My thoughts on First Aid

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My thoughts on First Aid

#1

Post by Scuba » Sun Aug 16, 2015 8:47 pm

I wrote this for Sarge a few months ago....


This past weekend I went on a weekend hike and hang with Sarge and other members of the Wilderness Ministry. Whenever I leave the house I carry some basic medical gear with me whether it is a jump bag in my truck or a kit for a weekend hike. In talking with others about my kit I was carrying I volunteered to write an article for Sarge about what I think needs to be included in a kit or kits.

Before I go any further, let me start by saying that I am NOT in any way affiliated with the National Outdoor Leadership School (NOLS) and have never attended any of their excellent (so I have been told) Wilderness Medicine Institute courses. I have been involved in EMS for over 20 years starting as an EMT-Basic, moved up the EMT chain and I am now a Registered Nurse. My military training involved both standard self-aid and buddy care, Emergency Department Medicine and Combat Medicine with many advanced aspects (water rescue, mountaineering and high altitude rescue among others).

How I have been trained and how you have been trained (if at all) may be vastly different so I will endeavor to keep this as simple as possible and only make product recommendations for a backpacking First Aid Kit that will work for a user with little to no medical training. Our goals are to:
· Manage pain and illness
· Stop Bleeding/Shock
· Manage small wounds (cuts, scrapes, blisters)
· Stabilize fractures or sprains

Looking around the internet, I think dollar for dollar the best entry level starter kit is the Adventure Medical Kit Adventure First Aid 2.0 . It includes the following:
Bandage Materials
· 16 - Bandage, Adhesive, Fabric, 1" x 3"
· 1 - Bandage, Adhesive, Fabric, 2" x 4.5"
· 4 - Bandage, Adhesive, Fabric, Knuckle
· 12 - Bandage, Adhesive, Plastic, 3/8" x 1 1/2"
· 4 - Bandage, Butterfly Closure
· 4 - Dressing, Gauze, Sterile, 4" x 4", Pkg./2
· 4 - Dressing, Gauze, Sterile, 2" x 2", Pkg./2
· 4 - Dressing, Gauze, Sterile, 3" x 3", Pkg./2
· 2 - Dressing, Non-Adherent, Sterile, 2" x 3"
Bleeding
· 1 - Gloves, Nitrile (Pair), Hand Wipe
· 1 - Trauma Pad, 5" x 9"
Blister / Burn
· 1 - Moleskin, Pre-Cut & Shaped (11 pieces)
Fracture / Sprain
· 1 - Bandage, Elastic with Clips, 2"
· 1 - Cold Pack

Instrument
· 2 - Safety Pins
· 1 - Scissors, Bandage with Blunt Tip
· 1 - Splinter Picker/Tick Remover Forceps
· 2 - Thermometer, Disposable
Medical Information
· 1 - Caring for Children in the Outdoors Manual
Medication
· 3 - Acetaminophen (500 mg), Pkg./2
· 3 - Antihistamine (Diphenhydramine 25 mg)
· 3 - Ibuprofen (200 mg), Pkg./2
· 1 - Aspirin (325 mg), Pkg./2
Other
· 1 - After Bite® Insect Relief
Wound Care
· 12 - Antiseptic Wipe
· 2 - Cotton Tip Applicator, Pkg./2
· 1 - Tape, 1/2" x 10 Yards
· 4 - Triple Antibiotic Ointment, Single Use


This kit is a good starting point and in my opinion a minimum for everyone on the hike. At $20.22 on Amazon with Prime (priced Feb. 10, 2015) it is an inexpensive and lightweight (1 lb) option that covers most of the basics and with a few additions can be an excellent First Aid Kit (FAK).
With our earlier stated goals we can now look at this kit and see what it has and what it might need to have added.
For managing pain and illness this kit has:
· 3 - Acetaminophen (500 mg), Pkg./2
· 3 - Antihistamine (Diphenhydramine 25 mg)- aka BENADRYL®
· 3 - Ibuprofen (200 mg), Pkg./2
· 1 - Aspirin (325 mg), Pkg./2

