Patroller Advice Request: What to put in a 1st Aid Kit

[Sinecure]

I thought of posting this in the other Patroller thread about packs but didn't want to hijack that thread.

I've done a basic, certified 1st aid class (last year, need a refresher soon) and CPR class. Mine was geared specifically for motorcyclists, which was very helpful for me at the time - it included stuff like accident scene management and how to remove a helmet as safely as possible (don't unless you absolutely need to and then its a 2 person job). Even before that I've always kept a decent 1st Aid kit in my car and usually take one if I go hiking with the kids. Mostly my 1st Aid kits get used for scraped knees, but I've had reason to use butterfly closures, big gauze pads, finger cots and other stuff at times.

Here's my question:

As a patroller, what items would you recommend I carry with me when skiing? I always build my own 1st Aid kits since the stock ones are crappy and missing lots of important things. So what do you consider essential (remember I'm not an EMT or medical professional so my ability to do complex things is very limited). Also, I want to travel as light as possible. Maybe we should break the list into optional packets based on whether we'd be in or out of bounds.

Just a reminder, this is intended as a list for the general public to carry, not what you'd carry as a patroller.

Minimal Kit for in resort:


Optional Nice-to-haves for inbounds:


Minimal Kit for OB lift-served or short day-hike skiing (maybe just list additions to the above in-resort minimum):


Optional Nice-to-haves for OB:




Also, if you know of great on-line tutorials or resources to learn how to deal with some of the more common injuries we'd encounter while skiing, I'd love to hear those tips. For instance, are there tips on how to build a litter to extract someone from the BC? Are there clever ways to use skis, poles, shovels, probes, snowboards, duct tape, etc. in a rescue or as 1st Aid items? Best ways to signal for a rescue if you don't have cell phone coverage? If there are two of you and your partner can't be moved, do you stay with him/her or go look for help?

TIA for your help.

[dk_alaskan]

One of the things i will bet most don't take out into the bc is a SMALL lightweight torch (you can get one weighing only a few ounces) and steel wool (when torn apart into shreds makes a good fire starter) for fire incase somethng happens and you need a fire in a hurry. Another thing most don't have is small compact flares, the main kit i take with (vac sealed factory pack called an S.O.S. kit purchased from Eagle Fire and Safety in Anch) has 5flares/launcher which are less than 2.5" tall and about 1/4 wide, weigh next to nothing and can be seen for 2+ miles. It is a pretty complete kit takes up little space. Another thing i would think about would be a sammy splint. can be used for many things. I have a snow claw soft plastic shovel as an absolute emergency shovel in case my main shovel breaks. It also doubles as a splint, sled and a pack protector (have mine strapped to the outside of my back, adds some protection for both my pack and my back). I pack a few small tubes of superglue, unopened so if there is a nice gusher that bandaids and duct tape aren't working can be sealed (much the same as Derma-bond, the medical equivalent).

hope this helps a little

[Orange Julius]

I don't patrol but have been involved with a good number of ski-based backcountry rescues.

The bitter truth is even with EMT level or above training there is only a limited amount of things you can do for someone hurt in the mountains.

What I have found to be the most helpful when treating trauma from a big climbing/skiing fall has been large amounts of gauze and a bunch of rubber gloves. The gloves are essential to allow bystanders to become active helpers, and any time you have to dig into your pack for anything, you have to put on a new set of gloves and dump the blood-soaked ones. Lots of gauze to deal with bleeding, which is one of the true life threats you can treat to some degree while figuring out an evac plan.

Other stuff that has been really helpful-
ACE bandage
cravats
CPR mask

notebook/pen that works in cold, wet - this is essential, document everything. have someone make a copy of it all before a patient goes into a helicopter, and stick the copy on the patient package.

SAM splint - you can A-team an equivalent, the the original works really well and is very light. I stuff one down the backpanel of my pack.

NSAIDS - advil, excedrin, etc - a loading dose of these can help an evacuation of someone with a bad sprain, strain etc who has to go out by ground, They don't do much compared to narcotics but they are available OTC and the patient can self-administer. In an official capacity you may not be authorized to give these out, but you can set them in the snow and have the patient pick them up. :-) Excedrin has a nice dose of caffeine in it which can be helpful for yourself.

