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Scot: Welcome to the "Who Cares About Men's Health" Sideshow. This is a fun little episode we're excited about. Survival tips, fact or fiction. You've heard these before. Don't eat snow, because if you do, it'll make you more dehydrated. To prevent hypothermia, you've got to get in a sleeping bag with somebody else naked. And then this is a good one. After an avalanche, what you should do if you get covered by snow is spit so you know which way to dig to escape. We're going to find out if those are true or not.

My name is Scot Singpiel. On "Who Cares About Men's Health," I bring the BS to the show. And the MD to my BS is Dr. Troy Madsen.

Troy: Hey, Scot. I am so excited for this because I've heard these myths and I want answers.

Scot: And Producer Mitch is in the mix.

Mitch: Hey. I also want to know if I should butter my burns at some point. That's what I keep hearing.

Scot: Oh, okay. Well, our guest, Graham BZ. Is that your last name? BZ? That's what we're calling you.

Dr. BZ: My last name is Brant-Zawadzki, but it's long and terrible, so BZ is much more . . .

Scot: Yeah, it's cool.

Troy: I have to say this, too. Scot has this fear, like this deep fear of mispronouncing people's last names. I was so excited for him to pronounce your last name. And then he just totally glossed over it. So I'm disappointed.

Scot: Well, I didn't even know what it was. Even his email says Graham BZ, so I didn't know what his last name was. I thought, "I don't know." So here we are.

Troy: Made it too easy for you, Scot.

Scot: Anyway, he is an interesting doctor that practices mountain medicine, and that's actually a thing. What exactly is mountain medicine?

Dr. BZ: So mountain medicine is a subset under wilderness medicine, which is a larger umbrella term, and it all refers to medicine in an austere environment. I'm part of the Wilderness Medical Society, and you'd be surprised how hard it is to come up with a good definition for what wilderness medicine really is. But it's basically when we're providing medical care beyond the scope of your typical medical system and infrastructure.

Scot: All right. And I actually went to the WMS, the Wilderness Medical Society website, because I was trying to figure out exactly what it was you did. They have a definition there. "Wilderness medicine, also known as expedition medicine, is a practice of medicine where definitive care is more than one hour away and often days to weeks away. Defined by difficult patient access, limited equipment, environmental extremes. Decision-making, creative thinking, and improvising are required." So does that sound fair?

Dr. BZ: That is fair. I will tell you that I'm part of a committee to currently update that definition. But I think that that pretty much sums it up adequately for now.

Mitch: Graham, when it comes to expedition medicine, all these cool terms, what's some of the cool stuff that you get to do?

Dr. BZ: I think the best teaching case or one of the most influential cases for me was actually we were training some Peruvian mountain guides down in Peru. It's kind of a train-the-trainer model where we go and train the mountain guys and then they go on and train these other folks within their own country.

And the course that I went to, we basically hike into the base of this 18,000-foot peak, and the base camp is at about 15,000, so it's pretty high altitude. And some of these folks flew straight up from Lima, which is sea level, into Cusco and didn't really take the proper precautions in terms of acclimatizing before coming up.

And so one of our cohorts developed pretty severe HAPE, which is high altitude acute pulmonary edema, and required more than just oxygen. So we actually had to deploy what's called a Gamow bag, which is a positive-pressure, kind of an inflatable, almost like a sleeping bag that you kind of crawl into and then pressurize.

We learn about that a lot as students, especially in wilderness medicine, but what we don't learn about is just how much effort it takes to maintain pressure in this bag. Basically, think about using a bike pump, or even a foot pump. You can use both. And you're continuously pumping nonstop for hours to maintain this pressure.

Scot: To keep a person alive?

Dr. BZ: To keep a person alive and to keep this person . . .

Scot: Wow.

Dr. BZ: Yeah. To keep their oxygen saturation up, you're just continuously pumping and pressurizing this bag. And the idea is that you do that to temporize them to a helicopter evacuation, or at least just improve them enough so that they can then get down on their own.

So for about four hours at 2:00 in the morning, we're all just sitting there pumping and keeping this bag pressurized so this person could oxygenate themselves and improve a bit enough to get walked out.

The whole experience was definitely a humbling one. And then trying to get this poor person hiked out to . . . I think it was about a four- or five-mile hike down to where we could actually access a vehicle and then get him out from there.

Scot: And all of that happened because this individual went from sea level to 15,000 feet too fast without actually taking intermediate steps to get their body used to it.

Dr. BZ: Exactly.

Scot: Wow. And how long would that normally take to get used to something like that?

