# Any non-comercial folks carrying an AED in their safety / first aid kit?



## ornerymoose18 (Mar 12, 2018)

I'm a huge Buffalo Bills fan and the Damar Hamilton on-field cardiac arrest has me pretty shook up and is making me think having an AED along with a big group trip (and knowing CPR and how to use it properly) might not be a bad idea.

Do any of you buzzards keep one in your standard equipment? They're pricey but seem indispensable when shit really hits the fan.


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## zaczac4fun (Mar 21, 2018)

W-AEMT here and here's what I concluded after researching renting or buying one for my last Canyon trip (short version, I decided it wasn't worth it). 

Less than 1/2 of out of hospital cardiac arrests (CA) have a rhythm that is shock-able by AED. Even less so in CA resultant from downing (without underlying cardiac conditions - see next point).
My group did not contain at-risk members. No known chronic conditions (or ages) that could predispose a them to sudden cardiac arrest or infarction.
If you were to get a CA with a shock-able rhythm and convert it with AED to perfusing rhythm (pulses) the management of these patients is often extremely complicated and repeat loss of pulses is not uncommon.
-Lastly, as you noted AEDs are expensive and require regular upkeep compared to the likelihood of use (statistically most injuries occur in camp, and statistics for river deaths usually include health risk factors and often the lack of PFD).

I might reconsider the calculus if my group contained members with cardiac risk (age, obesity, or chronic conditions). 
Absolute most important thing you can do to improve the survival of drowning patients is make sure everyone in the group is trained and refreshed in HIGH QUALITY CPR and rescue breathing. Generally, (otherwise healthy) drowning patients need oxygen and the quicker breaths and chest compressions are provided the better the outcome. Everyone needs the training because you don't know who's gonna be the one to pull them out of the water, also you may end up performing CPR for a while and will need to rotate compressors to maintain quality.

With regards to the Hamilton incident, most of the experts I read agree it was likely Commotio cordis (usually suffered by youth baseball players). Basically its getting hit in the chest in the exact right spot, in the right way, at the exact right time in the cardiac cycle- relatively rare.

This is just what I've found. I know there are a good handful of other emergency medical people on this forum and I'm curious to read their calculations.


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## Will Amette (Jan 28, 2017)

One of my boating clubs owns one. It is available for members to check out if it's not currently in use for a club event.

That said, an AED won't save your life. An AED can correct a specific type of arrhythmia. Advanced care is still needed immediately. Until/unless a normal rhythm is restored, it's CPR that keeps blood (and oxygen) flowing to organs including the brain. If you are somewhere really remote, the AED may not provide the life-saving treatment some assume it will. 

The AED is only part of the chain of survival. The next link is early activation of EMS and advanced care. That's not going to happen in the wilderness.


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## Idatah (Dec 30, 2021)

Nice response (zaczac4fun).

I was wondering about the after-care. In some situations, (closer to life flight/urban areas) maybe it could bridge the time to extraction and more advanced care? Good comment on having an understanding on who in the group has recent training.

Recent CPR and AED training was enlightening and an excellent reminder on rescue breathing and AED use (e.g., only 2 of 4 rhythms are shockable).


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## nolichuck (Mar 11, 2010)

ornerymoose18 said:


> I'm a huge Buffalo Bills fan and the Damar Hamilton on-field cardiac arrest has me pretty shook up and is making me think having an AED along with a big group trip (and knowing CPR and how to use it properly) might not be a bad idea.
> 
> Do any of you buzzards keep one in your standard equipment? They're pricey but seem indispensable when shit really hits the fan.


I've been carrying one on all my multi-day trips in a Pelican case for about ten years. I replace the battery every 5 years. It has never been used but my group of boaters feel like it is an important part of our first aid kit. It only weighs a couple of pounds and is very easy to use. It will only work if it determines that the person needs to be shocked.


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## BastrdSonOfElvis (Mar 24, 2005)

If it gives you good feels then great. The bottom line is that if you have to use an AED and the patient doesn't get to an ICU PDQ then it isn't going to matter. Hauling one into a wilderness canyon doesn't really make a lot of sense, IMO.

In the post-forced-experimental-mRNA vax world, the unfortunate truth is that we're all at much higher cardiac risk. Evidence is showing that some measure of heart damage is likely universal, and several nations (not to mention life insurance underwriters) have raised the alarm about the impossible to ignore massive increase in sudden death of healthy prime-aged people. Not to mention elite athletes in their prime collapsing on field. But, you know, it's all tin-foil hat conspiracy theories, I'm sure the vaccines are perfectly safe and Big Pharma and their government partners in crime have only our best interests in mind.

It is a terrible shame that Hamilton is in such bad shape and was likely entirely avoidable. I hope he pulls through. He was a teammate of my nephew at Pitt and by his account a great kid.

Edit: it seems he was able to open his eyes and grip the hands of family members so...good sign.


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## nervouswater (Jun 3, 2008)

I’d be more inclined to bring oxygen over an AED if I was choosing between the two.


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## Riverlife (11 mo ago)

Very good points made regarding the limitations of an AED. I have been personally involved with performing CPR on an individual where an AED was not applicable. We actually had one on hand, but no shock was ever advised, and would not have been helpful at all. They are great tools to have, but just be very aware of what they can and cannot do, and be sure to have a follow up plan for evacuation.


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## Pinchecharlie (Jul 27, 2017)

I work in schools as maintenance. Anyways I gotta do a certain amount of training for stuff. You know , how to escape a gun man , epi-pen yada yada. We have one and even though I wasn’t paying attention during my training , the deal is so dumbed down that you basically follow very specific instructions and then when it’s hooked up it tells you what’s going on. So to have it doesn’t mean you have to do the thing and it monitors the patient so…I dunno? Why not ? It’s like all things over the top , only need one when you need one. Can’t use one unless you have one. I may have borrowed ours for a trip, think the head nurse said it was a few hundred dollars? I dunno ? Just kinda remember it from that training day I was day dreaming about skiing or something other than the subject at hand. Now iam thinking a guy should put together a hospital raft and get invited in lots of trips??? That’s probably a real bad idea huh?


