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Paradox
06-07-2006, 11:24 AM
I'd like to start a thread on the general topic of first aid. More specifically:
1.) What do you carry?
2.) have you thought about carrying or stopped carrying?
3.) What sort of situations requiring first aid have you seen on the trail?

I have always carried some ibuprofen, antacids, loperamide (antidiareal), and some band-aids. Recently, I put some benedryl (diphenhydramine) in my pack. I have access to inexpensive injectable epinephrine, but I'm 48 and have never had an allergic reaction to anything including poison ivy. It weighs a few ounces, so I will probably add it only when hiking in large groups.

My office defibrilator weighs 10+ pounds and is the size of two car batteries. I'm gonna leave it in the office. (If the big hits me on the trail pour some spring water over me and "Hot n Sweaty" and I will salute you all.)

My hands seemed to get the most abuse with cuts and bruises. Since I've started wearing gloves even in summer it is much less of a problem. Preventive medicine.

I usually get blisters, but just hike through them. I spend the next day making my wife miserable about them. I have never stopped once to take care of a developing blister.

David Metsky
06-07-2006, 11:56 AM
No amount of first aid equipment is going to help you if you don't have proper training. I highly recommend SOLO Wilderness F/A. They teach the course up in North Conway but also through a variety of organizations all around the northeast. The proper knowledge of what to do and what not to do is more important than the specifics of what you carry.

I carry bandaids, ACE bandage, tape, gauze, protective gloves, some pain medicines, my Epi-Pen (I'm alergic to bees) and Benadryl, cravats, webbing straps (for splints), SOAP notes forms, and I usually have my Crazy Creek chair (splints, insulation from the ground). On group day trips I include a small sleeping bag and/or tarp for an extended stay out.

I've seen and treated cuts, scrapes, bee stings, an axe imbedded in a foot, a broken leg, broken fingers, hypothermia, heat exhaustion, and some folks just not feeling well.

-dave-

Waumbek
06-07-2006, 12:14 PM
Likewise, the Hulbert Outdoor Center (http://www.alohafoundation.org/article/view/7123/1/949/#WFA) (Aloha Foundation) in Fairlee VT (not far from Hanover NH) offers a variety of courses from FA on up to EMT level.

I don't need an epi-pen and, after a number of past VFTT discussions on WFA, I'd be disinclined to carry one for others without explicit training in its use.

Moleskin. Tick tweezers.

sapblatt
06-07-2006, 12:26 PM
Bandaids - about 5 different sizes
Bacitracin
Ace Bandage(s)
Drugs - Advil, Pepto, Immodium, Benadryl, Zyrtec (seasonal allegies) - Paradox - don't you need a prescription for epinephrin??
Moleskin - although it needs to be a real nice day for me to stop for blisters...I walk thru them.
Tincture of Benzoin
Bandages
Multi tool - scissors are indispensable
Bivy Bag (which can double as a body bag :eek: )
I often, but not always carry a sleeping pad - important insulation if you need to sit awhile and wait for help - also as Dave stated, they can be used as splints.
Nail clippers - I have found them worth having a few times...helpful if you tear a nail on a rock or tree or need to get creative with a splinter.

Potassium cyanide - in case things look hopeless. :D :eek: :D :eek:

On my never ending list of things to do - is to take a good wilderness first aid course...I carry the stuff, I read a lot, but that kind of training is indispensable.

bubba
06-07-2006, 12:36 PM
Paradox - don't you need a prescription for epinephrin??
Mike, the general public call Paradox "Dr." therefore, his "have access to" reference.

In certain areas I've bought and carried a snakebit kit, adhesive tape is standard equipment and, as Dave mentioned, having protective gloves is something that you should always have -- I learned to carry some in my car glove box. Hey, you never know.

sapblatt
06-07-2006, 12:39 PM
Mike, the general public call Paradox "Dr." therefore, his "have access to" reference.

In certain areas I've bought and carried a snakebit kit, adhesive tape is standard equipment and, as Dave mentioned, having protective gloves is something that you should always have -- I learned to carry some in my car glove box. Hey, you never know.

Light dawns on Marble Head - thanks bubba - did not know about the "DR."

This could be the first instance in the history of automobiles that someone actually put gloves in a glove box.

giggy
06-07-2006, 12:40 PM
I just take a small first aid pack with me with the typical stuff in it - I have some formal trianing via the army so I hope thats enought to deal with any situation - been pretty lucky so far. I think I could deal with minor issues.

