Scott Rollins, M.D.INTEGRATE YOUR HEALTHGrand Junction Free Press Health & Wellness Columnist

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January 31, 2013
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ROLLINS: Gearing up for safety

What if your routine cross-country ski jaunt on the Mesa turned emergent and you were stranded. Would you be able to spend a night out on the Mesa this time of year? Or how about an incapacitating sprained ankle or illness during the backpacking trip, how would you deal with that? Having the right medical gear is simple and might just save a life. Here are some tips on where to start preparing or updating your kit.

Preparing a medical kit requires addressing a few general issues first. What is the purpose of the kit? The contents are determined by the nature of the trip, and the specific injuries or illnesses most often encountered. My day kit is mostly a survival kit with fire starters, rescue mirror, emergency blanket, compass, knife, cordage, etc. The kit I taking rafting or camping is my standard adventure medical kit, with the survival kit included and now adding more medical supplies. The kit in my car has contents that would be appropriate if we got stranded or came upon an accident.The level of medical training of the party is another issue. Obviously, the people using the kit need to know how to use its contents appropriately. A license or degree does not guarantee adequate knowledge of wilderness medical skills. I might have IV fluids and injection medications while everyone could have wound care and basic medications. Knowledge of what to do is sometimes more important than the contents of the kit.The destination of a trip has a big impact on kit contents. Consider climate, terrain, altitude and unavoidable dangers of certain areas. For example, desert hiking requires different items than winter mountaineering. When backcountry skiing I add a metal cup to melt snow, a Nuwick 120-hour candle, and small lightweight snow shovel. Consider endemic diseases. A kit for use in America is different than a trip to another country where malaria or other diseases are endemic.The length of trip determines how much to bring. I don't need a week supply of different medications in my day pack, but for a two-week camping trip I need to prepare for a complete course of medications should they be needed. Consider high use items such as blister pads versus rarely needed items such as epinephrine and stock accordingly.The size of the party is a similar variable as length of trip, and again requires stocking more high use items. Even as a kid on adventures with my buddies, I was generally the "go-to" person whenever there was trouble. So I've learned to prepare for myself and family, but also recognize that I might be treating others as well.Exposure is the amount of time until outside help can be reached and may greatly influence the level of care needed and thus the supplies. From the Grand Mesa I might walk downhill to a highway in a day, or call a medical helicopter to fly in, while on a remote river or backpacking trip you might be days away from help.Bulk, weight and cost are variables. Include items with multipurposes and take a modular approach to packaging that allows changing kits without completely repacking. I've prepared small, light kits for as little as $25 and also spent thousands for huge kits used by commercial companies caring for employees spending months in remote parts of foreign countries.

Think maximal protection and maximal accessibility. Use containers that are easily located and allow you to rapidly identify the contents using labels or visible colors. Divide "mini kits" among party members to avoid loss of the entire kit.The materials included reflect the needed functions. A fundamental need is to stop bleeding. One can use direct pressure with bare hand, clothing or pressure bandages. I keep a complete wound kit for convenience with minor wounds, but for anything life-threatening, plan to use cotton clothing or other material and not try to stock huge amounts of pressure bandages.Treating and closing wounds can be done with butterfly bandages, steri-strips or sutures with surgical equipment. Duct tape can be cut into a very effective butterfly bandage. Cleansers and disinfectants, local anesthetics, bandaging materials and blister treatment fall into this category. In the wilderness, you should boil or purify water for cleansing a wound just like you would to prepare for safe drinking.Splinting is a common need for a sprain or fracture. Prefabricated splints are widely available and I always carry a light-weight SAM splint. Improvisation is the key as most anything can be splinted with a stick and duct tape. Coban, or "vet wrap," makes a great compression dressing and soft splint.Monitoring vital signs is important and a watch is helpful for checking pulse rate. A thermometer can be useful. A blood pressure cuff is rarely needed. Special equipment is needed for administering medication by injections or IV fluids. Usually in wilderness settings more serious life support equipment is not realistic, such as artificial airways, chest tubes, electroshock, etc.I recommend purchasing an empty specialty bag such as a first aid kit, toiletry bag or camp kitchen bag then filling it with materials. Prepackaged kits are costly and not usually complete to my specifications anyway. Most supplies can be purchased at a pharmacy or through your doctor. I simply drop my organized bag into an ammo can for water protection.

Here is a comprehensive list of different medication categories to consider: antibiotics, analgesics (painkillers), anaphylaxis, anti-histamines, anti-pyretic (for fever), anti-emetic (for nausea and vomiting), anti-diarrhea, anti-fungal, anti-parasitic, anti-tussive (for cough), cardiovascular, decongestant, dental, dermatologic, diabetes, diuretic, hemorrhoidal, IV fluids, laxatives, local anesthetic, muscle relaxant, ophthalmic, otic, rehydration, sedative, snake bite and vaginal. About half the medications can be found over the counter without a prescription. I recommend speaking with your physician about prescription medications. I generally meet with a patient for a short office visit to discuss the various medications that are indicated and simply write them a prescription. I'm careful to include "first aid kit - for expedition use only" on the prescription and emphasize the medications are for the patient or family use only. Giving the medications to other people is discouraged due to issues such as allergies or medication interactions, and patients have to use their discretion and accept responsibility if sharing medication with others.Remember the old saying, "proper prior preparation prevents poor performance" and once packed and ready to go I don't give it another thought because I'm prepared. Most wilderness medical emergencies can be handled with a good adventure medical kit, a little first aid knowledge, and the determination to succeed with grit, spit and a whole lot of duct tape!Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call 970-245-6911 for appointments or more information.


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The Post Independent Updated Jan 31, 2013 11:36AM Published Jan 31, 2013 11:34AM Copyright 2013 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.