Monday, March 16, 2015

Heat Exhaustion, Heatstroke, and the Butt Bake (or Texas summers in general)

I asked Tom to write up something about Heat Exhaustion for an upcoming group trip in the Houston Area in August we call the "Texas Butt Bake".  He did such a good job, I decided to post it here so that I could find it when I need to and to make it accessible to more folks than just Hammock Forum members. This info is just as relevant for all Gulf Coast states as it is for Coastal Texas.

Heat Exhaustion, Heatstroke, and the Butt Bake (or Texas summers in general)

Texas in the summer sucks. It’s hot. It may or may not be humid. It may rain. There will be mosquitos. And we plan to hike and hang in these conditions. In this article I am going to fill you in on heat related illnesses, and how to avoid them.
Heat related illnesses are strongly related to the heat index, a measurement of how hot you feel when you combine the air temperature and relative humidity.  The formula used isn’t easy. There are a ton of variables. Below is the NOAA chart to help you figure out the Heat Index.


Heat Exhaustion

“Heat Exhaustion is a heat-related illness that can occur after you've been exposed to high temperatures, and it often is accompanied by dehydration.
There are two types of heat exhaustion:
-Water depletion. Signs include excessive thirst, weakness, headache, and loss of consciousness.
-Salt depletion. Signs include nausea and vomiting, muscle cramps, and dizziness.
Although heat exhaustion isn't as serious as heat stroke, it isn't something to be taken lightly. Without proper intervention, heat exhaustion can progress to heat stroke, which can damage the brain and other vital organs, and even cause death.” Ansorge, R. (n.d.). Heat Exhaustion. Retrieved from http://www.webmd.com/fitness-exercise/heat-exhaustion.
Signs and Symptoms of Heat Exhaustion
Body Temp from 99.6-104
Altered mental status (anxiety, confusion)
Extreme thirst
Pale, ashen skin tone
Dark colored urine
Fast, weak heartbeat
Nauseous
Excessive sweating
Dizziness or fainting
Fatigue and cramping
headache

Treatment of Heat Exhaustion
HYDRATE  ( alcohol and caffeine are NOT hydration)
Move to coolest environment available
Remove tight or restrictive clothing
Actively cool using icepacks, fans, immersion
Heat Stroke
Contrary to popular belief, Heat Stroke isn’t always a progression following Heat Exhaustion. It can be and most times it is; but if conditions are extreme enough, you can skip Heat Exhaustion and proceed directly to Heat Stroke.
“Heat stroke results from prolonged exposure to high temperatures -- usually in combination with dehydration -- which leads to failure of the body's temperature control system. The medical definition of heat stroke is a core body temperature greater than 105 degrees Fahrenheit, with complications involving the central nervous system that occur after exposure to high temperatures.” Heat Stroke. (2014, December 3). Retrieved from http://www.webmd.com/a-to-z-guides/heat-stroke-symptoms-and-treatment,
Signs and Symptoms of Heat Stroke
Body Temp above 104
You stop sweating, despite heat exposure
Red, hot, dry skin
Altered mental status (severe confusion to comatose)
Fast heart rate, usually VERY strong but sometimes weak
Siezures

Treatment of Heat Stroke
Remember, Heat stroke is a life threatening problem, do not delay
Call 911
Move patient to as cool an environment as possible
Remove all clothing, place icepacks in patient’s groin, armpits, neck and back
Fan and apply wet sheets or thin cloth (evaporative cooling)
Hydrate if possible,  to include electrolytes if possible
Immerse in cool water if possible
How to avoid becoming a victim of Heat related illnesses.
Many of these will seem like common sense, but sometimes, common sense ain’t so common.
Don’t drink alcohol or caffeine when engaged in strenuous activities
Drink plenty of hydrating fluids ( water, Gatorade™, or the like)
Wear light colored, light weight, loose clothing (more on this later)
Wear a wide brimmed hat
Wear sunscreen (SPF 30 or more)
Know how your medications affect your body. Diuretics, antihistamines, stimulants and ╬▓eta blockers are just a few that can have an adverse effect
Plan strenuous activities to AVOID the hottest part of the day
Monitor your urine color. Light colored urine is a sign of adequate hydration.
TALK TO YOUR DOCTOR BEFORE ENGAGING IN ANY STRENUOUS ACTIVITY, INFORMING THEM OF ALL THE DETAILS

