Backpacking First-Aid Philosophies

[Rex Sanders]

Companion forum thread to: Backpacking First-Aid Philosophies

Two ibuprofen and a five-year-old Band-Aid ain’t gonna cut it.

[David Gardner]

Great stuff Rex. I always thoroughly enjoy your well written and insightful articles.

I just recently re-examined my own FAK and so much of what you mentioned is true that I had to laugh, from the lack of sticky Band-Aids to the discolored meds, so it was long overdue.

The thought of packing a specific first aid kit for a specific type of trip has not generally occurred to me except on a few extraordinary occasions, like a solo trip in Alaska brown bear country for which I brought some battle wound-type blood clotting bandages and powder. I don’t think they make the powder anymore.

On the other hand,  I’ve pretty much always been a type III fun kind of guy so “the usual” FAK that I built covered a fair number of different scenarios at 8.5 oz. Tailoring the kit to a specific upcoming trek shaved that about in half, without leaving out my booklets and cheat sheets (never! That’s stupid light).

[Matthew / BPL]

2. Assemble your best-guess first-aid kit for most backpacking trips.

3. Go back through all the ailments covered in your class, plus your specific requirements.

4. Which maladies can you not effectively take care of because of your kit?

Thanks for this advice. I haven’t ever thought about it in quite that manner. It seems obvious in retrospect.

[Arthur]

I would like to know any real data on most common types of injuries that occur in backpacking. I have seen somewhere that burns and creek crossing accidents are the most common injuries. I wonder if the burns comes more from the car camping crowd and campfires. For an example of a need for data, I have been hauling around a small ace wrap for a decade because I just assumed that twisted ankles would be common when hiking with a backpack. However, never seen or had one. That sort of data would be helpful in customizing the pack to the trip. And BTW, you can buy Celox clotting granules. in 2 or 15 gram packages. Never used it, but I wonder what kind of wound a small 2 gram package would cure that simple pressure would not. Inquiring mind here.

[Lowell k]

I am a medical professional so have that view, but I take into account who I am with and who I might come across. For example, there are older gentlemen out there and so I carry some emergency heart meds and a catheter. Will you likely ever need these, no. Is it worth a few additional ounces, yes imho.

Actually, at 58 years old I am now in that category of person who might need more than a bandage and some ointment.

[Rex Sanders]

Arthur – NOLS keeps records of illnesses and injuries on their backcountry training trips, involving many thousands of people going back decades. My NOLS WFR instructors frequently cited those experiences, which NOLS uses to tailor first aid classes and books. Try looking on the nols.edu web site for stats.

— Rex

[Arthur]

Rex, I looked on their page. 35% strains, sprains, tendinitis. 30% for “soft tissue” injuries. Fractures 10%. A bunch of other issues below 5%, including 3% burns. I guess I will keep my little wrap.

[Curtis Ware]

Great article, as. WFA instructor, I would be interested in seeing your Cheat Sheets.  Also would love to see the list that goes along with the FAK picture.  Thx in advamce

[Matthew / BPL]

I have a cheat sheet on waterproof paper that is tape-hinged to my NOLS Pocket Guide. The cheat sheet decides some of the acronyms I know I’ll forget and some reminders about when to use acetaminophen vs ibuprofen. It also has the current version of the Lake Louise test (⬅️ Not the correct version, I’m too lazy to look for it… The 2018 version omits difficulty sleeping). The back side of my cheat sheet has lines for SOAP Notes.

I’m tempted to share my cheat sheet (it’s nicely designed) but I’m concerned about sharing what is essentially NOLS IP publicly and I am concerned that it could have an error on it.

[Rex Sanders]

Curtis: I posted a recent FAK list here, but constantly making minor changes.

https://backpackinglight.com/forums/topic/whats-in-your-fak/#post-3712121

My cheat sheets are for important WFR topics not covered by the NOLS WFA Pocket Guide: Focused Spine Assessment, and Psychological First Aid. Can’t remember what I’ve changed from older guidance, and recommendations change, so see the latest NOLS WFR guidance to make your own.

