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In last week's blog I explored the variables surrounding what type of wilderness medicine course you "should" take. Over the next few weeks, I'll discuss how to decide what you should consider taking with you in your first aid kit when you venture outside and offer some specific suggestions. This week I'll discuss the contents for a basic first aid kit.
If you were going to spend an afternoon hiking cross country and, given the terrain and undergrowth there was a good chance that your path would take you through brambles, you might first purchase, or borrow, protective clothing. You might also choose to carry some supplies to treat superficial and full-thickness wounds in case your sleeve or pant leg pulled up as you pushed through the
If you were part of local Search & Rescue "Hasty" team that responded to climbing accidents at a local climbing area you would probably carry materials to treat musculoskeletal injuries, have rapid access to a litter and more people, and have reliable emergency communication and transportation.
Note that there is a big difference between what rescue teams carry in their first aid kits and what general backcountry users carry. Rescue teams expect and plan to use their first aid supplies, general backcountry users trips attempt to mitigate any hazards and potential injures by good site management.
For trip leaders, the decision what to carry in your first aid kit—or if you should carry a first aid kit at all—is based on your ability to recognize and assess the hazards you are likely to encounter during your trip, your ability to mitigate them without injury, your ability to predict the type and severity of your injuries if you can't, and your ability, and your ability to purchase and carry the supplies you need to treat those injuries.
Statistically, playing in the backcountry is pretty safe; life-threatening injuries and illnesses are rare. Most traumatic injuries are simple cuts, scrapes, and blisters. Environmental injuries, like dehydration, heat exhaustion, sunburn, and cold, are common, uncomfortable, and typically easily treated (and preventable). Since most trips are short—a day or two—and consist of healthy people, medical problems are minimal and tend to focus on headaches and general aches & pains. Problems in longer trips tend to by related to poor hygiene.
Below are some thoughts on what to carry, and why for a basic first aid kit.
The Basic First Aid Kit
Cuts & Wounds
You need materials to clean, dress, and bandage a wound to prevent it from becoming infected and to promote healing. Use clean drinkable water to flush the wound free of dirt and bacteria before covering it. Dressings are applied directly to the wound after cleaning and bandages are applied over the dressing to hold it in place. In some cases, a dressing and bandage are one and the same.
- I like cleaning a wound with a small syringe; it's easier to use and generally more effective than cutting a corner off a plastic bag. Choose the size of syringe whose weight and volume you like. Typically larger syringes are easier to use because of their greater volume; as their size increases so does their weight. While 12 or 35 cc syringes can only be used for wound cleaning, larger 60 cc syringes can be used for suctioning a patient's airway, flushing ear wax from an infected ear, or giving an enema. Before flushing the wound, remember to wash the surrounding skin with soap and water or water followed by a povidine-iodine solution to help prevent harmful bacteria from migrating into the wound. A pair of tweezers or forceps can be handy to remove small stones and visible debris as well as cactus spines and splinters.
- I prefer to carry roller gauze, a small bottle of Tincture of Benzoin, white petroleum jelly (Vaseline®) or a petroleum-based antibiotic ointment (Triple Antibiotic Ointment®, Neosporin®, etc.), and flexible medical tape to dress and bandage simple wounds rather than carry an assortment of band-aids (unless I'm on a short trip with young kids, then Dora and Star Wars band-aids have their uses). Neither do I carry individually wrapped gauze pads; instead, I cut what I need from a two-inch gauze roll. After you have cleaned the thoroughly cleaned the wound, paint the skin around it with two coats of Tincture of Benzoin to help the tape stick. Then cut and impregnate a few layers (about a quarter of an inch) with the petroleum jelly or ointment for the dressing and place it over the wound to help protect the wound and promote healing. The Tincture of Benzoin should extend roughly 3/4 of an inch past the edges of the gauze on all four sides. Finally, cut enough flexible medical tape to cover the dressing and Benzoin. Monitor for the signs and symptoms of a local infection: increased redness, tenderness, pain at the site. For clean, shallow wounds, you can leave the dressing in place for up to two days; deeper wounds require more frequent changes.
- For clean shallow cuts, especially to the face, I carry and use steri-strips to close the wound to decrease scaring and promote healing. Never close a deep or excessively dirty wound in the field. Use Tincture of Benzoin to help the strips adhere. To use: approximate the wound edges—avoid overlapping—place the steri-strips about 1/8 of an inch apart.
- If I'm in a wet environment—a place where it rains a lot or I'm paddling—I carry and use a micro-thin film dressing. Micro-thin film dressings (Tegaderm®) are clear, water-proof, and breathable. You can put them directly over a wound, over steri-strips, or over a dressing and ointment. For details on how to apply micro-thin film dressing please refer to this blog article.
Blisters are the bane of hikers and sportsmen and women everywhere. Fortunately, with a little attention, they are relatively easy to prevent and treat. The BEST prevention, by far, is ENGO Blister Patches. ENGO patches adhere to your footwear, NOT your foot and will last for weeks before needing replacement. If you regularly get blisters in a specific spot, put a ENGO patch on your hiking boot under that spot and PRESTO, no more blisters. No kidding. If you get a hot spot, stop and apply an ENGO patch to your boot and you won't get a blister.
