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Many commercial first aid kits are seriously deficient. Most include little more than a few band-aids and bandages to cope with minor cuts or scrapes, some aspirin and salve, maybe a compress and triangular bandage, if you're lucky. Many low budget commercial survival kits include even less in the way of medical supplies. These hardly come close to the sort of supplies that might be needed. Authorities on wilderness and survival medicine stress the importance of carrying a comprehensive medical kit with plenty of extra compresses and large capacity bandages and dressings to cope with the traumatic injuries often associated with an aircraft or automobile crash.

The most important thing to keep in mind is that it is unlikely that an ambulance is going to pull up and take you to a hospital around the corner. This is where wilderness and survival emergency medical treatment differs from traditional first aid or EMT training. In fact, the terms "first aid" and "first aid kit" become something of a misnomer when used in the context of survival. Certainly, there will be a period of "first aid," but "survival (or wilderness) medical treatment" and "medical kit" are a more correct description. It goes far beyond initial first aid.

Traditional first aid treatment for serious injury or disease involves stabilization of the patient so they can be safely moved to a hospital for treatment. Out in the wilderness you are on your own and whatever you do must suffice for the duration of the survival predicament. Typical first aid training is helpful and much better than nothing, but often inadequate and inappropriate for the circumstances.

Even most wilderness medical training makes assumptions that the injured party can be evacuated, though it will take time and may be difficult, and that help can be summoned within a reasonable time frame. This assumption may not be valid for survivors. A survivor or group of survivors must be, worst case, completely and totally self-contained. If you avail yourself of wilderness medical training, be sure to explain this to the instructors so they can address specific issues where this survival perspective might affect medical treatment and decisions. Survival medicine is NOT the same as wilderness medicine. Help may not only not arrive in a timely manner, it may not arrive at all in the foreseeable future. Our goal is to provide our visitors with sound advice that covers all potential survival situations. Many of our readers are going to carry field surgical equipment, regardless of wether or not you or I may consider that appropriate. As such, we'd be neglecting our responsibility to them if we stuck our head in the sand and ignored that reality. With luck, we dissuade the majority and perhaps make others think twice.

Remember, the most important piece of medical equipment isn't in the medical kit, it's in your skull. All the supplies and equipment in the world will do you little good if you haven't the training to make the best use of it. In an emergency you may not have time to read the first aid or wilderness medical treatment manual. Even then, at best, these manuals are a mediocre substitute for good training and hands on experience. The nice thing is, this sort of knowledge can be just as useful at home or work as it will be in a survival situation. It couldn't hurt to have the skill to save someone's life.

Medical Kits

Adventure Medical, Atwater Carey Ltd., Outdoor Research (OR) and Wilderness Medical Systems all make good wilderness oriented first aid kits. Choose their medium or larger size kits, depending on the size of the survival kit itself, and go from there, using the suggestions provided here. Generally, the very largest expedition size kits are not the best choice, if space is at a premium, since they are quite bulky. I've listed the smaller kits within their product line that I feel are best suited for survival kit use. If space is not a problem, by all means, get the largest kits. In most cases, everything you need can be stuffed into the next to largest size kit. The soft packs for these kits are available for purchase separately, if assembling your own kit appeals to you, or if you want to upgrade to a larger kit using the supplies you already have.

A note about where you put these kits. If there are injuries, you don't want to have to go searching through the survival kit for the medical supplies. They should all be on top, readily accessible. It's also important to be sure the medical kit, alone, can be removed from the survival kit without disturbing the rest of the kit, or at least without making too much of a mess of it. Since the medical kit will generally also serve as your general purpose first aid kit, you may need to remove and replace it just to deal with a small injury or some other mishap or discomfort not necessarily related to a survival situation. There's also always the possibility you will be the first to arrive at the scene of an accident.

If you do make use of the medical supplies, don't forget to replace them at the earliest opportunity. Otherwise, over time, you can deplete the kit of the essential supplies you may need some day. The manufacturers can supply replacement items and modules or you might find them at a local safety or medical supply store.

My kits were originally based on the OR kits, the first to market with these comprehensive wilderness first aid kits in organized zippered pouches. Since OR made the market for this style kit, the others have followed. Each has its strengths and weaknesses, but none of them is seriously deficient. The most important and salient differences are noted below.

