NO FIRST AID KIT - REALLY!!

I was sent a link on Twitter by a friend of mine entitled No First Aid Kit. The You Tube info clip was made by Dave Canterbury of the Pathfinder School in the US, a man who I have a very high regard for. Now I am hoping that this video is a survival video for one of those situations when you really do have an emergency and absolutely no equipment with which to treat any injuries and in many ways that would be fine. DC makes some interesting points that are valid but he also at the same times says some things which make me cringe and scream NO, NO. NO.

Medical emergencies in the wilderness are much more difficult to treat than injuries sustained in the city or urban areas in first world countries. They are characterised by lack of available equipment, long evacuation times, environmental factors, difficult access etc etc. Injuries sustained can be very much harder to treat and the approach taken by this video is far too simplistic and it is not based on very much practical experience.

I take particular issue with DC's section on bleeding and bandaging. Bleeding accounts for many deaths both internally and externally, with every drop of blood we lose the oxygen carrying capacity of the haemoglobin is reduced. Bleeding is either compressible or non-compressible in real terms and either severe or life threatening. The advice given in the video is to take a linear approach to the problem citing direct pressure and if that does not work using elevation and so on. This is just plain wrong and will, in the case of a severe life threatening bleed lead to the death of the victim. Bleeding control should be considered much more holistically and a tool-box approach taken to each situation. Compressible bleeding by its very nature occurs on arms and legs only. You cannot compress bleeding within the torso or head, therefore in victims in which bleeding can be compressed one needs to incorporate bleeding control techniques appropriate to the type and severity of the bleeding.

The environment takes its toll on the health of people, however in the wilderness situation it is much more devastating. Medical experience obtained by the worlds military medical services has shown that there is a Lethal Triad of Death at cellular level and advances in the treatment of war victims in hospital aims to treat not only the visible and obvious injuries using the well established C, A, B, C, D, E formula, but also contributing factors such as the effect of cold on clotting for example. Other factors are the acidosis caused by reduced oxygen supply to cells, and the ability of the blood to coagulate.

Severe injury reduces the threshold for hypothermia from the established 35 degrees C to 36 degree C. Hypothermia comes on earlier in the presence if severe injury. Hypothermia interferes with cellular metabolic oxygenation and blood coagulation. Delays in stopping blood loss or poor bleeding control skills also lead to reduced cellular oxygenation and increased acidity of the the internal environment, earlier onset of hypothermia and the consequent effect on coagulation. Stopping bleeding therefore is a multi faceted approach and one needs at the very least some good equipment or a very good training course and ideally both.

Now I am not saying that this cannot be done without equipment, but what I am saying is that if you do not have this equipment, you need to have the knowledge and skill set to do the job properly and this is poorly addressed or conveyed in the video. It is advice that people will take up for no other reason other than the fact that it is Dave Canterbury saying it. I truly believe that Dave Canterbury does a valuable service to his followers, but in this respect the consequences of his advice are potentially dangerous and misguided individuals, faced with a serious casualty will find that putting the bleeding element in particular into practice will be much more difficult and may well lead to a very poor outcome.

Some readers of this blog will ask what my credentials are. Up to now I have never put my head above the parapet but I need to justify this blog and give it some professional weight. I was a Combat Medic for 22 years and for a period of that time I was the Chief Medical Instructor to UK Special Forces and post military I co-founded Exmed UK one of the worlds leading remote area medical life support companies. I continue to provide medical support while pursuing a life of adventure, survival and safety so in that respect I have learned, seen and experienced a lot of wilderness type injuries as well as the usual combat related trauma.