Lightweight First Aid and Trauma Kits: Perspectives from a Mountain Rescue Medic

[Emylene VanderVelden]

Companion forum thread to: Lightweight First Aid and Trauma Kits: Perspectives from a Mountain Rescue Medic

This article features an interview with a Canadian Mountain Rescue Medic, focusing on how to assemble lightweight first aid and trauma kits for backcountry travel.

[Dena Kelley]

Enjoyed. I’m in a local SAR group and am always interested in the perspectives of others who do this, as I’m relatively new to it. Thank you for this article.

[Roger Caffin]

Once you have checked the breathing, stopped the bleeding, and maybe immobilized the limb (or whatever), what is the next step?

Sit down, take a deep breath, get the stove out and make coffee. For the victim, strong coffee with sugar ‘on doctor’s orders’, even if they normally don’t take either coffee or sugar. And yes, we HAVE done this at times (like more than a few times).

Chers

[David P]

Thanks for posting this Emylene! I like how Michael stresses knowledge over just adding more to your fak. What good are all those tools without the ability to concoct a plan of action to implement them effectively? Stripped down true medic kit- i have actually decided to Add a few key items from your interview after reading, my 2oz med kit is going to swell a bit, but not that much!

@roger- do you think that one or two of those 100 calorie gel packets with 50mg caffeine would be as effective as actual coffee for the victim in a situation like you’ve been in? Sometimes I just take those and not coffee grounds…

[Roger Caffin]

do you think that one or two of those 100 calorie gel packets with 50mg caffeine would be as effective as actual coffee for the victim in a situation like you’ve been in?
No, I don’t think so.

First of all, hot coffee is a lot different from cold energy gel, even if the gel contains caffeine. A hot drink going down your throat is just … different. Better.

But just as important is the action of sitting down, thinking, and letting the shock go past. You can keep going despite the shock – for while, but it is better to relax and let it pass. The sooner you let it go, the milder will be the reaction.

At the risk of being banal, injuries injure, but shock can kill.

Cheers

[David P]

Thanks for that. Good to know!

[Matthew / BPL]

Coffee seems like a good way to put STOP (stop, think, observe, plan) into action. It also signals to the patient that they are in a safe enough place that we can take ten minutes to boil some water and have a drink. I can also see it being a good routine when traveling solo and something happened. Great idea. Thanks, Roger.

[Chris R]

Re. not worrying about blood contamination. What about encountering an injured stranger on the trail or another camper injuring themselves? Certainly been known to happen.

Giving caffeine to a patient. Potential for masking changes in vital signs?

[Dena Kelley]

We always carry hot chocolate in our SAR group. Roger’s right- a hot drink is enormously comforting. And sugar is a must, whether it’s treating shock or hypothermia or low blood glucose. I carry decaf coffee, also, and some cider packets. Caffeine might cause an aberration in a patient’s vitals, but we look for that anyway. The first set of vitals you take, and even the second, can often be garbage because the patient can be in ASR -acute stress response, either sympathetic (anxiety) or parasympathetic (fainting) – and it can look like shock when it’s not. On the flip side, if they really are in shock, you’re going to see their vitals trending regardless of whether you add caffeine or not. I don’t think, personally, that I would choose to give a patient caffeine (at the dose regular coffee contains- decaf coffee and hot chocolate contain negligible amounts)- mostly because I really don’t want to potentially add anxiety or a faster heart rate. But a hot, sugary drink- definitely. And Roger is right, also, that the fact that you’re willing to do something like that is a strong indicator to the patient that they are stable and you’re providing patient comfort on both a physical and a psychological level.

[Paul Wagner]

I used to lead coaches meetings for youth soccer with a fellow coach who was an EMT. He always suggested that the most important part of a FAK was a cell phone to call some who knew what to do.  The gear is definitely secondary to the expertise.

[David Thomas]

I also like the emphasis on knowledge over gear.  And, yeah, dressings and triangular bandages are over-stocked in commercial first aid kits because they’re cheap and harken back to Scout first aid training. And, yes, those stupid little mouth-to-mouth masks are harder to use than direct face to face.

But like Michael said, a few basic drugs are potentially very helpful and you can’t fabricate or improvise those.  Except maybe by making a willow bark tea.

Hot chocolate, sure, as a break in the action and a pause for thinking.  But the 100-calorie gel pack is smaller and lighter than any stove/pot combo and can be given in for more settings.

