Basic, basic 1st aid for minor booboos

Doug lists both Neosporin and Betadine in his basic 1st aid kit...I have picked up both, but not sure which should be used for what. I use the neosporin on booboos before bandaging them up. I also have alcohol wipes for cleaning wounds.<br><br>Also, where can I find Martin's burn cream, I can't find it any where.<br><br>A buddy at work told me not to use that hand sanitizer gel for cleaning wounds, is this true?<br><br>Looking to take a red cross class...I took a 1st aid/CPR class at work, but it ended up being a refresher, but not an intro. Go easy on me, I'm new to this stuff.

Hi:<br><br>I can't comment on the Neosporin but back in my EMS days we were told by the ER doctors to use Betadine and never alcohol to treat wounds and prepare IV sites.<br><br>The reason given is that the alcohol would damage exposed nerves and underlying skin tissue while the Betadine would not. <br><br>Additionally, alcohol can be accidently passed into the blood stream if it is used to clean an IV site prior to the insertion of the catheter. This can cause subsequent blood tests to indicate that the patient has consumed alcohol. <br><br>I realize the second point is beyond the realm of first aid but it is food for thought. Anyway, the point I am trying to make is that we should avoid applying alcohol to wounds if another treatment is available.<br><br><br>Chris<br>

I agree. IV prep was the main reason I carried betadine; I guess I just carry it out of habit now, as I rarely ever carry IVs anymore - the trips the last few years don't really call for that level of preparedness I think of it more as a prep for invasion (IV, surgery, etc.) than anything else.<br><br>In my experiences, no matter what I've done first aid-wise, civilian ER docs ignore you, assume you're a complete incompetent idiot, and re-cleanse a wound even if that is traumatic to the tissue. One of my boys has a hell of a scar as a result of that - wrist to elbow. My experiences with Army and Air Force docs have been much more positive, but then, they knew me personally in most cases. I guess I understand why the ER docs do what they do.<br><br>There are a few dissenters regarding betadine as a wound cleansing agent from what I've read - not strong dissentions. Sterile water with or without a surficant (soap/detergent) has been what I've seem used in ERs to cleanse wounds.<br><br>Alcohol wipes could be used as a drying agent on minor poison ivy type irritations, I suppose, altho it might also spread the oils - I'm not sure.<br><br>Neosporin debates go back and forth. I take middle ground - I use it on minor wounds, but with twice daily airings. My guess is that it makes little difference either way if the wound was cleansed and the patient is otherwise healthy, but I'm not educated in that area, so my opinion is just that - an opinion.

Martin's is sold through George Townsends, listed in the retailers section for equipment.

It is highly doubtful that the little bit of alcohol on a alcohol pad, prior to starting an IV would cause the blood alcohol to elevate. Most IV start packs in fact have alcohol pads as well as Betadyne to prep a site for an IV. Both have potential uses. Generally alcohol by itself does little to disinfect a site/wound, the contact time to kill various bacteria can be quite long. Generally we use the alcohol pad to remove gross dirt and body oils, the Betadyne is then used to actually disinfect the site. Keep in mind some individuals have iodine allergies (shell fish alleries will give you a clue) and Betadyne should not be used. Beachdoc any thoughts? Pete

An often ovdrlooked expedient flush is contact lens saline solution. It is sterile and can be squeezed for a jet effect or poured slowly.

