My First Aid Kit – What am I taking whilst bikepacking in New Zealand?

firstaidkit

I’m off bikepacking for a couple of months across New Zealand starting in January and I’ve been thinking about what I would want to carry with me regarding a first aid kit. Of course you can buy them straight off the shelf and head out onto the hills but I often find them lacking. Or sometimes completely useless. So what would a Paramedic take with her? And why is she referring to herself in the third person?

You need to take into account where you are going and access to healthcare. If you are planning a remote trip along the Amazon you’ll need different kit than if you were to spend a few weeks touring vineyards in the south of France (for which you’ll probably need a lot more Paracetamol for your hangovers!)

With bikepacking – the lightest option is usually the best option. This is never so apparent than when climbing up a mountain pass with an over-laden bike wishing you’d pack a few less socks or the jeans you’ll never wear.

But when packing you also want to be as prepared as you can be without going over board. I’m not planning on suturing my leg back together on a mountainside with nothing but a stick to bite down on. I’m not Rambo. Realistically I’d do a running repair and try to get myself off to a hospital to get the wound cleaned properly and closed. Although I am trained in wound management and closure, if I can’t get it clean- I’m not closing it.

You also need to think about what sort of injuries or illnesses are likely to occur. Feasibly, I’m going to fall off my bike a bit. So gravel rash and bruising are quite likely. Hopefully nothing much worse but FOSH (Fall onto Out Stretched Hand) injuries are common with biking, which results in wrist, elbow and shoulder and possibly clavicle injuries. Bites, stings and other illnesses are also real possibilities. Before I put myself off going completely here’s my list.

My First Aid Kit contains*:

  • Saline pods and sterile gauze for washing eyes and for wound cleaning/debridement (rather than hydrogen peroxide/alcohol which slows wound healing by damaging tissue)
  • Tweezers and tick remover
  • Steri-strips
  • Roll zinc oxide and Transpore tape
  • Conforming bandage
  • Cohesive bandage
  • Ambulance dressings
  • Sterile low adhesive dressings
  • Selection of Plasters
  • Triangular bandage
  • Ibuprofen/Paracetamol/Cetirizine Hydrochloride or Chlorphenamine Maleate (for pain relief, fevers and minor allergic reactions)
  • Immodium
  • Electrolyte replacement sachets (although if you’re cycling you might be using these in your water bottle anyway)
  • Epi-pen (not everyone will need to carry one but if you have experienced an anaphylactic or severe allergic reaction to anything then this might be a good idea)
  • Couple of pairs of gloves
  • Duct tape
  • Sun block
  • Hand sanitiser
  • Foil Blanket
  • Scissors

If you are travelling to the distant corners of the world with limited access to healthcare facilities you may want to supplement the above with:

  • Suture kit (if you are trained and comfortable using it)
  • Water filter
  • Irrigation syringe
  • Povidone-lodine USP 10.0% (normally saline will do the job for wound cleaning but for a wound with lots of contamination this may be useful)
  • Stronger pain relief (Codeine etc)

If you fancy a bit of remote first aid training before you embark on your trip head on over to our website to find out all the training courses that we run. Nearly all of our courses have a remote/outdoor element to them and we go up into the local hills to give you real life scenarios to practice on.

*This kit is based on my own personal research and what I feel comfortable carrying on a fairly remote trip with access to healthcare facilities within a reasonable distance.

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My First Aid Kit – What am I taking whilst bikepacking in New Zealand?

Essentials of Advanced Airway Management

Airtraq

I changed roles for the day recently and instead of blogger and all round office admin extraordinaire, I became a student on one of our courses.

MTRS have started running an Essentials of Advanced Airway Management course and this November I put myself forward as a student. It is something that I think we, as Paramedics, do not get the opportunity to practice on a regular basis. How many tubes do you actually get to pass a year? It’s definitely an area of my practice that I want more experience in. If we are not being exposed to situations that require intubation skills how do we keep well rehearsed and up to date?

