input needed abut first aid kit
Posted by: Darwin
input needed abut first aid kit - 01/07/10 12:02 PM
What do you recommend to be included in a first aid kit for 7-14 day trek?
-It will be just me on the trail.
-I will be hiking in the spring or fall, and will be in North America in mountain areas.
-I will be hiking on-trail.
-I don't have any first aid training.
-I don't have any allergies.
Posted by: aimless
Re: input needed abut first aid kit - 01/07/10 01:42 PM
Your answers will improve if you can give us more information, such as:
How many hikers will be served by the contents of the kit?
What season will you be hiking in, and in what location?
Will you be going off-trail?
What sort of training do you have? (Because there's no sense taking items you won't know hiow to use.)
Do you or any of the other hikers have specific medical needs, such as allergies, to take into consideration?
There are probably several more good questions I am missing here, but the more you say, the better the forum members can sort out the details for you. Otherwise, there's just not much useful to tell you, based on the scanty info you provided.
Posted by: Broadway
Re: input needed abut first aid kit - 01/07/10 03:57 PM
Generically, what would you say should go into a first aid kit, no matter the circumstance?
Posted by: aimless
Re: input needed abut first aid kit - 01/07/10 04:30 PM
1. Some kind of painkiller. Ibuprofen has good anti-inflammatory qualities that, for me, make it a slight favorite over aspirin or tylenol (acetominophen).
2. A few gauze pads (you can cut them to size), adhesive tape (or, in a pinch, duct tape can be used) and antibacterial ointment (e.g. neosporin).
3. Some way to treat blisters. For me that means a steel needle I can sterilize with a flame to lance them. I often use the adhesive tape (see above) to protect the area. See also: antibacterial ointment (above), in case of infected blisters. Other people like moleskin. Or other products specific to blisters.
4. A small basic first aid booklet, of recent vintage. If it gives much space to making and using tourniquets, it's too old.
5. Any personal medications you take.
It is possible to go far, far beyond these few bare basics I've just mentioned. For example, anti-diarrheal pills are popular, as are anti-histimines such as benedryl. Even antacids. Once you get started, there's really no obvious stopping place apart from personal preference.
Many multi-purpose items can be leveraged in first aid situations. For example, the ubiquitous bandana is extremely useful. Alcohol you brought for your alcohol stove can also become a hand-sterilizer before handling a wound. Duct tape can be helpful if you need a splint stabilized in place.
But by far the best aid in a first aid situation is knowledge. Spend some time visualizing emergencies that might arise and how you might handle them. Take a first aid class. Read a mountaineering medicine book.
Posted by: oldranger
Re: input needed abut first aid kit - 01/07/10 06:53 PM
Training. Without that, you are just a bull in a china shop.
Posted by: Darwin
Re: input needed abut first aid kit - 01/07/10 09:42 PM
Thank you so much for your input. Here's the answers to the above questions:
-It will be just me on the trail.
-I will be hiking in the spring or fall, and will be in North America in mountain areas.
-I will be hiking on-trail.
-I don't have any first aid training.
-I don't have any allergies.
Where can I get info on first aid training?
Posted by: Jimshaw
Re: input needed abut first aid kit - 01/07/10 10:06 PM
Darwin - good one
![goodjob goodjob](/forum/images/graemlins/default/good-job.gif)
I think maybe he didn't read your post... Wake up Aimless
![crazy crazy](/forum/images/graemlins/default/crazy.gif)
I carry some Tylenol, Vicodin, a couple bandaids, nail clippers, chap stick, sun lotion, a couple CCs of liquid soap and a tiny bottle of liquid tears to clean junk out of my eyes.
You can of course carry a lot more, but most people are prepared for the last thing that happened, not the next. I had one of those blue hydro gel thingies and it came in handy when friend had a bad abrasion. Maybe a tiny foil packet of polysporin, but really most injuries are minor things that you shrug off except for broken bones and knowing how to deal with that is a good idea as is your strong pain reliever of choice.
Jim
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/07/10 11:17 PM
Try the American Red Cross for first aid classes. What they give you is the type where 911 is right around the corner, but it's good for a start, and at least teaches you the general principles of the initial approach, triage, how to do CPR and to stabilize things for the short term. The Red Cross occasionally offers backcountry or wilderness first aid courses. NOLS offers them around the country. These are generally 16-hour courses taking place over 2 days and generally cost about $200. You can find out the nearest ones by googling. If nothing else, at least try to get the simple 4-hour course offered at most workplaces. My church offered one for free last spring. It wasn't comprehensive but was an excellent review for me and was certainly excellent for those who had never had first aid.
