Overland Medicine: Over-the-Counter Field Pharmacy

Editor’s Note: This article was originally published in Overland Journal’s Winter 2022 Issue.

Travel by four-wheel-drive vehicle affords rapid access to the middle of nowhere, which is a potential mecca of peace and tranquility until said vehicle breaks down, or its jockey becomes ill. As an emergency and wilderness medicine physician, I’ve been trained to identify stranded steeds and queasy jockeys by watching for the diagnostic hallmarks: flailing human legs protruding through the rear hatch of a roadside SUV while the grumbling supplications of the afflicted curse all deities for hiding either the Torx Security bits, or worse yet, the anti-diarrheal pills, in a small, unmarked tactical pouch located in one of the gear tubs.

Specialty tools and over-the-counter (OTC) pharmaceuticals deserve more forethought and a handier place of residence. A vehicle’s medical kit should be divided into two quickly retrievable allotments: a canteen-sized “trauma pack,” like the commercially available individual first aid kit (IFAK) made famous by modern war fighters, and a larger, more comprehensive and “tucked away but not forgotten” expedition medical kit (EMK) which contains a well-thought-out field pharmacy whose contents, or lack thereof, may be all that stands between you doing the Mojave Road and doing the green apple foxtrot from one landmark to the next. Let us apply the same urgency, in a premeditated manner, to the double checkage and assembly of your vehicle’s OTC field pharmacy.

Education, Preparation, and Common Sense

A well-stocked medical kit is useless if you’re not trained to use it. A quality Wilderness First Aid course will dedicate a section to helping you assemble your own OTC field pharmacy. Request a refund if the topic is not covered.

Most conveniently acquired “comprehensive” medical kits are sorely lacking in the OTC department. There’s no excuse, as OTCs can be obtained without a physician’s prescription. Thus, acquiring a fresh bottle of everything on my preferred formulary simply requires day tripping to the local drug store, surrendering a month’s rent, and devoting all your vehicle’s unused payload to the project. Thankfully, there’s an easier way. Start with a quality, commercially available first aid kit (such as Adventure Medical Kits’ Mountain Guide, $105). Dump the contents onto your tailgate and separate the medications. Using my OTC Field Pharmacy Checklist, use a pen to check off each item as you go, heading inside to raid your home’s medicine cabinet when your shiny kit comes up short. A box of disposable pill pouches (50 count, $4.60 at cvs.com) will go a long way in organizing and restocking your kit. Avoid pill bottles because the incessant rattling chorus can mask that of a broken shock reservoir and degrade the bottle’s contents into what may be mistaken by a border guard as “nose candy.” Be sure to label each pouch with a Sharpie marker, including indication, drug name, potency, and the recommended dose and frequency, taking into consideration the need for pediatric doses if necessary.

For medications you don’t already have at home, I recommend purchasing a small box of individually wrapped doses, which are infinitely more convenient. Split a box with friends and pimp their ride too.

When choosing between liquids or pills, always choose pills: they are more compact; don’t freeze, burst, and leak; don’t precipitate out of solution; and are easily dispensed to different parties when necessary. Some medications aren’t available as pills, such as eye drops and skin emollients. Double bag them each now to prevent a sloppy mess later.

All pharmaceuticals sold in the United States are required to display an expiration date (usually 12-60 months), but the Department of Defense and Strategic National Stockpile’s Shelf Life Extension Program (SLEP) determined that 88 percent of the medications it examined could have expiration dates extended an average of 66 months. A safe bet for adventure travel is to adhere to published shelf lives for prescription medications but leave some wiggle room for your OTC field pharmacy.

What follows is a reasonable short-list, generic name in bold and common brand name in parentheses. All medications are pills unless noted. Read and follow manufacturer’s labels and use common sense. Grab your kit and a marker, check off your contents below, and then kick back with a coldie to celebrate your preparedness.

OTC Field Pharmacy Checklist

Analgesia (pain)

  • Ibuprofen (Motrin) or naproxen (Aleve) are NSAIDs (non-steroidal anti-inflammatory drugs). Choose one or the other, but I like naproxen because it lasts 12 hours. NSAIDs inhibit blood clotting and shouldn’t be used in the presence of bleeding or use of other blood thinners. They irritate the stomach, so avoid them if you’ve got ulcers.
  • Acetaminophen (Tylenol) or paracetamol (known as Mapap in some countries) is one of the safest pain medications and does not affect blood clotting. Avoid when disorders of the liver are present.
  • If needed, you can take an NSAID plus acetaminophen because they work differently. You don’t have to alternate them.

