UKC

Hi Folks
I've published an article on first aid kits; the content is primarily garnered from my own experiences but, as we know sometimes we all need a little reality; if you have a few moments, please take a look and offer your opinions; it's not intended to be right or wrong, but hopefully useful. The content is intended for use by people involved in outdoor activities seeking knowldege about what to put in their kits.

https://www.keyadventures.co.uk/articles/first-aid-kits-for-outdoor-activit...

If you prefer to contact me directly, pleasee email simon@keyadventures.co.uk

Thanks
Simon McElroy

Key Adventures

Very informative thanks.

Just wondering what the Haribou is for in the Event pack, as there’s ‘jelly for hypoglycaemia’. Is it incase the raver at the festival has an attack of the munchies post ‘dropping one’?

Thank you, very informative.

I've found in over 50 years of mountaineering that the most common items I have used both for myself and other I've been with have been:-

Plasters - I carry them in strips and cut them to size as needed - the most common problems are cuts, grazes and blisters

Scissors for above

Tweezers - very useful if someone falls over in prickly terrain like the Corsican Maquis

Sterile wipes

Tube of Germolene

Vaselene for chapped/sore groins

That's not to say I don't carry bandages and dressings, but the above are what I have to replace most often in my first aid kit, and use most often

Blimey. In 50 years of mountaineering I've never used a first aid kit.

You are 52 and have mountaineered for 50 years ? Great! I have mountaineered for about 30 years and have had to use my first aid kid once or twice. I have realised that I need much more/different things than supplied by the prescribed items/things in a pack!  

As a substitute for Haribo, perhaps...?

Maybe they're a veggie/vegan alternative to Haribo...

If I saw a packet of sweets, then they would be fair game.

Have you borrowed from a first aid kit?

You've been lucky then.

UKC kindly freezes your age when you join. My life in the mountains started age 6 but it was another 6 years before my first solo Munro.

The grand total of one plaster

This thread is the one that is bookmarked on UKC for me for some reason so easy to link to it now, lots of interesting views on it.  

https://www.ukclimbing.com/forums/rocktalk/what_emergencies_to_expect_climb...

I like the fact you have chocolate in your first aid kit.

I recently bought an hemostatic gauze (quick clot) also known as Israeli bandages. Not used it yet. The one time I could've used it, when I sliced my knuckle badly, I was bleeding loads, so I wrapped my fingers in tissue and completely forgot about the gauze until after the bleeding stopped.

For us cheapskate types, plastic gloves from the petrol station are great. You can keep several pairs in your rucksack, or running pack, as emergency gloves to keep warm. They weigh nothing and are water proof. Not sterile, but better than nothing.

I'd swap the saline solution for 1L of spring water. (If you dont need to carry it far). You can drink it, mix it with the dioralite, use it for burns and irrigating eyes, cleaning wounds etc. The saline solution is a bit specialized and there's not much of it.

I'd swap the haribo and fruit jelly for glucose tabs. More sugar, quicker acting and you can make a drink out of them.

I'd add some imodium, for dhioreaha. And a pack of tissues, if the imodium doesnt work. Also for nose bleeds etc.

Good work. 

I'm intrigued about the scalpel! Why do you carry that?

I would consider having a small flapjack bar or similar with the haribo/ glucose gel.  The pure sugar is good at picking the blood sugars up but won't maintain them and there is a risk of a rebound hypo.  Complex carbs will sort this out.  Also good if you forgot to pack your lunch!!

Personally I've always found that injuries in the mountains require either very basic first aid (blister plaster, paracetomol, improvisation with normal kit etc) or a helicopter. 

I carry a scalpel blade to trim my corns on multi day trips, then to finely slice salami into my tea

Sam splint

Gaffer tape - wrapped around a light stick

Blister plasters

3M 1"tape

Field dressing

Sterile wipes/savlon

Vaseline

Ibuprofen/paracetemol

Space blanket

Leatherman

Mobile phone with OS locate on it

youtube.com/watch?v=LIwzET2r2FA&

2:10 Dr Dave Hillebrandt talks first aid kits. This is really designed around rock climbers with sea cliffs in mind with the emphasis on decision making and improvisation in the event of a serious accident but lots of good general advice anyway. 