I tweaked a little on the “Most people (maybe everyone) I backpack with could bleed all over me and I wouldn’t worry about it.”  If everyone’s intimates were alway disease free HIV/ Syphilis / etc would never spread.  Two people I’ve hiked with were looking pretty bad in 1995 and then a lot better in 2000 but never told me they were HIV+ but based on the timing of their sickness, their recovery, and being in higher-risk group, I have my suspicions.  Point being: you never know.

The recommended SAM splint is pretty versatile and fairly light, but I recommend you also practice with your CCF or inflatable sleeping pad to improvise an air splint.  You have to keep checking it hasn’t gotten too limp or too high in pressure as temperatures and elevations change, but you can splint a wide variety of broken limbs more comfortably that way than with sticks and cordage. Also, examine any internal-frame packs with aluminum stays in them – those are fabulous because you can bend them to fit a particular limb but they’re stiff enough to provide a lot of support.

[David P]

Shock treatment- The cider packets sound yummy dena! I may opt to toss in some cinnamon and Orange Peel chamomile tea with some honey or sugar… soothing aroma, calming herbal properties… depending on the severity I might add some compassionate touch in there (shoulder, foot, hand, scalp massage) if ever faced with the situation…

great tips for splinting David , thank you ! Got me thinking how else to multipurpose the stays in my pack…

Wound Care- this is kind of a minor aside but personally I just use soap and water to clean wounds and then Vaseline when dressing wounds instead  of Antibiotic Ointment.  This was recommended to me by my Dermatologist after recent cancer surgeries and also my wife (who is an RN) says that hospitals don’t routinely use hydrogen peroxide or antibiotic ointment any more. Because of the nature of my work I have become fairly proficient at wound care. I will keep a minor wound covered and moist with the Vaseline for 3 or 4 days usually changing dressing once a day… especially important at work or in the backcountry to prevent infection also reduces visible scarring.  Hypafix is an indispensable part of my FAK- in the realm of dressing retention I have found none better

 

[Dena Kelley]

FWIW in WFR training they told us it’s cool to use neosporin around a cleaned wound or even a light coating on the bandage that dresses the wound (also you can lightly coat bandage with iodine) but not IN the wound. Bacteria love an anaerobic environment so by sealing the wound with neosporin or vaseline you can actually create the perfect warm, moist, airless environment in which bacteria will thrive. You want to keep the wound moist but also allow it to breathe. This was actually a huge take-away for me from the class because I have always been one to just fill up the cut full of neosporin and toss a bandaid on it, and apparently that wasn’t the right thing to do, ha.

[David Thomas]

My physician wife recommends something (Neosporin, vaseline, whatever) to keep the wound edges moist during healing.  Otherwise, more of the margins will dry out, die, and the healing and resulting scar will be over a wider area.  I managed to successfully reattach the tip my thumb after a distracted-vegetable-slicing incident while backpacking in New Zealand with only Bandaids, Neosporin and trying to keep it as clean as I could.

[Greg Mihalik]

If someone in the group is taking anti-coagulants (including 83mg aspirin) they need to come with CELOX Rapid or you should carry it to stop serious bleeding.

CELOX works independently of blood clotting factors, and is fast compared to compression alone. It could take “bleeder” well over 30 minutes to get things stopped otherwise. CELOX is sterile and can remain in place until secondary treatment.

[David Thomas]

In addition to the over-the-counter pills mentioned in the article, on a more remote trip or with a larger group, I like to have:

• a topical antibiotic cream (see above),
• a steroid cream for insect-bite / poison oak itching,
• sunscreen, and
• an anti-fungal for athlete’s foot.

I get mini professional-samples of them in very small tubes because they’re compact and light, correctly labeled in their original packaging, and the stuff still on patent and prescription strength is the latest, most powerful stuff.  It helps to know lots of physicians or at least be on good terms with your dermatologist.

[Greg Mihalik]

Neosporin is contra-indicated for about 20% of the general population. I, being in that group, develop small blisters at about day 5 of application.  Mupirocin 2% is a better option.

[John S.]

Nm

[Greg Mihalik]

^^^^

… provided an antibiotic is not needed.

If I gash myself in the woods I’ll go with an antibiotic. When I start developing a staff infection under my pack straps I’ll go with the antibiotic. Petroleum jelly by itself won’t get the job done.

[Roger Caffin]

If I gash myself in the woods I’ll go with an antibiotic.
Why?
I just stick a BandAid on.

