Lightweight First Aid

[R Petrelli]

I like the idea of carrying first aid supplies regardless of the extra weight that adds. But even with that in mind and being relatively new to backpacking I want to keep my gear choices very weight influenced. Im looking to put together a small, day first aid kit and a multiday (up to a week) two person kit. Im also trying to figure out a good storage container/bag for the kits as well. Im sorry if there are any threads out there for this already. Thanks in advance for any and all suggestions!!

[Ken Thompson]

http://www.backpackinglight.com/cgi-bin/backpackinglight/00022

[Terry Trimble]

Why make one when you can get one made for Ultra light backpacking by adventure medical kits called the ultra light .3 for $9.99 and under. The one I use the the package is a bright yellow silnylon case with a zipper. It weighs 2.55 oz.
The new kit has a alosack case and claims to be water tight. I have found with alosack ziplock bags is they do not hold shut as well as regular ziplock bags and they tear were the ziplock is bonded to the bag.
Terry

[Link .]

The article Ken linked is very good but I think you need to be a member to read it.Here is what Andrew Skurka has said

Be realistic about in-the-field first aid

There are two categories of first aid situations:

1. Field treatable, e.g. blisters, headaches, mild diarrhea, small cuts, and anaphylaxis; and,
2. Not field treatable, e.g. broken bones, HAPE and HACE, anad cardiac arrest.

My first aid kit is designed only to treat the former. I carry ibuprofen and loperamide, Luekotape and duct tape, Krazy Glue, Hydropel, and callus cushions (to take pressure off blisters), among a few other items.

In the very unlikely event something more serious happens, I get resourceful with what I have (closed cell foam pad, guylines, extra clothing, pen knife, etc.) Even if I carried 50 pounds of medical equipment and was a certified EMT, I’m still not equipped to treat serious medical problems in the field over the long-term.

Mike Clelland

http://www.youtube.com/watch?v=7yIjXGXcWI0&feature=channel&list=UL

[Kevin Babione]

You should only need one first aid kit – it should work as your kit for day hikes as well as multi-day trips. I make two changes depending on the length of the trip:
– Quantity of medications (Tylenol, Advil, etc.)
– Amount of blister treatment (which I actually carry for other people to use)

As the previous poster mentioned, you can either treat it or you can't. My First Aid kit does two things:
– Covers me for minor cuts, scrapes, blisters, and aches & pains
– Provides what I need for First Aid if something bigger happens

My assumption is that we will get to proper medical treatment as quickly as possible if anything big happens, before bandages need to be changed or anything like that.

The other factor to consider is your distance to help should something major happen while you're on the trail. I do most of my backpacking in Pennsylvania so I know that I'm never very far from a road of some sort. I carry good maps and a GPS with me so that if I needed to go and get help I could.

[Leonid Angere]

I highly recommend carrying a small vial of potassium permanganate. A little goes a long way. Someone wrote a blog post about it recently:

http://ferfal.blogspot.com/2012/05/survival-kit-potassium-permanganate.html

[Roger Caffin]

I'll expand on what Kevin wrote:

> – Covers me for minor cuts, scrapes, blisters, and aches & pains
Bandaids, micropore tape, some Panadol, maybe a very small amount of burn cream.

> – Provides what I need for First Aid if something bigger happens
If something bigger happens, the best First Aid item is a mobile phone or EPIRB. Don't imagine you can cope: get professional help.

Perhaps the single most important item is KNOWLEDGE of First Aid. Without that an ambulance would not help; with it you can do miracles with the stuff in my list, plus the odd bandanna etc. (Been there, done that, the hospital put in 30 stitches later.)

Cheers

[R Petrelli]

Thanks so much for all the insight. I like the idea of just focusing on "treatable" issues. Ive looked into the Adventure Med Kits and liked the idea of a waterproof lightweight sack for the kit. Is it worth the purchase or is it more practical to use a ziplock?

[Terry Trimble]

I have back country emergency training from boy scouts, Also when ever I cut myself open since age 10 and needed stitches I would go to the ER and doctor could not get help so I would assist in stiches in my knee and bottom of my foot .

I always add my small carpet needle and nylon thread to my first aid kit stitch myself up if I need to it does not really hurt to stitch yourself up .

When I had no insurance I cut my hand open on my table saw it took about 20 stitches and I left no scar after it healed up.

I then cut my hand open again with razor blade back about 6 years ago I could not get it to to stop bleeding to use the CA glue stitching method.