Dr. BZ: So there are different . . . It kind of depends on your strategy. There are different strategies for acclimatization. For the course we were doing, we would recommend up to two weeks to really properly acclimatize. I think taking up to four to six days for that level of transition is kind of the minimum that you'd recommend.

Scot: All right. Let's get to it. Let's get to these myths here, these questions. We're going to throw these out here and I thought maybe we could all just kind of play along. Now, I don't know, Troy, if you know some of these answers since you've got the MD here. Don't participate. But Mitch . . .

Troy: I don't. That's why I want to know the answers. Yeah, these are questions we've talked about and I've heard these, and some of these, I'm really curious.

Scot: All right. So the first one, don't eat snow if you're out in the wilderness and you don't have any water because it'll actually make you more dehydrated. So this is one of those situations maybe you're out, it's wintertime, you've run out of water, you're not near a water source, you're not near your car, and you need to survive. Should you eat snow or not? This says you should not. I think that sounds silly. That's my take. Mitch, what do you think?

Mitch: I guess I don't understand how it would make you more dehydrated. For me, that's the thing. It's water. It's just super cold water, right? What on earth is in the snow that's going to make you more dehydrated?

It's like when coconut water came out. Does anyone remember when the coconut water craze was going? I was doing some volunteer work up at Sundance, and the lady I was working with, she's like, "Oh, coconut water hydrates you better than water." And I'm like, "That doesn't make any sense." So on the flip side, we now have snow and I'm like, "How does it dehydrate you if it's water?"

Troy: Well, this is what I've heard, though, Mitch. The rationale is that the water content of snow is so low, especially here in Utah where it's super dry, that it takes more effort and uses more energy to produce than water, just like putting snow in your mouth, than it really produces water. So that's the rationale I've heard. I don't know if that's true, but that's what I've heard.

Scot: All right. We heard Graham chuckling a couple of times, so we'll see if that's his tell or not. Is that true? True or not?

Troy: Yeah, what's the word?

Dr. BZ: I don't think anyone has ever looked at drinking snow in the Sierras versus Utah and wondered if they're . . .

Mitch: "Is it dryer?"

Dr. BZ: Yeah, exactly. But I think Troy is pretty spot on. So the problem with . . . Snow is mostly air, especially again here in Utah. So you'd need to eat about, I think, 8 to 10 quarts of snow to meet the same amount of just liquid water.

Again, it's much colder the body temperature, so every time you're putting that snow in your mouth, your body is spending energy to melt that snow so that you can drink it, and that burns calories. In the end, it does consume more total body volume water than you actually are receiving for it. So point to Troy. That is right.

Troy: So this is true. I'm going to say I can't take credit for this because I never would've believed it, and then I saw it in a Sundance film. And in this Sundance film, these guys were lost out in the snow, and one guy said to the other guy . . . This guy was super dehydrated. He was like, "You can't eat the snow. It's going to make you more dehydrated. It just takes up too much energy. You can't do it." And I was like, "That's stupid."

Then I thought about it more and I was like, "Maybe it makes sense." It's true. You just don't get a lot of water out of snow. The water content is really low.

Scot: And to make the connection, burning energy requires, in that chemical process, water is what we're saying, right? That's why it uses more water.

Dr. BZ: Correct. That's exactly right.

Scot: Okay. Yeah. Got to go back to my cellular biology class that I never took. So what should you do instead?

Dr. BZ: So what you want to do is you want to find another way to melt the snow that's not using your own body's energy. So if you can heat the snow up in any way, even just leaving it in the sun in a spot where it can be melted, then you can drink the liquid melted snow and that's going to be the best way you can hydrate.

Troy: I'm going to ask this because I know Scot is thinking it. What if you had a container and you filled it with snow and then you peed on the snow?

Scot: What?

Mitch: What?

Troy: And then the warmth from the urine . . . You're going to have some urine in there. Is that just going to be useless? Is it going to be just too . . .

Scot: You pee on the container if you've got the container, and then hopefully the heat transmits.

Troy: I don't know. Do you think it would?

Dr. BZ: That is an excellent question. So it would depend on how dehydrated your urine was to begin with, I think, because dilute urine is . . . You're still going to be able to pull . . . We always get asked this. "Can you drink your urine if you're dehydrated?" And the answer is if you're coming from a hydrated status . . . Well, an answer, I should say. If you're hydrated, you can kind of drink your urine over a couple of cycles before it really starts ruining your kidneys and other things as you're getting more and more distillate.

So if you're pretty hydrated to begin with, that's already urine that you've heated up and you've used those calories already. You might as well put it in the snow and dilute that urine a bit. And if you're in dire straits, I think that's an ingenious way to potentially temporarily hydrate yourself.

Troy: So maybe it would work then.

