Putting together a first aid kit

7:14 p.m. on October 17, 2017 (EDT)
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I’ve been realizing that my prepackaged EMS first aid kit is a lot of dead weight, so recently I’ve just been putting a few things in a ziploc bag to save weight and not have to sort through a lot of junk. But, I think I don’t have enough stuff now - a few 8” pieces of strengthtape, moleskin, a bottle of benzoin tincture, and Q-tips, all for blister care, a few bandaids and some gauze, a small pair of scissors, medical tape, and not much else. So I guess I need to find a happy medium and put together a kit that will cover my needs for the likely injuries such as smaller cuts and foot care, without leaving me completely helpless if I or another hiker should ever suffer a more serious injury. All without carrying a full-size pack of gear like the army medics did. 

One thing I’m planning on doing is replacing the heavy (and breakable) bottle of benzoin tincture with swabs. Just bringing strengthtape or leukotape is another, since it sticks much better than medical tape and in the case of strengthtape it really stretches so a little does a lot. 2x2 gauze squares weigh next to nothing and have many uses, so I may leave the moleskin at home in favor of gauze tightly taped in place with strength/leukotape for blisters. Same goes for replacing bandaids. Alcohol pads, maybe iodine/betadine swabs, a few pair of rubber gloves, and a couple quick clot pads for stuff that’s beyond bandaids & gauze. Is there anything anyone would add or leave out?

10:00 p.m. on October 17, 2017 (EDT)
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I would start by looking at the contents of the EMS kit and deciding what of that you feel you need. I agree those kits have a lot of dead weight in the outer case, excess packaging, and more quantities of certain items than you may need.

Once you have a list of what you want to bring then think about quantity -- how many of each thing you may want.

From the items you've listed I personally would add the following:

  • antibiotic ointment
  • tweezers
  • magnifier
  • tick remover (if they are a risk where you hike)
  • wound closure strips (similar but not the same as band-aids)
  • yes to alcohol prep pads
  • I would keep the moleskin, maybe one small sheet of it, if you're prone to blisters
  • I didn't see any medications on your list, I always carry a variety of over-the counter medications including aspirin, acetaminophen, ibuprofen, antihistamine (benadryl), decongestant, antacid tablets,anti-diarrhea, and laxatives. I take only a few pills of each to cover likely needs and put them all in a tiny ziploc along with a list of what's what (color and size of each pill, what it is, recommended dosage, and expiration date of the particular pills in the kit).
10:18 p.m. on October 17, 2017 (EDT)
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Instead of moleskin, try quality duct tape for blisters.  I have used it for years.  The cheap stuff doesn't stay on all day if you have sweaty feet, but good duct tape lasts a while.  As soon as you feel a hot spot, tape it up.  This way you can carry duct tape for double duty - first aid and gear repair.

11:09 p.m. on October 17, 2017 (EDT)
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Phil

i did the same thing for my personal pack on big outtings (I don’t need to carry a cpr mask or space mummy bag )

my mini kit contains 

mole skin , small roll gauze , small roll medical tape, medium size heel bandages , rubber gloves, couple aspirin/Motrin, small ziplock bag & antiseptic wipes 

It all fits in a 4”x4” bag

11:10 p.m. on October 17, 2017 (EDT)
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If you're prone to blisters:

https://www.trailspace.com/gear/other/compeed/

Best for treatment after the fact, not so much for prevention. As far as I know available only at Walgreen's in the US. I just bought some to deal with calluses on the tops of my hammer toes.

7:07 a.m. on October 18, 2017 (EDT)
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I use the strengthtape for hot spots & blisters now, with benzoin tincture applied and allowed to dry as an adhesion enhancer I can hike all day without the tape starting to peel. It’s waterproof and stays on even in the shower, too. The important thing is to round the corners off. Taking the time to apply it tightly and without any wrinkles is also important. Recently I bought some leukotape after reading a review here, but I haven’t gotten around to cutting any and finding a way to store it when I don’t have my trekking poles. The strengthtape has a waxed backing and comes as a roll of 8” x 2” pieces so putting 3 or 4 in is no problem. For most blisters I only use 1/4 of a piece. 

But I do have room in my quiver for more than 1 arrow, so I’ll check for compeed at the local Walgreen’s. And add in the other items mentioned. Thanks for the input!

