# Major first aid kit: What's in it?



## PBR62 (Feb 17, 2014)

Wondering just what qualifies as a major first aid or medical kit as required by national parks for multi-day trips


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## RASIL (Jan 18, 2010)

PBR62 said:


> Wondering just what qualifies as a major first aid or medical kit as required by national parks for multi-day trips


Check this link. http://www.nps.gov/grca/planyourvisit/upload/Noncommercial_River_Trip_Regulations.pdf Page 19


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## Salidaboater (Nov 5, 2013)

The NPS site just has suggestions not really the best if you want to be prepared.
Here is a site that might help you General Use First Aid and Medical Kits
Here is another - NOLS
The grand is one place to pay serious attention to your medical preparedness. IMHO 

PM Be glad to help


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## restrac2000 (Mar 6, 2008)

They don't ever check content from my experience.

In general, first aid kit should match the skills of your highest trained participant. We have been lucky as we always have a WFR-certified rafter (myself, though expired) or above. I would hope most trip have at least a standard first aid trained individual as a minimum. Have them build or recommend the contents of the kit. I have downgraded my kit a bit over the years as I have failed to re-certify and practice in a meaningful way.

Use the various links above but make sure you know how to assess the situation and apply the right care before reaching into the kit. 

Hope your national park floats are without incident.

Phillip


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## streetdoctor (May 11, 2012)

minimal is all you need unless you think you're going to be days away from help. Something to control bleeding, make a splint, a pocket mask, some ibuprofen, maybe an epi-pen if someone has a known bee allergy. 

Antibiotic ointment, alcohol, neosporin, etc. is all fluff and is just taking up space.


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## Salidaboater (Nov 5, 2013)

I believe they are talking about the Grand which means you could be 20 days or more away from help. Minimal isn't very good advice.


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## streetdoctor (May 11, 2012)

Salidaboater said:


> I believe they are talking about the Grand which means you could be 20 days or more away from help. Minimal isn't very good advice.


multi-day could also mean two days. As always everyone has there own opinion, this is just mine. Kind of like being a paramedic for 10 years… some one asks me to "do something" there isn't much you can do without your kit. You can have all the supplies in the world if you don't know how to use them it doesn't matter. Unfortunately definitive treatment for major trauma is always the OR. Doubt you're going to fit that into your first aid kit. (although I'm sure some people try!)

If I was trying to pack for a 20 day trip I might try to get some antibiotics, not sure how you're going to do that without a prescription though… and then you're practicing medicine without a license. A satellite phone would probably be more useful though...


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## Salidaboater (Nov 5, 2013)

streetdoctor said:


> multi-day could also mean two days. As always everyone has there own opinion, this is just mine. Kind of like being a paramedic for 10 years… some one asks me to "do something" there isn't much you can do without your kit. You can have all the supplies in the world if you don't know how to use them it doesn't matter. Unfortunately definitive treatment for major trauma is always the OR. Doubt you're going to fit that into your first aid kit. (although I'm sure some people try!)
> 
> If I was trying to pack for a 20 day trip I might try to get some antibiotics, not sure how you're going to do that without a prescription though… and then you're practicing medicine without a license. A satellite phone would probably be more useful though...


The second post in the thread refers to the Grand Canyon Website, which is why I assumed we are talking about the Grand. A large part of the Wilderness First Responder training is the difference between front country medicine and backcountry medicine. And a lot of emphasis on evacuation decision making.

On the Grand an Evac is very expensive and a serious event for the NPS and not done lightly. So a sat phone is not used lightly..

So the major medical kit needs to be well thought out. You may need to take care of certain wounds for an extended period of time, up to 20 days.

As well as other serious non evac events.


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## RASIL (Jan 18, 2010)

OP asked what was required. Hence the link with the recommended list. If you follow that they can't complain. 
Having the training to go with the kit of course is vital. Also knowing the health of your individuals is also key to knowing what extras you may need. Everyone should have basic first aid, just for everyday life. 

REI & NOLS offer Wilderness First Aid every few months. Definitely worth the time and expense. Two months after I took it I was using the skills on a river with items I would not of thought to bring before the class. And that is with 30 years of basic/occupational FA background.


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## PBR62 (Feb 17, 2014)

The list of "required items" for the Yampa/Green trip simply says one major medical kit. I don't think it went into detail about what was in one. I'm guessing those trips aren't "days away from care". 

Thanks for the info. I've had WFA but we don't have any WFR's on the trip as yet.


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## mrkyak (Jul 11, 2005)

For Grand trips I always take an ankle brace, knee brace and back brace in case they are needed.


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## carvedog (May 11, 2005)

streetdoctor said:


> minimal is all you need unless you think you're going to be days away from help. Something to control bleeding, make a splint, a pocket mask, some ibuprofen, maybe an epi-pen if someone has a known bee allergy.
> 
> Antibiotic ointment, alcohol, neosporin, etc. is all fluff and is just taking up space.


For real? After years of not cutting myself with kitchen knives I managed to do so night one of our Selway last year. Antibiotic ointment is very important in my first aid kit and my cut was healed by trips end. A little betadine first but I don't think I would have had that result without the antibiotic ointment. 

Alcohol can be very important. Without whiskey I wouldn't have survived having that fly cut out of my scalp. Way too many nerve endings up there.

