medical skills

Wound Closure with Super Glue

Wound Closure with Super Glue 225 225 Greg Ellifritz

In very remote areas without available medical attention, it might be necessary to close a wound.  Doing so with steri-strips is the easiest method, but steri-strips don’t always work in extremely wet conditions.


The next best option is to use a tissue glue.  Super Glue or Crazy Glue is of a very similar chemical composition and may be easier to find.  I always carry a tube of the gel superglue in my third world first aid kit.


The article below goes into great detail about how to effectively use the glue to close a laceration.  Highly recommended.


Skin Glue in Survival

Marine Animal Bites and Stings

Marine Animal Bites and Stings 768 506 Greg Ellifritz

Adventure travelers often play in the ocean.  Ocean snorkeling, diving, swimming, surfing, and kayaking all expose on to the chance of being bitten or stung by some aquatic critters.


Over the years, I’ve experienced many of these envenomations.  Lots of jellyfish stings.  My sea kayaking tour guide got stung by a stingray in Belize.  It laid him up for a couple days.  This can be very serious stuff if you aren’t careful.


Even those of you who visit “tame” locations should still be cautious.  Last month I wanted to test my new snorkel mask before taking an ocean excursion.  I waded into the ocean off the beach of our five-star resort in Cancun.  I was in water about three feet deep and dove in.  I was instantly face to face with a pissed off stingray.  I’m amazed I didn’t get stung.


This is a compilation of simple first aid tips for handling marine animal bites and stings in the field.


Marine Animal Bites and Stings

Eye Injuries

Eye Injuries 300 214 Greg Ellifritz

Treating eye injuries in remote locations is a topic that doesn’t get enough attention.  These injuries are fairly common and can certainly wreck your trip or force and expensive evacuation if not managed correctly.


In Approach to the Red Eye, you’ll find a quality tutorial on diagnosing and treating common eye injuries in the field.  Check it out if you are at all interested in remote medical care.



Parasitic Infections

Parasitic Infections 150 150 Greg Ellifritz

I’ve traveled to more than 50 countries on all seven continents and I’ve never been afflicted with worms.  I caught giardia one time, but that was when I was hiking in the United States.


I think most travelers’ concerns about worms are overblown.  With that said,  here is a fairly comprehensive article about dealing with parasites.  It might be useful to stockpile a few of the recommended drugs/alternative treatments in case of an emergency.


What’s Bugging You? Dealing With Parasites in Humans


Albendazole, Mebendazole, and Metronidazole are commonly available without prescription in most developing world pharmacies.  I have them all in my travel medical kit.

Wound Cleaning in Austere Environments

Wound Cleaning in Austere Environments 800 450 Greg Ellifritz

Many of you might not have a well equipped medical bag that you carry on your travels.  What if you cut yourself and don’t have accesses to definitive medical care?  What if you don’t have chemical wound disinfectants like alcohol or hydrogen peroxide?


The proper cleaning of wounds is of critical importance, especially in austere conditions where there are limited (or non-existent) supplies of chemical disinfectants or antibiotics.  With proper irrigation, chemical disinfectants and antibiotics aren’t likely to be necessary.  It takes about one liter of water under pressure per inch length of wound.   Here are some more tips on how to do it right.


Antediluvian Methods? An Evidence-Based Approach to Wound Irrigation


You may also fine the information below valuable.


Wound Cleaning is One of the Most Important Skills to Know


This article is guide for cleaning and dressing wounds in the field.  When you don’t have the luxury of a hospital nearby, preventing infection is extremely important.




Wilderness Wound Closure

Wilderness Wound Closure 728 485 Greg Ellifritz

I get a lot of questions from remote travelers about wound closure in the field.  They ask about stapling and suturing.  Those skills are useful, but honestly most lay practitioners would be better off using steri-strips or glue to close wounds.


Check out the article linked below.  It provides one of the best tutorials I’ve seen about how to close wounds using glue.  Since the article has been released, there has been new research that has been published about using the common cyanoacrylate (Super-Glue or Crazy Glue) glues on human skin.


All cyanoacrylate glues are antibacterial.  The new research indicated that the over-the-counter version of these glues may sting more, but will work almost as well as the surgical Dermabond.  Your hardware store superglue will not harm tissue and will hold about one day less than the premium tissue adhesives.


If you are planning on adding glue to your first aid kit, I would advise buying the “gel” form of the product.  I find it easier to use than the liquid.

The Complete Guide to Using Super Glue for Cuts


And speaking about austere medicine, you may also want to read this article about the best way to sterilize medical instruments in the field.


Surviving Riots and Political Demonstrations

Surviving Riots and Political Demonstrations 217 346 Greg Ellifritz

*This is an excerpt from the chapter “Surviving Third World Riots and Political Demonstrations” from my book Choose Adventure.  With the riots we’ve seen over the last couple weeks, the information will be useful for you.  As our country descends into chaos, the advice from a third-world safety book might become necessary to survive our daily activities.




Riot police in Santa Cruz, Bolivia just waiting for trouble to break out.


