From a Paramedic’s Point of View – Swimmer

This is from a posting on Paddle Praddle from a very seasoned boater and paramedic. It was in response to a recommended minimalist first aid kit that is inexpensive and minimizes items that need to be monitored for expiration.

• Take a class. River side isn't the place to be flipping through pages trying to remember stuff. Pack your brain... it's portable, readily accessible, and very user friendly.
• Ace bandage. They are used to hold on dressings to control bleeding, hold on dressings that can cover an eye, don't require tape to hold together. Can be used to make splints and if things go really sideways they can be used to lash together shelter building material (simple lean to).
• A couple of kotex pads. Aka: sanitary napkin. They are designed to hold blood and do the job well. They are cheap, sanitary, and have a sticky back that will stick to the Ace bandage to help prevent it from slipping out of place. Keep in mind that hopefully your victim will be mobile and will require evacuation from the river so body movement will try to dislodge the bandage. Two should be enough if used in conjunction with direct pressure.
• A few 4x4's. They make them out of plain gauze which is almost like cheese cloth, and they make them with an absorbent material sandwiched between the layers. I prefer the plain gauze myself because it packs smaller and can be unfolded, re-tooled into other uses such as ties for a splint. 4x4's also make excellent eye patches, can be used to scrub clean wounds, and packed into gaping wounds.
• Liquid iodine. Assuming your patient doesn't have an allergy to shellfish or iodine, you can drip some into the wound to help slow down infection. You can also add it to water to disinfect for drinking or wound irrigation. The bottles are small, light weight, but do expire.
• A couple of triangular bandages. Sling / swath for bummed shoulders, eye bandages, head dressings, make shelter, shred for fire kindling.
• 800 mg Motrin... check allergies before giving but it helps with soft tissue injuries, orthopedic injuries, and fever. OTC doses are 200 mg tablet... can give 600 mg every six hours, 800 mg every 8 hours… no more than 2400 mg in 24 hours. It's processed by the kidneys so keep that in mind if pt is severely dehydrated, suffered great blood loss, or has renal issues.
• Benadryl for allergic reactions. If you mix the Benadryl with some Prilosec (the OTC upset tummy medication) you increase the histamine blocking action and can be more effective. But this is riverside survival medicine. You wanted simple and cheap...Benadryl. 50 mg by mouth. may make them sleepy but I am betting the adrenaline of being in the boonies, taking meds from a dry bag while looking at a few hours of evacuation time will keep them awake and alert.
• Small light source...led lights running on AAA battery. They make some really good ones. I prefer Black Diamond gear but that's just one suggestion.
• Food source... Gu, Cliff Bar, Power Bar (damn tough in the cold though). Can also go with a Snicker's bar, something like that. High carbohydrates with some protein thrown in. Helps stave off hypothermia by giving the body energy to burn and make heat. Eating also forces someone to slow down, take a break, gather their thoughts, thus stopping a headlong plunge down Panic Lane. Before you feed someone, make sure they aren't going to puke it back up. We usually don't feed head injuries because as their condition worsens they may lose their ability to control their gag, end up puking, then choking on their puke. Aspiration pneumonia is not a nice condition.
• I wrap my water bottle in duct tape. With that tape I can splint ankles, fingers, use the tape to hold on bigger splints. Can be split down lengthwise, made into ties to help build a hasty shelter. It can hold on bandages and be used to blaze a trail to mark your passage for SAR trackers or to help you re trace your steps.
• Spark... flint / steel at the bare minimum. I carry a flint/steel, a Bic lighter, and "strike anywhere" matches dipped in paraffin for waterproofing. Practice with it. Building a fire in wet conditions suck. It's hard, rarely truly successful except on TV. I make a mix of melted paraffin (found in grocery stores in the canning section) and pencil sharpener shavings, maybe toss in some lint from the dryer vent. Melt it all together, and then pour it into cardboard egg carton. Makes a dozen fire starters. These things burn even when damp and burn by themselves for several minutes, giving damp tinder a chance to dry and get a wood fire burning. A little bulky but worth it. I usually carry two. They don't expire.
• Knife. 3 inch blade minimum. Don't have to be Rambo, but it doesn't matter if you have the world's best first aid supplies, if you can't get a hurt patient through a cold night at the bottom of the Cheat Canyon, you haven't done anything. Other words… stopping bleeding is only one issue. Environmental survival is just as important. You need to be able to cut tree boughs to makeshift ground insulation, whittle kindling, make a shelter, cut bandages, clothing, duct tape. If it's got a shiny blade, then you have one more signal device to help catch rescuer attentions.
• Space blanket. I've used one at night while dressed in a dry suit, temps got to 38°. It sucked. Too lightweight to really wrap around yourself but I am pretty certain that if I had someone to tuck it all under me, it would be much more effective. Lightweight, cheap. I personally carry a bivy sack made from similar material, a little thicker. But you wanted small, lightweight, and cheap. The bivy sack is about the size if a grapefruit.
• Poor man's bivy of 45 gallon contractor trash bags. 3mm tough black plastic. Can punch a hole in the bottom for your head, make a poncho, and help keep you warmer. Can carry brush for firewood, can be split down two sides and made into a tarp, ground cloth, whatever.

The things I have described can be crammed into a Nalgene bottle or small dry bag.

I know my spelling, grammar, punctuation is poor but I've been up all night. if you have other questions, drop me an email or a note here.

Steve