I also know someone who slipped on a boat box and drove an oarlock thru their skin on the back of the leg. They disinfected, stitched it up and he finished the trip. They obviously watched for signs of infection and they had enough 4x4s, gauze and sterile supplies to keep it clean. by week two he was almost back to normal. 
Without those supplies he would have had to be evacuated. 

While I get that you are a firefighter/paramedic and typical response is package for ER/OR/hospital, under some circumstances evac can be two days away in some wilderness river areas. With the NPS having helis standing by maybe less in the GC but what is wrong with trying to take care of your own medical issues unless evac is warranted?


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## rioperro (Jan 11, 2013)

I find it much easier to float with Dr's. EMTs work well too. Hell, Randy is a vet. A paw, a hand. He can fix you or your dog.


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## Schutzie (Feb 5, 2013)

I agree with cavedog; when medical care is days away you have to be able to deal with infection and discomfort.

A doctor I ran with liked Hydrogen Peroxide; I've found lots of uses for it over the years. If you don't like Neosporin it's a good universal bug killer.

I discovered Aquaphore; buy it at Walgreen's. Hospitals use it for radiation burns. I've used it on sunburn that was blistering; it killed most of the pain and the next day it was just a little red; no blisters. Great for when you grab that skillet off the fire without thinking or for the hero that don't need no stinkin sun tan lotion and charbroils themselves.

You gotta deal with pain; a burn or cut or rash or earache or toothache can be as disabling as a broken bone, and often the only answer is pain control. We never carried prescription stuff, but there are enough pain killers out there over the counter to help at least a little bit.

The real challenge isn't the minor cuts and stuff that happen, or the major life threatening injuries; your course of action is generally pretty clear cut and in the case of a major injury, you can't be expected to carry everything needed for every possibility; your goal is evacuation by the fastest means available.

The challenge is the unclear issues; someone gets whacked on the head hard enough to make them goofy for awhile; do you evacuate now, or wait to see what happens?

Someone may or may not have a broken bone, joint, or torn ligaments etc.; do you evacuate or tell them to "tough it out"

Someone starts complaining of pain, more than a sore muscle or strain. Evacuate or see what happens? I was hours away from launching on a 5 day Cat trip when I started having abdominal pain. I checked into the emergency room because the trip leader made me; it was indeed appendicitis, and with a post surgery infection I was 7 days in the hospital. If the trip leader hadn't basically put me in the truck and taken me to the hospital I certainly would have launched. And died.

This isn't all fun and games; you have to really think in advance about what you will do if something happens, and decide what equipment or knowledge you need to respond to it. You can't be a trained emergency room physician carrying your portable OR with you, but you also can't toss a box of bandaids in the dry box and call it good.

I still say, go to your physician and ask what they'd want in a first aid kit if they went on a trip. Not what they'd bring (cause they'll bring the good pain killers and a lot of sharp things you shouldn't touch), but what they'd want in the kit if they were unconcious or something. My physician even gave me all kinds of stuff, like wraps and bandages and samples.


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## restrac2000 (Mar 6, 2008)

> While I get that you are a firefighter/paramedic and typical response is package for ER/OR/hospital, under some circumstances evac can be two days away in some wilderness river areas. With the NPS having helis standing by maybe less in the GC but what is wrong with trying to take care of your own medical issues unless evac is warranted?


Support. Beyond the medical implications is the fact that the backcountry is shrinking in many of these places. Policy follows these actions especially with the cost the NPS and agencies are eating for rescues nowadays.



> Originally Posted by street doctor
> If I was trying to pack for a 20 day trip I might try to get some antibiotics, not sure how you're going to do that without a prescription though… and then you're practicing medicine without a license. A satellite phone would probably be more useful though..


You recommended an epi-pen in your first response which is Rx as well which would be theoretically just as problematic. Point being, I have never heard of a backcountry medical case involving these types of Rx on private trips leading to legal issues. I have carried Rx painkillers and antibiotics on every trip longer then 2 days. Only had to use 1-2 of the painkillers in all of that time but it made a difference. 

The prescriptions are in the first aid kit to be self-administered as well, never "given" by anyone other then the person consuming them and I don't provide such things to minors (never dealt with the parental consent issue). This is also the case with OTCs.

All-in-all I think the first link provided the OP the choice on how to construct the content answer pretty well. The rest of what we all are talking about exposes how complex the issue can be beyond boxed kits. Day trips are one thing but multi-day becomes nuanced.

Phillip


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## PBR62 (Feb 17, 2014)

Yep, got a good list. Just in case the ranger wanted to look at contents, I'd be covered and not have an issue with "non-compliance" or something.


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## carvedog (May 11, 2005)

restrac2000 said:


> Support. Beyond the medical implications is the fact that the backcountry is shrinking in many of these places. Policy follows these actions especially with the cost the NPS and agencies are eating for rescues nowadays.


Please elaborate. I am trying to figure out why trained medical personnel would eschew basic first aid that I use nearly every single time I am on the river. In this case antibiotic ointment. Truly not picking a fight just trying to understand the logic of this.


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## restrac2000 (Mar 6, 2008)

carvedog said:


> Please elaborate. I am trying to figure out why trained medical personnel would eschew basic first aid that I use nearly every single time I am on the river. In this case antibiotic ointment. Truly not picking a fight just trying to understand the logic of this.


