Wilderness Medical Kits

Organizing the medical equipment for an expedition requires an enormous amount of planning and forethought. No matter how much equipment is hauled in, one cannot possibly prepare for every conceivable illness or accident. The variables on any expedition or wilderness excursion are complex, making generic advice on “what to take” difficult without an operational context. Major considerations should include the following:

• Environmental extremes of the trip (e.g., arctic, high altitude, tropical, desert)

• Time of year (e.g., climatic conditions) and disease conditions

• Specific endemic diseases

• Medical expertise of the intended user

• Medical expertise of other trip members

• Total number of expedition members, including ancillary staff (e.g., porters, local guides, expedition staff)

• Duration of trip

• Age and sex of participants

• Known preexisting medical problems of the group

• Distance from definitive medical care

• Availability of communications (e.g., cell phones, radios, satellite phones, telemedicine capability)

• Availability and time frame of rescue

• Medical kit weight and volume limitations

• Responsibility for local health care

Medical Kits

• The wilderness medical kit should be well organized in a protective and convenient carrying case or pouch. For backpacking, trekking, or hiking, a nylon or Cordura organizer bag is optimal.

• Clear vinyl compartments protect components from dirt, moisture, and insects and keep items from falling out when the kit is turned on its side or upside down.

• In aquatic environments, store the kit in a waterproof dry bag or watertight container, such as a Pelican or OtterBox case. Inside, seal items in resealable plastic bags with “zippers” (e.g., Ziploc) because moisture will invariably make its way into any container.

• Some medicines may need to be stored outside of the main kit to ensure protection from extreme temperatures. Capsules and suppositories melt when exposed to temperatures above 37°C (98.6°F), and many liquid medicines (e.g., insulin) become useless after freezing.

• Commercially produced kits are available, either prestocked or unfilled.

• Fragile items and injectable medications can be carried in small, portable plastic containers (e.g., Tupperware).

Organization

Medical supplies can be divided into four categories: personal kits, group kit, medical devices and medications, and specialized equipment for environmental and recreational hazards. The size and complexity of the medical kit depend on the amount of equipment required, duration of trip, and number of team members. For smaller trips, a single person can carry a moderately sized comprehensive medical kit for the group. For longer expeditions, or expeditions with many participants, larger kits may be divided into several smaller kits for individual members to carry.

Personal Kit

Each trip member should be responsible for and carry a personal kit. This avoids constant disruption of the group kit. Personal kits are variable but should include commonly used items.

Comprehensive Group Medical Kit

The group medical kit should be carefully constructed to meet the likely needs of the entire group. The contents of the group medical kit will vary greatly depending on the environment, risks and hazards, and skill level of the medical provider. In general the group kit should contain the following:

• Medical guidebooks (electronic or print) and Internet sources if available

• Comprehensive first-aid kit

Pre-Made Medical Kits Premade medical kits are filled with items to cover general cuts and scrapes. They are not specific enough to cover a broad array of injuries. First aid kits tend to emphasize treatment, but they also deal with prevention items, such as water treatment material and gloves. First aid kits should emphasize improvisation and multiple uses. For example, duct tape can be used for numerous issues rather than one specific issue. If you are aware of the medical condition of the participants and recognize endemic or common diseases in the area, you can take the appropriate medicines with you. Containers Containers for first aid kits will vary along with the contents.

For example, a six day trek over mountainous terrain far from cities will require a medical kit that is lightweight and contains items that can treat emergencies related to high-altitude illness, cold exposure, trauma, and geographically specific infectious diseases. A three-day river trip with four young, healthy people can be in a metal container, it can be more substantial, and can contain items to treat abrasions as well as items for a twisted ankle and splints. Many commercial kits are available and carry essential supplies and equipment but do not contain prescription medications.

Making your own kit is an option and can save money. Either way, you will need to adjust and bring items that pertain to the specific activities and location planned. PAWS Though it’s not practical to list each item that should go in every type of medical kit, some general items are helpful to have.

The acronym PAWS is an excellent way to remember the category of items to include in a first aid kit.

