One of the best parts about Remote Pursuits is the people I get to meet.  One of the first connections I made when I launched Remote Pursuit’s Facebook page was Shane Daniels.  Shane lives in Iowa and hunting is a huge part of his life. Shane’s expertise is one that I hope you all find helpful. This post is the first in a series about First Aid in the Backcountry. We have combined Shane’s medical expertise with some of my personal experiences to bring you some great tips. Remember, being prepared is half the battle.

Shane’s Bio:
Shane Daniels is a Nationally Registered Paramedic and is certified in Iowa and Minnesota. Shane has 7 years of EMS experience and is currently employed at Iowa County Ambulance Service in Iowa County, Iowa.  He has certifications in: Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Basic Life Support (BLS) for Healthcare Providers. Shane completed paramedic school at Kirkwood Community College in Cedar Rapids, Iowa. Courses included: Prehospital Trauma Life Support (PHTLS) and Advanced Medical Life Support (AMLS). Shane keeps his knowledge and skill set fresh by attending continuing education emergency care conferences, and in service training sessions along with reading EMS journal articles.

Shanewith Deer2An Iowa native, Shane was introduced to hunting by his father at the age of 12. Ever since that first deer season, Shane was hooked on hunting and hasn’t looked back. In 2003, he found an even deeper passion for hunting when he was introduced to bow hunting and learned to seek and appreciate new challenges. It’s because of these challenges and the constant learning from failures that Shane continues to pursue his passion of hunting. A full freezer never hurts either. Shane’s favorite animals to hunt are animals he has yet to fill tags on: Turkey and Elk.  Dream hunts include Dall Sheep and Mountain Goat. Shane is planning to get married this June and looks forward to many adventures with the love of his life, Hannah.

   

 

—   First Aid in The Backcountry, Part 1: Written by Shane Daniels, edited by Matt Wymer   —
You’ve drawn the tag of a lifetime, or you have decided to go on an over the counter do it yourself hunting adventure. You have the best gear you can afford, packs lists are checked, and GPS coordinates  and maps are loaded. You busted your tail in the gym and you are prepared to hit the wilderness. However, you might not have been as thorough as you should have been.

How much time and thought did you put into your life insurance policy: your first aid kit? Hunting in the backcountry can spell big trouble. Even for minor things such as sprains, when you’re away from the conveniences of a medical facility. Having a well thought out first aid kit can literally mean the difference between life and death, success and failure, continuing on, or returning home.

lightweighkitWhether you decide to buy a pre-stocked first aid kit, or put one together yourself from scratch, there is no right or wrong way to go about putting together your own first aid kit. How you go about your backcountry adventure may determine what you put in your kit, and how you go about putting it together. If you’re going with a guide or group of buddies, best case scenario would be to have a base camp extensive first aid bag/kit to work out of.  If base camp is not an option, or you’re going the OTC DIY route, then having a well thought out individual first aid kit is the way to go.

This series will be broken down with 2 types of first aids kits in mind: the kit for those hunting from a base camp (heavy duty), and the kit for those hunting remotely out of their backpack (light weight). Ideally you will have both of these, as well as one for your home and each of your vehicles; each specifically tailored to the potentials risks you may face. Lets start with the first aid kit for the remote backpack hunter (the light weight kit), and then look at the items that can be added to build up a more comprehensive base camp kit in Part 2.

There’s a saying that holds true to backcountry hunts: ounces equals pounds, pounds equals pain. When putting together (or buying) your light weight first aid kit, weight is key. It is critical to be mindful of weight and space when deciding what to stock the first aid kit with. In order to keep things organized and simple its best to break a kit into sections.

For example: certain pockets can be designated for bleeding, musculo skeletal injuries, wound repair, medications, etc. Break the kit down in a manner that you will remember. A wise idea is to create a system and apply it all your first aid kits (labeling, colored pouches, etc.). Below are some suggested items.  Note, these are merely suggestions so don’t feel like whatever is written here is gospel. Feel free to pick and choose for your own kit. (Matt – while Shane may try to hold some punches back with you readers, this guy is an EMT. He knows medical emergencies, and it is my opinion that what that Shane lists below, is in fact “your must haves.” Maybe, not all, but certainly most of it. Tailored to your trip and risks exposure.)

Disclaimer: Shane is not endorsing or condoning any particular product in this article and neither Shane or Remote Pursuits is getting paid for discussing any particular product (in some cases Affiliate links are provided). The products I (Shane) will discuss are what I have seen works in the field, what is FDA approved, or what research has shown works effectively. While I (Shane) am a licensed EMT, this article should NOT be a substitute for as much emergency medical care as you can afford to take. Wilderness First Aid should be practiced, and thought through, just as carefully as any skill in your tool kit.