Dr. BZ: Yeah, I'd say.

Troy: It's better than drinking your urine, it sounds like. At least if you have a big old thing of snow and you can pee in it or . . . I don't know. Again, hypothetical here. I'm not recommending it.

Dr. BZ: I think last resort Hail Mary kind of stuff.

Troy: Yeah, don't do this every time you're out skiing.

Scot: Try to use the sun's energy first, I think, would be a good . . .

Dr. BZ: I was going to say, if you're going to use a container to try to melt snow, you want the back half of that container to be . . . Use dark clothing or something that's reflective so that that energy isn't just passing through the snow. You're kind of trapping heat energy in that container as well.

Scot: Oh, okay. Yeah, that makes sense.

Troy: Kind of dark container or something there. Okay. That makes sense. Yeah.

Scot: All right. Myth number two. To prevent hypothermia, you need to get the person who has hypothermia naked into a sleeping bag, and that body temperature helps warm them up, as opposed to just getting in clothed because you wouldn't be transmitting enough heat. So the question is, is that just a clever pickup line, or is that a legitimate survival strategy, Graham?

Dr. BZ: I don't want to discourage anyone from crawling into a sleeping bag naked with another person, if that's what seems like the right thing to do. But it will help. It'll definitely help warm someone up faster than just putting them in a sleeping bag and clothes by themselves because you're going to help transmit . . . Again, you're going to help heat that sleeping bag and help raise the temperature of that environment faster. So getting into that sleeping bag with that person will definitely help.

The reason we say get in naked is because the way a sleeping bag works is it radiates heat back at you. And if you're wearing a lot of clothes together, then you're kind of trapping heat under your clothes and it's not radiating to that person as effectively.

So technically, yes, that would be the fastest way to warm someone up. Do you need to do that? Probably not. There are, again, other ways to do it. I think putting someone in a sleeping bag with a heated bottle of water or another heat source can act in the same way.

Really, the best thing to do to warm someone up if they're not comatose, if they're still awake and alert, is to use their own body's thermodynamics. So get them active. Get them doing jumping jacks. Get them moving. If they are in the sleeping bag, have them moving up and down and doing kind of snow angels in that sleeping bag as much as possible to help burn calories as well from the inside.

So I hate to say it, but if you're going to be in a sleeping bag with someone, you also want to be active in that sleeping bag.

Troy: There's just so much more to this. This is one of the things I heard too. This is one they teach in Boy Scouts. It's like, "If this ever happens, you have to . . ." It's just like, "Huh, okay."

But it sounds like there are other alternatives and maybe better alternatives, like you said, like a heated water bottle or something like that to really get the job done. But it sounds like it makes sense if you're in that situation and you have to do it.

Dr. BZ: And again, totally naked is probably a bit dramatic. You don't want to be both in a sleeping bag but also covered in all your winter gear. If you're in long johns and underwear, that will be equally as effective.

Scot: All right. Question number three. After an avalanche, if you get trapped in an avalanche, in order to know which way to dig to escape, you should spit because then the spit is going to go down, because that's what gravity does. It pulls things down. Mitch, what do you think? Yes or no?

Mitch: When we were doing our pre-production, it was the first time I've ever heard of this. And I guess I never would have thought to . . . I guess you would get all turned around, but spitting is the last thing I would think of doing to try to figure out which way was up or down. I guess that's my first question. When trapped in an avalanche, do you get tossed around enough that you don't know which way to dig?

Scot: Yeah, hold on that answer, Graham. Let's go to Troy.

Troy: This is one I have heard for years. I don't know if it's also one of those things people just say, but it does make sense. If you're tossed around in an avalanche, you may not know which way is up. And I've heard that if you want to know which way is up, spit, because then if the spit just falls back on your face, you know your face is facing up, and if it falls to one side, you know the other way is up. If it falls straight down, you know that up is back behind your head.

Obviously, there are certain logistical issues if you are trapped in an avalanche, so that's probably the bigger question. But I'm curious, Graham. Is this something you've heard or something you've ever recommended?

Dr. BZ: So I think the bigger question . . . The first question is, can you get tumbled around enough to not know which way is up or down? I've never been in an avalanche, but talking to those who have, the answer is absolutely yes. I mean, if you've ever been just even in a whiteout, you can kind of get vertigo and lose your sense of your body in space. So you can definitely be disoriented like that.

The bigger question is what can you actually do about it. So we talked a bit about how snow is roughly one-tenth the density of water. And that, again, varies by the type of snow and where you are and how dry it is, etc.