P - Prevention / Procedures

A - Analgesics / Antibacterials / Antiseptics

W - Wound care

S - Survival

Prevention/Procedures Prevention

• These are items for the prevention of illness and potential problems:

• Water filter and water purification tablets

• Gloves

• Sunscreen/lip balm

• Sunglasses

• Blister prevention and treatment

• Insect repellant and barriers (netting / treated clothes)

Procedures

There are specific tools of your trade that may be used in a variety of situations:

• Wound care material: steri-strips, tape, gauze, Medi-honey, sutures, etc.

• Scissors

• Dental repair material: Cavit, eugenol, etc.

• Blood pressure cuff and stethoscope

• Syringe

• Flexible splints

• Safety pins

• Needles

• Tweezers

Analgesics, Antibiotics, Anaphylaxis

There should be medicine available in each kit that covers pain and infection that could be encountered. You should know what diseases are common in the area you’re headed. As well, you should know the diseases and chronic conditions of the people traveling in your group.

Paracemetol (also called Tylenol and Acetaminophen) belongs to a class of drugs that relieves pain and lowers fevers. It does not prevent the clotting of blood, so it is safe to use in head injuries. Aspirin prevents blood from clotting, which promotes bleeding. Therefore, it should not be used in any kind of head injury.

Aspirin, also known as acetylsalicylic acid (ASA), is a medication used to treat pain, fever, and inflammation. Ibuprofen is used to relieve pain from various conditions such as headache, dental pain, menstrual cramps, muscle aches, or arthritis. It is also used to reduce fever and to relieve minor aches and pain due to the common cold or flu.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever.

Antibiotics Select antibiotics that cover a broad spectrum of pathogens. Here are some common broadspectrum antibiotics to consider taking:

• Doxycycline: lung, skin, and tick/mosquito-borne infections

• Cipro: HEENT, enteric, lung, skin, and urinary infections

• Amoxicillin /clavulanic acid: HEENT, lung, skin, enteric ▪ Azithromycin: HEENT, lung, skin, enteric organisms

Anaphylaxis

Anaphylaxis is one of the true medical emergencies that one may see in the wilderness. You should always be prepared to treat an anaphylactic patient.

• EpiPen®

• Antihistamines

• Salbutamol/albuterol inhaler

• Oral steroids

• Ranitidine

Wound Care

Regardless of the activity, abrasions and lacerations are among the most commonly experienced injuries. As a result, appropriate and adequate supplies for wound care are one of the essential parts of a medical kit. Having each person on the trip bring their own necessary wound supplies will help to ensure that enough wound care supplies are available.

Below are different treatment options for primary wound care:

• Gloves

• Alcohol swabs, antiseptic wipes

• Gauze

• Steri-strips, benzoin

• Tape

• Ace bandages

• Compressed gauze

• Pressure bandage

• Tourniquet

• Irrigation equipment

• Band-aids and plasters

• Antibiotic ointment

• Gauze wrap

• Survival

The potential for the group members to be separated, and other worst-case scenarios need to be considered. Below is a list of items each group member should carry at all times.

• Map, compass, knife, fire starter, matches

• Torch/flashlight

• Communication equipment: satellite phones

• Space blanket

• Knives

Other Helpful Suggestions

The CDC website provides information for the preparation of a first aid kit for any location in the world. The information provided includes a list of antibiotics, items for a first aid kit that is specific to that area, and a list of other medicines important to have. It also talks about diseases endemic to that area and any required vaccinations. Look at ‘Traveler’s Health’ and follow the links to first aid kits and medicines. Their information is current and up to date on the latest medical and health issues worldwide.

Documentation

Materials such as a pen and paper are an essential part of a first aid kit, though they are often left out. A pen and paper can be used to document illnesses and injuries. Write down essential data and document important facts. Instructions can be written down, and a history of what aid was rendered can be memorialized.

Expiration Dates

Check the medicines in your first aid kit often to see if their effectiveness has expired. The expiration date addresses medicine’s highest effectiveness. It’s a gauge of how close to its optimal efficiency a drug will function. That date is based on several factors, including how well the drug worked when it was tested and then sealed in its unopened container, and whether it was maintained at certain temperatures and moisture levels. Once the drug is opened, its expiration date isn’t as useful to gauge its effectiveness. Typically, medicines will change into a brownish color when they lose effectiveness. However, EpiPen’s are airtight. Experts think the expiration date is a good gauge of the injectable drug’s highest potency.