First, I want the reader to understand that these are only my suggestions. This article is not a substitute for advice from your own physician or other recognized authorities in first aid and wilderness medicine. Advice from this article should be compared to other resources and reviewed along with specific information about medical history and the planned activity.
Hiking is an excellent sport and exercise, whether for a short day hike, a longer walk for a few days or a week, or a long distance trek for several months. As with any sport, preparation and training help to make the endeavor fun and safe. As with any sport, injuries, accidents and illnesses will occur. In general, a first aid kit should be part of your survival gear and always available for hikes. It is a good idea to keep a kit for all general activities as well as one that is targeted to specific endeavors. For instance, you don’t need the same gear for water skiing as you might carry for a spring walk in the Smokies. However, there are several basic items that you will want to have, at least on your person. You can compare this to how you carry your driver’s license while driving to the corner store, carry a Voter’s Registration card when voting, carry a Passport when traveling to Paris, and carry a driver’s license, Social Security card and proof of citizenship to a new job.
So let us begin with the basic ID. Grab a 3×5 card and write your name, address, phone numbers, identifying numbers, insurance numbers, next of kin, and a list of illnesses and medicines you take. Then in RED, write your allergies. Laminate this card. This card stays on you all the time.
Next, find something to carry your first aid kit in. Look outside the envelope. For instance, you might want to put ID, a few bandaids and Aspirin in a film canister that you keep in your pocket, or attached to a lanyard about your neck with your compass and whistle. This container needs to be small, light, and easily carried. The container should be in your possession for every short walk to get water, use the toilet, sight see, or other activity.
For more involved first aid, a larger package (Ziplock bag, soapbox, or other small container) should fit into your pack and will contain more significant gear. It should offer convenient access and never be buried in your pack. Wander around the grocery store, pharmacy, or your basement to find just what you will need. Some are able to make a small box work, keeping it in a pocket. Others will feel the need to keep a kit that requires a fanny pack. If you do much winter or off road travel, you may want to consider keeping a larger kit in your trunk that would include a shovel and more heavy and bulky gear for treatment of trauma or basic CPR.
In my case, I use Ziplock bags. I like the firm quart size that will stand independently. (A sturdy plastic bag can double as an emergency water container). Because it is clear, you can take quick inventory of your first aid resources. A sandwich baggie might be worth bringing to help contain ticks and other nasties you might find attached to you, and want to take to your doctor or ER if you become ill-having a specimen handy may aid in the diagnosis of a tick borne infection.
I like to keep essentially two kits. The one attached to me will provide essentials if I lose my pack. This is a small Ziplock, jar, or film canister attached to a lanyard with a compass, mirror, LED light and whistle. This kit also contains the ID card. I might put a Mylar blanket in this container, just in case I need emergency shelter. Two large black trash bags can also serve this purpose, and will collapse to a very small size. I also put a BIC lighter in the kit. This part of my kit gives me emergency shelter, ID, medical information, three means of signaling for help (mirror flashes, light flashes and the whistle), as well as means to start a fire. I also attach large safety pins to my zippers. These help attach slings and splints made from clothing, bandanas and other gear, and double as a convenient zipper pull.
The larger Ziplock bag or other container will sit in the top compartment of my pack. This bag will also contain prescription medicines, along with labels from your pharmacy to identify and confirm that you are in possession of medications and not diverting prescriptions for abuse. Some pharmacies provide a service to pack medicines in individual dose packs, which helps prevent breakage, spoilage, water damage, and aids identification. Avoid the usual fragile pill bottle that will allow humidity (which dramatically reduces the shelf life of your medicine) and crushing of contents. Consider using a ball of cotton soaked in Vaseline to reduce breakage, as well as means for cleaning a wound, starting a fire, or other use. A small magnifying glass can give you an additional way to make a fire, as well as a means to check a wound or search for ticks. There should be a small notepad that details the contents of the container, numbers and types of medicines, and can be used to keep a chronology of treatment, along with a small pencil. You should make a few choices about non-prescription medicines such as Aspirin or other analgesics, vitamins, GI remedies, electrolyte replacement powder, salves, lotions and other agents. Personally, I carry Aspirin, two moderate strength oral narcotic tablets, pink bismuth tablets (Pepto Bismol), Tums for daily calcium supplement, and possibly one or two sleeping tablets. An antihistamine, such as Benadryl, can help treat reactions to allergies or insect bites and stings.