A coroner’s report from 2013 which investigated the death of a 27 y/o female in the East Midlands found that her death was contributed to by an unrecognised oesphageal intubation. No end tidal monitoring device was used in this instance. East Midlands Ambulance Service had not released a mandate to make the use of such devices compulsory. The incorrect placement would have been recognised much sooner if end tidal monitoring were used. The paramedic that had conducted the intubation had not received any further training or assessments in advanced airway management since he had been signed off as competent four years before the incident. (https://www.judiciary.gov.uk/wp-content/uploads/2014/07/Perrons-2014-0158.pdf)

2015-11-04 16.36.50

On the course we learnt about all the bits of kit there is out there to assist you with those difficult intubations like video laryngoscopy and the Airtraq, how to perform a surgical airway, how to intubate underneath a vehicle or in a cupboard. Ok, that sounds ridiculous but the reality is, we may come across those situations and we need to be confident in our abilities when we need them.

2015-11-04 16.46.56This was all conducted under the very experienced, watchful gaze of Dr Will Jones. A Consultant Anaesthetist from Leeds Teaching Hospital Trust, who had some great tips and advice and we all left feeling much more confident.

The course is fully accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) and internationally recognised. More details about the course can be found on the airway site.

For more information on this course or any of the course we run, please head to the website or contact us directly.

Essentials of Advanced Airway Management

Fancy some free First Aid training?

MEDICREAR

We are going to be running a free first aid training/refresher session on the 2nd September here at MTRS HQ between 0900 and 1230 hours.

It’s an ideal chance to refresh the skills that you picked on your First Aid course. We’ll be looking at the latest updates and new equipment, running through some first aid scenarios and of course you’ll get a chance to practise CPR.

All of these sessions will be delivered by Paramedics and those working in the remote rescue area.

If you are interested in coming along please email info@mountaintrauma.co.uk. It is free to attend but places are limited to please pre-book via email.

For more info about us and where we are located head on over to our website.

Fancy some free First Aid training?

Competition Time!

Why don’t you head on over to our website where we have recently added a new section for competitions and discounts.

Right now we have a competition running in which you could get a 50% discount on the ECRE course that we run at our HQ in Ambleside.

If you are an event organiser and would like win £250 worth of medical provision at one of your events, we have just the competition for you….

Closing date is the 1st of August so get entering and good luck!

Winners will be contacted shortly after the competitions close.

Enter here.

Competition Time!

Medical Director Vacancy.

We are currently seeking a part-time Medical Director to join our team and to work on a flexible/casual basis. This position would suit a doctor who wishes to develop their skills and experiences within the event medicine and medical education industry, whilst maintaining their full-time position within the NHS. The contracted hours would be worked from our offices or when suitable, remotely from home.

Contracted Hours – 12 hours/month (extra hours available by working at events & education courses). Potential to increase contracted hours following a six-month review.

Pay – £255/month.

Venue – Ambleside, Cumbria.

To Start – ASAP (March 2015).

Essential Skills

  • Consultant/Senior Registrar ST3/4+ (preferably EM or Anaesthetics)
  • Pre-hospital Care experience
  • ATLS/ALS qualified
  • Experience working with clinical governance
  • Full, clean driving license

Desirable Skills

  • ATLS/ALS/PHTLS instructor
  • Private Prescriber number
  • Experience of writing PGD’s
  • MIMMS qualified
  • Experience of remote clinical supervision
  • Event Medicine experience

The successful candidate will be responsible for:

  • Offering clinical advice to the management team who in turn will pass on to paramedics, rescue technicians and junior doctor grades
  • Supporting staff development and advising on staff training
  • Advising and overseeing clinical audits / clinical governance
  • Advising on evidence best practice in both medical education and event medicine
  • Working with and advising the management team on medicine management

If you are interested in joining our professional and growing organisation please send your CV as well as a covering email to nick@mountaintrauma.co.uk.