But when you think about an avalanche . . . So snow just sitting on the ground is maybe, let's say, one-tenth the density of water. Once that avalanche is set off and all that snow is sliding down the hill and then sets at the bottom, all that snow is now compacted and the density has increased. It's at least doubled. There are some studies that show that it can go significantly more than that. And so that snow is no longer that nice, fluffy Utah powder we like to play in. That is now basically, for all intents and purposes, concrete.

And so even if you knew which way was up or down, the ability to dig yourself out is more or less impossible. Just being under a foot of cubic snow can translate into hundreds of pounds that are on your body.

And so I think a better way to know which way to dig out is if you can move any part of your body, it's probably under the least amount of snow. Or if it's even sticking out of the snow, that's the direction you'd want to go if you can move anything.

But what unfortunately kills a lot of avalanche victims, even those that are only partially buried, meaning that a part of their body is still sticking out of the snow or just very shallow, a shallow burial, is even in a shallow burial, people just can't dig themselves out. They don't have the ability.

Troy: That's an interesting thing too. Graham, I think we often have this image that people get covered in avalanches and they get tossed around and hit trees and rocks and they die from that. I think you kind of alluded to it a little bit there. What percent of people actually die from that versus just die because they're stuck there and they just can't get out?

Dr. BZ: Yeah, that's a great question, Troy. We looked at this locally here in Utah. And what happens is we actually compare a lot of our avalanche data in the U.S. and North America to European data and we see a stark difference in the rates of trauma for that exact reason.

A lot of avalanches in backcountry terrain and the Alps and other parts of Europe happen well above treeline, and so there are a lot fewer obstacles to strike, such as trees, boulders, things like that. And so we see a lot more deaths that are due to purely asphyxiation from suffocation under the snow versus patients here in the U.S. where maybe the rescuers get to them in time but they've suffered severe traumatic injuries, which have led to their decline.

So it's a great question. We see a much higher incidence of trauma with avalanche here in North America than in some other parts of the world.

Troy: Interesting. It sounds like, bottom line, you can spit if you want to spit. Maybe that will let you know which way is up. But it sounds like the more . . .

Scot: Just end up having a wet face.

Troy: Going to have a wet face. Yeah, it's probably not going to help a whole lot. But yeah, I like what you said there about if there's a body part that moves, it's probably by the surface or it's not covered, and if you can move any direction, that's the direction you want to go.

Dr. BZ: Exactly. If you are in that phase where maybe the slide is slowing but hasn't fully set up yet and you can still move any part of your body . . . You've probably heard of this idea of swimming with the avalanche, and that actually has a lot of credence.

We know that larger particles float to the top. If you think of an avalanche, it's kind of laminar flow of particles.

So the same way we call it the Brazil nut effect, that in a bag of nuts the bigger nuts always float to the top, or in granola, the bigger clumps are always at the top. And by the time you're at the end of the bag, it's all the crumbs at the bottom.

The same thing happens in an avalanche. So you want to make yourself as big as possible and you want to try to push all those particles, as many as you can, below you so you can float on top. So if you can do that to stay shallow in the pack, that's great.

And then another thing to do is, as a last resort, try to make as much space around your head to make a pocket of air that you can use to survive longer than you might otherwise.

So one of the things we look for in avalanche rescue to determine if a patient has a better chance of survival is if they have an air pocket around their face or if there's any snow impacted in their mouth. Because if there's snow in the mouth, or what we call an ice mask, where the snow in front of the face is kind of melted and then refrozen and sealed off, then that patient has a lot lower chance of survival because they've had less air to breathe while waiting for rescue.

Troy: So it sounds like just keep moving if you can move.

Dr. BZ: Yeah. Move as much as you can, as long as you can.

Troy: As long as you can, yeah. Hopefully, none of us are ever in that situation.

Scot: It sounds terrifying.

Troy: Absolutely horrible. Yeah, it just sounds awful.

Dr. BZ: I will say that the more I've learned about avalanche safety and snow science, I thought I would be able to use that to go further in the backcountry and do cooler things, and it's had the exact opposite effect. I'm much more conservative than I ever was before I recognized the danger.

Scot: Now that you know.

Troy: I can imagine.

Scot: The danger is more than what the average layperson realizes, then, is what I'm getting from you.

Dr. BZ: Yeah. I think we've made a lot of strides in avalanche science and snow safety, and we have these decision rules people use and what we call obvious clues where people look at terrain features and try to determine what the risk of an avalanche is. And those are all fantastic things.

But I think they also sometimes give people a false sense of security in terms of thinking that they can't be in an avalanche if those rules say that it's safe, but the opposite is true. An avalanche can happen anywhere at any time. I think a lot of us get very lucky when we're recreating in the backcountry, and we think that translates into good choices when it's just the luck that nature provided us that day.