“For people who study the universe of disorder, automatic Kalashnikovs serve as reliable units of measure…Anywhere large numbers of young men in civilian clothes or mismatched uniforms are carrying Kalashnikovs is a very good place not to go; when Kalashnikovs turn up in the hands of mobs, it is time to leave.”- CJ Chivers


In addition to having dealt with some pretty unruly crowds in my work as a cop, I’ve been caught up in a few riots during my third world travels.  In Brazil, I was tear gassed by the police because I was in the middle of a riot that broke out during a 600,000-person free concert on the beach.  In Peru, I was even stuck in a riot where one of the rioters (a striking transportation worker) was shot by the military.  There were others as well.  I’ve seen some insane crowds.


In each of the bad spots I encountered, it was relatively easy to get out without having to resort to violence.  If someone uses common sense and keeps up good situational awareness, he or she can usually get away before things get too bad.


If the country you are visiting begins experiencing some political instability, protests, or violence, it would be prudent to get out of the region.  Often these events are localized and simply getting out of the involved city will reduce your danger.


If you can’t get out, do as much as possible to blend in with the locals. You don’t want to stand out in a situation like this.  Call your embassy for advice.  If you are an American, be cautious about physically going to your embassy during political unrest.  US Embassies are often targeted for protests, vandalism, and violence.  The American embassy may not be the safest place to go.  If you are in serious danger, consider going to the Canadian, British, or Australian embassy instead.  No guarantees, but those friendly embassies may be able to help.


If you are holed up in your hotel room and can’t escape, call the US Office of Overseas Citizens Services in Washington D.C.  They will be able to place you in contact with local embassy or consular officials.  The phone number is +1 888 407 4747 (during business hours) or +1 202 647 5225 (after hours).


I prefer to be as far away from any civil insurrection as possible, but I realize that some circumstances make that impossible.  The riot may be completely surrounding you or exits may be blocked.  If you find yourself in a situation like this, get inside a building.  A lockable location would be best, but just getting inside is better than nothing.  Most riots occur outdoors and on the street.  Getting inside will often keep you away from the majority of the violence.


The more dangerous situations are the riots or mob violence situations that seem to pop up without warning.  The best advice I can give you is to pay attention to your surroundings and have an escape plan for every location you visit.  When you see things starting to go bad (massing police, masked looters, people setting fires), GET OUT!  Implement your escape plan.  Don’t stick around and become a target for police batons, gangs of teen looters, or panicked crowds.  Usually the people who get hurt or killed in these events are the people who aren’t paying attention or who want to stand around and be a spectator.


If you accidentally happen upon looters, rioters, or large political demonstrations, walk away by the most direct route possible that allows you to avoid the unpredictable crowd.  Don’t run; that only draws unwanted attention from the rioting crowd.  Just walk quickly, avoiding eye contact or any interaction with the rioters.  As you walk, keep an eye out for places of sanctuary you may be able to use to escape the violence for a short period of time until the crowd passes.  Fighting against the crowd will be difficult.  Think of crossing a river, it’s easier if you don’t fight the current.  It’s the same way with crowds.  If you get surrounded by a group, move with the group as you work your way to the edge of the crowd or to your pre-planned escape route or sanctuary location.


If, despite your best efforts to avoid problem areas, you find yourself surrounded by a mob or overtaken by a riot, quickly get your back to a wall.  That way you won’t be surrounded and will only have to deal with a few people at a time.  I’ve found this tactic works very well.  If you fade back to a wall and stop moving, often the crowd will ignore you and pass right by.


Once you get your back to a wall, organize yourself and plan your escape.  If you are wearing a backpack, bag, or purse, swing it around to the front side of your body where it can serve as a shield (a panel from an old ballistic vest carried in the back pocket of your backpack will give you even more comfort).  This also prevents thieves and looters from trying to take it from you.  Take a look at the crowd.  Look for gaps.  Your goal is to look far enough ahead to move from gap to gap, exploiting the openings in the crowd.  Holding both arms in front of you with your hands together in a wedge shape will help get you through the crowd.  Move along walls if you can with your “wedge” out in front of you, deflecting people off to the side.  Turning your shoulders to make your body narrower as you squeeze through the crowd will also help.


Having some sort of less lethal weaponry is useful.  Many of the criminals who are caught up in the spirit of the riot are not very dedicated or motivated.  A quick blast of pepper spray will usually make them look for easier targets.


If you are attacked and you don’t have any spray (or the spray doesn’t work), you must act decisively.  Don’t get caught in the middle of two or more attackers.  If possible, keep moving to the outside of the group of attackers to “stack” them, or line them up so you only have to fight one at a time.  If you do get surrounded, violently attack one of the gang members and either use him as a temporary shield or blast through him to make your escape.  Don’t just blindly run away; you may be running into an area where there are more problems.  Instead of running AWAY from the criminals, run TOWARDS safety.  And remember that “safety” in this case may not be the band of police in their riot gear with batons out and ready.


