EMTs and paramedics – what do you carry?

GLD wrote:Much the same reason WMI doesn't recommend stitching in the wilderness.

They don't recommend stitching in much the same way they don't recommend a surgical cric in the wilderness. It's so far outside your scope of practice you could be sued for negligence per se regardless of any injury sustained so be careful with that one. Super glue probably falls into the same category, though not as firmly. I once had to do surgery on myself after I super glued a small grain of Joshua Tree granite into a flapper. I thought I had cleaned it throughly but the rock was skin-colored, the flapper was deep, and it was stuck in the corner. Steri-strips would have made it a non-issue.

Jace Mullen wrote: (Emphasis mine) Really? You think it's irresponsible not to carry things needed for long term management of a patient for a day cragging? I'm honestly curious and intent for this comment to stimulate discussion and civil debate, not flaming. And for a major trauma I would much, much prefer to have trauma shears than most of the stuff you have listed.

Jace, thanks for catching me in one of my many moments of stupidity. I agree with you, (and disagree with my 2 hour ago self) it is not irresponsible; I honestly don't know why i put that, probably to sound more intelligent or something... I guess I didn't fully read the authors question either. The kit I listed is a generic kit that can be applied to a variety of outdoor activities.

Honestly, with the exception of bleeding control, you probably aren't going to do very many "life saving" things in the back country. If they aren't stable; they aren't probably going to make it.

Back country: I carry a SAM, typical bandage equip, xeroform, benadryl, ASA, quick lot, combat tourniquet, sterile hemastat and forceps, a few 10 ml flushes, a few blunt tips, steri-strips, benzoin, neosporin, gloves and hand wipes. It all fits nicely into a fishing tackle bag that's about 4x6x8, is light weight, and you can handle most wound care and orthopedic trauma. I think the ease of use of a combat turn and a SAM make their added weight more than worth it. You can improv the tourniquet but the combat turn is so fast, easy and light it's worth it.

I don't carry more than about 30 ml of fluid and I don't carry any IV equipment.

If I'm just going out for the day: ASA (I fish and hike with my dad a lot who has heart issues), SAM, tape, 4x4s

Maybe tape.

W-EMT

rging wrote:Two things, a knife and skills. You can get out of anything with that, oh and duct tape. Shoot that's three things.

Agreed. As an EMT, ski patroller, swiftwater rescue tech, raft guide, kayak instructor the two most often used tools in my med kit are a Spyderco knife and roll of white duct tape.

The first aid supply list people are bringing up is absurd...

For traumatic injuries, the only thing you can really do outdoors is stop the bleeding and offer pain medications. Quick clot, knife, climbing tape, and pain meds. You can easily make a tourniquet out of a sling or strap on your back pack.

Really, what you need is some type of spot device to call SAR if someone is really badly injured so they can get to a trauma surgeon as quickly as possible, bandaging/splinting isn't going to do anything, just a waste of weight on your back.

EMT-P RN CCRN

Lots of awesome suggestions here. But the best suggestion posted is to stay within your scope bro. Don't pack stuff you don't know how to use, don't pack meds your not 100% about.
Start there and keep it simple. As you gain more experience and training, you can add to your kit. But let your skills dictate what you pack.
If you plan for every type of emergency that you may encounter in the back country, your ruck will be full of rescue gear, leaving little room for camping and climbing gear.
In my opinion, your ability to assess risk and your escape plan (in case you or one of your party actually do get hurt), will serve you better than a ton of trauma supplies. I don't say that to discourage. In fact, I think every climber should have some kind of a kit, not jus the doctors, nurses and medics who climb. I also think every climber should have some kind of medical training; basic first aide and a CPR card will do.
For what it's worth, I have a fully equipped 'jump bag', complete with AMBU bags(adult and peds), an OB kit, meds, IV start kits, a few liters of NS, a ton of trauma supplies and a D size O2 cylinder. But that bad boy stays in my truck back at camp or the trailhead.
In my ruck, I have sterile gauze, some 4inch bandage rolls, snips, tweezers, cloth tape, a sterile 20ml syringe(for wound irrigation), an Emergency Blanket, Tylenol, Motrin, Benedryl, Neo-Sporin and 4-5 packets of GU. That's it.

