First Aid Kit: Too Far Down the UL Rabbit Hole?

[Bob Kerner]

I think I may have gone a bit too far down the UL rabbit hole in terms of de-bulking my FAK and would appreciate some feedback from others who may have fallen into the same hole and climbed back out.

Last year I began seriously examining everything in my pack and weighing it. I asked myself, “When was the last time I used this?” and if I couldn’t answer the question I removed it. I got my kit down to a baggie using suggestions from Reddit, Mittencamper and other sages of UL and their websites. I basically have a couple of gauze pads some moleskin, tape, stretch bandage, some antiseptic wipes and a few pills. My starting point was one of those small Adventure Medical Kits.

Well my choices came back to bite me this weekend while day hiking in the ‘Dacks. Moments after summiting one of the lesser peaks, someone announced “Be careful heading down, someone is injured and laying across the trail.” I went to help and she had an obviously fractured ankle and was laying on a patch of ice, shivering. At this point I should probably disclose that I’m a paramedic and nurse in my regular life but never once have I needed all that stuff in the Adventure Medical kit!

Deformed ankle: I removed my SAM splint years ago. Never used it and it took up the most space. Same with the emergency blanket (after all I always have a puffy jacket or sleeping bag with me!). We were fortunate that a WFR hiked up from the nearby Olympic Center and the woman was evacuated within an hour, but I was kicking myself on the way back to camp over the stuff I removed in the interest of shedding weight and items never used.

Where is the happy medium here? My impulse is to put all that stuff back in my pack, but I feel like that’s still ‘packing your fears’ more than making a rational choice. You have to draw the line somewhere, else you’d be hauling the 50lb pack the Ranger humped up the mountain.

[John Vance]

I have followed your path as well.  My experience has been you can’t account for every calamity and after 45 years of backpacking and thousands upon thousands of miles, medical issues for me have either been you need to get out or evacuated quickly or you just suck it up and deal with it.

I have come across others like you did, and worked with what we had to make the best of a very bad situation for the trip out.   The worst was a broken collar bone, a compound fracture between the wrist and elbow, broken ribs and a punctured lung.  He was thrown from his horse and then kicked several times and a little more than 30 miles from the nearest trailhead.

He mended but later said it was a long ride out.  We were on top iof the continental divide in the Winds at 12,000 feet having seen shod horse prints and wondering how in the world a horse could be coaxed up there – it turned out there were two.

I have a friend that was an ER doctor at the time she went on her first trip with me for about ten days.  She showed up with a 25lb FAK that covered just about everything including a stapler and an IV drip for dehydration.

She almost wouldn’t leave the trailhead until we convinced her she would be better off with us and a reasonable FAK than alone at the car with hers.

I carry a minimalist kit that works.  Cuts, minor burns, stuff to keep infection at bay and a variety of pills for pain, inflammation, allergic reactions, and on longer trips a 10 day cycle of amoxicillin and serious pain killers.  My worst personal backcountry situations have been a staff infection in my abdomen, kidney stones, and IT band inflammation that left me unable to walk.  Oh, and a bad full body sunburn on the PCT when I fell asleep, naked on a rock, surrounded by snow and sunny skies while my freshly rinsed clothes dried.   I spent the next day under my tarp and the following several days hiking slowly in boxers and a long sleeved top often carrying my pack in my arms.  Nothing in my FAK to help.  A cold freshly dipped bandanna was my best friend.

At the end of the day we assume the risk and balance our strategies to mitigate it.

[Brian W]

My suggestion is to take a NOLS Wilderness First Aid class.  You’ll learn enough to know where you can cut corners.  You’ll also learn to improvise.

[Rex Sanders]

Everyone hits a different happy medium for FA kits, depending on their experience, training, and willingness to help others. Yesterday I saw a thru-hiker gear list that listed one item under First Aid: duct tape. I usually take a 10 ounce kit. Most BPLers are somewhere in between. It’s hard not to carry your fears, especially if you have first-hand experience.

