In to the Uknown (again) 1st IRF workshop in the Ukraine

As the demand for International rafting federation courses is growing year on year, I am noticing that I am able to travel to new exciting destinations to run IRF courses. This year alone my travels have taken me to Morocco, Nepal, France, UK and now to the Ukraine for their first ever IRF workshop with Kiev Kayaks. 

After a period of email communication with Anton Federenko of Kiev Kayaks my bags were packed and I was heading out to the Ukraine not knowing what to expect.

Anton kindly picked me up from the airport and took me to his river base in the middle of the Ukraine. We arrived late in the evening and to be honest I was dead beat tired having spent the whole day travelling. So a quick set of hellos, then off to bed.

The morning of day 1 kicked off with the typical course introductions. Having now delivered a few workshops I now have a set pattern of how I like to run my workshops.

First off I needed to asses a few key points

• Our communication skills. I do not speak Ukrainian & I know that my fast Northern English accent can be hard to understand sometimes. I was happy in the end as 80% of the group had really good English. I was also lucky to have a interpreter Andri, who was also a kayaker.   

• The groups prior experience. This became quite interesting as the group was pretty big, we had 12 participants in total. The ability of the group ranged from a medalist at the 2015 Adddas sickline Kayak championships right the way through to a handful of local guides with no formal training. 

I decided to strip everything back to the raw basics. I had arranged the workshop over 5 days as this allowed me to really concentrate on getting the basics right before we could move onto more advanced options. We got dressed and made our way to the river. After a quick discussion about PPE (personal protective equipment) we started on safety talks. I was aware that I had a few trip leader candidates. I asked for a volunteer to step forward. Lurii stepped forward and presented a really good safety talk that only needed a few minor tweaks.

After Lurii´s talk we discussed what constitutes a good safety talk  and these were the outcomes.

Set the scene: In order for the talk to be effective the customers must be positioned in such a way that the guide giving the talk is the sole focus of their attention. 

Actions speak louder than words: I explained to the guides that in various other rafting destinations around the world not all of your customers will speak the same language as the guide giving the safety talk. We also discussed the fact that people remember actions more than words. A simple exercise of giving a safety talk without talking was shown & appreciated in the fact that all of the relevant information was given in half the time of a normal vocal talk.   

Give correct demonstrations: Show your customers exactly what you want them to do. If you show the customers the wrong technique they will practice the wrong technique. A classic example of this was explaining to the customers that if they fall out of the raft to adapt the whitewater swimming position.. Where infact we want the customers to participate in their own rescue and swim back to the raft aggressive style.  

The Flow of the safety talk: We discussed the correct sequence in which we should introduce the various subjects within a safety talk. We noticed that most guides give the paddle commands at the start of a safety talk. We discussed the fact that once you have completed the safety talk if you sit the customers in their paddling position in the raft and introduce the commands just before you get on the water the customers are more likely to retain the information given to them. Having the customers sit and practice the commands on the dry land also allows the guide to rectify any issues and give some good coaching points This can also work as a warm up too.

We moved on to the river where I got to see some pretty good guiding skills. We had a nice 200m section of class 3 where we could easily run laps which was great. I did notice that the guides had been running the same lines for years so I spiced things up and got them too run some new lines. Been situated on the bank I could asses more guides a lot quicker. I would have plenty of time to be in a raft with them during the week. I was also useless in the raft as I was struggling with the Ukrainian paddle commands.

Most of the candidates had come from a racing background. Primarily racing the former soviet design inflatable catarafts.

The main issue here was that the candidates were trying to guide the rafts in racing mode which meant a lot of things were rushed. We spent the afternoon slowing things down. We really focused on the guide controlling and steering the raft and using the customers as the "engine". Instilling the discipline into the crews to only paddle when the guide tells you was interesting to watch. We also looked at the totally new commands of "Get down" "Hold on" and backwards paddling. After a few hours of hard work we were making good progress.

Later in the day we looked at personal whitewater swimming skills.I needed to instill the thinking process into why where & how we swim instead of just jumping in. After a afternoon a trying some new techniques and strategies we  ended day 1 with a swimming Olympics, which I also used as the personal swimming assessment as per the IRF guidelines.

We rounded off day 1 with a introductory rope work session. We practiced the following knots

• Bowline
• Round turn & 2 half hitches
• Clove hitch 
• Figure of 8 Bite 
• Water knot 
• Alpine Butterfly 
• Overhand bend 
• Double fishermans 
• Friction Hitch
• No knot

Day 2 kicked off with a quick revision of the knots we learnt on the previous evening. We also discussed river signals before heading to the water to work on our rafting skills. I wanted to now get the guides working as a team on the river using some basic river running principles. I found the CLAP model worked well for this workshop.

