What’s in your first aid kit?

[Michael Gardner]

I am curious to see what others may carry in their first aid kits. I'm trying to trim some fat on my 10 oz. kit without being overly opptomistic. I am a career Paramedic, so the medical knowlage is in place, however, I tend to have the mindset to be ready for what might happen, not necessarly does happen. Hey, at least I've stopped carrying around a 1 liter I.V. bag and surgical cric kit! I'd really love to see what ya'll carry for maybe a 2-3 day hike, what's worked for you for certain ailments, and maybe even a good war story from the backcountry (those are always fun!). This is list of what I carry so far, feel free to pick it apart:
2- 4×4 bdg 1- 5×9 bdg
1- quick clot 1- mole skin
1- roll gauze 6- butterfly sutures
misc- band aids 1- CPR barrier
2pr- Gloves 1- 14ga. IV cath
2- Triple antibiotic packets
2- sting relief pads
4- alcohol pads
4- Iodine pads
1- small super glue
1- 20cc syringe
Amoxicillin, Benedryl, Immodium, Pepto and Tylenol

[Dave T]

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[Jesse Glover]

I just carry a few band aids and some alcohol pads. Also I carry Advil Tums and Gas-x. I may have to put a tube of super glue in my kit I use it at work but never thought about taking it hiking.
BUT for a paramedic I dont think your kit is too crazy since you know how to use it. Maybe get rid of the CPR barrier thing and just carry less of every thing else. Do you NEED alcohol AND iodine?

[Ross Polete]

I would think with your background you would carry what you think you will need and just a little more. I found this site and maybe it will help you out. http://www.whiteblaze.net/index.php?page=med_guide

I personally want to carry as light as possible, but when it comes to first aid and survival kits I think it is best to have what you might need and hope you don't use it; rather than go so light and need something you don't have. I try to pack my first aid and survival kit to be used in conjuction with each other rather than on their own. The Eagle Scout in me still wants to be prepared; Hence, the epi-pens I carry.

[Bob Bankhead]

Alcohol pads are great for cleaning the dirt and sweat off the area to be covered by moleskin. Then I apply the tincture of benzoate, then the moleskin. Works great on sweaty body part like feet.

My 1st aid kit (2.875 oz) for solo trips of up to 8 days. It never gets smaller than this (too much trouble to unpack and repack). I've only REALLY needed it once….and it worked.

1 Aloksak
3 triple antibiotic packets
2 Tegaderm Self Adhesive pads
2 Moleskin 3×4@
1 20 ml irrigation syringe
3 bandaids
6 alcohol wipes
5 butterfly bandaids
0.2 oz tincture of benzoate
2×2 Imodium caplets
1 needle-nose tweezers
12 Ibuprofin 200 mg @
6 Vicodin
2 Ciprofloxacin

If I'm going to be out longer or going into a "higher risk" environment, I'll increase some of these items and/or add other appropriate items.

Yes, I have prescriptions for the Vicodin and Ciprofloxacin. My doctor is also a long-distance backpacker. I also know when and how to use them, and more importantly, when not to do so.

I also know how to use a suture kit, but I prefer to leave that to the pros. I'll stick to butterflys. My sewing kit will work if I REALLY need one.

Several items in my pack, such as my notebook and pen, bandana, duct tape, and spare guyline, can do double duty as 1st aid supplies in a real emergency.

[Michael Gardner]

Thanks for all of the insight guys! Especially the links from Dave and Ross. I looked through all the past forums and couldn't find anything, but alas, there it is!
To Jesse, SUPER GLUE IS THE BOMB! It is great for those less severe lacerations that wouldn't require stitches and on parts of the body, like knuckles and fingers, that are constantly flexing and moving. I know some ERs are using it to close wounds (Although it's probaly made by Pfizer instead of Elmer's and will probaly cost ya $600!) It always sticks (even two fingers together, ooops) and sets within seconds up to a minute. Just clean the cut like you normally would and your good to go. The small sqeeze tube I carry weighs 0.2 oz. It will start to flake off after a few days like a scab.
As for the CPR barrier, it's just one of those things. I carry another small one in a keychain-pouch on my car keys. I've had that for almost 10 years and haven't had to use that either. Unfortunatly, the chance of a CPR save (Spontainious Return of Circulation) is realistic under ideal conditions (less than 6 min EMS response time, AED). One can only imagine being in the back country. However, that wouldn't stop me from trying, there's always that chance that lies somewhere between slim and nothing. Plus the barrier weighs in at 0.3 oz. Thanks again everyone. Keep 'em coming.

