Middle Fork River Expeditions

Middle Fork River Expeditions ~ Leader’s Medical Kit Guidelines

MFRE Leader’s Medical Kit Guidelines

Middle Fork River Expeditions REQUIRES medical supplies to be available on all trips. It is impossible for one medical kit to handle all medical problems on trips, but it should contain enough supplies to treat common complaints and minor problems, or to offer some assistance until the victim can be evacuated. This list of contents is suggested as a minimum.

QUANTITY DESCRIPTION COMMENTS/SUBSTITUTIONS
BANDAGE SUPPLIES
20 Plastic adhesive strips (Band-aid) 1” x 3” Tape and pieces of gauze can be used,
but nothing is as convenient or as efficient
as basic Band-aids.
20 H-shaped adhesive strips (knuckle bandages), (Coverlet) or large size (2-3” wide) adhesive strips Convenient, but tape and gauze can be used.
4 Gauze pads 4” x 4” Sterile, individually packaged pads are bulky and sterility is not usually necessary for wound dressings. Take only a few sterile packages, and a cleanly wrapped stack of nonsterile pads (which come in bulk packages). Clean cotton (lint-free) cloth can be used as an absorbent dressings.
10 Gauze pads 2” x 2” Larger gauze can be cut in half.
2 Trauma pad Large, bulky absorbent pads for wounds with a lot of bleeding or oozing fluid. Improvise with menstrual pads or lint-free cloth
2 Ointment impregnated gauze
(Vasoline gauze, Aquaphor or Xeroform) Non-stick dressing for burns, abrasions or other wounds. Improvise by putting ointment on a regular gauze pad.
2 Eye pads For patching an eye closed due to an abrasion on the cornea. Can improvise with folded gauze. If used, should keep the eye closed. Use only overnight, then remove and reevaluate.
1 Gauze wrap (Kling) 3 or 4” To hold dressings more securely and comfortably than tape where there is hair, movement, moisture, or rubbing.
1 Gauze wrap 2” Wider gauze can be folded while wrapping
1 Elastic wrap (ACE) 3 or 4” Mild support for sprained joints; outer wrap
for dressings; partial immobilization for
wounds or injuries.
Substitutions: Gauze wrap and/or cloth for wounds; for immobilization, use bulky wrap or incorporate splint material in wrap; for example, piece of foam sleeping pad.
optional Elastic wrap 2” Same as above, especially good for hands and wrist.
1 Hypoallergenic tape (dermacell) 1/2” Hold dressings. Easy to remove, does not
cause skin irritation. Dressings can be tied on,
but tape is the best.
1 Adhesive tape (cloth-type) 1”
(Zonas) Hold dressings; tape over blisters; tape sprains. Adherence when wet and use for taping sports injuries make this tape most versatile. Of course, duct tape can also be used.
optional Adhesive tape (cloth-type) 2” If taking one roll, 1” or 2” is personal choice. Wider tape can be torn vertically.
1 each Steri-strips 1/4”
Optional, add 1/8” Hold together edges of small cuts. It is better
to leave wound edges slightly apart than to tape a
wound with the edges curled inward.
Improvise by cutting pieces of tape. New cyanoacrylate skin adhesives are great and easy to learn how to use, but they are expensive.
1 Triangular bandage 51” Arm sling or can be torn in strips for tying bandages, splints. Any large piece of fabric (T-shirt, towel) can be substituted.
2 Moleskin or mole-foam sheets (approx. 6” x 10”) Cover blisters or protect potential blister areas;
foam can also be used to make donut pads to protect calluses or bunions on the feet. Can use cloth tape or even duct tape applied directly to the skin to cover blisters.
1 Splint (flexible, padded aluminum—SAM®) Splint any small to medium-size joint. Alternatively, improvise splints from any number of available materials: rolled towel or down jacket, ensolite pad, ski poles, wood, etc.
TOPICAL MEDICATIONS
2 Oz Tincture of iodine (2%) or betadyne solution (10%)
Topical swabs (not as versatile) Topical disinfectant for cleaning wounds, can also be used for water disinfection. Regular soap is fine to clean wounds on the trail. Make a dilute (10:1) solution when used directly on or in a wound, but can use full strength on intact skin. Alternative: use soap and water for skin and flush wounds with clean (preferably boiled water)
15 gm or
8 small packets Antibiotic ointment (Polysporin or equivalent, generic “triple antibiotic ointment”) comes in small packets also that can be given to someone for ongoing self treatment Keeps dressings from sticking to oozing scrapes and burns; softens dry, cracking wounds and crusts. Does not replace cleaning and removing dirt and crusts to prevent infection. Regular petroleum jelly (Vaseline®) can be used. Some people are allergic to Neosporin.

