Just took a trauma course from a medic with 3 or 4 combat tours under his belt. Here is what I learned from him:

Yes quick clot can cause necrosis
Combat gauze is still recommended and doesn't cause necrosis
Packing a deep wound with arterial bleeding with ordinary steril gauze is fine
hemostats are impractical in this setting

My background is military and EMS FWIW here is what I carry when I'm solo: Imodium, mucho tape, NSAID, Benadryl, moleskin, Neosporin, and common sense. Anything else I need I can scrounge from my pack. I'll flush any wounds with sterilized water.

If I'm hunting or in the back 40 during the hunting season then I'll carry a GSW kit as well. If I'm hiking with my kids or untested hikers then I'll bring a mac daddy blister kit including tincture of benzoin and alcohol prep pads. If you are a real bad @$$ then you can give the blister a hot shot with the benzoin or superglue. Hurts like heck but that blister will be good to go.

I don't do things 10 hours away from my truck that I would do 10 minutes away from my truck. The summit will be there tomorrow. The snow field will probably soften up once the sun hits it. If I keep walking I'll find a safe place to cross the stream. I make more mistakes once I've hit the wall so I know when to call it a day. I'm older now so I've lost any compulsion to perform back 40 acrobatics. My feet are pretty tough but they are my first priority of work during breaks.

I only worked EMS full time for three years and only applied a traction splint once in that time. In my experience mid shaft femur fractures are not super common but they do happen. You are only limited by your imagination but this is basically how I learned to use a field expedient one in my WFR class:

http://www.youtube.com/watch?v=W2H6J4fvUeQ

A couple of things I can drop is the triangle cloth, and the cheesy big red cross REI trifold. Although I do have a multi-use purpose for them, while technically they are parked in my First Aid Kit.

288 grams, but I can easily shed 108 grams for those two extra items.

oh and why the glowstick? Paranoia. I admit it. Murphy's law. I once had THREE headlamps die on me on the same day.
headlamp #1 I dropped on the driveway and cracked.
headlamp #2 I cracked the case trying to replace the battery @ trailhead.
headlamp #3 died no apparent reason at camp, cheap junk made in China.

I like the idea of non-flammable light source that is separate technology from a headlamp.

The wound seal powder is a gimmick that I'm curious to try someday, but not sadistic to cut myself to test. That is why i have the NewSkin spray, I used it before, it works, it stings and smells, but can also lock in an infection if the wound is not cleaned properly before the seal spray.

Edited by RogerDodger on 02/06/2013 12:29:21 MST.

Great thread.

I have training and field experience as an EMT-I, WEMT, and some tactical medicine. Bob's post is superb, nobody can tell you just what you should carry. Some tips:

- Improvisation is imperative.

- Tactical medicine techniques can be leveraged for hunting or bushcraft injuries: gunshots, arrow impalements, hatchet accidents, etc. Knowing how to pack a wound for hemorrhage control is good. If I was a hunter I would carry a commercial tourniquet like the CAT or SOFTT-Wide. Learn how to properly construct and secure an improvised tourniquet. It is possible to do it wrong and speed up the bleeding.

- Few LW/UL hikers are toting guns or axes but most have stoves of some sort. Be ready to deal with burns.

- Prevention is huge.

- Environmental medicine matters.

- Injuries from the knee down are serious because they can be (or become) mobility killers.

- I only applied a traction splint for a snapped femur once in the field, but the patient said it improved his pain better than the morphine we gave him.

Edited by El_Canyon on 02/06/2013 17:47:00 MST.

I took the advice of everyone who posted. Your comments and insight may very well save my life.



My kit now includes:

10 Band-Aid Flexible Fabric Quilted
2 Sterile Gauze pads
3 Sterile Sponges
3 Alcohol Wipes
2 Antiseptic Wipes
1 Tube Neosporin Antibiotic Cream
1 Sheet Moleskin
6 wound closure strips
8 Band-Aid Advanced Healing Blister Cushions- these are designed to sit on the wound for several days, acting in place of a scab. For bad blisters.
4 J&J Advanced Care Tough Pads- larger cushion pads designed to sit on the wound for several days. For bad cuts.
1 ACE Bandage with two clips
2 tablets of Antihistamine
Aleve painkillers
Papaya enzymes for stomach issues
Medical Tape

Other items also in separate plastic bags within first aid kit:
SeamGrip
Gorilla Glue
Emergency Whistle
2 patches for rain gear

Everything stored in an Aloksak, 6in x 6.75in

Sorry, no weight. I haven't got a scale. If I had to guess I'd say 3.5oz, it's a hair heavier than my Sawyer Squeeze.