Was agreeing with you, hence the use of "support". The rest of the comments were maybe too vague but were to criticize the over reliance of rescue personnel and a general lack of self-rescue skills in the backcountry. The various managers and agencies I interfaced with while working with canyoneering agencies showed time and again that too many people are under-prepared and go in with the attitude that SAR will solve every problem for them in the backcountry (hence it metaphorically shrinking).

All for self-reliance in the backcountry. WFR standards/protocols are defined for situations 10 miles or more from a hospital.....not very limited. 

As for the details of creams....I carry 'em. You can keep a wound clean without them but they seem to make it easier and more certain with less work. His use of "minimal" threw me off but some of his descriptions were anything but, he just seems to dislike creams. So be it. One of the most talented and respected outdoorsmen I know never carried more than duct tape and a painkiller for his crazy multi-day land adventures. I am sure his extensive training could help macgyver a solution to many situations but I know I need a few more tools.

Mileage will vary. (None of the personnel running medical certs I have received could even agree on a backcountry kit) 

Phillip


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## benpetri (Jul 2, 2004)

I think its important to understand there are actually two functions of a major first aid kit. The first is obvious in that you want to be prepared to try and stabilize someone if you have a major emergency (e.g. bleed out, broken bones, medical emergency, etc.) while you await evacuation.

However the second role is to be able to treat the minor stuff to prevent it from turning major, especially when you're out for an extended period of time. For instance on my recent Grand trip one person in our group had hands that were very badly chapped, cracked and starting to get infected and puffy by day 7 or 8. Its a very minor thing, but if you just let it go, then by day 10 or 12 you may having to evacuate someone who has a fever and is in serious shape. Neosporin and bandages may not sound like much, but his infection cleared within a day or two just using this basic stuff.

Overall though the most important thing is to have the knowledge about first aid. Take a class (ideally) and read some books. Wilderness First Responder by Buck Tilton is a good reference. You can take all of the splinting equipment in the world but if you have no idea how to build a splint or when to use one, its sort of pointless.


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## Fuzzy (May 25, 2005)

Duck Tape


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## duct tape (Aug 25, 2009)

Fuzzy said:


> Duck Tape


For a Grand trip? Yes, please take me!


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## Fuzzy (May 25, 2005)

yes always take ducktape and a fuzzy thing on all your grand trips


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## slickhorn (Dec 15, 2005)

newskin. 

It ain't mandatory. but man do I tear up my hands rigging, and I have multiple hangnails by day 3. these ALWAYS get infected in the backcountry. 

I've learned to hit 'em with some neosporin then some newskin to seal out the grit and keep 'em clean. A swollen pus-filled thumb that can't take any pressure due to a HANGNAIL is a shitty thing to suffer through on a trip. 

Got 2 right now I'm reeling in after a 3 day illinois trip. guess I got weak hands.


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## OldandBitter (Jun 11, 2011)

I discovered Aquaphore; buy it at Walgreen's. Hospitals use it for radiation burns. 

Harrumph on the Aquaphore. I used it during my radiation fun time. It worked as well as any of the lidocaine infused ointments. Now that you mention it I've get few spare tubs that are going into the first aid chest.


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## whip (Oct 23, 2003)

Chris a marine wildlife biologist sewing up my 1" + knee laceration



prob wouldn't a worked to duct tape that one we were in White Bird ID hours from an ER


Didn't have any local anesthetic but booze was plaentiful


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## B4otter (Apr 20, 2009)

Got my EMT (in AZ back in 1979, one of the first) and have kept WFR current for awhile. Thought about being a medical professional until I re-thought it (realized I wasn't emotionally equipped to deal with the trauma, my yuppie-scum doctor brother makes up for me by being almost exclusively devoted to "delivering patient services" - and earning $300k per year...). I also have a problem with the sight of blood - not immediately, but later: makes me puke.
I've seen BAD backcountry injuries, including leaking brain pan (after mis-step down in the Maze, a very long time ago, and he lived and recovered). And I've seen tons of sprains and strains - the most common injuries. But one of the most insidious was just common cut on a Grand trip that developed into full on blood-poisoning despite best efforts to treat it over course of 7-8 days. Classic symptoms, radiating purple nasties after about 5 days, we cleaned and bandaged (hand wound) repeatedly to no avail - until finally flagged over a commercial trip whose boatman I knew and they had doctor on board with broad spectrum antibiotic (some amoxy- or other - "cillin"). 
Today I carry Cipro, a different broad spectrum -cillin, and epi-pen. Always. Even if expired. And stay current on your certifications, good practice gaming scenarios if nothing else. Be safe.
P.S. - other very common scenario is BURNS. Carry stuff to deal with 'em!


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## Mike Hartley (May 1, 2006)

Most of the stuff you deal with entails cleaning wounds and bandaging. So I have lots to deal with that. And I too know of minor cuts that eventually required evacuation from grand. That evacuation took 2 to 3 days to be able to put together. I love having Tegaderm of various sizes. I am an RN so on the trip like the grand I carry lots of extras. To me that feels especially important since a number of the people I boat with are in their 60s.
Various antibiotics
Assorted pain meds
Epi and Atropine
Oral airways and an LMA
IV supplies and a bag of LR
Stethoscope and a BP cuff
Benadryl!
Lomodium!
Of course you have to know how to use this stuff but someone can lose a lot of blood pretty easily from a fall or breaking their leg while scouting a rapid. Or they can go south pretty quickly if their gallbladder goes bad and they get septic. It's nice to have some support for them while you're waiting for the chopper to come in.
Even before I was an RN, I found doctors to be pretty open to prescribing many meds like antibiotics for a trip like this.
Hell I'd even like to have a defibrillator along but so far I can't stomach putting out the money for that!


