Wilderness Medicine/First Aid Kit

I'd like to ask Greg and Ron what they beleive should be the minimum adequate first aid/medicine kit, and what minimum medical training should be for members of an excursion. Maybe answer for both short excusions (one - three day), to more extended excursions (onw week or more). Thinking right now mainly the North American or European mountian environments...

Best,

Brian.
 
W

Walt Welch

Joined
Oct 7, 1998
Messages
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Well, I am not Greg or Ron, but I will chip in here, as I have some expertise in the area. I am an ER MD with 20 years' experience, and was a pharmacist before that, and biochemist before that.

What training should every member have? BLS aka CPR), for one thing. You never know when you might have to use it. Training other than that, in general first aid, is usually available locally, often under the auspices of the Red Cross. Check with your local EMT's or Fire Dept. if you have trouble locating a training source.

Were I assembling a first aid kit for a group of which I would be a member, here is what I would put in it:

Lidocaine and Marcaine (people allergic to one can tolerate the other). Syringes, suture and suture set (has sterile scissors and forceps, both thumb and hemostat type). Betadine solution. Scalpels. Tape (paper, foam, and cloth adhesive). Sterile Q-tips and bottle of Ophthetic (eye anesthetic) for foreign body (on cornea) removal, few tubes of ophthalmic antibiotic drops and ointment, eye patches, and homatropine.

If you have a corneal abrasion, or actinic corneal burn ('snow blindness'), or foreign body on cornea which leaves a divot when removed, that patient is in intense pain. You can turn him into a productive citizen again by patching his eye with opthalmic ointment (Gentamycin is my favorite) AFTER dilating his pupil with homatropine. This paralizes the ciliary muscle, which is the muscle that changes pupil size. Much of the pain with eye injuries is due to ciliary muscle spasm. These injuries tend to heal quickly; 24-48 hours.

Continuing with equipment; a few rolls of cast padding and fiberglass cast material. I can put a hematoma block (injecting anesthetic into the fracture site) in a fractured wrist, and reduce it without x-ray, if I have to. This is also good for splinting severe sprains.

Trauma shears. These are the heavy scissors with blunt tips, the blades being angled about 30 degrees relative to the plastic handles. Will cut through thin sheet metal.

Dressings; from battle dressings to band-aids. Topical antibacterial ointment. Topical anti fungal cream. Topical lice killing solution (Pyrinate A200). Some nasal packing and nasal forceps in case you have refractory epistaxis (nose bleed), common at high altitudes, and have to pack someone's nose. A few silver nitrate sticks to cauterize the bleeding artery in the nasal cavity if visualized. Anesthetize the nasal mucosa with cotton pledget soaked in lidocaine first; it (AgNO3) stings like heck.
Tongue blades (useful for splinting digits).

Drugs: first of all, have extra prescription medicine for those who need it. Have your buddy carry the extra set of meds, so if you lose your pack, you are not SOL.

Further drugs: antibiotics. First gen cephalosporin for skin infections, such as Keflex. Amoxicillin or Augmentin for pharyngitis ('strep throat'). Ciprofloxacin for invasive enteritis; you know you have this if you have fever, abd. pain, and blood or mucus in stool. Common traveler's diarrhea does not cause these symptoms. Some Lomotil, or OTC Immodium for simple diarrhea. Some Flagyl, for Giardia. Some vials of Rocephin, a third gen cephalosporin. This is for last ditch use in overwhelming infection. Say, someone has lymphangitis (red streak going proximal from infected site; 'blood poisoning') and a fever, and the oral Keflex is not working, you can give the Rocephin IM. It gives high blood concentrations that last for 24 hours.

Some epinephrine and Benadryl. Used for allergic reactions. Prednisone; for use with severe allergic reactions or exacerbation of asthma. An albuterol inhaler would be nice for wheezing as well.

Some Photon II lights. Nearly all medical procedures require light, and you shouldn't depend on others to provide it. White would be best color for this purpose.

STERILE GLOVES; a bunch of non-sterile ones as well; they are much more compact than the sterile ones. Just cram the wadded up gloves into one of the gloves.

I did this off the top of my head, so have probably forgotten some things. Perhaps other posters can help me out.

Hope this helps, Walt
 
Wow...Dr. Welch...you provided a great answer. I have been a Rural Physician Assistant for 7 years (only part time now) and can relate to everything you posted. I wonder though if it might be beyond the scope of those without your experience. BTW, you'd be a great addition to any trip someone might go on.

I advise people to have at least two members on the team with EMT training, the rest with first responder training, and all certified in CPR.

