Alpine (rock) first aid kit?

Don’t forget about PPE for the person treating the injured. A few pairs of nitrile/latex gloves are invaluable and weigh nothing. 

NateC wrote:

I disagree with Blake. Life threatening bleeding is not hard to learn to identify and it’s better to apply the TQ than not have one. There’s decent research showing that improvised tourniquets are far less effective than purpose made like a CAT, indicating that improvisation is more difficult than folks believe.

Agree, indication is not an issue.

We looked at a bunch of this research when I took my WEMT in 2018. If memory serves, the research is weak at best (or was in 2018). The only large study basically compared a complete lay person given a designed TQ to a lay person given a bandana and basic instructions (and nothing to use as a windlass), compare the results. It read like it was funded by Big-TQ (sarcasm). And the other large meta analysis was in combat settings. Neither of these are good comparisons to a trained wilderness first responder using principles and equipment they've learned and practiced. Which brings us back to the one thing folks can almost always agree on- get trained, stay practiced.

I'm open to having my mind changed. But also, a decade of SAR and I've never seen first hand or even heard first hand of someone needing a TQ... So it'll take a lot of convincing to get me to add one to my alpine first aid kit.

Andy Shoemaker wrote:

Agree, indication is not an issue.

We looked at a bunch of this research when I took my WEMT in 2018. If memory serves, the research is weak at best (or was in 2018). The only large study basically compared a complete lay person given a designed TQ to a lay person given a bandana and basic instructions (and nothing to use as a windlass), compare the results. It read like it was funded by Big-TQ (sarcasm). And the other large meta analysis was in combat settings. Neither of these are good comparisons to a trained wilderness first responder using principles and equipment they've learned and practiced. Which brings us back to the one thing folks can almost always agree on- get trained, stay practiced.

I'm open to having my mind changed. But also, a decade of SAR and I've never seen first hand or even heard first hand of someone needing a TQ... So it'll take a lot of convincing to get me to add one to my alpine first aid kit.

Thanks for challenging my assertion on this. I looked to see if there was newer research on this and found a study from 2020 supporting what you are saying.

It stated that with proper materials and some training, an improvised tourniquet can be as effective as commercial. There’s caveats there, but for my training and personal kit, this may lead to me making some changes. Thanks, Andy!

https://pubmed.ncbi.nlm.nih.gov/33230091/

Mountain Project isn’t the cesspool people make it out to be. One just has to use it in the right way! 

I have a question: have any of you been present for application of a tourniquet?

I am curious because I have not.  
Also, all of my “knowledge” would be out of date.
However, my experience not so much out of date. As in my layperson’s life, a couple/3 times a decade I am there when “something” happens. My brains goes right to EMT mode. Bottom line though is I have no experience with tourniquets. I don’t even recall having them available as a ski patroller. I do recall my training though. I am open to learning. 

I have not, nor have I needed to. Holding direct pressure has always worked, including on arterial bleeds. That’s also the point I was trying to convey, it’s a very rare situation that only a tourniquet will solve. I’m sure others may have had to, but I would wonder if they are in a skewed population. Meaning they are ALS/Flight medics that are called to those scenes. I’ve worked BLS, ALS, and ED (granted the ED isn’t a level 1 trauma), but the MD’s I work with and know also advocate for pressure vs tourniquet. 

EMT/WFR here.

Major bleeding control (gauze and absorbent dressings), wound care (good heavy-duty adhesive bandages, moleskin, etc.), some ability to immobilize an injury (which can be accomplished with good tape and improvised materials), nitrile gloves, and something for exposure/hypothermia (emergency bivy or reflective survival blanket) would all be high on my list.

A tourniquet is also on my list, especially for anyone with the training to use one. There are a number of options, and it can be difficult to balance bulk with capability. The CAT Gen 7 is certainly one of the established standards. Pressure dressings can also be very effective for serious bleeding, especially when combined with wound packing/hemostatic gauze if indicated.

For meds, I carry basics like ibuprofen and acetaminophen, as well as aspirin for a suspected heart attack, I also have some Loratadine for my own personal allergies. Benadryl can also be useful for allergic reactions, but epinephrine is the primary treatment for anaphylaxis—if you have a known severe allergy to something you may encounter while climbing like bees!, carry your prescribed epinephrine.

Full disclosure: we're actually bringing a climbing-specific first aid product to market soon, so this is a problem I've spent a lot of time thinking about. We're also planning educational content focused specifically on climbing medicine and managing emergencies in the vertical. In the meantime, it's great that you are staying prepared. 

Also keep in mind that most search & rescue is free in most states! Don't be afraid to call.

Eric Craig wrote:

I have a question: have any of you been present for application of a tourniquet?