Outdoor Research's pouches seem to pack the most into the least space, while making it easy to find what you need quickly. One downside of these packs is that the open pockets don't protect the contents from the environment as well as Adventure Medical and stuff can be lost behind the fabric pockets. The solution to the latter problem is just to indicate on each pocket, with an indelible ink pen, what's in it, if it isn't readily apparent. Another minor drawback is that while you can stuff a lot into these pockets when you assemble the kit, it isn't always so easy to get it all back into the pockets in the field, if need be. OR provides more bulk supplies and less individual use packets, an advantage for our purposes. OR doesn't include some of the more sophisticated supplies, as found in the Adventure Medical kits, but they can be added without having to replace too much of the OR kit contents. For survival kit use the OR kits are still an excellent choice. They will accommodate an amazing amount of supplies without getting disorganized or too bulky, a consideration for many.

Adventure Medical produce what you might call "leading edge" kits, at a slight price premium. These kits have a good selection of equipment and supplies and a well designed soft pack with some excellent and unique features, though the packs are not quite as compact as others. That could be a consideration for some. Everything is protected behind clear flexible vinyl, a superb feature. Adventure Medical uses few individual pockets, mostly for equipment, with most supplies in bulk pouches. Since you can see into these pouches easily, it isn't as bad as it sounds, though you must still rummage around at times for the supplies you need. On the other hand, it's a lot easier to get stuff back into these pouches than into the overstuffed pockets of the OR kits. Adventure Medical uses some better quality, more sophisticated products in some cases, where OR uses old standbys. Virtually all preparations in the Adventure Medical kits are in individual use packets, a disadvantage for survival use, but an advantage otherwise. The "Fundamentals" and "Backcountry" are the best choices from Adventure Medical for inclusion in a survival kit.

In 2003 Adventure Medical introduced both a lightweight and modular line of kits.

Atwater Carey provides a good value, but the packaging of the kit is not as accommodating as Adventure Medical's or OR's. Atwater Carey relies strictly on individual use packets of medications. These kits will probably require a bit more supplementing than the others. The "Family" and "Expedition" kits are most appropriate for a survival kit.

Both Adventure Medical and Atwater Carey also make some of their kits, equivalent to these recommendations, available in waterproof Pelican dry boxes. These are targeted at the water sports and marine markets, but the contents are virtually the same as their regular kits. This style packaging will appeal to some, but the down side is that there is relatively little extra room for additional supplies and equipment, whereas the soft packs can easily expand and accommodate a lot more. Other disadvantages are that they are much more bulky and heavier than the pouch style kits and cost a great deal more because you are paying for the Pelican case.

Wilderness Medical Systems includes high quality items, but the packs themselves are not very organized, being little more than bulk pouches. One significant advantage is that they will custom pack your kit with pretty much anything you desire. Don't like individual packets, they will provide bulk supplies, Want more of something and less of something else, no problem. Want to add items not included, they'll be happy to provide. The listed components are just a starting point.

As noted in passing above, even the best of these first aid kits really ought to be supplemented with more or different supplies and equipment, if you're serious about survival. They need to be shifted from the realm of first aid to the somewhat more demanding requirements of survival. While designed explicitly for wilderness use, the needs of, for example, aviation crash survivors with regards to trauma supplies and medications can be both greater at the onset and last longer, as well, than that of a group of backpackers or mountain climbers. Not all the extra bandages or supplies will necessarily fit inside the first aid kit itself, but don't let that stop you. They can be packed separately in the survival kit, as I have done with mine.

Review Doug Ritter's Medical Kits

Home First Aid Kit

General and Wilderness Medical Supplies

Bandaging is always a priority and it sometimes seems there will never be enough, so the more you have, the luckier you will feel, if you should ever need them. Many can be boiled and re-used in a pinch. Commercial or mil. spec. trauma bandages (BloodStopper, TrauMedic, etc.) are the most versatile. Other bandaging products to consider include large (3x3, 4x4, 5x9, etc.) gauze or trauma pads and dressings (J&J "NU-GAUZE" are the most absorbent gauze pads I've found and are not appreciably bulkier than regular ones when packed), 2 and 4 inch gauze compresses, gauze roll bandage (the best clings to itself and is "stretchy"), triangular bandages, burn dressings (Spenco "2nd-Skin," "Aquaphor," etc.) and transparent waterproof but breathable dressings (3M "Tagaderm") and bandages (3M "Clean Seals" and Curad "Aqua-Protect) which now bring this same breathable waterproof protective technology to the adhesive bandage market.

