First Aid Kit advice

[mooreshire]

The transition from limestone to (generally sharper/pointier) lava tubes has left me much more concerned about my ability to offer attention to minor injuries that may occur underground. I was wondering if anyone could offer some insight to what sort of first aid supplies you carry.

My kit, so far....



1 small wire splint with pad
1 pair of latex-free gloves
2 sealed q-tips
2 sealed cotton balls
2 4"x4" sterile gauze sponges
2 3"x3" sterile gauze pads
1 4"x5-yards gauze bandage
2 1"x5-yards gauze bandages
1 4"x4" sterile compress bandage
1 5-yards roll of 1/2" waterproof medical tape
3 butterfly bandages (medium/small size)
1 sealed cotton triangular bandage
1 1% iodine prep pad
1 6% benzocaine bite/sting pad
1 wet nap
1 Mylar emergency blanket

I know I need some more antiseptic and perhaps a pair of scissors, and I bet I could do with a second triangular bandage. We always bring more energy bars and water than we plan to consume in case we have to wait for rescue. If there's a group member wearing any cotton, they pocket a Mylar blanket of their own.

I was thinking that instead of a set of smaller band-aid style bandages (I have three of the butterfly style for holding closed anything small that wants to gape) I might carry some of that liquid bandage stuff they have nowadays - but I've never worked with it and don't know how fragile the packaging would be.

The two PB&J size ziplock bags aren't cutting the mustard - I need something tough and water resistant to carry it all within my pack, potentially rubbing/crushed between a rappel rack and a Nataline bottle.

What else should I consider bringing with me? I'm an Eagle Scout and many years ago I was on a champion competition first aid team along side several EMTs... but if you don't use it you loose it and I know I must be overlooking some stuff. I'd still like my pack to fit through a squeeze so that battery operated defibrillator is out. Any suggestions?

[NZcaver]

Welcome to the forum.

Check out previous first aid kit topics here, here and here. (One of these days maybe I'll consolidate them into a single topic...)

Looking over your list of contents, one suggestion is to add some over-the-counter oral medications and maybe a few additional survival-related items appropriate to local conditions. I listed the contents of my kit here here, and despite a few minor changes over the years everything is mostly still the same. I no longer carry the basics in a bulky Pelican case. Now I use a small nylon dry bag about twice the size of my fist (the smallest one in this very handy set of three). My kit goes with me on virtually all caving and hiking trips.

As you alluded to in your post, skills and knowledge are also important. More discussion on that here - How much first aid training do you have? Personally, I recommend taking one of the many excellent wilderness medical classes offered by Wilderness Medical Associates or a similar provider. For cavers, acquiring some cave rescue training might not be a bad idea either.

It's always good to Be Prepared!

[mooreshire]

Ah. As you noted in the 2008 thread....

We've discussed this on the forum before, but for some reason when I search for "first aid" no results show up. Weird.

Thanks for the linkage!

I think I'll forgo any oral medication (my partners and I will have to tough through it, or hold it in/down), but I appreciate the idea for disposable thermometers and providone iodine swabsticks from your kit - both seem to reduce the involvement of dirty hands. I also read through to find the product name Dermabond, and I'll likely add a few capsules of something like it in case I want to glue someone shut. I bet I should carry at least one more pair of gloves, in case something needs to be re-dressed after a bit or (heaven forbid) there's more than one injured person.

Thanks again!

[NZcaver]

Happy to help.

Incidentally, I now know why nothing shows up searching for "first aid." The search feature ignores words with 3 letters or less like "aid." It's also preprogrammed to ignore common terms like "first," if it thinks that's the only word being searched for. So it sees nothing. Alternatively you can either search for "first aid*" (with the added * as a wild card) or do a regular Google search for "cavechat first aid."

Also, don't be too hasty to glue up wounds. Outside of a sterile hospital environment this will almost certainly seal bacteria inside, becoming a petri dish for the growing infection. Not cool. If you have to close a wound, at least give yourself the ability to inspect it and allow it to drain. Especially on long or remote trips. With the gloves, you might want to disinfect one pair at a time and seal them in baggies. Clean gloves helps prevent you putting additional bacteria in the wound.

