/ First Aid Kits

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the walking cave man - on 20 Sep 2012
I was in Langdale over the weekend with a bunch of friends to do Langdale Pikes and Bowfell (was a fantastic walk), however we were discussing First Aid kits before we set off.
Now I think I'm over cautious, but I was amazed that some of the walking group did not have any first aid with them and therefore was wondering what other's took with them and what they tent to have in their first aid kits?

http://walkingcaveman.blogspot.co.uk/
DancingOnRock - on 20 Sep 2012
In reply to the walking cave man: It varies. It's an area I've been pretty lax recently. Well the last 10years probably.

Elastoplasts and safety pins. Generally I'm not sure there is really any need for anything else. All those no. X sterile bandages etc?
annieman - on 20 Sep 2012
In reply to the walking cave man: There are other threads on what constitutes a First aid kit. If you are responsible for a group, being paid, it should be "adequate and appropriate". If you are out with your mates then whatever.

I deliver a lot of DofE and carry a significant FA kit and only use blister repairs. But one day i'm going to come accross a bigger problem.

There is no easy,simple answer to this. Carry a FA Kit that represents your skills. Come on a FA course?

Robin
Glyno - on 20 Sep 2012
In reply to the walking cave man:

paracetomol
aspirin
ibuprofen
codeine
assorted plasters
compeed
steristrips
tick tweezers
hand sanitizer
survival bag
Dave Perry - on 21 Sep 2012
In reply to Glyno:
OK, I'll bite.

Paracetomol. 1st Aid? I think not. It';s a very mild pain killer.
Asprin? Ditto
Ibuprofen. Anti inflam. Hardly worth taking on the hill is it?
Codeine.?? Mild pain killer but not really first aid is it? Unless you get a life threatening tooth ache.
Compeed??? Surely you'll know if you've been walking for a few years whether you'll get blisters?
Steristrips. Well they might come in handy if 'The Big Cat' tears a rip in your body. But wouldn't a bandage do?
Tick Tweezers - I didn't know ticks were immediately life threatening.
Hand sanitizer. So your mate has just fallen down the hill, bleeding to death and you are going to stand there washing your hands with the stuff?

Survival bag. Well is it 1st Aid? Debatable but good to have anyway
IainRUK - on 21 Sep 2012
In reply to the walking cave man: If leading then I have one.. if on my own.. almost never take anything..

you cope with what you have.. I put a stake through my leg and strapped it up and hopped 6k..

..admittedly I nearly lost the leg to infection..
DancingOnRock - on 22 Sep 2012
In reply to IainRUK:

> ..admittedly I nearly lost the leg to infection..

You idiot. You should have cleaned your hands with sanitiser first!

I went on a hill based first aid course. Safety pins, elastoplasts and metal mirror if on your own. I'm thinking maybe gaffa tape would be a good addition.
Ben Sharp - on 22 Sep 2012
In reply to Dave Perry:
> (In reply to Glyno)
> OK, I'll bite.
>
> Paracetomol. 1st Aid? I think not. It';s a very mild pain killer.
> Asprin? Ditto
> Ibuprofen. Anti inflam. Hardly worth taking on the hill is it?
> Codeine.?? Mild pain killer but not really first aid is it? Unless you get a life threatening tooth ache.
> Compeed??? Surely you'll know if you've been walking for a few years whether you'll get blisters?
> Steristrips. Well they might come in handy if 'The Big Cat' tears a rip in your body. But wouldn't a bandage do?
> Tick Tweezers - I didn't know ticks were immediately life threatening.
> Hand sanitizer. So your mate has just fallen down the hill, bleeding to death and you are going to stand there washing your hands with the stuff?
>
> Survival bag. Well is it 1st Aid? Debatable but good to have anyway

I think you're seriously missing the point of a first aid kit, it's not just about saving lifes it's about treating injuries, life threatening or otherwise. Paracetamol and compeed are probably the most used items of first aid, to leave them out because they don't treat hardcore enough conditions for you seems odd.

Have a read of Kath Wills first aid kit (http://www.ukclimbing.com/articles/page.php?id=3593). She seems to know what she's doing and the fist thing on her first aid kit list is a bothy bag.

This is good as well - http://www.ukclimbing.com/gear/review.php?id=4581

Personally I wouldn't take a few things on that list but non of them are stupid suggestions:
asprin - treatment for suspected heart attack,
steri strips - what if the big cat is just your kid put their hand in some glass?,
tick tweezers - normal tweezers would be more versatile but if you're out for a few days walking and your in a place where you get ticks everyday they're not a bad idea,
hand sanitizer - ok it isn't your first concern if someones bleeding to death but what if you get something in your eye, you want someone with dirty hands treating it?

One thing that seems to be missed off most lists and which is always at the top of mine is a pencil and some paper - one of the most useful things to have in an actual emergency.

Ben
Snoweider - on 22 Sep 2012
In reply to the walking cave man:

I have 2 sorts of 1st aid kit, one for working with groups which has the kitchen sink, and one for walking/climbing with mates, which I don't need very often and is pretty minimalist. It contains the following:

2 big wound dressings, triangular bandage, tape, plasters, tick tweezers, steri-strips, pencil (with gaffa tape wrapped round it) paper. I recently had call to use this kit for a nasty hand injury and wished I'd included a small pair of nail scissors to help with fashioning appropriate dressing.

To the poster who thinks steri-strips are unnecessary, they are one of the most useful things I carry. Talkative cuts that are clean will heal much better if closed quickly and are far less likely to need a stitch or become infected. My motto with first aid is "prevent worsening, promote healing". Its not just about making do.

I usually carry a bunch of pain killers and antihistamines in my pocket too for personal use as I'm a wimp.
Snoweider - on 22 Sep 2012
In reply to Snoweider:

Just re-read this and realised I must sound pretty odd having a 1st aid motto. Oh well. Maybe I'm accident prone.
DancingOnRock - on 22 Sep 2012
In reply to Snoweider: You don't think posting on a forum about the contents of your first aid kit is odd then?

Joking aside, maybe we get complacent. I don't consider a survival bag or a torch as part if my first aid kit. Although they would save my life. I would be quite happy to climb into my survival bag overnight and walk off the hill unharmedin the morning.

I almost was benighted with a group of friends out walking in November. They all started to get worried as the sun began to set. I couldn't understand the problem, just walk by torchlight. Until they all said they had no torches.

Complacency.
abzmed on 22 Sep 2012
In reply to Snoweider:
> (In reply to Snoweider)
I must sound pretty odd having a 1st aid motto.

No, it shows you actually listened to any 1st aid training you received.
3 P's, Preserve Life, Prevent deterioration, promote recovery.
Snoweider - on 22 Sep 2012
In reply to abzmed: Ha! I'd forgotten about preserving life. Duh. Explains a few things. ;-)
vark - on 22 Sep 2012
In reply to Dave Perry:
> (In reply to Glyno)
> OK, I'll bite.
>
> Paracetomol. 1st Aid? I think not. It';s a very mild pain killer.
> Asprin? Ditto
> Ibuprofen. Anti inflam. Hardly worth taking on the hill is it?
> Codeine.?? Mild pain killer but not really first aid is it? Unless you get a life threatening tooth ache.

Paracetamol is surprisingly potent. It reduces the need for morphine post-op by 30% if given regularly.

A combination of paracetamol, codeine and ibuprofen is very useful for moderate pain. Unless you have access to morphine or something similar it is about as good as you can get.
vark - on 22 Sep 2012
In reply to Snoweider:
> (In reply to the walking cave man)

> To the poster who thinks steri-strips are unnecessary, they are one of the most useful things I carry. Talkative cuts that are clean will heal much better if closed quickly and are far less likely to need a stitch or become infected. My motto with first aid is "prevent worsening, promote healing". Its not just about making do.