Pete:<br><br>I thought that as well when I heard it. Then our medical control MD produced a study which showed just that.<br><br>This was about eight years ago but it stuck in my mind. Shortly thereafter the hospital stopped buying alcohol prep pads and only stocked Betadine wipes.<br><br>BTW: Betadine stains do not come out of white polyester uniforms :)<br><br><br>Chris

I would like to see the study, keep in mind 70% isopropl alcohol will evaporate and even if using a large bore cath. like a 14g the i.d. is extremely small. The introduction of enough alcohol by this method, elevating blood alcohol levels which are detectable just is not logical. Pete

A recent trip to the ER for a minor would taught me a few things. Betadine is used only before an incision is made or an IV is used. Unless the wound is already infected, nothing is used to clense the would but saline solution. The ER nurses seem to think that Neosporin will reduce scarring, but they don't make any claims to its use as an antiseptic. And the one that surprised me was : Only cover the wound if it is prone to getting contaminated. It's OK to have those grusome stitches showing so long as you're not outside digging ditches or something. The more time it spends exposed (but cleansed with saline) the faster and better it will heal. Please note that this comes from the ER nurses and not the docs. I'm not sure why the doctors are so 'hush hush' about proper treatment. Perhaps it's for the return buisiness?<br><br>

I approach this from several angles. As an urban paramedic, I generally deal with severely injured patients; my main concerns are ensuring an adequate airway and circulation and dealing with major life threatening injuries. Generally, with lacerations my main concern is controlling bleeding. We also, would flush wounds contaminated with dirt or chemicals with just sterile saline and cover with sterile dressings. Transport time is generally short. However, in the wilderness setting, where I may have to treat a patient for an extended period of time, the approach is a little different. While still concerned with major life threating injuries, we also may an attempt to clean wounds more thoroughly. I also make trips to rural Ecuador to provide disaster preparedness and response training; we also provide direct patient care. In these cases we treat wounds, generally on the feet and depending on the severity aggressively, because of the environment, lack of clean water and follow-up medical care. Generally cleaning with Povidone-iodine scrub, triple antibiotic ointment, sterile dressings and occasionally, oral antibiotics. Pete

Pete:<br><br>I went through my old course material but was unable to find the specific info (Its been about 12 years).<br><br>As I recall, the study was performed because a patient had blood drawn and the resulting analysis indicated alcohol in the bloodstream. It was then determined that the patient had not consumed any alcohol for an extended period prior to the draw.<br><br>The hypothesis that was tested and subsequently proven was that the the cathether had been contaminated with the isopropyl alcohol during insertion. This, in turn, caused the incorrect results<br><br>I believe, but I am not 100% sure, that the original patient took legal action against the involved hospital because of the erroneous results.<br><br>I remember this study because I was part way through my EMT-I training when our hospital suddenly mandated the use of Betadine for all IV starts.<br><br>

In theory, I guess it would be possible to contaminate the blood collection tube. Our jurisdiction has been using isopropyl alcohol pads for starting IV’s for many years, even if the blood draw is used for drug/alcohol levels. Maybe it is one of those urban legends that get started based upon one study or observation. Pete

hypothetical guessing that might explain the apparent volume contradiction:<br><br>1) The needle or catheter that was used to sample the blood alcohol level was directly contaminated with pure isopropyl during insertion and sampling. <br>combined with<br>2) isopropyl alcohol reacts more strongly by a factor of 10 with whatever reagent is used to test for ethanol levels in the blood.<br><br>If either or both of the guesses is correct then the concern with the minute amounts of isopropyl in an alcohol swab might make for an innaccurate reading of blood alcohol levels in a large individual.

OK you guys are starting to get a little too technical for me :)<br><br>So in short, should I ditch my alcohol wipes for some Betadine instead?<br><br>Also, how do you organize your 1st aid kit? There are loose items floating around the tiny pouchie everywhere!!! Aaauggh! I put them in plastic baggies within the 1st aid pouch, but still a mess and a pain to get to what I need.<br><br>I may pick up some of those jumbo paper clips (the black clamps with the metal rings) and hold bandage type-X, bandage type-Y, etc. together with them.

