Introduction

This article features an interview with a Canadian Mountain Rescue Medic, focusing on how to assemble lightweight first aid and trauma kits for backcountry travel.

Invariably, when I release a new trip report with my gear list, the forum has at least one person ask: ‘what is in your first aid kit?’ Though, I am generally savvy with emergencies, (I did spend a fair bit of time with emergency services and have certainly been a patient more than my share of times) I am not a doctor, a nurse or a paramedic. Though I have taken many medical courses, I am long since expired on most of the relevant certifications, except basic first aid. I am perfectly capable of administering basic medical care to myself and packing my own kit. However, I balk at doing either for anyone else if I can possibly avoid it. I am evasive about answering the question to say the least.

Disclaimer

I will start with a relatively generic disclaimer: no one can tell you what to put in your kit. You are the best person to evaluate your needs based on your own skills and medical liabilities. That said, insight from a medical professional is a great place to start. In my case, I built my kit around ideas I got from my family doctor (he’s an outdoor enthusiast), an ER nurse friend of mine and my physiotherapist. I took wilderness first aid and have had a fair amount of experience either managing an emergency as a responder or being a casualty (I’m a pinch accident prone.)

I do, however, believe the question of ‘what goes in your first aid kit’ begs an answer; a very good answer from a current professional (read: not me.) And, if you don’t use your skills, you lose them and the certifications expire.

Candidate Search

To that end, I decided to find a professional to interview. I needed someone not only with medical experience, but also with outdoor experience (and preferably emergency trauma experience). Odd combination, which I put on the back burner for several years.

My search for a perfect interview candidate, accidentally ends one afternoon. As I stand in a line for a desperately needed cup of coffee, a stranger walks into the line behind me. Uncharacteristically, my, typically introverted personage introduces itself.

Turns out, my extroverted alter ego made friends with Michael. Michael is an avid kayaker, canoer, mountaineer and backpacker. On top of all of his outdoor pursuits, Michael is a paramedic and firefighter in the mountain community of Clearwater County, Alberta, Canada. Some time later, Michael and I part ways and I realize he’s going to be my interview subject to help us answer the question, ‘what goes into your first aid kit?’

The Interview

A few months later, I meet with Michael for the interview. He’s tall, athletic with a boyish, unassuming charm and an affable grin. He is an obvious introvert, but with an air of confidence and intention.

Em: So what goes into a mountaineering paramedic’s kit?

Michael: I think experience as a paramedic tells me more about what isn’t important in a kit than anything else. Most life-saving tools and interventions come down to training, quick thinking and thousands of dollars worth of bulky electronic equipment. None of these are possible in a physical first-aid kit.

People shouldn’t fool themselves into thinking that loading up with a lot of dressings, bandages and splints will make a positive outcome more likely than loading up with knowledge of injuries and illnesses and the techniques for managing them.

Em: What is in your head is more important than what you carry.

Michael: It’s funny, now that I’m thinking about it, me being a paramedic probably allows me to weed out a lot of items more than it has me adding a bunch of items. I carry a few different things than a first aider, but a lot less of the common things. Improvising is easier when you understand what is going on and what the objective is.

For instance, people get hung up on items of wound care needing to be sterile. I know better…Clean is preferred but sterile is not a necessity. I always say, a dirty sock stuffed in a wound is still better than hypovolemic shock.

Em: In the backcountry,  is there really such a thing as sterile? Most medical personnel I know would debate how ‘sterile’ conditions are in hospitals. There is contaminated, clean and clean enough to do surgery. If you aren’t a surgeon, the last one is irrelevant. Humans are relative germ factories. Is there any case where you would be seriously worried about clean dressings?

Michael: Large area burns, deep or full thickness burns, that is. Infection can happen fast when you lose a large portion of skin. That’s the main reason I add roller gauze to my kit, they come sterile.

Em: What is a common item you would eliminate from every backcountry first aid kit and why?

Michael: Instructions (on how to use first aid supplies). [laughing] Ok, I’ll give a real answer… Probably most of the tensor bandages and triangular bandages because they’re bulky and can be easily substituted with other things. Most kits seem to throw in a lot of them. I keep a couple if I have the luxury of room.

And I also toss the stupid little CPR face shields. They don’t work. Especially for a layman first aider. An actual CPR face mask would be optimal but are larger.

