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Michael Mangold
(mkmangold) - F
Medical Ultralight on 02/26/2007 20:09:55 MST Print View

The title of this thread may be an oxymoron since there seems to be very few ways to backpack as the medical leader and still maintain "ultralightedness". However I am always looking for ways to lighten my load. Any suggestions on how to travel lightly medical-wise? I think multi-use gear is important but I am open to all ideas. For example, my walking staff doubles as a traction splint and I keep duct tape wrapped around the pole so that I don't have to carry a separate, heavy roll. Thanks in advance...
Mike

larry savage
(pyeyo) - F

Locale: pacific northwest
Re: Medical Ultralight on 02/26/2007 21:54:56 MST Print View

OK, I dumped my pack out to take a look.
There's some kind of spenco moleskin, cloth tape, an ace bandage, a sterile needle,painkiller,dental floss,allergy stuff,anti-diah med.,a sanitary napkin,glacier cream and sunblock,disposable sunglasses,sting-eze,a broad spectrum antibiotic [that canadian water].
I'll skip the cell phone/ sat phone argument. My theory is you can treat some trauma like sprains and lacerations, most environmental like hypothermia,dehydration,allergic reactions, and very little medical.
[The antibiotic was for a trip to Nepal and is still in there]
The pills are pretty much bagged together with a legend paper, I also have the tweezer part of a swiss army knife in there. There is some kind of cheese looking stuff...

Michael Mangold
(mkmangold) - F
Re: Re: Medical Ultralight on 02/26/2007 22:10:32 MST Print View

Larry
Good point: what am I truly packing for? I look at the location (with all of its relevant weather, topography, and natural resources), the type of co-backpackers (generally fit or newbies or even older in age), duration of trip, and then I think about worse-case scenarios. And I don't mean cell/sat phones but rather the really bad things I can handle. Which makes my approach rather more medical than most.
What cheese looking stuff are you talking about? When DID you last open that pack??????

larry savage
(pyeyo) - F

Locale: pacific northwest
Re: Re: Re: Medical Ultralight on 02/26/2007 22:39:06 MST Print View

If someone falls 15 feet you would treat the trauma probably immobilizing them until somebody way smarter then me tells you the spine is ok, you'ld stop the bleeding/treat for shock/ splint up obvious stuff...if the same person becomes dehydrated then dizzy and falls 15 feet you'ld treat the environmental [fluids] and the trauma.
Perhaps the obvious most important thing would be a wilderness first aid class so we could determine where the line gets drawn in the sand.
I really like to carry stuff and hanging out here is slowly weaning me of this, I still had a thoracotomy kit from search and rescue days in there awhile back ... ?
I do a lot of solo trips and my theory of leaving old foodstuffs in my pack is paying off, my pack is become sentient and keeping me company. Or maybe that's sapient, anyway my pack really knows several very good jokes.

Edited by pyeyo on 02/26/2007 22:42:10 MST.

Jay McCombs
(jmccombs) - MLife

Locale: Southwest
Re: Medical Ultralight on 02/27/2007 16:22:51 MST Print View

Sat phone and GPS.

Serriously though. Think about what your talking about doing vs. what you should do vs how much its going to pay off. Femurs aren't easy bones to break, they generally require a significant amount of trauma. And while traction splints help relieve pain, I can think of few times when you'd want to use a traction splint before getting c-spine protected (I guess if I had a traction splint, was int he middle of no where, and had no c-collar, heh).

My point is, where does is stop vs how much is it going to help. In cases of serrious injury beyond stopping bleeding and protecting an airway there's not a lot you can do in the field. EMS guys will tell you the most life saving tool they carry is their heavy foot that they use to mash the accelerator.