If you have room, carry both. The alcohol pads are great for removing dirt and body oils (around the wound) and finish with the Betadine . I personally like the use of Benzalkonium Choride wound cleansing pads (from Bound Tree http://www.boundtree.com/home.asp) They are $2.50 for a box of 100. I am not sure you should ask me about organizing into kits, I probably have far too many “medical kits” around the house and vehicles. Many of the companies that sell EMS equipment have great empty kits to which you can add your own supplies. I have made up kits to supply to Red Cross, Civil Defense and Fire departments in Ecuador using backpacks I picked up at a Eddie Bauer outlet store for under $10.00 and bought zippered pencil pouches, made of clear vinyl on one side so you can see what is in the pouch and nylon on the other side for $1.00 at our local dollar store. There are both expensive and cheap options, but the more organized and familiar with how you packed your gear the easier it to deal with an emergency. Remember all these products have a shelf life on should be rotated on a regular basis. Pete

Roger that Pete, I will carry both.<br><br>So what is the neosporin for? Does it help wounds heal faster? Prevent Bad Things from growing on your boo boo? Should I just save the space and ditch it?

Neosporin, is the brand name for an antibiotic ointment, generic or store brands should be just as effective. The Bound Tree (or anyone of the other ems suppliers should work as well) web site likely has their own brand, cheaper. One could argue either way if it is worth the space or not. If the wound is cleaned well, in the short run the ointment may not be necessary. If medical care is not available in a reasonable amount of time, a very dirty wound or if the person has some other type of medical problem (like diabetes) the ointment may prevent an infection. I would not tie up space in a PSK, but if you have an additional medical kit/bag and you have the space, it could not hurt to include some packages. Keep in mind they will have an expiration date.

Pete,<br><br>I had a few packs of the smaller antibiotics, but they burst in my pocket. Not good I like the Neosporin tubes, so I referred it as that though I shouldn't have (like Kleenex).<br><br>I guess I'll leave it behind. Kind of bulky, but better than those little bursting ketchup packets.<br><br>Finally, do I need those rolls of tape and gauzes? I use the gauzes for cleaning, but otherwise don't know what else to do with them.

An interesting link: everything you ever wanted to know about Betadine™. Stain info is #6, most of the way down. Right at the top it also mentions that it's formulated to be timed release, who knew!<br><br>http://www.woundcare.org/newsvol2n2/ar1.htm<br><br>And if you can stand one more EMT(B, Wilderness) opinion on this topic, it's my understanding that alcohol is fine for cleaning INTACT skin. Less optimal on mucus membranes and not at all good for any open wounds. Its lysing action kills OUR exposed cells, including nerve cells as mentioned above, just as readily as it lyses microbes.<br><br>With regard to Betadine™ application, I was taught to dilute it to the color of extremely strong tea (slightly transluscent through a small quantity) and use an irrigation syringe to rinse wounds under a bit of pressure. The advantages of this are better flushing and debriding of debris and less irritation and stinging from full-strength Betadine™ solutions and it goes little farther. And you can use even somewhat non-sterile water as long as it's clear-running with no debris, just make the dilution a bit stronger.<br><br>Also if you're gearing up for extended wound care, I'd recommend taking some triple antibiotic of some type after all; if you're daytripping leave it. Betadine™ is good for flushing and short term antiseptic use but antibiotic jelly stays put better long term and somewhat physically excludes recontamination and resists washing off by sweat or in water environments when properly covered and dressed. Plus when you have a leg full of road rash, the mild anesthetic they add to some of the triple antibiotic formulations feels really good!

Irrigation of a wound with plain water (or sterile saline if you want to be fancy) is the best course of action......dilution is the solution to pollution.<br>Chris is correct, alcohol and peroxide are quite injurious to tissue and should not be applied to a wound. <br>Betadine solution is the least toxic antiseptic to use on wounds that I am familiar with. I prefer not to use neosporin in my practice and use plain bacitracin ointment simply because a large number of people are allergic to the neomycin in neosporin

Pete is right. Alcohol pads really remove dirt and debri from the skin and give everyone a false sense of security. I understand that it takes 20 minutes of direct contact with alcohol to kill bacteria.<br>Betadine is a superior antiseptic.

