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Wilderness
First Aid
Deborah
Smith, BA, BSc, NREMT-P
When
medical care is needed in a wilderness or remote setting, often
the equipment supplies and contact with more advanced care will
be unavailable. The following contains recommendations for supplies.
As well as suggestions for preparation this list is for the "healthcare
professional" i.e. a previously trained medical personnel i.e. EMT,
Nurse, Doctor, etc. Although some items may require special training,
it is the responsibility of the health care worker to ensure she/he
knows what is in the kit and its proper use.
Packaging
Your
supplies should be easily accessible and kept in a waterproof pack.
There are many inexpensive packs available at surplus stores. In
some cases plastic toolboxes may be an option to consider (just
not when you are backpacking) if you choose to place items together
in module form, ziplock bags work well for this. It is also helpful
to label the ziplock bags as a way to inventory and keep track of
your items.
Further
consideration should be given to weight and ease of carrying. Many
items can be improvised such as splints and carrying items that
serve multiple purposes is an excellent way to lesser the weight
and bulk of your kit. If you cannot improvise it, you may need to
carry it.
It
is best to start with an evaluation of "Who" "What" "Where" "When"
and "Why".
I
Who
*How
many people in your group? In larger groups supplies can be divided
up for easier carrying. A practical way to divide up supplies would
be by modules for certain conditions i.e. a Wound Module.
*Do
the group members have any medical conditions?
*Age
of participants and general fitness for the activity may also be
factors to consider when packaging your kit.
II
What
*Kinds
of activities will you be participating i.e. diving, climbing, hiking
etc.
*Consider
the train and weather conditions.
III
Where
*Obviously
different things may be needed for tropical vs. mountainous environments.
*How
remote will you be? Will you be able to access them?
Is
the Socio-political climate hospitality?
IV
When
*Trip
Duration
*Seasonal
considerations
V
Why
*Is
your trip for a relaxing vacation or a relief mission?
*Are
you preparing to care for your own medical needs as well as those
of others?
"BASICS"
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Personnel
Protective |
Non-Latex
Gloves-Many pairs depending on risk and length or tip CPR
Mask |
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Diagnostic
|
Stethoscope
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BP
Cuff |
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Thermometer
suitable to extremes of patient temperatures |
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Multi
Use Items |
Safety
Pins |
|
Duct
Tape-Reroll on a tongue depressor for smaller packaging
Remember
that extremes of heat make duct tape difficult to work with
Trauma
Shears (They come in different sizes if space is an issue)
Splinter
Forceps/Tweezers
60
cc Syringe-For wound irrigation or as a makeshift suction
device
Sewing
Needle and Thread
Large
Heavy Duty Trash Bag-Shelter, Splints
Extra
Ziplock Bags-Help contain your Bio-Waste
Parachute
Cord-Ideal for Improvising a litter
Head
Lamp-handy item for working at night
Notepad
and writing device
Tampons
Hand
Warmers-Small Inexpensive |
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Wound
Management |
Assortment
of Cloth "Band-Aids"-they adhere better
Non-stick
Gauze Pads
4x4's
gauze pads they can be cut down so no need to carry 2x2
5x8
(Large) Dressings
Large
Non-Adhere "Telfa" Dressings (cut them down to usable size)
Large
Non-Stick Gauze
6"
Roller Gauze (cut down to 3" or 4")
Moleskin
Spneco
Second Skin_Excellent product for burns
2"
Cloth Tape-Consider Silk or Paper* or Transpore |
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Wound
Cleaning |
Biodegradable
Soap |
|
30
cc providone iodine (to mixed with 1 litre of the cleanset
water available) |
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Splinting
|
Most
Splinting Equipment Can be improvised |
|
Sam
Splint-$$$ but nice-Consider Using Tinfoil and duct tape to
replace this Ace Bandage
Triangle
Bandages-easily made but the prepared ones are inexpensive
and lightweight. |
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OTC
Medications |
Topical
antibiotic cream |
|
Analgesic,
Antipryetic and Anti-inflammatory-such as Tylenol, Ibuprofen,
and aspririn
Antihistamine-such
as
Benadryl
Antacid-Mylanta,
Gelusil, Pepto Bismol, Maalox
Antidiarrheal-Immodium,
Lomotil
Anticonptipation-Metmucil,
glycerine suppositories
Antifungal/yeast-Tinactin,
Myastatin
Dental
Problems-pain relief from clove oil, Orabase
Temporary
dental fling material such as dental wax or Cavit
Oral
Electrolyte Replacement Solution-You can make your own and
bring a prepared or
Special
Needs and Medications-such as prescription antibiotics, asthma,
inhalers, altitude meds, epinephrine, etc. |
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More
than the basics-consider for base camps, first aid station
in remote areas etc. |
Diagnostic
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Otoscope
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Pulse
Ox-limited uses |
|
Glucometer
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Airway
and Breathing |
OPA's
NPA's
BVM
Endotracheal
tubes and disposable Laryngeal scope
Crico-Tyrotomy
|
|
|
IV
Equipment |
Alcohol
Wipes
Catheters
(16 and 18's)
Drip
Sets
Fluids-Bags
of Normal Saline can also be use to irrigate wounds |
|
|
Wound
Management |
If
necessary although not usually recommended outside sterile
environments
Skin
Stapler
Tissue
Glue
Suture
Materials and Needle Driver |
|
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Other
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Foley
catheter
Hemostat
Scalpel
Blade and Handle
Syringes
and needles |
|
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Medications
|
Epi
1:1000 SQ
Benadryl
(IM, IV, Oral)
Antibiotics
(Oral, IV)
Nitro
Spray (Sublingual)
Prednisone
Ventolin-Meter-Dosed
Inhaler |
|
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Consider
|
O2-Remember
Masks and O2 regulator
Medications
for Seizure Management i.e. Dilantin, Valium
Xylocaine
Special
Situations such as Altitude |
References
Auerbach,
Paul, MD. Medicine for the Outdoors. New York: The Lyons Press,
1999.
Bowman,
Warren, MD. Outdoor Emergency Care. Lakewood, CO: National Ski Patrol,
1998.
Forgey,
William, MD. Wilderness Medical Society Practice Guidelines for
Wilderness Emergency Care. Merrillville, IN: ICS Books, 1995.
Tilton,
Buck, and Frank Hubbell, DO. Medicine for the Backcountry. Old Saybrook,
CT: Globe Pequot, 1994.
Web
Pages
http://www.wildmed.com/wma_faid.html
http://www.equiped.com/medical.htm
Commercial
Suppliers
www.adventuremedicalkits.com
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