscitator is used the Laerdal ‘resusci folding bag’ would arguably be better owing to its size and ease of cleaning. A cervical collar is included for use if a neck injury is suspected.
Baxter intravenous giving sets with the ‘pumping’ type of drip chamber are supplied.’ The accessories needed for setting up an infusion are packed into the box of each set throughout this scheme. They are held onto the inner card with adhesive tape to prevent them scattering when the box is opened. There are two different cannulae familiar to the doctors involved. A syringe, container for blood for cross-matching, a Typenex identification wrist band label, swabs, adhesive tape and a venous tourniquet are also included. The
Fig. 2. View of Resuscitation bag shown after removing the Ambu resuscitator.
Medical equipment for an accident team
181
Flg. 3. The wallet with intubation items.
Fig. 4. View of Surgical bag after removing the polyfusor of Hartmann’s and one packet of syringes and needles.
182
R.
W.Gabriel
Fig. 5. Amputation instruments.
intravenous solutions in the bag are Hartmann’s 500 ml and Haemaccel500 ml. A large padded wallet (Ambu ‘intubation insert’) contains all the intubation items (Fig. 3). Endotracheal tubes areeach cut to a standard length based on 15 cm for the 5.0 mm size, with increments of 1.0cm for each 0.5 mm difference in diameter and each is fitted with a connector. Malleable introducers (stilettes) are included for a difficult intubation and nasopharyngeal airways for any patient in whom the use of the oral type is impossible. An Abelson cricothyrotomy cannula is provided for any patient who would otherwise be considered for a tracheo~tomy.~ For the management of patients
who are found to be too restless without recourse to sedation of some kind there are ampoules of diazepam and pentazocine together with syringes, needles, adhesive strapping and swabs. These are provided in case the drug pack should not be immediately to hand. The surgical bag Label letter: B. Weight: 6 kg. Size: 470 x 170 x 270 mm Two plastic groundsheets are includedand those can be used for spreading out the equipment if the ground is wet or muddy. This bag (Fig. 4) contains instruments for amputation (Fig. 5 )
Fig. 6. Cut-down instruments.
Medical equipment for an accident team
183
Fig. 7. Drug case.
and intravenous cut-down (Fig. 6) which are packed separately. Each set is in a roll of material so thick that if opened on an uneven surface it will remain flat and the instruments will remain in their slots rather than collect into a central heap (Fig. 4). A dressing towel and swabs are included. After sterilising the roll, a pre-packed sterile disposable scalpel and sterile sutures are stuck onto the envelope with adhesive tape before placing in the outer wrapping. No skin sutures are needed as the operative site will require subsequent review under sterile conditions in hospital. For an intravenous cut-down one of the cannulae packed with the giving set would be used; additional types of cannulae are, therefore, not required. The use of a pneumatic tourniquet will control haemorrhage both during an amputa-
tion and during transport back to hospitalthe selection of surgical instruments is thus considerably r e d ~ c e d For . ~ situations in which a conventional amputation saw cannot be used it has been previously suggested that an osteotome and hammer be used.’ Alternatively a Gigli saw may be used, with cholecystectomy forceps to introduce the bladeS and these instruments are included in this scheme, plus some spare blades. To aid introduction of the chest drain, a scalpel is packed with the Heimlich valve, together with some swabs and adhesive tape. A sterile disposable urine bag may then be attached if desired. Two packs of abdominal swabs are included and for dressing the wound some ‘Surgipads’ are packed in an envelope with the bandages (Fig. 4).
184
R. W.Gabriel
Fig. 8. Spares box.
