First aid without borders

 

 

Carrying a medical kit, especially when venturing beyond the territory of hospitals and paved roads, is like fastening your seatbelt before driving: You hope you won’t need it, but you wouldn’t want to be the one who flies through the windshield.

E ach year, Rotary’s Service Above Self motto inspires thousands of humanitarian endeavors, many of them in remote or developing areas. On these trips, most travelers shoulder their own gear, and therefore want less of it.

While cutting back to one sweater or a single pair of sandals may suffice, when it comes to medical kits, veteran travelers advise never to skimp or assume you’ll be able to purchase critical items once you arrive. Carrying a medical kit, especially when venturing beyond the territory of hospitals and paved roads, is like fastening your seatbelt before driving: You hope you won’t need it, but you wouldn’t want to be the one who flies through the windshield.

Medical kits have three purposes: They enable the traveler to manage known medical conditions, and to prevent and treat travel-related illness and injury.

1. Manage known medical conditions.

Leah McClellan, a registered nurse who works in an urban emergency department and coordinates volunteer surgical teams in Latin America, speaks from experience when she urges travelers to pack extras of any necessities, whether it’s corrective lenses, an additional week’s worth of daily medications, or rarely needed emergency treatments such as asthma inhalers. While in the Guatemalan highlands, McClellan realized she must have unknowingly eaten something that contained peanuts, to which she has a potentially deadly allergy. As her skin erupted in hives and her chest tightened, she assessed her two EpiPens, lifesaving epinephrine injectors used by individuals who have anaphylactic reactions to food or medication. She used the first dose and waited for the symptoms to recede, as they typically did. She recalls struggling to breathe in a one-room house, “in a town with one dirt road and a lot of horses – and I’m allergic to horses too.” An hour later, the hives worsened, and her throat began closing. “I was petrified to use my last EpiPen,” McClellan admits. “I remember thinking, if I take this, I will be out of medication, I may have to go home, and all the work I’m doing will be put on hold. Then I thought, if I don’t use this second dose soon, I may die.” McClellan did use her last EpiPen and had to return to the United States. “Eventually, the work got done, but in those hours, I felt extremely vulnerable and scared.”

For many people, less dangerous conditions such as seasonal allergies and motion sickness worsen when they’re traveling in new climates or riding on rough roads in crowded buses, so consider packing enough remedies to last the duration of the trip – and then some. Despite the extra room it will require, leave all medications and supplies, such as syringes, in pharmacy-labeled containers to avoid complications at border crossings. Officials in any country view stray pills (and their possessors) with suspicion. Finally, carry copies of prescriptions or documentation on letterhead from prescribing physicians, preferably translated into the appropriate language.

2. Prevent travel-related illness and injury.

You can do much of the work before your departure by visiting the U.S. Centers for Disease Control and Prevention (CDC) Travelers’ Health interactive Web pages, which provide country-specific information on recommended vaccinations and current epidemics. Travelers clinics, located in many large cities and tailored to businesspeople, can assist with research on itinerary-specific preparations and administer vaccinations and oral medications – although often at exorbitant rates. The U.S. State Department Web site offers up-to-date travel restrictions, safety advisories, and lists of prohibited medications in foreign destinations. Carrying proof of immunization is crucial, as failure to do so can result in detention at ports of entry. (Travelers in Mexico who lacked proper immunization records reported mandatory blood draws by a squad of local officials and armed soldiers.) Also, find out how far in advance you need to initiate destination-specific oral medications such as antimalaria and altitude-sickness pills. 

You can avoid many of the most common but potentially serious travel-related illnesses and injuries by packing a handful of basic items, including antibacterial wipes or antiseptic gel, insect repellant, sunblock, and water filters or iodine tablets. Also remember sandals for bathing and sturdy, broken-in walking shoes: In tropical climates, small cuts and blisters more rapidly develop infection.

3. Treat travel-related illness and injury.

When careful planning and precautions fail, a medical kit can be a literal lifesaver, but only if travelers know how to use it, and if it’s accessible at all times. (The one exception is during air travel, as most airlines have restrictions on sharp items and liquids in the main cabin. But even if you stow the kit, keep your personal medications with you.)

Ann Nora Ehret, an osteopathic physician with experience in family, emergency, rural, and shipboard medicine, has participated in medical evacuations in the Grand Canyon, Bush villages of western Alaska, and the Bering Sea. She advises medical providers who travel internationally to carry a copy of their license and to plan for the needs of the rescuer as well as the victim. One medical evacuation in which she participated took place during a blizzard. As she worked to stabilize her five-year-old patient in status epilepticus, a state of continual seizures, “being prepared for the weather, having a headlamp and ample antinausea medications – for me as well as the patient – were key.” During another evacuation in the Grand Canyon, Ehret used a mirror to signal an overhead commercial flight, which in turn radioed a nearby airport, which then sent a helicopter to rescue the hiker involved, who had been stabbed in the femur by a broken tree limb during a windstorm. “We were fortunate to have clean irrigation water, antibiotics, pain medications, dressings, and splints,” Ehret recollects. Yet it was the chain of action carried out by various participants that ultimately resulted in a successful airlift, illustrating the point that activating resources can be as important as packing well.

The CDC, Red Cross, and travel organizations recommend the following components, with quantities varying depending on the duration of the trip and the number of people in the group:

• Non-latex gloves
• Gauze pads: Small (2 x 2 in.) and large (4 x 4 in.)
• Absorbent trauma pads for pressure dressings on bleeding wounds
• CPR mask
• Alcohol swabs
• Suture kit
• Adhesive tape: Silk is preferable to plastic, as it adheres better to damp skin
• Adhesive bandages: Multiple sizes
• Elastic bandages for sprains and strains
• Slings
• Splints
• Moleskin for blisters
• Tweezers
• Scissors
• Digital thermometer
• Emergency Mylar/solar blanket
• Instant cold compresses
• Matches in a waterproof container
• Headlamp
• Glow sticks or flashlights and extra batteries
• First aid/medical reference guide
• Visual translator cards: To use as communication aids during medical emergencies

Medications

• Pain or fever: Acetaminophen, aspirin, or ibuprofen
• Gastrointestinal: Antidiarrheal treatments, antibiotics for severe diarrhea, oral rehydration solutions, laxatives, antinausea medications, and antacids
• Upper respiratory: Antihistamines, decongestants, cough suppressants/expectorants, and throat lozenges
• Saline eyedrops
• Topical: Antifungal and antibacterial ointments or creams, 1 percent hydrocortisone cream for rashes or irritated insect bites, and aloe gel for sunburns
• Anti-venom: These kits are hard to come by, typically require refrigeration, and vary by region, so it’s best to follow basic guidelines for any bite. Keep victims as still as possible and immediately transport them to a medical facility. If the snake, scorpion, or spider has been killed, bring it (in a sealed container) to the medical facility as well, handling it carefully, as it may still harbor venom.

Miscellaneous

• Toilet paper: Local alternatives may be newspaper or leaves
• Mouthwash: Useful for brushing teeth when drinkable water is limited or unavailable
• Wet wipes/baby wipes: Luxurious in the absence of running water
• Pen and paper
• Safety pins
• Duct tape: Handy for everything, from shoes to boat hulls
• Mosquito net for sleeping, depending on the location
• Battery-powered radio and extra batteries