Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Chapter 34: Appropriate Medical Technology

An emergency medical products website offers an unlimited opportunity to pack your bags with useless equipment. The cornucopia of gadgets, apps, and solutions looking for a problem can fill a truck, overload a med kit, and boggle the mind. Fortunately, the exercise of stuffing what you think you need into a pack and then carry- ing it for several miles uphill in a snowstorm can really help reset your priorities. Some of the equipment and material used in the ambulance or emergency department will func- tion well in the backcountry, but most will not. Appropriate medical technology for the offshore and wilderness environment is closer to that used by veterinarians and home health care nurses. You are looking for equipment that is simple and light with few moving parts. Bandages and dress- ings will need to survive harsh conditions but be simple to apply. Medications should not require close monitoring or prolonged administration, and they should not cause unacceptable side effects. Fortuitously, in all categories, the choices are limited. Backcountry Medical Equipment The size and weight of medical supplies and equip- ment carried will be determined by how you

transport it, the role you fill, your level of training, and the number of people to be covered. There is no point in carrying anything that you don’t know how to use, and no reason to carry anything that can be improvised from something else. Mariners and motorized rescuers can usually find space for dedicated splinting materials, irrigation solu- tions, and other bulky supplies. The practitioner who backpacks a medical kit will need to be much more discriminating. A simple pocket or intraoral mask connected to a helpful rescuer provides heated and humidified ventilations without the weight and complexity of an oxygen-powered system with an external heat source. Vet wrap, an elastic bandage origi- nally designed for livestock, stands up to mud and rain much better than the white roller gauze found in the emergency department does. Pain medication that can be administered by mouth, transmucosal route, or intramuscular injection is easier to manage than anything that requires an intravenous (IV) line. Carrying traction or long leg splints for the lower extremity is generally not necessary for a patient who is going to be carried anyway. A well-padded litter or vacuummattress effectively splints everything from the neck through the tibia. Stabilization of ankle, wrist, hand, and fore- arm injuries can be accomplished with a simple