— Rex

[John S.]

2018 Lake Louise Acute Mountain Sickness Score

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191821/

WFR Cheat Sheet

http://andyheld.com/downloadable_files/WFR%20cheat%20sheet%2041.pdf

[Albin Zuccato]

Great article!

I very much agree with you statement that a first aid course is primarily for others. Of course it comes handy if you know how to tread your own blisters (or what else). But in my view this is not the important part.

I used to be a scout leader and the children frequently asked me why they would need to learn first aid if I am trained rescue swimmer. They always got the answer you propose: They actually learn it for me! If I am “really” hurt, which I unfortunately have been several times and seen in others, I know from experience that I need help from someone else. The body is most likely in shock and even if you would know what you do normally, it is unlikely that you know then.

So, I send the same statement as you: Please, learn first aid for my sake and I learn it for your sake. It is a social responsibility!

Finally, I practical observation – I strongly recommend to keep track on the “best before date” for medication. That is why I choose to keep it in the blister as the usually have the time stamped upon them. If you repack, you need to keep that information somewhere as it is unlikely that you get a turnover that keeps the meds fresh!!!

[Eric Blumensaadt]

When I was a Ski patroller with EMT level training (plus cold weather injury training) I was usually the “first aid guy” on many group backpacking trips. Luckily nothing serious happened but my first aid kit, by necessity was about double what my individual kit was. Such things as a compact mouth-to-mouth device and some more large safety pins and more waterproof bandage tape were typical group items  brought.

Even now, post ski patrol and with no refresher courses, I am still carrying some extra first aid items on group trips. I stand ready to help certified first aiders and they are aware of my training and first responder experience.

I’ve found that my ski patrol experience helped me stay calm during injury/illness response and that calms other first aiders as well as the patient.

[Scott S]

Thanks, Rex. I just got WFA certified and enjoyed it so much I’m signed up  for a WFR course in December. My first attempt at a FAK after the class weighed in at 13 ounces. I pared it back somewhat by breaking it into: 1) PPE: A small sack with 2 pairs of rubber gloves and a disposable face shield. 2) Trail Aid: What’s the most likely stuff I’ll want while hiking? (E.g., blister kit, band aids, tweezers, small scissors (in pocket knife). 3) Medicine. 4) Trauma stuff (including syringe irrigator).

For me, breaking it down into these categories helps me to organize my kit. I probably agonize the most about trauma, because treatment requires the heaviest components but also seems the most likely inducer of panic, particularly severe bleeding incidents. Currently I’ve resolved the agony by packing stuff for severe bleeding, but no splints. Would love to hear how others make their cost/benefit decisions.

[karl hafner]

As a physician and former NYS guide I would recommend that you find medications that can do double duty if possible and do not duplicate meds.  Why take benedryl and zyrtec?  Both are antihistamines and sedatives. One is once a day ( fewer pills) and the other is 2 pills four times a day.  Claritin is once daily and non-sedating  antihistamine.  Excedrin and aleve are both NSAID’s.  Max dose for aleve is 2 tabs 3x daily (Rx dose).  I would recommend a once or twice daily NSAID Mobic or Celebrex (those are Rx).  If you are taking antihistamines for emergency use then I would take something like claritin reditabs that does not require you to swallow, just put in mouth.  Two days worth of an antibiotic could also be justified.  Some people are allergic to PCN, definitely no quinolones due to side affects.  Sulfa’s can be used for upper and lower tract infections, but again some allergies and rarely lower your sugar.  I used to take a large kit but found it never got used so it has shrunk.  Blister protection is a must.  If with a group that has minors make sure you have written permission to treat and include a list of meds and allergies for people. Used to carry sutures but realized that pressure,  bandaids and maybe steristrips work just as well.   I put my pills in a weekly pill container and label each section with name on one side and dose on the other.  They can open so its in a plastic bag.  If you have cell service and forget what a pill is just google the number/letters on it and you’ll get its name and size.

