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Pigpen
07-08-2008, 19:25
The course I am at is in the process of revamping our med kits/CLS bags. After looking thru the pitiful things in the 25lbs CLS bag (most of which we will never need) I decided maybe you guys could better help me out. We have authorization to purchase, but I am just alittle behind the power curve of what is out there and where to look.

Let me give specifics of the type of injuries we might sustain and you all take me home please.

In priority from worst case to common:
Rattlesnake/Coral Snake bite
Broken lower leg or arm
Heat injury
Class II or III sprains (ankle injury)
Minor cuts (rarely requiring stitches)
abrasions

We are looking for something light weight (obviously, aren't we all) which could easily fit in a day-pack. We also can get the patient to a facility in <45 minutes.

swatsurgeon
07-09-2008, 15:43
The course I am at is in the process of revamping our med kits/CLS bags. After looking thru the pitiful things in the 25lbs CLS bag (most of which we will never need) I decided maybe you guys could better help me out. We have authorization to purchase, but I am just alittle behind the power curve of what is out there and where to look.

Let me give specifics of the type of injuries we might sustain and you all take me home please.

In priority from worst case to common:
Rattlesnake/Coral Snake bite
Broken lower leg or arm
Heat injury
Class II or III sprains (ankle injury)
Minor cuts (rarely requiring stitches)
abrasions

We are looking for something light weight (obviously, aren't we all) which could easily fit in a day-pack. We also can get the patient to a facility in <45 minutes.

-snake bite: KNOW WHERE THE CLOSEST HOSPITAL IS WITH A SUPPLY OF CROFAB!!!!!!!
-broken limb: sam splint x2, or if you can find it a pillow splint that you blow up but is small/thin/light weight before inflation....tape
- heat injury: IVF, light weight space blanket to set up shelter and create shade, pocket battery fan, ice packs that you smack and activate
- sprains: advil, alleve, cloth tape

ss

cornelyj
07-09-2008, 19:14
Trying to stay in my lane but....

sugar packets.
FREE at the nearest BK or cafe' shoppe.

Maybe a small bottle of eye wash, eye cups are tiny and work.

couple of 1" by 1" swaps Alcohol Prep Pads, Triple Antibiotic, Dispatch and of course the Sunny's BBQ wipes.

CPR micro-Shield (mouth barrier.)

+1 on ice smack bags.

+1 on Triangle Bandage.

...all items enclosed in kit not listed.

I work at a gym, outside fields(games) and skate park and have similar "problems". Heat casualties and ankles (knees) are the biggest boo boos that I have to deal with. Typically anything else I'm giving my grid to the 911 operator for many reasons besides patient is in danger.
I have always used the don't carry it if you wouldn't use it on your momma.
I'll post a picture of my so called "kit" if interested.
All inside a Maxpedition FR-1 0226
http://www.maxpedition.com/store/pc/viewPrd.asp?idcategory=7&idproduct=404

Doczilla
07-09-2008, 19:39
I'm afraid I don't quite know the setting you are in, which might be helpful, or what age groups you typically deal with, but I agree with SS's recommendations. I would add the following:
Bacitracin ointment
Epi pen autoinjector or 1cc syringes with ampules of 1:1000 epinephrine. The latter is far smaller and cheaper, but there may be legal issues with who can administer them. Bees and related insects kill more people every year than all other animal attacks combined, so regardless, I would have epi in my kit.
Albuterol inhaler
A couple of bandaids
Ace bandage or two
For tape, I'd get 2" cloth athletic tape, and that's all. Versatile, strong, and a good adhesive.
Nasopharyngeal airway (NPA)
Baby aspirin (for suspected cardiac chest pain)
Other meds: benadryl, claritin, tylenol, advil, immodium, oral glucose gel

A couple of things that you probably always have, but never hurts to have a small backup (travel section at Target):
sunblock
bug repellent

I agree completely with the SAM splints, and I feel they are a lot more versatile than the inflatable ones. You can essentially make any splint you can think of, including a c-collar for spinal immobilization.