Unless you can get a wound properly clean it is much safer to leave it open, covered with a dressing, until such time as you can properly clean it. Closing a wound may actually increase the infection rate.

Snoweider - on 22 Sep 2012
In reply to vark: Aye as you say, there are wounds and there are wounds...

I think I said talkative cuts that are clean- which is a specific type of cut. I wasn't going to go in to gory details but why not....? For example, camping knives can inflict nice clean flappy or gaping wounds that can be well managed with steri-strips. If you think the wound needs cleaning, then don't close it. Not rocket science.
vark - on 22 Sep 2012
In reply to Snoweider:
> (In reply to vark) Aye as you say, there are wounds and there are wounds...
>
> I think I said talkative cuts

Not sure what you mean by this, it's not a term I've ever encountered before. I assumed the first use was a typo

Nutkey on 22 Sep 2012
In reply to the walking cave man:
Walking - nil. For running,I'll take a bit of extra food, and a survival bag if the weather is bad. A torch if appropriate - eg runs where an injury might keep me on the hill after dark. I can't think of any piece of medical equipment (apart from a pair of crutches) that I'd both know how to use AND would be essential in getting off the hill.
sjbutterworth - on 22 Sep 2012
In reply to the walking cave man:

Zinc oxide tape is about all you need.
Dave Perry - on 22 Sep 2012
In reply to the walking cave man:

So Asprin is useful for treating suspected heart attacks. I think not?. There is some evidence that it might help prevent some heart problems such as Myocardial Infarction but I'm not sure I could tell the difference between that and say, Angina Pectoris. Can you? So there's your mate Jeff laid out on the ground with a suspected heart attack and you are going to administer asprin? What if he's unconscious? I'd hope for better than that!!

Paracetemol and Compeed are the most used first aid treatments? I would have thought plasters and asprin might just be used a little more, don't you? Compeed is used for those folk whose feet haven't got used to walking boots yet or you've just got yourself a nice new pair. Best to make your feet get used to the boots in the first place, and secondly prevention by ensuring that the minute you feel any start of a blister is to put on a plaster before you need compeed

Steri strips.. So Darryl falls and cuts his hand on glass. Without bandages, wipes, absorbent material et.al, you're going to stick it together with steri strips. Do they stick to blood?? And when you get to outpatients won't they want to remove them to clean the wound ? Wouldn't a simple first aid dressing do the job until then?

Tic removers? Do people really check for ticks when on the hill???

Patacetomol good for post op need for morphine? So your mate Jeff falls off the ridge, cracks his head open, breaks his wrist. Are you telling me the best you can do for jeff is give him paracetamol????? "It's OK Jeff,. just don't bleed to death because I'll give you some pills which will stop you needing too much morphine if we can get you to a surgeon first" Wouldn't Jeff prefer a couple of bandages???

So a combination of ibuperfen, asprin, codene or whatever etc., is useful for "moderate pain". Jeffs going to love you if he's now unconscious after his fall isn't he? "I hope he doesn't bleed to death then I can give him my nice pill collection" - What my be causing the pain in the first place? I'm sure Jeff loves your good intentions but I think he would want a bandage first and worry about the pain after you've stopped the blood and gore.....
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Ben Sharp - on 22 Sep 2012
In reply to sjbutterworth:
> (In reply to the walking cave man)
>
> Zinc oxide tape is about all you need.

Heard quite a few people say that. You can do quite a lot with zinc oxide tape, maybe all you "need", but certainly not all you might "want". For a lot of times when a first aid kit is useful there is plenty that the tape wouldn't do. Plus duct tape is much stickier and more versatile.

Can you take a grid reference on a piece of zinc oxide tape? Can you relieve pain with it?

Ask yourself what you would prefer if you got an ice axe in your eye: (a) hold on while I improvise by taping this sweaty buff over your eye, or (b) hold on while I tie this sterile dressing over your eye.
If you break your leg wouldn't you prefer a SAM splint to a couple of sticks held together with zinc tape? Ok it's not "necessary" but it's barely noticeable in your sack.
Why suffer through a headache instead of carrying a few grammes of paracetamol.
An ambulance dressing must weigh 20-50 grammes. Ok, it's not necessary but for the weight penalty it seems a small price to pay "just in case" because if you're unfortunate enough to be able to make use of it, you'll be glad you have it.

Improvisation is great but it's not the only way and I see no reason to replace a fist sized first aid kit with a single roll of zinc oxide tape just because I can.
Ben Sharp - on 22 Sep 2012
In reply to Dave Perry:
I'm not quite sure why you're being so aggressive but hey, some people are just nob ends.

> So Asprin is useful for treating suspected heart attacks. I think not?. There is some evidence that it might help prevent some heart problems such as Myocardial Infarction but I'm not sure I could tell the difference between that and say, Angina Pectoris. Can you? So there's your mate Jeff laid out on the ground with a suspected heart attack and you are going to administer asprin? What if he's unconscious? I'd hope for better than that!!

I don't personally carry asprin but I wouldn't be as keen to ridicule it as quickly as you do. Ok so you can't tell the difference between your google results but what if Glynco can, should he not carry them either. Or should no one carry any first aid equipment that you personally can't use?
St. Johns Ambulance seem to think it's a useful first aid treatment if you find someone having a heart attack but then what do they know compared to you? (http://tinyurl.com/36t6deb)
"What if Jeff is unconscious?" What if he isn't? First aid isn't about finding an example where "x" treatment isn't necessary and totally abandoning that course of action because you've found one instance where it's not appropriate.

> Paracetemol and Compeed are the most used first aid treatments? I would have thought plasters and asprin might just be used a little more, don't you? Compeed is used for those folk whose feet haven't got used to walking boots yet or you've just got yourself a nice new pair. Best to make your feet get used to the boots in the first place, and secondly prevention by ensuring that the minute you feel any start of a blister is to put on a plaster before you need compeed

So asprin's the daddy now is it? I thought it was as pointless as paracetamol. Either way it doesn't matter, having pain relief in your first aid kit isn't something which deserves criticism imo.
I'm not sure what you have against compeed. You say you should stop as soon as you feel a blister and put a plaster on, why not just put a compeed on which doesn't come off as easily. You say compeed is used for "those folk that haven't got used to walking boots", so what are they to do then? You admit that some people need to use compeed so why shouldn't they carry it? First aid kits aren't just for experts like you, if someones feet haven't got used to boots then why not let them take compeed in their kit?
Also what if your stiff B3 boots cause you blisters despite what you do? Would you be stupid to put a compeed on before you set off or should you just hold everyone up and take a 5 minute break while you put a plaster on your hot spot which will get rubbed off in a few mins? I'm not sure I'd be too happy climbing with someone who takes a break "the minute they feel the start of a blister".

> Steri strips.. So Darryl falls and cuts his hand on glass. Without bandages, wipes, absorbent material et.al, you're going to stick it together with steri strips. Do they stick to blood?? And when you get to outpatients won't they want to remove them to clean the wound ? Wouldn't a simple first aid dressing do the job until then?

Again, what's with picking examples where something is inappropriate to prove that it's never useful? Why are you going to outpatients for a wee cut? I don't think the original suggester of steri strips intended to use them as a replacement for bandages or to treat a major wound.

> Tic removers? Do people really check for ticks when on the hill???

Most probably don't but I'm not sure why you would have a problem if someone did. If I was out for a 10 day walk and I got a tick somewhere I'd take it out, probably not with tic removers as I don't carry them but they'd certainly do the job if you had them.