Scot: Graham, thank you so much for coming on the show and using some of your mountain medicine experience to talk us through these rumors, and some good tips there too for any of our listeners that might happen to like to go out and recreate in the backcountry. We sure appreciate you being on the show. Thanks for listening and thanks for caring about men's health.

Dr. BZ: Thank you so much. Thanks for having me.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: All right. Welcome to the "Who Cares About Men's Health? Sideshow" today. We've got our mountain medicine expert on the show. Going to talk to him about the first aid winter kit that you should have in your car. Especially if you live in Utah or areas like Utah, where you might go on a car drive across the state of Wyoming in the wintertime, and if something happens it might be hours before somebody is able to help you. So what should you carry with you to stay safe? This is "Who Cares About Men's Health?" My name is Scot. I bring the BS and the MD to my BS, Dr. Troy Madsen.

Troy: That's me, Scot.

Scot: And producer Mitch is in the mix.

Mitch: Hey there.

Scot: And we've got Graham BZ, who practices mountain medicine here at University of Utah Health. Welcome, Graham.

Dr. BZ: Thank you so much. Thanks for having me.

Scot: On the podcast, I want to get a story from you if we could. So on the podcast, we talk about something called the core four, and that's to be healthy now and in the future, that if you concentrate on your nutrition, your activity, your emotional health, your sleep, and then the plus one more is you've got to know what your genetics are, that that'll go a long way to keep you healthy, prevent disease, and just, you know, make life a little bit nicer.

Any of those things are things that you struggle with, Graham? We like to talk about that on the show to just kind of normalize it a little bit. I, you know, sometimes struggle with my activity and my nutrition. I know Mitch does as well. I don't know about Troy. Troy is a super . . . I mean, he runs marathons and stuff, so he's fine. But Mitch and I are listening, if you have any stories you'd like to share. I mean, how's your health in terms of those things?

Dr. BZ: I always say, first of all, for my mental health, I never compare myself to Troy because it's always so depressing.

Troy: Oh, right. Yeah. You're doing much better than I am, I know that.

Dr. BZ: But I struggle with all of those things as well. I think I could use . . . using, you know, shift work as an excuse for making it hard to motivate, to get up in the morning and be active before I do anything. Or, you know, getting home at 2:00 in the morning and forcing myself . . . trying to prevent myself from just eating an entire pint of ice cream when I get home when I want to prevent stress.

I think I definitely struggle with that. The biggest thing for me is having some sort of routine, whether it's, you know, whatever time of the day it is I've . . . When I build my schedule, I'm a big to-do list person. I'm a big calendar person. And I actually put whatever I need to do on my calendar. And so whether it's my workout or activity for the day, it's got its own designated time slot.

When I was better at focusing on my diet and my nutrition, I would actually plan my meal out the next day. I would kind of think about, "All right, this is what I have in the fridge. This is what I'm eating for each lunch, of each meal." When I had that kind of planned ahead of time, it was much easier to follow that routine and stick to it rather than just trying to do it in the moment, where I'm like, "Oh, I'm pretty hungry, maybe I'll just grab a handful of chips or have that candy bar instead of getting a meal."

And so, for me, I definitely struggle with it. It's something I wish I was better at, but when I do succeed, it's when I'm really intentional and really plan it out.

Scot: I think that's a great point. I think, you know, for some people that does work really, really well. And I think we tend to believe that stuff like exercise or what you're going to eat, when you're going to eat, it just kind of happens, right? But it really in our busy lives doesn't. And if you want to avoid eating that pint of ice cream, you've got to be full on something. So if you've planned out, "Hey, this is what I'm going to have for my meal. I know if I bring a meal to work that makes all the difference when I get home. I'm not, you know, in the sweets and stuff." So good lesson there.

Dr. BZ: Well, I wish I could practice what I preach all the time, but.

Scot: Yeah. Well, it's all a work in progress, right?

Dr. BZ: Yeah, yeah.

Scot: I think that's the thing we're all learning on this podcast.

Troy: Yeah, it is. Yeah. And it's so refreshing to hear that from you to, Graham, because I struggle with the exact same thing. And obviously, we both do shift work, we get home late or early, depending how you look at it, you know, 3:00 in the morning or whatever. And yeah, I agree. I'm the same way. I've got my calendar. I have to plan things out. I have to think ahead and be like, "Okay, this is what I'm doing then." I think for anyone who's doing shift work, that's a big challenge. So it's great to hear you're doing that and making it happen.