'zilla

Red Flag 1
07-09-2008, 21:13
Afrin nasal spray, or Neo-Synepherine. Can help with simple nose bleeds.
Naked photos of H R Clinton or the current Speaker of the House would work as an emitic should you need one. (Sorry, couldn't help myself!)

RF 1

Doczilla
07-09-2008, 21:35
Naked photos of H R Clinton or the current Speaker of the House would work as an emitic should you need one. (Sorry, couldn't help myself!)

Oh, that's just wrong....

I feel ill now.

'zilla

Go Devil
07-09-2008, 22:29
Hello PigPen,

Not exactly sure about what your situation is, but below is a link to what we use here. Our lawyers and insurance reps are happy with these products. There is quite a bit of concern with liability when "custom" medical supplies are administered.

http://www.adventuremedicalkits.com/kit_series.asp?series=100&seriesNav=Dom


The Fundamental pack ($80.00 at Gander Mnt.) is more than enough for us (bandages to SAM Splints), but then again, I am not sure what your application is.
The complete package is roughly 9"x7"x4". Fits great in our hydration packs and doesn't weigh much if anything.

Hope this helps,
GD

The Reaper
07-10-2008, 06:11
I would like to add for those contemplating putting together a kit to use if they run across an accident, that my understanding is that the Good Samaritan laws do not cover any penetration of the skin, like IVs and crics, or administration of meds unless you have a medical license of some sort.

We had an 18D burned because he started an IV on a child at a car crash. The ER docs said that he saved her life, but the parents sued, and won a judgement against him.

Just a word to the wise.

TR

cornelyj
07-10-2008, 14:58
+1 on what Reaper said happened to a kid I worked with...

adal
07-10-2008, 21:19
PM sent

sf11b_p
07-11-2008, 18:30
In priority from worst case to common:
Rattlesnake/Coral Snake bite - can't help with this

Broken lower leg or arm - SAM splints yes but padding, wraps and tape to secure are needed.

Heat injury - shade, rest, wetting and fanning along with fluid replacement. The fluids should include electrolytes. Severe heat injury requires rapid cooling so in addition the chemical cold packs are useful. You can get hot/cold packs which are also useful for sprains and various athletic injuries.

Class II or III sprains (ankle injury) - The hot/cold packs, cold spray and supportive taping. Supportive taping is different from the elastic wraps. Supportive tape is a combo of gel wrap or foam tape (same thing really) and cloth tape over that. The first wrap protects the skin from sticky adhesive. Some knowledge of athletic training wraps is needed.

Minor cuts (rarely requiring stitches)
abrasions - The typical antibiotic ointments and sprays, tuff skin or spray bandage, super glue or cut sealer, band aids and sterile gauze rolls, butterfly (knuckle) bandages, wound and eye pads and an eye cup, with rolled medical tape.

We are looking for something light weight (obviously, aren't we all) which could easily fit in a day-pack. We also can get the patient to a facility in <45 minutes.

I'd buy the pack and items separately. You'll get exactly what you need in the quantities you need, it'll likely be cheaper. Also pack the loose items in rubbermaid or tupperware sandwich containers, Keeps things clean dry and together.

I'd also have some medical information cards, allergies, medications, prior and current ailments such as asthma, ulcers or heart conditions etc, about your people.

Bandage scissors, disposable gloves, CPR mask or barrier, thermometers, tweezers, penlight/flashlight and batteries. Sterilization liquids or, povidone iodine and alcohol pads (light weight) for skin and instruments. Hydrogen peroxide and sterile saline for irrigation, Irrigation syringe, and a good eye irrigation and lubrication kit would likely be handy as well. Space blanket. Think about including a couple burn dressings. Triangular bandages and pins.

Aspirin, Advil, Tylenol, Motrin or simply Aspirin, Acetaminophen, and Ibuprofen are always nice, with attention to patients tolerance for them. Hydrocortisone, benadryl creams, calamine lotion for the itchies. Benzocaine or Lidocaine for numbing scrapes, toothache or insect bites. Diphenhydramine for allergy or nausea. You might include an anti-diarrhea and antiacid.

All of these items can be googled or found in most drug stores. The cold hot/cold packs, cold spray and athletic training tapes can be ordered online or found in some sports or local stores. Get them in bulk with a mind to shelf life.

