Improvised chest seal

Today I did some Macgyver playing in one of our airway kits. A new friend turned me on to an “old way” to make a nice, improvised chest seal complete with a flutter valve. Credit for this technique belongs to “Starlight” over at Close Protection World forums. While I am new to their community I have to say I have already seen a couple nice tricks and traded some info on their “Medics Forums”.

Adventure Doc Kit

Here is a copy of his post teaching this method over on their forum. The pictures are added by me and taken earlier today playing with our airway kits and being bored on my off week.:

“OK Guys, leading on from my airway management thread, I thought I’d explain how to make an ACS out of a surgical glove.

Now, before any of you hard arsed medics out there in Oulooland, say “yeah, boreing, tell us something I don’t already know”, this is written for the benifit of all. I am very aware that there are aspiring medics out there who read these threads, because they are keen to be given professional info and improve their skills. So if you already know this (and I’m sure most of you will) don’t slag me off for trying to educate. Thanks guys.

So here we go:
An ACS is an Ascherman Chest Seal. They retail at about £10 a go, so are fairly expensive, and at an incident, you may need several of them. So I thought you may like to know how to make your own.

1. Take one (or several) of your surgical gloves and lay it flat infront of you with the thumb pointing away from you (towards the 12 O’clock)


2. Get your dressing sheers, and from slightly towards the palm from where the fingers join the palm, cut off all of the fingers. You should be left with a tube which is completely open at both ends, with a thumb attached. You should also be left with all of the fingers attached to a single very thin piece of glove. These also have a use, but for the purposes of this exercise, disguard the fingers bit.

3. With the glove still layed in front of you, with the thumb at 12 O’clock, cut the 6 O’clock part (closest to you) of the glove, length ways from the cuff to where the fingers were.

4. Now pick up what’s left of the glove and open it out. You should have a flat, roughly rectangular peice of glove with the thumb still attached, roughly central and pointing vertically. (can yer see what it is yet?)

5. Using whatever tape* comes to hand secure this firmly and on all sides over a sucking chest wound. Now snip off the top bit of the thumb. This will create a flutter valve, and help to prevent a Tension PX in the same way that an ACS would do.

*for tape, in an emergency use waterproof gaffer tape. I carry about a metre of this wrapped around and old credit card or similar. It then lays flat in your pocket, or tucked inside your body armour cover ready to use.

Obviously, the best thing to do is prep a few of these in a controlled environment BEFORE they’re needed in anger, and ALL team members should be carrying them, not just the medic.

I hope that all makes sense ladies and gents. When I demo this to others it takes me quite literally a minute, and makes instant sense. But expaining it in text, is a tad more difficult. So if it’s thrown up more questions that answers, or I’ve managed to thoroughly confuse someone, please feel free to comment on this thread.

I’ll answer publicly so that we all learn from the obs of others.

Keep safe,

Starlight Out

Now this is pretty damn cool! I think most of know the three sided occlusive dressing, burping it, etc. The concept of the flutter valve addition is a nice touch. I typically carry one or two of some commercially made “chest seals” in my vest/pack. What happens when you lose the pack or have three penetrating injuries? The ability to improvise is almost a requirement in an austere setting and this is a perfect example.

Medical Clinic and Facility Consultation

Adventure Doc is very excited about a few new requests we have been receiving to design and build several medical facilities for our clients. This subject was actually the topic of my Master’s Thesis and the original paper can be viewed here: http://www.rrh.org.au/publishedarticles/article_print_830.pdf

These new remote and austere site medical facilities are highly customizable and based on the needs of our clients and patients. A new website is under development and will be completed shortly. This website will detail several new services offered by Adventure Doc:

  • Design and Construction of medical facilities at any location, worldwide
  • Staffing of these facilities with Doctors, Physician Assistants, Nurses and Paramedics
  • Improvement and upgrade of existing medical facilities
  • Addition of laboratory and radiology services to existing medical clinics
  • 24/7 consultation from these facilities to Board Certified American physicians
  • Medical Records and EMR services for patient management

Through Adventure Doc’s unique partnership with an Architectural Firm that specializes in healthcare facilities we are able to add a new dimension to designing and building medical facilities in remote and austere environments.