> Patacetomol good for post op need for morphine? So your mate Jeff falls off the ridge, cracks his head open, breaks his wrist. Are you telling me the best you can do for jeff is give him paracetamol????? "It's OK Jeff,. just don't bleed to death because I'll give you some pills which will stop you needing too much morphine if we can get you to a surgeon first" Wouldn't Jeff prefer a couple of bandages???
> So a combination of ibuperfen, asprin, codene or whatever etc., is useful for "moderate pain". Jeffs going to love you if he's now unconscious after his fall isn't he? "I hope he doesn't bleed to death then I can give him my nice pill collection" - What my be causing the pain in the first place? I'm sure Jeff loves your good intentions but I think he would want a bandage first and worry about the pain after you've stopped the blood and gore.....

Ah, it's Jeff again, conveniently sustaining an injury where paracetamol isn't the most appropriate treatment. So your reasoning is that because Jeff doesn't need paracetamol in this instance then no one ever does. Case closed.
If you had to drag yourself off the hill with a non-life threatening injury like a broken leg I'm sure you'd be glad of knocking back a half dozen paracetamol, some codeine and some ibuprofen. Just because you get them over the counter doesn't mean they don't work. Besides why do you have a problem with someone carrying a few painkillers to treat a headache or migraine?

vark - on 22 Sep 2012
In reply to Dave Perry:
> (In reply to the walking cave man)

You seem to be lacking the most important thing you might need in an emergency-knowledge.

> So Asprin is useful for treating suspected heart attacks. I think not?. There is some evidence that it might help prevent some heart problems such as Myocardial Infarction but I'm not sure I could tell the difference between that and say, Angina Pectoris. Can you?

There is very good evidence for the use of antiplatelet agents for acute coronary syndromes.
In the vast majority of cases the only effective way to differentiate angina from MI is with blood tests. Consequently most people with chest pain will be given aspirin long before the final diagnosis is made.

>So there's your mate Jeff laid out on the ground with a suspected heart attack and you are going to administer asprin? What if he's unconscious? I'd hope for better than that!!

You have been watching too much Casualty and seem to be mixing up cardiac arrest and myocardial infarction

>
> Steri strips.. So Darryl falls and cuts his hand on glass. Without bandages, wipes, absorbent material et.al, you're going to stick it together with steri strips. Do they stick to blood?? And when you get to outpatients won't they want to remove them to clean the wound ? Wouldn't a simple first aid dressing do the job until then?

I would agree

>
> Patacetomol good for post op need for morphine? So your mate Jeff falls off the ridge, cracks his head open, breaks his wrist. Are you telling me the best you can do for jeff is give him paracetamol????? "It's OK Jeff,. just don't bleed to death because I'll give you some pills which will stop you needing too much morphine if we can get you to a surgeon first" Wouldn't Jeff prefer a couple of bandages???
>
> So a combination of ibuperfen, asprin, codene or whatever etc., is useful for "moderate pain". Jeffs going to love you if he's now unconscious after his fall isn't he? "I hope he doesn't bleed to death then I can give him my nice pill collection" - What my be causing the pain in the first place? I'm sure Jeff loves your good intentions but I think he would want a bandage first and worry about the pain after you've stopped the blood and gore.....


I have a little experience of dealing with unconscious trauma patients and curiously enough tend not to use oral analgesia in such cases. I don't think I suggested using analgesia in place of resuscitation, I was merely making the point that you were wrong. Even in major trauma analgesia plays a vital role but ABCs will be taken care of first.
Pain has a significant adverse effect on your physiology, especially in situations such as chest injuries. Early analgesia makes a significant difference.

P.S. The active metabolite of codeine is morphine!


vark - on 22 Sep 2012
In reply to Ben Sharp:
> (In reply to sjbutterworth)

> If you break your leg wouldn't you prefer a SAM splint to a couple of sticks held together with zinc tape? Ok it's not "necessary" but it's barely noticeable in your sack.

The SAM splint always appears on these threads but I am never quite sure what people think they are going to do with them. THey might make immobilisation of some ankle fracture easier but you ain't going to be walking out just because you have a SAM splint.
They will be little use for more proximal fractures of the lower leg and no help at all for a femoral fracture.
They are useful for upper limb fractures but can easily be replaced by improvisation.
My other half recently broke her wirst and I made a perfectly good splint from a bit of Karrimat and some zinc ox tape

Given the amounts of money spent on ever lighter kit it always seems strange to carry something so redundant.

cezza - on 22 Sep 2012
In reply to the walking cave man:

Some stuff that can actually save someones life, some stuff to improve their chances and some stuff to to make them more comfy:

Pocket resus mask
antihistamine
Epipen
Ventolin
Asprin
ibruprofen/paracetomol/diclofenac
large clean bandage
duck tape





The Lemming - on 22 Sep 2012
In reply to the walking cave man:

Hands up all those that have ever happened across a cardiac arrest in the street or on the hill?

These things are very rare indeed, and chances are, god willing, you will never happen across one in your lifetime.
Ben Sharp - on 23 Sep 2012
In reply to vark:
> (In reply to Ben Sharp)
> [...]
>
> [...]
>
> The SAM splint always appears on these threads but I am never quite sure what people think they are going to do with them. THey might make immobilisation of some ankle fracture easier but you ain't going to be walking out just because you have a SAM splint.
> They will be little use for more proximal fractures of the lower leg and no help at all for a femoral fracture.
>
> Given the amounts of money spent on ever lighter kit it always seems strange to carry something so redundant.

It's hardly an essential bit of kit but given the nature of climbing I don't think it's a bad idea to have one slipped down the back of your rucksack, it's pretty unobtrusive and hardly heavy.

Climbing takes you to plenty out of the way places and lower leg injuries are more common than in other activities. Especially in winter when a fall can more easily bust up your ankle. There's nothing wrong with tailoring your first aid kit to increase your chances of hopping off the hill without help.
If you sprain your ankle half way up a winter climb then unless you carry poles there's not a huge amount you're going to be improvising with unless you start cutting up your rucksack. Might make the abseil/crawl/hop down more comfortable.

Ben
Snoweider - on 23 Sep 2012
In reply to vark:

Talktive- opening and closing when you move. Nice.

Fascinating that this thread has created so many different opinions. There are a fair few experienced people on here and some that have strong views.....

On the subject of sam splints, I've used one to imobilise an injured lower arm when there was no option but to descend under own steam. It was a suspected fracture, but turned out to be just a sprain, but it was a quick way to make casualty comfortable in a situation where we didn't have much time.

I'd only really consider carrying it when out with groups where I have responsibility for first aid.


Snoweider - on 23 Sep 2012
In reply to Snoweider:

Still unsure why you find steristrips so unhelpful. I've used them on a number of occasions, in remote places, with big clean cuts that are not going to get to a+e for various reasons. They have promoted healing. They weigh nothing. Sure they have limited applications, but as you say, knowledge, is what is needed in a 1st aid situation.

By the way, if you have difficulties getting them to stick, something clever I have seen is a dab of iodine on either side of the wound. They stick beautifully to that. I've not been able to get hold of any iodine for my own kit as it is banned by the eu, so haven't tried this myself, but it was done to me after a nice cut with a sharp knife and worked a treat.
vark - on 23 Sep 2012
In reply to Snoweider:
Steristrips are great, I use them on a daily basis. The question is whether you need them in a first aid kit. Thin strips of zinc oxide tape will work just as well.

With regard to wounds that open when you move, these are unlikely to be satisfactorily treated by sterstrips. A significant wound that does this will probably need suturing. There is no benefit from steristriping such a wound, a dressing is all that is required.
vark - on 23 Sep 2012
In reply to Ben Sharp:
> (In reply to vark)
> [...]

