Basic First Aid Kit
|Quantities depend on size of party and length of trip. For additional ideas on kit composition please see the referenced books.
When an outdoor accident occurs no matter how slight, or when you realize you are lost, panic is the first reaction we all must encounter and defeat before it brings on more harm. How you handle the effects brought on by panic can determine your rate of success or failure in any outdoor emergency situation.
Anyone can become lost, separated or stray too far from camp as night sets in. Just remember that you have within you the ability to protect yourself. Survival is a common element in all human beings, we do it everyday in the concrete and asphalt jungles of civilization… now you have to do it in the wilderness. The premise is the same, keep your wits, use your brain. DO NOT PANIC… let your positive self rule your decisions.
To emphasize the effect that panic has on an individual, let me familiarize you with the “RULES OF 3.” Experience has shown that you can only expect to survive a panic induced emergency situation for 3 seconds, you can only survive without oxygen or from severe bleeding for up to 3 minutes, you can survive exposure to excess heat or frigid cold for up to 3 hours and you can survive without food and water for up to 3 days. Panic is your major enemy, panic is the one thing you must overcome at once because panic can and will harm you.
To help you deal with panic lets look at a simple method of handling an emergency situation. Remember the acronym S.T.O.P.
Sit – Think – Observe – Plan.
- SIT: When you realize that you are lost take the time to sit down and collect your thoughts. You are not lost, you are right where you are, your camp, vehicle and everyone else is lost.
- THINK: What do I have at my disposal both physical and mental that can help me in this situation. Take an inventory of your survival kit items and how you will use them. Take an inventory of your mind, remember what you always thought you would do if you got lost. Most of all remain positive, you will survive.
- OBSERVE: Look around, is there shelter, water, high ground, an open area so the searchers can see you. It will be easier for those searching to find you if you can stay in one selected location that will allow you to build a fire, provide shelter, set out signals and be in an area that can be seen at a distance or from aircraft.
- PLAN: Now create your plan of action. Be positive and take care of yourself. If it is late in the day, build a fire for heat and signaling, find or make a shelter against the weather, and most of all remain positive, you do have the ability to survive. You have conquered the major danger of not allowing panic to cast your fate, you can now conquer anything else that confronts you.
When journeying into the wilderness it is important to carry a complete first aid kit and book. It is also wise to take a first aid course. A good diet, cleanliness and appropriate clothing will lower the risk of harmful situations.
Disease, infection and often, insect bites can be avoided when maintaining a proper diet. It is important to bathe daily but if this is not possible be sure to wash your hands frequently. Soap can be made using ashes and animal fat or by boiling the inner bark of a pine tree. Construct a toothbrush by mashing the end of a green twig. When setting out for your journey remember to pack a wide range of clothing and extra footwear.
If an accident occurs in the wilderness it will be your responsibility to deal with the situation. The specific sequence of actions when dealing with this situation is:
- Remain calm, providing your patient with quiet, efficient first aid treatment.
2. Keep the patient warm and lying down. Do not move this injured person until you have discovered the extent of the injuries.
3. Start mouth-to-mouth artificial respiration immediately if the injured person is not breathing.
4. Stop any bleeding.
5. Give your patient reassurance. Watch carefully for signs of shock.
6. Check for cuts, fractures, breaks and injuries to the head, neck or spine.
7. Do not allow people to crowd the injured person.
8. Do not remove clothing unless it is imperative.
9. Decide if your patient can be moved to a proper medical facility. If this is not possible, prepare a suitable living area in which shelter, heat and food are provided.
Shock is a depression of all of the body processes and may follow any injury regardless of how minor. Factors such as hemorrhage, cold and pain will intensify shock. When experiencing shock the patient will feel weak and may faint. The skin becomes cold and clammy and the pulse, weak and rapid. Shock can be more serious than the injury itself.
Use the following method to prevent and control shock:
- When treating injuries:
i. restore breathing
ii. stop bleeding
iii. treat breaks and fractures
2. If there are no head or chest injuries place the patient on his/her back with the head and chest lower than the legs. This will help the blood circulate to the brain, heart, lungs and other major organs.
