Patroller Advice Request: What to put in a 1st Aid Kit

can someone elaborate on the whole painkiller issue. I usually have motrin/advil in my pack, but I just got my wisdom teeth out and have a some 600mg ibprofen and 500mg hydrocodone, that I am thinking of adding to my standard BC pack. When would it be a good medical call to administer one of these?

Here's my vest, not a lot, but it definitely weighs a fair amount.

6 cravats (you only need 2-3, I carry double in case I get back to back calls)
6 roller gauze (again double)
2 wire splints (doubs)
Pocket mask (for a bc kit I'd go with the little plastic shield thing, way smaller/lighter)
Latex Gloves
Medical Tape
Electrical Tape
4x4 gauze
Large Band-aids
Smaller Loony Toons band-aids (for the bro-brahs with ouchies)
Anti-septic wipes
Candy Bar (hypoglycemic)
bio-hazard bag

Not so medical
leatherman
Paperwork
Self evac equipment, webbing, rescue 8, 90ft of 5mm p-cord
earplugs

This equipment can handle a lot of calls, but remember that we have a lot more resources at our disposal, just a call away.

I'm sure there's more in there too.

I thinking about getting one of those sliver or gold space blankets that reflect body heat back. They weigh nothing and keeping the injured party warm is a must for stopping, or atleast delying them going into shock, also good if you get stuck out for the night. Another usefull and often overlooked thing is tiger balm or deep heat. Great for minor aches and pains. I had gnarly shin bang last season and it was the only thing that got me through work. + all the stuff everyone else said.

I'll second (or third or fourth) taking some sort of wilderness first aid course if you spend a lot of time in the backcountry. I took a class with SOLO (conveniently located in near Tuckerman's) a few years ago. Wilderness first aid classes are great because, unlike normal first aid classes, they assume that you're at least 8 hours from a hospital. Many of the things they teach (fixing dislocations, pulling traction on broken legs, even feeding the patient) would get an EMT fired (EMT's are trained to stabilize patients on the way to the hospital so doctors can work on 'em). After one of these classes you would have a very clear idea of what to include in your first aid pack and (more importantly) how to use it.

Check out the SOLO site:

http://www.soloschools.com/wfa.html

(oops, not many of you are on the East Coast- well, find your local SOLO equivalent)

1. A Vicodin with 5mg of hydrocone is really very little. In the hospital it's commonly given to get patients to stop bothering the nurse so as to stop getting paged. I really doubt someone with a broken femur and two adrenal glands' worth of adrenaline circulating through their body will stop breathing after a Vicodin/Lortab. People get a six-pack in the little foil blisters to go from the ER if they complain about their stubbed toe loud enough.
2. Why bother with pocket masks if you're a non-professional rescuer? Chances of getting HIV or HCV from puke during CPR or rescue breathing is pretty low. Let's think about the cause: pulseless from sudden cardiac death in the backcountry? Pulseless from trauma? Pulseless from lightning strike and arrhythmia? You'll probably make a better seal with your lips than with cold plastic, anyway.
3. You can never have too much skill at dealing with ortho injuries and lacerations IMHO. All the stuff that WEMT teaches about backcountry management of dislocations and fractures could actually help.

No one's mentioned airways - I carry a set but you gotta be an EMT-B or better.

I carry a little aspirin for MIs, and some Glutose for low BGL. A light, gloves, shears, a blob (mask), some band-aids and tape, cravats. gauze, and some pads for big-time bleeding. See above about EMT-B. Maybe some eyedrops.

Most anything else I'd need will be in the trauma pack. Not all of this helps with the WFR scenario.

Here's a slightly different climber's perspective. Weight is a guiding factor. If it's too heavy, you won't carry it. I basically use the same set-up for BC skiing.

So yeah, Patrollers have no interest in this list.

