Outdoor recreation is gaining popularity in India at an unimaginable pace. An opportunity to explore beautiful valleys, high passes, raging rivers, deep gorges and sharp ridges provide an adrenaline rush to our system. Those who spend time seeking these experiences should also know the value of being safe on their adventures.
Outdoor recreation has an inherent risk attached to it. You may be hours or days away from definitive medical care. Seldom do trekking and adventure companies have a doctor available at camp. A trek leader with training in First Aid can play a crucial role in caring for medical patients and organizing an evacuation.
If you have signed up for a trekking experience, here are a few items we suggest you carry in your personal first aid kit that can really come in handy. Do keep in mind that this is a recommendation. Actual items and numbers would depend on your medical condition, expedition style, group size and duration of program.
Wound management or First Aid kit
Soft tissue injuries are the most common injuries that can occur in the backcountry. From small scraps to deep cuts they can occur due to negligence. It is a challenging task to keep the wound clean of dirt and prevent spread of infection. You need to pay extra attention once you have developed an infection in the wound. This requires washing the wound every 12 hours with clean drinkable water and redressing. Here are few things that are easily available at your nearest medical shops to stock in your first aid kit :
Surgical or examination gloves – I cannot emphasize enough, the importance of zero contact with any kind of discharge from wounds. Whether it is blood or pus, it’s best for you to create a barrier against it while treating a wound & handling dressings. There are a variety of materials used for gloves Latex, Nitrile, Vinyl are few examples. Check that you or the patient are not allergic to any of these materials.
Irrigation syringe – An irrigation syringe can help in washing off the dirt that may get stuck in the wound. Pouring clean drinkable water from a bottle would also work, however it doesn’t provide the pressure you need in order to flush the debris out of certain wounds. Using a 20 or a 50 ml syringe can be a tedious job; but it does serve the purpose and also saves water.
This is more important when you are on trail with limited water supply. Untreated water may have bacteria that might get left behind in the wound, which in turn can lead to infection.
Antibiotic cream – Once the wound has been cleaned, the next step is to do the dressing. Traditionally we have the understanding that antibiotic ointment should be applied right on the wound. Our body is capable of healing cuts and wounds, if we keep it healthy it can do the job perfectly well. For minor cuts you may apply the antibiotics on the outside perimeter of the wound. This will help in creating a barrier against bacteria that might make its way in. You may also add antibiotic ointment on top of a gauze pad or roll.
Gauze pads – Gauze pads are loosely woven translucent fabric. For wound dressing these pads are generally made of cotton which helps in absorption of blood or any other discharge from a wound.
You may place a gauze pad directly over the wound. They come in various sizes but 2 by 2 or 4 by 4 are ideal sizes to have in a kit.
Gauze roll – It is similar to a gauze pad in its material. It consists of a certain length and width of translucent cotton mesh. Gauze rolls are the most important for securing a dressing on a wound. There are various width sizes and lengths available in the market. From 2” to 4“. Based on your needs, a 2” can be a good size. They usually come wrapped in paper. Hence, they are at risk of being exposed to water and dirt. Securing them in a ziploc is a good idea.
Athletic tape – 1 or 2 inches wide tape which usually has better adhesive than the commonly available band aid, especially in an outdoor setting. You may apply a band aid on a small cut and re enforce that with the athletic tape.
Q tips – Cotton q tips can be helpful to spread ointments without touching wounds.
Lighter – This is helpful to sterilise the tweezer or safety pin, if you require to use it on an open wound or extract a splinter.
Safety pin – Safety pins are lightweight and are helpful to get splinters out. Sterilization of such tools prior to bringing in contact with open flesh is advised. Do not use a rusty pin on your skin.
Tweezer – In case of debri accumulation on the wound, you would need tweezers to pull out the small particles like dirt, pebbles, glass etc. Remember to sterilise prior to application either by burning the tip or applying alcohol based rub or sanitizer.
Toothbrush – A soft bristle toothbrush can be a nice tool to gently clean up around the wound. A little bit of mild soap and water can also help you with this job. Do make sure that the soap doesn’t enter the wound. Not a necessity.
Trauma shears or scissors – Trauma shears or scissors come in handy to cut tape or gauze roll etc.
Medical waste disposal bags – You probably do not want to leave any trash up on the mountains let alone your medical waste. Medical disposal waste not only looks dirty it also increases the chances of infection to others. These bags are not expensive and can help in maintaining the pristine nature of the environment.
