The Importance of Self Rescue vs Professional Rescue
As a member of a SAR team I know the importance of getting a professional rescue... but I also know the difficulty involved... sometimes SAR is busy with another mission. Sometimes it is too risky to deploy a team. Sometimes you are are beyond the ability of SAR to reach you easily. You should be prepared to effect as much self rescue as reasonably possible. If your self extrication fails you need to be able to hold out and stabilize until rescue can be effected by oustide parties. How long until they even know? Do you have a radio or phone? Are you in communication range? Will rescue not come until you are overdue? (hopefully you left an itinerary and check in times).
With good communications and helicopter deployment here, a SAR medic can be to you in 30 minutes! Can you help stabilize a yourself/a critical pt until then? What about an hour? What about a lot longer?
Is My Kit Extra Large?
You’ll notice that several items in my kit are removed depending on the activity. My proclivity towards higher risk act ivies and my involvement with SAR is the major reason that I have a significant trauma component to my first aid kit. If all I did was class 2 and occasional class 3 summits and trails, I’d carry significantly less. That is all a lot of people do and they are happy and nay not need the beefier trauma compenent.
Trauma sheers are very rare… usually only come along for SAR, kayaking, maybe BC skiing.
Pocket mask/OPAs come along only for SAR, BC skiing, kayaking, extended trips above treeline in the summer.
SAM splints comes along only for activities where extremity injury is likely and improvisation would be troublesome: SAR, BC skiing with snowboarders present, longer treks with heavy packs, going solo.
Coban is so usefull and multipurpose... especially if you have to do wound care/check circulation on the immobilized area! It is also better than anything else for strengthening and supporting an ankle/knee/wrist/elbow while still leaving it mobile.
The rest of the trauma kit is multiuse and light probably even to a gram counter (I’m an ounce counter). I prefer not to improvise trauma dressings from my probably otherwise needed and often pricey clothing. However, I’ll be more than happy to tear up the patient’s clothing as needed.
Bandaids because infections suck and they reduce pain and further injury, speed healing, etc.
Meds/packets are extremely small and extremely light even to a gram counter… and then you consider the great relief and use they can deliver especially from such a small package.
As for the need for CPR/Barriers… rescue breathing
Here are just a few backcountry maladies off the top of my head that could require rescue breathing: progressive phase of most types of shock, closed head injuries, lighting strike victims, near drownings, near suffocations, severe asthma, severe anaphylaxis, severe hypothermia, certain c-spine injuries, some seizures, HAPE, HACE, severe smoke inhalation, temporary airway obstruction combined with unconsciousness, etc etc etc...
Those are some pretty darn good reasons to carry a CPR barrier. If I find you on the trail and you aren’t breathing, you probably aren’t going to get any more than two rescue breaths from me unless I have barrier or mask (unless I know you and like you a lot). If you already have blood/vomit on you, I might not give you 2 rescue breaths. I don’t intend to catch a life long, possibly fatal disease trying to save you. Also, the thought of someone puking down my throat while I breath for them is somewhat unappealing. So, I carry an extremely small/light barrier at all times. I carry a mask when the risks are higher.
You’ll want a barrier when you consider that without one, statistically, the chance of exposing yourself to disease is about equal to the chance of saving their life.
The same theory is behind having a pair of gloves. I'm not touching your blood/vomit/*BEEP*/urine with my bare hands.
As for CPR in the backcountry, it all depends on what happened to them. Not all arrests are from blunt trauma (which has a near zero save rate). Most avalanche fatalities are suffocation/CO2 toxicity (then trauma, then hypothermia). I have a friend who performed CPR for 45 minutes on one of his friends who bought it in a slide. Most river deaths are drownings. Two weeks ago, we had a guy fall into a lake and drowned during an MI! I would imagine most mountaineering deaths are hypothermia and shock followed by massive blunt trauma. Backpacking? I have no stats but I’d wager MI, hypothermia, and shock are at the top. The Wilderness Medical Society protocol for wilderness CPR is 30 minutes, less if provider will be endangered.