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 

Compeeds 

Assorted plasters 

Non adhesive dressings (selection)

adhesive dressings (selection)

Suture kit 

Wound cleansing wipes 

Bandages 

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

Hardwear

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 

Stethoscope

Sphygmomanometer

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.

Summary

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
Mark