Chapter 129: The doctor’s bag and other emergency equipment

GPs who perform home visits and nursing home visits require the traditional doctor’s bag that includes the basic tools of trade: drugs (including those for emergency use), stationery and various miscellaneous items. Country doctors will by necessity use their bag for more emergency home and roadside calls. These recommended contents are simply a guide for cross-checking.

• Sturdiness

• Lockable (e.g. combination lock)

• Ready interior access

• Uncluttered

• Disposable single-use items

• Light, portable equipment

• Regular checks to ensure non-expired drugs

• Storage in a cool place (not boot of car)

Traditionalists may prefer the Gladstone bag, whose style confers a sense of time-honoured assurance. Pragmatists may opt for a fishing tackle box: far from elegant, but the sight of those organised compartments emerging during a crisis can calm the nerves.

Stationery (checklist)

• Practice letterhead and envelopes

• Prescription pads

• Sickness/off-work certificates

• X-ray, pathology referral forms

• Accounting and Medicare forms

• Dangerous drugs record books

• Continuation notes

• Tie-on labels for emergencies

• Recommendation forms (to psychiatric/mental hospitals)

• Pens

Many of these items will increasingly be replaceable by a portable computer connected to a virtual ‘paperless’ office.

Miscellaneous items

• Quick reference cards:

  • – the doctor’s bag checklist¹

  • – dosage details of drugs, all age groups

• Handbook of emergency medicine

Many details can be stored on a smartphone, including drug dosage apps, local maps and local emergency phone numbers.

Equipment

• Sphygmomanometer (aneroid)

• Stethoscope

• Pulse oximeter

• Diagnostic set (auriscope + ophthalmoscope)

• Tongue depressors

• Tourniquet

• Small needle disposal bottle

• Scissors

• Syringes 2, 5, 10 mL

• Needles 19, 21, 23, 25 gauge

• Scalp veins (butterfly) needles

• IV cannulae 16, 18, 20 gauge

• Alcohol swabs

• Micropore tape

• Thermometer

• Spacer (e.g. Volumatic, for asthma)

• Artery forceps

• Urine testing sticks

• Pathology specimen bottles

• Skin swabs, throat swabs

• Torch

• Patellar hammer

• Oral airway (e.g. Revivatube, Resuscitube—FIG. 129.1, Guedel)

• Laerdal pocket mask (FIG. 129.2)

• Scalpel (disposable)

• Examination gloves

Drugs

Drugs (oral)

• Samples of commonly used:

  • – analgesics

  • – antibiotics

  • – antidiarrhoeal agents

  • – anti-emetics

  • – antihistamines

  • – sedatives

• Glyceryl trinitrate (although sublingual tablets deteriorate after opening)

• Soluble aspirin (for myocardial infarction)

• Sumatriptan

Drugs (sprays)

• Glyceryl trinitrate

• Salbutamol aerosol

Drugs (topical)

• Anaesthetic eyedrops

Drugs (injectable)

Refer to TABLE 129.1.

A study of 512 Queensland GPs revealed the range of emergency equipment and essential drugs carried.⁴ The most common emergencies were acute asthma, psychiatric emergencies, seizures, hypoglycaemia, anaphylaxis, impaired consciousness, shock, poisoning and overdose. The drugs used most were adrenaline, benztropine, diazepam, glucagon, haloperidol, hydrocortisone, naloxone and salbutamol (inhaler).

The issue of what drugs to carry is always an interesting intellectual exercise. It could reduce to just a few items such as adrenaline, diazepam, naloxone and morphine.⁵ Doctors who are called to manage emergencies more frequently and in more remote locations generally prefer a broader range of drugs, which requires increased checking of stocks.

Drugs (suppositories)

• Indomethacin

Rural doctors, especially in isolated areas, usually carry additional equipment in their motor vehicles when called to the scene of an accident or other emergency. The equipment will vary according to geographic factors, the ambulance service and the special interests and enthusiasm of the practitioner.

Storage of drugs

The main issues are safe storage of opioid drugs, avoidance of overheating (keep <25°C), accessibility in emergencies and careful recording of Schedule 8 drugs in a register. Diphtheria and tetanus vaccines should be stored in a refrigerator.

Emergency drugs

The value of emergency drugs for the doctor’s bag continues to be debated. Essential drugs are highlighted in TABLE 129.1. One challenging paper suggests that drugs such as penicillin, diazepam, haloperidol, chlorpromazine, frusemide and tramadol be replaced.² The options recommended as more appropriate would be ceftriaxone or cefotaxime (for severe infections), midazolam, olanzapine and amiodarone, while CPAP or BIPAP is preferable to frusemide for acute ventricular failure.