Thread: Supplementing Store-Bought First Aid Kit

Duct tape sucks for first aid. Take enough good athletic tape to tape an ankle (and learn how to do it). That can turn an evacuation into a self rescue--a ski or climbing or hiking boot will fit o ver a properly taped ankle and you can walk pretty well even with a bad sprain. I use plain aspirin as a pain killer--just as effective and no more dangerous than ibuprofen, naproxyn, etc. And avoid nsaids in people who take aspirin for their heart--nsaids counteract the beneficial effects of aspirin. SAM splints seem to be a good idea for a longer trip with a lot of people especially--might make someone comfortable enough to wait in base camp while the rest of the group plays, rather than having to abandon the trip. SAM splints make a nice neck immobilizer for neck strains. Bandaids are nice for keep blood off your gear; for more serious bleeding clothing cut up will work until the victim can be evacuated. As far as how long drugs last no one knows. The manufacturer picks some Arbitrary date, tests the drug, and if the drug is still at full strength that's the expiration date. They don't bother testing any further out. Why should they, when they can sell you more drug to replace the expired drug. The defense dept did their own tests on a lot of drugs because they were spending a lot of money on replacing old drugs and found out that most drugs were good for much longer than their expiration dates. They use their own data to decide when to replace drugs, but they have refused to make their information public.

I heard about the military tests on effective shelf life. I have an awful lot of 2 year old Ibu.

You mentioned ankle strapping and ski boots, reminded me of another topic. I'll try and keep the scenario as general as possible. If you had an injury that after splinting required monitoring of circulation, strength and motion down at the toe of one leg. Would you remove the ski boot to do so? Even if it could add to the injury, or could cause huge pain, or could reduce the splinting and compression benefits of the boot? We are caught out overnight as a result of the injury.

Originally Posted by Hohes

I heard about the military tests on effective shelf life. I have an awful lot of 2 year old Ibu.

You mentioned ankle strapping and ski boots, reminded me of another topic. I'll try and keep the scenario as general as possible. If you had an injury that after splinting required monitoring of circulation, strength and motion down at the toe of one leg. Would you remove the ski boot to do so? Even if it could add to the injury, or could cause huge pain, or could reduce the splinting and compression benefits of the boot? We are caught out overnight as a result of the injury.

I guess the question would be--after you splinted the fracture after straightening any obvious deformity,if the circulation, motion, and/or sensation were bad what could you do about it in the field? In general--while there may be exceptions--treatment of injuries in the field are either minor and can be treated in the field, or major and require urgent evacuation, if possible. Major injuries can't really be treated in the field. EMT's, patrollers, and medics are trained to treat victims who will be rapidly evacuated in most situations, but in a wilderness situation the speed of evacuation becomes the overriding concern. That's why I take a fairly nihilistic approach to first aid kits--bring stuff to treat minor injuries and try to stay out of trouble. The farther you are from potential rescue the more margin you leave yourself. If you can climb 5.12 in Yosemite doesn't mean you should do it 3 days hike from a trailhead.

I'm confused. Any time you have to monitor circulation, due to impairment of an extremity, you're at risk of losing the limb. If circulation goes bad, what are you going to do? Shouldn't you already be doing that? If circulation is compromised, I'm going to the get a heli if I can't get them out myself.

CPR masks can basically be thrown in the trash. AHA guidelines are disposing of ventilation by a lay person soon.

I'm not sure what country the MD/Anesthetist is from, but ketamine and a benzo have no place outside a facility with monitoring capabilities. Why even bring that up? We are discussing what can be added to a first aid kit, not what happens in the hospital. Also, all the talk of technique is useless without the person knowing how and being competent to do the procedure in the field.

Originally Posted by BS720

Also, all the talk of technique is useless without the person knowing how and being competent to do the procedure in the field.

+1000. carrying around crap if you don't know what to do with it is stupid. For winter travel a sleeping pad and a warm jacket, or better yet a sleeping bag, can literally be a life saver.

For "foreign" trips, Cipro (get a scrip from a travel doctor) in combination with immodium or the like. My personal experience is that immodium alone isn't enough to restore "normalcy" with 3rd world nasties.

Originally Posted by BS720

I'm confused. Any time you have to monitor circulation, due to impairment of an extremity, you're at risk of losing the limb. If circulation goes bad, what are you going to do? Shouldn't you already be doing that? If circulation is compromised, I'm going to the get a heli if I can't get them out myself.

Bad weather, heli can't fly. Waist deep powder, no way you are dragging him out over terrain. You are stuck there for the night at least. Leg is in traction. Should the boot be removed or not?

I've heard non-skiing instructors say hell yes. Boot comes off.

