First aid kit contents and tradeoffs

[[Jack]son]

Hi all,

Having recently completed a wilderness first aid course but also being weight conscious, I am curious to know what people include or exclude from their personal FAKs.

Obviously there are clear trade-offs between ability to treat problems and the extent of care for problems, risk management and weight.

What do you consider essential?
What do you consider to be non-essential but very useful and justify on this basis?
What would you consider to be superfluous?
What is your FAK list and weight?
Is the FAK even an area where one *ought to* justify weight savings?

Obviously FAKs vary hugely depending on the size/make-up of a group. Here I am asking about your personal FAK, not those used for, say, club trips etc..

Looking forward to your input.

Jackson

[DanShell]

There have been some good threads on this already and they are always subjective to opinion of course and at times can be slightly controversial.

But Ill start it off by offering my 'opinion' based on my limited experience.

I used to carry way to much stuff. Some of it was laughable really. I mean, realistically there is only so much I could treat in the bush or anywhere for that matter. It comes down to life threatening...then its time to get the chopper in, or is it a simple strain, scratch, cut blister etc.

So what works for me is this.......
I keep some items to treat/prevent/help blisters. Things like duct tape, some padding, those fancy bandaids that are like a second skin and some tape.
I keep a proper compression bandage....one of the big suckers that will actually do a whole leg properly in the case of a snake bite...in fact I have two.
I also keep a range of meds that work for me. Ibuprofen, panadol, anti inflams, antihistamine and anti diarrhoea tablets.
I recently added some antiseptic type wash based on an experience of needing it and not having any.
I also have one of those silver space blankets, mainly to be seen in the event of a rescue but I guess it might be used for its intended purpose.

And thats about it. For me its a matter of what is likely to happen and what am i actually capable of treating anyway.

I know my kit will come across minimal and no doubt get some criticism but it works for me.

[DanShell]

Just to add to what I have said, I spent a bit of time considering different scenarios that have been presented to me at first aid courses for instance and then applying those things to bushwalking.

So things like a sling.....I can use some clothing if I really need a sling.
Splint.....stick
Dressing.....clothing
Bleeding.....clothing
Any type of bandage besides compression......clothing
Broken leg.....chopper
Serious ligament injury etc....chopper

I am like most people in regards to being very limited in what I can and cant do anyway. I am not a paramedic, I do first aid for work ever year but even then its limited.

See my common theme

[GPSGuided]

In 2016 and being weight conscious, I would suggest the following considerations amongst others,

- Likely injuries and conditions encountered eg. Pre-existing medical issues.
- You know when and how to use the equipment - eg. No point in bringing a fancy bandage when you don't know how to fold and apply.
- Don't bring if there's make do - eg. No need for splint or fancy gauze if there are tree branches or towels/toilet paper.
- Consider the urgency of treatment - eg. Most skin abrasions or cuts don't need that full treatment apart from a general clean and stopping the bleed, the rest can wait till one returns to the car later in the day.
- Weather - eg. Winter vs Summer.
- Consider the extraction scenario - eg. One needs to prepare a lot more if one can only walk out after an injury. Otherwise it's 2016 and owning a PLB helps.

So for me,
- Betadine ointment (first line antiseptic + emergency water purifier)
- Meds (just a few tablets/capsules of Panadeine and antibiotics)
- 2 large stick-on bandaids (if it truly requires dressing, then these are the sizes)
- Elastoplast tape
- Small-medium sterile pad
- Elastic crepe bandages x2 (also act as snake bite bandage)
- Guedel airway x2 sizes
- Space blanket
- Folding knife (when one really needs to cut)
- Small folding multi-tool (with scissors and tweezers)
- Paracord - Just part of my general bushwalk gear.

+ PLB

+ Know how to be creative with available gears when providing first aid and to the condition.

[weeds]

Jackson, I would be interested in what your thoughts first up after the course and their suggestions.

One thing to consider........on our first multi day hike (three nights four days) I thought I had it covered being mindful that I didn't want to carry excess. My 12yo stacked it on day two and cracked his head open. Over the next 24hrs we had used pretty much all our supplies. We washed the bandages so they were available.

We will now carry more stuff across the family

[Gadgetgeek]

Its an experience thing. Some people end up liking certain products, or hating them. for example, I've seen many kits with half a roll of white strapping tape. I hate the stuff. A couple years of sport med taught me that I need half a roll to do a good job on a single joint. That tape can stay on for max, two hours, but if there is swelling, it has to come off. I would commonly go through a couple rolls a game, let alone a multi-day walk where I'd be wanting to reasses the injury. Nope. for a fresh injury I'll do a compression bandage, and check it often. For an old injury, you carry as much tape as you need, either white tape, or brown leuko-tape. But its not that effective in most cases.

