Archive for the ‘Wilderness First Aid and other First Aid Topics.’ Category

First Aid Kits

Wednesday, January 26th, 2011

People often ask me what they should include in their first aid kit.  The unfortunate answer is “It depends.”  In this post, I will discuss a number of factors that can influence what you want to put in your kit and in subsequent postings, I will talk about kits for various purposes and scenarios and what I think they should contain.  To briefly summarize, the contents of a first aid kit depend on:

  • What is your level of training and comfort level using certain equipment?
  • What is your role in the first aid/EMS/medical response tree?
  • How many people you need to look after with this kit?
  • What levels of injury do you want to be prepared to handle?
  • How long you will be using the kit before it can be restocked?
  • What other resources are available?
  • How long will it take until professional or para-professional help arrives or you can get to professional help?
  • What legal or policy requirements or limitations apply to your situation?

I live in a city where the average EMS response time is around 3 minutes.  If I am stocking a first aid kit for home, I will need the dressings, bandages and other materials to deal with issues like minor cuts that will be solved in the home with no outside medical care.  I also need to have the materials on hand to deal with serious emergencies for maybe 5 minutes or so, since EMS will take over by then. 

 If I am putting a first aid kit in the car, I will again want to deal with minor cuts and scrapes, but recognize that I may come upon an accident and need to deal with more serious trauma until EMS arrives.  I should have plenty of sterile dressings on hand.  However, I don’t need any really fancy dressings or bandages, since anything I put on somebody at an accident scene will be cut off and thrown on the floor just as soon as they get to the hospital.

 For a weekend car-based camping trip with a scout troop, I am going to be prepared to deal with cuts and scrapes, bites and stings and non-trauma items like tummy aches, dehydration and homesickness.  I will also need to be prepared for trauma and sustaining a victim for the longer response times associated with more remote areas.

 For a backpacking trip, the kit becomes more complicated, especially on a longer trip to a remote area.  I have to deal with minor injuries and prevent them from becoming major ones.  I will want to sustain care as needed to keep somebody with a minor problem on the trail as opposed to ending their trip.  That may mean multiple dressings over a period of days for a single laceration.  I have to be prepared to deal with severe injuries when help may be delayed for a significant time.  On top of all of this, I have to minimize the bulk and weight of my kit.  This calls for the inclusion of some of the high tech tools now available, like waterproof but permeable dressings that can be left on a wound until it is healed, fancy dressings for blisters and hot spots and the like.  One should also think “outside the kit” about other items in the backpack or crew gear that could be of use in an emergency.  The kit also needs to be ready for medical issues – stomach aches, fevers and the like.  For older guys like me, pain relievers for muscle and joint pain are a must.  While I believe in a  crew kit that has the materials needed for an emergency readily at hand, I think the size of the kit can be reduced by having each member of the crew provide their own personal kit for minor issues and spread out the stuff that you do not need to access instantly, like the acetaminophen and NSAIDs. 

More to come on this subject…

First Aid Section

Tuesday, January 25th, 2011

This section is a breakout from the Scouts and Outdoor category and is presently under construction.

Scout Personal First Aid Kits

Monday, November 16th, 2009

Although the Troop has comprehensive first aid kits on every trip, every scout should make it a habit to have a small personal first aid kit.  The focus of this kit should not be to handle major trauma, rather it should be designed to solve little personal problems that arise along the way.  That being said, a scout should never keep a medical problem to himself, especially on a high adventure trip, where minor problems like blisters can turn into trip ending major problems if not properly dealt with.  Counsel your scout to always let the adult leader know if he has a problem, even if he is perfectly capable of handling it himself and is doing so.  I do not recommend pre-made kits.  I think the right individual kit for a backpack is a heavy duty one quart zip-lock type bag.  In it, there should be a few band-aids, antiseptic pads (such as providone-iodine pads) some topical antibiotic ointment (like a triple antibiotic), some some hydrocortisone cream, a sheet of moleskin and a few sterile gauze pads.  Of course, adjust this for personal needs and allergies.  Remember that Second Class rank requirement 6B is to prepare a personal first aid kit to take with you on a hike, so your scout can do this for credit at the appropriate time.   For the antiseptics and topical meds, the best way to handle these are in little single use packages.  A big tube weighs too much.

More Still on Northern Tier First Aid Kits

Wednesday, July 15th, 2009

The Northern Tier kits are now available on the Rescue Essentials web site.  Here is the link: http://www.rescue-essentials.com/servlet/Detail?no=457  I have to admit I had a bit of sticker shock when I saw the price, and I have not independently priced everything on the list, but after looking at a few things I did not already have that were on the NT list, why this kit is expensive made a bit more sense.  The Tegaderm dressings are $8+ a box of 8 at Walgreens.  That is over $1.00 per dressing.  The anti-fungal cream at Walgreens is almost $10.00.  The waterproof bag is around $25 at REI.  It really adds up.  Whether it adds up to $150 I can’t say, but if you are worried, you can figure it out for yourself.  For guys who don’t have a first aid supply locker like I do, just having somebody put it all together in the right quantities is worth something.  I appreciate the fact that they put them together for our crews who needed kits and wanted kits that met the recommendations of Northern Tier.  I know that NT does not check the kits and their recommendations are just that (I called them and confirmed), but I also think folks normally recommend things based on experience. 

