Thursday, May 9, 2013

First Aid Kits

If you follow me on facebook, you probably know that I am an instructor with the Wilderness Medical Institute (WMI). Because of that I spend a lot of time talking to people about first aid kits. If you read this blog regularly you know about my mishap last year and the fact that I didn't have a first aid kit in my boat when I needed it. Since then I have changed a few things, and with the addition of  mountain biking to my list of regular activities, I needed to add a couple of things.

I have always been a fan of the theory that the bigger your first aid kit, the less likely you are to need it. This is a theory that has worked well for me. I use a 15 liter dry bag as my first aid kit when paddling. It  lives in front of my feet in the cockpit, so it is easy to get too. Only when it was out of reach did I need it.

Many times people tell me they just want to buy an empty kit, and they will fill it themselves. This is a mistake. No matter which brand first aid kit you buy, the manufacturer can get the supplies for it much less expensively than you. So I recommend that people buy a first aid kit, then remove the things they wont ever use, and add things they will.

I really like this little REI kit, though there are many good options. I have yet to find one that comes in a  dry bag. I don't like the idea of moving the kit around with me as I change activities. So when I started mountain biking I bought another little rei kit, and added it to the hydration pack I was using for cycling. I have the identical kit in my deck/lap bag when I kayak. I then have my large 'expedition' kit in the trunk of my car, which comes with me on multi-day trips.

This is the kit that goes with me on day trips.

I have added to it two pairs of nitrile gloves. A WMI wound pack (which is the best 4 dollars you will ever spend) I got rid of the small roll of tape that comes with the kit and replaced it with a full size roll of athletic tape. I also added an irrigation syringe. In the yellow bag I have things like sunblock, and powerfood, chap stick. a light source, etc.

This is the exact same kit in my hydration pack. With the exact same additions and subtractions. I don't have to think about what is where, and what the kit contains. it is just ready to go.

and finally, my expedition bag. On the left, in a ziploc bag, a large ace bandage, a triangular bandage and two rolls of tape. Next to it - rolled up - is a large SAM splint. I think of this as 'musculoskeletal'. Gear for dealing with a sprain/strain or fracture. All the way to the right I have another ziploc, this is filled with roller gauze, an assortment of bandages 2x2, 4x4 and bigger, WMI wound packs, tincture of benzoine, band aids, irrigation syringe. Nitrile gloves, Trauma shears, and tweezers. I think of this as 'Trauma'. Materials for dealing with any sort of traumatic injury. Laceration, punctures, avulsions, burns. you name it. In the middle is a small black bag with a BP cuff and mini maglight. A Littman lightweight stethoscope. A CPR shield and an ALS field guide - the one I carried when I was a medic.

Before an expedition I will add medications to the big kit. Here are things I don't carry. No quick clot, or commercial tourniquet products. Unless you are in a war zone you won't need them, and I have heard very contradictory information of how well quick clot works. No sutures. First, you probably wont need them, second, in the back country sutures can cause more trouble than they are worth. Without a local anesthetic they are painful to use. If the wound gets infected you have to cut them out, clean the wound and re-suture. The WMI wound pack carries steri-strips that when paired with tincture of benzoine and a transparent semi-permeable dressing works better, and is more field maintainable.

I am fanatical about gloves. I buy expensive nitrile gloves that fit me really well. This way I can actually do things with them on. I don't care what people say, you can improvise a lot of things, but not gloves.

The most important piece of gear I carry however, isn't in any of these kits. It is what I have learned over many years. First as  WFR, then an EMT-BASIC. Then I worked as an EMT while I studied to get my Paramedic, but honestly after all of that training, and work, my wilderness medicine skills really got hammered home when I became a WMI instructor. WMI refined my skills and made me a better practitioner, and a better teacher. I highly recommend that you take a wilderness medicine course. Much like my theory on first aid kits, I think the better you are trained the less likely you are to need it. Or at least that is my hope.