A few tampons or standard size (not the thin style) feminine sanitary napkins can serve not only their intended purpose, if necessary, but they can also be used as highly absorbent compresses for dealing with bleeding or seeping wounds. Kotex "Discreet" brand are the smallest package, but some means of cleaning the fingers prior to insertion must be provided when used for their intended purpose. The disinfectant in the medical kit or packaged antiseptic towellettes would suffice.

Elastic bandages are valuable for many medical and survival uses and are versatile performers. The self adhering styles are the best, followed by those with built in clips which cannot be lost. Elastic bandages which have loose metal clips, which experience tells us will be promptly lost, are not the best choice. You can always use safety pins or tape to secure the bandage (sometimes you have no choice), but tape can be a PITA, particularly when the bandage must be removed and replaced regularly.

Splints

A "SAM Splint" or a wire mesh splint can prove very useful when dealing with broken bones or sprains or to hold things together. The SAM Splint, which stands for "Structural Aluminum Malleable," is a light aluminum sheet sandwiched between thin foam. It is quicker and much easier to work with than other styles, including the wire splint. You don't have to improvise padding for the SAM splint as required with a wire splint or one made from found materials. It is easy to cut a small piece off for use on smaller body parts like a finger. It can be stiffened, if needed, by putting a crease in it. Unlike the typical wire mesh splint, it has no sharp barbs where the wire mesh has been cut to size, so you won't risk a cut or puncture wound.

Click for the SAM Splint Web site and QuickTime video of how to use the SAM Splint.

The standard 36 inch SAM Splint is about 3/4 inch wider and six inches longer than typical wire splints. It is 4 1/4 inches (11 cm) wide and comes in four different lengths: 36 inch (91 cm), 18 inch (46 cm), 9 inch (23 cm), and a finer size: 4-1/4 x 2 inches (11 x 5 cm). The 36 inch is standard for most medical kits. Its weight, 4 oz., is about the same as old style steel wire splints, but almost double that of an aluminum mesh wire splint. Its biggest drawback is just that, it's bigger. With the foam padding, it is quite a bit bulkier than the wire splints, taking up three to four times the space, depending upon how you pack it. It is available rolled and folded flat. The flat is usually easier to pack, but the round can be "squashed" into a more rectangular shape. Vacuum packing will reduce this bulk somewhat, but not a lot.

Wire ladder splints, which look exactly as you'd expect from the name, are not as versatile as these other styles since they do not mold to the body part as readily and don't lend themselves to use on small body parts. Inflatable splints are too limited, too heavy, too bulky and too susceptible to damage for survival use. Cardboard splints just aren't durable enough and if they get wet, well...

Adhesive Bandages

The old fashioned plastic or sheer plastic style bandages are poor performers. I suggest you simply trash any plastic strips in your first aid kit and replace them with better products wherever possible. The elastic knit cloth type bandages stick lots better, stay on longer, and are easier to live with, conforming to the body much better. "Coverlet" brand by Beiersdorf are the best, though difficult to find (try the Yellow Pages under "First Aid Supplies or Medical Equipment & Supplies"), closely followed by Curad "Flexible Fabric." Johnson & Johnson "Band-Aid" brand "Flexible Fabric" bandages have pads which extend all the way to the edges of the bandage so that it cannot be sealed completely. This risks contamination of the wound and is not acceptable, in my opinion. The elastic knit style is available in a wide variety of sizes and configurations.

