The Pragmatic Approach

“We pack our fears” is an old adage in the backpacking community, and it couldn’t be more true when applied to first aid kits. I’ve seen (and probably carried myself) kits weighing many pounds with enough gear to account for the worst situations imaginable. But after more than 20 years of backpacking, I now take an approach that focuses more on what is most likely, that considers ways to re-use other gear for more extreme cases, and that takes into account my own training and limitations. I am not a medical professional. I do have a fair amount of first aid training, including Wilderness First Aid, and through my involvement with search and rescue (SAR). And I’ve had many conversations over the years while hiking and backpacking with physicians, Wilderness First Responders, nurses, and EMTs. I was initially surprised by how sparse their kits were but over time I really came to appreciate their more pragmatic approach.

Overview

In this post, I’ll do my best to outline all of the components of my personal kit, I’ll offer some specific recommendations, and I’ll wrap up with a few suggestions for organization. I’m going to stress that this is a personal kit. It is not the kit I take when I am responsible for others, it is not the kit I take when doing SAR. It’s also not a guide for how to perform first aid or really the finer points of how to use these items. This post is really just focused on the components to consider for your kit. Where it helps to explain why I am choosing certain items, I’ll explain how I use them, but mostly I will leave it to you for knowing how and when to use these items. And I highly recommend anyone heading into the backcountry to have basic first aid training, preferably wilderness first aid (WFA — “woofa”) training. And if you don’t have a basic field guide, get one. A small pocket guide is fine, but I make good use of the fact that I am already carrying a phone and so I have a collection of reference books downloaded to my Kindle library.

Twofirstaidkits

Twofirstaidkits

Aches and Pains

I’ll start here because it is the part of my kit that gets the most action. To address the general achiness after a long day of hiking and the stiffening of joints, I carry Ibuprofen (e.g. Advil). It can really be as simple as that, though I also usually carry some Acetaminophen (e.g. Tylenol). Ibuprofen has the benefit of not only reducing pain but also reducing inflammation. But Ibuprofen and Acetaminophen each can also address fevers and since they each work in different ways, they can even be taken together. Just pay attention to the dosage cycles.

How much to carry? This is a general question for each item and I usually base it on the length of my trip and the worst-case scenario. During a trip a couple of years ago, I suffered an excruciatingly painful knee injury on a 3000′ descent into camp. It’s the only time I have seriously considered calling for help, but I instead took Ibuprofen and decided I could hobble the final 3 miles to my designated camp and would reassess in the morning. With 20 miles to the trailhead, I determined that with pain management I would be able to do it if I spread it over two days. That would be 2x200mg pills every 4 hours.  Even if I didn’t take them after setting camp, I would need at least 8-12 pills. I had a lot on hand and the reality is that I ended up doubling on dosage and dosing early a few times. I probably took closer to 20. I do not recommend this, by the way, but you do what you need to do. My point here is really to consider the length of your hike, how an injury may extend your hike, and adjust your kit to ensure you are covered for the possibility of needing treatment that covers you until you reach your final destination.  For a bad injury like this, you should be assessing your quickest exit, which may mean turning around. So generally, worst case is that you are right at your halfway point and can either complete your hike or turn around; so plan treatment or 1/2 of the hike distance and much longer duration as you may be moving at a slower pace.

Put in Your Kit:

Blisters

I rarely get blisters, but based on my personal experience when hiking in groups or even just encountering folks on the trail, this is probably one of the more common injuries people deal with. And the key to handling blisters is really to avoid them. So let’s start there, how to avoid blisters to begin with.

Many people often just attribute it to a poorly fitting shoe, or boots that need to be broken in, or feet that aren’t callused enough, or accept that it’s just what happens when you hike. While some of this may be true, I really do believe that you can mostly avoid blisters and there is no reason during routine hiking and backpacking that you should have to suffer from blisters. A little prevention here will serve even better than your kit and will help inform you on how and when to apply your kit.