There's other tricks and favored items that are availabledebatable but I believe I've hit most the basics. I was LRS with some aid and minor medical training not a qualified SF medic.

A good sharp knife as always might be handy and a charged cell phone.

swatsurgeon
07-11-2008, 20:21
Rattlesnake/Coral Snake bite - can't help with this

Broken lower leg or arm - SAM splints yes but padding, wraps and tape to secure are needed.

Heat injury - shade, rest, wetting and fanning along with fluid replacement. The fluids should include electrolytes. Severe heat injury requires rapid cooling so in addition the chemical cold packs are useful. You can get hot/cold packs which are also useful for sprains and various athletic injuries.

Class II or III sprains (ankle injury) - The hot/cold packs, cold spray and supportive taping. Supportive taping is different from the elastic wraps. Supportive tape is a combo of gel wrap or foam tape (same thing really) and cloth tape over that. The first wrap protects the skin from sticky adhesive. Some knowledge of athletic training wraps is needed.

Minor cuts (rarely requiring stitches)
abrasions - The typical antibiotic ointments and sprays, tuff skin or spray bandage, super glue or cut sealer, band aids and sterile gauze rolls, butterfly (knuckle) bandages, wound and eye pads and an eye cup, with rolled medical tape.



I'd buy the pack and items separately. You'll get exactly what you need in the quantities you need, it'll likely be cheaper. Also pack the loose items in rubbermaid or tupperware sandwich containers, Keeps things clean dry and together.

I'd also have some medical information cards, allergies, medications, prior and current ailments such as asthma, ulcers or heart conditions etc, about your people.

Bandage scissors, disposable gloves, CPR mask or barrier, thermometers, tweezers, penlight/flashlight and batteries. Sterilization liquids or, povidone iodine and alcohol pads (light weight) for skin and instruments. Hydrogen peroxide and sterile saline for irrigation, Irrigation syringe, and a good eye irrigation and lubrication kit would likely be handy as well. Space blanket. Think about including a couple burn dressings. Triangular bandages and pins.

Aspirin, Advil, Tylenol, Motrin or simply Aspirin, Acetaminophen, and Ibuprofen are always nice, with attention to patients tolerance for them. Hydrocortisone, benadryl creams, calamine lotion for the itchies. Benzocaine or Lidocaine for numbing scrapes, toothache or insect bites. Diphenhydramine for allergy or nausea. You might include an anti-diarrhea and antiacid.

All of these items can be googled or found in most drug stores. The cold hot/cold packs, cold spray and athletic training tapes can be ordered online or found in some sports or local stores. Get them in bulk with a mind to shelf life.

There's other tricks and favored items that are availabledebatable but I believe I've hit most the basics. I was LRS with some aid and minor medical training not a qualified SF medic.

A good sharp knife as always might be handy and a charged cell phone.

Okay , I may only be a seasoned trauma surgeon, Paramedic/flight crew operational medical director and tactical medic (surgeon) and not knowing it all but what the hell do you need a topical cold spray for and padding for a splint...this isn't camp we're talking about here. Electrolyte fluid...above and beyond saline: WHY?
Be practical , responsible and keep it tactical, i.e., space/weight/utility(multi-use) smart........you get to carry all of the team gear and let me know how happy you are humping all of the useless gear!!
My luck, you're a retired 18D....right?
ss

sf11b_p
07-13-2008, 01:26
Be practical , responsible and keep it tactical, i.e., space/weight/utility(multi-use) smart........

Indeed, and now I'll be silent too.

sf11b_p
12-05-2008, 15:07
edit

Boomer-61
12-05-2008, 18:08
Pig Pen,
Just got back from the Wilderness Medicine Society certification course and have this for your viewing pleasure.

Chapter 16

Wilderness Medical Kits

Bringing appropriate medical equipment and supplies into the backcountry is essential. This chapter discusses general considerations, planning and preparation, and specific items that can be used for multiple purposes.


General Considerations

• There is not one all-purpose medical kit that will provide for all situations. There are too many variables that must be considered when packing a medical kit for use in the wilderness. We will provide you with an approach to help guide you in developing your medical kit.

