As the first blog post on the wilderness medicine section, I want to start by introducing myself and outlining the goals of this blog section.
Me and my Outfit: I’m a climbing guide that became increasingly interested in wilderness medicine. I became a paramedic, took lots of wilderness courses, taught courses for Wilderness Medical Associates and ended up as a residency trained emergency physician. Now, in addition to rock and ice guiding, I teach wilderness medicine courses designed specifically for rock climbers through Granite Arches Climbing Guides. I’ve published in the climbing magazines, academic emergency medicine journals and popular press books about wilderness medicine, and I’m a clinical professor of emergency medicine at a state medical university. Over the years I’ve learned a good bit about climbing, medicine, wilderness travel and medical care in out of the way places. The guides who work with me at Granite Arches have lots of experience as well. We hope to bring some of this experience to you and we look forward to learning from the community as well.
Goals: I want this section of the blog to be a forum for education and discussion about wilderness medicine for rock and ice climbers—especially in the southeast. After all, no matter how much experience you have, everyone can use more training and experience in first aid. Climbing today is pretty safe, and we are just as likely to use our wilderness medicine skills for accidents peripheral to climbing–beestings, heart conditions, lacerations, joint sprains, etc–than directly related to it. And even when serious climbing accidents do happen, good training and experience might be the difference between better and worse outcomes.
First some universal truths about equipment selection and providing medical care in out of the way places:
1) Knowledge and experience are more important than equipment. The largest medical kit in the world in the hands of an unpracticed climber is not very helpful. A corollary is that a very experienced provider can often do very well providing care with little more than his/her hands….to a point. That’s because training and experience allow for the recognition of important medical conditions and determine the proper interventions for stabilization and transport. So if you are outdoors a lot, in rather remote areas, seek training in wilderness medicine. Its fun and educational. And it may make a difference for you or someone else.
2) No one medical kit is exactly right for every outing. Thus, you will want your kit to adapt to the situation. Kits for different outings in different terrain with different risks, weather and activities, different levels of providers, and different distances from cell towers and hospitals should all be different.
Medical Kits Part 1: The Componential Kit and the CPOD
The approach I advocate for quickly adapting your medical kit for different outings is to have a componential kit with various “pods” that serve different purposes. Today we will discuss the “core” pod or “CPOD”—the lightest, simplest most important pod for most situations that you will keep with you most everywhere and at most times. To this you add various additional pods that augment the CPOD to bring on outings as needed. That may be a few more items (for a 1-2 day Grade VI big wall) or 20, 40, 60 lbs of equipment on larger expeditions to a remote basecamp. You can always jettison some pods at basecamp, or at the base of a climb as needed. But the CPOD should go with you just about everywhere. This means in your hydration pack or small backpack on long climbs.
A good place to start for the CPOD for a climber in the southeast would be with the following:
1. A thin CPR shield OR a true rescue mask (heavier, bulkier). You need a CPR shield or true mask to breathe for people who are not breathing or who are not breathing enough. True, people who are not breathing at a crag from major trauma will likely not survive. However, there are many other etiologies of “respiratory arrest” that are fixable. These include asthma attacks, allergic reactions, lightning strikes, collapsed lungs. In these cases it may be necessary to help someone breathe or breathe for them until they can breathe on their own.
2. Trauma shears. Mandatory. Get a small set. Better than a knife. Makes accurate cuts on fabric and materials far superior to knife cutting. Allows you to fabricate infinite items from others. For example, use shears to fashion a small piece of your water bottle’s plastic lanyard to repair a broken zipper pull. Fold duct tape or coban in half, cut a half circle and you have a custom fit blister doughnut. Cut hair. Cut webbing, Cut harnesses. Crucial in trauma assessments to allow the removal of clothing without moving the patient (with the caveat that you must always weigh the risk of destroying insulation layers in the wilderness). The uses are endless.
3. Duct tape. A must have for everything. Gear repair. Wound closure. Splinting. Sucking chest wall wound occlusion, restraints, boot hotspot treatment, patient immobilizing, packaging, the list goes on and on. Find or make a compact roll on a small caliber cardboard roll for space savings.
4. Epinephrine. Epinephrine is absolutely essential for your medical kit. In the event of life threatening allergic reactions—from insect bites, food allergies or medications– it will save lives. In the hands of advanced providers it can also be used for very serious asthma and even when someone’s heart stops. Indispensable. Anyone with some training should be able to achieve a prescription for it by discussing their outdoor hobby with their doctor. Look for a video on administering epinephrine in the near future.
You will need either:
a. two of the commercially made “EPIPEN” auto-injector type devices or
b. make your own kit (much cheaper)
i. 2 count 1ml ampule vials of 1:1000 epinephrine
ii. 2 count 1 ml syringes with matching 1″ 25 gauge needles either built in t or separate
iii. Several alcohol prep pads (optional)
IV. An additional option would be a multi-dose vial of epinephrine (more on this in a future post).
5. Plastic gloves. Vinyl, chloroprene or nitrile. 2 pair min. You have to have gloves to safely provide medical care.
6. Aspirin. 2 count (minimum) 325 mg tabs. More if able. This is the medicine you give to people that you think are having a heart attack. If you are a guide, this is a must. This is the only medicine shown to improve survival in people having heart attacks. It changes platelets (the blood parts that form clots) so that they don’t aggregate and form clots in heart vessels.
7. Motrin. 12 count 200 mg tabs. “Vitamin I”, the go to over the counter pain reliever and anti-inflammatory.
8. Benadryl. 4 count 25 mg tabs. Vital for life threatening allergic reactions, it is also useful for mild/moderate reactions, nausea, sedation, sleeplessness, and as a local anesthetic.
9. Coban. 3 inches wide, 10-15 feet (stretched). This should be taken off of the cardboard spindle and then rerolled and pressed flat for space savings. This stuff is elastic, strong and handy for wound repair and coverage, splinting, gentle compression. It is very light and compact.
10. 2×2 and 4 x 4 gauze. 4-8 count of each. This is for covering things you want to keep clean (lacerations, bones poking through skin, holes in the chest, damaged eyes, etc). Gotta have it.