Medical Kits

[Mike7]

I personally don't fully understand taking quick clot for a personal backcountry kit, after having the opportunity to use it in the military. I guess I just can't think of very many likely situations where it would be too handy, even for the few people out there who really know how to use it. I have not used the latest stuff however, I will admit. Maybe the latest stuff is a miracle product and penetrates right through uncontrolled bleeding/wet wounds and seals up large arteries as well? Maybe we have someone on here (like a Special Forces Medic or Airforce PJ) who has used the newer stuff in theatre and can speak to its possible utility for wilderness medicine?

I think for non-medical/trauma people, they are generally shocked to see how vigorous you need to be with applying pressure when trying to stop major hemorrhage or when attempting to dry a wound for application of a chemical or electrical clotting agent. I think they are also often shocked about how well this pressure can work.

As an example of a likely backcountry scenario/injury, I saw a guy just last week who injured himself and was even on plavix (a potent blood thinner). He stuck a hose cutting knife all of the way down into his thigh muscle, luckily cutting only a very small artery in the muscle. He had blood all over because of a bandage putting pressure everywhere around the wound, but not in the wound. Still, he was already starting to clot as it had been 20-30 min since the injury. Even after I pulled a large hematoma/clot from the wound while exploring it and extending the skin portion of the wound (which caused bleeding to begin again as expected), it took less than 4 minutes to completely stop the bleeding with direct firm pressure into the wound. I ultimately did not have to ligate any arteries, but did end up using a small amount of cautery before closing his muscle and then more superficial layers.

If in the woods, he would have been just fine having a pressure dressing and then getting out to medical care. Maybe a clotting agent would have allowed him to walk out on his own with less chance of bleeding but I don't think so? And also with the clotting agent he would have required more clean up and tissue debridement/loss I suspect when he did get out to definitive medical care. So something to consider then is weighing the benefits vs. the risks of carrying and using these products I think.

 

[kodiakfly]

This has been a good thread, and what I was going to say has already been said; build your own kit and don't get carried away with it. I think of "First aid" and I think "first responder." As in, getting something stabilized enough to receive actual treatment. I remember when I wanted to build my first kit and I went absolutely nuts with it, and that was silly. It wasn't a matter of training, it was a matter of "what in the hell am I going to do with that, that is going to do me any good in that situation?" I wanted to pack (in my truck, not on my back) a stethoscope, charcoal, sutures, and on and on...cool stuff and used in an ER or OR, but not in the back of my truck. I've learned since my younger years to keep it simple. In my line of work, I deal with getting a survivor to medical attention...not patching him up in the back of the helo. Even our RS's, some of whom are paramedics, don't get crazy with gear and aid kits on an actual SAR case. I think of it the same in the back country...anything I do to myself or someone else is going to be undone or upgraded as soon as we're to proper medical aid.

I've broken a leg before...I know that won't kill me. So I carry two ACE bandages with me that can wrap anything- stick or poles to stabilize something, or hold bandages onto a cut, or even hold loose or torn tissue together if it's really that bad. And that leads me to what will kill me...bleeding. If I'm running a saw in timber, I'll carry duct tape and maxi-pads (don't laugh, a lot of cutters carry them). I don't go that nuts while hunting since I don't hunt with a 660 Magnum, but I do carry gauze and bandages as the bulk of my kit. A few Band-Aids, motrin 800's, and some other odds and ends, but nothing too elaborate since all I'm trying to do is stabilize until someone, somewhere else can actually treat and heal.

 

[dotman]

My kit is very basic and fits in a prescription bottle.

1 - 2x2 mole skin
2 - 4x4 gauze
1 - super glue
6 - ibprophen
1 - Vicodin
3 - anti craps

Prescription bottle I wrapped in two feet of duct tape.

 

[Mmcan]

My advice to consider having the ability to start an IV on yourself and give IV fluids doesn't supersede staying out of trouble (you should do dangerous work with a companion to assist you), and getting to an acute care facility asap, or have help coming to you via EMT's or even life flight (I don't know where you are, but some places are so remote that Helicopter evac is prudent). But if you are hurt so badly that you cannot extricate yourself and you have to wait at all for help, and if you have a wound that causes significant blood loss, 2 liters of IV fluids won't cause a dilutional coagulopathy. It's standard ATLS protocol. It's what will be done as soon as you hit the emergency room , unless you're so hypovolemic and actively bleeding that we would go straight to transfusing O neg blood as soon as it's available (minutes). But those IV's would be started and have IV Fluid running until the blood is there.