So I and went to Kaiser emergency room waited total of 5 hours with 2 hours on a table in ER I kept asking for a stitching kit so I could sew myself up and get the hell out of their and they kept saying no. The nurse did the job and it only took 10 stitches and left a big scar.
Terry

[Angelo R.]

+1 for the Mike Clelland videos linked by Anna.

[Stephen M]

Thanks Anna for posting those videos :-)

[Thomas Vree]

Please, please, don't glue or stitch yourself up. Super bad idea. Let a knowledgeable medical practitioner back in a sterile operating room do that.

[rich y]

Stitching yourself: probably not too safe if you don't know what you're doing.

BUT if I have a big enough gash, I'm going to slather krazyglue on that like there's no tomorrow.

[Dean F.]

In the past couple of years my first aid kit has gotten very sparse. If you're being generous you can spout the party line about how when your knowledge base increases you will need less gear, but my medical knowledge base has always been rather considerable so honestly it is probably just complacency- I have yet to have a serious injury while hiking and I'm too lazy to carry a bunch of weight that I never need.

For day-hikes or weekenders I have a ziplock with some gauze, some Kling or Coban, a little triple-antibiotic ointment, Steri-Strips, and benzoin, as well as a couple of band-aids. My personal preference for tape is something like Hypafix or Mefix since it makes a handy blister-cover, too. I also carry diphenhydramine (Benadryl), ibuprofen (Motrin), and acetaminophen (Tylenol). The Benadryl is for envenomations and reactions to plants like poison ivy, and also helps sunburn a little. Heck, the Tylenol and Motrin will help you feel a little better after a sunburn, too, but mostly those are for soreness and the headaches that I get sometimes. (I usually carry an awful lot of Motrin, actually.) And note- you can take the Motrin and Tylenol at full strength simultaneously if you need to. They don't interact, but that can be a lot of NSAID at once so GI upset or ulcers are possible if you are predisposed.

For a day-hike or weekender I don't see much point in Loperamide or an antibiotic.

If you want to consider it part of the first aid kit, I also carry Hydropel and SportSlick. Likewise, my mini-Leatherman includes scissors and a tweezer, and duct-tape is all-purpose for almost any use where the Hypafix fails. Hand sanitizer is, well, a sanitizer, as is ethanol-based stove fuel.

But then I generally don't do activities that put me in great risk of large open wounds. I just hike, no mountaineering- at most a scramble now and then. If I got a big wound somehow I'd pack it with the gauze and bail out of the hike. Smaller wounds I might irrigate and Steri-Strip, and maybe bail out of the hike- but I can recognize a wound infection. Another point against suturing- I'm not sure where laymen could easily get their hands on the suture. It's not like WalMart stocks it. Or do they? Anyway, the single biggest cause of consumption of my first-aid supplies is the expiration date of those supplies. Practically speaking, if you pack something that is hard to get your hands on then it is a real pain to replace it when it expires every so often. Sticking to over-the-counter stuff is easiest.

Finally, Terry's experience notwithstanding I think that most people would have trouble doing a proper job of stitching themselves up in the back-country. Primarily you have to be sure the wound is clean first, which means irrigating, which hurts, etc. I doubt that anyone wants to haul a set of needle drivers around, though I guess that the pliers on a multi-tool would work. Steri-Strips and benzoin are a lot more user-friendly and tolerant of errors- and if you have a wound too big for that you should probably just pack it and bail. If you do want to carry suture carry a general-purpose nonabsorbable monofilament like nylon. Being nonabsorbable they will have to be removed later but most laymen can't distinguish an absorbable suture that's decaying from a wound infection, and they also can't manage subcutaneous sutures to avoid that problem. Monofilaments are less likely to sequester bacteria. The only convincing reason I can think of to carry an absorbable suture would be to tie off bleeding vessels in a really big wound before you close it, but even then laymen would be better served just to keep pressure on it for half an hour or so; I would not accidentally put a needle through a named vessel or nerve but can you honestly say the same?