If you get a hot spot and fail to treat it, you will likely get a blister. The simplest solution at this point is to drain the blister, drain it (or remove the lid) and cover it with a hydro-gel dressing from Second Skin®.
For more details on preventing and treating blisters please refer to this blog article.
Life-threatening Allergic Reactions
Life-threatening allergic reactions, also know as anaphylaxis, are unpredictable and, while rare, can quickly lead to death. Bee, wasp, fire ant, hornet, and other types of stings are common causes, as are food and drug allergies. The ONLY treatment is an intramuscular shot of epinephrine; epinephrine reverses the signs and symptoms. This topic is too complicated to address in depth in this article. Suffice to say that the recognition and treatment of a life-threatening allergic reaction using epinephrine requires study and training. I firmly believe that everyone in the outdoors should carry and be trained to use epinephrine. If you aren't, please take a wilderness medicine course—preferably from us—before you go on your next trip.
General Aches & Pains
Most general aches and pains from muscle soreness to headaches can be treated with ibuprofen or neproxen, which ever you prefer. Both are over-the-counter medications available from most grocery and drug stores.
The Basic First Aid Kit Contents
In summary, at the very least you should consider carrying a basic first aid kit to treat the problems listed above. Adhere to over-the-counter drug directions and warnings. Prescription drugs should be carried and administered only under the supervision of a licensed physician. If this is all you carry, you can fit everything listed below into our Minimalist First Aid Pack.
In addition to your first aid kit and emergency action plan, remember to carry a cell phone, satellite phone, or SPOT for emergency communication.
- Two epinephrine auto-injectors. You'll need training and a physician's prescription to purchase. Carry in the pack's interior zippered pocket.
- 25 mg diphenhydramine (Benedryl®) capsules or caplets for itching associated with allergic reactions and for use in addition to epinephrine for the treatment of life-threatening allergic reactions. Purchase over-the-counter and carry in a 0.25 Nalgene bottle in one of the pack's velcro loops.
- 200 mg ibuprofen (Advil®) or neproxen sodium (Aleve®) tablets for general pain. Purchase over-the-counter and carry in a 0.25 Nalgene bottle in one of the pack's small velcro loops.
- White petroleum jelly (Vaseline®) or a petroleum-based antibiotic ointment to protect and promote superficial wound healing. Purchase over-the-counter and carry in a 0.25 Nalgene bottle in one of the pack's small velcro loops.
Wound Treatment Supplies
- Surgical scissors to cut gauze rolls, ENGO patches, flexible medical tape, and Second Skin®. Carry in the pack's interior slash pocket located behind the zippered pocket.
- Uncle Bill's Silver Gripper Tweezers to remove cactus spines, splinters, and embedded debris. Attach it to the interior zipper with a small steel split-ring.
- 12 cc irrigation syringe to flush wounds. Put it in the elastic loop designed to hold it.
- Cotton applicators (Q-tips®) to apply Benzoin, PI solution, or ointment to skin. Purchase in most stores and carry in a 28 ml Snap Top Nalgene container in two of the pack's small velcro loops.
- Tincture of Benzoin to help tape and steri-strips adhere to the skin. Purchase and carry in a 0.5 Nalgene bottle in one of the pack's velcro loops.
- 10% povodone-iodine (PI) solution to help clean and disinfect the skin around a wound; it can also be used to purify water. Purchase and carry in a 1 oz narrow-mouth Nalgene bottle in one of the pack's medium sized velcro loops.
- Two-inch roller gauze for wound cleaning and dressings. Carry in a 50 ml Snap Top Nalgene container in one of the pack's medium sized velcro loops. Consider carrying a second sterile roll in the pack's interior zippered pocket.
- One 4 x 6 inch ENGO patch for blister prevention. Carry in the pack's interior slash pocket located behind the zippered pocket.
- Four Second Skin® Blister Patches for blister treatment. Carry in the pack's interior slash pocket located behind the zippered pocket.
- One foot of folded two and/or four inch flexible medical tape for holding gauze dressings in place over a wound; I carry both sizes. Carry in the pack's interior slash pocket located behind the zippered pocket.
- Two each of two- and four-inch micro-thin film dressings. Carry in the pack's interior slash pocket located behind the zippered pocket.
- Three each of 1.5- and 3-inch packets of steri-strips for closing shallow facial wounds. Carry in the pack's interior slash pocket located behind the zippered pocket.
- Two scalpel blades for lancing abscesses. Carry with or without a handle; the pack will be lighter without the handle; the handle makes it easier to wield the blade.
- Space pen or mechanical pencil for taking patient notes. Carry in one of the pack's spine pockets.
- One WMTC Patient SOAP note for documenting a more serious problem. Carry in the pack's interior slash pocket located behind the zippered pocket.
- Extended-range digital thermometer for taking a core temperature. Carry in one of the pack's spine pockets.
- Oral Rehydration Salt packet for treating moderate dehydration in a severe heat challenge. Carry in the pack's interior slash pocket located behind the zippered pocket.
In next week's blog I discuss contents for a small group's wilderness first aid kit.