One thing a good first aid course will teach you is how to improvise things like splints and such from what you have rather than taking an extensive (and heavy!) first aid kit that you'll probably never use. Of course if you're going with a party and are responsible for the group first-aid kit, you'll need more--but if this happens you'll also need the training.
My kit is mostly bandaids, moleskin, "Second Skin," a few non-stick gauze pads, two one-time packs of antibiotic ointment, one or two sanitary napkins (which per my first aid instructor make the best compresses for heavy bleeding), a few pills--lotromin, benadryl, tylenol. For my dog I take buffered aspirin, an extra-large size doggie boot to cover a bandaged pad, and self-adhering veterinary wrap, which (with a little duct tape reinforcement on the outside) works fine for human sprains, too. All the rest of my stuff (except tylenol, which is poisonous for dogs) can be used on either me or the dog. As you may notice, my kit ia pretty heavily slanted towards blisters and minor cuts. I also have a couple of clean empty ziplock sandwich bags in there to use for wound irrigation (put tiny hole in one corner of bag and squeeze).
Be sure your kit includes any medications you personally need to take. Label them well. Any narcotics should have the prescription label on them and should never be given to anyone else.
Re first aid books and internet information (the latter is often not dated--never use undated information): If they mention tourniquets for anything (except an already amputated limb), or snake bite treatment consisting of cut-and-suck, venous tourniquets or Sawyer extractors, they are woefully out of date and should not be used. This per my-son-in-law-the-ER-physician. CPR has also changed (since my prior course in 1998)--it's now 2 ventilations to each 30 compressions.
Posted by: PerryMK
Re: input needed abut first aid kit - 01/08/10 08:14 AM
First aid training is first.
Of course the usual bandaids, gauze, tylenol, etc. A luxury item in my first aid kit is
Soothe-A-Sting Swabs . I also usually carry ointment for cracked heel, an antibiotic ointment (Neosporin or similar) and tweezers with magnifying glass. Sometimes I will have some peroxide or alcohol wipes disinfecting.
Not necessarily part of a first aid kit but related: hand lotion to prevent chapping, lip balm/chapstick, and of course sanitizing gel to keep hands clean for eating.
Posted by: balzaccom
Re: input needed abut first aid kit - 01/08/10 10:49 AM
We often travel pretty far from the trail, but our first aid kit still isn't huge. Here's what we take:
1. Ibuprofen and a couple of tylenol (acetominophen). THese are good for lots of things, including the headaches from minor altitude sickness.
2. Gauze pads, adhesive tape and neosporin.
3. A sewing kit. Has needle and thread. First aid for both humans and your pack!
4. Moleskin
5. Sudafed--a few for allergy/irritaion/poison oak. ANd Immodium, just in case the beaver fever hits.
6. Ace Bandage--lots of applications here/
7. My wife's numerous medications.
Posted by: Steadman
Re: input needed abut first aid kit - 01/08/10 01:00 PM
Darwin
The "What First Aid Kit?" topic in the Lite Gear Forum (started in April of this year) has some interesting answers that you may find helpful.
However, I carry "Heavy" for first aid supplies, but that is mostly because I've ended up using my kit a lot. It seems like either I'm getting hurt, or someone around me is getting hurt on every 2nd or 3rd trip. With Mr. Murphy as my constant companion, and because I plan to be able to treat other people (I am a former, no longer certified, EMT-B) what I am suggesting is probably heavier than many others here would tolerate. The first aid I'm preparing for is a combination of trauma and "mom medicine" - which no one is going to teach in one place in one course.
1. Training/knowledge - Boy Scout Handbook is a great reference for basic level first aid, and costs about 10 bucks. It will not go into ways to better plan and use OTC meds - something I'm interested in knowing more about. I'm always looking for a better resource (NOLS?). American Red Cross is a good source for training. So is the local ambulance company, but they don't do much bandaging any more - hospitals are usually close, and tape will hold the bandage on adequately for that time period.