Next I include trauma and injury supplies. Think about what accidents and conditions may occur on your walks. I divide these into two groups. First, let’s consider minor inconveniences that make the walk difficult but can be tolerated. These include abrasions, blisters, sunburn, dehydration, insect bites and stings, and other minor traumas or conditions. Get two pairs of latex gloves and use them to contain each other. In the fingers of these gloves put your minor injury supplies such as bandaids, moleskin, Compeed or other bio-occlusive dressing, butterfly strips and other wound dressings. Add to this small tubes or packets of salves such as triple antibiotic creme, diaper creme, sunblock (often included in skin lotions), DEET or other insect repellant.
The second group deals with potential trip ending events such as burns, lacerations and orthopedic injuries. Grab your choice of 3-inch gauze roll, Ace Bandage, 4X4 pads, sanitary napkins and other wound dressing. Add to this either a small roll (10 feet) of Duct tape or bandage tape. I keep more duct tape rolled around my hiking poles. You might want to carry a small amount of Saran Wrap, which can be an excellent temporary burn dressing. You could carry a SAMS splint, but remember that hiking poles and mattress pads can do a very good job of splinting with duct tape, with torn clothing, safety pins, or rope to keep the splint in place. You should also arm yourself with basic first aid education regarding lacerations and musculoskeletal injuries, and not just a book to thumb through during a crisis. You should make decisions about carrying snakebite equipment, remembering that the old advice of cutting, sucking out poison, and such are now considered to be very ill advised.
Finally, consider what you might need for other life support. Iodine tabs or solutions can help clean wounds and treat water. Are you prepared to provide mouth-to-mouth resuscitation, or will you carry a barrier to protect you from a potentially infected and non-responsive victim? Do you feel the need to carry snare wire or fishing gear to obtain food? Do you understand the need to get a hypothermic person out of wet clothing, even if only to put them into large trash bags to warm up?
One can find multiple uses for first aid items and the means to improvise with what you already carry or wear. Many find they can do well with only ID, a few bandages and limited medication and lotions. Most find their own comfort level with the decisions of what gear to bring or to leave behind. There is little need to carry a first aid kit that would provide all the functions of an urban paramedic’s kit. Regardless of what you bring, make sure you know how to use it. Take the time to learn basic first aid for the major maladies of the trail. This knowledge should include recognition of hypothermia and hyperthermia, dehydration, fever, infection and shock. One should have knowledge of how to stabilize a potentially fractured limb, how to stop bleeding, and how to manage burns, insect bites and other injuries.
A well-stocked mind will make a well-stocked first aid kit out of items at hand.
Editor’s Note: Dr. Thornoloe’s last statement couldn’t ring more true to a lightweight backpacker. The keys to minimizing the weight of your first aid kit include an increased base of knowledge that allows you to use other equipment items to treat major injuries, and accepting the possibility that minimizing your first aid supplies may result in ending your trip early due to an inability to treat a normally minor injury. Also, one must keep in mind that the need for rescue and survival equipment depends largely on your hiking locale. In most places in the lower 48, carrying survival equipment can usually be replaced by participation in a good wilderness survival curriculum; however, the importance of rescue (signaling) equipment cannot be emphasized enough. With a life-threatening injury, nothing is more important than getting the victim out of the wilderness FAST. This need alone may justify carrying items like a cellular telephone, signal flare, strobe light, or red smoke bomb.