Gloves

The first thing in your First Aid kit should be your gloves.

We wear gloves not just to protect ourselves from blood and HIV but from ALL body fluids and ALL infection.  

That's the obvious stuff but it is useful to have a few spare pairs in your kit because you never know when you are going to need to improvise.

 

Improvised Chest Seal

The classic improvised treatment for an open chest wound is to tape a plastic sheet along three edges to cover the wound but leaving the fourth side open to allow the wound to 'vent'.  This design - with the plastic in direct contact with the skin has a tendancy to stick to the skin as blood congeals and completely occlude the open chest wound; increasing the risk of a tension pneumothorax.

We can improve that by simply cutting off the thumb from a medical glove the based on the Asherman Chest Seal's flutter-valve design,

You are not going to cut the thumb straight off the glove, imagine cutting the thumb off around the thumb joint.  About an inch all around the base of the thumb.

Cut the very tip off the thumb and open up the base.   This can be stuck to the chest, covering the open wound with a flutter valve. 

 

You've now got the remains of a glove left.   What can you do with that?

 

Needle Decompression

Using the same theory as before, before attempting Needle Decompression, cut the 3rd and 4th fingers from the glove (just in case you are having a really bad day and need to do this twice).

Insert the needle into the glove finger before penetrating the chest.  With the cannula in place and need removed, the finger becomes a one-way flutter valve when secured allowing for decompression without allowing air in.

Now you've got the index and little finger left, what can you do with that?

 

Tourniquet

The remaining scrap can be used as a quick TQ for cannulation or for securing the IV tube or Sp02 lead the the casualty's wrist.

 

Wound Irrigation

All wounds need to be cleaned but in an austere environment with limited supplies, using sterile syringes for wound irrigation might not be the most appropriate use, or you just might not have a syringe (but you will, of course, always have a syringe).

 

Gloves Irrigation 2.JPG

Which Gloves?

Latex gloves are the most comfortable gloves to wear with the least loss of tactile function but there is a minor risk or allergy to the wearer or the casualty.

 The Health & Safety At Work Act (1974) places a general duty upon employers to keep employees and others (such as clients) healthy and safe at work.  The Control of Substances Hazardous to Health (COSHH) Regulations 2002 asks employers to undertake an assessment of any substances used at work that are hazardous to health.

Natural rubber latex is a potential allergen and therefore falls into these categories, as such many first aid and medical organisations have withdrawn the use of latex gloves (as well as 'powdered' gloves) to eliminate the risk of causing harm to the user and the potential of a subsequent court case for compensation.

Kinder egg.gif

The two popular options are non-powdered vinyl or nitrile.

Vinyl gloves are the cheapest and most durable but least stretchy and with the greatest loss of sensitivity.  Nitrile gloves are more durable than latex and more elastic than vinyl gloves which is why they have become the most popular choice.

If you are carrying gloves as part of your kit, you can keep pairs together and protected from dirt and water in the yellow container found inside a Kinder egg.  It's not sterile, but that doesn't matter (1), it's clean.  And a good excuse to eat chocolate.


Which colour?

Seriously?  Working with members of the armed forces and security services, occasion we come across Black nitrile gloves.  Why black?   Because they're tactical and that is cool.  Your position will never be compromised by wearing blue gloves.  The helicopter you arrived in probably did that.

You will look pretty ninja in your black gloves but you won't see blood on them when checking the casualty and neither will you be able to make notes on the back of your hand.  Ditch the black gloves.


Work Gloves

Unfortunately examination gloves do not last long in industrial, remote or hostile environments and putting a pair of work gloves on top looses tactile sensation and fine motor control.  The solution is incredibly simple - chop the thumb and index finger from your work gloves as these are the two digits we use the most for delicate procedures, the rest of your hands remain protected. 


1.  Perelman VS,et al/  (2004)  "Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial."  Annals of Emergency Medicine. Mar;43(3):362-70.