I took out about fifteen cheapo bandages that looked like they'd fall off, Insect Sting treatment, extra moleskine, and some generic ibuprofen. I was shocked at how sparse my kit was; I had no way to treat an injury larger than what I might be able to ignore. Now I can cover small wounds to prevent infection and still treat more serious wounds.

Might add more Gauze.

Thanks again for the help!

Edited by mdilthey on 02/07/2013 11:24:23 MST.

Hey Max,
If you can find single servings of some of the ointments, like the stuff in an office medicine cabinet, that would save you the penalty of taking taking a full size tube (about 100 uses) of neosporin. Its the same as the triple antibiotic.

Another option, read up here on bpl search for making your own containers from drinking straws or those fat tapioca boba tea straws from the asian coffee tea shops.

http://www.backpackinglight.com/cgi-bin/backpackinglight/forums/thread_display.html?forum_thread_id=16817

Pretty cool thing. Seal it with heated needle nose pliers.

Edited by RogerDodger on 02/06/2013 23:29:57 MST.

Max,
Regarding the emergency whistle. For less than a dollar you can upgrade your pack's chest sternum strap buckle with an REi buckle that doubles as a whistle. Look at the REI Flash 65 pack, the orange chest buckle is a whistle. One less extra thing to pack and multi use as a buckle.

Have fun with it ;)

edit: here is the link to the REI Whistle / Sternum strap chest buckle. used to be $1, now $5
http://www.rei.com/product/848923/gear-aid-whistle-sternum-strap-buckle-kit-34

Edited by RogerDodger on 02/07/2013 09:19:42 MST.

That looks like a 1 oz. tube of Neosporin in your baggie. I suggest you save almost an ounce and put in one or two small packets of triple antibiotic. Triple antibiotic, bacitracin zinc ointment, Blistex, hydrocortisone cream, and so on come in little packets that weigh half a gram to one gram. They can be found in medicine cabinets at some places of employment or ordered online. If you had a couple triple antibiotic packets, your Neosporin weight would be reduced from 1 oz. to 1/16 oz. A little goes a long way - I used it daily on a trip last fall, and one packet lasted me six days.


Last year, I bought a bunch of first aid stuff (and food) online at minimus.biz. Free shipping over $20. They've got small sizes of many of products.

Looks like I was writing at the same time Roger was...

Sounds like you might be interested in some advanced first aid training. I took the WFR course through these guys and would highly recommend them.

http://www.wildmed.com/

"If I was a hunter I would carry a commercial tourniquet like the CAT or SOFTT-Wide."

These are great tools for those who work with/around firearms, chainsaws, etc. While it's easy to improvise a tourniquet, these are hard to beat and are much more effective than using a traditional cravat and stick.

One important thing to remember when buying these off of Ebay is that they are susceptible to UV degradation. Many of them were carried by GIs returning from theater and often times they are worn on the body armor and are exposed to the sun.

If anyone is interested in buying one for a trauma kit, pay a couple extra bucks and buy a new one.

My impression of serious injuries is that you can never have too much antibiotic. At the risk of over-preparing, I can imagine a lot of scenarios where not having a way to prevent infection is a very bad thing, which to me makes it the only thing to bring extraneously. Bandages can be improvised; antibiotics can't.

My worst-case scenario is slipping on a fallen log and getting a gash or impaling injury on my leg. I think I can reasonably prepare a first-aid kit for walking out of that or a similar injury and then count on using my head and staying put for anything worse (and normal precautions like telling people where I'm going.) In the event of that injury, my solution is to use the wound closure strips, gauze, an improvised covering along with the ACE bandage, and a hefty amount of Neosporin to keep the wound clean and infection-free for a few days of travel out of the wilderness. In that case, I might use 3/4 of a tube over two or three days.

