Whats in YOUR kit Medical preplanning for wilderness activity

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Whats in YOUR kit?Medical preplanning for
wilderness activity

• Jason R. Pickett, MD EMT-P/T
• CPT MC USAR
• Wright State University
• Dept. of Emergency Medicine

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Why were here

• Basic principles of preplanning
• Preventive medicine
• Medications
• Field improvisation
• Packing the kit

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What you carry

• Depends on where youre going, and
• How youre traveling, and
• How long, and
• How close to medical help youll be, and
• Your level of skill in medical care
• If you dont know what it is or how to use it,
  you dont need to carry it

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Two is one and one is none

• ALWAYS pack medical gear for longer than you
  anticipate being out
• Pack for possibilities as well as probabilities
• Pack extra of the things that will really save
  your life
• Split the gear among all parties
• What if you lose one bag?

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At a basic level, you should be equipped to

• Conserve heat
• Make fire
• Purify water
• Dress wounds

Gently moisten the finger, then kill
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Preplanning the trip

• Gather some intel
• Indigenous wildlife/insects
• Prevalent diseases transmitted by wildlife
• Malaria, basically. Do you need pills?
• Typical weather for that area and time of year
• Prepare for hotter and colder

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Preplanning the trip

• If traveling internationally
• Local language (have a phrasebook)
• Local currency (pack some extra)
• Security risks

How can I help you today?
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Preplanning the trip

• Immunizations
• Tetanus booster for everyone within the last 5
  years
• Hep B always a good idea
• Especially if youre going to be helping others
• Other vaccinations, such as Hep A, may be a good
  idea depending on where youre going

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Preplanning the trip

• Let someone know youre going
• If flying, file a flight plan
• Have a plan and someone to check in with
• So they know when to come looking for you

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How far away is help?

• Will your cellular phone work?
• Are you within range of rescue?
• Can you tell them where you are?
• Do you have a means of getting their attention?
• Fire, smoke
• Flares

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Summoning help

• Radio or satellite phone
• GPS device
• In a marine environment, flares
• In a wilderness environment, make fire
• Signaling mirror

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Summoning help

• Know who the primary rescue agencies are in the
  area you are going and how to contact them
• For state parks, usually the local Sheriff or
  state SAR agency

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The party

• Number of people
• Pre-existing medical conditions
• Medications needed

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The Party

• If anyone takes prescription medications, bring
  it
• Even if its just a day trip, bring a couple of
  days worth at least
• Bring enough for roughly twice the amount of time
  youll be out
• Diabetics?
• Extra glucometer

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What you should know before you go

• Stop bleeding
• Splint a fracture
• Sling an arm
• Make a litter
• Immobilize the neck
• Drain an abscess
• Make a proper fire
• Purify your water

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Make fire

• Disposable lighter
• Cheap, small, durable, but keep it dry
• Not Zippos
• Fuel evaporates over a couple of days
• Fire starting equipment
• Vaseline soaked cotton balls (in a film canister)

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Purify water

• Filter bottle or pump
• Purification tablets
• Solar still

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Purifying tablets
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Water bottle
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Filter pump
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MIOX

• Creates a brine solution which is added to water
• Mixed oxidants destroy viruses, bacteria,
  parasites

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Solar Still
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Food

• It never hurts to have some accessible
  high-calorie grub in your kit
• GORP- Granola, Oats, Raisins, Peanuts
• Nutritional bar
• Clif, Powerbar, etc. (not the gels)
• Homemade stuff
• Nuts, honey, peanut butter, raisins, dried
  cranberries, banana chips, MMs

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Basic First Aid Kit

• Dont waste your money on the commercially
  available stuff
• You really dont need first aid cream
• Or alcohol wipes, unless youre starting IVs
• Bandage scissors?
• BP cuff?
• Snake extraction kit?!

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What you DO need

• Gauze 4x4s, though dressings can be improvised
• Tape, medical
• Tape, duct
• Parachute cord
• Improvised airway equipment
• Tweezers
• Dental cement

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What you DO need, cont.