WFR courses emphasize improvisation with available materials. That’s why they can often deal with backcountry emergencies better than MDs.

I haven’t carried a SAM splint in years, and the latest WMI WFR courses no longer recommend them, preferring bulky padding and exterior tension (e.g. Ace bandage or spiral-cut t-shirt) over rigid splints in most situations.

— Rex

[Rex Sanders]

John Vance’s post reminded me of a couple of river trips.

1989, Middle Fork Salmon, Idaho, 10 people and eight days in the wilderness with no communications. The person in charge of First Aid brought a full 20mm rocket box (~35 liters) of supplies. We never opened it.

1996, Grand Canyon, Arizona, 12 people and 16 days in the wild with minimal communications and lengthy evacs. The dentist in charge of First Aid brought two carry-on-suitcase Pelican boxes of supplies. We used a SAM splint, two Ace bandages, and a variety of meds for my injury-prone wife. But I treated more people with a tube of SuperGlue I brought along for the small cuts everyone suffered on dried-out hands and feet.

On most of the other multi-day, multi-person river trips I’ve taken the equivalent of an AMK Expedition Medical Kit. With WFR training, we never encountered a situation we couldn’t handle.

Very different situation when you are responsible for a bunch of other people, but it’s still possible to go overboard.

— Rex

[John Vance]

+2 on training.  When I was a scout leader we carried a fairly complete kit, including sutures that were used on three occasions over a six year period.

Rex – very true about the difference when you are responsible for others.  Especially when you aren’t familiar with their habits and risk taking.

[dirtbag]

So, that situation you were in.. ended up ok.. and you didnt have the sam splint or whatever else you think you could have used, but didnt have.. correct? It worked itslef out..i say, “Carry on”.

[Matt]

Ditto what dirtbag said.  You made it work with what you had.  Job well done!

Duct tape, sticks, a bandana, and ibuprofen can go a LONG WAY to stabilizing a lot of trail injuries.  Leave your fears at home with the SAM splint.

[Bob Kerner]

It worked out because someone (a WFR) from the Olympic training facility showed up with a small trash bag containing a SAM splint, 4 triangular bandages, 1 pair of gloves and a large wool blanket. Ranger and state police arrived a few minutes later with a litter and a chainsaw.

Chainsaw used to clear the trail to make it easier to get down!

To those who wrote about “get training” yes I agree but I consider myself pretty damn well-trained to begin with. Had I been called upon to do so, I know how to make splints out of tree limbs, trekking poles, coats, etc. We had a plan to do that and would have had ‘real’ help not shown up. That”s not really the issue. My concern is (my guilt?) that I had the splint etc in my FAK but removed it out of concern about bulk and weight. And maybe I went too far trying to shed weight.

Having typed this, I realize the obvious response is: “Well you don’t carry a chainsaw, do you?… and obviously that was needed for this particular situation.”

[Jenny A]

I have found that many people are prone to their own particular types of injuries.  Mine tend toward blisters on my feet, cuts from fish hooks and knife blades, and occasional sore muscles.  My FAK fits in a small baggie and is designed to address those things that my experience has shown happen to me.  (The FAK is in addition to my 10 Essentials kit, which is slightly more comprehensive.)  I also carry a Delorme Explorer SEND, which is insurance for the things the FAK might not deal with.  It might be selfish, but I won’t carry first aid items to cover every injury others might have on the trail.

The Bad Things that might happen generally don’t, so don’t pack for them.  Your choice, of course.

[Jacob]

HYOH and all that, but I think we can have an objective discussion about risk. There is a lot of experience on this forum.

Outside of certain fields I don’t think many people see these but they are all over if you look for them: risk matrices

I think people should think about the worst thing that is most likely to happen on their trip.

