Medical Kits for Expeditions and the Backcountry

shutterstock_35627896I give credit for the information learned and presented here to Howard Donner, MD who is an expert in Wilderness Medicine.

Those of us who enjoy traveling in the backcountry understand there are inherent dangers and risks for serious injury and even death.  Many people go out into the wilderness and travel far into remote areas and might be days away from the nearest medical clinic.  I think it’s important for everyone to carry a first aid kit, and someone in the group to carry more advanced supplies if needed.

I realize that organizing medical equipment for an expedition into the backcountry requires a lot of planning.  You cannot be prepared for every possible illness and accident no matter how many supplies you bring with you.  There are many opinions on what should be brought and the opinions here are my own after my travels, adventures and taking multiple classes in Wilderness Medicine and Search and Rescue disciplines.  Remember that when the medical kits are too heavy they are more likely to be left behind and not be available when they are desperately needed.  I try to take into consideration size and weight constraints and I choose items for my kits with that in mind.

The contents of the kits may depend on:

1)   Age of the hikers

2)   Distance from local medical care

3)   Number of people in the trip

4)   Environmental extremes of the trip

5)   Length of the expedition

6)   Diseases endemic to the area of travel

7)   Medical expertise of the medical officer

8)   Availability of rescue (helicopter for example)

9)   Medical experience of the other expedition members

10)  Pre-existing health problems of the participants

I generally recommend that each hiker carry their own personal first aid kit, and then have a base camp kit for the entire group depending on the size.

Personal first aid kits might have the following:

1)   Pain medications such as ibuprofen and Tylenol

2)   Sunscreen and lip protection

3)   Water disinfection supplies

4)   Blister care

5)   Minor wound care – band aids/ointment

6)   Insect repellent

7)   Personal medications (for pre-existing problems)

8)   Malaria prophylaxis (if there is risk)

9)   Throat lozenges/cough drops

Base Camp Kits will depend on the factors described above, but may contain some of the following – note that I would pick and chose from the list below but usually not take everything here:

1)   Antibiotics – Preparation for common problems. i.e. upper and lower respiratory infections, skin and soft tissue infections and bacterial diarrheas.  I usually carry azithromycin (i.e. Z-Pack) for the respiratory illness.  Duricef (which has the advantage of dosing once to twice a day) is useful for skin infections but consider Bactrim for MRSA.  I usually carry Ciprofloxacin for bacterial diarrheas although there are some newer agents out there (see my blog on traveler’s diarrhea).  Also consider taking antibiotics for protozoan infections if going on longer or more remote trips (i.e. metronidazole or tinidazole).

2)   Analgesics – I like to have a strong oral narcotic medication in case of  a serious  medical problem such as a broken bone or worse.  Consider Percocet or Vicodin.

3)   Respiratory – I have asthma, so I carry albuterol, but it is also useful for exercise induced bronchospasm.  Prednisone is also useful to have for asthma exacerbations and to treat poison ivy, poison hemlock, or poison oak exposure.

4)   ENT (Ear/Nose/Throat) – Rhinorockets are essentially nasal tampons that are useful for nosebleeds.  They are lightweight and simple for anterior nasal packing.  Afrin nasal spray is a great topical decongestant and is useful for nosebleeds and Eustachian tube dysfunction during altitude changes.  Zyrtec or other antihistamine for allergies. Throat lozenges or hard candy are very useful for cough or sore throat.  Sudafed or other oral decongestants.

5)   Eye – Topical eye antibiotic such as Ciprofloxacin ophthalmic for the treatment of corneal ulcers.  Cyclopentolate HCL can be helpful for relieving the ciliary spasm of photokeratitis or uveitis.  A topical anesthetic such as Tetracaine is useful for corneal exam and to help get a climber off the mountain – but should not be abused.  Fluorescein for staining corneal defects.  Ketorolac Ophthalmic solution for minor irritation, Zaditor for allergic conjunctivitis and a penlight or blue LED.

6)   CNS/Brain – Ativan or Xanax for anxiety.  Anxiety can be common with individuals travelling far from home.  Caffeine (No-Doz) useful to relieve caffeine withdrawal headaches or for a little extra “get up and go.” Motion sickness medication – i.e. scopolamine or antihistamines.

