With the current COVID-19 crisis we are trying to be prepared as possible for the foresee-able future. One aspect of self-reliance that might be over looked is being able to deal with small medical emergencies at home. Any trip to a hospital will likely put further strain on an already stressed medical system. To that end now is a good time to take inventory of your home medical supplies.
My Medic is a first aid supply company that has an amazing variety of medical supplies. It can be a bit overwhelming trying to decide what first aid kit you should start with so they have a handy “kit finder” that will help you narrow the selection. Our home kit is the basic “MyFAK” model. Then we have one Solo kit in each of our cars.
While having a properly stocked first aid kit is important knowing how to use what is in it is even more important.
The SOLO School located in Conway, NH offers some of the best wilderness medicine training anywhere. While they are closed until at least May 1st once they are back running courses consider enrolling in one of their programs (classes are offered all over the country). There are also a half-dozen or more free online first aid classes. While stuck at home you could brush up on skills through websites like FirstAidForFree and the Red Cross.
Accident prevention is high on our priority list right now and being able to deal with small injuries without visiting the hospital means we are more self-sufficient. I’d encourage every one to adjust their personal level of risk acceptance until we get through this crisis. Our family is limiting our exercise to short nature walks and bike riding around our neighborhood. Bike gloves and helmets are a must when riding. Make sure you are getting an hour of responsible outdoor time every day! We hope everyone stays safe and sane during these difficult days!
I started writing this post on March 9th, the day after my accident. Most people who know me know that I prefer to debrief and learn from mistakes soon after an incident before details can be forgotten or recalled inaccurately. For a couple reasons after only a few paragraphs I stopped writing until today, three weeks later.
The first reason, I think, was because I was actually injured. While being partially buried in an avalanche last April was a bit of a shake up the lack of injury made it easier for me to talk about it soon after it happened. This accident required a trip to the University of Vermont’s Medical Center’s Emergency Department. It’s been almost three weeks since the accident and I’ve recovered enough to go on short walks with the kids and dog. I can sleep on the injured side again. Riding a bike, skiing, or climbing are likely activities that are still a few weeks off.
The second reason I think I’ve delayed sharing this accident is from watching the severity of COVID-19 ramp up significantly in the weeks following my accident. My injury and situation pales in comparison to the stress many families are experiencing due to the current pandemic. While this injury ended my winter guiding season it is clear the season was unfortunately going to end pre-maturely as we try to flatten the curve. Despite these two reasons today I decided to sit down and finish this account and share it for whatever benefit can be found.
Events leading up
On March 5th I drove over to the Adirondacks to teach an AIARE avalanche course for the iconic Mountaineer in Keene, Valley NY as part of their annual Backcountry Ski Festival. It was an amazing event to be a part of and I can not say enough about all of the staff of The Mountaineer who made me feel right at home in their neck of the woods. I was co-instructing with Casey Henley, a fantastic outdoor educator and mountain guide. We had an amazing group of 10 positive and engaged students. The weather was beautiful every day and while the snowpack was on the thin side we were really making the most of our time together.
On the last day of the course, March 8th, the class planned a ski tour of Angel Slides off of Wright Peak. We toured as two separate groups of 6. The first 2.5 miles are very gentle rolling terrain, then about a half mile up a drainage and a couple pitches of denser trees before reaching the base of the 1,500 foot slide path.
We ascended the left hand slide to about 3,600 feet and after making some snowpack observations enjoyed some of first steeper turns of the course. Skier’s far right held some still cold powder and I was feeling pretty good as I reached the bottom.
The next leg was some pretty tight tree skiing just under 20 degrees (steep for tight tree skiing given the snow conditions). We took it very slow and methodically made our way back down into the drainage. It was work and I could see some fatigue settling in with a few students in each group. We still had a 2.5 mile rolling hiking trail to take us back to the trailhead.
Opinions were split on what the best way to cover that distance would be. Two in my group with local knowledge opted to re-skin for the exit. The rest of my group decided to ski it. CalTopo says the 2.2 miles from the Dam only loses 300 feet. My decision to ski it was influenced by how sticky my nylon climbing skins were getting in the quickly softening snow. Timing wise it seemed it was 6-in-one and a half-dozen in the other. With each small downhill the skiers would pull away from our two skinners, and with each herring bone or side-step up over the next small incline the skinners would quickly catch us.
Less than a quarter mile from the road our exit and tour was just about complete. A short little descent brought me to the bottom of the last significant pitch of the day. I was at the front of my group, and had just caught up to our other team and was making small talk with them after moving just slightly to the left side of the trail.