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## Montet202 (Aug 22, 2020)

I am a retired paramedic. My wife is a firefighter/paramedic. I’ve taken part in countless resuscitation efforts. I see absolutely no need for an AED on a remote multi day trip. Even in the incredibly rare event of a non traumatic cardiac arrest with a shockable rhythm, the care needed following cardioversion is not available. You still need a massive amount of oxygen, IV anti-arrhythmia drugs, etc…and definitive care, meaning a cardiac catheterization.

This is a similar discussion as with epi-pens. An epi-pen only buys time. If you don’t follow it up with cortico steroids it only gives you the opportunity to say a nice farewell. Not that you shouldn’t carry an epi-pen, but you need the rest of the drugs to go with it when you are far from advanced care.


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## Pinchecharlie (Jul 27, 2017)

So can a guy survive a heart attach on the Grand Canyon? Say he’s with you and you get him back to beating and breathing and you have a good sat phone? Just curious


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## Montet202 (Aug 22, 2020)

Pinchecharlie said:


> So can a guy survive a heart attach on the Grand Canyon? Say he’s with you and you get him back to beating and breathing and you have a good sat phone? Just curious


I’d say not at all likely, but it depends on the cause. A likely cause, on a river trip, would be hypoxia from a near drowning. If they hadn’t been under for too long and you were able to get them oxygenated, it’s possible.
If the cardiac arrest was due to trauma, or an ill heart, start digging.


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## Pinchecharlie (Jul 27, 2017)

One more thing I guess…


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## Tanaman (Nov 13, 2020)

What saves lives is early CPR and early defibrillation (from an AED). AEDs DO save lives, seen it plenty of times. Will it save every cardiac arrest... no, but if a person arrests out in the middle of nowhere AEDs are the only thing that we have available that could save their life. That being said, I don't carry one just because I don't want the responsibility for upkeep in case it fails. Also using an AED on a wet person with wet rescuers could end badly! If I were to do a longer trip with an "at risk" individual, I could borrow one form work.
I think instead if it were me and I had _witnessed _someone's arrest, I think I would try a pre-cordial thump and see if it had any effect (chances of working are pretty slim) if not, then its CPR until your arms fall off.


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## ColoRobo (Jan 22, 2021)

Something I concluded at CPR training last month is that a Stop the Bleed kit IS something we should all be carrying. Packable gauze, tourniquet, large absorbent pads, etc. I too work in a school and sadly we are trained to use these to pack bullet holes in people; great times we live in. But I can see it's usefulness with tending to a deep cut, deep puncture from a stick, or post-bear attack on the Smith River.


https://www.bleedingkits.org/all-products/premium-personal-stop-the-bleed-kits.html


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## zaczac4fun (Mar 21, 2018)

Montet202 said:


> This is a similar discussion as with epi-pens. An epi-pen only buys time. If you don’t follow it up with cortico steroids it only gives you the opportunity to say a nice farewell. Not that you shouldn’t carry an epi-pen, but you need the rest of the drugs to go with it when you are far from advanced care.


Per UpToDate: Biphasic (repeat) reactions only occur in approximately 5% of anaphylaxis cases following epi....


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## BastrdSonOfElvis (Mar 24, 2005)

ColoRobo said:


> Something I concluded at CPR training last month is that a Stop the Bleed kit IS something we should all be carrying. Packable gauze, tourniquet, large absorbent pads, etc. I too work in a school and sadly we are trained to use these to pack bullet holes in people; great times we live in. But I can see it's usefulness with tending to a deep cut, deep puncture from a stick, or post-bear attack on the Smith River.
> 
> 
> https://www.bleedingkits.org/all-products/premium-personal-stop-the-bleed-kits.html


No one should go anywhere without a tourniquet handy.


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## zaczac4fun (Mar 21, 2018)

BastrdSonOfElvis said:


> No one should go anywhere without a tourniquet handy.


Apply directly around the neck 
But in all seriousness, yes, tourniquet or at the very least hemostatic gauze should be part of your kit (the big fluffy dressing are less for life saving and more for soaking up the blood... like a tampon)


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## Idatah (Dec 30, 2021)

zaczac4fun said:


> Per UpToDate: Biphasic (repeat) reactions only occur in approximately 5% of anaphylaxis cases following epi....


I was wondering about this and planning to look into it more. Thanks. My own experience with a reaction (to allergy shots) I recall only receiving epinephrine, but I could be remembering incorrectly. I've only seen the emphasis on the epi-pen but I'm not a medical professional.


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## zaczac4fun (Mar 21, 2018)

I think it's interesting most of this conversation has revolved around multi-day trips but many of the more technical (dangerous) rivers around here are still well over an hour out from advanced life support. Length of trip matters to me when I am considering aid kit contents like wound dressings and medications that will relieve discomfort or prevent someone from needing to be evac'd but when it comes to cardiac arrest and similar- it's the same stuff whether out for a day or a week.


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## Montet202 (Aug 22, 2020)

Tanaman said:


> What saves lives is early CPR and early defibrillation (from an AED). AEDs DO save lives, seen it plenty of times. Will it save every cardiac arrest... no, but if a person arrests out in the middle of nowhere AEDs are the only thing that we have available that could save their life. That being said, I don't carry one just because I don't want the responsibility for upkeep in case it fails. Also using an AED on a wet person with wet rescuers could end badly! If I were to do a longer trip with an "at risk" individual, I could borrow one form work.
> I think instead if it were me and I had _witnessed _someone's arrest, I think I would try a pre-cordial thump and see if it had any effect (chances of working are pretty slim) if not, then its CPR until your arms fall off.


Early CPR, and AEDs absolutely save lives in conjunction WITH diffinitive care. They rarely, if ever, work alone. 


zaczac4fun said:


> Per UpToDate: Biphasic (repeat) reactions only occur in approximately 5% of anaphylaxis cases following epi....


I have very rarely (maybe once or twice) seen anaphylaxis stopped entirely by epi alone.


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## Montet202 (Aug 22, 2020)

zaczac4fun said:


> I think it's interesting most of this conversation has revolved around multi-day trips but many of the more technical (dangerous) rivers around here are still well over an hour out from advanced life support. Length of trip matters to me when I am considering aid kit contents like wound dressings and medications that will relieve discomfort or prevent someone from needing to be evac'd but when it comes to cardiac arrest and similar- it's the same stuff whether out for a day or a week.


It would make far better sense to carry an AED on shorter day trips where you are much closer to advanced care and diffinitive care.