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## cataraftgirl (Jun 5, 2009)

I cringe whenever I read about someone stitching up a wound in the backcountry. Yikes! That's asking for trouble big time, and only rarely actually needed. Keeping a wound clean and properly dressed is the safer course of action in most circumstances.


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## lhowemt (Apr 5, 2007)

Yesterday I tried to slice the tip of my finger off. While getting it evaluated I learned that triple antibiotic ointment isn't recommended anymore. Bacitracin or neosporin.


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## lhowemt (Apr 5, 2007)

Regarding the usefulness of certain items, I now always carry double antibiotics. I once got a finger infection on the MFS. Fortunately a friend was a Dr. He had some, I had some, and he had me double dose. I still ended up filing my wedding ring off with a leather man, but I stayed on the river, didn't lose my finger, or have the infection go systemic. That leather man was the ONE tool on the trip with a diamond file. Without it I would have been in trouble. I also now carry a ring cutter and hope it is forevermore "fluff"


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## cataraftgirl (Jun 5, 2009)

lhowemt said:


> Yesterday I tried to slice the tip of my finger off. While getting it evaluated I learned that triple antibiotic ointment isn't recommended anymore. Bacitracin or neosporin.


I'd go with Bacitracin. More and more people are developing allergic reactions to Neosporin. We don't stock Neosporin in my hospital anymore. Neomycin (the Neo in Neosporin) is one of the three ingredients in triple antibiotic ointment. For wound cleansing you want clean water and a syringe to power flush. Chlorhexadine (Hibiclens) is preferred over betadine. Hydrogen peroxide is ok if that's all you have, but it's not a great wound cleanser.

I remember your ring story. Scary stuff. Two of my rafting friends have tattoo wedding bands so that won't happen on the river. Do you carry a ring cutter now?


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## deadlizard (Mar 10, 2008)

*Fortunately we had both a doctor and nurse for this.*

And yet even with 2 full size med kits, the sutures turned out to be too small and broke. Ended up using some type of butterfly tape. I'm always whining about over packing and too much gear but I make an exception for that when it comes to the first aid kit. Left a decent scar. This was on a DiamondDown.

Personally I have no skill set but fortunately boat with those that do.

http://www.paddleon.net/PaddleOnVidLink.aspx?vidname=TheLeg&up=1

Gene


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## Schutzie (Feb 5, 2013)

whip said:


> Chris a marine wildlife biologist sewing up my 1" + knee laceration
> 
> 
> 
> ...


 Huh. Back in the day Duct tape was THE go to for "sealing" any cut or puncture. On anything or anyone.
1) Apply Hydrogen Peroxide and/or Neosporin (depending on how deep it was). 
2) Clean. Repeat step 1. 
3) Apply gauze. Apply duct tape. Proceed.

I mean, if duct tape can't fix it, you either replace it or evacuate it. Really.

On one trip a famous (who shall remain unnamed) professional football player decided he had cracked a couple of ribs. We had nowhere near enough tape to meet the need, but we did have duct tape. Lots of duct tape. 
Under his tutelage we wrapped his entire chest tighter than a ducks ass, right over his man pelt. I suspect the volume of alcohol and other substances in his blood at the time caused him not to consider the consequences. Or our warnings. We determined finally that it would be a good learning opportunity for him.

Five days later while loading up at the take out he decides he should remove the tape, you know, now that his ribs felt better. 

Screamed like a little girl, our big strong hero did. It even attracted unwanted attention from the rangers. We explained, and they agreed it was indeed a learning experience.

Moral of the story; duct tape will attach to just about anything, and do it well enough that you have to consider removal technique. But, as a bandage the stuff works well if applied properly.


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## turtle83 (Mar 17, 2009)

B4otter said:


> Got my EMT (in AZ back in 1979, one of the first) and have kept WFR current for awhile. Thought about being a medical professional until I re-thought it (realized I wasn't emotionally equipped to deal with the trauma, my yuppie-scum doctor brother makes up for me by being almost exclusively devoted to "delivering patient services" - and earning $300k per year...). I also have a problem with the sight of blood - not immediately, but later: makes me puke.
> I've seen BAD backcountry injuries, including leaking brain pan (after mis-step down in the Maze, a very long time ago, and he lived and recovered). And I've seen tons of sprains and strains - the most common injuries. But one of the most insidious was just common cut on a Grand trip that developed into full on blood-poisoning despite best efforts to treat it over course of 7-8 days. Classic symptoms, radiating purple nasties after about 5 days, we cleaned and bandaged (hand wound) repeatedly to no avail - until finally flagged over a commercial trip whose boatman I knew and they had doctor on board with broad spectrum antibiotic (some amoxy- or other - "cillin").
> Today I carry Cipro, a different broad spectrum -cillin, and epi-pen. Always. Even if expired. And stay current on your certifications, good practice gaming scenarios if nothing else. Be safe.
> P.S. - other very common scenario is BURNS. Carry stuff to deal with 'em!



