Sunday, 11 October 2015

Wilderness medical training & medical kits

One question that I am constantly asked is do I offer first aid courses. The answer is currently no. I am working on it though. Running first aid courses are a  big part of my plans in the future to offer courses aimed specifically at kayakers & rafters.
One of the reasons that I do not offer first aid courses is that I am yet to find a syllabus that I feel delivers enough training and skills to offer kayakers & raft guides who are leading groups into the wilderness where they will be a minimum of 1 or 2 days away from any type of professional medical help.

Wilderness first aid training 
I have seen plenty of companies that try to offer this but unfortunately normally the training falls short of the required standard.

Saying that I have found 2 companies that actually do deliver a gold standard wilderness training in my opinion.

Picture from here.

Wilderness medical training (UK & Europe), short WMT have been offering training to those heading overseas into situations where they will be far from help for 20 years now.
I use WMT for my own personal first aid training, I feel that their 4 day advanced wilderness medicine course has given me the knowledge, skills & confidence to deal with problems when they occur (tried and tested).
The thing that sets WMT apart from other courses is fact that their courses are so much more than a first aid course, they really do prepare you to work in the wilderness. The WMT course covers a  multitude of skills that you never get taught on a standard wilderness course. Here are a few of the subjects covered
  • Advanced wound mangament (wound closing using staples & glue)
  • Giving fluid therapy through subcutaneous re hydration
  • Intramuscular injections to administer Adrenalin,local anesthetic, pain killers
  • Advanced fracture and dislocation management
  • Oxygen therapy
  • Use of prescription only antibiotics
This is very good and well I can hear you thinking. But where can I get access to the medications that I have just learnt how to use. WMT have an excellent relationship with Nomads travel clinic in London where you can then purchase prescription only medications along with all of the other medications that you need to build your own expedition medical kit.
WMT will enforce the point that prescription only medications (POMS) are not to be used in the UK or where medical assistance is close to hand.

One of the fundamental skills I learnt on the courses I have taken with WMT is to always carry their excellent field guide booklet whilst on my travels. You will be amazed how much you forget through skill fade when you are faced with having to deal with an emergency situation.

The Advanced wilderness medicine course is taught over a 4 day residential course and is delivered by professional healthcare practitioners from the national health service in the UK along with some seasoned expedition leaders. The course allows you to learn advanced techniques with like-minded individuals. The price for the course can be expensive but you cannot put a price on saving a human life plus you are also arming yourself with skills for life.

The WMT advanced medicine field manual.

On the other side of the pond in the USA their approach to wilderness first aid training is a little more structured & unified than in Europe. The professional standard for people venturing into the wilderness is to hold the wilderness first responder certificate. By law all first responder courses must last for a minimum of 75 hours. The WFR teaches you how to understand the human body and its systems. Group scenarios play a big part in the WFR syllabus allowing the course students to get hands on practice of the skills learnt in the class room sessions. I would personally recommend Sierra Rescue in California. The Sierra Rescue tutors all come from a river guiding back ground. Sierra Rescue are also the regional provider of Rescue3 courses in California.

Picture from here

Medical kits 
One thing that really boils my blood when I am working on rivers around the world is the complacency from river guides towards their own and company first aid kit.
In my eyes the standard of first aid kit on a commercial rafting trip is a direct reflection of the company offering the trip. I normally find too that poor first aid kits normally go hand in hand with poor guide first aid skills.

Moldy damp wet out of date first aid kits are no excuse when you are charging your customers a premium rate for rafting.  After all your first aid kit is a massive part of your customer service. All first aid kits should be clean, dry well marked & well stocked. You should be proud of your first aid kits.
Paddle Nepal first aid kits.
A few of the professional companies that I have worked for have allocated 1 guide to be responsible for the up keep of the first aid kits. This generally seems to work.

During my travels I have learnt the lesson the hard way and have discovered that carrying my own first aid kit is normally the best option. The question I have to ask myself is what to carry?

I tackled this question by creating 2 first aid kits.
Kit #1

Kit#1 is the kit I use when I am heading off with groups where I know I will be far from help. Kit#1 is classed as my base camp kit. I will explain a little about the kit.

