Comments to:

Keith Conover, M .D., FACEP, M edical Director

36 Robinhood Road, Pittsburgh, PA 15220-3014
412-561-3413 kconover+ @ pitt.edu



Revisions
T h i s rev i si o n , 1 . 2 , i s o ffered i n p rep arati o n fo r th e rel ease o f a m ajo r rev i si o n
o f th e WE M S I P erso n al Wi l d ern ess M ed i cal K i t l i st, w h i ch w i l l b e n u m b ered
2 . 0 , an d rel eased at th e b egi n n i n g o f 2 0 0 0 . Y o u w i l l n o te red l i n ed ch an ges
th ro u gh o u t th e l i sts, rep resen ti n g ch an ges fro m v ersi o n 1 . 1 , w h i ch h ad
rem ai n ed v i rtu al l y u n ch an ged fo r y ears.
S o m e o f th e m ajo r h i gh l i gh ts o f th e p ro p o sed ch an ges are as fo l l o w s. T h ese
are ex p l ai n ed i n m o re d etai l i n th e en d n o tes:
A sal i n e l o ck an d sal i n e fl u sh h av e b een ad d ed to th e A d v an ced K i t, to
al l o w WE M T s at th e scen e to start an I V , to gi v e m u l ti p l e m ed i cati o n s,
an d to h av e a p aten t I V read y fo r w h en I V b ags an d tu b i n g arri v e.
I M k eto ro l ac (e. g. , Toradol

) h as b een tak en o ff th e l i st, as i t h as

v i rtu al l y n o ad v an tages o v er o ral i b u p ro fen (see en d n o tes).
T u b ex i n jecti o n s an d sy ri n ges h av e b een tak en o ff th e l i st, as th e
co n tai n ers l eak w h en o v erh eated .
A o n e-w ay v al v e h as b een ad d ed to th e ad v an ced k i t, to p ro v i d e so m e
WE M T p ro tecti o n d u ri n g m o u th -to -en d o trach eal -tu b e v en ti l ati o n .
A sm al l sk i n stap l er h as b een ad d ed , fo r scal p w o u n d s an d fo r m i n o r
l acerati o n s.
D ro p eri d o l h as b een ad d ed as a m u l ti -p u rp o se rep l acem en t fo r b o th
p ro ch l o rp erazi n e (e. g. , Compazine

) an d h al o p eri d o l (e. g. , Haldol

) fo r
Personal
Wilderness
Medical Kit
Version 1.2 10/7/99 Version 1.2 10/7/99 Version 1.2 10/7/99 Version 1.2 10/7/99
Wilderness EMS
Institute
Personal Wilderness Medical Kit
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sed ati o n , n au sea, an d m i grai n es.
A fter d u e co n si d erati o n , w e h av e ad d ed m i d azo l am (e. g. , Versed

) to
th e A d v an ced K i t, fo r sed ati o n fo r p ro ced u res an d fo r co n tro l o f
sei zu res, an d rem o v ed ci p ro fl o x aci n (e. g. , Cipro

), b i saco d y l (e. g. ,
Dulcolax

), b i sm u th su b sal i cy l ate (e. g. , Pepto-Bismol

) an d
cy cl o b en zi p ri n e (e. g. , Flexeril

).
A fter a p u b l i c co m m en t p eri o d o f th ree m o n th s th e d ead l i n e fo r co m m en ts
i s D ecem b er 3 0 , 1 9 9 9 w e w i l l p o st th e n ew o ffi ci al v ersi o n , n u m b ered 2 . 0 ,
o n th e WE M S I Web si te, an d an n o u n ce i t p u b l i cl y th ro u gh th e u su al
ch an n el s, i n cl u d i n g th e w i l d ern ess-em ergen cy -m ed i ci n e l i st (sen d " su b scri b e
w i l d ern ess-em ergen cy -m ed i ci n e" to M ajo rd o m o @ l i st. p i tt. ed u to su b scri b e;
m o re i n fo rm ati o n av ai l ab l e at h ttp : //w w w . w em si . o rg/).
Choosing a Wilderness Medical Kit: The Basics
C h o o si n g th e co n ten ts o f a w i l d ern ess m ed i cal o r fi rst ai d k i t i s h ard . B u t i f
y o u are p u tti n g to geth er su ch a k i t, y o u m ay l o o k to th i s d o cu m en t fo r h el p .
T h e Wi l d ern ess E M S I n sti tu te staff an d co n tri b u to rs p u t a l o t o f effo rt i n to th i s
d o cu m en t. O n e o f o u r m i ssi o n s i s w i l d ern ess m ed i cal ed u cati o n , so w e are
m ak i n g th e l i st p u b l i c, b u t al so sh o w i n g h o w w e d eci d ed o n th e l i st. T h e l i st
m i gh t n o t b e ex actl y w h at y o u n eed fo r your m ed i cal k i t. B u t w e h o p e y o u
fi n d th i s d o cu m en t, w i th al l o f i ts p ri n ci p l es an d ex p l an ato ry n o tes, a go o d
starti n g p l ace fo r d esi gn i n g y o u r o w n k i t. I f d esi gn i n g a l arge team k i t, y o u
m ay w an t to l o o k at th e WE M S I T eam M ed i cal K i t d o cu m en t, av ai l ab l e at
h ttp : //w w w . w em si . o rg.
A s w e sai d , assem b l i n g a m ed i cal k i t i s h ard . B u t th ere are m an y w ay s to
m ak e i t easi er. Y o u can si m p l y get a l i st fro m so m eo n e au th o ri tati v e an d
assem b l e a k i t b ased o n th at. B u t i t m ay m ak e m o re sen se fo r y o u to ask
certai n b asi c q u esti o n s, an d th en assem b l e a k i t b ased o n th e an sw ers.
S o m e o b v i o u s q u esti o n s, b u t o n es w o rth ask i n g o u t l o u d at th e b egi n n i n g, are:
Who i s go i n g to u se th e k i t, an d w h at i s h i s o r h er l ev el o f trai n i n g?
For WEMSI, these are people trained in accordance with the WEMSI
WEMT Curriculum, who also have EMT-basic or EMT-paramedic
training or the equivalent, and who have authorization from a
physician to carry and use the kit as part of a wilderness EMS
agency/SAR team.
Who w i l l th e k i t p ro v i d e fo r -- h o w m an y ? A n d are th ere an y special
needs (e. g. , p regn an t w o m en , d i ab eti cs, sm al l ch i l d ren , d o gs, h o rses)?
For WEMSI, the kits will be used to provide initial care for the subjects
of wilderness and backcountry search and rescue operations, including
lost person searches and mountain and cave rescue operations. The
kits will also provide care for members of field teams, including dogs
Personal Wilderness Medical Kit
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and horses, when they are remote from standard medical care.
How longw i l l th e k i t h av e to p ro v i d e m ed i cal care fo r th ese p eo p l e?
For WEMSI, the kit design is for the most common sort of mountain
and cave search and rescue operations in North America tasks
usually lasting 4-12 hours, rarely lasting longer, perhaps up to a day or
two without resupply.
Wherew i l l th e p eo p l e b e go i n g? F o r i n stan ce, th eres n o n eed fo r
al ti tu d e-rel ated m ed i cati o n s i f th ey re ju st i n th e A p p al ach i an
M o u n tai n s (w h ere al ti tu d e i l l n ess i s ex ceed i n gl y rare), an d n o n eed fo r
a sn ak eb i te k i t i f th ey re h i l l -w al k i n g i n I rel an d o r B ri tai n , w h ere th ere
are essen ti al l y n o p o i so n o u s sn ak es. For WEMSI, the answer is in any
wild or backcountry area or cave in North America, exclusive of the
Arctic.
How much can th ey carry ? I f i ts a ri v er rafti n g tri p , a fai rl y h eav y k i t
i s O K , b u t i f i ts fo r a l o n g b ack p ack i n g tri p al o n g th e A p p al ach i an
T rai l , w h ere i ts u su al l y p o ssi b l e to get to a ro ad an d to a h o sp i tal
w i th i n a d ay o r so , a l i gh ter k i t i s i n o rd er. For WEMSI, the answer
from the field is if we gotta carry this around with us all the time, up
and down mountains and through cave crawlways, its gotta be small
and light.
A sk i n g th o se q u esti o n s i s ju st th e b egi n n i n g. N ex t co m es a d el i cate b al an ci n g
act. F o r ex am p l e: reco n ci l i n g th e team d o cto r (w h o w an ts y o u to carry
ev ery th i n g i n cl u d i n g fo u r b ags o f I V fl u i d s at 2 . 2 l b s. a b ag) an d th e team
m em b ers (fan ati cal l y w ei gh t-co n sci o u s b ack b ack er-ty p e o n es w h o cu t th e
h an d l es o ff th ei r to o th b ru sh es an d th e m argi n s o ff th ei r m ap s an d w h o w an t a
k i t th at w ei gh s l ess th an an o u n ce). A n o th er ex am p l e: w e h ad co n si d ered
ad d i n g an am p o u l e o f 5 0 % d ex tro se to th e k i t. B u t i t i s v ery h eav y , an d
fragi l e, an d i n al m o st al l cases, o n e can get so m e o ral gl u co se o r o th er fo o d
i n to an y h y p o gl y cem i c p ati en t i n th e w i l d ern ess. F o r th at m atter, i n stan t
gl u co se test stri p s w ei gh v ery l i ttl e; h o w ev er, th ey h av e to b e k ep t i n an
ai rti gh t co n tai n er th at i s fai rl y l arge, an d h av e a sh o rt sh el f l i fe w h en ex p o sed
to h eat (as i n a p ack o r car i n th e su m m er). S i n ce al m o st al l w i l d ern ess
p ati en ts n eed gl u co se o r fo o d cal o ri es, w e d i d n o t i n cl u d e gl u co se test stri p s
i n th e k i t, ei th er.
H ere are a few p ri n ci p l es to gu i d e assem b l y o f y o u r m ed i cal k i t, th o u gh
co m p eti n g o n es th at m u st b e d el i catel y assessed an d b al an ced .
Durability
Wi l d ern ess m ed i cal k i ts m u st w i th stan d cru sh i n g an d d ro p sh o ck s. T h e
d egree o f p ro tecti o n d ep en d s o n th e en v i ro n m en t. F o r stan d ard m o u n tai n
search an d rescu e, th e p ad d i n g o f a so ft case, th at can b e i n serted i n a
w aterp ro o f b ag, m ay b e accep tab l e. F o r cav e rescu e, th o u gh , a w aterp ro o f an d
Personal Wilderness Medical Kit
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cru sh p ro o f case su ch as th o se m ad e b y P el i can , o r a su rp l u s am m u n i ti o n b o x ,
i s m u ch m o re ap p ro p ri ate. F o r k i ts th at m ay b e u sed i n b o th setti n gs, th e k i t
can b e i n a so ft n y l o n o rgan i zer case, i n serted i n to a w aterp ro o f p l asti c o r
n y l o n b ag (o r ev en ju st a p ack w i th a go o d rai n co v er) fo r m o u n tai n rescu e,
an d i n serted i n to a P el i can case o r am m o b o x fo r cav e rescu e.
Wi l d ern ess m ed i cal k i ts m u st al so w i th stan d tem p eratu re ex trem es
m ed i cati o n s th at req u i re refri gerati o n o r a co n tro l l ed ro o m tem p eratu re, o r
th at are d an gero u s w h en fro zen an d rew arm ed , are n o t accep tab l e.
I n fo rm ati o n ab o u t d ru g stab i l i ty u n d er tem p eratu re ex trem es i s d i ffi cu l t to
fi n d , b u t so m e referen ces can b e fo u n d at h ttp : //w w w . w em si . o rg i n th e
P h arm aco l o gy L esso n P l an .
Wi l d ern ess m ed i cal k i ts m u st al so b e u sab l e d esp i te o ccasi o n al o u td ated
m ed i cati o n s m ed i cati o n s th at are u n safe w h en o u td ated , su ch as
tetracy cl i n e, are n o t accep tab l e. M ed i cati o n s th at sti l l h av e si gn i fi can t
p o ten cy after ex p i rati o n are i d eal fo r w i l d ern ess k i ts. (M o st d ru gs are sti l l
go o d fo r a y ear o r tw o after th ei r ex p i rati o n d ate, i f n o t gro ssl y ab u sed o r k ep t
at ex trem e tem p eratu res, b u t th ere are ex cep ti o n s. )
Flexibility
Wi l d ern ess m ed i cal k i ts m u st h av e th e eq u i p m en t an d m ed i cati o n s to h an d l e
co m m o n an d seri o u s p ro b l em s. B u t to sav e w ei gh t, eq u i p m en t an d
m ed i cati o n s sh o u l d h av e m u l ti p l e u ses. M ed i cal k i ts u sed b y search an d
rescu e team WE M T s sh o u l d b e u sab l e fo r d o gs an d h o rses, as th ese an i m al s
are o ften p art o f th e S A R effo rt. (T h ats w h y th e WE M S I WE M T C u rri cu l u m
al so co n tai n s a secti o n o n v eteri n ary em ergen ci es. )
I d eal l y , a S A R m ed i cal k i t sh o u l d sep arate i n to sm al l er m o d u l es -- so as n o t to
h av e to carry en ti re k i t o n ev ery task , esp eci al l y i f i t i s a " b ash " team try i n g to
get i n to a p ati en t as q u i ck l y as p o ssi b l e al so to b e ab l e to d i v i d e th e k i t
am o n g team m em b ers. S ee th e Organization secti o n b el o w fo r WE M S I s
so l u ti o n fo r th i s.
A l th o u gh a S A R m ed i cal k i t m ay b e u sed ju st i n o n e area, i t sh o u l d b e
ad eq u ate fo r m u tu al ai d req u ests to o th er regi o n s. F o r ex am p l e, a N o rth
A m eri can S A R WE M T k i t sh o u l d carry m ed i cati o n s fo r h i gh al ti tu d e i l l n ess.
E v en team s i n th e A p p al ach i an R egi o n o f th e M o u n tai n R escu e A sso ci ati o n ,
o r th e E astern R egi o n o f th e N ati o n al C av e R escu e co m m i ssi o n sh o u l d carry
th ese. T h ese o u t o f regi o n m ed i cati o n s co u l d th eo reti cal l y b e l eft o u t
ex cep t fo r o u t-o f-regi o n resp o n ses. O n th e o th er h an d , th ey d o n t w ei gh
m u ch . A n d , a h i gh -al ti tu d e o u t-o f-regi o n resp o n se m i gh t co m e d u ri n g an i n -
regi o n o p erati o n -- m ean i n g th at WE M T s can t go h o m e to get th e m ed i cati o n s
th at th ey v e l eft o u t. A n d su d d en l y go i n g to al ti tu d e w i th o u t tak i n g Diamox

