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.

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!

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!

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. 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

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.

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.

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!

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

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.

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.

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.

My wife and I often carry "afterbite" its an ammonia pen thingy. It stings 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 ( 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.

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

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.

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!