James

Vitamin I

Super glue 

I know its rubbish

My first aid kit consists of blister plasters (certainly the most often demanded item), a rolled bandage, some antiseptic ointment and a roll of Leucotape (second most popular item). In addition, I always have a bivouac sack with me and there's always a knife or scissors in the party in the unlikely event that mine isn't in my pack -- the same holds for tissues or toilet paper. In general, I've found that this is more than sufficient.

There are many things that I carried in the past and leave at home, today. I don't carry any medications -- ibuprofen and paracetamol are definitely out. I've never had a headache in the hills and, outside of mild to moderate headaches, there's pretty much nothing they're good for. You can't give them to others and you can't use them if there's even a slight chance that a paramedic might end up treating you in the near future so what, exactly, are they for?

Interesting concept I hadn't heard before, why can't you give them to others, and as long as the paramedics know they have had paracetamol what is the issue?

Hangovers

Having done first aid at work courses, they recommend not giving aspirin etc, as it is considered mal-practice. You are not qualified to make a medical decision.

Even with a heart attack, where aspirin has been proven to be of benefit. You need to say something long the lines of; 'I have some aspirin here, which may or may not be of benefit, I cant give them to you, but they are there if you wish to take one yourself.'

Has this every been tested in court or is it "you MIGHT get sued", I can't find any reference to it. They are not prescribed drugs which would be a no-no, over the counter is a totally different matter. I wouldn't recommend they stuffed into someones gob if they are unconscious, but if someone says "I am having a heart attack" "Oh, would you like an asprin?" "Yeah okay" is going to get you into any sort of trouble.  

This is workplace first aid, so I expect that some of it is to stop them getting sued. On the notes we were told to make, were things like the LOT number and expiration date on any bandages, dressings etc. The reason being, that ambulance chasers will pounce on these things, if they are not recorded. Someone might be grateful to be patched up and sent to hospital. However, when they get the no-win-no-fee calls, they may change their opinion of the treatment given, if it earns them some cash.

Interested to hear the opinions of others.

I've gone with the line of thinking that a climbing accident will generally result in either the climber needing very little medical help or items that can't be easily improvised, or sustaining a serious injury and needing urgent treatment and evacuation probably by helicopter. So my first aid kit contains the bare minimum of things that might be needed to help keep someone alive until help arrives. Mainly dressings and things to control bleeding, and basic medication (because it weighs nothing).

I'm very tempted to add a PLB to my emergency kit as very often I'm either on my own or with one partner, in areas with no phone signal, and the consequences of a disabling injury could be serious.

I have a couple of sanitary towels in my FAK. Useful for their intended purpose for clients caught short, but can also be used as an emergency dressing with a bit of gaffer tape or micropore tape, and I have used them for this purpose once!

It's worth making the point that no-one in the UK has ever been successfully sued for providing first aid.  As long as you are acting within the boundaries of what you have been trained to do, and act to the best of your ability, making the judgements that you think are right at the time, you are utterly safe.

If I came across someone on the hill, rolling around saying they had symptoms of crushing chest and shooting pain in their left arm, I would have no hesitation whatsoever in telling them that I think they were having a heart attack and that they should take this aspirin while we wait for the ambulance.  I am equally unconcerned about the risk of breaking a rib during CPR or the Heimlich.  *

There is a certain type of person who seems to delight in telling people that they have to be terribly careful because 'they'll get sued' but 99% of it is based on hearsay or simply made up (see also - elf'n'safety gorn mad, which usually boils down to the same two causes).

Regarding paracetamol and ibuprofen - there is a strong case for not giving them in serious circumstances whilst waiting for emergency responders, because in such circumstances they will probably do very little to help, and may well impede the ability of the paramedic to give more effective drugs when they do arrive.  I do carry them, though, for use in minor cases- if you have sprained your ankle and are walking off, some mild analgesia will be very welcome indeed.  And I can certainly recall a number of days out after a heavy night which p'mol and brufen made one hell of a lot more bearable...