It was about 3:45pm. I was stopped on the left side of the trail a few feet from the bottom of the slope. I was facing to the left, skis parallel on the slope, just below a water-bar log feature that was partially buried into the trail. I didn’t hear or see my student coming. He was moving fast as he went over the back of my skis and caught my boot as he flew past. My legs were taken out from under me and I came down on my left side with some force landing on the protruding waterbed. The pain in my left chest and abdomen was instant and blinding. I rolled to my knees and took a breath. I knew I was hurt. I reached under my shirt and palpated my left ribs. My senses were returning. Someone had a hand on my shoulder and was asking if I was OK. It was one of my students, Veronica, an emergency room physician from PA.
I didn’t think anything was broken but I had a pretty significant about of abdominal pain. I decided to try to stand and was able to. Someone was carrying my skis to me from 15 feet downslope… I didn’t realize until later that the force of the hit took me out of both my skis while I basically just fell in place where I was stopped. The student had tried to avoid me and was uninjured from his crash. So close to the parking lot. I decided to walk out. I tried not to groan to much.
Back at the parking lot I was determined to finish the course properly and then figure out what steps to take regarding my injury. I instructed students to rally on the Visitor Center porch and start their debriefs. I went into the bathroom so I could look in the mirror. I lifted up my shirt and was surprised to not see any bruising yet. There was a noticeable “indent” for lack of a better term, about the size of a small apple, just under my lowest left rib. My abdomen was not asymmetrical. I could see some swelling on the outside.
I rejoined the class and we began our course close. I started to rush the process a little as standing and talking was quite uncomfortable. I asked Casey to run most the course close. He used the “one rose and one thorn” tactic to have each student reflect on the effect of the course. I love that style of debrief, but I was thinking I needed to speed this along, as it was now just past 5pm and my original plan was to make the 5 hour drive back to North Conway.
We finished the course close and I asked Veronica if she could step inside and do another assessment of my injury so I could make a decision. She was willing and as I lay on the visitor center couch performed a quick abdominal exam. Again, ribs and chest felt fully intact. Severe pain and tenderness in my ULQ and LLQ, areas that harbor my spleen, stomach, and a kidney. No left arm or left shoulder pain (good news for my spleen). There’s not much that can be diagnosed with soft tissue/organ injuries without an ultra-sound, something Veronica had been considering adding to her adventure kit for sometime (and she has subsequently added as she is pursing expeditionary medicine).
I discussed my plan to try to drive home and seek medical attention locally. I did not want to get stuck in Lake Placid if my injury would require overnight hospitalization or surgery. In hindsight I was being very stubborn and short-sighted, but whatever, I decided I would drive home and monitor my heart-rate and try to be hyper-aware of any change in mental status. If I felt the slightest bit dizzy or nauseous I would pull over, put my hazard lights on, and call 911. That was my plan. I called my wife and told her what happened and that I was going to drive home. I would call her every 30 minutes as long as I had service.
It took almost an hour on the road for my heart-rate to fall under 100. It dropped down to 80 and I hoped it would stay there as Veronica had said if it stayed above 100 after an hour I was likely dealing with some internal bleeding or organ damage. I left the radio off and just focused on the drive and what my body was feeling. While waiting for the Plattsburg Ferry I slowly walked into the empty waiting shack and changed out of my ski clothes. I couldn’t reach down to take my ski socks off. As they directed our cars onto the ferry I was selected for a random trunk search. Changing clothes and two trips to my trunk while moving slowly, I was must have raised some suspicion.
While crossing Lake Champlain as the sun set I felt the slightest bit better. The pain wasn’t as bad now that I wasn’t driving. I tried to breath calmly. We reached Vermont and the pain came back quickly with a bit more intensity. I had been on the road for almost two hours. I called a family friend back home, a doctor at my local hospital, for her opinion.
She didn’t like my symptoms. The fact that small bumps in the road caused noticeable increases in the pain, the location of the injury, the possibility of how bad it could be… I had planned to make it to my local hospital in North Conway so I would be closer to my family should I need to be admitted, but in talking with her it was pretty clear they would probably just put me in an ambulance and transport me to Portland, Maine Medical… adding another hour to seeing definitive care.
I was about to pass Burlington. I made a decision, put my signal on, and exited the highway with my Waze app guiding me to the Emergency Department of Vermont’s Medical Center. Ten minutes later I called my wife back and told her I was walking into the ER to get checked out.