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## zaczac4fun (Mar 21, 2018)

Montet202 said:


> I have very rarely (maybe once or twice) seen anaphylaxis stopped entirely by epi alone.


🤷‍♂️ Not to discount your experience, or get too far into the weeds, but here's my source : UpToDate


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## Tanaman (Nov 13, 2020)

zaczac4fun said:


> I think it's interesting most of this conversation has revolved around multi-day trips but many of the more technical (dangerous) rivers around here are still well over an hour out from advanced life support. Length of trip matters to me when I am considering aid kit contents like wound dressings and medications that will relieve discomfort or prevent someone from needing to be evac'd but when it comes to cardiac arrest and similar- it's the same stuff whether out for a day or a week.


Epi _can_ break anaphylaxis in certain instances but I wouldn't want to rely on it. Too easy to carry a small vial of roids (I put in the same box as the epi) but even that isn't 100%.


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## ornerymoose18 (Mar 12, 2018)

Montet202 said:


> It would make far better sense to carry an AED on shorter day trips where you are much closer to advanced care and diffinitive care.


I actually got the idea for this question because they have a couple AEDs strategically staged along the Alpine Daily stretch of the Snake.


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## zaczac4fun (Mar 21, 2018)

Same for commercial sections of the Ark.


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## Montet202 (Aug 22, 2020)

Tanaman said:


> Epi _can_ break anaphylaxis in certain instances but I wouldn't want to rely on it. Too easy to carry a small vial of roids (I put in the same box as the epi) but even that isn't 100%.


100%. We keep epi, IV solu-medrol and benedryl, as well as a course of dex in our group first aid kit. If the epi works, fantastic. If not, we are prepared.


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## Conundrum (Aug 23, 2004)

I'd rather bring an AED than an anit-vaxer spouting a bunch of shit. And a tourniquet can easily be made from many things that have other uses but feel free to bring whatever you're comfortable using. Keep your 55 gal drums of beans and rice dry.


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## Bootboy (Aug 25, 2020)

Montet202 said:


> 100%. We keep epi, IV solu-medrol and benedryl, as well as a course of dex in our group first aid kit. If the epi works, fantastic. If not, we are prepared.


That’s a pretty well thought out kit. I’d add Pepcid (famotidine) to the kit as well to round it out.


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## Bootboy (Aug 25, 2020)

Montet202 said:


> I’d say not at all likely, but it depends on the cause. A likely cause, on a river trip, would be hypoxia from a near drowning. If they hadn’t been under for too long and you were able to get them oxygenated, it’s possible.
> If the cardiac arrest was due to trauma, or an ill heart, start digging.


Cardiac Cath Lab specialist here…

As someone who has worked in cardiology for nigh on 12 years, I’d like to reiterate this point.

You could have a “heart attack” and survive if it’s a mild myocardial infarction. 

But if you have an MI that results in cardiac arrest, that’s a big deal and will very likely kill you without prompt, definitive care.

When your heart stops for any reason, its very upset for a good reason, and those reasons need to be addressed.

Fatal, shockable arrhythmias require more than just simple defibrillation. They require significant intervention in a clinical setting.


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## BastrdSonOfElvis (Mar 24, 2005)

Conundrum said:


> I'd rather bring an AED than an anit-vaxer spouting a bunch of shit. And a tourniquet can easily be made from many things that have other uses but feel free to bring whatever you're comfortable using. Keep your 55 gal drums of beans and rice dry.


So we’re going to pretend that 20 something elite athletes dying on the field is normal now? 



https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Boards/BOH/Meetings/2021/Public%20Comments%20324%20to%20328.pdf



Use a search engine with an independent algorithm and educate yourself. What will it take to overcome your child like suspension of disbelief and naive trust in an industry that has screwed us time and again?

Or just throw around derogatory labels. That’ll change the fact that we’re all paying tax money to be Pharma’s lab rats and it’s having predictably negative results. 

While we’re at it, as you are fumbling to try to exert enough pressure with a belt or a boat strap or shoestrings and a stick, your patient with a brachial or femoral artery bleed is dying fast. I hope it’s not me you’re trying to save, McGyver. Or you could spend (er ma gerd) thirty whole dollars!


https://www.narescue.com/combat-application-tourniquet-c-a-t.html







CAT Tourniquet - GEN 7 - North American Rescue


Combat Application Tourniquet - NEW single routing buckle, durable windlass system with free-moving internal band & Red Tip Technology - North American Rescue




www.galls.com





Don’t ask me for rice and beans when you’re starving — you don’t get any now.


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## Nanko (Oct 20, 2020)

I understand why this can’t happen, but I wish a doctor could write up a couple days of opiate pain meds. It could really make a difference to someone while evacuation is arranged.


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## coult45 (May 14, 2020)

Nanko said:


> I understand why this can’t happen, but I wish a doctor could write up a couple days of opiate pain meds. It could really make a difference to someone while evacuation is arranged.


pre-installed doses in your garmin satellite device which sends out a bat signal when you “break the glass” to access said pain killers. Now we are on to something…


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## MNichols (Nov 20, 2015)

Lifetime EMS here, can't dispute anything that's been said here from a medical standpoint. At the end of the day, to me anyway, taking an AED isn't a bad idea, but the chances of needing one, or that using one given protracted evacuation times, is minimal. If you really wanted to carry something that has a likelihood of being helpful, carry a Lucas AutoPulse.






LUCAS - Chest Compression System







www.lucas-cpr.com





They ain't cheap, but they are effective, and with 2 batteries they can run almost 2.5 hours. I've used one a couple times, and while I hope never to have one sitting on me, they do work, and work well. Reports of a powerline worker in MI being on one for 2.5 hours and living support my case.

While you're at it, you might bring along a transport ventilator and a selection of ET tubes or King Airways, a Lifepack 15 patient monitor, normal saline, drip set, selection of angiocath's, Epi, Morphine, versed, clot busters...

This above was mostly tongue in cheek, I guess my point would be, that you really don't need to lug an expensive delicate piece of equipment that may or may not help in a backcountry situation, when in many instances, simple CPR (that everyone here SHOULD know) is relatively foolproof, needs nothing other than your hands and your weight, and has a decent chance of helping the patient having a cardiac incident, until they can be moved to the next level of care.