BaseCamp: Lots of crap for day to day ouchies. Stuff for blisters, cuts, larger wounds, stuff for cleaning wounds, stuff for headaches, for gut infections (Cipro), etc.... most of the crap that has been mentioned. Stuff for serious injuries PLUS stuff to take care of day-to-day hassles.

Summit Pack (and day trips): This is largely designed to deal only with the most serious injuries. Everything else, as much as it might suck, is not a concern.
- Tape. Lots of it - duct tape too.
- Gauze. Lots of it
- Percoset - For when you either (a) leave your bud and get help, or (b) drag him out screaming the whole way.
- Steroids for HACE if going to altitude (although some docs have pointed out: "you think once you realize someone has HACE they can still swallow? Hah!")
- Leatherman/knife (which you should already have for other reasons)

The theory is that with enough pressure and gauze you can stop any bleeding that can be stopped. Anything else is minor enough that you can suck it up and deal. Learn to put joints back in and how to splint things using the crap already in your pack (or the pack itself). The plan is to take care of the most serious things and then get the fuck out of there.

It's not a pretty system, but it is built around the idea that you're simply NOT going to carry a big-ol' first aid kit in your summit pack.

jesus christ summit must carry a huge pack w/ him. i always try to keep some narcotics in my pack but damn if they ever stay there for long. so my answer is duct tape and drugs.

Its sort of funny and ironic that this thread got resurrected. I really wasn't thinking along these lines last year when I started this thread, but I've now decided to pursue becoming a volunteer patroller. I've completed the first few steps (ski check, OEC (like EMT) training). Next month we start the on-hill practical stuff dealing with sleds, etc. I didn't actually decide to so this until last spring, but obviously I was thinking about it earlier.

Thanks for all the good input. Right now my pack just has the standard issue stuff from my OEC class. Now I need to make it realisticaly practical (swap m&m's for glucose, add some fun band-aids, antiseptic wipes, etc.). Already have cravats, airways, pocket mask, SAM splint, O2 wrench, tape, cord, knife, sharpie, 4x4's, gloves, gauze, ab-pad, shears (wear full zip pants if you don't want yours cut off by patrol), leatherman, etc.

In my everyday vest, I carried:

Copenhagen
mint snuff
leatherman like tool
2-4' cam straps
2 maxi pads
roll of coban
one roll of athletic tape
led headlamp (we have night skiing)
lighter and some waterproof matches
small amount of duct tape
3 triangular bandages
free hot chocolate cards
emt sheers and tape cutting scissors
4 pair rubber gloves
few gauze
space pen/waterproof note pad
small amount of surveyors tape
sharpie
bandaids
refusal of service form
small roll of softwire
half a sam splint
chapstick
small tin of sunscreen
6' of tubular webbing
2 locking biners
CPR mask with o2 inlet

I was considered a minimalist with my vest. Really, you can't carry everything. The best thing you can carry is a radio so people can bring you what you need after assessment.

I would highly recommend checking local protocol for patrollers administering narcotics or even simple pain killers like Ibuprofen. By giving meds out of the scope of practice, you are greatly enhancing the chance of a lawsuit if shit goes down.

I carry 5 darvocets in my bc pack for me and friends should we need them though and the list greatly changes from my patrol vest to my bc pac

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Originally Posted by Conundrum

In my everyday vest, I carried:

Copenhagen mint snuff
leatherman like tool
small amount of duct tape

free hot chocolate cards

6' of tubular webbing
2 locking biners


I was considered a minimalist with my vest, but the hot chocolate cards worked magic with the chilly cougars.

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fixed it for ya...;)

I carry a couple of rolls of kerlix, some 4x4's, maybe a 5x9 and some bandaids. Everything I need I fit loosely in a gallon size ziplock. Grab that and then there is no reaching back into your pack with bloody hands. Really, if you need more than that, you need help and they can bring the trauma pack.

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Originally Posted by soul_skier

can someone elaborate on the whole painkiller issue. I usually have motrin/advil in my pack, but I just got my wisdom teeth out and have a some 600mg ibprofen and 500mg hydrocodone, that I am thinking of adding to my standard BC pack. When would it be a good medical call to administer one of these?