Scot: All right. What is in your survival kit in your car? Now we're talking about a winter survival kit. If you're going to do any traveling over the, you know, the wintertime and you live in kind of a remote area, like here in Utah, you can drive a lot of places where you might not be near a town. Or if you have to travel like I do to another state and you have to drive across a state like Wyoming, if a storm hit and you had to spend the night in your car or a couple of nights, what kind of survival kit would you have? Graham, do you have one in your car, and what do you recommend?

Dr. BZ: I do. And I'm so glad you're asking me this because my wife makes so much fun of me for my kit that I keep in my car.

Scot: Maybe this is something just guys like, I don't know.

Troy: Yes, exactly.

Dr. BZ: There's probably something to that. You know, I've actually . . . So I also commute out to a hospital in Wyoming for work as well. And I've had one particular close call where being stuck would have been awful. And so my kit, I keep kind of continuously adding to that kit over time. But I think with any medical kit, you want to think about, you know, what you're using it for, the environment you're going to be in, and how far you are from definitive care or rescue. So, you know, how long are you planning to use these materials to survive?

Thankfully, in a car, you know, 24 hours is probably pushing it in terms of how long you need to be. If you're on a highway, I should say commuting to Wyoming, something like that and you're stuck in a storm. So your kit can be sized down for that. If you're going further out into the wilderness, then plan for more time.

I have a couple of things. So one, I have something for just kind of self-rescue, like you should do with any activity because the best way to get yourself out of something is to be able to get yourself out and not rely on someone else for help. So now in my car, I've got some traction devices that I can use to place under the wheels if I were to get stuck in deep snow or sand or mud. I have a -- I'm trying to think of the term for it -- a tow rope, basically, that's a very heavy-duty, synthetic rope that I can attach to a point in my vehicle and hook it up to somebody else's if I needed to pull someone else out or vice versa. And I also have my own jack, a spare tire, all those things.

So whatever you can do to help yourself, I think is super important.

Troy: And what do you mean by traction devices? Are you talking like tire chains or like cables or something like that? Or what exactly do you have there?

Dr. BZ: So no. So you should always have those things, especially if you don't have four-wheel drive. So I have four-wheel drive and winter tires. I actually hate putting chains on and cables, but I think those are great things to have, especially on a road like that.

There's a bunch of different commercial devices you can get that are kind of deployable tracks that you can put down onto loose snow or something. I think Trax, T-R-A-X is one company, and just as an example. Not that I'm endorsing them over another. But they're basically these traction pads you can put down to help your wheels get traction and get out of a rut, especially, you know, I think a lot of people, myself included in the past, when you get in deeper snow, you try to get yourself out and you end up spinning your tires and digging yourself down. And then the more you do that, the harder it is to get those tires out. So these traction devices, you can place down and give your tires some grip to help you get out of those ruts.

Troy: Oh, nice. And you can get those down far enough where your tire can actually get a little traction on it. Once it's on there, then it's going to start moving forward on that traction?

Dr. BZ: Exactly. And that brings up another thing I have, which is a snow shovel. Not the one you . . . I mean, if you wanted to, you could carry the one you bring in your house, but that's going to be pretty cumbersome in your car. So I actually have an avalanche snow shovel that you put in an avalanche pack for back-country skiing or snowboarding. Because sometimes you dig your car so deep that you're actually kind of high pointing it and the chassis of the car is actually in the snow. And so you have to have a shovel to help dig around those tires so you can dig that, you know, spot for that tracking device or at least dig a trough out for your car to drive out of.

Troy: And have you ever used this stuff? Have you ever had to use it?

Dr. BZ: I have actually. I'm embarrassed to say how many times.

Scot: What? Really? Because I'm sitting here this whole time thinking . . . I'm the one that wanted to do the topic and I'm thinking the whole time, "Oh, I'd never use any of that stuff." And you're like you've used it multiple times.

Dr. BZ: Well, I should say again . . . So getting yourself out of things is the best thing to do. The very best thing to do is make good choices, and I have definitely not made good choices.

Troy: Prevention.

Dr. BZ: Yeah, prevention is key in all these situations. When you miscalculate, that's where these devices can be very helpful.

Troy: See I can definitely think of times I wish I had these things. Like, especially the traction devices, I never even thought about that. I guess I should have known they're out there. But that seems like an incredibly useful thing, because I've definitely been stuck in the snow and just been like, "How am I going to get out of this?" So that's good to know.

Scot: Yeah, they're useful for sand too. If you ever decide you want to go out into the desert or whatever with your four-wheel drive vehicles, a lot of people use them for sand as well. There must-haves.

Dr. BZ: There's some really big, burly ones that people love to put on the side of their adventure vans that are not, you know, practical to put in the back of most cars, but they also make some much smaller ones that fold up or roll that are still very effective that I just . . . I basically have all the stuff just stuffed around my spare tire. They kind of divide up my spare tire in the back of my car, and it fits very well.

