1999, June/July Adirondac Adirondoc
In addition to the usual supply of bandages and blister treatments, most campers like to include some medications with their first aid gear. The number of “over-the-counter”- (i.e. available without prescription) remedies available these days has never been greater. Whether this development is a boon for public health or not I will leave for wiser commentators. What I will do, however, is provide some help for the camper trying to select a few safe and effective medications to include in a backpacking first aid kit. I have tried to select items of use to folks on a trip ranging from a few days to a week in length, and never very far from civilization: exactly the type of trek that characterizes most Adirondack experiences. The medication needs of a group on a multi-week expedition, for whom medical care may be more than a day or two away, are beyond the scope of this article.
There are a few important words of caution before getting into specific recommendations. Given the variety of brands and strengths of the drugs I will be discussing; it would be confusing to provide dosage guidelines. For these, please consult the instructions that accompany the medications. Also remember that dosage modifications may be needed for children, the elderly. and individuals regularly taking other medications. Be sure to discuss these with a health care professional. When traveling with small children, do not forget to keep these items secure, especially if the original child-proof containers are left at home.
Here are the general categories of medications I find useful on such short treks. In keeping with my usual ‘”multi use” principle of gear selection, I have tried to focus on drugs that have more than one use.
Pain Relievers. These are the most often requested items on any trip, usually because of headache or musculoskeletal aches and pains. For such purposes, the non-steroidal anti-inflammatory drugs (“NSAIDs”) are the most effective. These include such brand names as Motrin”. Advil”, and Orudis”.
These drugs are also said to be effective in minimizing the systemic effects of severe sun exposure. if taken immediately. A few people have difficulty tolerating these drugs. mainly because of stomach sensitivity. In such cases, acetaminophen- based pain relievers such as Tylenol” are a somewhat less effective substitute.
Antihistamines. These medications were originally formulated to deal with allergic reactions such as “hay fever.” They have other uses in the backcountry, however. Some will help relieve itchiness from non-allergic causes such as insect bites. Old standby antihistamines such as Benadryl are safe and effective.
Gastrointestinal medications. Mild intestinal upset is a common accompaniment to the change in diet and activity that characterize wilderness camping. Here, the variety of over-the-counter agents is overwhelming: antacids (e.g. Maalox) and acid blockers (e.g. Pepcid) for heartburn or stomach upset. medications for diarrhea (e.g. Immodium) and drugs for nausea and vomiting (e.g. Emetrol). To minimize the number of items carried in the pack. it would be nice if a single agent could be used for all of these indications. For this purpose, I tend to rely on bismuth subsalicylate formulations (Pepto-Bismol chewable tablets). While this may not be the best choice for each individual gastrointestinal problem. it has some effect on all of them. Campers who tend to have major problems with heartburn, especially at bedtime, should probably also carry either an antacid or an acid-blocker along with them.
Skin products. Sunscreen is an obvious necessity. especially for canoe trips or treks involving time in open areas such as on peaks. Additionally, a .5% hydrocortisone cream (Cortaid) is a very effective remedy for skin irritations from poison ivy or particularly itchy insect bites. Calamine lotion. although used for generations. is a messy, ineffective concoction with no redeeming value. Finally, there is no reason to carry sunburn treatment lotions (none of which work very well anyway) if you use sunscreen properly.
Antibiotic ointment. The most important way of preventing infection in minor wounds is by thorough soap and water cleansing (see Adirondac, <January/ February. 1999). However, the current practice guidelines for wilderness wound treatment also call for the use of antibiotic ointment under dressings. For this purpose, agents such as Neosporin work well.
Most of these items are available in “drugstore brand” generic forms, under a variety of names. treatment also call for the use of antibiotic ointment under dressings. For this purpose, agents such as Neosporin work well. Most of these items are available in “drugstore brand” generic forms, under a variety of names. For simplicity. I have used only common brand names; the gcn eric equivalents, however. are perfectly acceptable and generally cheaper. Pharmacists, who arc increasingly tired of spending their days dealing with insurance companies, are usually very happy to come out from behind the counter and share their expei- tise with you. Be sure to ask them for help.
-Thomas R. Welch. M.D.General First Aid