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Well thats a sticky topic. If you are a trained rescuer like an EMT, you can't give it to anybody without medical control's okay. And neither advil or hydrocodone are on the EMT med list in VT or UT. So it a no go. However, if you are just out there with your buds and they get hurt and you are sure that they won't sue you should something happen you could give them some advil to take the edge off the pain. It won't do much for a major injury but it will help.



In my pack I carry:
Avy shovel and probe
100ft. of 6mm rope, beaners, webbing, slings, harness
extra gloves, hat, sunglasses, headlamp
Whistle, knife, leatherman, zip ties, compass
med kit: band aids, cravats, cling, ace wrap, tegaderm (occlusive dressing), 4x4's, 2x2's. airways, pocketmask, gloves, 14ga needle (for chest decompression) stethascope, 8 ft of mason line, SAM splint, tape, trauma shears

I might be forgetting something those are the major components.

What about those clotting agents like traumadex and quickclot? I know that those are worst case scenario, but I'm curious to know what some of better medically trained mags think of the stuff? I've read that quickclot is nasty stuff, but that traumadex works pretty well.

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Originally Posted by dirtybryan

What about those clotting agents like traumadex and quickclot? I know that those are worst case scenario, but I'm curious to know what some of better medically trained mags think of the stuff? I've read that quickclot is nasty stuff, but that traumadex works pretty well.

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I carry ActCel hemostatic gauze and Celox hemostatic granules. I figure that with an extended extrication, stopping the bleeding ASAP is key. I also figure that it gives me more hemmorage control in a smaller lighter package.

The US military is pretty stoked on HemCon hemostatic dressings, but have had mixed results with the (old exothermic) version of QuickClot. Also, expect changes to that sacred cow policy of "no tourniquets until everything has failed twice" that has been taught.

I have used ActCel gauze to good effect the one time I used it on myself. I'll post more tomorrow after I drill the PHTLS instructor about these.

The first generation quickclot could be nasty if not used properly or in the right condition and could cause burning amoungst other things. The newer version is much better although i haven't used it yet. Summit is right though, you're going to see the use of tourniquets coming in vogue. The latest studies show that they don't cause the damage that was once thought.

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Originally Posted by Sinecure

Its sort of funny and ironic that this thread got resurrected.

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Just what I was thinking. Everyone give Sinecure a big round of applause -- he passed his OEC exam yesterday.

Re narcotics, one of our fellow candidates used to be a rescuer for a parachute club a couple decades back. He says that their first aid kid was a fifth of Jack Daniels and a nickel bag, because that's about all you could do for someone after a parachute accident. (I wasn't clear on whether that was for the victim or the rescuer.)

Coincidentally, I was talking about the quickclot stuff with a non-skiing co-worker earlier today. What's the deal?

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Originally Posted by mcs

On the other side of things, mnflyfish, has an indisputable point. "Barrier"
masks are worthless. Not only do they only 1/2 work, but they won't form
a good seal. Spit, blood and vomit always get in the way and you'll be
in contact w/ it unless you have a real mask. Spend the $8 and let it
take up a bit extra room -- it'll be worth it when you need it.

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I agree with this. When you take your CPR class get a prescription for a real mask.

and take a OEC or WFR class. only problem with an oec class is you most likely keep working for the patrol that you take it from. you will learn a lot about stabilizing the injury witch will do lots for there recover.

The more pain someone is in the more damage that will be done to the soft tissue. That's why drugs help but that puts a lot of responsibly on the rescuer.

The Tree Rat

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Originally Posted by TreeRat

only problem with an oec class is you most likely keep working for the patrol that you take it from.

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I think this varies quite a bit from region to region. Around here, it's not done on a patrol basis. There's a searchable course listing on the NSP website.

