Members of a wilderness trip should be fully informed about the drugs, devices, and other equipment being carried, whether for a personal or group medical kit. Medical personnel should be aware of the medical history of the person to whom a drug or intervention is being administered. A medical history form should be filled out by everyone on a trip, and the person(s) responsible for the medical kit should be familiar with the completed form of every participant before the trip commences. (5)
It is also very important to be cognizant of the regulations of countries through which a group will be traveling while carrying medical supplies, especially narcotics. Useful information can be found through the International Narcotics Control Board.
Proper certification is required to administer certain medications, use specific equipment, and perform specific interventions in a wilderness environment. Therefore, no one should be able to access a community or expedition medical kit without the requisite credentials. Various certification levels recognized by all American states include:
- Consumer (no medical or wilderness certification)
- First Aid
- Wilderness First Aid (WFA)
- Emergency Medical Responder (EMR)
- Emergency Medical Technician (EMT), Advanced EMT (AEMT)
- Advanced practice registered nurse (APRN, including nurse practitioners), physician assistant (PA)
- Physician (medical doctor [MD] or doctor of osteopathy [DO])
Consumers can make the decision to take medications from their personal medical kit. Although this varies by state in the U.S. (and countries outside the U.S. have their own regulations), if permitted by state law, a WFA, EMR, and EMT can generally assist with administration of certain prescription medications (for example, nitroglycerin, aspirin, epinephrine autoinjector; oxygen is more restricted), and OTC medications (such as oral glucose, antihistamines). Even when assistance is permitted by state law, it is generally limited to these medications. AEMTs, paramedics, APRNs, and PAs are permitted to administer a wider variety of medications and perform certain interventions that are not allowed for the preceding credentials. Physicians practice at the highest level and can prescribe and dispense/administer all medications (including all controlled drugs) and perform interventions based on their specific training/certification.
REFERENCES/ADDITIONAL RECOMMENDED READING
(1) Chapter 25. Wilderness Medical Kits. In: Forgey WW, ed. Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care. 5th Ed. Guilford CT: The Globe Pequot Press, 2006: 114-117.
(2) Forgey WW. Chapter 3. Expedition Medical Kit. In: Bledsoe GH, Manyak MJ, Townes WA. Expedition & Wilderness Medicine. New York, New York: Cambridge University Press, 2009: 30-39.
(3) Lipnick MS, Lewin MR. Chapter 91. Wilderness Preparation, Equipment, and Medical Supplies (Chapter 102). In: Auerbach PS. Auerbach’s Wilderness Medicine. 7th Ed. Philadelphia, PA: Elsevier , Inc. 2017: 2272-2301.
(4) Forgey WW. The Expedition Medical Kit. Appendix. In: Bledsoe GH, Manyak MJ, Townes WA. Expedition & Wilderness Medicine. New York, New York: Cambridge University Press, 2009: 709-714.
(5) Forgey WW. Chapter 2. Assessing Expedition Medical Needs. In: Bledsoe GH, Manyak MJ, Townes WA. Expedition & Wilderness Medicine. New York, New York: Cambridge University Press, 2009: 19-29.
Iserson KV. Medical planning for extended remote expeditions. Wilderness & Environ Med 2013;23:366-377.
Hawkins SC, Simon RB, Beissinger JP, Simon D. Appendix A: First Aid Kit Contents for Mountain Travel, Appendix F: Recommended Medications for Mountain Travel. Vertical Aid: Essential Wilderness Medicine for Climbers, Trekkers, and Mountaineers. Burlington, VT: The Countryman Press, 2017.
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