Wilderness Medicine -- Backcountry First Aid (excellent article!)

[Mike7]

I ran across this article, which is an excellent straight forward backcountry first aid summary in my opinion. If you learn everything in this article, I believe you will know more proper first aid than 99% of other people in the backcountry.

http://contemporarypediatrics.moder...ing-illness-or-injury-great-outdoors?page=0,0



I will make a few comments on the medical kit that the author details at the end of the article:

I personally don't carry all of the first aid kit items mentioned for solo and partner backcountry hunting. But if I was tasked with carrying a kit for a group in the backcountry as has been the case previously, then I might take most of those items, and potentially some additional items depending upon the length of the trip, location, etc. Knowing the medical history of those along on your trip can be a big help with making critical decisons on taking or leaving items also...like albuterol for Asthma or Epi-pens for severe insect allergies, etc. It is not feasible to pack a hospital on your back, but there is nothing more frustrating as a medical provider, than watching somebody on their way to death right in front of your eyes (like anaphylaxis from a nut allergy), when you know how to help them, but don't have the necessary tool/medicine to make a difference.

When on foot, I choose not to carry a SAM splint or prewrap but do carry some light weight less bulky cloth athletic type tape and some tincture of benzoin which will get the job done for an ankle sprain or for making a crude splint. If I or a hunting partner actually fractures an ankle, that is what the satellite texter is for...because I (and 99.9% of other people) am not walking out on a broken ankle, whether I have a SAM splint or not.

I don't carry an emergency reflective blanket when I have my overnight camping gear, because that is what my pad and quilt are for.

I don't carry a separate sterile solution irrigating bottle or syringe, but do have a tiny bottle of contact/artificial tears solution and a large syringe for flushing the Sawyer mini-filter (those mini's plug up easily). A 1 L platypus bag that has potable water which can be poured into a wound, along with 4x4 gauze dressings that can be used to perform a scrub of the wound while irrigating with gravity applied water will in my experience (except for irrigating eyes) be just as effective or nearly as effective as high pressure irrigation from a large syringe (a syringe which just adds more bulk to your pack if you don't already have it for your water filter system).

I don't carry alcohol pads to wipe down instruments, as washing instruments with water, wiping with a paper towel which I carry in my cook kit, and then letting air dry in the sun is pretty darn sterile. I you were using your instruments on multiple group members that may have Hepatitis C, etc., then maybe addding an alcohol pad in the process would be advisable though.

I do bring aspirin (great instruction on use are in the article), naproxen instead of ibuprofen (this has little lower cardiac risk), and antihistamines, as mentioned on the author's list. A small mini-leatherman can be packed, which has excellent small scissors and tweezers, and which can serve a multitude of functions from cutting tape and hangnails, to pulling splinters and applying steri-strips.

Hopefully, this helps someone.

 

[Finch]

Notably, serious injuries are almost twice as likely to occur in camp than while mountain climbing!

I found the above little tidbit in quotes pretty interesting! Never would have thought that. I'm still lacking on getting a first aid kit together but I do plan on getting it done before my upcoming trip.

I never saw it mentioned in his kit or yours but how about some sort of blood clotting agent? Your opinion on packing that? How about superglue for wound closure?

 

[Mike7]

I have clotting agent in my larger home/vehicle kit, but choose not to carry it for my solo backcountry kit for the lower 48. Good really firm pressure for most wounds that can effectively be treated in the prehospital setting (i.e. not penetrating chest wounds, etc.), works better than most people would think. Having seen clotting agents used, I can definitely see where they may have a role in some circumstances, but like all things in your kit, you have to weigh the likelihood of use vs. the inconvenience of every additional thing that you bring. On a remote raft trip (particularly with other hunters that could accidentally shoot you) in Alaska for instance, then I would likely bring it...but I choose not to bring it for routine trips a few hours from the trailhead that I take around here.

I find Superglue to be messy and hard to use well, even when you have help from another person, so I use steri-strips and tincture of benzoin instead. One guy can easily pull a wound closed on himself with steristrips. The only downside to this would be that you would have to shave your hair around a head wound to use steri-strips, so I sometimes have a single ampule of Dermabond if going with others (like thicker non-messy Superglue) that I can repair a head wound with. Even with Dermabond it would be difficult to repair a head wound on oneself I think. Staples are great for head wounds and for dogs. A stapler is very light, but is bulky, so it gets left in the car/home kit. I repaired a couple of large barbed wire fence gashes in my bird dog puppy just last month back at home after irrigating with the sterile saline used to rinse contact lenses. Some dogs don't like the skin staples, but it is pretty easy to do even on an anxious dog who is moving around some...and they work great.