Bandages made with flexible foam plastic tape adhesive have recently become available. The jury is still out, but they seem to be an improvement in some areas. Curad's "ActiFlex" seem to perform better than 3M's "Active Strips" or Band-Aid's "Sport Strips." Like the rest of the line, the Sport Strips pad extends all the way to the edges, a significant failing. They also performed surprisingly poorly in wet adhesion tests. The ActiFlex are the only adhesive bandages which seem to hold particularly well on damp skin, making them an excellent choice for tropical or life raft use. If used on dry skin, either the ActiFlex or Active Strips perform adequately and the foam tape doesn't absorb moisture the way the fabric bandages do. While the foam tape doesn't stretch quite as much as the elastic knit, it does stretch in all directions, an advantage. Some people find these the most comfortable to wear, others still prefer the elastic knit.

Don't forget to include specialty bandages for knuckles and fingertips. They aren't an extravagance. The hands seem to be a magnet for injuries and are the most susceptible to contamination. These specially configured bandages protect wounds in these areas much better and stay on much, much longer.

As noted above, transparent waterproof but breathable bandages (3M "Clean Seals" and Curad "Aqua-Protect), which are an outgrowth of products designed initially for surgical and hospital use, are now readily available and offer some significant advantages for wilderness care. The thin clear protective material is flexible enough to work in most places without coming loose. It really seals the wound completely, which in the dirty wilderness environment is probably a good idea in many cases. In some cases you may want to then cover this bandage with something to protect the thin material for abuse.

Wound closure or suture strips are a modern replacement for butterfly bandages, used to close a wound and hold the edges together. Most kits include a package of these with about three to five strips per package. This is another example of a specialty bandage that you should have more of in the kit. These strips are much better than butterfly bandages, are easier to use and take up less space besides. Having tried out more than a few of these products over the years, the "Cover-Strip II" by Beiersdorf seems to be the winner here. The advantage is that they can be repositioned in case you goof in applying them, which occurs frequently. The others, such as J&J's "Steri-Strips," cannot, losing their tackiness if pulled up.

Another technique for closing wounds is to use "super glue" (also often called "crazy glue") to join the edges of the skin together. This is a fairly common technique in many emergency and operating rooms. My emergency medical consultants seem to agree that there is no need to try to find and purchase the overpriced "sterile" super glue used in hospitals and now available over the counter from some limited sources, trademarked "Dermabond." Any unopened tube of super glue will work satisfactorily. There remains some controversy with some doctors and those who sell and manufacture the Dermabond claiming that consumer grade super glue is dangerous, but many others have found, as we have in our own personal experience, that it works fine with no adverse effects.

One advantage of the Dermabond is that it looks "medical" which might be an advantage for use on someone who might otherwise be concerned when you try to use a consumer packaged super glue.

Dermabond comes in a crushable ampoule applicator, which does make it easy to "paint" the edges of a wound. Super glue is available in applicator packaging that makes it easier to position exactly one drop exactly where you want it without making a mess of the patient or yourself, but you still must use some means, NOT YOUR FINGER, to spread it out. These sturdy plastic applicators seem less susceptible to damage than the conventional small metal tubes of the glue that offer less control and are worth the small extra cost.

Use Google to search on Dermabond and you'll find plenty of information on the proper use of this glue.

Preparations

Many kits now include small towelettes, pads or swabs of various antiseptics, adhesives, cleansers and the like packed in individual application packets. While very convenient, the shelf life of this packaging tends to be pretty short, much less than if the product was in liquid form in a bottle. While very convenient, all too often you tear open the package to discover the pad is dried out and useless because the packaging leaked or was punctured. If you rely on these sorts of packaged products, be sure to replace them with fresh ones every year or two. Another serious drawback is that they are of such limited quantity. Better to pack small containers of the preparation, either instead of, or perhaps better, in addition to the packets.

Small 1/2 or 1 oz. plastic bottles of things like Betadine (Povidone Iodine 10% solution), an antiseptic scrub, or Mastisol, an adhesive (much better adhesive than Tincture of Benzoin, often found in kits. It also doesn't sting like Benzoin does if you inadvertently get it in the wound), can often be obtained from your physician, who receives them as samples, or at a good medical supply house. Alternatively, you can decant from a larger bottle into a small one. The one drawback, such as it is, is that you also need to pack small gauze pads or cotton balls to apply these preparations.