In the end, you just have to carry the stuff that will keep someone alive long enough to get out to definitive care. An extra layer of clothing and a foam pad can make all the difference!

[ninjabirdman]

gloves, gauze pads, roller bandages, some cravats (cloth triangles for making slings, among other things).

if you want to screw around with splinting, ^^^ dk_alaskan is right, a sam splint it small, light and can splint almost anything for you. probably overboard for inbounds, great idea for the bc.

duct tape.

[72Twenty]

A flask.

[cj001f]

An extra layer of clothing and a foam pad can make all the difference!

x2 + cellphone (which may or may not work). Injured on the snow people will get cold quick. Don't plan on getting a fire started soon enough to make a difference in winter.....

[SkiEvil]

"SAM splint - you can A-team an equivalent, the the original works really well and is very light. I stuff one down the backpanel of my pack."

Take an empty bleach bottle. Cut the top and the bottom off. Cut the cylinder down one side to create a strip, trim to about 4 inches in width. Best splint outside of a SAM spint that I have ever used.

[mcs]

4 pairs gloves, 1 cpr mask (like this:
http://www.galls.com/style.html?asso...RO007&cat=2734, NO "keychain" masks), sam splint, 2 curlex rolls, trauma shears (to cut clothes & expose wounds)

If you're on patrol, don't give medicine unless your protocols allow it. Besides,
giving aspirin for a traumatic injury is nothing short of stupid. Aspirin encourages blood flow and inhibits clotting.

If you're in the b/c, bring moleskin & duct tape for blisters. Add headache
medicine and benedryl for alergic reactions & nausea (betcha didn't know
benedryl did that, did you? ). You might even consider one of these:
http://www.geocities.com/slishmansplint/

Yes, you can make an emergency b/c tobaggon out of a patient's skis/poles/
shovel and some cord. If you can't find anything on a search, let me know
and I'll send you some info.

Lastly, incase you're tempted to put super glue on a 'gusher,' -- that's a
bad idea. You're not a doctor, you're job is to get the person TO a
doctor (preferably alive). So: 1) direct pressure 2) elevate the limb
3) indirect pressure (pressure on major artery feeding injured limb).

Hope that helps.

[dk_alaskan]

the super glue and fire thing were for a general bc pack you can use for a variety of things, i.e skiing, hiking, climbing, etc. I agree with MCS, if you are patrolling, no meds, super glue fix, etc. and is right about the direct pressure etc. The super glue thing is for a cut that would need stitches, hasn't stopped bleeding but isn't very deep (no jugular gluing/limb transplants) and done ONLY in a situation where you have no other recourse.

a GOOD quality multi tool is a MUST for ANY pack. not a fan of leatherman's, the plier tines seem to break very easily when they get cold. I have had good luck with the kershaw locking jaw multi tool. I really like the vice function and has come in handy on numerous occasions

[summit]

I strongly reccomend a WFR class. It will teach you all sorts of backcountry care and improvised care techniques.

____

Here are the contents of my 1lbs super survival/utility/first aid kits:
The battle between ultralight and ultrapreparedness:

First Aid Kit

BSI:
Laerdal CPR 1 way barrier
3pr Nitrile gloves

Bandaids/Antiseptic:
9 Nexcare bandaids
2 2x1.5" bandaids
1 2x2 Mole Skin
4 alchohol pads
2 benzalkonium chloride pads
1 soap towlette

Trauma:
1 4x4 ActCel Hemostatic Gauze
1 2x4 ActCel Hemostatic Gauze
1 2" gauze roll
1 5x9 Trauma Pad
3 4x4s
1 2x3 nonstick
5 Butterfly Closures
1 4" Coban Roll (self adhering ace bandage)
1 2" Cloth tape roll

Meds/Misc:
2 triple antibiotic ointment packets
8 220mg Aleve
8 Ibuprofen
1 antidiahhreal pill
1 2 psuedofed/acetomenaphine packet
1 hydrocortisone cream packet
1 sunscreen packet
1 blistex packet
2 saline/eyedrop singles
1 benzalkonium/lidocaine/aloe cream packet
1 burn gel packet

In the winter:
Half the bandaids/antiseptic

Added when going BC/SAR Skiing/climbing/mtb/kayaking:
Pocket mask + extra gloves + OPA (not when solo)
Sam Splint (or anytime solo)
Triangular Bandage
Small Trauma Sheers (not when solo)