 

[Finch]

Thanks for the info! What is your opinion on some of the store bought kits like Adventure Medical that are geared towards outdoor minded folks?

 

[Becca]

Great article Mike, thanks for sharing. I spent some time retooling our first aid kit awhile back, basically going from a pre-fab adventure medical kit (which was heavy and had a lot of stuff I no longer carry) to my own custom kit that's lighter weight and more specific to our needs. As you mentioned, I definetely add items to the regular kit depending on the group and/or setting (our bro in law has a profound nut allergy, so if he goes along I'm sure we have an epi pen).

I carry an empty 10cc syringe with the thought that I could irrigate a wound or an eye if necessary, although I have never needed it yet. It's minimal weight penalty.

I do also carry a small quick clot gauze, due to the remoteness of many of our trips and the length of time it would take for help to arrive. I know direct pressure will take care of most wounds, but again it's minimal weight penalty for something that might be useful in the event of a bad situation.

I still think the most important item in our kit is still our satellite phone. As you said, in the event of a fractured leg or other severe trauma an evac really becomes the most feasible alternative, and having a reliable way to communicate with first responders is paramount.

Great article for anyone, and also a good reminder for those of us in healthcare. Managing an emergency in the field is a lot different from in a clinic or hospital....

 

[Mike7]

I completely agree with Becca's take on things. I also think medical and non-medical people alike can take away something from this article and the associated links. I personally have no use for most of the prefab first aid kits that I have seen. I feel like people are way better off as far as cost and usefulness, just buying a small OR or Kifaru pullout (or doubled quart freezer bag even), and then filling it with needed items which can all be obtained from the over the counter pharmacy section at the local store and amazon.com.

 

[rodney482]

I too carry the quick clot bandage.

 

[Ironman8]

I'm glad to see that a tourniquet was included in the article. I've seen too many guys say "ah I don't need that, I'll just use a shoelace/550 cord". Not only is a shoelace not adequate to stop arterial flow (like the article suggested) but you could do significant damage to the tissue and/or nerves that the cord/lace is wrenching down on. When you NEED a tourniquet, no pressure bandage or hand pressure will do. You also don't want to be fooling around with cords or undoing a shoelace when seconds count. Have one that is pre-made specifically for the task at hand and know how to use it. For the 2 ounce weight of a CAT Tourniquet, it makes no sense not to have one.

One other thing. I'm a big believer in having a "pocket" med-kit readily available on your body with the bleeder supplies. I carry the CAT TQ, Israeli bandage, Combat Gauze, and a pair of gloves in a quart size ziplock in a cargo pocket for a total of 6 ounces. The band aids and meds stay in the pack. I don't want to be fooling around searching through my pack for a med kit while I'm bleeding out.

 

[5MilesBack]

When on foot, I choose not to carry a SAM splint or prewrap but do carry some light weight less bulky cloth athletic type tape and some tincture of benzoin which will get the job done for an ankle sprain or for making a crude splint.

Ok, I have to ask.......how do you use ToB for an ankle sprain?

 

[Becca]

I completely agree with Becca's take on things. I also think medical and non-medical people alike can take away something from this article and the associated links. I personally have no use for most of the prefab first aid kits that I have seen. I feel like people are way better off as far as cost and usefulness, just buying a small OR or Kifaru pullout (or doubled quart freezer bag even), and then filling it with needed items which can all be obtained from the over the counter pharmacy section at the local store and amazon.com.

I went to a roll top 1L drybbag for ours, and then have individual ziploc bags inside (one for med, another for dressings/bandages, and another for gear repair supplies/sewing kit). I got tired of always having to dry out the kit everytime we came back from a trip....many of the supplies inside are destroyed by water, and it seemed to constantly get wet. We deal with some wet weather, as well as water from packraft trips so perhaps this would be less of an issue for others.

 

[Mike7]

I went to a roll top 1L drybbag for ours, and then have individual ziploc bags inside (one for med, another for dressings/bandages, and another for gear repair supplies/sewing kit). I got tired of always having to dry out the kit everytime we came back from a trip....many of the supplies inside are destroyed by water, and it seemed to constantly get wet. We deal with some wet weather, as well as water from packraft trips so perhaps this would be less of an issue for others.