2. Supplies
a. CPR Mask (Microshield) (remember my caveat about treating others)
b. Gloves (remember my caveat about treating others - I use rubber kitchen gloves, which can be used for multiple things and (if you wash them between patients) multiple patients in a pinch.
c. Triangular bandages - 2; these things are all purpose for splinting and bandaging (esp. for big wounds).
d. Ankle wrap - I replaced one of 3 triangular bandages with this b/c I tend to roll ankles.
e. Some roller guaze, 2"
f. roll of two inch tape
g. 4-10 4x4 gauze pads, depending on how long you stay out. Cut these down as needed to deal with cuts, burns, etc. See note at end.
h. Small nail/bandage scissors (need to cut down moleskin/gauze pads)
i. pack of bandaids
j. small tube antibiotic
k. personal medications
l. pain meds (tylenol, motrin - remember that they do different things and have different side affects, so I take some of each)
m. anti diaherrals (Immodium AD) - one to two courses
n. cold medicine (pills) - usually sudafed
o. Bendryl (sp?)
p. Moleskin
q. alcohol wipes (kind you use for prepping injection sites)
I probably forgot a couple things, but I need to repack my kit and it's at home. Some of these supplies go bad over time.
Note - I plan to manage an injury for one person for the entire period of the trip OR plan to expend all of my supplies on a badly hurt person, ending my trip in a medevac. I recommend you adjust the number of expendables (4x4s, bandaids, meds, tape, roller gauze) accordingly. I don't think that you should have to adjust the number of reuseable supplies (triangular bandages, ankle wrap) or REALLY BAD INJURY supplies (gloves, CPR mask) much based on trip length - but I've never been out for 1 week +, so I'll defer to those who do go out longer.
The kit I've described is really a small expedition kit - but it is also what I want for me (and carry with me when I travel for business, less the scissors) if something goes REALLY wrong. Keep in mind that I have almost emptied my kit of a given supply on a couple of occasions - once for a 1x2 inch 2nd degree burn to a kid's arm that we had to manage for the weekend.
If you plan accordingly, you can probably replace some of the bandaging supplies I've described with extra clothing (and cut the clothing up when you needed to), but going lightweight tends to remove the extra cotton t-shirt that you'd use for that sort of thing.
3. I'm going to take some kids out later in the year. What I'll probably insist that they carry is:
a. small pack bandaids
b. some moleskin
c. 2-3 triangular bandages
d. any medication that they normally need, or might need in an emergency
e. maybe a couple 4x4's. I haven't decided yet.
I've "listened" to a lot of conversations in this forum about being responsible for ourselves when we go out into the woods - what essentially amounts to "being prepared." To my mind, this is "prepared" but my level of training is different and my experience has probably been worse than average.
I always counted on the awl or knife blade on my multitool or swiss army knife for the sort of thing that many are talking about using a sewing needle for.
Thank you for letting me contribute. I look forward to "hearing" the follow on comments that this generates, particularly from the folks with SAR/EMS experience.
Steadman
Posted by: Steadman
Re: input needed abut first aid kit - 01/08/10 01:25 PM
FROM AIMLESS'S POST (THE QUOTE GOT BOGGLED WHEN I TRIED:
---------------------------------------------
4. A small basic first aid booklet, of recent vintage. If it gives much space to making and using
tourniquets, it's too old.
---------------------------------------------
Aimless, the recent US Military experience in the Middle East is bringing tourniquets back into use. They've found tourniquets to be useful for treating traumatic injury (blast effects and gun shot wounds) to the extremities (arms and legs). I recall that one of the reasons they were losing people to these sorts of injuries was that they were bleeding out before they could get the victim to a surgeon. If you can get the victim to a surgeon w/in 1 hour, they've also been able to save limbs treated in this manner.
This is an old news articile, but it helps get the point across: http://www.baltimoresun.com/news/bal-te.tourniquets02may02,1,3994385.story
Obviously, the situation being discussed here is a "life or limb" situation with uncontrollable bleeding - the sort of thing you'd use a tourniquet for in pre-war experience as well. The basic line of thought here WAS: direct pressure, elevate, pressure points, and THEN tourniquet.
What has changed is that tourniquets have moved up in the menu of options when someone gets shot or blown up - because they are bleeding out FAST due to cut or torn arteries and veins. To give you an idea of how seriously military medics are starting to think about this, one I knew pressed several tourniquets off on me when he found out that I don't carry one.
NOT the sort of thing you'd usually think about when backpacking, unless you're going during hunting season
![laugh laugh](/forum/images/graemlins/default/laugh.gif)
and even then the incidence would be really low. A blaze orange hat might be the better, more weight and pain conscious, choice.
