Backcountry First Aid Kit, By Richard Rhodes

[ffparamedic]

Where is the best place to buy some of these supplies and a CAT tourniquet "cough" free shipping "cough"? That video made it seem slick and easy to use.

That link didn't work. Medical supplies and products from top manufacturers for EMS providers - theEMSstore here you go.

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[nrh6.7]

Great article and perfect timing. Putting mine together now. Couple questions for you...what are the two individually wrapped items below the triangle bandage. Also, can you irrigate with filtered water if needed.

 

[ffparamedic]

Great article and perfect timing. Putting mine together now. Couple questions for you...what are the two individually wrapped items below the triangle bandage. Also, can you irrigate with filtered water if needed.

Nrh,

Thank you! That is dermabond. It's for wound closure. As a general rule I don't find it advisable to close a wound in the Backcountry. But, since I feel comfortable knowing the patho behind an infection I feel comfortable doing it if needed.

You can, I recommend filtering and then treating with iodine tablets or boiling it as well.

Let me know if I can help you any more!

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[RyanC]

Good article. Your kit looks a lot like mine. I also carry combat gauze and a SAM splint. Just can't get away from carrying those 2 other items. SAM splints work well and are light so why not...as far as combat gauze, I would hate to be in a situation where there is an arterial bleed in the groin or other area I can't get a tourniquet. Something else I have carried is a one gallon zip lock with small hole poked in the bottom corner for pressure irrigation, just fill it up and squeeze. Doesn't quite give you the pressure of a 30mm syringe with 20 gauge catheter but works in a pinch.

Thanks for sharing and getting the conversation started.

Ryan

 

[COlineman78]

You can, I recommend filtering and then treating with iodine tablets or boiling it as well.

Would you recommend adding campsuds to the water as well?

 

[ffparamedic]

Good article. Your kit looks a lot like mine. I also carry combat gauze and a SAM splint. Just can't get away from carrying those 2 other items. SAM splints work well and are light so why not...as far as combat gauze, I would hate to be in a situation where there is an arterial bleed in the groin or other area I can't get a tourniquet. Something else I have carried is a one gallon zip lock with small hole poked in the bottom corner for pressure irrigation, just fill it up and squeeze. Doesn't quite give you the pressure of a 30mm syringe with 20 gauge catheter but works in a pinch.

Thanks for sharing and getting the conversation started.

Ryan

Thank you for your input.

I like the SAM splint as well. I'm not sold on the combat gauze in terms of central aterial bleed I don't feel the average end user could adequately place that in time to effectively save your life and also get extracted from the back country.

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[ffparamedic]

Would you recommend adding campsuds to the water as well?

No, I wouldn't. I don't think it would have any benefit, and depending on the elements may not be a great idea.

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[OG DramaLlama]

There is a ton of information on technology for emergencies...Sat Phones, Garmin In-Reach, Iridium Go....but not much on how to bridge the gap between injury and rescue. Excellent article on doing just that.

I have spent my time between two extremes...When I first got into back-country hiking/hunting 8 years ago I just walked into a REI and purchased the largest most fancy kit with expectations that made me an expert wilderness paramedic. Complacency set in and I never checked it or kept it up refreshed with new supplies, and as time wandered by it almost became one of the pieces that I wondered if I could cut cut out of my pack (Because, you know, nothing bad will never happen to me). 4 years later I ended up with a minor injury and finally pulled the kit to find out that 99.139% of worthless with the bandages being compromised, expired, and things I had no idea how to use was expired. Took the .861% of the usable kit, tape, and patched up with what I could and hiked out to make sure nothing got more serious.

Last year I went minimal (Larry Bartlett style W/O the "herb"al recommendation)....Gauze, electrical tape, Tylenol, and a package of sour gummy worms....And while skinning the head of my elk my knife slipped on the skull and I sliced my thumb fairly close to the bone. Again, not too serious, but the blood loss was fairly intense and the electrical tape tourniquet was not ideal when an opposable appendage is needed to field dress and elk timely a hot archery season. Being solo it took me the good part of 2 day cutting and packing to get the meat safe. This left my injury mostly unattended to.....Over the course of that short time an infection set in as a good amount of debris had worked its way into my makeshift bandage. I now sport a nice scar and have a loss of feeling across the side of my thumb. Fairly stupid consequence for what should have been a simple fix in the field.

Very much appreciate all of the find resources you provided in this article as to prevent my future blunders from being more costly.

 

[ffparamedic]

There is a ton of information on technology for emergencies...Sat Phones, Garmin In-Reach, Iridium Go....but not much on how to bridge the gap between injury and rescue. Excellent article on doing just that.