If there isn't a rapid way to move that patient to the next higher level of care, then all bets are off. Even in Grand Canyon, where they do run a chopper for evac, the chopper has to have the right conditions to fly,and a place to land..

Ya do what you can, with the materials you have available, to render the best patient care you can. Sometimes the patient dies. We all are going to suffer that, but you can have a little consolation that at least you gave it your best. Despite that, some patients die anyway.

At least they will have passed, doing something they love, which would be my wish for when the time comes..



> Edited<


All that being said, my lifetime EMS has most always involved a fully stocked ambulance, and a package and transport mentality.


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## kayakfreakus (Mar 3, 2006)

Nanko said:


> I understand why this can’t happen, but I wish a doctor could write up a couple days of opiate pain meds. It could really make a difference to someone while evacuation is arranged.


My primary care doc was fine with giving me some Percocet (maybe 5 or 10 don’t remember) and said he did the same for big trips for himself. I just said going on the grand and if I get hurt evac will take a while and wanted to have something.


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## Conundrum (Aug 23, 2004)

My point on the tourniquet was bring whatever works for you-that means having it with you, cost, and use. Personally, I bring 2-3 triangular bandages (cravats) pretty much anywhere I’m more than 5-10 minutes from care. You can buy 40 of them for $5. If I bought 40 actual tourniquets, I’d be out $1,200. Triangular bandages are tiny and live in all my packs, first aid kits, and glove boxes. They have more than one aid use from tourniquet to emergency toilet paper. All that said, I do have an actual tourniquet in my big aid kit which doesn’t go on a day ski trip, bow hunting out of my backpack, or a mtn bike ride from my house. 

If looking cool with a $30 tourniquet Velcroed to some molle on your plate carrier is your thing, that is your prerogative. My experience has been most people I’ve seen carrying these when asked don’t know what the term distal means or why it’s important.


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## SomeYeahoo (Jul 27, 2020)

Having brought two people back to life with an AED (one in a hotel bar and one in an airport), I think it's a good question.

That said, I've never bought one and don't carry one on my raft. I don't carry a Bag Valve Mask either but have seen some people do so. I carry a pretty beefy first aid kit but all anybody ever seems to want is bandaids.


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## SomeYeahoo (Jul 27, 2020)

zaczac4fun said:


> Per UpToDate: Biphasic (repeat) reactions only occur in approximately 5% of anaphylaxis cases following epi....


We always worry about this in the ED and watch people for a while after giving epinephrine, but I'm not sure I've seen it in 20 years. It can't possibly be 5% based on my experience. I have given second doses before, but it has never been like the first dose worked in those cases and then later they got worse again. It was always that the first dose worked but maybe not as well as we would have liked. 

At any rate, epinephrine is a very important part of a wilderness first aid kit. Much more important than an AED. If there is one drug to carry, that's it.


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## SomeYeahoo (Jul 27, 2020)

kayakfreakus said:


> My primary care doc was fine with giving me some Percocet (maybe 5 or 10 don’t remember) and said he did the same for big trips for himself. I just said going on the grand and if I get hurt evac will take a while and wanted to have something.


Having done the same for many years, I think narcotics are far less useful in the wilderness than most of us imagine. First because most pain responds very well to tylenol and ibuprofen, which are cheaper, easier to get, and without the worries about people abusing them. But second because when pain is really, really bad, the oral narcotics don't seem to do any good anyway. There's a pretty fine line between oral non-narcotic pain meds and needing IV pain meds. This was brought home to me again recently as I tried to help a friend with a kidney stone avoid an ED visit. The first 7.5 mg of hydrocodone, 800 of ibuprofen, and a zofran didn't do much and he puked up the second one and then went to the ED for some IV morphine. 

That said, I still carry a few pills in my kit, but I just don't think it's all that critical. Most of the time if someone really needs something like that for long there's a helicopter involved today anyway.


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## SomeYeahoo (Jul 27, 2020)

BastrdSonOfElvis said:


> No one should go anywhere without a tourniquet handy.


I agree this is an important part of a first aid kit bigger than anything but perhaps a backpacking size kit.


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## SomeYeahoo (Jul 27, 2020)

ColoRobo said:


> Something I concluded at CPR training last month is that a Stop the Bleed kit IS something we should all be carrying. Packable gauze, tourniquet, large absorbent pads, etc. I too work in a school and sadly we are trained to use these to pack bullet holes in people; great times we live in. But I can see it's usefulness with tending to a deep cut, deep puncture from a stick, or post-bear attack on the Smith River.
> 
> 
> https://www.bleedingkits.org/all-products/premium-personal-stop-the-bleed-kits.html


All of which can be fashioned from material you already have with you. The tourniquet is actually the hardest part to recreate well. But you can stuff strips of clothing into wounds and it works fine. Clean? No. But if it's bad enough that this matters clean is definitely a secondary consideration. 

The real tip here is to get direct pressure right on what's bleeding rather than build a huge mountain of fluff on top of it. You need to stop the bleed, not absorb it.


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## SomeYeahoo (Jul 27, 2020)

Pinchecharlie said:


> So can a guy survive a heart attach on the Grand Canyon? Say he’s with you and you get him back to beating and breathing and you have a good sat phone? Just curious


Keep in mind a heart attack (a plumbing problem) and a cardiac arrest (an electrical problem) are not the same thing. People survive heart attacks all the time. Surviving a cardiac arrest is much more rare. The typical cardiac arrest that occurs with a heart attack is a ventricular fibrillation arrest that really doesn't respond to anything but electricity within the first 10 minutes (and good compressions the longer into that 10 minute period you go). Thus the thread about hauling an AED around. 

But yea, if someone drops dead from a V-fib arrest and you slap an AED on him 2 minutes later and shock him, you're probably going to restore a normal rhythm, he'll probably be awake 5 minutes later, and he'll still be alive 2 hours later when the helicopter gets there and he'll get a stent put in 6 hours later. The AED definitely could save someone with a heart attack in the Grand Canyon that would otherwise die.


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## zaczac4fun (Mar 21, 2018)

*MNichols* was waiting to hear your point of view, 
Thanks, SomeYeahoo taking the time to provide some wisdom point by point.