> Climbing takes you to plenty out of the way places and lower leg injuries are more common than in other activities. Especially in winter when a fall can more easily bust up your ankle. There's nothing wrong with tailoring your first aid kit to increase your chances of hopping off the hill without help.
> If you sprain your ankle half way up a winter c limb then unless you carry poles there's not a huge amount you're going to be improvising with unless you start cutting up your rucksack. Might make the abseil/crawl/hop down more comfortable.
>

you need to have a think about the physics of this. The SAM splint is deliberately designed to be malleable. The forces through an ankle joint are massive, especially on uneven ground, and way exceed the force needed to bend a SAM splint. Consequently it will do little or nothing to support your ankle if you try and walk on that leg. It might offer some useful support if you are not moving and awaiting rescue.
If you want to support a significant ankle injury in such a way that you can mobilise on it then you need something like an Aircast boot.
I have yet to see even the craziest poster on one of these threads suggest carrying one of these.

Snoweider - on 23 Sep 2012
In reply to vark:
Agree about thin strips of zinc oxide. Nice thing about steri strips though is they are sterile and ready to go. They weigh nothing. They cost pence. Agree about big wounds needing suturing.

Would mostly agree about the sam splint being useless for aiding mobility in lower leg injuries. However if you were hopping out on your own it might make a foot flopping around on the end of your leg a bit more comfortable, but its not going to help with weight bearing one jot. Its a nice easy piece of kit for making upper limb injuries more comfortable though but its so bulky I only carry it when working. It is surprisingly light however so don't mind carrying it if Ive got the kitchen sink anyway.

I think the difference here with personal kits is that an item like a sam splint is big and bulky, and you can certainly improvise with other stuff, a steristrip pack takes up less room than 2 plasters, so why not carry it if you are confident about its application?

I think basically we are on the same page here!
topout123 on 23 Sep 2012
In reply to the walking cave man:

I do tend to take an extra foil blanket to give out to others I may/have met/meet on my walks in the mountains. It's so many people out on the hills that have no 1st aid kit.
Snoweider - on 23 Sep 2012
In reply to topout123:
> (In reply to the walking cave man)
>
> I do tend to take an extra foil blanket to give out to others I may/have met/meet on my walks in the mountains. It's so many people out on the hills that have no 1st aid kit.

Really? Does that mean you carry two? Interestingly I'm not a fan of foil blankets, they aren't much cop on a breezy day, if you want to help passers by you could consider carrying a spare hat and a bag of barley sugar. Prob do as much good.
jimjimjim on 23 Sep 2012
In reply to Dave Perry: Couldn't of put it better myself. To me I think there's little point to these type of 1st aid kits that people carry on the hill. I've got one that i keep in my car but it's really more of a comfort pack when little things go wrong. If there was a serious injury knowledge is your best bet, a ripped up t shirt some bog roll some finger tape and a mobile is all i know how to use.
Dr.S at work - on 23 Sep 2012
In reply to the walking cave man:
FWIW, when walking alone.

2 compeeds's for every day of the trip
tape
maybe a couple of plasters

have taken analgesics in the past but generally don't these days, would for a multi day trip. If with a mate would pool kit and decide on what to carry based on the injuries we both sustain on a regular basis
Ben Sharp - on 23 Sep 2012
In reply to vark:
> (In reply to Ben Sharp)
> [...]
>
> [...]
>
> you need to have a think about the physics of this. The SAM splint is deliberately designed to be malleable. The forces through an ankle joint are massive, especially on uneven ground, and way exceed the force needed to bend a SAM splint. Consequently it will do little or nothing to support your ankle if you try and walk on that leg. It might offer some useful support if you are not moving and awaiting rescue.

Yeah, sorry I should have been more thorough with my explanation, I was talking about hopping on your good leg, not the injured one. I'm not sure even the most steadfast advocate of them would suggest it allowed you to walk again with a broken ankle.
Ben Sharp - on 23 Sep 2012
In reply to jimjimjim:
> (In reply to Dave Perry) Couldn't of put it better myself. To me I think there's little point to these type of 1st aid kits that people carry on the hill. I've got one that i keep in my car but it's really more of a comfort pack when little things go wrong. If there was a serious injury knowledge is your best bet, a ripped up t shirt some bog roll some finger tape and a mobile is all i know how to use.

I always find this argument rather odd, I understand that there are people that buy a first aid kit off the shelf and then it sits in the bottom of their bag filled with things they don't know how to use. That's pretty pointless because as you say, knowledge is more important. But what I don't get is then saying that knowledge alone is better than knowledge plus a first aid kit. A large first aid kit is reasonably pointless if you don't know whats in it but I don't see why anyone has a problem with someone putting together a small first aid kit containing things that they feel might be useful. It's as if taking a few minutes to choose a few things you might need suddenly means you haven't got "the knowledge".

I don't understand how you know how to strip off your sweaty T-shirt and put it against an open wound but don't know how to use a field dressing. The principal is the same, only one option leaves you freezing cold and further contaminating a wound and the other leaves you with a 30 gramme sterile dressing on.

There are instances where treating an open wound in the manner you suggest might leave you wishing you had a first aid kit with you. In driving sleet all you're going to be left with is exposure, a soggy lump of toilet roll and one less item of clothing to keep you warm. That doesn't exactly put you in the best position to help someone. And if you're phone dies and you need to go for help then what are you going to write your grid reference and casualty details down with? First aid isn't rocket science and there's nothing wrong with carrying a first aid kit. I know it's cool to be an "all I need is a roll of finger tape" kind of guy but I wonder whether when the sh*t hits the fan you might wish there was a 300g first aid kit sitting in your bag.
abzmed on 23 Sep 2012
In reply to Ben Sharp:
> (In reply to jimjimjim)
> [...]
>
> >
> There are instances where treating an open wound in the manner you suggest might leave you wishing you had a first aid kit with you. In driving sleet all you're going to be left with is exposure, a soggy lump of toilet roll and one less item of clothing to keep you warm.
First aid isn't rocket science and there's nothing wrong with carrying a first aid kit.

A few points on the thread, nothing wrong in use of bits of clothing to cover / treat a larger wound, infection is a bit far down priority lists in a "1st aid" scenario. The thing with dedicated dressings is that they are totally designed for purpose and work a treat, coming as they do with both pad and ties ready to go.

Splints. Use what you have, agree on forces through an ankle while weight bearing. Once managed a reasonably effective evac off a hill with a lad strapped into 2 x walking axes along foot / up leg. Worked a treat for keeping him reasoably pain free as well.

Analgesics in 1st aid kits in the eyes of the HSE is a total no no. Asprin in use for MI is a special case, but even that comes with a few checks and balances / questions asked 1st.

If a kit is for personal use put what you want in it (and more importantly as others have already said, know how to use it correctly), but if the kit is for use on others, in your duty as a First Aid person, leave the medicines out of it or you could potentially find yourself in trouble. Worst case scenario? Give someone some simple Brufen for a headache, next thing they've thrown a big reaction to it / choke / die.
OK, it's a bit extreme, but most out there aren't qualified Dr's or Pharmacists and wouldn't think to ask about pre exisiting conditions / allergies / taken before with no ill effects etc.
There's good reasoning behind not keeping meds in a 1st aid kit.

Bimble on 23 Sep 2012
In reply to the walking cave man:

In my basic kit:

- selection of plasters
- triangular bandage
- 2 small bandages with absorbent dressings attached
- 1 large bandage
- gauze & micropore tape
- scissors
- gloves
- foil blanket
-Co-Codamol, Ibuprofen & 2mg Diazepam tablets

I've also got a few FFD's stashed away, but they only get dragged out for work if it's likely to be a hairy one.
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vark - on 23 Sep 2012
In reply to TryfAndy:

Why diazepam? I can't imagine sedating someone would help in most first aid situations.
mp3ferret on 23 Sep 2012
diazepam is used as a treatment for seizures.

Got to say, loving this thread. Particularly some of the utter horse sh**e being bandied about as fact.

