Epinephrine in the Wilderness Medical Kit

As a recreational or professional climber, you gotta have epi in your kit. This was outlined in the previous wilderness medicine post.  The need is most obvious in the warmer months when hymenoptera (bee-like) species are most active.  And if you are working outdoors, the responsibility is likely yours to have the epinephrine ready when the wrong insect stings your client and they begin to have trouble breathing, low blood pressure, and scratchy throat. These are classic symptoms of anaphylaxis, a condition that usually responds readily to epinephrine. And for those with more training and advanced medical control, epinephrine can play a role in severe life threatening asthma exacerbations.

But how do you carry and administer epinephrine?  At the very least, you need two doses of  epinephrine carried in a durable, compact, lightweight package.  There are various ways, and like most things in life the right solution varies with context.  But for most climbers and their medical kits, I recommend either two single dose ampule vials, or multi-dose vial epinephrine.  With minimal training, multiple dose vial epi administration can be mastered.  Multi-dose and ampule epinephrine allows more medication in a smaller package for far less money than using the alternative–the Epi pen.

How to get it:  In order to carry epinephrine and multi-dose epinephrine you will need training and a prescription for it.  Consider discussing with a physician that knows you and your work and would be willing to work with you on this. 

When to use it: Epi is given to patients experiencing anaphylactic reactions.  This follows allergen exposure, and symptoms include high heart rate, rashes, nausea and vomiting, scratchy throat and low blood pressure.  Seek medical training to learn how to diagnose this.

What you need: (for the multi-dose vials) : You will need a vial–typically 30ml– of epinephrine “1:1000″, two or three  1 ml tuberculin syringes and two or three 25 ga. 1” needles that will fit them.  1:1000 is read as “one to one thousand” and means that there is 1 gram of epinephrine in 1000 ml of fluid, or 1 mg of epinephrine in 1 ml of fluid.  You need a protected carrying vehicle that will keep these materials safe. Larger syringes can be acquired with attached needles which is handy.  However, using larger syringes with multi-dose vials make it more possible to improperly administer too much medicine.  See the medical kits post explaining the single ampule epinephrine.

epinephrine multisyringe

How to give it:  Adults get 0.5 ml of the medicine in the upper outer thigh.  This will mean that you will fill the syringe to the “0.5” ml mark on the syringe, about half of the syringe.  Kids get about 1/3 of this dose. The dose can be repeated if necessary.  People receiving epinephrine should be taken to the hospital as soon as possible.

If you haven’t already taken a wilderness medicine class, consider it strongly, most longer courses will cover administration of epinephrine.

Epinephrine in the Wilderness Medical Kit

10 Uses for the Cordelette

Scott Perkins, Head Guide

1) S.E.R.E.N.E. anchor when constructing a gear belay

2) Tie a ‘Quad’ for 2 piece belays and top ropes

3) Create an extended rappel with 3rd hand Autoblock

4) Escape a belay

5) Ascend a rope

6) Tie a “rescue spider” for tandem rappels

7) Cut it up for bail anchors

8) Lower a climber past a knot or rappel past a knot

9) Construct a hauling system

10) As an aider for that slightly ­too­-difficult crux move

A cordelette can be made of 6mm or 7mm nylon cord or 5.5mm Dyneema cord. I prefer to use 20 feet of 7mm cord for its strength, versatility, and resistance to fatigue. The cord can be permanently tied into a loop using double fisherman knots for nylon cord or triple fisherman for the Dyneema materials. Some climbers and guides prefer to leave the cord untied and add knots as needed, others choose to carry the cord in a Rabbit Ear configuration consisting of Overhand­ on-a­-bite or Figure­ eight­ on-­a-­bite knots tied at each end of the cord.

10 Uses for the Cordelette

wilderness medicine Climber’s Medical Kit Part 1: the “CPOD”

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 swis-guiding-small-headshot fr clickbookmedicine. 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.

The CPod

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. Rescue MaskTrue, 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. MakesTrauma Shears 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 tapeA 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. EpinephrineEpinephrine 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. epiIn 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.vinylgloves

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.
coban only

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.


wilderness medicine Climber’s Medical Kit Part 1: the “CPOD”

Vector Physics for the Climber

swis-guiding-small-headshot fr clickbookWe’ve all heard about vectors.  In physics, a vectors is loosely defined as an entity outlining the magnitude and direction of a force.  The concept is important because–as we teach our clients–it is important to be aware in our climbing practices of how we multiply or add forces in our favor–or multiply or add forces to work against us.   Loosely, one way that we use vectors and forces in our favor is through our belay devices.  These devices utilize directional changes to increase the forces/tension on the climbing rope to hold climbers during falls of varying forces.

Unfortunately, we also can arrange our systems to multiply forces against us.  You have heard of this when your were told to “keep your angles small” in the arms (or legs as some climbers say) of your anchor.   But how much difference does it make?   What is the math behind the teaching?

Well let’s start by reviewing the basics.  In short, at less than 60 degrees between the arms of your anchor, each arm will likely only “see” or “feel” ~50% of the force applied to the anchor if there are two arms, or ~33% if there are three arms, and so forth.  Between 60 and 120 degrees, however, the forces “seen” by each arm of the anchor begin to increase beyond their fair share of the downward force applied to the anchor. That is, at 120 degrees, each arm “sees” the entire applied force–whatever that force may be.  In effect you have now doubled the force applied to your anchor simply by the unfortunate arrangement of the anchor components.  Angles beyond 120 degrees quickly become more dangerous.

The simplified math behind these angles are outlined in the image below in three examples. Pay special attention to the 160 degree angle . . . simply applying a climber’s body weight plus his/her gear generates 2425 Newtons of force on each anchor arm, or 4850 Newtons of force total.  That’s almost 5 kN which approaches some carabiner’s open gate strength.  And that’s just the force of body weight.




Vector Physics for the Climber

On belay!

After over 15 years of guiding rock, snow and ice in the southeast and beyond, Granite Arches Climbing Guides finally has entered the era of social media. Over the next several months Granite Arches will roll out several social media/education sights designed to better educate the public about our qualifications and courses, stay in better touch with our previous clientele, and to reach out to new clientele about all that is going on at Granite Arches.  And we are busy making a lot of exciting plans for Granite Arches.  But more on that later.  For now, this blog hopes to be a forum for education and discussion for climbers in North Carolina, South Carolina, Georgia, Virginia and the surrounding areas, and post pictures of some of our outings.

Stay tuned!

On belay!