Is it practical to have IV's with you? As I said before, if you're carrying chainsaws and that kind of equipment, you have room and the ability to also bring IV set ups. And if you're going to get training in suturing and wound care, starting an IV is even easier to learn, albeit it more difficult depending on what kind of an injury you might have. Chainsaws and axes tend to whack lower extremities more often than upper extremities or your non-dominant upper extremity, so you usually have your good hand, and sometimes both hands available to start an IV once you've made your best effort to stop the bleeding by applying pressure and compressing the area.

https://www.osha.gov/SLTC/etools/logging/manual/logger/chain_saw/saw_injuries.html

I carry these things with me when I'm working alone or backcountry camping out of my vehicle . But I have access to them and borrow them from the shop as needed.

 

[dotman]

My advice to consider having the ability to start an IV on yourself and give IV fluids doesn't supersede staying out of trouble (you should do dangerous work with a companion to assist you), and getting to an acute care facility asap, or have help coming to you via EMT's or even life flight (I don't know where you are, but some places are so remote that Helicopter evac is prudent). But if you are hurt so badly that you cannot extricate yourself and you have to wait at all for help, and if you have a wound that causes significant blood loss, 2 liters of IV fluids won't cause a dilutional coagulopathy. It's standard ATLS protocol. It's what will be done as soon as you hit the emergency room , unless you're so hypovolemic and actively bleeding that we would go straight to transfusing O neg blood as soon as it's available (minutes). But those IV's would be started and have IV Fluid running until the blood is there.

Is it practical to have IV's with you? As I said before, if you're carrying chainsaws and that kind of equipment, you have room and the ability to also bring IV set ups. And if you're going to get training in suturing and wound care, starting an IV is even easier to learn, albeit it more difficult depending on what kind of an injury you might have. Chainsaws and axes tend to whack lower extremities more often than upper extremities or your non-dominant upper extremity, so you usually have your good hand, and sometimes both hands available to start an IV once you've made your best effort to stop the bleeding by applying pressure and compressing the area.

https://www.osha.gov/SLTC/etools/logging/manual/logger/chain_saw/saw_injuries.html

I carry these things with me when I'm working alone or backcountry camping out of my vehicle . But I have access to them and borrow them from the shop as needed.

Are you a doctor? I would say most people have zero clue how to actually do this and add in a very shocking experience I doubt most would remember even if shown a few times. If your that remote and have zero cell service probably better to invest in a sat phone. Jmo

 

[Becca]

I personally don't fully understand taking quick clot for a personal backcountry kit, after having the opportunity to use it in the military. I guess I just can't think of very many likely situations where it would be too handy, even for the few people out there who really know how to use it. I have not used the latest stuff however, I will admit. Maybe the latest stuff is a miracle product and penetrates right through uncontrolled bleeding/wet wounds and seals up large arteries as well? Maybe we have someone on here (like a Special Forces Medic or Airforce PJ) who has used the newer stuff in theatre and can speak to its possible utility for wilderness medicine?

No totally sure Mike, but I think the current quick clot packets are a bit different than the powder many military folks had bad experiences with when the product was first released. You are absolutely correct that most bleeding can be staunched by applying hard manual pressure. I suppose I carry (the single, small sized) packet in our med kit for an occasion when I couldn't get bleeding stopped by any other method (pressure, or tourniquet as a last resort). It is not something I ever plan on needing, but it doesn't weigh much and seems like it might give me an extra option if I was in a situation where I couldn't stop serious bleeding by any other means. I too would be very interested to hear from someone with first hand experience using the current product.

Several years ago, I cared for a patient who sustained an accidental gunshot wound to the back of her leg while camping in a remote area, severing several major arteries. Her husband applied a tourniquet, and packed the wound with a quick clot packet and called for help. She survived a 15 mile atv ride through some rough country to meet a waiting ambulance, was airlifted and after extensive vascular surgery survived and was able to keep her leg. Her surgeon told me he was amazed that she didn't die en route considering the extent of the injury to the blood vessels, and credited the quick clot with keeping her from bleeding out before they could get her to help. It made a big enough impression on me that I added a small packet to our kit and haven't looked back.

 

[jmez]

I don't carry much.
Duct tape on a lighter
Half a roll of waterproof 1 inch tape
Couple telfa pads
Couple alcohol wipes
Alleve

 

[rodney482]

I use a kifaru pullout

Aleve
benadryl
quick clot bandage
medical tape
superglue
tiny roll of duct tape
tweezers
bug bite creme
antacid
small led light
bandaids
4x4 gauze
spf lip balm
canister ( Vaseline, WP matches, cotton balls )

 

[dotman]

Something I just noticed is that some people have items in their med kit that I have in other kits such as the cotton balls and vas, I have tweezers on a small muti-tool, chap stick or lip balm in my pocket, paracord, etc.