Steadman
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/08/10 04:13 PM
Be sure to maintain your first aid kit:
First, go through it after each trip and replace what you used. (Of course, if you didn't use anything, no need for this.)
Second, go through it once a year and replace the medications. It's best if the labels for the medications (I use computer-printed slips that I put inside tiny ziplock bags with the pills) have the expiration date on them. I do this each winter and replace anything that will expire in the next year.
Third, examine the bandages, especially those in sterile paper wrappers, which with time and squashing into the pack tend to get ratty and therefore unsterile. If the wrappers are turning yellow with age, it's definitely time to replace the bandages!
Fourth--maybe this should be first!--reread your first aid text (assuming it's of recent vintage) and try to update your info every year. I'm lucky in having a son-in-law who is both a backpacker and an ER physician. You can get a lot of info online, but as I mentioned earlier, be absolutely sure it's of very recent date, not undated and from a reputable source. Of course be sure that you take a CPR refresher course as indicated on your CPR card. Frankly, you're far more likely to need CPR skills back near home (such as your workplace) than out in the wilderness. If someone has a heart attack out in the wilds, there's not much you can do if help can't get there within 20-30 minutes. Without a portable defibrillator (far too heavy to carry backpacking), I've been told that the chances of saving a heart attack victim with only CPR and no prompt hospital followup are less than 5%. For lightning strike and drowning, though, CPR can really make a life-and-death difference!
Finally, do not try to perform first aid on anyone else until you get training. A recent court case (here in Oregon) considered this negligence and that Good Samaritan law didn't apply. The case was where some completely untrained bystanders moved someone with a spinal injury without first stabilizing the spinal column, with the inevitable results.
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/08/10 04:28 PM
What I was taught (back in the days when everyone was taught to use a tourniquet) even then was that you use a tourniquet only in cases where the limb is lost anyway. If you have to use a tourniquet, you've already sacrificed the limb. In other words, it's used only to keep someone from bleeding to death when everything else has been tried and it's a case of it being better to lose the limb than the life.
The reason tourniquets are no longer recommended for civilian first aid use is that far too many people were losing limbs unnecessarily due unnecessary use of tourniquets. For the military, or any other case where the limb is completely mangled and there's severe arterial bleeding, it's a bit different. But once a tourniquet is applied, the limb is gone! Out in the wilderness, there is absolutely no way you are going to get the victim to a hospital in less than an hour!
Posted by: Steadman
Re: input needed abut first aid kit - 01/08/10 09:12 PM
OregonMouse
I'm sorry I've distracted the point of this thread. You're a moderator - can you pull my two posts and your post so that this stays on track, or PM me and tell me how to do so? I'm really more interested in the other part of this.
Steadman
Posted by: oldranger
Re: input needed abut first aid kit - 01/08/10 09:19 PM
The ability to improvise is a really critical component of your first aid training, and hence your kit. I always carry a bandanna which can serve as a triangular bandage (because of this potential use I try hard not to use it to blow my nose). The stays in your pack can form the basis for a splint ( I have drilled holes in the ends of mine in preparation for this - saves weight, too).
On one very interesting encounter while on a recreational climb, we fashioned a cervical collar from a blue foam pad and tape to stabilize our victim. It worked fine.
Look at all your gear and think of how the items you are carrying can serve for victim care. Since you almost always want to treat for shock, the ability to supply heat and retain a stable body temperature means your stove and sleeping bag, tarp, etc. will often come into play.
One of the most useful things I ever did in a First Aid class was to tell the students to fetch their packs and see how we could improvise in the face of various scenarios. I learned a lot myself.
Your attitude is important as well. In most wilderness situations, you are going to be with the victim a lot longer than urban situations, a reasonably upbeat, positive demeanor helps the victim.
I have never applied a tourniquet, or seen one applied, for real, in more than 300 emergency scenes, including one amputated arm and several gunshot wounds. I queried a good friend, who had been working as a paramedic for about a year, about this. He had never used a tourniquet, either. Battlefields are a different situation - one reason I have never applied a tourniquet may be because the victim had bled out and expired by the time we arrived on scene - there is usually a lapse of at least an hour or two between the incident and the arrival of SAR personnel. Just another reason why a wilderness traveler should have training in first aid.
