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Well, of course you should carry a First Aid kit – but what should be in it? If you look in most of the kits available in the marketplace you will find a whole lot of things you will never ever use. They are there because the manufacturer is trying to cater for every possibility under every situation, most of which are not that likely in the bush, and some of which are ridiculous. Of what use is it to put a triangular sling on someone to handle a broken collar bone in the middle of the bush? The person can’t carry a pack that way and wouldn’t be able to walk very far anyhow: you would be better off sending someone to get help. If the person really has to walk, use a safety pin to attach their sleeve to the opposite shoulder of the shirt.
What is really important to understand is that Remote Area Medicine is different from domestic First Aid. For a start, the 'First' bit is wrong: if the injury is small it may be 'All' the aid the patient is going to get. If the injury is large, the patient isn’t going anywhere. Forget about the whole concept of 'First Aid' in the bush.
We used to carry a large First Aid Kit suitable for field surgery, but most of the contents never got used and went out of date. These days we carry a few Panadol, some wide micropore surgical tape (very all-purpose), a small amount of burn cream, a handful of Band-Aids (both ordinary and wide), a sterile scalpel blade in its sealed wrapper (weighs nothing), a special needle for spikes and splinters and some iodine pills for sterilising water. Add a couple of clean handkerchiefs from the spare clothes bag for bandages, a bit of string and a sharp pocket knife from the goodies bag, and that’s it. It makes a very small kit – and the bandaids are about all that ever get used anyhow. It all goes in a well waterproofed bag of course.
What is more important is to learn some basic First Aid principals and little bit of what we might call "practical home nursing". Learn things like what to do for a burn or a serious cut or abrasion, and when to give up and send someone for help. You aren’t going to do major surgery on a bushwalk. Splints? What for, you aren't going anywhere without help. A company called First Aid International has a First Aid manual on line which gives some instruction, although the first line is usually 'send for an ambulance'. (My thanks to Franco G for the updated URL.)
Purely as an example I will mention an accident I had while cross country skiing. I fell on the metal edge of my new XC skis, and put a huge gash in the side of my knee. It went right through to the bones underneath; if you held the skin out you could (almost) see the insides of my toes. I patched the huge gash shut with some bandaids and some micropore tape, put a heavy wad of toilet paper over that and tied a handkerchief over the lot. The cleaned up injury is the left hand photo. Later on I cleaned the wound up a bit and used some more micropore tape to hold the edges together. Then we headed out to the car and Cooma Hospital, where a doctor put in 30 stitches in 3 layers to hold it together. The right hand photo shows the result a week later. The bottom line is that I was able to deal with a very serious wound with just bandaids and micropore tape - and some knowledge. Mega-First-Aid kits need not apply.
Hygiene gets a separate heading to itself because it is that important. Some campsites have gained a reputation for ‘bad water’ because so many parties of kids get sick there. There are few things worse than a dose of gastro in the bush. The strange thing is that more experienced walkers downstream from these sites don’t get sick, even though they are drinking exactly the same water. Maybe they have been more careful with the water, or maybe they have been more careful with their personal hygiene: washing their hands carefully after going to the toilet. This is something young kids have a poor reputation about. It is interesting that I am also seeing these same comments in medical literature, with some comments that hand washing is probably far more important than filtering or treating water for bugs. Certainly, some walkers never bother with water treatment, and never get sick.
That said, there are a few places where the water is known to be risky because there have been too many people leaving too many faeces lying around. The Whites River corridor up from the Munyang power station in the Snowy Mountains and especially around Whites Hut has a well-deserved reputation for Giardia lamblia for this reason. This may have something to do with the number of people camped up there at times and the terrifying 'toilet' next to the hut. (The floor looks ready to collapse into the pit below.) The same problem is sometimes found at the Dex Ck site near Cloudmaker, with crap lying around in the open. The local NPWS Ranger takes a spade out there to clean up (bury) the mess sometimes.
The do’s and don’ts are fairly simple. Do not poo near any running water. Some say you should definitely bury your poo, while others point out that exposed poo has a far far shorter decomposion time - but it looks yuk if left somewhere visible. Then wash your hands. A distance of at least 5 metres from the water and at least 10 cm of soil cover have been recommended, but the latter is rarely feasible most of the time. Well, stay away from the creeks and cover it up with leaves, anyhow. Or maybe, in the Snowy Mountains where there are brumbies, hide your poo under their huge dung piles perhaps? One has to add that there is little point in being too fanatical – in areas where there are few people and no surface flow of water. In high density areas more care is obviously required. In really high-use areas the Service are placing pit toilets – use them.
The other half of the story is soap. Now some books go on about the horrible dangers of letting any soap get in the water. For a small party of walkers in a remote are this is a bit of an exaggeration, but since you can always let the soap fall on the soil a few metres away from the water, why not keep the soap out of the water? On the other hand, just how much soap do you need to use? If you start by scrubbing (rinsing) your hands without any soap, you won’t need much. If you avoid frying and burning your pots, you won’t need a lot for the washing up either. It all helps. We take one of those very small hotel soap disks: and one lasts an awful long time - years.
As an aside, the author has seen creeks with a build-up of what looks like soap froth way out in the bush. It isn't soap or detergent, but instead 'saponifins': natural surfactants from vegetation. Quite a few Australian trees will release this in the rain.
Mark Stiebel contributed these pointers to some information at the Australian Museum about "nasties" we can meet in the bush and at the coastline. Do they explain why some visitors to our country worry? But then, how many walkers have ever had a problem? You leave them alone, and they will normally leave you alone.
Black House spiders
Mike Harding contributed these URLs about snakes, during a discussion that we should all leave them alone. (His email address requires tweaking.)
The big hazard with removing Ticks is the damage they can do to you when you try to remove them. The problem is that the bit they have stuck into you to feed has barbs on it, and these barbs resist the casual poking which you might do when noticing a slight itch. Some serious effort has to be used - or you have to persuade the tick to get out. If you squeeze them accidentally while trying to pull them out they may regurgitate their stomach into your skin, thereby putting a lot of rather bad foreign proteins into you. These can cause a very serious reaction, a huge swelling, and even some necrosis of the immediate skin. Not good.
Some people have suggested dousing them with metho. It may get them out, but it also gets them 'drunk' and they may spill the contents of their stomach into you during the process. That means your body gets the maximum possible dose of foreign proteins, making for a pretty bad allergic reaction which can take a week to die down.
Some people use heat: the head of a burnt match or a patent device of some sort, but you can be sure the latter won't be around when you need it (and is extra weight), while many of use no longer carry matches. As I haven't tried using heat myself I can't say how well it works.
Kevin and Debbie in WA report that they saw a nurse in a hospital use this brilliantly simple trick. Take some fine thread (no weight), tie a simple overhand knot in the thread, place it over the tick as close as possible to the skin, tighten the knot around the tick and pull. The loop of thread will grab the tick around its 'feeding spike' rather than put pressure on its body. They say it might help to stretch the skin a bit while doing this. I have tried this myself, and found that while it can work with large fat well-fed ticks, it is very hard to do with small ticks. It is also hard to do when they are well-embedded. And the patient can get a bit agitated while you fiddle around ...
Finally, Jason provided these information sources about the terrifying dropbears you can meet in the Australian bush and which puzzle the hell out of overseas visitors:
http://www.dropbear.trav.net/p.html (URL non-functional: censored?)
http://members.ozemail.com.au/~kingpin1/dropbear.htm (URL non-functional: censored?)
There must be lots of other good info out there about other cute little things that bite or scratch?
Contributions are sought.
© Roger Caffin 1/3/2002