Okay, maybe that last post was a bit flip. The important question about first aid is, what situations are you expecting and what do you plan to do about them? There is something of an inverse curve describing first aid/medical emergencies, relating frequency to acuity. At one end, you have high-frequency, low acuity events, like a cut finger, and on the other end you have low-frequency, high acuity events, like a broken neck. This is a very crude model, of course, because there are also low-frequency, low-acuity events as well, but we ignore them.
Towards the lower end of the scale, where fingers get mashed with hammers and sinuses give you headaches, supplies are the determining factor for whether or not you can “treat” them. If you have a tweezers, you can remove a splinter, regardless of whether you’re a surgeon or a goofball. If you don’t have a tweezers, you’ll have to improvise something and again, your formal education has little impact.
Towards the upper end of the scale, though, training and experience become huge factors in your effectiveness. Whether or not you can amputate a crushed arm, for instance, has very little to do with the sharpness of your saw and a lot to do with whether or not you have any idea how to use it. (not to say that supplies don’t matter- plenty of Haitians would like you to know that vodka did not work as a sterilant.) The low-frequency/high acuity end of the emergency scale is also a “long tail”- it keeps going and going, with the relative importance of experience to materiel continuing to explode exponentially. Almost nobody, for instance, can separate conjoined twins, no matter how well equipped they are.
The question that arises when discussing first aid, or emergency medical training in general, is how much of that curve are we expected to handle on our own. Obviously, no matter what the sustainable zombie folks would like, noone can manage “everything” without recourse to a higher level of care. Quantitative goals, like attempting to handle, say, 95% of all emergencies, sound good at first, but founder on poor epidemiology (and extreme contextual variation- 95% of emergencies in Montana are not the same as 95% of emergencies in Uganda) and on a certain fuzziness at the lower end of the scale. Plenty of “emergencies” aren’t actually dangerous, even if you do nothing. When I was homesteading, my fingernails were pretty much always a catalog of fingernail-trauma; I was well within the bounds of good sense to ignore them and my fingers came out fine. What you include in your first-aid scope of practice depends on what you consider worth treating, and what you feel comfortable leaving alone; again there is plenty of cultural and contextual variation.
Somewhere, though, you have to draw the line and say “I will be trained and equipped to handle anything up to this point, and after that I will look for higher levels of care.” Everybody is going to approach that differently, but ultimately my proposal (which I was trying to foreground in the previous post) is that available training isn’t a bad place to start. If you take the fraction of problems that you are experienced in handling, declare that your scope of practice, and pack your “first aid” kit appropriately, you will at least be making a sensible decision. If you buy a pre-packed kit that lacks supplies you use every day, you’re ripping yourself off. If you buy a pre-packed kit (or build one based on internet advice, or some “how to survive” book) that contains items you’ve never used before, you are at best wasting space, and at worst posing a real risk to anyone you attempt to take care of.
If you don’t like this proposal- if limiting yourself to the familiar and easy seems restrictive- I have two pieces of advice. First, abilities and knowledge are always extensible- you can always learn more and get better at what you’ve already learned. So, go learn more. Secondly, ask yourself: what is your motivation for having a first aid kit anyway? We have a cultural fantasy about being in a desperate situation where improvisation is the only option; this is the basis of virtually every medical TV show out there, and plenty of other narratives as well. In real life, though, these situations are way, way up on the high end of the curve, and tend to end very badly. I wasn’t kidding about the Haitians, I was there- plenty of American surgeons, high on cowboy legends about seat-of-the-pants decision making and improvisational surgery, amputated arms and legs using booze-sterilized hacksaws. The results weren’t pretty- not only were a huge portion of the wounds badly infected, but Haitians stopped trusting American medical personnel. Plus, other teams were trying to avoid amputation entirely, and to my knowledge nobody has ever demonstrated that the surgical cowboys had a better survival rate (or a lower disability rate) than the conservative French or UN or Haitian doctors. Until somebody does that, all evidence will be anecdotal, but c’mon now.
Basically, to imagine that you would be able to manage an emergency you haven’t trained for is far more irresponsible than just not having a first aid kit in the first place.
