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August 5, 2009 Comments (0) How-To Articles

Assembling Your Own Wilderness First Aid Kit

Firstaid02aIn the middle of the forest, you’re on your own.   This demands your respect insofar as it requires proper preparation.  Running willy-nilly into the bush is a recipe for disaster, as so many news reports of lost or injured hikers have shown us.  A bit of preparation, luckily, goes a long way.  Acknowledging the possibility that an ‘incident’ may occur leaving us injured or lost is key to both safety and peace of mind.  This does not mean we should carry fifty pounds of emergency gear on our backs!  But a few necessities and a hefty bit of knowledge are clearly a must.  Fire, shelter, water, and food are (for the most part) easy enough to prepare for.  We can learn how to make or procure all of these from what’s around us.  For better or worse, proper first aid is a different story.  Nature doesn’t provide us with the best tools to treat a serious injury, and an ambulance is no longer just a phone call away.   Because of this, a well-designed first aid kit must be part of our gear, as well as the knowledge to properly use it.

Before going further, I must stress that there is absolutely no substitute for real, hands-on training from professionals.  Whether it’s a course at a Red Cross, or training from an emergency medical professional willing to teach you, the small cost of time and money to get this education is well worth it.  There are techniques and knowledge that cannot be fully gleaned from books or the internet!  And no matter what, professional treatment for any serious injury should be sought immediately.  However, many small and moderate incidents can be appropriately managed with a little conscientiousness and supplies.  To this end, what follows are a handful of recommendations about how to build a proper first aid kit for camping and backpacking.  Most, if not all, of these ingredients can be easily obtained from any pharmacy.

There are numerous pre-assembled kits available on the market today.  Some are great, some aren’t.  Many are built for specific purposes; some for the home, for work sites, or for camping.  There are several limitations to these, however.  First, you put yourself at a disadvantage when you carry a kit that you didn’t design.  You must know exactly what each and every piece of first aid equipment is used for, why it is there, and how to use it properly.  Just ‘taking someone’s word for it’ is not enough.  Many of these kits also contain components not fully suited to the outdoors.  They may include cheap/small band-aids that won’t last long against brush and weather, fragile tools (shoddy shears, etc), containers that are of a much larger (or smaller) size than is needed, etc.  In contrast, assembling your own kit from hand-selected components ensures that you will be getting exactly what you (as an individual) require, and that you know exactly why it’s there.

With all that prologue out of the way, where do we begin?  How about the container.  This is an easy part to overlook, but an important one.  Your kit doesn’t do much good if it’s been soaked from rain leaking in, or crushed in the bellows of your pack.   Many folks just shove things into a Ziploc pouch (I’ve seen every size used for this purpose), but there’s a good chance of leaks or accidental openings, and no crush protection.  The plus side is they’re extremely lightweight and cheap, and see-through.  If you decide to go this route, I’d suggest at least using the heavy duty type with the slide-lock, as these are less likely to leak or open accidentally.  Another option is a simple cloth/canvas/nylon pouch, which are stronger and more resilient, but still crush-able.  If you store your kit in a safe part of your pack, then either of these options will be suitable.  Lastly, a hard-shell case will work quite well.  These should be high quality and leak-proof, such as the Pelican brand cases.  No matter what you choose, make sure you keep your first aid kit in an easy-to-access part of your pack, always in the same place, and in an easily recognizable container.  It’s important that even a second party looking for your first aid kit would recognize it immediately.

How big should it be?  This depends on a couple of factors.  How many people are going with you, and are you solely responsible for them?  The size will obviously go up a bit as the number of dependents does.  For a one person / solo kit, it is often about a 4″x4″ pouch/container.  This size can be almost double for a group of people (though a smart gent will have others sharing the load for this sort of thing).  How long are you going to be gone?  A day hike kit will probably not be the same as one for a week long excursion.  Those engaging in more ‘extreme’ activities like rock climbing or rafting may need a larger, more specialized kit. Under any circumstances, the weight need not be substantial, but it will vary highly based on your perceived needs.