1-2 Oz Aloe vera extract, gel, or other 90-100% strength preparation Good treatment for burns (along with cleaning and bandaging).
1 small tube
or tin Zinc oxide cream The only means of complete sun protection for nose, lips, face.
1 tube
Sunscreen SPF 15 or greater Sunburn can be a serious problem. Sun protection is the responsibility of the client, but many underestimate tropical and high altitude sun. Leaders can carry this as a back-up supply or ask another member in the group to share, when needed. (SPF is a measure of protective effect.)
1 Lip protection Same reason as sunscreen. Zinc oxide gives most complete protection.
15 gm tube or
6 small packets or each Cortisone cream
AND: Antifungal cream (myconazole, tinidazole, clotrimazole)
OR: Mycolog cream (combination anti-fungal, antibiotic, and cortisone) Treatment of irritating, itchy, red skin rashes. Cortisone cream is for suspected allergic rash, anti-fungal cream for suspected fungal infection, but it is often hard to tell allergic from fungal. Typical fungal location in groin or between toes is a clue. Rash on hands more likely contact allergy.
6 Benzoin ampule/swabs or tiny bottle Helps tape or moleskin stick to skin. Apply to skin, wait 30-60 seconds until sticky, then apply tape.
1 Temporary dental filling
Cavit® or Dentemps® Lost fillings, newly painful cavities, broken teeth. Alternative: gutta percha stick. Clean tooth well by rinsing, then dry with cotton before filling hole. Some pain relief is obtained by oil of clove on cotton, packed into cavity (do not cover cotton with Cavit)
6
optional Hemorrhoid suppositories or ointment (Anusol HC®, Americaine®, Nupercainal etc.)
For pain and itching of hemorrhoids. Not uncommon problem, but will resolve in the same amount of time with or without medication. These medicines only help decrease discomfort. A&D ointment or zinc oxide can be used.
NON-PRESCRIPTION MEDICATIONS
20 Aspirin tablets 325 mg or Ibuprofen (Advil® or Motrin®) non-prescription strength = 200 mg
Prescription strength is 600 or 800 mg. Pain, fever, joint and tendon inflammation. Dress minimally to help temperature come down. In hot climates, wipe or sprinkle cool water on the skin so evaporation can help decrease temperature. Dose for anti-inflammatory effect: aspirin–two tablets four times a day; ibuprofen–400-600 mg every 6 hours or 800 mg with each meal. Major side effect for both medications is upset stomach, so take with meals.
20
Acetaminophen (Tylenol) tablets 325 mg Pain and fever (for those who cannot tolerate aspirin); no anti-inflammatory effect, so not as useful for tendonitis and swollen joints, except for some pain relief. Dose: 650-1000 mg every 4-6 hours.
12 Cold capsules containing antihistamine and decongestant (Actifed®, Dimetapp®, many others) Symptomatic treatment of upper respiratory infections, sinus problems, ear pressure from congestion, and allergic symptoms. May carry antihistamine and decongestant separately (see below).
1 Nasal decongestant spray 1/2 Oz (Afrin®, Neosynephrine) Tablet decongestants: pseudoephedrine (Sudafed®, others) Decongestant spray works faster than tablets; gives rapid relief of ear pain during an airplane flight. They work well for nasal congestion during high altitude climbing or sinus pressure from a cold. Frequent use of sprays causes dependency with increased congestion when trying to stop. These are mild stimulants. Tablet dose: 30-60 mg.
