What should be in the first aid kit?

[Trekkin]

Hey Keith. Thx very much for the well worded, informative reply. I should have worded my response more clearly, as you raise very valid points. I am not knowledgeable enough to ever hand over an Epi-pen to anyone else, unless they're familiar (and prescribed) for their use. After speaking with my SO's general physician about the incident he was concerned that if she were to get stung again on that kind of scale that the result could very well be anaphylactic shock, and gave a prescription for it (for her use only), which we renew yearly. When I said that it'd be good to have in the event you encountered someone in need, I was thinking more along the lines of someone who's used 'em and happened to find themselves without in a time of need. I am not a physician, and am not knowledgeable enough to try and field diagnose someone (no disillusions there, really).

The presription meds I'm given prior to heading out are presribed in my name, and per my GP, are for my use only. However, if a member of my party is suffering from (insert serious malady here) and their mobility is necessary to ensure their or the other members well-being, then I'll be more comfortable knowing I potentially have that avenue available to me, and them. Would I, or do I, hand out pain meds/antibiotics willy-nilly? Absolutely not. But in the event of a broken leg, I like knowing I can afford that person some relief while I try the cell phone/hike out/otherwise work on getting that person the best help I can, in the most timely manner possible. Having said all that, over 10yrs of extended backpacking trips with 3-6 people, I've never given anyone anything 'cept Motrin and words of encouragement.

Hope this allayed some of your concerns, as I appreciate the feedback and justified curiosity.

 

[twigeater]

lots of good points, SAR-EMT40!

One thing I changed after wilderness first aid, was instead of carrying one baggy of OTC drugs, now each goes in it's own little baggy. And I hand the baggy to the person rather than handing them some pills. I guess I'm really supposed to carry each in it's own labelled bottle, but that isn't gonna happen.

I don't want anyone elses "it won't hurt you" prescription drugs, and I'm not sharing mine, LOL...
I also don't want someone using a needle and thread, sterile or not, to sew me up - unless I was bleeding to death I guess. I sliced two toes on a trip once, and the EMT who was with us said he wished he'd brought his new staple gun thingy - I was really glad he hadn't!

My kit:

first aid book
tick remover
scissors
neosporin
bandaids, bandages
duck tape
OTC meds - IB, Imodium, pepto, etc
plastic gloves
iodine and equilizer tabs
butterfly bandaids
alcohol swabs
aloe swabs
tape and steri strips

 

[Puck]

Keith
Great post! I have had EMT training in CT also. so if I could add some points. An EMT can not dispense medications, it is beyond the scope of thier training. The patient must do that themselves, if they can. So people who are sharing thier prescriptions with others in thier groups are really exposing themselves legally, and are exposing the other person to harm as well.

The EMT has at thier disposal a fully stocked ambulance with collars, back boards, straps, O2, airway devices, splints..... and this is to prepare the patient for immediate transport to the ER. In the back country we really don't have anything to properly immobilize the patient for transport. If a person is a fall victim there is must be an assumption of C-spine injury unless they are consciece and a full assesment could be made. In the case of a Cspine injury the patient's hope is SAR and to be immobilized and treated for shock in the mean time. Injuries for sprains, strains and fractures can be splinted but the pain just becomes part of the adventure. I could not see giving pain medication beyond OTC drugs.

I carry most of what people have mentioned as well as homeopathic remedies that may be indicated in first aid situations.

 

[linehant]

>> In some cases such as a trip into the Wind Rivers , Denali or the like it [Oxycodone, etc] might be the only relief that person gets and may help keep them clamer and still. even more imporatnet that a injured person is not moved unless nessessary<<

That summarizes very well the purpose for having the stuff in the "big" (aka backcountry) kit.

 

[RGF1]

I have to admit to a curiosity about all the people who are carrying epi pens. Who are you getting them from and for what intended purpose? I am pretty sure that all of you are not doctors. Are they supposed to be used on you or has your doctor OK’d you to use them on other people? Do you know what the reactions of the body from epi pen are? Do you know the key indicator when to give an epi pen is? Do you know how to keep the persons airway open? Do you know how long an epi pen lasts? Do you know what to do when the epi pen wears off in 5 to 10 minutes (answer to previous question) and that person is still suffering from anaphylaxis? Are you aware how sensitive epis are to heat and cold and the limited shelf life they have? The woofers out there. Who is your medical control to use the epi pen or do you have standing orders to use it on someone else? Is that person going to put their medical license on the line for your actions?


Oxycodone. Holy crap. Is that prescribed to you or are you a doctor? If you are in that much pain that you are taking that strong a pain medication, what are you doing in the backcountry? If you plan on giving that to someone else don’t even tell me, I don’t want to know.