I usually take a cell phone with me - I don't buy this crap that its unethical to bring. if ya need help, it will save time and effort to get you help fast and in the most efficient manner. Plus - it allows for 1900 numbers to pass the time while your waiting to be rescued :eek:

sleeping bear
06-07-2006, 12:59 PM
I usually carry a fairly large first aid kit including a small backcountry medical guide. I have been a W first responder for several years now, the best stuff I've gotten from the certifications is how to AVOID being in a situation that required the training.

While I've never been party to a major injury or illness in the backcountry, I have used my training with regards to hypothermia and frostbite several times (generally early recognition and prevention). On two occassions I was able to recognize and treat the early stages of hypothermia in my dog. :eek:

When I fell about a month ago and cut my shin I was very glad to have alcohol wipes, large bandages, tape and a large quantity of ibuprofen with me.



Oh yeah, and blisters! I'm a PRO with moleskin and tape! Whew, how'd I forget that one?? :eek:

nartreb
06-07-2006, 01:01 PM
No specific "first aid" equipment, but enough multi-use stuff (like duct tape) that I could easily fashion a splint, sling, tourniquet, bandage, etc. I s'pose I ought to add a couple of sterile pads and an alcohol wipe or two, but the closest I've come to giving first aid on the trail was giving advice on how to tape over a blister.
Oh, I do carry one of those reflective emergency bags. Other than discovering that they're very fragile (shredded one trying to pull it over my sleeping bag one cold night), I've no idea how useful they are. Anybody ever use one?

Waumbek
06-07-2006, 01:12 PM
Oh, I do carry one of those reflective emergency bags. Other than discovering that they're very fragile (shredded one trying to pull it over my sleeping bag one cold night), I've no idea how useful they are. Anybody ever use one?

Not exactly, but I have seen someone use a reflective silver "suit" (oversize pants and shirt) to great advantage one Labor Day coming down from Mt. Washington when an ice storm hit. It held up in the wind. I never thought it would.

Bobby
06-07-2006, 01:18 PM
I added a "Sam Splint" to my pack last year. I got it from an EMT, but have seen them for sale at EMS. It's a splint, comes in a roll. When you straighten it out and form it around a limb, it stiffens and stabilizes the injured area. It's very lightweight, too.

Paradox
06-07-2006, 02:53 PM
Paradox is a dentist. As far as I am concerned, there are no contraindications to epinephrine for an anaphalactic reaction, that follows an insect sting. Without it they die, within minutes. Yes, everyone should get trained in its use, but honestly, the training for this takes minutes. I feel more comfortable with giving someone a quadracep injection with an epi-pen than I would giving someone CPR. I've never done either, in a real life situation.

Don't worry I won't be bringing my root canal files or extraction forceps on the Pound the Presis. :D

kmac
06-07-2006, 03:03 PM
http://www.vftt.org/forums/showthread.php?t=6931&highlight=aide


check out this thread that was posted several months ago :)

Chip
06-07-2006, 03:17 PM
No amount of first aid equipment is going to help you if you don't have proper training. I highly recommend SOLO Wilderness F/A. -
That's the first thing I did when I decided to get back into backpacking, knowing I'd also be responsible for my young posse.


... my Epi-Pen (I'm alergic to bees) and Benadryl...
I had my first allergic reaction about 1 1/2 years ago, went through the desensitization therapy and have since been stung again (stepped on a ground nest and got 3 hits hiking here by myself last spring :rolleyes: ) with no reaction, but I still carry the epi-pens and benadryl.

People seem concerned about bear in the woods. A more realistic concern is unexpected allergic reactions. I believe many Doc's would give you a prescription for Epi-pens if you explained you were leading a group in the woods. I realize there is liability. Some will argue carrying extra meds "just in case" is akin to carrying a gun, not a problem for me and mine.

Umsaskis
06-07-2006, 03:40 PM
Oh, I do carry one of those reflective emergency bags. Other than discovering that they're very fragile (shredded one trying to pull it over my sleeping bag one cold night), I've no idea how useful they are. Anybody ever use one?