But also some good advice.
abzmed on 23 Sep 2012
In reply to mp3ferret:
Indeed, but then usually either buccal or PR and I don't think crushing the tablets and trying to insert them is quite what he'd in mind ;-)
csw on 23 Sep 2012
In reply to the walking cave man:

I carry a SAM splint in winter - wrapped round goggles, it stops them getting crushed and it's no great penalty in terms of weight or bulk
Dave Perry - on 23 Sep 2012
In reply to the walking cave man:

My point is that carrying a few pills, steristrips and plasters is no real substitute for proper 1st aid.
Why not carry some decent bandages/slings which are really more useful than pills for preventing further injury or loss of life.

If you look at MR rescue stats, most/many accidents involve things like sprains, cuts, breaks and other incapacitating injuries. These are more likely to be correctly treated by bandages, slings rather than pills and other tiny items. These coupled with a basic 1st aid training is going to be of more help to Jeff (or Julie than pills isn't it?)

In the few accidents I've assisted in on the hills I've always found that it's better to focus on the main issues rather than stuff that can be sorted out much later.

For example:- You have to assist someone off this hill in bad weather following a bad tumble and they now have a painful, incapacitated leg/knee that won't work very well (if at all) and is extremely painful as they hobble off the hill. Your injured mate (and you) will find it much more helpful in reducing pain and further injury if you bandage his/her knee up to stop/limit it moving this way, rather than giving them any of the sort of mild painkillers that have been mentioned alone.
ClayClay - on 23 Sep 2012
In reply to the walking cave man:

imodium and plenty of it
DancingOnRock - on 23 Sep 2012
In reply to the walking cave man: This has actually been a good thread for me.

I'm expanding my first aid kit.

Safety pins
Neurofen
Paracetemol
Mirror
Zinc oxide tape
Field dressings (will look at some different sizes)
Gauze
Scissors
Tweezers
Some sort of wipe, alcohol or other.

I think zinc oxide, gauze and scissors will make for better custom elastoplasts, they're never the right size.

A timely reminder for me, thanks.
DancingOnRock - on 23 Sep 2012
In reply to the walking cave man: Comfort and reassurance are the most important tools. Pain killers and hot water with a brew kit work wonders.
Bimble on 24 Sep 2012
In reply to vark:
> (In reply to TryfAndy)
>
> Why diazepam? I can't imagine sedating someone would help in most first aid situations.

Who said it's for other people?! It helps me with muscle cramps at night after a long day out, and the 2mg are alow dose anyway.
vark - on 24 Sep 2012
In reply to Dave Perry:
> (In reply to the walking cave man)
> If you look at MR rescue stats, most/many accidents involve things like sprains, cuts, breaks and other incapacitating injuries. These are more likely to be correctly treated by bandages, slings rather than pills and other tiny items. These coupled with a basic 1st aid training is going to be of more help to Jeff (or Julie than pills isn't it?)
>
> For example:- You have to assist someone off this hill in bad weather following a bad tumble and they now have a painful, incapacitated leg/knee that won't work very well (if at all) and is extremely painful as they hobble off the hill. Your injured mate (and you) will find it much more helpful in reducing pain and further injury if you bandage his/her knee up to stop/limit it moving this way, rather than giving them any of the sort of mild painkillers that have been mentioned alone.


You do have seem to have very little understanding of first aid, physics and biomechanics.
As I pointed out above the forces through a joint are huge, especially on even ground. Wrapping a crepe bandage around a knee will do sod all. Decent analgesia might allow some people to mobilise who otherwise wouldn't be able to otherwise. For those who cannot mobilise analgesia may be all you can usefully do.

You seem to be deliberately failing to understand the function of analgesics. Google pain ladder and educate yourself.

Whilst I realise that being involved in a couple of incidents has made you feel that you can speak with some authority on this matter, there are a number of people on here who deal with this kind of stuff all day, every day.
JayPee630 - on 24 Sep 2012
In reply to vark:

Maybe it's for when they get gripped on a route and they need calming down... ;-)
Snoweider - on 24 Sep 2012
In reply to Dave Perry:

> My point is that carrying a few pills, steristrips and plasters is no real substitute for proper 1st aid.

Please define proper 1st aid as you understand it.

> Why not carry some decent bandages/slings which are really more useful than pills for preventing further injury or loss of life.

Each scenario is different. You like to pick specific scenarios to prove general principles wrong. I can do the same. My mate has a migraine, your bandage is useless. Does that mean you shouldn't carry a bandage?

>If you look at MR rescue stats, most/many accidents involve things like sprains, cuts, breaks and other incapacitating injuries.

Thats a glib summary of some very complex data. I'm unsure here whether you mean call-outs, or physical injuries to casualties. Do you include dehydration, hypothermia, low blood sugar, mental health and underlying conditions in your summary?

> In the few accidents I've assisted in on the hills I've always found that it's better to focus on the main issues rather than stuff that can be sorted out much later.

In the few (but probably more than most people) accidents I've assisted with in the hills I have learned to expect the unexpected and take a full history if possible. It seems that for you 1st aid is a very black and white issue, either someone is pumping blood and about to die, or they are not. In reality it can be a lot more complicated, and its also useful to carry items that can make life more comfortable this too comes under 1st aid. Yes they can be sorted out later, but why allow them to get worse if a few small lightweight items can resolve them more quickly in the field?
I just read a really interesting blog post about "stupid-light" in backpacking circles. Its not about first aid kits, but I think it could apply here to the gaffa tape and ripped t-shirt brigade. http://andrewskurka.com/2012/stupid-light-not-always-right-or-better/



Dave Perry - on 24 Sep 2012
In reply to vark:

I'm sorry you feel I have little understanding of 1st aid etc., I won't disabuse you as your mind is probably made up (sorry - couldn't resist that one).

My 1st post was directed to Glyno whose list of 1st aid items contained a number of pills/pain killers and lacked anything to treat the kind of more serious injuries you may also encounter on the hill. It may be true as you state that paracetamol reduces the need for morphine post op if given regularly but it seems to me that if they are going to need morphine they'd likely to have some physical injury as well and Glyno has nothing to treat this with?.... You may not necessarily stay with the patient following rescue/evacuation/ or in the hospital anyway. As you state a combination of paracetamol, codeine, Ibuprofen is useful for treating moderate pain, But what about dealing with the cause of the pain?? Indeed you suggest in your second post that you should cover a wound with a dressing. But you need one in the first place!!! and tht is what I said.

In your 3rd go at me you mention Asprin. No problems with being given asprin. But.... I'm up a hill on a day like today I'd really hope that I'd be evacuated or rescued. Whilst waiting for this to happen I'd hope I was put in a bivvi bag and my ABC was kept going. And how many on here can be certain the exact cause of the chest pain in the first place?? (I've never watched casualty either)

Indeed we don't seem to be particularly disagree.

I've no axe to grind or disagree with your other points unless you want me to have ago about SAM splints.......?
Pete Cook - on 24 Sep 2012
In reply to the walking cave man:

Hi, Read through the posts and the one thing to remember is having the ability to use the equipment carried, this can be gained by joining a recognised first aid course relevant to your sport/activity/area etc. So some pointers that you may wish to consider..

+ Area/conditions that are likely to be encountered
+ Type of equipment carried by yourself/others/available locally
+ level of training in first aid and incident management gained

As a matter of interest I carry the same first aid bag and incident kit whether I am on a solo walk/with friends or when I am leading groups in the UK hills purely out of personal experiences over the past 35 years.

http://remotefirstaid.com/Outdoor-Pursuits-First-Aid.php

Feel free to contact the office on 0700 345 0249 if you wish to talk direct to one of the training team on this matter.

Pete Cook
Dave Perry - on 24 Sep 2012
In reply to Snoweider:

"Please define proper 1st aid? Is this a quiz? Do I get points?? Incidently whilst every scenario is different I was listening to a neuro surgeon/specialist? on the radio the other day and he insisted that giving pain killers for a migraine, simply makes the migraine either more frequent or more painful in the medium to long term as it is a neurological misfunction. But, he, I'd give pain killers myself too!!!.