* I had a briefing once a year when I worked in schools, re-training us to give an epipen injection to students in anaphylaxis.  Every year, the trainer made a huge song and dance about how we must under no circumstances use the epipen once our 365 days of certification were over.  Every year, I would ask her if, were I to be on a school trip in 366 days, and a child under my care who I knew had an allergy leaving them prone to anaphylactic shock was dying in front of me, she really expected me to stand there with their epi-pen in my hand and not give the injection, and every year she delighted in telling me that yes, I must not use it.  Utter, utter nonsense.

In case it sounds like rain dear

This bit was cut and pasted from a longer bit about paracetamol and I don't want to cause any confusion or mis-interpirate any intentions or advice given on training courses.

I am not a paramedic, however I am a Tech. If I rocked up to somebody who had taken paracetamol before I arrived then I would follow what it says on the box, as in I can't give any more paracetamol within 4 hours of the last dose being taken and I can't give any more beyond 8x500mg in a 24 hour period.

Beyond that I can give other forms of pain relief, if required but taking paracetamol before I arrive would not stop or hinder me from doing my job.

Paracetamol is a good form of pain relief and if that is all that you have to reduce pain then why deny yourself pain relief?

This is just an observation. Before my current job I too attended First Aid in the Workplace courses and I appreciate that there are real restrictions about what can and can not be put into a workplace First Aid box.

Its a big litigation world that we all live in. I just want to say that taking paracetamol before an ambulance arrives will not delay treatment.

Every year, I would ask her if, were I to be on a school trip in 366 days, and a child under my care who I knew had an allergy leaving them prone to anaphylactic shock was dying in front of me, she really expected me to stand there with their epi-pen in my hand and not give the injection, and every year she delighted in telling me that yes, I must not use it.  Utter, utter nonsense.

It is utter nonsense and just wrong. A member of the public with no training could grab an anaphylactic's epi-pen and administer it in an emergency with no problem at all. I remember the person who trained us once said that if the first dose didn't work then we could give a second dose. Someone then asked if we needed to, could we give another child's epi-pen if we didn't have the casualty's own pen to hand and she responded by saying that we couldn't, because the doses were measured to suit the child. I then said that surely the dose couldn't be that precise if it was OK to give a 100% additional dose and that not using another child's pen was probably more to do with leaving them without one. I didn't get an answer to that and have since been told that when it comes to saving a life, pretty much anything goes.

Genuine interest Lemming. You carry anything a little more 'exotic' as part of your kit?

The paramedic can give morphine and the advanced paramedic can give ketamine if required.

I don't want to be the cause of a constructive discussion about first aid kits being side tracked when a lot of good information is being discussed.

I just wanted to state that using paracetamol before an ambulance arrived would not impede or delay treatment or other options of pain relief.

Of course it's utter nonsense - and the 'measured dose' thing is nonsense piled on nonsense. There are only two sizes, for children <25kg and for everyone else!

Lemming - that's interesting to read. I've been told by more than one trainer not to give paracetamol if there is any substantial chance that a paramedic might be called, because it has interactions with a number of other drugs they might choose to use. Is that not something that you as a tech find to be a problem - you don't find yourself rocking up and your paramedic says ''dammit, I can't use <x> because they've just taken 1mg paracetamol"?

I can't speak for anybody else but it has never been a problem for me or the para I work with provided they are not allergic to paracetamol. The person will know if they are allergic.

Fun fact about epi-pens (jext ect). Despite being a POM (prescription only medicine) you can use one in an emergency (anyone's one). Along with a few other POMs

The Human Medicines Regulations 2012
238.  Regulation 214(2) does not apply to the administration of a prescription only medicine specified in Schedule 19 where this is for the purpose of saving life in an emergency.
 

• Adrenaline 1:1000 up to 1mg for intramuscular use in anaphylaxis
• Atropine sulphate and obidoxime chloride injection
• Atropine sulphate and pralidoxime chloride injection
• Atropine sulphate injection
• Atropine sulphate, pralidoxime mesilate and avizafone injection
• Chlorphenamine injection
• Dicobalt edetate injection
• Glucagon injection
• Glucose injection
• Hydrocortisone injection
• Naloxone hydrochloride
• Pralidoxime chloride injection
• Pralidoxime mesilate injection
• Promethazine hydrochloride injection
• Snake venom antiserum
• Sodium nitrite injection
• Sodium thiosulphate injection
• Sterile pralidoxime

Should we ever meet and I am in anaphylactic shock please grab the nearest epi-pen and stab me! Will buy you a pint as a thanks.