• A good, sharp knife
• Antifungal cream (Lamisil, Lotrimin)
• Antibiotic ointment (Neosporin)
• Sunblock
• Insect repellant
• Mylar space blankets, one for everyone
• Tennis ball

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What you DO need, cont.

• SAM splints
• Lightweight splinting method for lots of purposes
• Flashlight, extra batteries and bulbs
• Lightsticks? Maybe if moving at night

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Medications

• Depends on where and for how long
• Basics for all kits
• Tylenol
• Advil
• For severe pain, take 4 tablets every 8 hours
• Benadryl
• Immodium
• OraGel topical anesthetic for teeth
• Epi-pen

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Epinephrine auto-injector (Epi-Pen)

• Given for severe allergic reactions where the
  breathing is compromised
• Prescription only
• Have 2 at least

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Medications

• Phenergan
• Anti-nausea, but will cause sedation
• Zofran
• VERY expensive anti-nausea medication that will
  not cause sedation
• Vicodin or Percocet
• Narcotic combination pills for severe pain
• Contain Tylenol
• Will cause sedation

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Medications, cont.

• Diastat
• Rectally administered Valium for seizures
• Really only if you have someone with a seizure
  disorder or if you are in a particularly remote
  environment
• Prednisone, cream and oral tablets
• Useful for treating a number of rashes or
  inflammatory conditions
• Gookinade ERG
• Electrolyte powder
• Add to water to create balanced rehydration
  solution

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Antibiotics?

• If in an environment where extraction is
  difficult (open water, WAY out in the wilderness,
  high altitude)
• Broad spectrum
• Cipro- Good for most things GI, UTI
• Flagyl- Covers Giardia, a parasite from stream or
  pond water
• Keflex- Covers skin infections well

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Airway care

• If someone needs airway support in the field,
  theyre in deep trouble
• Oropharyngeal airways, nasopharyngeal airways
• Safety pins

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Advanced care

• IV fluid
• Probably not necessary
• Adds a lot of weight
• Rehydration can be accomplished orally
• NG tube
• If you know how to place it, this may be of use
  for rehydration

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Advanced care

• Novocaine, Lidocaine, Marcaine
• Only in experienced hands

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Advanced care

• Tourniquet
• If youre camping in Fallujah, yes
• In the absence of gunfire, very unlikely to be
  necessary, but know how to make one
• Quikclot, Hemcon dressings
• Again, unless youre a Ranger
• Cricothyrotomy kit
• No freakin way

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Advanced care

• Surgical Kit
• Look, I know everyone wants to do an amputation
  in the field, but
• Unless you know what youre doing, forget it
• Scalpel, sterile
• THIS might be useful for draining an abscess

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High Altitude

• Acetazolamide
• Decadron
• Nifedipine
• Problems particular to this environment are best
  treated by rapid descent

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Marine

• Dramamine or Bonine
• Meat tenderizer
• For jellyfish wounds
• Fish hooks to catch lunch
• Pliers to extract fish hooks
• Know what VHF channels are monitored (16)

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Diving

• Where is the nearest decompression chamber?
• 14g 2.5 angiocath (IV catheter)
• For decompressing a pneumothorax
• ONLY for those who know what theyre doing

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Packing your gear

• Keep it dry and minimize space
• Ziplock bags will suffice for most stuff
• Vacuum food sealer
• Extra clothing layers, fleece
• Some meds
• Fire starting equipment, water purifying tablets
• Technological equipment (GPS, Sat phone, extra
  glucometer for a diabetic)
• Duct Tape wrap several turns around a canteen or
  another piece of equipment

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Quick reference

• Most important
• Radio frequencies/phone numbers (if you have a
  sat phone) of rescue agencies for your area
• Coast Guard
• Local Sheriff

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Quick reference

• US Army Special Operations Forces Medical
  Handbook
• Ditch Medicine, by Hugh Coffey
• Field Guide to Wilderness Medicine, by Auerbach,
  Weiss, Donner
• Comprehensive Guide to Wilderness Travel
  Medicine, by Eric Weiss
• Wilderness Medicine Beyond First Aid, by William
  Forgey
• Wilderness Medical Society Practice Guidelines,
  by Forgey and the WMS

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Questions?