First Aid Kits for International Trips

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Should I be carrying a first aid kit?

What should be in a first aid kit?

What about antibiotics and prescription pain medications?

Epinephrine?

Bhutan First Aid Kit.jpg
 

International trip leaders frequently ask us about what they should be carrying in their first aid kits. The answer is invariably, “It depends.”

The first step in putting together a first aid kit for international travel is to ask the Safety Matrix® questions: the Who/What/Where/When/How/How long of your program.

  • Who – What age group and how many? Pre-existing conditions of group members?
  • What – Are you taking classes in a Western European city or engaged in wilderness adventure type activities, water based activities or field research type activities? Will the group divide up sometimes making it sensible to have more than one kit?
  • Where – Climate considerations? Local medical resources? Remoteness? Altitude? Sun? Dry/Wet?
  • When – Rainy season when there may be more rashes, slippery roads and more mosquitoes? Tourist season which may entail more crime or at least more alcohol? Will it be warm or cold or both?
  • How – What is your budget? Are you staying in high-end hotels that have first aid supplies or in home stays? How much do you want to spend on first aid kits? Will the kit be exposed to weather or to being crushed, etc.? Do you need to carry it on your back? Can a large kit be carried in vehicle or boat and smaller kits be carried?
  • How Long – Can supplies be easily replaced or is what you bring what you have for the duration?

The answers to these questions dictate what you should have for a first aid kit.

For war correspondents, safety in conflict zones may mean being able to travel light and fast even as they schlep heavy camera equipment while wearing body armor. They are often at high risk for sustaining life-threatening trauma. It makes sense for them to carry minimal first aid supplies designed to help a victim of trauma survive in the short term. To that end they may carry military grade tourniquets, tape, trauma dressings, a chest seal and tension pneumothorax decompression needle (an advanced scope of practice technique that wouldn’t be appropriate for lay persons outside of a combat zone). They are also often more at risk for travelers’ diarrhea, infectious disease and dog bites, but can access necessary supplies away from the conflict zone.

Some off-shore sailing programs operate in very remote areas. They may be more than 5 days away from the nearest port and well out of reach of helicopter rescue. They are legally permitted to carry advanced equipment and medications.  That doesn’t necessarily mean that they should. Inexperienced and untrained persons should not be trying to put in intravenous lines or insert endotracheal tubes. Off-shore sailing vessels usually have excellent communications and can be in frequent contact with medical professionals so including prescription medications makes sense.  Weight is not a consideration per se, so carrying bottled oxygen makes good sense as well.

For educational travel, if your program is operating in a high income country capital city with excellent medical facilities, where emergency medicine is a distinct discipline and where an ambulance is likely to show up within 10 minutes of calling the equivalent of 911, it might make sense just to advise students to carry whatever over the counter medications that they might need and not bother with a group first aid kit. If you are in a low-income country and conducting research in a remote area, it might make sense to carry an extensive first aid kit.

RULES OF THUMB

  • Ready-made commercial first aid kits are not usually a good value. They appear as if they are well stocked, but the bulk of the kit is packaging for individual doses of over the counter (OTC) medications. They usually include items you don’t want and lack important items that you do want.
  • A good organizer is worth the expense. There are very good soft pouch style and belt-pack style organizers available from outfits like Conterra®
  • If you are operating in a marine environment, you’ll need a waterproof hard box style organizer, e.g., a Pelican Case. If you are on a limited budget, small stuff sacks or Tupperware containers will suffice.
  • Don’t bring anything that you don’t know how to use.
  • Don’t bring multiple items that do precisely the same thing. You might choose to bring more than one NSAID (non-steroidal anti-inflammatory drug) like aspirin and ibuprofen because, while they both are comparable for managing pain and fever, aspirin has higher anti-clotting properties for someone who might be having a heart attack and ibuprofen has superior anti-inflammatory properties for sports injuries, etc. On the other hand you don’t need to bring 3 separate products for fungal vaginitis, athlete’s foot or jock itch. One antifungal should suffice.
  • Utilize items that have multiple uses. A 60cc syringe (no needle) is excellent for cleaning wounds and for suctioning airways. In a pinch, it works great for administering an enema.
  • Don’t store non-medical items (sun block, bug dope, tampons, etc.) in the first aid kit.
  • Do not store personal prescription medications in first aid kit.
  • Don’t bring goofy stuff, i.e., snake bite kits or tick pliers.

BASIC FIRST AID KIT

The list below is put together with the idea of keeping it simple. You could easily double the number of items here by adding fancy tools, high tech bandages (Gore-Tex impregnated with antibiotics, etc.) and a broader range of over-the-counter medications. However, for most issues, the kit below should suffice. Quantities of bandages, OTC medications, etc. would be determined by length of program, nature of activities and destination country.

Tools

  • Multiple pairs of latex or vinyl gloves (blood borne pathogen protection)
  • Bandage scissors
  • CPR mask or NuMask
  • 30cc or 60cc syringe (wound irrigation)
  • Tweezers
  • Thermometer
  • SOAP notes (standardized format for recording and organizing medical information) and pencil
  • Safety pins

Bandages/Dressings

  • Major trauma dressings
  • 4 x 4 dressings
  • Roller gauze (3“)
  • Athletic tape (better than medical tape)
  • Band-aids
  • Elastic bandage (“Ace wrap”)
  • Triangular bandages (cravats)

Topical Medications

  • Povidone-Iodine or Betadine for wound care
  • Bacitracin/Triple Antibiotic Ointment
  • Hydrocortisone Cream – Anti itch cream
  • Antifungal cream

Over the Counter Medications

  • NSAIDS, (ibuprofen)
    • Aspirin – Do not give aspirin to children (Reyes Syndrome)
  • Acetaminophen (Tylenol)
  • Imodium
  • Pepto-Bismol
  • Antacid tablets
  • Diphenhydramine (Benadryl)

Other

  • Epinephrine – EpiPens or ampules/vials with syringes for use in the event of life threatening system allergic reactions (anaphylaxis). Requires training and a prescription in the U.S.

NOTE: A number of programs do not do this because their participants with a history of anaphylaxis bring their own epinephrine. Understand that while food allergy history is predictive to a significant degree, 50% of people who die of anaphylactic reactions to bee stings and other hymenoptera exposures, have no history of significant allergic reactions.

Optional Recommended Additions

  • Trauma shears
  • Stethoscope – For listening to lung sounds if spending significant time in water based activities or at high altitude
  • Kelly Forceps – May be useful for stopping bleeding or wound exploration and cleaning
  • Small Magnifying Glass – To assist in wound cleaning and for distinguishing small ticks
  • MoleFoam or 2nd skin - For blisters if hiking
  • Burn dressings
  • Small flashlight

ADVANCED FIRST AID KITS
If you are traveling in low/middle income countries and/or in remote locales, it might make sense to consider carrying a few prescription medications. These should be managed either by protocols written out by the prescribing physician or preferably by digital communication oversight (tele-medicine). Do not put program leaders into a position of practicing medicine. There is a reason why physicians undergo extensive schooling.

Antibiotics might include 1 – 3 broad-spectrum antibiotics, each intended to address a particular type of issue. One for butt/belly problems, one for wound infection and one for ears eyes nose and throat, etc. Your advisory physician might decide to include prednisone to stabilize an immune system if a student had an anaphylactic or asthma problem during the program.

Prescription pain medications are not generally recommended for most first aid kits. Carrying them can engender legal complications and there is potential for abuse.

Bill Frederick is the Founder and Director of Lodestone Safety International