Similarly, single application foil packs of antibiotics, salves and the like, while convenient, aren't necessarily the best choice for our uses. If you only need a little of the compound, the remainder is wasted and cannot be saved for possible future use. If you need more than a few applications of the compound, the number of packets on hand, you are also out of luck. In a survival situation, with the possibility of numerous dressing changes, you'll run out too soon, unless you add lots. Small tubes of these preparations are a better bet for survival use. However, if you do open a tube for some other first aid requirement, you should probably replace it at your earliest convenience since it loses its sterility once opened. Once again, the best bet may be to have some of each, single use packets and tubes.

While it's hard to get docs to agree on anything, the generally accepted standard treatment for small wounds these days involves cleaning and disinfecting it thoroughly with Povidone Iodine 10% solution (or the surgical soap version of same). The strong stream from an irrigation syringe can be used to better clean out debris, if necessary and forceps can be used to pull out any imbedded debris.

Afterwards the choice is to either cover it with a dry bandage or apply antibiotic ointment (single, double or triple as it suits you), then apply the bandage. Put ten docs in a room to discuss this issue and you'll find about evenly split, plus a few with their own favorite dressing, but you won't go seriously wrong either way. In the wilderness, where infection is a far bigger potential problem, seems that application of antibiotic ointment is a better bet.

The standard treatment for minor burns is to cool it immediately under cool (not cold) water. Since this isn't always possible in the wilderness, or even other places. some alternative must be considered. The two most highly recommended treatments are both based on natural remedies, aloe and tea tree oil. Both act to cool the heat of the burn and prevent drying out.

My choice is George Townsend & Co.'s "Martin's BurnAway Plus," which is a tea tree oil product that also includes aloe and some other ingredients. This has proven very effective in numerous instances, both on heat burns and sun burns. Nothing else I have tried even comes close, pain goes away almost immediately and doesn't come back, healing is speeded up significantly. It must be used to be believed. (It has also proved incredibly effective when used on insect stings of all sorts.) For dressing, again, a aqueous gel product like 2nd Skin is the best way to go.

Specialty Medical Supplies

Concerns about blood borne pathogens have led to products designed to shield the aid giver. There are kits available which include disposable suits, gloves, face masks, etc. All well and good, if you have the space and no weight constraints. However, if the injuries are massive or bleeding severe, it's virtually impossible, in a survival environment, to avoid contamination. The best you can usually do is to bring along a supply of surgical gloves, most first aid kits only include one pair, and a CPR mask. For gloves, the thicker style are more durable and puncture resistant and some experts recommend vinyl or nitrile gloves because they are tougher, though somewhat less tactile. Also, many people are allergic to natural latex. The best natural latex gloves I've found are "Diamond Grip" by Microflex Medical Corp. (800-876-6866). For CPR protection, the smallest and lightest solution is the "CPR Microshield" by Medical Devices Int'l which is available at most medical or safety supply houses and from Adventure Medical.

A dental repair kit would make a good addition to a comprehensive kit. A tooth can be damaged during the crash or a filling could come loose or be lost. These and other dental problems could manifest themselves just when you need the extra problems the least.

You want to select a dental kit or product that utilizes a single component compound for filling cavities and repairing teeth. "Cavit" is the best such product according to my dentist advisors. It is easy to use and hardens after contact with saliva. Those which require you to mix two compounds together, a powder and a liquid catalyst, are much more difficult to use. There are a number of different kits available and both Adventure Medical and Atwater Carey offer a good one that includes Cavit.

If you fly with young children or infants, you need to consider their special medical needs, aside from any personal medications required. These should include pediatric medications, chewable analgesic tablets or liquid analgesics for example. An oral medicine syringe can be a big help for infants. A few adhesive bandages with cartoon characters or bright colors might be worthwhile. Pediatric modules with such supplies are available from the kit suppliers. Discuss this issue with your pediatrician and include any additional items recommended.

Rx Meds

You should give serious consideration to including some strong prescription pain medications and antibiotics in your survival medical kit. Easing the pain of a serious injury can be vital when your options are limited. Pain can often be so debilitating that it can adversely affect survivability due to its detrimental effects on a survivor's mental state, though, pain alone has never killed anyone directly. In some rare cases pain can even be a help, giving a survivor something to focus upon. More often, however, pain can prevent you from doing things that must be done, if you are to survive, no matter what. Not everyone has the capability to ignore severe pain, if that's what is required. Under these circumstances, pain relief is the only practical alternative, despite the adverse effects some of these drugs may have.