Be very careful with things like Cipro. It is rare but it can cause some horrid side effects, I know because it happened to me. I took one pill, about an hour later my ears started ringing loud, both my feet went numb, my hands went numb, my eyes hurt, horrible anxiety/panic attacts, brain-fog, weakness, joint pain, insomnia-basically its called Central Nervous System Poisoning. This lasted over a month and was the most uncomfortable time of my life.

My ears have never stopped ringing, they ring 24/7 now, its called tinnitus I guess, and I have learned to live with it. It has a FDA red-lable warning stating that it can cause permanent nerve damage! Mine were considered moderate side effect, If your curious google "CIPRO Is Poison". It was prescribed to me by a doctor, and the only reason I'm posting this is because I would hate to see this happen to anyone, especially on a river trip.


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## cataraftgirl (Jun 5, 2009)

turtle83 said:


> Be very careful with things like Cipro. It is rare but it can cause some horrid side effects, I know because it happened to me. I took one pill, about an hour later my ears started ringing loud, both my feet went numb, my hands went numb, my eyes hurt, horrible anxiety/panic attacts, brain-fog, weakness, joint pain, insomnia-basically its called Central Nervous System Poisoning. This lasted over a month and was the most uncomfortable time of my life.
> 
> My ears have never stopped ringing, they ring 24/7 now, its called tinnitus I guess, and I have learned to live with it. It has a FDA red-lable warning stating that it can cause permanent nerve damage! Mine were considered moderate side effect, If your curious google "CIPRO Is Poison". It was prescribed to me by a doctor, and the only reason I'm posting this is because I would hate to see this happen to anyone, especially on a river trip.


Also can cause achilles tendon rupture. Great stuff for UTI, but I'd never give it to anyone else. I hesitate to give anything that's not OTC to folks on the river. Most people carry their own stash of prescription meds if they think they may need them. Giving prescription meds and suturing up wounds are things that to me fall into the category of......just because you can, or think you can, doesn't mean you should. If a WFA or WFR class doesn't teach it, then you probably shouldn't be doing it.


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## Schutzie (Feb 5, 2013)

Recently departed Doc Baker (RIP) said it best;
You shouldn't be able to kill anyone with what's in a first aid kit, but please don't try; if you aren't sure or don't know what to do, don't.

Never carried anything prescription in our kits. Passengers were known to carry "prescription bottles" of stuff, which was none of our business, and if a doctor happened on the trip they always had their own first aid kit which we gladly guarded with more care than the beer.

Lowly river guides have no business playing doctor; tape it up or evacuate it.


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## malloypc (Jun 6, 2009)

Mike Hartley said:


> Hell I'd even like to have a defibrillator along but so far I can't stomach putting out the money for that!


We purchased one for our 2007 Grand trip - $100 per person didn't seem too steep.


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## cataraftgirl (Jun 5, 2009)

malloypc said:


> We purchased one for our 2007 Grand trip - $100 per person didn't seem too steep.


Now this is the one medical item I might be convinced to bring. These can be found in most public buildings now days, are fairly simple to use, and can save a life.


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## Kendi (May 15, 2009)

I teach WFA classes. My kit has all kinds of goodies and frankly I use it all the time as most everyone I boat with knows I am well supplied with that kind of stuff.

That being said- When I teach the classes I always tell my students "the most important thing in your first aid kit ISN'T in the kit- it's between your ears"

If you don't know how to use it- it's useless. Bringing the right stuff is important, but you also need to know how to use it.


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## wyosam (May 31, 2006)

cataraftgirl said:


> Also can cause achilles tendon rupture. Great stuff for UTI, but I'd never give it to anyone else. I hesitate to give anything that's not OTC to folks on the river. Most people carry their own stash of prescription meds if they think they may need them. Giving prescription meds and suturing up wounds are things that to me fall into the category of......just because you can, or think you can, doesn't mean you should. If a WFA or WFR class doesn't teach it, then you probably shouldn't be doing it.


I agree- if for no other reason that I'd like to hang on to my license- my job supports my boating habit. I do tend to carry some suture in almost all my outdoor pursuits, but I dont really have any intention of sewing people. It is however great for gear repairs, and readily available to rescue from the trash at work. Not interested in passing out prescription meds, but the big kit on the raft is well supplied with OTC stuff for various ailments.


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## lhowemt (Apr 5, 2007)

cataraftgirl said:


> Achilles tendon ruptue


Speaking of cipro, this happened to my mother. Both, and they never healed properly. I will never take it, or related class( levaquin too?) unless it is life threatening. It is sad how much the toxic side effects are downplayed and ignored. Poison for sure.


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## whip (Oct 23, 2003)

The gold standard for wounds is Keflex/cephalexin. Cipro and Levaquin are not indicated for wounds. We had a terrible foot injury with and ugly open wound on a boaters heel a few days into a grand trip. Not surgically repairable. We did dressing changes daily. As there was no sign of infection we did not consider antibiotics. I carry a scalpel too but I wouldn't take out your appendix or gall bladder. Chopper go! It goes back to using what you know. As far as antibiotic ointment, yes we're not using it much in the hospital. Creates resistant bugs. But on a multiday river trip exposed to all the microrganisms in a river. Heck yeah I'd smear it all over a wound.