I don’t have much experience out on the trail, but it seems to me, based on where I hike, that slipping/tripping and falling down a steep hill side with a pack on is the highest risk hazard; a risk level of 16, probable and significant. Maybe its not probable, I haven’t seen data, but I have tripped and slipped just not fallen. In industry that’s called a ‘near miss.’ Its important to pay attention to stuff that almost happens too.

So I carry a few QuickClot gauze bandages (3inx24in,  the two packs come in ziplock style bags, so I have some in the bags and some just in the individual packaging), two of the QuickClot sponges, and a leatherman raptor. The rest of my kit is more or less the standard assortment that you have. I have never used any of my FAK so I don’t know if it will work the way I think it will. I hike with friends and family, people I love. My kit contents are under a lb and can stop bleeding and gain access to wounds without moving the person, I think. With your experience it should be a lot easier to identify what would actually make a difference in a hypothetical, high risk situation.

If are confident in your plan to improvise that splint had you needed to then I don’t think you should feel guilty about removing the actual splint from your kit. If deep down you know that improved splint wouldn’t have worked, then maybe carrying something that would work up icy trails where people tend to break their ankles is a good idea.

 

[Iago Vazquez]

Had I been called upon to do so, I know how to make splints out of tree limbs, trekking poles, coats, etc. (…) And maybe I went too far trying to shed weight.

I’m not expert. But I’m with Jacob on this one. If you can improvise something in the field, in my opinion it makes sense removing it. Having it ready it’s always easier, but the 5 to 10 minutes it would have taken you to improvise a SAM isn’t worth the hassle of carrying it regularly IMO. Regarding other possible items, if something can’t be improvised and you see the potential/likelihood of needing it based on your environment, I would say you are justified in taking it. In the ‘Dacks and the Whites chances of a fractured ankle seems much higher than the trails I’ve visited in WA, the Tetons, Shenandoah and the Smokies. So if you decide you want to put the SAM back in, go for it.

And as someone said, once you are in charge of a group, the number and type of injuries increases. Apparently the number one injury in Scouting is burns, typically cooking related. Do I foresee burning myself cooking? No, I do not. But I bring a much more thorough FAK when I am with Scouts.

Every outing near or below freezing that is going to be beyond 1 hr. from the car, I typically bring a 40 degree quilt (14 oz) (EE Revelation) and an MSR E-Bivy (7 oz). If someone is immobile, both those items will help preserve some warmth for a few hours. I have never had to deploy them, but I will keep on bringing it. I suppose a tarp is best for someone who truly is immobile, but I am picturing lower leg injuries rather than spinal ones. And I could always rip the bivy in half and turn it into a tarp if the case presented itself. Based on my outings, I see the risk for someone having trouble walking out often.

Most people think I am crazy for carrying these two items. I feel I’m justified. Bring whatever you feel you want to and leave whatever you are comfortable improvising or are not likely to need. HYOH.

[W I S N E R !]

A rabbit hole indeed.  Emergency training, creativity, risk adversity, confidence, personal fitness…All of these things factor in.  I think certain activities also tend to warp people’s perspectives regarding risk and FAK contents.  I’ve recently joked about it with some BPL members (and ex-members) that I used to do long distance events with.  Looking back, some of us were pretty damned brash about being able to crank out a 50K+ solo run in the wilderness with nothing but a headlamp, water, some Leukotape, and energy gels.  There was no “What if I fall off a cliff or get hurt?”.  It was simply “I won’t fall off a cliff or get hurt.”  We were young, fit, and maybe a little lucky, but it always worked out.  I suppose that’s “youth” and taking it by the horns, so to speak.  I’ve toned it down considerably since those days- and I suppose that’s what’s called growing up and getting fat!  But interestingly, I’d bet my overall backcountry risk level is somewhat higher now simply because I don’t have that level of fitness right now. Correspondingly, I’m inclined to carry a little more than I used to.

Quite subjective and not something I feel I could give any relevant advice on without knowing a person pretty well.

[Sean P]

I was an army medic for many years and now a nurse.  I used to carry a 2l med kit for a platoon of soldiers (30 men).