I am curious because I have not.  
Also, all of my “knowledge” would be out of date.
However, my experience not so much out of date. As in my layperson’s life, a couple/3 times a decade I am there when “something” happens. My brains goes right to EMT mode. Bottom line though is I have no experience with tourniquets. I don’t even recall having them available as a ski patroller. I do recall my training though. I am open to learning. 

I have applied them 2 times in the field, once with climbing puncture injury. None of these were in professional situations while I was working.

In professional situations I have used/been present for application many more times.

The endless wars we decided to start waging in the past 25 years has contributed loads of data for the use of tourniquets and changed their use. The commonly taught standard now is to first apply pressure,  if it bleeds through then apply fresh dressing and more pressure, if it bleeds through again apply a tourniquet.

It seems that where my opinion and Blake’s may differ is that he hasn’t had a case where he is away from a hospital and needing to control an arterial bleed. He’s welcome to correct me if I’m mistaken.

My experience has been that pressure can work  very well, until you have to extricate the patient. At that point, controlling and monitoring the bleed becomes much more difficult. In an alpine climbing situation (the original scenario of the OP question) I assume that I’m a long way from help and may have a very complex evacuation. This is where my reasoning comes from. 

NateC wrote:

My experience has been that pressure can work  very well, until you have to extricate the patient. At that point, controlling and monitoring the bleed becomes much more difficult. In an alpine climbing situation (the original scenario of the OP question) I assume that I’m a long way from help and may have a very complex evacuation. This is where my reasoning comes from. 

This is a great point. Same applies if you need to leave your partner to go get cell service or help. Maintaining pressure on a major bleed can't be the responsibility of the patient.

The comment above suggesting aspirin is a good one. Especially as the average age of the climbing party exceeds say 50y/o.

Nate, thank you for the response. It’s kind of mind blowing! Would you share your related work background to help put this in perspective for me?

I was just a regular EMT 1A ski patroller. For 11 years. I understand this generally limits my experience in both quantity and variety. Compared to other possibilities. And yes I have been involved with a few mountain rescue deals. Just been in a certain spot at a certain time, each circumstance different.
I will consider getting myself updated on tourniquet use and protocol, as a result of this conversation.

Thanks to Blake too.

Eric, I currently work as a flight nurse on a helicopter in Western WY. Prior to being a flight nurse I worked 6 years as an ER nurse in busy trauma centers. I also worked 11 years as a professional ski patroller and for 10 of those years wasn an Outdoor Emergency Care instructor. 

I took a 2 day wilderness emergency medical course. Not a wiffer accredited course. It felt like too much information too fast. About all I really took away from it was put the white shit on the red shit and transport as fast and safely as possible to someplace where people Like Nate are and they can do their thing. I allready knew that from in the field experience. I feel like I would need a lot more classroom time and a lot of practice to actually be competent in wilderness first aid.  All I do is direct pressure, hockey tape the shit out of it and try to get you to real help without fucking up your spine. .    One of my co workers years ago had been  a full time patroler at a large northeastern ( Icey) ski resort. worked his way up to patrol #2 He averaged 80 wrecks a season being first on.  Sometimes 6 wrecks a day Christmas week, Presidents week etc. When I  worked for him on a painting crew he was patrol #1 at a dinky little family ski area and  also on the small town ambulance. He complained that he was getting really rusty.  from six wrecks a day at Okemo to 6 wrecks a year  at Suicide six  and a few ambulance calls a week he felt he was loosing his edge.  Me taking a two day course 5 years ago and not practicing at all since then is not rusty. Its completely  useless.  Heck I took part in a few rescues over the years but not a single one since that course. And that's a good thing. 

Anecdote: At Telluride Ski Resort a fella sliced the back of his thigh on a sharp rock under powder in hike-to terrain.  As more Patrollers stacked up on the scene, not a single one could stop the massive hemmorhaging attempting to improvise a tourniquette.  20min later, an actual C-A-T arrived on scene and did the trick.  Very, very life threatening.  A chopper was called in.  

But, a rare requirement in the alpine.  

My alpine kit: athletic tape, drugs, foil bivy, wee lil knife, ace bandage, hemostatic gauze, heavy duty nitrile gloves, alcohol wipes, iodine tablets.  Tape and drugs do all kinds of good things to get back to the truck, if you know how to use them.  

SAR card!!    $12 for 5 years.  

Most important first aid to carry is knowledge. And,  maintain your cool under pressure, eh.  People losing their sh*t are worse than surface sh*tters.  

Andy Shoemaker wrote:

I'm open to having my mind changed. But also, a decade of SAR and I've never seen first hand or even heard first hand of someone needing a TQ... So it'll take a lot of convincing to get me to add one to my alpine first aid kit.

