First Aid

[Chip]

I do carry Immodium, but I should add a laxative too, as I believe THAT problem is more common in the woods, being on a different diet and also with kids that don't want to use a pit or whatever.

 

[skibones]

first aid

I would suggest some chewable baby asprin. I carry it for possible cardiac problems. After checking that the person has no allergies to asprin giving 4 for a total of 325 mg is the standard treatment in my state. I would try to get permission from a doctor by phone or radio if that was possible.

The aspirin for cardiac problems would be a great addition to my pack-never thought of it. Otherwise i carry the usual: bandaids; duct tape; iodine tablets; mole skin; space blanket; advil. I think the epi pen would be a good addition-just in case.
I need to look into taking a first aid course.

 

[Paradox]

I just finished the thread referenced in SAR EMT40's posting above. Folks, I'm hiking with him.

 

[Clown]

I'm going to second David Metsky's WFA Solo school. I have heard very good things and first aid trianing will go much farther than any med kit you can buy.

Also I'm going to second SAR-EMT's advice on carrying baby asprin. It really could help someone that had heart trouble, plus nothing is worse than a headache when your two days from the car on a backpacking trip.

As far as the epi pen goes, well I wouldn't carry one. Almost anyone who will need one should have it on them at all times when hiking. You should just use theirs. On a side note, epi though probably won't seriously harm you if you don't need it, is NOT very long lasting. If someone is suffering from a severe reaction they need to get to a hospital fast. An epi pen will stop the reaction, but only for a short period of time. There is still a very good chance that the reaction will continue.

When it comes to med kits, I think it depends on how much you feel you want to improvise. Someone mentioned a SAM splint, but I'm sure most of you could fashion a decent splint out a stick that would work just as well (for example). Personally, I would love to carry way more than you would ever need but it is not practical. I can envision all kinds of what-ifs and senarios. For the most comfort I suggest band-aids and protection for blisters. Always carry tape because you can use that for a million things.

 

[skibones]

As far as the epi pen goes, well I wouldn't carry one. Almost anyone who will need one should have it on them at all times when hiking. You should just use theirs. On a side note, epi though probably won't seriously harm you if you don't need it, is NOT very long lasting. If someone is suffering from a severe reaction they need to get to a hospital fast. An epi pen will stop the reaction, but only for a short period of time. There is still a very good chance that the reaction will continue.

Could you have a reaction to a bee sting or several bee stings and not know it ahead of time? That's why i think an Epi pen might come in handy-for the remote possibility that you or someone in your hiking group might have a severe reaction. The epi pen might help until that person could get to a hospital.

 

[Clown]

If you were authorized to carry it, and administer it. In massachusetts an EMT can administer an epi-pen if the patient has a prescription for one. An EMT can carry an epi-pen, on an ambulance, if their employer has given them a special training course on when and how to use it. So what I'm saying is that as an EMT I needed extra training after school in order to carry one around with me. Though, anything is possible, so I strongly suggest that you get training before carrying one around.

 

[Chip]

Could you have a reaction to a bee sting or several bee stings and not know it ahead of time?

ABSOLUTELY ! I had my FIRST anaphylactic reaction at age 44, no previous indications of ANY allergies, including pollen. If I had had my first reaction in the woods I probably would've expired there. You suffocate as your throat constricts. I'll take my chances with the epipens. I understand SAR-EMT40 and appreciate his input and knowledge. I just don't believe SOLO would be teaching the use and discussing how to acquire the pens in their First Aid classes if there weren't more gain then harm with having them.

 

[Happyfeet]

For short day hikes I usually just carry a small FA kit with a few band-aids, small gauze pads, tape, advil & benadryl. I have a much larger one for longer trips that has the same plus a variety of banages, butterflies, kling, sam splint, wider tape, immodium, children's advil bacitacian, gloves, gloves and more gloves and a small pocket mask plus some things I can't remember. I always thought the small one would be enough until a couple years ago we were approaching the summit of Monadnock when a man hiking with his family tripped coming down, picked up speed and almost went head first into a boulder, landing within a few feet of my feet. He tore open his arm. It took all the bandages I had to cover it and I found out that the 1/2 " tape that comes with the first aid kits is useless. It took my duct tape to cover it. Now I usually carry my larger one all the time. I also agree that training is a must. I have 25 years of EMS experience including 19 as a paramedic but am still planning an taking a SOLO course in the near future.