Why do you get blisters? Simply put, it’s friction. There is a sliding force being applied to your skin; causing layers of your skin to separate, the gaps being filled then with fluid. I may write another article at some point diving into the finer points of socks and shoes, but for the purpose of this post, know that most blisters can be prevented and it starts with finding and eliminating sources of friction. Keep your feet dry. Invest in high-quality socks, like Darn Tough. Learn how to properly identify a good fit in your shoes or boots, and how to lace your footwear properly.

The key to treatment out on the trail begins the moment you start to feel any irritation. I can’t stress this enough. Don’t put it off. Don’t wait for the next break. Stop where you are and address it immediately and you can still avoid a blister. At this point, the only thing I do is apply Leukotape P. You may be familiar with a similar product, Leukotape K, or “kinetic” sports tape that you see athletes apply for support. The “P” variety doesn’t stretch, which is much better for this application. It adheres extremely well, is breathable, and has a slick surface. It will keep your skin holding well; instead of the skin sliding against the point of friction, the tape will be sliding. But, you do not want to apply it directly to a blister! When you remove the tape, it will peel and tear your now loose skin. This is for treatment ahead of a blister. And yes, you can use duct tape in a pinch, but Leukotape is much better at conforming to the shape of your anatomy and it’s breathable.

If you actually develop a blister, you need to take care to not put anything as sticky as Leukotape on the compromised area of the skin. This is where I like Moleskin. You can cut a hole in the moleskin to surround your blister or even put the moleskin right over your blister if it isn’t severe. Moleskin doesn’t stick particularly well. But you’ll also often find it rolled up in your sock after just a mile or two of hiking. I like to apply a piece of Leukotape over the moleskin to hold in place. I’ve found this to be very effective when I do actually develop a blister.

Put in your kit:

Minor Burns

Likely causes of minor burns are going to include minor sunburns, handling of a stove or pot that hasn’t sufficiently cooled, or scalding from uncareful handling of boiling water. The result can vary from broad, superficial burns, to a small but deeper burn that may result in some blistering or exposure to lower layers of skin. I’m not talking about the more serious, full-depth, burns here.

For the broad superficial burns like a light sunburn, the most immediate treatment will come from cool, running water. If you are near a cool stream, place the burned area of skin in the water. If that isn’t possible, soak a bandana in cool water and apply it to the burn. For additional relief, you can apply a lotion containing aloe-vera, and take ibuprofen for pain and inflammation.

If there is any blistering or opening of the skin, some additional care is needed. There are a lot of ointments on the market, but they generally seem to fall into two categories:

  1. Antiseptics w/ Analgesic:  These mostly use benzalkonium chloride for the antiseptic with lidocaine for the analgesic pain relief. Some will contain aloe and other inactive ingredients specifically formulated for burns.
  2. Triple Anti-biotic: These use the combination of bacitracin zinc, neomycin sulfate, and polymyxin B sulfate.

Finally, you’ll want some small bandages and tape to dress your wound.

Put in your kit:

A couple of additional notes: If you shop based on ingredients, you’ll notice that there is actually little difference between the many products on the market. Some of the differences are just marketing. For example, Neosporin +Pain Relief and Neosporin +Burn Relief have the same ingredients. They are both a triple antibiotic (with ingredients as described above) plus pramoxine hydrochloride, a topical pain relief.

You may consider then if you really want to carry multiple specialized ointments or simply carry one all-purpose first aid ointment. Similarly, if you are already carrying leukotape you may consider just carrying that instead of additional tape just for applying bandages.

Small, Bleeding Wounds

For small cuts and scrapes, similar to burn wounds, you’re going to want to clean the wound well, apply an antibiotic ointment, and close or otherwise bandage the wound. Cleaning an open cut in the backcountry can be a challenge. Imagine yourself stumbling on the trail, breaking the fall with your hands. You have small lacerations on the heel of your palms and the open cuts are filled with trail grit. The first challenge is going to be the lack of running water with sufficient pressure to really clean the grit out. An irrigation syringe is really handy in these cases. I like the 12cc Dental Syringes with a curved tip.

Dental Syringe

The next issue is access to clean water. Water that is clean enough to drink should be fine.  Another reason to frequently top off your filtered water supply and to carry at least one bottle without adding supplemental flavoring.