1st aid is to me, pretty black and white - with shades of grey!!! my comments related to Gyno's list of pills with nothing to deal with the possible causes of pain. No bandage/sling, tape or dressings for example. I did not say, I think' that pills/pain killers have no place. I don't think, dehydration, hypothermia, low blood sugar, mental health" can be treated with pain killers. Do you?
Dave Perry - on 24 Sep 2012
In reply to Ben Sharp:

I'm sorry you don't like Jeff. He's a nice chap really.

I never (regarding blisters) stated that you should not take plasters or compeed with you. I simply said, like you, that it is better to put something on BEFORE you go out if you think you're going to end up with a blister/s.

My point is that Jeff would prefer you to treat his cut/s, breaks etc., with bandages and not just with pills, which is almost all the contents of Glyno's 1st aid contents.

And I'm not getting at Glyno, (or you) just the contents, or lack of, essentials in his suggested 1st aid kit.
Snoweider - on 24 Sep 2012
In reply to Dave Perry:

Hi Dave, I wondered if I was misreading your posts so gave you the benefit of the doubt and re-read them. Either I'm very dim, or in your original post you scoffed at Glyno's inclusion of painkillers, not because he had missed out big wound dressings, but because you didn't see them as being useful.

Anyway, I'm glad that you have clarified things and hopefully I'm now right in understanding that you are not going to bring out the hill police on anyone who puts pain killers and steri-strips in their first aid kit. Agree with you about wound dressings. Please god let nobody gaffer-tape me up when nice sterile dressing will do. Having said that, I carry gaffer tape too, and have gaffer taped a sam splint to someone's arm once.

This thread is wonderful because it highlights the huge differences in experience and knowledge, and in the end, you should only carry what you are happy using. The only thing that I would get really evangelical about in the end is that everyone, not just climbers and walkers, should go on a 1st aid course, and keep it up to date and fresh every few years.

Dave Perry - on 24 Sep 2012
In reply to Snoweider:
Well,fair enough I was/am a bit cynical regarding pain killers, but as I've said this was really because the list gave them without having other adequate kit - so I did rather scoff a little and will apologise for my appalling lack of,.......errrr? tact?

Certainly I doubt anyone on here would deny (or has) that first aid training and continual refresher training is the most useful aspect of any first aid kit.
The Lemming - on 24 Sep 2012
In reply to the walking cave man:

I had to look up what SAM splints were, as I'd never seen one.

Think I'll stick with ingenuity and what kit I have to hand when presented with whatever unfolds in front of me.
Withnail - on 24 Sep 2012
In reply to the walking cave man:

A sam splint or two can replace the backing of a rucksack in some situations therefore adding no extra weight.

Quite useful as a cervical spine collar if awaiting rescue services with someone who requires in-line immobilisation-althought hit or miss with sizing. Also, splinting itself provides analgaesia which can be more comfortable for someone awaiting rescue.

I think first aid kits are quite a personal thing based on group, experience, route etc. For instance, I might carry a samsplint in Scotland in winter but probably not in the alps (every gram counts!)

Withnail - on 24 Sep 2012
In reply to the walking cave man:

...trekking poles can be very handy, gaffer tape is amazing for loads of stuff in my opinion!
MG - on 24 Sep 2012
In reply to the walking cave man: Generally nothing. Something for staunching blood flow and pehaps a bandage othewise. Everything else is either pointless (aspirin) or overkill.
mikebarter387 - on 27 Sep 2012
In reply to the walking cave man:
http://www.youtube.com/watch?v=9iOM57bYG68

You may find this of interest.
yeti on 27 Sep 2012
In reply to the walking cave man:
I do say that a cut isn't serious unless you can do ventriloquism with it

i usualy carry
plasters
stretchy bandage, had too many sprains
whistle
claritin, cos it's hard to walk if you can't breathe
and if i'm way too far from medical care superglue (never used it though)

yeti
David Hillebrandt - on 27 Sep 2012
In reply to Dave Perry:

I have not even bothered to read all this thread but do feel I should intervene on the matter of Heart Attacks and Aspirin use. Firstly Heart Attack (Myocardial infarction or MI) in unfit hillwalkers has been one of the commonest causes of death in the British Hills for many years according to MR stastics. Secondly Aspirin is not used for its pain relieve (analgesic) action but for its anticlotting (antiplatelet effect). One adult aspirin chewed early after the onset of symptoms suggestive of an MI reduced the mortality by 23% according to the very respected ISIS (International Study of Infarct Survival) published in the Lancet in 1988 which looked at survival of 17,000 patients.

I think carrying one soluble Aspirin may be worth the weight and bulk in your kit.

David Hillebrandt
vark - on 27 Sep 2012
In reply to David Hillebrandt:
Aspirin is good but not that good. The odds of death were reduced 23%, the absolutes risk reduction was 2.4%.

"804/8587 (94%) vascular deaths among patients allocated aspirin tablets vs 1016/8600 (118%) among those allocated placebo tablets (odds reduction: 23% SD 4; 2p <000001)."

The number of patients you need to treat with aspirin to save one life is therefore 42.
Carry aspirin if you want. One day you may be able to use it and it will give you a lovely warm feeling inside- statistically though it will probably not make much difference.
The Out Door Design on 28 Sep 2012
In reply to the walking cave man:

For climbing, my kit will focus on Airway, Breathing and Circulation similar to the US Army IFAK: www.usamma.army.mil/assets/docs/IFAK.pdf
Pinged - on 28 Sep 2012
In reply to the walking cave man:

Gosh, a fair bit of vitriol spewed about such a great bit of kit.

I recently attended an REC First Aid Cousre (the 16hr one) and it really opened my eyes to just how much you can do if you combine a little knowledge, some common sense and an intelligently stocked first aid kit.

Think about the activities you are going to be undertaking and stock your kit accordingly. If you're a climber, think about carrying a sam splint for any breaks and plenty of crepe and triagular bandages. Also get yourself a couple of military dressings from Bound Tree Medical.Com...they only 2 quid and are super useful.

Start with a decent kit for an outdoor activity (lifesytems camping or mountain a great start)and tweak contents to suit.

And on the subject of asprin..the thinking at the moment is that 300mg of asprin to a suspected heart attack victim can only do good. You can even but little keyrings with a watertight holder for a couple of tablets!


ANd remember, if you are in a position where you have to offer first aid, noone is going to be judging you!

Crofty - on 07 Oct 2012
In reply to PFWJ: Surprised no one has mentioned that Aspirin should not be administered by a first aider. They have no right to prescribe drugs to anyone (maybe with exception to a family member). However it can be suggested to the suspected heart attack casualty that they may want to put one in their mouth to chew after leaving one within reach and then they take it. Some people are allergic to aspirin.
In answer to original question I carry a small first aid kit not much bigger than a grapefruit, bought commercially with a couple of additions.
More important is proper first aid training involving a structured approach to assessing, managing and treating the situation. It is amazing what can be done with very little, my first aid trainers saying is do very little WELL.
Wainers44 - on 08 Oct 2012
In reply to Crofty: Thats probably because the advice has very recently changed. At a FAW requal in the past few weeks we were all told that aspirin can now be given by a first aider ( and therefore held for that purpose in the first aid kit subject to Employer Risk Assessment). Allergy is still an issue obviously.