[Arthur]

Like the Claritin reditabs. Will replace with those. Thanks Karl.
Lowell, what cardiac drugs do you take and what kind of catheter?
David, they make Celox clotting granuals and Avitene.
Scott, this is very much about not packing fears and trying to predict accidents that will likely happen on the trail, then trying to find the best weight to benefit ratio. Obviously, there is no perfect answer here. I do not bring things to treat events that are unlikely, take high resources to treat, or have marginal benefit in the field. My kit weighs about ½ pound. For most, that is crazy big, but it has saved many hikes. I have a few left-over skills from my career. I hike with a small group of regulars and I am the 1st aid guy. I don’t pack for random people on the trail, but for my crew. This approach has often enabled us to keep hiking instead of forcing a turn around. A bit selfish, I know. I am not trying to prevent a true SARS call. That’s for the pro’s.
Most of my items are for preventing the hike from being called. Eye patches (have “treated” corneal tears & abrasions). Steri strips, benzoin, leukotape, tiny bit of hibiclens (have closed hand, scalp, face lacerations with good results and no sutures). 20 G needles, scalpel blades with no handle and good tweezers (removed splinters, foreign bodies in hands and feet). 3x clip on magnifying glasses (I’m old). Small ace wrap (never used). Small surgical scissors. Band-Aids, Tegaderm, safety pins and gauze. Gloves. (used often). Comb for removing segmented cactus if in that environment. My skills. (I witnessed a cardiac arrest, did cpr, and the victim/friend bought me dinner 6 days later after a helicopter evac and a defib implanted). High quality waterproof bag for it all.
Garmin inreach and phone linked to it to enable more detailed texting not possible with the 1984 garmin interface.
Meds: Vit I, ondansetron injectable, Flomax, (my history of kidney stones), Benadryl, Diamox, Decadron, Cialis (for HAPE, not what you think. Some people I hike with live at sea level), ab salve, small betamethasone cream, 350 mg aspirin for MI. 1mg Epi and syringe, Toradol injection for pain. (all but the Epi, ASA and Cialis have been used.)
Things NOT taken: CPR mask. Now would only be used for a lightning strike. I have every vaccine known to man other than dengue. I’ll take my chances on getting the few other diseases from the victim. Airways. I did anesthesia and know my way around the airway. Bleeding granules. If I was hunting, I would bring them. Most trauma I have seen are small lacerations and blunt trauma, not big, open, bleeding wounds. My friends don’t bring big knives or saws to impale themselves. No guns in our group. Face shield. I wear bifocals. Triangle bandages, splints. Make due with torn shirts and hiking/tent poles. Cold compresses, emergency blanket, thermometer, blood pressure cuff, stethoscope. I would love to have most of these, but the weight/information ratio is not favorable. Big blister kit. My friends wear good running shoes now and we don’t get many boot blisters. Leukotape covers it if needed. Narcotics, sedatives, or sleeping meds. (in a rare group campsite, I caught someone going thru my pack after talking about first aid, I am sure they were thinking I had narcotics since I had other prescription drugs). Snake bite kits. (obvious) No longer take antibiotics, especially Cipro. We are very careful to prevent GI issues from water and poor hygiene. Again, benefit to risk ratio is poor.
Open for any thoughts.

[Rex Sanders]

I covered many of my FAK decisions in the following thread last month, starting here and extending across several questions and replies:

https://backpackinglight.com/forums/topic/whats-in-your-fak/#post-3712121

Some of the meds seem duplicative – but I carry each one for a good reason. At an average of 6.5 grams per pouch including pills, not a big weight penalty.

As I wrote in the story:

Get trained. Consider your unique requirements. Then put together your own first-aid kit.