For those of you who have no medical training. Do you think you are covered under the good Samaritan laws? About forty-five states have Good Samaritan laws. They are all about the same in content. You are covered if you try to help a person and it doesn’t work provided you work only to the level of training you have received. That means that if you have no training at all then you can apply first aid only. If you have a CPR certification then you should be able to do that reasonably well but if you make a mistake you will not be prosecuted or have a winnable lawsuit brought against you. If you start giving the person medications and start whacking away at them with your Leatherman to do open heart surgery the law isn’t going to protect you which is probably a good thing.



I understand that some of you may have certifications that I know nothing about. If that is the case please mention it so that others know that you are not some lay person who plans on dispensing narcotics in the backcountry because of a bad headache. It would not be good for people to think that if someone is complaining about the pain from a broken leg from a 15 foot fall with a witnessed episode of LOC that shoving narcotics into him is a good thing to do (it really isn't) simply because you have it in your pack.

Keith
WEMT
CT EMT-D
PHTLS

Kieth. I carry Epi pens because of my alleregen induced Asthma and are perscribed

As for Oxycodone I wear a Duragesic patch and funtiion fine with it . I would be riding the lifts to the views with out it. I also cary Morhpine in case of sever injury buty is only for my use as I already deal with chronic pain.

On long tiprs people often carry something such as percocet or Tylenol #3 if they talk to thier MD and get a perscription
To be honest if I broke my leg and was still concious I would hoope some one would give me a strong pain reliuver unless rescue was aonly a few hours away.
FWIW I am active with Aspen SAR when I am in CO. Tthey are probably the best there is . I have awliderness frist responders certificate and am certified for CPR.
I think it is a good idea fro every one ot hav basic frist aid knowledge espically if you are hiking or other wise a distance from imedaite medical assistace .
I doubvy any one is talking about perfoming advanced medicla proceedures on any one.
The big thing with narcotics has more more to to with our drug laws than any thing else .

 

[Artex]

Crazy glue is a must for med kits.

I thought I've heard that it could be used in lieu of butterfly bandages or even stitches. If so, does anyone have anymore info on this? I'd still be a bit hesitant to use crazy glue near an open wound, but wouldn't mind looking into it a bit more.

 

[Warren]

I have to admit to a curiosity about all the people who are carrying epi pens.

Oddly, as mentioned above epi pens were covered in a SOLO Wilderness First Aid Course. With much of the disclaimers you mention. The context of the training was coming upon someone who had on on their person or traveling with a person who carries one. I did think the mentioning of it even in that context was odd.

Dermabond (Medical superglue) for wilderness medical use is still going through discussions. A new type is now available and it is being looked at. The greatest problem with the superglues is the propensity for people to try to close deep wounds without proper debridement in the backcountry where that proper cleaning of the wound cannot readily be done. The result is that they lock in tremendous infections into the wounds that cause very bad results. Using Sterie strips in the backcountry is the recommended way to close deep wounds after thorough wound irrigation is done.

Steri Strips is what I've been recommended by Doctors to deal with lacerations. I've the two times I've needed them, I found them useless in a backcountry situation. Either I had old ones or applied them incorrectly but my impression was that they are not intended for an environment were the treated area will still be in use and flexing (laceration on hand or leg). I'm still looking for an alternative and there's super glue in my repair kit if it's ever really needed though I have doubts about the effectiveness of glue, I've thought a staple kit would be a better choice. Anyway, my point is that I haven't found a suitable treatment for a laceration where you still must self evacuate.

Great post and good reminder about wound irrigation.

 

[Puck]

The big thing with narcotics has more more to to with our drug laws than any thing else .

Narcotics are physically addictive. The withdrawl could be hell. Yours is a dangerous idea.

 

[RGF1]

Narcotics are physically addictive. The withdrawl could be hell. Yours is a dangerous idea.

Puck It is improbable that a persom will become addicted after a few doses ofa Narcotic. I take one and have little chopice I do not get "high"
In fact the truth is that most ODs in ERs are from OTC pain reliewvers.
Gving some one a small dose of oa narcotic is in no way f going ot make them addicted.
onme of the myths of the drug war . Actually Opaites are safer and have less side effect that OTC pain relievers.
the debate is more political anbd historical than informative .
I was given the choice of take the narcotic or havew 80 % chance of never walking avgain what do you think I chose.
Aslo most of the problems aroud addiction are becasue the drugs are illegal nothing more but that is something I can talk about of the board. I think you mistunderstood me.
There is also a big myth about withdrawl most never go through that and it takes years of extreamly heavy use to get to that point not one or two pills.
I am not trying ot be harsh but i really would wantva pain rel;iver if I broke a bone. On most major expedtions they carry morphine and other drugs. many on Denali do so .