Field first aid kit should include:
1. multiple dressings and bandaids (various sizes)...not so many that you can't carry your sleeping bag.
2. Betadine solution or swabs.
3. Super glue for simple lacerations - clean the wound, approximate the edges, apply to the outer skin surface. it will probably need to be reapplied every 2 days.
4. Optholmic ointment (I like Erythromycin) and eye patch. Apply ointment to corneal abrassions 4 times a day. Cover eye if patient is experiencing pain due to the light(this may or may not occur depending on the severity of the abrassion).
5. Topical antibacterial cream (I use triple antibiotic ointment)
6. Topical corticosteroid (for inflammatory rash) and antifungle - I cheat and use a product called lotrisone which is a combination of the two (cuts down on weight).
7. Several bee sting kits (used for any severe life threatening allergic reaction)
8. Antihistamine (benadryl)
9. Antidiarrhea agent (Lomotil is great)
10. Prednisone 50 mg tablets for severe allergic reactions or asthma
11. Albuterol inhaler for asthma
12. Antibiotics:
a. Augmentin for unrelenting URI and suspected Pnuemonia with fever and increased severity of symptoms.
b. Zithromax for unrelenting URI and Suspected pnuemonia and increased severity of symptoms without fever.
c. Cipro for UTI or travelers diarrhea
13. Scissors, gloves, and tape.

That is what I carry. I improvise most everything else. This whole kit (excluding the big dressings) fits in two containers that are slightly bigger than the size of those old tin bandaid cans.

that's what I advise...or if your lucky get Dr. Welch to go with you. His expertese would be a welcome addition to any team :>)

------------------
Greg Davenport
http://www.ssurvival.com
Are You Ready For The Challenge?


 
I am very happy to see this forum! I have a stupid question though, if you do not have a Doc in your group, is there any way to legally obtain and possess medication like lidocaine and marcaine? When I had pain associated with a wisdom tooth, I used 10% benzocaine in gel form...and my first thought was, "this is legal," 'cause it worked!
 
Don,

Greg mentioned a beetle that he ate that got him high in the "Favorite Meals" thread. Could save you $ in those painkiller costs if he shares what breed it was...
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Hee Hee -- good to see you, Bud!

Brian.
 
ANEW will be offering Pre Hospital Emergency Medicine classes (probably in the summer of 2000). We are doing our lesson plans which will be submitted to the MOD and the state (to get Continuation Credits (CE) assigned). We will be offering two classes. One for those who have EMT type training and one for those with more advanced skills (paramedic or above). the goal is to combine our survival program with our (mine and others of my staff) extensive wilderness and prehospital medical credentials and skills.

If you are interested in such a course let me know (via personal email) and I'll set up an email list to advise you when it is set up.

Best.


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Greg Davenport
http://www.ssurvival.com
Are You Ready For The Challenge?
Are You Ready To Learn The Art Of Wilderness Survival?

 
Hi Don,

In response to your question about where do you get things. If you spend a lot of time in the wilderness...find a Doc (or PA) that understands what this means. They are usually very willing to provide the needed items for your med kit. Be ready to explain why you need it and how you intend to use it.

I have taken care of many of my patients who do extended travel.

When Ron Went on his Jungle trip this year...we spent some time talking (he knew what he wanted) and I was able to provide most of everything for his trip.

Hope that helps.

------------------
Greg Davenport
http://www.ssurvival.com
Are You Ready For The Challenge?
Are You Ready To Learn The Art Of Wilderness Survival?

 
Great suggestions. Every good first aid kit should also have a snake bite kit, something in a single malt preferably. We don't have too many poisonous ones this far north except for the deadly snow snake, which is rare, but you can't be too careful.
 
I asked my PA and Flight Doc, they thought I was NUTS as I'm on PRP.

Well it was worth a shot anyway
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So now what does a poor sucker like me do when I'm only allowed to take asprin without seeing a Doc????

However, their is a farm store close by with all kinds of meds for horses/cows/pigs ect ect ect that you do not need a prescription for (VBG)
 
The Zithromax is a good idea. The new macrolides (e-mycin family) are very potent and have long half lives. I would still suggest the IM Rocephin, however. Anyone can give a IM shot. I agree with the steroid cream also. Good idea.

The crazy glue idea is one with which I am familiar, but frankly I think some Steri-Strips would work better. These are just like paper tape (which you could use in a pinch) cut into strips. Criss crossing these across the wound, then splinting it if it is on an extremity, would give a stronger closure. Especially if you coat the skin around the wound with tinctue of benzoin. Don't get this into the wound, however, as the alcohol in it stings.

Hope this helps, Walt

You are legally allowed to possess syringes, sutures, lidocaine, in fact all the things I mentioned, IF prescribed by a physician. I would find the nearest mountaineering doc (and there are quite a few) and see if he would be amenable to your requests.

One technicality about narcotics (which is a legal term, not a medical one; it simply means that the use of the drug is monitored by the government). If you have Vicodin, codeine, or Percocet etc. Leave it in its' original Rx container. It is against the law for you to possess it out of the container. I am not sure if this is federal or CA law, but I think it is federal.

