by Bill Thorneloe, David Schultz, and Ryan Jordan | 2001-08-20 03:00:00-06
There are a few categories of equipment that can be the subject of hostile discussion around a campfire. First aid and emergency equipment certainly are among them. We've met hikers with first aid / emergency kits ranging from a baggie full of Band-Aids to five-pound expedition kits.
The purpose of this article is to highlight some of the differences in first aid and emergency equipment selection among three self-proclaimed "lightweight" hikers that reflect opinions on the subject that span a broad spectrum between "conservative" and "why the heck do I need this?"
We'll start with Bill and Dave critiquing each other until Ryan joins in, no longer able to tolerate the banter.
Dave's Rationale: Over the last several years, my business has taken me all over the United States. On these trips, I have been lucky enough to find the opportunity to hike extensively in areas that were totally new to me. Unfortunately, I also tend to push my personal envelope a bit and have a unique talent for getting lost. When I go hiking with other folks, they are usually newbies who don't have a lot of outdoor skills, don't always have the best equipment, and often push themselves a bit harder then they should. Being well prepared is essential for where and how I hike, so I carry 25 ounces of preparedness for those times when things didn't go smoothly.
These items, along with my general equipment, help me handle a wide range of medical problems. My goals in selection are:
First Aid Supplies
BILL THORNELOE: Dave, your list is excellent and quite reasonable, particularly given the weight. I suspect that our kits look quite similar, but this kit may be closer to the contents of my top compartment Ziploc bag. This would serve someone very well, but I suspect that there is duplication and some outdated equipment here.
DAVID SCHULTZ: It could be that my relative inexperience in the healing arts leads me to be overly cautious. I know that if I mishandle a small problem, my lack of skill and experience means that I have a higher chance of failure if the condition worsens. This is why I emphasize items needed to clean and disinfect a wound.
BILL: Why carry moleskin and Bioclusive dressings and Curad blister pads? Why not just the Bioclusive dressings?
DAVE: While the Bioclusive dressings are very useful in that they are waterproof and breathable, they are relatively fragile and do not breathe well when compared to the non waterproof, but tougher, Spenco Adhesive knit. So for ultra heavy sweaters like myself, I find that the Adhesive knit works better. For low perspiring folks like my wife, Bioclusive dressing keeps the blister clean in a relatively dirty environment. I also use the Bioclusive dressing for covering cuts and other non-weeping wounds.
BILL: Why carry both Percogesic and Percocet, neither of which will treat major pain (I carry two 20-mg OxyContin tabs)?
DAVE: The only reason I carry the Percogesic (over-the-counter or OTC med), is that my wife tends to get an upset stomach from ibuprofen. I have found Percocet (prescription or RX med containing acetaminophen and the narcotic oxycodone) to be quite effective on moderate to severe pain and far more effective than any non RX meds available. Certainly there are stronger alternatives (OxyContin 40, MS Contin 30, etc.), but not being a medical professional, I have limited access to RX meds. Before moving, I had a long relationship with my family physician and getting a few RX meds was not such a problem. Now I must use a large and impersonal managed care group and can no longer acquire RX meds for a field kit.
BILL: Why carry iodine prep pads, alcohol pads, povidone-iodine solutions and water treatment tabs? I can see the povidone to help adhesion of skin closures…but the rest?
DAVE: It is far easier to use a prep pad to disinfect a small area than it is to mix up some povidone-iodine solution. But, if I had to clean or irrigate a larger wound, the prep pads would not be sufficient, so I carry both. I am intrigued with the idea of using the water treatment tabs to mix up a batch of wound irrigant/disinfectant. This deserves exploration. Omiting the povidone-iodine will save about an ounce.
BILL: Why carry the extra and non-waterproof packaging of sterile gauze pads, instead of a plastic wrapped Kling roll gauze?
DAVE: Ease of use and sterility.
BILL: Why breathable tape and duct tape and skin closures?
DAVE: You’ve got a good point here, Bill. I could lose the breathable tape. I'll keep the Cover Strips though. They are quick and easy to use.
BILL: Why carry gut sutures as any "stitches" will be removed and revised on arrival at the emergency room (ER)? I suspect the nylon or silk suture (I carry but did not list) would be more visible and also useful for gear repairs. Heck, a curved needle and the dental floss could service in a crisis.
