Extreme & Wilderness Medicine

Medical Preparedness

The American Center for Disease Control (CDC) recommends that travelers carry a supply of the following over-the-counter medications:

• Antidiarrheal medication (for example, bismuth subsalicylate, loperamide)
• Antihistamine
• Decongestant, alone or in combination with antihistamine
• Anti-motion sickness medication
• Medicine for pain or fever (such as acetaminophen, aspirin, or ibuprofen)
• Mild laxative
• Cough suppressant/expectorant
• Cough drops
• Antacid
• Antifungal and antibacterial ointments or creams
• 1% hydrocortisone cream
• Insect repellent containing DEET (30%-50%) or picaridin (up to 15%)
• Sunscreen (preferably SPF 15 or greater) that has both UVA and UVB protection
• Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol
• Lubricating eye drops
• Mild sedative or other sleep aid
• Medicine to prevent altitude sickness
• Water purification tablets 

To this list, I also add an alertness aid such as 200mg caffeine tablets, a daily multi-vitamin, and toothache medicine such as Orajel or Anbesol.

A good antibiotic such as Ampicillin, Amoxicillin, Ciprofloxacin, Doxycycline, or SMZ-TMP (Sulfamethoxazole and Trimethoprim) can be very important to treat infections. While antibiotics usually require a prescription from a physician, and it is important to understand which antibiotic to use, at what dosage, and for how long; if you understand these things it is interesting to note that these same antibiotics can be bought in pet stores to treat fish and birds. Search for Fish Flox, Fish Zole, Fish Cycline, Bird Biotic, and Bird Sulfa and compare their ingredients with the antibiotics sold in your local pharmacy. Although these pet medications are not labeled for human consumption, they are the same drugs as given to humans. In a hostile and non-permissive environment, where access to a physician and prescription drugs may not be possible, pet medications may be an emergency alternative.

Individual First Aid Kit            

In addition to a supply of medications, an individual first aid kit is essential. The exact contents of the kit should be tailored to your capabilities. A recommendation for the basis of your kit is the “Adventure Medical World Travel Medical Kit”.

First Aid & Medical Training

An understanding of basic first aid is essential for anyone operating in a hostile and non-permissive environment. At a minimum review first aid manuals such as: First Aid - FM 4-25.11 (December 2002) and the Combat Lifesaver Course - Student Self-Study.  Of course, it is important to take a first aid course where you are able to practice hands-on skills. There is a specific advantage to studying military first aid. That advantage is that military training is focused on treating injuries in hostile and non-permissive environments, and often teaches skills that go well beyond what is taught in a civilian community first aid course.  Additionally, I recommend reading the Hesperian Health Guides: Where There Is No Doctor and Where There Is No Dentist. Both are available as a PDF, or for purchase as a printed book on the Hesperian web-site.

I recommend two additional medical reference books:

The Survival Medicine Handbook: A Guide for When Help is Not on the Way - June 13, 2013, by Joseph Alton & Amy Alton – http://goo.gl/kpqZEm

The Doomsday Book of Medicine - August 25, 2015, by Ralph La Guardia M.D. – http://goo.gl/dXPUkr