Jeez; I must be getting slow. One thing you should always have is some kind of NSAID: Aspirin, Motrin, Advil, etc. also have along Tylenol for those who cannot tolerate NSAID's. Use obviously for pain or fever.
 
Read the Wilderness First Aid site. It is very good, and I suggest that everyone read it.

One more thing: make SURE you are up to date on all your immunizations, especially tetanus. Remember that if you have a tetanus infected wound, it requires antibiotics; the tetanus toxoid shot only mitigates the neurological complications (tetany, spasms).

Hope this helps. Walt
 
Doc Welch,,very comprehensive list. I hope that there are a lot of physicians that would be as amenable to this proactive approach to pharmacological preparedness as you are. I am a clinical pharmacist and your statement about carrying un-labeled controlled substances was correct. It should be in a labelled Rx bottle. Even if it were not a law, any Ranger or law enforcement officer who finds a few T#3'S or vicodins stuffed in your first aid kit with no label is gonna want to know where you "discovered" them. May lead to an unecessary hassel where you will have to prove that the medication is in fact yours. Finally, with regard to controlled substances,please do not "borrow" those 30 percodan that your aunt Tilly never used after her dental surgey!! Why? Well, for example possesion of 6 or more vicodin tablets without a valid prescription in the state of Florida constitutes possession with intent to traffic. Yeah,,there is a lot of grey area and I'm not trying to dramatize the situation but just want all forum members to have the information to avoid any problems in this world where ignorance of the law is not a defense (even if the law is ignorant!).Prescription fraud etc. seems to be a hot spot these days with the federal and state government agencies. With regard to the drugs in your emergency kit, be sure to check expiration dates and do your best to keep them moisture free. Also exposure to extreme heat may accelerate degradation exponentially and render a potentially potent drug ineffective or cause precipitation of an injectable which may be more harmful than helpful. So be sure to swap out unused quantities at regular intervals. An EPI-PEN that has been in your kit for 3 years and 5 trips through the desert isn't gonna do you much good in a pinch. Bottom line is as with all things knowledge is power so know what you are carrying, when to use and not use it and how it should be stored.
 
Rob; excellent post. Thanks for the info. Jeez; good thing I am a doc, otherwise I would get busted for trafficing (I toss all my drugs into one bottle, and yes, I know what each one is).

You brought up a good point about humidity. Some film coated tabs will actually shed their film coating in humid conditions. A friend of mine went to Bali, and his Zantac (I think) started shedding. One way to prevent this would to ask a doc for sample bottles of drugs. These little bottles often have little silica gel dehumidifiers in them; you could put these in your Rx bottles.

Of course, you could just toss in some silica gel crystals, but that might provoke some LEO to say to you, 'You have some 'splaining to do about these here crystals!'

Hope this helps, Walt
 
Walt, I agree that IM Rocephin is a good idea. Sometimes I get 60 plus miles from a road (on foot) and if a cellulitis or other significant infection were to set in...Rocephin would be ideal to front load (although you and I both know that when these infections are bad it may take multiple injections). I may have to add it. I also forgot to mention that I carry ibuprofen (or naprosyn 500mg) and tylonal.

Hey Rob, Do you think the meds in individual wrap (like the stuff drug reps give us) would preserve longer? The only problem if they do is they are almost always expired when we get them....I always get labels on small little bags and move my meds into them...thus I decrease the bulk on the bottles that usually come with the RX. Probalby not wise. Perhaps I could use old iodine bottles, etc. (just put a label on).

thanks for the great info :>)

------------------
Greg Davenport
http://www.ssurvival.com
Are You Ready For The Challenge?
Are You Ready To Learn The Art Of Wilderness Survival?

 
One other thing I might suggest -- if you're in the habit of hiking alone, a small mirror would come in handy for fixing up injuries to the face.

Also, if you hike with your dog, and live somewhere that has porcupines, a small multitool with a pair of pliers can be *very* handy (it was for me and my mine).
 
These are the kinds of things I like to see.
I have a pretty good first-aid kit put together over time that includes most of what has been mentioned.
I also work in the medical field(EMT, Field Medic, CPR Instructor/Trainer, BTLS certified, suture certified, Phlebotomy Tech certified, etc....) so am able to acquire the necessary items much easier than most.
I would say I have some experience but I for one know that I can learn alot from all Y'all with the "experience"
Thank you and keep up the good work.

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The vague and tenuous hope that GOD is too kind to punish the ungodly has become a deadly opiate for the conscience of millions.

*A. W. Tozer

2 Cor 5:10
 
Geez guys, if you keep posting this kind of information, Bladeforums will start charging for subscription.

Wonderful stuff and a great service to the forum.

Thanks! I really appreciate it.

I can see down the road an FAQ will be needed. Hope someone with the appropriate expertise will be willing to compile it.



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Hoodoo

When you arrive at the fork in the road, take it.
Yogi Berra
 
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