My logic; if it's flawed, don't hesitate to say so. This just felt like 1-2 ounces that were graciously accepted to put my mind at ease, but experience could correct me.

Edited by mdilthey on 02/07/2013 11:27:19 MST.

Oh, also, I carry the whistle with my winter camping backpack because I don't want to buy a buckle whistle when the bag itself weighs upwards of 5lbs. The ounces saved there could easily be saved through massive cutting and trimming; i'll get to it eventually.

My 3-season backpack has a built-in whistle already. There, I actually care about ounces quite a bit.

Hi Max,

I too carry Neo in my FAK. It's in what is referred to as "single use" packs. They are little sealed foil envelopes of Neo that I cannot find anywhere anymore in my area.

"My logic; if it's flawed, don't hesitate to say so."

I won't because it isn't. ;-)

My single use packs have been all that I have ever carried on the trail and have never had to use one of them. What I have used more of from my FAK has been Ibuprofen after straining my knee and some tape for a developing blister.

Just because I've been lucky and have not had to use any of my Neo doesn't mean that I don't see the logic of the 1 - 2 ounces that you carry.

FWIW I'm at that age where the health professionals routinely ask if I've fallen lately. ;-b

Up until last year I had never fallen on the trail. I didn't need any Neo after the fall but as I said before, "I've been lucky..." If it makes you feel more comfortable carrying a larger amount of Neo by all means you should.

As for what I carry my plan was to go lighter, use it if needed, determine if I had enough to continue on or pick some up at a trail town or resupply point. My last option would be to bail if the injury were serious enough.

This will probably make English teachers all over the country cringe but, Lighter Ain't Always Righter! ;-)

Party On,

Newton

Edited by Newton on 02/07/2013 11:53:28 MST.

I’m not a doctor but I did stay in a Holiday Inn Express last night….

I almost lost my mom to sepsis a couple years ago due to a physician not following needle protocol so infection control is high on my list of priorities. I use the ointment to take care of minor scrapes and cuts. If I have a serious laceration/abrasion, my SOP is to clean the wound the best I can after boiling my Swiss army tweezers and flushing it with sterilized water (which ISN’T boiling!) I would then immediately execute my evacuation plan. Cellulitis/Gang Green is nothing to mess around with.

My line of thinking is that my first aid kit is designed to keep small injuries from becoming big problems and if I’m seriously injured/sick, that I have what I need to di di mau to the trail head to seek definitive treatment.

In a HYOH sense, you are never wrong for carrying it but a whole tube may be overkill.

Somehow I managed through the first 30-some years of my life without knowing what Neosporin is, or what it does. I just used rubbing alcohol and it stung!

Then I got married and the Mrs introduced me to Neosporin, now it's in my first aid kit, in single servings quantity. I hope she doesn't introduce me to any more magic potions from her medicine cabinet :)

There's probably a more appropriate happy medium, but I can picture myself with 2 inches of a drinking straw filled with neosporin and a 5-inch gash, thinking "What now?"

I'm glad I'm not the only one who occasionally reads between the lines of the UL bible, though. Party on, newton!

Then it becomes a matter of getting out rather than fixing yourself. There are things that you will not be able to fix and will then need to rely on your other preparations.. knowing bail out points and/or contacting rescue.

If you have a large laceration the best you can do is close it up and minimize bleeding. A whole tube of neosporin won't help much.. but steristrips, gauze and tape will.

Avoiding accidents is generally easier than dealing with one. In rock climbing we have "don't fall" zones.. sometimes you can't protect adequately and you can either back off or go up knowing you're unprotected. If you are far from rescue or rescue contact it is best to know what risks you should avoid. Descending steep terrain carefully.. crossing rivers at safe areas etc.

skills vs gear.

When in doubt, as to whether you should take it, some of it or none of it, you can always do a little accounting fraud and reclassify the big tube of Neo as your ONE allowed guilty pleasure, luxury item, some take a fancy coffee press, others bring a 16 oz weapon or a heavy paper book.

The BPL UL sports high commissioner will not be auditing and disqualifying your trip.

Edited by RogerDodger on 02/07/2013 13:16:18 MST.

I think my luxury item is my 3lb DSLR Camera and chest pack, haha...

Has anyone tried the Adventure Medical Kit line? REI sells the .5 model that comes in under 4 oz.