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Blog

Guide to Insect Repellents, Insecticides, and the Prevention of Insect-borne Diseases

11/15/2017

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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
  • Avoid spraying repellents on or near the face; instead spray on hands and then rub on face; avoid contact with the eyes and mouth.
  • Parents should apply repellents and insecticides to children.
  • Reapply regularly and if/when mosquitoes—or other insects—bite.
  • Lower concentrations provide shorter protection.

DEET
  • 30% concentration should provide protection for 6 hours.
  • 20%-23.8% concentration provides 4-5 hours of protection.
  • 6.65%-10% concentration provides about 1-3 hours of protection.
  • Concentrations over 50% offer no additional benefit.
  • Controlled-release products might offer a longer duration of protection even with lower concentrations.
  • Safe for children > 2 months in concentrations of 10%-30%.

Picaridin
  • 20% concentration provides protection for up to 7 hours.
  • 10% products provide protection for up to 5 hours.
  • Known as icaridin in Canada. Canada recommends against use in children under 6 months.

IR3535
  • 7.5% concentration provides about 10-60 minutes of protection.

Lemon Eucalyptus Oil
  • Protection for up to 2 hours.
  • Not recommended for children < 3 years.

Permethrin
  • Kills insects on contact. Apply to clothing, gear, netting, & tents; it will last through numerous washings/rain storms. Do not use directly on skin.

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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Understanding Drug Expiration Dates

4/18/2017

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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:
  • Storage matters: Store medications in dry, cool spaces away from light in air-tight containers. Correctly stored, most drugs retain their full potency years beyond their expiration date.
  • Solid drugs are more stable than liquid. If the physical condition of the drug remains unaltered by time, it is likely safe to use but may not have full potency. Discard any drug that shows visible degradation. This includes liquids that have changed color, become cloudy, or present with a precipitate.
  • With ophthalmic drugs, the limiting factor is the continued ability of the preservative to inhibit microbial growth. With that in mind, it’s best to toss eye drops and ointments after their expiration date.
  • Biologic products, insulin, and oral nitroglycerin, degrade rapidly beyond their expiration dates and should not be used. Depending on how it is stored, epinephrine can also degrade rapidly, however it remains safe to use if it is clear and free of particulates—you just may need more of it. One study showed that properly stored EpiPens 5-7 years past expiration date retained more than 70% of the original potency; many 2-3 years past their expiration date retained more than 90%.
Common sense, indicates that:
  • Outfitters should check and replace all expired medications before leaving for a trip.
  • You should replace medications that are required to treat a potentially life-threatening condition ideally before but definitely ASAP after their expiration date. That said, a year won't make a difference in the potency for most drugs.
  • If the medication is for a minor health problem (headache, mild pain, hay fever, etc) and it’s for personal use, it’s reasonable to use it. Discontinue use—and replace it—if the drug does not yield the expected therapeutic response.
  • When in doubt, consult a pharmacist before the drug expires.
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The Hazards and Benefits of Over-the-Counter Acetaminophen, Ibuprofen, and Naproxen

1/19/2017

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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:
  • IF you must take one of these medications, take the lowest therapeutic dose for the shortest period of time.
  • Make sure you are hydrated before taking any medication.
  • Take ibuprofen or naproxen with food to decrease the risk of developing GI problems.
  • Do not take ibuprofen or naproxen for muscle aches; instead, increase your water and electrolyte intake and rest.
  • If you choose to carry and take acetaminophen, remember that it is used in numerous cold, flu, sinus, and sleep medications. Keep track and don't exceed 3 g/day; use less if possible.
  • Do not drink alcohol if you are taking acetaminophen.
  • Do not take acetaminophen if you are fasting or cannot keep food down due to nausea and vomiting. 

​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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T-shirt Cutting 101

12/18/2016

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No need to carry triangular bandages when you know how to spiral cut a shirt to get a cloth roll. Combine with a 36-inch SAM splint to immobilize an unstable wrist or forearm, knee, or ankle.

Click on the video to the right to see how to spiral cut a T-shirt. Look at the slide show below to see how to mold, pad, and wrap a padded aluminum splint.
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.
Want more information on this and other wilderness medicine topics? 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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Wilderness First Aid Kits—general concepts

11/30/2016

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Wilderness First Aid Kit Articles
Assembling a first aid kit is a need-dependent process that varies from individual to individual, company to company. We created the following 4-part article series to help guide you. We strongly suggest you read all of them, in order, before making a decision. You may find that you want (or need) multiple kits.
  • Part 1, general concepts
  • Part 2, the basic kit
  • Part 3, beyond the basic kit
  • Part 4, the expedition kit
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.


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Wilderness First Aid Kits—the expedition kit

11/29/2016

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Wilderness First Aid Kit Articles
Assembling a first aid kit is a need-dependent process that varies from individual to individual, company to company. We created the following 4-part article series to help guide you. We strongly suggest you read all of them, in order, before making a decision. You may find that you want (or need) multiple kits.
  • Part 1, general concepts
  • Part 2, the basic kit
  • Part 3, beyond the basic kit
  • Part 4, the expedition kit
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.

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Wilderness First Aid Kits—beyond the basic kit

11/29/2016

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Wilderness First Aid Kit Articles
Assembling a first aid kit is a need-dependent process that varies from individual to individual, company to company. We created the following 4-part article series to help guide you. We strongly suggest you read all of them, in order, before making a decision. You may find that you want (or need) multiple kits.
  • Part 1, general concepts
  • Part 2, the basic kit
  • Part 3, beyond the basic kit
  • Part 4, the expedition kit
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.

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Wilderness First Aid Kits—the basic kit

11/29/2016

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Wilderness First Aid Kit Articles
Assembling a first aid kit is a need-dependent process that varies from individual to individual, company to company. We created the following 4-part article series to help guide you. We strongly suggest you read all of them, in order, before making a decision. You may find that you want (or need) multiple kits.
  • Part 1, general concepts
  • Part 2, the basic kit
  • Part 3, beyond the basic kit
  • Part 4, the expedition kit
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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