December 20, 2007

First Aid Kits
Some Tips to Help Create an Ideal Kit for You

Rule #1—“The Context Equals the Content.”
There are many excellent first aid kits on the market today. Manufacturers have done their best to take into consideration many factors, from cost to the actual contents. That is why there are so many choices in style and content. For many people, they just want a "good first aid kit in their pack, because they need one." A good comparison is to look in someone's car. Some people are comfortable adding oil and jumping a dead battery, so they carry extra oil and jumper cables, some people do not. It usually is the person who has had experience and training that carries the appropriate amount with them, either in their car, or their backpacks. How do you know what to carry? Besides your experience in the environment in which your traveling, you are now getting training to help you handle emergency situations. These are by far the most important components.

Now, to put together the "tools" that you will need. As superb as manufactured kits are, you will probably want to customize one, or build your own kit, using the context of its use as the major criteria. Other factors include:

• The environment in which you travel will help you choose what is needed for potential problems that may arise, and how to handle an evacuation, if needed.
• The activity itself will help you, due to its remoteness, and potential problems in that environment.
• What do you have for other available resources, such as people, gear, and communications.
• Who is participating - how many, what is their medical history, knowledge and skill level..
• What can you improvise for splinting materials, litters, etc.
• What can not be improvised.

Remember the Three Mechanisms of Injury:

• Trauma
• Medical
• Environmental

The First Aid Kit
The kit itself needs to fit the environment and group's needs. Carrying a dry box on a backpacking trip can really be a memorable experience. Or the "biology experiment", that greets you when you open up a wet kit in an emergency. The kit needs to be organized and waterproof, accessible in an emergency, and user friendly. Some groups, such as commercial raft companies, carry "minor med kits" on individual boats, and a "major med kit" in the sweep boat. In smaller groups, usually the person with the most medical training, or the trip leader will carry the kit. In these situations, it is always good to know whom you have with you (medical history), and where their medications are, if necessary.

Let's get to the kit -

Carrying Device - One that works best for you, and the environment in which you travel. Dry Bag/Box, fanny pack, compartmentalized pouch, ziplock bags, etc.

Personal Protection - it is generally a good idea to have these at easy access. Gloves can be placed in various places in your pack, or on yourself, such as a lifejacket in a film canister, etc.

• Vinyl or Latex Gloves - 2 to 4 pairs per person*
• CPR Mask - or at the very least, a CPR Shield
• Airways - dependent on level of training

Wound Care - this is probably the most used portion of the kit:

• Bandages - 3" and/or 4" rollergauze that stretches and possibly self-adhering such as Kling, Curlex, and Coban. Like ace bandages, care should be given to checking CSM at regular intervals and taking care not to wrap too tight. They are usually reusable for the same injury, so 1-2 per person should work.
• Dressings - it is a personal preference to carry multiple sizes of sterile gauze bandages. But it is always easier to cut a 4" x 4" smaller than it is to make a 2" x 2" bigger. Although not necessary, different dressings will help make wound care much more manageable. 2 to 4 per person are minimal.
• Non-Stick Gauze Pads - is a great dressing to use directly on the wound. Wounds tend to "weep", and in long term care, dressings must be changed. If you have ever removed a regular gauze pad that has "wept" to the wound, then you will want some non-stick gauze, such as Telfa. 2 to 4 per person.
• General Purpose Gauze Pads - like the name, they have many uses for wound care, from padding to absorbency. Generally, these are used more than any other gauze, because of its versatility. Since these have so many uses, 4-6 per person.
• Combine and Trauma Dressing - used where high absorbency and/or padding are necessary. Larger sizes in these are usually recommended. Surgipad is the most common. 1-2 per person*
• Occlusive Dressings - an excellent dressing when you want to keep a wound dry in a wet environment. Care must be taken to remove these dressings during rest periods to help promote healing in a prolonged context. Examples include Bioclusive and Tegaderm. 1-2 per person*
• Bandage Strips - better known as Band-Aids, is really a bandage with an attached dressing. Strips when used on hands, etc. in a remote setting will need some help from duct or cloth tape. It is again important to change these regularly, so bring enough. Usually 6-8 per person*.
• Tape - a real necessity. 1" cloth tape is usually all that is needed in a basic first aid kit. From securing bandages to closing wounds, cloth tape can do it all. 1 roll.
• Duct, packaging and other tapes make great securing tools for bandages, splints, clothing, etc. Be careful to watch for constriction and other circulation problems. Instead of carrying duct tape on a huge roll, great options such as water bottles, ski poles and lighters have been adorned with it in case of its inevitable use. 20-30 ft.*