Feel free to ask the grotto for more advice. Aaron should be able to offer you some pointers.

[harrym]

As a wilderness EMT and emergency physician, I will offer my advice.

Forget about commerically-packaged first aid kits. They're worthless. Make your own.

I have three or more medical kits. One is minimalist. A second first aid kit is something like yours. My third medical kit is comprehensive (and stays in the car).

My minimalist first aid kit consists of duct tape, a splint and bivouac gear. That's it. What's my rational? You can only carry so much in a cave pack. If space is limited, then bivouac gear is much more important than bandages.

If the injury is minimal then you can treat it with duct tape and/or a splint, and then exit the cave for further treatment.

If you cannot treat it with duct tape and a splint, then you're probably going to have to wait for help or rescue. So you need to bivouac and you have to have something to help keep you warm. What good is a pack full of bandages at that time? (I guess you could burn the bandages for heat.) A mylar blanket is great as a wind break, but you also need insulation from the cave floor and a source of heat.

I carry a small insulating pad in my cave pack, and at least one source of light is carbide for the heat. (You can sit on the insulating pad, put the carbide light between your legs, and wrap yourself with the Mylar blanket.)

Often I might carry a more comprehensive first aid kit in my backpack that stay outside of the cave entrance. It would be similar to yours, with a few minor changes. I would carry 10-15 pairs of latex gloves, not just one. And elastic bandages are very useful for wrapping wound and other injuries. Something to rinse wounds would be great, you can even just add some iodine to drinking water to rinse a contaminated wound, it's better than nothing.

Finally, I keep a fully-stocked medical kit in my car that has plenty of everything.

Of course, you have to add a few things here and there to take care of your own personal issues, e.g., Epi-Pen if you are allergic to bee stings.

[PeterFJohnson]

Forget about commerically-packaged first aid kits. They're worthless. Make your own.

I agree. Although they do come in nice lightweight waterproof pouches...

I carry a pretty minimalist set up as well but I do worry a bit about treating someone who is bleeding(many people carry knives which are good at cutting their owners, for instance). As a result I carry quik clot.

As a physician, do you have any opinion on quik clot Harry? Am I wasting pack space?

[mooreshire]

Wow - great advice from all angles. Many thanks all around.

I've added a few iodine swabsticks and disposable thermometers to the kit, as well as some more gloves and a small bottle of tissue adhesive (LiquiVet, sold for de-clawing - the human stuff was too expensive). I read more into the infection risks that come with gluing people closed and won't use the stuff unless the situation would also involve moving the patient to the hospital as soon as we surface. I also got a bottle of purpose-sold liquid tissue adhesive solvent to keep in the car-kit so I could properly remove the glue for a re-dressing if necessary.

The priority towards bivouac gear seems a very sound argument. I carbide cave and regularly warm my hands with my lamp, though I hadn't considered additional preparations for the body heat one will surely loose sitting for any period on the cold (often wet) stone. What size/thickness range and of what sort of material is advisable? I'm imagining cutting a piece out of a cheapo blue backpacking <10mm thick sleeping pad, but assuming it's thick enough what dimensions might be most useful? A butt-cushion sized piece (which might slip easily enough against your back inside a caving pack) doesn't help an unconscious partner as much, but a thicker pad large enough to lay someone out in the fetal position on might be pushing the limits of what I'm likely to lug below.

[Scott McCrea]

Throw in some safety pins and you can fashion a sling by pinning an arm across the chest. A razor blade is handy (and small) for cutting off clothing or the corner of a ziplock baggie for a Macgyver irrigation syringe. Imodium can be a life saver when hours or days from an entrance.

Some cave packs (ahem) come with removable closed cell padding that makes good insulation, splint padding and even splints.

Multipurpose gear and some creativity can do amazing things.

[harrym]

As a physician, do you have any opinion on quik clot Harry? Am I wasting pack space?

Direct pressure is always the primary and best way to control bleeding. QuikClot is not going to negate the need for direct pressure.

Would I carry QuikClot?

I carry a tiny package of a similar material in my car's medical kit, for use in nose bleeds that cannot be controlled with direct pressure.That's all I would use it for.

I've never needed a clotting agent for anything but nose bleeds during my career in the ER.