3. If severe head and chest injuries are present elevate the upper body. If chest injuries are present, elevate the injured side to assist in the functioning of the uninjured lung.
4. If the injured person becomes unconscious, place him/her in a face down position to prevent choking on blood, vomit or the tongue.
5. Keep your patient warm and under shelter.
If breathing has stopped, begin mouth-to-mouth resuscitation. Place the patient on his/her back and follow these steps:
- To open the airway lift the patient’s neck and tilt the head back.
2. Keeping the neck elevated, pinch the nostrils to prevent air leakage.
3. Place your mouth completely around the victim’s mouth and blow, watching for chest expansion.
4. After removing your mouth, listen for air leaving the patient’s lungs and watch for the chest to fall. Check for an airway blockage if the chest does not rise.
Repeat these steps approximately 12 to 15 times per minute. If treating a child, cover the nose and mouth with you mouth. Use smaller puffs of air and repeat this method 20 to 25 times per minute.
To control bleeding, elevate the wounded area above the heart and apply pressure using either gauze, clean cloth, dried seaweed or sphagnum moss. Use pressure at the pulse point between the injured area and the heart if bleeding fails to stop. If bleeding still persists, use a tourniquet between the injury and the heart. This method should only be used in extreme situations. After bleeding has been controlled, wash the wounded area with disinfectant and apply a dressing and bandages.
A fracture is classified as either a simple (closed) or compound (open). Signs that a fracture is present include:
- Pain at the affected area.
2. The area may or may not be deformed.
3. The victim is unable to place weight on the area without experiencing pain.
4. A grating sensation or sound may be present during any motion of the injured area.
Treatment is as follows:
- If in doubt, treat the injury as a fracture.
2. Splint the joints above and below the fracture.
3. If the fracture may penetrate the skin, it could be necessary to apply traction to straighten the deformity.
4. Be sure to pad your splints.
5. Check the splint ties frequently to be sure they do not hinder circulation.
6. Cover all open wound with a clean dressing before splinting.
Dislocation happens when the ligaments near a joint tear, allowing the movement of the bone from its socket. It is unwise to treat a dislocation unless you are a trained professional as permanent damage may occur. The affected extremity should be supported using a sling or other device and pain controlled with aspirin or other suitable drugs.
Treat sprains by applying cold to the area for the first 24 hours then once the swelling has subsided, let the sprain sit for a day. Apply heat the following day to aid in the healing process. The sprain should be splinted and rendered immobile until the pain has completely disappeared.
Concussions or other head injuries are often accompanied by a leakage of watery blood from the nose or ears. Other symptoms may include convulsions, an unresponsiveness of the pupils or headache and vomiting. Keep the injured party warm, dispense a pain killer regularly and allow time for the body to rest and repair.
Heat exhaustion is not uncommon when water is not sufficient. The body becomes dehydrated and salt-depleted, resulting in nausea, faintness, a weak, rapid pulse and/or cold and clammy skin. Treatment includes plenty of rest, liquid and salt tablets.
Sunstroke may occur when the body is exposed to excessive sun. The body becomes overheated and provides too much blood to the circulatory system resulting in a flushed, hot face, rapid pulse, headache and/or dizziness. Treat sunstroke by resting in a cool area and applying and consuming cold liquid. Prevent sunstroke by wearing proper headgear.
Muscle cramps occur when the muscle accumulates excessive lactid acid or a loss of salt through perspiration. Treatment includes resting, deep breathing and stretching. Restore the salt balance immediately.
Burns are most commonly followed by shock. Administer a pain reliever immediately, apply gauze covered in Vaseline to the affected area and bandage. The patient should consume more water than usual.
Symptoms of snowblindness include scratchy or burning eyes, excessive tearing, sensitivity to light, headache, halos around light and temporary loss of vision. Bandage the victim’s eyes and use cold compresses and a painkiller to control the pain. Vision will generally be restored after 18 hours without the help of a doctor. Always wear snow goggles or sunglasses in snowy areas to prevent snowblindness.