 

Travel Medical Kit

Having recently returned from a seven week adventure that took us from the hustle and bustle of Athens, Greece to the steep and deep gorges on the Island of Crete, the hot desert of Egypt and the lush greenery of the Nile River banks, we had a wide variety of potential travel health risks.  Well before our trip started, I began planning what we would need to carry in our medical kit. 

A good travel medical kit contains just enough to deal with potential problems you might run into but is still light enough to be carried.  One can carry a small Emergency Department with them that weights in around 100 kilos, but are they really going to be carrying that with them…everywhere?  A medical kit that is left behind does not help when you are away from your room!   On the other hand, I have seen a very tiny medical kit that has 3-4 ibuprofen and a tiny piece of gauze.  This is very portable and only weights a few grams…but will it help me if I get into a problem?

When I begin to think of building a travel medical kit, a few key things need to be known:

  • How many people are traveling?  What are their ages?
  • Where are they going?
  • How many days are they traveling?
  • What are they doing for activities?
  • How far from advanced medical care will they be?
  • Does anybody traveling have prior medical problems?

How many people are traveling?  What are their ages?

A medical kit made for two people will be a lot different than a kit to be used by 250 people.  Sheer numbers of basic items are required to treat inevitable problems such as blisters.  Carrying enough moleskin for 250 travelers would require a very large pack, by itself!  Knowing the number of travelers will allow you to form an idea of numbers of items to carry.  This generally goes for basic and commonly used items such as simple pain control medication, blister treatment, band-aids and anti-diarrheal medicine.  No one can ever be fully prepared for all potential problems and have adequate amounts of all required items.  A great story is of an expedition paramedic that was flying into a remote location with the expedition team.  Their plane skidded off the runway on landing and there were a lot of broken bones, cuts and some internal bleeding.  There was no way he could have planned for that and he very quickly ran out of morphine, waiting for the incoming rescue team.

The ages of the travelers is important to know, especially if children are involved.  Kids are not simply “little adults”.  They have different types of illnesses, require different types of medications and especially different doses of medicines and fluids.  Anybody traveling with kids should have a special kit for just “the little ones”.  A group of twenty-something adventure travelers will likely not be having a lot of problems with chest pain or angina.  A group of eighty-year-old sightseers will probably not have too many birth control device failures. 

Where are they going?

Travelers headed to a malaria endemic region had better be prepared to prevent mosquito bites and have antimalaria medicine ready.  Mosquito bite prevention is not so much of an issue to those headed to Paris or London.  Location is everything in travel medicine and knowing the risks of the area you are visiting will help you not only build a viable medical kit but also prevent illness, overall. 

How many days are they traveling?

A trip over a long weekend is obviously a lot different than a 7 week adventure.  Just like the number of people traveling, the duration of travel means you will need to be carrying more of the common items that will be used on a more frequent basis.  Even though you are only traveling with 4 other people, carrying a total of two doses of ibuprofen will not get you very far over 7 weeks.  Our group used a lot of ibuprofen.  In fact, a lot more than I expected.  This was due to the sheer beating our legs got walking through the gorges and mountains on Crete.  Fortunately, we were able to resupply on the trip.  Had we been in a remote location, there might have been some trouble!   

What are they doing for activities?

Carrying a bunch of medicine for high altitude and mountain sickness is worthless if you are going on a SCUBA trip.  Carrying a lot of blister treatments and ibuprofen is very wise for a group planning on a lot of hiking or walking.  Take close look at your activities and potential risks associated with these events.  This applies to all activities, not just athletic or sporty pursuits.  Adventurous eaters will likely need more anti-diarrheal medicine than the average person.  People planning to spend a lot of time by the pool or on the water will likely use up sunscreen faster than those planning on a lot of indoor shopping.  Is your group at risk for broken or twisted ankles from walking around ruins?  Are they at special risk for sunburn?  A lot of bus or car travel could mean a need for anti-diarrheal medicine to avoid a lot of embarrassment.  Tailor your kit to the activities planned.

 How far from advanced medical care will they be?