[Jesse Glover]

Dude if I had 6 vicodin in my pack they wouldn't last me 8 miles much less 8 days…

[G Dup]

– alcohol for fuel, sterilization, and emergency mood reassignment (i keed you)
– all sorts of meds, most are mixed up in a sak but i'm familiar with their colors – benadryl, claratin, excedrin (aspirin, caffiene, tylenol), ibuprofen, immodium, pepto bismol tabs, tylenol
– and of course 100 µg fentanyl patches my doctor gave me for headaches – don't worry jesse, I know how and when to use them ;-)
– bit of medical tape and duct tape
– butterfly closures
– cordage (guy lines)
– floss
– hand sanitizer
– moleskin
– tiny tube of crazy glue

Might be other stuff I haven't remembered…
Looking into acetazolamide for AMS – I hear a little coca to chew also works well.

edit: Looking at your list reminds me… I need to find one of those tiny plastic tweezers for my kit. They have come in way too handy for those incessant cholla/cactus spines. Steroidal anti-inflam cream helps as well. Use duct tape to remove (nearly) invisible glochid spines.

Mike, I was curious what the syringe is for? Irrigating what – a blister, massive infections? What about the amoxicillin? I'm not versed on antibiotics, but what would this help with? Sickness from dirty water? Do you bring a whole regimen of the pills and have to keep taking these everyday ow what? Is it fast acting? Seems like it'd only be useful on long (ie. multi week) hikes from the sound of it, no?

[Michael Gardner]

"Looking into acetazolamide for AMS – I hear a little coca to chew also works well"

By AMS are you refering to Altitude Sickness or Altered Mental Status? And if so, how will a diuretic help for either? Sounds like it will just help to dehydrate you.

But hey, I live about a foot above sea level so I'm not familiar with treatments for altitude sickness. Maybe it's commonly prescibed in mountian regions? I'm not trying to be condisending, I really don't know anything about it.

I don't have it listed, but I have a pair of those little tweezers that come w/ a small Swiss Army knife as well as the scissors from it as well. The thin metal edge on the tweezers is a bit more effective at getting under the skin than the thicker plastic ones.

Irregation is exactly what I use the syringe for. The Amoxicillin is for any suspected infection or sepsis (Fever, nausea, vomiting, diarrhea, weakness, malaise). The recommended dose is (3) 500mg tabs a day for 10 days. I don't carry anywhere close to a 10 day supply. Maybe 2 days- just enough to get the ball rolling on fighting infection until more definative care can be given.

Unfortunatly, It would take 30 tabs for a full corse, which I WON'T carry. I'm sure there are better antibiotics that require less pills (like Z-packs) but this is what I have available to me at the moment.

BTW: Dude! Forget the Vicodin, you have Fentanyl?! You lucky guy! I'm sure as an adult you know your limits for you own meds and how to use them and blah, blah, blah… but be careful- Cause that's some pretty good stuff. As long as you're not like some of these rocket scientist high school kids in my area and decide to eat them you should be in pretty good (actually, really, really good) shape.

Mike

[Cayenne Redmonk]

I've used acetazolamide for AMS. Not as a treatment, but as a preventative measure. I start taking it two or three days before my trips. The literature says it removes bicarbonate from the body via frequent urination, setting off a chain of events that has a side effect of the body being able to adapt to changes in altitude at a much faster rate than normal via enhanced ventilation.

I've used it twice, and felt awesome on both trips. For me, it has let me drive from sea level to the sierras after work, and start hiking in the morning without loss of appetite or upset stomach.

[Michael Gardner]

Very cool. I'll keep that in mind when I get a chance to venture into higher altitudes.

I could conjur up a chain of events that could possibly be negative to losing bicarb from your system (acidosis, purely speculation of course), but it sounds like you've had some really good results and no ill effects from it.

Is it a prescription med or OTC?

[Skruffy McGruff]

I'm far from an expert in this arena. However, after advice from my mother-in-law, an ER physician, my kit contains super glue, duct tape, and Benadryl. Nothing more. Make sure the glue is brush-on, it's much easier.

[Jason Brinkman]

I will have to dig my kit to list exactly what is in there, but it is basically a customized Adventure Medical UL 0.5 with a final weight of 6 ounces.

I have taken a FA/CPR/AED course here and there, but generally speaking, my first aid kit has more to do with caring for myself. I do not frequently find myself in situations where care of others would be likely. At least not on hiking/backpacking trips. My multi-day wilderness river rafting kit is much more comprehensive.