• The decision of what equipment to bring or to leave behind depends on multiple aspects of a specific trip, including type of activity, group size, distance, time and availability of evacuation. For example, a backpacking trip of seven days over high, mountainous terrain that is far from civilization requires a medical kit that is lightweight and contains items that can treat emergencies related to high-altitude illness, cold exposure, trauma, geographically specific infectious diseases, and avalanches. This is in contrast to a one-day river trip near a highway where weight is less of an issue and evacuation may be aided by a nearby vehicle. In the latter scenario, a kit with supplies to treat emergencies related to water sports, cold exposure, and trauma would be appropriate.

• While having the right equipment is important, it is impossible to carry all foreseeable items into the wilderness. Improvising with what is available becomes necessary for any trip. Items that are versatile or those brought for other purposes such as safety pins, gauze, duct tape, and camping equipment can be used in various ways and can replace specific items.

• When in a group, especially if you are the medical leader, you need to consider the age, past medical history, and allergies of each member of the group. In addition, everyone should have their own personal kit that contains basic bandages and supplies in addition to their personal medications. There is no need for the sole medical provider to carry very basic supplies for the whole group. Finally, if there are a lot of supplies needed for the group medical kit, then that kit can be divided among the group.

• Keep in mind that some people have allergies to medicines and tapes, so bring alternative medicines and supplies.

• Several options exist for types of kits. The two most important aspects are protection of the supplies from the elements and organization of the equipment. Cordura is an excellent material for most activities except water-related activities, where a waterproof container is necessary. Be careful of the medications that need to be at a certain temperature to maintain their integrity.
• Many commercial kits are available and carry essential supplies and equipment but do not contain prescription medications. Making your own kit is another option and can save money. Either way, you will need to make adjustments and bring items that pertain to the specific activity.

Specific Items

• It is not practical to list each item that should be placed in every type of medical kit.

• Some general items as well as specific items are listed below. The acronym PAWS, as outlined below, is a general guideline of items to place in a kit.


Prevention / Procedures

Prevention can make or break a trip, and good judgment is the key ingredient. Many crisis situations can be avoided with adequate planning and preparation.



Procedures require certain tools that may be used in a wide variety of situations. Items in boldface are recommended for a basic kit, while the remainder should be considered for longer trips.

* Note: closure of wounds in the wilderness is controversial. For a wound that has a higher risk of infection, delayed primary closure or healing by secondary intention is appropriate. Some wounds may warrant closure for hemostasis or if it needs to be closed for functional reasons due to the size or location of the wound. In either case, it is essential to properly irrigate with pressure using sterile saline or filtered water.


Analgesics / Antibiotics / Antiseptics / Anaphylaxis

This category is comprised of medications and other substances for a wide variety of uses in the backcountry.

Each member of the group should bring his or her own medications for any preexisting medical problems.

• One consideration for antibiotics is to bring those that cover a wide spectrum of pathogens, thereby reducing the total number packed.

• A fluoroquinolone such as levofloxacin in addition to azithromycin or doxycycline will provide a broad spectrum for most potential infections.
o Levofloxacin – skin, lung, and enteric infections
o Azithromycin – skin, lung, and enteric infections
o Doxycycline – skin, lung, urinary, and tick/mosquito-borne infections

• Anaphylaxis is one of the true medical emergencies that a provider will likely see in the wilderness. You should always have a method available to treat the anaphylactic patient. At a minimum you should have injectable epinephrine, such as the Twinject or EpiPen®, antihistamines, albuterol inhaler, and oral steroids.

• For analgesia control beyond acetaminophen and NSAIDs, opioid analgesics may be needed. The oral route should suffice in most instances, but injectable medications may be required. Be aware of the laws pertaining to the distribution and transport of these controlled substances as they vary both nationally and internationally.

• Prior to the trip, be familiar with each medication as it is essential to know the dosing, side-effects, and contraindications of each one.

Please refer to other chapters that specifically address the recommended medications for the different wilderness emergencies.