7)   Cardiovascular – A beta-blocker such as Lopressor or Tenormin for chest pain or heart attack.  Nitroglycerine for chest pain/MI, Aspirin for chest pain or heart attack, Nifedipine for HAPE (High Altitude Pulmonary Edema) or hypertension.

8)   Gynecological – Urine pregnancy test – rule out an ectopic pregnancy in a female in reproductive age with pelvic pain or bleeding.  Oral birth control pill for hormonal cycling or dysfunctional uterine bleeding.  Fluconazole for yeast vaginitis

9)   Gastrointestinal – Pepto-Bismol for non-dysenteric diarrhea, Imodium for long bus rides, etc., Miralax for – “Freeze dried megacolon” i.e. constipation as a result of eating freeze-dried food.  An anti-nausea medicine such as Zofran – I prefer the oral disintegrating tablets.  An antacid such as Prilosec, oral rehydration solution (dehydrated packets) – i.e.. “Jeevan jal”, or other Sports Drink.  Annusol HC or Tucks pads to treat hemorrhoids.

10)  Altitude illness – Acetazolamide (Diamox), Dexamethasone (for cerebral edema), Compazine for altitude associated nausea and ibuprofen or naproxen for altitude associated headache.  Albuterol inhaler.  Nifedipine for field HAPE treatment.

11)  Topicals – Lamisil AT (or other antifungal cream), Lidex or other topical steroid cream (good for insect bites), Insect repellant with DEET, Silvadene cream for burns or Bactroban for topical antibiosis.  Aloe Vera Gel is excellent for minor burns and irritation.  Vaseline for chapped lips or fever blisters.  Labosan or other sun protection for lips.  Betadine solution (not the scrub).

12)  Blisters – Moleskin (lots of it), Adhesive foam for making donuts and padding for boots, Compeed is a very durable, product for painful blisters or Blistoban to reduce friction.  Duct Tape – good for preventing blisters (i.e. a new pair of boots on a long trip).

13)  Wound Care – Steristrips (multiple sizes), Tegaderm or Opsite for abrasions, Staplers (the small 15 shot  3M are great), Sutures – multiple sizes of both nylon and absorbable.  Superglue for instantaneous treatment of painful skin fissures.  Dermabond and misc. gauze and Band-Aids.

14)  Surgery – Angiocath for emergency tube thoracotomy, Uncle Bill’s tweezers, Sliver pickers (for foreign object removal), #11 scalpels for incision and drainage.  Instruments:  Bandage scissors, tissue scissors, needle drivers, and tissue forceps.  20 or 30cc syringes with 18 G. angiocath for wound irrigation and TB syringes for administration of lidocaine.  Gloves, Safety pins.

15)  Orthopedics – SAM splints, both full-length and finger sizes (great for improvising just about anything).  Kendrick Traction Device – very lightweight design for femoral traction.  Another newer splint is the Slishman Traction Splint (STS) for femoral fractures.  Adhesive tape for splinting ankles and fingers.  ACE Wraps, Fiberglass 3M One “One Step” splints, Air casts or gel casts are great for sprained ankles.

16)  Injectable Medications – Epinephrine 1:1000 (anaphylaxis treatment), Morphine sulfate or consider ketamine.  Dexamethasone, Ondansetron or Compazine, Benadryl, Ativan or Valium (consider rectal administration), Lidocaine, Toradol, Antibiotics such as Rocephin might be an option.

17)  IV’s – Multiple sizes of angiocaths (16, 18 & 20G).  Intraosseous needle for IO infusions, Heparin locks, Bacteriostatic normal saline or heparin flushes, IV fluid volume expanders

18)  Airway – Oral airways such as the LMA, pocket mask

19)  Dental Kit – Cavit (no mix temporary filling), Eugenol (topical analgesic), Dental floss

20)  Miscellaneous items to consider – Stethoscope, snakebite kit, paper/pencil, headlamp, tongue blades, sterile applicators, Foley catheter (16F with 30cc balloon).  A Foley can be used as a urinary catheter, improvised chest tube or posterior nasal pack for bloody nose.  Water disinfection system, spare sunglasses, urine chemstrips.

If you are interested in learning more about wilderness medicine, a great resource for information is the wilderness medical society:  http://www.wms.org/

This document is for informational purposes only.  I realize that if you are not a licensed medical provider, it may be very hard to obtain some of these products.  Many of these products should only be administered by experienced medical providers.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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