Now, for myself, I keep it pretty lean.  The survivable things that will kill you in the field, statistically, are environmental injury and traumatic injury – you can’t do anything for medical conditions (unexpected heart disease/stroke/severe infection etc).   Hypothermia is taken care of by shelter+ warm gear and food   and shelter + exposure/wetting down and fanning for hyperthermia. Heat exhaustion is gastrolyte or just rest and food and water.

Which leaves traumatic injury.  Bleeding is survivable and will kill you quickly so I carry compression bandages and a combine dressing.  Fractures can be attended to by immobilising with strips of cut up shirt (the casualty’s shirt) and a hiking pole for splinting and then the casualty must be kept warm (their gear and shelter) – these can be achieved by the items you and the cas are already carrying.

Any other traumatic injury (i.e. head injury, internal injury) is not treatable with first aid equipment in the field and the cas will live until they are evacuated or they will die,  irrespective of what you carry.  In this situation, treatment of shock (shelter, keep warm and hydrated) and assessing regularly is the only realistic option until evacuation – obviously wilderness first aid knowledge will be of assistance but more equipment will not.

Early evac and surgery for severe injury is lifesaving so  PLB or similar is worth more than a SAM splint.

In Australia snakes can kill and are easily and effectively treated by compression bandages (this treatment is for australasian snakes) which, handily are also used for pressure bandages for extensive bleeding.

i don’t concern myself with CPR masks etc. as if the cas needs CPR in the field they are unlikely to survive and if it is my loved one i don’t need a mask.  In the field won’t do CPR on someone I am not personally invested in as they just won’t survive until evacuation except for specific instances such as toxicity (environmental neurotoxins).

IMHO it is the less serious stuff that is hardest to treat and to triage (i.e. evac or not) such as sprains, lacerations, abdominal pain of no clear cause, severe headache etc.

 

The easy stuff is dressing strips, superglue, ibuprofen, gastrolyte, scissors, forceps, steri-strips, antihistamine etc.  I don’t carry antiseptic as it is ineffective in the field as an antibiotic treatment and washing a wound with clean running water is no worse.

if you are leading a walk it is always good to know the medical problems in the party (allergies/asthma etc) and know where their epipen and ventolin puffer are.

Of course, you can carry much more and carry something for every eventuality but wilderness first aid is not like an episode of House.  Just my AUD 2c (US1.5 cents).

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[dirtbag]

So.. basically if you honestly deep down feel so bad about it.. and now think you need it.. carry the sam splint .. its weight is negligible along side the chain saw.

[Matt]

Bob, I hope you can find a way to feel good about the things you brought to the situation – experience, calm, expertise – and let go of the guilt concerning the things you did not.

[Jacob]

“So.. basically if you honestly deep down feel so bad about it.. and now think you need it.. carry the sam splint .. its weight is negligible along side the chain saw.”

Its theory vs practice.

In theory we can all improvise sam splints and Macgyver anything we want. If in practice the theories aren’t going to work and you have gained the experience to know that, then yes you should self reflect.

I can only think of one reason to feel guilty about almost using an improved splint; believing the splint would have failed. If all logic dictates it would have worked then consider the guilt irrational and ignore it.

 

While we talk about specific first aid equipment efficacy: Antiseptic vs Irrigation Syringe?

For a long time I always heard to clean, sterilize, then bandage. Now I am hearing that thorough rinsing and bandaging is better in the field? There are probably UL  12cc irrigation syringes that would be lighter than antiseptic ointment/spray. I used to carry liquid povidone iodine thinking it would be multi use, but the bottle leaked so now I have ointment and am considering switching that for an irrigation syringe. Any thoughts from the nurses/paramedics/medics?

 

 

[Roger Caffin]

There are two problems with the ‘sterilise’ bit:
* The chemicals used to sterilise the wound (eg iodine) can damage or kill the surface skin cells, which is not going to help healing.
* If you sterilise the area, you are removing all the beneficial skin bacteria which are really your primary defense against infection.