The probability of infection is very high in wilderness injuries and is a leading cause of disability and death when comprehensive medical treatment is not available. Antibiotics can make the difference. Prophylactic use of antibiotics in any wilderness or survival environment is generally a good idea. You can't possibly carry something for every bug you might contract in the wilderness, but a well chosen broad spectrum antibiotic or two will be a lot better than nothing. These are usually effective against the most common infections that occur in such environments. If you are traveling in areas other than North America, then additional antibiotics to deal with the bugs and problems endemic to those areas may be appropriate. Consult with your physician or a specialist about this.

Discuss with your physician the inclusion in your medical kit of some of the medications listed below. Some doctors may be very hesitant to provide the requisite prescriptions; some will refuse flat out. If your personal M.D. isn't interested, you will have to find one who is. One source would be the emergency room at your local hospital or trauma center. These emergency room physicians and trauma specialists may be more understanding and accommodating. Your best bet is to ask around for a doctor who specializes in wilderness medicine or who is associated with a search and rescue organization and thereby has a keen appreciation for what you are trying to do. You can also contact the Wilderness Medical Society for a referral. Another alternative is Wilderness Medical Systems who's medical ditrector, Dr. Gil Preston, will provide prescription medications in their medical kits after a phone consultation.

For pain relief:

• Hydrocodone Bitartrate 5 mg and Acetaminophen 500 mg Tabs (GENERIC, Vicodin, Vapocet and others) #
  and/or
  
• Hydrocodone Bitartrate 7.5 mg and Acetaminophen 750 mg Tabs (Vicodin ES) #
  and/or
  
• Oxycodone Hydrochloride 5 mg and Acetaminophen 325 mg Tabs (GENERIC, Percocet and others) #
  and/or
  
• Ibuprofen 800 mg Tabs (GENERIC, Motrin and others)

Traditional Antibiotics:

(Note: you might be able to get these or an equivalent antibiotic from your doctor as samples in sealed packages)

• Cephalexin 500mg Tabs (GENERIC, Keflex) #
  and/or
  
• Erythromycin 500mg Tabs (for those allergic to Penicillin or Cephalexin) #

Non-traditional Antibiotics:

(Note:These both are smaller pills than the traditional antibiotics above and the number of pills required is much less, but they are more expensive. Use when space is at a premium.)

• Ciprofloxacin 500mg Tabs

  (These are taken only twice a day, halving the number traditionally required)

• Zithromax 250mg Capsules

  (A full course of treatment only requires six doses, but they are VERY expensive.)

Another prescription medication to consider is a topical adrenocortico-steroid. These drugs are used to treat contact dermatitis (ie. poison ivy, oak and sumac), minor burns and sunburn and various other skin irritations. Non-prescription strength Hydrocortisone .5% and 1% is often included in first aid kits. It is very low potency, one reason it is available over the counter, and not much help in a lot of cases. A better choice might be one of the more potent medications in this class of drugs. Triamcinolone cream or ointment .1% or .5% (Aristicort, Kenalog) is much more potent and effective and available as a generic, making it inexpensive. Your doctor may offer other suggestions in this same class of drugs.

A caution: There is no such thing as a totally safe drug. This includes common over the counter drugs such as Aspirin, Tylenol, etc. This is even more significant with regard to prescription medications. You should always include with the medications comprehensive instructions on the use of any prescription drug you pack in a kit, including what they should be used for and how (indications), dosages, cautions (contraindications), likely adverse reactions and interactions, etc.

One way to accomplish this is to photocopy the information out of one of the many drug references available (Physician's Desk Reference (PDR), Complete Guide to Prescription & Non-prescription Drugs, etc.). Your prescribing physician should be able to assist in this and may be able to provide the manufacturer's drug information sheet itself. Also, some states now require this information to be included with every prescription.

