NO FIRST AID KIT - REALLY! !

Yesterday I was sent a link to a You Tube video that has me a little bit disturbed http://www.youtube.com/watch?v=VVonW8fBzPY. Normally I would just watch, enjoy or not and move on. In this case the video has been put out there by someone who I really respect as a bushman, hunter, survivalist and is one of the big names within the community. If there were only a few views on his site then I would create a fuss, but that is not the case. Lots of people are going to see this and because of who it is, will almost take his views as gospel, when in fact there is a lot within the content to dispute and at the very least discuss in open forum.

The point being made in the video is that a first aid kit is not required as part of your survival/bushcraft kit and that everything that you need can be improvised from the equipment within the pack. The thrust of the video appears on the face of it to have some valid points to those that have not much more than rudimentary first aid or medical training. The point is that you can do everything said in the video but, and here is the crux, should you? One has to be an expert in wilderness first aid or medicine with a lot of experience to effectively  put into practice what is being postulated, in such a way that does not increase mortality or morbidity.

Lets put it into context. Survivors are very often injured and people who travel, at least regularly in the wilderness are most likely to suffer from the effects of the environment or trauma or both in the first instance. Although people do have medical emergencies in wilderness areas it is less common. Primary care issues such as rashes, coughs, colds, gastro-intestinal illness etc, etc, are rarely life threatening although I accept that they may become so over time. The immediacy of traumatic and environmental emergencies means that interventions need to be quick, effective and maintainable. Wilderness environments pose particular problems in that equipment is often lacking, the evacuation times are longer, and the climate is a major factor in both the rescue and the victims physiology.

I don't want to critique every aspect of this video, however I will address the major issue that I have a problem with and the one which I think shows that the creator of the video is more an enthusiastic amateur with not much more than other peoples learned knowledge and not a large amount of practical first aid experience, which is a real shame because the guy is normally awesome.

Bleeding is one of those things that has turned the pre-hospital world on its head over the last 10 to 15 years. Indeed the usual ABCDE protocol for first aid treatments is now changing rapidly to C-ABCDE or even MARCH in some trauma assessment methodologies. Bleeding has three natures, capillary bleeding, venous bleeding and arterial bleeding. Treatment for bleeding is dependent on whether or not it is compressible or non-compressible. Indeed that is a really good classification. Compressible bleeding is found on limbs while non-compressible bleeding refers to bleeding within the torso or head where the first aider has no access.

Capillary bleeding is not usually life threatening except rarely, perhaps, in patients who are haemophiliacs. Venous bleeding can be serious but is low pressure in its nature and therefore if compressible and assuming that the victim is not suffering from haemophilia relatively easy to treat also. Arterial bleeding on the other hand can be rapidly life threatening to the point where you only have seconds to control the situation.

The approach to severe or catastrophic arterial bleeding is holistic and one needs a tool-box of techniques in order to stand any chance of effectively treating this at all in the presence of high pressure blood loss. The video suggests a very linear approach starting with direct pressure and suggests that if it doesn't work then move onto elevation and so on. In reality all tools in the haemorrhage control tool-box, including tourniquets, pressure points, elevation, packing, compression dressings, windlass control, haemostatic agents, and traction all feature, some in a linear fashion some simultaneously, for example direct pressure, haemostatics and elevation should all be used at the same time.

Now I could write a book on the control of bleeding, I really could. I have dealt with bleeding caused by penetrating trauma and blunt trauma, I have done it in hospital, in an ambulance, in a war zone, in the wilderness and many other places and one thing I can say with absolute certainty and that is that severe bleeding is anything but easy to treat. In fact it can be a right SOB and one has to work every trick in the book in order to achieve a good outcome.
First aid books often appear to make it sound as though its is easy to deliver first aid and the video seems to give that view credibility and in my experience it is rarely that way. Sure some things like airway management can be anything from the simple to the desperate, and that is the reality of first aid, it can be real easy, but it can also be real hard. To suggest that you can effectively carry out first aid skills using materials that are not designed for the job is leading people into a false sense of security. It can be done, I could do it and do it reasonably well, but the average person without specialist training would be hard pushed, and thats just dealing with the bleeding problem, it does not address all the other associated problems of being in a wild place.

The real problem is that putting a bandage on a severe bleed is probably not going to work very well. Ideally one must have specialised bandages such as those used by the military or their civilian equivalents such as Woundstop distributed in the UK and Europe by MDD http://www.mdd-europe.com/Produkt/firstcare-woundstop-pro-45m/ . The reason these bandages are so good is because they have been designed specifically to manage these injuries, in fact they are so specialised that in order to maximise their potential one must have appropriate training and the same is true with tourniquets and windlass application and haemostatics. All the items highlighted regarding bleeding in the video are simply not fit for purpose, with the sole exception of perhaps packing a wound cavity.

Wilderness first aid is not urban first aid and while I accept that in a true survival situation you would make do with what you have or can improvise, this should not be considered normal practice for vacation or leisure trips into the wild places of the world. So for those that consider this video in the same light as the other videos then I urge you to think again. Get specialist training for the wilderness and learn exactly how to use the equipment.

The uploader also talks about pain and using over the counter medications which is fine for mild perhaps even moderate pain, but pain is going to be a major factor in what you can and cannot do with a patient. It takes skill, patience and knowledge for a patient to become compliant. Trauma injuries by their nature are painful, often extremely so and even the safe limits of the over the counter medications is not going to make a real difference.

There is some good stuff in the video and quite practical however there is in my mind a disconnect between minor first aid conditions that can be treated easily with rudimentary equipment but to venture out routinely without the key items to deal with a major trauma injury is in my view simply folly. I am not suggesting that one needs to pack a full scale EMT or Paramedic pack, but just a bit of thought and some simple easily available items your ability to do so much more is enhanced greatly and the benefit to a patient may mean the difference between survival or not.