WFA and now First Aid kit changes for me

[BrianLe]

When I took my last "wilderness oriented first aid" course, I was struck by how these folks seemed to just assume the "weight vs. safety" trade-off should always tilt towards "safety" for anyone they considered to be responsible. They didn't quite come out and say it that way, but I had a sense that each of the instructors carried a relatively huge amount of medical supplies whenever they went in to the woods.

I'm certainly not saying that's "wrong", just that it isn't necessarily for everyone.

From the specific list at the start of this thread:

To irrigate woulds I'd take the bite valve off of my platypus hose.
Triangular bandages: if in need I'll make the conscious choice to cut up some existing piece of clothing or outerwear to make one.
Tick removal: my tiny knife includes small scissors and a small tweezer, which in fact I used to take a tick out of my leg with on the AT.
Salt: generally I have lots of salty foods with me.

Many of the things on that list I do agree with and carry anyway, though not all primarily for "first aid" --- aspirin and tylenol for example, ziplock bags, safety pin, moleskin, a watch.

I guess I just agree with whoever said earlier that it's a natural progression to take stuff out when on an "ultralight" kick, then add a lot back in right after a first aid course, and then to back off and take some of that back out for a more long term, steady state first aid kit.

[Blissful]

When I took my last "wilderness oriented first aid" course, I was struck by how these folks seemed to just assume the "weight vs. safety" trade-off should always tilt towards "safety" for anyone they considered to be responsible. They didn't quite come out and say it that way, but I had a sense that each of the instructors carried a relatively huge amount of medical supplies whenever they went in to the woods.

I'm certainly not saying that's "wrong", just that it isn't necessarily for everyone.

From the specific list at the start of this thread:

To irrigate woulds I'd take the bite valve off of my platypus hose.
Triangular bandages: if in need I'll make the conscious choice to cut up some existing piece of clothing or outerwear to make one.
Tick removal: my tiny knife includes small scissors and a small tweezer, which in fact I used to take a tick out of my leg with on the AT.
Salt: generally I have lots of salty foods with me.

Many of the things on that list I do agree with and carry anyway, though not all primarily for "first aid" --- aspirin and tylenol for example, ziplock bags, safety pin, moleskin, a watch.

I guess I just agree with whoever said earlier that it's a natural progression to take stuff out when on an "ultralight" kick, then add a lot back in right after a first aid course, and then to back off and take some of that back out for a more long term, steady state first aid kit.

Unfortunately the water to irrigate a wound is dirty from your saliva in the tube and not sanitary enough. Better off getting a fresh bag and using aqua mira or filtered water. Needs to be as clean as possible. The syringe again weighs little and effectively cleans. And hikers have gotten off because of wound infections.

A triangular bandage weighs zip and is much easier to make a sling or other bandage, believe me. I tried to make some stuff from clothes. Not secure enough to do what you need it to do. And you'd rather cut up clothes when you can carry an ounce of a bandage? This was an eye opener for me. Same as I take a small ace wrap.

Tick removal too - this is for the deer ticks. Dog ticks, sure can use the tweezers you have. Deer ticks much harder to remove d/t size with head intact so as not to excrete more bad stuff into you.

Salt - you can't give someone with heat issues salty foods, they need the liquid and salt easily dissolves. It also makes an oral hydration solution.

That's why I mentioned weight in the beginning of the post. All the things you mentioned add negligible weight to one's kit.

[Don H]

Unfortunately the water to irrigate a wound is dirty from your saliva in the tube and not sanitary enough. Better off getting a fresh bag and using aqua mira or filtered water. Needs to be as clean as possible. The syringe again weighs little and effectively cleans. And hikers have gotten off because of wound infections.

I don't think irrigating wounds is something you will need to do on the trail. I worked for years as a Paramedic and I never irrigated wounds in the field. On the AT you are rarely more than a few hours from medical treatment. Major wound care should consist of controlling bleeding and bandaging. Irrigating major wounds (I'm talking about something like a 6" gash in the head from a fall that's bleeding like a stuck pig!) just results in more bleeding and introducing more bacteria into the wound no matter how sterile you think your procedure is.

Minor wounds should be allowed to bleed a bit, treated with a topical antibiotic and covered. This is where I saw several people get into trouble. Small wounds that got infected and became major problems. It's just something you need to keep on top of buy keeping an eye out for infection, changing bandages and keeping the area as clean as possible. Not something that is easy in our hiking environment.

[Blissful]

I don't think irrigating wounds is something you will need to do on the trail. I worked for years as a Paramedic and I never irrigated wounds in the field. On the AT you are rarely more than a few hours from medical treatment. Major wound care should consist of controlling bleeding and bandaging. Irrigating major wounds (I'm talking about something like a 6" gash in the head from a fall that's bleeding like a stuck pig!) just results in more bleeding and introducing more bacteria into the wound no matter how sterile you think your procedure is.

Minor wounds should be allowed to bleed a bit, treated with a topical antibiotic and covered. This is where I saw several people get into trouble. Small wounds that got infected and became major problems. It's just something you need to keep on top of buy keeping an eye out for infection, changing bandages and keeping the area as clean as possible. Not something that is easy in our hiking environment.

I wouldn't think so as a paramedic in the "front country" as they call urban areas. Help is nearby. I guess the syringe idea comes into play of trying to keep a major wound as clean as possible in the back country, hence irrigation for dirty wounds. I mean I won't debate how much bacteria is added by a syringe vs leaving a dirty wound with its bacteria present alone. But with the scenarios presented, even three miles up a trail from the road (in the case presented by the instructor it was the rocks of Old Rag) and with a major injury and blood loss where the patient cannot hike, it could still take upwards of 10 hours to get a person down with rescue personnel from time of discovery. And that is if you can get a phone signal. 10 hours with a dirty wound is plenty of time for bacteria to multiply in a big wound and raise havoc in the system.
Of course the more treacherous parts of teh AT are well away from medical help. There are many, many places on the AT that roads are a good distance away, not to mention medical help farther away than that. So this time factor could be multiplied.
I think your last two sentences sums it up well.

[Don H]

I wouldn't think so as a paramedic in the "front country" as they call urban areas. Help is nearby. I guess the syringe idea comes into play of trying to keep a major wound as clean as possible in the back country, hence irrigation for dirty wounds. I mean I won't debate how much bacteria is added by a syringe vs leaving a dirty wound with its bacteria present alone. But with the scenarios presented, even three miles up a trail from the road (in the case presented by the instructor it was the rocks of Old Rag) and with a major injury and blood loss where the patient cannot hike, it could still take upwards of 10 hours to get a person down with rescue personnel from time of discovery. And that is if you can get a phone signal. 10 hours with a dirty wound is plenty of time for bacteria to multiply in a big wound and raise havoc in the system.
Of course the more treacherous parts of teh AT are well away from medical help. There are many, many places on the AT that roads are a good distance away, not to mention medical help farther away than that. So this time factor could be multiplied.
I think your last two sentences sums it up well.

"Front country" paramedics also deal with extended delays in extricating patients to a medical facility. An example would be someone trapped in a collapse, cave in, etc. In my state of Maryland we have (as most states have) a Wilderness Protocol for EMT and EMT-Paramedic levels. At this level of training irrigation of wounds is allowed.

If you want a recent first hand account of a major injury on the trail and how long it took to evacuate someone ask Rusty Bumper who posts here occasionally. He was medivaced off Chairback after breaking his leg. If I recall it was 4 or 5 hours and that was in the 100 Mile Wilderness. Now if they would have had to carry him down, who knows how long that would have taken.