12 Diphenhydramine capsules 25 mg (Benadryl®) Antihistamines alone are specific treatment for allergic symptoms of watery nose and eyes; also useful for more bothersome allergic reactions like hives and itching. The side effect of drowsiness makes them useful as a non-prescription sleeping medication. They decrease nausea and stomach cramping and are used for motion sickness. Dose: 25-50 mg every 6 hours. Drowsiness is the major side effect.
12 Throat lozenges For relief of sore throat; very popular on high altitude climbs for dry throat and cough. Cough drops and hard candy also helps and tastes better.
12
optional Bismuth-subsalicylate tablets (Pepto-bismol®) Mild relief of traveler’s diarrhea, upset stomach Do not take if intolerant or allergic to aspirin.
6 Antacid
Maalox, Mylanta, Gelusil or others Acid reflux “heartburn.” Non-essential drug but can be useful. If not rapidly effective, the problem is probably not acid.
6 Milk of Magnesia tablets Constipation. Not everyone gets diarrhea when traveling!
2-6 Oral electrolyte solution—for trips with high risk of diarrhea. Replace fluids and electrolytes lost from moderate to severe diarrhea. Water and fruit juice or a pinch of salt plus a few tablespoons of sugar in one liter of purified water are fine for mild to moderate dehydration, but are not as good for serious dehydration.
MISCELLANEOUS
1 bandage scissors
Sewing stores sell small folding scissors, or carry larger “trauma” bandage scissors A fancy knife or just plain blade will do.
1 Tweezers (splinter forceps—Uncle Bill’s® or Splinter Pickers) A sharp knife point or hypodermic needle (I prefer 18 gauge) can be used for probing in the superficial skin layer.
1 Syringe for irrigation (20 cc works best, but can use 10cc) For pressure washing wounds. This is the best way to remove dirt and debris and decrease risk of infection. If wound remains dirty, scrub and if still dirty, pack open with gauze, do not close. Improvise with baggie with pin hole poked in bottom. Unlike needles, the syringe can be reused, if there is no contact with the wound or blood. Clean carefully with alcohol or iodine after use in case there was any splash back.
1 Pocket CPR masks In reality, there is little risk from mouth-to-mouth, but masks remove the hesitation.
6 Latex gloves For avoiding blood contact when treating wounds and to decrease contamination from hand to wound.
10 Medication envelopes (small) Use when someone chooses to take some medication. Let them begin with 1-2 doses or a day’s supply. Do not give anyone your whole supply of a medication; you may not get it back.
1 Note paper and pencil Recording medical information; sending written message when evacuation or communication is necessary; drawing a map of victim’s location. Do not reply on spoken message to give medical or rescue information.
1 Fire starter (candle, lighter, water/wind-proof matches) These three items are useful to treat trail collapse (when a client does not want to take another step). This situation responds to rest, warmth (or cooling in hot weather), and an energy snack.
1 Candy or Glucose Paste (energy source)
1 Emergency space blanket
1 Knife Standard guide equipment with a million uses.
1 Thermometer
Hyper- and hypothermia Measure or check for hypothermia. Regular thermometer only goes to 96F (35C). Low measuring thermometer necessary for recording hypothermia temperatures. For fever, may use plastic strips with temperature-sensitive dots.
3 Safety pins Many uses for slings, bandages, pin-hole glasses.
Duct tape Many uses
Adventure Medical Kit comes with a booklet. Other recommended resources are: Medicine for Mountaineering by Wilkerson
Medicine for the Outdoors by Auerbach
Wilderness First Aid by Wilderness Medical Society and National Safety Council
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