Cheers

[David Thomas]

I notice that often those with the most medical training feel the most naked without all the cool, specialized gear.  Thankfully, my MD wife was a backpacker and world traveller before going to med school and can still travel pretty light.  We each lean towards the pint baggie of pills, blister care, some tape and scissors (maybe on our Classic pocket knife).  We both ramp it up for larger groups, more kids, more remote settings, longer trips and the Third World.

As for the SAM splint?  Pretty multi-purpose, yeah.  But if have a roll of tape or really know my knots (I do), I can do as much or more with a CCF pad or inflatable pad, aluminum stays from my pack, trekking poles, tent poles, and clothing even before getting into using sticks and leaves.

I think the most useful items for an unknown first aid situation are those tools that let you use and modify other supplies. A knife, good scissors, multiple needles and thread.  Brainstorm in advance about what you can use and realize that gear is ultimately disposable and therefore highly modifiable.

Skills before gear.

Practice your skills before packing your fears.

e.g. can you do a traction splint for a broken femur from two trekking / ski poles?  You no longer need to take a Wilderness First Aid course from me.  Just watch a YouTube video.  But practice is even better (or you won’t know how very much you need to pad their crotch).

[Bob Kerner]

We stopped using Providone in the hospitals as a wound cleanser because there is ample evidence that it is destructive to healthy tissue, as Roger mentions above. You’re better off with soap and water, though employing that in the extreme cold might carry other disadvantages.

Thank you all for your feedback. I believe it’s good to check in with others who have more or different experiences under their belts every now and then to check your mental model. Your comments have been helpful. I’ve been fortunate to reach middle age without having to deal with anything serious on the trail until this past weekend, so I count myself lucky.

I’m also super-impressed by the work the State Police and DEC Rangers do. Top shelf people up there in Lake Placid/Keene Valley.

[Roger Caffin]

Pouring rain, steep shale gully – sharp stones. A member of the party (not me) slipped and gashed his thumb pad (on the palm) open – quite deeply.

I washed it out (not that his hand was clean anyhow), pulled the edges together, strapped it up with BandAids and micropore tape, folded his thumb to his palm to compress the cut and stuck a leather glove over his hand. Meanwhile, another member of the party brewed up some coffee with sugar (in the rain, in the gully). We all had some.

No throbbing, so I left it alone for a week. When I finally pulled the glove off and removed the bandage – it was healing up nicely. Had to protect it for another week, but that was fine.

Cheers

[Ian]

This conversation is similar to the “should I carry bear spray” question.  You’re not *wrong* to carry a 20lb FAK but that may not be the most reasonable solution.  I might carry a CAT tourniquet during hunting season but would likely rely on an improvised tourniquet on other trips.  For most trips, my FAK is about 3-5 ounces and Vitamin I and Benadryl account for 99% of its usage.

I do know someone who benefited from baby aspirin so I always have some in my kit.

For flushing out a wound, my preferred water bottle is a 32 fl ounce Aquafina bottle with a Smartwater flip cap lid on it.  You’ll go through the water in short order if you just flip the lid, but I can always poke a hole in the lid itself to throttle back on the volume that I’m flushing with.

I almost lost a loved one to sepsis so infection control isn’t lost on me, but my priorities in the field are to stop bleeding and package the person up for evacuation.  I’m not going out of my way to introduce contaminates into the wound but that’s not my immediate priority.  Sepsis and infection battle will be won or lost at the hospital IMO.

Not arguing anything that’s been written here about CPR but offering a caveat.

Lightning strikes scare me more than bears or mountain lions.  If someone in my party was lifeless after getting struck by lighting, I’d give CPR a shot.  More here:

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.105.166571

Same for drownings

http://www.swiftwaterrescue.at/content/info/cpr.html

My last WFR course was about 20 years ago so a good portion of my training has likely been updated since I went through.  Some advice that I feel is timeless is to practice your improvised treatments at home.