On the other hand, I love the wide white adhesive bandage fabric, really versatile, and works well with a non-stick dressing for seeping wounds like scrapes. I find I get good coverage, decent staying power, works well over blisters, and can be soaked off pretty easily.

A couple big dressings for major bleeds, and have an exit plan.

Again, it really depends on who and how far you are going. I focus on multiples of the kind of bandage I'd be willing to replace in the field (wound maintenance) but for the bigger stuff I'm more likely to just have one or two since I know that its likely I'll be trying to evac.

Your main focus should be shock management, having a shelter you can put up over the injured person, and getting them off the ground is the absolute key. I just did a wilderness first aid where it rained almost the entire time, really put it into perspective how much that can make a difference.

[[Jack]son]

Jackson, I would be interested in what your thoughts first up after the course and their suggestions.

One thing to consider........on our first multi day hike (three nights four days) I thought I had it covered being mindful that I didn't want to carry excess. My 12yo stacked it on day two and cracked his head open. Over the next 24hrs we had used pretty much all our supplies. We washed the bandages so they were available.

We will now carry more stuff across the family

I'm sorry to hear that, what a rough first trip! I hope it wasn't too serious.

In the course I learned that all of the first aid I perform beyond basic strains, smalls wounds etc. will be preparing a casualty for the emergency services and managing their condition. Obviously if an injury is serious enough you're gonna hit the PLB, but how the injured person(s) is cared for can have a huge impact on their prognosis. A lot of what serious first aid is seems to be managing pain and preventing shock.
With that in mind I will now include the following:
-A CPR mask of some sort, one shot or reusable. Of course this will depend on where you're walking. If I was going to walk the Port Davey track in Winter I certainly wouldn't bother, but if I was walking the Three Capes track in summer I would definitely include one. I would also want to keep one in a vehicle at all times. The one shot masks are extremely light, but the reusable ones might be somewhere around 100gm. It's the last thing you want to have to use, but it could save someone's life.
-I also think carrying some sort of blade for removing clothes around a fracture, bite or bad strain is a very good idea. The first thing paramedics will do the they see a patient with these ailments is cut their clothing off. It makes managing the person easier and gives the paramedics a head start. A knife would definitely do the trick, but I also use a small pair of medical scissors for cutting dressings down to size, cutting tape and a bunch of other small things.
-A triangle sling, super light and has endless uses.

My first aid kit will now always include:
-non-stick dressings
-a length of hypafix
-10cm width compression bandages
-a few sections of gauze
-medical tape
-small pair of scissors
-saline solution
-betadine
-some bandaids
-pain killers
-emergency blanket
-a pair of gloves
-cpr mask
-triangle sling
*edit -some Rocktape for blisters*

I was also taught that one of the first principles of first aid is to minimise risk to oneself, and to therefore always use the gear of the injured party first. This seems to be a good justification for carrying a moderately supplied FAK. I would want to carry anything that may be needed to treat ME if something happens. I don't want to have to rely on what other people are carrying should I get injured. Maybe this is something a lot of people don't consider?

Jackson

P.s. and obviously a PLB

[DanShell]

Jackson, I think your on the right track. Its always going to be open to opinion.

Most people in the bush carry some sort of sharp instrument even if it is for cutting open food packets so include it as a part of the first aid kit or a part of your cooking kit......

Saline solution I'm not a fan of. CPR mask, fair enough. Pity they don't make an ultra light defib, then perhaps more lives would be saved when they required cpr??

[[Jack]son]

Saline solution I'm not a fan of. CPR mask, fair enough. Pity they don't make an ultra light defib, then perhaps more lives would be saved when they required cpr??

I can definitely understand why you'd opt to leave the saline at home. I justify it on the basis that it can be used to irrigate wounds and clear eyes. I guess you could almost as easily use drinking water.

I imagine an UL defib would be a game changer!

I also should have said that in spring I'll take antihistamine eyedrops.

[GPSGuided]

Based on experience and academic stats, if someone needs extended CPR out there, I'm afraid to say it's a hopeless scenario. Protecting the airway and the urgency of needed mouth to mouth, I wouldn't have the time to dig in the pack for that CPR mask. Just do it. So as such, leave that mask for the First Aid Course and do what's realistic out in the field. For that ultra-light defib, say your prayer and swear words, then give that fist thump. That folding knife will come in handy if one needs the bypass the airway in a choke scenario too.

