EMTs and paramedics – what do you carry?

Mark Pilate wrote: In the back country, I'd only admit to being a WEMT if A). the girl is good looking, or B). Or Someone really really really needs help. I'm not slicin' up my pack or pad for some stunned dork who can hobble out on his own.

If they aren't in my party, I'm not admitting to shit. I'll give a helping hand but, other than that, you're on your own. (with the already noted exceptions.) My good friend broke his wrist and I still only cut up his gear. My gear left unscathed.

So a question for all of you wanting to be Billy Bad Ass and saying you just take tape and a knife and can McGruber their way out of anything:

If you are out and have some sort of open wound, would you rather have the wound irrigated and bandaged with steril 4x4s or a dirty t-shirt duct taped to it? What if a doctor came to you in the urgent care and said 'fuck it, just tape this t-shirt to it for a few hours. Then, we'll deal with it'? If it's all you've got, than great! But if you can carry 1 lb more of equipment and actually deal with a wound than why not? I guess if you are that big of a pussy you can't handle 1 lb of extra weight than stick with your knife and duct tape. All of the equipment I said i carry weighs 1.2 lbs total! That's equal to half a nalgene of water. I can hear your vagina swelling from here thinking about carrying it.

You don't have to bring the whole ER, but like Jace said, why let an accident ruin the rest of the trip when you can handle it well enough to last a few days.

Sterile 4x4's, might as well use sterile gloves and technique as well. Off belay!!

I started out as an EMT, now progressed through to being an ER doc. The more medical training I've gotten, the less I've carried.

I absolutely have different kits for different activities. For cragging, I basically carry nothing. Very little that I can bring beyond an epi pen will make a difference in a situation where rescue personnel can be there quickly, and holding c-spine and putting direct pressure on bleeding are the only really effective interventions that need doing.

For big walls, I carry a SAM splint, benadryl, ibuprofen, one roll of cling wrap, an ace bandage, and moleskin.

For extended backcountry trips, add in suture supplies, iodine swabs, and a couple different broad spectrum antibiotics. Maybe one or two other things.

My expedition kit is smaller and lighter than most commercial "hiking" first aid kids.

John D wrote:I've guided for more than 10 years and worked as a front country EMT for 5. When I'm out on my own, I carry duct tape (on my water bottle), maybe some coaches tape, and a small multi-tool I actually just made up a list for a kit that I needed while I was working as a team medic in rural parts of Africa, I was at least 6 hours from definitive care, so I felt pretty certain that if it was possible to keep someone alive for that amount of time/transport, I could do it with this kit. CPR Mask/barrier Gloves SAM splint Kerlix/Gauze roll 4x4's Ace Wrap/Coban Athletic Tape Triangular Bandage Trauma Shears Tweezers/forceps Alcohol swabs Providone Iodine swabs Tylenol Ibuprofen Benadryl baby aspirin Albuterol Inhaler glucose tabs/gel Epipen/twinject/Vial of epinephrine and syringes I find less is more, some of the kits I've had to carry when guiding are ridiculously big and heavy. If you can improvise and know a few tricks, you can manage most problems with minimal kit.

Your plan included doing CPR for six hours?

PatrickV wrote:Sterile 4x4's, might as well use sterile gloves and technique as well. Off belay!!

Sterile 4x4 just means it comes in a closed package as opposed to just having some gauze float around your pack. You'd rather have a dirty t-shirt I guess?

I personally would punch anyone dumb enough to try to get near me with QuikClot. There's a reason it's getting pulled out of tactical medic kits left and right. That stuff is nasty and dangerous to victim and would-be rescuer alike.

Yeah, I've used it once and that was a gun shot to the shoulder. Not as useful as I initially thought. I have 2 in my pack that are about to expire, and when they do, I probably won't repace them.

Jake D. wrote:Carrying a trauma bag around to the crag with you waiting for something to happen is silly. Having it in your car available is not. plus you're more likely to be in an accident on the road than on the rock. you'll notice i'm not the only one saying that carrying the ER with you isn't necessary.. And that SAR's experience would be useless if we had crashed and caused a more serious accident. Then there would be 2 accidents and one less responder. To be called an EMT it takes a few weeks.. to be called WFR it takes a few days. So I am always amused that people hold credentials in such high regard. Edit: Oh please.. you're going to go off on a "look how hardcore i am, i'm a medic blah blah" then hide behind Rule #1 lol All I said was you don't need the kitchen sink. you can be all sensitive about it if you want but you don't need all that gear. And you shouldn't tell people to perform surgery that will get them sued.

Are you a medical professional?

Donald - its not about "trying" to be anything. Its about being reasonable about what you can really accomplish and like all gear selections, minimizing extraneous stuff. I'll agree with you on a few 4x4's worth their weight. I forgot I have 2 stuffed in my helmet (probably not even useable after over a decade up there) but I have cut off and used the sleeve of my poly-pro (on myself) with no adverse effects. I skip the drugs and the epi-pen stuff mainly because: that shit perishes way quicker than I ever use it, and I don't need it personally (and like I tell my wife, its all about me). When kayaking or sailing for extended periods, I have dermabond (I love the stuff --would be interested in Scott O's opinion vs suture kit, cleanliness then becomes key)

I've also rigged an IV of D5W using marmot piss, GU, and my camelback but this is only for true Billy Bad-asses such as myself....

It helps to look at the two types of emergencies you will encouter (other than minor scrapes and cuts) Either the person that get hurts or has a medical issue will self extricate (with or without help) or they will have to wait for rescue. If they self extricate, injury/patient stabilization and pain meds are helpful. Weather you want to carry Sam splints or use your packs frame sheet or sticks, be able to stabilize an injury and give some pain/allergy/ASA meds depending on the medical emergency and extricate.