10:02 a.m. on October 18, 2017 (EDT)
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Moleskin is not best used for preventing blisters, that's when you use duct tape, leukotape, or other coating that acts as a friction barrier. After a blister develops then moleskin is great -- cut a hole in it for the blister to fit in and then the thickness of the moleskin will cushion around the blister and keep it from getting worse and from hurting so much. You don't want to put duct tape, leukotape, or any sticky tape directly on top of a blister that has already formed.

10:31 a.m. on October 18, 2017 (EDT)
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I know, I use the tape on hot spots before they become blisters. When I have a blister I use tape with gauze on top of the blister to prevent sticking and give a little cushion. I’ve never used moleskin that would go more than an hour or so without starting to peel, so I started using strengthtape because that stuff will stay in place all day long without peeling. It’s smooth so if my sock bunches up and starts rubbing again it slides over the tape without grabbing. 

11:00 a.m. on October 18, 2017 (EDT)
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I like to carry an Ace bandage, back brace and opiods for pain. Mulit-tool is good for reoving fish hooks, porcupine quills in dogs and slivers of wood. 

4:56 p.m. on October 18, 2017 (EDT)
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I definitely go minimalist in my first aid, as many things can be improvised if needed. A lot of my first aid kit also doubles as my repair kit, and some hygiene stuff,

I carry the following, if I need something more than this than I need a helicopter

1)small assortment of various meds, a few doses each. ibuprofen etc, Imodium, Benadryl, sinus/multi cold-especially in the colder months. I carry these all in one of those small travel size hard plastic tubes of advil etc,

2) A sewing needle, also carried in the same plastic tube as the meds. This can be used for various things.

3) gorilla tape, can be used from blisters to repair of almost anything. sticks to wet surfaces and holds quite well.

4) dental floss, also multi purpose doubles as sewing thread, or anything thin cordage might be needed for

5) CAT tourniquet, if you need this. YOU NEED THIS! No, you can't really duplicate this with a belt, or with a rope. You can fabricate a makeshift tourniquet but it will be NOWHERE near as effective. This doesn't weigh much, and it literally can be a life saving device in the backcountry. I carry one everyday.

6) Israeli battle dressing, for major wound care. If I get a small cut or scrape etc I can fabricate a band-air or even a small bandage out of tape and toilet paper, spare clothing or a bandana.

 

 

If I encounter any medical situation that I can't make do with the above, than I or the person I encountered has a SERIOUS issue and needs immediate help... i.e. a helicopter. 

Let's be honest with ourselves here. In the backcountry our most common injury is small cuts and scrapes that don't really require any intensive medical/first aid intervention. These are more annoying than anything. Next up would be joint injuries such as a twisted/sprained ankle, knee etc. After that it would probably be more severe bone/joint injuries such as a broken X, Head injuries, and severe cuts. Other issues can be less physical in nature and be more allergenic, such as insect stings, bites and what not.

You can improvise a minor bandage. You can improvise taping of an ankle or joint. You can take meds to help with allergic reactions or bowel issues. You can improvise a splint. But if you have a severe bleed, that is an immediate danger, and sometimes direct pressure just isn't enough. I strongly recommend everyone carries a tourniquet, and if you really don't want to, at least learn how to properly apply one so that you can have a better shot of improvising at least a semi-effective one.

Most importantly, use your brain and don't do stupid things in stupid places with stupid people at stupid times and you will avoid most problems. Most major accidents are easily avoidable and can usually be traced back to complacency, moving too fast for conditions, or simply taking undue risk by jumping off of things etc.

11:34 p.m. on October 18, 2017 (EDT)
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The most important component of a first aid kit should be one's training and experience.  To save weight and bulk, think about how other items that are carried could be adapted for various first aid situations (one that ranks high for versatility is a simple bandanna).

I do not share the enthusiasm for a tourniquet as a regular component of an FAK.  In somewhere around 470 SAR missions I and my group never had to employ a tourniquet - one of these involved a virtual arm amputation by the rear rotor of a helicopter.  One of our group worked as a paramedic in town, seeing lots of situations.  I asked him if he had ever used a T- answer - "never" (this was after about two years of employment.

Tourniquets have their place, but I don't think they are really all that necessary as routine carry for the typical outdoor situation.