I wonder how many people carry duplicates because they are in multiple kits.

 

[Mmcan]

Are you a doctor? I would say most people have zero clue how to actually do this and add in a very shocking experience I doubt most would remember even if shown a few times. If your that remote and have zero cell service probably better to invest in a sat phone. Jmo

Yes, I am. But this is such simple stuff that just about anyone could learn how to do it.

Totally agree w having the capability to call for help. But that can be a long wait.

 

[dotman]

Yes, I am. But this is such simple stuff that just about anyone could learn how to do it.

Totally agree w having the capability to call for help. But that can be a long wait.

That makes sense you would have one and it probably is simple but then again, for me, defending your taxes against the state and Feds is simple as well .

 

[Mike7]

Becca, good info. I might have to rethink the Quickclot due to the low cost, weight, and greater utility in the larger sponge form. I see that a person can get a 50 gm sponge on Amazon for $14. I could see the new stuff potentially being a helpful aid for stopping severe bleeding from a sharp deep arterial injury (Gizzly bite to a carotid, broadhead to a femoral artery, etc.)...and potentially helpful in allowing one to stop more moderate bleeding on themselves without an available buddy for aid. In Alaska, the advantage of having this is might be greater with the increased distances and times for potential evac and in more unpredictable weather.

Larry, I would think that the Quickclot if kept dry, would last long beyond the expiration date?...and wonder if the expiration date is like that with medicines and directed at the lowest common demoninator (i.e. meds kept open in a humid, warm environment with light exposure). I usually give everything extra protection from abrasion and moisture with Ziplocs, so would probably do the same with that item as well.

Mmcan, even if you are able to overcome all of the obstacles of getting a good IV going on yourself, how much time are you really buying? Crystalloid solution does not remain intravascularly for long.
Also, if you look at the Mortality/Time Curve produced by the US Military on Gunshot and Fragment Wounds in the "field"(not including blast/burn injuries associated with IEDs), you will see the following (paraphrased and summarized by me):
1) 20% die within 6 minutes from catastrophic injury or significant injury to the head, heart, and major vessels regardless of what you do (it wouldn't matter if these people were in the hospital trauma center parking lot when their injury occured).
2) 10% more die within an hour from massive bleeding or an airway problem. An IV will not help these people; instead only buddy or first responder aid in the form of pressure, clotting agents, and airway management.
3) 10% more die in hour 2-4 from ventillation problems and shock primarily (with just a small amount or 1.4% from a closed head injury and hypothermia if not kept warm and if not to a neurosurgeon within 2-3 hrs). These people can be saved potentially with a tube thoracostomy and fluid resuscitation if needed...but this is only helpful if bleeding has been stopped and they are to a surgeon within 4-6 hours generally. These people will die regardless of IV fluids, if profound shock has occurred already within the first 3-4 hous because of end organ damage.
4) 10% die between 6 and 72 hrs from infection (this is particularly true with abdominal wounds that did not receive early surgical care and debridement within the first 6-12 hours)(1.8% of this group will die even if they get surgery in a timely fashion due to complications such as pulmonary embolism).
5) The remainder of the injured tend to live beyond their initial trauma, no matter what you do.

So considering all of this, I would bring an IV if possible, if I was the only medical support for a large group, but even in that capacity the chances of me using it in the field in a "bleeding scenario" would still not be great. Perhaps an IV would prove valuable for an abdominal wound or some other injury scenario where the individual was NPO, the bleeding had been stopped, and it would be some time before evac? Maybe for a scenario where the bleeding had been stopped, but the individual was just going into shock just before evac arrived? Just something to consider.

-Mike

 

[kodiakfly]

LOL. I wonder what the OP is thinking right now. Interesting talk, but I think we've gone beyond first aid kits.

Yes, I did mention running saws, but that was to convey that my hunting kit is less "blood-related" than my timber kit....but I also carry a small fire extinguisher in my timber kit, and that's why it's not apples to apples. I'm not saying one would need that level of response in a backcountry kit. If you're carrying IV's, and talking about that much blood loss I think we're beyond first aid kits and first responder training. If you're a doctor or a nurse those skills are second nature to you. But me, even with what I do in SAR, I'm not gonna start an IV anywhere...I'm going to put a tourniquet on it. I think we need to remember hunting situations and think about what kind of care we're going to be called upon to administer- sprains, breaks, cuts, etc. If we're talking about IEDs and cutting off lower extremities...well you're a more adventuresome hunter than I am!