After getting through initial COVID-19 screening the woman at the counter asked what I was here for. I said something like “Suffered some physical trauma to my lower left abdomen and now experiencing acute pain, some slight deformity, swelling, and well… I’m in a lot of pain.” The other woman asked how it happened. “Skiing injury” was my short reply.
“Ok, you’re all checked in, go have a seat and we will call you when its your time.”
I didn’t get three steps away from the counter before my name was called and I sat down with the triage nurse. He took my vitals. I looked at the heart-rate monitor… pulse 92, blood pressure 163/125. That’s not good I thought. They prepped a bay for me and I started to get hooked up. They took blood samples to run a full set of labs and I was asked to provide a urine sample. That would be tough as I was feeling very dehydrated since I finished my water at about 3pm when we started our descent and it was now 7pm and I was told I couldn’t drink anything, even water, just yet. I managed a urine sample, and there was no blood, so hopefully kidney is good.
In less than an hour the ER physician came in to give a full exam. An ultrasound was ordered. I waited. The bay next to me was taken up by an elderly man who had shortness of breath, felt weak all day, and had a mild fever and stuffed up nose. It dawned on me coming to the hospital next to an international airport was putting me at risk to the Coronavirus, but things weren’t quite as bad as they are today so I didn’t worry too much.
The physician could not find any blood in my stomach or other obvious bleeds in my organs from the ultrasound. He felt a CAT scan was appropriate. I cringed at how the increasing financial cost this accident was going to effect my family but I was done trying to just hope for the best and a CAT scan would be pretty definitive. The technician who wheeled me down the hall for the scan inquired about my injury and when I told her it was while teaching an avalanche course she confided she had just bought her first avalanche beacon. I encouraged her to follow that wise purchase up with a formal avalanche course soon.
After the cat scan the waiting began. Still not allowed to drink anything. The nurse let me know the doctor was going to get to me soon but they were dealing with a serious trauma that just came in and it might be a little while. I waited. Around 11:15pm the doctor came in with the preliminary results. No internal bleeding or ruptured organs. Diagnosis… internal abdominal contusions. Basically bad bruising on the inside of my abdominal cavity. My ribs had done there job absorbing the impact and protecting my organs. Still hurt like hell. I could be given morphine for the pain but that meant I would have to be admitted overnight. I declined and asked to be discharged… and for a glass of water.
Driving home was now out of the question as I was three hours from home along mostly dark less travelled roads and had been up since 6am and was feeling the fatigue from a full ski tour, dehydration, and injury. I checked into a local hotel in Williston, VT, just east of Burlington, and spent most the night trying to find a position I could fall asleep in, something that would become a nightly ritual for the next couple weeks. In the morning I had a small breakfast in the hotel lobby while the morning news confirmed that Williston, VT schools were closed following a faculty member with COVID-19 symptoms. I got on the road and headed for home.
Reflection… what happened?
On the drive home I had plenty of time to rethink the whole day and what led up to the accident. I told my students during our debrief that my “thorn” was that I pride myself in careful risk management and rarely will cop to “bad luck” being the culprit when an accident occurs. Even the word “accident” bothers me. I got hurt. That means I made a mistake. What was that mistake and how could I have avoided it?
I called the student who had crashed into me on my drive home for a few reasons. First of all I wanted to see how he was doing. He had expressed concern and regret over losing control and taking me out. I tried to, probably unsuccessfully, alleviate some of that guilt. I was in charge of managing the risk during our tour and it was on me for stopping in a spot that still had some risk from skiers behind me.
After my conversation with him and a few weeks of contemplation here’s my list of contributing factors;
Fatigue: He admitted he was quite tired at the end of the tour having negotiated terrain that was at his upper level. He mentioned he was frustrated with the rolling terrain exit and felt he wasn’t letting himself pick up enough speed to surmount the inevitable next uphill section which would result in tiring side-stepping to get back to a slide-able grade. He went into this last descent picturing a big uphill on the other side and thus came into view of me and some of the other students on the narrow trail with way too much speed.
Inexperience: This was basically his 2nd time back-country skiing. He had taken a one day mountaineering skills course and a one day back-country skiing skills course where he had skied in Huntington Ravine (likely lower Fan and out the Sherburne Ski Trail). His resort skiing resume was long but tree skiing was a first for him, and he knew that taxed his energy.