Lets talk about why the military (TCCC) doesn't recommend improvised TQs and why they fail:
-they take longer to apply = more blood loss.
-without a proper windlass they are not tightened sufficiently leading to veinous but not arterial occlusion (basically allowing blood into the limb that is bleeding but not allowing any of it back into the body) = even worse blood loss than with intervention. 
-They also tend to loosen over time leading to the same problem as above.
-they can be too narrow leading to permanent tissue and nerve loss loss. = back to the lose a limb to save a life.
*Conundrum *You probably already knew these things but now everyone else does too, and with those in mind, can you improvise and effective and safe TQ? Yes. You can apply direct pressure until a makeshift TQ is applied, you can select and utilize a windless and tighten to occlude arterial blood flow, you can repeatedly reassess the makeshift TQ to assure it is still effective, you can select a material and band that is appropriately wide (1.5-2"). Are they as good as a $40 CAT or SOFT-T (please don't buy discount TQs), probably not, but could do the job, _almost_ everything in can improvised but with compromises and its up to each of us to decide that cost-benefit, hopefully with proper knowledge or good advise to back up those choices. Personally, I don't always carry a TQ with me, but they are in my backcounty and big kit.
For another example: I carry a BVM in my large med kit. Do I need it? No, but I prefer it over giving mouth to mouth or mouth to mask for an extended time and it is what I am most comfortable and familiar using. I don't fault SomeYeahoo for not carrying one as I'm sure he's thought that through.

Knowledge weighs nothing and the only cost is little humility (or a couple hundred bucks for a WFA).



SomeYeahoo said:


> I carry a pretty beefy first aid kit but all anybody ever seems to want is bandaids.


This, IBU, tylenol, aspirin, some pepto... and I'd just as soon it stay that way.


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## SomeYeahoo (Jul 27, 2020)

Totally agree with you on the tourniquet. The pre-made military ones are top notch and MUCH better than improvised for all the reasons you described. It's in my kit. I have sterile gauze too, but I consider that much less essentially since everyone always has clothes that can be cut up into gauze.


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## Montet202 (Aug 22, 2020)

Bootboy said:


> That’s a pretty well thought out kit. I’d add Pepcid (famotidine) to the kit as well to round it out.


Yes, Pepcid, as well, for sure.


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## Montet202 (Aug 22, 2020)

zaczac4fun said:


> *MNichols* was waiting to hear your point of view,
> Thanks, SomeYeahoo taking the time to provide some wisdom point by point.
> 
> Lets talk about why the military (TCCC) doesn't recommend improvised TQs and why they fail:
> ...


Few people really understand arterial pressure and how tight a tourniquet has to be to stop it altogether. Arterial blood flow is very tough to completely stop.


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## Montet202 (Aug 22, 2020)

Our group kit has what is needed for probable life threatening stuff, but is primarily for minor things to keep you comfortable on a longer trip away from the grocery store. Cold medicine, Imodium, i-bus, ASA, naproxen, etc. Basic wound care for something that might need daily care, but not evacuation.

It seems we are into our kit daily for one thing or another, but have not needed it for anything serious.

Point being: most of the medicine practiced on a multi day trip will be like the rest of medicine practiced everywhere else; primarily comfort care. Be prepared for minor things as well as the critical.


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## CROE (Jul 29, 2008)

to BSOE above....the current evidence of significant cardiac problems with the MRNA vaccines is statistically VERY SMALL....younger adult males statistically yes myocarditis (small fraction of 1% ever documented) but reality of actual real life cardiac problems again extremely small....I am a physician....show us the evidence if you think this is a real life issue....thanks, Chet


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## Will Amette (Jan 28, 2017)

After a recent trauma, I have decided it's time to stop procrastinating and put together a very comprehensive first aid/medical kit.

Does anyone have a comprehensive list of what a kit should contain in the wilderness? I can recreate the kit we have at the aquarium. The biggest concern we have there is a large animal bite, but EMS is very close by. I know Pelican makes a couple sizes of nice cases. Aside from roll gauze, gauze sponge, gauze pads, Sam Splint, Israeli gauze, touniquet, coban, and basic "ouchie" stuff like band-aids, immodium, antibiotic ointment, hydracortisone, what's in your raft trauma kit?

Is there a good online resource to put a comprehensive kit together? Are any off-the-shelf kits worth looking at, or should I start from an empty box? If off-the-shelf, what are they likely to be lacking that I can add?

I'm a cheap bastard, but if $1000 will help me keep a friend alive, I'll be happy to have spent the money.


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## kayakfreakus (Mar 3, 2006)

Will Amette said:


> After a recent trauma, I have decided it's time to stop procrastinating and put together a very comprehensive first aid/medical kit.
> 
> Does anyone have a comprehensive list of what a kit should contain in the wilderness? I can recreate the kit we have at the aquarium. The biggest concern we have there is a large animal bite, but EMS is very close by. I know Pelican makes a couple sizes of nice cases. Aside from roll gauze, gauze sponge, gauze pads, Sam Splint, Israeli gauze, touniquet, coban, and basic "ouchie" stuff like band-aids, immodium, antibiotic ointment, hydracortisone, what's in your raft trauma kit?
> 
> ...


Few good threads out there already, think this is most recent:









A better First Aid kit


[What’s up buzzards I guess I’m still suffering from cabin fever here in NE Oregon, cause I’m going through all of my rafting gear and slowly getting ready for the next season. I’ve used a 50Cal ammo can for my group First Aid kit for like the last 10 years. If it’s one thing it’s...




www.mountainbuzz.com





I certainly appreciate those who do adding their advice and experience, thanks to the first responders/nurses/docs


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## BastrdSonOfElvis (Mar 24, 2005)

Conundrum said:


> If looking cool with a $30 tourniquet Velcroed to some molle on your plate carrier is your thing, that is your prerogative. My experience has been most people I’ve seen carrying these when asked don’t know what the term distal means or why it’s important.


Uncle Sam didn't give a shit what looked cool on our PCs, we had tourniquets because they save lives. Many thousands of lives over the course of the War on Terror. And soldiers didn't need to know medical terminology to know to put the CAT between the hole and the heart.

Don't worry, though, bud, even though you think your slick I'll still stop on the river to pull my CAT off my PC to save your life while your buds are fumbling around with bandages trying to stop a bleed.


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## Bootboy (Aug 25, 2020)

For those wondering, @SomeYeahoo is an Emergency Medicine doctor. 

