Wilderness First Aid, & Kits Pt I

 

Over at Captain's Journal, Herschel mentioned an article made some "interesting points", and then excerpted part of the listed first aid supplies recommended.

Which perks our ears up, because we're always on the lookout for new or better ideas. And we haven't done a medical post in awhile.

And after a careful reading of the article in question, we've definitely become interested.

In beating it about the head and shoulders with a stout cudgel. When we find our self saying "No! No!" within the first few grafs, it's not going to be good.

We shall fisk it in (probably) three parts, rather than a mega-post. Because we lead a busy life, and haven't the time to invest in deconstructing it all in one go.

For those similarly time-constrained, the TL;DR version:

1. Your go-to medical texts for wilderness medical emergencies should be authored by someone named Forgey, Auerbach, or Alton. Those are literally the Gold, Silver, and Bronze medalists in the field. There are many other good texts, but those are the reigning champions, IMHO.

2. If you use one of the secondary texts not listed, make sure it is authored by someone with MD, DO, PA, RN, or, ffs, at least EMT-P after their name. There are virtually no "gifted amateurs" in the medical field. Listen to professionals, who've been there, and done that, and not people trying to quote them accurately, from a dearth of professional wisdom.

3. The author of the linked Field and Stream article, Jim Baird, is absolutely an avid outdoorsman, adventurer, and experienced wilderness survivalist. He and his brother beat out six other survival pairs on the fourth season of Alone in 2017, and won by outlasting the coldest fall and wettest winter on Vancouver Island, for 75 days. He's been on many trips in what is absolutely pristine wilderness, far beyond the pavement. The problem is, he knows about half of what he should about wilderness first aid, and there's no way to tell which half he's getting right if you're a novice. I give his article a C- overall, as in barely passing. But that's because the things he gets right, he gets very right, and he definitely knows some of his stuff. If I were in the wilderness, he'd definitely be a handy and experienced guy to have along. Just not as the medic.

4. As a general rule, so-called "outdoors" publications are either too stupid, too lazy, or too cheap, to seek out the three subject-matter experts, above, or anyone similarly qualified, and instead keep asking their regular outdoor writers to contribute articles on topics far beyond their expertise. I don't begrudge the authors, because all that adventuring doesn't pay well these days, so anything for an honest buck is understandable. But the lack of competent editorial oversight is glaringly obvious, and you owe your readers a discount if you're not going to do that job. For this reason, often the best use of any article from an outdoors magazine, in a survival situation, would be to fold it carefully, carry it in your kit, and then, if one were forced to survive, to tear it into small strips, and use them to light one's campfires or signal fires. That act, alone, will probably save lives and limbs.

And with that, on to the dissection:

A good first aid kit ranks highest among the gear that you never want to use. Still, taking the time to research and assemble the best first-aid kit is a must before you venture into remote areas. A good place to start is with a pre-assembled wilderness first-aid kit. Then remove whatever you don’t need from the kit and replace it with the items you will need.

Fair enough. So, which things will I not need?  How do you know that? How would anyone? It's nice to sound like you could know that, but the fact you never explained it leads inescapably to the conclusion that this advice is from hindsight, out of one's tailpipe. Just saying.

Will this cost more than your run-of-the-mill first-aid kit? Yes. Will this customized kit be more useful in treating a serious injury in the backcountry? Hell yes. After you’ve assembled your first-aid kit, the next step is learning how to use the items inside it to treat common outdoor injuries. This story covers some of the most common of those injures. But before we get started, I should warn you:

 Graphic images ahead…

Yawn. They're not that graphic. Get on with it. 

Burns 

Few meals are more satisfying than a shore lunch at fish camp. This might seem like the last place you’d encounter an injury—but accidents happen. Especially when hot oil and fire are present. Here’s how to deal with a nasty burn:

1. If possible, get the burn on ice. Otherwise, dose it with cool water. Wrong

No! NO! NO! You never "ice" burns. Period. Full stop. Got ice? Throw it in the water you soak the burn in. Never put ice on a burn. Water pulls the heat out, 25 times faster than air, and burned flesh continues to burn until the heat transferred into it is pulled out. Dunk the burn, or put clean cloths soaked in cool water on it to pull the heat out. But no ice.

2.Blisters will form; don’t pop them. The fluid under the blisters is sterile and, when left intact, your chances of infection are less likely. 