More on Northern Tier First Aid Kits

Tuesday, July 7th, 2009

I spoke to Northern Tier today about the contents of first aid kits and they confirmed that their list is considered a recommendation, not a requirement.  So, for those who disagree with what is on their list, you can change things.  That being said, I have suggested to Rescue Essentials, who is putting together a turnkey kit for use at Northern Tier, that they include everything on the recommended contents list so that they can tell people if they buy their kit, they are getting everything Northern Tier recommends.  I don’t see any other way to do it.  That allows the purchser to add and subtract as they see fit, but does not put the vendor in the quandary of playing God and substituting their judgment for that of the Boy Scouts when they are putting together a product with scouts in mind.  Hopefully they will have the kit up on their web site this week. 

Northern Tier First Aid Kits

Sunday, May 31st, 2009

Our Wilderness First Aid Class has generated some discussion about what is the perfect first aid kit.  I have been asked for my views and advice for those planning a kit for their vehicle, for day hikes and for the upcoming trip to Northern Tier.  Let me start by saying that there is no such thing as a perfect first aid kit.  Any first aid kit is a series of compromises, informed by the intended use of the kit.  Rather than try to define the perfect kit, I will share some of my views as to essentials for kits for various uses and allow the reader to apply their own judgment to help them decide what is right for them.   I will start with the Northern Tier kit.  It needs to be sufficient to sustain a crew of up to 9 traveling by canoe for a week in the boundary waters of Minnesota and Canada.  It not only needs to have contents that will permit a response to a serious accident in a remote area where help may be delayed, but should also have what it takes to deal with the everyday cuts, scrapes, aches and pains the crew will encounter over the course of the week.  The first place to start is the list of requirements for first aid kits published by Northern Tier.  Regardless of my opinions, they have set out certain requirements, so having everything their list is the place to start.   

Space and weight are at a premium.  The canoeing environment demands a fully waterproof bag.  Even though the kit may be placed inside another waterproof bag or pack, the importance of keeping the kit dry suggests to me that it be afforded double protection.  That being said, if it is to be stowed inside a pack, the pack can be relied upon to provide abrasion resistance, so the waterproof bag might be one of the very lightweight ones now commonly available.  Here comes a compromise:  A first aid kit is supposed to be readily accessible in an emergency.  If you have a kit in a waterproof bag in a pack, is that going to impair your access to it when seconds count?  My view is that if somebody is going to die over a few second delay in getting to the first aid kit, they probably are not going to make it in any event.  The critical steps to saving a life don’t require anything in the kit.  Assuming you are willing to forego a breathing mask for CPR and sterile gauze for the first attack on an arterial bleed, so you can afford a few seconds getting to the kit and avoid the risk of losing everything to wetness. Here is the list of items on Northern Tier First Aid Kit.  I will give my comments below each item. 

Band Aids, flexible type/water resistant There are the traditional type stips and fully waterproof types that completely seal the wound and don’t let anything in or out.  For the former, I like the flexible fabric style.  For the latter, I have no preference.  I have some concern about fluid and perspiration causing a sauna effect inside a waterproof dressing, so I would only use one if I was confident the wound would get wet from the outside without it.  I would have more regulars than waterproof, but would carry some of each to Northern Tier.  You could go through a lot of these during a week at Northern Tier for cuts and blisters, so I would pack plenty to permit frequent dressing changes.  I would have each participant have 5 in their personal kit and have 25 or 30 in the crew kit.   

Knuckle and Fingertip bandages These are fancy band-aids that are easier to fit and keep on the spots indicated.  In a pinch, you can get by without them.  I would have no more than 10 and the more I had, the fewer regular ones I would take. 

4” x 4” Gauze Pads These are the holy grail of a first aid kit.  Remember that sterile dressings are something that cannot be improvised in the wilderness.  I would have 10 or more and would probably fill whatever extra space I had in my kit with extra 4X4s.  Put them in a ziplok.   

Butterfly Skin Closures or Steri-Strips I carry steri-strips, but remember you will need the tincture of benzoin to help them stick.  Also remember that  Red Cross procedures say don’t close a wound, since you could close in the bacteria and get a nasty infection.  If you can’t scrub it, I would not seal it.  I would carry 3 packages of Steri-strips.  They are light.  Be careful when you open the package, because there are a lot in each package and you can keep them clean and use them later if you have to. 

3” or 4” Ace (Elastic) Bandage I would take no more than one or two.  They can be reused.   

Waterproof Tape I would take a roll.  You can use duct tape if you run out. 

Moleskin or Spenco 2nd Skin This is another product you can run through a lot of on a trip like this, especially if people do not have good, well fitted boots.  Maybe 4-5 sheets in the crew kit and a sheet in each person’s personal bag. 

Tincture of Benzoin This is an antiseptic, but more importantly, it is like a primer for skin that allows bandages like steri-stips to adhere better.  I like the small single use ampoules and would have 4-5. 

