Expedition Medical kits, everything but the Kitchen Sink by Dr Sean Hudson
Probably the most common question I’m asked as an expedition medic is ‘What shall I put in my medical kit?’ The question is very hard to answer and would receive a different answer from probably every doctor involved in remote medicine. It is dependent on skills, experience, environment, preferences, and purpose of expedition.
There are several items, which I always carry in my pocket if I’m working on an expedition in a wildnerness area:
· Roll of zinc oxide tape- covering blisters, taping injuries and dressings
· Ibuprofen- simple analgesia, especially useful for musculoskeletal injuries
· Imodium- To control the problem of gastroenteritis whilst participating in essential activities
· Tincture of iodine- used to purify water and antiseptic for wounds
· Gauze dressing- Simple dressings
· Compeed or similar dressing- adds padding to nasty blisters
The rest of the kit really depends on your experience and distance from help. I normally would break the kit down into:
· Fracture Management
· Lotions and potions
· Dressings and Wound Closure
· Medical Emergencies
· IV Access and fluids
· Specialist Equipment (depends on environment)
· Analgesia is going to differ relative to your country of origin. As a doctor I would always take Morphine, IM Voltarol, Rectal Voltarol, Co-codamol, Paracetamol.
There are a variety of ways of immobilizing a fracture, the simplest being ingenuity, some zinc oxide tape or clingfilm. Otherwise Sam Splints are very versatile and a Kendrick Traction Device is lightweight and fantastic for lower limb fractures.
You want antibiotics to cover as wide a variety of infections as possible from dental abscess to travellers diarrhoea. I normally take Co-Amoxiclav, Ciprofloxacin, Metronidazole, and Flucloxacillin. Remember always be aware of sensitivities to antibiotics.
Irritating skin conditions are common on expedition especially in tropical regions, consider taking an antifungal, an antihistamine, a steroid and an antibiotic, Clotrimazole, Anthisan, 1% Hydrocortisone, and Fucidin and an Antiseptic spray or liquid.
Simple dressings possibly impregnated with betadine are useful, together with some dry dressings and crepe bandages. Wounds can be closed with steristrips, sutures, staples or even superglue. Some training is essential.
I always carry a Salbutamol Inhaler, and treatment for anaphylaxis, Adrenaline, Piriton and Hydrocortisone. IV Fluids, Giving Sets and Venflons and an assortment of Syringes and Needles.
Extra equipment is often needed for different environments.
· Altitude Expeditions are most likely to see AMS, HACE and HAPE, so the training and medication to look these conditions is imperative. Dexamethasone, Nifedipine, Acetazolamide, Oxygen and a Hyperbaric Chamber, Increasingly other medications are being trialled with some success.
· In polar environments portable devices for rewarming hypothermic patients are useful, The HEATPAC is light and easy to use.
Lightweight stretchers are useful, they can be improvised from rope but some ski stretchers are invaluable whilst backcountry skiing
As you can see there is no easy answer to this question. You may choose to take a 25kg rucksack full of equipment, or it may fit into a camera case. Look at the common conditions, endemic diseases, common injuries and logistical and medical support and adapt your medical kit to fit the occasion, and don’t ask too many doctors otherwise you’ll end up taking the kitchen sink.
Specialist equipement can be hired from Expedition and Wilderness Medicine, see their remote media support page.
About the author
Dr. Sean Hudson is a Fellow of the Royal Geographical Society and on the expeditionary advisory board for Summit. Sean has been involved in a wide array of expeditions over the last 18 years. During this time he has trekked across the Darien Gap, The Thar Desert, worked as a trekking guide and Chief Medic for Raleigh International in Namibia and Zimbabwe, a trauma medic in Columbia and ski field doctor in New Zealand. Since 1998 he has worked for Across the Divide Expeditions as medic and expedition medicine advisor, providing medical cover on expeditions in 21 different countries. Dogsledding to Desert trekking in Namibia. In 2002, he and his wife, expedition medic Dr. Caroline Knox, helped to established Expedition and Wilderness Medicine, which seeks to provide comprehensive training for medical professionals working as expedition medical officers in a variety extreme and remote environments.