Gentlemen,

I am currently in EMT-B training. This will be complete in May, then I will go into EMT-I class during the summer session. At that point I plan to work part-time for my county for a good while before considering pursuit of EMT-P.

As I'm going through my training I'm constantly evaluating the gear & techniques to apply towards wilderness/remote settings, as opposed to well-stocked "scoop & go to the hospital" runs.

Based on your experiences, what are some recommendations for effective yet lightweight/minimum bulk BLS gear where you might sacrifice some utility for packability? IE I'm thinking you couldn't justify toting a BVM in a bugout bag, but a pocketmask would be OK... or would you go to a microshield? See what I mean?

Another example, I happened across [this link] for a lightweight/low-bulk BP cuff & gauge. What do you think of it?

In general, I'm interested in your recommendations for BLS gear that while not ideal in an ambulance-supplied situation, would be acceptable when all the gear is carried on your back and every ounce counts.

Thanks!

I became an EMT-1 in 1978, spent almost all of my time treating victims of auto accidents. Of all the goodies in my state-issued kit, the things I used most were 4x4's, Cling (or the equiv), oropharyngeal airways, pocket masks, hard C-collars, and oxygen. Lots of oxygen. BP cuff without stethoscope (too noisy on the side of I-5, went for systolic by palpation). Almost never used big trama pads, air splints (before they took them out of the kits), stuff like that.

Obviously an O2 bottle isn't going to fit into your lightweight kit, so I think that if I was getting down to the lightweight nitty gritty, I would carry 4x4's, cling, a pocket mask (with one way valve or course), airways, one triangular bandage, and maybe a Sam splint and a couple of sanitary napkins. A BP cuff if you want, but at the EMT level knowing the BP is not going to help you all that much, 'cuz you can't fix whatever is broken. Paramedics and docs love to have a BP history, but way back in the boonies it isn't going to help all that much, because you probably won't have a paramedic to pass that info to for a long time, and by then the victim will probably be stable, better, or dead...

BLS gear can be categorized into trauma, medical and airway equipment. I’m leaving out OB kit since I believe you can improvise.

Lets start with medical since that is simple. You will have on you: glucose, epi pen, baby aspirin, charcoal, albuterol and maybe vomit inducing syrup. All together that’s a small pouch that doesn’t weight much. There are not many substitutions you can do there but some items such as aspirin can have double purpose. If you are doing above on your own I would include stuff such as water gel, more pills, antibiotic ointments etc etc. If you are operating under your county you have to follow your county’s protocols and off line medical directions.

Trauma:
Your trauma bag should consist of cravats and klings. 4 inch wide would be preferable since they can be cut to size. Few one inch tapes (or some extra duct tape) and off course rolled lightweight SAM splints. 4by4s for coverage and 5by9s for absorption.

C Spine collars of all sizes can be substituted with one that can be adjusted to person’s neck or you can cut one out of the SAM splint. Peroxide will be good infection control fluid and optional cold pack for swelling reducing but many people carry ice in their coolers. If you don’t want to carry a head bed try using rolled up clothing to stabilize the head.

Think about bringing a burn sheet or if you don’t want to carry one get some burn water gel. For cold emergencies instead of full heat pack bring heat patches, they are small and if you get cold you can smack them in your boots or gloves.

Also if you want to double use items: use a towel or blanket to form a horse shoe splint for ankle elbow fractions. Don’t carry any splints and hope for having a tree nearby (or a wooden fence)

Airway:
Airway management is tricky. OPAs are lightweight and you can get and carry a basic set. I would prefer pocket mask over face shield. Now I tell you why I would want a BVM: I can deliver fuller blows with better quality air, easier and longer… Is it worth the space? For me it is. Throw away nasal cannula, NPAs and baby/infants BVM.

Get a mannequin and do the CPR on him for as long as you can. Than do the same with BVM. BVM can be folded down and soft trauma supplies can be placed in and around the voids. Pocket mask can be as well used separately.

BP cuff you showed was good enough. If you don’t want a scope you can get BP by palp.

Now if you have time and resources here’s a list of equipment that would blow you socks off:

New Carbo tanks which weight nothing but store much more that traditional tanks. Or new Access AED which is as big as small paperback. Same goes for foldable long boards.

Stuff you should have already on you would be a flashlight, knife, notebook and watch… Substitute your shears with Bench made Rescue Hook.

Just remember that most likely if something happens you are going to be a medical authority on the scene. You are going to be very much in charge. In the wilderness medicine it is easy to improvise. But with all the improvisation going on, it is also very easy to forget about well being of the patient, infection control and basic evaluations. Just because you lack physical resources it doesn’t mean you have to downsize your mental resources. Treat you patient as you were wearing your uniform, as if you would like somebody to treat you mon or dad, treat them with dignity and respect as you were on the real dispatched call. Go thru your ABCs, AVPUs, CUPS, SAMPLEs, etc etc… Constantly revaluate and asses. Once you started medical care, you are it to the end or until patient was transferred. Emergency medicine fixes symptoms but it doesn’t fix problems. Just saying… since I’ve seen an “EMT” giving guy two aspirins on the trail and leaving him. How do you leave somebody with 34R and 140P who states that has a radiating pain down his arm and a previous arrest?