Posted by: Jimshaw
Re: input needed abut first aid kit - 01/08/10 10:45 PM
Steadman, Mouse
No please leave the posts, they are very informative. In the rare event that you do run into a really bad situation at least we have had a chance to read your input. My first aid training was in Boy Scouts about a millennium ago. Though we did discuss tourniquets, we also learned that pressure points are more useful and less damaging. I guess I'm lucky - I did break a leg once but it was at orienteering meet and there was doctors there, otherwise I would never have been running in the woods in the first place...
![eek eek](/forum/images/graemlins/default/eek.gif)
Other than that I never get more than a cut and since I no longer carry really sharp dangerous knives, they are rarely bad cuts. No, if someone has to be rescued its someone else, which is why I feel safer traveling alone - true.
Jim
Posted by: Tango61
Re: input needed abut first aid kit - 01/08/10 10:50 PM
Where can I get info on first aid training?
.
As OM pointed out, the Red Cross does offer basic first aid classes.
You might also go to a BSA Scout shop and pick up the first aid merit badge booklet. It has very good information.
You can also check with your local BSA council and see if any troops offer 1st Aid training and Wilderness First Aid training.
In the Dallas area, Troop 1000 out of Grand Prairie offered the WFA class 1-2 times a year. They do this as one of their service commitments to the community and to the Scouting community. It was taught by professionally trained first responders.
If there is an REI store close to you, they sometimes offer a basic 1st aid class.
Tango61
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/09/10 01:39 AM
First of all, I'm NOT a moderator, so I can't do anything. Besides, there's nothing wrong with what you brought up in your post! The problem is that in a wilderness situation, unlike a combat area, there's no helicopter standing by--even if one has a PLB or other signaling device, it may take a day or two for the bureaucratic wheels to grind and SAR to reach the victim. Unfortunately.
There have been cases in which idiot carrying hunting rifle at a slant downward with the safety off managed to discharge it into the leg of the idiot walking directly in front of him. That would probably be one of those "tourniquet or die" cases.
Posted by: DTape
Re: input needed abut first aid kit - 01/09/10 06:22 AM
Finally, do not try to perform first aid on anyone else until you get training. A recent court case (here in Oregon) considered this negligence and that Good Samaritan law didn't apply. The case was where some completely untrained bystanders moved someone with a spinal injury without first stabilizing the spinal column, with the inevitable results.
Do you have a link to this case (or enough info that i could find it on lexis-nexis, etc.... I am curious as to the facts and findings.
The only similar case I could find in a cursory search was a CA case, in which the higher court (over)ruled that the good samaritan law did not apply to NON-medical care. In this case, had the person been performing medical care, they would have been immune from liability, but pulling someone from a wrecked car was not medical in nature. Nor did they exercise "due care" (which the good samaritan law provides an exception).
http://www.courtinfo.ca.gov/opinions/archive/S152360.PDFInterestingly, in Baxter's dissent, he makes an analogy to backpackers... "A hiker can be sued if, far from other help, he or she causes a broken bone while lifting a fallen comrade up the face of a cliff to safety, but would be immune if, after waiting for another member of the party to effect the rescue, he or she set the broken bone incorrectly."
Posted by: oldranger
Re: input needed abut first aid kit - 01/09/10 10:31 AM
The most important things one learns in any first aid training is to focus on the basics (ABCs) and to be cautious with moving the victim - as opposed to those who get their first aid impressions from TV, where heroic transport always comes high on the list.
Posted by: Tango61
Re: input needed abut first aid kit - 01/09/10 11:16 AM
And ABC's would be AIRWAY,BREATHING, CIRCULATION.
Airway - make sure it is open, learn how to clear
Breathing - if their not, check the airway and begin rescue breathing
Circulation - make sure blood is going where it is supposed and not were it isn't. Don't forget to check for internal bleeding also (some additional training may be needed here).
You can also add "D" to that for "deadly poisoning".
That includes internal (something ingested or inhaled) & external (skin contact - poison ivy family, insect stings - particulary bees & wasps, and venomous reptiles - a whole 'nother thread).
Happy learning!
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/09/10 04:02 PM
No, I don't, but it was on the local news here in Oregon last spring just before I took a basic first aid course as a refresher. Rather scary case, too. I never found out if it was appealed or the results of the appeal, if any.
We were told that even with the minimal amount of training we got in the four hour course, we'd be protected--another good reason for everyone to take a course, even a short one, and keep up the certification.