i s d efi n i tel y not a go o d i d ea.
Personal Wilderness Medical Kit
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Kit Capabilities
T h ere are tw o m ai n targets fo r th e WE M S I P erso n al Wi l d ern ess M ed i cal K i t.
T h e fi rst target o f th e k i t i s th e search su b ject o r rescu e v i cti m . T h e WE M T
sh o u l d h av e en o u gh eq u i p m en t an d d ru gs, w i th i n th e co n tex t o f a k i t th at
w ei gh s l ess th an a p o u n d o r so an d i sn t v ery b u l k y , to p ro v i d e stab i l i zi n g
care fo r m o st sev ere w i l d ern ess i n ju ri es an d i l l n esses. A team w i th a l arger
m ed i cal k i t w i l l u su al l y arri v e w i th i n a sev eral h o u rs, an d w i th so m e i tem s
fro m a stan d ard E M T k i t (B P cu ff an d steth o sco p e, b an d ages an d d ressi n gs,
sp l i n ts), an d m ay b e so m e I V fl u i d s, th e WE M T can p ro v i d e reaso n ab l y go o d
care fro m m o st co m m o n w i l d ern ess i n ju ri es an d i l l n esses.
T h e seco n d target o f th e k i t i s th e fi el d team s m em b ers. WE M T s sh o u l d h av e
en o u gh m ed i cati o n to start treatm en t fo r co m m o n p ro b l em s i n th e fi el d , th en
fo r m em b ers to get h o m e, get an ap p o i n tm en t w i th th ei r fam i l y d o cto r, an d
h av e th e co n d i ti o n re-ev al u ated . C o n si d eri n g th e real i ti es o f b o th S A R
o p erati o n s an d getti n g ap p o i n tm en ts w i th o ffi ce-b ased d o cto rs, en o u gh fo r 3
d ay s o f treatm en t seem s reaso n ab l e.
Expense
S o m e S A R team m em b ers w i l l h av e to p u rch ase m ed i cati o n s w i th th ei r o w n
m o n ey -- m an y S A R team s can 't affo rd to i ssu e ex p en si v e k i ts to th ei r
WE M T s. T eam WE M T s w i th sel f-p u rch ased m ed i cati o n s gen eral l y u se th ei r
k i ts fo r p erso n al tri p s as w el l as fo r S A R o p erati o n s.
S am p l es are o ften av ai l ab l e th ro u gh p h y si ci an o ffi ces, o r fro m m an u factu rers,
w h i ch m ay h el p d ecrease th e co st o f m em b ers k i ts.
E v en i f th e team i ssu es ev ery th i n g i n th e k i ts, few S A R team s h av e m u ch
m o n ey , so m ed i cati o n s an d eq u i p m en t m u st n o t b e to o ex p en si v e.
Safety
A n y w i l d ern ess m ed i cal k i t sh o u l d co n tai n i n stru cti o n s o n th e safe u se o f i ts
m ed i cati o n s. I t i s q u i te p o ssi b l e th at th e WE M T b eco m es i n ju red , an d a team
m em b er w i th l ess trai n i n g w i l l n eed to u se th e k i t. A n d , a rem i n d er ab o u t
u ses an d d o sages i s al w ay s ap p ro p ri ate fo r an y th i n g th at i sn t u sed o n a
regu l ar b asi s.
T h ere are (at l east) tw o go o d ap p ro ach es to th i s. F i rst, th e p h y si ci an m ed i cal
d i recto r, o r p rescri b i n g p h y si ci an , can p ro v i d e d etai l ed stan d i n g o rd ers fo r th e
u se o f m ed i cati o n s i n certai n si tu ati o n s, an d a co p y o f th ese sh o u l d b e p l aced
i n th e m ed i cal k i t. S eco n d , a l i st o f m ed i cati o n s, b o th th o se i n th e k i t as w el l
as co m m o n m ed i cati o n s carri ed i n w i l d ern ess trav el ers k i ts, th ei r co m m o n
i n d i cati o n s, co n trai n d i cati o n s, d o sages, an d an y cau ti o n s, p ro v i d es a u sefu l
referen ce. S ev eral o f th ese are av ai l ab l e i n w i l d ern ess fi rst ai d b o o k s, an d
Personal Wilderness Medical Kit
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WE M S I i s d rafti n g a p o ck et w i l d ern ess p h arm aco l o gy referen ce w i th th e
WE M S I Wi l d ern ess E M T i n m i n d . S tan d i n g o rd ers sh o u l d b e p ro v i d ed b y th e
WE M T s p h y si ci an m ed i cal d i recto r.
Accountability and Security
P h y si ci an s sh o u l d b e rel u ctan t to p rescri b e o r i ssu e m ed i cati o n to WE M T s
u n l ess th e m ed i cati o n s are m an aged i n an accep tab l e w ay .
T h ere are tw o w ay s fo r a p h y si ci an to p ro v i d e m ed i cati o n s fo r m ed i cal k i ts.
F i rst i s to prescribe th e d ru gs fo r each i n d i v i d u al WE M T , an d ex p ect th e
WE M T to u se th e k i t fo r p erso n al u se w h i l e i n th e w i l d ern ess. T h e WE M T
m ay th en to u se th ese p erso n al m ed i cati o n s fo r o th ers w h en n eed ed , u n d er
th e v ari o u s state G o o d S am ari tan L aw s, an d m o re i m p o rtan tl y , u n d er th e
co m m o n -l aw p ri n ci p l e th at req u i res o n e to p ro v i d e care u p to o n es cap aci ty
w h en ai d i n g an i n d i v i d u al i n d i stress l est o n e b e gu i l ty o f gro ss o r w i l l fu l
n egl i gen ce.
H o w ev er, a m o re p ro fessi o n al arran gem en t i s fo r th e p h y si ci an h av e a
p h arm acy , u su al l y a h o sp i tal p h arm acy , issue th e d ru gs to each WE M T .
C o n su l t w i th th e l o cal D ru g E n fo rcem en t A d m i n i strati o n o ffi ce, an d w i th a
h o sp i tal p h arm aci st ex p eri en ced i n d eal i n g am b u l an ce serv i ces.
M an y m ed i cati o n s i n w i l d ern ess m ed i cal k i ts are av ai l ab l e i n i n ex p en si v e
gen eri cs w i th o u t a p rescri p ti o n o v er-th e-co u n ter o r O T C . Wh i l e i t i s
p o ssi b l e to i ssu e O T C m ed i cati o n s to each WE M T , th e ex tra co st m ay b e
u n w arran ted . I f each WE M T i s resp o n si b l e fo r rep l aci n g O T C m ed i cati o n s as
th ey b eco m e o u td ated , i t m ay al so m ak e sen se to m ak e each WE M T
resp o n si b l e fo r rep l aci n g p rescri p ti o n m ed i cati o n s, to o . I f so , req u i re WE M T s
to i n sp ect th ei r k i ts o n a regu l ar b asi s, p erh ap s o n ce ev ery tw o m o n th s, an d
rep l ace d ru gs o r eq u i p m en t th at are o u td ated o r d am aged . D ru gs an d
eq u i p m en t u sed fo r p ati en t care sh o u l d b e rep l aced i m m ed i atel y .
T h i s d o cu m en t n o w p ro v i d es a p l ace to n o te th e ex p i rati o n d ate o f
m ed i cati o n s, as w el l a ch eck b o x to u se d u ri n g i n sp ecti o n s. A M i cro so ft Wo rd
v ersi o n o f th e tab l es th at fo l l o w i s d o w n l o ad ab l e fro m h ttp : w w w . w em si . o rg --
an d th en th e ex p i rati o n d ate can b e fi l l ed i n o n o n es co m p u ter, an d a co p y
p l aced i n th e k i t fo r i n sp ecti o n s.
E sp eci al l y fo r sch ed u l ed d ru gs ( n arco ti cs ) th at are i ssu ed , i t i s i m p o rtan t to
d o cu m en t u sage, an d to d o cu m en t w h en d ru gs are w asted o r d estro y ed .
T h e l o cal D E A o ffi ce an d a l o cal h o sp i tal p h arm aci st can h el p set u p
p ro ced u res to m eet fed eral an d state req u i rem en ts. I n gen eral , sch ed u l ed
d ru gs m u st b e k ep t secu re. D u ri n g w i l d ern ess trav el , tw o sm al l , l i gh tw ei gh t
trav el l o ck s, o n e each o n ex tern al an d i n tern al n y l o n cases p ro v i d es th e d u al
l o ck i n g th at i s u su al l y req u i red ; al th o u gh th i s i s n o t m u ch o f a d eterren t,
k eep i n g th e k i t i n o n es p ack i n th e b ack co u n try i s p ro b ab l y b etter secu ri ty
th an a h eav y steel b o x i n an u rb an am b u l an ce. H o w ev er, w h en a k i t i s not i n
Personal Wilderness Medical Kit
Page 7 of 26