I have spent my time between two extremes...When I first got into back-country hiking/hunting 8 years ago I just walked into a REI and purchased the largest most fancy kit with expectations that made me an expert wilderness paramedic. Complacency set in and I never checked it or kept it up refreshed with new supplies, and as time wandered by it almost became one of the pieces that I wondered if I could cut cut out of my pack (Because, you know, nothing bad will never happen to me). 4 years later I ended up with a minor injury and finally pulled the kit to find out that 99.139% of worthless with the bandages being compromised, expired, and things I had no idea how to use was expired. Took the .861% of the usable kit, tape, and patched up with what I could and hiked out to make sure nothing got more serious.

Last year I went minimal (Larry Bartlett style W/O the "herb"al recommendation)....Gauze, electrical tape, Tylenol, and a package of sour gummy worms....And while skinning the head of my elk my knife slipped on the skull and I sliced my thumb fairly close to the bone. Again, not too serious, but the blood loss was fairly intense and the electrical tape tourniquet was not ideal when an opposable appendage is needed to field dress and elk timely a hot archery season. Being solo it took me the good part of 2 day cutting and packing to get the meat safe. This left my injury mostly unattended to.....Over the course of that short time an infection set in as a good amount of debris had worked its way into my makeshift bandage. I now sport a nice scar and have a loss of feeling across the side of my thumb. Fairly stupid consequence for what should have been a simple fix in the field.

Very much appreciate all of the find resources you provided in this article as to prevent my future blunders from being more costly.

Elkholic,

You are spot on. Sometime we pack around too much or not enough. There has got to be a happy medium. I'm glad your even worked out okay in the end for you.

Designing a kit for yourself and your environment and knowing how to use those items can go a long way in successfully mitigating a crisis.

I'm glad I was able to help in a small way, if I can help you anymore please don't hesitate to ask!

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[RyanC]

Thank you for your input.

I like the SAM splint as well. I'm not sold on the combat gauze in terms of central aterial bleed I don't feel the average end user could adequately place that in time to effectively save your life and also get extracted from the back country.

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I have seen combat gauze work and maybe that is why I carry it. Simply packing it might work but I would rather pack it with gauze that is impregnated with a hemostatic agent....just increases the likelihood of stopping/slowing the blood loss long enough to call a medevac. Curious as to what you recommend for that situation.

 

[ffparamedic]

I have seen combat gauze work and maybe that is why I carry it. Simply packing it might work but I would rather pack it with gauze that is impregnated with a hemostatic agent....just increases the likelihood of stopping/slowing the blood loss long enough to call a medevac. Curious as to what you recommend for that situation.

RyanC,

Thank you for your follow on feedback, these conversations are important to have and I really appreciate it.

Perhaps I should have been more clear in my statements. Combat gauze works, that is an established fact and it does a pretty good job from what I can tell and the times I have used it. However, in my use it has been anecdotal evidence to establish that claim, was the gauze used? Yes. Was it the reason the bleeding stopped or was it the fact the the bleeding vessel was pressed against bone and or tissue that stopped the bleeding? We won't ever truly know that kind of answer. Has plain gauze and direct pressure stopped bleeding before? Yes....So, it's kind of one of those six of one half dozen of another type incidents.

Here are some things I do know about it. #1 It works #2 Our Military issues it and it has been used in a lot of GSW incidents to help save life and limb. #3 Very few EMS agencies in the CONUS use it (mainly because of the expense)

I personally don't carry combat gauze for a variety of reasons, the expense, the fact that direct pressure will stop the bleeding and because I feel that central arterial bleeding of that nature you WILL NOT access your kit, open the gauze and apply it to yourself in time to save your life, not even factoring in the communication issues you will face or the extraction time. If combat gauze was the miracle that made all of those things happen then it would be a miracle.

Here is a video I that gives some illustration to arterial bleeding time and intensity. Femoral bleeding with disclaimer - YouTube

Here is another of a GSW that got a femoral artery, notice the amount of blood loss in just a few seconds. Now imagine trying to concentrate well enough to aid yourself as you are struggling just to stay alert. LVMPD Shoots Man After He Fires At Police - YouTube

Thank you again!

 

[Randle]

Great article, I carry a 2.0 0z peroxide in my kill kit for blood trailing , how do you feel about wound cleansing with it?

 

[ffparamedic]

Great article, I carry a 2.0 0z peroxide in my kill kit for blood trailing , how do you feel about wound cleansing with it?

2 oz is not a lot, but hey! It's some. I would clean and irrigate the wound, apply the peroxide. Allow to drain and dry and then put the topical antibiotic cream on the wound and bandage it up!

Thank you for your feedback on the article.