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## cataraftgirl (Jun 5, 2009)

I've had my knee replaced & now have a plate & screws from a shattered femur, so my Ortho doc wants me to carry Keflex along just in case. One other note on wound care. High power, vigorous flushing with clean water is a must. I carry a 10cc syringe with a flush tip in my kit. Clean those nasties out every day.

Things I like to carry......syringe for flushing, lots of different size dressings, blister stuff, poison ivy stuff, burn stuff, sports wrap for sore joints & tendonitis, finger splints.


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## lhowemt (Apr 5, 2007)

cataraftgirl said:


> I remember your ring story. Scary stuff. Two of my rafting friends have tattoo wedding bands so that won't happen on the river. Do you carry a ring cutter now?


Yes I do, but I no longer wear my ring either. Between that experience and intermittent swelling from RA, I want nothing to do with a finger tournaquit. I also encourage people to remove rings before trips, I've heatd too many different horror stories from ring accidents.


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## [email protected] (Jun 1, 2010)

Here is what I carry in my first aid kit and a copy of a form I ask all participants to fill out


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## hummer (Jun 30, 2005)

*!st Aid kit - group kit & personal*

I'll try to attach my lists - one for a major or group kit, and one for personal, 
as individuals have specific issues -- I've had serious elbow infections so I carry antibiotic for that, and another for sinus infection. Personal physicians will usually give an RX for specific purpose when you tell them it's for your 1st aid kit, multi-day river trip etc. 
Pain meds are only in crisis and if victim is sure they're not allergic - and even that is a risk. 
Prevention of injury is better part of Wisdom when help is simply not available.


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## El Flaco (Nov 5, 2003)

Sam Splints- versatile and very handy:
Amazon.com: SAM Splint 36" Rolled - Orange & Blue: Health & Personal Care


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## whip (Oct 23, 2003)

by the by if you get a head laceration and the hair is 2-3" or longer after rinsing with clean water and soap you can tie the lac closed with hairs on either side of the cut to keep her closed


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## PBR62 (Feb 17, 2014)

So....is it better to buy the contents piece-meal or buy a ready-made kit with all/most/some of them and fill in any missing items?


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## Kendi (May 15, 2009)

I generally say buy a kit that meets at least 70% of your needs and then add/ replace as desired.


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## lchastai (Oct 4, 2010)

If anyone just wants a list, here's my google spreadsheet that I compiled from a number of different sources. I'm a WFR, so I don't have anything that I wouldn't use above that training. You are welcome to copy and use at your leisure...

https://docs.google.com/spreadsheet/ccc?key=0AkVJDTnIzr5EdEhFcWM2TkQzSGZScWcxNm9RcFRKLVE&usp=sharing

Cheers! Lynne


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## sleighr (Nov 14, 2011)

lhowemt said:


> Regarding the usefulness of certain items, I now always carry double antibiotics. I once got a finger infection on the MFS. Fortunately a friend was a Dr. He had some, I had some, and he had me double dose. I still ended up filing my wedding ring off with a leather man, but I stayed on the river, didn't lose my finger, or have the infection go systemic. That leather man was the ONE tool on the trip with a diamond file. Without it I would have been in trouble. I also now carry a ring cutter and hope it is forevermore "fluff"


that's just it is it not? ya carry all this stuff to patch you and your friends and patch your boat and fix most things that might crop up and hope ya never need any of it. ... mercifully most of the time ya don't need much ...


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## mtriverrat (Jan 29, 2012)

These are the things I used on my Grand trip from my expedition first aid kit and glad I had them. Ace wrap and SAM splint for broken wrist. Vet wrap for dislocated shoulder and what turned out to be a broken bone in arm. Just wrapped it onto his chest for stabilization. Lots and lots of super glue for cuts on fingers. Lots of saline for cleaning wounds. THey have cans of wound wash that work great. Mass doses of vitamin I (ibuprofen. Have everyone bring some biotears or similar eye drops - your eyes get dry down there. Mass quantities of bacitracin. Cold medicine. A course of zithromycin for a respiratory infection. Suture kit for a nasty head wound. Print off the directions from youtube - just like that Holiday Inn Express commercial - anyone can do it. Did I say vet wrap - take lots. Make everyone bring bag balm or Burt's Bees hand salve cuz an ounce of prevention is worth it for the dry cracking hands. Yep it was a goat rope, but glad I was prepared. No one took a helicopter ride so I feel like I did my job.


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## dgosn (Sep 8, 2006)

It's interesting to see what people carry, and want to carry. For a major medical kit, I tend to go towards what's likely to happen:
- burns(gel, sterile dressing)
-dehydration(electrolytes maybe 500ml IV)
-sprains (Ibuprofin, ace wrap)
-broken bones (splint)
-infection (meds, or cream)
-trauma (lots of sterile gauge and wraps)
-colds (OTC meds)
-diarrhea (OTC meds, electrolytes)
-inflammation(cold pack, OTC meds)
-general ouchies (tape, gauze, super glue)


I've also seen the Med kits that are carried by the person that wants to be George Clooney and play ER doc... Intubation kits, and AEDs are great, but in the middle of nowhere they may only extend someone's life by hours. 

AEDs only shock 2 cardiac rhythms, V-tach and V-fib. While a well timed shock may buy some time an AED without cardiac drugs and/or cardioversion following won't do much. 