Regarding those "emergency blankets," I don't usually carry the real flimsy kind (that can fold into a 3x6 inch square), but I always carry a somewhat bulkier version in the winter - it is almost like a real thin tarp, reflective on one side and bright red on the other. It is quite flexible and lightweight, and quite durable, although somewhat bulky. It does a fabulous job of keeping my butt dry, if not warm, when eating lunch on a snowy log (if I bother to pull it out). But, the main thing I wanted to note was that it actually provides some measurable warmth when I'm wrapped up in it. I used it (very skeptically at first) when I was sitting in the snow all morning monitoring eagle visits to a moose carcass in northern Maine one March. I wrapped my legs and lower torso in it as I sat in the snow, and I definitely noticed that I was warmer than when I took it off. I don't know if it was the wind blocking qualities or the actual reflection of my body heat, but I was pleasantly surprised. It probably made my legs feel all of 5-10 degrees warmer.

keepin' on
06-07-2006, 04:21 PM
...I believe many Doc's would give you a prescription for Epi-pens if you explained you were leading a group in the woods...
I asked my doc for one, for personal use in case of emergency, and he said no way. I explained to him the possibility of being stung repeatedly in the middle of nowhere, still no luck!

does anyone know if these pens are "tailored" to suit ones individual needs? meaning potential for more severe reaction = more meds in the pen.

SAR-EMT40
06-07-2006, 04:22 PM
I would suggest some chewable baby asprin. I carry it for possible cardiac problems. After checking that the person has no allergies to asprin giving 4 for a total of 325 mg is the standard treatment in my state. I would try to get permission from a doctor by phone or radio if that was possible.

Paradox, I also carry cavit which I find to be very effective for a crown that has fallen off or filling that falls out. I'm sure you would have lots better stuff though for dental emergencies.

As far as CPR. It is something that everyone should be trained in. Recognize its limited use in the wilderness though.

It might be that time of year to review some medical info. :D :o

An old medical thread (http://www.vftt.org/forums/showthread.php?p=82052#post82052)


Keith

SAR-EMT40
06-07-2006, 04:28 PM
I asked my doc for one, for personal use in case of emergency, and he said no way. I explained to him the possibility of being stung repeatedly in the middle of nowhere, still no luck!

does anyone know if these pens are "tailored" to suit ones individual needs? meaning potential for more severe reaction = more meds in the pen.


No tailored pens, there are two sizes, .15 for children and .30 for adults. It is not uncommon to use 2 or three for an adult (suffering a severe reaction) until a line (IV) can be gotten in so that epi can be given that route.

Also, being stung isn't the reason to have or use one. Even multiple times. Having an anaphylactic reaction is. That reaction can occur from many sources. Number one reason for an anaphylactic reaction is contact with nuts or nut products.

epi is not candy and it does have very serious side effect (on the heart and vascular system) but there are no contraindication in someone suffering from anaphylaxis. Key is making sure that someone is having an anaphylactic reaction and not just a reaction.

Keith

jjo
06-07-2006, 05:12 PM
Just ordered a new first aid kit from REI. Need to get over there and p/up. Thanks for good info above...

David Metsky
06-07-2006, 06:18 PM
I have gone into anaphylactic shock twice, then went through the shots to build up my resistance and I've been stung since without any serious reaction. But I still carry an Epi-Pen and my DR makes sure it's not expired. A friend got accidently shot with one while doing a F/A demo with what she thought was a practice pen. It's definately not candy, there was an immediate and kinda scary reaction for someone not suffering from anaphylactic shock.

If someone knows they are alergic they should carry a pen. If they don't know it, you probably shouldn't be giving them one. However, if I had mine with me and saw someone in trouble, I'd be hard pressed not to offer mine. But you also need to know how to treat after that, Benadryl, evac, etc.

To me, training (and more training, and retraining) is the most important thing. I redo my WFA every two years, and it's amazing how much you forget between them and how much the SOP changes over time.

-dave-

Chip
06-07-2006, 06:21 PM
I do carry Immodium, but I should add a laxative too, as I believe THAT problem is more common in the woods, being on a different diet and also with kids that don't want to use a pit or whatever.

skibones
06-07-2006, 06:38 PM
[QUOTE=SAR-EMT40]I would suggest some chewable baby asprin. I carry it for possible cardiac problems. After checking that the person has no allergies to asprin giving 4 for a total of 325 mg is the standard treatment in my state. I would try to get permission from a doctor by phone or radio if that was possible.

The aspirin for cardiac problems would be a great addition to my pack-never thought of it. Otherwise i carry the usual: bandaids; duct tape; iodine tablets; mole skin; space blanket; advil. I think the epi pen would be a good addition-just in case.
I need to look into taking a first aid course.