Medications
A hunter should carry with them enough personally prescribed medications for any medical conditions they have, always assume the worst case and bring plenty! Last thing a hunter needs is for their hunt to be cut short because they didn’t bring enough prescribed medication that they’re dependent upon (i.e. diabetics definitely need to not forget their glucometer with enough test strips).

Suggested medications to consider putting in your kit include:

  • NSAID pain killers. (Nonsteroidal antiinflammatory Drugs) NSAID pain medications are great because they’re multipurpose for minor to moderate pain and have antiinflammatory properties (inflammation can sometimes be half the battle when managing pain). NSAIDs are also great for reducing fever in the event of an unexpected illness such as the flu. Naproxen (AKA Aleve) is a more potent NSAID for moderate pain that is persistent, so not a bad idea to think about packing a few doses. Tylenol, although not in the same class of medication as Ibuprofen or Naproxen, is also a good idea to bring to alternate with Ibuprofen for fever control to prevent overload on your kidneys and your liver. (Matt – I prefer Naxoproxen and always bring a few on my hunts. I typically take one every day to combat inflation before it starts. Shane’s suggestion has me adding Tylenol to my kit in case of a fever.)
  • Glucose paste . Yes, typically for diabetics, but the backcountry places arduous demands on the hunter. Your body burns through glycogen like a furnace and sometimes our ego and pride can get in the way of us recognizing the signs and symptoms of hypoglycemia when we haven’t eaten enough throughout the day. Glucose paste reverses that very fast and buys you enough time to eat something and get your blood sugar up to stable levels. Beware though, glucose paste burns rapidly, so make sure you eat something. Never give glucose paste to anyone who is semiconscious or unconscious with the cause being hypoglycemia. The last thing you want to do is administer it to someone who potentially cannot maintain their own airway and create an airway compromise. That’s a true medical emergency that can be avoided
  • Diphenhydramine (Benadryl) . An effective antihistamine that attacks the source of allergic reactions. Onset of effectiveness can be on the longer side, but the duration is very long lasting. The most common side effect is drowsiness.  Benadryl is a must have for any First Aid kit.
  • EpiPen. EpiPens are commonly prescribed to those who have known true allergic reactions(anaphylaxis) to certain foods, medications, bee stings, etc. and is a life saving medication. EpiPens are very fast acting and assist in counteracting the life threatening symptoms of anaphylaxis. Diphenhydramine is the second line medication to take with an EpiPenin the event of anaphylaxis as it works on counteracting histamine release that creates the life threatening symptoms. (Side note: there are 2 types of allergic reactions. First is the aforementioned anaphylaxis. Second, is anaphylactoid reactions. These are the reactions that you have time with to take care of. Not life threatening usually, but still miserable nonetheless. Anaphylactoid reactions can turn life threatening however if it progresses to where swelling in the airway, mouth, and tongue occur. So regardless of the extent of allergic reaction, get on top of it and treat yourself accordingly.)
  • Imodium. Dehydration is a backcountry hunter’s worst enemy. And nothing gets you dehydrated faster than a good case of the squirts. If you only have one or two spouts of diarrhea, then it is wise to hold off on taking it. But if you’re having persistent diarrhea, then definitely pop those bad boys in, chased with lots of water (or some sort of electrolyte replacement drink).
  • Triple antibiotic and Hydrocortisone . Cuts, rashes, itchy and irritated skin, and bug bites are inevitable on a backcountry hunt.

Bleeding (managing and treating): Suggested items are as follows:

Rubber Exam GlovesNever stock a first aid kit without them. 2-5 pairs of gloves of your hand size should be adequate.

Tourniquets:  Tourniquets have saved many lives on the battlefield in Iraq and Afghanistan. It’s because of this that tourniquets have re-surged as the most effective means to stop arterial and severe venous bleeding from extremities. No longer do you need to do a makeshift tourniquet with whatever you have on hand and use a stick for a windlass. You can purchase tourniquets of various sorts that require no assembly. The two tourniquets that are approved by the Emergency Trauma Committee are the Combat Application Tourniquet (CAT) and the Special Operations Forces Tourniquet (SOFT).

The CAT is essentially an adjustable velcro strap with an attached windlass that a person can apply, tighten, and secure with one hand. So if you happen to be involved in a hunter on hunter accidental shooting, accidental self inflicted gunshot wound, or a bear attack where you have an arterial extremity bleed, you can be rest assured that you’ll have a means to stop the bleeding on your own. The SOFT is similar in design to the CAT, but the windlass is metal. Both are proven in stopping severe extremity bleeding. Another tourniquet option is the SWAT-T.