th e b ack co u n try , i t i s i m p erati v e to k eep i t secu red as w el l as p o ssi b l e.
Organization
T h e o rgan i zati o n o f an y k i t w i l l b e co n ten ti o u s w h en ev er m o re th an o n e
p erso n i s i n v o l v ed . H o w ev er, m o st p eo p l e w i l l agree th at m ak i n g th e k i t
m o d u l ar, so th at a l i gh ter su b set can b e carri ed i n certai n ci rcu m stan ces, o r
th e k i t can b e d i v i d ed am o n g d i fferen t p eo p l e, i s v al u ab l e. WE M S I h as fo u n d
i t so fo r o u r k i ts, an d h as o rgan i zed th em as fo l l o w s. (S ee F i gu re. )
T h e Minimum Module i s to al w ay s b e carri ed b y Wi l d ern ess E M T s, ev en i f o n
a rap i d resp o n se fo r a rescu e, o r o n a sm al l , h i gh l y m o b i l e scratch (" h asty " )
search team . T h e d esi gn o f sev eral co m m erci al m ed i cal k i t b ags al l o w s a
p o u ch w h i ch can V el cro i n to a l arger b ag. T h e sm al l er p o u ch w o u l d b e i d eal
fo r th e M i n i m u m M o d u l e, an d th e l arger b ag fo r th e S earch M o d u l e.
H o w ev er, th e M i n i m u m M o d u l e al o n g w i th th e A d v an ced M o d u l e i s b i g
en o u gh th at m an y WE M T s carry tw o fu l l -si ze n y l o n fi rst ai d b ags, o n e w i th
th e M i n i m u m an d A d v an ced M o d u l es, an d an o th er w i th th e S earch M o d u l e.
T h e Advanced Module i s fo r th o se w i th A L S (A d v an ced L i fe S u p p o rt) sk i l l s
th e ab i l i ty to start I V s an d gi v e I V o r I M m ed i cati o n s, an d to p erfo rm d i gi tal
i n tu b ati o n . T h e A d v an ced M o d u l e i s an en h an cem en t to th e M i n i m u m
M o d u l e -- ev ery WE M T w i th ad v an ced trai n i n g (E M T -I n term ed i ate an d ab o v e)
an d accred i tati o n to p erfo rm ad v an ced sk i l l s sh o u l d carry th i s ad d i ti o n al
m o d u l e w h en ev er o n a search an d rescu e o p erati o n .
T h e S earch M o d u l e sh o u l d b e carri ed b y WE M T s w h en go i n g o n a search , as
o p p o sed to rescu e, task . T h e S earch M o d u l e i s carri ed fo r m o st search task s,
esp eci al l y i f th e team i s fai rl y l arge o r w i l l b e i n th e fi el d fo r an ex ten d ed
p eri o d . F o r so m e search es, b o th cav e an d ab o v e gro u n d , i t m ay b e
ap p ro p ri ate to " stage" a fu l l k i t, i n cl u d i n g th e S earch M o d u l e, at a cen tral
l o cati o n , easi l y accessi b l e to al l search team s. F o r a l arge team th at m ay sp l i t
u p , sev eral WE M T s m ay each tak e a M i n i m u m M o d u l e w i th o n l y o n e WE M T
carry i n g th e fu l l k i t, i n cl u d i n g a S earch M o d u l e.
Packaging
F i rst ai d k i t b ags fro m A tw ater-C arey (1 -8 0 0 -3 5 9 -1 6 4 6 ;
h ttp : //w w w . o m n i b u s. co m /atw atercarey /), O u td o o r R esearch
(h ttp : //w w w . o rgear. co m /m ed i cal /m ed i cal . h tm ), o r si m i l ar p ro v i d ers w o rk
n i cel y fo r o rgan i zi n g th e WE M S I P erso n al Wi l d ern ess M ed i cal K i t. T h e
M i n i m u m an d A d v an ced m o d u l es fi t n i cel y i n th e A tw ater-C arey E x p ed i ti o n
k i t b ag, an d th e S earch M o d u l e fi ts i n an o th er si m i l ar b ag. T h ese b ags h av e
th e great ad v an tage o f k eep i n g th i n gs b etter o rgan i zed , i m p o rtan t i f y o u 're
u si n g th e b ag al l th e ti m e.
F o r ab o v e-gro u n d rescu e, ju st p u tti n g th ese b ags i n a p l asti c b ag d eep i n o n e's
Personal Wilderness Medical Kit
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p ack sh o u l d b e ad eq u ate p ro tecti o n . F o r cav i n g, y o u can p u t th e en ti re
co n ten ts i n to a P el i can case, am m u n i ti o n b o x , o r T u p p erw are b o x th at can b e
seal ed w i th d u ct tap e.
F o r p i l l s, i t i s i d eal to h av e p rescri p ti o n m ed i cati o n s i n sep arate b l i ster
p ack agi n g fro m th e h o sp i tal p h arm acy , w i th an ex p i rati o n d ate m ark ed o n
each tab l et's p ack agi n g. S o m e n o n p rescri p ti o n m ed i cati o n s are al so av ai l ab l e
i n b l i ster p ack agi n g. M o st b u t n o t al l o f th e b l i ster p ack s h av e ex p i rati o n
d ates o n th em . Y o u can u se a l au n d ry m ark er to p u t ex p i rati o n d ates o n each
i n d i v i d u al p i l l 's p ack agi n g i f n eed ed . F o r p i l l s n o t av ai l ab l e i n b l i ster
p ack ages, i ts easy en o u gh to p u t so m e i n a ti n y zi p p er-l o ck p l asti c b ag (o ften
y o u can get a few free fro m y o u r l o cal h o sp i tal p h arm aci st). P ri n t u p a l ab el
o n y o u r co m p u ter w i th th e n am e an d stren gth o f th e p i l l , an d th e ex p i rati o n
d ate. C u t o u t th e l ab el , l am i n ate i t w i th so m e cl ear tap e, an d p l ace i n th e
zi p p er-l o ck b ag w i th th e p i l l s to p ro v i d e a go o d l ab el .
S o m e d ru gs co m e o n l y i n am p u l es th at are o p en ed b y sn ap p i n g o ff th e to p .
T h ey h av e th e ad v an tage o f b ei n g v ery co m p act an d l i gh t, b u t th e
d i sad v an tage th at th ey are fragi l e an d d i ffi cu l t to p ack . S m al l v i al s w i th
ru b b er p l u gs o n th e to p , co v ered b y fl i p -o ff l i d s, are p ro b ab l y su p eri o r --
h o w ev er, m an y d ru gs are o n l y av ai l ab l e i n sn ap -o ff am p u l es, so y o u n eed to
d ev el o p p ack agi n g fo r th i s.
M an y p eo p l e h av e tri ed m an y d i fferen t m ean s o f p ack agi n g. M o st o f th ese
h av e b een o n sm al l p ack ages p eo p l e fi n d i n th ei r " ju n k " b o x es an d th erefo re
can 't gen eral l y b e rep ro d u ced b y o th ers. Wh at y o u n eed i s so m eth i n g th at i s:
ch eap , o r easy to m ak e
p ro v i d es m o d erate p ro tecti o n agai n st b reak age (n o te th at th e o u ter
p ack agi n g o f o n e's m ed i cal k i t sh o u l d al so p ro v i d e so m e p ro tecti o n , so
th i s i n n er p ack agi n g n eed n o t b e " b o m b p ro o f" o r " cav ep ro o f" )
l i gh t
n o t b u l k y
S o m e h av e m ad e a p ack age u si n g th e card b o ard " rack " i n w h i ch am p u l es are
sh i p p ed i n th e b o x . T h i s can b e cu t d o w n to th e ri gh t si ze fo r th e n u m b er o f
am p u l es. O n e can th en cu t o ff a p i ece o f sti ff 3 /8 " cl o sed -cel l fo am th e sam e
si ze as th e " rack " an d u se d u ct tap e to tap e i t o n th e fro n t o f th e rack . D u ct-
tap e th e b o tto m , b u t l eav e th e to p o p en . Y o u can th en sl i d e th e am p u l es i n
fro m th e to p . T h ey seem to stay i n ju st fi n e w i th o u t tap i n g th e to p . Y o u
co u l d tap e so m e fo am o r an ad d i ti o n al p i ece o f sti ff m ateri al to th e b ack to
p ro v i d e ad d i ti o n al p ro tecti o n , esp eci al l y fro m fl ex i n g th at m i gh t b reak th e
n eck o f th e am p u l . B u t th at w o u l d ad d to th e b u l k an d w ei gh t.
F o r sto ri n g m ed i cati o n v i al s an d am p u l es, m an y are p l eased w i th a ti n y
P l an o fi sh i n g tack l e b o x cal l ed a M i n i M agn u m 3 2 1 3
(h ttp : //w w w . p l an o m o l d i n g. co m /tack l e/3 2 1 3 . h tm l , av ai l ab l e i n ex p en si v el y
Personal Wilderness Medical Kit
Page 9 of 26