To piggy back some on what David said, as an example, I oftentimes hear people say that they would use a belt as a tourniquet.  Not all belts are created equal and I really haven’t seen much in the way of success.  Normally I/they could feel a distal pulse after applying it in a training environment.  If your belt works, then that’s great, but confirm this before you need it.  I have stopped a distal pulse with a gauze roll (several wraps around the arm) but if I ever used it in this way, after I stopped the bleeding, I’d apply a second tourniquet with something stronger (eg cut from clothes, shirt sleeve, whatever).

Same thing for making traction splints with your trekking poles.  Try a dry run or two in the front country.

Good talk.

[Sean P]

@ Ian

I have jury rigged a windlass tourniquet on some poor bloke trapped in the drivers seat in a car vs tree collision.   We used a triangular bandage and I can’t quite remember what we used for the windlass.  The problem is it is not as stable as the CAT – which locks nicely.

And yes – good points re: cardiac arrest from lightning and drowning  I was thinking more of traumatic injury.

 

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[Luke Schmidt]

My personal kit needs an upgrade but I see two areas I want to cover.

1. I want to treat minor injuries well enough that I don’t have to change plans just  because I run out of something. A good example here would be a deep cut. I want enough bandages and disinfectant to finish the trip. I don’t want to mess around with the possibility of a staph infection (been there). I also don’t want to evacuate and go home for a couple cuts and not enough bandages. So I might go a bit heavier on what I consider “maintenance ” supplies.  Lots of bandages for example. More then a tiny tub of Triple A cream etc. The longer and more remote the trip,  the more “maintenance ” supplies I pack.

2. Serious injuries like broken  bones just get stabilized and evacuated so I only need a bit there. I’m pretty basic because I can improvise.

I also put a small backup light and a lighter in my FAK. They ONLY get touched if there is an emergency.  But that gives me a backup for two small items I often misplace.

[Dean F.]

If you’re a paramedic and a nurse then you are the target demographic for the Wilderness Medical Society.  Granted, their stuff is mostly high-impact rescues, but I thought you might find it interesting.

I think I posted the exact same risk matrix graphic a few years ago.  Risk is not just probability- it is probability times severity.  I’m a surgeon, so among other things I carry a pneumodart… but I know how to use it.  Low probability, but high severity, and it’s pretty light, so since I can use it I carry it.  Laymen probably should not bother.  But generally I agree with Luke, above.

But this is one area where skill can replace equipment, and there is also a lot of potential multi-use gear.  I think carrying suture is ridiculous since 1) it is so unlikely you’ll need it, 2) if you do then steri-strips are almost certainly a better and lighter option, and 3) if worse comes to worse an eyed needle and floss or gear repair thread soaked in ethanol would do for a temporary closure.  Heck, you shouldn’t close dirty wounds at all!  Clean them, pack them, dress them, hike out.  Likewise, duct tape or any medical tape (I like Medipore-type tapes) makes acceptable steri-strips, especially if you carry some Mastisol or benzoin, both of which are available in very small and light single-use ampules (which is what I carry).  I don’t think you need to pack a SAM splint again- don’t be ridiculous.  If you really need a splint THAT desperately they are quite easy to improvise- just be sure to use a lot of padding, and don’t accidentally create a tourniquet with your dressing or something equally rookie.  (For laymen- be careful putting an ACE or gauze dressing too tight circumstantially on a severely injured limb.  The limb later swells, and the dressing gets so tight it cuts off the blood supply and they lose the limb.  Check it often- don’t just place the dressing and ignore it.)

If that person you’re talking about was truly in extremis I am confident that you could have helped them considerably by getting them off the snow, into insulation, and improvising a splint.  When someone is that badly hurt and you’re their only option, well, your hike is over, Brother, so you don’t need to worry about sacrificing stuff like cutting clothing into strips or scavenging your pack suspension.  Their life matters more, obviously, so start chopping your stuff up.

