One of my students asked me to write a blog about putting together a first aid kit. Since this is an important piece of gear that all paddlers should carry with them, I will try to make some suggestions on getting training and assembling a good basic kit. I am not a doctor or medical professional. I carry certifications for Wilderness First Responder and CPR as an ACA kayak and canoe instructor, but there are many people out there who have a lot more knowledge and experience in diagnosing and treating illnesses and injuries in the outdoors than I do. I merely hope to encourage my kayaking students, and other novice paddlers, to give some thought to making and carrying a first aid kit as part of the gear carried on all trips, whether lasting just a couple hours or a couple weeks. You are hereby advised to seek additional information and training from more recognized authorities on the subject. Having now given you my disclaimer. . .
What you decide to carry with you is likely going to depend on several factors like
- where you are going.
- what you will be doing.
- how long you will be gone
- how many people will be using the first aid kit.
- what first aid/medical training the people on the trip have had.
- how much space/weight you have available to carry a kit.
Leaving the question of big expedition kits, let’s assume that most people are just looking to put together a basic first aid kit to cover day trips with groups of 1-5 paddlers. The first question you need to address is the issue of first aid training. A first aid kit does you no good if you have no idea how to recognize and treat the likely injuries and illnesses that you will encounter on a trip. In fact, many of the first aid situations that you are likely to face on a paddling trip may not be treated by anything you are carrying in your kit. Add to that the fact that it’s always better to prevent an illness or injury rather than having to treat it after it occurs, having a good knowledge base is more important than anything in your first aid kit.
While basic Red Cross first aid courses are better than nothing, these courses are designed for people and situations with ready access to the 911 emergency system. Once you recognize an emergency, your treatment plan is generally to call in the professionals and keep the patient and bystanders safe until they arrive. The emphasis is on providing treatment for those injuries or illnesses that will kill in minutes (i.e. heart attack, respiratory distress/arrest, severe bleeding) before the paramedics can arrive.
For a paddler, a better choice for first aid courses is one of the wilderness first aid courses offered by SOLO, Wilderness Medical Associates, or NOLS Wilderness Medical Institute. These programs focus on the unique issues faced while trying to provide treatment for an injury or illness when professional help may be hours or days away. By virtue of the fact that paddling is a slower-moving mode of travel that often takes us off the beaten path away from roads, this is more likely to be the situation that we will face if someone in our group becomes ill or hurt. Wilderness first aid courses are much longer in duration than a standard Red Cross first aid class, but they are going to cover much more information in terms of identification and treatment as well as methods to evacuate someone who is no longer able to get himself to the take-out.
As far as the actual first aid kit that you carry, you should think about what the most likely issues are that you will need to deal with. For you own protection, when you need to treat someone, your first aid kit should contain several pairs of gloves (nitrile or latex) to protect you from contact with blood and other body fluids. You should also carry a breathing shield/barrier of some kind in the event that you need to provide rescue breathing. You will also want to have some hand sanitizer and things like alcohol prep pads to protect yourself and the patient from the transfer of bacteria and germs between people as well as the introduction of germs into a wound.
In order to document your treatment of a person, you should carry a small notebook and pencil. This will help you keep track of what you have done, document information the patient and witnesses give you, identify changes in the patient’s condition over time, and pass that information on to the professional care-givers when you are able to finally transport the patient to more definitive medical care. Wilderness Medical Associates has small booklets of what are called “SOAP” notes (SOAP stands for Subjective, Objective, Assessment, Plan to remind you to cover all these aspects in treating a patient.), but any notebook will work if you know what information you need to record.
If you are not a medical professional who regularly treats illnesses and injuries, you may also want to include a compact first aid booklet for reference. I carry the Wilderness Medical Associates “Field Guide of Wilderness & Rescue Medicine”. Adventure Medical Kits publishes “A Comprehensive Guide to Wilderness & Travel Medicine which is included in many of the Adventure Medical first aid kits. Both of these books are only about 4″x6″ and fit easily into a first aid kit. Adventure Medical Kits also publishes “A Comprehensive Guide to Marine Medicine” which might be a good book for a sea kayaker’s first aid kit.
Conditions such as sunburn, dehydration, motion sickness, hypothermia, and hyperthermia are best prevented in the first place, which is why you want to get the training needed to recognize early symptoms and take quick preventative action. If you do need to treat them, you are often using items that aren’t normally associated with your first aid kit – things like plenty of extra water and clothing to protect someone from sun, wind, or cold. In wilderness first aid, you are taught to make use of everything you have at your disposal, not just what is in your formal “kit”. However, in your first aid kit, you may want to carry an emergency space blanket, anti-nausea medication, high energy snacks, sunscreen, and burn cream.