 

[SAR-EMT40]

I've the two times I've needed them, I found them useless in a backcountry situation. Either I had old ones or applied them incorrectly

Use tincture of benzoin around the wound. That will keep the strips held in place. Just don't get it into the wound. It will sting like hell.

Keith

 

[SAR-EMT40]

RGF1 I understand what you are saying and generally agree. My wife is a chronic pain patient. Addiction is not the consideration in this case. But other very serious ramifications are. Please see my other comments about the scenerio below.

I understand the interest in helping your fellow man when they are hurt or injured. Especially when they are far from help. That is why I took the training that I took. One of the misconceptions is that a lot of the OTC meds are safe and in general everyone is correct. But even giving an OTC med to someone can be problematic. Let’s say you give Tylenol to someone for pain. They suffer a reaction. Did you ask them have they ever taken it before? Maybe they were allergic. Someone has chest pain. You give them 4 baby aspirin after you remember to check to see if they have ever had an allergic reaction and they say no. They take the aspirin and die from a gastric bleed. You didn’t ask them if they had an ulcer or any other contraindications for use of aspirin. Did you kill them? Maybe, I don’t know, but his family’s lawyer will say you did and maybe the medical profession as well.

My example of the person with the broken leg from the fall. Giving him an opiate could very likely kill him. He experienced a witnessed loss of consciousness (LOC). He will likely have sustained serious brain trauma. If his brain swells, an almost certain occurrence, your going to have all you can do to keep him breathing. Opiates (Morphine,Oxycodone) suppress the breathing centers of the brain making breathing even more difficult. God help you if they discover during the autopsy that he had opiates in his blood stream that were not prescribed to him. His broken leg was painful but not life threatening but, your (generic your) treatment for his pain killed him.

As with most things in life, things are just not as straight forward as they sometimes appear. Most of the time, this fuzziness in life is an interesting side effect. In medical emergencies it can change a persons life.

I definitely am not suggesting that you walk away (there is something called a “duty to act”. In most states even an EMT does NOT have a “duty to act” unless he is on duty. If you or I see someone hurt I am under no legal obligation to get involved. The second I put hands on or interact with the patient I am at that point obliged to give the best care I can until I turn that patient over to someone of equal or higher medical authority. If I decide that I want to leave and tell a bystander without equal or higher training to me to watch this person and I leave that is called abandonment and is a very serious charge. Saying that, I wouldn’t walk away under most cases either. But giving medications is a very risky business. You should be aware that there are many pitfalls and you have no legal recourse if something goes wrong.

Twigeater, as far as that person who was going to staple your toe lacs for you. I would ask him to show me either a doctors/PA degree or let me see how he was going to do it on himself first. I am not positive but I thought that staples are contraindicated on fingers and toes because of the amount of flesh over bone. Do you (does he) realize how many vessels and nerves are in the toes? Jesus! He possibly could have done a lot of damage. Steri strips, tincture of Benzoin and probably immobilization if you cannot get out to have it looked at by a doctor.


Sorry for another kind of long one. It is shorter than the last one though.
Keith

 

[Puck]

RGF
All of that may or not be so. However, the take home message is; giving somebody a narcotic is a crime unless you are trained and under a doctor's direct and immediate supervision. Opiates are a controled substance.

 

[RGF1]

Puck I know it is crime But the thread would become political I would happly talk about it of board. I am a chronic pain patient. I for know do not ask do not tewll might work or say to the EMT I had a x from a old Perscritption ( do not ask do not tell.)
Kieth I would never even give a tylenol to a person with out asking if they have reaction to it. frist .
I have a good deal of education and qualifications . I just feel that the silly notion if you give a person a narcotic they will become a life time addict is just that plain uniformed . Having broken bones I know the extream pain. .

As I said the drug debate is more poltical and historical if one knows about our Big Brother is watching and knows best drug laws.
Also Kieth I once again a jury would not find for a plaintif in such a case . I think taking a person to court for helping is just plain greed. and most juries know it. It might never even get that far or get thrown out by a judge the plaintiff would also have to prove negligence and malice. tough one in this type of case.
I do think this thread shows how we quickly give up our rrights and resposiblities along with asseing blame Sadly huma kindness can now be a when something goes wrong . Sadly Human Kindness can now bwe a crime or amtter for ltigation.

 

[linehant]

"Giving somebody a narcotic is a crime..."

ROFL!!!

Heck... I think y'all are being petulant and argumentive because **I** have a "stash", and you don't. You're jealous.