Just how effective aspirin actually is has been discussed by others far more qualified than me earlier in this thread.
jonnie3430 - on 08 Oct 2012
In reply to Snoweider:
> (In reply to topout123)
> [...]
> Interestingly I'm not a fan of foil blankets, they aren't much cop on a breezy day,

I've just stuck my foil blanket back in the bag after finding one incredibly useful after an accident (the casualty had one in their bag.) I had always relied on a belay jacket for sitting around immobile in waiting for MRT if I had to, but I think we had three belay jackets on the casualty and a foil blanket over the top to keep them warm and the wind off. We would have been fine without it, but it was better with it. If there was rain it would have been much harder to keep them warm and dry and the rest of us would have suffered. (Bothy bags are great too, but wouldn't have worked so well in this situation (semi prone casualty lying on top of two others to keep warm and support neck and upper body on a cramped ledge,) the bothy bag wouldn't have fit us all in so would have to be used as a blanket and the foil blanket was great at this...)

(Sod's law now states that I'll probably get stuck out overnight this winter when I should have a bothy bag and have a foil blanket instead...)

Carolyn - on 08 Oct 2012
In reply to jonnie3430:

Trouble with foil blankets is they're so thin, they can get shredded by fairly moderate winds. The foil adds remarkably little to their heat retaining capacity, so they're really just a thin sheet of polythene - orange survival bag is a bit more robust, and can also be used as a blanket.

But as ever, it's all a compromise between weight and effectiveness, and they'll work well in some situations.
Crofty - on 09 Oct 2012
In reply to Wainers44: I just did my 3 yearly 16hr remote area first aid course on Sat/Sun and the instructors say no problem with them taking it themselves, providing they are aware and you ask if they are allergic, not taking any other drugs that it may interfere with and they are not suffering from haemophilia. The course providers had also just been updated on the Friday to all current practices and a lot had changed.

Research shows it is greatly beneficial if diagnosise of heart attack is correct, what if it is not a heart attack and you give the drug. I'd be letting them take it.

one of the things that has changed When checking responses from a casualty, you are no longer allowed to pinch the earlobes, you have to squeeze the shoulders above the collarbone because a first aider damaged someone!!!
StuDoig - on 09 Oct 2012
In reply to Crofty:
Hey Crofty,
I did a similar course a week ago and just to emphasis that there is not necessarily a single correct answer, they taught it slightly differently...

It was fine to give someone with a suspected heart attack aspirin so long as you had no reason to believe the had a condition etc that would cause complications. They also emphasized that as long as you were acting with best on intentions, there was virtually nil chance of being prosecuted / sued as UK good Samaritan laws are very robust and if its not a heart attack, there's not a huge amount of damage that can by done by a single aspirin. they did say to try and get the person to take it themselves first, but not to be afraid of administering if need be.

They also suggested several methods of trying to get a pain response for different scenarios, inc. pinching ear lobes (though they did say it wasn't particularly efficient).

I think it nicely shows that since these 2 or 3 day courses are very much only scratching the surface, what you are taught will vary slightly depending on the experience and background of the person running the course and indeed the questions and backgrounds of those on the course.

I have to say, a very worthwhile experience doing the course and I'd heartily recommend anyone to go on one.

Cheers,

Sturat

check - on 21 Oct 2012
In reply to the walking cave man: What are you likely to come across and what are you trained to use? Some people seem to be getting their knickers in a twist over nothing. If it's a minor injury then they don't need much done and if it's serious then you need MTR/SAR and they'll be able to do way more than you no matter what level you are trained to. I carry a small first aid kit that I bought from an outdoor shop and to be honest its useless. Some large dressings, 3 or 4 triangular bandages, I think aspirin is a good idea and something to keep a casualty warm whilst you wait for MRT is all you need. In my opinion SAM splints, paracetamol, ibuprofen and the likes have their place but not on a mountain. To put it in a first aid way;
Catastrophic haemorrhage: dressings and pressure
Airway: jaw thrust and positioning
Breathing: not a lot you can do on a hill, a couple of cannula to decompress a tension if trained
Circulation: again dressings and positioning of casualty
Disability: not a lot can be done on a hill but some food is good for hypoglycemia.
If someone needs to be fully immobilised and you are suspecting a neck injury do not put on a makeshift collar as it will need to be taken off and this can cause unnecessary movement.
Flinticus - on 23 Oct 2012
In reply to The Lemming:
I've just added a SAM splint to my kit after breaking my ankle while walking solo & out of phone signal range. Luckily had not gone very far at all and was on a decent track so could crawl along the grassy margin. I had nothing I could convert into a splint and there was nothing around.

I'll also be adding walking poles to my kit.
s.scott - on 23 Oct 2012
In reply to vark:

You can use a sam splint as a neck brace to apply traction on a suspected spinal injury.

JayPee630 - on 23 Oct 2012
In reply to s.scott:

What's your medical background s.scott?
s.scott - on 23 Oct 2012
In reply to JayPee630:

I got my boy scouts first aid course.

No, I've only done a 16hr outdoor first aid course last summer. Why?

My previous comment looks a bit silly without the context. Which was someone saying their was no use to carrying a sam splint.
JayPee630 - on 23 Oct 2012
In reply to s.scott:

You want to apply traction to a spinal injury...? Don't think the patient will be very happy with that.
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s.scott - on 23 Oct 2012
In reply to JayPee630:

Really, care to explain why not?

Also I'm not a doctor so maybe I'm not using the right words, but I was taught to immobilise the neck and pull the neck gently away from the body and maintain that pull.
JayPee630 - on 23 Oct 2012
In reply to s.scott:

Immobilise the neck for sure, but pull it away? AFAIK it needs to be kept in a 'neutral' position, extending it is not right and is likely to possibly damage the patient further.

But maybe it is a semantic issue. Any doctor/nurse care to expand?
Withnail - on 23 Oct 2012
In reply to s.scott:

Dude, I dont know who taught you that but applying prehospital traction to a neck injury is a very, very, very bad idea.

Neutral alignment yes but pulling the neck away from the body definately no.

If at all unsure in what your doing with spinal injuries and the casualty is breathing/conscious I would suggest leaving them where they are, keeping them warm and phoning for rescue.

hope that helps

Jon
The Lemming - on 23 Oct 2012
In reply to s.scott:

> Also I'm not a doctor so maybe I'm not using the right words, but I was taught to immobilise the neck and pull the neck gently away from the body and maintain that pull.


By all means immobilise the neck and put into neutral alignment.

But I'd strongly suggest that you do NOT put any traction into the activity. I'm also going to bet a large wedge of cash that you may have miss heard or misinterpreted the tutor over the traction bit in your First Aid course.
check - on 23 Oct 2012
In reply to s.scott: NNNNNOOOOOOOOO!!!! FFS!!!! Who the hell told you that? Tractioning an arm or leg in a pre-hospital environment is bad enough, putting traction on a C-spine injury will paralyse the patient. Why make a temporary collar when it will have to be changed? Kneel at the head and hold neutral alignment, keep it simple.
The Lemming - on 23 Oct 2012
In reply to s.scott:

I would not even make a temporary collar either. Personally, I'd hold the neck in neutral alignment until somebody came along with a purpose made collar. If this meant that I had to sit or kneel for hours then so be it.

Caralynh - on 23 Oct 2012
In reply to s.scott:

Dear lord. There's a reason I've stayed away from this thread. This is it.
s.scott - on 23 Oct 2012
In reply to The Lemming:
> (In reply to s.scott)
> I'm also going to bet a large wedge of cash that you may have miss heard or misinterpreted the tutor over the traction bit in your First Aid course.

I probably did because I haven't seen mention of it in the little booklet they gave us.
Just goes to show about skill fade.


The Lemming - on 23 Oct 2012
In reply to s.scott:
> (In reply to The Lemming)
> [...]
>
> I probably did because I haven't seen mention of it in the little booklet they gave us.
> Just goes to show about skill fade.

Some skill fades can have serious consequences.
s.scott - on 23 Oct 2012
In reply to The Lemming:

Scratch that, just spoke to a lad (same first aid course/instructor but a month earlier than me) and he remembers it exactly as I do.

