First Aid Kits for Wilderness Hiking and Backpacking

by Mike Radomski

   

The best first aid kit is one you know how to use.  It is important to understand its contents and which items can have multiple uses. It is also important recognize your first aid kit’s limitations and thus learn how to use your environment to provide emergency resources. For example, I do not carry a Sam Splint on backpacking trips because I know there are many ways to improvise immobilizing a joint using resources from the environment (i.e. trees and branches)  

I highly recommend taking a Wilderness First Aid (WFA) course.  WFA skills are important to anyone tackling local trails or planning multi-day backpacking adventures in the High Peaks. WFA will teach you the essential skills for remote first aid, help you understand decision points for care when an ambulance or ranger is several hours or days away and how to use materials in your environment to administer critical care.

WFA Class Practical Skills Scenario - Chestnut Ridge Park.. 

Every first aid kit should have a base set of items to address basic first aid which includes wound care, medication and various “tools”. We will classify these items as Essential. Vertical Aid by Seth C. Hawkins goes over 9 considerations when building a first aid kit:

1. Medical Knowledge of Group
2. Size of Group 
3. Climbing Environment
4. Destination and Diseases/Illnesses Common to the Region
5. Medical History of Group Members
6. Duration of Trip
7. Distance from Definitive Medical Care and Availability of Rescue Assets
8. Availability of Communications
9. Space and Weight Considerations

The quantity of Essential items is dependent on all the above factors. Including the Recommended first aid items in your kit may depend on one or more of the considerations above.

Vertical Aid recommends using the PAWS acronym as a helpful guideline for organizing the creation of your first aid kit:

• Prevention/Procedures
• Analgesics/Antibiotics/Anaphylaxis
• Wound Care
• Survival

Pre-made vs. Custom-made

There are many very good pre-made kits on the market. I recommend looking at the Adventure Medical Kit (AMK) line. They have a wide range of kits for different group sizes, lengths of trips and activities.  For example, I carry the AMK Ultralight/Watertight .5 on local day hikes and a larger kit for multi-day backpacking trips. 

AMK are a very good, inexpensive way to jump start your first aid kit. The AMK Ultralight/Watertight .9 is rated for 1-4 people, 1-4 days and contains many of the Essential items we will review in this article. When you try to build your own kit, you often have to buy large quantities of some items, enough to fill several kits.

Although the pre-made first aid kits are very good, you will still want to add (or remove) trip and group specific items.  The pre-made kit may contain items you will not need for your climate or time of year.  It will most certainly not contain all of the quantities of each items needed for a group.  For example, groups with kids will need more bandaids than groups with only adults. Conversely, the adults in the group may need more supplies of Ibuprofen and diarrhea medications.

My recommendation is start with an Adventure Medical Kit.  They are the best “bang for your buck”.  I suggest starting with the AMK Ultralight/Watertight .9 First Aid Kit or AMK Mountain Series Weekender First Aid Kit.  One of the added features of the Mountain Series over the Ultralight is the included Wilderness and Travel Medicine Guide Book.   It is good resource to have in the backcountry when you cannot Google treatments and symptoms. The trade off with the Mountain Series is that its case is not waterproof, like the Ultralight’s.

The NOLS Wilderness Medicine handbook says:

There is no such thing as the perfect first aid kit, so you should consider your needs and build a kit that meets them.

Below is an extensive list of first aid items for wilderness travel compiled from a number of different sources including NOLS, REI, NPS, Alpine Institute, ARC, and Vertical Aid. Many lists are just that lists. I wanted to create a comprehensive list AND give some explanation on the uses of each item.

Essential Items

PREVENTION/PROCEDURES

Item	Possible Uses
Small Trauma Scissors	For cutting  clothes, tape, dressings, forming moleskin, etc.
Medical Gloves	Body Substance Isolation (BSI) – keep yourself safe!
Tweezers	Remove wood slivers, ticks.
Nail Clippers	There is a whole article on Outside about it.
Electrolyte Tablets	Replenish lost electrolytes, for dehydration. NUUN tablets are are my favorite.
Aquatab water purification tablets	Purify water when other methods have failed or are unavailable.
Medical Tape	Almost as good as Duct Tape, suitable for wound care.
SPF 15 lip balm	Chapped lips suck! Can be used to start a fire.
SPF 30+ sunscreen (PABA-free)	Packets are good for a backup to your primary bottle.
Duct Tape	MacGuyver could make a stealth bomber with it and he didn’t have Gorilla Tape, can be used it to fix tents/shoes/etc, seal wounds, pad blisters, immobilize a broken bone, etc,  etc, etc…
Small notepad & waterproof pen	Keep track of important primary and secondary assessment data.
Hand sanitizer	Clean hands on the trail is a luxury, it is a good idea to sanitize your hands before and after care.
Irrigation Syringe	Cleaning out deep wounds without touching the wounded area, flush out an eye.
Oral Thermometer	Monitor temp changes in patient, changes can be symptomatic of multiple conditions.
Insect Repellent	Mosquitoes suck!
Vasaline	Chapped lips and other parts, fire starter, burns and minor scrapes.

