I want to run this theory by everyone & see what you guys think. Attaboys are nice but criticism (hopefully constructive) is actually more useful.

Most first aid kits are really last aid kits. They have an abundance of materials for final treatment (Band-Aids, burn ointment, etc.) but no real FIRST aid stuff. There are usually no infection control stuff (mask, rubber gloves, CPR mask) or big dressings for serious bleeding. If your kid cut his hand and you put a dressing on it, that’s last aid. The patient is not going to the hospital. FIRST aid should be Airway, Breathing, Circulation & Bleeding control. This includes protection for the aid person from blood borne pathogens. Where I live, we can get an ambulance in less than 10 minutes. It is not practical to splint a broken bone. The EMTs on the rig will have all the stuff needed. I would just use pressure to stop bleeding and traction on the broken limb. However, during a wide area emergency, they may arrive late or not at all.

So, I divided my medical equipment into 3 parts. There is Kit 1, the Delay/Transport Kit and the Final Treatment Kit.

Kit 1 is what you use first on an injured person. This kit contains the surgical mask, nitrile gloves, CPR mask, 2 battle dressings, 3 sizes of airway, KY jelly (lube for the airways), tube of Traumadex, Asherman chest seal, Magill forceps (for choking), emt type shears, instant glucose (diabetics), etc. This kit is designed solely to keep the guy alive long enough for the ambulance to get here.
I’ve got it in a Blackhawk drop leg pouch. I used to EDC it at the looney bin where I used to work. The large battle dressings are the most important as you can do CPR without equipment. The Traumadex & chest seal are for bullet holes in the chest.

The Delay/Transport kit is, as its name suggests, for use if the ambulance is delayed or non-existent due to the emergency. I’m thinking huge demand, trees down, giant snowdrifts etc. This kit has the stethoscope, sphygmomanometer, splints, burn dressings, IV stuff, flexible stretcher, blanket, oxygen bottle, triangular bandages, sterile saline, etc. This kit is for longer-term survival of the patient (several hours). You must make the decision: wait for the ambulance or transport the patient to the hospital yourself.

The 3rd kit is the Final Treatment kit. This is the one that has treatment supplies for problems that can be managed without going to the hospital. This kit has all the meds, splinter forceps, disposable scalpels, tick removal tool, moleskin, betadine, sunburn cream, etc.

BTW, You’re not prepared without training. Everyone should take a Red Cross First Aid & CPR course. Additional training is optional, but to me the above is a minimum for all.

You say you have in kit 1 magill forceps for choking. I don't know your level of training...As a former NYC medic (4 years) and 6 more as an EMT (also in NYC) plus 8 years as a SW Florida medic (in an area hit by Charley) I've only had to use the magill forceps ONCE. It was for a guy in cardiac arrest who blocked his airway with moo shu pork. The magills didn't help. He needed a surgical airway. Also as far as I've been trained...magills were only to be used by direct visualization-by a larnygoscope and blade (not mentioned in the kits)....not a 'blind' procedure.

Kit 3 has scapels...Why. I've only needed it once.
Meds? For who and what kind. I'll offer someone Tylenol, Aspirin or Ibuprofen but they have to pick it up and be able to take it themselves (thus I'm not prescribing it!)...Other than that though and I only have medications for my family.

I fully agree with cjk, overkill in a medical will either get you in trouble and or take up wasted space. For years now i see ems personel go nuts on gear.........and half of it you'll never use. such as magill forceps......first unless you acutally see a small object in an airway(assuming heimlich didnt dislodge it) chances are no forcep is going to get it either. And too many of certain items is over kill as well. Keep them for replacements, but unless its a known extended trip-you probably dont need 150 4x4's, 10 blades, a small stretcher etc..... see the point. Lastly Meds-i do have a few advanced drugs i tote on special trips, but as CJK mentioned i too reserve them for myself/immediate friends family due to liability and "suit" issues.
PS-for the best all around medical course-look in to a wildnerness medical course

FYI- I have only needed to use Magill forceps one time in my career. It was to remove a plug of chewing tobacco from the airway of a cardiac arrest patient. As stated by CJK, it was used only under direct visualization with a laryngoscope and blade.

Pete

My dad is a paramedic and told me the most I will ever need is some 5x9's, tape, triple antibiotic ointment, gloves, cpr mask, water (THE CLEANER THE BETTER), and a cell phone. There might have been some more stuff but that is what sticks with me. Everything else is beyond my skills. I do have a surgical kit from CTD.com, but that is only if someone trained is present or can tell me what to do (only in a pinch). I do plan to expand my kit as my education and training increases.