[Bogong Moth]

As I have some medical training (but no, I'm not a medical doctor) I always have to remind myself to go easy on the FAK supplies. Mostly any serious injury requires a hospital far more than a first aid kit.

I do take one packet of thick-ish suture- not because I think we should be stitching small skin wounds out there in the field, but because if there's a serious arterial bleed I know that my best chance is to ligate it right there and then. I've never used it (except for temporary equipment repairs) but it's my safety blanket.

[GPSGuided]

As I have some medical training (but no, I'm not a medical doctor) I always have to remind myself to go easy on the FAK supplies. Mostly any serious injury requires a hospital far more than a first aid kit.

I do take one packet of thick-ish suture- not because I think we should be stitching small skin wounds out there in the field, but because if there's a serious arterial bleed I know that my best chance is to ligate it right there and then. I've never used it (except for temporary equipment repairs) but it's my safety blanket.

You are on the money here.

Though, the practicality of ligating a vessel in a field trauma situation will very much depend on one's skills. Without additional instruments (especially arterial clips), one's ability to put a functional stitch and knot on the torn end of a significant sized vessel is pretty haphazard. A tourniquet would be more realistic while smaller vessels respond well to direct compression. On this, paracord can be dissected out for finer cords/threads, perfect for your flagged application if needed and practical.

[Eremophila]

- Betadine or Savlon
- Painkillers and some Immodium
- couple of non-stick dressings/sterile pads
- a small sheet of butterflies if I have some, might be an eye pad floating around too
- Elastic crepe bandage, 1 or 2 medium
- Triangle bandage
- Have a small Swiss army knife in my pack, would also take tweezers and/or splinter probe
- bulk bandaids and blister dressings - this being my Achilles heel so to speak
- some alcohol swabs
- some pre-cut lengths of Fix-o-mull with a few larger sheets and a small pair of scissors
- a Korjo.... big orange plastic bag. Emergency blanket/bivvy bag thingy? It stays folded in the bottom of the pack, ready to use as waterproof pack liner, good for stowing both packs outside the tent if there's two of us, or could be used as a visual aid if you were trying to be seen.

I reckon that's about it. Must do a re-inventory.

[GBW]

Pretty basic FAK here also, as mentioned, anything that serious ( broken leg, head injury, heart attack, snake bite ) calls for emergency assistance so:

bandaids and tapes x plenty
10cm wide compression bandage x 2
dressings x 2
Eye pad
Betadine
Panadol/painkillers/voltarin
Stingose
Swiss Army knife
Safety pins, scissors, tweezers, needle, thread (for repairs, I probably wouldn't sew up a bad wound)

That's about it.

[slparker]

As I have some medical training (but no, I'm not a medical doctor) I always have to remind myself to go easy on the FAK supplies. Mostly any serious injury requires a hospital far more than a first aid kit.

I do take one packet of thick-ish suture- not because I think we should be stitching small skin wounds out there in the field, but because if there's a serious arterial bleed I know that my best chance is to ligate it right there and then. I've never used it (except for temporary equipment repairs) but it's my safety blanket.

You are on the money here.

Though, the practicality of ligating a vessel in a field trauma situation will very much depend on one's skills. Without additional instruments (especially arterial clips), one's ability to put a functional stitch and knot on the torn end of a significant sized vessel is pretty haphazard. A tourniquet would be more realistic while smaller vessels respond well to direct compression. On this, paracord can be dissected out for finer cords/threads, perfect for your flagged application if needed and practical.

I completely agree - ligating a vessel is pretty hard because of, well,all the blood and it's slippery - a challenge in a bloodless field with forceps, good light and a someone to mop your brow let alone with clumsy fingers out in the field.
Most arterial bleeding in a FA context in bushwalking is likely to be from extremity trauma and an arterial tourniquet is easier, safer and likely to be more effective than ligating an artery. exposed mesenteric (abdominal ) bleeding is where you need to ligate but the chances of this are small in a FA situation out bush i imagine - and the forces involved in creating such a n injury would be likely to kill the victim by other means.

Not that carrying sutures is a bad thing and it might come in handy for fixing other stuff. like lacerations, tents and blown out boots.

[lee737]

Sutures, without additional instruments - needle holder, forceps, and without training, is unlikely to be useful. That spurting artery is unlikely to be particularly easy to see, let alone get a stitch secured around, especially in someone moving about and screaming because you are hurting them.... For lacerations you should then also have means to properly ensure antisepsis, and some local anaesthetic, and with this comes training again. Better to leave it open that close it dirty. For lacerations, clean out the dirt as best you can, irrigate with the cleanest fluid you have, preferably sterile, and tape it up and cover.
Saying that I put together a small suture kit (with the pre-requisites above) for more extended trips, but also include some glue - far easier for more lacerations....

