What if your routine
cross-country ski jaunt on the Mesa turned emergent and you were stranded -
would you be able to spend a night out on the Mesa this time of year? Or how about an incapacitating sprained ankle
or illness during the backpacking trip – how would you deal with that? Having the right medical gear is simple and
might just save a life. Here are some
tips on where to start preparing or updating your kit.
General Considerations
Preparing a medical
kit requires addressing a few general issues first. What is the purpose of the kit? The contents are determined by the
nature of the trip, and the specific injuries or illnesses most often
encountered. My day kit is mostly a
survival kit with fire starters, rescue mirror, emergency blanket, compass,
knife, cordage, etc. The kit I taking
rafting or camping is my standard adventure medical kit, with the survival kit
included and now adding more medical supplies.
The kit in my car has contents that would be appropriate if we got
stranded or came upon an accident.
The level of medical
training of the party is another issue.
Obviously the people using the kit need to know how to use its contents
appropriately. A license or degree does
not guarantee adequate knowledge of wilderness medical skills. I might have IV fluids and injection
medications while everyone could have wound care and basic medications. Knowledge of what to do is sometimes more
important than the contents of the kit.
The destination of a
trip has a big impact on kit contents.
Consider climate, terrain, altitude, and unavoidable dangers of certain
areas. For example, desert hiking requires
different items than winter mountaineering.
When backcountry skiing I add a metal cup to melt snow, a Nuwick 120 hour
candle, and small lightweight snow-shovel.
Consider endemic diseases. A kit
for use in America is different than a trip to another country where malaria or
other diseases are endemic.
The length of trip
determines how much to bring. I don’t
need a week supply of different medications in my day pack, but for a two week
camping trip I need to prepare for a complete course of medications should they
be needed. Consider high use
items such as blister pads versus rarely needed items such as epinephrine and stock
accordingly.
The size of the party
is a similar variable as length of trip, and again requires stocking more high
use items. Even as a kid on adventures
with my buddies, I was generally the “go-to” person whenever there was
trouble. So I’ve learned to prepare for
myself and family, but also recognize that I might be treating others as well.
Exposure is the
amount of time until outside help can be reached and may greatly influence the
level of care needed and thus the supplies.
From the Grand Mesa I might walk downhill to a highway in a day, or call
a medical helicopter to fly in, while on a remote river or backpacking trip you
might be days away from help.
Bulk, weight and
cost are variables. Include items
with multi-purposes and take a modular approach to packaging that allows
changing kits without completely repacking.
I’ve prepared small, light kits for as little as $25 and also spent
thousands for huge kits used by commercial companies caring for employees
spending months in remote parts of foreign countries.
Containers and Equipment
Think maximal
protection and maximal accessibility. Use
containers that are easily located and allow you to rapidly identify the contents
using labels or visible colors. Divide
"mini kits" among party members to avoid loss of the entire kit.
The materials included reflect the needed functions. A fundamental need is to stop bleeding. One can use direct pressure with bare hand,
clothing, or pressure bandages. I keep a
complete wound kit for convenience with minor wounds, but for anything
life-threatening or large plan to use cotton clothing or other material and not
try to stock huge amounts of pressure bandages.
Treating and closing
wounds can be done with butterfly bandages, steri-strips or sutures with
surgical equipment. Duct tape can be cut
into a very effective butterfly bandage.
Cleansers and disinfectants, local anesthetics, bandaging materials and
blister treatment fall into this category.
In the wilderness, you should boil or purify water for cleansing a wound
just like you would to prepare for safe drinking.
Splinting is a
common need for a sprain or fracture.
Prefabricated splints are widely available and I always carry a
light-weight SAM splint. Improvisation is
the key as most anything can be splinted with a stick and duct tape. Coban, or “vet wrap”, makes a great
compression dressing and soft splint.
Monitoring vital signs
is important and a watch is helpful for checking pulse rate. A thermometer can be useful. A blood pressure cuff is rarely needed. Special equipment is needed for administering
medication by injections or IV fluids.
Usually in wilderness settings more serious life support equipment is
not realistic, such as artificial airways, chest tubes, electroshock, etc.
I recommend purchasing an empty specialty bag such as a
first aid kit, toiletry bag or camp kitchen bag then filling it with
materials. Prepackaged kits are costly
and not usually complete to my specifications anyway. Most supplies can be purchased at a pharmacy
or through your doctor. I simply drop my
organized bag into an ammo can for water protection.
Medications
Here is a comprehensive
list of different medication categories to consider: antibiotics, analgesics (pain killers),
anaphylaxis, anti-histamines, anti-pyretic (for fever), anti-emetic (for nausea
and vomiting), anti-diarrhea, anti-fungal, anti-parasitic, anti-tussive (for
cough), cardiovascular, decongestant, dental, dermatologic, diabetes, diuretic,
hemorrhoidal, iv fluids, laxatives, local anesthetic, muscle relaxant,
ophthalmic, otic, rehydration, sedative, snake bite and vaginal.
About half the
medications can be found over the counter without a prescription. I recommend speaking with your physician
about prescription medications. I
generally meet with a patient for a short office visit to discuss the various
medications that are indicated and simply write them a prescription. I’m careful to include “first aid kit – for
expedition use only” on the prescription and emphasize the medications are for
the patient or family use only. Giving
the medications to other people is discouraged due to issues such as allergies
or medication interactions, and patients have to use their discretion and
accept responsibility if sharing medication with others.
Remember the old
saying, “proper prior preparation prevents poor performance” and once packed
and ready to go I don’t give it another thought because I’m prepared. Most wilderness medical emergencies can be handled
with a good adventure medical kit, a little first aid knowledge, and the
determination to succeed with grit, spit and a whole lot of duct tape!
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Bio
Scott Rollins, MD, is Board Certified with the American
Board of Family Practice and the American Board of Anti-Aging and Regenerative
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women, thyroid and adrenal disorders, fibromyalgia, weight loss and other
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