Clothing for summer hiking
Cotton is cheap, in more ways than just money. When you sweat in cotton your are left in a wet cotton shirt that does a poor job of cooling you via evaporation (when compared to the other choices I list below). If you are wearing that sweaty cotton and the temperature drops, you will now be wet AND cold. Below from best to worst are my recommended materials.
1. Merino wool. Look for 150g(silk weight, ultralight, micro weight) or lighter weight and now you have a summer outer layer and you can use it for winter layering also.
Pros:  Antibacterial (stink free). Very fast wicking and drying. Very soft. Exceptional temperature regulation
Cons: price (be prepared to pay $50 or more for a t-shirt), but deals can be found (I like Sierratradingpost.com)
 There are many brands but here are a few you can look for
a. Icebreaker. Good mix of quality and value (my personal fave )
b. Smartwool. Good quality, a little more expensive
c. Patagonia. Another decent mix of quality and value, but often they are Merino blends
2. “sport” synthetics. Whether you  like UnderArmour HeatGear, Adidas ClimaLite/ClimaCool or Nike Dri-Fit, they are all synthetic materials that work by wicking sweat away from the body to evaporate on the surface of the fabric.
Pros: inexpensive(20-$30 for a t-shirt type garment). Easy to find (any Academy or sporting good store). Wide variety of colors, styles, designs.
Cons: 30 minutes in, you will smell. When they are wet and the temp drops, you will be cold. Can be (but not always) rough on the skin when compared to merino and even cotton. Nowhere close to flame retardant, they will melt to your skin.
3. Cotton and cotton blends. Some blends aren’t terrible. For years I wore 65/35 poly/cotton blends in the military and they don’t suck, they just could be better. In the heat, sweaty cotton DOES allow for some evaporative cooling, but the moisture transfer from your skin to the surface of the fabric is poor in comparison to merino and sport synthetics. Add in humidity and it just feels even worse and performs worse.
With that being said here is what I will wear for the Butt Bake Hike.
ExOfficio synthetic or Icebreaker merino boxer briefs. (very light weight, keep my bits and pieces dry, and decreases the funk. Easy hand wash and line dry.
Merino or synthetic t-short or tank top
Lightweight poly/cotton rip-stop shorts or pants
DarnTough merino socks
A keffiyeh/shemagh (so many uses, too many to list)


What you need to bring to the Butt Bake
Comfortable clothing
Water AND the ability to filter water if needed (Sawyer mini or Squeeze are nice cheap options)
A 3x5 card filled out as follows and LAMINATED, Keep handy in an outside pocket or on a lanyard
Name
Address
Emergency contact w/ phone #
List of medications person is on
Allergies and medical conditions
Blood type (if known)
Bug spray
Sunscreen
A First Aid kit if you have one.
All the rest of your hammocking gear and food.

If you are doing the Butt Bake hike plan to:

Get up early. If we can be on the trail by 7 am, we can easily be off the trail before noon, even including breaks.
Prehydrate. Everyone is going to drink at least one liter of water before we leave.
Carry a minimum of 2 liters of water and a filter device. We might have water available on the trail, we might not, and we will plan accordingly. Even my dog will be carrying at least 2 liters of water.
Have the above 3x5 card ready to go.
Remember, this hike is going to be a slack pack. Only carry what you HAVE to have with you. My gear will consist of water, first aid, filter,  and a poncho. Everything else will be in my truck or in a box someone else will bring over.


Monday, February 16, 2015

Guest Blogger Tom Humerick's Advice On A Hiker's First Aid Kit

Tom is a Veteran USAF PJ Medic with an impressive resume that I won't go into here.  But I know him and his military experience and trust this advise. First Aid in the field is a sorely neglected topic in a hobby that is heavy on talk about gear, chow, and trip reports  Thanks, Tom, for posting this here.  

This past weekend I went on a weekend hike and hang with Sarge and other members of the Texas Men’s Ministry. Whenever I leave the house I carry some basic medical gear with me whether it is a jump bag in my truck or a kit for a weekend hike. In talking with others about my kit I was carrying I volunteered to write an article for Sarge about what I think needs to be included in a kit or kits.

Before I go any further, let me start by saying that I am NOT in any way affiliated with the National Outdoor Leadership School (NOLS) and have never attended any of their excellent (so I have been told) Wilderness Medicine Institute courses. I have been involved in EMS for over 20 years starting as an EMT-Basic, moved up the EMT chain and I am now a Registered Nurse. My military training involved both standard self-aid and buddy care, Emergency Department Medicine and Combat Medicine with many advanced aspects (water rescue, mountaineering and high altitude rescue among others).