People who get zapped with an AED don't simply just shake it off and continue on, they are likely to have a ton of problems that require serious things not found in a first aid kit. The only exception is if a shock was followed by a prompt medivac landing and transport. 

Traumatic cardiac arrest has a minimal survival rate with advanced life support except rare occurrences in children. Cardiac arrest without a return of a pulse and breathing after about 5 minutes is also a pretty dire situation. People may initially 'survive' but usually don't last long. 

The same goes for Intubation Kits- If someone needs a ET they also need an ER quickly. That said, I do carry a King Tube, and a couple airways (cheap!!). A King Tube may be useful for an allergic reaction until the epi takes hold and airway swelling goes down. But you'll also need several doses of epi and benidryl.

On thing I do think could be useful is a vacuum mattress. They are bombproof, have carry handles and are more supportive than a backboard. They also are much more comfortable to be secured in. A vacu-mattress would be great for the random chance of a spinal injury. 

http://www.thefirestore.com/store/p...um-Mattress/?gclid=CPraiZunzL0CFQ5gMgodJiMA2A

A CPR mask is of course great for drownings and should be carried, but again CPR means a Hospital is going to be needed very soon.

A cool head with basic equipment is more useful than a full panic with all the gadgets. A Sam splint, OTC meds, antiseptic. and trauma dressing along with duct tape and ingenuity can go along way. 

Laura's story of the wedding ring is interesting, something I would never have thought of. Luckily ingenuity prevailed over fancy doodads. Had the ring not been removed at best she would have lost a finger, and at worst developed sepsis and been very ill and experienced organ failure.

There are 4 absolutes to first aid and EMS:
1. Air goes in and out
2. Blood goes round and round
3. All bleeding eventually stops
4. All cardiac rhythms eventually stabilize

If you can manage these things to your skill set that's all that can be done. I've worked with some nasty traumas and sick people, and almost always basic first aid came into play first. Treat the most lethal problem, prepare for shock and manage it, and then focus on the smaller problems, and if needed initiate help ASAP.

-sn


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## duct tape (Aug 25, 2009)

dgosn said:


> It's interesting to see what people carry, and want to carry. For a major medical kit, I tend to go towards what's likely to happen:
> - burns(gel, sterile dressing)
> -dehydration(electrolytes maybe 500ml IV)
> -sprains (Ibuprofin, ace wrap)
> ...


I'm an MD (maybe you are too?) and these are all excellent points.

Do you take an IV set and some LR or NS on raft trips? 

I struggle with airway management - not sure what is really realistic, even if heli evac is available, albeit hours away. I've thought about ET tubes, cricothyrotomy sets (or at least large bore IV cannula or 1ml tuberculin syringe), ambu bags, LMA's, King tube, etc. Not really sure I can or want to go this route.

Can't imagine taking an AED on a river.


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## 39571 (May 27, 2012)

Heroin, and band-aids, because they stick on me.


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## asleep.at.the.oars (May 6, 2006)

My MD kit has antibiotics, prednisone in addition to Benadryl & epi, a suture kit (with lidocaine/needles so I can clean well), and then WFR level supplies including the recipe for oral rehydration solution. I keep it all in a regular sized ammo can. I figure if I can't either improvise it with the victim/patient's clothing/gear and a leatherman or treat it with what I have, they're gonna need an evac, and with what I bring I might be able to change a common reason for an evac into a stay & play level injury or illness.
I don't carry any advanced airway supplies, or anything else that would be a prelude to immediate hospital care. I figure it to be a vanishingly small chance that most "physician level" interventions would actually improve the outcome, compared with hauling a much larger box of unused supplies on trip after trip. I think a fentanyl lollipop would be a good addition for fracture/dislocation care, I just don't want the hassle of being responsible for narcotics.


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## GAtoCSU (Apr 18, 2005)

duct tape said:


> I'm an MD (maybe you are too?) and these are all excellent points.
> 
> Do you take an IV set and some LR or NS on raft trips?
> 
> ...


I'm an MD. I don't think that IV solutions are worth while on a trip. I also wouldn't take an airway kid or an AED on the river. If it gets that bad, the person is in serious trouble, and there's not much that I'm going to be able to do for them when we're hours from help. Also, a king tube or LMA might seem like a good idea, but most of these guys are going to vomit and then you're wishing you had a definitive airway, or nothing in there to push it back down the wrong tube. 

Also, where do you stop? Do you take sedatives and paralytics? Multiple size tubes? BVM's? Code drugs through the ETT?

Now what might be interesting is 20cc's of marcaine and a 4 inch spinal needle with syringe. Could do intra-articular blocks for shoulder dislocations, off palpation alone, and make someone with a should dislocation much more comfortable and get it back in sooner rather than later.


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## GAtoCSU (Apr 18, 2005)

lhowemt said:


> Speaking of cipro, this happened to my mother. Both, and they never healed properly. I will never take it, or related class( levaquin too?) unless it is life threatening. It is sad how much the toxic side effects are downplayed and ignored. Poison for sure.


The 90-day cumulative incidence of Achilles tendon ruptures among fluoroquinolone users was 17.7/100,000

That's not impressive. It may triple your risk of tendon rupture, but it's still incredibly low. With that said, if I have an option I don't prescribe it to people who play professional basketball or varsity level sports.