Wounds in the field should be undergo open management and never be sutured. Its impractical to cary IV supplies, intubation equipment, etc. Think about the longest you've ever bagged someone (if you have) and you'll realize that its not a long term solution. I think my point is you should re-evaluate what you expect to accomplish in the middle of nowhere with a serriously hurt person. Beyond keeping them protected from the elements, controlling bleeding, and keeping them hydrated/fed if they are able to drink I honestly don't think you're going to impact outcomes much. I have a fair amount of medical training and only carry blister stuff, benedryl, naproxen, and little else. A good, well thought out escape plan is far better than tons of high tech medical gear.

John Haley
(Quoddy) - F

Locale: New York/Vermont Border
Self Treatment on 02/27/2007 16:48:07 MST Print View

As an EMT for many years I find myself carrying only a few items into the wilderness for even relatively long solo treks. If I'm seriously injured there's not a whole lot I can do besides using common sense, if I'm able to. The chances of treating oneself for a serious trauma are remote at best. About all I carry now is a small roll of duct tape, antiseptic, butterfly strips, and band-aids. Obviously these items are for minor comfort for minor injuries.

So far the worst scenario I faced was badly tearing my ACL while deep in the ADAKS in the late winter. I walked two and a half days in blizzard conditions experiencing the worst pain I'd ever endured. Upon reaching the closest road I walked into an inn and collapsed. I'd done what I needed to do. I mention this only to show that the mind has to be complete control in any emergency situation. Band-aids won't help.

This doesn't really dwell on a multi-person trek, but the concept of clear thinking applies. There's a limit to how much one can take in the way of medical supplies, even in a group. Every contingency cannot be anticipated.

Edited by Quoddy on 02/27/2007 16:55:58 MST.

John Baird
(jbaird) - F

Locale: Deleware Watergap A_T
M/U on 02/27/2007 17:25:23 MST Print View

John, I agree with most everything you say, as an EMT with my local fire dept. for the past 20 years I suggest we both have seen and treated a huge (dare I say plethora) of scenarios.
After seeing the rescue on Mt. Hood the other day, I might add the very small and light transmitter which sends a ping out to rescuers triangulation. Maybe it’s an age thing but it seems to me solo hiking can be fatal and this transmitter is looking better and better to me.

John Haley
(Quoddy) - F

Locale: New York/Vermont Border
Micro Transmitter on 02/27/2007 17:45:29 MST Print View

John...I just recently checked on the latest 9oz unit and was dissapointed to find that it sold for $1750. I told the sales person that I expected about $750. I'm looking into other models right now. I'm going to be very isolated on a long trek later this year and I think I'm doing this to quell my wife's fears as much as anything else. I'll agree that as the age increases, the feeling of being mortal does too. Not like when I used to have a float plane drop me off in the Canadian wilderness and spend weeks getting back out...no fears back then. Ah, to be young again.

John Baird
(jbaird) - F

Locale: Deleware Watergap A_T
Our status of people to watch out for on 02/27/2007 22:26:29 MST Print View

John you forget about all that age related collective experience we have. I see that we have been placed in the same bag of curiosities as "newbies and older age people".
Thank you so much.... Michael

larry savage
(pyeyo) - F

Locale: pacific northwest
Re: Our status of people to watch out for on 02/27/2007 23:15:20 MST Print View

I think Bozeman Mtn. Products has a prototype bush buddy ultralight autoclave in the works so we can once again return to the glory days of high altitude field surgery ... I've got a really strong desire to say it's going to cost an arm and a leg but I'll refrain from that and stick to insect bites, sprains, and splinters.

paul johnson
(pj) - F

Locale: LazyBoy in my Den - miss the forest
Re: Re: Medical Ultralight on 02/28/2007 01:40:37 MST Print View

JM,

You make some good points. This is the main reason my med kit went from way, way over two pounds (4+lb on some hikes) to just a few ounces - just enough to deal with the types of situations you specified. This became even more true as my solo treks became the norm. While on solo treks, who was i going to treat? Just me. What "battlefield" procedures was i going to be ABLE to perform on just myself???!!! So why carry the equipment? Why carry the equivalent of a FMF Corpsman's B1? Makes no sense. Top that off with any advanced skills that i possessed being a tad rusty (let's see...the shin bone is connected to the knee bone???...) and covered with 30+yrs of dust since my military days...

my med kit now resembles yours, i would guess.

not sure if you carry anything "special" for pain management? sometimes, but not always, i do. now, evaluating when and if such should be used, that's another story, isn't it?