Does someone have the statistics on what the most common medical issues are while in the outdoors? My understanding is that cuts, scrapes, burns, insect bites, and allergies are the most common problems. What other medical problems should the average (non medical) person carry items for while hiking, camping, and in their evacuation bag (BOB)?

Thanks!

I have encountered the following medical conditions in the field (wilderness setting):

Dehydration
Fractures/sprains/strains due to falls or trip hazards
Hypothermia
Hyperthermia
Asthma attacks
Chest pain/possible MI

Pete

What can be done for someone having an asthma attack? What if they don't have an inhaler or it is empty?

Asthma attack is not in my first-aid booklet!

I can only speak for myself and not other EMS providers, protocols or EMS systems, so take what I say with a grain of salt.

Many times when encountering a patient experiencing an asthma attack, my first line of defense is a psychological vs. pharmacological intervention. Having the patient calm themselves through slow controlled breathing can and has at least for me, been enough to “break” the cycle of respiratory distress.

My oldest daughter, when she was younger, suffered exercised induced asthma attacks, being a competitive swimmer, more then once she suffered an attack and was in severe respiratory distress. Many times, not always, I was able to get her to “break” the attack through a claming, reassuring voice and talked her through the attack with slow controlled breathing exercises.

Although, I am not suggesting you do this, but Primatene mist is still available over the counter. For many years, it was the one medication used by asthma sufferers as their first line of defense. Just something to consider.

Pete

Although it is unpolular to say so, I was always under the impression that except in rare cases, asthma is self-limiting. True or no?

When in I was in high school, I had a good friend with fairly bad asthma, and his mother fauned and fretted over his attacks. We were with his grandfather one day, and he had a attack, and no inhalor. His grandfather said something to the effect that he'll either calm down, or pass out, and in either case it'll be done with. He was right. He almost passed out, he did calm down, and it was over with.

Asthma can and often is a life-threatening event. Approximately 20% of children and 5% of adults suffer with asthma within certain populations. Age, ethnicity, environmental factors, medications, other medical conditions and whole host of other factors can influence not only the prevalence in a given population, but the degree to which any individual will respond to an attack. There are many triggering factors, emotions, environmental, medicine, etc. and what will trigger an attack in one individual, another asthmatic will weather fine.

Reported deaths due to asthma range in the 1000+ per year, so I would not consider asthma to be self-limiting, unless you consider death to be a resolution. With that said, many individual asthmatics can resolve an attack without medications. I would not however, rely upon that method solely. If an individual were having an attack, he or she hopefully would have their medication on hand. Whether they did or not, I would still activate 911 or take the individual to the hospital, as some attacks are only temporally resolved through medications, etc. and another attack can come on quickly.

Pete

Hyperventilation will either calm down or pass out.....asthma can kill. Yes it is good to go the psycological route of calming them down but a true asthma attack is a pysiological event where the bronchioles narrow. Some patients require Rx intervention to open them up.

With hyperventilation you will have the 'panicky looking' patient. What I mean by that is they are anxious and panicky but have good color and their respirations are not labored. They will be breathing at a rate of 40 per minute plus. Usually they have tingling in their hands, feet and around their mouth. They will have (sometimes severe) cramping in their hands.

An asthmatic will be anxious because they CAN'T breathe. They can sometimes be heard wheezing even without a stethescope. They may even be turning blue. We have a list of questions that we ask them and the further down the list we get then the more critical the situation could be.

A technique called "Pursed Lip Breathing" works well and is much of the same thing as paramedic pete described.
You inhale SLOWLY through the nose as much as you can and then press your lips together and blow out SLOWLY as if you were blowing bubbles or extinguishing a candle.
For more on asthma hear is a start American Lung Association


<img src="/images/graemlins/blush.gif" alt="" />

I have asthma, and it's very much under control. The only time it really scared me was when I was selling vacuum cleaners (or rather, trying to).

One thing I've read is that although it seems like you're having problems getting air in, the real problem is you're having trouble getting air OUT. When it comes time to pull air back in, your lungs are still full, so it SEEMS like you're having trouble getting air in. I've experimented with that when I have a bit of a problem while jogging- I'll work hard to give my lungs a bit of extra squeeze at the end of exhaling. It seems to help a bit. What helps me more though is to wear a heart-rate monitor, and use that to pace myself better and not let the asthma activate.