The probability of picking up a harmful bacterium in the wild must be utterly microscopic compared to the probability of picking up one in, say, a hospital.

It sounds like a misuse of antibiotics.

Cheers

[David P]

I gash myself once a month at work, often I’m very dirty or covered with some nasty product, thorough irrigation of  the wound and some soap is way more important. Antibiotics are never “needed” they kill the good bacteria along with the bad and the bad bacteria can become resistant to it, it is a worldwide healthcare issue right now. Bacterial antibiotic resistance. But to each their own.

And regarding letting a wound “air out” or “dry up”

[Roger Caffin]

Vaseline eh? Interesting idea. My wife carries a tiny pot for her lips: I will try it one day. Simple is better.
Thanks.
Cheers

[Emylene VanderVelden]

I love the coffee idea but agree with the risk of changing vitals. On caffeine I can exhibit an (asymptotic) arrhythmia. I sometimes hike with a former cardiac patient who can’t have caffeine with  prescription meds. In reality though, use what you have. Most first aiders make amazing splits and wound dressings but are terrible at taking vitals.

I completely attest to and support the psychological benefit  and reassurances of the action of making a ‘cuppa’ of anything. A warm beverage has benefits for cold, shock, and mental acuity.

One of the best pieces of advice I got from a wilderness first aid course was to actually get a panicking or passive bystander to make the hot drink. It calms the bystander, gets them out of your hair with a basic task, and gets them actively participating in emergency management. Thereby mitigating or preventing a secondary shock casualty.

[Roger Caffin]

One of the best pieces of advice I got from a wilderness first aid course was to actually get a panicking or passive bystander to make the hot drink.
There are not too many suggestions which get me to take my hat off, but that is one of them. Very clever indeed.

Cheers

[Bendrix B]

Wound care and warm beverages:

Vaseline is good, easy to apply and carry.  I’ve found that unflavored Chap Stick is better.  Its a bit harder to apply but it last a lot longer and creates a better barrier from both outside intrusions and the migration of moisture and oil from your skin.  It will quickly relieve the pain of cracked skin, dried out by cold dry air (here in the Northeast) or desert air.  On one trip a guest developed a fissure of the sphincter, probably from the common experience of not being able to defficate in a strange place, then finally releasing an larger, harder stool than normal.  You may be disgusted or laugh, but its a real thing.  The anus is a dangerous area to have an open wound as it is regularly exposed to a high bacterial load.  I instructed the guest to mash some Chap Stick between finger and thumb until it was soft, then apply it liberally to the fissure.  The fissure healed in a few days.  I’ve since recommended that to others which similar results. Anyone who’s experienced a fissure will know how hard it is to keep one clean and heal it.

A warm beverage that is very beneficial is warm water and honey.  I’ve not encountered anyone alergic to honey.  It has a pleasant taste and lots of calories.  If you are dealing with hypothermia, blood loss and other injuries, dehydration is present and must be addressed.  The calories will cause the body to warm.  It takes a lot of calories to warm a 160lb human who’s core temperature has dropped.  I always carry honey packets in a hard container.  You can’t carry honey in a squeeze container or one with a small mouth cause honey gets very hard even at 50F, and impossible to squeeze out.  The packets are easy to peel open in any temp, but they are fragile hence the hard sided container.

I like to carry an Israeli Bandage  because it is the most versatile tool for staunching bleeding and simultaneously pressuring a wound.  We use axes in camp, and the young guys (20s) always show up with big sharp knives the purchased for the cool.  Cuts are always a problem.  Sever cuts could be life threatening and a fool with an axe can put it through a foot in a heartbeat.  So can a weary, sleep deprived pro.

Michael’s advice that the most important tool is the knowledge you have is the best advice there is.  Where to get it?  I don’t think you can achieve an adequate education in wilderness medicine from a book.  I’ve got a bunch.  The best education is hands on, using the supplies, acting out scenarios where you must think and act under pressure in unexpected circumstances.  You can do that at SOLO in New Hampshire – http://www.soloschools.com  SOLO teaches regular courses ranging from a three day Wilderness First Aid to a multi week Wilderness EMT. The price is reasonable, and the first time you need what you learn, dirt cheap.

We get used to being in contact with people and emergency services.  Our society generally expects there to be help available immediately at the push of a button.  We are backpackers and we search out solitude.  Don’t expect that cell phone to work when things go wrong.  Even if it works, don’t expect help to arrive soon, and if the weather goes to hell, maybe not in time.

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