He’s just too embarrassed to admit it publicly. Lol


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## Conundrum (Aug 23, 2004)

BastrdSonOfElvis said:


> Uncle Sam didn't give a shit what looked cool on our PCs, we had tourniquets because they save lives. Many thousands of lives over the course of the War on Terror. And soldiers didn't need to know medical terminology to know to put the CAT between the hole and the heart.
> 
> Don't worry, though, bud, even though you think your slick I'll still stop on the river to pull my CAT off my PC to save your life while your buds are fumbling around with bandages trying to stop a bleed.


Bro, simmer. Thank you for your service-seriously. I'm talking about the assholes and bubbas at protests at capitol buildings all kitted out. If I need someone with quick access to a tourniquet while rafting because my biggest risk is IEDs and gunfire, I'm going to sell my raft. This is a rafting forum. Yes, soldiers in war time have different risk factors than sunburns and hangovers. They should be prepared differently just like guys on soldier of fortune forums are not discussing which river sandals to buy or how to cheap out and make their own groovers.

Knowledge and a cool head are your best assets for wilderness first aid. I'd rather someone take a class or buy a book and read it instead of a tourniquet without learning how to use it.


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## zaczac4fun (Mar 21, 2018)

Bootboy said:


> For those wondering, @SomeYeahoo is an Emergency Medicine doctor.
> 
> He’s just too embarrassed to admit it publicly. Lol


Great, now that you’ve outed him to this group he’s gonna get a buncha DMs asking about butthole warts and strange discharge!


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## BastrdSonOfElvis (Mar 24, 2005)

Conundrum said:


> Knowledge and a cool head are your best assets for wilderness first aid. I'd rather someone take a class or buy a book and read it instead of a tourniquet without learning how to use it.


No argument there. But I can think of a half dozen ways off the top of my head you could see an arterial bleed if you're running serious rapids and GSWs and IEDs aren't on that list. And you act like a masters is required to use one? CATs are so easy an 18 year-old grunt full of adrenalin with few thoughts between his ears outside of kill, survive, and pussy can save his battle buddy's life with one after a twenty-minute demonstration. They fit in a PFD pocket. Rafting, kayaking. skiing, snowmobiling, biking, running saws, shooting, in the truck -- there's really no reason not to carry one. Literally in your pocket.

I honestly can't believe I'm still beating this horse. Just grab a tourniquet and put it in your kit, people.


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## BastrdSonOfElvis (Mar 24, 2005)

zaczac4fun said:


> Great, now that you’ve outed him to this group he’s gonna get a buncha DMs asking about butthole warts and strange discharge!


Fukn A, man, I got a rash...


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## Conundrum (Aug 23, 2004)

I won't disagree that knowing how and having to stop a major bleed is important. I will say of all the injuries I've been a part of in the woods including administering CPR, AED, O2, tractions for compounds, backboards for spines, and a lot of stuff in between, haven't ever had a major bleed that required a tourniquet. I guess it's a pet peeve of mine and that's my issue, not anyone else's, that there's a tacticool movement of late and tourniquets always come up and get talked about a lot while many more common serious injuries and illnesses are not. The only people I know who have ever needed to apply one have served in the military and were in a military setting when they needed it.

Back to AEDs. I've been on trips where someone has brought one as they have one for work so it's maintained and accessible at no real cost to the group. Otherwise, I probably wouldn't go out of my way to bring one.


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## Pinchecharlie (Jul 27, 2017)

Do you get to an age where you are worried about it? I mean iam starting to think this shits to dangerous! I ll remember you medical guys if I get any permits. Your beers are on me lol!


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## Dangerfield (May 28, 2021)

If you have an AED like I do - nothing wrong to bring it.

1. Slim chance of a recovery, but stilll better odds than tonight's MEGA Millions drawing.
2. Takes up less space than a cardiologist and a crash cart.
3. Might give a person the option of saying a proper "farewell".
4. If anyone on the trip give me shit about it, well they can sign a DNR.
5. I carry it in my vehicle most of the time, so it goes where I do (in the boat) so it doesn't get stolen out in the boonies.

Also, make sure you have the proper training/certification for this device. As with other medical items like administering O2, know the laws and limits.


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## Kickinback (Jun 19, 2014)

DNR is signed, if I go down just strap me to a boat or better yet just bury me there. Above the high water line of course.


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## Montet202 (Aug 22, 2020)

Dangerfield said:


> If you have an AED like I do - nothing wrong to bring it.
> 
> 1. Slim chance of a recovery, but stilll better odds than tonight's MEGA Millions drawing.
> 2. Takes up less space than a cardiologist and a crash cart.
> ...


There are no needed training/certifications for AEDs. Training is, obviously good, but they are designed to be used without training.


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## Dangerfield (May 28, 2021)

Kickinback said*, DNR is signed, if I go down just strap me to a boat or better yet just bury me there. Above the high water line of course. *

No problem!  I always wanted to use that worthless folding shovel for for some purpose.


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## Dangerfield (May 28, 2021)

Montet202 said:


> There are no needed training/certifications for AEDs. Training is, obviously good, but they are designed to be used without training.


Washington State is a bit more demanding on the legalistic side. My AED crosses state lines so I would hope there is some reciprocal grace. 

Here is a synopsis with the second and fourth bullet checked (followed) and hoping not having to use bullet #4. Bullets #1 & #3 are a bit overboard.

*Washington State AED Law*

 *Summary of Requirements*







PhysicianUpon acquiring a defibrillator, medical direction must be enlisted by the acquirer from a licensed physician in the use of the defibrillator and cardiopulmonary resuscitation.







CPR/AED TrainingExpected defibrillator users must receive reasonable instruction in defibrillator use and cardiopulmonary resuscitation by a course approved by the department of health.







EMS NotificationThe person or entity who acquires a defibrillator shall notify the local emergency medical services organization about the existence and the location of the defibrillator.







Maintenance ProgramThe defibrillator must be maintained and tested by the acquirer according to the manufacturer’s operational guidelines.







Notification of UseThe defibrillator user shall call 911 or its local equivalent as soon as possible after the emergency use of the defibrillator and shall assure that appropriate follow-up data is made available as requested by emergency medical service or other health care providers.


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## Tanaman (Nov 13, 2020)

Don't need an AED... Just give me a battery, cables and call me MacGyver!