For longer trips a lot of people on this forum advocate having your doctor give you a few narcotic pills in case you have to hike out on a sprained ankle and some antibiotics. In concept I agree with this, yet on all the longer hikes I've done I never seem to get around to picking some up. And I WORK at a hospital. I have packed loperamide on occasion, but you can get that over-the-counter. Otherwise I just take a bit more of similar stuff. For most hikes I can probably get out safely on a sprained ankle, even if it takes a while and I go hungry for a day or two. And it is hard (and expensive) to bring antibiotics for all eventualities. Your most likely malady is some sort of infectious gastroenteritis or infectious diarrhea, most of which have weeks-long incubations anyway and will thus hit you AFTER the hike, IIRC. The ones that have shorter incubations are viral so antibiotics aren't much use. If I were to bring a single broad-spectrum antibiotic a fluoroquinolone would be a good choice, but they are very expensive, especially for something you probably won't use and will have to throw out in a few months. On the cheaper side I think that something like Septra (aka Bactrim) would be decent, but you won't find a cheap single agent with great coverage. If you're doing truly long expeditions and want to cover the enteric culprits that people obsess about you'd need to bring some Flagyl. (I use the combination of fluoroquinolone/Flagyl a lot in my practice.)

Crazyglue- also a decent idea in concept, but I've never carried it. Realistically there's nothing it'll fix that a Steri-Strip and some benzoin won't. Also, I worry about the tube getting a leak- if you want surgical glue I'm pretty sure drug stores sell Dermabond capsules nowadays, don't they?

I have stopped carrying a large-bore needle. Really, what are the odds that I'm going to come across someone with a tension pneumothorax? I also don't carry a syringe for irrigation- I'm pretty sure that I could improvise something easily, and I'm a low-pressure believer anyway.

HAPE and HACE- there is no treatment other than descent. You may have heard of people taking Diamox or other diuretics but those are to speed acclimatization and to help control AMS symptoms, not HAPE or HACE. Descend. Fast. Hell, use your EPIRB if you have one because those are acutely life-threatening problems. Luckily I live at 7000 ft and have never had an altitude ailment.

I think that most people who are outdoorsy enough to come to this forum could improvise a splint.

Etc.

[Nick Gatel]

Dean,

Great post!

Awhile back there was another FAK thread, and I mentioned that it would be really interesting and helpful if you posted your kit. Probably around the time our Uncle sent you on that nice tour overseas ;=)

So…as I expected, you focus on prevention rather than "what if."

BTW your GG trip didn't sound like a play-it-safe trip.

Anway, thanks for the information. Good to know what a professional uses.

[Mary D]

Thank you, Dean, for your list! I have bookmarked it to use for future reference!

I looked up the Coban you mentioned. It sounds just like veterinary wrap, a self-adherent non-adhesive wrap used to hold bandages on legs of dogs or horses or whatever animal is being treated. Is it basically the same stuff? I did some experimenting with it and found it would work just fine for supporting an ankle or other joint with a some duct tape strips added on the outside (where they won't stick to the skin). And of course if my dog rips a dewclaw I would use it on him! I did find out that it has to be replaced every year or two because under pressure and in a hot pack it eventually fuses together. It's certainly a lot lighter than Ace bandage! (I also can get it free from my-daughter-the-veterinarian.)

[Mike M]

Dean- thanks for the post! I've never brought aspirin (like you ibuprofen and acetaminophen), but there has been a lot of press of late about an aspirin or two for a heart attack victim to chew- I was thinking of throwing in two 325 mg aspirin into the kit for that reason-thoughts?

Mike

[Ryan Dorn]

I was a Corpsman (medic) in the Navy and spent my fair share of time treating Marines in the field. When not dealing with battle oriented injuries, you'll primarily have to treat small cuts such as a knife slip, burns to the hands, small punctures from sticks, sickness such as diarrhea or headaches, ankle sprains, abrasions to the hands and knees from falls, and allergy issues such as bee stings. I'm generally tasked as the "group medic", so I need to be prepared, but I still want to be as light as possible. My 4 ounce community kit includes…

Wound:
-Super glue (wound closure)
-Quik Clot (bleeding control)
-Wound closure strips
-Band Aids
-Surgipad (surgical dressing) x 2
-A few small sponges and gauze

Small container of pills different pills (a few each):
-benedryl (antihistamine)
-loperamide (diarrhea)
-Naprosyn (pain)
-loratadine (seasonal allergies)
-Tylenol PM (just in case someone can't sleep… usually me.)

Burns, stings, blisters
-antibiotic ointment packages
-burn cream packages
-sting cream packages
-Moleskin

Misc…
-DryFlex waterproof bag to hold everything
-Mini tweezers
-Safety pins
-Sterile q-tips for removing things from the eyes, ears, etc.
-Thermometer strips

There are a lot of things that we already carry that can take the place of first aid kit items such as that most people carry tape, so there's no need to carry dedicated tape, hand sanitizer, knives, etc that fill out the kit.