The SWAT-T tourniquet is ridiculously simple in design but so effective. It’s basically a roll of stretchy rubber that you tightly roll above the affected area of bleeding and tuck into itself. All tourniquets are effective and have been proven, and neither really have an advantage over the other in terms of effectiveness. (Available on Amazon, direct from SWAT-T)

SWAT-T

 

The only difference is the weight and portability aspect of these tourniquets. The SWATT is significantly lighter and more portable than the CAT or SOFT, so that’s something to definitely consider. However, please be careful with where you buy a tourniquet from! Only buy a tourniquet directly from trusted and known sources. Examples include: North American Rescue, Rescue Essentials, or Chinook Medical. Knock off tourniquets have flooded the market, so be EXTREMELY cautious if you choose to buy one from Amazon (be sure to check the vendor), Ebay, etc.. It is best to buy directly from the manufacturer source when you can. This is definitely something you don’t want to have malfunction on you in the heat of the moment!

Hemostatic Agents: Hemostatic agents are great at stopping bleeding if a tourniquet is unavailable or used in conjunction with a tourniquet.  Gauze with the hemostatic agent packed inside of it applied with pressure is a highly effective means to stop bleeding. Studies have shown that using a hemostatic agent dressing with pressure also has little incidence of rebleeding at the wound site as a result of movement. This is HUGE for the backcountry hunter because extrication will result in lots of movement for the patient, regardless of extrication method. The key to success in use of a hemostatic dressing is wound packing, and to wound pack correctly (yes, there is a correct way to wound pack). Packing the dressing allows for the dressing to soak up blood creating pressure in the wound. This allows the hemostatic agent to activate which promotes clotting to control the bleeding. QuikClot is a name brand that comes to mind when anyone thinks of hemostatic agents. The only FDA approved procoagulant supplement is Combat Gauze by QuikClot. Combat Gauze is also the hemostatic agent of choice for Tactical Combat Casualty Care guidelines developed by the United Special Operations Command. Celox gauze and ChitoGauze are other brands of hemostatic agent gauze that are available on the market.

CombatG

Israeli Bandage: Very effective at hemorrhage control in a bandaged package. Think of it as a tourniquet that’s not a tourniquet. It can be used as a primary means to control bleeding, a bandage to apply pressure and secure dressings that are already in place, and as a secondary means to control bleeding. It secures to itself with plastic clip and can be used with one hand if need be. So another smart choice to consider if you’re hunting by yourself. It is FDA approved and takes up very little space in your kit. Another plus, the price is tag ridiculously cheap. Depending on where you buy them, they can be less than ten bucks.

Wound Care

Dressings: There are an assortment of dressing types and sizes. The purpose of any dressing is to cover a wound to minimize further damage to the wound area, minimize any further bleeding, and to help minimize infection while promoting healing. Dressings come in various sizes ranging from a 2”x2” gauze sponge to a 10 inch x 2.5 foot multi-trauma dressing. Dressings are versatile and can be used for an assortment of applications and assortment of wounds.

Dressings allow for creativity in situations such as immobilizing foreign objects in your body. Use your own discretion on quantity of each type of dressing you stock your kit with since each kit is different than the next. If you’re not sure, I recommend stocking your kit with 2-3 of each type of dressing, as room permits.

Bandages. Bandages are used to bind a dressing to a wound and keep it in place. Bandages can also be used to hold a wound together by itself, but typically they are used in conjunction with a dressing. Bandages come in various forms made of different materials; with some bandages able to adhere to itself. Kling Wrap (Stretch Bandage, Gauze Bandage) and Coban (SensiWrap) are examples of self adherent bandages that are worth their weight in gold.  ACE Wrap (Elastic Wrap, Elastic Bandage), although not self adhering, is a great means of bandaging a wound. It also is a great tool to use with splinting/immobilizing fractures and dislocations. Triangular bandages are what most people see in first aid manuals and rightfully so. They are versatile in wound care and splinting extremities (think arm in a sling). People are also using tactical scarfs and articles of clothing for dressings and splinting with great effectiveness.

Tape: A staple in any first aid kit.  Every kit must have some. Medical tape, cloth tape, 100MPH tape, and duct tape are excellent choices to consider. With limited space in a kit however, one roll of cloth tape and a wing span(or two) length of duct tape should suffice. (Matt – one tip is take a few feet 100MPH tape of and wrap it around a tubular object, in my case my trekking pole, just below the grip.)