 

[gelton]

I used combat gauze this past season. My hunting partners dad was on blood thinners and his nose would not stop bleeding due to altitude. He tried everything and nothing worked until I busted out the combat gauze. A small piece stuffed in each nostril stopped the bleeding.

 

[Smash]

As a Paramedic/RN I would have to agree with the contents of this kit. My favorite thing in my kit is my 4 inch ace wrap. I don’t carry an Israeli bandage only because I feel it is a duplicate of my ace wrap.

The one piece of advice I always preach is for someone who goes out and buys something such as the adventure medical kit is to buy two of them. With the first one open it up as well as all of the packaging and play and practice with the item to familiarize ones self and then put the second one in the pack.

I don’t keep a SAM in my pack but do have one on the snowmobile. I enjoy them a lot but just don’t like the bulk in a back pack.


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[ffparamedic]

As a Paramedic/RN I would have to agree with the contents of this kit. My favorite thing in my kit is my 4 inch ace wrap. I don’t carry an Israeli bandage only because I feel it is a duplicate of my ace wrap.

The one piece of advice I always preach is for someone who goes out and buys something such as the adventure medical kit is to buy two of them. With the first one open it up as well as all of the packaging and play and practice with the item to familiarize ones self and then put the second one in the pack.

I don’t keep a SAM in my pack but do have one on the snowmobile. I enjoy them a lot but just don’t like the bulk in a back pack.


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Thank you for your input, always great to hear from someone with experience. You are right about using the ACE wrap for a TQ. ANd it cannot be stated enough the importance of practicing with your equipment prior to needing to use it!

 

[Mike7]

Richard, thanks for the article. Just a couple of additional things for people to consider when assessing their own first aid needs.

Consider Peptobismol tabs over loperamide if you are going to bring something for diarrhea. Pepto is typically more effective and also has antibacterial properties. Some don't even recommend loperamide/Imodium for infectious/bloody diarrhea.

Consider Bacitracin ointment instead of Neosporin. A good number of people are allergic and can get a rash from the neomycin.

Consider bringing just 4x4 guaze and 4" ace wraps/tape. This can treat anything a 2" ace wrap and rolled guaze can plus more.

I personally don't bring any bandaids or alcohol pads. If someone can tell what these are good for treating, then I am all ears. I want to like them, because they are both light in weight. But the bandaids are occlusive yet still let dirt in, creating a dirty, moist environment over the wound. Unless you are diabetic on insulin (or maybe plan on removing fingernail polish in the field because you have an infection at the edge of our fingernail), I just can't think of any medical use for alcohol swabs?

In addition to the Benadryl that Richard mentions, consider bringing 81 mg chewable aspirin if you or your hunting partner is over 40 (in case of chest pain/MI).

4x4 gauze srubs with filtered water poured into the wound are good for cleaning just about any wound that you might encounter. If you can not see fat in the base of the wound, you should then have no problems closing the wound right away with Dermabond, or benzoin/steristrips which is what I prefer for non-scalp wounds. If the wound extends beyond the deeper skin layers down into the fat, and you are medically inexperienced, then it is probably best to just clean the wound and approximate it with a bandage/tape without closing permanently. I have treated litterally thousands of wounds in this manner with water or saline scrubs with zero infections.

And finally, I personally don't carry a tourniquet on solo or 2-person backpack hunting trips in the lower 48, because death from blood loss is typically not what kills people in the backcountry. Which makes sense, considering how well our major arteries are protected and how well the average person clots. Not only that, but for a tourniquet to be a useful part of a kit, a person would have to have life threatening bleeding from and extremity which is distal enough to utilize the tourniquet. Instead, the major causes of backcountry death include: falls, avalanches, drowning, MI, getting lost, hypthermia, dehydration, snowmobile accident, bear attacks, trees and rocks falling or rolling on you, lightning, homicide, and gastrointestinal bleeds. However, if I was a hunting guide in Alaska on a river trip with a bunch of hunters from California, then I would definitely rethink bringing a tourniquet.

 

[ffparamedic]

Richard, thanks for the article. Just a couple of additional things for people to consider when assessing their own first aid needs.

Consider Peptobismol tabs over loperamide if you are going to bring something for diarrhea. Pepto is typically more effective and also has antibacterial properties. Some don't even recommend loperamide/Imodium for infectious/bloody diarrhea.

Consider Bacitracin ointment instead of Neosporin. A good number of people are allergic and can get a rash from the neomycin.

Consider bringing just 4x4 guaze and 4" ace wraps/tape. This can treat anything a 2" ace wrap and rolled guaze can plus more.

I personally don't bring any bandaids or alcohol pads. If someone can tell what these are good for treating, then I am all ears. I want to like them, because they are both light in weight. But the bandaids are occlusive yet still let dirt in, creating a dirty, moist environment over the wound. Unless you are diabetic on insulin (or maybe plan on removing fingernail polish in the field because you have an infection at the edge of our fingernail), I just can't think of any medical use for alcohol swabs?