Scot: It's cool. So you've got your tools to get you out of the situation. What other kit do you have and what's in it?

Dr. BZ: Yeah, so I've got . . . I always carry . . . I have probably too much water. I have like 10 gallons of water, but I always carry spare water.

Troy: You've 10 gallons of water in your car?

Dr. BZ: Well, that's just the . . . Yeah, I do.

Troy: That's awesome. I'm impressed.

Dr. BZ: And that, you know, moves out of my car sometimes. And whenever I'm going to Wyoming, that's in there. It's just one of those big, kind of blue squares.

I actually have a sleeping bag that I keep in my car. I've got some extra pair of gloves. And so I basically have a bin that I move in and out of my car when I'm going, you know, anywhere, like going to work or going on a bigger trip. And so it's got an extra sleeping bag, an extra beanie, extra pair of gloves, an extra jacket. I think I've got like six or seven like meal bars in there as well. I've got waterproof matches and kind of one of those match kits. And always have duct tape. Wherever you go you need duct tape.

I've got a headlamp and a flashlight because you always want to make yourself visible as well. They make some really great kind of emergency lights as well, the triple one that's like a flashlight and a flasher. And you can kind of put that on the back of your car if you are going to sleep in your car so you stay visible for plows and things like that. So I've got one of those. I've got a knife as well. I feel like pretty much every vehicle I have or backpack I have has two headlamps and two knives just because I go a little overboard on that.

Troy: I was going to say you never know when you need two knives.

Dr. BZ: See, if you've got two knives, you've only got one knife, it's the same with headlamps.

Scot: What? I don't understand that saying.

Troy: The second knife breaks or what?

Dr. BZ: Yeah, it breaks or you lose it, or yeah, I like to have some redundancy in the safety stuff.

Troy: See, I'm just thinking of the movie, "The Grey" with Liam Neeson, when he was fighting wolves and he had two knives. It made perfect sense. He had a knife in each hand, so I guess . . .

Dr. BZ: Well, exactly. Yeah, you never know when the pack of wolves are going to come out.

Troy: Yeah, you never know. But yeah. See, I am feeling so inadequate right now. In my car I have a roll of duct tape.

Dr. BZ: That's good.

Troy: I have a blanket. I do have a spare tire and a jack.

Scot: Maybe a couple of French fries down the side of one of the seats.

Troy: Yeah, I think there's some Cheetos under the driver's seat, maybe some peanuts or something. I might have a screwdriver and some zip ties, like if I could do something, you know, to fix my car, if I actually knew how to fix it. So I am feeling very inadequate. But this is like incredibly helpful to hear this because, yeah, I like the idea, like you said, Graham, you've just got your kind of your bin, it has everything in it. Obviously, you're not dragging this stuff around town all the time, but if you're going on a long drive, you just grab it and you throw it in and you've got everything you need.

Dr. BZ: Yeah. And again, you can see . . . My wife makes fun of me because mine's a little overkill. I will say, so zip ties are great. The other thing that works really well for any sort of securing or kind of jury rigging some together are Voile ski straps, if you're familiar with those. They're very heavy duty, kind of stretchable straps that have saved me in a lot of different environments. And so I've got a couple of those in the bin as well, and a multi-tool like you said.

Scot: Mitch, how's your survival kit shaping up in your car? How are you doing?

Mitch: It's pretty miserable. I'm the opposite of Graham in my relationship. Jonathan has maybe seven different first aid kits and survival kits in each of our vehicles and everything. I just have some tools. Like, I drove junk cars for so long in my life, I have a mobile thing to fill up my tires. I have a full tool kit. I have spare spark plugs, spare battery jumpers, etc. But nothing if my car were to break down into like the wilderness. I think I maybe have a Red Bull in a glove box, but.

Troy: Well, since we're talking about Wyoming, I have to tell you my favorite, not favorite, but just, yeah, a survival experience in Wyoming. I pulled off an exit. I was driving through Wyoming. I was super tired. So I took a nap, but I left my lights on. And it was just an exit out in the middle of nowhere in Wyoming. And so my car died and there's no one there. And so I just I had jumper cables. So I do have jumper cables in my car. So I got out and I'm just walking along the highway just thumbing and holding up jumper cables, thinking like some nice person will just see I need my car jumped. Like, no, they're going to think like some creep is out here walking along, getting ready you to strangle me if I pull over. So fortunately, I found like this old, rundown gas station like a couple of miles down the road, middle of nowhere. So I found the guy there and the guy's like, "Yeah, if you give me 40 bucks, I'll go jump your car." So.