Matt

Go to the Wilderness Medical Associates (WMA) web site: http://www.wildmed.com/main.html and check out their courses. Built in to the courses are sections on equipment selection for wilderness conditions. I have had the opportunity to take a number of courses from them at one of the EMS conferences. The instructors were great and did cover the importance of selecting EMS equipment for remote areas and had most of the products on hand for us to play with and evaluate. The instructors were Rick Lipke of Conterra http://conterrastore.com/catalog.lasso and wrote the Technical Rescue Riggers Guide http://conterrastore.com/action.lasso?-d...se=detail.lasso and Jim Morrissey of WMA who wrote The Wilderness Medical Associates Field Guide http://conterrastore.com/action.lasso?-d...se=detail.lasso

Pete

Excellent feedback, guys. Your experience and professionalism shows. I truly appreciate it.

Good point on sticking with ABC, SAMPLE, etc. Do you guys know if anyone publishes SOAP/SAMPLE forms on waterproof paper (like Rite-In-The-Rain)? I was thinking it would be good to include a few sheets like that in the kit, along w/ a Space Pen cartridge. Conterra has the forms but they don't seem to be on waterproof stock.

Great point on the BVM, Matt. It's exactly that kind of "been there, done that" wisdom I'm looking for. I don't have any field EMS experience yet, and all I know at this point is just book-learning. I am only too ready to listen to the veterans who know what's what. I found a compact BVM [here] that looks interesting.

How about tracheal tubes? Here in S. Carolina, even EMT-B's are certified to do intubation. I ask regarding the "wilderness" angle because I do a lot of rockclimbing, so you can imagine the obvious MOI involved, and if someone gets seriously crunched on the rock, interrupted breathing is highly probable. While tubes that require visualization would mandate a laryngoscope, how about CombiTubes? IIRC there are some other no-visualization tubes out there too. However, I'm talking out of my element here.

Intubation is made simple for NYC medics. I do any ALS skills outside my medical direction (aka not on the job) most likely I can kiss my certification good bye.

For intubation patient needs to be unconcious or sedated. You are lucky if he is the first case. That the tube goes in, somebody bags, you heal. What if they are in level 9 pain but negative LOC? You need to start IV and give them up to 20 mg of Diazepam or up to 5 mg of Midazolam. Where are you going to get that for your private portable kit?

ALS skills sound great in the field but they need much longer follow up, they are riskier and require more sophisticated equipment. Most likely any field jobs you get will be a trauma of enovironmental emergency. That should be an area of concetration. You friend who fell down needs hot lights and cold steel not medicine. He needs clear ABCs, long board, cspine and transport.

Matt

One of the rude facts of wilderness medicine is that folks who need rapid transport and full medical facilities will most likely not make it. If you spend all your equip on them you waste it. If there is a chance of medivac and you have already spoken with the fly-boys then you should do all you can to help. OTOH, if you are relying on your signal mirror to attract attention and are at the bottom of a ravine next to the poor bloke who just broke his neck and is gasping out his last or worse not breathing but looking at you conscious and in desperate pain - sorry, he ain't gonna make it. If you are in the backcountry time to definitive medical care will be measured in hours not minutes and sometimes in days. Handiling bleeding and broken extremities is possible and should be attempted, You may even be able to handle a heart attack or stroke if God is with you and you can get them through the accute episode with CPR (for the HA ). Damaged spine or neck is very likely to be fatal and interruption of any of the ABC's is likely to be likewise fatal.

For wilderness medicine be prepared to stop cap, venous, aterieal bleeding, Be prepared to stabilize broken bones, Be prepared to make the patient comfortable and most importantly be prepared to communicate. If you carry a long board, cSpine collar, AED, intubation kit, etc but can't call in the helo you are not much more likely to bring out a live patient than if you were only carrying a bandana and a bottle of aspirin. If you can call in the medivac to an exact GPS coordinate then all of the ALS / BLS stuff becomes useful. Remember, all of this gear and training is designed to stabilize the patient during the "golden hour" until they can recieve definitive medical attention. If that medical attention is days away you aren't going to be able to substitute for it. That hour is all your patient has.

You can treat hypo - hyper thermia, snow blindness, altitude sickness, sun burn, minor - major bleeding, broken legs & arms, concusions, even strokes with patience, rest, warmth, shade, and bandannas. Some sterile 4X4 and compression bandages and maybe a sam splint would be helpful but all can be improvised. The one thing that can't be improvised that would make a difference is the transport. If you can't call in the cavalry then you aren't going to get the patient to the help that they need in time - period.

Massive trauma, or Major medical conditions are fatal in the back-country.

Got it. Thanks guys.

As a followup to People with bad injuries and long transport times die in the back country also applies to in-town.

They may have not said it yet in your EMT class but not every patient is going to make it. Some patients will die regardless of how good your skill, how quick your transport, and how much equipment and supplies you use. This is really hard to learn. One of the reasons we go to school is to learn how to help and heal.

We don't hear or don't accept that we cannot cure all ills. You will have patients that are dead and stay dead. You will have patients near death and you cannot bring them back. It you stay in medicine long enough you will have a patient die.

Back country injuries are more likely to kill patients because of the severity and long transport times. Focus on the basic care and comfort the seriously injuried.

Matt can you elaborate on the Carbo O2 tanks, just for general interest? I've never heard of them and haven't seen much fruit from a Google search.