Blisters are the painful, and common, result of ill-fitting footwear. At the first sign of discomfort, remove boots and socks and place a piece of adhesive tape over the affected area. If it is absolutely necessary, open a blister by first washing the area thoroughly then inserting a sterilized needle into the side of the blister. Apply disinfectant and a bandage.
Headaches are often experienced in the mountains due to inadequate eye protection, tension in the neck, constipation or “water intoxication”, a swelling of the brain tissue which happens when the hiker has sweated excessively over a period of days and consumed large quantities of water without taking salt tablets. Aspirin may be used to alleviate the pain but one should find the source of headache to prevent further discomfort.
Snake bites are not overly common in the ADK. One species of venomous snake, a rattlesnake is found in the dry belt of the southern interior. If you come across a snake slowly ease back. A snake bite rarely causes death; victims may be left untreated for up to eight hours.
After an attack occurs:
- Keep the person calm, reassuring them that bites can be effectively treated in an emergency room. Restrict movement, and keep the affected area just below heart level to reduce the flow of venom.
2. Remove any rings or constricting items because the affected area may swell. Create a loose splint to help restrict movement of the area.
3. If the area of the bite begins to swell and change color, the snake was probably poisonous.
4. Monitor the person’s vital signs — temperature, pulse, rate of breathing, blood pressure. If there are signs of shock (such as paleness), lay the victim flat, raise the feet about a foot, and cover the victim with a blanket.
5. Get medical help immediately.
Bee stings are common and harmless unless you are allergic. Remove the stinger then apply disinfectant and clod water to reduce the swelling.
A change of diet, dirty cooking utensils or the consumption of tainted water may result in diarrhea which in turn will cause a loss of nutrients and precious body fluids. Take extra care in cleanliness and boil water for an additional three to five minutes to avoid diarrhea.
When the temperature of your body falls to a level at which your vital organs can no longer function you are experiencing hypothermia or exposure sickness. Hypothermia will develop rapidly and is caused by cold, wet and/or windy weather that chills the body at a speed faster than it can produce heat. A lack of energy-producing food and proper clothing will heighten the speed at which hypothermia will affect you. Always remember to bring extra clothing. It is important to hike at the speed of the slowest member of your party. Take frequent breaks and keep a close watch for members experiencing signs of fatigue. Exposure sickness generally occurs in temperatures of less than 10 C (50 F).
Symptoms are easily recognizable:
- Feeling cold and constantly exercising to keep warm.
2. Uncontrollable shivering and numbness.
3. Violent shivers. Your mind becomes slow and starts to wander.
4. Violent shivering ceases and muscles begin to stiffen and become un-coordinated. Exposed skin becomes blue and thoughts are foggy. Victim usually lacks the capability of realizing how serious the situation is.
5. Pulse and respiration slows.
6. Victim will not respond and becomes unconscious.
7. The section of the brain controlling the heart and lungs ceases functioning.
Treatment must be quick and efficient:
- Move the victim to a sheltered area, out of the elements.
2. Remove wet clothing and replace with dry clothes and if possible, a sleeping bag.
3. Wrap warm rocks and place them near the patient.
4. Do not let the victim fall unconscious.
5. Give the victim a warm, non-alcoholic drink.
6. Allow another person in the sleeping bag to share body heat.
7. Exhale warm air near the vicinity of the patients mouth and nose.
What is frostbite?
Frostbite is a condition where the skin and underlying tissue actually freeze. It occurs when body parts, usually the extremities such as the toes, feet, fingers, ears, nose and cheeks are exposed to extremely cold conditions. The condition rarely occurs in fit and healthy individuals in still air temperature above minus 10 degrees Celsius but may do so at higher temperatures in high winds due to the wind chill effect.
What causes frostbite?
Certain processes taking place in the body, in response to exposure to extreme cold, cause frostbite.
- Firstly, blood flow to the skin and extremities is slowed down as blood vessels constrict (narrow). This occurs so blood can be redirected to the vital organs to keep the body alive and warm. Ice crystals form in the tissues, the blood vessel walls are damaged and the cells start to break down.