Posted by: DTape
Re: input needed abut first aid kit - 01/09/10 07:17 PM
Each state has their own laws, and it is interesting how different the good samaritan laws are, and how they are applied/interpreted. In some states, having training increases ones potential liability since there is a greater expectation of due diligence, the "they should know better" idea.
Anyway, if you are ever at another workshop and they bring it up, I'd love to be able to read the court decision. They fascinate me; especially the dissents.
Posted by: Steadman
Re: input needed abut first aid kit - 01/10/10 10:05 PM
1) Tango61
You’re probably past (have newer and better than) my practical experience, and you raise a GREAT
![goodjob goodjob](/forum/images/graemlins/default/good-job.gif)
point about poisons and toxins, but my last (10 year old training) had:
D = deformities (broken bones, etc)
E = extrication
I don't think it really makes a difference - just a way to organize information and prioritize injuries.
2) OregonMouse/JimShaw – thank you
![thanks thanks](/forum/images/graemlins/default/thanks.gif)
– I wasn’t sure if I’d just skirted the boundaries of what is acceptable here.
I don’t know how military practice is going to transition over to the civilian world. Most of what I am hearing about tourniquets is self or buddy aid, immediate action type stuff – where the victim will bleed out if the bleeding is not stopped in the next minutes. I, too, was taught to go for pressure points, and back that up with a tourniquet only if I can’t control the bleeding. But even my conversations with my paramedic peers a decade or more ago sometimes involved quotes like “well, I can pump him full of fluid, but if he doesn’t have enough red blood cells to move oxygen around it won’t matter what the volume is in his circulatory system…”. I agree with OregonMouse that the most likely case for tourniquet use in a backpacking setting is a hunting “accident”.
However, I don’t think that anyone should walk away from this conversation thinking that a gun shot wound to the extremity means the right response is a tourniquet. The Army is still trying to figure out what constitutes a good tourniquet (some work better than others – the improvised kind that you and I might come up with probably won’t work really well, based on what I’m reading).
3) Darwin, if I were you I’d go pick up a 14 day kit at REI, Campmor, or some other dealer and take a class. That is a great place to start.
![smile smile](/forum/images/graemlins/default/smile.gif)
Steadman
Posted by: Tango61
Re: input needed abut first aid kit - 01/11/10 09:35 PM
Steadman,
Thanks for the feedback. Your "D" and "E" are great.
The "D" of "deadly poisoning" was actually suggested to me by a Scout so we continued to use it.
"Deformaties" I usually cover in the "B" for bleeding as part of the "external" category. I emphasize that external can come not only from lacerations (cuts) but also from compound fractures (bone coming through skin).
Was "Extraction" for extracting the victim from immediate danger or for extracting something from the body?
I've always taught that if something has impaled the body, it should be stabilized as much as possible and the victim transported to the hospital for its extraction.
Of course, common sense is called for in these instances on whether to remove the item or leave it. And, how much damage will be caused by trying to minimize the amount left in the body. And, also what type of transportation is best.
Posted by: gorge_medic
Re: input needed abut first aid kit - 01/12/10 09:10 PM
I would add to the list of posters who have recommended taking a first aid course...Good Samaritan laws are slightly different from state to state, but across the board it seems that the best legal protection you can have is to have a certification from some agency stating that you have been trained and evaluated, and then doing just what you've been trained to do. There are several companies that teach a lot of wilderness-oriented courses; I would say that the top three would be Wilderness Medical Associates, Wilderness Medical Institute (owned by NOLS), and SOLO. There are also some more regional bodies, such as WEMSI in PA. For people who work in the healthcare industry already, the Wilderness Medical Society is not to be discounted, though they seem to offer more research activity as well as a fellowship option.(Disclaimer...I teach for WMA, but have met people certified from all of the above groups and have found more similarities than diferences)
All the talk of tourniquets is interesting, so I thought I'd comment...tourniquets are also posed to make a comeback in frontcountry EMS, particularly for SWAT medics. Recent studies have indicated that tourniquets can be applied for up to 4-6 hours without lasting tissue death. Since the normal clotting process (without other factors such as hypothermia or certain medications) is around 15-20 minutes, there seems to be a good strategy to applying a tourniquet initially to control life-threatening bleeding, then slowly releasing pressure after about an hour. I would also (not had the occasion to do so), use a tourniquet to temporarily stop blood flow while cleaning a wound if I anticipated moderate to severe bleeding. Realistically, though, well-aimed direct pressure and elevation will stop about 95% of bleeding in the civilian world. Tourniquets are popular with military medics, IMO, because they routinely encounter multiple patients while people are shooting at them.