Lot's of good stuff here. My experience (patrolled 7 years 16-22 Senior at 18) has been you just need to get the victim and injury stabilized first and then worry about shock. Shock was always my biggest problem. (U got to move). (Yes I’ve done three broken backs) Pain is not going to be a big deal for awhile with most injuries. Then get help & get out. Bleeding Maxi Pads & Kotex can be a great help, Arms slings (Cravats), Air splints & Tape Tape Tape

RE clotting agents: I was reading in a book about using potato starch as a clotting agent. Has anyone ever heard of this, or tried it?
Edit: googled and found this:
http://jada.ada.org/cgi/content/full/133/12/1610-a
and http://www.rense.com/general30/stop.htm

Bump.

Wondering what Summit has after drilling the PTHLS guy. I spoke to a buddy going to West Point and it sounds like his short training is with the older quick clot stuff. However he mentioned something that really jumped at at me which was that with deep wounds (his example being a gun shot wound to the upper thigh) that even if the quick clot stops the bleeding, you risk losing the limb because there is the risk of coagulating too much blood so you have to get the wounded to a medic in under 3 hours for this reason alone.

I'm curious if the risk of too much coagulation is due to them using powder and the risk of pouring too much into the wound and if hemostatic bandages that you can push into an open wound to try to stop bleeding carry this risk and to what degree since these bandages are predosed so to speak.

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Originally Posted by dirtybryan

Wondering what Summit has after drilling the PTHLS guy.

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The instructors were extremely knowledgeable about many things, but didn't claim to be the best experts on this topic.

In terms of general external hemorrhage control, PHTLS is advocating, instead of the old,
1. Direct Pressure/Pressure dressing
2. Elevation
3. Pressure Point
4. Tourniquet

Now according to (COTACS):
1. Direct Pressure/Pressure Dressing
2. Tourniquet
3. (Hemostatics in certain circumstances)

Make sure you know what your are doing with a tourniquet. Here is a refresher for you prehospital providers:

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Originally Posted by PHTLS 6th Ed. pg 182

Sample Protocol for Tourniquet Application

1. Attempt at direct pressure or pressure dressing must fail to control hemorrhage.
2. A commercially manufactured tourniquet, blood pressure cuff, or "Spanish windlass" is applied to the extremity just proximal to the bleeding wound.
3. The tourniquet is tightened until hemorrhage ceases, and then it is secured in place.
4. The time of the tourniquet application is written on a piece of tape and secured to the tourniquet ("TK 21:45" indicates that the tourniquet was applied at 9:45PM)
5. The tourniquet should be left uncovered so that the site can be monitored for recurrent hemorrhage.
6. Pain management should be considered unless the patient is in Class III or IV shock.
7. The patient should ideally be transported to a facility that has surgical capability.

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This is what .mil is using http://www.narescue.com/Product1.asp...&Product_ID=20 You can put it on yourself one handed!

As far as hemostatics and using tourniquets for long periods (anyone here should read this:)

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Originally Posted by PHTLs (6th Ed) p 182, 189-190 Shock

Topical Hemostatic Agents....
The data demonstrating the effectiveness of the HemCon dressing and the QuikClot often include injuries (e.g. liver and aortic trauma) that correlate poorly with the types of injuries that prehospital care providers encounter. To date, no published data exist about the use of topical hemostatic agents in the ivilian setting, and only anecdotal reports exist for the military experience. A prehospital care provider might be tempted to delay transport to use one of these novel but unproven tecnologies. In the civilian setting, no data shows that these products are superior to direct pressure and rapid transport to an appropriate receiving facility. Application of HemCon and QuikClot may be appropriate in a prolonged-transport situation.

..........