Paradox
06-07-2006, 07:01 PM
I just finished the thread referenced in SAR EMT40's posting above. Folks, I'm hiking with him.

Clown
06-07-2006, 07:22 PM
I'm going to second David Metsky's WFA Solo school. I have heard very good things and first aid trianing will go much farther than any med kit you can buy.

Also I'm going to second SAR-EMT's advice on carrying baby asprin. It really could help someone that had heart trouble, plus nothing is worse than a headache when your two days from the car on a backpacking trip.

As far as the epi pen goes, well I wouldn't carry one. Almost anyone who will need one should have it on them at all times when hiking. You should just use theirs. :) On a side note, epi though probably won't seriously harm you if you don't need it, is NOT very long lasting. If someone is suffering from a severe reaction they need to get to a hospital fast. An epi pen will stop the reaction, but only for a short period of time. There is still a very good chance that the reaction will continue.

When it comes to med kits, I think it depends on how much you feel you want to improvise. Someone mentioned a SAM splint, but I'm sure most of you could fashion a decent splint out a stick that would work just as well (for example). Personally, I would love to carry way more than you would ever need but it is not practical. I can envision all kinds of what-ifs and senarios. For the most comfort I suggest band-aids and protection for blisters. Always carry tape :) because you can use that for a million things.

skibones
06-07-2006, 07:34 PM
As far as the epi pen goes, well I wouldn't carry one. Almost anyone who will need one should have it on them at all times when hiking. You should just use theirs. :) On a side note, epi though probably won't seriously harm you if you don't need it, is NOT very long lasting. If someone is suffering from a severe reaction they need to get to a hospital fast. An epi pen will stop the reaction, but only for a short period of time. There is still a very good chance that the reaction will continue.




Could you have a reaction to a bee sting or several bee stings and not know it ahead of time? That's why i think an Epi pen might come in handy-for the remote possibility that you or someone in your hiking group might have a severe reaction. The epi pen might help until that person could get to a hospital.

Clown
06-07-2006, 07:40 PM
If you were authorized to carry it, and administer it. In massachusetts an EMT can administer an epi-pen if the patient has a prescription for one. An EMT can carry an epi-pen, on an ambulance, if their employer has given them a special training course on when and how to use it. So what I'm saying is that as an EMT I needed extra training after school in order to carry one around with me. Though, anything is possible, so I strongly suggest that you get training before carrying one around. :)

Chip
06-07-2006, 08:25 PM
Could you have a reaction to a bee sting or several bee stings and not know it ahead of time?
ABSOLUTELY ! I had my FIRST anaphylactic reaction at age 44, no previous indications of ANY allergies, including pollen. If I had had my first reaction in the woods I probably would've expired there. You suffocate as your throat constricts. I'll take my chances with the epipens. I understand SAR-EMT40 and appreciate his input and knowledge. I just don't believe SOLO would be teaching the use and discussing how to acquire the pens in their First Aid classes if there weren't more gain then harm with having them.

Happyfeet
06-07-2006, 09:15 PM
For short day hikes I usually just carry a small FA kit with a few band-aids, small gauze pads, tape, advil & benadryl. I have a much larger one for longer trips that has the same plus a variety of banages, butterflies, kling, sam splint, wider tape, immodium, children's advil bacitacian, gloves, gloves and more gloves and a small pocket mask plus some things I can't remember. I always thought the small one would be enough until a couple years ago we were approaching the summit of Monadnock when a man hiking with his family tripped coming down, picked up speed and almost went head first into a boulder, landing within a few feet of my feet. He tore open his arm. It took all the bandages I had to cover it and I found out that the 1/2 " tape that comes with the first aid kits is useless. It took my duct tape to cover it. Now I usually carry my larger one all the time. I also agree that training is a must. I have 25 years of EMS experience including 19 as a paramedic but am still planning an taking a SOLO course in the near future.

Waumbek
06-07-2006, 09:17 PM
I would suggest some chewable baby asprin. I carry it for possible cardiac problems. After checking that the person has no allergies to asprin giving 4 for a total of 325 mg is the standard treatment in my state. I would try to get permission from a doctor by phone or radio if that was possible.

Paradox, I also carry cavit which I find to be very effective for a crown that has fallen off or filling that falls out. I'm sure you would have lots better stuff though for dental emergencies.