If you want the medication packed into something other than the standard pharmacy pill bottles (a good idea), give these to the pharmacist with the prescription so he can put the label on the container. Obviously, if the container is too small, as might be the case in a personal size kit, this won't work. It is best to use containers with screw on tops, or small plastic bags with zipper lock style seals, both of which are significantly more air tight and water tight than a standard pill bottle. You might also ask the pharmacist for some of the small packages of desiccant that is included in many bulk drug containers. These can provide an extra measure of insurance for your own supply. Adventure Medical uses some nice small containers that are fitted with hinged plug style tops, but they can be difficult to open if there has been a significant pressure change as can occur while flying.

If you use a container, rather than the zipper lock style bag packaging, make sure the pharmacist (or do it yourself) firmly packs any remaining space in the pill bottle with cotton. Otherwise, over the long term, vibration can destroy the tablets. If you use the bags, thicker 4 mil bags are much more durable than the more common thinner 1.5 and 2 mil bags and are much less likely to be inadvertently punctured or to wear through while packed in the kit, a common problem with thin bags.

For non-prescription, and even some prescription drugs if you get samples from your doctor, blister packaging may be available and this is an excellent alternative. However, care must be taken when packing this style of packaging into the kit that the thin aluminum backing is not inadvertently punctured. Sometimes, the best solution is to nest the blister packs together inside a protective zipper lock style plastic bag.

When deciding how much of these medicines (as well as non-prescription meds) to carry, consider the worst case situation. You should include sufficient doses of the medicine to cover each person for the duration of your maximum anticipated survival term. Obviously, you can't know for sure how long it will last. A week is generally considered acceptable for such planning purposes. For antibiotics, you may want to have the standard full course of treatment, typically 10 days for traditional antibiotics, for each person.

Many medications and particularly these prescription drugs are adversely affected by high temperatures. To protect the potency of these drugs, try to avoid exposing them to high temp eratures by removing them from the aircraft, if it is going to be parked in very hot climates and especially if it will be left outside in warm or hot weather. Even in moderate climates the temperature inside an aircraft can rise dramatically due to solar gain. You can moderate the effects of high temperatures, in any case, by packing them deep in the mass of the survival or medical kit. If you do not want to remove the whole survival kit from the aircraft or the medical kit from the survival kit, consider packing the meds in their own container which can be easily slipped in and out of the kit.

Bites & Stings

The best treatment for snake bites is to avoid them in the first place. That isn't difficult if you use reasonable caution. If you should be so unlucky as to be bit, then you will have to deal with it. Carrying anti-venom in a survival kit is impractical and using it outside a clinical situation is asking for serious trouble. It would be far more dangerous than doing nothing. Many studies have concluded that the odds of a healthy adult dying from a venomous snake bite are slim. The odds are in your favor. You may get very ill, but you will likely survive.

Snake bite kits are found in many survival kits, but most are worse than useless. It is best to abide by the classical physician's dictum, "primum non nocere," Latin for "first do no harm." The old fashioned snake bite kits often included can cause additional damage, potentially more dangerous than the snake bite itself, and don't work worth a damn anyway. You cannot suck or drain an appreciable amount of venom from the bite using oral means or cutting into the bite. The traditional "Cutter" kit and its clones, with a razor blade to cut an "X" across the fang punctures and rubber suction cups to suck the blood out, is now universally derided by knowledgeable experts. If you own one, throw it away! Really!

Again, you cannot extract venom by making the requisite cuts and sucking the blood, whether through manual or oral means. If your survival or medical manual still includes such advice (and many older ones do), cross it out or otherwise obliterate it. Leave these dramatic measures to the movies where it is make believe and no one is really hurt.

The only kit worth carrying is the Sawyer "Extractor." This has proved very effective with insect bites, if used promptly. It will also improve your chances after a snake bite, reportedly removing about 35% of the venom, if treatment is started within three minutes, without causing further injury or trauma. The Extractor uses a venom pump suction device, akin to a syringe but it creates suction when the plunger is depressed, with various form fitting adapters to create a *very strong* vacuum, sucking the venom out through the original punctures.

Note those figures well. Thirty five percent isn't a lot, but it can be enough to make a difference, if you were unlucky enough to be among the 2/3 of those who actually are envenomated when bit. More to the point, three minutes doesn't give you much time, so remain calm and forget about running around hysterically searching for and attacking the dumb snake. Just get away and get on with the treatment.