Let’s look at a basic list for a good kit, as well as some good optional items, before discussing the ‘why:’

Basic components

Firstaid03aWound Care

Basic components:

4″x4″ gauze pads (4+)
2″ gauze roll  (1)
Non-adhesive gauze pad (2)
Adhesive bandage tape (1 roll)
Butterfly closures (6)
Adhesive bandages, various sizes (10+)
Triple antibiotic ointment (1 small tube)
20 ml syringe (1)
Povidone/iodine solution (1 small bottle)
Soap (1 small bar/small bottle)
Scissors (1)
Tweezers (1)
Moleskin pads (2)
Latex gloves (2 pair)
Hand sanitizer (1 small bottle)

Optional Components:

Duct tape (~2 feet)
Heavy steel sheers (1)
Super glue (1 small container)
Small mirror
Acetaminophen 325mg tabs (10+)
Prescription medications (per need, include Rx label)
Epi-pen (1)
Activated charcoal (1 small container)
Aloe vera gel


Medications

Ibuprofen 200mg tabs (10+)
Diphenhydramine 25mg caps (5+)
Loperamide 2mg tabs (5+)
Hydrocortisone cream, 1% (1 small tube)
Electrolyte packet (2)

Incidentals

Sunscreen
DEET bug spray
Tampons
Personal wipes
Q-tips

Wound Care

Firstaid06aSupplies for basic wound care are what most people immediately think of for a first aid kit.  Especially for knife nuts, this is not an inappropriate intuition (it’s not at all uncommon for a slip o’ the blade to lead to a nice gash, doubly likely when wet, cold, and tired).  In the comfort of our homes, we can often feel more lax about caring for this type of wound.  But out in the woods, where aseptic environments are difficult to come by, good wound care can prevent a small cut from turning into an infected pain in the rump.  The actual care will be discussed later, so for now let’s talk about basic items that would be intelligent to keep handy.  First, gauze pads are an important staple. It’s hard to have too many of these around.  Their primary use will be to help in cleaning injuries, and for use as a primary dressing. The size will depend a bit on your container, but I usually carry 4”x4” pads.  A roll of gauze (several inches wide) is a lightweight addition that can help in wrapping long lacerations or broadly inured areas. I also keep a few non-stick adhesive gauze pads in my kit, as these are ideal for burns and blisters.  Second, we’ll need some hypo-allergenic adhesive first aid tape to secure the bandage.  An elastic bandage also works well for this purpose, and can be included if not deemed too bulky or redundant.  Under any circumstances, allowing the wound to ‘breathe’ is important for proper healing.

Keeping a few small adhesive bandage strips (“Band-aids”) is worthwhile for minor cuts and scrapes.  Butterfly closures are also important; these are thin adhesive strips that are placed across a laceration to help keep it closed (think stick-on stitches, but not as effective).  Many outdoorsmen favor taking Superglue along for this purpose as well, to place atop an already cleaned and irrigated wound for closure.  This is an acceptable practice on very minor cuts.

No matter the size of the injury, cleanliness is vital.  There are many bacteria that live commonly in the dirt that you may not readily find on the hard surfaces of the city.  Some of these can cause particularly nasty infections.  To combat this, an injury must be cleaned as thoroughly as possible before bandaging. In the home or doctors office, a steady flow of saline or even tap water will serve the purpose of irrigating a wound.  (Irrigating simply means to flush with an aseptic wash to rid the injury of nasties.)  At home, I keep a small pressurized spray container of normal saline.  As these are often too big/heavy for a wilderness first aid kit, syringes containing sterile saline can be obtained.  If these cannot be found, plain syringes (volume of 20 ml or so) should be brought along and then filled with the most aseptic fluid available.  Soapy water is another effective irrigant, and probably the most easily devised when in the woods.  Boiled water that has been allowed to cool will work, as will filtered water that has been disinfected with povidone/iodine solution (in a pinch).

Firstaid05aAfter irrigation and cleaning, triple-antibiotic ointment should be applied to the wound in a thin layer.  Take care not to touch the wound or ointment with your hands after it has been cleaned, as you may inadvertantly contaminate it.  A few pairs of latex gloves are an intelligent addition to a kit because of this, as they are lightweight and largely ‘foolproof’.  Manipulating an open injury with bare hands is an invitation for further infection, and ‘washed’ hands are not likely to be fully aseptic.  Once bandaged (not too tightly!), the wound should be cleaned 3-4 times a day as previously instructed, with daily bandage changes.