fro m m an y h ard w are an d sp o rts sto res, an d v i a th e I n tern et fro m su p p l i ers as
h ttp : //w w w . w serv . co m /o cean p ro /i n v en to ry /tb o x 9 8 . h tm ) T h i s ti n y b o x h as
sm al l co m p artm en ts th e p erfect si ze fo r tw o sm al l m ed i cati o n v i al s, an d w i th
a ti n y b i t o f p ad d i n g i n each sm al l co m p artm en t, p ro v i d es sh o ck p ro tecti o n ,
as w el l as o rgan i zati o n . Wi th so m e m o d i fi cati o n (cu tti n g) w i th a h o t
so l d eri n g i ro n o r a to o l su ch as a D rem el d ri l l w i th a sm al l cu tti n g saw , th e
l arger v i al s o f ceftri ax o n e an d w ater fo r d i l u ti o n w i l l fi t i n to th e l arger
co m p artm en ts o f th i s b o x .
R ep ack agi n g fl u i d s su ch as S ti n gE eeze , p o v ad o n e-i o d i n e an d ti n ctu re o f
b en zo i n i n to sm al l er b o ttl es can sav e w ei gh t an d b u l k , p ro v i d ed th e b o ttl es
d o n t l eak al l o v er th e i n si d e o f th e k i t. S ti n gE eze can b e rep ack aged i n a
4 cc ey ed ro p p er ty p e b o ttl e, av ai l ab l e fro m su p p l i ers su ch as C at N o .
0 3 0 0 7 1 0 A fro m h ttp : //w w w . fi sh ersci en ti fi c. co m /, an d p o v ad o n e-i o d i n e
so l u ti o n an d b en zo i n can b e rep ack aged i n to ei gh t-cc N al gen e b o ttl es,
av ai l ab l e fro m su p p l i ers su ch as h ttp : //w w w . fi sh ersci en ti fi c. co m /, C at N o . 0 2 -
9 2 3 -1 1 A , N N I N o . : 2 0 0 2 9 0 2 5 .
Personal Wilderness Medical Kit
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Medical Medical Medical Medical
Kit Kit Kit Kit
System System System System
Overview Overview Overview Overview
N o tes:
1 . S ee WE M S I T eam M ed i cal K i t
an d P erso n al Wi l d ern ess M ed i cal
K i t d o cu m en t tex t fo r d etai ls.
2 . M i n i m u m M o d u l e carri ed b y al l
WE M S I m ed i cs at al l ti m es.
3 . A d v an ced M o d u le carri ed o n ly b y
WE M S I m ed i cs w i th A L S
accred i tati o n , at al l ti m es.
4 . S earch M o d u l e carri ed b y WE M S I
m ed i cs w h en o n a search o r o th er
o p erati o n (i . e. , n o t a rescu e) o r as
an o p ti o n o n so m e rescu es.
5 . A P erso n al Wi l d ern ess M ed i cal
K i t i s to b e i n clu d ed i n th e
T eam M ed i cal K i t
6 . I tem s su ch as li tters co n si d ered
p art o f T eam R escu e E q u i p m en t
rath er th an T eam M ed i cal K i t.
7 . T eam M ed i cal K i t d i v i d ed i n to
m o d u les so can b e d i stri b u ted
am o n g m em b ers o f team ; o r,
o n so m e o p erati o n s, o n l y
selected m o d u les m ay b e
carri ed i n to fi eld .
Wilderness EMS
Institute


Personal Wilderness Medical Kit
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Minimum Module
1

Prescription-only items are noted by ! !! !
Names are U.S. generic and tradenames. Items removed from version 1.1 noted by
strikeout, items added to version 1.1 underlined; both types of changes also noted by
a vertical line in the margin.

Exp
2

Date
# Item and size/strength Usual Dose
Pain Meds
3


2 0
1 0
i b u p ro fen 2 0 0 m g tab l ets (e. g. , Advil

,
Nuprin

, Motrin

)
4

n ap ro x en 2 2 0 m g tab l ets (e. g. , Aleve

)
5

Pain:
ii PO, then i PO BID

2 5
1 2
! !! ! acetam i n o p h en w i th h y d ro co d o n e
tab l ets (e. g. , Vicodin

, Lortabs

,
Anexsia

: 5 0 0 m g acetam i n o p h en , 5
m g h y d ro co d o n e)
6 , 7

Pain:
ii PO Q4H PRN
Allergy Meds

1 ! !! ! i n jectab l e ep i n ep h ri n e an ap h y l ax i s
k i t (Epi-Pen

) (m ay o m i t i f h av e
ad v an ced m o d u l e w i th i n jectab l e
ep i n ep h ri n e)
anaphylaxis:
i injection

1 ! !! ! al b u tero l R o to cap i n h al er
8


4 8 ! !! ! R o to cap al b u tero l cap su l es fo r
ab o v e
9

asthma:
i cap Q4H PRN

6 d i p h en h y d ram i n e 2 5 m g tab l ets (e. g. ,
Benadryl

)
1 0

allergy/sedation:
i-ii PO Q4H PRN

2 0
5
! !! ! P red n i so n e 1 0 5 0 m g tab l ets
1 1 , 1 2 , 1 3
allergy/asthma:
50 mg PO QAM
GI Meds
14


1 2 l o p eram i d e 2 m g. tab l ets (e. g. ,
Imodium-AD

)
diarrhea: ii PO, then i
PO q loose BM up to
7/day

1 0 ! !! ! p ro ch l o rp erazi n e 1 0 m g. tab l ets (e. g. ,
Compazine

)
1 5 , 1 6



4 m ecl i zi n e ch ew ab l e 2 5 m g. tab l ets
(e. g. , Bonine

, Antivert

)
1 7

motion sickness:
i PO TID PRN

4 ! !! ! TransDerm Scop

tran sd erm al
sco p o l am i n e p atch es
motion sickness:
i to skin Q3D
Bites and Stings
18


1 S aw y er E x tracto r K i t as directed

1 Sting-Eeze

so l u ti o n 1 5 cc b o ttl e
1 9 , 2 0
as directed
Cardiac Meds

3 0
4
A sp i ri n 3 2 5 m g (5 gr. ) tab l ets
2 1 , 2 2
chest pain:
i PO

6 ! !! ! n i fed i p i n e 1 0 m g cap su l es (e. g. ,
Personal Wilderness Medical Kit
Page 12 of 26




Exp
2

Date
# Item and size/strength Usual Dose
Procardia

, Adalat

)
2 3


1 ! !! ! b o ttl e n i tro gl y ceri n e sp ray (e. g. ,
Nitrolingual

)
2 4

chest pain:
i spray SL Q3 PRN
Antibiotics Etc.
25


2 4
6
! !! ! ery th ro m y ci n tab l ets 2 5 0 m g
tab l ets
2 6

azi th ro m y ci n 2 5 0 m g tab l ets (e. g. ,
Zithromax

)
2 7

infection:
ii PO, then i PO daily

1 2 ! !! ! ci p ro fl o x aci n (e. g. , Cipro

) 2 5 0 m g.
tab l ets
2 8 , 2 9



3 B aci traci n o r p o v ad o n e-i o d i n e
o i n tm en t1 g fo i l p ack ets
3 0

! !! ! 3 . 5 g tu b e p o l y m y x i n /b aci traci n
(e. g. , Polysporin

) o r b aci traci n
o p h th al m i c o i n tm en t
3 1

wounds:
to skin BID

1 m i l d l i q u i d so ap 3 0 cc b o ttl e, e. g. , Hibiclens

; o r, a sm al l
p i ece o f so l i d so ap (to sav e w ei gh t) ; o r, a sm al l (e. g. , 8 cc)
b o ttl e o f w aterl ess h an d san i ti zer
3 2 , 3 3


1 P o v ad o n e-i o d i n e so l u ti o n 1 5 cc b o ttl e (e. g. , Betadine

)
3 4

Thermometer

1 B ecto n -D i ck i n so n d i gi tal th erm o m eter (m ay su b sti tu te R ad i o
S h ack o r si m i l ar co n ti n u o u s-read i n g d i gi tal th erm o m eter)

1 sp are b attery fo r ab o v e

1 0 th erm o m eter co v ers fo r ab o v e
3 5 , 3 6

Misc.

4 th i am i n e (v i tam i n B -1 ) 3 0 0 m g.
tab l ets
3 7

starvation, prior to
refeeding: i PO

4 ! !! ! h al o p eri d o l 5 m g. tab l ets (e. g. ,
H al d o l

)
3 8

sedation:
i-iiii PO

2 p ack ets Gatorade

o r ERG

p o w d er, each to m ak e l i ter

2 4 p ai r ex am gl o v es
3 9


1 p o ck et C P R sh i el d

1 1 " (b y at l east 1 0 y ard s) w aterp ro o f ad h esi v e tap e
4 0


3 1 sm al l p rep ack aged u n i ts o f ti n ctu re o f b en zo i n
4 1

8 cc b o ttl e ti n ctu re o f b en zo i n
4 2


6 steri l e co tto n ap p l i cato rs (" Q-tips

" )
4 3


1 3 " b y 5 y ard s (stretch ed ) el asti c b an d age (e. g. , Ace

, Coban

,
Vet-Wrap

)

1 3 " b y 5 y ard s (stretch ed ) co n fo rm i n g ro l l er gau ze (e. g. ,
Kling

)

8 m ed i u m -si ze (e. g. , 3 " x 3 " ) gau ze p ad s
4 4


1 2 O B -ty p e co m p ressed v agi n al tam p o n s
4 5

Personal Wilderness Medical Kit
Page 13 of 26




Exp
2

Date
# Item and size/strength Usual Dose

3 sm al l p i eces o f cl ear ad h eren t d ressi n g (e. g. , Tegaderm,
OpSite)
4 6 , 4 7


3 # 1 1 scal p el b l ad es, steri l e

1 stri n g fo r ri n g rem o v al

1 p ap er cl i p , m ed i u m si ze
4 8


2 l arge safety p i n s

1 n y l o n zi p p er b ag o r eq u i v al en t fo r M ed K i t

1 w aterp ro o f co n ten ts/p ro to co l s/stan d i n g o rd ers
4 9


5 o n e-p i n t freezer-sty l e zi p l o ck p l asti c b ags (i f n o t av ai l ab l e
el sew h ere i n S A R p ack )

2 sm al l (5 -stap l e) sk i n stap l ers
5 0


5 WE M S I P ati en t R eco rd F o rm s
5 1


5 WE M S I P ati en t R eco rd co n ti n u ati o n sh eets




Personal Wilderness Medical Kit
Page 14 of 26



Advanced Module
52

Prescription-only items are noted by ! !! !
Items removed from version 1.1 noted by strikeout, items added to version 1.1
underlined; both types of changes also noted by a vertical line in the margin.

Exp
Date
# Item and size/strength Usual Dose

2 ! !! ! k eto ro l ac tro m eth am i n e 6 0 m g.
i n jecti o n (e. g. , Toradol

)
5 3



2 ! !! ! m o rp h i n e su l fate 1 0 m g/m L , 1 m L
v i al s
5 4

pain:
2-10 mg IV Q10-Q4H
PRN
5-10 mg IM Q -4H
PRN

2 4 ! !! ! n al o x o n e 1 m g/m L , 1 m L am p u l (e. g. ,
Narcan

)
excess narcotic:
1-4 mg IV/IM

1 ! !! ! m i d azo l am 5 m g/m L , 1 0 m l v i al (e. g. ,
Versed

)
5 5

sedation:
3-5 mg IV Q10
seizure:
14 mg IM

1 ! !! ! ceftri ax o n e 2 g p o w d er, an d steri l e
w ater 1 0 m L , fo r reco n sti tu ti o n (e. g. ,
Rocephin

)
5 6

infection/open
fracture:
2 g IV/IM

2 ! !! ! ep i n ep h ri n e 1 : 1 0 0 0 , 1 m L am p u l :
su b sti tu tes fo r E p i -P en i n b asi c k i t
anaphylaxis/severe
asthma:
0.3-0.5 cc SQ Q10

2 ! !! ! d i p h en h y d ram i n e 5 0 m g/1 m L v i al
(e. g. Benadryl

)
allergy:
50-100 mg IV/IM

2 ! !! ! p ro ch l o rp erazi n e i n jecti o n 1 0 m g/2 cc
(e. g. , Compazine

)
5 7



2 ! !! ! h al o p eri d o l 5 m g/1 cc i n jecti o n (e. g. ,
Haldol

)


4 ! !! ! d ro p eri d o l 2 . 5 m g/m L , 2 m L v i al sedation/nausea:
2.5-10 mg IV/IM

2 ! !! ! d ex am eth aso n e 1 0 m g/m L , 1 0 m L v i al
(e. g. , Decadron

)
5 8



6 al co h o l p rep p ad s, i n fo i l

1 T u b ex i n jecto r
5 9


2 ! !! ! 1 cc sy ri n ges

2 ! !! ! 3 cc sy ri n ges

2 ! !! ! I M n eed l es

2 ! !! ! S Q n eed l es

2 ! !! ! 1 8 ga, l o n g, o v er-th e-n eed l e I V cath eters
6 0


1 v en o u s to u rn i q u et (fo r starti n g I V )

2 sal i n e l o ck
6 1


1 2 0 cc b o ttl e sal i n e fl u sh so l u ti o n
Personal Wilderness Medical Kit
Page 15 of 26




Exp
Date
# Item and size/strength Usual Dose

1 ! !! ! 6 . 5 m m en d o trach eal tu b e
6 2


1 O n e-w ay v al v e fo r en d o trach eal tu b e
6 3







Personal Wilderness Medical Kit
Page 16 of 26



Search Module
Prescription-only items are noted by ! !! !
Items removed from version 1.1 noted by strikeout, items added to version 1.1
underlined; both types of changes also noted by a vertical line in the margin.