Wound Cleansing - a must in any remote setting needs to be done well and often. What is needed now is Povidine Iodine (PI) used in a solution with water, to adequately irrigate the wound and surrounding area. In many kits, PI is in the form of pre-soak pads that pack well, but you need quite a few to make the proper solution with water (looks like weak iced tea). Be careful of carrying it in bottles, it will leak. And, in cold environments it will freeze. There is are some people who are allergic to iodine, so check your medical history first. Alternatives that have an alcohol base usually have a tendency to "sting" or "burn" if applied directly to a wound. There are some good biodegradable camping soaps, as well as medical "scrubs" that can be used for cleansing around wounds. The most important factor here is copious amounts of water for washing off residue. A irrigation syringe, 12cc to 60cc, works great for washing out wounds, as well as, a corner cut off a ziplock, which is squeezed like a cake decorator. Wound closing is an option when the person needs to be able to walk or paddle with a minor injury. The risk of infection is greater when the wound is close, so prior wound cleansing is vital. Butterfly bandages, Steri-strips, or even cloth tape can be used.

Splinting - is probably the most improvised skill there is. Ensolite pads, lifejackets, packs, paddles, ski poles, etc. all make great splints. The key here is to make sure you use the injured's equipment first! There is nothing worse then watching the helicopter fly away, after a successful rescue, with your sleeping pad wrapped around a person's unstable leg injury. The two best commercial splints going for extremity splinting, is the 36" Sam Splint (foam covered aluminum), and the aluminum wire splint. You will also need a way of securing the splint to the injured. Ace wraps, Coban, Kling, and triangular bandages all work well. And, don't forget the duct tape. Remember to watch for constriction, comfort, and compatibility.

Blister Care - the key here is prevention. At the first sign of a hot spot, care should be taken. Personal preferences include, moleskin, molefoam, first aid tape, and duct tape to prevent blisters from forming. Once a blister forms, the care changes to open wound care, with wound cleansing and proper bandaging.

Hardware - this the stuff that can make someone a hero for being able to pull out a splinter, or make an emergency shelter.

• Tweezers - The "Splinter Grabber" is the best for compatibility, followed by splinter (really) tweezers.
• Pins - both safety and blanket pins have multiple uses. Mostly, they can be used wherever material needs to be secured such as using a sleeve as a improvised sling, or securing a tarp as a shelter.
• Plastic bags - somewhere in your pack, extra plastic bags is a good idea. Large ziplocks make great irrigators, improvised glove, or occlusive layer. Big trash bags are perfect for vapor barriers when wrapping up a patient, emergency shelter, and to put trash in.
• Thermometer - in a cold environment, a hypothermia thermometer covers most needs, and a normal thermometer makes sense elsewhere. There are many good disposable thermometers on the market, such as Tempa-Dot, that are also unbreakable. A digital indoor/outdoor thermometer with a probe is a good resource to tell temp. variations of a patient who is either immobilized during or waiting for evac, although not as accurate as a medical version.
• Trauma shears - is a good resource for removing clothing, cutting improvised splints to size, and just about anything else.
• BP Cuff and Stethoscope - although they are added weight and bulk, they give the first responder vital signs that may help tell a big deal from not. Generally, expedition or large groups have these as part of their major med kits. Some first responders carry only a stethoscope to help them hear lung, heart, and digestive sounds.
• Heat/Cold Packs - again usually carried in major med kits, these will help in short term context. Water bottles with warm water, cooled wet towels, filled ziplocks, can be improvised heat/cold packs.
• Survival Gear - like an ensolite pad, they are not generally thought of as part of the first aid kit, but are very useful in handling an emergency situation.
• Mirror/signal device - a compass with a mirror could save you a scary and painful trip out of the woods because of a spruce speck in the eye, or help you locate an adventuresome tick or leech. It can also be used to signal aircraft or other groups, too.
• Whistle - long after a human voice gives out from yelling, a whistle can still be blown. Some groups even have pre-planned signals, such as river guides.
• Flashlight/headlamp - the majority of overdue hikers are caused from not having a light, or spare batteries and bulbs. Select a light appropriate to your activity, and that either has a foolproof switch that won't turn on in the pack, or that the batteries can be turned around in.
• Lighter/ waterproof matches- if you are traveling in wet, cold environments it is also good to carry a fire catalyst, such as fire ribbon, or fire gel.
• Flagging tape - can be used to give wind direction to helicopters, making out a bushwhack trail, signaling. Blaze orange and neon blue seem to show up best on land.
• Parachute cord - strong and light, 100' of p-cord could secure an improvised shelter, build a litter, and even mend a broken paddle. 10 to 15' of mechanic's wire make a good addition for stronger repairs.
• Survival blanket - there are 2 good alternatives here that both accomplish the same job of vapor barrier, heat reflector, emergency shelter. The fiberglass reinforced Sportman's Space Blanket holds up to high winds and multiple uses. It makes an excellent shelter, and when put behind you is an excellent heat reflector from a fire. The original Space Blanket is a great lightweight alternative that is compact and light, but impossible to ever repack to original size. This blanket is reported to be a good emergency replacement if sunglasses are lost, as you can see through the blanket. The actual UV protection is the only question. The silver reflective surface also makes a space blanket a great signaling device.