Any time that a legal blood alcohol is drawn, a non-alcoholic antiseptic must be used to avoid the defense attorney's complaint that his client's alcohol level was affected by the antiseptic used as a skin prep.

A second thought just came to me, tying your post to an earlier thread regarding the effectiveness of potasium permanganate in one's PSK. <br><br>In a wilderness situation, sterile water is not likely to be readily available, but there are a few options.<br><br>1. Untreated drinking water from a water bottle, perhaps from a well.<br>2. Treated water with potasium permanganate<br>3. treated water with iodine (potable Aqua)<br>4. Treated water with Chlorine tablets.<br>5. Betatdine wipes.<br><br>Given these options how would you rank them in order of preference? Or which, if any, would strike fro the list completely?

Bill<br>I have no experience with potassium permanganate other than the crystals burn skin. I can think of no advantage in using it over iodine for water purification. Iodine is more efficacious against parasites than chlorine tablets, which is why iodine is used by the military.<br>My preference in your situatio would be water treated with iodine or chlorine tablets followed by betadine wipes. I would not use water from a bottle, as the organisms from the human mouth cause VERY interesting and severe wound infections.

In addition to cleaning a wound, sterile gauze pads can and should be used to control bleeding; the net-like weave will help blood clot stemming blood flow. Keep in mind for major bleeding, do not remove the gauze to look at the wound, this just allows the bleeding to resume, just keep adding gauze pads. With gauze pads wrapped with a snug (not overly tight) roller gauze bandage, direct pressure and elevation of the affected limb, generally most bleeding can be controlled. Occasionally, it may be necessary to apply direct pressure to a pressure point between the wound and the heart. A tourniquet is a last resort and is ALMOST NEVER needed if good direct pressure is applied. The use of a tourniquet should be applied by individuals trained to do so, as it can result in the lost of the limb and even death.

Thanks for the reply. The more potasium permanganate is discussed on the list the less and less important it seems to be, except perhaps as a fungucide. Doug, you have it listed in your PSK. Have you ever used it?<br><br>Beach Do, as a practicle matter, if I'm hiking and someone gets a bad cut, I am not likely to have a bottle of sterile water. If I have previously treated my drinking water with Iodine, it's quite likely that my mouth have been on the nozzle, as you indicated, that would be bad.<br><br>Treatment of any water will take approx. 30 minutes. So it seems that unless you have betadine wipes that it would be best to let the blood flow a bit (assuming its not a massive, life threatening laceration, and then bandage. <br><br>Once the bleeding has stopped, you could clean up with sterile water, but by then the effect may be minimal as the blood has already clotted and formed a scab. Any nasties would already be in the wound and/or blood stream, or bared from entry by the scab, correct?<br><br>(I wouls still clean the area to prevent future infections should the scab open up, though).

Bill,<br><br>It would seem to me that your post assumes that you do not have a first aid kit, so this may be inappropriate, but most good first aid kits include a bottle of eye wash, which, I assume would be acceptable for wound irrigation. I don't know what the medical opinion is on this, but I have used them as such a few times with no subsequent infection problems.<br><br>Take care,<br><br>Andy

Billy<br>The way that I would approach any wound in a first aid environment would be to protect it from further contamination. I would irrigate the wound with whatever clean water that I had available IF there was visible gross contamination and physically remove it if necessary. Then I would apply a sterile dressing, or in the absence of that, I would put the cleanest thing that I have on it.<br>I think that there is probably too much concern on this site, especially with regard to daily carry PSK's, to include bandaids and sterile dressings.<br>I would use sterile dressings if I had a first aid kit, otherwise, I would follow the example of the Saturday matinee heroines and rip up some thing (Not my good petticoat!) and fashion a dressing and bandage.

