Doc in a Box
Building Your Own Medical Kit
By Tamia Nelson
August 23, 2011
A Note to the Reader I am not a doctor, and in this article I'm writing only about what works for me, not laying down hard‑and‑fast recommendations for others. So ask your own physician to help you assemble a medical kit to meet your needs. And then be sure you learn how to use it. 'Nuff said? I hope so.
I looked long and hard at the impressive series of stair‑step drops on The River. I looked at my inflatable. Then I asked myself, Can I portage this boat around the worst of the rapids without using the blazed trail? That trail climbs high up to the top of a ridge, where it parallels The River for almost a mile before returning to the water's edge. In so doing, it avoids all the rapids, even the easy Class I‑II stretches at the bottom. I thought I could do better by bushwhacking a short distance through the woods on the flank of the ridge. I'd bypass the Class IV‑V drops, but I'd get a free ride in the easier water below.
Ignoring the visions of Deliverance that flashed before my mind's eye, I started to climb, easing my way through a dense hemlock‑maple‑beech woods. Much of the time I couldn't see my feet. This didn't bother me. I was moving slowly, and there was nothing to worry about. Or so I thought. But I couldn't have been more wrong. As I neared the end of my impromptu bushwhack, I caught sight of The River again. That's when I felt the ground give way under my foot, followed immediately by a fiery bolt of pain that shot up my shin, stopping just short of the knee.
I eased the boat off my shoulder and lifted my leg to get a better look. The torn pants and dripping blood told me all I needed to know. Something — a sharp stub on a beaver‑gnawn branch? — had gouged a six‑inch‑long gash in my leg. Luckily, the laceration wasn't deep, and though I'd also twisted my knee when I lost my footing, the joint could still bear my weight. Leaving my boat where it lay, I picked my way carefully down to the The River. Once there, I shucked off my rucksack and pulled out my "Doc Box." Then I cleaned and dressed the wound. After that, I retrieved my boat and headed downriver as planned — a little stiff and sore, perhaps, but none the worse for wear.
As injuries go, this one was pretty minor. Still, I was glad I had my Doc Box in my pack. A first‑aid kit is the one Essential you hope you'll never use, but when you need it, you're always glad it's there. And chances are good that you will need it, sooner or later, even if you're not a hard‑charger. You don't have to take a tumble on a greasy portage trail or bang you head when you blow a roll. There are plenty of less spectacular ways to get hurt. In fact, you're most likely to come to grief in camp, cutting yourself while chopping vegetables for a stew, or burning your hand when a pot boils over. Or maybe you'll just spend a little too much time out in the midday sun and suffer accordingly. This sort of thing isn't exactly uncommon, is it? Which is why a first‑aid kit is truly Essential.
But this leaves a vital question hanging in the air:
What Should It Contain?
There are probably as many answers to this as there are paddlers. Many folks buy ready‑made kits, ranging from pocket‑sized pouches, holding a few band‑aids and a gauze pad or two, all the way up to compartmentalized bags the size of small backpacks, filled with enough stuff to quicken the pulse of a corpsman. And I'm sure these are very satisfactory. But I've always assembled my own. That way I know (1) what I have, (2) why I have it, and (3) how (and when) to use it. It pays to get professional advice when you put a kit together, of course, especially if you're assembling a medical ("second‑aid") kit for a long expedition to a remote area. Standard references like Medicine for Mountaineering make invaluable suggestions, too.
As important as it is to have the right kit, however, it's even more important to know the Right Stuff. In an emergency, far from home and help, you're the doc. So you need at least a rudimentary understanding of anatomy and physiology, along with the ability to assess a patient (whether it's yourself or someone else), make a provisional diagnosis, and begin treatment. You won't get this from reading a book. It takes hands‑on instruction and intensive drill, beginning with the ABCs. Luckily, instruction in the art of wilderness medicine is much easier to come by today than it was when I first started knocking around the backcountry. And I can't think of a better investment for any paddler.
Now let's get back to the business of stocking a kit — or more likely, kits, since I doubt you'll be happy with only one. After all, a day trip on Golden Pond is a very different affair than a month in the high Arctic. And as it happens, I have no fewer than three kits: a first‑aid kit for day‑trips, an augmented kit for weekenders, and a comprehensive medical kit for longer outings. Even these get tweaked, depending on the nature of a particular trip. For example, if I'm planning an amphibious trek, I need to be ready to deal with "road rash" and saddle sores, in addition to the usual range of backcountry emergencies.
That said, here's a peek at …
The Contents of My "Doc Boxes"
Serious injury and illness can strike anywhere, at any time. You can find yourself at death's door in your own backyard. Nonetheless, the odds are on your side. Short, local trips don't often require that you pack a field hospital. Much of the time, I get by with a simple …
First‑Aid Kit. My cell phone is my friend when things go badly wrong, but I don't want to have to call for backup if I scrape my shin or stub my toe. A simple kit fills the bill here. And this is what it looks like:
Farwell emptied these two tins of their "curiously strong" peppermints long ago, at which point I repurposed them to hold my first‑aid kit. I could just as easily have packed everything inside a heavy‑duty freezer bag, I suppose, but the tins protect the contents from crushing. That's a good thing, because I often stuff them into my shirt pockets. When I'm messing about in my Pack canoe, however, the tins go into doubled freezer bags or an OtterBox. Here's what I've packed inside:
One tin holds supplies for basic wound care; the other contains a selection of over‑the‑counter nostrums to deal with bouts of indigestion, minor aches and pains, and the like. I carry these OTC medications in small ziplock envelopes, each one labeled with the contents, dose, and expiry date. (You'll find a complete inventory here, if you're interested.) A pint‑sized ziplock bag sometimes accompanies the tins. It holds a few gauze pads and other flat dressings.