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## lhowemt (Apr 5, 2007)

GAtoCSU said:


> The 90-day cumulative incidence of Achilles tendon ruptures among fluoroquinolone users was 17.7/100,000
> 
> That's not impressive. It may triple your risk of tendon rupture, but it's still incredibly low. With that said, if I have an option I don't prescribe it to people who play professional basketball or varsity level sports.


While risks are evaluated from a population wide basis, individual use should be person specific. I hear of no other problems associated with other antibiotics, and this wouldn't be the first wonder drug "later" found to cause problems. Sure, this is anecdotal, but that is no reason to discount avoiding one drug if other options exist. You might consider widening your pool of people to avoid it with, such as family with hisotry and other existing tendon/joint issues (such as RA). Honestly I get so tired of the pro-cipro mantra, sometimes it seems like there is a huge conspiracy to protect it and utterly disregard people's concerns. It reminds me of Vioxx. I think this does more harm than good for the use of the drug. When drugs get pulled from the market those people that have no other options lose that drug as an option.

90 days isn't enough to look at either, with my mother it was after a couple of doses over perhaps a year? I don't recall the exact time frame (and now she is gone). She was also over 65, and I think the warning specifically recommends avoiding Cipro of senior people due to potential tendon issues. Drugs are so complicated, we each respond differently. We need to be our own advocate.


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## GAtoCSU (Apr 18, 2005)

lhowemt said:


> While risks are evaluated from a population wide basis, individual use should be person specific. I hear of no other problems associated with other antibiotics, and this wouldn't be the first wonder drug "later" found to cause problems. Sure, this is anecdotal, but that is no reason to discount avoiding one drug if other options exist. You might consider widening your pool of people to avoid it with, such as family with hisotry and other existing tendon/joint issues (such as RA). Honestly I get so tired of the pro-cipro mantra, sometimes it seems like there is a huge conspiracy to protect it and utterly disregard people's concerns. It reminds me of Vioxx. I think this does more harm than good for the use of the drug. When drugs get pulled from the market those people that have no other options lose that drug as an option.
> 
> 90 days isn't enough to look at either, with my mother it was after a couple of doses over perhaps a year? I don't recall the exact time frame (and now she is gone). She was also over 65, and I think the warning specifically recommends avoiding Cipro of senior people due to potential tendon issues. Drugs are so complicated, we each respond differently. We need to be our own advocate.


While I will agree that a lot of factors should and need to be considered when prescribing any medication to anyone, one thing that is often overlooked is what we are actually trying to accomplish by giving out said antibiotic to the person in question. Each hospital and region should have their own antibiogram to help guide and tailor treatment for suspected pathogens, which when combined with the patient's medical history will help us prescribe the right agent. 

For example, we have a large percentage of females over the age of 65 that are growing extended beta lactamase resistant E. coli, pseudomonas, and, Enterobacter in their urine. When I'm prescribing an antibiotic for one of them to go home on for their UTI, I may be doing so with a fluoroquinolone in hopes of covering them against some of the more exotic bugs out there, which our micro lab has shown our bugs to be susceptible to. Nothing is more frustrating than sending a 70 year who is perfectly stable home with a UTI, only to have her come back in 48 hours fulminately septic, altered, and sent to the ICU b/c we prescribed something with less coverage.

Everything has their pluses and minuses. Fluoroquinolones are not on the list of drugs to avoid in the elderly (unless they have other problems, medications, etc that make them a higher risk). Macrobid is contraindicated. Amox, augmentin, etc have limited use and come with very common side effects. Bactrim has one of the worst side effect profiles of any antibiotic. What's left?


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## lhowemt (Apr 5, 2007)

GAtoCSU said:


> While I will agree that a lot of factors should and need to be considered when prescribing any medication to anyone, one thing that is often overlooked is what we are actually trying to accomplish by giving out said antibiotic to the person in question. Each hospital and region should have their own antibiogram to help guide and tailor treatment for suspected pathogens, which when combined with the patient's medical history will help us prescribe the right agent.
> 
> For example, we have a large percentage of females over the age of 65 that are growing extended beta lactamase resistant E. coli, pseudomonas, and, Enterobacter in their urine. When I'm prescribing an antibiotic for one of them to go home on for their UTI, I may be doing so with a fluoroquinolone in hopes of covering them against some of the more exotic bugs out there, which our micro lab has shown our bugs to be susceptible to. Nothing is more frustrating than sending a 70 year who is perfectly stable home with a UTI, only to have her come back in 48 hours fulminately septic, altered, and sent to the ICU b/c we prescribed something with less coverage.
> 
> Everything has their pluses and minuses. Fluoroquinolones are not on the list of drugs to avoid in the elderly (unless they have other problems, medications, etc that make them a higher risk). Macrobid is contraindicated. Amox, augmentin, etc have limited use and come with very common side effects. Bactrim has one of the worst side effect profiles of any antibiotic. What's left?


Excellent point, and example of how a drug may be the best one, given the specific details.

So as to not derail the thread, one thing I have added to my multiday kit is epsom salts. What a great way to clean a wound daily on a river trip! I was able to keep my finger slice clean on this trip with frequent dressing changes and daily epsom soaking. If only I had worn my splint regularly so I didn't bang it and dislodge the adhering that had been going on before the trip. Well at least it didn't prevent my trip, and I had no problems associated with it. I hadn't ever really used the stuff, and it cleaned the wound wonderfully.


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