>>"fair amount of medical training"

from our previous exchanges, it's NOT really FAIR for you to say "fair" - that's quite an understatement. you have as much as or more training than my wife. a GREAT amount of training PLUS emergency experience is more accurate. However, it's understandable why you hesitate to cite credentials (my wife has made the same request of me). So, we'll leave it at that.

Edited by pj on 02/28/2007 01:42:01 MST.

John Baird
(jbaird) - F

Locale: Deleware Watergap A_T
Medical Ultralight on 02/28/2007 06:04:03 MST Print View

Not to get into a pssng contest here, but I think you are talking about using a common sense approach to this. I am sure you don't mean it the way it sounds because even with a minimal amount of training one can certainly effect the outcome of some situations.

Gene .
(Tracker)

Locale: New England
Re: Medical Ultralight on 02/28/2007 12:15:05 MST Print View

Being a solo backpacker 75% of my trips, I plan for the basics; and pack that into a sensible kit for the climate/terrain I'm headed to. Taking it a step further I refresh my memory on splinting, dealing with more serious injuries if heading out for a more extended trip.

Having covered lots of backcountry miles (knocking wood) I've never had a major injury, though have encountered, and assisted others who did. I think about where I'm heading and focus on what I'm doing to prevent injurying myself by taking 'bad risks'. Yeah, my 'injury clock' is ticking but I think I have a few more safe trips due me.

Kevin Sawchuk
(ksawchuk) - BPL Staff - MLife

Locale: Northern California
Re: Medical Ultralight on 02/28/2007 13:23:15 MST Print View

Let's take an overview:

The medical kit depends on many factors--in order of importance:
What is your knowledge level?
How far are you from a rescue?
How big is your group?
How long are you gone?
What are the common problems you are likely to encounter?

The aim of medicine is to prevent problems first. So encourage your trip members to prepare ahead of time (fitness), bring the specific medications they need, and to take care of small problems (blisters, thirst, cold) before they become big problems (cellulitis, dehydration, hypothermia). A medical kit should be designed to treat the treatable problems you're likely to encounter. If someone falls and has major head trauma or internal bleeding they is probably nothing you can do for them but get help.

First GET KNOWLEDGE: It's the most important thing in your kit and weighs nothing. You'll be able to do more with a 6oz first aid kit after taking a wilderness medicine course than you could do with a 2# kit without training.

Then tailor your kit to your trip: On most trips (2-3 days, evacuation 1-2 days away) blisters and minor injuries (cuts/sprains) are by far the most likely small problems that can turn into big problems so a variety of tapes and bandages are first on my list. Also benzoin to help it stick. Rarer is more major trauma and generally splints can be made from branches and clothing. Pain medications (non-Rx and Rx) can also make a big difference in comfort and ability to travel under own power. Allergic reactions can be treated with Benedryl (non-Rx) or an oral steroid--if a trip membeer has had anaphylaxis before they need to carry their own epi-pen. Altitude illness is somewhat less common and most types can be prevented or treated farily easily with Diamox or descent of 500-1000'. Infections are less common, but I carry 1-2 types of antibiotics as it can make a big difference in comfort, the ability to travel under one's own power and survival. However most infections are viral and won't respond anyhow. I throw in a few safety pins (allow you to use your shirt for a sling, keeps an open airway), a pair of gloves, syringe and needle (draining pus, relieving a tension pneumothroax and know how to do an emergency trachiostomy with a swiss army knife (however I do have 4 years of medical school under my belt). I'll look through my kit when I get home tonight and add anything else I find.