How I have been trained and how you have been trained (if at all) may be vastly different so I will endeavor to keep this as simple as possible and only make product recommendations  for a backpacking First Aid Kit that will work for a user with little to no medical training. Our goals are to:
·         Manage pain and illness
·         Stop Bleeding/Shock
·         Manage small wounds (cuts, scrapes, blisters)
·         Stabilize fractures or sprains
Looking around the internet, I think dollar for dollar the best entry level starter kit is the Adventure Medical Kit Adventure First Aid 2.0 . It includes the following:
Bandage Materials
·         16 - Bandage, Adhesive, Fabric, 1" x 3"
·         1 - Bandage, Adhesive, Fabric, 2" x 4.5"
·         4 - Bandage, Adhesive, Fabric, Knuckle
·         12 - Bandage, Adhesive, Plastic, 3/8" x 1 1/2"
·         4 - Bandage, Butterfly Closure
·         4 - Dressing, Gauze, Sterile, 4" x 4", Pkg./2
·         4 - Dressing, Gauze, Sterile, 2" x 2", Pkg./2
·         4 - Dressing, Gauze, Sterile, 3" x 3", Pkg./2
·         2 - Dressing, Non-Adherent, Sterile, 2" x 3"
Bleeding
·         1 - Gloves, Nitrile (Pair), Hand Wipe
·         1 - Trauma Pad, 5" x 9"
Blister / Burn
·         1 - Moleskin, Pre-Cut & Shaped (11 pieces)
Fracture / Sprain
·         1 - Bandage, Elastic with Clips, 2"
·         1 - Cold Pack

Instrument
·         2 - Safety Pins
·         1 - Scissors, Bandage with Blunt Tip
·         1 - Splinter Picker/Tick Remover Forceps
·         2 - Thermometer, Disposable
Medical Information
·         1 - Caring for Children in the Outdoors Manual
Medication
·         3 - Acetaminophen (500 mg), Pkg./2
·         3 - Antihistamine (Diphenhydramine 25 mg)
·         3 - Ibuprofen (200 mg), Pkg./2
·         1 - Aspirin (325 mg), Pkg./2
Other
·         1 - After Bite® Insect Relief
Wound Care
·         12 - Antiseptic Wipe
·         2 - Cotton Tip Applicator, Pkg./2
·         1 - Tape, 1/2" x 10 Yards
·         4 - Triple Antibiotic Ointment, Single Use


This kit is a good starting point and in my opinion a minimum for everyone on the hike. At $20.22 on Amazon with Prime (priced Feb. 10, 2015) it is an inexpensive and lightweight (1 lb) option that covers most of the basics and with a few additions can be an excellent First Aid Kit (FAK).
With our earlier stated goals we can now look at this kit and see what it has and what it might need to have added.
For managing pain and illness this kit has:
·         3 - Acetaminophen (500 mg), Pkg./2
·         3 - Antihistamine (Diphenhydramine 25 mg)- aka BENADRYL®
·         3 - Ibuprofen (200 mg), Pkg./2
·         1 - Aspirin (325 mg), Pkg./2

So this kit has 3 different pain relievers and a good, proven first gen Antihistamine. What about Gastrointestinal issues? I would add:
For diarrhea - Loperamide (Imodium®) – preferably in dose packs
For an upset stomach/diarrhea - Bismuth subsalicylate (PeptoBismol®) preferably in dose packs


To Stop Bleeding/Shock this kit has:
·         1 - Gloves, Nitrile (Pair), Hand Wipe
·         1 - Trauma Pad, 5" x 9"

To this I would add:
One more pair of gloves
A few more 5x9 Trauma Pads ($1-2)
A Tourniquet ($0-30)
Quikclot® ($16.99-40)

A tourniquet is an indispensable tool and for us something as simple as a tree strap and a stick or toggle can work well. If you want a commercially available tourniquet I recommend the SOFTT-W . Other commercial tourniquets are good; I think this is the best.

Quikclot® is a hemostatic bandage or sponge that is impregnated with an inorganic mineral that accelerates the body’s natural clotting ability without an exothermic reaction. The hemostatic agents we first used in the military were granules we poured into the wound but in many cases they burned the patient with the heat they produced; Quikclot® was the solution to that problem. Available from Amazon or many other places, I would recommend the QuikClot Sport 50g package ($16.99) over the less expensive but smaller 25g package. While direct pressure and elevation can’t be replaced, QuikClot® is an excellent addition. If you are a prepper/survivalist or a hunter, I would instead recommend the QuikClot Combat Guaze. It costs twice as much but is designed for the treatment of traumatic bleeding.