If you are out in the back country and definitive treatment is potentially 3+ to even 24+ hours away climbing tape and a knife are great but limited. There is a whole world of possibilities between life threatening trauma and minor trauma that you can treat with a few extra supplies. You can absolutely get by with climbing tape and a knife but you could do so much more with minimal added weight. You can do a lot more than 'just stop the bleeding'.

If someone has a large laceration you can minimize bleeding, irrigate it, cover it with neosporin and a steril bandage. If it is on a spot that has significant tension, steri-strips can help keep it closed. You could just put a dirty t-shirt and climbing tape on it, but the supplies needed for better care weigh maybe half a pound total.

If someone has a fracture or sprain, you can mold a SAM splint to fit just about any body part easily, quickly, and effectively with minimal equipment. A SAM is less bulky than an improvised splint, more comfortable, fewer pressure points, better support, 'dummy' proof (directions are printed right on the side) in case you aren't the one making the splint, cheap, and light weight. On top of that, you don't have to mess with cut up webbing, back packs, pads, and you get to wear your shirt out. A 36" SAM costs about 10$, weighs 1/3 lb., and can be bought rolled or folded so you can fit it in your pack however you want.

Edit: Davi brings up a good point. Electrolite pack for ORT of some sort should be in there. I have emergen-C but there are tons of good ones out there.

I also sometimes put in general survival stuff. Some fishing line, hooks, a few caddis flies, dry tender, matches, iodine.

Ill carry everything from SAM splints, self heating blankets for cold weather, tons of gauze/tape/kt tape/gloves, IV bags/starter kits, gauze, NPA hose just in case, basic MEDS, 18/20 GA needles.You don't need to bring the kitchen sink, just plan what you need for a day/multi day/back packing/ etc etc. When I am just on a day climb ill carry a EMT responder fanny pack basically with everything I need. If I'm doing more then ill pack more. Medical skills are very perishable IMO, not only is it important to have the right supplies but you see people buying these kits and not knowing how to use everything in it.

Crash cart, vent, attending on speed dial and neosporin.

harry potter wand

A roll of elven mithril for quick clotting and patching up wounds.

This was taken out of a wilderness first responder training text.
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Best advice from this book is to bring what you have knowledge of and are comfortable using.

Dehydrated water. Suriously tho, tea tree oil is so much better than triple antibiotics.

I'll stick with Dean's kit: "Benadryl, Epi pen, and tape" plus add a knife and latex/nitrile gloves. If I can't fix it with this, you're in need of real help. That's when I use my 28 years of experience as an EMT and call 911 ASAP.

You can drag a ton of stuff up the wall but then what will you be doing, climbing or medicating. Nobody is expected to perform miracles wherever they go and I haven't had to use more than the gear I have, thank god.

Do what you can to stabilize the person and keep them comfortable until help arrives. If you are far from help; good luck.

I think it's funny that people are so into bringing Neosporin.. you're going to be getting home that day right? you're not going to get an infection in a few hours.. how many times do you get a flapper or smash your finger and just shove chalk in it and keep climbing.

I find the large kits here amusing too. as an Athletic trainer i'm basically in the same position as WFR with easier ambulance access. The things I use on a regular basis are what are in my bag. gauze, steri strips, white tape, duct tape, band aids, moleskin, pocket knife, safety pin, mylar blanket, benadryl, advil.

You're not going to save the world.. only pack what you need. NOLS thinks otherwise and if you look at all of their gear suggestions you get packs around 50lbs of crap. I laughed at a guy on the LT who pulled out this 2lb tri fold FAK that had more crap than my work kit.