• Communication (Have clear communications systems always.)
• Line of sight (Always have line of sight with the raft in front and behind you.)
• Avoidance (Avoid any necessary risk by taking the safest lines and having clear communication.)
• Positioning (Clearly position yourself so that you are combining the 3 elements above.)   

After lunch we got stuck into some throwbag work. We looked at various designs of throwbags along with the construction of a throwbag. I introduced the group the the cleanline principle and then we were good to go.

  We took the time to look at various belay options along with introducing thrower positioning.

Once the group was happy with the basics we moved on to some more advanced throwbag rescues such a "drop bagging" & double swimmer throws.

The next section to be looked at was throwing a coiled rope. We looked at the benefits of

• Small coils vs big coils 
• Butterfly coils 
• The TRU technique

I found it challenging to explain to the group that there was not one set way to re-throw a rope that in fact there were many different ways which also work for a variety of different people. The group also agreed with me when I mentioned that throw bagging should be practiced lots.

The IRF throwbag test ended the afternoon session which all of the team passed confidently.

Our evening session continued with stepping up our rope work skills. We started off by looking at the following subjects:

• PRE (personal rescue equipment) based on the 4,3,2,1 principle
• Anchor tying and the forces associated with this
• Progress capture using pulleys & prussik loops

I had now manged to teach all of the foundation skills needed to build a mechanical advantage system which would follow on the morning of day 3. 

Day 3 arrived and is affectionately know as "Wobbly Wednesday". All of the candidates were a little tired after 2 testing days on the river. I decided to keep the team on the land for the morning so that we could spend the morning looking at pinned boats and mechanical advantage systems. 

The Big 4 for unpinning a raft were practiced

• Strong arm pull 
• Rope pull
• Vector pull 
• MA system

I then introduced the group to building mechanical advantage systems with basic river equipment. We all built the following systems. 

• Internal simple 2:1, 3:1, 5:1
• Internal Compound 9.1 
• External 3:1 , 4:1

The group also found the T method for calculating MA quite useful. We ended the session with the standard IRF ropework test. 

The afternoon session of day 3 was spent exploring true rescues, mainly live bait rescues. A short session explaining to the group the mechanics of the chest harness function on their PFD´s led us perfectly into the practical side of their use. First we practiced releasing the harness under a load and then we practiced live bait rescues.

The morning of day 4 was spent looking at entrapment's. We practiced a selection of systems used to quickly rescue an entrapped customer. We all agreed that the best method was the down & dirty technique of getting hands on as quickly as possible. We also strongly agreed that river rescue is a teams sport and should be practiced

as a team. 

In my eyes most  group now had all of the skills needed to tackle a trip leader scenario assessment. We spent the remainder of the workshop working through the trip leader scenarios for the trip leader candidates to pass the required level needed. We got a few funny looks from some of the other local rafting  companies practicing all of this unneeded strange foreign voodoo magic but we did not mind.

 The trip leader scenarios were completed with ease and it was heart warming to watch the guys putting some new ways of thinking and skills to use. 

The Morning of day 5 started with flip drills before tacking the IRF written paper before final debriefs and goodbyes. 

The Ukraine now has its first IRF certified guides and trip leaders. It was a privilege to work with these guys. Good Luck !

Mark

Raising the bar in the Himalayas

As many of us witnessed the disaster caused by the 2015 earthquake in Nepal, my thoughts turned to how I could personally help towards the long term rebuilding process. 
I have had the honor of travelling to Nepal for kayaking and rafting based trips since 1998. Since 2013 I have also run a series if IRF guide training programs and workshops for Nepali raft guides and kayakers.

Marshyangdi was an excellent venue. 

Nepal has the largest representation of IRF qualified guides on the current IRF guide register.

A large portion of Nepali raft guides now work overseas during the monsoon season in Nepal. I have personally worked with Nepali raft guides in countries as far away as Iceland. Nepali guides have a worldwide reputation for been hardworking professional guides. 

I wanted to arrange an IRF instructor workshop and create some new Nepali IRF instructors to ensure that the IRF standards are kept for years to come. I approached the IRF to see if there was anyway they could help with the funding of the course. The IRF kindly decided to waive the administration fees for the Nepali candidates on the course making it easier on the pockets of the guides who wanted to attend the course. 