We were never very far from advanced medical care or the ability to re-supply our medical kit with basic items.  Travelers who are flying into a remote locations and then being dropped off will have very different needs than a group planning on a day of museums and sightseeing in the capital city.  The more remote your location the longer you need to be prepared to provide care.  In addition, you will need to be prepared to provide a higher level of care because simply calling an ambulance is not always an option.  Even if a rescue team is sent, it may take a few days to reach your location.  The other question that needs to be asked is, “What level is the nearest, advanced medical care?”  A run down, poorly stocked clinic in a developing nation has a good chance of re-using medical supplies.  This means a high risk of infection!  A modern hospital in a nearby city of 2 million people will likely have superb medical care.

Does anybody traveling have prior medical problems?

Knowing the medical history of your travel companions is very important, especially if you are going to be preparing a medical kit.  A traveler with a history of heart disease will require a few different medications than a pregnant woman.  Travelers that take medications on a daily basis should be carrying their home medications with them on their travels.  They should also be carrying an extra supply for a few more days, in the event of delays or extended travel.    

What I used

After a great deal of research and experience with many medical kits, I opted to use the Adventure Medical Kit Mountain Medic as my “starter kit”.  I say the term starter kit because no pre-made kit will ever have the exact items you need.  A medical kit should be customized by the users to carry more or less of certain items, adding extra medicines, taking out a few things that might be redundant and personalizing the kit.  I had never used the AMK Mountain Medic before this trip but have to say that this was totally the right choice!  I will be using this as my advanced medical kit “starter” for the majority of my future adventures. 

I initially chose the kit because of the extensive diversity and amount of items the kit came with, directly from the manufacturer.  This was a good starting point and saved me the hassle of gathering up a blood pressure cuff, stethoscope, individual packets of ibuprofen, quick clot,  nasal trumpet airways and other useful but hard to find items.  Second, the kit came in a wonderful pack tha allowed me to add extra things I needed without carrying a second bag.  The amount of medical supplies and diversity that the Mountain Medic came with were quite impressive and you can see the kit’s basic contents here.  Building on the great foundation from the Mountain Medic, I then set to work adding my own personal touches based on our group, locations visited, activities and time away from home.  Talking about the customized kit will require another post….

Cheap prescriptions for travel health

Rodrigo Senna

Image: Rodrigo Senna

Travelers should be prepared with a first aid kit, of some sorts, at all times.  Travel puts people in new surroundings and situations that often leave them trying to solve a problem with just what they are carrying.  Having a first aid kit prepared can save time finding a local pharmacy or doctor when you are looking for basic medical care.  Often, cost is a barrier to  a budget traveler, when it comes to assembling their kit.  A great kit can be made without costing more than your hotel bill!

Prescription Medicines

Travelers like to be self-sufficient.  Carrying their own antibiotics for traveler’s diarrhea, respiratory infections and urinary infections are common requests from travelers.  A visit to their doctor yield common prescriptions that often cost a lot of money.  Typical “traveler medicines” and uses:

  • Ciprofloxacin  (diarrheal illness, pneumonia, urinary tract, salt water infections)
  • Doxycycline (antimalarial, pneumonia)
  • Anti-fungal cream (skin infections)
  • Metronidazole (diarrheal, parasites)
  • Tmp/SMX  (urinary infections)
  • Amoxicillin (respiratory, ear infection)
  • Loratidine (allergy)
  • Benzonatate (cough)
  • Oral contraceptives (menstrual regulation, vaginal bleeding)
  • Promethazine (nausea/vomiting, motion sickness, sleep)
  • Cyclobenzaprine (muscle relaxant)
  • Dexamethasone (altitude sickness)
  • Ibuprofen (pain, fever reducer, anti-inflammatory)
  • Prednisone (dermatitis, allergy)

These medicines, plus many, many more are available on the WalMart $4 plan.  Checking with your doctor about the medicines you are getting for your trip and why you’ll need them can help decide what types are best suited.  Comparing what you’ll need, with your doctor’s help, against the WalMart formulary can save lots of money and still give you a usable medical kit.  The key thing is that you are getting what you’ll potentially need.