Thanks.<br><br>I keep a first aid kit in my pack. Plus I have a smaller version in my fanny pack for short day hikes. This is separate from my PSK. For minor cuts, I'm sure betadine and sterile bandages are easy enough to apply. My thoughts were to how to react to serious cut in the wild. I have had first aid training plus a few real life experiences, but none that I would catagorize as a life threatening injury. <br><br>We have often preached on this forum that one should practice skills before we are forced to rely upon them. Wilderness emergency medicine is an area where I feel I have a weekness. Treatment and the decision processes in a survival situation are different from normal circumstances. In Scouts, we are taught that first aid is temporary aid until profession care can be given. Most of the techniques infer that help is relatively close at hand. And for the most part, that's true. But not always.<br><br>I think I was trying to imagine possible scenarios in my head, along with the knowledge that I have some gear in my first aid kit and PSK. What should I do? What should I use?<br><br>I agree, grab the petticoat (the every day one) and apply direct preasure to stop the bleeding. Once the bleeding is under control, I would have to decide what to do. If care was a few hours or less away, wait for profession care and leave the wound wrapped, even if it's not a sterile bandage. But if help is a day or more away, should I consider cleaning the wound. And, if so, with what?<br><br>As I write this, I now realized that I'll have sufficient time to treat water either by boiling and cooling or using iodine tablets. Hmmm... I think I had better place one of those wilderness first aid books that have been recommended on my birthday list!<br>

An experience yesterday reopened my eyes to field care. We located a lost mare in the Sespe ( wilderness area and home to the Condor recovery program.) She had suffered a massive facial wound with copious bleeding and associated dehydration. First Aid consisted of quickly staunching blood flow with my filthy silk bandanna and a crude rehydration via my 21/2 gallon G.I. canteen and tubing into the anal cavity. We then "ponied" the mare to a designated campground where a DVM met us via cellphone ( this time we had one!) The horse was "jugged" ( given IV fluids) ,mildly sedated for pain and transported ASAP. Only then did the actual wound get examined. We found puncture wounds from a mountain lion had damaged the nasal process and eye orbit. Most animal owners see a tissue wound and slop quarts of ointments on the wound, call the DVM and then watch him/her slowly, often painfully have to remove it all, again after often having to deal with other life threatening issues. I relearned the basics; keep it simple and get to qualified help ASAP.

Willie<br>I think that there is a significant issues in question. First, what is a reasonable level of training to undergo to feel comfortable to provide emergency care. What equipment is it reasonable for a prepared layman to carry with him on an outing, and what are likely injuries to expect in a remote setting.<br><br>You mentioned the wilderness EMT program. The wilderness EMT program is an advanced medical program that advocates reduction of dislocations, advanced wound care, and use of medications that fall outside of the realm of the "usual" paramedic. There are many states that would not allow these treatments to be applied by a non-licensed practitioner.<br><br>I think for the average weekend "explorer" a basic red cross course in first aid is adequate. I would think that the majority of injuries can be handled with basic first aid and possibly external assistance in evacuation.<br><br>For a scout leader or someone with comperable responsibility for others, an EMT course might be appropriate. However, EMT courses focus on motor vehicle trauma with an emphasis on spinal immobilization and cardiac emergencies which are the "bread and butter" of an EMS system. Much of the equipment used in EMT programs is not available down in the boondocks.<br><br>As you and I have discussed previously, if I were approached by a layman planning a trip to the Boundary Waters Canoe Area, I would consider the inclusion of antibiotics; stuff for nausea, vomitting, and diarrhea; something for little pain and big pain; injectable corticosteroids; something for eye injuries and infections; and so on. I do the same for cruising sailors now in my practice.<br><br>How much of this stuff do you (1) want to carry and (2) are you REALLY gonna need on a weekend trip? What is the risk to the patient if they don't receive "advanced" treatment? <br><br>Responding to the question that you raised regarding wound care, there is no emergency in the treatment of a major soft-tissue wound. When a doctor is confronted with a laceration that occurred longer than eight hours ago or is heavily contaminated, appropriate treatment is to pack the wound with sterile gauze (dry or soaked with sterile saline or a dilute solution of betadine or clorox). The packing is changed daily for three days. If there is no infection after three days, the wound can be sutured with no increase in scarring and a far lower risk of infection. In the situation that you describe, there is no rush for definitive treatment.