Acetaminophen (Tylenol) Ibuprofen (Motrin) Diphenhydramine (Benadryl) Ranitidine
Epinephrine injector Glutose paste Simethicone (Mylanta) Loperamide (Imodium AD)
Topical steroid Glycerine suppositories Azithromycin Ciprofloxacin
Pseudoephedrine
(Sudafed) Albuterol MDI Oral rehydration Aspirin
Amoxicillin with clavulanate (Augmentin) Ceftriaxone Metronidazole Dexamethasone
Analgesic- narcotic oral/intramuscular Sedative - oral Acetazolamide Nifedipine
Anti-malarial / other anti-parasitic Tinactin antifungal Prednisone Aloe Vera
Cycloplegic Ophthalmic antibiotic Ophthalmic anesthetic Saline eye wash
Antiemetic (oral dissolving or suppository)



Wound Care

This is by far the area that will get the most use, as most injuries are simple wounds. Bring plenty of bandages for the small wounds. A wound requiring daily dressings can use up a kit quickly on extended trips.


Gloves Wound closure strips Tincture of benzoin Alcohol swabs
Band-Aids Moleskin /or 2nd skin Large trauma dressing 4X4 gauze
Irrigation equipment Povidone-iodine solution USP 10% Antiseptic towelettes Antibiotic ointment
Sterile scrub brush Knuckle bandage Sterile dressing Tape (cloth / duct)
Elastic bandage (ace) Q-tip Eye pad Triangular bandage
Gauze wrap Tegaderm Wound adhesive (Dermabond) 1% Lidocaine + topical lidocaine gel



Survival

The potential for the group members to be separated and other worst-case scenarios need to be considered. Below is a table of items each group member should have on his or her person.


ID / pencil / notepad Flashlight Map / Compass Matches, lighter
Knife / multi-tool Nylon cord Bandana / ace wrap Energy bar
Gauze / tape Whistle / mirror Medications Space blanket


In-vehicle Medical Kit

A medical kit to keep in the car can serve as an extra kit while traveling to a trailhead and as a more comprehensive kit in the event of an evacuation. This kit is comprised of the previously listed items in addition to the following:


Burn dressings Splints, traction equipment Board for spinal immobilization (folding or short) Additional gloves
Ropes, rescue equipment Blankets Extra food, water scissors
Flashlight Battery cables Lighter, matches Long burning candles
Radio, citizens band Toilet paper Tarp Saw, metal cutting
Foil or window shelter Chains Fire extinguisher Flares (6)
Shovel Cables / tow chain Wedge blocks Stove, cookware



Specific Activities

Specific activities or certain patient populations may need other equipment in addition to those items previously discussed for the general medical kit.

Climbing and Canyoneering

Bring rescue equipment for difficult evacuation, extra splints and wound care supplies, and water purification.

Mountaineering

Consider altitude illness medications such as acetazolamide, dexamethasone, and nifedipine. Consider other equipment that is more specific to altitude problems such as the Gamow® bag, extra sunglasses, avalanche safety and rescue equipment, thermometer, and cold-exposure items (hand and foot warmers, space blanket, and aloe vera for frostbite).


Water sports

Consider bringing a bag-valve mask, water disinfection equipment, ciprofloxacin, and metronidazole.

Pediatric

Bring medications in chewable or suspension form (appropriate dosing according to weight), smaller sizes of equipment (mask, airway, needles), Magill forceps, and tympanic membrane anesthetic.

Boomer

shr7
12-05-2008, 19:11
• Anaphylaxis is one of the true medical emergencies that a provider will likely see in the wilderness. You should always have a method available to treat the anaphylactic patient. At a minimum you should have injectable epinephrine, such as the Twinject or EpiPen®, antihistamines, albuterol inhaler, and oral steroids.
Boomer

I would make special mention of this. You mentioned you may be as far as 45 mins. away from care. Just an Epi-pen won't get you there.

Also about the section on antibiotics. It may be tempting to write them off as "non life saving" in an emergent condition, but early empiric therapy with appropriate antibiotics has been well established to save lives. (Proven in a much different population, of course, but the principle holds true.) For the person who goes down with a nasty infection at 1am, when you can't evacuate the area until 5am, early antibiotics could save their life.

SR