In any case...my personal kit contains mostly "routine maintenance" items like blister care, band-aids, both ibuprofen and tylenol, an anti-diarrheal, some trauma supplies like triangular bandages, roller gauze, and vet wrap, and some wound cleaning supplies. I packed it this way based on my prior experiences with what I typically encounter (and that's an important distinction). The biggest advice I can give is to leave the McGuyver suture kit at home (including butterfly bandages)...the types of wounds that truly need suturing require training and experience, and closing a wound leaves it prone to infection.
A particularly good (IMO) reference is "The Outward Bound Wilderness First-Aid Book" by Jeff Isaacs. Not particularly pack-friendly by UL standards, but a great reference to be used in conjunction with wilderness first aid training.
Hope that helps, PM if I can be of further help!
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/12/10 11:08 PM
Ah, somebody else who uses vet wrap! I originally got a roll for my dog, on the advice of my-daughter-the-veterinarian, but I tried it on me and discovered it works well, either to hold bandaging in place or (with some duct tape reinforcement on the outside) for sprains and such. It's a lot lighter than elastic bandage.
Thanks for the advice and clarification!
Posted by: Jimshaw
Re: input needed abut first aid kit - 01/12/10 11:38 PM
A question, when my leg was severely damaged I was advised by the doctor and nurse that even normal drugstore hydrogen peroxide is strong enough to kill healthy skin cells and I was ordered to clean my surgical spots with it diluted half and half with water. Comments? I also understand that is not to be used for brushing teeth as it is too corrosive to enamel?
So anyway my dog cut her leg badly on a piece of lava. I carried her to my truck (I learned to never get a dog too big to carry) and made her lie still until we could get her home. Being that it was a Sunday I washed the large open wound with hydrogen peroxide - I probably diluted it, photographed it closeup - and carefully closed the wound so no hair was inside and wrapped it with vet wrap and told her "no lick" which she seemed to understand.
The next afternoon I got her in to see a vet and we unwrapped the wound. I showed him the print of the closeup and he was amazed and said, "If you hadn't shown me the picture I would not have believed her leg was laid open like that 24 hours ago." It had healed closed and we never did anything more and she was fine afterwards.
![goodjob goodjob](/forum/images/graemlins/default/good-job.gif)
So maybe hydrogen peroxide does belong in a first aid kit to be used on humans and dogs and vet wrap can be used for both species as well.
Jim
Posted by: Eugene
Re: input needed abut first aid kit - 01/13/10 03:18 AM
A question, when my leg was severely damaged I was advised by the doctor and nurse that even normal drugstore hydrogen peroxide is strong enough to kill healthy skin cells and I was ordered to clean my surgical spots with it diluted half and half with water. Comments?
Hydrogen peroxide can certainly kill cells, but at the site of an injury, I think the tradeoff is more than acceptable since it kills off foreign cells too. After the initial disinfection, try to stay away from using it again. Same thing with alcohol.
Posted by: gorge_medic
Re: input needed abut first aid kit - 01/13/10 11:36 AM
Hydrogen peroxide definitely kills everything it comes into contact with, good or bad. I hadn't heard of diluting it down, although the concept seems to make sense. As an alternative, I tend to carry a couple of providone-iodine wipes add to water; the wipes come as a 10% PI solution, which is again too strong, but you can simply add the wipe to a liter bottle of water and steep it like tea. When the water gets to the color of a strong tea or a Newcastle, it's at a 1% solution and is suitable for cleaning wounds.
Probably the most important thing to realize, though, is that the sterility of the water used to clean wounds doesn't matter; there has been at least one study that shows that tap water is just as effective as sterile saline. What matters more is flushing the wound under pressure (such as through a syringe, or a ziploc baggie with a hole pricked in the corner) to move the bacteria out of the way. I pack the PI wipes for situations where there might not be a lot of water available to me, but my first choice is always about a liter of drinking-quality water.
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/13/10 02:39 PM
The highly dilute iodine solution what my-daughter-the-veterinarian had me use on my dog the time he got some skin cuts that got irritated. Since I'm highly sensitive to iodine, I won't use it or even carry it. When I used it on my dog, I carefully wore disposable gloves.