Becca makes a good point, and a person can get slightly heavier and but cheaper roll top dry bags like she is using at Walmart even (which is what I used to carry my medical kit in). I just prefer a zippered bag for my survival kit (which includes my medical kit) so I don't have to pull everything out to see it. So far I haven't had any water get into my kit using these OR Zip sacks (I seam seal them and they have waterproof zippers), but then again I am not in Alaska either. I do organize & put everything inside of 1-2 labeled ziplocs inside of the OR Zip Sack. It is a big joke around home, how many ziplocs I can go through. If rafting, everyting important, including my survival kit, goes inside of my 65L Sea to Summit Big River dry bag also.
http://www.amazon.com/gp/product/B0..._m=ATVPDKIKX0DER&pf_rd_r=0QWYEM4989ACXZPG53M7

 

[Mike7]

Ok, I have to ask.......how do you use ToB for an ankle sprain?

I was referencing the part of the article that mentions tape not sticking when doing an ankle tape job without prewrap. It won't be as comfortable, but a line of benzoin down each side of the leg and foot will allow the tape to stick while still properly taping the ankle.

 

[Take-a-knee]

I too carry the quick clot bandage.

That little "baggie" of Quick Clot granules is useless IMO. The Quick Clot Gauze, if you know how to use it, is a lifesaver.

 

[Take-a-knee]

I went to a roll top 1L drybbag for ours, and then have individual ziploc bags inside (one for med, another for dressings/bandages, and another for gear repair supplies/sewing kit). I got tired of always having to dry out the kit everytime we came back from a trip....many of the supplies inside are destroyed by water, and it seemed to constantly get wet. We deal with some wet weather, as well as water from packraft trips so perhaps this would be less of an issue for others.

Good ideas. Also, breast milk storage bags are the best organizer/protector for small sundry medical items I've found.

 

[5MilesBack]

I was referencing the part of the article that mentions tape not sticking when doing an ankle tape job without prewrap. It won't be as comfortable, but a line of benzoin down each side of the leg and foot will allow the tape to stick while still properly taping the ankle.

That's funny because with all the years of taping my ankles for basketball, we used the prewrap to keep the tape from sticking to our skin and easier to cut it all off when done. Not sure what kind of athletic tape wouldn't stick to the skin. I always keep tape and prewrap in the truck, but I never pack it in with me. I do have duct tape wrapped on a flashlight, though probably not enough to fully tape an ankle.

 

[Mike7]

I would not recommend taping without prewrap or some sort of padding, except in an emergency. The prewrap helps to pad and with getting the tape off as you mention, but I believe it also helps the tape stick. Some people even apply a spray adhesive before putting the prewrap on. I suppose a person could in an emergency also just tape over a thin sock to avoid skin breakdown from the tape applied directly to the skin?...but the taping technique would have to be adjusted to get the tape to stay on I would think just as if applying the tape directly to the skin without an adhesive. The cloth tape that I have used in my minimal taping experience, sticks well to prewrap and itself, but not to skin. Maybe we can get some input from an Athletic Trainer on here who has done a lot of taping. I tape ankles rarely (just for the occasional sprained ankle for the soccer players who live in my house).

 

[rodney482]

Yes the gauze.. I also carry one in my patrol vehicle

That little "baggie" of Quick Clot granules is useless IMO. The Quick Clot Gauze, if you know how to use it, is a lifesaver.

 

[5MilesBack]

I suppose a person could in an emergency also just tape over a thin sock to avoid skin breakdown from the tape applied directly to the skin?...

This works too, I've done it. I've never had any issues getting athletic tape to stick to anything. It sticks to itself very well, so taping over a sock works. If you do it right, it will stay in place and provide the support your ankle needs. My problem is......I'm just not packing all that stuff into the backcountry with me. A roll of tape takes up room and isn't light.

 

[Take-a-knee]

Seems like I read years ago in Backpacker that serious burns from stoves, followed by falls, were the most common serious backcountry hiker injuries.

 

[jmez]

I played college football and they wouldn't tape our ankles with pre-wrap. Had to shave, unless you wanted to pull the hair with tape, and tape right to the skin. Required to tape them to practice. Pre-wrap just slips and doesn't allow you to get a good tape job.

It is not easy to tape and ankle so that it will do any good if you've never done it or have experience with it. Most people would be better off just carrying a McDavid ankle brace if they are worried about ankle issues. Light, takes up almost no room and they work really well.