Because we make do with what we have and our water may not be the cleanest, and keeping the wound clean will be a challenge, application of antibiotics or antiseptic ointment is all the more important. A general purpose first aid cream or triple antibiotic will do fine here.

For a dressing, the same bandages and tape you’re carrying for burns can be used. But that can sometimes be too much for smaller cuts and too difficult to keep clean over a long hike. An assortment of bandaids of varying sizes will be nice to have. Additionally, I usually include a few laceration closure strips, like the 3M Steri-Strips. They can be useful as they’ll keep the skin closed tight, making it easier to keep clean and promoting quicker healing.

You may also want to consider carrying Tincture of Benzoin. This is a compound to apply around the area of the wound (not in the wound). It is an alcohol base so there is some antiseptic benefit but the primary benefit is to improve the adherence of the bandages. You can use it before applying moleskin, first-aid tape, bandaids, or wound closures and it does really work well. I generally find it unnecessary. If I have trouble with a bandage sticking, I will overlay it with leukotape, which holds exceptionally well.

Put in your kit:

Note what is not on this list: alcohol wipes. They tend to be included in many first aid kits and are indeed useful antiseptics. However, they also damage healthy skin. Use them to clean your hands, tweezers, or your knife, but not to clean your wound. If the skin surrounding your wound is dirty or oily, some will use the alcohol wipe to clean the surrounding skin. If you are cleaning your wound with soap and water, this shouldn’t be necessary, and definitely not necessary if you use Tincture of Benzoin.

A few rules to keep in mind: if it stings your skin, it’s damaging your skin and the solution to pollution is dilution. Clean your wound regularly with nothing but water (and gentle soap if you have it).

Minor Allergic Reactions, Insect Stings and Bites

For simple inhaled or ingested allergies and for particularly bothersome stings and bites, I carry Benadryl (diphenhydramine). Some folks prefer other antihistamines and there are several available so just carry what works well for you. I won’t address more severe reactions here. If you have known allergies that warrant the use of an epi-pen, then you probably know it, probably have the pen, and know to carry it. However, if this is you or you hike with someone that does have severe allergies, talk to your doctor about appropriate dosages and be aware that there are actually up to 5 additional doses within a single auto-injector. Search youtube for videos on how to access and just be armed with the knowledge in case of emergency.

If you are stung by a bee, first look for the presence of the stinger. A bees stinger is barbed and typically remains in the skin and literally rips out of the bee along with the venom sack. That venom sack will continue to pump for a short period of time so you want to carefully remove it. But don’t just pinch and pull it out with your fingers. This will just squeeze the remaining venom through the stinger and into your skin. Instead, pull your skin tight and scrape the stinger off. I get stung many times throughout the year (I’m a beekeeper) and I’ve found it easiest to just use the backside of a pocket knife but any flat edge should work well.

Once the stinger is removed, and for any other type of sting or insect bite, clean the area well and apply hydrocortisone cream if necessary to reduce itching and swelling.

For contact allergies, like poison ivy, treatment is as with insect bites. Clean and treat with hydrocortisone or Benadryl as warranted.

Put in your kit:

Nausea and Diarrhea

Upset stomach and diarrhea are the worst when you’re in the backcountry, particularly if you have a long hike ahead of you. Some antacid and an anti-diarrheal can go a long way; at least make it bearable to hike out if you must. Pepto Bismol or Kaopectate (both are bismuth subsalicylate) can offer some relief but Imodium (loperamide hydrochloride) is preferred by many.

In the backcountry, diarrhea can quickly become a more serious condition if you aren’t careful. You need to drink plenty of (clean) water and consider replacing lost electrolytes. I usually carry rehydration or sports electrolyte drink mixes in my meal bag. If that isn’t something you regularly consume, consider adding to your first aid kit for use only as needed. And while we are on the topic of clean water, is it possible you got to this point by drinking contaminated water? Maybe your water filter has failed? For this possibility, I do like to carry a chemical backup to my water filter. There are a lot of options out there but I carry Aquatabs because they are simple and light.

