First Aid considerations - boating

Introduction & Need for Training

Instructors, trip leaders, and participants need to mitigate risks for any outdoor activities. The best risk reduction measures are trip planning and training. I suspect that none of us with expensive paddling experience hasn't seen some sort of medical issue take place over the years. This is a major reason the ACA requires proof of suitable first aid training when requesting liability insurance. All first aid certification courses these days require CPR/AED training. After that, they specialize a bit. At the entry level we have basic (urban) first aid. This level of training may make sense if you can guarantee professional care can reach you within an hour without much difficulty. A reasonable example would be a roadside park & play near most cities. Truth be told, it's hard to imagine a 5 hour class would be suitable for most of our paddling trips. The next level of training is Wilderness First Aid (WFA). This class takes one weekend and covers the basic first aid needs for weekend outdoor trips. For most of us, this is the minimum level of training we should take. Advanced Wilderness First Aid (AWFA) takes about one week and provides more training on stabilization and evacuation. Planning overnight trips, AWFA is more suitable. Wilderness First Responder (WFR) takes two full weeks and is far more comprehensive. Anyone leading extended trips in the wilderness need this level of training. Many professional outfitters require WFR certification for their staff. Training/certifications also have an expiration date - usually two years. Each Winter (off season), check your certification card and recertify as necessary.

Common Incidents

Training and planning are essential but sometimes you need tools to work with. This is where a First Aid Kit comes into play. Commercial first aid kits have a wide variety bandages, implements, and medicines. Some are very minimalistic and hardly cover situations we have seen on river trips. Others are very expensive and seem to mimic a medical clinic. You can make your own kit and this is perhaps the best route as many pre-made kits are more targeted to land based activities. Here is a list of issues I have seen or heard of on river trips:

  • Cuts, abrasions, splinters
  • Headaches (even hang-over's)
  • Hypothermia & Hyperthermia
  • Dehydration & cramping
  • Eye injuries
  • Sprains & fractures
  • Spinal injury
  • Bee, snake, tick, etc. bites
  • Burns & Blisters
  • Drowning
  • Digestion track issues
  • Diabetes issues

Storage

Before we think about what tools and supplies we may need for the above issues, let's think about how we are going to carry this stuff. First and foremost, most first supplies must be kept dry. It is nice if we can easily access the contents without spilling all over the ground as well. Pelican containers are rectangular, crush proof, and water tight. It's easy to open the lid and inspect most of the contents. Two downsides are the price and you need to be careful when closing to make certain none of those plastic baggies get between the rubber seal. A one quart Nalgene wide mouth bottle is very inexpensive, crush proof, and water tight. The major downsides are limited size and having to dump everything to get at what you need. Dry bags (most call these damp bags) don't provide crush protection but are very spacious. When using these, everything needs to be secured in high quality zip lock bags. Some first aid kit contents like a Sam Splint cab be stored separately. One variety of zip lock bags that are very useful are made by AlokSak. These are very inexpensive and approved for diving down to 200'.

Protection

When administering first aid, you need some basic protection. Common items are Nitrile gloves, CPR mask, and eye protection. Few first aid kits carry eye protection. I stow common swim goggles in one of my dry bags, sometimes I wear them. These are great for practicing rolls if you wear contact lenses. They also come in handy when someone drops gear in the water and you need to try and retrieve that gear. Another great use is eye protection with gauze. A bio-hazard bag (small sturdy plastic bag) and a bottle of hand sanitizer.

Supplies

Let's take a closer look at the above list and determine our needs:

  • Cuts, abrasions, splinters: Band-aids assortment, sterile gauze pads & rolls - 4", triangular bandage, ace wrap, vet wrap (sticks to itself even when wet), 2" silk tape (hypo-allergenic tape which sticks to wet skin), safety pins, Tincture of Benzoin (Makes dressings adhere well)
  • Hypothermia & Hyperthermia: Water! Carry at least a quart., Honey packets or Glucose
  • Dehydration & cramping: Water
  • Eye injuries: See cuts & abrasions, Saline contact solution
  • Blisters: Second skin blister pads

Tools

These are items we may use more than once or are used for special purposes:

  • Cuts, abrasions, splinters: Trauma shears, tweezers, irrigation syringe and splash shield (crucial), 1.5" hypodermic needle, combat gauze (somewhat expensive but could be a real life saver)
  • Headaches (even hang-over's)
  • Hypothermia & Hyperthermia: Space blanket bivvy, insulation, tarp or large plastic sheet, neoprene dive hood or insulated skull cap, water proof matches
  • Eye injuries - Swim goggles
  • Sprains & fractures: Duct tape & cord for splints, Sam Splint, instant ice compress (optional)
  • Spinal injury & other serious injuries: Pen/pencil & multiple SOAP notes, digital thermometer
  • Bee, snake, tick, etc. bites: Tick twister
  • Miscellaneous: Small non-climbing carabineers, small first aid guide, small light

Medications

As always, pay close attention to your special needs. If you have an underlying medical condition such as severe allergies, make certain you bring your personal medicine/s and inform someone else in the group. Medicines have certain shelf lives before their effectiveness degrades. Every Winter (off season), empty out all of your medicines, inspect expiration dates, and order replacements. A first aid kit inventory sheet is quite valuable and strongly recommended.

Whenever anyone uses the kit, they should ad their name and date and decrement the count of any used supplies/medicines. Medicines should be purchased in individually marked packets which are easy to identify and have clear expiration dates. These packets typically provide dosage guidance as well. There are many online sites that sell medicines for restocking your kit at reasonable prices. For most, the one item in your kit that will get the heaviest usage is Ibuprofen (AKA: Vitamin I). I carry an additional small bottle and place in the easiest to access part of my kit. We seldom need to access these medicines so place all of them in one bomb proof zip lock bag like AlokSak. Brand names in parenthesis are simply provided as examples, nearly all have generic equivalents which are less expensive.

  • Cuts, abrasions, splinters: Triple Antibiotic
  • Headaches (even hang-over's): See pain management
  • Hypothermia & Hyperthermia: Honey Packets
  • Dehydration & cramping: Electrolytes (Pedialyte)
  • Bee, snake, tick, etc. bites: Diphenhydramine (Benadryl), Hydrocortisone (Cortisone)
  • Burns & Blisters: Burn Gel
  • Digestion track issues: Aluminum-Magnesium Hydroxide (Alamag, Maalox), Bismuth (Pepto-Bismol, Diotame), Loperamide (Imodium, Kaopectate, Diamode)
  • Pain management, inflammation: Aspirin, Acetaminophen (Tylenol), Ibuprofen (Advil, Motrin), Naproxen (Aleve)
  • Diabetes issues: Oral Glucose (Cake Icing, Honey Packets)
  • Miscellaneous: Decongestant - Pseudoephedrine (Sudafed)

Conclusion

These are only suggestions for items to consider in first aid kits, many will have different requirements (and levels of training). A good practice is having two persons bring first aid kits on your trips - each will pack different items and that diversity can be quite valuable. Using a risk management approach as above is a good way ensure your kit has what is needed should an incident take place. Your contents will vary over the years as you encounter new situations, this is why I plan to add a small bottle of saline solution to my kit based on several participants scratching their eyes - water worked but saline solution and cool shades are even better. First Aid techniques and special gear evolve over time, thus the need for retraining. If time and budgeting are available, consider pursuing the next higher certification level.