Doc, Ill be the first to admit my PSK first Aid supplies do not an ER make. In reallity it is simply a readily accessable unit to keep little things from putrefying into big things. My equine unit at the ranch gets an almost weekly utilization, yet some items lanquish until expiration ( and are promptly replenished.) So, heres my question. I am on a trail, have a standard first aid and CPR card recently renewed. I have one of the commercially prepared larger units reviewed by Doug. I come across a trauma victim, unconscious, with a medic alert bracelet describing any special needs. There is a G.P. 15 minutes down the trail and I have a handheld to summon a medivac. What do you, the G.P. arriving on scene want me to have in terms of supplies, holding to the maxim of "Do no harm" until your timely arrival? Theres also a fast moving weather front coming in, and I may very well be preparing a shelter for the night as you stabilise the victim. Id like to hear from our Physician in the fine city of Singapore also.

Chris;<br><br>I hope I'm not being presumptous in throwing my 2 cents in here, but when I took my Wilderness First Aid Instructor's ticket in February, the Instructor-Trainer started off by dividing the class into groups and telling each group they had 10 minutes to go through their packs and put together an improvised First Aid kit. Since everyone in the class was a First Aid instructor, there were more commercial First Aid supplies than there were improvised ones; but the two things that nobody thought to provide were a cervical collar and a bedpan. Apparently, hardly any student in Wilderness First Aid thinks of providing those, unless they've taken the course before. <br><br>An excellent book on the subject, IMHO, is the St John Ambulance Official Wilderness First Aid Guide by Wayne Merry. (ISBN 0-7710-8250-9, if you're interested.) That's the official textbook for the Wilderness First Aid courses I'm now qualified to teach, fwiw. If you can get hold of a copy, I'd be very interested to hear your opinion of it, btw.<br><br>Thanks for all the great advice, too.

I will.

One of my more memorable mountain rescues started out as a recreational climb - three couples on an overnight climb near Tucson, AZ. I was just chatting with a guy I had just met about archeology, when we got word of a serious accident up the trail ahead of us. We raced to the scene and arrived, finding a climber who had just suffered serious head injuries - a falling rock had fractured his climbing helmet and left a nasty contusion dead center on his forehead. At that point, the new guy, who had followed us up said, "Don, I didn't tell you what I do for a living. I am an MD and I just finished three years working in an ER." I thought I had died andgone to heaven. Funny thing, none of had a cervical collar in our packs either. We improvised a very acceptable C collar from a foam pad. Improvisation is a key skill in wilderness first aid. You can't carry all the stuff you will need, and even if you do carry it, you will run out when you encounter other than a fairly basic situation.

Chris,<br>I think that there are few things that the average GP would find useful that you would not already have available. Most are neither trained nor familiar with the care of multiply injured patients. In my experience, few physicians are comfortable with out of hospital (new touchy feely term to replace pre-hospital care in EMS circles) emergencies.<br>Unless your setup includes a portable CT scanner and tech as well as a blow-up neurosurgeon, there is little to offer your patient in that environment from a medical standpoint other than basic ABC stuff. I emphasised the importance I placed on a basic (to me) airway kit of laryngoscope and blade, endotracheal tube, and a paralyzing drug and sedative drug that I always have around. Basic drugs that are usefull in the field are benadryl and epinephine, a narcotic analgesic, a local anesthetic, a sedative (valium, versed, propofol, etomidate, etc),an anti-emetic, and a steroid--all injectables. I would not burden myself with ALS drugs: lidocaine, epinaphrine, etc. I would regard a remote area cardiac arrest as a terminal event, just as I would one on a dive boat 35 miles off shore in my back yard. Sounds callous, but I have never heard of a normo-thermic person surviving two or more hours of CPR in any medical or lay literature.<br>From a surgical standpoint, I would want to be able to put in a foley catheter, a chest tube, or a surgical airway. It simply is not reasonable to think that you can carry two or three gallons of IV fluid necessary to rescuscitate a trauma patient who really needs blood and a surgeon, so I would rely on a heparin or saline lock. There is some current enthusiasm for the use of 3% saline in lieu of 0.9% saline or lactated ringers for the EARLY resuscitation of an injured patient. I really don't have a well informed opinion about that yet.<br>It really would not take a lot to make me happy.<br>If anyone wants to have the benefit of an acquaintance of mine's hard work on the subject, look at Dr Keith Conover's site for more information: www.pitt.edu/~kconover/. <br>I think that this may generate some interesting discussion.

Doc, I just skimmed his site. There is much worthwhile there.

Chris<br>Keith lives and breathes wilderness medicine and cave rescue. His wilderness medical stuff is outstanding.<br>Jeff<br>

Sorry, been busy at work and have just checked in.<br><br>As the G.P. if I have been informed of an unconscious trauma victim, I would take the responsibility of bringing all the required equipment IVs / truama bag / fluids and medication. Being ATLS and ACLS trained helps too. As the first aider on the scene, just like beachdoc said, the best you can do is basic ABC stuff. Check and maintain airway, assist breathing if necessary and check and maintain circulation (including stopping any obvious bleeding).<br>In any trauma victim, particular attention has to be paid to protecting the cervical spine and airway. SO don't move the victim unless you can move him in one piece to protect the spine (unless of course the position he is in puts him in risk of further injury )<br><br>In terms of equipment of the first aider:<br>With the larger trauma kit you carry I doubt if an oral or nasal airway is provided. Max is a CPR mouthpiece and mask. That's important for keeping him alive till help arrives.<br><br>First aid supplies to cover any open wounds / bleeding points would be important as well.<br><br>Beyond that you've done more than anyone else besides a doctor can do. Even with my trauma and resusitation equipment, I am also limited. I would need the equipment and expertise in the ER to properly manage the patient. At the most I would be able to stabilise the cervical spine / start an intravenous infusion / catherise and if really necessary, put in a chest tube ( but field conditions are hardly the ideal place to do it).<br><br>And if a storm front is coming up, a shelter would be much appreciated by both doctor and patient till the medivac (helicopter / ambulance arrives to bring him to a better facility.<br><br>Even in my Batallion Casualty Station in my armored unit (that is with 2 vehicles full of equipment), there is acutally very little we can do with trauma victim but to resuscitate, stabilize and evacuate.<br><br>So in all actuality, the most important factors are :<br>1. Training - Do the ABCs / Do no harm<br>2. Call for medical help<br>3. A first aid kit is only just that - First Aid. Sure it can stabilize some fractures / stop bleeding etc but you will need further help in a trauma.<br>There is a huge difference in a first aid kit and a trauma kit, but in a survival situation, a simple first aid kit is better than nothing at all. So in terms of equipment , barring you carrying a trauma bag, the most important 'pieces of equipment' you could have are proper training and a means of comms to summon medivac.<br><br>Just my 2 cents worth.

Trusbox,beachdoc-thanks for the insights. My greatest fear getting injured are well meaning people that push their skills and supplies. The "surgical kits" pushed by vendors with battlefield surgery manuals a prime example. I was bitten on two occasions by Pacific Diamondback Rattlesnakes ( both in the ankle or lower leg.) Both were "dry" bites ( no envenomation) and I merely had the wound cleaned and a tetanous shot. My greatest fear was the maniacs with Cutter snake bite kits trying to put a tourniquet on, slash Xs with these ancient razors and suck the wound. That and the idiots trying to kill the poor snakes to I.D. them while I sat in the jeep. It wasn't their fault I was focused on dentalium shell beads and not what was beyond my nose ;O)

This site is a huge source of information!<br>I just saw it, but I'm overhelmed for the amount of informations :)<br><br>thanks,<br>mac