Wilderness FAK's in Perspective

[Rick Marchand]

1.What would you put in a "bare bones" first aid kit?
2.What would you consider a longterm kit?
3.What factors go into differenting between the two? (Time, location, current health, etc...)
4.What advice can you give based on personal experience in the field?
5.Would Rogaine with "minoxidil" be something Talfuchre should look into?

Inquiring minds want to know!!!!




Rick

 

[Rick Marchand]

My personal FAK is as simple as it gets..

-Large field dressing
-antibiotic/antibacterial/antifungal cream
-4x4 gauze pads
-Steristrips
-tape

I don't carry asprin/tylenol, allergy meds, decongestants, immodium, etc... in my personal FAK's. I really can't remember the last time I took any of those meds at home. I don't go into the bush with the expectations of carring for others on the trail my personal kit is for me and geared toward my needs.

My family FAK is different and has several different type of meds, assorted bandages, hot/cold packs and all kinds of other crap one might find in a loaded kit. If and when I start guiding professionally, I will carry a large kit like this, too.

 

[kage]

I just posted this in the other thread about FAKs:

As far as minimums, my experience is from a military standpoint, as a mountain guide and SAR, and as an EMT. I think the very least you need for most traumas include (use more or less depending on situation, weight and space):

-Roller gauze (preferably 4-6"): Kerlix is best, but it's bulky, so I prefer H&H PriMed gauze, which is the same size roll but vacuum packed to save a ton of space (you can fit 2 PriMeds in the same space as 1 Kerlix). Kling gauze is decent and readily available at Wallyworld, most drug stores, etc, but not nearly as fluffy and absorbent. Used for covering wounds, some compression, wound packing, etc.
-Compression Bandage ("Ace bandage") (preferably 4-6"): I prefer the kinds with velcro on the ends for a closure, as there's no crappy clips to lose or break. I've replaced most of my compression bandages with SWAT-T's because they work as compression bandages and also make excellent tourniquets. The only draw back is that they do not absorb fluids the way a regular compression bandage does and they don't breathe so they're hot and sweaty for sprains and strains. Use compression bandages to cover gauze, provide compression for sprains and strains, as a pressure dressings, improvised snow goggles, etc.
-Trauma Pad (4x6" or 5x9"): Nothing works better for absorbing copious amounts of fluids.
-4X4 Gauze Pads (Topper Sponges may be the only Johnson and Johnson product I like): can be cut down if you need to. Used for cleaning wounds, covering wounds, etc. If you're really concerned about weight and space you can cut patches from your roller gauze, but then the rest of the roller gauze is no longer sterile.
-Triangle Bandage or Large Bandana: used for slings, compression, wound packing, to cover eye wounds, making "doughnuts" to pad impaled objects, etc. Bandana's should be a part of your survival kit anyways, so you could skip this for your trauma kit.
-Large Safety Pins: Use to improvise slings with a long sleeve, pick splinters, secure bandaging, fish hooks, sewing leather or canvas, and also to secure airways (by pinning the tongue to the lower lip. Ugly, but it works).
-1 Quart Ziploc freezer bag or Alokasak: for holding the kit and also as an ice pack if it's snowy/cold, pressure irrigator by filling with sterile water and/or diluted iodine solution and poking a hole in the bag and squeezing, for packing larger wounds, saving severed body parts, for treating sucking chest wounds, etc.
-Duct Tape: for securing bandaging, closing wounds (don't do this in the field as you are inviting infection), securing avulsed skin, and a billion other uses. Gorilla Brand is still the best that I'm aware of.
-Meds: Epi-Pen if you have a prescription, Benadryl for anaphylaxis, aspirin for pain/heart, tylenol for pain/fevers, ibuprofen for pain/inflamation, immodium AD because diarrhea is your body trying to get rid of something unpleasant at home but is potentially dangerous in the wild,
-Assorted Bandages: for boo-boos. I like the 3M Nexcare ones.
-Neosporin + Pain Reliever: Pain relief is important for kids and burns. Wounds heal twice as fast and it helps to keep the wound cleaner. Do not use in deep wounds as it can be toxic.