I don't know how this information will help with someone else though, this is purely how my lungs work.

The main purpose of surgical kits & sutures in a medical kit is to impress people who don't know any better. Except for perhaps removing splinters or lancing a blister, they are almost useless. Yes, I know the conventional wisdom about leaving blisters intact, but they are very painfull to walk on and unless you are independently wealthy & can afford 4 bearers with a sedan chair, you have to drain them. If you have to hold wound edges together, use butterflys or Steri strips instead of sutures.

<<If you have to hold wound edges together, use butterflys or Steri strips instead of sutures. >>

In a no $hit emergency, you can use super glue. It was invented for that specific purpose in Vietnam.

It has been said before and I will say it now, duct tape and super glue rule.
Through some thermal resistance on it and you could probably use it to fix the space shuttle.

<img src="/images/graemlins/cool.gif" alt="" />

My apologies as I was not very clear in my original post. I will try to answer all, but...
I was originally posting about surviving in place. I am not going to tote a portable hospital about, especially since I am not a MD.
I have a laryngoscope, but it is a tight fit in the case. I did not intend to imply that one should just jam the forceps down the throat and grope about.
Scalpels & scissors are good in your kit. A scalpel is good for splinters, opening abcesses (did that on myself)etc.
The medical items given were just examples, not a complete list.
The meds are for me & my family, people who are not likely to sue me. I would not give meds out to others, esp. prescription ones.
I am not a surgeon by any stretch of the imagination. I used the incision & drainage method (used before antibiotics) after a cat bite got infected. after 3 days of daily opening & drainage, it healed up. I also did part of a root canal on myself. I had an abcess at the upper end of an upper tooth root. The DDS drilled a hole, prescribed the wrong antibiotic & said "Wait ten days and let it drain". On the second day the hole got plugged & the pain was enormous. No drug would touch it. I was at work & it was at night, so I opened the hole myself. I used a piece of wire sterilized with alcohol and pushed until blood came out. The pain was gone within 3 min. The next day, the doc changed the antibiotic & all was well after that.

I forgot to mention this previously: I don't recommend sealing a wound in the field. Especially, don't do it if you are going to take the patient to a hospital emergency room. The doc there will be really annoyed if he has to try to unseal it to check for abcesses, dirt & whatnot. He cannot be responsible for the condition of the wound if he cannot see what is really involved. He will be really steamed if he has to remove some amateur stitches. One time, when doing my observation time in the ER, a biker guy was brought in. He had gotten into a fight and got hit in the head with a 2x4 with nails in it. He was way too tough to go to the ER, so he had his significant other sew him up with ordinary sewing thread. After the wound got grossly infected, he decided that perhaps a visit to the hospital was in order. He was admitted & put on IV antibiotics.

In general, people with severe life threatening asthma never go anywhere without their inhaler(s) and an epi pen. If I were to come across an asthmatic trapped in rubble, I would ask them where it is, retrieve it for them, and help them use it. People with moderate asthma can usually, with breath control techniques, remain functional. When I have an asthma attack, I can drive and walk and do everyday tasks, but I can't run, talk for a long time, or do algebra :-). I also become very cranky at people who try to draw me into long conversations. Don't they know that every breath is precious!

Usually, my asthma is provoked by allergies. I inhale a bad thing, say, for example, mold; my body reacts by shutting down the airways. If I move myself to an environment with cleaner air and sit quietly for a while, breathing becomes easier. But I won't be "normal" for another day or two. This is not "all in my head" or "self limiting"; it's documented by lots of expensive tests. But, emotions can certainly contribute to making it worse. As long as I remain calm, I can function well enough to not need help (unless I'm trapped under rubble, in which case, please help me remove the rubble. Inhalers will not be necessary).

People with exercise induced asthma usually normalize a few minutes after they stop the exercise. My brother has this kind of asthma and he uses an inhaler before exercise. He also works out a lot, trying to stretch the lenth of time he can exercise without having an attack. He is definately improving, but it takes work and dedication, not a reliance on medication.

Psychology does play a role in health and non-health, but it is the same role whether the patient has asthma or a broken leg. You wouldn't tell someone with a broken leg that they would get better if their mother stopped being so controlling, would you?

I have an epi pen in my purse, should the need arise, but in two years I've only had one attack that couldn't be solved by moving to an area with cleaner air. That time, I was still functional enough to drive home, hook up my nebulizer, and treat myself.