Direct pressure is impractical during a long transport, so significant external hemorrhage should be controlled with pressure dressings. If these efforts fail, a tourniquet should be applied. In situations where a tourniquet has been applied and transport time is expected to exceed 2 hours, attempts should be made to remove the tourniquet after more aggressive attempts at local hemorrhage control. This can be accomplished by removing the pressure dressing from over the wound once the tourniquet has controlled the hemorrhage. Next, any blood clot is manually wiped from the wound. A topical hemostatic agent (first a HemCon dressing, followed by QuikClot if HemCon fails) should be applied and a pressure dressing reapplied. The tourniquet should then be slowly loosened while observing the dressing for signs of hemorrhage. If no rebleeding occurs, the tourniquet is completely loosened but left in place in case hemorrhage recurs. Conversion of a tourniquet back to a dressing should not be attempted in the following situations: (1) presence of Class III or IV shock; (2) complete amputation; (3) inability to observe the patient for rebleeding; and (4) tourniquet in place longer than 6 hours.

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Considering that most places I could forsee the need for a hemostatic agent would involve prolonged extrication, I might bring it into the game earlier than PHTLS recommends if it is me and my buddies.

While the Wilderness Medical Society does not have anything in their Practice Guidelines covering hemostatics, PHTLS does comment on modified wilderness care:

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Originally Posted by PHTL 6th Ed - p 553 Wilderness Trauma Care

Hemostasis
Control of bleeding is part of the primary survey. On the street, arterial bleeding can kill. In the backcountry, however, even venous bleeding can kill, if it continues for a sufficient time; every RBC counts. Therefore, bleeding control, using standard measures such as direct pressure and elevation are as important or more important in the wilderness.

At times, however, finding a bleeding site to provide direct digital (finger) pressure over the "bleeder" (bleeding blood vessel) is no that easy. Direct digital pressure for 10 to 15 minutes is far superior to a pressure bandage at controlling bleeders.

Therefor, some wilderness EMS protocols suggest using a a pressure point or a proximal blood pressure (BP) cuff as a tourniquet for 1 or 2 minutes to control the bleeding initially. Then, after letting the BP cuff down careful, the location of the bleeder usually becomes obvious, and a gloved finger covered with a gauze pad (to prevent slipping can be carefully placed over the bleeder for 10 to 15 minutes. If the bleeder starts bleeding again, direct digital pressure for another 10 to 15 minutes almost always stops it.

Note that we are suggesting using a BP cuff tourniquet for only a few minutes. It is important to remember to let the BP cuff down and not use it by itself to stop bleeding; otherwise , the limb might develop permanent damage.

Various companies market special dressings and powders and other devices.

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OK that section was clearly not as well written as the Shock section. Clearly the author was different or the editors paid less attention. Nevertheless, the protocol suggested is interesting and I would think it a smart idea to use hemostatic gauze with that digital pressure/short TK combo.

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Originally Posted by dirtybryan

I spoke to a buddy going to West Point and it sounds like his short training is with the older quick clot stuff. However he mentioned something that really jumped at at me which was that with deep wounds (his example being a gun shot wound to the upper thigh) that even if the quick clot stops the bleeding, you risk losing the limb because there is the risk of coagulating too much blood so you have to get the wounded to a medic in under 3 hours for this reason alone.

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This statement makes no sense at all in that coagulation is not going to kill the limb. However, lack of bloodflow to the limb can still cause the pt to lose the limb. If an artery is completely severed, surgery is required reconnect the vasculature. It's similar to having a tourniqueted extremity (you have 2.5 or so hours before the TQ starts causing problems). However, the problem wouldn't be caused by the hemostatic agent, but by the trauma. It's not like these clots are reentering the circulatory system. If someone needs these types of interventions, they are going to see bright lights and cold steel ASAP anyways.

From my reading, what .mil did experience with quickclot (old formula) was that too much powder with too much blood could lead to an exothermic reaction that caused vascular and tissue damage to the point where the hemostatic agent was much worse than a tourniquet. This was a quickclot specific issue.

I missed when you first posted this response, but decided to look it up while I was putting together my first aid kit and I'm glad I did. Thanks for all the good info!

reminder bump.

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