Exp
Date
# Item and size/strength Usual Dose
Pain Meds Etc.

3 0 acetam i n o p h en tab l ets, 3 2 5 m g (e. g. ,
Tylenol

)
6 4

pain/fever:
i-ii PO Q4H PRN

4 ! !! ! cy cl o b en zi p ri n e 1 0 m g. tab l ets (e. g. ,
Flexeril

)
6 5 , 6 6



4 ! !! ! p h en azo p y ri d i n e h y d ro ch l o ri d e
tab l ets, 2 0 0 m g (e. g. , P y ri d i u m

)
6 7

UTI symptoms:
i PO TID
Cough, Cold, Allergy Etc.
68


1 3 1 5 m L sq u eeze b o ttl e o x y m etazo l i n e
n asal sp ray (e. g. , Afrin

)
6 9

nasal congestion:
i spray BID PRN

8 1 2 -h o u r su stai n ed -rel ease
p seu d o ep h ed ri n e tab l ets 1 2 0 m g. (e. g. ,
Sudafed

)
nasal congestion:
i PO BID PRN

8 1 2 -h o u r su stai n ed -rel ease
ch l o rp h en i ram i n e tab l ets 8 m g. (e. g. ,
Chlor-Trimeton

)
7 0

allergy symptoms:
i PO BID PRN

8 d ex tro m eth o rp h an -co n tai n i n g co u gh
d ro p s (e. g. , Hold

)
! !! ! Humibid-DM

tablets
71

cough:
i PO PID PRN
Eye

1 ! !! ! 1 m L d ro p p er tu b e tetracai n e
o p h th al m i c so l u ti o n
painful eye exam:
2-20 drops

3 fl u o rescei n stri p s
7 2
as needed

1 ! !! ! 3 . 5 g tu b e p o l y m y x i n /b aci traci n (e. g. ,
Polysporin

) o r b aci traci n o p h th al m i c
o i n tm en t
7 3



1 2 m L d ro p p er b o ttl e cy cl o p en to l ate
o p h th al m i c so l u ti o n 0 . 5 % o r 1 % (e. g. ,
Cyclogyl

)
corneal abrasion or
snowblindness:

GI

1 2
8
an taci d tab l ets
fam o ti d i n e tab l ets 1 0 m g (e. g. , Pepcid-
AC

)
7 4

reflux/hyperacidity:
i-ii PO BID PRN

4 b i saco d y l tab l ets 5 m g (e. g. ,
Dulcolax

)
7 5 , 7 6



1 2 b i sm u th su b sal i cy l ate tab l ets (e. g. ,
Pepto-Bismol

)
7 7


Allergy
Personal Wilderness Medical Kit
Page 17 of 26




Exp
Date
# Item and size/strength Usual Dose

1 ! !! ! 1 5 g tu b e fl u o ci n o l o n e aceto n i d e
cream 0 . 2 % o r si m i l ar h i gh -stren gth
stero i d cream o r l o ti o n (e. g. , Valisone

,
Benisone

, Lidex

, Kenalog

,
Aristocort

, Uticort

, Synalar

)
allergic rash/insect
bites:
apply to rash QID
PRN

1 ! !! ! 1 o z. tu b e Pramosone

1 % o r
Aveeno

cream
7 8

itching:
apply to skin Q4H
PRN
Altitude Etc.
79


6 acetazo l am i d e tab l ets 2 5 0 m g (e. g. ,
Diamox

)
preventing AMS:
tab (62.5 mg) PO
BID
treating AMS/HACE:
250 mg PO BID

! !! ! n i fed i p i n e cap su l es 1 0 m g (e. g. ,
Procardia

, Adalat

)
HAPE:
10-30 mg PO QID
Misc.

1 1 5 g tu b e m i co n azo l e n i trate cream 2 %
(e. g. , Micatin

, Monistat

)1 0 m L b o ttl e
cl o tri m azo l e so l u ti o n (e. g. ,
L o tri m i n

)
8 0 , 8 1

fungal skin infection:
apply BID-QID
yeast vaginitis:
i mL intravaginally
daily

1 1 cc T B sy ri n ge, n o n eed l e (as v agi n al ap p l i cato r fo r ab o v e
an ti fu n gal )

1 p ai r sm al l sh arp sci sso rs (n o t n ecessary i f av ai l ab l e o n
WE M T 's p o ck et k n i fe)

1 p ai r fi n e-p o i n t sp l i n ter fo rcep s (n o t n ecessary i f av ai l ab l e o n
WE M T 's p o ck et k n i fe)

1 S am S p l i n t o r eq u i v al en t fl ex i b l e sp l i n t
8 2


4 3 " x 4 " p i eces o f m o l esk i n

1 0 sm al l ad h esi v e b an d ages (e. g. , 1 " x 3 " Bandaids,
Coverlet)

3 sm al l p i eces o f cl ear ad h eren t d ressi n g (e. g. , Tegaderm,
OpSite)

5 m ed i u m -si ze " su tu re stri p s"
8 3


6 steri l e co tto n ap p l i cato rs (" Q-tips

" )
8 4







Personal Wilderness Medical Kit
Page 18 of 26




Physician Addendum
This provides some general ideas for items that physicians may want to add to their
kits; for purposes of standardization, recommend packaging this separately from the
other kits.

Exp
Date
# Item and size/strength

p en i ci l l i n

ci p ro fl o x aci n (e. g. , Cipro

) 2 5 0 m g. tab l ets

caffei n e p i l l s
8 5


tri m eth o p ri m /su l fam eth o x aso l e

D u ragesi c p atch es

m i d azo l am

k etam i n e

I V th ro m b o l y ti c
8 6


a co b al t b l u e p en l i gh t

a p o ck et o to sco p e an d o p th al m o sco p e

p rescri p ti o n p ad

M ero cel ep i stax i s tam p o n s

a F o l ey cath eter

l o cal an aesth eti c

w i re saw fo r am p u tati o n s
8 7


K el l y cl am p

n eed l e h o l d er

su tu re m ateri al

1 2 b i saco d y l tab l ets 5 m g. (e. g. , Dulcolax

)


Personal Wilderness Medical Kit
Page 19 of 26



Notes
(new notes since version 1.1 are in italics)


1
S o m e h av e su ggested to m o v e 2 /3 o f each o f th e an al gesi cs, etc. i n to th e search k i t, b u t th i s
m ak es th e k i t as a w h o l e m o re cu m b erso m e; al so , i t m ak es i t m o re l i k el y th at th e m i n i m u m k i t
w i l l b e o u t o f a m ed i ci n e w h en n eed ed .
2
S o m e o f th e over-the-counter (OTC) medications recommended for this medical kit do not
have expiration dates stamped on them. For such medications, we recommend that WEMTs
enter an expiration date two years from the date purchased and inserted in the medical kit.
3
I n M i n i m u m K i t b ecau se: WE M T -B asi cs m ay n eed to gi v e p ai n m ed i cati o n s to th e i n ju red to
assi st sel f-rescu e.
4
O ral p ai n m ed i cati o n s m ay al l o w a p ati en t to sel f rescu e an d th u s are p art o f th e M i n i m u m
K i t. T h e A d v an ced K i t co n tai n s i n jectab l e n arco ti cs b u t a b asi c p ro v i d er m i gh t h av e to u se th e
k i t an d th u s sh o u l d h av e access to o ral m ed i cati o n s.
5
For all intents and purposes, naproxen has the same side effects and efficacy as ibuprofen,
but can be taken only twice a day as compared to ibuprofen. Naproxen is also available
without a prescription as an inexpensive generic. Some feel that choline/magnesium salicylate
(e.g., Trilisate

), although a prescription drug, may be a better drug than naproxen. However, at

present, this is still a minority opinion, and the majority recommend staying with an
inexpensive OTC drug. See h ttp : //w w w . p i tt. ed u /~ k co n o v er/ftp /tri l i sate. h tm for details and
share your opinions with the wilderness-emergency-medicine Internet discussion list,
instructions for subscribing at the beginning of this document..
6
S o m e su ggested su b l i n gu al m o rp h i n e as a n o n i n jectab l e stro n ger n arco ti c; I 'v e n o t b een ab l e to
fi n d an y m o rp h i n e p ro d u cts m ark eted fo r th i s u se, n o r an y go o d i n fo rm ati o n o n an y p i l l
fo rm u l ati o n s th at co u l d b e u sed th i s w ay . A l so su ggested w as D u ragesi c sl o w -rel ease
fen tan y l p atch es; h o w ev er, th ey tak e a l o n g ti m e to b u i l d u p , an d th u s are n o t v ery ap p ro p ri ate
fo r i m m ed i ate acu te p ai n . T h ey m i gh t b e accep tab l e fo r l o n g-term p ai n rel i ef d u ri n g an
ev acu ati o n , b u t th at's n o t th e p u rp o se o f th i s p erso n al w i l d ern ess m ed i cal k i t. T h ey m i gh t
m ak e a go o d ad d i ti o n to a team k i t.
7
In light of our attempts to lighten the kit, and the time span for which the kit is designed, we
decreased the number of hydrocodone/acetaminophen tablets.
8
C o m m en t> I w o u l d reco m m en d u si n g a m etered d o se i n h al er rath er th an R o to C ap s i n a
w i l d ern ess en v i ro n m en t. T h o u gh i t i s co n tro v ersi al , m an y o f m y p u l m o n ary co l l eagu es th i n k
th ere are p o ten ti al p ro b l em s u si n g R o to C ap s i n h u m i d (i . e. , co astal , rai n y , th e S o u th i n th e
su m m er) en v i ro n m en ts. Wh en h u m i d , th e p arti cl es m ay aggregate an d n o t b e d ep o si ted
effecti v el y i n th e d i stal ai rw ay s.
R ep l y > I n teresti n g. I h ad n 't h eard ab o u t th i s. A d i sp en ser an d th e fo u r ro to cap s th at fi t i n si d e
(w i th a l i ttl e tri m m i n g o f th e b l i ster p ack ages) i s l ess th an h al f th e si ze o f a m etered -d o se
i n h al er, an d ab o u t a fo u rth th e w ei gh t. A n d rem em b er, w e're ask i n g p eo p l e to carry th i s stu ff
w i th th em _al l _ th e ti m e. I s th e ex tra w ei gh t w o rth i t? A sk y o u r p u l m o n ary fri en d s, ad d i n
y o u r o w n m em o ri es o f carri n g a p ack d u ri n g a l o n g search , an d p l ease get b ack to m e w i th y o u r
th o u gh ts.
A n o th er co m m en to r al so q u eri ed w h eth er th ere w o u l d b e p ro b l em s w i th th e R o to h al er w o rk i n g
w el l i n th e fi el d .
R e-R ep l y > Wh en I q u eri ed th e atten d i n gs I h av e h eard ex p ress sk ep ti ci sm o v er th e u se o f
p o w d er i n h al ers i n th e p ast, n o n e o f th em co u l d p ro v i d e a referen ce to su p p o rt th ei r cl ai m s.
O n search i n g th e l i teratu re, I co u l d fi n d l i ttl e o b jecti v e d ata to su b stan ti ate th i s as a b i g
p ro b l em . I n fact, th e b est arti cl e (H i l l er et al , J. P h arm aceu ti cal S ci 1 9 8 0 ; 6 9 (3 ): 3 3 4 -7 . )
i n d i cated th at A L L aero so l s tested h ad i n creases i n p arti cl e si ze at h i gh h u m i d i ty an d th at
M D I 's [M etered D o se I n h al ers] ten d ed to b e M O R E u n stab l e th an p o w d er-gen erated aero so l s!
Personal Wilderness Medical Kit
Page 20 of 26