The important message is: Get Knowlege first and you can lighten your kit a lot through technique and improvisation.

Addendum:

After reviewing my kit I'd like to add a few more comments. First for "wound care" I bring Steri-Strips which hold a clean/sliced deep wound together well--I saved a trip to the ER after slamming the bridge of my nose on a metal support upstairs in Ryan's gear loft (bathroom downstairs, lights out, trying to navigate in the dark), a tape called Leukopore which really sticks well (duct tape just doesn't) an assortment of bandages including circles (great for fingertips with a slice down the side to seal better). I also bring a topical antibiotic--they sell small foil packages which can be used multiple times. I also have a couple of compeed patches for blisters.

I carry Doxycycline (and if on a longer trip Ampicillin also) for an antibiotic, Benedryl, Vicodin, Aleve (long lasting with 12 hour dosing=fewer pills), Loperamide (anti-diarrhea) Decadron and diamox (mostly high altitude problems but decadron works for allergic reactions that last a while). I also have a small flashlight and some micropure tablets (for water and wound cleaning ). I also carry a few windproof matches and some heavy string and fishing line with needles stuck in a small piece of insulite pad. Finally, a small glue stick (not really first aid but very helpful if you step on your glasses--it will burn and drip hot glue where ever you need it.

Edited by ksawchuk on 03/11/2007 22:28:11 MDT.

Douglas Frick
(Otter) - MLife

Locale: Wyoming
Re: Re: Medical Ultralight on 02/28/2007 13:34:22 MST Print View

>The medical kit depends on many factors--in order of importance:


One more factor: Are there kids along?

They do seem to get into more trouble than adults, although usually of a less severe nature. Also, kids' pain tolerance is fairly low, and the healing effect of a kiss and a band-aid is well known. My personal kit only weighs a few ounces, but I grab the big one with lots of bandages and ointments when I'm backpacking with kids.

John S.
(jshann) - F
Re: Re: Medical Ultralight on 03/01/2007 03:50:33 MST Print View

Kevin, what are your antibiotics of choice for backpacking?

Michael Mangold
(mkmangold) - F
Medical on 03/02/2007 10:28:09 MST Print View

Kevin: that's what I've been looking for. The "safety pin through the tongue" technique sounds gross but is effective. As far as "newbies and older age members" I meant the people you would be hiking with, NOT readers of this forum! And apparently assessing that beforehand is part of prevention.

Michael Mangold
(mkmangold) - F
Re: Re: Re: Medical Ultralight on 03/02/2007 10:59:06 MST Print View

John S: my intent for this discussion was to get some ideas on what is necessary to carry along while ultralight backpacking since my past experience has been with medical missions, not hike-throughs. On mission trips, I carry a quinolone such as Cipro or Levaquin, a penicillin or cephalosporin, and maybe Bactrim. These 3 classes cover skin infections, traveler's diarrhea, dental infections, UTI's, and a host of others.
In addition to NSAID's, usually ibuprofen, I may carry a narcotic although that depends on the destination. If no narcotic, I'll bring Tylenol, too. Imodium is a must as is Benadryl. I bring prednisone but have found that I rarely use it. Instead of an opthalmic antibiotic ointment, I will bring drops that contain anitibiotic and a corticosteroid. The drops allow me to treat more than one eye infection if good hygiene is practiced.
Instead of a C-collar, I bring along a Sam's splint which can be used for several purposes besides cervical stabilization. For most other possible breaks, I can get pretty creative with duct tape although the result is not pretty! I also bring along a couple of packs of oral rehydration powder. I haven't had to use this yet since Gatorade us usually available close to the missions. We saw more cases of dehydration and other heat-related illnesses on our last trip to Mexico than anything else. That was mainly due to the fact that we traveled with a bunch of teen-agers (1000 of them!) who, for the most part, had never been out of the country before...
Mike