From my previous experience of operating IRF workshops in Nepal I knew to expect big attendance numbers. I needed to recruit an IRF assessor to help me operate the course. I also needed a Nepali raft company to help me organize the logistics and hosting the trip. Paddle Nepal kindly provided us with bus and the equipment for the course free of charge which was great. 

I also recruited Canadian river legend Jim Coffey from Esprit rafting to be my co instructor on the course. I remember I was really impressed with Jim's series of river rescue videos called rescue for river runners. Jim kindly agreed to help with the project which was great. 

Jim explaining the finer points of the safety talk.

Over the following months I noticed that the course was attracting interest from around the globe. We now had bookings confirmed by guides coming from Ecuador, USA, Australia,UK & India  The course was taking shape fast. 

I had taken the time to select an appropriate river the workshop. I needed a testing class 4-5 river that would keep us on our toes for the duration of the workshop. I decided to re use the Marshyangdhi river which flows from the Annapurna region of Nepal, situated in the Lamjung area between Kathmandu & Pokhara. I have used the Marshyangdhi for previous courses and found it to be a truly testing piece of water. The top section compromises of around 18km of continuous class 4 & 4+ rapids. The lower section of the river below the dam has a 15km section of slightly easier class 3 & 4 rapids for those on the course who were looking for their class 3 skills to be developed.  

Any 5 day rafting based course is going to be physically demanding. So I decided that the group would need a good base for the duration of the workshop. Again I selected the Mango Tree eco resort on the banks of the Marshyangdhi to be our base for the week. The Mango Tree provided us with 2 really good meals per day and some comfortable tents to rest our heads at night. 

Going to the river, Mango Tree resort behind us. 

The week prior to travelling to Nepal I had been running an IRF workshop in Morocco. This was my first workshop of the season which meant I was primed and ready for the Nepal course. 

After arriving in Nepal I met up with Jim. We both spent a day kayaking the Marshyangdhi as a check out run to identify some potential teaching & trip leader scenario sites. Both myself and Jim both agreed that the Marshyangdhi was going to be the ideal choice of river for the workshop. 

The evening before the workshop started we held a pre workshop meeting. This was a chance for us to meet the students for the week and collect all of the relevant paper work: logbooks, first aid certs etc. 

The rest of the workshop looked like this:

Day 1 0600
Bus departure to the river  was at 0600 hrs. We jumped straight into course by holding  2 brief sessions on knot tying and river signals. This was the ideal wake call for the group. 
Once we arrived at the river and inflated the rafts we had a PPE (personal protective equipment) check along with a PRE (Personal rescue equipment check).
As we were 2 instructors on the course this gave us the opportunity to be able to assess 2 safety talks at a time. This is where we identified a few key points.

Safety talk key learning points (as previously discussed in other blog posts:)

• Actions speak louder than words. 
• Avoid using complicated English (keep it simple).
• Arrange your customers into a place where you are the sole focus with no distractions. 
• Summarize your safety talk into 3 key learning points at the end of the talk. 
• Your safety talk continues during the trip, you should be constantly recapping your talk as you approach the rapids. 

We took to the water for a 3 hour paddle down the continuous class 4 & 4+ section of the upper Marshyangdhi. This gave myself & Jim the chance to observe and assess the raft guiding and customer communication skills of the guides as they guided their boats down the river. 

Day 2 0600

We decided that early morning starts were the order of the day. This gave us chance to take advantage of the cooler mornings. For our instructor candidates I gave an example of instructor standard theory session on safety kayaking tactics. This session had 2 main aims. 

1. The students got to see the required standard needed for instructor candidates who needed to give their own presentation later in the week.

2. The IRF is the only body to give structured safety kayak teaching. The session was a spring board into a discussion on the role of a professional safety kayaker on a commercial rafting trip. The key learning points were.

• Safety kayakers who can also guide a raft and have rafting abilities are a big bonus on a commercial trip.
• Safety kayakers need to be thinking 2 or 3 steps ahead of the raft guides on the trip. 
• Forward thinking safety kayakers are able to put themselves in the right place at the right time in order to play a key role in a rescue if needed.

We took to the water and stepped up the tempo by looking further into the rafting capabilities of the students. We did this by observing the students making challenging maneuvers on class 4 rapids. These maneuvers included forward and reverse ferry glides along with some challenging breakouts. Each of the candidates came off the water tired and tested. We spent the evening looking into some of the rope work components needed for the following days rope work test 

Day 3 
Today was called wobbly Wednesday. The intense sun and heat was taking its toll on all involved with the course. We both agreed that today was going to be a park and swim day. We parked the bus at a convenient roadside rapid and spent the day finishing off the guide assessments. It was a pleasure to spend the day swimming in the river to escape the heat. All of the students were today put through their paces and tested on the following skills:

• A challenging swim
• Throw bag test making 2 throws with a packed and unpacked throwbag 
• IRF flip drill 
• Ropework test. The students had 5 minutes to construct a functioning  mechanical advantage system using their own equipment. 