Medical Director Vacancy.

Pre Hospital Paediatric Trauma care – how do we improve?

The introduction of regional trauma networks in 2012 shows that there has been a shift in thinking about how we deal with trauma in a pre-hospital setting. Of the trauma that we encounter such a small percentage involves paediatrics so our likely exposure to significant paediatric trauma is very small.

This does mean that responders may be inexperienced and this inevitably creates more anxiety. More anxiety means an impairment of clinical judgement and performance which creates more anxiety…..etc. etc. ad infinitum!

How many of us feel that added pressure when we attend to paediatrics? We might be theoretically well versed in what to do but the reality of getting that IV access, providing pain relief and doing emergency interventions, that are second nature when dealing with adult patients, may become extended efforts or worse still, unsuccessful.

Half the battle is recognising the sick child – as lack of recognition leads to decompenstation and then potentially an irretrievably sick child.  Going back to the limited paediatric training that we get, I’m sure we all remember that “children are not small adults” and physiological changes can occur rapidly with occult warning. Therefore, close and careful monitoring of the patient is essential and any changes should be interpreted in the context of the differing physiology of children.

So a good theoretical understanding and good assessment skills are required and then of course there is the need for repetition of practice…….which is where it comes unstuck, we just don’t get enough! The less we practice something the more the need for theoretical and practical training to try to overcome the huge lack of clinical exposure.

With such little exposure to paediatric trauma the experience that we acquire dealing with adults has to be translated to dealing with paeds. They both experience the same life-threatening injuries and although the injury pattern may well be different, the life-saving interventions are the same or sufficiently similar that it should instill a degree of confidence in the clinician.

In an ideal world we would be equipped with all the paediatric trauma equipment that we have for adults (the pelvic splints, the femur traction splints etc) . But this is not currently the reality and combined with the wrong, ill-fitting monitoring equipment makes identifying an ill child that much harder.

The 2011 recommendations from the NHS Clinical Advisory Group are that ambulances be equipped with paediatric monitoring and resuscitation equipment. They also advised that improvements need to be made in the skills and knowledge of the clinicians to treat the seriously injured child with triage criteria that are clear and simple. They go further and suggest that there is a need for a review of the delivery of analgesia to include the intranasal route and vascular access to include the use of up-to-date intraosseus devices, rather than the hand needle.

There seems to be quite a few hurdles in the pre-hospital management of trauma in paeds but given that we have little control over policy, equipment and geography what can we do to better prepare ourselves for these incidents? Most ambulance services currently rely on the individual to complete their own professional development which is a huge failing to their staff as regular update training and clinical placements would go a long way in reducing skill-fade and would certainly help with clinician confidence.

Hopefully the recommendations in the NHS Clinical Advisory Group’s report will be implemented soon as there is definitely scope for improvement in how we currently deal with children involved in trauma. What do you feel would help improve your practice?

For further info/reading:

http://www.ukpics.org.uk/documents/Management%20of%20Children%20wi~dvisory%20Group%20Report%201%20.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500002/

http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/trauma_emergencies_in_children_overview_2006.pdf

Pre Hospital Paediatric Trauma care – how do we improve?

Pre-Hospital Trauma Symposium – bookings now being taken!

The dates for the 2015 Pre Hospital Trauma Symposium have been announced – the 15th and 16th April. We will be running the Symposium at our head-office up at Brathay Hall, Ambleside.

We have a great line-up of speakers throughout the 2 days. There will also be workshops so you can get hands on with your trauma care and have a play with some new trauma equipment. A full programme can be found here.

It is being run by healthcare providers for healthcare providers with a view to making it as up-to-date and relevant as we possibly can to improve your knowledge and practice.

Evidence of attendance will be provided which can be used in CPD portfolios.

Bookings can be made here with discounts available for Early Birds, Students and College of Paramedic members.

 

 

 

 

Pre-Hospital Trauma Symposium – bookings now being taken!