I've heard skiers say not a chance.

Another aspect of the situation is ruling out spinal injury. If the mechanism of injury was big enough to break a femur that is now in traction, you have to assume spinal injury until it is ruled out. "By the book", ruling out spinal means monitoring circulation, strength and motion in the feet (amongst other observations). So that means at least taking the boot off the uninjured leg.

I say the boot stays on the injured leg. Impossible to get it off in the field.

Originally Posted by Hugh Conway

For winter travel a sleeping pad and a warm jacket, or better yet a sleeping bag, can literally be a life saver.

It amazes me how few 'backcountry skiers' carry a decent belay jacket in the event they are caught out overnight.

^^Right. I'm not trying to nitpick, but is there not a point, say, bleeding to death, where you drag him out over terrain? With a leg in traction, you really don't know what's up. Maybe he nicked the femoral artery and is slowly bleeding out. At that point, I'm saying fuck it, fashioning a rescue sled from his skis, and dragging the dude out. Wast deep pow or not.

Edit: Oh, yeah, and I hope his skis are the new 198mm waist models

Originally Posted by BS720

dragging the dude out. Wast deep pow or not.

Same.

So I tried it once in practice. Waist deep pow, flat ground, with a commercial rescue sled kit (Brooks Range). To make any progress at all, you have to go ahead and pack down a trail as wide as the sled, then come back and tow the sled on the track. Not ideal, but given all night you can make progress. Doing a rising traverse was almost impossible, lots of shovel work to fashion a road. Then you need someone to belay the sled from uphill to keep it from slipping off the traverse track. If you can avoid very steep slopes, it is almost easier to haul them direct up the slope using that 20-30m of rope you are carrying to set up a Z or C+Z system. Very slow progress though as on steeper terrain you need to belay the sled every time you re-build the system. Helps to have a lot of trees around. Until they get in your way. 60m of rope would be better. Yeah, right.

Bottom line for me is what was said above: bad weather + "over the back" terrain = no injuries can be tolerated. In fact any terrain without direct downhill access to a road does not tolerate injury, regardless of weather. It isn't theme park. There are spots I love to ski, but if you get injured there, you have no easy exit at all. None. Unless you get a helicopter, and they are too weather dependent.

note: I think the Brooks Range sled is excellent on hard snow and approach roads, though does not work so quite as well with reverse camber skis. And an injured snowboarder on snow shoes is just plain hooped.

Rescue sled 1kg + rope kit 1kg + firstaid kit/repair kit/thermos/belay jacket etc 2kg = 4kg of "just in case" gear.

Originally Posted by Hohes

Another aspect of the situation is ruling out spinal injury. If the mechanism of injury was big enough to break a femur that is now in traction, you have to assume spinal injury until it is ruled out. "By the book", ruling out spinal means monitoring circulation, strength and motion in the feet (amongst other observations). So that means at least taking the boot off the uninjured leg.

I say the boot stays on the injured leg. Impossible to get it off in the field.

I would tend to think you could run a pretty effective focused spine assessment with the ski boot on and feel comfortable with your decision. Really all you need to find out is if they have sensation and even if it's difficult to determine due to the injury if there other CSM's are all in tact and they pass every other part of the FSA then I'd go ahead and bet on no spinal injury. I agree with leaving the boot on though just from a pain management position, its going to hurt like a mofo.

Hugh is spot in with Cipro, it can be a real trip saver and instantly make you everyone's best friend if multiple people get sick.

In lieu of a sam splint I carry around a small roll of stout chicken wire, works well for splints, wrapping and holding things together, small repairs and reinforcements etc and is light.

A more direct answer to the question boot on or off--it doesn't matter.
Another point I would make regarding narcotics like vicodin or percocet, if you can get them--an earlier poster, an anesthesiologist, mentioned the risk of the blood pressure dropping out. While narcotics given intravenously, in anesthetic doses, can drop the blood pressure, I've never seen that with oral narcotics, or even with intravenous narcotics given in analgesic (pain reducing) rather than anesthetic (coma inducing) doses. If you have the drugs it's ok to use them if the victim can swallow and keep them down. If they fall asleep I would probably let them sleep. If it's a relatively mild injury the sleep is a relief. If it's a major injury you're already doing everything you can to evacuate and there's not much else you can do if they deteriorate. An exception might be a heli evac in marginal weather where the heli might need to know if the person is stable enough to wait or not=--in such a case it might be best not to give them so much meds that they go to sleep, or if they are asleep you might have to try and see if you can wake them. Contrary to popular belief--making someone stay awake never saved anyone's life (unless it was to hike out), most people with internal injuries who die don't bleed out of their mouth at the end, and most bullets are dropped into a plastic bowl with an unsatisfying little thud, not a nice clank, although I always tried to get a metal bowl when I could.