3. When the blisters pop on their own, you face a serious chance of infection forming between the dead skin of the blister and your body. Using a sharp, small, and sterile pair of scissors, trim the dead skin off as close to the outside of the burn as possible. 

4. Wash the wound thoroughly. Soap and water will disinfect the wound as well as anything, but make sure to boil your water first. And then let it cool off before you wash with it! 

5. Keep the wound covered. Dirt or other debris or unsterile water can lead to infection. Keep these things out of the wound by covering the burn thoroughly and changing the bandages daily. Non-adherent gauze pads will create less pain and won’t open the wound when changing bandages.

Duct tape can help secure and waterproof bandages. Remember to bring lots of bandages in your first-aid kit.

We use non-adherent dressings. Bring lots of those. Bandages are what we use to hold dressings in place. Dressings get changed, either daily, or when they're wet/dirty/saturated. Bandages can be cleaned and re-used. Duct tape should be kept the hell away from any burned tissue, unless you want to risk removing the intact skin as well as the burned tissue. Skip duct tape; get some good first aid tape in the first place. Paper, plastic, and silk, and probably the mega-sturdy white heavy-duty first-aid tape.

6. Bring clindamycin—the type of antibiotic most commonly used for treating infections. If the burn starts to become infected, begin taking the antibiotic right away and make immediate plans to get out.

Burns are on the outside. The only antibiotic you should be worried about using is either OTC Neosporin, or, if you have/can get it, Silvadene ointment, which is an Rx item. Put that on the burn. Nothing else. Not butter, grease, Crisco, or any 57 other Granny's Homemade Cure ideas that sound like a good idea at the time. The patient, and the burn nurse who has to scrub all that crap out of the burn, will both thank you later.

And the go-to antibiotic for an infected burn is penicillin, or erythromycin. Resistant strains are another problem entirely. So basically, forget every bit of Item 6, except in case of spreading infection, "make immediate plans to get out." The rest is pure crap.

We would also suggest that it's a lot easier to prevent burns than to treat them. Wear stout leather gloves. You'll lose a fraction of your dexterity, but you'll prevent a boatload of problems by letting your gloves literally take the heat, instead of your fingers and hands. And keep your face out of things that flare up, like lanterns and stoves. Eyebrows grow back, but eyes don't and burn scars are forever.

It gets better: almost the entire section on Frostbite can be used without revision. One correction is redlined.

Frostbite

When temperatures drop, inadequate or damp boots or gloves are common causes of frostbite. In extreme conditions, taking your gloves off for even a short period of time can be all it takes to cause frostbite. On windy days, your face is equally at risk. Prevention is paramount. Being prepared with the right clothing and keeping it dry is your first defense against frostbite. But if conditions get the best of you, here’s what to do:

1. Find shelter out of the wind. Set up a tent and get inside. No tent? Duck behind some sort of natural wind block—or build one. Do whatever it takes to get your frostbitten skin out of the cold.
2. Gently warm the frostbitten area. Keep in mind that rubbing the frostbite or walking on it (if it’s your feet) to warm up the frostbite can create further damage. Use warm water or body heat to warm the frostbitten area. For example, tuck frostbitten fingers in your arm pit. Refrain from using a hot pad, stove, or hot water to warm the area, because frostbite makes the area numb, you could burn it.
3. Continue to keep the frostbitten area warm and dry. Elevating it will help curtail any painful throbbing, and consider taking ibuprofen.

 Post Frostbite Tips: An area of your body that has suffered frostbite never fully heals, meaning it will react to the cold more easily in the future. So, if you’ve had frostbite of any severity, be extra prepared the next time you venture into cold temperatures. The following are also good extra steps to take:

• Hot pads for your feet and hands are very helpful.
• Line your bare feet with a plastic bag or (nope; dumb idea. Sweat in the bag turns into ice, turns into re-frozen frostbite. Gangrene. Bye bye feet.) GoreTex socks before putting on your socks and boots is a good idea.
• Mittens are warmer than gloves. They work best without glove liners; that way they allow your fingers to touch for skin-on-skin body warmth. 
• Carry a balaclava to protect your face when it gets windy.

We'll leave it here for now, and continue with the second part momentarily.

And then the third and final part, including our suggested kit list.