So this kit has 3 different pain relievers and a good, proven first gen Antihistamine. What about Gastrointestinal issues? I would add:
For diarrhea - Loperamide (Imodium®) – preferably in dose packs
For an upset stomach/diarrhea - Bismuth subsalicylate (PeptoBismol®) preferably in dose packs


To Stop Bleeding/Shock this kit has:
· 1 - Gloves, Nitrile (Pair), Hand Wipe
· 1 - Trauma Pad, 5" x 9"

To this I would add:
One more pair of gloves
A few more 5x9 Trauma Pads ($1-2)
A Tourniquet ($0-30)
Quikclot® ($16.99-40)

A tourniquet is an indispensable tool and for us something as simple as a tree strap and a stick or toggle can work well. If you want a commercially available tourniquet I recommend the SOFTT-W . Other commercial tourniquets are good; I think this is the best.

Quikclot® is a hemostatic bandage or sponge that is impregnated with an inorganic mineral that accelerates the body’s natural clotting ability without an exothermic reaction. The hemostatic agents we first used in the military were granules we poured into the wound but in many cases they burned the patient with the heat they produced; Quikclot® was the solution to that problem. Available from Amazon or many other places, I would recommend the QuikClot Sport 50g package ($16.99) over the less expensive but smaller 25g package. While direct pressure and elevation can’t be replaced, QuikClot® is an excellent addition. If you are a prepper/survivalist or a hunter, I would instead recommend the QuikClot Combat Guaze. It costs twice as much but is designed for the treatment of traumatic bleeding.


To Manage Small Wounds, this kit has:
· 16 - Bandage, Adhesive, Fabric, 1" x 3"
· 1 - Bandage, Adhesive, Fabric, 2" x 4.5"
· 4 - Bandage, Adhesive, Fabric, Knuckle
· 12 - Bandage, Adhesive, Plastic, 3/8" x 1 1/2"
· 4 - Bandage, Butterfly Closure
· 4 - Dressing, Gauze, Sterile, 4" x 4", Pkg./2
· 4 - Dressing, Gauze, Sterile, 2" x 2", Pkg./2
· 4 - Dressing, Gauze, Sterile, 3" x 3", Pkg./2
·
· 2 - Dressing, Non-Adherent, Sterlie, 2" x 3"
· 1 - Moleskin, Pre-Cut & Shaped (11 pieces)
· 1 - After Bite® Insect Relief
· 12 - Antiseptic Wipe
· 2 - Cotton Tip Applicator, Pkg./2
· 1 - Tape, 1/2" x 10 Yards
· 4 - Triple Antibiotic Ointment, Single Use

To this I would add:
-Dr Scholl’s® MoleskinPlus (the moleskin in this kit is pretty cheap stuff) The Moleskin plus is also padded and you can easily cut it to whatever size you need.
- WaterJel® Sterile Burn Dressing I recommend getting a 3pack of 4x4 pads
-BiteMD™- the kit includes an AfterBit®e pad; I like the BiteMD™ applicator tube better.

To stabilize fractures or sprains, this kit has:
· 1 - Bandage, Elastic with Clips, 2"
· 1 - Cold Pack

Sort of underwhelming, huh? If I break a leg or arm in the wilderness I get an ACE bandage and an icepack? The 4 mile hike out with that broken limb to get to help is going to really suck. Here is what I would add:
-SAM Splint at 123g for one, these are an excellent way to splint an extremity fracture. At least get one, two isn’t a terrible idea.
-A triangle bandage. You have all seen one; it is the perfect tool for making a sling for an arm or shoulder injury.