I do always carry at least one elastic bandage in my FAK.

5:51 p.m. on October 19, 2017 (EDT)
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hikermor said:

The most important component of a first aid kit should be one's training and experience.  To save weight and bulk, think about how other items that are carried could be adapted for various first aid situations (one that ranks high for versatility is a simple bandanna).

I do not share the enthusiasm for a tourniquet as a regular component of an FAK.  In somewhere around 470 SAR missions I and my group never had to employ a tourniquet - one of these involved a virtual arm amputation by the rear rotor of a helicopter.  One of our group worked as a paramedic in town, seeing lots of situations.  I asked him if he had ever used a T- answer - "never" (this was after about two years of employment.

Tourniquets have their place, but I don't think they are really all that necessary as routine carry for the typical outdoor situation.

I do always carry at least one elastic bandage in my FAK.

 You are correct, most paramedics have never applied a tourniquet, especially older ones because they were vilified for an incredibly long time. That is also partly due to the level of care they are able to provide and the speed of which they can get someone to an even higher level of care in major urban areas. Ask some rural paramedics if they have ever used a tourniquet and you will get a much different answer.

And I truly mean no offense, but if you did not have to apply a tourniquet to an "virtual arm amputation" then it wasn't as severe as it looked. I don't doubt it was probably a gruesome injury though. They were also probably very quickly able to be transported to a higher level of care. Severing of an artery causes massive hemorrhaging as I am sure you probably already know. In very few cases can arterial bleeding be stopped by direct pressure alone. Sure it can be slowed to a great extent but it wont be stopped completely in the vast majority of cases.

Tourniquets were vilified for a long time, but modern medicine has debunked these myths over the past many years and they are now very commonplace.

Tourniquets are THE best choice to control hemorrhaging in the extremities, especially if you are an untrained person or do not have immediate access to higher level of care. Tourniquets are now recommend to be used anytime the availability of higher care is delayed for more than 1 minute. ONE MINUTE! That's huge, and this came about largely from the military's usage of them in the middle east. Countless studies performed in the last 15 years or so have changed most major medical associations recommendations on their use.

If you somehow manage to injure yourself to the extent that you need a tourniquet while in the backcountry you have several problems 1)are you even able to call for help? 2)If you are able to call for help, how long will it be before help arrives?

I would say you would be lucky to be at a higher level of care within an hour, much more likely your looking at 2-4 hours on average if not longer. You can easily succumb to bleeding in a matter of seconds to a few minutes. For the weight and space that they take up, it is an insurance policy worth having. It's 3.5oz that I always carry and have for a long time.

You could probably live your entire life without needing one. I could probably say that about a lot of medical devices, but most other devices I couldn't easily and physically take with me or they require some form of specialized training to use. A tourniquet however only weighs a few ounces, can literally save your life if it ever is needed, and folds up to the size of a pack of cigarettes. You can take a simple free online training course on their use if you have about twenty spare minutes, so anyone can get at lease rudimentary training in their use.

It always comes down to personal choice to carry anything

2:32 p.m. on October 20, 2017 (EDT)
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I am beginning to get the impression that you really like tourniquets....We were always able to stop bleeding with direct pressure, and occasional use of pressure points.  The amputation I referred to was an injury occasioned by a bystander walking into the spinning rear rotor of a rescue helicopter.  The arm was only held in place by  skin and a few ligaments.  I believe that self clamping by convulsing muscles impeded blood flow.  Complete removal occurred later at the hospital, which happened some hours later - the chopper was even more disabled that our victim, who was extricated by a long, slow technical evacuation.

I really don't know for sure, but I suspect that the general nature of wounds incurred in the outdoors, from falls and such, differ from those incurred on the battle field.  Any thoughts?

I am well on my way to living my life without benefit of a bit T....

2:39 p.m. on October 20, 2017 (EDT)
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Well, I did a bit of googling and sure enough, the American Red Cross does advocate tourniquets and hemostatic agents in very severe situations.  However, this language precedes their recommendation -  "Almost all bleeding can be controlled by steady, direct, manual pressure, with or without a gauze or cloth dressing over the wound."

 

I think it is safe to say that we are both right....

9:50 a.m. on October 21, 2017 (EDT)
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I carry quick clot but everyone should consider carrying at least one tampon in the kit.  