- Secondly, with continued exposure to the cold, as the extremities get colder and colder, the blood vessels dilate (widen) for a brief period before constricting again. This happens because the body is trying to preserve as much function in the extremities as possible. However, the blood returning to the extremities leaks out through the leaky blood vessels. This causes further damage to the tissues.
Who gets frostbite?
Certain groups of people are at greater risk of getting frostbite than others, these include:
- Winter and high-altitude athletes, e.g. mountaineers and skiers
- Individuals stranded in extreme cold weather conditions
- Soldiers, cold weather rescuers and labourers working in cold environments
- Homeless people
- Very young and the very old people
- People with decreased blood flow to the extremities such as those with peripheral vascular disease or diabetes
- Those taking certain drugs that constrict blood vessels, e.g. nicotine (smoking) or beta blockers
What are the signs and symptoms?
The signs and symptoms of frostbite include coldness, firmness, stinging, burning, numbness, clumsiness, pain, throbbing, excessive sweating, pallor or blue skin discolouration, rotting skin and gangrene. Frostbite has been classified under the following categories that relate to the degree of injury.
This is also called frost nip and occurs in people who live in very cold climates or do a lot of outdoor activity in winter. It involves the top layer of skin (epidermis) and presents as numbed skin that has turned white in colour. The skin may feel stiff to touch, but the tissue underneath is still warm and soft. Blistering, infection or scarring seldom occurs if frost nip is treated promptly.
This is superficial frostbite and presents as white or blue skin that feels hard and frozen. Blisters usually form within 24 hours of injury and are filled with clear or milky fluid. The tissue underneath is still intact but medical treatment is required to prevent further damage.
Deep frostbite appears as white, blotchy and/or blue skin. The underlying skin tissue is damaged and feels hard and cold to touch. Blood-filled blisters form black thick scabs over a matter of weeks. Proper medical treatment by personnel trained to deal with severe frostbite is required to help prevent severe or permanent injury. Amputation may be required to prevent severe infection.
Fourth-degree frostbite is where full-thickness damage affects muscles, tendons, and bone, with resultant tissue loss.
What treatment is available?
Prior to reaching a place that can provide proper medical attention the following should take place.
- Shelter patient from the cold and move to a warmer place.
- Replace wet clothing with dry soft clothing to minimise further heat loss.
- Do not try to thaw frostbite unless in a warm place (warming and then re-exposing frozen parts to the cold cause permanent damage).
- Do not rub the affected area with warm hands or snow, apply direct heat such as heater, fire or heating pad, as this can cause further injury.
- Warm the entire body, not just the frostbitten parts, by wrapping in blankets and protecting the frostbitten parts until a suitable place is reached to start the rewarming process.
Once the patient has reached an appropriate facility the rewarming process can take place. Rewarming should be rapid to avoid further damage.
- An appropriate warming technique is the use of a whirlpool bath or tub of water at 40-42 degrees Celsius. Avoid warmer temperatures or dry heat because of the risk of thermal injury.
- Warm wet packs at the same temperature can be used if a water tub is not available.
- Rewarming or thawing usually takes about 20-40 minutes and is complete when tips of the affected area flush, the skin is soft and sensation returns.
- Apply dry, sterile dressings to the frostbitten areas and place between fingers and toes to keep them separated. Try to restrict movement of the affected areas as much as possible.
- Clean any dead tissue around clear blisters but leave blood-filled blisters intact to reduce the risk of infection.
- Analgesics such as morphine sulphate may be administered for pain. The thawing out can be very painful.
Within days of the thawing process further blisters may form. These should settle after about a week but may leave behind dead blackened tissue that form scabs. If the frostbite is superficial, pink new skin will appear beneath the scab. If frostbite is deep, the end of the finger or toe will gradually separate off. In some cases surgery may be required to remove dead tissue. This is not usually performed until 3-4 weeks after the initial injury, as the full extent of damage to tissues is not usually complete until this time.