Bleeding seems to worry people, but truth be told backcountry bleeding is usually trivial.  Even trivial bleeding looks dramatic to laymen, though, so people obsess about it.  And if someone is having catastrophic bleeding in some remote wilderness location then they are probably unsalvageable no matter what you do.  Someone mentioned QuickClot and similar agents, and I assume that you mean what I would call “Combat Gauze” rather than the old exothermic QuickClot powder (which should NOT be used any more).  Well, I guess that’s an option.  But for me almost any bleeding that these would be effective on I can stop other ways, so I don’t carry it.  Like most trauma practitioners I feel that direct pressure is under-rated.  Everyone wants the quick and easy fix, but direct pressure weighs zero grams… The other issue is that it is difficult for laymen to place.  Oddly for a hemostatic agent, it works poorly when it is thoroughly soaked, so you have to hold effective direct pressure on the wound to stop the audible bleeding first, then wipe it clean, and then TIGHTLY pack the wound with the combat gauze while suppressing bleeding with the pressure, and then hold more pressure on it for a while.  So granted it’s great stuff, but it’s more of a direct pressure adjunct than a stand-alone solution.  And laymen never pack tightly enough, because that hurts and they stop when the patient starts screaming.  I do not.  :)

Oh, and people often bring up using tampons in large punctures (e.g. gunshot wounds).  Well, that doesn’t work on surgical-level bleeding, but it does do a handy job on more trivial bleeding and it makes things look clean and neat enough that the laymen stop hyperventilating.  So, keep it in mind.  But, seriously, there was a study a while ago that showed it doesn’t work on audible bleeding.

Former category (trivial bleeding)- I cannot tell you how many times I have gotten panicked calls from ER providers about bleeding, then just walked to the ER to find a huge blood-soaked dressing and underneath it is some trivial thing that I just put my finger on for twenty minutes.  Knowledge replaces equipment on that one, for sure.

Latter category (catastrophic bleeding)- Surprisingly hard to get this in the backcountry, barring some freak occurrence.  Usually it will be accompanied by other devastating injuries, such as in a severe fall, so they’re screwed anyway.  (Drowning and falls account for almost all backcountry fatalities.)  Not much you can do.  Military medics may carry TXA but no one else can afford it.  At most I might carry a tourniquet, since purpose-made things like the military tourniquets do work significantly better than improvised ones- this has been proven in studies.  In fact improvised ones are not much better than placebo.  A little, but not much, in laymen’s hands.  And you have to actually know how to use the real ones, too.  To the point that if you haven’t been trained on them, I’d say don’t bother carrying them- yes, it’s actually that tricky.  Again, your hike is over.  If you have to you can stand there applying direct pressure until you fall over from exhaustion.  Find helpers to switch off with you.  Ignore the screaming- they would rather be in pain than die.  Probably.  Should earplugs be in your FAK?  :)  Sorry- I guess I’m being a typically callous surgeon again.  It comes from having to hurt people to help them every day.

So, what do I carry?  Well, for typical short trips:

Pneumodart or 14g needle (as above).  As you can see in the link above, I’ve gone back and forth on this a bit.

Some very basic meds- Benadryl (for rashes or as a sleep aid), Tylenol and Motrin (yes both- you know why), TUMS, Imodium, antibiotic ointment, and on longer trips maybe an oral antibiotic covering enteric infections and a narcotic (which most laymen will have a hard time convincing their docs that they need).  One or two aspirin doses might be handy for a heart attack victim.

Pre-perforated Medipore tape, a Kling or a Kerlix roll, and Co-Ban.  I like the Kerlix because I can cut it to size for any use that I can imagine where I need some gauze, but I usually do carry a few 2×2 gauze so that I don’t have to open the roll for something truly minor.  A 2×2 and one square of Medipore is a fine Band-Aid.  Other tape brands similar to Medipore include Mefix or Hypafix.  Kling is elastic, which some people like, but that’s what I have the Co-Ban for, and I prefer the plain gauze Kerlix for other uses.  On a longer multi-person trip I might carry a small ACE wrap, if only because I can re-use it if I have to check and re-dress a wound during a long evacuation.