10:35 a.m. on October 21, 2017 (EDT)
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20171021_092540.jpg
I made up two of these kits, one for me and one for my brother, when we were fly fishing in Idaho over September.  It weighed around 2 and a half ounces.  Clockwise from the ziplock bag is a pair of nitrile gloves, bandaids, gauze, Aleve, antibacterial ointment, alcohol pad, Advil, Tylenol, a striker and that credit card knife in the center.  As you can see I used some of the Advil and Aleve.  I also had a couple of cotton balls for firestarter in there which I used on an overnight trip (which is why the striker was in there).  

5:24 p.m. on October 21, 2017 (EDT)
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Most of the stuff in first aid kits just creates the illusion that people can help with first aid. Hiking specific stuff is useful like moleskin, and band aids and Ace bandages. 

The most important thing to remember when you leave a trail head is that help is a long way away.  Maybe days away.  Your brain needs to register that required extra level of caution. Judgement in avoiding climbing and falls, dangerous stream crossings, etc. is your most important tool. 

People have this idea about getting hurt in the back country and a helicopter coming to save them in an hour.  Guess again.  I got hurt far from anywhere.  The first problem is there is no phone reception.  Then we found out there were no helicopters available. None.  Plan B was driving 100 miles on dirt roads to a ranch air strip where we got a fixed wing airplan to Bend.  First morphine took about 5 hours with a busted femur.  the plane ride cost $15,000 and the insurance company had a $5,000 limit. 

The most important rule in the back country is don't get hurt.  Use caution at all times. When in doubt don't.  Take the long way. Do not take chances. 

9:55 p.m. on October 21, 2017 (EDT)
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Being cautious is one of those things that often one of those things people use with “it goes without saying,” but that should always be said. A lot of people may have a lot of things to say about me, but never that I’m not cautious once I leave pavement. Hell, if anything I’d say I’m over cautious, but I’m not really sure there is such a thing. 

In any case, I made some changes based partly on advice in this thread and partly on ideas I’d had that prompted me to start this thread, and will probably add and subtract a few things along the way. 

9:20 a.m. on October 22, 2017 (EDT)
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hikermor said:

I am beginning to get the impression that you really like tourniquets....We were always able to stop bleeding with direct pressure, and occasional use of pressure points.  The amputation I referred to was an injury occasioned by a bystander walking into the spinning rear rotor of a rescue helicopter.  The arm was only held in place by  skin and a few ligaments.  I believe that self clamping by convulsing muscles impeded blood flow.  Complete removal occurred later at the hospital, which happened some hours later - the chopper was even more disabled that our victim, who was extricated by a long, slow technical evacuation.

I really don't know for sure, but I suspect that the general nature of wounds incurred in the outdoors, from falls and such, differ from those incurred on the battle field.  Any thoughts?

I am well on my way to living my life without benefit of a bit T....

 That I do! I have seen them save many lives over the last 15 years or so. You are correct that battlefield and hiking injuries are not very similar, but the situation post injury is very similar. You may or may not have anyone in the immediate vicinity to assist you, and even if you do , getting to a higher level of care is at a bare minimum of an hour away much likely to be longer. A lot of hikers are alone, or in small groups. If your in a group your chances are much better at surviving. Being alone means you are your own first responder, and you have to apply your own direct pressure etc. It's quite hard to apply sufficient direct pressure on your own body, especially if its in an awkward position.

It's hard for us to imagine the circumstances of some catastrophic injury happening to us. But as has already been said in this thread, the best way to mitigate the risk of them happening in the first place is to use an abundance of caution and don't take needless risks. The bottom line is that they *can* happen, it's not probable all the time, but it is possible. The chances increase the more the situation changes, for example if it's hunting season or your going climbing. We should all be aware of the risks in whatever area we are going into. 

We evaluate risk in everything we do in life. If you want to go far into the backcountry with nothing but some toilet paper and duct tape than have at it. If you want to go into the backcountry carrying a 20lbs medical kit then I would also say have at it. I aim for something a little above minimalist, but capable of handling the however unlikely but severe injury.