[Lindsay]

I must agree with the above posters. Trying to suture an artery in the bush will be an exercise in futility. Far better to use direct pressure/constrictive bandage, and as others have pointed out, any sort of suturing without being able to thoroughly clean the wound is asking for an infection.

[GPSGuided]

I wouldn't be too worried about the infection risks of suturing if one can be evacuated within a short time frame. The whole area is contaminated and adding a needle and suture makes little difference. But there are more reasons why one should not try any fancy suturing when alternate simple solutions could be applied (ie. tourniquet, direct compression), and that's tissue preservation. Messing around with the torn vessel/nerves endings under sub-optimal conditions will just extend the damaged segment and will further compromise any reconstruction attempts later on in hospital, let alone the chance of unintended damage to other structures by the wide bite of the needle. The KISS principle applies here.

I would carry packets of surgical sutures on walks for other reasons eg. Repair of gears. They are at their finest for the quality of needles and the variety of strong suture materials.

[taipan821]

My first aid kit

Base module

sterile triangular bandage - sling, bandage, pad for severe bleeding
7.5cm crepe bandage - for head wounds
10cm heavy crepe/compression bandage x2 - snakebite, muscloskeletal damage, wound dressing
30mL saline steritube - eye and wound irrigation
10cm fiximull tape (1 metre) - securing dressing, blister prevention
7.5cm x 10cm Non-adherent dressing x2 - minor wound care
7.5cm x 5cm waterproof island dressings x2 - minor wound care
XL band aids x4 - blister care
bandaids x6 - boo boos
square bandaid x2 - hotspot prevention, really small boo boo
3.5g burn gel satchet x2 - burns
povidone iodine swab x2 - wound cleaning
500mg paracetamol x6 - pain relief
400mg ibuprofen x6 - anti-inflammatory
200mg Aluminium Hydroxide (Mylanta) tablets x2 - indigestion
10mg Lorentadine tablets x6 - anti-histamine
1 metre of hypoallergenic tape

Base module weight - 190grams
If I am soloing I add 4 more compression bandages, If I am undertaking an activity that has a high risk of trauma I add an arterial tourniquet, 4 and 6 inch emergency bandages.

I do not carry gloves, this is my first aid kit and it is to be used on me by me. I would consider suturing gear a waste of time, it takes skill and practice and thee risk of infection outweighs the few advantages, KISS principle rules. I have been trained in suturing during a course and I haven't used it since. It is hard to say what gear is essential and what isn't because that's more personal choice than anything. This is my kit contents, it has downsized from 800grams to 190 grams

when in doubt, many treatments have been solved by superglue and duct tape

Hope that helps Jackson

[jimjim]

+ 1 x 300 mg aspirin tablet and an understanding of when to use it.

[andrewa]

I like DanShell's early posts, and JimJim's one - I'm a 50+ yo GP, so hopefully have some understanding ( and, yes, I presumably also have some practical skills, which may make me more relaxed about medical problems)

I think DanShells first post sums it up well. I broke my wrist in remote NZ last year - improvised splint. Cardboard and sock. Dealt with it when back in Oz a few days later. Aspirin would have been a nice edition, but a bonus.

I'm off to Kiribati (Kiritimati) in a few weeks to go fly fishing - in the middle of no-where - there is only one flight in and out per week, and no practical hospital facilities, so I will take a bit more stuff, but that really only involves some additional antibiotics etc. Anything serious, I'll rely on my Medivac insurance.

Keep it simple. A bandaid or two, a couple of panadol (or an aspirin). With better communication facilities these days, compared with 20yrs ago, we probs need less first aid...

A

[Moondog55]

Blisters and small cuts and abrasions are all I have had to deal with personally in the last 20 years but I still carry a major trauma kit for big /deep wounds
A couple of compressed dressings and a couple of 150mm roller bandages and a few XL tampons
If I was in a coastal area when traumatic amputation was a possibility I'd add a decent constriction bandage or army tourniquet but not for my normal walking
Still my FAK weighs about 500g minimum and lot more kept in the car, bandaids and leukopor tape mostly but the #15s and big roller are bulky not heavy which is what most folk whinge about
I do try and separate FAK from medications and pain management tho and to be honest they weigh a lot more and take up a lot more room these days