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Fleas, mosquitoes, lice, assassin bugs, sand flies, chiggers, ticks and other biting insects may be carriers of an infectious disease. With the advent of global warming, insects and insect-borne infectious diseases are spreading to new areas. To protect yourself against contracting an insect-borne infectious disease, the Centers for Disease Control and Prevention (CDC) recommends using the following insect repellents and insecticides; they have been shown to be safe and effective, even in pregnant and breastfeeding women. Clothing, tents, and mosquito netting are ideal for first order of protection and sleeping, especially when saturated with Permethrin (which kills insects on contact). To protect against chiggers and ticks, wear light-colored or white long pants, long-sleeved shirts, and socks so ticks can be more easily seen; pull socks over pant cuffs. Wear a hat and place petroleum jelly around hairline to keep ticks from crawling into hair (where they will be very difficult to find). Do a thorough tick check each morning & evening before entering and leaving your tent. The CDC does not recommend other insect repellents and products as they have not been shown to be effective despite manufacturers claims. These include natural plant oils, (such as citronella oil, cedar oil, geranium oil (or geraniol), and lemongrass oil), repellents containing vitamin B1 or garlic, and wristbands and ultrasonic devices. Application
DEET
Picaridin
IR3535
Lemon Eucalyptus Oil
Permethrin
Interested in learning first aid? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
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In 1979, the U.S. Food and Drug Administration (FDA) began requiring an expiration date on prescription and over-the counter medicines so it’s not surprising that the FDA strongly recommends disposing of all expired drugs. That said, in 1985 the FDA began testing medications for the Department of Defense under the Shelf Life Extension Program (SLEP) to see if it was safe for the military to stockpile medications. Continual testing shows that many Rx and OTC drugs retain full potency years beyond their expiration dates. And, current data also shows that no drugs currently in production have been shown to be toxic past their shelf life. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military. That said, it’s difficult for an individual consumer to know how long a specific drug will remain active beyond it’s expiration date as it’s ingredients, type and presence of any preservatives, and storage conditions can dramatically affect the drug's potency and life expectancy. Obviously we have control of what we put into our own first aid kit but how do we, as expedition leaders and medical officers make decisions about drug use once in the field and faced with someone else’s first aid kit that contains expired medications? Below are some practical guidelines:
 Over the counter (OTC) acetaminophen, ibuprofen, and naproxen are commonly used to treat pain and fever. Because they are labeled and packaged for OTC use most people consider them safe. This is not true. In addition, many people also believe that more is better. This is also not true. In fact all three medications have the potential for serious side effects. Aging further increases the risk of serious side effects as older people, especially those over the age of 65, often have a decrease in liver and kidney function and are mildly dehydrated.
In addition to its therapeutic effects, acetaminophen is a dose-dependent liver toxin; patient who take acetaminophen with alcohol or while fasting-due to illness, anorexia, or malnutrition-are at serious risk for liver failure. Even if taken at the current OTC recommended dose (not to exceed 4 g/day), the drug can be toxic. The FDA expert panel recommends lowering the standard dose from 1,000 mg to 650 mg and the maximum dose/day to 3 g/day. Accidental overdose send roughly 80,000 people to the emergency department each year; at least 500 are fatal. Part of the problem is that acetaminophen is found in more than 600 OTC medications including cold, flu, sinus, and in Rx codeine-based medications (Vicodin® or Percocet®). Patients unaware of the potential for serious complications often mix and match drugs containing acetaminophen and easily exceed the maximum daily dose. Forewarned is forearmed. Ibuprofen and naproxen also have serious side effects. Chronic use of both, including aspirin, may cause indigestion, gastric or duodenal ulcers, and fluid retention. In addition, ibuprofen use slightly increases the risk of a heart attack or stroke. Renal damage is also possible and significantly increases if the patient is dehydrated (as is often the case in an outdoor setting). Not surprisingly the risk of adverse effects increases substantially with dose and course. Note that while many athletes take ibuprofen or naproxen for general muscle soreness, neither drug has been shown to be effective. Remember that the GI side effects of both drugs increase if the drug is not taken with food and the renal effects increase if the patient or athlete is dehydrated. Follow the following simple guidelines greatly reduces your chance of adverse effects:
Interested in learning first aid? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
Padded Aluminum Splints may be purchased at our online store and fit into the outside zippered pockets on our Guide and Expedition first aid packs.
Introduction
Whether you are traveling alone, taking part in an expedition, or responding as a member of a search & rescue (SAR) team, you will need a first aid kit. What you should take and how you should package it depends on many things. There is no generic first aid kit. Below are a few basic concepts that you will need to know in order to begin building a kit that meets your needs.
As the size of the expedition group gets bigger or the trip longer, you will need to carry more of the basic first aid kit contents and additional drugs to treat medical problems that typically don't arise on shorter trips due to the one to three week, or longer, incubation period required for most infectious diseases. Our Expedition Pack can typically hold enough supplies for a group of 8-12 people for up to three weeks, more with resupplies. The needs of larger groups (typically found on commercial raft trips) can be met by using multiple packs.
A good guide has excellent self- and situational awareness, a complete understanding of the terrain and environmental hazards they may encounter and strategies for mitigating their associated risk, together with a reasonable assessment of their clients skills. Despite their training and skill, risk cannot be completely eliminated, and injuries and illnesses can occur. The prudent guide will carry supplies to address both common and unlikely, but possible, scenarios. As the terrain increases in difficulty, the potential for both stable and unstable musculoskeletal injuries increases; and, it makes good sense to add a padded aluminum splint, self-adhering bandages, and perhaps kinesiology tape to the contents of the basic first aid kit. In conjunction with a cloth roll cut from a T-shirt, a padded aluminum splint can be used to stabilize most common extremity fractures—forearm, wrist, knee, and ankle. Self adhering bandages may be used in lieu of a cloth roll to secure the splint or by itself, to support a strain or sprain or hold a dressing in place. Kinesiology tape is a specialized tape with an adhesive backing, and when combined with with Tincture of Benzoin, can also be used to protect against or support a strain or sprain. Maxi-pads can be added as emergency trauma dressings and OTC medications to treat common medical problems like diarrhea, constipation, sinus congestion, acid stomach, etc.
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 wilderness travelers are healthy, medical problems are minimal and tend to focus on headaches and general aches & pains. Problems in longer trips tend to be related to poor hygiene.
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Our public YouTube channel has educational and reference videos for many of the skills taught during our courses. Check it out!
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