 

 

 

9:22 a.m. on October 22, 2017 (EDT)
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I echo ppine's take on first aid.  Prevention and cautious decision making is the best first aid.  My first aid kit is for very minor stuff, cuts and scrapes, aches and pains but not significant, immobilizing injuries.  I take routes that are mapped and well traveled especially since I'm alone 95 percent of the time.  Any off trail travel, like when I fly fish, is done in close proximity to a stream and even then I have to choose my route wisely because there's always a chance of rolling an ankle or coming to an impossible cliff section.  Taking the long way is the easiest way to avoid pitfalls.  

2:53 p.m. on October 23, 2017 (EDT)
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Barbara and I just got back last night from our periodic renewal Wilderness First Aid Course. Every time I do the renewal, I think about doing a full First Responder course. If you haven't done so, but intend to spend time in  the back country, I suggest you think hard about going through a good course. Since I spend a lot of time wandering the woods and hills during climbing expeditions, I need to be ready to deal with incidents.

As for first aid kits, I have found that the best approach is to go through a WFA course run by a company like NOLS and their Wilderness First Aid, First Responder, and Wilderness EMT courses. When you go through the courses, you will get hands-on scenarios. This helps you figure out what you really will need in a real-life situation. With this information of what is really useful in the field, start with a quality first aid kit that was thought out for the conditions you encountered in the scenarios. The best "starter" kits I have seen and used are from Adventure Medical Kits. 

By combining your training experience with the kits and sources like the pocket-sized books by professional wilderness medicine people like Eric Weiss, Paul Auerbach, and if you plan on spending time above 10,000 ft, high altitude medical experts like Peter Hacket, you can build a complete but minimal size and weight kit tailored to what you will actually encounter.

Renewing courses serve two major functions - first is refreshing what you learned before, and second is that the medical world continues to evolve. One example of evolving thoughts is CPR - how to do it and for how long. This has evolved every year or 2 since my father fell over in the Sierra backcountry with a heart attack.

One other factor is that the WFA courses teach you how to improvise. One of the things the pre-packaged kits do not include is what you will need for that turned ankle or dislocated shoulder, or how you evacuate your buddy who tripped and hit his/her head on a rock.

If you are reading me as saying "the most important item for your first aid kit is your head and experience", you are correct. The fanciest "crash kit" does no good if you don't know the basics.

11:01 a.m. on October 24, 2017 (EDT)
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Knowledge doesn't weigh anything. Neither does good judgment.

11:44 a.m. on October 24, 2017 (EDT)
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ppine said:

Knowledge doesn't weigh anything. Neither does good judgment.

 Exactly!

7:11 a.m. on October 25, 2017 (EDT)
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An important piece of gear that can't easily be improvised, an irrigation syringe. I couldn't recommend this more for anyone's kit. 

https://store.nols.edu/collections/first-aid-supplies/products/irrigation-syringe-12cc

8:30 a.m. on October 25, 2017 (EDT)
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Sean Van Cleve said:

An important piece of gear that can't easily be improvised, an irrigation syringe. I couldn't recommend this more for anyone's kit. 

https://store.nols.edu/collections/first-aid-supplies/products/irrigation-syringe-12cc

 It is useful to be able to clean a wound in this manner. I however do not carry a dedicated syringe for this task. Depending on my current pack load out I might have the sawyer syringe with me for backflushing the water filter. Otherwise I always have at least 1 water bottle with a squirt style top. While a water bottle isn't as effective as a syringe, it does still accomplish the task but may require significantly more water to accomplish the same effects as the syringe.

I usually have one of those platy soft bottles with the sport top which can be rolled and squeezed that helps in getting some pretty good water pressure.

8:43 p.m. on December 16, 2017 (EST)
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A little late to the game.

As a Wilderness First Responder who hikes a lot and ends up rescuing people a lot, I offer the following.

