First Aid Kits The question of what to put in your backcountry First-Aid Kit is easy to answer - “it all depends”. The “depends” part is where it gets tricky, and requires you to assess the following issues: 1. What kinds of problems do you expect to encounter? 2. What kinds of treatment do you feel comfortable administering? 3. How far away is definitive medical care? and 4. How much stuff do you really want to carry with you? Of course, the best answer for a non-medical boater is to beg the question entirely by inviting a doctor to go on your trip and let him/her worry about it. Unfortunately, I may not always be available and while you could ask Morgan Wright, you have to think about the wisdom of having a Pathologist as your medical resource. (Just kidding Morgan.) After 25 years of hauling a major medical kit on all my overnight river trips, I have come to the conclusion that I could probably get by with having just three things in my bag; Tylenol, sunscreen and bandaids. However, I guess I have just been lucky so far and the following list of items should cover most of the common “emergencies” that are likely to befall the average trip participant. I have left out some obvious things that you see every week on “ER”, such as a stethoscope and blood pressure cuff because: A. you don’t need them to tell if a victim is alive or dead, and B. unless you have the right medications or equipment to treat the problems you find, the information is useless. I have attempted to divide the gear into logical sections, but there will, by necessity, be some overlap. In addition, some of the items have multiple uses other than medical as you shall see. INSTRUMENTS • Leatherman OR Gerber Needlenose Multi-plier OR Swiss Army knife and pliers - I wouldn’t even take a day trip without mine. • Thermometer - preferably a digital indoor-outdoor type with a probe that can be used orally, rectally or in the armpit. This way
you can determine hypothermia since the usual drugstore variety only go down to 96F. ($15.99 at Radio Shack) • Scissors - the kind they advertise that can cut a penny in half. • Tweezers - with fine points for removing splinters. • Small magnifying lens - for finding splinters. Can also be used to focus sunlight to start a fire if everything else fails. • Single edge razor blade or #11 scalpel blade - for lancing abscesses, making incisions, etc. • Needle (preferably curved) and thread - for repairing your drysuit or your buddy’s major scalp laceration. • Strike anywhere matches in a waterproof case. • Pencil and pad - it is extremely helpful to emergency medical personnel if times, patient condition, and treatments are recorded. You won’t remember the stuff - trust me. WOUND STUFF • Betadine - to cleanse wounds • Bandaids - various sizes. • Butterflys • Benzoin tincture - apply to skin and let dry before applying butterflys or tape. • Bandages - (Hint - Maxipads for big wounds, Pantiliners cut to shape for small wounds. They are lighter, cheaper and more absorbent than 4X4’s.) • Small clean sponge - for cleansing wounds. • Polysporin ointment - to dress wounds. • 2" roller gauze • 1" adhesive tape - NOT the waterproof kind, but the sport tape. • Superglue - great for small cuts, especially on fingers. (You can also fix your sunglasses.) • Xeroform gauze, 3"x8" - non-stick wound dressing, (Can also be lit with a match and will burn for 15 minutes while you try to start a fire with wet tinder.)
• Latex gloves - can also be used as a waterproof cover for an injured hand. SPLINTING STUFF • 1" adhesive tape and benzoin (already mentioned) • 3" ace bandage • 10 medium sized safety pins (many uses, just ask me) • Sam splint - $14 at REI • Duct tape - Absolutely essential rafting equipment. • Moleskin MEDICATIONS - PAIN • Tylenol regular strength (325mg) • Ibuprofen 200mg (e.g. Advil) • Codeine or hydrocodone if you can get it. INFECTION • Cephalexin (Keflex) 500mg - useful for respiratory,
urinary and contaminated wound infections. Can be
used in people allergic to penicillin. • Cipro 500mg - drug of choice for traveler’s diarrhea, but very expensive (most MD offices have samples) INTESTINAL • Imodium 2mg capsules if possible - for diarrhea. OR • Pepto Bismal chewables • Benadryl 25mg - for nausea. Also useful for itch and for runny nose. • Pepcid AC - for heartburn, ulcers, etc. EAR, NOSE, THROAT • Benadryl (already mentioned) • Entex LA - decongestant. OR Sudafed. • Afrin nasal spray - very useful to control recurrent nose bleeds. • Throat lozenges, your choice. • Oil of cloves - to numb a bad toothache. SKIN • Nupercainal ointment or benzocaine - anesthetic. • Polysporin ointment (already mentioned)
• SPF15 waterproof sunscreen • Zinc oxide ointment- your choice of colors. • Hydrocortisone cream • Insect repellent • Sting-eze OR meat tenderizer • Vaseline - to lubricate chafed areas. Also useful on
Well, that’s about it unless you want to perform major surgery or
you’re planning to go to an area requiring special equipment or
medications, such as tropical South America. All of the above will
easily fit in a 50 cal. ammo box. A few comments about commonly
1. Triangular slings - not necessary. Use safety pins to pin sleeve
to front of shirt.
2. Snake bite kit - virtually useless, and can be dangerous.
3. Space blanket - cannot warm someone already cold, and they
usually rip as soon as you start to use them.
4. Waterproof tape - doesn’t stick any better than sport tape, and
leads to skin maceration if left on.
5. Instant ice - bulky to carry and usually only stays cold for ten
minutes. Use river water to cool an injury.
6. Alcohol pads - not necessary. Use soap or betadine.
If anyone has found other useful items that they carry, please give
me a call. 2005 By Dr. Dan Schaffer M.D.
News in Pharmacovigilance N° 50 REGIONAL CENTRE OF PHARMACOVIGILANCE – ANGERS, FRANCE Pharmacology-Toxicology Department Focus: 5-Fluorouracil and capecitabine: avoiding potentially lethal toxicities 5-fluorouracil (5-FU) and capecitabine (Xeloda ®) (pro-drug of 5-FU) are both derived from pyrimidines and quite often used in the treatment of gastrointestinal and breast cancers. O
Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine A Szegedi, R Kohnen, A Dienel and M Kieser 2005;330;503-; originally published online 11 Feb 2005; BMJ doi:10.1136/bmj.38356.655266.82 Updated information and services can be found at: References This article