Long list but the first aid kit is very light (12oz fully loaded minus shears/pocketmask), versatile, and fits a 1qt ziplock baggie (minus the splint/shears/pocketmask)

Need to add:
Cinch-Tight H pressure dressing, betadine, & 2 more OPAs

Survival/Utility Kit:
2 10' Duct Tape Rolls (1 green, 1 heavy duty)
1 Butane Lighter
1 Box Waterproof Matches
1 Bottle Potable Aqua
1 48' 0.18kN 3.2mm Nylon/Poly cord (To be replaced with 50' 3.2mm 4.9kN Spectra Aircore Plus or 50' 3mm 14.2kN Technora Cord)
6 12" zip ties
1 Roll camping TP
1 Space Blanket

To add:
1 10' 20Ga uninsulated copper wire
1 micro LED light
1 suvival saw chain
4 Safety pins

Weight ~6oz fits in a ziplock sandwich baggie

When not carrying overnight gear and/or in the winter add 2nd space blanket or space bivy

-------

Elsewhere in/on pack (not included in above kits/weights):
Brunton 26DNL-CL Avalanche 1.2oz Compass/Inclinometer/Mirror
Altimeter or AGC Ascent Altimeter/Barometer watch
WalMart Whistle/Magnifying Glass/miniCompass combo
Halogen/LED Headlamp (may leave at home on occasion once I get the mini LED light)
Knife or Multitool
More duct tape
Usually 2 of the following: Yaesu VX-5R, Motorola HT1250, GMRS/FRS, cellphone

-------

This list was meant to cover the basic survival/first aid items I carry not including clothing, food/water, camping gear, etc

(for the record I'm a WEMT on a SAR team, not ski patrol)

[ninjabirdman]

hey summit -
i'm in an OEC class right now, and almost everything you have listed makes a lot of sense. i'm curious, what do you carry the copper wire for, antenna to extend range of radios (shot in dark)? and what's a survival saw chain?

[mcs]

Anyone have one of these?
http://www.backcountry.com/store/PTZ...-Headlamp.html

I threw one in my b/c emergency kit years ago and it has seriously saved my
tail a couple of times. Super tiny but it puts out enough light to ski (slowly)
with. Highly recommended.

[ninjabirdman]

having a headlamp is a great idea, but i usually just carry my normal headlamp in the bc as opposed to a specific tiny emergency one. it's light enough anyway, no reason to own two.

[summit]

hey summit -
i'm in an OEC class right now, and almost everything you have listed makes a lot of sense. i'm curious, what do you carry the copper wire for, antenna to extend range of radios (shot in dark)? and what's a survival saw chain?

On second thought I won't be adding this as I forgot they weigh 3.5oz

The copper wire weighs nothing and is purely for improvising repairs (I used it once to fix someones freeride binding on top of a 3000ft chute)

[bio-smear]

After I had a tooth pulled last year, I stashed the unused Vicodin in my ski pack. I asked my dentist straight up "hey is it ok to give these to a ski buddy with a broken leg?" He said yes, but I still wonder. I don't think I'd administer them if I suspected internal bleeding or uncontrolled bleeding from an open wound, but for a severe sprain or fracture, it would probably make their experience a little better.

Communication:
We usually carry GPRS radios, which while pretty much useless for long distance communication, in the Tahoe area we often have line of sight with other ski areas, even if we're out of bounds/BC. Cell phones are becoming more reliable too.

Ive also thought about carrying my small VHF aviation-band handheld radio with me. If you were way the fuck out in the middle of nowhere, you could theoretically radio a passing aircraft, and commercial flights often monitor the emergency frequency 121.5 Mhz, I guess they could call 911 for ya.

Personal locator beacons are becoming more popular too, they are picked up by satellite when activated and transmit GPS coordinates (if they have the GPS feature) or are triangulated. I think that racer dude who lost both legs in the BC does ads for them.

Got a little off topic I guess.

Stainless steel saftey wire could be a lifesaver too. Like Summit said, you could use it to fix or bind something by wrapping and twisting.

[ninjabirdman]

in case you have to go all aaron ralston on somebody?

heh, j/k, that thing looks sweet.