If you're nice and help others:
-Nitrile Gloves: protection from infectious diseases, improvised CPR shield, wound packing, treating sucking chest wounds, etc.
-CPR Mask if you have room or CPR Shield

If you go into harms way, add:
-Tourniquet: the above mentioned SWAT-T or H&H TK-4 if space is at a premium or CAT or SOFT-T
-Hemostatic agent: preferably one contained in gauze, instead of loose powder
-Bolin Chest Seal or petrolatum dressing
-Nasopharyngeal Airway (~28 French) and packet of surgical lubricant
-3" 14 Gauge Catheter, if you've been formally and adequately trained in it's use

If you're going for an ultra-minimalist kit I wound get:
-6" Tactical Medical Solutions Olaes Bandage or H&H H-Bandage
-Nitrile Gloves

I'm sure I've forgotten a thing or two, but this should get it done.


Hey Rick, when you start guiding look me up and I'll give you a much more detailed list of info for a kit, including a ton of field improvisations. These become more and more important as weight and space becomes more and more of a factor. My kits have been honed from over 20 years of experience, and although they may not be exactly what you want or need, at least they'll give you ideas.

 

[cheekser]

for my bare bones FAK (in altoids tin), personally, I always carry some type of allergy med, since my enjoyment of the great outdoors is usually hampered by hay fever, etc...I also like super glue in lieu of a smattering of bandaids, but do carry some med. tape, gauze pad, and butterfly closure strips - great to use if it were to be a deeper cut I was concerned with. I like the handy single-use packets of antibiotic ointment; nice and compact. This type of kit rides in my pants pocket daily. for canoe trips/hunting, etc. I'll bring along a more complete FAK.

 

[Any Cal.]

I never used to carry anything, because I figured if it was bad enough to matter, a couple band-aids and aspirin wouldn't make the difference.

Somebody, years ago, it might have been Rescue Riley, made the point that little things can turn into bigger ones when they cause you to be distracted or make hurried decisions...which made a lot of sense.

At this point, I figure FA is some of the lightest gear there is, and when out and about, would like to have the ability to bandage myself up enough to get on with other things. Now I carry the standard AMK medic kit, an ACE bandage, and extra moleskin, tape, and gauze. That weighs @ 6oz, and covers a lot of oops, whether my own or someone else's. If I am bushwacking, or have extra space, I also take an AMK "big gaping wound" kit that weighs about 3 oz, which has some big sterile pads, iodine capsules, etc.

While I don't care much to carry things specifically for someone else, if two of us are out, and the other gets hurt, being able to patch them up may make it so we can walk out together, or so they can carry on and continue to be of help for the rest of the trip.

 

[Marcelo Cantu]

I am also of the "simple" camp. I carry:

• a terrific (although quite expensive) antibiotic ointment called Mupirocin. I have these little 2ml tubes in every kit.
• Band-aids of various sizes
• 4x4's
• Triangular bandage
• Ace wrap
• Chlorhexidine wipes
• tape

I do have a larger kit for the rare times that I'm in deep woods that does include meds and more stock of everything.

I also carry Aspirin with me. I generally am out where I'll run into other active people and you never know when an Aspirin may save a life.

 

[Brad "the butcher"]

I did a little backpack/fishing guiding back in the 1990's Rick and kage is on the money with having a large comprehensive FAK. You are responsible for them and should at least have your wilderness first aid and st johns Level II.
For liability factors as a guide this is a must IMOP
Gravol and immodium with some ibuprofren is a must for me. Nothing like taking a rookie in the mountains with nausea and mudbutt.

For just myself hiking with my first aid experience I bring about half of what kage has but I am comfortable improvising.

In my 4x4 I have the full level II responders kit same one ambulance guys carry away from the truck. I have helped with some nasty crashes on the road and idjits camping.

still wish I picked up that miniparang you made dammit....broke now

 

[TheGame]

I only carry one for myself, and if anyone comes with me, they can fend for themselves on bringing a better one if they wish. I only have the essentials, Ace bandage, bandaids, a couple sponge-like things, some tape, and alcohol prep-pads. I also have one of the AMK first aid kits (not sure which) that I won. Never really took the time to go over everything in it, so I couldn't exactly tell you what was in it

 

[kage]

I see steri-strips and buttefly bandages on many outdoor FAK lists. In a wilderness environment you should avoid closing wounds as this is likely to cause bacteria to be trapped in the wound which can lead to infection. A small cut can and does become life-threatening in wilderness situations. I had a nick under my thumb nail in the jungle that caused my hand to swell and become useless before I drained and cleaned it, while squeeling like a little girl and nearly gagging from the smell of infection. Closing wounds also sometimes causes wounds to heal from the outside in instead of the inside out (open healing), which can lead to different complications. Sutures for exterior lacerations is typically for cosmetic reason and helps to reduce the amount of scarring (internal sutures are a completely different thing, but you shouldn't be doing them, so don't worry). Chicks dig scars, so man up and take the scar instead of risking losing a limb or dying of sepsis, a particularly unpleasant death.