Thnaks for the reality check! I guess I was guilty of "over analyzing." <br><br>With regards to the weekend warrior on scout trips. I am not authorized to administer any medication other than non-asperin for pain releif. And that's with the express written authorization from the parent on each trip's permission slip. So any additional meds I carry would be for myself only.<br><br>Most outings are near enough to civilization that we're usually only hiurs away from help. That would usually be over-night at worse. However, there are times when that could be prolonged if we were to get lost and/or use poor judgement and travel away from where we're expected.<br><br>Some of our outings would put us several days away from care, such as te Boundary Waters trip. This would be the type of trip where I'd be most concerned if something went terribly wrong. I have heard stories of paddlers who misuses a hatchet and hacked their legs instead of fire wood. Or one adult leader who went into shock after using an undluted DEET insect replelent. So even the layman may be faced with a prolonged emegency situation where propping up the feet and keep warm until help arrives is not sufficient. This type of scenario is not covered in Red Cros Training, at least it asn't many years ago when I took it. (That statement alone should send up a flag that I need to retake the course )

Actually, there are some BSA requirements - wisely so, I think - for persons with advanced training to accompany activities that take Crews/Scouts farther away from emergency responders, just as there are requirements for some advanced capabilities for activities with "higher risks" - for example, climbing. No need to go into details here - Willie, if you would like to contact me via email sometime, I can pass on what I know regarding those kinds of requirements and then - if you like - we can discuss those particulars here.<br><br>If you're taking a Boundary waters trip through the Charles Sommers Canoe Base, you're going to be covered by the staff and the resources the base has, even in remote areas. If your Troop is doing it on thier own or via some other outfitter, you may or may not be required to add some trained capability to your adult leadership on the trip - particulars of the trip will dictate that. A peak-bagging trip into a remote wilderness area may or may not require similar capabilities, again depending on how "far" away (time-wise) are the emergency responders. The requirements seem to be based on good sense.<br><br>Hope this helps.<br><br>Scouter Tom

Chris -<br><br>Sounds like you did a great job - hope the mare heals up OK. Is it just me, or was that a pretty ambitious cougar? I've laid eyeballs on them a few times and see the scat frequently (NOT here in Illinois, Willie!) - except for 3 deer kills I found at various times, seemed like they mostly were eating bunnies and birds (and the occasional dog if I understood the scat correctly). I only lived in cougar country a couple of years, so most of my sightings have been incidental to other "business" - I'm curious what you make of the attempt to take down a horse.<br><br>One quick story: Once upon a time... We came across a freshly cougar-killed mule deer - night before. Set up a dry camp in a natural "blind" in a prevailing downwind direction about 100 meters away, hoping to catch a glimpse. Should have stayed up all night; gave up about 1/2 hour after moonset. Heard nothing, but next morning - deer was gone. A few drag marks, then just splay-footed pug marks. Tracked it about 1/2 mile up to higher ground - quite an outpost - where we found the carcass - now minus the meat on a ham - stashed up in a scruffy conifer - I mean, UP a tree. Must have tossed the carcass "over its shoulder" and walked off - and we never saw anyplace where it touched ground, other than an occasional scrape (dangling hoof, we assumed). Strong bugger!

Tom, The couger was a younger juvenile and underweight. We found the poor creature with her head kicked in by the mare. She was desperate! California passed legislation giving them total protection. Now we have gone from unsportsmanlike hunting to overpopulation. The Sespe is also the dumping ground for problem park bears. So; problem bears, starving lions, marijuana farms with booby traps, lost cattle and hikers and neophyte nimrods shooting at anything in sight make for a great field test of gear!