To Manage Small Wounds, this kit has:
·         16 - Bandage, Adhesive, Fabric, 1" x 3"
·         1 - Bandage, Adhesive, Fabric, 2" x 4.5"
·         4 - Bandage, Adhesive, Fabric, Knuckle
·         12 - Bandage, Adhesive, Plastic, 3/8" x 1 1/2"
·         4 - Bandage, Butterfly Closure
·         4 - Dressing, Gauze, Sterile, 4" x 4", Pkg./2
·         4 - Dressing, Gauze, Sterile, 2" x 2", Pkg./2
·         4 - Dressing, Gauze, Sterile, 3" x 3", Pkg./2
·          
·         2 - Dressing, Non-Adherent, Sterlie, 2" x 3"
·         1 - Moleskin, Pre-Cut & Shaped (11 pieces)
·         1 - After Bite® Insect Relief
·         12 - Antiseptic Wipe
·         2 - Cotton Tip Applicator, Pkg./2
·         1 - Tape, 1/2" x 10 Yards
·         4 - Triple Antibiotic Ointment, Single Use

 To this I would add:
-Dr Scholl’s® MoleskinPlus (the moleskin in this kit is pretty cheap stuff) The Moleskin plus is also padded and you can easily cut it to whatever size you need.
- WaterJel® Sterile Burn Dressing I recommend getting a 3pack of 4x4 pads
-BiteMD™- the kit includes an AfterBit®e pad; I like the BiteMD™ applicator tube better.

To stabilize fractures or sprains, this kit has:
·         1 - Bandage, Elastic with Clips, 2"
·         1 - Cold Pack

Sort of underwhelming, huh? If I break a leg or arm in the wilderness I get an ACE bandage and an icepack? The 4 mile hike out with that broken limb to get to help is going to really suck. Here is what I would add:
-SAM Splint at 123g for one, these are an excellent way to splint an extremity fracture. At least get one, two isn’t a terrible idea.
-A triangle bandage. You have all seen one; it is the perfect tool for making a sling for an arm or shoulder injury.

Other items to add:
Wilderness First Responder: How To Recognize, Treat, And Prevent Emergencies In The Backcountry At $20-25 it isn’t the cheapest book out there, but it is an excellent resource on most of the injuries you could see while hiking or camping.
Name
Address
Emergency contact w/ phone #
List of medications person is on
Allergies and medical conditions
Blood type (if known)
LAMINATE AND CARRY

 
A 3x5 Emergency card. EACH MEMBER IN YOUR GROUP SHOULD HAVE ONE. Have the following info on it.

With the exception of the tourniquet, the book and with QuikClot® sport (not the combat gauze) everything here can be easily had for $100 or less.
Now, I was also asked to list what I carry on a weekend trip, so here we go:
My IFAK (Individual First Aid Kit) on my chest rig contains:
·         QuikClot Combat Gauze (X-ray), 3” x 4 yards
·         Combat Medical Systems, Decompression Needle, Mojo Dart, 14GA, 3.25”
·         Nasopharyngeal Airway, 28fr w/packet of lube
·         Tytek Medical, EZ Gauze TM-215. Sterile (Z-Fold Dressing)
·         Nitrite Gloves, Purple, Large 2 pr
·         PMI HALO SEALS, 2-pack
·         Dynarex, 2” Elastic Bandage
·         4” Israeli Emergency Dressing (Pressure dressing)
·         Combat casualty card with rubber band for attachment and pencil
·         SOFTT-W Tourniquet
·         Sharpie
·         Small notepad
·         EMS Shears
·         Hemostats
·         ITS Fatboy pouch
   Most of this is available commercially as the ITS ETA Trauma Kit Fatboy

My aid kit in my pack contains everything I recommended for your kit plus:
A suture kit
2 air splints (1 full arm, 1 full leg)
Glucose Gel, 3pks
Electrolyte packs, 3 oral mixes
2 more QuikClot Bandages
4 more Israeli Bandages
2 Rolls of Kerlix
1 roll of Coban
1 EpiPen
1 Ring Cutter
My personal medications

My kit is significantly more expensive and some of the items require training, but it is basically an expanded version of the kit I recommend for all hikers/campers.

One final note. I purposely left airway management out of this post. If you don’t know what you are doing you can severely injure or even kill a person if you do the wrong thing. I highly recommend you contact your local RedCross and take a CPR/First Aid course and they will show you how to properly establish and maintain a patent airway. If there is ANY possibility of a spinal injury, do not move a person unless you ABSOLUTELY have no other option.