Gastrointestinal

  • Meclizine (Bonine) or dimenhydrinate (Dramamine) can treat nausea, motion sickness, vertigo, and vomiting. Choose one, but remember they are both very sedating and shouldn’t be taken when operating a motor vehicle. Nausea and vomiting are the most frequent causes of seeking medical attention when traveling. But Doctor, I’m vomiting and can’t keep anything down. It’s your lucky day. Dimenhydrinate can go in the rear with the gear, available as Gravol, a “comfort-shaped” suppository. Bottoms up!
  • Loperamide (Imodium A-D) treats diarrhea by slowing down gut motility and increasing anal sphincter tone, helping you get to the wadi before you potty.
  • Bismuth subsalicylate (Pepto-Bismol) soothes the stomach’s lining to treat heartburn, slows intestinal secretions to decrease diarrhea, and binds some bacterial toxins involved in traveler’s diarrhea. Bismuth can turn your stool black, but so can a bleeding stomach ulcer. If the black stool lasts more than a day, see a doctor.
  • Polyethylene glycol (Miralax) powder stimulates secretions into the colon, softening hard stool and expeditiously treating constipation. Bisacodyl (Dulcolax) and psyllium husk powder (Metamucil) are kinder, gentler options, but I’m a man of action. Go loaded for bear: choose Miralax.

Skin

  • Dress superficial wounds with bacitracin, neomycin, or polymyxin (available together as Neosporin ointment) to help prevent infection in wounds treated in the field. Don’t forget, the solution to pollution is dilution. Irrigating wounds with drinkable water is more important than slathering them with antibacterial ointment.
  • Hydrocortisone cream (Cortizone 10, Aveeno) treats itching associated with allergies, eczema, psoriasis, insect bites, and poison ivy.
  • Clotrimazole (Lotrimin) antifungal ointment treats jock itch, athlete’s foot, and some vaginal infections.
  • Chapstick Bring an extra and become a hero.

Ocular

  • Contact lens saline or any drinkable water can be used to flush foreign bodies and contaminants from the eyes.
  • Ketotifen (Alaway and Zatidor) is an antihistamine used in allergy eye drops to relieve itchy eyes.
  • Visine is a brand-name eye drop that comes in several formulations, usually including some combination of pheniramine (an antihistamine for itching), naphazoline (causes blood vessel constriction to reduce eye redness), and polyethylene glycol (a lubricant).

Allergy

  • Diphenhydramine (Benadryl) should be in every medical kit. It treats anaphylaxis (life-threatening allergy), seasonal, and environmental allergies. It also causes drowsiness and is marketed as the sleeping aid called Unisom. The same allergy symptoms can be treated with loratadine (Claratin) or cetirizine (Zyrtec), which are less sedating and safer for drivers.

Cough/cold

  • Oxymetazoline (Afrin, Zicam, Dristan) or phenylephrine (Neo-synephrine) nasal sprays can relieve congestion. Choose one but beware that repetitive use can cause worsening congestion. They can also help stop a bloody nose when squirted inside and the nose is then pinched because both medications promote blood vessel constriction.
  • Cough and cold medications come in countless formulations. I carry Dayquil and Nyquil tablets.

Aspirin

  • Aspirin (Bayer Aspirin) makes the blood’s platelets less sticky, and three 81-milligram “baby aspirin” tablets should be chewed by anyone suspected of having a heart attack (unless they’re allergic to aspirin) while you call 911 or arrange for immediate evacuation.

Hopefully, your OTC field pharmacy is now complete, and it deserves a place of honor in its own labeled pouch on the rear window’s MOLLE panel, in between the 8-pound D-cell flashlight and the tactical container of hand sanitizer, or at least inside of your vehicle’s Expedition Medical Kit. “To relieve the suffering of fellow humans” is one of mankind’s highest callings, so drag your family and friends away from their desks and plan a road trip. Enjoy the tacos, don’t drink the water, and carry a well-stocked OTC field pharmacy kit. Doctor’s orders!

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Jon S. Solberg, MD, FAWM, FACEP, is a military- trained, board certified emergency medicine physician; he is a Fellow in the Academy of Wilderness Medicine with a diploma in mountain medicine. His medical exploits have taken him to a jungle hospital in Cameroon, a combat zone field hospital in southern Afghanistan, and across Greenland as the medical officer for the first longitudinal crossing by motor vehicle, to 82.5°N. Passionate about community involvement and education, he teaches wilderness medicine courses, provides direction for EMS, fire departments, and search and rescue groups, and mentors medical students and resident physicians as the Chairman for the Department of Emergency Medicine at the University of North Dakota. He and his wife, Agnieszka, enjoy exploring the backcountry in their Power Wagon and Maule M-5 bush plane.