  • Learn to use your map, and keep track of where you are at all times, to not end up down somewhere off your route attempting to "short cut" somewhere in rough terrain increasing the chances of being lost or hurt. People have a tendency to "know" where they are and be completely wrong -- it's the way brains work. Fight that by knowing navigation skills and trusting the compass over your judgment. People will firmly believe a compass is broken before they will change their minds about this being the "right way" - I've done that once myself. Fortunately not in a critical situation.
  • If it's wobbly, slippery, has cracks in it, don't step on it. Falling from a height of more than 3 feet triggers a WFR's concerns of brain or spinal injury because it can happen, easily.
  • If the water's more than knee deep and you can't see the bottom, wear your boots. If you find yourself being pushed harder than you thought you'd be, don't keep going into deeper water, go back. If you have one or more friends, cross together holding on to each other's wrists. Falling into cold snow melt exponentially increases loss of body heat. Being swept against rocks and trees in the water causes injuries. Getting your foot caught between things in the water can twist ankles.
  • Hypothermia sets in more often in summer, because people think it's warmer. It is. But hypothermia is not about feeling cold -- it is about your temperature at your core, which is supposed to be within a very narrow window -- being in wet clothes with a cold breeze blowing can lead to your core temperature dropping two or three degrees, and then you are on the road to moderate or severe hypothermia. Learn what the early signs of it are, learn how to layer up or down accordingly and manage your thermoregulation. Drink plenty of water.
  • Hyperthermia (heat stroke) is also a risk, and very difficult to manage in the backcountry. Another set of symptoms everyone should know - because you will be the one to help your friend who is showing symptoms and unaware that he/she is having thermoregulation issues, whether hypo- or hyper- -- these issues are the real danger of solo hiking, because you can start going there and never even notice it.

You'll avoid a lot of the typical issues with injuries this way. Above all else, stay calm - take deep breaths and try to avoid panicked decisions.

To make a walking splint for a limb, forget sticks, poles, or SAM splints. A couple rolls of self adherent wrap tape and spare shirts will be a much more comfortable and stable splint.

9:05 p.m. on December 16, 2017 (EST)
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If there are any things that really sunk in from 12 years in the army, it’s keepingvtrsck of where I am on a map and preventing heat & cold injuries! I memorize the general route before heading out, and update with my map & cheap pocket compass/whistle/magnifier/thermometer. I haven’t used my good orienteering compass in forever because I rarely go too far from established trails, and memorizing the planned route means I know how to get back if I leave the trail for some reason.  

I’m pretty good with basic first aid, too, but keeping up on that was harder since we didn’t actually DO it very often. As soon as I find a local class that agrees with my schedule I’m taking a WFA course. 

3:58 p.m. on December 17, 2017 (EST)
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Phil from what I gather from friends that took the Course or WFR its money well spent...

11:19 a.m. on December 21, 2017 (EST)
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I took the 80 hour WFR from NOLS. Very highly recommended. There are classes around the world. You can find them on their website.

I no longer dither and debate about when to pull the trigger on the PLB - I know how to assess symptoms, what's serious and what is not, and have a lot less anxiety about helping other people.

I'll be doing my re-cert next February and looking forward to it.

5:38 p.m. on January 1, 2018 (EST)
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crazy glue. glue cuts shut, also glues split fingers or toes. Second skin. Tums. 2 Tensors, didn't notice them posted. I think everything else is mentioned. Gorilla tape is better than duct tape. Often easier to apply to blisters too. I still carry mloe skin as well as if needed you can make it like a corn pad for extra comfort under the gorilla tape.

1:18 p.m. on January 4, 2018 (EST)
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Garage sale said:

crazy glue. glue cuts shut, also glues split fingers or toes. Second skin. Tums. 2 Tensors, didn't notice them posted. I think everything else is mentioned. Gorilla tape is better than duct tape. Often easier to apply to blisters too. I still carry mloe skin as well as if needed you can make it like a corn pad for extra comfort under the gorilla tape.

 After watching someone in pain after trying to use crazy glue, I never recommend it any more. Superficial stuff maybe, but should never be used on open wounds -- you want pus and junk to come OUT, not be trapped in there festering. Same with stitches -- even if you have training in how to do it, consider you are in the wilderness, not a controlled and sterile environment, and leaving things open is better.

I carry Tegaderm in several sizes. Irrigate the wound well, and if it is deeper cover with a sterile gauze and wrap it or tape it. If it's very superficial like a graze I use the Tegaderm - breathable, keeps stuff out of it and keeps clothing from irritating it, and it's clear so I can check on the injury. I used it last week and when it was obvious the area was not so superficial as it seemed and still bleeding (a cut knee) we cleaned it again, irrigated with iodine, applied dressing and wrapped it. She was able to walk out without further issues.

5:57 a.m. on January 5, 2018 (EST)
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