In order to make this bag independent for surgical procedures in the event of separation from the rest of the equipment the following are also included: 2 intravenous giving sets, intravenous fluids (Hartmanns 500 ml and Haemaccel 500 ml), drugs (diazepam, pentazocine, ketamine and atropine) syringes and needles and a cricothyrotomy cannula. Drug case
Label letter: D. Weight: 6 kg. Size: 420 x 305 x 210 mm
A general practitioner’s case is used for the drugs (Fig. 7). Syringes, needles, adhesive tape and labels are included. Tubunics of papaveretum are additional to those carried in the doctor’s pockets. Although a portable anaesthetic machine could be caUed for from the hospital it is not a part of this immediate scheme as there is a choice of intravenous agents plus lignocaine. Entonox would also be available from the ambulance service.
Medical equipment for an accident team
185
Fig. 9. Spares box shown after the top tray is removed.
Spares box
Label letter: S . Weight: 22 kg. Size: 460 x 350 x 410 mm This container is designed to provide reserves of the most commonly used items (Figs 8 & 9). It is thus larger and considerably heavier than the other units and an assistant may be required to help to carry it some distance. Lights
TWO Pifco Litemaster battery lanterns were chosen for night work. Summary
Equipment assembled for use by an accident
team is described. The aim is to provide independent lightweight units that a medical practitioner can easily carry yet which will contain the essential items which he may need. A complete list of equipment is included. Compromise is inevitable which makes planning difficult particularly if action is seldom needed. Some schemes may need alternative equipment and individual preferences must also be taken into account.
Key words
EQUIPMENT; emergency teams.
186
R.
W.Gabriel Acknowledgments
The author wishes to thank Dr P.O. Pyle, Consultant Anaesthetist, Luton and Dunstable Hospital, for his encouragement and many helpful ideas, Dr T.M. Moles, Consultant Anaesthetist, Southampton General Hospital, for his constructive suggestions and also Mr J. Harrison, ARPS, and the Department of Medical Illustration, Luton and Dunstable Hospital, and Mrs P. Tisbury for secretarial assistance.
Appendix of equipment lists One of each item is supplied unless otherwise indicated. Resuscitation bag Carrying bag (Ambu-ever ready pack, large). Laerdal ‘jet suction unit’ (Vickers Medical). Ambu resuscitator Ambu E valve (anaesthesia t~-22/15). Masks: size I and 4 (McKesson-flat rim type). ‘Quick-Clip’ cervical collar (Fermo Washington). Suction catheters: 2 x 12 FG, 2 x 8 FG (Portex): 2 x 5 FG (Warne). Pharyngeal suckers: 2 x intermediate size (Argyle). 2 x infusion sets with pumping chambers (Baxter) each containing: Medicut cannula 18 g (Sherwood), Venflon cannula 17 g (Everett), 10 ml syringe (Brunswick), 1 m of 25 mm adhesive tape (wound onto the syringe container), Blood group bottle, 2 x miniswabs, 5 x gauze swabs 100 x 100mm, Venous tourniquet (rubber tube +clamp) and a ’Typenex’ identification label (Fenwal). Hartmanns solution 500 ml (Boots, polyfusor) and Haemaccel solution 500 ml (Hoechst). 5 x record cards. 2 xpolythene bags (for dirty equipment). Inner intubation wallet: (Ambu ‘intubation insert’ without contents) containing: Adult laryngoscope (Penlon, plastic type), Infant laryngoscope(Penlon, plastic type), Endotracheal tubes (red rubber type-each fitted with 15 mm BOC connector). Cuffed: 9.5 mm, 8.0 mm and 6.0 mm. Uncuffed: 5.0 mm, 4.0 mm and neonatal (Warne 12 FG), 2xcatheter mounts (each fitted with 15 mm elbow and
+