I do have a few questions if you will indulge us:

– Are wounds that require a 5×9 blg common in non-motorized recreation situations?

– How well does the quick clot work, and when should it be used as opposed to allowing the wound to flush?

– What might one use a syringe for?

I have never carried a CPR barrier because I figure my chance of needing it are very remote.

But really Mike, we would probably learn more by asking you why you carry what you do.

[Richard D.]

I highly recommend listening to this podcast:

PBP Episode 9 – Shana Tarter – Wilderness Medicine
(http://www.practicalbackpacking.com/blog/)

Until then I had basically been taking just bandaids, antibiotic ointment, and a hand sanitizer. She strongly recommends an irrigation syringe, plastic gloves, and waterproof-breathable bandages that I can't get where I live.

[CW]

I mostly carry stuff for blisters but I have WFR training so I've been taught to improvise a lot.

[Adam Rothermich]

Assorted Band-aids, Benadryl, Vitamin-I, Pepto, a little moleskin, alcohol pads, a larger dressing, and maybe some other small things (don't have it in front of me).

My whole gear/body repair kit, with Superglue, needle and thread, weighs a hair over 3 oz.

I don't have any specialized first aid training apart from what school and Scouting provides.

Adam

PS: I'm also curious as to whether acetazolamide is prescription only or not. I'm going out to Colorado for a week at the end of the summer, and since I live at about 1,100 ft I'd love any help acclimatizing as smoothly as possible.

[Michael Gardner]

From Jason: "I do have a few questions if you will indulge us:"

– Are wounds that require a 5×9 blg common in non-motorized recreation situations?

I've personally used them in many non-motorized incidents. They cover a pretty decent area and are extra absorbent.

– How well does the quick clot work, and when should it be used as opposed to allowing the wound to flush?

No personal experience w/ Quick Clot, my department doesn't use it. I know the Military uses something similar. After reading everyone's replies, this is one of the items I've decided to remove from my kit. I'll give it to a friend of mine, who is an avid hunter. That will save 2.15 oz. itself. Thinking back to some of the more severe lacerations we've treated, even some impressive looking, spurting, arterial bleeds have been controlled w/ a single 5 x 9, kling, direct pressure and elevation.

– What might one use a syringe for?

Irrigation of wounds. It directs water flow better than my hydration tube.

-I have never carried a CPR barrier because I figure my chance of needing it are very remote.

I agree that the chance of needing it is remote as well. Like I said before, I've been carring the one on my key ring for years, never having to use it either. It's one of those mental things I'll have to get over I guess.

-But really Mike, we would probably learn more by asking you why you carry what you do.

I'm pretty knowlagable about treating trauma from the back of an ambulance. On the trail is a different story. I could tell you all of the equipment I'd bring if I was called to an injured hiker, and 30-40 lbs. later we'd have it all. That is why I'm reaching out to those who have a few trail miles under their belts and keep checking out this forum for any new posts. Again, thanks everyone for your comments, critiques and suggestions. Thanks to ya'll my kit has gone from 10 oz to 6 oz. If I knock it down to just treating minor ailments for myself it'll probally go down to 3-4 oz.

[Michael Gardner]

Rick,

Thank you very much for the link for this podcast. Shana Tarter even talks quite a bit about AMS and acetazolamide for treatment/prevention and it's effects and side effects. It is a prescription med.

Thanks again,

Mike

[Jamie Shortt]

* Pills (18 ibuprofens, 6 pseudopheds, 4 benedryls, 4 imodiums)
* Duct Tape
* 2 Gauze Pads

[Peter Fogel]

Consider adding:

Cayenne Pepper. It's a fantastic pain numbing and blood clotting agent.

Turmeric: It reduces inflammation and swelling.

A 1/4 oz. or so of each can go a long way.

Peter

[Ian Price]

Interested to note in your original post that you carry a 14 g Cannula – what are your anticipated uses for this? Relief of Tension Pneumothorax?, Deep irrigation of wound beds?
I notice also that you no longer carry IV fluids (!) – have seen a couple of interesting reports on PR rehydration therapy using improvised equipment – any thoughts?

Other stuff I carry – two most common sizes of Guedel airway, i justify these with the view that in someone with decreased GCS, they greatly simplify the potential airway management issues, again, any thoughts?

[Dean F.]