I do carry alcohol wipes--not to use on open wounds but to disinfect the skin over blisters should they have to be pierced. Could I dilute that if I need something for wounds? I certainly wouldn't use it undiluted on raw tissue (ouch!).
Thanks again for the advice and help!
Posted by: Steadman
Re: input needed abut first aid kit - 01/13/10 03:58 PM
Tango61: I was an EMT at the time, so Extraction involved mainly involved protecting the victim while the fire guys ripped the car apart, and getting the victim on a backboard for transport to a hospital for definitive care. Lots of tools involved in doing that.
Seperately, I understand impaled objects the same way you do.
OregonMouse/Gorge Medic: the field disinfectants discussion is interesting. I carry alcohol wipes for disinfecting cuts, and carry baby wipes for sanitary issues. I might not have thought to hose out a bad cut with drinking water as part of scrubbing it out - though it should have been obvious to do so.
Steadman
Posted by: gorge_medic
Re: input needed abut first aid kit - 01/15/10 09:48 AM
OregonMouse, I'm not sure about diluting alcohol wipes...my gut feeling is that plain water would work just as well, but I'm not sure. I'm headed off soon to do a course, let me bounce the idea off some others and check through the literature I have.
Posted by: OregonMouse
Re: input needed abut first aid kit - 01/15/10 11:53 AM
I was taught in first aid and also by my son-in-law-the-ER-physician that anything that stings does so because it is injuring the tissue and therefore should not be used on open wounds. For whatever that's worth.
Posted by: lori
Re: input needed abut first aid kit - 01/15/10 01:37 PM
We were given the Army first aid manual when I signed up for SAR - irrigating wounds with clean water is SOP. But, if it's tick removal or similar, you can bet I'm getting out the disinfectant swab. Alcohol kills the bacteria, but it's also destructive to tissue, so I'll save it for wounds with a higher probable negative outcome. The last gouge on the hand healed up cleanly after being irrigated, dosed with triple antibiotic cream, and wrapped. The last tick bite got infected despite removal by medical personnel - grrrr.
Posted by: Jimshaw
Re: input needed abut first aid kit - 01/15/10 06:48 PM
My wife and I often carry "afterbite" its an ammonia pen thingy. It stings
![smirk smirk](/forum/images/graemlins/default/smirk.gif)
when put on a bite, BUT it attacks poisons and seems to majorly affect how bad a bite gets.
I rolled over on a blackwidow that bit me
![eek eek](/forum/images/graemlins/default/eek.gif)
( I saw the body), I felt it. Immediately we put after bite on it and used a venum sucking device and more afterbite and it never was more than a red spot that went away after a month. I WOULD DEFINITELY USE IT ON AN EXTRACTED TICK SITE, THE MORE IT HURTS THE BETTER.
![goodjob goodjob](/forum/images/graemlins/default/good-job.gif)
A friend of mine fell on granite and scraped up a bunch of skin on his leg. I had a blue hrdogel thingy about 3"x3" that covered most of it. We went home the next day. The blue thingy was covering the worst part and it healed the quickest. I've used a couple of them on other people - I never get hurt.
Jim
Posted by: Aquah0lic
Re: input needed abut first aid kit - 01/19/10 11:13 PM
I would caution anyone on leaving a tourniquet up longer than 90minutes. At 90minutes nerve tissue is quite hypoxic and at risk for permanent injury. If you need to leave a tourniquet up for long periods of time you need to drop it every 90min for 5min to ensure adequate blood flow to distal tissue and nerves. Of course this has to be balanced with blood loss. In the case of profuse arterial bleeding that is a threat to your survival you will be trading your life for permanent neuropathy. The 90min rule is the standard of care in the surgical literature.
Posted by: gorge_medic
Re: input needed abut first aid kit - 01/27/10 08:37 AM
OM, after talking it over and revisiting the studies I could find, it looks like diluting alcohol for cleaning a wound has negligible effect. The most important overall factor, it seems, isn't what you use to clean a wound, but how much pressure you use to irrigate it. Just pouring any liquid is going to be less effective than using some pressure. The PI solution is recommended when potable water is in short supply.
Even when water is in short supply, using good technique doesn't use a lot of water. As little as 100mL can be effective (although this depends on the size and level of contamination of the wound).
Hope this helps, and that it's information you never have to use!