G i v en th ese facts, I retract m y co n cern s ab o u t u se o f p o w d er i n h al ers an d v o w to d i stru st al l o f
m y atten d i n gs fo r at l east 6 m o s.
I sti l l th i n k M D I 's m i gh t o ffer so m e ad v an tages i n term s o f # o f d o ses p er o z. an d m o re u n i v ersal
k n o w l ed ge o f tech n i q u e, b u t I d o n 't feel stro n gl y en o u gh to reco m m en d o n e sy stem o v er th e
o th er. T h e p o i n t m ay b eco m e m o o t o v er th e n ex t few y ears as C F C 's are b an n ed i n o th er
p ro d u cts an d th e p ri ce o f M D I 's go es u p (m ay b e a l o t) si n ce th e p ro p el l an t w i l l b e l ess w i d el y
av ai l ab l e.
9
Experience with severe asthmatics in the backcountry has led many to recommend more
albuterol.
1 0
C o m m en t> D o es o n e n eed tw o sed ati n g an ti h i stam i n es (b en ad ry l an d ch l o rtri m eto n ?
P erh ap s S el d an e w o u l d b e p referab l e to th e l atter.
R ep l y > 1 . D o n 't l i k e th e S el d an e/ery th ro i n teracti o n .
R ep l y > 2 . S el d an e i s a p o o r an ti h i stam i n e fo r acu te (as o p p o sed to ch ro n i c) u se.
R ep l y > 3 . We w an ted b o th a sh o rt, stro n g-acti n g an ti h i stam i n e (d i p h en h y d ram i n e= B en ad ry l )
fo r acu te sh o rt reacti o n s (b eesti n gs, d y sto n i c reacti o n s, etc. ), an d so m eth i n g l o n ger-acti n g fo r
m o re l o n g-l i v ed p ro b l em s (rh i n i ti s, p o i so n i v y , etc. ) an d C h l o r-T ri m eto n 1 2 m g ex ten d ed p i l l s
are th e l east sed ati n g go o d Q 1 2 H an ti h i stam i n e w e co u l d fi n d .
1 1
I n M i n i m u m K i t b ecau se: m ay b e n eed ed to treat b ro n ch o sp asm o r al l ergy , an d th e ep i an d
al b u tero l w i l l w ear o ff i n rel ati v el y sh o rt o rd er (h o u rs).
1 2
C o m m en t> I w o u l d reco m m en d m o re p red n i so n e tab l ets. 6 0 m g i s o n e d o se fo r an asth m a
ex acerb ati o n .
R ep l y > A gree. I n creased fro m 6 to 2 0 to al l o w m u l ti p l e l arge d o ses fo r p ro b l em s su ch as h i gh
al ti tu d e cereb ral ed em a, sev ere al l ergy , o r sev ere asth m a.
1 3
Prednisone is available in 10 mg, 20 mg, and 50 mg tablets. The usual dose of prednisone for
severe asthma or allergy is 40-60 mg daily, and lower dosese are rarely needed, so switching to
50 mg tablets decreases the weight and bulk of the kit slightly without any significant increase
in expense.
1 4
I n M i n i m u m K i t b ecau se: m o ti o n si ck n ess, v o m i ti n g an d d i arrh ea m ay al l i m m o b i l i ze a
rescu er.
1 5
C o m m en t> I th i n k co m p azi n e su p p o si to ri es m i gh t b e p referab l e to p i l l s, b u t I reco gn i ze th e
sto rage p ro b l em s etc.
R ep l y > P eo p l e can gri n d u p a p i l l , m i x i t w i th an M & M fro m th ei r go rp , o r so m e an ti b i o ti c
o i n tm en t, an d m ak e th ei r o w n su p p o si to ry .
1 6
Many people questioned the utility of an oral medication for nausea and vomiting, other than
a chewable pill for motion sickness (meclizine), and though the pills could potentially be used
as a suppository, the utility seemed so low that we have removed this medication.
1 7
C o m m en t> G I : I sn 't m ecl i zi n e an R x i n th e U . S . ?
R ep l y > I f b o u gh t as A n ti v ert , y es; i f b o u gh t as B o n i n e , n o .
1 8
I n M i n i m u m K i t b ecau se: b i tes an d sti n gs o ccu r u n p red i ctab l y an d th ese treatm en ts m u st b e
ap p l i ed i m m ed i atel y to b e o f an y u se. L o cal sti n g treatm en t i s i n cl u d ed b ecau se th e p ai n fro m
m u l ti p l e sti n gs m ay b e d i sab l i n g to a rescu er.
1 9
C o m m en t> I s S ti n g-E eze o f p ro v en effi cacy ?
R ep l y (K C )> N o go o d sci en ti fi c ev i d en ce I 'm aw are o f, b u t an ecd o tal l y i t w o rk s l i k e a ch arm .
I t's a w i tch es' b rew o f al l av ai l ab l e O T C an esth eti cs an d sti n g rel i ev ers. I 'v e u sed i t w i th go o d
su ccess m y sel f; i t real l y h el p s.
2 0
Fifteen ccs is a lot to carry for something that is used in 0.5cc doses, max. It is easy to
repackage some of this in a small dropper bottle, e.g., a 4cc eyedropper type bottle, Cat No.:
0300710A from http://www.fisherscientific.com/.
2 1
I n M i n i m u m K i t b ecau se: asp i ri n so i m p o rtan t i n th e earl y treatm en t o f u n stab l e an gi n a o r
Personal Wilderness Medical Kit
Page 21 of 26




M I , w h i ch i s b eco m i n g m o re co m m o n i n th e w i l d ern ess.
2 2
We have decreased the dose, relying on naproxen and hydrocodone as analgesics, and
reserving aspirin for use in chest pain.
2 3
C o m m en t> A d v an ced stu ff: I w o u l d ad d su b l i n gu al n i tro gl y ceri n an d /o r p aste to th e l i st.
R ep l y > T h ey d o n 't l ast l o n g i n a p ack , esp eci al l y i n th e su m m er an d i f b ei n g k ep t i n a car tru n k ;
k eep i n g th i n gs u p d ated i n a S A R p ack i s a b i g p ro b l em , to o . We d eci d ed to si m p l y rel y o n
n i fed i p i n e fo r v aso d i l ati o n , co ro n ary d i sease, etc. See below.
2 4
Nitroglycerine spray reputedly has a longer shelf life, and better heat resistance, than the
pills. Also, nifedipine is much out of favor for the treatment of chest pain, due to the
hypotensive effect. Therefore, we have moved nifedipine to the altitude section, because it is
still invaluable for high altitude pulmonary edema, and added nitroglycerine spray. When
going to altitude, the nifedipine and acetazolamide can be transferred to the Minimum Kit if
desired.
2 5
B o th ery th ro m y ci n an d ci p ro fl o x aci n i n M i n i m u m K i t b ecau se: m i gh t h av e p ati en t w i th
o p en fractu re an d w i sh to ad m i n i ster o ral an ti b i o ti c i m m ed i atel y ; m i gh t h av e team m em b er
w i th sev ere d i arrh ea w h o n eed s ci p ro fl o x aci n i m m ed i atel y ; an ti b i o ti cs m ay b e l i fesav i n g i f th e
p ati en t i s i l l w i th a seri o u s i n fecti o n rath er th an i n ju red .
2 6
C o m m en t> R ath er th an ery th ro , y o u m i gh t co n si d er o n e o f th e n ew er m acro l i d es.
A zi th ro m y ci n , th o u gh co stl y , o ffers th e ad v an tages o f go o d G I to l eran ce (an d w e're i n th e
w o o d s after al l ) an d th e ab i l i ty to carry a 2 w eek co u rse i n 6 p i l l s.
R ep l y > Y es, b u t Z i th ro m ax [azi th ro m y ci n ] i s _v ery _ ex p en si v e, an d th ese p eo p l e n eed to b u y
th ei r o w n d ru gs. I f i t w ere th e sam e co st as ery th ro , w o u l d agree. I t's al so p regn an cy catego ry
B , u n l i k e B i ax i n [cl ai ry th ro m y ci n ], so azi th ro m y ci n i s a b etter ch o i ce fo r th at reaso n .
H o w ev er, u n l i k e ery th ro , azi th ro i s n o t a p ed i atri c m ed i cati o n .
M an y o th ers su ggested azi th ro m y ci n as an al tern ati v e, an d th at sam p l es are av ai l ab l e; b u t d o u b t
w e can get en o u gh sam p l es fo r al l w h o w i l l n eed i t.
D ecreased fro m 4 0 to 2 4 ; th i s w i l l p ro v i d e 6 d ay s o f 2 5 0 Q I D , o r 3 d ay s o f 5 0 0 Q I D . R esi sted th e
tem p tati o n to go w i th ju st 5 0 0 m g tab l ets; 2 5 0 m g tab l ets al l o w sp aci n g d o ses b etter fo r th o se
w i th G I i n to l eran ce.
2 7
We had initially not considered azithromycin because of cost, but it now less expensive,
covers most bacterial and atypical pathogens likely to affect team members in the backcountry,
is safe in pregnancy and infancy, has few side effects, and can be taken once a day, improving
compliance. Azithromycin is also now used routinely in all pediatric age groups, another
argument in its favor. Some recent references include the following:
1. Hopkins S
Clinical toleration and safety of azithromycin
Am J Med 1991; 91:40S-45S
2. Kuschner RA, Trofa AF, Thomas RJ, et al.
Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an
area where ciprofloxacin resistance is prevalent
Clin Infect Dis 1995; 21:536-41
3. Juckett G
Prevention and treatment of traveler's diarrhea
Am Fam Physician 1999; 60:119-24, 135-6
4. Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P
Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years
Clin Infect Dis 1998; 26:341-5
5. Khan WA, Seas C, Dhar U, Salam MA, Bennish ML
Treatment of shigellosis: V. Comparison of azithromycin and ciprofloxacin. A double-blind,
randomized, controlled trial
Ann Intern Med 1997; 126:697-703
6. Shanks GD, Ragama OB, Aleman GM, Andersen SL, Gordon DM
Azithromycin prophylaxis prevents epidemic dysentery
Personal Wilderness Medical Kit
Page 22 of 26