Back-to-the-Barn Syndrome: We were so close to the trailhead after a fairly long tour. I was really happy with how the three day course had gone and was excited to get on the road and get back home. We had covered so much more serious terrain and we were in the final stretch. This may have caused me to relax my normal “what could go wrong here?” type attitude.
While I’ve rethought this day almost every day since the only thing I feel I could have done differently is just moved a little more off to the side where I stopped. It wasn’t a blind corner or just over a convexity and in debriefing with Casey he didn’t think I could have done much different.
Recovery- Week One
The first week was pretty bad. I don’t like taking pain medication so I probably put myself through some un-necessary discomfort. Dressing was painful. Walking was painful. Driving was manageable but getting in and out of the car was awkward and painful. I let Corey, my boss, know I couldn’t do any outdoor field work in the weekend’s upcoming avalanche course. I was optimistic I could handle teaching the classroom portion. Just 5 days after the accident I welcomed a new group of avalanche students into our classroom space. I split the classroom sessions with my co-instructor Grant like we normally did. I was feeling ok despite the increased physical activity.
Around 2pm I went home while Grant took the class into the field for some physical rescue practice. No sooner did I walk in the door did I get hit by some uncontrollable muscle cramps in my abdomen. It was as bad, and even somehow worse, then how it felt the day after the accident. I was brought to the floor while the spasms made me wonder if I had somehow ruptured something. I called my wife at work and put her on speaker while I tried to get my body under control. Deep breathes. I made it to the freezer and got the large gel ice pack and wrapped it around my left side. The spasms slowed. My heart rate came back to normal. I was ok, but I wasn’t ready to go back to work yet, even in a diminished capacity.
Recovery- Week Two
Slowly the daily pain level reduced. I could sleep on my uninjured side. The first week I could only sleep slightly reclined on my back… either side did not work. Not fun for a side sleeper. I could go on short walks now, which was quite timely as schools were closing and social distancing was coming at us quick. I was able to help convert our downstairs into a more suitable learning environment for the distance learning that was about to be how almost every child was going to start attending school. I made a few trips to the stores to stock up on the things everyone has been stocking up on. Every day I didn’t come down with a fever or cough made me more confident my ER visit hadn’t had me contract the Coronavirus.
Recovery- Week Three
This current week is almost pain free. I was able to manage the snowblower to clear the 8 inches of snow we got this past Tuesday. I could not shovel the snow from our front porch though. That motion is 100% off-limits, somewhat ironic as anyone who has watched me teach proper shoveling avalanche rescue knows I would place well if the Olympics had a shoveling sport.
I’m anxious to be able to physically do the things that keep me emotionally healthy. Social distancing is a mixed blessing while I’m recovering. I’m hoping there might be a little snow left by the time I feel I could go for a very light easy ski, but the reality is if those few dozen cold powder turns on Angel Slide were my last of the season I’m ok with that. There’s more important things happening right now. It should be clear to anyone who recreates outside now is not the time to take risks. I’ve avoided following up with my PCP following this injury because I don’t want to burden an already stretched thin resource nor do I want to spend more time in a hospital just yet.
It’s hard to stay positive when the evening news paints a darker and darker future but I’m trying to focus on the good things that are coming out of this. Cooking more for the family. Daily family walks with the pup. Attacking house projects I’ve managed to put off for years. We are going to come out the other side of this a stronger family and I hope a stronger society that realizes what’s most important in life.
Finally I want to ask everyone reading this to really look out for each other during the next few months. Be a responsible citizen and respect social distancing, stay at home directives, and most importantly limit and minimize your amount of risk-taking. We all need to enjoy some time in nature but do it in your backyard in a low-risk manner. Even if I was 100% recovered I would limit myself to easy walks and hikes below tree-line and on very low angle slopes. I would not go mountain biking, rock climbing, back-country skiing, or any activity that is more prone to accidents. Our first responders and medical system are begging us to avoid injury right now. Please do your part.