During the day we also looked at the use of the integrated chest harness on our rescue PFD´s by practicing some live bait rescues. 

Days 4 & 5 

The next 2 days were spent running trip leader scenarios. We had started to notice that all of the students were starting to gel as a team of guides which was going to make the trip leader scenarios not only a test but a true learning experience. If you ask any guide who has already completed a trip leader scenario they will always comment that the scenarios are a true test of experience, judgment & skill and most of all the scenarios are fun. 

The first set of scenarios for the class 3 candidates were set on the lower section of the river. Both the trip leader and instructor candidates soon learnt the benefit of having well trained and focused safety kayakers assisting them on their scenarios. Between us Jim & myself were setting some challenging realistic scenarios. 

The second set of scenarios were help back on the challenging top section of the river for the class 4-5 trip leader and instructor candidates. We witnessed some true professionals at work here. The scenarios attracted lots of attention from the locals to the point where I had to tell one of the Nepali students to inform the locals that we were training and the man stuck in the river under the flipped raft was only pretending. Although we did see a concerned family cut a piece of bamboo to use as a reaching pole for one of our guides who was pretending to be a casualty of the scenario.  

Day 6 

Each of the scenarios was passed with flying colors along with all of the instructor candidates presentations. We put on the water on the morning of day 6 with one class 4-5 TL scenario to run. During this scenario we dealt with an unconscious victim. The scenario brought up the topic of carrying AED devices on a river trip. Hopefully in time to come we will start to see more and more AEDs been carried on commercial rafting trips. 

Ian acting as the unconscious victim during the scenario. 

The last section of the workshop was to spend the rest of the day testing the safety kayak skills for those who wanted to be assessed for the safety craft awards. We dealt with multiple & panicked swimmers along with unconscious swimmers. We also looked at way to control a raft from a kayak. 

As the course closed to an end each student received a detailed feedback session. The students all agreed that the workshop was a demanding but rewarding workshop with high standards in a fun safe learning environment. New friendships were made and the rafting world is now better off having some more IRF qualified instructors, trip leaders and guides from all corners of the world.   

Many thanks to Jim Coffey from Esprit and Paddle Nepal for helping to organize the course! 

Congratulations Nim, Josh, Grim, Ian, Chris, Daniel, Franco, Bharat, Dinesh, Bidur, Maila, Suraj, Arjun, Diraj and Manju! 

Happy paddling, Mark 

Work has begun

                                     The raft guide handbook

For a while now I have wanted to produce a handbook that contains all of the relevant information for raft guides and safety kayakers as a point of reference. I have found that death by power point is not the way forward when running guide training courses. I want to produce a book that a raft guide can use time and time again.

For this Project I have teamed up with Darren Clarkson King who already has already produced a number of excellent guide books.

The book will contain chapters all relevant to the work of a raft guide.

Here is where you come in. I would like you to send in any stories or anecdotes you may have from your time on the water.

We are really interested in your learning outcomes and how the said experienced became a learning process  for you future trips .

below is a example from one of my own experiences along with the learning out comes.


Location: Nottingham uk
Early in my raft career I was working on a artificial slalom course in the UK. I myself was the trip leader and had delivered the safety talk. I had asked the customers if they had any medical conditions if so they had to inform me.
 During the session we had a flip I was the downstream raft so I ended up picking up the pieces from the notorious merry go round eddy. I noticed that one customer was floating with his whole body and head submerged under the water. He had a correctly fitting PFD but it was not floating him correctly.
Once I got the customer and he got his breath back I asked him why he was floating so awkwardly?

He replied to me " My false leg filled with water and weighed me down"  He also promptly replied "My amputated leg is not a medical condition. I had not seen his prosthetic limb under his wetsuit.

Learning outcomes:

• Add asking for prosthetic limbs is now part of my pre trip medical screening.   
• People are not always forthcoming with their medical history. 
• A prosthetic limb can a fill with water and render the swimmer with extra weight on top of their normal weight when swimming.
   

please email you stories to Info@lapinkoskikoulu.com. The stories with the best learning opportunities will be published in the book 

regards 

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