What works well for me probably won’t work well for you.

— Rex

[Rex Sanders]

More on first aid philosophies

Do you want to be ready for emergencies only, or also improve comfort and performance?

For example, I carry a couple of different antihistamines. Benadryl is good for both emergencies like anaphylaxis from bee stings, and for comfort/performance like inflammation, allergies, and sleep. But I also carry Zyrtec, because sometimes I want hay fever relief without drowsiness.

I also carry a variety of pain relievers. Some are better for particular aches than others, like migraine. And certain people can’t handle specific meds.

The weight of extra pills is almost negligible, as I mentioned above.

Some backpackers believe they can gut it out through these problems, and save an ounce or two (30-60 grams). On the other hand, comfort/performance problems can make a bad situation much worse – like if you are in too much pain to hike out on your own.

But there are much heavier ways to pack your fears than a slightly hefty first aid kit.

HYOH.

— Rex

PS – Tip for sick or injured people too stubborn to call 911: Ask someone else to call for you. Worked out great for me a couple of times.

[Matthew / BPL]

100% agree with Rex on the utility of carrying a few extra pills. I use Claritin and Benadryl in different situations.

My FAK weighs seven ounces too. I’m cool with that.

[John S.]

https://www.goodrx.com/blog/best-non-drowsy-antihistamine-allergies/

Here is an interesting article on why Karl Hafner talked about Zyrtec being a sedative. Of the non-drowsy antihistamines, Zyrtec may be the most sedating maybe because it still crosses the blood-brain barrier.

[Bill (L.Dog) Garlinghouse]

Wonderful post.  I went thru a similar process when planning an AT thru hike.  With experience including Scouting, US Navy, Outdoor Emergency Care (Ski Patrol) and WFA, I started with what are the most likely injuries/maladies, what I would need to deal with them, and what I could improvise out of my pack or nature.  I also considered your philosophical question in that I am certainly the type who stops to help others.

I documented the process here: http://www.laughingdog.com/2011/10/backpackers-first-aid-kit.html

That hike ended early, which gave me an opportunity to rethink everything in my pack.  What I did to my first aid kit is  documented here: http://www.laughingdog.com/2013/01/rethinking-my-pack-first-aid-kit.html

That kit has evolved over the years. The syringe for irrigation is long gone, replaced by a smart water flip cap that when screwed onto my water bottle made a great irrigation tool. Confirmed when I cleaned up a hiking buddy’s shredded knee before bandaging and sending him to the ER.  He later said the ER doc commended me for the cleanliness of the wound!

Today my FAK weighs 255g.

Undocumented was the tiny tube of epoxy that I actually did use to close a self-inflicted knife wound on my hand.  I would never have used that on another, but my backpacking kit has a fresh tube, and I have a truly nice scar to show-off around a campfire.

I will also say having “NOLS Wilderness Medicine” as a kindle book on my phone came in handy a couple of times.

W. Garlinghouse
AT 2000 miler
“L Dog”

[Rex Sanders]

I have along history of unexpected reactions to medications. For example, as a teenager, I had both year-round hay fever and terrible insomnia. But in college I couldn’t afford prescription antihistamines for a while. Suddenly I could fall asleep quickly and sleep through almost anything.

Decades later: Benadryl makes me drowsy, Zyrtec doesn’t. But Benadryl for anaphylaxis is how I was trained, so I’m safer recommending that to someone else.

Again: What works well for me probably won’t work well for you.

— Rex

[Steve Thompson]

My 1st Aid kit is minimal.  Benadryl, Sudafed, Bisacodyl, Immodium, MeclazineHCl, and Tylenol for OC meds.  Eliquis, Allopurinol, Colchecine, and Prednisone for Rx meds.  This covers what I need, what I can do for pain, and what I might need for gastro distress.