See you in the mountains (hopefully locally and on a mellow walk),
We all carry a first aid kit with us on our adventures right? For today’s Tech Tip I want to share what first aid kit I use and how I customize it with a few extra items. While you can go to a pharmacy and piece together your own kit I prefer to start with the Adventure Medical Kits Ultralight/Watertight .7 Medical Kit as it’s a solid foundation to build upon. Here’s the details on the kit:
Designed for life in the bottom of the pack, zippered rip-stop silicon nylon outer bag has 2 inner DryFlex™ watertight pouches to ensure contents are kept clean and dry
Wound care items: 3 butterfly closure strips, 2 triple antibiotic ointments, 3 antiseptic wipes and 1 pair of nitrile gloves
Other equipment: splinter picker forceps, 3 safety pins and a 26 x 2 in. roll of duct tape
Silicone nylon pouch
8.5 x 6.5 x 2 inches
This is a great start for only 8 ounces! AMK markets this as ideal for 1-2 people for 1-4 day trips. While I do find the suggestion a bit arbitrary I feel this is a great size for a group leader or guide to start from. There is a .5 version that weighs less than 4 ounces that would be good for trail running, casual hiking, or just to keep in the glove box. A very minimalist .3 version is better than carrying nothing.
Now let’s get into what I add to this kit to make it a bit more capable of handling any situation. The first thing I add is a Petzl Zipka Headlamp. This 2.5 ounce headlamp has great light output and the retractable cord keeps it from getting tangled with other things in the kit. I consider this a bit of a “back-up” headlamp. If I know I’ll be out after dark I bring my Petzl Actik Core Headlamp and have the Zipka available to loan to someone who forgets their headlamp.
I then add a simple small knife that can be used for cutting bandages, duct tape, and clothing to make slings & swathes if need be. Occasionally it might even have to cut some summer sausage and hard cheese.
Then I add a fire starter, usually just a small Bic lighter but you can go for a fancy windproof one if you want!
Then I have a small travel size Advil bottle that I carry extra Antihistamines (Benadryl) and pain/fever reducers (Advil). I prefer to use this bottle and refill it from home when needed and save the prepackaged medications for when I forget to refill this container. Don’t forget to check the expiration dates on the prepackaged medications!
I also squeeze in a small notebook with a pencil. This is important for writing SOAP notes or sending detailed information with someone. On longer trips I carry a Rite in the Rain Notebook separate from my first aid kit.
With still room to spare I now add my two EpiPens. While I haven’t been tested for a bee allergy I feel it is a good idea for me to carry Epi after getting swarmed and stung by over a dozen yellow jackets last year. There’s also the fact that some one in my care may have a unexpected severe reaction when we are over an hour away from definitive care and having Epi in the party could be a life-saver. I also add a super light disposable CPR Face Shield.
Finally I add about 3 extra pairs of Nitrile gloves in addition to the one pair that comes with the kit. It has been my experience on multiple rescues that one pair of gloves is never enough in the mountains as they will definitely tear while dealing with a patient, and bystanders who might be able to help often don’t have their own gloves.
These additions bring my first aid kit up to one pound 5 ounces. Considering that if I grab my first aid kit I have 5 of the “Ten Essentials” I’m more than ok with that weight! I also carry either my SOL Escape Bivy (summer) or my more durable Ortovox Single Bivy (winter or while on rescues).
I’ve also taken to sliding a Saywer SAM Splint down into the back panel of my pack. While I can improvise splints from my wilderness medicine training a real SAM splint is really nice to have for quick ankle/wrist fractures or as an effective neck collar.
I feel the above set-up is quite adequate for the amount of time I spend in the mountains both guiding and recreating. For expedition leaders or large outing club type groups I’d suggest looking at the Adventure Medical Kit Ultralight/Watertight PRO Medical Kit. It’s quite all inclusive with a SAM Splint, EMT Shears, precision forceps, and more.
Undoubtedly carrying a first aid kit in the mountains is a very good idea. Accidents will happen. The longer your recreate in the mountains the more likely you, someone in your party, or someone you come across, will need a touch of first aid. Hopefully it’s something minor like a blister or small scrape. Unfortunately we can’t remove all risk from our outdoor hobbies and will are going to break some bones, or worse. There’s two things YOU can do to make these situations better.
#1 Carry the right gear
#2 Get some training
Wilderness First Aid courses are offered all over the country! Stonehearth Open Learning Opportunities (SOLO) teaches Wildness First Aid (16 hours), Wilderness First Responder (72+ hours), and Wilderness EMT (170+ hours). If you have zero medical training, and wish to play in the mountains for decades to come, do yourself a huge solid and sign up for one of these courses! You’ll be more prepared to handle what comes your way!
I hope you found this helpful. If you did please let me know in the comments below. If you carry something different or I missed a key item please let me know! Just so you are aware the links above (except for SOLO) are affiliate links. That means if you click on them, and make a purchase, a small commission is earned. That really helps keep this blog going, so if you do make a purchase thanks! If not maybe just share this article with someone you think could benefit from it!