22 mm BOC connector), Oral airways (sizes 1, 2 and 3), Nasopharyngeal airways (Goldman t y p e 4 . R . Bard,-26 FG and 30 FG), Lignocaine ointment, Magill’s intubatingforceps, Open-wove bandage (50 mm), Adhesiue tape* (1 m of 25 mm wound onto a suitable spool), Syringe (20 ml) with Record nozzle for use as cuff inflator, 2 x Plastic clamps (‘All-purpose clamp’ with ends cut o f f 4 . R . Bard), 20x Gauze swabs (100x 100 mm), Abelson cricothyrotomy cannula (Becton Dickinson), Malleable introducers (Adult Talley hardened type and M&IE Child type), 5 x Identification bracelets, Fibre tipped pen, 6 x Syringes (2 ml) and 21 g needle (Brunswick), 2xButterfly needles (21 INT Abbott), 10 x Miniswabs, Scissors (210 mm Ward Crank Bend, Rocket Instrument Co.), 10 x Diazepam (Valium) ampoules (10 mg/2 ml) and 1OxPentazocine (Fortral) ampoules 60 mg/2 ml. Surgical bag Carrying bag (Ambu-ever ready pack, large). Surgical sets (amputation set, cut-down set: see separate lists). Swabs and dressings (2 x 5 abdominal swabs, 5 x ‘Surgipad’ 200 x 200 mm (Johnson & Johnson), 2 x crepe bandage 150 nun and 2 x crepe bandage 100 mm). Pneumatic tourniquet with 865 mm Velcro cuff (Zimmer Orthopaedic). Trocur catheter 16 FG 255 mm long (Argyle). Heimlich valve (Becton Dickinson) with 5 x swabs 100x100 mm, scalpel + B blade and 1 m of adhesive tape. Uribag (Meredith). Abelson cricothyrotomy cannula (Becton Dickinson). Aneroid sphygmomanometer (Accoson, duplex model with Velcro cuff). 2 x Infusion sets and cannulae, etc. Hartmann’s 500 ml (Boot’s polyfusor) and Haemaccel 500 ml (Hoechst). 2 x Cannulae packs each containing: 2 x Venflon cannula 17 g, 2 xButterfly needle (21 INT Abbott), 2 x 2 ml syringes and needle (21 g Brunswick) and 1 m adhesive tape. Ampoule container containing: 5 x diazepam
* The adhesive tape used throughout is masking tape as it adheres well, yet can readily be torn without the need for scissors.
Medical equipment for an accident team ampoules (10 mg/2 ml) and 5 xpentazocine ampoules (60 mg/2 mi). Ampoule container containing: 2 x ketamine 5 ml (100 mglml) and 2 x atropine 0.6 mg. 5 x Record cards. Fibre tipped pen. Scissors. 2 x Plastic groundsheets 6 m square.
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5 x Swabs (100 x 100 mm). Inner wrap: small ‘Sterifield’ 600 x 600 mm. Outer wrap: bag, Code K. Protective wrap: bag, Code K. Disposable Gillette scalpel with D blade. Plain No. 2/0 catgut (No. 103).
Drug case Amputation set Amputation saw-Army pattern (Down Bros GT630-01-R). Gigli saw: 1 pair handles (Down Bros 5351). 3 blades-Swedish model (Down Bros 5350-01). Amputation knife with 150 mm blade (Rocket R3.700). Moynihan’s cholecystectomy forceps (Rocket R2.782). 2 x KeIly Halstead curved artery forceps (Rocket R1.605). 2 x Miles Phillips curved artery forceps (Rocket R1.659). 2 x Spencer Wells artery forceps (Rocket R1.860). Bonney’s toothed dissecting forceps (Rocket R1.446). Mayo Hegar needle holder (Rocket R2.274). Mayo straight scissors (Rocket Rl.161). Green dressing towel (900 x 900 mm). 10 x Swabs (150 x 100 mm). Inner wrap: small ‘Sterifield’ 600 x 600 mm. Outer wrap: bag, Code H . Protective wrap: bag, Code H. 2 x Disposable Gillette scalpels with B blade. 2 x Chromic No. I catgut (No. 115) and 2 x chromic No. 0 catgut on round body needle (No. 450). Cut-down set Halstead non-toothed straighl mosquito jorceps (Rocket R1.594). Halstead non-toothed curved mosquito forceps (Rocket R1.595). Treves jine-toothed dissecting forceps (Rocket R1.487). Blunt single hook (Rocket R2.001). Aneurysm needle (Rocket R2.410). Fine pointed straight iris scissors (Rocket R1.102). Green dressing towel (600 x 600 mm).