 

[Waumbek]

I would suggest some chewable baby asprin. I carry it for possible cardiac problems. After checking that the person has no allergies to asprin giving 4 for a total of 325 mg is the standard treatment in my state. I would try to get permission from a doctor by phone or radio if that was possible.

Paradox, I also carry cavit which I find to be very effective for a crown that has fallen off or filling that falls out. I'm sure you would have lots better stuff though for dental emergencies.

Keith

But wouldn't aspirin be potentially lethal for some strokes (brain bleeds)? With no phone or radio contact, which is all too often the situation in the Whites, should the amateur risk giving it to someone else or to oneself? Fixodent works fine to re-cement crowns temporarily, although I don't know that I'd bother lugging a whole tube of it with me just in case.

 

[Paradox]

With regard to the fixodent/cavit question. I really don't think about bringing it on the trail because my job as a dentist depends on permanent solutions. Hence, everything but the smallest filling in my mouth is crowned (I ain't tellin' you who did them!) I use cavit all the time for temporaries on root canals, but have never thought to bring it on the trail. I have received a number of cell phone calls on mountain tops about broken teeth/fillings, and they want to know why I can't meet them at the office in 15 minutes. I tell them about the after-hours fee of $300 and they immediately start to feel better. After the pause, I then tell them to pack the hole with sugar-less gum. Sugarless gum is readily available and very inexpensive. Gets 'em by till Monday.

 

[SAR-EMT40]

But wouldn't aspirin be potentially lethal for some strokes (brain bleeds)? With no phone or radio contact, which is all too often the situation in the Whites, should the amateur risk giving it to someone else or to oneself?

I wouldn't suggest that anyone dispense medicine without a license but, the symptoms for heart attack i.e. chest pain, often perceived by the patient as crushing or viselike. It can be radiating or not and doesn’t clear when exercise stops and lasts more that 10 minutes. Also difficulty breathing and heavy sweating (diaphoresis) is often associated with a heart problem as well. Past history of a heart condition is also a good indicator.

Strokes can fairly easily and accurately identified by using the Cincinnati pre-hospital stroke scale test. Three parts. First, ask the patient to speak the phrase. “You can’t teach an old dog new tricks.” Second, ask the patient to smile. Third, ask the patient to hold both their hands out in front of them at eye level with their eyes closed. If the patient’s smile is droopy or if one arm drifts or they cannot repeat the phrase or they slur the speech or cannot do it at all. If one of these findings is abnormal and new the chances of stroke is 70%. All three the chances are 85%.

As far as dispensing medication without a license. It is illegal. Like I said I would make a good faith attempt to contact a doctor. Assuming that I couldn't get in touch with one, would I give an aspirin if I suspected a heart attack or assist someone with an epi pen if I was certain they were having an anaphylactic reaction? Almost certainly, following the protocols that I am familiar with but I would also be aware that doesn’t really, legally protect me. I would always attempt to provide the best care I could for my patient. That is a defense that can be used in court, but it might not be a winning one.

If you are suggesting that it is a generally a bad idea to give medications to yourself and especially someone else without a doctors consent you are absolutely right. Even Nurses/EMT's/Paramedics work dispensing medicine, Oxygen, Epi, aspirin, glucose, etc because a specific doctor says they can. Their medical control. Without that permission they are practicing medicine without a license.

Keith

 

[SAR-EMT40]

Could you have a reaction to a bee sting or several bee stings and not know it ahead of time? That's why i think an Epi pen might come in handy-for the remote possibility that you or someone in your hiking group might have a severe reaction. The epi pen might help until that person could get to a hospital.

If your question is can you have a reaction the first time that you are stung the answer is supposed to be an emphatic no. You cannot have an anaphylactic reaction to the first contact with the whatever the protein is that causes the problem. At least that is what I have been taught. Your bodies overreaction to the protein by releasing to many histamines is what causes the problem. It cannot respond to the protein unless it has been exposed at least once before.

Like Clown says, an epi pen is serious enough that they are accountable medications carried on the ambulance, nice looking bus by the way Clown. In CT we have extra training for them but we are not epi certified. We are all epi certified in CT as EMT's but we ask permission from medical control if the person doesn't have a prescription for a pen already. Aspirin is a different matter. Used to be we had a protocol we used to administer aspirin but that was changed and the administering of aspirin is now considered a paramedic skill. That is supposed to change again in the near future as ridiculous as that may sound.