Sure anything can happen, like a bear mauling or you get shot in the femoral artery by a meth head but my kit is not geared for catastrophic calamity. I'm geared up for stabilizing something, and stopping blood flow if I fall and shove a broadhead through my leg. I'll leave the IV's, needles and such to my wife (OR nurse) and you doctor types, and I'll stick with the basics.

 

[Mmcan]

So yes, I'm kind of chuckling about how this has evolved. I love what I do and have been an anesthesiologist at level 1 trauma centers for almost 25 years. I'm also w the wilderness medical society so this is field work as well.

I love what I do, and not a week goes by that we aren't training a new doctor, med student, nurse, PA, dental student, EMT, fire fighter, or someone about basic medical tasks.

If you want to learn about these things, the opportunities are there.

Don't underestimate your ability to help yourself, or the ability you and others have to hurt you or someone else.

 

[Aron Snyder]

I've given myself an IV in my foot many times. I can't get them as easily as I could a few years ago, but they were handy when I was extremely dehydrated.

I was trained for this type of stuff and have done it many times, so there was no danger.

 

[Mmcan]

I've given myself an IV in my foot many times. I can't get them as easily as I could a few years ago, but they were handy when I was extremely dehydrated.

I was trained for this type of stuff and have done it many times, so there was no danger.

If you think there is a need/opportunity to teach this kind of basic skill at one of your seminars, I would like to help with this.

 

[Mike7]

Sorry to nerd out on everyone, but I find this stuff interesting. Working in the field in varying capacities, definitely changed my view on things compared to working in a tertiary hospital in training or even as an ER doc in a rural area. I would completely agree with an IV being of much more utility for non-bleeding related problems in the civillian prehospital setting. Heck, I've used one many times, but my point is that most of the time either you can get away without needing one or it is impractical.

Aron clearly has a lot more experience than the average hunter, and I'm guessing felt better quicker using an IV when he did for dehydration, etc. But most of these things can be treated without an IV also, and many times in the field, the amount of IV fluids needed is impractical in my experience. As an example, Mmcan I'm sure knows the amount of IV fluids it takes to resuscitate a severe burn victim or someone with cholera...it's a lot. If you are in the field with a small group and it is going to take 20 L of IV fluids to get someone through one of these problems and you only have 3-4, do you use all of your resources when patience and cheap World Health Organization electrolyte formula can produce the same end result?

It is a great skill to have, but having the ability and experience needed to put an IV in yourself when you are dehydrated, like Aron can do, would be down on my list of needed skills as a civillian hunter wanting to know important first aid.

 

[Aron Snyder]

Sorry to nerd out on everyone, but I find this stuff interesting. Working in the field in varying capacities, definitely changed my view on things compared to working in a tertiary hospital in training or even as an ER doc in a rural area. I would completely agree with an IV being of much more utility for non-bleeding related problems in the civillian prehospital setting. Heck, I've used one many times, but my point is that most of the time either you can get away without needing one or it is impractical.

Aron clearly has a lot more experience than the average hunter, and I'm guessing felt better quicker using an IV when he did for dehydration, etc. But most of these things can be treated without an IV also, and many times in the field, the amount of IV fluids needed is impractical in my experience. As an example, Mmcan I'm sure knows the amount of IV fluids it takes to resuscitate a severe burn victim or someone with cholera...it's a lot. If you are in the field with a small group and it is going to take 20 L of IV fluids to get someone through one of these problems and you only have 3-4, do you use all of your resources when patience and cheap World Health Organization electrolyte formula can produce the same end result?

It is a great skill to have, but having the ability and experience needed to put an IV in yourself when you are dehydrated, like Aron can do, would be down on my list of needed skills as a civillian hunter wanting to know important first aid.

I agree for sure!

I could have just drank a bunch of water/Gatorade and got the same result. ..just takes longer.

 

[kodiakfly]

No, no need at all to apologize for "nerdery!" I think it's interesting too, and I'm not even trying to stifle it. Just noting that we've come from first aid kits to IED's and IV's. I think for car camping, or like was mentioned and you're part of a very large group and you're the primary source of medical aid, then yes I agree the skills to start an IV would be beneficial.

 

[trapperjay]

Fantastic thread. Can any of the medical personnel comment and/or Aron give us their idea of what constitutes the 'bare necessities' of a kit? (I apologize in advance if I missed it and it's already posted.)