[Dean F.]

For my edification, what kinds of medical problems are you all worrying about?

Honestly, I probably carry so little due to simple laziness and complacency, so there isn't really much thought involved. :) I haven't really done anything too epic recently. I did carry a bit more on my recent GRCA hike that was supposed to be 10 days (and ended up being 5) but not much- we were in a national park for goodness sakes. I figured that help is nearby in the form of rangers. (I admit that I carried a nylon suture and a hemostat.)

Yes, Coban is that non-adhesive wrap that supposedly only sticks to itself. It sounds like the veterinary wrap you mentioned.

Aspirin in case of a heart attack? Why not? It's multi-use. I'm not at risk myself and I rarely hike where there are crowds so I doubt that the odds of me coming upon a victim are significant, but why not? Might actually be a decent idea if you're someplace crowded, like Yosemite or something, or if you are at risk yourself.

I guess that my biggest thought process is this: I go with the odds and carry supplies for problems that have a decent chance of happening. I might also carry supplies for any specific problems that are unlikely but catastrophic- for instance an epipen if I had allergies. But I don't. I can't walk around with a trauma bay in my pocket, so I don't try. If I or anyone else gets hurt that badly I'll abort the hike- that may mean being hungry and uncomfortable during a long walk out if the injury slows me down but doesn't rate SAR. So be it- the odds are low enough that I'll chance it. If I need to I can sacrifice clothing or bandanas to make dressings, or otherwise improvise stuff. After all we're talking about a valid emergency, here. And, really, if someone has a wound so big that you're packing an entire T-shirt into it don't you think you should call for help? But the likelihood of such an injury is remote enough (for me and the hiking I do) that it's not worth hauling much else. Admittedly, I probably have a broader skillset than most and can improvise more effectively, so bear that in mind. And of course I'd think differently if I were the medico on an Everest expedition or anything similar.

So, really it's about treating annoyances that would ruin my hike. Anything worse than that should probably END my hike- it's just not worth making an injury worse to finish the planned route. I carry a SPOT.

IIRC according to Auerbach the most common causes of life-threatening medical issues in the back country are things like:

Drowning, which apparently leads the list by a large margin.
Gravity, either falling or being hit by falling objects, usually rocks.
Environmental exposure, meaning hypothermia or heat injuries.

For most of these there is nothing that you're going to be able to carry in your pack that's going to make a big difference. The exception is that falling and being hit by falling objects can produce a pretty wide range of injuries- I figure I can take my chances as I mentioned above. Well, and of course carrying medications appropriate to pre-existing medical conditions. You can treat hypothermia pretty well with what you're already carrying- insulation, a companion's body heat, and a way to heat fluids. Everything else is too big to carry. On a real winter expedition maybe carry a chemical hotpack. And don't jostle them- very hypothermic people can be flipped into a fatal dysrhythmia just by being bumped. For heat injuries it'd be nice to be able to cool fluids, but you can't carry a refrigerator in your pack. Hope there's a cool stream nearby. For drowning, either your CPR class saves the day or it doesn't. Likewise lightning strikes. Carrying an Ambu bag isn't practical, let alone a code cart. There is NOTHING that you can do for HAPE or HACE except descend as fast as possible by any means possible. AMS is an annoyance that might make my hike less than fun so maybe if I were going very high very quickly I'd consider Diamox prophylaxis, but otherwise you just treat it with NSAIDs, rest, and tincture of time. My Benadryl is for envenomations. Snakebite kits are just a way to fleece the uninitiated of a bit of money- they don't work, and by all indications actually make things worse. If it is serious enough, kill the critter and take it with you to the ER for identification.

Actually, BY FAR most of the annoying things that might make my hike un-fun are just treated with NSAIDs like Tylenol or Motrin.

Oh, one other thing to consider: if you carry a needle and thread in your repair kit you CAN sterilize those and use them as suture, as has been mentioned. In fact cotton suture used to be very common back in the day, though it isn't nowadays. And nylon thread isn't really much different from Ethibond. I'd be sure to remove them early, though- a less than ideal woven suture makes me worry about bacteria hiding in the weave. In fact, considering how unlikely it is that you'd get an injury that was too big for a Steri-Strip but not big enough to end your hike, this isn't a bad plan.