Also epi’s only last for 10 minutes or so. If the reaction lasts longer than that, which is not uncommon, you must have something else going for you, or them. Either more epis or an IV or like Dave mentioned diphenhydramine (Benadryl) by mouth. Liquid or chewables are best as they are absorbed faster.

I should also mention that I have taken and recerted my Wilderness EMT from SOLO again last year and continue to do so. I think highly of the school and the teachers.

Keith

 

[Chip]

If your question is can you have a reaction the first time that you are stung the answer is supposed to be an emphatic no. You cannot have an anaphylactic reaction to the first contact with the whatever the protein is that causes the problem. At least that is what I have been taught. Keith

I get stung a few times every year. My first anaphylactic reaction was from my second or third sting that summer from the same nest in my yard.

 

[Waumbek]

If you are suggesting that it is a generally a bad idea to give medications to yourself and especially someone else without a doctors consent you are absolutely right. Even Nurses/EMT's/Paramedics work dispensing medicine, Oxygen, Epi, aspirin, glucose, etc because a specific doctor says they can. Their medical control. Without that permission they are practicing medicine without a license.
Keith

Thanks, Keith, for an interesting and clearly-written post. I understand the important legal implications of giving even OTC medications to others. What would worry me more, though, is the risk of giving the wrong ones. There must be gray areas in stroke and heart attack symptoms. Aspirin could drastically worsen some strokes. As an amateur, even in a wilderness setting, I think the "do no harm" to others ethic would be uppermost in my mind. I know someone who gambled and won--took the aspirin and survived the heart attack--but it was a very high risk move given the level of this person's medical knowledge.

 

[SAR-EMT40]

As an amateur, even in a wilderness setting, I think the "do no harm" to others ethic would be uppermost in my mind. I know someone who gambled and won--took the aspirin and survived the heart attack--but it was a very high risk move given the level of this person's medical knowledge.

You are of course correct and I am not suggesting that any untrained person dispense medications. The "first, do no harm" ethic permeates medicine from the bottom to top and is one of the reason why the protections given to bystanders with respect to the good Samaritan laws are all just about the same from state to state and basically protect people “to their level of training”. If you exceed that you have no protection. In the extreme there is Joe Sidekick trying to do open heart surgery. Clearly he has exceeded his level of training. Still exceeding but maybe less recognized is someone giving OTC medications to someone else to help them “treat” something they think they have identified. By doing that you have stepped over the line and have now acted like a doctor. If something goes wrong, you could be charged criminally and also held liable in a civil action. I can’t make it clearer than that.

I know that this is probably unneeded but I should point out that I am not an amateur (no offense taken) but neither am I a doctor, or a lawyer for that matter. I have certifications as listed below and have over 4 years service as an EMT locally and some backcountry experience as well.

NREMT
CT EMT-D
Wilderness EMT through SOLO
also
PEPPS
PHTLS
and hundreds of refreshers and other classes to numerous to mention.

Keith

 

[Clown]

We are all epi certified in CT as EMT's but we ask permission from medical control if the person doesn't have a prescription for a pen already. Aspirin is a different matter. Used to be we had a protocol we used to administer aspirin but that was changed and the administering of aspirin is now considered a paramedic skill. That is supposed to change again in the near future as ridiculous as that may sound.

Yes, I should have clarified, we also have to ask for medical direction when administering epi. What I meant was that we can administer it to patients that don't have a prescription, same as you guys apparently . The only thing we can give people without med direction is O2 and glucose since neither of those can really do any harm. We do not carry asprin either, lol I'm not really sure why though. We can give someone Nitro, but can't give them asprin? At least that's the way it is in my region, though I never quite understood that one.

 

[Waumbek]

I know that this is probably unneeded but I should point out that I am not an amateur (no offense taken) but neither am I a doctor, or a lawyer for that matter. I have certifications as listed below and have over 4 years service as an EMT locally and some backcountry experience as well.
Keith

"As an amateur" was meant to modify me, not you. I would worry about myself acting for someone else on partial medical information.