ANALGESICS/ANTIBIOTICS/ANAPHYLAXIS

Item	Possible Uses
Ibuprofen (Advil)	For inflammation, muscle strains, minor pain and cramps.
Acetaminophen (Tylenol)	For pain relief, fever reduction.
Aspirin	For response to heart attacks, chewing has been shown to have the fastest results.
Diphenhydramine (Benadryl)	For minor allergic reactions.
Loperamide (Imodium)	For diarrhea, explosive diarrhea is not fun in the wilderness.
Antacid (Tums)	For upset stomach.
Glucose Tablets	Good to have for low blood sugar and diabetic hikers.
Insect Sting Relief	See Insect Repellent, bees suck too!
Tincture of Benzoin	Magical serum that protects the skin and allows adhesives to to adhere better, even wet.
Burn Gel (Aloe Vera)	For sunburns and minor burns
Throat Lozenges	As DJ Kool said “Let me clear my throat.”
Cortisone Cream	Help with itching from poison ivy, rash or allergy
Gold Bond Powder	Curb moisture, control odor, and soothe minor skin irritations, notably jock itch

WOUND CARE

Item	Possible Uses
Hemostatic Gauze	Stop bleeding on large wounds, has agents that assist in clotting.
Moleskin	Reduce friction for blister care, finger cuff.
New-Skin	Liquid bandage for cuts and blisters.
Bandages (assorted sizes)	General small wound care.
Knuckle bandages	Shaped especially for fingers and knuckles.
Butterfly Skin Closures (Steri-strip)	For closing up deep wounds, especially when junior slips with the pocket knife
Trauma pad	Highly absorbent dressing for deep, bleeding wounds. A maxi pad is a good substitute.
Steripads (2×2 and 4×4)	Non-stick, used for dressing wounds or burns where other fabrics might stick.
Roller Guaze (2in x 5y)	For holding gauze pads in place, securing splints and improvising slings.
Coban Wrap (Self adhesive wrap)	Adheres to itself, but not other surfaces. Can be used like gauze, but will stay in place better on moving parts.
Sterile alcohol prep pad or Antiseptic towelettes	Clean wound and surrounding surface, clean your hands.
Antibacterial ointment	Prevent and fight infections in wounds, promote healing.
Triangular Bandage (cravats)	Many uses, common are a sling or tourniquet.
Sam Splint	Waterproof, reusable splint for immobilizing bones, can be used as a neck collar to immobilize the head on suspected spinal injuries.
Safety Pins	Securing bandages or splints to base layers, removal of wood splinters.
Elastic Bandage (ACE)	For sprains or securing a splint.
Cotton Swabs	Clean laceration or eyes.
Eye Wash Solution	Flush eye irritants.
Tegaderm Transparent Film Dressing	Provides a moist healing environment while allowing wound to breathe. Good for road-rash type injuries, can be improvised for a sucking chest wound.

SURVIVAL 

Item	Possible Uses
Lighter	Start a fire, sterilize needles.
Emergency whistle	Signal rescuers.
6 mm cord (2 m long) (750 paracord)	Lots of uses for cordage. Suggest looking at Dyneema based cord (1/8” has a breaking strength of 2,500lbs)
Survival blanket (84˝ x 52˝)	Ground cloth, blanket for warmth, improvised shelter.
Signal Mirror	Start a fire, signal rescuers

Recommended Items

Item	Possible Uses
CPR Mask, if trained in CPR	Body Substance Isolation (BSI) – keep yourself safe!
First Aid Manual	Knowledge is power, there is no Google in the backcountry. NOLS Pocket Guide or NOLS Wilderness Medicine Field Guide are good choices.
Chemical hand warmer	Treat or prevent hypothermia and frostbite during cold weather seasons.
Personal Locator Beacon	Send distress signal and GPS location to rescuers. There are many options, see this article.
Tenacious Tape	Great to repair gear and tents.
Dyneema Rope	Lightweight and super strong compared to Paracord.
Figure-8 rappel device	Can be used to lower or hoist patient from a cliff or ravine.
Carabiners	Many uses, can be used to create mechanical advantages or secure a patient.
Sewing kit	A needle and thread take up no space and can be very useful.
Bandana	You will look like a rock star, can be used to dress wounds, apply cold compress, improvised sling, etc, etc, etc.
Prescription Medications	Need is based on the group’s medical conditions.
Injectable epinephrine (Epi-pen)	Need is based on the group’s allergies, Epi-pens have more medicine than a single injection, see Retrieval of Additional Epinephrine From Auto-Injectors.
Medical waste bag	Keep group safe from used dressings and materials.
Emergency Bivvy sack	A lightweight, must have items for 3-seasons of the year.

References

• American Red Cross Wilderness First Aid
• Vertical Aid by Seth C. Hawkins
• https://store.nols.edu/collections/first-aid-supplies
• https://blog.nols.edu/2016/06/03/27-considerations-for-a-first-aid-kit
• https://blog.nols.edu/2017/06/27/5-things-to-check-in-your-first-aid-kit
• https://press.nols.edu/building-a-proper-first-aid-kit
• https://www.nwrafting.com/safety/personal-first-aid-kits
• https://blog.nols.edu/first-aid-kit-advice-river-travel
• https://www.rei.com/learn/expert-advice/first-aid-checklist.html
• https://www.nps.gov/grca/planyourvisit/upload/Noncommercial_River_Trip_Regulations.pdf
• http://www.alpineinstitute.com/articles/expert-tips/building-your-wilderness-first-aid-kit/