Must have been terribly hungry to take on a horse. Plus I imagine the dehydrated horse was in a weakened state and being a domesticated animal, must have seemed to be a viable target for the cougar.<br><br>re: Illinois. They were once indigenous to Illinois where they were also called Pumas [color:green](Puma concolor, Linnaeus, 1771 - a.k.a. Mountain Lion & Catamount)</font color=green>. But they are extirpated from Illinois now, which is a fancy word meaning they don't live in this area anymore. There still is a species of large cat in our state, the Bobcat, more correctly called the Lynx [color:green](Lynx rufus, Schreber, 1777 - a.k.a. Bobcat)</font color=green>. But it's on our state-threatened list.<br>

Beachdoc:<br>I appreciate your "to the point" medical perspective. I've learned to "underdo it" if at all possible. In October I was with my buddies high and far away.. on a horseback trip in Montana. Two of the guys are physicians, and I'm a gear/gadget freak. So our medical kit(s) would have put a MASH hospital to shame. <br> BUT... when one of the guys had a disagreement with his horse ending in being launched face first into a tree and causing a 5" lac. across his r.eyebrow and lid, I thought we'd be able to able to use all the neat stuff we were carrying. Didn't happen: the OBGYN looked at the wound and stated "not my end". The Opthalmologist opined that he couldn't do much without his Laser.... but used a bottle of visine one of us had to wash the big chunks of tree out of the guy's eye. Then he cut some butterflies out of duct tape, closed the lac., and we went on. <br>Today... not a scar. I'm dumping all of my firstaid supplies out in favor of a bottle of visine and a roll of duct tape.

Your minimalist approach strikes me as a pinch extreme!<br>

You're right Doc... but it's the most I can get precertified<br>by the Managed Care case manager... in the field.

With all due respect to Beachdoc, not all Wilderness First Aid courses are designed to train you to the level of professional paramedic or EMT. I teach a course which is one weekend long; it requires Standard First Aid as a prerequisite, so the total course is about 2 weekends (there is a combined 3-day course which combines Standard and Wilderness First Aid). I talked to a Saint John Ambulance volunteer last night who had taken a WFA through Red Cross many years ago, but unfortunately didn't have much time to compare notes and see how it differed from mine. <br><br>The course I teach is basically to go over the differences in treatment when medical help is more than 10 hours away. Up to 10 hours, Standard First Aid *should* be sufficient.<br><br>I also teach early recognition of potentially life-threatening conditions such as systemic infection (blood poisoning) and stress to the students that if one of your travelling companions develops such a condition, the vacation is OVER - I don't care how much you paid to get here, or how much you were looking forward to it, if your buddy has a cut that's gotten infected and red streaks are emanating from it, he needs emergency medevac immediately.<br><br>A good WFA course should also deal with when to call for emergency evacuation (and when you don't need to) as well as the basics of how to prepare a makeshift helipad and how to approach a helicopter or aircraft. <br><br>There are important differences between First Aid for an office environment and First Aid for 15 miles out on a X-country ski trail, but you don't have to be a licensed paramedic to be of use.<br><br>Just my $.02 worth. :-)

I appreciate your comments. Just as there are different levels of EMT certification, there are several different "vendors" of WEMT programs. I was involved some years ago as a reviewer for a WEMT course put together out of the University of Pittsburgh.<br>That course did endorse reduction of dislocations, use of antibiotics, and other procedures and methods that are not "street legal" in most places.<br>Don't intend to imply that there is not a difference between apples and oranges. <br>HOWEVER, anyone that employs a procedure must be prepared to deal with the adverse consequences. In the case of an unlicensed practitioner, that includes the legal consequences. Just a thought, since WEMT courses often teach a level of skill performance that exceeds that allowed by the various state medical boards.<br>