As a fairly ultralight backpacker weight is always a concern and being able to do a lot with a little is important. This is my FAK I took on the Long Trail (280mi) thru hike in Vermont.

in the tube is advil, i changed out the kidney shaped blister things for moleskin, mylar blanket added later, triangle bandage removed.
2-3oz

Active duty Navy Corpsman x3 years of service. Currently deployed with Engineer Marines in Afghanistan. Been climbing for 2 years.

I once saw a kid take a ground fall at a gym: ankle pain with inflammation. I forgot to pack the SAM splint, so all I could do was elevate his leg (which doesn't do much, but it factors in a lil to slow inflammation, thus, reduce pain). When I got back in from lookin in my car I found that bystanders had worked together to improvise a splint, but it was a messy job and they had ice packs wrapped up inside of the splint material lol! I imagine that patient felt the weight on his foot. Wish I'd had the SAM splint.

STOP using quik clot powder! It generates heat, which can burn tissue inside of the wound, including mucous membranes like eyes, nose, mouth, and it can be a nightmare for doctors to clean out. Look for gauze impregnated with "KAOLIN" hemostatic agent. If you're dealing with a large wound, the gauze must be stuffed up in there. Don't be shy-- the average adult can bleed out in seconds to a few minutes.

Anti-inflammatory meds are great, Marines ask for it all the time. Ibuprofen, Naproxen, Mobic. The Epi-pen can be a life-saver--I get the stories about climbers grabbing for pockets and getting bitten/stung by something. The epinephrine is a bronchiodilator and vasoconstrictor, so it'll reverse airway inflammation and compensate for hypovolemia, the cause of shock (in this case, anaphylactic shock). Pressure dressings--the packaged trauma dressings are great, but you can improvise, plus lighten the load and save space with some rolls of gauze (if treating an extremity, start furthest from the torso and wrap towards the torso. Compressed gauze is awesome!). Nasopharyngeal airway adjuncts can be a life-saver when working with an unconscious victim. If I explain every item I throw on this post, it could get really long, so start googling if you don't understand. Antibiotic ointment: infection CAN spread quickly, as not everyone has a strong immune system. Duct tape, medical tape. If you're gonna carry steri strips, have tincture of benzoin/iodine so you're prepared to close up a hairy wound.. On that note, carry a razor. Trauma shears are great, they can cut through a leather boot. Moleskin. Emergency blanket-- a combination of bleeding and hypothermia will prevent blood clotting. Knowing how to treat fractures and bleeding isn't everything, know how to identify and EFFICIENTLY treat heat and cold injuries. Coban can make bandaging cleaner and easier, it sticks to itself. Elastic wrap for joint injuries-- again, distal to proximal on extremeties.

If you wanna be motivated, look up how to perform a cricothyroidotomy-- it's not difficult, you can improvise the rigid airway with a number of things, and don't lack confidence about learning and DOING. If the poor guy/gal you're working on isn't breathing, the head tilt chin lift and/or jaw-thrust maneuver doesn't work and you can't get chest rise/fall with CPR and you can't see a foreign object in their mouth, they're gonna die. It's best just to try the cric. You'll increase the chance of survival if you can get something through that membrane. IV set with a bag of LR or NS can help treat massive blood loss both internally and externally, special training required.

When you're as passionate about treating trauma as I am, you don't mind carrying gear. The more you have, the more prepared you feel. Then there's no question about what to carry. Being so skilled and able to improvise is great, but the moment that you knock someone else for having more supplies than you do makes you a douche! I've been a victim of the jokes, but there have been times outside the wire when another Corpsman would need something and I had it, and vice versa. First responders help each other, don't cut each other down. Situations vary, and they're constantly changing as the seconds tick by. Two heads working together are better than one. It's better to have it and not need it, than to need it and not have it.

Don't panic! It'll make the victim panic. Save lives! OORAH!