Generic Medicines

The thing about medicine is that is is expensive to make, too.  Pharmaceutical companies charge lots of money for a “brand name” drug versus a generic drug.  When a medicine has been around for long enough time for the patent protection on the medicine to expire (10-20 years), a generic form becomes available.  This generic form is often times much cheaper than the “name brand” medicine.  When speaking with your doctor about medicines to be prescribed, inquire about the generic form.  A great example of this is with antimalarial medicine.  Doxycycline is a very old medicine and is available as a “generic”.  This is exactly why it costs so little, as compared to Malarone. 

Buying Medicines Internationally

Packing space and forget-fullness are just a few of the reason why people end up buying medicine in foreign countries, not to mention the price difference.  Buying medicine in a foreign country depends largely on the country and their regulatory history.  I would feel very comfortable buying medicine from a reputable pharmacy in most developed nations.  The problems begin when the pharmaceutical regulations get lax, as can happen in less developed nations.  Fake medicine trade is a billion dollar business and can have lethal consequences.  South East Asia is notorious for poor regulation and a thriving “fake antimalarial” market.  Before buying medicine that is supposed to protect your health, make sure you are getting what you are paying for!  Look for a reputable pharmacy and ask around. 

Hiking holiday? Here’s what to bring…just in case!

Mr. Thomas

Image: Mr. Thomas

Hiking holidays are a great way to spend your time off.  These trips are often done at new trails and areas you’ve never been before and that is part of the excitement.  Often, people do a bit of hiking while they are packing their trip with other activities and do not specifically plan for their outdoor adventure.  Shore excursions from cruise ships are a prime examples of this. 

The factors of an unfamiliar area, being unprepared and often in a hurry can stack up against someone, quickly.  When adventuring outdoors, you want as many things in your favor as possible.  Here’s what to prepare for your hiking excursion on your trip!

 SIGNALING DEVICE

  • Phone/mobile/sat phone
  • Mirror
  • Whistle

1896 telephoneBeing able to contact someone for help is probably the most important thing in an outdoor emergency.  Popularity of mobile phones has helped adventurers be rescued in a timely manner.  Make sure your device from home works in your new location and be prepared that you may not have a signal when outdoors.  Consider renting a local phone, for use during your trip.  Satellite phones can also be rented and provide connectivity, even in remote locations.

Mirrors and whistles serve to attract attention and are very reliable.  They do not run out of battery or lose signal.  Mirrors can reflect light to passing planes or other people, and whistles work well to draw attention, too!  Both are very lightweight and portable. 

EXTRA FOOD

  • Enough for 1-2 days
  • Energy bars
  • Comfort food

Most day hikes are just that, hikes that are over in one day.  Spending the night outside only happens if there is a problem, but you should be prepared for it.  Healthy people can generally go several weeks without food, but why try it!?  Carrying some extra food, in case you have to sleep out, can make a big difference for comfort and morale.  I am not saying to carry a full buffet, but a few energy bars are lightweight and can make you more comfy waiting for help or while your figure your plan out.

EXTRA WATER

  • Carry extra supply
  • Purification method (potable aqua tablets, filter, boiling)

Carry extra water outdoors!Humans may be able to go a week or two without food, but drinkable water is needed much more often.  Death from dehydration can occur in several days.  Carrying extra water is a vital survival tool and should not be taken lightly.  Anticipate your water needs, per person, for your adventure and plan ahead.  This can be carrying extra water or carrying a method to purify water found in the area.  Plan to spend a night outside and consider that you’ll need to drink water during this time. 

FIRE STARTER

  • Lighter
  • Flint and striker
  • Matches

The ability to make fire is something anybody who leaves a paved road needs to have.  Fire can be a great signal, especially at night.  Smoke from a fire can be a daytime signal, as well.  Not only does fire provide warmth, but it serves as a tremendous moral booster and makes the difference between an uncomfortable night outside and a potentially life threatening event.  Fuel can be found in the area or brought in your pack.  A few cotton balls or some tissue make perfect fuel sources to help get wood burning and take up a minimal amount of space.   

MULTI-TOOL/KNIFE

  • Leatherman
  • Swiss knife

Leatherman multi-toolA good knife is an incredibly valuable tool.  Multi-tools contain screwdrivers, files and many other accessories that can all have application if you find yourself needing to wait for a rescue or have to spend an unexpected night outside.  A good knife can help with first aid, shelter construction, food preparation and countless other chores that help improve your situation.