Other items to add:
Wilderness First Responder: How To Recognize, Treat, And Prevent Emergencies In The Backcountry At $20-25 it isn’t the cheapest book out there, but it is an excellent resource on most of the injuries you could see while hiking or camping.
Name
Address
Emergency contact w/ phone #
List of medications person is on
Allergies and medical conditions
Blood type (if known)
LAMINATE AND CARRY


A Laminated 3x5 Emergency card. EACH MEMBER IN YOUR GROUP SHOULD HAVE ONE. Have the following info on it.
Name
Person to contact in case of emergency and their phone #
List of allergies and medical conditions
List of meds they are on
Blood type (if known)

With the exception of the tourniquet, the book and with QuikClot® sport (not the combat gauze) everything here can be easily had for $100 or less.
Now, I was also asked to list what I carry on a weekend trip, so here we go:
My IFAK (Individual First Aid Kit) on my chest rig contains:
· QuikClot Combat Gauze (X-ray), 3” x 4 yards
· Combat Medical Systems, Decompression Needle, Mojo Dart, 14GA, 3.25”
· Nasopharyngeal Airway, 28fr w/packet of lube
· Tytek Medical, EZ Gauze TM-215. Sterile (Z-Fold Dressing)
· Nitrite Gloves, Purple, Large 2 pr
· PMI HALO SEALS, 2-pack
· Dynarex, 2” Elastic Bandage
· 4” Israeli Emergency Dressing (Pressure dressing)
· Combat casualty card with rubber band for attachment and pencil
· SOFTT-W Tourniquet
· Sharpie
· Small notepad
· EMS Shears
· Hemostats
· ITS Fatboy pouch
Most of this is available commercially as the ITS ETA Trauma Kit Fatboy


My aid kit in my pack contains everything I recommended for your kit plus:
A suture kit
2 air splints (1 full arm, 1 full leg)
Glucose Gel, 3pks
Electrolyte packs, 3 oral mixes
2 more QuikClot Bandages
4 more Israeli Bandages
2 Rolls of Kerlix
1 roll of Coban
1 EpiPen
1 Ring Cutter
My personal medications

My kit is significantly more expensive and some of the items require training, but it is basically an expanded version of the kit I recommend for all hikers/campers.


One final note. I purposely left airway management out of this post. If you don’t know what you are doing you can severely injure or even kill a person if you do the wrong thing. I highly recommend you contact your local RedCross and take a CPR/First Aid course and they will show you how to properly establish and maintain a patent airway. If there is ANY possibility of a spinal injury, do not move a person unless you ABSOLUTELY have no other option.


"I come in peace. I didn't bring artillery. But I'm pleading with you, with tears in my eyes: If you fuck with me, I'll kill you all." - Gen James Mattis, USMC RET.
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Re: My thoughts on First Aid

#2

Post by Rat » Sun Aug 16, 2015 10:24 pm

Dang, that's a lot of stuff...

· Manage pain and illness
I carry Tylenol, Ibuprofen and any prescriptions

· Stop Bleeding/Shock
Coagulant, and I use sutures from my PSK from dyneema fishing line (I carry the suture needle in my first aid kit) , my kerchief for really bad bleeding and I carry an assortment of small bandaids and a few butterfly bandages.

· Manage small wounds (cuts, scrapes, blisters)
Bandaids, butterfly bandages, duct tape for blisters, alcohol from my alcohol stove for antiseptic and superglue

· Stabilize fractures or sprains
Duct tape, kerchief, pack frame components or readily available natural resources.

I am well versed in CPR and wilderness first aid (REI courses).

This kit will handle normal hiking stuff for one person, two if stretched. If more people are going I would supplement this with more stuff especially pain and bleeding supplies but also antiseptic and antibiotic.

I also carry a bottle of saline solution for my contacts and I use this for irrigating wounds and eyes, it can be refilled with filtered water; I highly recommend a small squeezable bottle for irrigating.

All of this fits in my PSK and my small first aid kit that is always on my person (not in my pack) where it can't be separated from me (like during a stream crossing). I am never without these two items and my knife.
"I aim to misbehave." - Capt. Mal Reynolds

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