Trans R Soc Trop Med Hyg 1996; 90:316
7. Murphy GS, Jr., Echeverria P, Jackson LR, et al.
Ciprofloxacin- and azithromycin-resistant Campylobacter causing traveler's diarrhea in U.S.
troops deployed to Thailand in 1994
Clin Infect Dis 1996; 22:868-9
8. Bessette RE, Amsden GW
Treatment of non-HIV cryptosporidial diarrhea with azithromycin
Ann Pharmacother 1995; 29:991-3
9. Kuschner RA, Trofa AF, Thomas RJ, et al.
Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an
area where ciprofloxacin resistance is prevalent
Clin Infect Dis 1995; 21:536-41
10. Uchino U, Kanayama A, Hasegawa M, et al.
[Effects of azithromycin on fecal flora of healthy adult volunteers]
Jpn J Antibiot 1995; 48:1119-30
11. Rakita RM, Jacques-Palaz K, Murray BE
Intracellular activity of azithromycin against bacterial enteric pathogens
Antimicrob Agents Chemother 1994; 38:1915-21
2 8
S o m e h av e argu ed fo r th e ad d i ti o n o f v ari o u s fav o ri te an ti b i o ti cs: cep h al ex i n , am o n g o th ers.
We h av e resi sted th e tem p tati o n to p ro v i d e an an ti b i o ti c fo r ev ery co n cei v ab l e co n d i ti o n ,
i n stead try i n g fo r o n e w i th go o d gram p o si ti v e co v erage th at can b e gi v en to ju st ab o u t an y o n e
(ery th ro m y ci n ), an d o n e w i th ex cel l en t gram n egati v e co v erage, i n cl u d i n g al l co m m o n cau ses
o f i n fecti o u s d i arrh ea an d U T I s.
C h an ged fro m 2 0 to 1 2 . T h i s sh o u l d p ro v i d e 6 d ay s o f 2 5 0 B I D , o r 3 d ay s o f 5 0 0 B I D .
2 9
Azithromycin is now a second-line drug for infectious diarrhea, especially in areas where
pathogens have developed resistance to quinolones such as ciprofloxacin; azithromycin is also
a reasonably good drug for UTIs and therefore we have decided to eliminate ciprofloxacin from
the drug list.
3 0
C an al so b e u sed as l u b ri can t i f n eed ed .
3 1
Ophthalmic antibiotic ointment can be used for skin wounds, but not vice versa (the skin
formulation is irritating to the eye).
3 2
S o l i d so ap i s n o t i d eal , b u t i s m u ch l i gh ter, an d can b e co m b i n ed w i th so m e p o v ad o n e-i o d i n e
so l u ti o n fo r an ti b acteri al effect.
3 3
Waterless hand sanitizer is now widely available in the U.S., and for clearing hands of
bacteria and viruses, is reputedly as effective, if not more effective, than soap and water.
3 4
C o m m en t> D o w e n eed H i b i cl en s ?
R ep l y > D u n n o ab o u t H i b i cl en s; m i gh t b e n i ce, b u t agai n i t's h eav y . P l ai n so ap (D r. B ro n n er's,
o r w h atev er o n e's carry i n g) i s p ro b ab l y O K .
S o m e su ggested u si n g fo i l p ack ets o f p o v ad o n e-i o d i n e so l u ti o n ; h o w ev er, w e'v e tal k ed w i th
en o u gh p eo p l e w h o 'v e h ad th em ex p l o d e i n th ei r m ed i cal k i ts to sti ck w i th th e m o re-ru gged
1 5 cc b o ttl es.
3 5
C an u se an ti b i o ti c o i n tm en t as l u b ri can t.
3 6
Many have found that heat or pressure in pack medical kits causes the covers provided with
most digital thermometers to become unusable. A few small pieces of kitchen plastic wrap
wrapped around the thermometer can serve as a substitute.
3 7
C o m m en t> Wh y d o w e n eed th i am i n e?
R ep l y > T o gi v e to p eo p l e w h o h av e b een starv i n g fo r a l o n g ti m e (i . e. , w eek s) w h en fi rst feed i n g
th em , to p rev en t card i o v ascu l ar co l l ap se (get a co p y o f th e cu rren t S ecti o n 4 o f WE M T
C u rri cu l u m fro m h ttp : //w w w . w em si . o rg/, i f y o u w an t th e d etai l s).
3 8
C o m m en t> I 'm n o t su re I see th e n eed fo r P O H al d o l .
Personal Wilderness Medical Kit
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R ep l y > E M T -B asi cs n eed to sed ate p ati en ts, to o .
3 9
N o steth o sco p e i s i n cl u d ed , as can si m p l y p l ace ear agai n st th e ch est o r ab d o m en fo r l u n g o r
h eart o r b o w el so u n d s; an d , B P cu ff an d steth o sco p e to o h eav y an d o f o n l y m i n o r u ti l i ty
co m p ared to th e w ei gh t.
4 0
I n creased fro m 3 to 1 0 y ard s, an d ad d ed th e w o rd " cl o th , " to al l o w fo r tap i n g an an k l e
secu rel y w i th th e co n ten ts o f ju st o n e p erso n al m ed i cal k i t.
4 1
T h i s w as ad d ed d u e to th e great d i ffi cu l ty o f getti n g tap e o r ev en B an d ai d s to sti ck i n w et
w eath er.
4 2
We have found that a Nalgeneor similar HDPE bottle provides a much more durable form
of benzoin; and benzoin loose in a medical kit can be extremely destructive. Eight-cc Nalgene
bottles are available from suppliers such as h ttp : //w w w . fi sh ersci en ti fi c. co m /, Cat No.: 02-923-
11A, NNI No.: 2002 9025, for approximately US$0.50 each in lots of 12, as of fall 1999.
4 3
These were moved to the Minimum Module to allow for application of benzoin.
4 4
S o m e h av e su ggested th e ad d i ti o n o f a tri an gu l ar b an d age; h o w ev er, th i s can u su al l y b e
i m p ro v i sed fro m so m eth i n g su ch as th e tai l o f so m eo n e's sh i rt; o r, d u ct tap e can b e u sed
i n stead .
4 5
T h i s m ak es a co m p act b u t v ery ab so rb en t d ressi n g; so m e su ggested ad d i n g v ari o u s ty p es o f
trau m a d ressi n g, b u t w e o p ted to p i ck so m eth i n g th at w as v ery sm al l , n o t w an ti n g to i n crease
th e si ze o f th e k i t. O f co u rse, i t can al so b e u sed as a tam p o n fo r a fem al e p ati en t w i th
m en stru al fl o w .
4 6
S ev eral p eo p l e su ggested ad d i n g th ese, as th ey are i d eal fi el d d ressi n gs: w aterp ro o f b u t
v ap o r-p erm eab l e.
4 7
Moved to the Minimum Module both to protect team member wounds against contamination
by patient body fluids, and to provide IV site dressings.
4 8
F o r trep h i n i n g su b u n gu al h em ato m as.
4 9
Wi l l b e p ro v i d ed b y WE M S I .
5 0
Discussions about the appropriateness of wound closure in the field continue to rage, in the
street prehospital community as well as in the wilderness EMS community. A detailed
discussion is beyond the scope of this document, but the principles that guided us in adding
this stapler included: 1) the wilderness is at least as clean as most Emergency Departments,
at least in terms of virulent and resistant bacteria; 2) delayed primary closure at four days from
the initial wound provides excellent results, comparable to primary closure; 3) repairing
complex wounds is a skill that takes much training and experience, certainly beyond the scope
of a standard Wilderness EMT class; 4) staples are easier to use than sutures, more secure than
suture strips for patients or team members who are actively assisting in their own evacuation,
stapling of simple wounds can be learned in a few hours, and is a relatively low-risk procedure;
and 5) patients can bleed to death from relatively minor wounds, especially scalp wounds, and
especially when coagulopathic from hypothermia, during long evacuations. Therefore, we are
including skin stapling for simple wounds and badly bleeding wounds, especially scalp
wounds. 3M Precise DS-5 staplers are available from many suppliers; in 1998, they were
available for less than US$7.00 each from h ttp : //w w w . p ssd . co m /.
5 1
T h ese can b e d o w n l o ad ed fro m h ttp : //w w w . w em si . o rg/an d p ri n ted l o cal l y .
5 2
P h y si ci an s m ay w an t to ad d : p en i ci l l i n , caffei n e p i l l s fo r caffei n e w i th d raw al h ead ach es,
tri m eth o p ri m /su l fam eth o x aso l e, P y ri d i u m

, D u ragesi c

p atch es, I V m i d azo l am , I V k etam i n e, I V

th ro m b o l y ti c (E m i n ase

i s at p resen t th e b est ch o i ce, as can b e u sed i n a si n gl e d o se, th o u gh

q u i te ex p en si v e), a co b al t b l u e p en l i gh t, a p o ck et o to sco p e an d o p th al m o sco p e, a p rescri p ti o n
p ad , M ero cel

ep i stax i s tam p o n s, a F o l ey cath eter, a sm al l sk i n stap l er, so m e l o cal an aesth eti c,

w i re saw fo r am p u tati o n s, an d a K el l y cl am p , n eed l e h o l d er, an d su tu re m ateri al , at l east fo r
Personal Wilderness Medical Kit
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ty i n g o ff b l eed ers.
5 3
Recent studies e.g., [Turturro MA, Paris PM, Seaberg DC. Ann Emerg Med August 1995;
26:117-120. for example] show ketorolac no better for musculoskeletal pain than oral
ibuprofen; therefore, we have deleted this medication. In this double-blind, placebo-controlled
study, not only were 800 mg of PO ibuprofen and 60 mg IM ketorolac indistinguishable as far as
degree of analgesia, they were indistinguishable in terms of time to analgesia!
5 4
We discussed dilaudid as a possible alternative to morphine; however, many more people
know the dosage for morphine than know the dosage for dilaudid. And since it is possible,
even likely, that this kit might occasionally be used by someone who is familiar with a standard
paramedic drug like morphine, but not dilaudid, we elected to stay with morphine.
5 5
Over the years, we have had many discussions about the possible use of midazolam, or
another benzodiazepines such as Valium. Midazolam acquired a bad reputation when large
doses (10-15mg IV push) were used for sedation for endoscopy, without either visual or pulse-
ox monitoring of ventilatory status. However, smaller doses (4-6 mg IV push for the usual
adult) provide excellent relaxation, sedation and amnesia for common wilderness procedures
such as dislocation reduction. And, larger doses (0.2 mg/kg, about 14 mg for an average adult)
can be used IM for control of seizures. It also has the advantage for wilderness reductions that
it wears off in about half an hour, leaving the patient ready to assist in rescue efforts. As a
result, we have added a single multidose vial in the most advantageous concentration. This
represents more midazolam than is likely to be needed, but is still lighter than an adequate
dose in many more containers. Other long-acting benzodiazepines such as Ativan

or Valium

were considered, but the short action and rapid IM absorption led us to chose Versed