In the context of outdoor/mountain first aid for a suspected spinal neck injury. Bearing in mind were probably going to have to move the casualty anyway to insulate them and keep them warm.

Minimum movement of the body esp head and back, a jaw lift if the casualty is having breathing difficulties, tying the ankles together can help. And pull the head away from the torso in line with the body to extend the spine to prevent bones grinding and damage to the spinal cord.

Could anyone with more training than a 16hr course comment on this technique and explain what you should do.



Caralynh - on 23 Oct 2012
In reply to s.scott:

Errm yes. Do NOT pull anything. Hold the head in neutral alignment, or maintain the position the casualty is in (provided they have a patent airway). If you just need to insulate, a controlled log roll onto the side, then back onto an insulated mat is all you need.
If you must move the casualty without professional medical help (highly unlikely in the UK) then use clothing or whatever you have to hand to pad round the head and minimise movement. You will also have to consider the likelihood of spinal injury. For street medicine and in most cases UK mountain medicine, you can go on mechanism plus pain, for remote medicine , you have to be a little more selective, and use other neuro assessment tools since immobilising when days from help and limited comms is not ideal for either you or the casualty.

Cx
(WMAS paramedic, WEMSi medic)
s.scott - on 23 Oct 2012
In reply to Caralynh:

Well every days a school day. Thanks
vark - on 23 Oct 2012
In reply to s.scott:
I have a little more than 16 hours first aid training and can assure you this is bollocks. it is bollocks to the extent that I would be asking for a refund from whoever provided your course.
Furthermore, anyone who has run a course telling you this should be barred from running any further courses if what you say is accurate. Please name and shame and I will gladly report them to whatever authority they are registered with.
Traction has a place to reduce certain kinds of c-spine dislocations. This would be done in hospital and after imaging of the spine. It would usually be done by a spinal surgeon.

You should hold the neck in neutral. Do not f&@k with it. Many people with spinal injuries suffer a deterioration at the hands of the incompetent.

If you want to see how you apply traction to the c-spine google Gardner Wells tongs. I am sure someone will be along soon to say how vital it is to carry these alongside a SAM splint and supply of aspirin.

Drunken rant ends.



Caralynh - on 24 Oct 2012
In reply to vark:

LOL nice one!
Neil Williams - on 24 Oct 2012
In reply to Dave Perry:

"Paracetomol. 1st Aid? I think not. It';s a very mild pain killer.
Asprin? Ditto
Ibuprofen. Anti inflam. Hardly worth taking on the hill is it?"

The most common type of first aid I apply on myself is against a headache, and these are very useful in that regard. A headache can destroy someone's morale as they walk back down.

Why not carry something to deal with it?

Neil
TheDrunkenBakers - on 24 Oct 2012
In reply to the walking cave man:

My first aid kit comprises ibuprofen and paracetamol. Goodness knows what would happen if I suffered more than a headache on the hills.
Carolyn - on 24 Oct 2012
In reply to vark:

Well, yes. I can quite honestly say that if I've broken my neck up the hill in the UK, then having someone who has done a 16 hour first course try and apply neck collar improvised out of a SAM splint is quite possibly the last thing I want!

(Put me in the middle of some properly remote mountains with a medic experienced in emergency medicine and my opinion might change...)

On the topic of ridiculous things said by first aid trainers, I was once told on a FAW course that UK paramedics performed intracardiac adrenaline injections in the case of cardiac arrest. 500 ml of the stuff. Very Pulp Fiction. I was tempted to ask what dilution, but settled for raised eyebrows....
ledifer on 24 Oct 2012
In reply to Neil Williams:
> (In reply to Dave Perry)
>
>
> The most common type of first aid I apply on myself is against a headache, and these are very useful in that regard. A headache can destroy someone's morale as they walk back down.
>
> Why not carry something to deal with it?
>
> Neil

I carry the more serious stuff as well in my first aid kit but definitely the most frequently used is the paracetamol and ibuprofen, oh and the compedes as well. A few of my walks without blister plasters would have been a right ordeal.

Usually worth packing a couple anti diarrhoea tabs as well...

check - on 24 Oct 2012
In reply to s.scott: HEMS Paramedic Dip IMC RCSEd, so a little mor than 16 hours:-)
JoshOvki on 24 Oct 2012
In reply to the walking cave man:

Some interesting posts on here, trying to think what is in mine.

triangular bandage
Finger tape
some normal bandages
Compeed
couple of plasters
SAM splint (mainly used to support the rubbish back in my rucksack)
Aspirin
Paracetamol
Epinephrine (personal use)
Antihistamines
Gaffer tape (on my water bottle)
A whistle

Most things can be helped with that, maybe not fixed but helped all the same.
ads.ukclimbing.com
DancingOnRock - on 24 Oct 2012
In reply to the walking cave man:

Worryingly, on my outdoor first aid course, the first thing we were taught is not to become a casualty yourself. 3 of my friends were walking in Scotland when one of them suffered a heart attack. The other 2 started to give CPR but you can't do that for long before becomming a casualty yourself.

Another thing we learned was that some people die.

Of the 4 people I know who have given CPR, not one of them has been successful and one of them (a police officer) has done it 3 times.

Knowledge is the best thing and that knowledge should also include what to carry and knowing what you are carrying.

I was out all day once with my friends on a coastal cliff walk and we were getting more and more dehydrated as we had run out of water. We eventually got to a house and they let us have some water. As we sat down and looked through our packs for nibbles, one of the guys pulled out a bottle of water. The last thing you want to be doing when someone is injured is be asking round the group who has what or rummaging through your first aid kit looking to see what you have.

I get a bit worried about the "being prosocuted for dispensing medicines" attitude bit. Giving over the counter asprin/ibuprofen/paracetemol to someone who has had it before is hardly dispensing medicine. The main reason for not having it in a first aid kit is that people will help themsleves without telling anyone. The last thing you want when an office full of workers is coming down with carbon monoxide poisoning is for all of them to be quietly taking paracetemol for their headaches and not communicating that they've all got headaches.
Carolyn - on 24 Oct 2012
In reply to DancingOnRock:

> Of the 4 people I know who have given CPR, not one of them has been successful and one of them (a police officer) has done it 3 times.

On the other hand, there are some amazing success stories. My cynicism about the benefits of doing CPR on the hill was given a jolt by a callout earlier this year when there was a successful defib after around 45 min of resus.

Number 16 in Cockermouth callouts, and Number 33 in Keswick's:
http://www.cockermouthmrt.org.uk/callouts.aspx
http://www.keswickmrt.org.uk/rescues/2012.htm#latest

There are all kinds of reasons why this wasn't a typical story, but does go to show it can work.

DancingOnRock - on 24 Oct 2012
In reply to Carolyn: Sorry. I didn't mean not to try it. Just that you need to be able to take a view that at some point you may endanger yourself. The second thing we learned was summon help before starting CPR.

Again it's knowledge and the application of the equipment.

I found a first aid kit in the car last night, didn't know/had forgotten it was there. My next jopb is to look through it to see what it contains.
Wainers44 - on 24 Oct 2012
In reply to DancingOnRock: Best advice that was repeated many times in my recent re-qual was to do what can be done (given what skills and kit you have) but if its a serious incident get help there and pass the situation over to A. N. Other qualified (ie Paramedic) type person as quickly as you can!

I once witnessed a hilarious "argument" between a first aider and a 20yr experienced ambulance paramedic (who I fetched to the scene as I knew he was nearby). Mr First Aider did his best to continue to deal with the accident to an elderly gentleman using newspaper and string rather than let Mr Paramedic with first aid kit do his stuff!
DancingOnRock - on 25 Oct 2012
In reply to Wainers44: I suspect that was due to adrenaline and shock. People do weird things.

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