Keith

But wouldn't aspirin be potentially lethal for some strokes (brain bleeds)? With no phone or radio contact, which is all too often the situation in the Whites, should the amateur risk giving it to someone else or to oneself? Fixodent works fine to re-cement crowns temporarily, although I don't know that I'd bother lugging a whole tube of it with me just in case.

Paradox
06-07-2006, 09:29 PM
With regard to the fixodent/cavit question. I really don't think about bringing it on the trail because my job as a dentist depends on permanent solutions. Hence, everything but the smallest filling in my mouth is crowned (I ain't tellin' you who did them!) I use cavit all the time for temporaries on root canals, but have never thought to bring it on the trail. I have received a number of cell phone calls on mountain tops about broken teeth/fillings, and they want to know why I can't meet them at the office in 15 minutes. I tell them about the after-hours fee of $300 and they immediately start to feel better. After the pause, I then tell them to pack the hole with sugar-less gum. Sugarless gum is readily available and very inexpensive. Gets 'em by till Monday.

SAR-EMT40
06-07-2006, 11:14 PM
But wouldn't aspirin be potentially lethal for some strokes (brain bleeds)? With no phone or radio contact, which is all too often the situation in the Whites, should the amateur risk giving it to someone else or to oneself?

I wouldn't suggest that anyone dispense medicine without a license but, the symptoms for heart attack i.e. chest pain, often perceived by the patient as crushing or viselike. It can be radiating or not and doesn’t clear when exercise stops and lasts more that 10 minutes. Also difficulty breathing and heavy sweating (diaphoresis) is often associated with a heart problem as well. Past history of a heart condition is also a good indicator.

Strokes can fairly easily and accurately identified by using the Cincinnati pre-hospital stroke scale test. Three parts. First, ask the patient to speak the phrase. “You can’t teach an old dog new tricks.” Second, ask the patient to smile. Third, ask the patient to hold both their hands out in front of them at eye level with their eyes closed. If the patient’s smile is droopy or if one arm drifts or they cannot repeat the phrase or they slur the speech or cannot do it at all. If one of these findings is abnormal and new the chances of stroke is 70%. All three the chances are 85%.

As far as dispensing medication without a license. It is illegal. Like I said I would make a good faith attempt to contact a doctor. Assuming that I couldn't get in touch with one, would I give an aspirin if I suspected a heart attack or assist someone with an epi pen if I was certain they were having an anaphylactic reaction? Almost certainly, following the protocols that I am familiar with but I would also be aware that doesn’t really, legally protect me. I would always attempt to provide the best care I could for my patient. That is a defense that can be used in court, but it might not be a winning one. :D

If you are suggesting that it is a generally a bad idea to give medications to yourself and especially someone else without a doctors consent you are absolutely right. :D :D Even Nurses/EMT's/Paramedics work dispensing medicine, Oxygen, Epi, aspirin, glucose, etc because a specific doctor says they can. Their medical control. Without that permission they are practicing medicine without a license.

Keith

SAR-EMT40
06-08-2006, 12:26 AM
Could you have a reaction to a bee sting or several bee stings and not know it ahead of time? That's why i think an Epi pen might come in handy-for the remote possibility that you or someone in your hiking group might have a severe reaction. The epi pen might help until that person could get to a hospital.


If your question is can you have a reaction the first time that you are stung the answer is supposed to be an emphatic no. You cannot have an anaphylactic reaction to the first contact with the whatever the protein is that causes the problem. At least that is what I have been taught. Your bodies overreaction to the protein by releasing to many histamines is what causes the problem. It cannot respond to the protein unless it has been exposed at least once before.

Like Clown says, an epi pen is serious enough that they are accountable medications carried on the ambulance, nice looking bus by the way Clown. :D In CT we have extra training for them but we are not epi certified. We are all epi certified in CT as EMT's but we ask permission from medical control if the person doesn't have a prescription for a pen already. Aspirin is a different matter. Used to be we had a protocol we used to administer aspirin but that was changed and the administering of aspirin is now considered a paramedic skill. That is supposed to change again in the near future as ridiculous as that may sound.

Also epi’s only last for 10 minutes or so. If the reaction lasts longer than that, which is not uncommon, you must have something else going for you, or them. Either more epis or an IV or like Dave mentioned diphenhydramine (Benadryl) by mouth. Liquid or chewables are best as they are absorbed faster.