I am, among other things, an army surgeon. I am thus also tempted to bring a lot of stuff with me in my medical kit (if nothing else, it is a hell of a lot easier for me to stock narcotics) but I do try to restrain myself. I manage to do without a needle driver and 3-0 silk, as much as it makes me feel naked.

A 5×9? That's rather large, isn't it? I guess someone might get an open fracture or something, but then you're likely to improvise a dressing out of clothing, anyway. Such a wound would certainly justify ruining your $80 jacket. By far most wounds on the trail are tiny, and just need a 2×2, but a 4×4 (as you have) is more versatile and can be cut down to size. I carry real gauze because it is more versatile than those fake-gauze dressing sponges.

CPR barrier? Well, as you say it is very light… But it is also low liklihood of use, and probably not realistic to expect a save if you are far from an AED. Well, maybe my view is skewed a bit, as most of my codes are traumas not cardiac. Your call. But I'd say just keep your immunizations up to date (especially hepatitis) and know your hiking partners.

Quik Clot?!? Where are you hikng? Iraq? I'd wager that on the trail a massively bleeding wound to something that won't take a touriquet (trivial to improvise) is rare. I guess you just have to do your own risk-assessment, though. And even then I'd recommend one of the chitin dressings (such as HemCon) over Quik Clot. HemCon's are expensive as hell, but you are much less likely to injure the patient than you are with Quik Clot. Quik Clot is VERY exothermic. (And a pain in the a$$ for the surgeon to remove later…)

Conceivably you could do with one pair of gloves. Make the assumption that if you need more than one it will be treating the same injured guy until you can get him to safety, store the one pair in a ziplock (that you brought food or something else in) and reuse it. It is for your protection, after all, not his.

It is low likelihood of being needed, but I carry a 14g, too. It is lightweight insurance against tension pneumothorax if anyone takes a fall, and can be lifesaving. I'd hate to lose anyone to something that easily fixable.

Alcohol AND iodine? If you use an alcohol stove you can do without either, and just use your stove fuel. (This was a nontrivial influence on my choice of stove design.) Or use Purell, if you carry it. Purell is also a handy emergency firestarter…

For multi-use antibiotics amoxacillin is a pretty good one. Many will work. Fluroquinolones are handy, too. Just pick a favorite, and try to tailor it to your location. If you are going someplace exotic I find that the Infectious Disease fleas can be amazingly helpful, and actually quite interested. (Mefloquine Mondays, anyone?)

I keep telling myself to remember "I am not a walking tertiary care center." In the field I do not have an obligation to provide definitive care. I just have to get them to EMS alive.

That said, if I am to be the "medical guy" for a large group of people I don't know very well I tend to bring a LOT more stuff. E.g., anyone who needs an epi-pen should be responsible enough to bring his own and attach it to his pack strap where others can see it, but there are a lot of idiots out there. In such groups I also tend to bring aspirin for AMIs. (Otherwise I bring only 800mg Ibuprofens and 650mg Acetaminophens, so I can double-dose and walk out on a sprained ankle if I must. In truly remote areas I bring a couple of Percocet, for the same reason.) I haven't yet brought my own nitroglycerine, but I always think about it, and I might if I was in a large group in a very remote part of the world. Then I could at least give half of MONA therapy. Hmm, would Percocet count as "M", and let me give 3/4? I'll have to look that up.

Again, my world view is colored by my experience, so I tend to think of trauma. There are several injuries that will kill you quickly, but that are easily treatable in a trauma bay. (Emphasis on "in a trauma bay.") Various lists exist, the "7 Killers", the "Deadly Half-Dozen", etc. I'm sure that you have been taught to think of them. Forgive me if my list differs from yours, but I'm trained to think about these things differently than you, so I haven't looked this up in a while:

Exsanguination
Airway Obstruction
Cardiac Tamponade
Open Pneumothorax
Tension Pneumothorax
Hemothorax
Flail Chest

Exsanguination: This is your Quik Clot or HemCon. I maintain that they are low-utility, and improvising a tourniquet is all you have to know. For a solid viscus injury or other internal bleeding, activate the EPIRB and pray. Have you been taught permissive hypotension, or are you an old-school IV fluid guy? I'd recommend learning permissive hypotension for field medicine. For a pelvic fracture, sheet the pelvis. This is another injury that justifies ruining your $80 jacket.

Airway Obstruction: The knife on my Leatherman Micra is damned sharp, and I have hydration tubing, for my crichothyroidotomy That's the best that I think I can do without hauling a code cart with me.