Could this be an example of survivorship bias? I took an online "Stop the Bleed" course a couple of years ago, and it claimed that 50% of preventable deaths resulting from accidents/trauma were caused by blood loss (more than any other cause), and that death frequently occurs in minutes. If the vast majority of hikers/climbers aren't carrying tourniquets, the ones who need them probably don't live long enough to be rescued.

I also think I remember the stop the bleed course saying that improvised tourniquets are often ineffective or damaging even when a windlass is used. A proper tourniquet distributes the pressure over a fairly broad area, while an improvised one (made with cord, slings, or clothes and a windlass) concentrates the force over a smaller area such that the force required to stop arterial bleeding would also cause really high pain and tissue damage (not gradually from oxygen deprivation, but by directly crushing the nerves and tissue beneath it). And if the pressure isn't high enough, they can cause compartment syndrome by blocking the veins without blocking the arteries. And even if you do it right, it's more likely to work loose over time or with movement. I found it fairly convincing, but I'm just a lay person and may not have a full understanding.

Edit: https://www.stopthebleed.org/get-trained/online-course/

I am not opposed to having a tourniquit in my pack if Murphy does his thing and I never need it.... 

A lot has been said about tourniquets. Here's my 2 cents as a flight paramedic in the Front Range of Colorado (we do a lot of mtn scene flights): While I agree they don't take up much space and *could be useful, I can't think of any situations where I've actually seen them used. Thats not to say that they haven't, just that it'd be highly unusual. As others have said, possibly in the rare scenario where there's a super sharp rock involved. More likely a chainsaw or something like that of you're working on a trail crew or a similar activity. I personally prefer to carry hemostatic dressings and a good ace wrap (serves multiple functions).

My 2 cents...

NateC wrote:

It seems that where my opinion and Blake’s may differ is that he hasn’t had a case where he is away from a hospital and needing to control an arterial bleed. He’s welcome to correct me if I’m mistaken.

My experience has been that pressure can work  very well, until you have to extricate the patient. At that point, controlling and monitoring the bleed becomes much more difficult. In an alpine climbing situation (the original scenario of the OP question) I assume that I’m a long way from help and may have a very complex evacuation. This is where my reasoning comes from. 

I have been in the field with arterial bleeds, but was able to control the bleed using Israeli or H bandages. My field experience was also in urban/city settings lots of GSW's with minimal transport times. 

How do yall carry your drugs?  

I got OTC painkillers, prescription painkillers, immodium ad, caffiene, and benadryl all jouncing around in the same tiny plastic container.  

Certainly a poor/problematic system :/   What is a superior way to tote small quantities of multiple drugs??  

- without damage (mine bounce together and rub off on each other) 

- without mixing them together (the compressed ones break/powder all over all pills)

- and able to label/identify (theyre just loose pills in a tiny nalgene jar)

- in a very compact way with ease of use

Any awesome practices out there amongst you backcountry badasses?

Stiles wrote:

How do yall carry your drugs?  

I got OTC painkillers, prescription painkillers, immodium ad, caffiene, and benadryl all jouncing around in the same tiny plastic container.  

Certainly a poor/problematic system :/   What is a superior way to tote small quantities of multiple drugs??  

- without damage (mine bounce together and rub off on each other) 

- without mixing them together (the compressed ones break/powder all over all pills)

- and able to label/identify (theyre just loose pills in a tiny nalgene jar)

- in a very compact way with ease of use

Any awesome practices out there amongst you backcountry badasses?

If I’m carrying a lot (longer trip over 5 days up to a month) I use a little flip open pill case that I found on Amazon. I bought a 3 pack and use one to carry stuff with me on an every day basis. Looks like this…

For anything shorter, I have a little two sided daily case that has Tylenol + ibu on one side and aspirin + Allegra on the other. I generally don’t carry more than those things on short trips. 

This is what I do for week long solo trips.

Take a strip of aluminum foil, say 6” x 2”, and overlay it with a similar sized piece of Saran Wrap (optional, but nice). Place yer drugs about 1/2” above the bottom and in a line, remembering position left to right. Fold the bottom of the foil up to cover, then fold again and again until you run out of foil. Then use a Sharpie to label each pill location with an initial of the med and add the date. Finally, fold repeatedly left to right between each lump of pills and on each end. 

This works best for shorter trips where you just need a sampling of many meds. If you need to carry multiples of something, just make a dedicated foil pouch and label it.

https://www.walgreens.com/store/c/tylenol-500mg-acetaminophen-caplets,-travel-size-travel/ID=prod6054517-product

The wrapper comes off to reveal a plain white pill bottle. I usually have either 2 or 3 of these with various medications. They take sharpie very well so you can easily write a description. Sort of a modular version of what Nate has going on––which looks like a better solution for a bigger kit. Assuming you can label them easily enough.