Common minor injuries that may need treatment while on a trip would be cuts and blisters. You will need to have a way to clean and irrigate a wound. Your kit should contain a good pair of tweezers for picking debris out of a wound. For irrigation, you can carry a plastic sandwich bag with a tiny hole cut across one corner of the bag. Fill the bag with clean potable water (or an iodine/water solution) and direct the water into the wound through the small hole in the bag. There are also plastic syringes (no needle) that come with some kits that work very well for this purpose. Many of the commercially available kits will also include some triple antibiotic ointment for application to the cut after cleaning and before bandaging.
The challenge with treating injuries when on a paddling trip is that the environment is often wet making it hard to apply bandaging materials and padding. You should try to carry some sort of small microfiber towel that you can use to dry the skin around the wound. When purchasing your supplies, look for bandages and tape that have adhesives that will stick in wet environments. Tincture of Benzoin can be used to make adhesive bandages and tape stick better.
I also like to get some of the band-aids that are made from a more flexible fabric since the patient will most likely be moving around as he/she continues to paddle. The flexible bandages conform to the moving body parts better. For blisters, you should carry mole skin and mole foam to pad and protect the area.
Most bleeding can be stopped with well-aimed direct pressure to the wound with a gloved hand and maybe a gauze pad to soak up the blood. A bandage is used to cover and protect the wound once the bleeding has stopped. To bandage a larger wound, carry 4″x4″ gauze orTelfa pads and adhesive tape. 2-inch wide roller gauze can also be used to hold a bandage in place when tape is not practical. In some cases, you may need to hold the edges of a cut together to prevent it from opening up again. Adhesive tape will work just fine, but if you want to get fancy, you can carry some butterfly bandages (wound closure strips) in your kit.
To cut tape, gauze, and mole skin, I like to have a trauma shears in my first aid kit. They aren’t really all that expensive (under $10) and they can be used to cut through all kinds of materials that would be too thick for your average scissors or knife. Besides the tweezers that I mentioned earlier, some people may want to include a needle to help remove splinters from under the skin along with a method to disinfect the needle before probing with it under the skin.
Other items to include in your kit are a bandana or triangle bandage, several blanket/diaper pins, elastic wrap bandage, and duct tape. Some optional items for a more comprehensive kit might include SAM splint, a thermometer, and a stethoscope.
For medications, you will certainly want to carry any personal medications that you may need for your own medical conditions (for example, an emergency inhaler if you have asthma, emergency insulin if you are diabetic, Epipen for bee sting allergies). The generally accepted assortment of medications you will most likely want to carry includes aspirin, acetaminophen (Tylenol), ibuprofen (Advil), diphenhydramine (Benadryl), and meclizine (Dramamine). You may have other personal favorites like Tums or Pepto-Bismo that you use occasionally. While I don’t hand this stuff out as an instructor, you have more freedom to self-medicate when assembling your own kit.
Some of the better pre-packaged first aid kits available for purchase in the stores separate the supplies into individual “modules” that are specific to the kind of injury or illness being treated. This can be helpful if you have a large “expedition” first aid kit. Having the supplies organized and packaged in smaller zip lock bags for specific situations can make it easier to find what you need in an emergency. It also makes it easier to grab just the supplies you need for a day trip (you can grab the wound management module and leave the dental module behind).
All of your first aid supplies will need to be kept dry, so you will have to get some kind of waterproof container or drybag that can be used to protect your first aid kit from getting wet. There are several very good, and in some cases fairly expensive, products that will work very well and be very durable such as Pelican cases which come in a wide variety of sizes and provide protection from crushing as well as moisture. For small kits, you can find other containers that are less expensive and also work very well. If you have any old wide-mouth Nalgene bottles containing BPA, you may not want to drink out of them anymore, but they work very well as waterproof containers for small first aid kits and repair kits. Some paddlers will pack two first aid kits. They will keep a larger, more comprehensive kit in a hatch for treating someone on shore. A smaller, more easily accessible kit will be in a day hatch or in the pocket of a PFD to handle the more immediate cuts and blisters, low blood sugar, nausea, etc.
Once you have created your first aid kit, keep in mind that you should be checking it over periodically. Medications and antibiotic ointments expire and will need to be replaced. The adhesive on old bandages may get dried out and lose its ability to stick. Old tape may have melded into a gluey mess that is impossible to unroll and use. A leaky dry bag or container may have allowed the contents of your first aid kit to become wet, moldy, and useless. At the very least, you need to restock the band-aids and medications after using these supplies. You don’t want to go to your first aid kit in an actual emergency and find that the supplies are missing or unusable.
As the subject of first aid and first aid kits is an extensive as well as an important one, I expect that there are things that I have missed. If you notice an item that I have not mentioned (and should have) or would like to add some of your personal experience, I would be glad to have you comment. Please ask questions if something I have said is not clear. As I said at the start of this article, I am not, nor should I be, considered an expert on this topic. First aid is something that I have to know a certain amount about as part of my job as an instructor, but I don’t even play a doctor on TV. For those of you reading this, if you haven’t already done so, you need to get out and take some first aid training and put together a decent first aid kit that you know how to use if and when the occasion arises. Here’s hoping that band-aids are the only thing you’ll ever need out of your kit.