Put in your kit:

Tools

I don’t carry much in the way of additional tools specific to providing first aid for myself. You will want to consider a few items though if you aren’t already carrying them elsewhere. These include:

  • Knife: I usually carry a small pocket knife and simply use that if I need to cut tape.  If you don’t carry a knife you might want to include something like the little folding ceramic razor blade pictured below. At only 2 grams, it’s also nice to just put in your first aid kit so that you don’t have to fumble about looking for your pocket knife.
  • Scissors: You don’t really need both a knife and scissors. But if you prefer a pair of scissors, the Cuda 3″ Titanium scissors are a dream. They weigh just 20 grams are sturdy enough to cut through a pair of jeans if needed. Not a common task but also one that I would want to do with the flimsy scissors of a Swiss Army Knife.
  • Twezers: I do carry these tweezers. Again, not to knock the Classic Swiss Army Knife, but I find the tweezers in those knives nearly useless. A pair of Uncle Bills Sliver Grippers will add just 5 grams to your kit and prove invaluable in removing the smallest of splinters, cactus needles, or trail grit.
  • Finger Prick: As an alternative to tweezers, stainless steel disposable finger pricks can also work pretty well to work out an embedded splinter. I will usually carry one in addition to the tweezers.
  • Sandpaper: I know, it seems out of place and maybe it does belong with your hygiene kit. I keep a very small piece of sandpaper cloth for trimming sharp toenails. I trim my nails before any significant hike, but sometimes you overlook a sharp corner. Clippers would be overkill. You might find this sold as emery cloth. I do some woodworking and so have rolls of it readily available as it is commonly used by woodturners. The small piece you see below is about 3″ long, folded in half, and weighs less than 1 gram (0.86g).
  • Nitrile Gloves: Nitrile gloves are not only for use when providing care to others. If you’ve been in the backcountry for long, you’re likely to be a filthy mess. Sometimes it’s just easier, and it’s always safer, to just throw on a pair of gloves if you are treating an open wound, even on yourself. The idea is to limit the entrance of bacteria as much as possible. These aren’t sterilized gloves and we’re not going to fool ourselves into thinking we can create a sterile field out there. But every little bit helps.
  • CPR Shield: These are given out in CPR classes and usually come in a key-chain pouch. It goes over a subject’s face and has a one-way valve to allow you to provide life-saving breaths while avoiding cross-contamination. Resuscitation in the backcountry is a long shot, but in the current era of Covid and at only 5 g, you might feel better knowing you have it.

I usually carry a small notebook and a pen elsewhere. If you don’t you may want to also consider including in your first aid kit even a single piece of paper and a small pencil. It can be very handy to track when you are taking medication, to record vitals, etc. It’s also useful to record what you have taken out of your kit so that you have a handy reminder for replenishing it at the end of your trip.

Consider Adding To Your Kit:

What About The Serious Stuff?

Yes, sometimes more serious accidents will occur. And the simple first aid kit I am outlining here isn’t intended to suggest you shouldn’t consider those possibilities or plan for them. You should. But for personal first aid, it’s a bit of a cost-benefit analysis problem. An Automatic External Defibrillator (AED) can absolutely save a life in the event of a heart attack. Why don’t you carry one in your first aid kit? The probability of it being put to use is low, it’s heavy, it’s expensive, and someone else would need to operate it. Now apply that logic to nearly everything else that you might be thinking of throwing in your kit. Like a tourniquet. There are lots of statistics out there on causes of death in the backcountry. Arterial bleed-outs aren’t higher than heart attacks.  Sure, they only weigh a few ounces, so why not throw one in the kit? Well, we can say that about many, many, items and this is one example that can be pretty easily improvised.

And this is another key point: with a very low likelihood of occurrence, as long as I can still meet my essential needs (e.g. shelter),  I will consider improvising with what I have around me and am willing to commit to sacrificing my gear. I will cut straps off of gear to use for a tourniquet. I will use hiking poles, or even tent poles as a splint. I will use a sleeping pad as a splint. I can cut clothing into additional bandaging (keeping in mind, lots of bandages and gauze doesn’t stop bleeding; pressure stops bleeding). Sandwich bags and tape can cover a sucking wound. And so on.

