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

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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?

Trick or Trauma?

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Happy Holloween to our fans…..

The title is a very weak link, but recently we were asked by Openhouse medical products to answer some questions about trauma training and the courses we run.  Here are our answers.  We’d appreciate to hear your thoughts and answers to questions 1, 4, 6, 8 and 9. Please contribute in the comments below.

1. Why is it important is it for paramedics in the UK to be trained in trauma management?

It was estimated in 2010 that there are around 20,000 cases of major trauma each year in England, many resulting from road traffic accidents. Due to the promotion and continual improvement of health and safety, major trauma is less common than it was 10 years ago for example. Trauma calls make up a very small proportion of the workload dealt with by the modern ambulance service. The fact that clinicians are exposed to fewer trauma incidents and that transport times are now potentially longer as crews bypass local hospitals in order to deliver the patient to a major trauma centre, training in dealing with a trauma patient is more important than it ever has been.

2. Who do you teach trauma training to? How is the course taught?

We deliver the Pre-hospital Trauma Life Support (PHTLS), which is accredited by the Royal College of Surgeons (England) and the NAEMT. We also deliver in-house workshops to deal with major bleeding, splinting and airway management. We teach these course to a range of pre-hospital clinicians including paramedics, technicians, doctors, nurses, offshore medics, mountain rescue teams and the fire and rescue service. The PHTLS is delivered over two days and teaches the principles of managing the poly-trauma patient, hopefully boosting the confidence of the responder in such situations.

3. What methods and training devices do you use to help train medical professionals?

Delivery of these trauma courses is normally done so through expert teacher-led sessions, group discussions, problem-based learning, simulations and moulages. Students are also expected to pass a range of assessments on the PHTLS course. We also offer an optional third day where we put students through their paces with numerous non-assessed scenarios, utilising a professional casualty simulation team.

4. How can you teach medical professionals to be emotionally strong in cases of serious trauma emergencies? 

We cannot teach medical professionals to be emotionally strong but I believe emotions can be somewhat controlled by having the confidence to deal with trauma emergencies. Having the skills and knowledge to deal with what is facing us keeps our mind focused and reduces the feeling of being overwhelmed or out of our comfort zone. We teach students to be systematic and to adhere to a set of principles. How they achieve the principle may vary and the ability to improvise is an important skill.

5. Will trauma training provide you with a certificate of some sort?

All of our courses are certified. The PHTLS course certification lasts for 4 years.

6. How long will it take someone to be fully prepared for trauma situations? Will a young training paramedic come face to face with such incidents during their training period or only once they are fully qualified?

This is a hard question to answer. Yes, student paramedics will probably be exposed to some trauma incidents in their placements, and leave university with the hard-skill set to deal with such incidents. Due to the low occurrence and subsequent exposure to trauma, skills and confidence does tend to fade. It’s important to remain current, competent and confident and this is often achieved through some form of training.

Can we ever be fully prepared? I have good friends and experienced colleagues that have suffered serious emotional turmoil later in life having dealt with a traumatic incident or a collection of incidents that didn’t seem to affect them at the time. Clinicians should always be aware of the early signs of Post Traumatic Stress Disorder and know how to seek further help. We also need to look out for one another!

7. Do you use hyper-realistic medical training devices such as Simulaids?

We use a range of simulation equipment including Simulaids advanced life support training manikins, surgical airways and bone injection devices.

8. Is there a certain personality type, which you believe, makes a good trauma doctor, nurse or paramedic?

Certainly those with a level head and that can make decisions under pressure can be better suited to the role, however there isn’t just one certain type of personality as we all bring different things to the role. Some may excel at multitasking and dealing with the logistics, others will excel clinically while others will bring compassion and empathy. Being able to stay focused on the task in hand but also being situationally aware is a benefit.

9. If you could give one piece of advice for someone dealing with a serious medical emergency what would it be?

Don’t be distracted by the obvious injury and miss something life-threatening. This is achieved by being systematic and following the CABCD approach. This should be constantly reviewed throughout your time with the patient.

Don’t be distracted by the obvious injury and miss something life-threatening. This is achieved by being systematic and following the CABCD approach. This should be constantly reviewed throughout your time with the patient.

Trick or Trauma?

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?

Blood on Board

Dr Rachel Hawes of the Great North Air Ambulance Service is one of our speakers at the Prehospital Trauma Symposium. She will be discussing the benefits and challenges of carrying blood on board the aircraft. GNNAS is one of a few air ambulance services able to bring blood products to the roadside.

http://www.greatnorthairambulance.co.uk/news/post/gnaas-to-begin-carrying-blood-which-will-save-lives/

Are you a clinician who have seen the benefits of blood products being used for one of your patients in the prehospital setting? We’d love to hear your thoughts in the comments below.

If you would like to hear from Dr Hawes and some other influential speakers book your place at the 2015 Symposium and take advantage of some early booking discounts.

www.traumasymposium.co.ukm

Blood on Board