DAVE: Again, good point. The main reason that I carry a few gut sutures is that I learned that they were preferable for use in severe mouth lacerations. Granted, I have never run into such an injury. I imagine this could be very tricky.
BILL: Why carry a heavy first aid kit package when you have 2 gallon Ziplocs as well as latex gloves (i.e., for an emergency water container)?
DAVE: I used to use Ziplocs, but found that they were beat up so much that they were often replaced.
BILL: Why bring an irrigation bulb? I would use my Platypus and tubing to direct the flow, and squeeze the bag for more pressure.
DAVE: Excellent idea for when I am in a group. It will save 3 ounces. When I go solo, however, I usually only carry one bladder and no backup water container.
BILL: Have you considered orthopedic injuries and means of splinting or otherwise stabilizing a fracture?
DAVE: I considered carrying a SAM splint, but figured I could improvise by cutting up my closed cell foam pad and using duct tape, poles from my Nomad shelter, sticks, etc.
BILL: Overall, I believe I am picking nits on these questions. I suspect our real gear is identical, and that the choices of medications, wound treatments and such are solely personal preferences.
Bill's Rationale: My first aid kit responds to three questions. - First, what happens if I lose all or part of my gear? - Secondly, what are the most likely medical problems I will encounter? - Thirdly, what am I carrying that can be used for more than its intended use? I should know my gear and be able to accurately assess a wound or emergency. If I do not understand a piece of gear, it should be left at home. Without understanding the hazard, I am likely to make the situation worse by trying to intervene blindly. The most likely acute emergency will be trauma. I anticipate falls, fractures, bruises, abrasions, stings and bites. Burns may happen, but preparation for other trauma provides gear for this. Digestive tract (GI) distress with upset stomach, nausea, vomiting and diarrhea likely to impede my walk. I prepare for dehydration, hypothermia and hyperthermia. Infection concerns come next, addressed by water purification, hand cleaning, toilet hygiene, and wound cleansing. Finally, I consider comfort issues like sun burn. What would happen if I lost everything by the trail while I go for water? If I broke my ankle slipping on a mud bank by a creek bed, I would need to be able to alert someone of my location, stay warm, and avoid bleeding and shock. Hence, my lanyard kit. A lanyard or pocket kit, always with me, would provide for splinting and allow scrambling back to the trail. If I wandered away from a shelter wearing my fanny pack from the top of my pack, the contents of the top pocket would make a similar injury easier to manage. I also have the beginnings of good treatment for other problems including temperature regulation and dehydration. Unfortunately, dehydration and temperature problems are often first detected by confusion and cognitive deterioration. I have not figured out a reliable means for a solo hiker to recognize when their brain is going South, much less how to intervene. The closest I have found is attention to the UMBLES - Grumble, Mumble, Fumble, & Stumble - treated initially with sitting down in the shade, drinking water and assessing the circumstances. My clothing and backpack are integral to trauma care. I can fashion slings and braces for a variety of upper extremity injuries, dislocations and lacerations (cuts and scrapes) with clothing and well placed diaper pins. I can rig a splint with back pack stays and trekking poles using the closed cell mat or clothing to cushion the splint. I could even rig a litter with trekking poles or available sticks, clothing and diaper pins. My tent and sleeping bag are excellent for treatment of hypothermia, along with a warm cup of Jello. My water treatment and Platypus bags give me disinfectant, means to irrigate and cleanse a wound or foreign body in an eye. There are few GI problems that do not respond to Pepto Bismol, unless they demand a visit to a local emergency room. I carry much more on a canoe trip, especially medications and allergy treatments. When desert hiking, a larger mirror for signaling comes along. I don't carry a Sawyer Extractor, as I have not been exposed to either severe bee stings or snake bite. Poisonous snake bites require immobilization of the area bitten and evacuation of the patient by the quickest means possible. I don't carry Epinephrine as I have no history of anaphylaxis (shock) in response to allergy. Anyone with this susceptibility should provide their own and be able to use it immediately.
Lanyard Kit (worn on me at all times)
Primary First Aid and Emergency Items (in top pocket of pack, stored in a 1-Quart Ziploc bag)
DAVE: Well Bill, it looks like you've got all the bases covered. In comparing each of the items in my kit with their functional equivalent in your kit, my only question is: What do you do if you get a really bad case of the trots? Pepto Bismol just doesn't have enough "stopping" power, in my experience.