Em: And really how often are you going to be giving yourself CPR or traveling with someone you are afraid to give CPR? If you are giving CPR, it is most likely to be someone you are traveling with. Most people (maybe everyone) I backpack with could bleed all over me and I wouldn’t worry about it.

Michael: Exactly.

Em: What is one thing no kit should be without?

Michael: Duct tape. [laughing] Actually, no first aid kit should be without a user with a prevention mindset. Basically, no kit should be without brains. Always remember the brains!

Em: What’s a weird item in your kit most people wouldn’t think to put in, and what is it for?

Michael: Well, you’ll laugh… Condom, [laughing] its an emergency water container, waterproof bandage (fingers, hands), use it for its elasticity, crude glove, waterproofing for a firestarting kit (they stretch a surprising amount). Never actually used one yet for any of those though. Just seemed logical. They’re tiny and multifunction. Always a good thing to have in first-aid or survival kits.

Em: What do you look for in a first aid kit case?

Michael: Waterproof or water resistant, easily recognizable or marked as first aid, (might be sending someone else for it) and something that allows easy, even one handed access, without having to dump out all the contents. Most commercial options fit the bill but lots of other options too.

Em: I prefer to toss my meds in craft baggies from the dollar store and label them. I usually toss them in an old pill bottle afterward to prevent them from getting crushed. Is there a better method?

Michael: Same, I used to use mini bottles but never had a problem with them getting crushed in baggies. I do keep them organized separate from everything else in a mini nylon sack or designated pouch in the kit.

Em: I just dumped a pile of pink powder out of my kit the other day. Pepto doesn’t do well in baggies apparently. I used to always use a bottle then switched to baggies and switched back to bottles again.

Michael: You can still take the powder form. [laughing] I only have one tablet per bag so it doesn’t matter. The harder tablets I double up. The bags aren’t really robust enough to be opened and closed repeatedly anyway.

Em: Is there anything you think is an absolute no-no to toss out of your kit?

Michael: Never leave behind the meds. They’re basic meds but can still really improve a situation, and you can’t improvise them. Rapid fluid loss is really bad. Symptom control can’t be overstated when presented with diarrhea or vomiting.

Em: Same thing with hard tools like scissors?

Michael: Yeah, tools are the basis for improvising. Or at least, necessary for improvising.

Em: I know a lot of people think, ‘I’ll improvise a tool if I need it’, which can be done. However, it can cost precious time when it counts. Somethings cannot be improvised well either. Also, most people do a terrible job of improvising when they or a loved one are in pain.

What about antibiotics?

Michael: Antimicrobials would be a good idea for a long term trip, for treatment of various bacterial, viral, or protozoal infections, especially when you’re potentially a long time from getting out. Azithromycin (Z-Pak) is not effective against giardia, but a good choice for a wide variety of other bacterial infections.

Having the meds to treat high probability illness is always a plus. However, keep in mind that even quick recognition and treatment of, for instance, a bad case of giardia (with drugs such as Flagyl, tinidazole, etc.), diarrhea and other symptoms will continue for up to a week, for a lot of people. It’s very hard to “knock out” diarrhea fast and very easy to aggravate it. Even after treatment, dehydration will continue to be a serious safety concern, in a lot of wilderness settings where strength and endurance is required. Therefore, certain otherwise fairly benign illnesses, like giardia – in certain settings – would be cause for aborting a trip, if that option is open and depending on severity of symptoms, security of your position and available resources. (I say that having never suffered a case of it myself).

If you have no other choice or are in a good enough position to push through, having the right meds will indeed save you a lot of anguish.

The Kits

Now the brass tacks, what are the contents of Michael’s kits? Michael works on a sliding scale, he starts with a universal consideration kit and combines with items for the next size up kit. This strategy makes it easy to organize as each kit size addition can be stored separately but combined to make a larger kit when needed.

Additionally, meds are kept in a separate list and section of the kit to make using, replacing and ensuring expiration dates are valid easier. The amount of meds in the kit is determined by the length of the trip and the individuals on the trip. Everyone should be aware of what personal meds are needed by their adventure mates and where they are if the meds may be needed in a life-saving intervention (epipens, heart medications and inhalers etc.)