If you have a wound you should clean it out very carefully, making sure to remove any debris, then bandage completely to keep it clean. Clean the wound twice a day with soap and water (if it's a weepy wound you may have to soak it off in sterile water), not alcohol or anything else that will dry it out and continue to bandage it until the wound has naturally closed on it's own (usually 24+ hours, depending on the size, severity and location of the wound). Leaving a bandage on for too long doesn't allow it to breathe and will slow the healing process. You know when you leave a band-aid on for a couple of days and the skin gets all white and wrinkly and sometimes smells a little funky? That's not a good thing.

If the wound is large enough to require packing then you can soak gauze in warm sterile water (traditionally you would also soak it in 10% Povidone Iodine solution, but recently that is being called into question, so do the research on your own and make an informed decision if you chose to use this or a hypertonic solution) and stuff it into the wound then cover it up with more gauze to keep it clean. This allows the wound to heal from the inside out and it also puts pressure on bleeding vessels to aid in stopping bleeding. If a wound requires packing then it is serious enough that you should leave the wilderness area and seek professional help. Wound packing will cause a much larger scar, but instead of telling the hot girl at the bar the truth (that after singing kumbaya around the drum circle your knife slipped while making a wilderness quiche from sea gull eggs, earth worms and wild truffles with a side salad of watercress and nettle topped off with a wild strawberry vinagrette fermented in your own urine) you can tell her that you were munched on by a great white shark while you were fending off terrorists in a last stand where you were knee deep in shell casings before you ran out of ammo and had to kill off the last "tangos" with your titanium spork before they could kill off the man you were protecting, the future (leader of whatever country you come from). If she looks doubtful buy her another drink.

 

[Any Cal.]

I see steri-strips and buttefly bandages on many outdoor FAK lists. In a wilderness environment you should avoid closing wounds as this is likely to cause bacteria to be trapped in the wound which can lead to infection. A small cut can and does become life-threatening in wilderness situations. I had a nick under my thumb nail in the jungle that caused my hand to swell and become useless before I drained and cleaned it, while squeeling like a little girl and nearly gagging from the smell of infection. Closing wounds also sometimes causes wounds to heal from the outside in instead of the inside out (open healing), which can lead to different complications. Sutures for exterior lacerations is typically for cosmetic reason and helps to reduce the amount of scarring (internal sutures are a completely different thing, but you shouldn't be doing them, so don't worry). Chicks dig scars, so man up and take the scar instead of risking losing a limb or dying of sepsis, a particularly unpleasant death.

If you have a wound you should clean it out very carefully, making sure to remove any debris, then bandage completely to keep it clean. Clean the wound twice a day with soap and water (if it's a weepy wound you may have to soak it off in sterile water), not alcohol or anything else that will dry it out and continue to bandage it until the wound has naturally closed on it's own (usually 24+ hours, depending on the size, severity and location of the wound). Leaving a bandage on for too long doesn't allow it to breathe and will slow the healing process. You know when you leave a band-aid on for a couple of days and the skin gets all white and wrinkly and sometimes smells a little funky? That's not a good thing.

If the wound is large enough to require packing then you can soak gauze in warm sterile water (traditionally you would also soak it in 10% Povidone Iodine solution, but recently that is being called into question, so do the research on your own and make an informed decision if you chose to use this or a hypertonic solution) and stuff it into the wound then cover it up with more gauze to keep it clean. This allows the wound to heal from the inside out and it also puts pressure on bleeding vessels to aid in stopping bleeding. If a wound requires packing then it is serious enough that you should leave the wilderness area and seek professional help. Wound packing will cause a much larger scar, but instead of telling the hot girl at the bar the truth (that after singing kumbaya around the drum circle your knife slipped while making a wilderness quiche from sea gull eggs, earth worms and wild truffles with a side salad of watercress and nettle topped off with a wild strawberry vinagrette fermented in your own urine) you can tell her that you were munched on by a great white shark while you were fending off terrorists in a last stand where you were knee deep in shell casings before you ran out of ammo and had to kill off the last "tangos" with your titanium spork before they could kill off the man you were protecting, the future (leader of whatever country you come from). If she looks doubtful buy her another drink.