Hydrocortisone – Hydrocortisone is a steroid based ointment or lotion that can be used to treat skin swelling, rash, insect bites, stings and prickly heat. Do not use it on eyes. You may put it on your face if prescribed by your doctor.
Medications – Be sure to consult with your physician prior to taking any medication, its dosage and frequency to avoid contraindications and reactions.
Anti allergic – Allergic response is usually triggered by food, material or environment that cause uncontrolled discharge of histamines in our body. Carrying generic anti allergic meds or antihistamines is a great idea on your trek. Be sure to check with your doctor prior to doing that. Cetirizine and Levocetirizine are some commonly available anti allergy medications.
NSAIDs – Pain meds like Ibuprofen with 200 mg strength can be a good addition in a first aid kit. It can be used for muscle pain. NSAIDs may have an adverse effect on some people, please check that the patient is not allergic to such medication.
Fever meds – Acetaminophen & Paracetamol are easily available over the counter drugs for fever and body pain. Consult with your doctor on the dosage and frequency.
Water purification tabs – As you move for hours covering ground and or gain altitude, water is essential to help in acclimatization. On an average, it is suggested that a person should consume 3-4 (depending on factors like age, weight, exercise) litres of water in a day. We recommend that you carry 2 water bottles of 1 litre each with enough water purification tabs to last your trek. These tablets take 15-30 mins to dissolve and give you good water to drink.
Diarrhea meds – Consult with your doctor about which medicine would suit you best for diarrhea.
Lozenges – Keeping some throat lozenges in your medical kit can be helpful in suppressing coughing.
Prescribed medication – Remember to take your prescribed meds. We recommend taking 2 sets of your prescribed med. Carry one in your day pack all the time. Talk to your trek leader and tent mate about your medical condition and your plan to manage it while on the trek. If possible, take your medicine at the same time everyday this will help you and others to remember.
Band aids – Can be added. It does require some reinforcement, by athletic or duct tape. Depending on the days you are spending 10-12 is a good number to carry.
Sugar candy – Hypoglycemia or low blood sugar may occur due to physical activity for an extended period of time. Hypoglycemia can lead to lack of energy, lethargy and other complications like brain damage.
If you are a diabetic patient, managing your blood glucose level is even more important. Irrespective of the type of diabetes. Sweets, candy, juice or chocolate can be really effective for instant energy and increasing blood sugar level.
Oral Rehydration Salts
Balanced amounts of salts and sugar are very important for normal functioning of the body. When you are covering ground and or gaining altitude your body is constantly consuming electrolytes and salts. Lack of salt can cause painful cramps and can progress to other complications if left unaddressed. Taking ORS with water is helpful for hydration and replenishing salts & electrolytes in the body.
Digital thermometer – A digital thermometer can be a good addition in your first aid kit. However it is challenging to get an accurate reading in uncontrolled environments. While taking temperature make sure to clean the thermometer prior to & after any use by alcohol wipes or alcohol based sanitizers.
You can use a digital thermometer to record body temperature in two ways. Below the armpit (Mid axillary, my preferred way) or orally (under the tongue).
Usually there is a difference between temperature taken orally or under the armpit. Be sure to add a degree in the temperature displayed on your thermometer, if taking mid axillary. Prior to leaving for the trek check that the thermometer is working and the battery is good to last for the duration of the trek.
Duct tape – Duct tape comes in various sizes and lengths. You can roll some amount of it from a large packaging on to a pencil or on to your hiking pole. This is a helpful tool for general repair (except tent materials), which sticks for longer than other tapes. Duct tape can also be applied on the back of heels or on the outside of toes to prevent forming of blisters.
General Considerations; Where to pack?
You want your first aid kit to be easily accessible. If you are carrying a backpack, store it in the brian or the top pocket. If you are only carrying your day pack keep it on top. So you don’t have to empty the whole pack while looking for it.
How to pack?
Spending time on how to organize your FA kit can really help you save from the frustration of locating small things in the time of need.
You can buy first aid kits specially designed for these purposes from adventure stores or reliable online platforms. Organizing your kit in a few ziplocks can really save time and will also help in keeping your kit protected from rain.
Amit Arora, Outdoor Leadership & Wilderness Medicine Educator.
Reach out at firstname.lastname@example.org, to inquire about Wilderness Medicine & Outdoor Leadership training for your organisation.