In addition to your everyday carry items, there are a few other easily-carried items that may help you if you find yourself in a riot or mob:

A bandanna or triangular bandage– Besides its obvious use as a piece of multipurpose medical equipment, a wet bandanna can be tied or held over your nose or mouth to temporarily protect you from tear gas.  I prefer holding the bandanna rather than tying it over my mouth and nose.  A bandanna tied over one’s face screams “criminal” to the police.  I would rather not be a target for baton blows or rubber bullets if I am mistaken for a criminal

– Spare contact lenses if you wear them– Tear gas will destroy your soft contacts.  You will never want to put them back in again if they get exposed.  If you need your lenses to see, carry a spare pair.

– Protective glasses or sunglasses– When the police start firing beanbag rounds, Stingball grenades, and rubber bullets, you will want your eyes protected.  Those rounds hurt if they hit skin. If they hit your eyes, you can be seriously injured.

– Sturdy running shoes or boots– People who walk around in large crowds while wearing flip flops amaze me.  If bad stuff happens they aren’t able to run and their feet will likely be trampled by those who were smart enough to wear real shoes.  Be smart.  Save the flip flops for the beach.

A flashlight- if you are out at night in a crowd, you should have a light.  Besides its regular uses, a stout flashlight can be an improvised impact weapon.  If the riot occurs at night, you will want the light to check out any unlit alleys or other areas you might be considering for escape or refuge.


Pepper Spray/Tear Gas Exposure

If you get exposed to tear gas or pepper spray, don’t panic.  All the effects will diminish on their own without treatment in less than an hour.  The definitive treatment for the spray exposure is fresh air and cold running water.  Find a garden hose, shower, or sink. Flush your eyes and skin for 5-10 minutes.  After that, most of the effects will be gone.


If you don’t have access to running water, take a plastic water bottle and poke a small hole in the lid by using something like a safety pin.  Squeeze the sides of the bottle to create a stream of water coming out the hole.  Direct the stream into the affected eye or eyes.  If there is an open store, purchase a cheap bottle of contact lens saline solution to do the same thing.  If no water is available, open and close your eyes as hard and fast as possible to get the tears flowing.  This will hurt initially, but will speed up the decontamination process.


You will need to take a few more precautions if significant quantities of tear gas are in the air.  First, remove your contact lenses.  The gas will get trapped under your lenses and you won’t be able to open your eyes because of the intense pain.  It’s better to have some vision (even if uncorrected) than to be blinded when your contacts soak up a dose of pepper spray.  Then wash off any sunscreen, oil-based makeup, or skin lotions you’ve applied.  These will also bond with the tear gas and make it difficult to wash away from your skin.


 Additional Riot Self-Protection Advice

If you are able to find shelter inside a building as you make your escape, lock the door you used to enter and move to the rear of the building away from the direction of the crowd.  Try to find a rear-facing exit.  If the building is large enough, going out the back door might put you far enough away from the hostile crowd that you can walk or catch a taxi to get out of the area.  If escape is not an option, lock all the doors and stay away from the windows nearest the crowd.  You’ll have to wait out the rioters until it is safe to leave.  It could be minutes or days.  That’s why I advocate always carrying some emergency supplies on your person when you travel through developing countries.


In the event that your sanctuary location becomes untenable or you have to leave it for any reason, it’s a good idea to wear as much protective clothing as possible.  You want protection from impacts (rocks, bottles, etc.), fire, and police chemical weapons.  You should wear long sleeves, long pants, and closed toe, sturdy footwear.  Attempting to make your escape in shorts and flip flops may get you seriously injured or killed.


Think about wearing natural fiber clothes like wool or cotton.  Those are least likely to stick to your skin or melt when exposed to flame.  The only downsides of these materials is the fact that they wick tear gas and pepper spray, soaking up the chemicals and keeping them next to your skin.  To avoid problems with tear gas, carry a raincoat and put it on over your natural fiber clothing if you are in an area where chemical weapons are present.  The raincoat (ideally with hood) will keep most of the chemicals off your skin.



There is a lot more riot-oriented material in the remainder of this chapter.  If you would like to read about how to keep your family and children safe in a riot and information about dealing with rioters on foot when you are driving, check out Choose Adventure- Safe Travel in Dangerous Places.


Travel First Aid Kits

Travel First Aid Kits 680 400 Greg Ellifritz

Check out Nomadic Matt’s article titled How To Pack A Professional Travel First Aid Kit.

This is an excellent article on what kind of first aid supplies you should carry when traveling.  For most folks, Matt’s list would be enough to treat the majority of injuries they might encounter.

I would add a few things to make it more complete:

– a CAT Tourniquet for severe bleeding

– some duct tape (because surgical tape doesn’t stick well to wet skin)

– a broad spectrum antibiotic (usually Cipro, Levaquin, or Augmentin but you may consider Azithromycin if traveling in SE Asia)

– a prescription anti-nausea medication like Zofran.

Depending upon where you travel, you may be able to buy the prescription meds I recommend over the counter in other countries.