Cardiac Tamponade and Tension Pneumothorax: There is no body cavity that cannot be reached with an 14g and a good strong arm. I would not recommend that the laity try to do a Pericardiocentesis, but I would sure give it a try as a last resort. Any monkey can learn to do a Needle Thoracostomy just by googling it. (Diagnosing the tension pneumothorax, on the other hand, is a little tricker for a layman.) See, that 14g is multi-use! :-)

Open Pneumothorax: Some tape and almost any reasonably flexible piece of plastic can improvise an occlusive dressing, or better yet a semiocclusive dressing with a flutter valve. So, leave the labels on your water bottle. Or use the cellophane from a pack of cigarettes. I wonder if silnylon is airtight enough to work? Tyvek certainly is.

Hemothorax: Hmm. EPIRB and prayer, again? I guess if I was sure of my diagnosis I always have that knife and hydration tubing to improvise a Tube Thoracostomy, but I wouldn't recommend it to the laity. Who cares about the resulting empyema if you can save his life? Some jackass might decide to sue you, though, so he'd have to be nearly dead before I'd do this. Improvise a Heimlich valve from the finger of your glove.

Flail Chest: Definitely EPIRB and prayer. Usually these are caused by MVAs, and the only wilderness scenario I can come up with is a long fall. In such a case you will probably have more pressing problems than the flail chest. There are those who advocate wrapping the chest, but this really doesn't work and causes a lot of pain, thus leading to splinting and even worse oxygenation.

Another thing you will see on some lists is a Subdural or Epidural Hematoma, but I really can't think of a realistic way to do a burrhole in the field. Nobody really does them in trauma bays, either, for that matter. The neurosurgeons can get them into the OR pretty quick. I guess if I was on-call in some sleepy rural hospital with the nearest neurosurgeon hundreds of miles away I'd give it a shot. I know approxmately where to stick the Black & Decker, after all, and he's going to die anyway, right? But the weather would have to be REALLY bad to preclude a helicopter flight…

[josh wagner]

personally, i wouldn't use over the counter superglue on a wound ever – massive skin irritation and death of surrounding skin can be expected. the stuff they use in the ER is different. plus chances are in the woods i wouldn't get it clean enough and the docs would have to remove it when i got home anyway. duct tape or butterflies for me please.

[Michael Gardner]

Ian,

I'm not familiar with PR Rehydration, but if you're using the abrieviation "PR" in the context that I'm familiar with then wouldn't that resemble an enema! I'll research it though. If it's valid that means I could deliver up to 3 liters of fluid to a patient… and then buy a new hydration pack.

The IV fluids were before I considered going light,

By Guedel airway, are you refering to a nasalpharyngeal airway (NPA)? Just wondering, not familiar with that brand name.

Wow Dr. Fellabaum! Thanks!

Well, first of all, yes, I admit that I CARRIED the 14g cath for a tension pneumo and could use the finger of a glove for a Heimlich valve. I think I could easily diagnose one in the wilderness, even without a set of ears. Even so, I've come to realize that a long fall would be the most likely cause of a tension pneumo and am probally doing away with this, because prevention is the best medicine and hopefully I won't come across any of those idiots you mentioned. Hey, I guess you never know who you'll come across though. I'd be a little freaked about attempting a Pericardiocentesis in the wilderness. For a street medic that may be a once or twice a career procedure and I'd tend to think it would be a tough diagnosis in the wilderness. But your focus is obviously trauma surgery, mine is to get them to the trauma surgeon.

The quick clot is gone from my list… I'm still a fan of 5 x 9s, just because I know they work and I like my jacket;) I also like the idea of something clean on the wound, at least as a first layer, over a dirty pair of socks. I know the wound will get irrigated and all of that good stuff at the ER anyway, but that's just me.

I also agree that any plastic packaging would work for an occlusive dressing, just in case you're mistaken for a deer!

Alcohol pads- gone.

CPR Barrier- eehh.. I guess a 4×4 would keep the big chunks 'o puke out of your mouth. Mmmm… tasty!

I'm not familiar with permissive hypotension. I've been trained to dump fluid to keep 'em at least 100 systolic or until their blood turns into pink Kool-Aid, which ever comes first.

Thanks again, Doc! You have a lot of info to share, and I'd love to talk about it more but I think we're starting to loose the audience here! Feel free to PM me though.

Take care, and thank you for your service to Our Country.

[René Enguehard]

Isn't QuickClot toxic?

[Author]

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