.
5 6
C o m m en t> I w o u l d co n si d er i n creasi n g ceftri ax o n e to 2 g fo r a fu l l 2 4 h rs su p p l y .
R ep l y > A gree.
5 7
Droperidol is increasingly used for both sedation and nausea, and thus provides a single drug
that can be used to substitute for two drugs, prochlorperazine (e.g., Compazine

) and
haloperidol (e.g., Haldol

)
5 8
F o r treati n g h i gh al ti tu d e cereb ral ed em a, asth m a o r o th er b ro n ch o sp asti c p ro b l em s, o r sev ere
al l ergy .
5 9
We have found that Tubex ampules are not appropriate for most wilderness kits. Many of
the ampules, for instance the 10 mg Morphine ampules, are partly filled with air; and, when
they get warm, the air expands, pushing out the red rubber plug and emptying the contents of
the ampule into ones pack. Therefore, we have abandoned Tubex ampules entirely.
6 0
F o r rel i ev i n g ten si o n p n eu m o th o rax .
6 1
By adding saline locks and a saline flush, WEMTs at the scene can start an IV and give
multiple doses of IV medications. Too, it is often easier to start an IV before the patient has
lost much fluid, and when IV supplies arrive, the IV can easily be inserted into the saline lock.
We discussed adding a small bag of IV solution to the search kit for example, Navy SEAL
team members always carry a 250cc bag of Hespan in a pants pocket but finally decided that
for civilian use, the usefulness was not worth the weight.
6 2
C an b e p l aced b y d i gi tal tech n i q u e ev en w i th o u t a l ary n go sco p e.
6 3
The endotracheal tube can be placed (and covered with one thickness of a gauze pad to
prevent insect entry) and used without artificial ventilation, for example, in airway burns.
However, if mouth-to-ET-tube ventilation is necessary, a one-way valve provides the WEMT
protection from contamination from the patients airway secretions. One-way valves with filters
are available, but are generally bulky and heavy, and provide only incremental protection over
a good one-way valve. One small, light one-way valve that works with an endotracheal tube is
that manufactured by Laerdal for use with pocket masks; the one-way valves are available
separately from many suppliers, including item #36295 at http://www.mooremedical.com.
Personal Wilderness Medical Kit
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6 4
C o m m en t> D o es o n e real l y n eed asp i ri n an d i b u p ro fen ? B o th d ecen t an al gesi cs an d N S A I D s.
R ep l y > Y es, b u t asp i ri n can b e u sed b y i tsel f fo r th e an ti -p l atel et effect, fo r ex am p l e fo r a
stu d en t at o u r l ast WE M T cl ass; h e h ad co ro n ary -i sh ch est p ai n fi rst rel i ev ed b y S L N T G b u t
l ater retu rn ed an d i t w as u n rel i ev ed b y N T G . A sp i ri n i s i m p o rtan t fo r th i s. A n d , so m e p eo p l e
real l y d o b etter w i th asp i ri n th an acetam i n o p h en o r i b u p ro fen fo r m i n o r ach es, o r at l east th i n k
th ey d o .
6 5
C o m m en t> R ath er th an cy cl o b en zi p ri n e, v al i u m (th o u gh m o re o f a h assl e to get an d k eep
secu re) w o u l d b e m o re v ersati l e an d i s an effecti v e m u scl e rel ax an t.
R ep l y > R ecen t research sh o w th at b en zo d i azep i n es d o n 't real l y d o m u ch to rel ax m u scl es, an d
th at R o b ax i n an d F l ex eri l (cy cl o b en zi p ri n e) are m o re effecti v e.
C o m m en t> I w o u l d al so fav o r th e ad d i ti o n o f an i n jectab l e b en zo d i azep i n e.
R ep l y > F o r sed ati o n ? C an u se h al o p eri d o l fo r th i s. F o r m u scl e rel ax ati o n ? S ee co m m en ts o n
F l ex eri l , ab o v e.
6 6
We finally concluded that the benefits of cyclobenziprine (e.g., Flexeril

) for muscle strains is

really quite minimal compared to analgesics, rest and stretching. Therefore we removed this
from the list.
6 7
U T I s are m o re co m m o n am o n g w o m en th an m en . M en : i f y o u 'd l i k e to l eav e th i s o u t, p l ease
see th e co m m en ts u n d er an ti fu n gal cream .
6 8
The need for, or at least desire for, these medications can be supported by a trip to any local
drugstore and a look at the shelves.
6 9
As of September 1999, 3 mL "sample" or "travel" bottles of oxymetazoline nasal spray are
not available in the U.S. However, Afrin

and some other brands of oxymetazoline nasal spray

are now available in 15 mL bottles, which are relatively small and light.
7 0
We ch o se b o th l o n g-acti n g an d sh o rt-acti n g an ti h i stam i n es b ecau se th ey h av e d i fferen t u ses.
F o r ex am p l e, sti n gs o r o th er acu te al l ergi c reacti o n s u su al l y n eed o n l y sh o rt term treatm en t,
an d d i p h en h y d ram i n e can al so b e u sed as a sh o rt-acti n g sed ati v e. w h ereas th e su stai n ed
d ry i n g effect o f su stai n ed -rel ease ch l o rp h en i ram i n e i s i d eal fo r v i ral U R I s.
7 1
Dextromethorphan-containing cough drops are no longer generally available in the U.S.
However, Humibid-DM, a combination of guiafenesin (a possibly-effective expectorant
medication, reputedly to make it easier to cough out mucus) and dextromethorphan in a
sustained-release combination that lasts 12 hours, is still widely available in pharmacies in the
U.S. and, though it requires a prescription, is a lighter form of the effective cough suppressant
dextromethorphan.
7 2
C o m m en t> E y e: F l u o rescei n stri p s. S h o u l d a b l u e l i gh t b e o n th e l i st?
R ep l y > N i ce, b u t th e fl u o rescei n ev en w o rk s p retty w el l b y d ay l i gh t o r m i n i -M agL i te, an d a
b l u e p en l i gh t ad d s a l o t o f w ei gh t fo r o n l y a l i ttl e b en efi t, co m p ared to th e fl u o rescei n stri p s,
w h i ch w ei gh b asi cal l y n o th i n g.
7 3
Moved to the minimum kit where can also be used for skin wounds.
7 4
Famotidine is an inexpensive, highly effective method for controlling gastritis or reflux
extremely common problems during SAR operations due to lack of sleep, stress, and excess
caffeine consumption. Famotidine tablets are considerably lighter and smaller than enough
antacid tablets to provide a similar effect.
7 5
I t w as su ggested th at w e cu t d o w n o n th e n u m b er o f th ese tab l ets; th o u gh co n sti p ati o n can b e
d i sab l i n g, i t's n o t u su al l y as d i sab l i n g as d i arrh ea. C h an ged fro m 6 to 4 .
7 6
After long discussion, we elected to leave this out of the kit although constipation occurs
frequently in the outdoors and during SAR misions, and sometimes leads to abdominal pain,
constipation is seldom recognized as the cause, and thus the demand for laxative pills is low in
the field. A laxative is still appropriate for distribution as needed at the SAR base camp.
7 7
Since we have a H
2
blocker, and Imodium plus an antibiotic are better treatment for
Personal Wilderness Medical Kit
Page 26 of 26




gastroenteritis, the bismuth tablets seem superfluous.
7 8
Aveeno

cream has recently become available. Both Pramosone

and Aveeno

contains
pramoxine, a topical anaesthetic that is non-sensitizing (non-allergy-provoking, unlike many
other topical agents including diphenydramine, e.g., Benadryl). Thus both are highly
effective for the pain or itching of sunburn or poison ivy. Aveeno

, unlike Pramosone

, doesn't
include hydrocortisone. However, the anti-itch and anti-allergy effects of hydrocortisone are
minimal compared with the high-strength steroid cream, listed above. Aveeno

also includes
oatmeal and calamine, which are also good topical anti-itch agents.
7 9
O ral d ex am eth aso n e [e. g. , Decadron] n o t carri ed fo r h i gh al ti tu d e cereb ral ed em a, as 3 0 m g
o f p red i n so n e i s eq u i v al en t to th e 4 m g d ex am eth aso n e d o se u su al l y u sed fo r H A C E .
8 0
L o tri so n e w as su ggested as an al tern ati v e fo r " sh o tgu n " th erap y o f i tch y rash es o r v agi n i ti s.
A t p resen t, w e are sti l l stay i n g w i th sep arate an ti fu n gal an d stero i d cream s, as m o re effecti v e
an d m o re fl ex i b l e.
O n e su ggesti o n w as to u se th e n ew , h i gh l y effecti v e an ti fu n gal terb i n afi n e (Lamasil) i n stead o f
m i co n azo l e. H o w ev er, i t i s p rescri p ti o n -o n l y , co sts 2 to 1 0 ti m es as m u ch as m i co n azo l e, an d
th ere i s n o i n fo rm ati o n o n w h eth er o r n o t i t can b e u sed to treat y east v agi n i ti s.
Wo m en rev i ew i n g th i s m ed i cal k i t h av e al m o st u n i v ersal l y d em an d ed so m eth i n g fo r y east
v agi n i ti s. T h erefo re, w e d i sco u n t su ggesti o n s th at w e d ro p th i s m ed i cati o n i f th e su ggesti o n
co m es fro m a m an .
8 1
We also discussed the use of an oral antifungal, as is commonly used to treat yeast vaginitis;
however, these oral regimes are not currently accepted for jock itch and athletes foot, which
are also common wilderness afflictions. We realized that, to be effective for yeast vaginitis,
antifungal cream needs to be applied with an intravaginal applicator, as comes with Monistat-
7

and similar vaginal antifungals. However, such antifungal cream/applicator combinations

generally include more than 15g of cream, and are relatively heavy 3 oz. We realized that
Lotrimin

solution is effective for the organisms that cause yeast vaginitis, athlete's foot, and
jock itch. And a 10 mL bottle of Lotrimin

solution weighs only 1 oz. And a 1 cc TB syringe,

without needle, makes an excellent lightweight vaginal applicator; one can easily pull the
dropper top off of the Lotrimin

bottle and suck up a 1 mL daily dose of the Lotrimin solution

and apply intravaginally.
8 2
S o m e su ggested th e ad d i ti o n o f a tracti o n d ev i ce; h o w ev er, a tracti o n d ev i ce can u su al l y
(th o u gh n o t al w ay s) b e i m p ro v i sed w i th m ateri al s at h an d .
8 3
R em o v ed b u tterfl y stri p s as su tu re stri p s m u ch su p eri o r.
8 4
Moved to Minimum Module.
8 5
F o r caffei n e w i th d raw al h ead ach es.
8 6
E m i n ase i s at p resen t th e b est ch o i ce, as can b e u sed i n a si n gl e d o se.
8 7
WEMSI conducted some informal research on methods of amputation in confined spaces
including races between different methods. The winner overall was a two-step process using a
serrated lockback folding knife to cut through skin, tendon, soft tissue; and then using a folding
camp saw to cut the bone. This one topic engendered a long discussion on the wilderness-
emergency-medicine Internet discussion list see www.wemsi.org for the list archives.