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## Montet202 (Aug 22, 2020)

Dangerfield said:


> Washington State is a bit more demanding on the legalistic side. My AED crosses state lines so I would hope there is some reciprocal grace.
> 
> Here is a synopsis with the second and fourth bullet checked (followed) and hoping not having to use bullet #4. Bullets #1 & #3 are a bit overboard.
> 
> ...


My point is they are designed with the intention that they can be operated by a complete lay person. This is important information as no one should avoid using one for fear of screwing something up because they didn’t take a class or obtain a piece of paper.


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## SomeYeahoo (Jul 27, 2020)

Will Amette said:


> After a recent trauma, I have decided it's time to stop procrastinating and put together a very comprehensive first aid/medical kit.
> 
> Does anyone have a comprehensive list of what a kit should contain in the wilderness? I can recreate the kit we have at the aquarium. The biggest concern we have there is a large animal bite, but EMS is very close by. I know Pelican makes a couple sizes of nice cases. Aside from roll gauze, gauze sponge, gauze pads, Sam Splint, Israeli gauze, touniquet, coban, and basic "ouchie" stuff like band-aids, immodium, antibiotic ointment, hydracortisone, what's in your raft trauma kit?
> 
> ...


The key is to have the kit match the capabilities of the person using it. My kit looks very different from yours. For example, I've sutured at least three times on the Main. Should YOU have a suture kit in your first aid kit? Probably not.

Most of the meds I carry are over the counter: tylenol, ibuprofen, imodium, Mucinex-D, benadryl, pepcid, antibiotic ointment etc. But I also carry prednisone, epinephrine, narcotics, antibiotics, zofran. Make sure you have liquid/chewable meds appropriate for the ages of the kids on the trip.

Wound stuff is obviously necessarily. Bandaids, gauze, tape, coban etc. The thing is with a big wound on a river is you need a ton of it because you're going to have to change it so often. Imagine some sort of big dressing you have to put on on day 1 of a 6 day trip? You're going to need more than one roll of gauze and tape. I carry glue, injected anesthetics, irrigation stuff, and a suture kit. Basically, someone gets the same care on the river that they would get in my ED for a wound. Exact same stuff.

Few people carry the big critical care kind of stuff: IVs and IV meds, bag valve mask, AED (and somebody above mentioned a compressions machine). I'm not saying that stuff couldn't be used, but I'm not sure the bang for your buck is there. Injected meds and specific meds for the people on the trip can be useful, but you start worrying about the bang for your buck (and space.) Keep in mind all this stuff expires too eventually. Not as fast as the date on it, but eventually you don't want to trust it.

Military grade tourniquet. Needles for slivers get used. Moleskin gets used. Pads/tampons. Something for bad sunburns (lidocaine/aloe) is a good idea. SAM splint(s) and an arm sling has potential to be used (although I never have). And of course an InReach or Sat phone is worthwhile in wilderness. Soon your iPhone will work for that, but not yet.


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## SomeYeahoo (Jul 27, 2020)

zaczac4fun said:


> Great, now that you’ve outed him to this group he’s gonna get a buncha DMs asking about butthole warts and strange discharge!


No worries. I know how to stop those. I just repost them in this thread.


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## dpwater (Aug 2, 2011)

Does anyone wonder why AED's are located everywhere now in public? Heart disease is so prevalent in the population because of one thing: the standard American diet (SAD). Once known as the diseases of kings, now everyone can afford to eat like one thanks to concentrated animal feeding operations (CAFO's). Processed foods, factory meat etc. are the leading causes of health problems. 

My neighbor developed some "rare" heart condition. Rather than alter her diet she took the advice of a physician... You can eat whatever you want but you have to take these pills the rest of your life and you need to move to low altitude and live close to a hospital for never ending treatments.

We have a disease care system; not a health care system. Just another big business supporting other unsustainable big business.

Great discussion and thanks for the first aid input!


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## Will Amette (Jan 28, 2017)

SomeYeahoo said:


> The key is to have the kit match the capabilities of the person using it. My kit looks very different from yours. For example, I've sutured at least three times on the Main. Should YOU have a suture kit in your first aid kit? Probably not.
> 
> Most of the meds I carry are over the counter: tylenol, ibuprofen, imodium, Mucinex-D, benadryl, pepcid, antibiotic ointment etc. But I also carry prednisone, epinephrine, narcotics, antibiotics, zofran. Make sure you have liquid/chewable meds appropriate for the ages of the kids on the trip.
> 
> ...


Thanks. I was already thinking about how much wound care I would want. I'm going through an awful lot, but I can get more at a pharmacy if needed. On a trip like GC, my injury would earn me a scenic air tour, so I wouldn't need THAT much wound care. On the Jarbidge, that's another deal because it's so far to get out. I am trained for a BVM, but don't intend to put one in my kit; bulky. I have no intent for IV saline or anything I'm not qualified to use even if someone else on the trip is. I trust they'll have some for me if I need it. I have thought about learning to suture. I a told hot dogs are good to practice on. I expect I will need some kind of certification to actually buy them.

Mostly I just wanted to know what I was missing in a kit that I hadn't thought of. I know I can buy a pre-made trauma kit, but I also know they are usually designed for immediate care where EMS is on the way, not deep in a crack in the Earth. I am certified to deliver emergency oxygen, but only for dive incidents. I wouldn't carry it on a raft trip even though it could be really important.

Thanks again for the feedback.


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## Riverlife (11 mo ago)

Great thread! I appreciate the input and perspectives from those of you with a lot more medical experience. A lot of good information here for all river runners; especially those just getting started. I’m almost embarrassed by how unprepared I was for my first few local exploratory adventures: let’s just say that AED’s and tourniquets were far from my consciousness back then. I am often amazed at what I survived lol.


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## Pinchecharlie (Jul 27, 2017)

I made a post on what I should carry for my first aid kit once… of course then I had to take a class then another. This spring when I had my accident in a group of 5 boats I think. Not a single guy brought a kit on a boat or bad one in a truck lol. So… yeah. Of course on my first long trip I had the everything on board to do a heart transplant but when my kid needed a tiny little band aid there where none. I’ll post some pictures of the one at work it’s shockingly easy (haha) it’s as if it’s written for a complete idiot to understand lol (me) stupid first aid kit goes on forever. Mnichols linked a supply house for emt paramedics and I bought a “refill” for a large kit. Gotta bring it though!!!


