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EMTs and paramedics – what do you carry?
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By Arthur Nisnevich
From Boulder, CO
Jul 23, 2013
Skin the Cat, 11a @ The Zoo
I'm curious to hear from those who work professionally as EMTs and paramedics (wilderness or urban), what medical gear do you carry in your jump kits/first aid packs/backpacks when you go climbing or backpacking?

Do you have different kits for different types of outings? e.g. multipitch vs cragging? multi-day backcountry vs day hike? Winter essentials vs summer?

Do you have a favorite pack or bag that you use to put your contents into?

Just to be clear – there are tons of generic lists out there for "what goes into a first aid kit," so I'm really looking for good rationales and strong opinions on carrying certain things vs. others. What do people think are essential vs non-essential items specifically for climbing outings? Especially if you carry a minimalist kit or 'everything but the kitchen sink.'

BSI, scene safe!

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By ze_dirtbag
From TBD
Jul 23, 2013
cottonmouth
tourniquet, iraqi bandage x 2, sam splint, shears, tape, 4x's & bsi. if it's going to be a big trip, i'll throw in quick clot bandages......buy the bandages, not the powder and 1 or 2 iv setups (16,18 and 20 ga, macro drips, start kit, and 1000cc NS) It doesnt hurt to bring along some ibuprofen, antiseptic and vit e......

p.s.- i've been trying to find somewhere i can get my hands on some diamox

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By Taylor-B.
From CO & AK
Jul 23, 2013
Mt. Churchill, University Range
For cragging/alpine kit I only carry some bulky gauze, 2in cloth tape, anti-biotic ointment(for blisters), Xeroform, benadryl, iodine tabs and wear a cotton t-shirts to soak up blood, synthetic materials just let the blood soak through. I just keep this in a zip lock bag. And most important a cell phone or The Spot device.

In the expedition kit I'll bring some broad spectrum anti-biotics, Zofran, OTC meds, wound cleaning and management supply(especial non stick gauze, eye irrigation cup, suture material that is used mostly for gear repair.

Most doctors will prescribe you drugs for wilderness travel. Such as anti-biotics, zofran,altitude meds, epi-pens, ect.

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By Sorden
From inside the Bubble, Colorado
Jul 23, 2013
~Here to party~
Not a paramedic or EMT here...

+1 for the Quick Clot but I always have it, regardless of the type of day I'm planning.

Here's why: if I'm going to hump a med kit with me when I climb, wherever I climb, I'm packing for the worst, which is typically trauma, which is typically bleeding. One of my partners was an Army medic and swore by Quick Clot (the Army version is called "Combat Gauze.") Expensive, but it's what I want to have with me in an emergency.

Edit to add:
I carry the North Face Base Camp Travel Canister. I even bought a red one so it could be easily recognized as a med kit.

As a habit I started long ago: on the outside of each of my med kits I've written in Sharpie these words, "DON'T PANIC." This is borrowed from Douglas Adams. I don't respond to emergencies for a living so I need something to remind me to keep my head.

Since most of us don't carry the med kit up the route I will keep a small roll of medical tape in my chalk bag zipper pocket. If you need a bandage and you're several hundred feet above your pack, you can do wonders with your t-shirt and tape.

Kinesio Tape!!! - If you have a sprain or some other muscle injury that needs compression and don't want to carry bulky ACE wrap, this is the stuff.

I also carry an epi-pen and a small space blanket among the trivial list of odds & ends.

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By Taylor-B.
From CO & AK
Jul 23, 2013
Mt. Churchill, University Range
I've seen the quick clot application get blown into multiple rescuers and military persons eyes. Nasty shit, If there's a lick of wind I would think twice, especially if people are in tight quarters,clipped into anchors and can't move readily.

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By Jason Todd
From Ranchester, WY
Jul 23, 2013
Moss
A roll of tape.


For longer trips into the backcountry, I'll add a pair of gloves, a few "bandaids", a couple of 4x4s, a roll of coban wrap, moleskin, and some ibuprofen.

Beyond that everything else is improvised. When you are hours from nowhere, there just isn't a whole lot you can do if the above items can't get your patient back to "stable".

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By Buff Johnson
Jul 23, 2013
smiley face
Taylor-B. wrote:
I've seen the quick clot application get blown into multiple rescuers and military persons eyes. Nasty shit, If there's a lick of wind I would think twice, especially if people are in tight quarters,clipped into anchors and can't move readily.


He could still be talking about gauze or the pads; the powder is pretty much going away, and should go away for that matter.

epi is something else to also consider with some of the med lists provided.

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By Jace Mullen
From Oceanside, Ca
Jul 23, 2013
Wilderness EMT here currently working for a rural 911 system (thats also a major climbing destination).