To recap...

It's MY first aid kit. MINE! It's my Oxy prescription. MINE! MINE!!!!

If you don't want any, fine. But if I'm gonna be in the backcountry, someplace like the Winds, where help is a l-o-n-g way away, it's going with me. It's MY first-aid kit. The magic pills STAY.

 

[Jaytrek57]

Keith--

Great posts.

To answer at least for me. I have medical control sign off for my trips with kids. The doctor knows me, my level of training and reviews each kids med forms. She is also a pretty avid outdoors person so it makes things a bit easier.

I did have to use one once with a kid while we were basecamping in Bearstown SF. Scary. I am very thankful, for my training and more specifically, as you mentioned, the ability to identify what was going on. More thankful that your peers showed up quickly.

Again, thanks for sharing your knowledge.

peace.

 

[twigeater]

Originally Posted by SAR-EMT40
Twigeater, as far as that person who was going to staple your toe lacs for you. I would ask him to show me either a doctors/PA degree or let me see how he was going to do it on himself first. I am not positive but I thought that staples are contraindicated on fingers and toes because of the amount of flesh over bone. Do you (does he) realize how many vessels and nerves are in the toes? Jesus! He possibly could have done a lot of damage. Steri strips, tincture of Benzoin and probably immobilization if you cannot get out to have it looked at by a doctor.

No kidding! Just thinking about it makes me sick to my stomach - I'm sure that with staples in my toe, I would not have been able to continue hiking. As it was, I backpacked the next 7 days with no problem, other than keeping it clean.

The other thing is - two people on the trip had wilderness first aid certification, did wilderness rescue, and at least one was trained as an EMT. They wanted me to go out the next day and get stitches - but me and another guy said we didn't think I could have stitches after a certain amount of time (6 hours I thought) and they hadn't heard that. She said that she was trained that if a would was so long, and so deep (something like that) that it needed to be stitched.

 

[Puck]

Look, I don't want to debate drug laws, however, in the scope of this thread we should not give a medication to somebody needing emergency first aid. It is beyond our scope of training. If somebody is in shock or could go into shock, is suspected of having C-spine injury or is hemorrhaging (and yes a long bone fracture causes shock and hemorrhage and should be treated as a true emergency) a medication could kill them as Keith has pointed out. A pill could even cause a choking hazard in these extreme cases.

"First do no harm." Don't exceed your qualifications and training.

 

[Chip]

Who is your medical control to use the epi pen or do you have standing orders to use it on someone else? Is that person going to put their medical license on the line for your actions?

Obviously, we carry epi pens on the ambulance but it is carried as a controlled item. By controlled I don’t mean it is locked up but it’s use is controlled by our medical control officer (our doctor) and state and local protocols, as is all that we do.

This is interesting. I know group leaders can get signed waivers, like school nurses do, if anyone is allergic,
but there doesn't appear to be any requirement that a doctor does the injection.
The whole idea with Epipens is that the person who needs it will require it before a MD is available.

If anyone has a group leader consent form, I'd like to see how it reads.
Maybe I should get signatures before my tribes next outing.

 

[Mad Townie]

My first aid kit? I usually hike with a doctor!

 

[SAR-EMT40]

Twigeater,

Between 6 hours and 24 hours would probably be considered too long depending on location and how clean it was kept. Could you have gotten out in 6 hours? My understanding is that after that period of time the chances for infection being closed into the wound is too great. Was it a clean slice or ragged?

Part of the key to getting it sutured would have been how clean you could have kept it. Yeah - I know. Out in the woods, have to walk on the foot, etc. Not easy to do. Good irrigation of the wound, steri strips with tinture of benzoin on the wound margins to help keep it closed and imoblilzation of the toes if needed and a good dressing changed and checked every 12 hours or more often if you are crossing streams and mud, getting the dressing wet. Your gonna be walking funny for a while keeping the toes immobilized. Not walking for a couple of days may be better but may not be possible, I know.

I am curious what you/they actually did do and how well did it heal? Also, a 8 cm long 1 cm deep cut on my (old man) forearm I wouldn't stop my trip to get out and try to get stitches. A young girl (or guy for that matter) with a 2 cm long 0.5 cm deep cut on her face I would try to get out. I can handle a scar (to match all my other ones) on my arm, but a young person's face would/should be treated differently.

Fingers and toes (especially fingers) need extra special care. We typically use them a lot and there are lots of important parts very densely packed that make them function correctly. Nerves, blood vessels, muscles, and ligaments etc. This is why we only let Doctors/PA's/Nurse practitioners wield sharp pointy objects that are going to pierce those areas. They are supposed to know where all the important parts are.


Keith