ITINERARY LEFT WITH RESPONSIBLE PERSON

  • Where you are going
  • Which route you are planning
  • When you will be home
  • Who to call if you are not back by a pre-set date/time

Letting somebody you trust know where you are going and when you are due back should be second nature to outdoor adventurers.  The person you discuss your plans with doesn’t even have to be in the same country, as long as they know the details of your trip.  Make sure they know where you are going and when you are due back.  If you have not let them know that you’ve safely made it back, they should begin looking for you or arranging for help to find you.  Hotel employees, local ranger stations or friends/family back home are all good resources.  Ensure they have some contact information for your area and police stations are often good places to start.  Finally, when you do get back form your adventure, make sure to let them know so they don’t activate a search party!

EXTRA WARMTH LAYER

  • Fleece jacket
  • Hat
  • Gloves

Even in the hottest climates, one should be prepared for a drop in temperature, especially at night.  Changes in weather can come quickly and having an extra layer of warmth can help fight off hypothermia as well as make you a bit more comfortable.  A large amount of body heat is lost through the head and simply wearing a hat can help keep warm.  A fleece jacket and hat take little extra space but can make a night outside a lot more tolerable.

NAVIGATION AID

  • Map and compass
  • GPS
  • Know how to use them
Nalilo

Image: Nalilo

Getting lost is a common occurrence and I am frequently “lost” even at my home trails.  Relying on memory is difficult and next to impossible in an area you’ve never been before.  Carrying a map and compass or GPS is a good idea and may help you find your way back to safety.  However, simply carrying them does no good, unless you know how to use them.  Basic info on how to use a GPS can be found here.  A map and compass do not run out of batteries and never have “no signal”.  A compass requires a different skill than GPS and you can get the basics on compass navigation here.  Practice your navigation skills at home, before you get to the trails! 

BASIC FIRST AID KIT

  • Ibuprofen/pain reliever
  • Antihistamine
  • Antiseptic towlettes
  • Bandages/gauze
  • Space blanket
  • Personal medication

Every person going on an adventure should carry a first aid kit.  What you choose to carry in your kit is another matter, but everybody should carry a first aid kit, of some sort.  A basic kit should include the above items.  Many commercial kits are available, at most outdoor stores.  Also, the kit does no good if you leave it at home! 

PORTABLE SHELTER

  • Space blanket
  • Tarp
  • Plastic trash bag

Improvised tarp shelterCarrying some basic equipment that can be fashioned into a shelter is an easy way to minimize discomfort and risk outdoors.  Being prepared to stay overnight, even if you are only being out a few hours is a good way to help survive an emergency on the trails.  Several items, listed above, can be fashioned into an emergency shelter, if the need arises.  Shelter can keep you dry, keep you warm and even help signal for help.  Taking a few extra minutes to drop one of these items in your pack is a great idea.

Even those going off on a “day hike” should be prepared to spend the night outdoors, in the event of an unforeseen emergency.  Carrying a few extra items in your pack can make this night outside more comfortable and lessen the risk of serious injury or death.  These items can help you find your way back home, signal for help and let you take care of yourself and others, should the need arise.  I hope you never have to use any of them, but at least you’ll be prepared if you do have an unplanned emergency outdoors.

Spot Satellite Messengers

spot-satellite-messengerOutside Magazine just posted their list of the coolest gear in 2008.  I was happy to see the Spot Satellite Messenger listed in there, with ultralight jackets and stoves.

This is a device that offers almost world-wide coverage and allows you to send a “HELP” signal to people’s mobile phones, e-mail or a emergency call center.  Use of GPS satellites ensures that help finds you, too!  There is even an option to allow your friends to track your progress, by viewing your trip map on the internet. 

Basic service plans start at about $100/year and you can add the option of sending messages, notifying people of your arrival to a destination, for a bit more. 

This is a very cool idea, to me.  Fortunately, there are still places in the world that a mobile-phone signal doesn’t reach, yet.  This little device provides some extra security for those looking to “get remote”.

Travel Medical Kit at CheapOair

A very nice post about a traveler’s medical kit can be read over at the CheapOair site:

http://cheapoair.wordpress.com/2008/11/07/first-aid-it-for-traveling-abroad/

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