Real steri-strips are so light that I see no reason not to carry them rather than improvise, despite what I said above.

Benzoin.  It smells better than Mastisol.  :)  In fact, it smells divine…

Duct tape (doubles as gear repair).  The most relevant medical use is probably for padding blisters, but I rarely get those, since I wear trail runners instead of boots.

A little multitool with pliers, scissors, tweezers, and a nail file, if only for foot/nail care.  Obviously this has many other potential uses for gear repair, but also including cutting gauze and tape with the scissors, which is frustrating to do with a knife.  Likewise, cutting clothing off of patients.  Heck, they’re so helpful that if I were on a real multi-person expedition I’d probably carry a dedicated separate set of decent scissors or trauma shears.

Eyed needles and thick thread and unwaxed floss (this is actually in my gear repair kit).  But this is a use of desperation- if I need this then cleanliness is the least of my worries, so I’ll just “sterilize” it with my ethanol stove fuel or hand sanitizer.  Steri-strips will almost always be a better option, and certainly always for laymen.  But if someone couldn’t be evacuated for a day or two and I needed to cover their open fracture?  Sure, I’d consider it.  The orthopedist will just re-open it to wash it out later anyway.

A very sharp knife (I am a surgeon after all- I can do a lot with it, maybe even a trach).  Obviously multi use.  On larger trips I might carry a disposable 11 or 15 blade scalpel- one of the ones with a guard.  Most laymen shouldn’t bother.

A SOF tourniquet on occasion, but only if I’m doing something stupid that I shouldn’t.  Can be placed with one hand, and are proven to work better than CAT.  Generally I’m a very risk-averse guy, so I find it incredibly unlikely that I would ever need this.  (Though I do keep them in my car kit…)  I worry more about being in a large group full of less safety-conscious people, or coming upon someone else with a severe injury.

Nitrile gloves, for treating others.  I don’t want hepatitis, and now that I’m a civilian practitioner myself I have a much better appreciation for just how dirty civilians are, as a group, so to speak.  I got spoiled by the great medical care and annual HIV testing, etc., when I was in the Army.

The flushing syringe from my Sawyer filter can be used to irrigate wounds.  But I’m a low-pressure believer anyway, so just flushing slowly usually works for me.

InReach.  Realistically, the best thing you could have for a truly severe injury is something like this.

As you can see there is really not a lot.  Probably more than Luke, yes, if only because I have the skillset to use more, but I can still improvise most other things if the issue is severe enough.  And among other things I can recognize a wound infection, so I might continue a hike after an injury that others might bail out for, and trust myself to spot such a complication.  Plus, of course, we are all scarred by our experiences.  And when you’re a hammer every problem starts to look like a nail.  Etc.

On longer hikes I usually just carry a little more of the same, with the addition of some of the optional stuff I mention above, and maybe real scissors.  If I were the “designated medical guy” on a real expedition there would be a LOT more, of course.  Epinephrine.  Dexamethasone.  Field surgery kit.  Diamox for HACE.  Heck, maybe oxygen.  Etc.  And, yes, a SAM splint…  :)

EDIT– Re: lightning.  Yes, there is a saying, “After a lightning strike, treat the dead first.”  This means start CPR on those without a heartbeat before you worry about conscious patients with burns (which take quite a while to kill you).  Lightning can stop your heart yet leave you otherwise perfectly salvageable, just like other electrical injuries.  Even if you’ve never had a CPR class you’ve certainly seen it in movies, and I’d sure want you to try if it were me.  Feel for a neck pulse.  If there is none, go ahead, break ribs.  I’ll get over it.  In fact, if you don’t break ribs you’re probably doing it wrong.

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