 

[Kevin Rooney]

I would suggest some chewable baby asprin. I carry it for possible cardiac problems. Keith

Keith -

Aspirin works faster if placed under the tongue, like nitro, according to what docs have told me. Faster absorption.

Kevin

 

[porky]

There is some fascinating information on this thread, but it seems to have drifted from its original intent (as so often happens). As far as practicing medicine on others goes, yeah, don't do it. For your own first aid, carry gear and supplies appropriate to your training and personal needs. If in doubt about an item, ask your personal health care provider.

I have been hiking, canoeing and camping, mostly in the Northeast, for some forty years. I've also been a registered nurse in emergency medicine for about twenty-five years, and I have access to all sorts of medications and supplies. Nonetheless, I find that my usual first aid kit weighs about six ounces, fits in a quart-sized ziplock bag and contains no prescription drugs or esoteric medical supplies.

Moleskin and duck tape are both appropriate dressings for blisters. The time to treat a blister is as soon as you feel like you might be getting a blister. "Toughing it out" makes no sense; leading to increasing pain and injury, as well as potential infection.

Most of the medical emergencies I've seen have been limb injuries from mis-steps, falls and the like (ankles and knees are particularly vulnerable). All first aid courses cover the basic first response for these strains, sprains and fractures. I carry a 4" ace bandage and figure I can improvise a splint out of found materials, bandanas and the like. Cold spring water is readily available here in the NE, so I don't bother with chemical ice packs. Suspected fractures and other serious closed injuries should be evacuated.

Open wounds are treated with cleansing, sterile dressings, elevation and, if active bleeding needs to be controlled, compression with a hand or the aforementioned ace bandage. I carry lots of bandaids and gauze and some antiseptic soap (Hibiclens), as well as bacitracin ointment. Wounds that may require suturing should be evacuated to the nearest emergency room, preferably in six hours or less. Minor gaping wounds can be closed with "butterfly" bandaids or the like. Tincture of benzoin can help tape adhesives stick better to sweaty or oily skin. I carry some ampules of that.

Hypothermia happens; heat and dry clothing treats it. I carry fire starting materials and a couple of chemical hand warmers. The hand warmers can get cold hands working well enough to handle the lighting of a fire. I carry a "Blizzard Bag" emergency sleeping bag on day hikes, as well as a fly and ground cloth and some cord to fashion a shelter if I have to stop moving and hypothermia might threaten.

Minor allergic symptoms resulting from insect bites and stings, toxic plant contact, and similar issues can be treated with oral Benedryl and topical cortisone. I carry both. If one is prone to more serious allergic reactions, a discussion of the options with one's personal health care provider is in order, preferably before setting into the woods.

Gastrointestinal illness, especially diarrhea, seems common. More of it probably comes from poor hygeine than from contaminated water or food. Avoid consuming contaminated food and water. A bottle of isopropanol-based hand cleanser will facilitate frequent handwashing. Immodium for diarrhea, Ex-Lax for constipation and an antiemetic like Dramamine might be appropriate if one is prone to such issues. As I almost never suffer from GI problems, I don't bother carrying these drugs. Anyway, Benedryl is as effective an antiemetic as Dramamine, and I do carry that. Constipation is frequently caused by dehydration; diarrhea results in dehydration. If one is dehydrated, the treatment of choice is water, taken by mouth. If one is vomiting uncontrollably, evacuate to advanced medical care ASAP.

General aches and pains from injury or arthritis are treated with ibuprofen, acetaminophen (Tylenol), aspirin, etc. Tylenol is easier on the stomach and doesn't promote bleeding, but it's a less effective pain reliever. Any of these meds can also be used to treat fever. If someone has a persistent febrile illness, get out of the woods and see a doctor. Same goes for any other medical problem that seems serious.

Stuff like heart attacts, drowning, lightning strikes, and life-threatening injuries are best avoided. Learning CPR might help in the first three cases, but the victim must be stabilized and evacuated to advanced care really reallly quickly in the rare event that CPR actually restores life functions (or in the case of massive injuries). This is a difficult undertaking at any time, and often impossible in a wilderness area.

That's about it, except for knowledge and caution, which each cost little, weigh nothing and can save you heinie anywhere, even without a first aid kit.

 

[porky]

Correction

When I wrote "heart attacks" in the last paragraph of the posting above, I meant "cardiac arrest".