Carrying case: ‘Beaumont’ doctor’s bag (Down Bros.). Drugs: 10 xpethidine 50 mg, 10 xpethidine 100 mg, 20 xpapaveretum 20 mg, 12 xpapaveretum 30 mg/ml (‘Tubunic’), 10xatropine 0.6 mg, 5 x ketamine 5 ml(100 mg/ml), 5 x aminophylline 10 ml, 5 x lignocaine 1% 20 ml, 10 x diazepam 10 mg, 5 x methohexitone 100 mg, 5 xsuxamethonium 2 ml, 10xpancuronium 2 ml, 2 x dextrose 50% 20 ml, 2 x hydrocortisone 100 mg, 5 x naloxone 0.4 mg and 10 x water 10 ml. 10 x Ampoule files. 5 x Chloromycetin eye ointment tubes. Syringes: 2 x 20 ml, 5 x 10 ml, 10 x 5 ml and 30 x 2 ml. Needles: 50 x21 g, 1 0 x 2 3 g, 5 xmixing, 5 xAbbott Butterfly needle (21 INT) and 5 x Venflon cannula 17 g. 20 x Tie-on labels. 2 x Indelible pencils. 5 x 25 mm Adhesive tape. 50 x Gauze swabs 100 x 100 mm. 50 x Miniswabs. Spares box Container = Pharmacy transit box (W.C.B. Containers Lt d .). Jet suction unit. Laryngoscope (adult). 2 x Masks, size 4. Oral airways ( 5 x size 3 and 5 x size 2). Nasopharyngeal airways ( 2 x 26 FG and 2 x 30 FG). Endotracheal tubes with connectors (cuffed : 3 ~ 9 . 5 ,3 x 8.0 and 2 x 6.0 mm, uncuffed: 1 x 5.0, 1 x 4.0, 1 x neonate). 5 x Catheter mounts. Cuffinflating syringe. 6 x Plastic clamps. 6 x Cotton bandages. 2 x Spare cannisters for suction unit. 20 x Syringes (2 ml) with 21 g needle.
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10 xButterfly needles (21 INT). 20 x Miniswabs. 20 x Adhesive tape. 20 x Diazepam ampoules 10 mg/2 ml. 20 xpentazocine ampoules 60 mg/2 ml. 50 x Gauze swabs. Scissors. 2 x Lignocaine ointment. 10 x Polythene bags. Abelson cricothyrotomy cannula. 20 x Record cards. 20 x Identification bracelets. 2 x Fibre tipped pens. 5 x Pharyngeal suckers. Suction Catheters (10 x 12 FG and 5 x 8 FG). 5 x Trocar Catheters 16 FG 255 mm. 5 x Heimlich valves with 5 x swabs (100 x 100 mm) scalpel with B blade and 1 m adhesive tape. 5 x Uribags.
10 x Infusion sets. Each containing cannulae, syringe, etc. 10 x Hartmann’s 500 ml (Baxter, viaflex). 8 x Haemaccel 500 ml (Hoechst).
Lights 2 x Pifco Litemaster battery lanterns (Halfords).
References 1 . FINCH,P., NANCEKIEVILL, D. (1975) The role of
2. 3.
4. 5.
hospital mobile medical teams at a major accident. British Journal of Hospital Medicine, 13, 601. SNOOK,R. (1973) Medical aid at road accidentsequipment. U p h t e , 6, 916. ABELSON, L. (1959) Cricothyrotomy needle for the prevention of obstructive asphyxia (preliminary report). The Jewish Memorial Hospital Bulletin, 4.52. HINDLE, J.F. (1972) Personal communication. MOLES, T.M.(1975) Personal communication.