BILL: Severe diarrhea in the backcountry can be deadly, with attendant risks of dehydration and electrolyte disturbances. Sure, Pepto Bismol has limited "cork" potential, but is effective for most mild to moderate events, and should help slow the flow of a severe diarrhea. I aggressively push Pepto until symptoms begin to fade. I expect to use copious water and electrolyte replacement with Nutrasweet to help treat the dehydration, and Gatorade once that is exhausted. I would consider a narcotic, especially if I were already immobilized by diarrhea. Severe diarrhea is like a fracture - it takes us off the trail and on the way to an ER.
DAVE: The main differences I see in our approaches to emergency kits is that mine has a bit more emphasis on convenience and I try to make up for lack of experience with 4-5 oz additional gear.
BILL: I agree with the observation that our "kits" vary only in convenience and compartmentalization. I depend much more on "making do" with items originally designed for other uses. I carry a bit more than needed as I anticipate providing attention to others when on my own walks. This goes with the job. I expect that a first aid kit of a couple of bandaids and a waterproof match would be plenty for many, but too little for my confidence.
RYAN JORDAN: You two are a piece of work. I assumed that I could put two opinionated souls together, give you free license to hammer each other and you end up getting cozy and complimentary. What's up with that? Are you guys really serious about bringing an entire pound - or pound and a half - of first aid and emergency equipment? So I say, rid yourselves of all the nonessentials, use your head, and what the heck - roll the dice a bit. My kit weighs a paltry 5 ounces.
Ryan's Rationale: I prepare primarily for two things, minor ailments and light weight. Period. I'll try to use my brain for the big stuff. Sure, that might be risky, but that's what going light is about.
Blister Treatment and Wound Care Supplies
Emergency Survival Equipment
I limit this primarily to a firestarting kit, storm matches, birthday candles, and a mini-Bic lighter in a cardboard match box with extra strikers, vacuum sealed in a heavy waterproof plastic. Also a single mini-LED light (0.3 oz) and a tiny waterproof whistle (0.1 oz) for emergency signaling.
RYAN: That's it. All of these supplies weigh 5 oz and are stored in a 2” x 4” x 6” bright yellow silnylon stuff sack.
BILL: You have really trimmed your stuff down in the medicine department. Are you willing to rot in place without means of alerting rescue for significant trauma?
RYAN: What do you mean? I carry a Photon single-LED mini-light for signaling (smile). The advertisements say that it's visible for a mile.
DAVE: Now Ry, I agree that a decrease in weight can lead to an increase in risk, but with all of the wild stuff that you do (much of it solo as I understand), you ought to consider a bit more preparedness.
RYAN: "All that wild stuff?" It's a matter of perspective. I really toned it down after I become a father! I think it’s high time you explored your wild side, my friend.
BILL & DAVE: "Git a rope."
BILL: OK, Ryan, why would you want iodine wipes unless you fail to bring iodine for water purification?
RYAN: What is with you guys and your iodine? It's time to get with the program and use something that actually works for water disinfection. While iodine is still appropriate for virus protection, viruses are the least of your problems, at least here in the U.S. Bacteria and protozoan cysts (Giardia and Crypto) pose a more serious threat to backcountry water. I opt for a chlorine dioxide chemical kit (e.g., Aqua Mira) due to its greater efficacy towards microorganisms. Hey, thousands of city water treatment plants around the world that are using chlorine dioxide can't all be wrong. But the bottom line for iodine wipes is this: simplicity of use. Hassling to make a concentrated solution of iodine using Potable Aqua tablets is not my idea of a great time. In addition, with iodine crystals, you also run the risk of incompletely dissolving the crystals when preparing a topical solution. If an undissolved crystal comes into direct contact with flesh, it can cause damage to the tissue via a pretty aggressive oxidation reaction. But that should be just fine with you guys, since y’all are also carrying burn ointment!
BILL: What's the point of triple antibiotic ointment? "Triple" is useless and potentially dangerous for open wounds. Vaseline or bag balm or skin lotion/sunscreen would be more practical, along with 20 grams of Silvadene for a burn or real infection.