Still, a paper bag might be a good thing to keep in the FAK, for people who are hyperventilating.

I'm not sure where you're planning on inserting your airways where you'll be needing KY Jelly <img src="/images/graemlins/wink.gif" alt="" /> I've used Lidocaine gel for ET tubes. Nothing for the hard plastic orals (mostly used to protect an ET tube).
Are you a physician? I believe all this requires an Rx. At least it did back when I was a paramedic. You also have shelf life issues. How do you roll over your IV stock with fresh supplies?

I agree with what others have said about the Magills. Used them once in a decade in the back of an ambulance. In desperation, after a drunken patient had tried to swallow a side of beef ... whole. Didn't work. The swallowing OR the Magills! <img src="/images/graemlins/wink.gif" alt="" />

If you personally own one of these, why are you asking first aid advice on this forum? No offense intended, but there are probably only a few of us here who even know what this is and are trained in its use. Either you have significant medical training to use (and own) all this stuff, or you've collected things that you really shouldn't be messing around with without training and experience. Again, no offense intended, but you questions seem odd taken in context with the advanced equipment you apparently own. Please don't tell me you've got a LifePak sitting on your coffee table! <img src="/images/graemlins/wink.gif" alt="" />

That about sums it up; I've also dealt with or seen:

Thermal burns
Frostnip and limited frostbite
Psych. event (patient on psych. meds unknown to trip leaders and not stated on medical history sheet filled out pre-trip wasn't taking them and got a bit unmanageable and belligerent)
Mild HAPE (patient had a more serious episode at higher altitude in the past)

I guess the point is that a big kit really isn't so important. Knowledge is more so, and so is getting patients with serious issues stabilized and evacuated and up the treatment chain.

- Steve (WFR)

Also the more mundane diarrhea and foot blisters.

Bee sting, blisters, assorted twists and sprains, 1 fractured femur, 2 lacerations both requiring stitching, FB in eye, dehydration, slivers, ticks, spider bites, 1 near drowning, ingrown toenail, gout attack. I got to camp a day late for the gunshot.
Dave

Wasn't there personally (was suppose to go though but got called in to work)...a friend of mine (also emergency prep mindset) was rock climbing in The Gunks (New Paltz NY) when someone went off rope and fell 73 feet onto the rocky trail about 100 feet to the side of where my friend was belaying someone. Multiple fractures, Head injury, internal bleed. You'll see it all sooner or later.

Idiot friend of a friend of a friend blew off 4 1/2 fingers and an eye shooting M80s out of a slingshot. That one was fun. Elevation and direct pressure to the artery works great.

Hopefully the KY is for the NPAs that he forgot to list...!



Good question, though I suspect his query was mostly about subdividing his medical loadout. Anyone who's willing to jam wires into their drilled teeth shouldn't be worried about what other people think.

Oh! Ya got me. I totally forgot about the nasal airways. Never used one of those personally, during years and years in the field. If I remember our protocols (it's been several years), I think we still were to use Lidocaine gel for NPA's, but I'm sure KY would work fine too. Certainly protocols like lubrication choice vary from area to area.

Very false. The number of ER visits from excerbations of asthma are legion. While asthma doesn't kill like it used to do, it is a dangerous disease that must be respected and treated.

Saw something simular about 8 years ago at the Gunks. Guy was setting up a top rope while tired after a day of climbing, and went over. Landed on the tril right in front of his son.
They dropped a biner earlier, and father said not top use it anymore because it fell 20 feet. Too bad he didn't think safety when setting the top rope up, and have a safety line.

Thank you, Mr. Glock-a-Roo! Somebody finally got it. The med equipment was just intended as an example, so the intent of the subdivision of the kit would be illustrated. Thanks to all who replied. I especially appreciate the list of injuries encountered in the field.

actually super glue was make by mistake at an eastman chemical plant.............neat accident huh?( i took care of the man whom made it as a patient once)

Oral airways-thats sorta a tricky one. as an alternative to ky, you can you antibiotic ointment (help save space and weight when doubling up or over packing, in some instances unless your comptent in your skill its probably not needed. One trick to pass on it you can use a safety pin to pin the tongue to the bottom lip to help secure an airway in emergent cases-this too saves space/weight when packing light.

medic pete said it......primatine mist is an option to carry. One of the simplest tricks is...if the attack happens to be at night or late evening...........sometimes taking a person out of a stuffy house and get them to breath the cooler night air....can cure a simple attack..........course for every other senario, there are other treatment modalities.