In addition to the Benadryl that Richard mentions, consider bringing 81 mg chewable aspirin if you or your hunting partner is over 40 (in case of chest pain/MI).

4x4 gauze srubs with filtered water poured into the wound are good for cleaning just about any wound that you might encounter. If you can not see fat in the base of the wound, you should then have no problems closing the wound right away with Dermabond, or benzoin/steristrips which is what I prefer for non-scalp wounds. If the wound extends beyond the deeper skin layers down into the fat, and you are medically inexperienced, then it is probably best to just clean the wound and approximate it with a bandage/tape without closing permanently. I have treated litterally thousands of wounds in this manner with water or saline scrubs with zero infections.

And finally, I personally don't carry a tourniquet on solo or 2-person backpack hunting trips in the lower 48, because death from blood loss is typically not what kills people in the backcountry. Which makes sense, considering how well our major arteries are protected and how well the average person clots. Not only that, but for a tourniquet to be a useful part of a kit, a person would have to have life threatening bleeding from and extremity which is distal enough to utilize the tourniquet. Instead, the major causes of backcountry death include: falls, avalanches, drowning, MI, getting lost, hypthermia, dehydration, snowmobile accident, bear attacks, trees and rocks falling or rolling on you, lightning, homicide, and gastrointestinal bleeds. However, if I was a hunting guide in Alaska on a river trip with a bunch of hunters from California, then I would definitely rethink bringing a tourniquet.

Mike, thank you for your response. Not a bad call on the pepto, although I feel that the folks suffering from those aforementioned issues should carry a medicine for each, or double quantity at least. I won't disagree with you on the Bacitracin, however I will leave you with a peer reviewed article on the fact that "bacitracin is the most common topical antibiotic known to cause anaphylaxis" Medscape: Medscape Access I would much rather have a rash than anaphylaxsis, I know this may come across as me "trying to prove you wrong, I am not. I require my medic students to bring me peer reviewed articles to refute a point and that is all I am doing.

4x4 Gauze cannot pack a wound which is what the rolled gauze is for. As far as the 2" ACE wrap, I can agree with you, although my pack will still have it. it is much more useful to wrap a small area like an ankle with 2" than 4" in my experience.

The bandaids are useful to me, maybe not to others. The alcohol is a great disinfectant for small wound cleaning.

Great idea on the Aspirin!!! I can't believe I haven't thought about this. It could be useful even if you and your partner are healthy. Aspirin is the ONLY medication PROVEN to actually help when having a heart attack!

I will ask you about your "thousands of wounds" as most infections occur a significant amount of time post injury can you unequivocally say that your patients never got an infection? If so, you have really dodged the bullet on that!

I will support you on not taking a TQ, but it is a small piece of kit that can help you. Most of the other causes of death you mentioned have no method of treating once it occurs other than the ones already mentioned.

Again, I hope you take this in the tone it is written in! I really appreciate your input.

 

[mtwarden]

thanks for the article! some good food for thought

I would echo the call for Leukotape- it's the best thing I've found for blisters and hotspots, but beyond that it's great for wrapping in general and you can make any size bandaids w/ the tape and gauze

yes on a couple of plain old aspirins- a very real life saver

I carry nearly an identical "med kit" (plus the above mentioned aspirin)

I carry a small/light, but effective irrigator- sourced from a hobby shop- not exactly sure what they use it for, but it definitely makes a good pressure stream of water to irrigate with

is Ace wrap the same as Ace bandage? Ace bandages are a little on the heavy side, was thinking of replacing it with "vet wrap"- appears to be lighter, not sure if it's as effective though???

 

[ffparamedic]

thanks for the article! some good food for thought

I would echo the call for Leukotape- it's the best thing I've found for blisters and hotspots, but beyond that it's great for wrapping in general and you can make any size bandaids w/ the tape and gauze

yes on a couple of plain old aspirins- a very real life saver



I carry nearly an identical "med kit" (plus the above mentioned aspirin)

I carry a small/light, but effective irrigator- sourced from a hobby shop- not exactly sure what they use it for, but it definitely makes a good pressure stream of water to irrigate with

is Ace wrap the same as Ace bandage? Ace bandages are a little on the heavy side, was thinking of replacing it with "vet wrap"- appears to be lighter, not sure if it's as effective though???

Thank you for the feedback. Thank for the luekotape advice. I will try it out.

No, it is not. It's two entirely different things. The vet wrap is a cohesive bandage meaning it sticks to itself, but doesn't exert any real pressure for a pressure type bandage.