Thanks for that. It seems like strains and sprains, and big gouges and cuts, are the most likely injuries for healthy outdoorspeople, at least from my perspective.

 

[kage]

Any cal.,

Of course it depends on what outdoor activities you're participating in. As a mountain guide I regularly ran into lots of strains and sprains, broken bones, abrasions and avulsions, blisters, severe head trauma from falls or rock fall, and then all sorts of environmental issues: acute mountain sickness, HAPE/HACE, dehydration, heat exhaustion, heat stroke, hypothermia, frost bite, snow blindness, severe sunburn from being at high altitude, etc.

I would say that on the trails I've probably run into more environmental problems than actual injuries, although they are usually minor and are often more to do with dehydration than anything. After that it's probably blisters and then strained ankles, followed by wrist injuries from stopping a fall when tripping.

In fishing areas I was always amazed by how many lacerations there are. Thin fillet knives do some serious damage amazingly fast. Also quite a few hook removals. Dehydration and sunburns are often a problem, too.

In campgrounds I've seen a lot of lacerations from people whittling to pass the time. I've also seen quite a few smoke inhalations from people blowing into their fires to get them started and sometimes burns and blisters from them falling into said fire after inhaling smoke. Also a lot of serious injuries that follow copious amounts of alcohol and the famous last words, "Watch this!"

 

[Rotte]

I'm in the improvisation camp. Tape is a good idea, but duct tape works for multiple purposes. I like having a couple 4x4's. Antibiotic goop is a good idea. I carry Benadryl in little packets for severe allergic reactions, but I've never actually need it. A few assorted band-aids--I seem to use these fairly frequently. But the one FAK piece of kit I never leave behind is a small pair of tweezers. From ticks to splinters, tweezers are a life saver. Don't leave home without 'em.

Actually, don't be at home without 'em either.

 

[beef]

My FAK is geared primarily towards snake bite, as that's my biggest worry in this country.
3 Roller bandages,
Bandanna
Painkillers
Imodium,
Antihistamine (a few of the plants round here can cause reactions)
Salt
2 Non adhesive pads
Cloth tape for blisters
Superglue (can't see myself really using this for wounds)

 

[Rotte]

Superglue (can't see myself really using this for wounds)

Great addition to a FAK. I've used superglue several times to put small wounds back together. I should throw some into my FAK. :thumbup:


Edit: just checked my FAK and I do have super glue in it. LOL. Little brown container has a tube in it. The other thing in there I really like is a small bottle of eye wash.

 

[beef]

I know it was developed for this purpose, but I've heard of it killing the tissue as well. How did you fare with it on cuts?

 

[koyote]

1.What would you put in a "bare bones" first aid kit?
2.What would you consider a longterm kit?
3.What factors go into differenting between the two? (Time, location, current health, etc...)
4.What advice can you give based on personal experience in the field?
5.Would Rogaine with "minoxidil" be something Talfuchre should look into?

Inquiring minds want to know!!!!




Rick

I keep a few bandaids for the kids. But, here's my basic light FAK:

4 butterflies
4 curad camo stretchy medium bandaids
3 small gauze pads
1 roll curad waterproof adhesive tape .5 inch wide. The roll has 5 yards and the case is 3/4 inch with a diameter of 2 1/4 inches.
1 ounce of iodine in a glass bottle.
one of the small officer's model Vics.
1 tube superglue.
5 alcohol pads.
decent tweezers.

I could go with a couple iodine wipes instead of the bottle, and drop the bandaids. But that's about it.

Reasoning: bandaids don't work. They don't stay on most any cut that needs one. This is due to cuts mostly in my experience being on hands or on/near joints. Movement and bandaids don't mix.

Long term- this may be a bit incomplete since we have some assortments of bags with the different levels of BOB and BIG (Bug In Gear)

***

1/2 and 1 inch tape, 5 rolls. 2 of the half inch, 2 'regular' 1 inch, and one roll of the super sticky stuff they use in hospitals.