If the person needs rescue, stabilize, treat for shock, keep hydrated and fed if possible, and keep them comfortable! Bleeding control, basic pain/allergy/ASA meds, water and/or electrolyte mixes, and space blanket or your warm clothing to keep them warm and comfortable.

People will survive when they can and have the will. Read all the stories on these forums of folks crawling 10 miles, uphill, in the snow, with broken limbs. Or those that wait for help for 30 hours with the help of their buddies, an old t shirt, and a sleeping bag. Our job as professionals should be keeping the scene calm, doing what we can with what ever we have to stabilze, and helping the patient be more comfortable, hydrated, and free of shock as we extricate them or wait for help.

It's great to have bandaids, 4x4s, steri strips, duct tape, cloth tape, trauma dressings etc... for basic wound care but you have to decide how much shit you want to carry.

Scott O wrote: Your plan included doing CPR for six hours?

Probably not, but we had no way of communicating with our medical director, and I'm not legally allowed to quit with out a doc telling me to, so possibly. Also I've have had people revive with just good CPR so may as well give it a shot, at the very least if we end up having to stop doing CPR due to exhaustion, I can say that I did all that I could do, instead of saying, "no I didn't try CPR because I didn't have a mask"

Donald Kerabatsos wrote: Sterile 4x4 just means it comes in a closed package as opposed to just having some gauze float around your pack. You'd rather have a dirty t-shirt I guess?

I was being tongue in cheek, I apologize. I actually carry gauze as well, just not sterile.

The question is one of where do you draw the line, and prioritization. If I have a large open wound after a fall up in the back-country: 1: stop the bleeding, 2: Keep me calm. 3: Get help.

I could care less if someone uses a dirty shirt (most likely) or "sterile" 4x4's, the first three things are the most important. Given that everyone is going to be a bit panicked, just focus on those.

Actually, if you keep the 4x4's in your helmet go ahead and use the t-shirt, its probably cleaner.

Regardless, I am going to get pumped full of IV antibiotics.

The problem with a lot of this, in particular the emergency cric, is not only how to do the procedure (extremely dangerous), it is when to do it. Did you do everything else first? Are you making the right assessment? Assessment before implementation. Don't take someone who just fell 40 feet on to their back and jostle them around trying to get that cool looking SAM splint on. Don't try to splint a fracture on the guy who has an obvious head injury and is trying to run away. Just keep him calm.

The most valuable thing you can bring to any emegency situation (assuming you are not at work) is calm, good judgement, good assessment skills, and an ability to prioritze. Everything else is icing on the cake. Hold off on that cric for a second, do you really know what is going on before you stab someone in the neck? Not a good thing to be encouraging people to do.

20 years of climbing and I have never seen a bad accident or been a part of one (knock on rock). I never carried a first aid kit till I became an RN. Now I have a very basic one. Benadryl, actiavted charcoal, aspirin, ibuprofen and percocet. Some tape, some gauze, a face mask, gloves, tourniquet, superglue and that is about it. No IV kits, no bags of normal saline that have been sitting in my hot car for a year (think those are still sterile?), no sam splint. I leave my kit at the base of long climbs. Sometimes I forget to bring it all together. I use my kit constantly for skin repair when I am out bouldering.

John D wrote: Probably not, but we had no way of communicating with our medical director, and I'm not legally allowed to quit with out a doc telling me to, so possibly. Also I've have had people revive with just good CPR so may as well give it a shot, at the very least if we end up having to stop doing CPR due to exhaustion, I can say that I did all that I could do, instead of saying, "no I didn't try CPR because I didn't have a mask"

So become a WFR, or WEMT, or go to a WUMP class. Wilderness protocols exist for a reason and termination of CPR after 30 minutes is one of those reasons. Regardless, i doubt the government of whatever part of rural africa will give you hard time about discontinuing CPR before the 6 hour mark.

Paramedic (with significant "bush doc" time in Alaska). I'm now a 2nd year M.D. student.

I bring to the crag:

Benadryl, a triangle bandage, athletic tape, hand sanitizer and nitrile gloves. Maybe a nasal airway and duct tape. Benadryl is about the only OTC med that can save a life in the woods. Plus it's damn near magical (allergies, anaphylaxis, nausea/vomiting, pain, insomnia).

Travel:

I went to my family doc for antibiotics like cipro and keflex, some zofran for nausea and an epi pen just in case the antibiotics don't sit well. Altitude drugs per necessity.

Don't really need much else.

outside of a lightning strike, CPR in the climbing backcountry is next to useless. Maybe for some blunt force trauma scenarios as well, but personally, "my own health and safety would become compromised" after about 10 minutes max of giving it the ol' college try.

(I've had to do it -with a partner- for over an hour under orders of medical direction.....CPR that is.....guy remained dead the whole time. Turned out the Doc knew the guy! never help out in a small town)

excepting cases of severe hypothermia, which never happens in the outdoors.

Buff Johnson wrote:excepting cases of severe hypothermia, which never happens in the outdoors.

CPR is of questionable value in hypothermic arrest and may be detrimental, although this is an area of ongoing study and debate.

Yeah Buff. You tryin to kill someone?? :) If Severe hypothermia, I'd hesitate to just start pumpin on 'em in the backcountry. The heart is pretty twitchy under those conditions....and definitive warm up is not likely an option.

I didn't imply to start efforts with an underlying rhythm present.

Although Scott's statement simply is not correct. We have more than just random-chance outcomes if we effort from the field and all the way to the table. The question marks are rescuer safety and effectiveness while in field transport, which is just reality of the situation.