Are you carrying the correct emergency equipment?

As we now find ourselves at the beginning of a Northern hemisphere season, a quick glance at various social media outlets are awash with various stories of epic high water runs and carnage.

Most of us will have been surrounded by snow all winter and are counting down the days until it begins to melt and all of our local runs start to rise for the season. During the winter you have found yourself watching countless amounts of online kayak porn with our minds mentally writing out mental cheques that we now want our body to pay off on. What can go wrong?

I noticed a comment  on social media the other day that California is finally experiencing a high-water spring. This quote sent a shiver down my spine 

“We are experiencing some of the highest levels in 10 years, a whole generation of kayakers have not experienced these rivers at these level before, its not pretty."

The next day I opened up my Facebook page and watched in horror some of the world's current well known expedition kayakers chase boating a swimmer down a tree infested run in flood. The life of the swimmer was at risk along with the team of accomplished kayakers that were chasing him.

Are we honestly thinking that we can not paddle all winter and pick up where we left off from last season? Are we not warming up on easier class runs first!

Let's imagine for a minute that a paddling buddy takes a swim and looses his or her boat and you both find yourselves stranded on the river. Help is going to be a good few hours away and long walk out. Worse case scenario you may even have to spend the night next to the river and wait for first light before you can hike out. To top it all off your buddy has badly twisted an ankle and is unable to walk.

The odds are now stacked heavily against you.

Do you have a back up plan & are you carrying the correct emergency kit if you need to spend a little extra time on the river?

Are you carrying the correct amount of emergency kit in your kayak to ensure your own personal safety and that of your injured friend ?

I do notice time and time again kayakers spending money on the latest kit: drysuit, kayak, paddle, PFD, sprayskirt and not investing in the correct emergency safety kit or training.

By simply investing  some time and money into the correct training and emergency kit you can rapidly re-stack the odds in your favor.

I personally carry the equipment below in the back of my kayak each time I go kayaking or if I am working as a safety kayaker on a commercial trip. The kit fits neatly into a watershed Ocoee drybag (besides my split paddle).

·         Samsplint

·         Headlamp / Maglite

·         Lightstick

·         Energy bars

·         Lighter, matches, kindling

·         Rescue saw

·         Leatherman / multi tool

·         Mobilephone

·         GPS/ SPOT device

·         Small first aid kit with note book and pen, water purification pills

·         Survival blanket / jacket

·         Woollen hat.

·         Group shelter (optional)

·         Duct tape

·         Spare split / breakdown paddle

·         Water bottle

Let's have a look at some of the items in detail and justify their inclusion.

Sam-splint

Sam-splints are a lightweight reformable splint that can be used to splint a wide variety of injuries. Sam splints can also be cut and used in kayak repair or to block the drainage hole if you have lost your bung. Samsplint have some amazing tutorials on their website.

Headlamp

The ability to see and for others to see you is going to help you lots when it gets dark especially if outside help is needed. Hiking out when its getting dark will be a lot easier when you can see where you are going. A headlamp is also going to come in handy if you need to inspect a wound that needs treating or removing a foreign object from an eye.

Lightsticks

The batteries on your headlamp or torch will eventually run out. A lightstick is a good back up. Military light sticks normally last for up to 24 hours & can make you even more visible to rescue teams.

Energy bars

Once the adrenaline has worn off you are going to need to eat in order to keep warm & restock energy levels. I like to carry both an energy bar and a drink solution as it will go further.

Lighters/ matches Kindling

Its getting dark and you are cold, wet & tired. You need heat & light, its time to get cracking on with building a fire. A fire will also provide you with a source of light that will make you noticeable to the emergency services. The task of simply building a fire will also keep your mind occupied whilst you are waiting for help. Lighters will also help if you a paddling in areas prone to leeches.

Rescue saw & Multi tool 

A very handy tool to deal with small trees blocking the river or worst case scenario getting through a piece of wood that is causing an entrapment of a paddling buddy. Also will come in handy if you have to make that fire or improvise a walking stick or stretcher for an injured paddler. The multi tool can be used for lots of tasks, it really is a must take piece of kit on all trips.

Mobile phone

If you have reception a phone is indispensable in an emergency situation . For those working in a commercial environment or providing first aid treatment the ability to film and record any treatment given may help you post incident if the courts become involved. I was once taught:

“No Notes, No defence”

GPS / SPOT device

As modern technology progresses satellite communication and tracking is becoming more accessible and most of all affordable. The ability to give someone your exact location or see a route out is going to help you lots. SPOT devises not only allow you to log your tracks they also offer an affordable way to contact emergency contacts or help when there is no mobile phone coverage.

First aid kit

The ability to support an injured limb, stop bleeding and dress a wound or give pain relief is a must. 

Survival blanket / jacket

The technology in survival blankets has increased 10 fold in recent years to the point where ultra marathon runners are now carrying modern survival bags instead of traditional sleeping bags. Foil based bags not only keep you warm & work in the prevention of hypothermia  they will also make you highly visible as they reflect the light. I personally use and recommend Blizzard survival blankets. If they are good enough for the Norwegian airforce and mountain rescue they are good enough for me.

Woollen Hat

2/3 of all body heat is lost through the head, if its going to be a long night you should try your best to keep warm.

Group shelter

Coming originally from the UK I cannot understand why the rest of the world have not started using group shelters. A group shelter weighs around 100grams and can keep people protected from the elements and provide shelter.  A rolled up group shelter can also work as a great improvised stretcher.

Pic Jon Gorman 

Pic Jon Gorman 

Pic Jon Gorman 

Pic jon Gorman 

Duct tape

Gaffa tape, Duck tape, Jesus tape say no more!

Spare paddle / Breakdown paddle

I am amazed to see the amount of kayakers with all of the latest bling kit and eventually loose their paddle I have carried a spare paddle for years. Luckily I have never had to use it myself. I have loaned it out to kayakers who have broken or lost their paddles multiple times. A split paddle can also be used as an improvised splint.

  

Water bottle

Its important to keep hydrated on a trip. I carry puritabs in my first aid kit. Nalgine water bottles are also water tight which means water cannot enter them so a perfect container for your first aid kit!

If you feel this is too much to carry on one person the kit could be split within a group of boaters. A good pre-trip plan & communication between team members will ensure that most eventualities can be catered for. All up my kit weighs less than 2kg.

Most of all practice,  practice, practice the following as one day you may need them:

- First aid skills and knowledge

- Fire making skills (in a controlled environment please)

- Navigation and electronic navigation skills

- Pre-trip planning and communication skills

Happy safe paddling! 
See you on the water,

Mark

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