Scot: Oh, that's real neighborly.

Troy: Yeah. It was super nice. I'm sure it's not the first time it's happened there, but anyway, yeah, I can't imagine. And do you carry like . . . Speaking of your car dying, since then I've thought, on long trips, you can get those kind of small things to jump your car battery that are rechargeable. Do you carry one of those as well?

Dr. BZ: I do. Again, out of experience. So I had a similar experience, and actually, Troy, you're familiar with this. So I was driving back from a shift at about 4:00 a.m. on Highway 80. And I got a flat tire between the two exits between my house and Troy's house. And so I was probably about four miles from home. So I pull over, I fix my tire, and I get into the car to drive, and I had left my headlights on and my battery was dead and I did not have one of those devices.

Troy: Oh, no.

Dr. BZ: Yeah. So I ended up . . . Thank God, I had my headlamps. And at the University of Utah, we wear black scrubs, so I'm running down Highway 80 trying to get home. And so I have my headlamp over my head, and I'm flashing it so someone can see me. And I have to run the four miles home to wake my wife up, who wasn't answering her phone, to have her take me to my car. So since then I use one of those devices. The one I use is called Jump-N-Carry, and I take it on all my van trips. We have a VW van that it definitely lives in the back of that. And I also have one, like a smaller version in my car as well, just so I don't get stuck in that situation also.

Scot: So if I'm hearing this right, it sounds like that in my car if I'm going to be driving out, you know, maybe this might be actually a trip out in the back country, I'm driving to go somewhere, I'm doing a little expeditioning or whatever, or just a, you know, across the lonely state of Wyoming on a highway in the wintertime, it sounds like there's a few categories of things I want to have. Thing number one is things to get me out of the situation I might be in, which you talked about. Thing number two is if you can't get out of that situation, warm clothes, sleeping bag, gloves, hats, boots, that sort of thing. I suppose that's also helpful if you have to walk and get help, because, I mean, how many of us would have adequate clothes to go on a prolonged walk in Wyoming, in the wintertime? And then it sounds like number three is food and water. Does that cover kind of the major things?

Dr. BZ: That's definitely how you want to think about it. Again, you don't have to have all the stuff in your car at all times. You should just think about the trip you're doing and how much time, you know, worst-case scenario you think you'd need to be self-sufficient or what you need to get yourself to a safe spot or to a place where you can contact folks.

Troy: And I'm going to ask this real quick here, Graham. I remember there was this horrible story like a couple of years ago. A guy was going out to interview somewhere out in like the west desert and took a wrong turn and his car got stuck and he went to try and find help and died out there somewhere. So I guess that brings up the question, and I've thought about it a lot since then. Are you better off if that does happen and you are in a situation where you get stuck, do you just stay in your car, or do you go out trying to find help?

Dr. BZ: So most of the time we advise, if you're lost like that, you stay with your vehicle, you stay where you are, because people are going to have a better sense of the general area where you're going to be. If you leave that space, if you leave that area, you know, vehicle, that's much easier to spot from, you know, a search helicopter, a search plane, it's going to be much harder to find you. So the best advice is to stay with your vehicle in that case. Unless you know exactly where you're going and you have a very good sense that you can . . . you know, if you passed a gas station four miles ago and you know you can get there, that's one thing. But if you're just completely lost and, you know, more than a reasonable distance from any infrastructure like that, just stay with your car.

Troy: And it sounds like with the kit you've got, you know, 10 gallons of water, you've got protein bars, you've got sleeping bags, you can just set up camp there and live there for a week and you're good.

Dr. BZ: Yeah. Honestly, it'd be a great break. Yeah, [inaudible 00:17:54].

Scot: Oh, my God.

Troy: So if you don't show up for a shift next week, I'll know what happened.

Dr. BZ: Yeah, exactly.

Troy: Graham goy lost? I guess he's okay.

Scot: I was going to say Graham's living better in the event of an emergency in his car than I live in my house. What do you bring to read to kill time? Since, I mean, you're going to be so cozy and well-fed and well watered.

Dr. BZ: Yeah. You have a spare book. You're listening to all your podcasts on your phone. You have an extra battery for that.

Troy: Just listen to 90 episodes of "Who Cares About Men's Health?" You know? What more could you need?

Dr. BZ: Exactly.

Scot: If the exposure doesn't kill you, the podcast will.

Troy: That will be the end.

Scot: All right, Graham, thank you so much for geeking out a little bit about what's in your first aid survival kit or your in-car survival kit. That's been a lot of fun. And thanks for sharing your health story as well. And thanks for caring about men's health. It's been great having you on the show.

Dr. BZ: It's been a ton of fun. Thanks for having me.