There are several small ‘bits and pieces’ that are important but sometimes easily forgotten, such as moleskin. This is used for protecting areas that are blistered or feel ‘raw’, such as the back of the heel when a boot is ill-fitted.  Like small adhesive bandages, these are so small and lightweight that it’s easy to add to any kit.  High quality, medical-grade scissors are quite useful.  These can be used to carefully remove clothing around a wound (if necessary) or trimming bandages.  Tweezers must also be included for removing small materials and debris from wounds or removing splinters or ticks.  Aside from the obvious use of signaling, a small mirror is very handy for a solo hiker.  If an injury needs attention but is located on the back, head, face, etc., it may be difficult to see. Having a small mirror allows you to clean or manage the area without guessing.  It also lets you perform your daily tick check more effectively. Tampons should be included if any females are in your party, and these can also be useful for emergency tinder or for large puncture wounds.  Biodegradable toiletry wipes are great for a quick bath before bed, or cleaning before meals.

Medications

Firstaid04aThe selection of over-the-counter (OTC) medications at a pharmacy can be overwhelming.  Many contain undesirable homeopathic ingredients, or multiple drugs when only one is needed.  My advice is to keep it simple!  Luckily there are only a few that are truly valuable in the outdoors.  With any of the OTC medications, it is wise to buy them in the individually packaged foil/punch wrappers.  This is both so that any law enforcement doesn’t have to take your word for it that the ibuprofen tablet isn’t an illegal drug, and so that you (and anyone else) can quickly identify the medication in question.

Pain and fever are two common issues encountered, from injury or infection respectively.  These are both best managed by an NSAID (non-steroidal anti-inflammatory drug), namely ibuprofen (a common brand name is Advil).  This medication is effective to control fevers, inflammation, and for mild to moderate pain.  The maximum dose is 3.2g per day, but this value should not be approached unless under the care of a physician.  Take one to two 200mg tablets every 4-6 hours as needed.  Ibuprofen will also help to decrease inflammation around injured or sprained joints.  This medication can be upsetting to the stomach, so eat a bit of food beforehand if possible.  It is also important to stay adequately hydrated when taking this.  Acetaminophen (the generic of Tylenol) is useful for pain and fever, but is not an NSAID and does not help with inflammation.  However, it is safer than ibuprofen for those with kidney problems, blood clotting disorders, or those who are pregnant.

Another event that needs to be accounted for is an allergic reaction.  Because of the wealth of flaura and fauna in the woods that we’ve not come in contact with before, it’s possible that we’ll react to them in an unforeseeable way.  A simple example is a true allergic reaction to a bee sting.  Aside from the natural discomfort caused by the global itching and inflammation, there is the possibility that the throat could become so inflamed or swollen that you could have trouble breathing.  This is an emergency!  The best treatment is an epinephrine injection, but this is a prescription only item.  If you know that you have a true allergy to something where this level of severity is possible, get a prescription for an Epi-pen autoinjector from your physician (both for home and for this kit).  Another treatment for this kind of reaction is diphenhydramine (generic for Benadryl).  Taking 50mg of this by mouth after signs of a reaction begin will greatly decrease your body’s response, and thereby decrease the inflammation, itching, and swelling.  Be mindful that this over-the-counter antihistamine can cause drowsiness (it’s a common ingredient in OTC sleep aids) as well as urinary retention.  To a small degree, diphenhydramine is also useful to treat nausea.  When in capsule form, the contents can be mixed with a small amount of water and formed into a paste.  When this paste is applied topically, it will treat local itching and inflammation.

Diarrhea is both a profound nuisance and danger, and is unfortunately all too common. The causes of diarrhea are numerous, but is very concerning when brought about by ingestion of pathogenic bacteria or viruses.  The treatment for this is not always to stop the diarrhea!  Often times, your body simply needs to clear the toxin or pathogen from the gastrointestinal tract.  If you give drugs to inhibit this diarrhea, you may be forcing the body to retain these toxins.  That said, if the loss of fluids becomes life threatening or the inconvenience extreme, loperamide (generic for Immodium) is the drug of choice.  It does not directly affect the quality of the stool, but it does inhibit the movement of the gut.

Diarrhea (as well as vomiting) can lead to massive fluid loss and electrolyte depletion/imbalance.  Clinically dehydrated individuals need to be re-hydrated under the care of a physician, as electrolyte changes that occur to rapidly can be fatal.  However, electrolyte packets (dissolved in water) can be used for oral replacement in less extreme cases.  Avoid sugary sports drinks and sodas for this purpose, as these can cause osmotic diarrhea and do as much harm as good.