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## zbaird (Oct 11, 2003)

IV's seem to get used used way to often on my trips. Pricks need to learn how to handle their booze. Staple Gus are so much more fun than sutures.


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## Rafter Larry (Aug 10, 2021)

Years ago I was planning on a Grand Canyon trip and was worried about rattle snake bites. So, I figured that I could get antivenom. But, if the victim is allergic I would need steroids, IV’s and solution. Maybe intubation equipment followed by appropriate supplies for that. That thought process got crazy real quick and I decided to go with the odds and just be careful. 
I think that satellite phones are very valuable for obvious reasons and should be considered on all long trips. I would include some basic splints, super glue and an aspen collar. I would include baby aspirin as well. I am on the fence about an AED because it has the potential to get crazy quickly but if you have room it is not a big deal. The big question is now that you treated the initial problem…what can we do now to get them help? That is where a way to communicate to the outside world comes in. I would be interested in hearing what types of devices people use for that.


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## zbaird (Oct 11, 2003)

Sat phone and know how to set up a good LZ


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## dsrtrat (May 29, 2011)

Both 


zbaird said:


> Sat phone and know how to set up a good LZ


Both times I have been involved evacuations from the Grand Canyon we used a combination of satellite phone and Garmin InReach. In the Grand Canyon emergency dispatch does not have the capability to read text messages so being able to speak directly with dispatch was very helpful. The InReach was good for post evacuation follow up with our designated contact person. We also made initial contact in one instance through the InReach with a designated person who then contacted dispatch and we followed up with a satellite phone call to dispatch. 
As for the LZ both times we set up the LZ, wet it down and secured the area the helicopter landed in a different place. The sites were selected by a former Grand Canyon ranger and former Grand Canyon S and R person. If it happens again, I am just going to secure the area and skip the sand wetting drill. They pretty much land where they chose as there are lots of variables involved in flying down there.


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## Dangerfield (May 28, 2021)

zbaird said:


> IV's seem to get used used way to often on my trips. Pricks need to learn how to handle their booze. Staple Gus are so much more fun than sutures.


Sounds like Rapid Rungs are mandatory for those that partake in booze excessively, followed by IV chasers.


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## Montet202 (Aug 22, 2020)

Sutures are not necessary. I learned, equipped myself, but quickly fell out of practice. Super glue, steri strips, tagaderm, and Zip Stitches will take care of almost anything basic suturing will take care of without all the tricky knots to remember. Also don’t need local anesthetics or to poke flesh.


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## zbaird (Oct 11, 2003)

dsrtrat said:


> Both
> 
> Both times I have been involved evacuations from the Grand Canyon we used a combination of satellite phone and Garmin InReach. In the Grand Canyon emergency dispatch does not have the capability to read text messages so being able to speak directly with dispatch was very helpful. The InReach was good for post evacuation follow up with our designated contact person. We also made initial contact in one instance through the InReach with a designated person who then contacted dispatch and we followed up with a satellite phone call to dispatch.
> As for the LZ both times we set up the LZ, wet it down and secured the area the helicopter landed in a different place. The sites were selected by a former Grand Canyon ranger and former Grand Canyon S and R person. If it happens again, I am just going to secure the area and skip the sand wetting drill. They pretty much land where they chose as there are lots of variables involved in flying down there.


Yep. They are going to land where they are going to land. Not saying you didn't set up a good LZ, but that's why I said a good LZ. Looking around for the absolute best spot possible within reach of your party and setting up for that can be a big deal. Extracts have been delayed, possibly even abandoned based on a bad LZ. Can be anything from bad selection to having something that looks loose to the pilot. They absolutely will not land if they think something is going to go flying when they come in. The pilots done there are pretty damn good. On one of the evacs I was at all we had was about a 20 x 20 (if that) beach that was flat. We got everything way away from that, locked it down and they plopped it down right on that spit of sand in the rocks.

Ground to air radio with Simplex channel programmed in can be a big help to pilots, assuming the guy on the other end has a clue. 




Montet202 said:


> Sutures are not necessary. I learned, equipped myself, but quickly fell out of practice. Super glue, steri strips, tagaderm, and Zip Stitches will take care of almost anything basic suturing will take care of without all the tricky knots to remember. Also don’t need local anesthetics or to poke flesh.


No fun in that!


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## caverdan (Aug 27, 2004)

Star link sat dish is where the future is going. They are already getting smaller than the one I used on Deso last fall. A solid signal of Wifi and cell service. Someone can be researching on a tablet or laptop as someone is talking to EMS on their cell phone..........just like at home.


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## zbaird (Oct 11, 2003)

BOOOOOOOOO!


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## BastrdSonOfElvis (Mar 24, 2005)

caverdan said:


> ...just like at home.


That’s kind of a bummer, though, isn’t it?


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## cupido76 (May 22, 2009)

Kickinback said:


> DNR is signed, if I go down just strap me to a boat or better yet just bury me there. Above the high water line of course.


See... in Canada we would just burn you and have some delicious smoked sausage, but we worry less about leave-no-trace in our sparsely populated north.


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## Pinchecharlie (Jul 27, 2017)




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## caverdan (Aug 27, 2004)

zbaird said:


> BOOOOOOOOO!


Come on Zack.........can you "picture" movie night? 🤩


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## zbaird (Oct 11, 2003)

Ive seen some puppet shows projected on the wall.


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## lhowemt (Apr 5, 2007)

Montet202 said:


> I have very rarely (maybe once or twice) seen anaphylaxis stopped entirely by epi alone.


Agree. Even one of my _mild_ anaphylaxis events took a couple of epis, benadryl, and pred to get it under control. On one occasion, a single epi didn't seem to do anything to stop the throat swelling (although it probably staved off worse swelling). Allergy kits are best if they include epi, benadryl, and prednisone.


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## Kickinback (Jun 19, 2014)

cupido76 said:


> See... in Canada we would just burn you and have some delicious smoked sausage, but we worry less about leave-no-trace in our sparsely populated north.


Well at least I would be put to good use. A Viking funeral sounds better though, but I understand Canadians have their own traditions.


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## cupido76 (May 22, 2009)

Kickinback said:


> Well at least I would be put to good use. A Viking funeral sounds better though, but I understand Canadians have their own traditions.


Look me up if you're thinking about rafting the Kootenay river... I will gladly show you our delicious customs.


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