Venomous bites from insects can present a potentially fatal hazard to those with serious allergies. The Sawyer Extractor is your first line of defense. It may also be worthwhile to carry a means to administer epinephrine (Adrenalin) to counteract anaphylactic shock, particularly if it is known that one is allergic. A note of caution, however. Epinephrine is a two edged sword. It can cause serious, life threatening problems. Be sure you understand the risks and you understand when and how to use it. Knowing when not to use it is as important as knowing when to use it.

There are currently only one product in the U.S. the "EpiPen" and "EpiPen Jr.," an automatic injection device which is easier to use for the inexperienced that a traditional hypodermic. Eacho only contains a single dose, so you need to carry at least two. You'll need a prescription for either one and should receive training if possible. Note that these have relatively short storage lives and they are heat sensitive, so need to be protected from high temperatures. Again, get thorough instruction in its use.

For insect bites, nothing I have tried compares with George Townsend & Co.'s "Martin's BurnAway Plus," a tea tree oil product that also includes aloe and some other ingredients. The effectiveness of this product has amazed many friends and skeptics. The itch goes away within minutes and doesn't come back; swelling and redness are reduced and soon disappear. It must be used to be believed.

Cut and Sew

A field surgical kit is a popular option included by many in their survival kits. I'm not quite sure what an untrained person expects to do with a surgical kit, but they continue to be hot sellers. Think about it, a doctor goes to school for years and serves a lengthy residency before he is considered qualified to perform surgery. You expect to do it, safely and competently, following the directions in a book?

With a doctor along, the surgical kit could certainly be an asset. However, even then, the subject of performing emergency surgery in the wilderness, even something as basic as suturing a wound, is very controversial. It is very difficult, nearly impossible, to get deep or severe wounds, the kind that might be appropriate to suture, truly clean in the wilds and the risk of complications, especially infection, is high. This is not a sterile environment, to say the least.

It is probably prudent to avoid field surgery by those not specifically trained and capable of evaluating the risks involved, especially if you have a reasonable expectation of being rescued within four or five days. That is almost always going to be the case. That's why you filed a flight plan or let someone know wehre you were going and when you woudl be back, and also why packed all that signaling equipment into the survival kit.

The goals of wound care in such a situation should be to control and stop bleeding, to vigorously clean the wound and then to keep the wound clean and dressed, using all those supplies you brought along in the medical kit. If rescue is likely to be more than five days away, however, field surgery might be a option to consider, but it is not something to be taken lightly.

With no training whatsoever, any attempt at wound repair could worsen a situation. On the other hand, when the alternative is possible or probable death, it may be the only viable alternative to watching someone die. With a minimum of training, simple procedures can be accomplished with a reasonable degree of competency. It could enhance survival prospects, if rescue is likely going to be delayed and there are no other choices.

More serious surgery, such as an amputation, carries a very high risk of an unfavorable outcome (medical-speak for "death") due to shock, or surviving that, sepsis. This must be balanced by the probable loss of life due to infection and other complications that would accompany any injury serious enough that amputation would be a consideration.

The bottom line is that inclusion of a surgery kit is a very personal decision. Make it an informed decision. If you want to carry a surgery kit (suggested minimum contents listed below) get some training in its use and recognize your limits. Imagine trying to fly for the first time after just reading a book and looking at a few illustrations. With a minimum of training in the use of surgical tools and techniques you could turn your surgical kit from a probable liability into a potential life saver.

A final note on the subject. Suturing is nearly always the most difficult task for the inexperienced. Even using silk instead of nylon, as recommended in our list, it can be a bear. An alternative to consider for simple shallow wounds is a surgical staple gun. Compared to suturing by hand, using one of these is a snap. It takes up a bit more room, but is quite light, weighing only a few ounces. For survival purposes, get a high capacity model with standard staples, not one with just five staples.

An added benefit is that they are reportedly much less painful, if no anesthesia is available. OK, to be totally honest they supposedly sting going in, but that only lasts a second and then the pain goes away. I cannot say I've tried that myself. You wouldn't leave the sutures out of the kit, but a staple gun may be worth consideration, if you are determined to carry a surgical kit. Best to also carry a staple remover, in case you are out there too long and the staples must be removed.

Review Doug Ritter's Medical Kits

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