Tips from the doc

As much as I would like to be a professional in the fly fishing industry, I will likely always be a mere doctor who fly fishes a lot. I am a physician with a specialty in emergency medicine. I also do a lot of international trips that combine fly fishing with international travel. Perhaps, this gives me a unique perspective on Chad Agy Presents: First Aid and Adventure Travel. In this post, I will go through everything that is in my first aid kit. Additionally, I will disclose some considerations for adventure travel pertaining to exposure to potential disease. Of course, an individual’s first aid kit should be tailored to their unique needs and underlying medical problems, in consultation with that person’s doctor. This article simply lists the things I throw in my bag before any big adventure, and is not meant to be a definitive list for a perfect, universal first aid kit. Many of these things can be purchased at a pharmacy or even a large outdoor retailer like REI. Some of the medications require a prescription from a licensed medical provider. I also adjust the kit to match the particular trip. A remote journey to the Alaskan wilderness or a foray deep in the Amazon will require the entire bag. Meanwhile, I might leave a few things out if I’m going to a nice lodge in Patagonia. Regardless, this may seem like a lot of stuff, but I fit all of it in a modest-sized bag. Medications Any angler who spends enough time abroad will eventually encounter an illness, either personally or with someone in their group. I carry three antibiotics on my big adventures, which provide wide coverage for many different bacterial conditions. Below is a list of the medications in my First Aid kit to handle a variety of infections. Keflex: This antibiotic is my go-to for skin/soft-tissue infections. It is first line for cellulitis, which is probably the most common bacterial infection encountered by travelers. It is also highly effective for urinary tract infections if anyone in the group is prone to that affliction. Doxycycline: Another antibiotic, this versatile drug is great for pus-producing infections like abscesses. Additionally, it is a great option to treat pneumonia. I also bring this antibiotic for emergency malaria prophylaxis. It is a good malaria drug, and I once took it when I started seeing mosquitos unexpectedly during a jungle trip. Be careful when taking doxycycline… it has the interesting side effect of worsening sun burns and can also cause profound nausea when taken on an empty stomach. Ciprofloxacin: Or “Cipro,” is another antibiotic that is familiar to many travelers. Traditionally, it is a common treatment for many of the bacteria that cause traveler’s diarrhea. However, with growing bacterial resistance to Cipro, many now argue that Azithromycin is a better drug for this purpose. Immodium: Speaking of diarrhea, this is an over-the-counter medication that treats diarrhea, which should be in every traveler’s first aid kit. Zofran: With diarrhea often comes nausea, and Zofran is a first line medication for an unsettled stomach. Phenergan: Another nausea medication. Perhaps a bit more potent than zofran, but with the unwanted side effect of drowsiness in some individuals. Injury Injury is another threat to people who like to wade on slimy river bottoms, hop through treacherous boulder fields, and hike steep stream-side trails. Oh hey, that’s us! Something as trivial as a sprained ankle can completely derail a trip. A fracture that would be a treatable nuisance back home can become a medical emergency when deep in the bush. I carry several items to deal with these potential issues. Sam Splint: This is a moldable piece of material can serve as a splint to help immobilize an injured extremity. Light and foldable, it easily fits in my baggage. Ace Bandage: I carry a few of these in my bag. These are stretchable bandages with velcro on the end, and can help affix a Sam Splint, provide support to a sprained joint, or apply compression to a swollen injury. Ibuprofen/Tylenol: These are essential medications for pain control of any injury. They also provide fever relief and treat body aches caused by infectious illness. Percocet: I carry a handful of Percocet to treat potential severe injuries. This is a strong pain medication with addictive properties. Fortunately, to date I have not had to use this medication. Bleeding/Wounds Of all the potential injuries that could be encountered on a destination fishing trip, bleeding is one of the complications that could immediately pose a threat to life. However, smaller lacerations are very common and more likely to be experienced than dangerous hemorrhagic emergencies. Dermabond/Super Glue: These products can effectively close lacerations up to several centimeters in length. Suture material: Travelers without a medical background may not be comfortable using sutures. However, tying a few overhand knots is all it takes to close a wound that may otherwise be left gaping. Suture material is also helpful for repairing torn clothing or broken buttons. Lidocaine (with epinephrine): Can be used in