1” or 2” Roll of Gauze I am not sure I have ever seen 1” gauze.  Even 2” seems narrow to me.  I like the vacuum packed 4.5 “Kerlix” clone product sold at Rescue Essentials.  I would have 2 or 3.   You can use this if you run out of 4X4s.   

Tweezers or Forceps These are important for splinters.  I use some very small ones from Brigade Quartermasters.  They give the best purchase on a splinter of any I have ever seen and they can clip onto a zipper pull. 

Scissors I would take a standard pair of “paramedic scissors.”  They are cheap and can cut anything. 

Tegaderm Dressing This is the 3M version of a large waterproof (but said to be breathable) band-aid.  It can seal off a moderate size cut.  I think they are pretty slick and would have a few, especially for Northern Tier.   

Latex or Nitrile Gloves I would have no more than one pair and would not have latex.   

Safety Pins, Large Size A few can come in handy for all manner of things.  Remember if you have triangular bandages, there are normally 2 packed in with each of them. 

NewSkin (Antiseptic Liquid Bandage) This is essentially a liquid glue that can be brushed on to a minor cut or scrape to seal it off from the outside environment.  It is waterproof.  I like the idea of something like this for minor problems in a wet environment, but would not use it on anything that might need stitches. 

First Aid Manual If you need to read the book on the trail, I think you are in trouble.  If they make us have one, I would say pack the lightest and smallest you can find.  Maybe one of the little cards from Rescue Essentials. 

Rescue Breathing Mask (disposable) This is the politically correct way to do CPR in this day and age.  If I had to cut weight and bulk, this is the first thing to go in my kit.  If you want to satisfy this requirement, get one of the little plastic shields.  I think they are worthless, but don’t take up much room. 

Thermometer (disposable) I am not sure why you need one, but would go for light and cheap. 

Medications 

Acetaminophen (Tylenol, others) I would have a bottle of 100.  Maybe more.  Think about how many people you have and how many they can take in a day and then think about how long it would take to run out if a lot of people were taking them for aches and pains. 

Ibuprofen (Advil, Motrin, others) I would have at least a bottle of 100 of these too.  In canoeing class, they called it Vitamin I and recommended taking it before and after paddling.   

Hydroxyzine (Benadryl, others) I would have a card of these capsules. 

1% Hydrocortisone Cream (Cortaid, others) I would have a full tube.  If you get a decent sized rash, you can use a lot in a week. 

Antifungal cream or spray I guess the same goes for this, although I have never used any on a camping trip. 

Foot powder Medicated powder is magic stuff, as we learned at Sea Base.  I would have a big bottle in the crew kit and a small one in each personal kit.  It makes you feel better and keeps chafing from turning into a nasty rash. 

Antibiotic Ointment (Neosporin, others) I would have a full tube.  If you get a kid with a big scrape, you can use a lot of it. 

Soap and/or waterless hand sanitizer There is nothing like soap to clean something and kill germs.  We will have plenty of water, so washing with soap should not be a problem.  If I took hand sanitizer, it would be a small pocket sized bottle. 

Sunscreen, SPF 15 or higher I would have a big crew bottle and personal bottles for each crew member, especially if they are fair skinned.  Remember, some people don’t need it and others are literally toast without it. 

Lip Balm (Chapstick, others) I consider this personal gear.  I am not going to share it, which can spread herpes.  Maybe have a spare tube or two in the crew kit if somebody loses theirs. 

That is the end of the items on their list.  Here is what I think they missed: After sun/sunburn gel (aloe) 

Somebody is going to get a sunburn and you need something to help provide some relief. Providone Iodine pads. 

These are antiseptics for cleaning a wound.  I would not consider steri-stripping a laceration without cleaning with this stuff first.  We used a lot at Sea Base as an antiseptic for a scout who had a chronicly infected scraped knee, later determined to be staph infection.  After cleaning with this, we put on the triple anti-biotic ointment.  I would have 10 or 20. SAM Splint 

I would have one. Immodium. 

You need this is somebody gets the runs. Pepto-Bismol or similar stomach ache remedy. 

Figure out what your crew likes and take something for stomach aches.   Emergency Blankets. 

They are small and light and come in handy.  I would have a couple in my kit.  Also, if you get some guy down who is wet or in the mud and you need to keep him warm, do you want to sacrifice your sleeping bag, or even his?  Save the bag for when you have him dried off and stabilized. Assessment forms. 

If you can remember everything, then plain paper would work, but if you need the prompts, take a few. I am sure there are a few more items I might think of, but these are the main ones. 

Source for First Aid Equipment

Tuesday, May 5th, 2009

I teach Wilderness First Aid and keep our troop first aid kits up to date.  I have been very impressed with the equipment, prices and service at a company called Rescue Essentials www.rescue-essentials.com.  I have placed several orders with them and they are always prompt and responsive.  The same SAM splint REI sells for $16.00, they sell for under $10.   I really like the fact they sell sterile gauze rolls in a vacuum sealed package which takes only a fraction of the space a traditional gauze roll takes.  I gave them a call and suggested they put together pre-filled kits for high adventure crews headed to Philmont, Sea Base and Northern Tier.  They are looking into it.