RYAN: The primary purpose of the cream is to provide a barrier to outside contamination - not unlike Vaseline or bag balm as you suggest. The secondary purpose is to disinfect the skin surrounding the wound and preventing these bacteria (e.g., Staphylococcus epidermidis) from colonizing the wound. Most OTC antibiotic creams are ineffective at treating massive wound infections - that is not the purpose here - but they are indeed effective at preventing the onslaught of a wound infection. Remember, the goal with these ointments is preventative treatment, not reactive treatment. As for danger, the antibiotic components of triple antibiotic ointments (which vary somewhat, but may include neomycin, bacitracin, or polymyxin B) can cause kidney damage or renal failure, but in most cases, this is only an issue when administered orally (as is commonly done to treat intestinal infections in pets). Applied topically (i.e., to the eye as part of an opthalmic infection treatment strategy) or to superficial (skin-deep) wounds, the chance that the antibiotics will be absorbed into the bloodstream at a high enough concentration to induce a life-threatening condition is extremely low. I do agree with you, though, that application of this ointment into a deep open wound is probably not a wise decision, since you'll have a rapid and direct path to the bloodstream. I do like your suggestion for Silvadene when faced with having to treat a serious wound infection that has already exploded.
BILL: Why so much Ibuprofen, Tylenol and Tylenol with codeine?
RYAN: I don't take meds on the trail for routine conditions like muscle aches. Thus, eight caps of ibuprofen provide two healthy doses to control serious inflammation, as might occur for a sprained ankle. Six caps of Tylenol provide three doses to help tolerate such common problems as severe headache caused by dehydration or acute mountain sickness. Sure, we can be careful and drink our water at regular intervals, or acclimatize by only climbing 1,000 feet per day, but that's simply not a reality in the mountains.
BILL: The variety of meds you carry enhances the risk of misidentification.
RYAN: Fair enough, but I eat wild mushrooms, too.
BILL: And codeine? It's too mild and short term and too frequently allergenic to be used reasonably in the backcountry.
RYAN: Each of us reacts differently to narcotics. I respond well (hey, calm down, I'm a clean-livin' good old boy). Tylenol 3 was successful at quenching the pain of a jumping molar nerve (which subsequently required an emergency root canal) while on a hike. Two years ago, I hiked 40 miles out of an extremely remote area on a broken talus bone (foot) using Tylenol 3, where emergency extrication was an option, but I chose to take the responsibility myself, since the injury wasn't life-threatening. The fact that Tylenol 3 is mild is the very reason I use it; it provides a nice balance between desensitizing myself to the pain and keeping my head clear enough to make reasonable decisions. Of course, I'm not allergic to it and I certainly don't administer it to others while in the woods for fear of an allergic reaction.
BILL: Immodium is useful only if diarrhea is the only GI event expected. Why not Pepto tabs?
RYAN: Immodium is a more aggressive plugger-upper than Pepto, and has the power to arrest diarrhea before it begins to severely dehydrate you, which Pepto won’t do in a short time frame. Pepto can handle vomiting for me. I have had adverse reactions to it in the past.
BILL: Throat lozenges? How about some honey or hard candy?
RYAN: You bet. Any of the above. I just like the menthol high that comes with some throat lozenges. The real purpose here is to fend off the Russian Army Hat Tongue and sore throat that often accompany dehydration at altitude. The addition of menthol clears sinuses and nasal passages and for this hay fever-prone hiker, really helps breathing when working hard.
BILL: And Benadryl? For what real purpose?
RYAN: Benadryl offers a few massive (prescription-strength) doses for a bee sting allergy. I've not responded well to epi-pens in the past, but have done great with benadryl.
DAVE: So, Ryan, what do you do when you slip off of one of those big rocks that you are so fond of climbing in your cross country treks and tear an eight inch chunk of meat out of your (fill in the body part)? If this is not bad enough, you also abrade a good patch of skin off of your (pick another part). Sure you could just pack the void that used to be filled with flesh with gauze (if you had any) and wrap it up all neat with duct tape. But, how are you going to get the crud out and disinfect that wound? Your iodine wipes just ain't going to be enough. Adequate cleansing is the most important aspect of wound management...