I wasn't thinking pharmacology, more along the lines of an OP to secure an unconscious partners airway while you go for phone reception/help, maybe wound glue or chitogauze as part of your winter kit when risk of laceration on spiky equipment is a little higher?

I'd agree with SAF's advice of an exceptionally simple first aid kit and wait for the helicopter to arrive.

Good advice. I'd definitely go for light and unobtrusive over comprehensive but what people carry will be coloured by experience. Only had to use kit twice on the hill, both times for random strangers. One was just minor cuts and bruises but the other gent was on blood thinners and had taken quite a knock to the head resulting in an impressive amount of blood loss.

6 months ago St. John's Ambulance were teaching that Aspirin was the only medication which could be dispensed by someone acting in a professional capacity as a first aider. I seem to remember that the rationale was that if someone is having a heart attack you are going to do a lot more good than any potential harm you could cause by administering aspirin. 

Personally I usually keep a box of paracetomol and a box of ibuprofen in my desk drawer at work and will freely give them to colleagues if they ask me for them.

Workplace first aid is a very different context to being out on the hill with your mates, however they both benefit significantly from a degree of pragmatism and common sense being applied.

And the only time I could have done with handing out some paracetamol was whilst waiting for a helicopter and I had none in my bag (which I normally do). Climber with a fractured wrist and ankle which were very minor injuries from a very nasty fall, and fortunately the tide was out at the time! 

The only drug that we carry as paramedics that paracetamol will affect us giving is paracetamol.  We can give it by IV but it is the same dose just with a quicker effect, but if a patient has already had paracetamol before our arrival it will already be starting to absorb into their system.  So no harm in offering a conscious person your supply of paracetamol and your water bottle, to take it with, if it will help with their pain!

Thanks for your replies, Lemming and SAF. Useful to know. That's exactly the sort of incident I was thinking of - waiting for help with a casualty in significant pain - and before this thread I would have not given paracetamol. 

My opinion, for what it's worth is that you should probably be careful about giving medicines before emergency services arrive, but not because they limit the options for further analgesia.  In the seriously injured patient reassurance, keeping them warm and injury(s) immobilised is probably the best pain relief you can offer.  You may be better withholding tablets in the cold and nauseated patient who is just going to end up vomiting.  Furthermore you need to be careful with ibuprofen - in a shocked and cold patient who is already under-perfusing their kidneys I suspect it could worsen renal impairment, and can also cause complications in those with peptic ulcer disease or asthma.  Paracetamol on the other hand is very safe and having had it prior to emergency services arriving will not limit any other pain relief that they can give (which would usually be morphine, fentanyl, penthrane, ketamine etc. etc.).  In an alert and stable patient with a simple injury (knee or ankle injury for example, but who couldn't walk out) I would happily give some paracetamol to alleviate pain, and if the patient knew they could take ibuprofen it's unlikely to cause any problems either.

As for aspirin, having some available in a first aid kit could potentially be life saving for someone with a suspected heart attack.  As with all medications if the patient can't take and swallow (or chew, for aspirin) themselves then you probably shouldn't be putting anything in their mouths!

The rules about epi-pens you describe sound ridiculous, thankfully I think common sense would prevail in a real emergency.

First aid kits are very personal, and what is in them will depend heavily on the training/ability of the user as well as where you are going to be, and an ability to improvise is useful.

Whilst probably not much use in your crag sack, on an expedition a scalpel could be really useful for toenail problems for example.  Incising a paronychia or cutting off the offending piece of ingrowing toenail could fix a very painful condition that renders somebody otherwise unable to walk.  Similarly a needle could be useful to trephine a subungual haematoma (very painful until the pressure is relieved) or even remove foreign bodies from eyes.  It all depends on what skills you have, and where the nearest help is I guess.

No pelvic binder ?

Is that a two ring or four ring binder that takes A4 paper?

Ring binder? Surely a job for a proctologist.