A quartered shop towel (in lieu of gauze), 2 sheets Spenco, 6′ leukotape, 5 neosporin band-aids, and a large safety pin.  These plus things like hiking poles and pieces of clothing handle anything from cuts and sprains to broken bones.  And finally a small tube cortisone cream and small tube athlete’s foot cream to treat and/or prevent the rash that likes to develop between on my butt and back where the pack sits (a wool shirt and wool underwear seem to help vs. synthetics but one bad experience and these are must haves).

Everything not used gets tossed and replaced annually.

[Roger Caffin]

To each his own, but for me that would be a huge FAK. I don’t even know what half of those drugs are or what they do.
The most commonly used items in my FAK are plain unmedicated Bandaids.

Everything not used gets tossed and replaced annually.
That could be excessive imho. A lot of drugs do have expiry dates, and it is those dates I watch.
Bandaids and safety pins expiry? Nah.

Cheers

[Rex Sanders]

Checked on using Benadryl for anaphylaxis – a life-threatening allergic reaction, sometimes to bee stings, or to foods like peanuts or shellfish.

Turns out that my knowledge was outdated (I was wrong), and I’m making some changes to my first aid kit and practices.

First and most important:

Epinephrine injection is the “gold standard” for treatment of anaphylaxis.

Not antihistamines, not steroids, not anything else.

EpiPen is the most infamous brand of epinephrine autoinjector. An EpiPen two-pack (you always want at least two doses available), routinely costs several hundred dollars (for $20 in drugs and parts), expires in a year (officially), and requires storage at 68 F to 77 F (20 C to 25 C). Even generic epinephrine autoinjector two-packs cost about $100 per year if you shop around and use coupons. In the USA. YMMV in other countries (please don’t laugh).

But if you need it, you really need it.

And be sure to practice with the training device. Too many people screw it up during emergencies and waste doses.

As a solo backpacker with no history of anaphylaxis, I find it very hard to justify the cost, weight, and storage challenges. Much less convincing my doctor that I need a prescription “just in case.”

Second: Any decent antihistamine can help reduce the non-life-threatening symptoms of anaphylaxis and allergies. After further research and personal testing, Benadryl (diphenhydramine) and Zyrtec (cetirizine) are out, Allegra (fexofenadine) is in. Allegra rarely causes drowsiness (approved for airline pilots), and it’s pretty hard to overdose.

Third: If it looks like someone is experiencing anaphylaxis in the backcountry, and there’s no epinephrine autoinjector available, I’ll encourage them to chew and swallow Allegra tablets while they can. Might help.

Again: What works for me probably won’t work for you.

Thanks to Karl Hafner who challenged my antihistamine choices above.

— Rex

Case Study: Anaphylaxis In The Backcountry, NOLS, 2019
https://blog.nols.edu/2019/10/30/19/case-study-anaphylaxis

“Our current curriculum emphasizes administering epinephrine for anaphylaxis because there is the erroneous concept that antihistamines can correct anaphylaxis on their own.”

3 Things That Drive Me Nuts In Wilderness Medicine Education, NOLS, 2015
https://blog.nols.edu/blog/blog-new/2015/03/23/3-things-that-drive-me-nuts-in-wilderness-medicine-education

“When I read the NOLS incident data history, solid enough to generate multiple medical papers, I can argue that anaphylaxis is rare in the wilderness. … the bottom line is that we don’t know the incidence of anaphylaxis in the outdoors. I have epinephrine in my first aid kit. I don’t imagine I will ever use it.”

Anaphylaxis — a 2020 practice parameter update, Journal of Allergy and Clinical Immunology
https://dx.doi.org/10.1016/j.jaci.2020.01.017

“Unlike epinephrine, antihistamines are poorly effective in treating cardiovascular and respiratory symptoms such as hypotension or bronchospasm when used acutely as monotherapy. Epinephrine is the first-line treatment of anaphylaxis because it has a faster onset of action and more appropriate and robust pharmacologic action compared with antihistamines.”

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