RYAN: I agree wholeheartedly with the cleansing part. The scenario you describe is similar to one I experienced while hiking near Cimarron, New Mexico, in 1986. I had just climbed a peak and was descending a steep talus slope, lost my footing and tore quite a lot of flesh from my upper thigh in the fall. Treatment required thorough cleansing - it was a very dirty wound - and took about 3 hours. My immediate approach was to flush the wound with my remaining water, which was about a liter. I then packed it with toilet paper (TP), wrapped a bandana around it, and high-tailed it down into the valley with access to a stream. Then I sterilized about a gallon of stream water (using iodine tablets) and used tweezers to pick every piece of grit I could find out of the wound, all the while rinsing with water and letting the wound bleed itself to prevent clotting while I was cleaning. I used triple antibiotic ointment on the outside edge of the wound, dressed it with some TP that had been soaked in some triple antibiotic creme (my barrier to outside infection), more TP on top, followed by six layers of a cotton t-shirt that I cut up, with duct tape to hold it all in place. This was an agonizing process for someone who is normally pretty impatient, but you do what you must. I hiked out the next day and within 36 hours after the injury was at a health clinic where I received kudos for wound cleansing and treatment but a lamenting lecture about hiking down talus slopes in sneakers.
DAVE: ...except that you also had a bad case of "the runs" early on in the trip and you only brought four Immodium tablets, so your TP has long since been used up.
RYAN: I actually only use TP to "polish" things up, relying instead on more natural sources for doing the dirty work. This becomes even more important when you have the trots. It's amazing how much comfort a prickly alpine spruce bough provides - if you wipe with the needles facing the proper direction. I've also long since replaced normal TP with those tough blue "shop towels". They make great TP for loose bowel movements because they are so absorbent, and are also ideally suited for wound dressings.
DAVE: If you knew that you would be found in a darn quick hurry, all of this might not be quite so bad. I notice though, that you don't have much signaling equipment so you might be hanging out for a while.
RYAN: In addition to the whistle and see-for-a-mile-LED-mini-light in my kit, I often carry a LED headlamp and a mirror in my toiletry kit (used primarily for grooming and tick checks). Finally, what happened to the power of fire? Three fires arranged in a large triangle can't be beat for night signaling. In daytime, a big wet smoky fire has the power to attract attention from miles away.
DAVE: OK, so your light runs out of juice in the middle of one of your night hikes. What do you do? You don't have any extra batteries.
RYAN: This is why I've gone to LED headlamps. I install fresh batteries, lasting between 40 and 120 hours, for any hike of more than a few days and use lithium batteries if the light will take them. I've yet to run out of juice, even on an all-night winter escape from a Teton summit, where the low temps can really suck the life out of batteries. But, if worse came to worst, and I didn't have the luxury of a moon or sixth sense to rely on, I'd just stop and camp.
DAVE: You are hiking deep into an area that has little water. While cooking dinner you accidentally knock your burning canister stove into the water bag on your hydration/filtration system. Now, not only can you not filter the small amount of water that you can scoop from the hoof prints that you find around the dry watering hole, but you can't carry any of the putrid water with you. A couple of Ziplock bags and some water purifying tabs could come in handy here.
RYAN: All of my food is packaged in Ziploc bags, either sandwich-sized or gallon-sized. I don't burn my garbage. I have enough Ziplocs in a week-long food supply to carry a few gallons of water. As for filtering, I always carry some kind of backup - usually, a chlorine dioxide chemical kit. And as a last resort, you can always boil the water to treat it, even using a fire if your stove fuel is gone.
BILL: Why is your firestarting kit vaccuum sealed? You need fire starters anyway. I'd carry the matches on me and leave the Bic in the first aid kit.
RYAN: I vacuum seal it for total waterproofness. The matches and lighter in this kit are to remain untouched except in an emergency - absolutely no exceptions. The fire is the last line of defense between you and hypothermia. When all of your equipment has failed, it is the only source of heat, other than your body, available in the backcountry. I carry a few backup matches in my stove kitl, although my stove uses a piezo ignition. The only other reason for a lighter is sterilizing a needle to pop blisters. On those rare occasions I use a match from in my stove kit stash.
BILL: By the way, where are your ID and your medical history? The search-and-rescue (SAR) folks who find you rotting away will be curious about who you were.
RYAN: Under the crown of my Tilley hat in a waterproof Ziploc with business cards that read: “If I’m alive, I’m a Backpacking Light subscriber. If found dead, please cancel my Backpacker subscription.”
BILL: Ryan, you may want to throw your organ donor card in that Tilley hat of yours.
DAVE: As well as your term life and disability insurance policies.
What can be learned from this discussion? Four overriding themes stand out:
"Face-Off: First Aid and Emergency Gear," by Bill Thorneloe, David Schultz, and Ryan Jordan. BackpackingLight.com (ISSN 1537-0364).
http://backpackinglight.com/cgi-bin/backpackinglight/00022.html, 2001-08-20 03:00:00-06.