I should also mention that I have taken and recerted my Wilderness EMT from SOLO again last year and continue to do so. I think highly of the school and the teachers.

Keith

Chip
06-08-2006, 06:40 AM
If your question is can you have a reaction the first time that you are stung the answer is supposed to be an emphatic no. You cannot have an anaphylactic reaction to the first contact with the whatever the protein is that causes the problem. At least that is what I have been taught. Keith
I get stung a few times every year. My first anaphylactic reaction was from my second or third sting that summer from the same nest in my yard.

Waumbek
06-08-2006, 07:36 AM
If you are suggesting that it is a generally a bad idea to give medications to yourself and especially someone else without a doctors consent you are absolutely right. :D :D Even Nurses/EMT's/Paramedics work dispensing medicine, Oxygen, Epi, aspirin, glucose, etc because a specific doctor says they can. Their medical control. Without that permission they are practicing medicine without a license.
Keith

Thanks, Keith, for an interesting and clearly-written post. I understand the important legal implications of giving even OTC medications to others. What would worry me more, though, is the risk of giving the wrong ones. There must be gray areas in stroke and heart attack symptoms. Aspirin could drastically worsen some strokes. As an amateur, even in a wilderness setting, I think the "do no harm" to others ethic would be uppermost in my mind. I know someone who gambled and won--took the aspirin and survived the heart attack--but it was a very high risk move given the level of this person's medical knowledge.

SAR-EMT40
06-08-2006, 09:40 AM
As an amateur, even in a wilderness setting, I think the "do no harm" to others ethic would be uppermost in my mind. I know someone who gambled and won--took the aspirin and survived the heart attack--but it was a very high risk move given the level of this person's medical knowledge.


You are of course correct and I am not suggesting that any untrained person dispense medications. The "first, do no harm" ethic permeates medicine from the bottom to top and is one of the reason why the protections given to bystanders with respect to the good Samaritan laws are all just about the same from state to state and basically protect people “to their level of training”. If you exceed that you have no protection. In the extreme there is Joe Sidekick trying to do open heart surgery. Clearly he has exceeded his level of training. Still exceeding but maybe less recognized is someone giving OTC medications to someone else to help them “treat” something they think they have identified. By doing that you have stepped over the line and have now acted like a doctor. If something goes wrong, you could be charged criminally and also held liable in a civil action. I can’t make it clearer than that.

I know that this is probably unneeded but I should point out that I am not an amateur (no offense taken) but neither am I a doctor, or a lawyer for that matter. I have certifications as listed below and have over 4 years service as an EMT locally and some backcountry experience as well.

NREMT
CT EMT-D
Wilderness EMT through SOLO
also
PEPPS
PHTLS
and hundreds of refreshers and other classes to numerous to mention. :D

Keith

Clown
06-08-2006, 09:57 AM
We are all epi certified in CT as EMT's but we ask permission from medical control if the person doesn't have a prescription for a pen already. Aspirin is a different matter. Used to be we had a protocol we used to administer aspirin but that was changed and the administering of aspirin is now considered a paramedic skill. That is supposed to change again in the near future as ridiculous as that may sound.



Yes, I should have clarified, we also have to ask for medical direction when administering epi. What I meant was that we can administer it to patients that don't have a prescription, same as you guys apparently :) . The only thing we can give people without med direction is O2 and glucose since neither of those can really do any harm. We do not carry asprin either, lol I'm not really sure why though. We can give someone Nitro, but can't give them asprin? :eek: At least that's the way it is in my region, though I never quite understood that one.

Waumbek
06-08-2006, 10:46 AM
I know that this is probably unneeded but I should point out that I am not an amateur (no offense taken) but neither am I a doctor, or a lawyer for that matter. I have certifications as listed below and have over 4 years service as an EMT locally and some backcountry experience as well.
Keith

"As an amateur" was meant to modify me, not you. I would worry about myself acting for someone else on partial medical information.

Kevin Rooney
06-08-2006, 11:13 AM
I would suggest some chewable baby asprin. I carry it for possible cardiac problems. Keith

Keith -

Aspirin works faster if placed under the tongue, like nitro, according to what docs have told me. Faster absorption.

Kevin

porky
06-08-2006, 12:09 PM
There is some fascinating information on this thread, but it seems to have drifted from its original intent (as so often happens). As far as practicing medicine on others goes, yeah, don't do it. For your own first aid, carry gear and supplies appropriate to your training and personal needs. If in doubt about an item, ask your personal health care provider.