[mnflyfish]

A SAM splint or a cardboard wrist splint, or both. A few rolls of cling, a handfull of various sizes of sterile pads, tape, 3 or 4 cravats, a leatherman or multi-tool, some band-aids, a communication device(will depend on where you go), a flash-light, a pen and paper (space pen is ideal), and above all lots of gloves.

Oh and without question a CPR mask. Don't cheap out here and get just the barrier mask but get the real deal. The barrier mask's valve goes both ways and I don't know about you but a mouth full of vomit is a terrible way to start the day.

So, if I think of anything else I'll post but this should keep you just fine.

Good Luck,
Jay

[G]

SAM splint, duct tape, and a shitload of vicodin.


That's all you'll ever need.

[Orange Julius]

If you have to give unprescribed old vicodin BE SURE to tell the "authorities" that the patient has taken it when they arrive. Morphine is often administered immediately for evacs.

There are reasons certain drugs are prescription only. It's not like they are just trying to make your life difficult. Vicodin and other narcotic painkillers mess with your nervous system by design. Be sure you know what you are doing. If you give these to someone and it complicates their situation you could be in some hot water. Proceed with caution. That said, sometimes narcotics are the only thing that will work.

[summit]

What Orange Julius said... do you really understand the effects of the drug you are (self)administering?

Vicodin depresses circulatory and respiratory rates... if you have a shocky patient, that's not good drug to give if you don't know what you are doing. They also wouldn't be what you want to give someone who is trying to assist in their extracation... coordination is negatively effected.

Be sure to tell the medical professionals what the patient has taken.

[mcs]

Man, you guys have really nailed it on the narcodics. I've been an EMT for
almost 4 years now and have seriously become a patient advocate (i.e. as
little pain as necessary). There's a lot to be said for the patient's mentality
affecting his/herself and others as well. On the other side, you're really
assuming a lot of risk by giving someone meds. Personally, I've even thought
about buying a stash for personal use (even thought I'm not a smoker) for
this reason. Carrying Vicoden is a really nice thing to do, though. I'd take it
if I knew it was a localized fracture and wouldn't lead to shock.

On the other side of things, mnflyfish, has an indisputable point. "Barrier"
masks are worthless. Not only do they only 1/2 work, but they won't form
a good seal. Spit, blood and vomit always get in the way and you'll be
in contact w/ it unless you have a real mask. Spend the $8 and let it
take up a bit extra room -- it'll be worth it when you need it.

Great input, guys.

[summit]

mcs i think you got it right. if i was sitting there with a closed femur fx, gimme some goddamned vicodin

additional vic (and many other narcotic pain reliever) consideration: contains nauseating agents... what are the implications to your pts airway? (and if they are immobilized? if they have altered loc (i'd consider that a critical contraindication anyways)? etc)

[mcs]

summit: You're right, narcodics are known to create nausea in patients. So
much, in fact, it's protocol in my district to administer an antiemetic
(no-barfing) agent parallel to morphine. As for the airway issue, they won't
compromise the patient's airway, but they will depress his/her respiratory
rate. You'd really have to take a lot of them, though (and OD, basically).
Hey, maybe we should ask Terril Owens??

[summit]

summit: You're right, narcodics are known to create nausea in patients. So
much, in fact, it's protocol in my district to administer an antiemetic
(no-barfing) agent parallel to morphine. As for the airway issue, they won't
compromise the patient's airway, but they will depress his/her respiratory
rate. You'd really have to take a lot of them, though (and OD, basically).
Hey, maybe we should ask Terril Owens??

phenargen + mso4? hehe put em to sleeeep ;-)

we would always insist on either an order for an antiemetic prior to a long tp or have the sending facility load them up

-----

the airway issue was if the patient vomited due to the vic while unresponsive or immobilized... risk of aspiration

the worry for CNS depression from hydrocodone (or other narcotic antiglesics) wasn't that the person would go apneic from that alone, but that it could exacerbate existing or imminent hypoperfusion or cause dizzyness in a patient trying to self extricate or assist in their extrication, that was all

------------------------------

for everyone another vicodin consideration: head injuries are a contraindication

[Core Shot]

Ditto on the SAM splint.
With Duct Tape, you can immobolize all kinds of shit.
I sometimes pull it out of the pack,but I really should leave it in at all times.