Medications - the legalities of using medications should not be taken lightly. Adequate training, written policies and procedures and medical control should all be considered. The big problem is that it is much easier to put the medicine in, then it is to take it out.

• Topical antibiotic cream - such as Neosporin, has been proven to promote healing in shallow wounds and help maintain a good barrier.
• Analgesic, Antipyretic and Anti inflammatories - such as Tylenol, Ibuprofen, and aspirin. It is personal preference to what has worked best for you.
• Antihistamine - such as Benadryl and Sudafed
• Antacid - Mylanta, Gelusil, Pepto Bismol, Maalox
• Antidiarrheal - Pepto, Keopectate, Immodium, Lomotil
• Anticonstipation - Metamucil, glycerine suppositories
• Antifungal/yeast - Tinactin, Mystatin
• Dental Problems - pain relief from clove oil, Orabase
• Temporary dental filing material such as dental wax or Cavit
• Special Needs and Medications - such as prescription antibiotics, asthma inhalers, altitude meds, epineherine, etc.
• Glucose - liquid glucose in a single use tube
• Oral Electrolyte Replacement Solution - such as Gookinaid, Gatorade, etc.
• Tincture of Benzoin - helps keep bandages attached
• Activated Charcoal
• Syrup of Ipecac

* General amounts for the usual day trip or weekend trip. If you can not be resupplied easily, such as a month long expedition or voyage, it is probably good to triple all these amounts. Program first aid kits that have youth at risk for clients will probably have more wound care materials than a expedition group of experienced participants, etc. There are no hard and fast rules to quantity, only your experience, your training, and your judgment. So, after looking over your kit, and you don't see "enough" povodine iodine pads, you are customizing your kit to your needs.

Finally, Putting This All Together.

The First aid kit must be well organized, weather proof, accessible in an emergency, and user friendly. There are many good ways to approach this concept. The simplest way to organize is to separate your bandages, dressings, meds, etc. with ziplocks, or some sort of waterproof dividers. Writing what's in the bag can help when the adrenaline is pumping, or some people even color code what is what. Having gloves, pocket mask, and other protection readily available is very important. Knowing what you can improvise with can also make an accident situation go more smoothly. Being able to quickly grab the ensolite, duct tape, and shears can greatly reduce the stress of the moment. Not only is the first aid kit itself important, it is how easily you can assemble all your resources.

Suggested Personal First Aid Kit List

1 - roll 1" cloth tape
4 - 4" x 4", or 3" x 3" general gauze pads
2 - non-adherent gauze pads
1 - 8" x 7" combine (bulk) dressing
8 - band-aid bandages
2 - 3" or 4" stretch roller gauze
3 - 3" or 4" occlusive dressings
2 - triangular bandages
1 - 4" ace wrap
1 - Sam Splint or wire splint
4pr - vinyl exam gloves
1 - CPR pocket mask w/ 1 way valve or shield
1 - Airways, nasal and/or airway
1 - blister kit (personal preference)
5 - povodine iodine packets
1 - trauma scissors
1 - splinter tweezers
1 - thermometer
1 - med kit (personal preference)
1 - blanket pin
2 - safety pins
1 - 12 to 60cc syringe
1 - 20-30' duct tape

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