Tweezers and Trauma Shears: Tweezers for pesky ticks and slivers. Trauma shears for cutting clothes off in emergency situations.

Occlusive Dressing (Chest Seal)This is a separate dressing for the purpose of sucking chest wounds, a life threatening emergency. There are several types of chest seals/occlusive dressings on the market, all of which work. A common technique is to take one individual petroleum gauze package and tape it on the sucking chest wound and taping 3 sides to allow air to flow out, but not back in.

However, latest research is suggesting to tape all 4 sides. I (Shane) recently attended an emergency care conference, of which one topic was battlefield trauma. The speaker discussed chest seals/occlusive dressings and said that at one of the TCCC refresher courses he was teaching, an attending Navy SEAL mentioned the effectiveness of using sticky rat traps as a chest seal. Cuts down on weight, cheap, and effective. (Matt – I searched for some sticky rat traps to link for you readers. However, many of them were laced with either poison or peanut butter. BE VERY CAREFUL about what sticky rat trap you decided to try! Non toxic ones do exist.)

Splinting/Immobilization

SAM SplintWhoever invented SAM Splint is a genius. I (Shane) have personally used SAM Splint countless times on the job and it works amazingly well. It conforms to the shape of the limb, you can cut it to shape and size with trauma shears, it’s lightweight, and affordable. SAM Splint can even be used as a cervical collar to immobilize the head and neck in the event of a possible cervical spine fracture.  Used with ACE Wrap and some creativity, you can splint a host of extremity fractures and dislocations. Very handy.

http://www.sammedical.com/products/sam-splint/

Products_SAMSplint

Camp Pillow. Being that you’re backcountry hunter, it’s safe to assume you won’t be carrying a pillow of any kind on you. But, in the case that you are, or you’re willing to sacrifice some bulkier clothing items you may have, you can splint a possible pelvic fracture. Simply stuff the pillow or clothing items in between the legs of the victim and wrap as snugly as possible.  Stuff the pillow as high in between the legs as you can get it. It may take two ACE Wraps to fully wrap the thighs and pelvic area. Don’t forget to consider you sleep pad or even your sleeping bag in such a scenario.

Ice/Hot Packs. Luxury items, but if you have room in your pack for them, they’re helpful with sprains,soreness, and aches.

Sling and Swathe. This is where the triangular bandage comes in handy. Upper extremity fractures and clavicle fractures are easily immobilized with a sling and swathe fashion splint. So whether that’s the triangular bandage, the tactical scarf, or the sweater on your back, the object is to immobilize and keep that upper extremity close to your body. (You can also use the Israeli Bandage previously mentioned)

Editors Comments: While the above list is not comprehensive, Shane certainly provides some great tips on the types of  items that provide the backcountry hunter with a sound individual first aid kit. A well prepared hunter must be able to meet the demands of the hunt, whether it be weather or a medical situation.  Please keep an eye out for Part 2, where Shane outlines some additional items that make for a more robust kit (aka the heavy weight base camp kit).  Below are some closing comments.

Time to call Lathrop & Sons...

Time to call Lathrop & Sons…

Footcare: One thing Shane did not mention, but it is critical for me is footcare. I’ve had hunts come about as close to ending as one could, due to blisters. A well stocked blister kit is a key item in my First Aid Kit.  One my favorite blister treatments are the BandAid Brand blister pads. Another product I have found helpful is Leuko Tape. I pretape my heels as needed.  Various options exist for taking care of and preventing blisters. Research, experiment, and figure it out BEFORE you need it. With that said, a well fit boot in the first place is your best bet. 

Another thing to consider is energy and hydration. Two products I use extensively on backcountry trips are the Wilderness Athelete Hydrate and Recover powders, and the MTN OPS Yeti Energy Powders. These, when mixed with water, make a huge differences on hard days. If you are using Shane’s kit above, you are most definitely having a hard day. While it may not be medically prudent to take these while injured, the guy carrying your sorry butt to safety (or sewing you up) is going to need hydration and energy.

Another thing I would like to point out is that you are not limited to the standard first aid “bags.” Kifaru, Stone Glacier, Exo Mountain Gear, and  many others make great little bags that can be used to separate and carry various First Aid materials. Experiment as to what works best for you, but make sure you always take a First Aid Kit. I personally use a Stone Glacier Camp Pocket. Its light, durable, and mostly see through,  perfect for First Aid Gear. 

Part 2: http://remotepursuits.com/first-aid-backcountry-part-2