a liquid, injectable form or may be bought over the counter in a cream form. This will provide anesthesia for subsequent suture placement. Preparations with epinephrine can also provide bleeding control. A small injection of lidocaine can also make it much easier to treat a fish hook embedded in the skin. Needles and syringe: For drawing up and administering lidocaine. Needles are also great for removing splinters. Hemostatic material: Several materials provide bleeding control and enhanced clotting, and may be purchased at stores like REI or Cabelas. Products like Combat Gauze and Quick Clot provide prompt bleeding control when applied with pressure. Coban wrap: I carry a couple rolls of this stretchy, compressive material, which can provide direct pressure to a wound. Gauze/Band Aids: No need for an explanation here. Gauze is an integral part of wound care due to its absorbent properties and padding. Antibacterial Cream: An essential ingredient that prevents infection in a fresh wound. Tourniquet: I don’t actually carry a tourniquet, as I can make one in seconds with a strip of t-shirt material and a stick (take a look at YouTube if you want to find out how). But this should be considered for bleeding control in the most severe extremity injuries as a life saving measure. Allergic Reactions Hypersensitivity reactions and allergies are potentially serious emergencies, but are often treated easily, even in austere environment. Bee stings, exposure to food allergens, insect bites, and a thousand other allergens may be encountered on a fishing trip. I carry the following medications to treat these issues. Benadryl: This classic anti-histamine is a helpful treatment for hay fever, itchy rashes, and insect bites. In many people, it comes with the side-effect of drowsiness. However, this property may be harnessed as a sleep aid, especially if stuck in a stuffy tent with snorers. Claritin: A second-generation anti-histamine, this over the counter medication has similar properties to Benadryl, but is less likely to cause drowsiness. Cortisone cream: Cortisone or another steroid cream is a handy tool for allergic dermatitis, most frequently caused by insect bites. Cortisone is purchased over the counter. More potent preparations like Triamcinolone are prescribed by a physician. Prednisone: This is a systemic steroid in pill form that can treat more significant allergic reactions. Hives all over the body? Widespread poison ivy contact dermatitis? An oral steroid like prednisone may be more practical than a steroid cream. Epipen: Epinephrine is the only medication that treats the most serious form of allergy: anaphylaxis. An Epipen delivers an injection of epinephrine through a simple device. This is perhaps the most important component of a first aid kit if there are any individuals on the trip with a history of significant allergic reactions. If an Epipen is needed, plans for evacuation should commence concurrently. Illness Illness is something every traveling angler needs to plan for. With fly fishing opportunities growing in every corner of the globe, anglers are exposed to a variety of pathogens, from the annoying to the deadly. Before embarking on an international adventure, it is wise to investigate particular threats at a given destination. This can be accomplished through a primary care doctor, and a number of travel clinics exist to provide consultation regarding this question. For medically literate travelers, this information is available on a country by country basis on the CDC website. A yellow fever vaccination is wise for any traveler who plans to spend much time in the Amazon, subsaharan African, or other parts of the world where this disease is endemic. The great thing about the yellow fever vaccine is that it only requires one lifetime dose. Documentation of a yellow fever vaccine is required in many countries and regions. Typhoid can be prevented by an oral vaccine. Of course, malaria prophylaxis is important especially in areas of the world that house the dangerous falciparum variety. And then there are the diseases without easy prophylaxis. Diseases like dengue and chikungunya are spread by mosquitos, and leishmaniasis is spread by sandflies. Before embarking on a jungle trip, I always treat my clothes with permethrin to deter these insects, and I wear long sleeves, pants, and a buff to stay as covered as possible. In Conclusion That’s a wrap! I can’t overstate the importance of consultation with a doctor when constructing a first aid kid for austere environments, especially if the traveler has underlying medical conditions. But the above list provides a good base for a solid, useful first aid kit. Don’t count on an outfitter or guide to come to the rescue in the event of injury or illness during a trip of a lifetime. Many outfitters are unprepared for emergency, and most countries have no licensing rules or regulations requiring any degree of preparation on their behalf. Preparation is key when planning these big adventures, and some degree of self-reliance may prevent injury or illness from ruining or ending a destination trip.