Quik Clot ?!? Wow. That's a big gun. Really, what are the odds that you'll need to stop major bleeding like that? And if you use it on anything less than immediately and dramatically life-threatening bleeding you're almost certainly harming your patient more than you're helping him. Direct pressure! (And plucking that stuff out of the wound in the ER later is a PITA.) The military has largely dropped Quik Clot and changed to chitosan-based hemorrhage dressings because the Quik Clot was causing more damage than it was preventing. Or if you can't stop the bleeding any other way a tourniquet can be life-saving, but they had better be jetting bright red arterial blood, and even then please try everything else first. If you can't get them to a surgeon within four to six hours of placing the tourniquet they'll loose the limb. (And most rural hospitals don't have a surgeon- the ER doc will need to call for air transport the the nearest medical center.)

I don't think that you need separate antibiotic ointment and burn cream. It's redundant. One of the most common burn ointments used in hospitals is… bacitracin. If you have a burn of so much body surface that it needs some sort of silver-based dressing then you need to suck it up and hit the EPIRB, friend.

Note on antibiotics: doxycycline and tetracycline are photosensitizing- they make you much more susceptible to sunburns. But on the other hand they are cheap…

[Eric Blumensaadt]

One of the very best ways to close a serious wound is butterfly bandages. They permit wound drainage but still keep the edges of the wound properly aligned if you did your part aligning them.

But first irrigate the wound as best you can with CLEAN, treated water, preferrably with water treated with chlorine dioxide (Aqua Mira or Katadyn) or evem old school idoine tabs.

[Daryl and Daryl]

"And, really, if someone has a wound so big that you're packing an entire T-shirt into it don't you think you should call for help?"

This sounds like the dark humor from Monte Python and The Holy Grail. "only a flesh wound….no problem" or something like that is how I remember the comments from the knight who just had a couple arms cut off.

[Paul Hood]

I too am bookmarking this thread… thanks for all the great input.

I had a situation where I took a bunch of novice mt bikers for a group ride and one went over the bars and really hamburgered one hand. The other scrapes he got were minor and easy to just rinse off but the hands were bad enough to consume all the bandaids I had with me, so I ended up using the bandaid wrappers. If the bandaids are sterile, so is the inside of their wrappers, so I just kept them clean and used the clean side against the wounds and taped up and tied off where we could to protect from further dirt/contamination.

He then walked back to the car with hands above head to help reduce bleeding and all was well. I was pleased to have the doc in the ER compliment the use of bandages and wrappers… The doc stated the wound was quite clean, so it seems to work (and does not weigh anything extra!)

maybe someone else will find that idea useful, but hopefully it just gets stored and never has to be used (like all the first aid stuff).

[Jake D]

i like steri strips to butterflys and super glue. they are my favorite thing to use at work (athletic trainer). the 1/4" ones are easier to use than the 1/8 skinny things. you can get a lot out of them by cutting them in half or in quarters if it is a small but deep thing.

epi pens are not the end all to an allergic reaction, they will need treatment afterward too so if you need to use one then you also need to get help soon too.

i've heard Quick-Clot burns like crazy so make sure they are in serious trouble before cracking that open.

I have a pretty small FAK that has a small amount of the stuff i use the most on the field. gauze, bandaids, steri strips, tape,duct tape, triangle bandage, mylar blanket, advil, benadryl.

having knowledge on treating first aid situations is much more important than having a lot of items. lots of stuff can be improvised.

[W I S N E R !]

Thank you Dean!

Very interesting to hear the perspective of someone with your background/expertise.

[Ryan Dorn]

Love your posts Dean, but for clarification….

The OLD Quik Clot powder (1st generation aka the "big gun" you spoke of) which was used by the military has been replace due to it blowing in peoples eyes causing injury, risk of thrombosis and burns.

BUT…

It was replaced with the NEW Quik Clot (2nd generation) which is a treated gauze. In fact, it is the only product of this type carried by all of the US military branches and is called "QuikClot Combat Gauze". It is extremely safe and effective, doesn't burn and is available retail now as "QuikClot Sport" for small to severe bleeding. It's not just a life threatening, massive bleed product anymore. Hell, they even make it for nose bleeds now. At 25 grams, I would rather have it than not.

And as far as the redundancy of the antibiotic cream and burn creams, the burn cream I was speaking of is a cooling gel that comes in a 3 gram ketchup style package (Water Jel Burn Jel Plus). It's more of a pain management thing because let's face it, burning the tip of your finger cooking can be quite painful especially since we often have sub-13 year old kiddies with us. They don't "man up" as well as we do. If I don't use the burn cream, a paste based toothpaste helps with throbbing burning pain as well. Seriously.

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