For a day trip I only care those things that I absolutely cannot improvise. That's pretty much tape, a sterile 4x4 or two (only the part touching the skin should be sterile). Maybe an ace wrap.

The further out I get the more I add. For example, if I'm in Joshua Tree I'm not worried about splinting but if I'm in the high sierra it becomes more important so I'll add an ace wrap or two. Light is right though.

I also always have some ibuprofen with me because it can help in a lot of situations.

In the backountry I worry about ABC's (not bringing any airway adjuncts or pocket masks though. I can make do without them. CPR without defibrillation/ALS will not be likely to work anyways). Bleeding control is next hence the sterile 4x4s and then improvise an further bleeding control.

An expedition would include a big ass first aid kit as you have to worry about more long-term care (infection control/wound closure) and you want to be able to handle the minor things well so the trip isn't ended by something stupid. A SAM splint would definitely be in any expedition kit.

Let me know if you have any questions and I can try to elaborate on what I said (I realize it's kind of an incoherent ramble)

EDIT: Also, of course, a pair or two of nitrile gloves. BSI is clutch but I can be pretty sure my partner doesn't have any deseases so it's more to keep my dirty ass hands from him.

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By MRock
Jul 23, 2013
Split shin after 5.9+ R lead
+1 for cotton t shirt.

I like to have an abundance of butterfly closures, as I can never get them to stick.

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By Jace Mullen
From Oceanside, Ca
Jul 23, 2013
MRock wrote:
+1 for cotton t shirt. I like to have an abundance of butterfly closures, as I can never get them to stick.


Spend the extra cash and get some Steri-Strips as well as some Tincure of Benzoin. Just make sure you have irrigated the wound with 500-1000MLs of water before you even think about closing it. Infection is no fun for anyone.

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By stephen crimin
From Provo, Utah
Jul 23, 2013
Deep water soloing at lake powel!
I am not an EMT but i'm a WFR but here is what NOLS Wilderness Medicine Institute recommends to carry. Trauma shears, tweezers, safety pins,oral thermometer, rescue mask, emergency blanket, 2nd skin dressings, antibiotic ointment, knuckle and fingertip fabric bandages, 3X4 non-stick gauze pads, Coban Wrap (7.6cm by 4.6 cm)
1-inch cloth tape, wire or SAM splint, gloves, 12cc irrigation syringe, providone-iodine solution, antiseptic towelettes, sterile scrub brush, wound closure strips (steri-strips), tincture of benzoin swabs, moleskin dressing, 1X3 fabric bandages, 4X4 sterile gauze pads, 3-inch conforming roll gauze, transparent film dressing, 4-6 inch elastic wrap (10.2 - 15.2cm), and Triangular bandages.

there are so many injuries that could potentially happen rock climbing, so by the nature of the sport, if you are responsible you need to carry supplies for an array of injuries. I work as a medic at a camp and I think these are all necessities, however, you could get by without the trauma shears, oral thermometer, tincture of benzoin swabs, and transparent film dressing. it woudld be wise to throw in some ibuprofen, asprin, or tylenol.

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By MRock
Jul 23, 2013
Split shin after 5.9+ R lead
Jace Mullen wrote:
Spend the extra cash and get some Steri-Strips as well as some Tincure of Benzoin. Just make sure you have irrigated the wound with 500-1000MLs of water before you even think about closing it. Infection is no fun for anyone.


Good advice! im going to get some CTB and steri strips for my kit

thats something else i forgot to mention, plastic sandwich bags. cut the corner off for wound irrigation, then use it to put all the bandage waste in.

FLAG
By Jace Mullen
From Oceanside, Ca
Jul 23, 2013
stephen crimin wrote:
I am not an EMT but i'm a WFR but here is what NOLS Wilderness Medicine Institute recommends to carry. Trauma shears, tweezers, safety pins,oral thermometer, rescue mask, emergency blanket, 2nd skin dressings, antibiotic ointment, knuckle and fingertip fabric bandages, 3X4 non-stick gauze pads, Coban Wrap (7.6cm by 4.6 cm) 1-inch cloth tape, wire or SAM splint, gloves, 12cc irrigation syringe, providone-iodine solution, antiseptic towelettes, sterile scrub brush, wound closure strips (steri-strips), tincture of benzoin swabs, moleskin dressing, 1X3 fabric bandages, 4X4 sterile gauze pads, 3-inch conforming roll gauze, transparent film dressing, 4-6 inch elastic wrap (10.2 - 15.2cm), and Triangular bandages. there are so many injuries that could potentially happen rock climbing, so by the nature of the sport, if you are responsible you need to carry supplies for an array of injuries.


(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.