I have been hiking, canoeing and camping, mostly in the Northeast, for some forty years. I've also been a registered nurse in emergency medicine for about twenty-five years, and I have access to all sorts of medications and supplies. Nonetheless, I find that my usual first aid kit weighs about six ounces, fits in a quart-sized ziplock bag and contains no prescription drugs or esoteric medical supplies.

Moleskin and duck tape are both appropriate dressings for blisters. The time to treat a blister is as soon as you feel like you might be getting a blister. "Toughing it out" makes no sense; leading to increasing pain and injury, as well as potential infection.

Most of the medical emergencies I've seen have been limb injuries from mis-steps, falls and the like (ankles and knees are particularly vulnerable). All first aid courses cover the basic first response for these strains, sprains and fractures. I carry a 4" ace bandage and figure I can improvise a splint out of found materials, bandanas and the like. Cold spring water is readily available here in the NE, so I don't bother with chemical ice packs. Suspected fractures and other serious closed injuries should be evacuated.

Open wounds are treated with cleansing, sterile dressings, elevation and, if active bleeding needs to be controlled, compression with a hand or the aforementioned ace bandage. I carry lots of bandaids and gauze and some antiseptic soap (Hibiclens), as well as bacitracin ointment. Wounds that may require suturing should be evacuated to the nearest emergency room, preferably in six hours or less. Minor gaping wounds can be closed with "butterfly" bandaids or the like. Tincture of benzoin can help tape adhesives stick better to sweaty or oily skin. I carry some ampules of that.

Hypothermia happens; heat and dry clothing treats it. I carry fire starting materials and a couple of chemical hand warmers. The hand warmers can get cold hands working well enough to handle the lighting of a fire. I carry a "Blizzard Bag" emergency sleeping bag on day hikes, as well as a fly and ground cloth and some cord to fashion a shelter if I have to stop moving and hypothermia might threaten.

Minor allergic symptoms resulting from insect bites and stings, toxic plant contact, and similar issues can be treated with oral Benedryl and topical cortisone. I carry both. If one is prone to more serious allergic reactions, a discussion of the options with one's personal health care provider is in order, preferably before setting into the woods.

Gastrointestinal illness, especially diarrhea, seems common. More of it probably comes from poor hygeine than from contaminated water or food. Avoid consuming contaminated food and water. A bottle of isopropanol-based hand cleanser will facilitate frequent handwashing. Immodium for diarrhea, Ex-Lax for constipation and an antiemetic like Dramamine might be appropriate if one is prone to such issues. As I almost never suffer from GI problems, I don't bother carrying these drugs. Anyway, Benedryl is as effective an antiemetic as Dramamine, and I do carry that. Constipation is frequently caused by dehydration; diarrhea results in dehydration. If one is dehydrated, the treatment of choice is water, taken by mouth. If one is vomiting uncontrollably, evacuate to advanced medical care ASAP.

General aches and pains from injury or arthritis are treated with ibuprofen, acetaminophen (Tylenol), aspirin, etc. Tylenol is easier on the stomach and doesn't promote bleeding, but it's a less effective pain reliever. Any of these meds can also be used to treat fever. If someone has a persistent febrile illness, get out of the woods and see a doctor. Same goes for any other medical problem that seems serious.

Stuff like heart attacts, drowning, lightning strikes, and life-threatening injuries are best avoided. Learning CPR might help in the first three cases, but the victim must be stabilized and evacuated to advanced care really reallly quickly in the rare event that CPR actually restores life functions (or in the case of massive injuries). This is a difficult undertaking at any time, and often impossible in a wilderness area.

That's about it, except for knowledge and caution, which each cost little, weigh nothing and can save you heinie anywhere, even without a first aid kit.

porky
06-08-2006, 12:29 PM
When I wrote "heart attacks" in the last paragraph of the posting above, I meant "cardiac arrest".

David Metsky
06-08-2006, 01:46 PM
I carry a 4" ace bandage and figure I can improvise a splint out of found materials, bandanas and the like.
While this is true, I carry a couple of webbing straps with fastex buckles. They work much better and much quicker than anything I can improvise, and have multiple uses beyond F/A. In the WFA course the instructors come over and judge your splint making. The first ones people make are always not padded enough and not tight enough. Making good splints that really imobilize an arm for a hike out is much easier with a few webbing straps. The Crazy Creek or SAM splint are also really useful, but rigid supports I find easier to improvise.