So, I to simply suggest that you consider two things:

  1. Carry an emergency communication device. I always carry one. Garmin inReach Mini/Mini 2 is the one I prefer.
  2. Take a Wilderness First Aid course and consider the ways in which you can stay safe and improvise care if needed.

This latter point is really the key to keeping your first aid kit lean and light. The odds of the more serious injuries occurring are low, the ability to provide self-care even lower, and for the ones where self-care is possible, most solutions can be improvised.

So What Do I Not Carry?

Related to the above, I don’t carry anything that I would be very unlikely to need and that I can improvise. I don’t bother to carry: SAM splints, tourniquets, or triangle bandages.  Nor do I carry wound pack/clot, trauma shears, ace bandages, suction catheters,  chest seals, Israeli bandages, thermometers, nasopharyngeal airway devices. I don’t carry full rolls of tape and I don’t carry a huge amount of gauze. I don’t carry pupil lights, finger splints, or cold packs. I don’t carry space blankets, saline washes, or cold packs. All of these things I have seen in packs marketed for backcountry use.

Regional Considerations

There may be other things that I don’t carry but that you should think about. Everything mentioned so far is pretty universal. But you may want to include additional items based on where you are hiking. In the eastern US, for example, I may consider tools to aid in the removal of ticks (small piece of straw and floss, if you are wondering). What might you need to consider for other areas? Snakebite kits? Instant Ice? Give it some thought and apply some pragmatic reasoning to determine if you really need it or if you can improvise it.

Organizing It All

To close this out, let’s organize and weigh what we’ve got. First, I do like a bit of organization so that I can find things quickly. Even in my Search and Rescue kit (which includes a lot of things that I don’t carry in my personal kit) I use a stuff sack so that I can literally dump the contents onto the ground and get to everything in an instant. But I group like things together and put them together in clear plastic bags.

In the photos above you’ll see a bag for “tools”, another for “ointments”, yet another for “bandages” and so on. I often use small bags, mostly reused from other things that I have purchased.  But a freezer bag works as well and includes a spot for marking the contents. I’ll do this, particularly for my search and rescue (SAR) kit as it is typical to be attending to a subject, providing first aid,  while another person is assisting, going through your kit to get what is needed. This makes it easier for the other person to zero in on where to find things.

You’ve probably noticed that most of the items I have shown so far are individually packaged. I’ve done this for clarity and I do actually use these in my SAR kit so that it is clear to both my subject and the other SAR members what is being administered. However, in my personal kit, I don’t usually do this. I buy Ibuprofen and other medicines and regular multi-dose bottles and then repackage them into individual containers like these:

Pillbottles

I do label them, along with the dosage, particularly when it isn’t standard. And for some items that I rarely use, where it may not be obvious what it is, or for which the generic name may not be well known, I either cut off the dosing directions from the original box, or write in on a slip of paper and put in the bag with the medicine.

Directions

Finally, I put it all in a lightweight first aid bag or stuff sack that is clearly marked as being a first aid kit. Keep in mind that it won’t always be you grabbing the kit. You may be instructing someone else to retrieve it, so you want it to be readily available and easily recognized. For my personal kit, I use the white stuff sack with the red cross. My SAR kit is in the orange stuff sack. The black kit is a larger kit I will occasionally carry if I am supporting a group.

In all cases, I opt for bags that are fairly or fully water proof. That white bag is made of waterproof dyneema and features water a water-resistant zipper.  Perfect for personal use.  The black is similar. Also made of dyneema with a water-resistant zipper.  These items rarely come out and if they do, they’ll only be minimally exposed to the elements. My SAR bag though will come out in all sorts of conditions, in all sorts of terrain, and is likely to be out and stay out for a while.

Bringing It Altogether

We’ve covered a lot of ground in this post and have put together a reasonable, pragmatic, kit for treating the most common types of injuries and ailments you are likely to encounter in the backcountry. What you see below is everything I’ll typically take, assembled and organized, packed neatly, and weighing in at only 3.58oz!  (note: I neglected to include moleskin in the first picture, but it is included in the final weight).

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