After Andy's great class I thought it might be useful to discuss what items would be good to have in our medical kits.  This would benefit both the people that attended the class that can't remember and others that couldn't make it. 

Ideally, we can get a URL for each of these too.  I'll update the list as people chime in.

Items mentioned in class:

• Bag to hold it in - Conterra is a good brand.  Andy likes this one
• Israeli Bandage(s)
• Scissors with rounded edge
• Knife with rounded edge
• CPR shield
• Suture kit
• Ace bandage
• Benedryl
• Tylenol
• Ibuprofen
• triangular sling
• long wrap
• large gauze pads
• safety pins
• pencil and paper
• tournaquet
• Sam Splint
• Propel
• Food / Power Bars
• Glow Sticks
• Plastic wrap
• Sharpie
• Plastic bags (grocery bags, garbage bags)
• Tecnu
• Prescription medications
• Bacitracin (Similar to Neosporin.  Neosporin sometimes causes redness)
  

Other Items mentioned around camp:

• Cold/Ice pack
• Heat pack
• Space blanket or space bivvy

 Good Retailers

Remote Medical International
Life Assist

 Is there a place to order a suture kit?

Probably better places but...

http://www.amazon.com/s/ref=nb_ss_0_6?url=search-alias%3Daps&field-keywords=suture+kit&sprefix=suture

http://www.amazon.com/s/ref=nb_ss_0_11?url=search-alias%3Daps&field-keywords=steri+strips&sprefix=steri+strip

Andy mentioned that REI sells them too.  Their intent is that if you are travelling the world where things aren't always so sterile that you can hand your suture kit to the doctor if you need stitches.

A good place to get supplies is Remote Medical International in Seattle. The only bummer is that they are local but the shipping gets you supplies in a day or so.

Andy

Good idea on the sharpies. I don't know if there is another list like this floating around. I do know that there are similar lists for bail out bags and general supplies.

I think every bag should have a bottle of Tecnu, esp if you are one of those unfortunate souls that is especially allergic to poison oak. Also, here is a link to the other brand of tourniquet; I like this one more since it is available in blue and you can write the time and date of application right on the device. The other tourniquet is sold by Remote Medical and can be found on their site.

I think the list is a great starting point. Ideally, it should be customized to the end users' needs and training. As we talked about in class I believe that a large group on an extended trip should have smaller kits broken down across each individual member and a primary bag located with either the leader or medical support.

A

edit-here is the Conterra bag I like. For comparison, I have the Longbow which is a fair bit larger. Space is most definitely a vacuum so I don't advocate getting the largest bag available.

One last vendor:

. I've bought from them in the past and it was trouble free. Their prices have been the best across the board.

A

Snake bite kit?

Butterfly bandages

Stuff to clean a wound with?

Neosporin?

You brought up a topic that I avoided somewhat intentionally and that is of snake bites. As a paramedic, the goal is to treat the symptoms associated with the envenomation and get the patient to a center with access to antivenin. In the backcountry, this isn't always an option. The most important thing to be aware of is the kinds of critters that habitate the area where you are at. This will affect the problems you'll see and the ways you'll go about treating them.

Here in the PNW, esp in the eastside, our biggest risk is rattlesnakes. Severe symptoms include nausea and vomiting, weakness, tachycardia, hypotension, numbness and tingling around the face and head, and respiratory collapse. Because these symptoms mirror so many other things, you'll want to depend upon the story to determine the culprit. As with anything else, before you start treating, the first thing to do is make sure that the biter is no longer near the bitee. Once you have determined that the patient is safe and that it was indeed a snake bite, the best course of action is immediate extraction and transport to a hospital. The onset of life threatening symptoms is usually around 2-6; initally signs and symptoms will include pain, redness, swelling, and more pain.

Don't bother with extractors (commercial or otherwise), sucking out the venom, etc. There is no benefit as the venom from a snake is usually injected too deeply for such a device to be efficacious. There may be some benefit to non-snake bites but save the money and don't bother with them.

Butterfly bandages are available commercially from companies such as Johnson and Johnson. They are probably a good idea to have. Another bandage is known as Steri-Strips and they are the "hospital version" if you will. To be most effective the skin needs to be totally dry and clean. Ideally, you'd use tincture of benzoin on the site to dry off the skin. Avoid getting the benzoin into the cut as it burns! Both of those products are available from Life-Assist as well as other vendors, I'm sure.

As for cleaning the wound, unless you are days away from a hospital, rinsing it clean with clean, potable water works fine. You can make up a iodine solution but be aware that it burns so it might be hard to get one of the kids to go along with it. Also, make sure that the water you use is drinking quality. The same parasites that make water undrinkable can also make things difficult when introduced in a wound. It doesn't need to be sterile, however. If the wound is free of large chunks of debris, rinsing is probably just fine. No need to go crazy with the scrubbing with iodine. You can also use hydrogen peroxide if you're so inclined.

Finally, neosporin is helpful but bacitracin ointment is probably a bit safer and cheaper. You can just get the generic from the drugstore.

Flash cards area a good idea but I don't have any recommendations. Having some sort of reference on hand is essential.

We talked a little bit about superglue for small, clean, and straight lacerations. It would work but it burns. Dermabond is a commercial glue used in the clinical setting and is generally available with a prescription only. The key to using any glue is assessing the injury site and application. If anyone wants to carry glue in their kit, that's their perogative. However, I don't recommend that they go and offer their services to other people.

In the US, there really aren't any side-effect free motion sickness tablets that I've found. The most effective OTC I've used is called Stugeron and it's available in the UK and elsewhere. For whatever reason the company that makes it has declined to import it into the US thus far. A prescription-only alternative is Zofran ODT. To be honest, anything like these medications should be a case-by-case kind of thing to be used only for personal discomfort. If you are prone to becoming car sick, you should have a handul nearby. Otherwise I wouldn't bother.

Posted By Craig Miller on 08/31/2009 9:47 PM
Thanks Andy. As always, great info.

We have drug store purchased Neosporin at home. I didn't realize it was dangerous and tend to liberally apply it to any cuts/scrapes any of us get. What's the concern?

I apologize about suggesting neosporin (or any "triple antibiotic") is dangerous. It isn't. I forget which of the three is the culprit, but one of the antibiotics in neosporin tends to cause redness and swelling in some people. Anyhow, bacitracin is usually cheaper which is why I recommended it. It's really six in one hand, half a dozen in the other.

A

one thing about the CAT tourniquets is that they are a one time use thing (this is what i was told by my medics). dont use the one in your med kit to practice with, once you twist it down at all you stress the bar and weaken it. now this may just apply to to us since we tend to be harder on our equipment but something to think about. also anything that is in a med kit that you dont know how to use is essentialy wasted space. having only a few items that you know how and when to use will do more than good than to have everything known to man, and having no idea what to do with half of it. just my 2 cents

I agree with Terrance about carrying only those items you know how to use.

As for the tourniquets, I'll have to disagree. While it makes sense that every "test" or training application will stretch the material of the tourniquet, I don't think that it will diminish the ultimate compressive force applied to the extent that it will make a difference. I think that in training, most people aren't going to apply a tourniquet with sufficient force to wear it out. Reading through the CAT tourniquet's instructions, no where is it mentioned that use during training diminishes its efficacy. It is clear that it is a single (ie-real world application) device. For those following along, this is a discussion specific to the CAT tourniquet, not the SOF Tactical Tourniquet which was demonstrated in class.

Now once one has been applied, I agree that it is not reusable. Reusing medical supplies is gross.

A