Jeez Hohes, lotta hypothetical there. I'd just say it depends. I've taken a number of boots off of fractured legs and ankles. It has always been in the patrol aid room, but with only someone to stabilize the limb - spread the boot, grab the back of the cuff and pull while you push up on the toe and the pt points their toes and the helper stabilizes the leg. If it was going to be a long time extraction, I'd think hard about doing it a) so that I could expose the ankle looking for an open fx, and/or b) so I could keep track of CMS, and/or c) to improve circulation to the distal limb. But, as pointed out, it depends.

I usually carry some hydrocodone/APAP into the bc, just in case - doesn't weigh much.

I kind of like old goat's approach - I tend to pack my kit with an eye to stabilization first, and self-rescue second. I'm an EMT-B.

I got some big lidocaine patches I carry that can numb an area on a limb or other injury.
Space blanket bivy is compact and lightweight for warmth. Has eye loops so it can be wrapped around a person and tied off.

Originally Posted by splat

I got some big lidocaine patches I carry that can numb an area on a limb or other injury.
Space blanket bivy is compact and lightweight for warmth. Has eye loops so it can be wrapped around a person and tied off.

The lidocaine patches might be nice if you cut the sole of your foot--might make walking out a lot less painful. Anyone tried them for that (I hope not)?

Originally Posted by Meadow Skipper

Jeez Hohes, lotta hypothetical there. I'd just say it depends. I've taken a number of boots off of fractured legs and ankles.

Thanks for your experienced input! That was really all I wanted to generate: discussion with different points if view. I tried it keep it as general as possible. And yes, it always depends.

Not sure if it was posted here. Dutch the duct tape from the kit. Wrap about 2 ft or so around your ski poles just below the grips. Don't get crazy but maybe two wraps on each pole. That's approx 8 ft that you don't have to keep in the pack.

Originally Posted by NmbrdDays

Not sure if it was posted here. Dutch the duct tape from the kit. Wrap about 2 ft or so around your ski poles just below the grips. Don't get crazy but maybe two wraps on each pole. That's approx 8 ft that you don't have to keep in the pack.

it doesn't take much time skiing for that duct tape on the poles to be rendered mostly useless

Originally Posted by Hugh Conway

it doesn't take much time skiing for that duct tape on the poles to be rendered mostly useless

But having a fully equipped first aid kit is essential when you cut the bejezzus out of yourself removing it.

Originally Posted by PNWbrit

But having a fully equipped first aid kit is essential when you cut the bejezzus out of yourself removing it.

How do you cut the bejezzus out of yourself taking duct tape off a ski pole??

Originally Posted by BS720

How do you cut the bejezzus out of yourself taking duct tape off a ski pole??

Just after you realize that the wad of duct tape on your pole has to be cut off.

Wrap around your Nalgene....

Originally Posted by Hugh Conway

it doesn't take much time skiing for that duct tape on the poles to be rendered mostly useless

Then you guys buy the cheap stuff. The 500 I put on my pole holds up just fine

It seems the less a person knows the more they carry. Or newbs that just came out of a course seem to think they can treat any injury they come across. Can always tell who the new staff keeners are at work as their the ones that show up with wearing a "bat belt". Nothing wrong with it, just a phase. Most anything can be improvised except for pain meds as long as you know exactly how to use them.

^^This. And I totally disagree about duct tape. I think with duct tape and a multitool, you can improvise a ridiculous amount of things. Duct tape sucks ass through a straw when you have to take it off, but it's strong, water resistant, and cheap as hell.

Originally Posted by Hugh Conway

it doesn't take much time skiing for that duct tape on the poles to be rendered mostly useless

Just about any kind of tape becomes useless after you've been taking the same roll of tape on every trip for the last ten years--on or off a ski pole. And duct tape and a leatherman may be good for a lot of stuff but not for taping an ankle--and taping an ankle, more than any other kind of first aid I can think of, can make the difference between walking out and being evacuated. Duct tape for when the marmot eats a hole in your pack. Athletic tape for when the wolverine eats a hole in you. (BTW SAC Bee had a picture a guy took of a wolverine crossing Beyers Lake in the Sierra west of Truckee--walking on the ice and swimming. First Sierra pic that wasn't done by a motion sensor camera aimed at bait.)

Originally Posted by snapt

Wrap around your Nalgene....

Flatten the last half of a roll and throw it in your pack. Unless, of course, we're talking about first aid kits that fit in your pocket.
Those are called band aids.