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By Arthur Nisnevich
From Boulder, CO
Jul 23, 2013
Skin the Cat, 11a @ The Zoo
MRock wrote:
Good advice! im going to get some CTB and steri strips for my kit thats something else i forgot to mention, plastic sandwich bags. cut the corner off for wound irrigation, then use it to put all the bandage waste in.


Cool tip! Less bulky than a sterile syringe, that's for sure.

I see the absence of a SAM splint in most of these lists – curious, why? Given the versatility of the tool, its relative low weight & packability, and the volume of orthopedic injuries in rock climbing, I would think most medics would want to carry it somewhere in their pack. Obviously you can improvise w/o it, but in your guys' opinions, do its benefits not outweigh the cost of owning & carrying it?

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By Arthur Nisnevich
From Boulder, CO
Jul 23, 2013
Skin the Cat, 11a @ The Zoo
ze_dirtbag wrote:
tourniquet, iraqi bandage x 2


I assume you're talking about these? If so, why the extra tourniquet?

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By David prsn
From Tustin
Jul 23, 2013
Temple crag, dark star
In my truck for longer trips. Conforming splint, plenty of trauma bandages/ 4x4/ kurlex/ swathe. Occlusive dressings! (great for rope burn/ road rash), trauma shears,

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By Jace Mullen
From Oceanside, Ca
Jul 23, 2013
Arthur Nisnevich wrote:
Cool tip! Less bulky than a sterile syringe, that's for sure. I see the absence of a SAM splint in most of these lists – curious, why? Given the versatility of the tool, its relative low weight & packability, and the volume of orthopedic injuries in rock climbing, I would think most medics would want to carry it somewhere in their pack. Obviously you can improvise w/o it, but in your guys' opinions, do its benefits not outweigh the cost of owning & carrying it?



For longer trips, I will cary one. But if I am anticipating >2 hours to definitive care, or rescue arrives on scene, I will not bring one. The reason is that there really is no reason to be moving shit around without pain management unless there is diminished circulation/nervous (CSM/PSMC) response. If so, I can make do with clothes and an ace wrap after applying traction in line. Otherwise, the ground is doing a fantastic job of splinting for me.

For cragging, I will probably have ALS soon enough that I'm sure my patient would rather me wait until they can have pain management before I go moving stuff around so no SAM splint then either.

SAM splints definitely have their place, and I LOVE them. I just don't think the weight/bulk is justifiable for shorter trips or trips within 2 hours of full ALS capabilities. For shorter trips, a ACE bandage or two will have many more potential uses as well as allow me to make a passable splint. Also, if I show up on scene and you've already splinted it, you better believe I'm taking that splint off so I can assess the injury.

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By Dean Hoffman
Jul 23, 2013
Benadryl, Epi pen, and tape are more than enough for anything short of an expedition. Without Benadryl the Epi is just postponing the inevitable, and tape will get you started on pretty much any type of trauma dressing. Take a wfr and learn to improvise.

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By ze_dirtbag
From TBD
Jul 23, 2013
cottonmouth
i forgot about super glue, i've used it for anything from flappers to gluing a guys scalp shut in rugby....versatile and cheap.

i saw one guy talking about the army bandage & quick clot etc. check out the iraqi bandage, its a hook & pull pressure dressing and you can get them impregnated with the quick clot....so in the end, you have a bulky dressing, pressure dressing, tourniquet, and quick clot.....just remember the same rules stand for this as with powdered quick clot, if it's bleeding profusely, soak up as much of the excess blood as you can before applying the quick clot....since it's inside a bandage it doesn't actually go down inside the wound so you need to make what you have as effective as possible

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By GLD
Jul 23, 2013
ze_dirtbag wrote:
i forgot about super glue,


Super glue has it's place but steri strips are better in case you need to re-open up the injury to manage an infection. Much the same reason WMI doesn't recommend stitching in the wilderness.

Of course, if you can get them to a hospital in a reasonable amount of time it is a great lightweight tool that the hospital can work around (not as easily as steri strips though).

FLAG
By rging
From Salt Lake City, Ut
Jul 23, 2013
CoR
Two things, a knife and skills. You can get out of anything with that, oh and duct tape. Shoot that's three things.

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By Jace Mullen
From Oceanside, Ca
Jul 23, 2013
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.

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By stephen crimin
From Provo, Utah
Jul 23, 2013
Deep water soloing at lake powel!
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.

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By Donald Kerabatsos
Jul 23, 2013
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

FLAG
 
By Josh Kornish
From Missoula, MT
Jul 23, 2013
Humboldt Bouldering
Maybe tape.

W-EMT

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By Zirkel
From Bishop, CA
Jul 23, 2013
Owens Gorge.  Mt Tom in background.
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.

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