The Alaska First Aid Kit

“Whaddya think?”

My buddy John and I were sitting at a wood plank table in a cabin as an October storm ripped through outdoors. Rain pelted the windows and our wet gear hung over the wood stove, dripping muddy water that sizzled when it hit the firebox. Two snorts of whiskey had been poured. And now that we were hunkered in and finally warming up, I pulled out my newly-assembled first aid kit, anxious to show it off.

I admit my question was somewhat rhetorical. Although I was happy for any advice he could offer, I was also hoping for an affirmation of the great job I had done putting the kit together. John had just finished a tour of deployment as a medical doc out of Forward Operating Base Rustamiyah just outside of Baghdad, where he had served in the base emergency rooms and in the intensely dangerous chaos of the Sadr City ghetto. Who better to ask about a field first aid kit?

John flipped through my carefully-selected items. “Yeah, this is all good… I guess. But you know what you really need? Duct tape and a satellite phone.”

I only halfway understood, and my pride took a small hit.

“When someone’s hurt,” he continued, “you need to stabilize any bleeding. And you need to make sure they can breathe - that their airways are clear. You keep them from going into shock, and then you get them the hell out of there as soon as you can.”

It was an epiphany moment for me, and as I took a sip of whiskey I began to think about it. Of course he was right. When the shit hits the fan - when someone’s really hurt - you don’t mess around, especially if you’re just an idiot fly-fisherman out in the boondocks. Back at the hospital, John might have the resources and skills to bury his hands in someone’s guts to keep them alive, but out in the field, what can we do, other than to take the most basic of measures? If someone’s truly hurt, what really needs to happen is to stabilize their condition, do no harm and get them to proper care immediately. It’s as simple as that.

With that, I was struck by the realization that most of the pieces in our so-called first aid kits are really just items intended to relieve the temporary nuisances of what are typically no more than bothersome minor wounds. We clean and bandage cuts, cover blisters, tape up swollen ankles, and dole out ibuprofen for banged knees, sore backs, and hangovers. Anything more than that, and we should probably fire up the motor, start rowing hard, or dial up the satellite phone to get our poor beat-up partner to a hospital.

Before we get into the specifics of what we include in our first aid kits, we want to emphasize there is no one-size-fits-all unit - it depends too much on who you are, where you’re traveling, what you’re doing, and how long you’ll be out (e.g., ditch your snakebite kit for your Alaska float trip).  And we also need to mention that if someone in your party has a particular affliction or medical need, then they should bring their own junk in sufficient quantity to take care of themselves, including enough for extended layovers due to weather or other unanticipated events. If they have a condition that can become serious, then they need to brief you and the others in your crew on how to care for them if they need it.

When we assemble our kit, we ask ourselves: what are the most common injuries we encounter as fly fishermen and outdoorsmen in the Alaska backcountry? In our experience, this tends to be cuts, burns, and twisted joints. And among us anglers, we would also include embedded fish hooks. Eye injuries - scratches, pokes, or debris in the eye - can be debilitating, and seem to be fairly common too. Considering this, you should make sure your kit adequately covers these basics.

To deal with the typical issues, we carry a variety of bandages and steri-strips, and even some superglue. There is always antibacterial ointment (silver sulfadiazine, bacitracin, or other), waterproof first aide tape, and elastic bandages and gauze for dressings. Ibuprofen is an effective anti-inflammatory, and if you can get your doctor to dole out something stronger to help with severe pain, then more power to you. For painful eye abrasions, try to get prescription proparacaine. And make sure you have plenty of tape for supporting and bracing ankles and other joints, making splints, and covering bandages.

These basics, along with the other items in our typical kit, are shown below. Note this is a fairly large collection that goes with us on lengthy trips or on boats - this ain’t no backpack kit. All the contents are double-bagged in small zip lock sacks. At the beginning of the season, and before big trips, we always make sure the goods are still intact: the liquids haven’t leaked; the tubes haven’t burst; the pills haven’t turned to dust; and the tape is still sticky.

The basics are:

Still, despite these precautions, sometimes we’re better off just moving on and trying to ignore our hurt. We’re reminded of our buddy Richard, who, mid-way into a long day of float fishing far from any roads, tugged a bit too hard to free a Mepps spinner that he accidently cast into an overhanging tree. The spinner broke loose from the tree and came at him like a stone shot out of slingshot. Smacking him right in the face, one of the treble hooks buried deep into the cartilage of his nose.

You can imagine the initial shock. But after his eyes came back into focus and his queasy-gut feeling wore off, Richard took a deep breath and admitted he wasn’t really hurt all that bad. Still, nobody wanted to try to remove the hook – not then or there anyway. So what did Richard and his two companions do? Well, they finished their float trip, of course. They drifted down the river, taking turns on the oars, and enjoyed a nice day of fishing. That’s not to say Richard wasn’t sometimes inconvenienced, though. From time to time, the breeze would pick up and the spinner blade would do what it was designed to do: flutter, spin, and wobble - all while the hook was embedded in Richard’s nose.