Aside from antibiotic ointment, there are only a handful of topical medications that are worth bringing with you.  A valuable example is a simple 1% hydrocortisone cream.  This is used to treat local inflammation and swelling on an area (such as a bugbite or poison ivy exposure), but should not be used on an area of open skin!   Doing so is an invitation to infection, as hydrocortisone will decrease the body’s ability to fight infection at that area.  Sunscreen is another obvious necessity, as is a DEET containing bug spray.

Some folks (either by accident or stupidity) may ingest something toxic to their system. A prime instance is when someone tries to ingest a plant that they think is edible and isn’t, or are testing to see if it is edible.  The result can be more than a little uncomfortable, as many are toxic to animals/humans.  This is a time that an anti-diarrheal medication would likely be inappropriate, since the body will need to clear it from its system.  Activated charcoal, however, may be of use.  This is not normal charcoal from a fire!  Once ingested, the huge surface area of the charcoal molecule can bind to toxins (as well as many drugs and other chemicals) in the gut.  I don’t feel this is a necessary component of a kit, but a good option if you have curious kids or pets.

Lastly, make sure to include a few tablets/doses of any daily prescription medications you take.  The effects of going without certain medications can range from moderate discomfort to life-threatening.  Besides which, it’s not fun to be dealing with withdrawal from a medication while also working through a possible survival situation.  If the substance is scheduled (meaning federally controlled, such as narcotics or opioid analgesics) it is wise to include the prescription or prescription label, just so you are beyond reproach should an overzealous forest ranger find them.

Things You Do Not Need:

An unfortunate bit of ‘wisdom’ that is often passed down is to carry a snake bite kit.  These kits contain various items, but the general notion is to cut around the bite, close off circulation to the limb/area, and to ‘suck’ out the poison.  This entire process is not recommended!  It will do more harm than good.  Cutting of circulation will damage the entire limb and do little to stop venom from reaching the circulation, and the local incisions only invite infection and do nothing to remove the venom (trying to suck out the venom is similarly useless).  The best practice after a snake bite is to place the victim at rest, keep them warm, and to remove any constrictive clothing or jewelry.  Make sure the area or appendage is below the level of the heart.  Do not apply ice, pressure, suction, or a tourniquet.  Get them to a hospital as soon as possible.

Oral antibiotics are often included in kits, but this is poor practice as well.  First, infections are caused by many different kinds of organisms, which may or may not be killed/stopped by a given antibiotic.  Also, some antibiotics do not reach certain parts of the body very well.  Lastly, the infection may be cause by a virus or fungus, and thus ‘typical’ antibiotics would be useless (and likely harmful).

Razor blades are another item often brought, but I’d wager the majority of people couldn’t tell you why they included it.  You won’t be removing anyone’s appendix while in the wild.  Leave it at home.

Multivitamins are sometimes included for possible ‘survival’ situations.  The fact is, however, that we intake much more than we need of most vitamins in our normal diet.  It also takes longer than a few days for us to deplete such vitamins to the point of clinical significance.  Vitamins require a good bit of water to properly digest and absorb, as well.

Clear nail polish is a bit of wisdom on par with ‘snake bite kits’.  The common notion is to take it for chiggers, thinking they burrow into the top layer of skin and that a coating of nail polish will suffocate and kill them.  This is untrue.  Chiggers are very small bugs that bite the skin and then produce enzymes to degrade the skin so they can feed.  This creates a lot of local irritation (itching and redness).  Chances are, the first few times you scratched the area you removed the chigger.  Treatment is to wash the area thoroughly and then to apply a topical medication for itching and inflammation (hydrocortisone works well).   The reason some folks feel better after applying the clear nail polish is not because it killed the chigger, but because it closed off the open ‘tube’ in the skin that it created.

Closing Thoughts

Again, this article is not meant to supplant face-to-face medical advice, training, or treatment.  These are only suggestions for those looking to better prepare themselves for medical issues in the field.  This list is not all-encompassing, as many individuals will have unique or unforeseeable needs.  But the kit as listed above will take care of the majority of small-to-moderate incidents in the wild.  If you already have a developed first aid kit, I would encourage you to take a second look at it.  Dissect it and really see what belongs and what doesn’t, what you know how to use and what you don’t.  And if you don’t, seek training! 

Visit:  http://www.pelican.com/
http://www.redcross.org

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