First off I carry the kit in a Pelican case. Peli cases are air & water tight. Peli cases have a reputation for being hard wearing and extensively used by the armed forces and medical profession.I have used conventional dry bags before but they always manage to get wet plus there is a high chance the contents will get squashed at some point.

All of my antibiotic medications, pain killers and injectables including all of the hardwear to go with them are stored in pouches that are attached to the lid of the case by velcro.

To make double sure that my kit stays dry and dust free I have grouped the medications together and then placed them into clearly marked ziplock bags.

Here is a list of what I carry in kit #1.

Antibiotics & Medications 
Azithromycin 500mg 
Prednisolone 5mg 
Ciprofloxacin 250mg 
Doxycycline 100mg  
Clarithromycin 250mg 
Diclofenac 50mg 
Prochlorperazine Buccal 3mg 
Fluorescein sodium 1% minims 
Chloramphenical eye ointment 
Tetracaine eye drops (local anaesthetic)
Chlorphenamine 4mg antihistamine
Bactroban antibiotic cream 15g
Hydrocortisone cream 30g
Tramadol capsules 50mg 
Tramadol for injection 50mg 
Prochlorperrazine stemetil 12.5mg 
Adrenaline 1;100 1ml amp
Hydrocortisone injection 100mg | 1ml amp
Lidocaine 1% 5ml local anaesthetic
Paracetamol 500mg 
Asprin 300mg 
lemsip cold and Flu 
Ibuprofen 400mg 
Co-Codamol capsules 
Loperamide Hydrochloride 2mg (imodium)
Movicol (laxative)

Wound management 
Liquiband human tissue glue
Trauma fix Military field dressing 
3M skin stapler & remover 
steri strips 
Assorted plasters 
Non adhesive dressings (selection)
adhesive dressings (selection)
Suture kit 
Wound cleansing wipes 

Triangular bandages
compressed dressings no 15 
Eye dressing 
Tubigrip roll 
Elasticated bandage 
XL sams splint x2
crepe bandage 

Burns dressing 
Cool therm burns dressing base camp kit assorted dressings
Paranet dressing

Ventolin Inhaler 
Zinc oxide tape 
Savlon spray
Deep heat cream 
Sterile eye wash 
Q tips 
Trauma sheers 
Digital thermometer 
E45 cream
Sterile gloves 
Foil survival blanket 
Injectables hardwear, needles,syriinges,giving set,butterfly needles.
Aqua tabs water purification 
Rehydration powder 
Sharps disposable pad 
Cotton wool 
Povidone Iodine antiseptic solution 
glucose tablets 
pen & note pad 
1L Saline infusion (sodium chloride 0.9%)
Face guard CPR
WMT Field guide 
Oxford university expedition and wilderness medicine handbook.

Kit # 2
This is my small day kit that I use on short day trips or when I know that help is nearby. The main aims of the kit are the following:
  • Stop bleeding 
  • Clean & dress a wound 
  • Temporary wound closure 
  • Support an injured/fractured limb
  • Deal with a small burn 
  • Mild pain relief
  • Rehydration 
  • Eye wash  

Kit#2 is normally stored in a watershed dry bag.

Case study  
I was travelling through Morocco to run a guide course in the Atlas mountains. I was travelling light as I was going to be on the road for 1 month in various countries. All I had with me was kit #2. One of the guests had been on the roof of the bus unloading some kayaks. Whilst climbing down from the roof he slipped and cut his ankle on the way down. We were 7 hours away from the nearest medical help in a dubious back country clinic. Ideally the ankle could have done with a few stitches.

By using my field guide & small first aid kit I managed to clean the wound and steristrip it back together. One of the key points we learnt on the advanced medicine course was to document as much as possible in case of later repercussions. In Kit#2 I had exactly what I needed to initially treat the wound and change the dressings and keep it clean for the next few days.
The injured ankle 48 hours after the accident.

Spend some extra cash and attend a first rate first aid course that gives you the level of training for the areas you will be operating in. Don't cut corners on your training.

Take some time to build your own medical kit and make sure it is secured in a suitable container.

Carry a field guide if possible. Also have a pen handy. Remember "No Notes is No defense". Take pictures, make notes, film if you can any first aid treatment given as you may need to recall on them at a later point.

Remember kis kis: keep it safe & keep it simple. After all prevention is better than cure.

Safe adventures


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