So much for trips close to home. On overnights and weekend getaways, I carry a larger inventory of first‑aid supplies, in what I call my …
Weekender. This has enough of everything to cope with more serious problems (and longer waits for help to arrive). It lives inside a heavy‑duty freezer bag, further protected by a stuff sack:
And this is what's inside:
- Adhesive bandages (Band‑Aids or near equivalents, in various shapes and sizes)
- Butterfly strips (used to close large, gaping lacerations)
- Gauze pads (various sizes)
- Non‑adherent dressings (various sizes)
- Gauze roll(s)
- Adhesive tape
- Compress dressing (a sanitary napkin works fine)
- Eye pad
- Bandanna (not sterile, but useful in a number of supporting roles)
- Elastic (Ace) bandage (this often goes along on day trips, too)
- Antibiotic ointment
- Alcohol swabs
- Hand cleanser
- Corn starch (useful in cases of wetsuit chafe)
- Petroleum jelly (another chafe remedy)
- OTC medications (the same selection as in my First‑Aid Kit, but in larger quantities)
- Breathe Right nasal strips (if I plan on doing any heavy breathing)
- Latex gloves (non‑sterile)
- Sharp pocketknife
The stuff sack is small enough to fit in a side pocket of my getaway pack, which comes with me on all my paddling and hiking trips. Since the Weekender always goes in the same pocket, I never need to grope for it. The orange color makes it easy to find when I put it down, too.
In short, my First‑Aid Kit and Weekender have everything I need for most trips, but expeditions to the back of beyond demand something more:
My Comprehensive Medical Kit. We've pretty much crossed the line separating first‑aid and definitive care here. The kit begins with the same list of supplies I use in stocking the Weekender, though I increase the quantities.
The OTC medications are also augmented with prescription drugs — sometimes called "legend drugs" in the States — tailored to the demands of specific trips. (NB You'll need a physician's letter and copies of all prescriptions if you'll be crossing international borders in your travels. Even then you should expect delays. And be sure to keep all prescription medications in their original packaging.) I also carry a magnifying mirror (to facilitate examination of the eye) and a sturdy fever thermometer, along with sterile gloves and a rudimentary field surgery kit:
This includes hemostats, forceps, scissors, and a scalpel and blades, plus a selection of sutures. I hope it goes without saying that these are of little, if any, use without prior training — and it should be borne in mind that suturing a contaminated wound is never advisable. I've also carried (and used) both padded aluminum splints (SAM Splints) and inflatable splints in the past, but I no longer bother with either one. Foam pads work just about as well. I've discarded my snakebite kit, too. Not only are poisonous snakes seldom encountered in the places I frequent, but the cut‑and‑suck treatment of snakebite is now wholly discredited. Primum non nocere (first, do no harm) applies here, as everywhere else in medicine.
Fortunately, fractures and snakebites are rare occurrences, indeed, but there's one relatively common class of medical emergency that just doesn't get no respect: dental mishaps. Which is mighty hard to understand, since a lost filling or cracked tooth can certainly put a damper on anyone's fun. This is why my comprehensive medical kit also includes a …
Dental First‑Aid Kit. But I won't bother to list the contents here. They're described in an earlier article.
Once you've assembled your own Doc Box, don't think you can put it in your pack and forget it. If you're lucky, you won't have to call on its contents often, but sterile dressings and medications have shelf lives, and you'll need to rotate stock from time to time. (Replace any supplies that you use at the earliest possible opportunity.) You'll also have to protect the contents from environmental assault. Call this …
The Care and Feeding of Your Doc Box
Water is your principal enemy here. And ziplock bags are the last line of defense. I buy them in sizes ranging from tiny (medications) to huge (large dressings, whole kits). These bags also serve several secondary purposes: they help you organize things, and they limit the mess if, say, one or more packets of antibiotic ointment burst. A word to the wise: Keep the sharp ends of forceps and scissors from poking holes in the bags.
Of course, your Doc Box won't do you any good if you can't find it when you need it. So mark it clearly and store it where it's easy to get at. When paddling with others, I also tell everyone where my kit is, and I make sure I know where they keep theirs. Why is this important? The answer to that question reflects the collective wisdom of three generations of grunts: If someone else is injured, and if you end up playing doctor, it's best to use supplies from the injured person's Doc Box when you treat him, unless this would delay treatment or compromise safety. After all, you may need your own supplies tomorrow. Harsh logic? Certainly. But sound advice, nonetheless.
Be sure, too, that you take inventory after every trip. Replace anything that's been used (or that's passed its expiry date), and inspect everything for damage. Retire any suspect ziplock bags now, as well. Then you'll know that your Doc Box will be there for you the next time you need it. That's the whole point, right?
None of us likes to think about the possibility of illness or injury on a paddling holiday, do we? And happily, most trips pass without incident. But occasionally our luck runs out. What then? Well, if you've planned ahead, you'll have what you need to meet many medical emergencies right in your pack. I'm pretty sure I've got most things covered. What about you? Is your Doc Box everything it could be? If you have any doubts, take a few minutes to check it out. Who knows? Those could be the most important minutes in your life.
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