A box of 100 alcohol swabs.

several dozen tegaderm dressings (used to cover IVs, also bitchin for a lot of knifemaker type cuts with some trimming)

2x 4 ounce bottles of iodine, plus never fewer than 2 bottles of betadyne (povidone iodine) in standard size.

a couple boxes each of bandaid "extreme hold" (ha. ha.) mixed bandaids, curad camo stretchy bandaids, pirate bandaids (kids), gauze pads in 1 and 2 and 3 inch sizes. Pads - the kind girls use (they are big ass super absortbant gause pads, and also do their normal duty).

duct tape.

superglue.

tinactin.

IV kit, stitching kit, hope I never need it surgical kit with dozens of extra scalpel blades.

tylenol- due to effects on my breathing, no aspirin or ibuprofen.

claritin

benadryl, tablets and liquid

calamine

castor oil

hydrogen peroxide.

cotton swabs.

vitamins

some assorted stronger painkillers.

olive oil

coconut oil

mineral oil

pepto bismol

hot cocoa, brandy, honey sticks. (yes.)

colloidal silver.

ace bandages and splints.

alcohol and distilled vinegar in gallons and quarts

some epipens, some primatene in mist and tablet form, lots of emergen-C type packets. Tea.

basic monitoring tools_ sphygmomanometer, thermometers, stethoscopes, etc.

I'm forgetting at least a dozen things, because there's a lot of multipurpose stuff and I'm doing a mental visual of the assorted bags and box. In any case, there's enough for a fair amount of time, and a lot of it gets rotated and used.

Factors that differentiate: time "away" from home/base/car, whatever. weight. person carrying. We operate as a unit, for reasons that should be obvious to anyone who has kids, lives in a kibbutz, or does co-housing.

We have some "real deal" type stuff in the set up, but we also have an RN (or she will be in April) and two other adults who have been through fairly advanced first aid training. I haven't done an IV in a human but I have in animals, and I've done stitches on both human and animals.

The ability to use the gear determines in large part what gear you should have, though in a long term situation you may find people with skills you don't have, but who lack materials.

field experience:

Cuts, abrasions, and such. Happen, usually fine if you clean them off and clean them OUT. apply chemical concoctions of choice, bandage. if it's short term, 99.99999% of the time tape, gauze, and iodine is fine.

joint damage- sprains, strains, dislocations. splints, wraps, pain killers, and time. I've hiked out on a bad sprain before, using field constructed crtuches. It sucks, but ... well, what else can you do?

breaks: splint and stretcher or slow walk (depends on the break)

Limb loss. Seen this, pressure, fast. torniquet. If you are far from help all you can do with the finger (or whatever) is cauterize and pray. Fortunately, the one I saw was on a flight line and medical help wasn't far away.

almost everything I've dealt with in the field in the WSS sense has been easily handled with gauze, tape, duct tape, a stitching kit, and iodine.

talfuchre should buy a bulk pack of razors

 

[tidefan]

I carry a comprehensive FAK when with the family. As a medic, I see how little things become big problems quickly. Imodium is a must as splattercrack is just wrong in the field. Any precription meds should be accompanied by the label to porve it's yours, and any OTC meds we use at home I try to keep close.

 

[Rotte]

I know it was developed for this purpose, but I've heard of it killing the tissue as well. How did you fare with it on cuts?

Works great. I maybe wrong, but I believe cyanoacrylate glue (superglue) is used in heart surgery to repair the pericardial sack. Good enough for me.

In my experience, it does great for small wounds that aren't too deep. Haven't had a problem with surrounding tissue damage or infections.

 

[Rotte]

Reasoning: bandaids don't work. They don't stay on most any cut that needs one. This is due to cuts mostly in my experience being on hands or on/near joints. Movement and bandaids don't mix.

I disagree. I used to think the same way, but I've found that the simple band-aid is actually pretty useful for keeping a wound closed and clean. I usually carry one in my wallet. (I say usually, because I just checked and I don't have one in my wallet right now--probably cut myself on one of your knives and used it. ) Band-aids can also be useful for protecting a ruptured blister. I say keep a few on hand.

 

[koyote]

I disagree. I used to think the same way, but I've found that the simple band-aid is actually pretty useful for keeping a wound closed and clean. I usually carry one in my wallet. (I say usually, because I just checked and I don't have one in my wallet right now--probably cut myself on one of your knives and used it. ) Band-aids can also be useful for protecting a ruptured blister. I say keep a few on hand.

Only time I ever use a bandaid is when I need a teeny tiny gauze pad, and then I still use the first aid tape. Otherwise the bandaid will come off in a few minutes. Dunno.

I'm not saying I don't bandage wounds- I just use gauze and tape.