-dave-

bubba
06-08-2006, 02:29 PM
There is some fascinating information on this thread, but it seems to have drifted from its original intent (as so often happens).
I say it just got even better. Nice post Porky, thanks.

[where else could I have said... "nice post porky"?? :) ]

BorealChickadee
06-08-2006, 10:38 PM
Anaphylactic reactions and epipens:

I have food allergies with anphylactic reactions. First line of defense is benadryl, followed by prednisone, then epipens.

One thing to be aware of: single dose Epipens are preserved with sulfites. Multiple dose bottles (think ER) do not have sulfites.

I am also allergic to sulfites so using an epipen is a last resort for me. If I'm going down anyway, I'm going to stick myself with the epipen because I've got nothing to lose, but I've got to tell you I've suffered through some horrible reactions without using the epipens. I measure my reactions by how many benadryls it takes to reduce the swellling and allow easier breathing.

And on the trail....I only eat my own food.

But to comment of the first aid kit. duck tape . The cure all for cuts and blisters. Slap that baby on and you've occluded the air mighty fine...no air...no pain.

David Metsky
06-08-2006, 11:16 PM
And taking a hit from an epi-pen may simply allow your throat to open enough so you can take more Benedryl. A pen by itself isn't the best approach. I was told to tape 4-6 Benedryl to the Epi-Pen, since you'll never need it without the other.

A friend use to claim his F/A kit consisted of an ACE bandage and a cyanide tablet.

-dave-

Waumbek
06-09-2006, 07:35 AM
A friend use to claim his F/A kit consisted of an ACE bandage and a cyanide tablet.
-dave-

I always hope I'll survive until "second aid" arrives.

SAR-EMT40
06-09-2006, 11:43 AM
And taking a hit from an epi-pen may simply allow your throat to open enough so you can take more Benedryl. A pen by itself isn't the best approach. I was told to tape 4-6 Benedryl to the Epi-Pen
-dave-


In the wilderness context this is about as good as its going to get. Like Dave says, an epi is a short term solution, typically 10 minutes or so before it starts to wear off. If you don't have another epi available or have started some other course of treatment and the reaction is still occurring you could still have very serious problems. Absorption by the oral route into the blood stream (again I suggest liquid or chewables) is going to take 10 or so minutes. There is one other method that is getting consideration in the wilderness medical community for anaphylaxis, and it is over the counter, very fast acting but dosage is a problem and it isn't approved for this type of application. If this changes I'll make mention of it.

In the ambulance that 10 minute time frame is used to get a line in so that epi can be administered directly to help stem the reaction on the way to the hospital.

As with all medical considerations I will repeat and has already been mentioned. You don't know me. I am who I say I am but you don't know that. :D I have already told you I am not a doctor, so do yourself a favor and run anything medical, including what I say past your doctor first.

Keith

LivesToHike
06-10-2006, 01:39 PM
If hiking by myself I carry a small first aid kit - bandaids, gloves, cleaner, and a ankle wrap. If hiking with a larger group and/or overnight, I'll carry a larger first aid kit with non-Rx medications, more gloves, sam-split, larger bandages, paramedic shears, tape, iodine, anti-bacterial gel, CPR mask, etc.

Maybe, just maybe, the best thing one can carry with them are common sense and compassion. It's a very challenging environment when one is 5-10 miles from the road and certainly more than a hour from an ER. Using what one has on hand and keeping in mind doing-no-harm and helping another are probably the best one can do. One can improvise in the wilderness.

Training helps dearly - I don't intend in the least way to knock that - I well understand the value of education. CPR and first aid are good things to know. I've had some minimal first responder level training and seminar courses, but I don't currently run with an ambulance or fire service, so I haven't gone for an EMT cert, etc. I even used to work as an engineer on heart monitors. But I'll be the first to admit that it's really easy to forget things, without constant use of those skills, no matter what the level. Right now, renewing my certs every 2 years is about it.

BTW, my hat's off to anyone who does maintain EMT, EMT-I, EMT-P, etc level skills or higher (nurses, PA's and Physicians). It's very hard work and the pay off is in knowing more about how to handle and treat emergency medical situations, and in helping others. It's a great thing.

--LTH