Universal Considerations (Day Trip +)

My universal considerations for every kit (the list may get long but most of these are light and small items):

Editor’s Note: links to specific products are not necessarily links to the exact products in either Michael’s or Em’s kit, but are representative of the types of products that are popular choices by members of our community.

Commentary:

Michael: Between that and the gear you would be carrying, that covers a bunch of small annoyances as well as splint building and major bandaging, so you can toss out the splint materials and bulky triangular bandage (substitute with clothing).

Em: I actually don’t carry a blade, I carry nail clippers with a sharp pointed file. It’s one of those tools I cannot replicate on the fly and serves a crucial and practical function in a pinch.

Michael: I hadn’t thought of that one, it makes pretty good sense.

Em: I like the seat belt cutter though, great idea. I also saw Victorinox is making a “blister pack” of tools about the size of a credit card called a SwissCard Lite which pretty much covers everything. It’s light and compact, but it’s also heinously expensive. Neat tool for backpackers on an unlimited budget.

• Approximate Total Weight: 7oz (200 g) (with glow sticks)
• Approximate Total Size: 1 Quart Ziplock Bag or Smaller

Minimalist Kit (2-3 Days)

Michael: I’d then work up from there to your most minimalist kit which would add some wound care supplies but only enough for isolated trauma (a single deep laceration, a single bad burn, a single broken bone) as any multi trauma in the wilderness environment is going to require improvisation anyway – unless you travel with a trauma jump kit.

As your trip length increases, the kit gets larger to account for higher potential and repeated use.

So in the most minimalist kit (solo, light 2-3 day trip) I would add:

• Approximate Total Weight: 3 oz (91g)
• Approximate Total Size: 1 Quart Ziplock Bag

Medium Kit (3+ Days 2+ People)

In my next largest kit (a multi day backpack with another person, for instance), I’d add:

• Approximate Total Weight: 7.4oz (210g)
• Approximate Total Size: 1 gallon Ziplock bag or smaller

Commentary

Michael: And by the way, the tick removal with a syringe is a ‘Michael field special.’ You don’t want to squeeze a tick when removing and you also want to save it/them for testing.

It’s something that I’m starting to take more seriously as I know a few people now that have contracted Lyme disease from local tick bites. It’s pretty much a North American wide thing now. Just to qualify that it’s not a well known method. There’s special tweezers too.

Em: Any reason you don’t toss your emergency blanket out? Most backpackers who practice ultralight skills want to throw them out because they have sleeping bags etc.

Michael: I don’t bother chucking it because I’m not watching my weight to that extent. If I was watching the grams, I’d only carry it on single day hikes. No reason to keep it if you have a sleeping bag other than redundancy’s sake.

Em: You are also out climbing for longer days where the bigger kit goes, but the sleeping bag doesn’t?

Michael: Yup, when I’m with other people especially. My climbing partner doesn’t carry much in the way of first aid. In that case, I bring the bigger kit which contains the emergency blanket.

Large Kit (Multi-day, Multi-person, Paddling)

In the largest kit I’d carry (multi-day paddling trip), I’d add:

• Approximate Total Weight: 8.4 oz (239g)
• Approximate Total Size: 1 Quart Ziplock bag and 1 Gallon Ziplock bag or smaller

Commentary:

Michael: These aren’t exactly what my kits look like, but would be reasonable, minimalist kits for an intelligent first-aider, in my opinion.

Em: Any reason a backpacker shouldn’t toss the SAM splint?

Michael: The biggest kit is the one that goes on the long term, remote trips where it may be several days or weeks before help gets to you and you may need to have every advantage getting yourself or partners out. You might need typical items used as splint materials as crutches or their intended purposes in the long term.

The SAM is versatile. They make good neck braces and can be incorporated into bulk dressing for rib fractures. You can always cut it in half to save weight  and space but still have a small amount of rigid splint to work with.

Em: Yeah, I could see the problem with using a makeshift splint out of existing materials (ice axe, trekking poles, tent poles) you are already carrying, because you may need those items during the course of a long self-rescue.

Baseline Meds

For meds, I always have the following for myself (and are a good baseline for everyone):

Comprehensive Meds

In my bigger kit I’d add:

Commentary

Michael: I can’t really give weights or amounts on meds, I can give a basic idea but it depends on who is on the trip and what the individual needs of the users are. I have some more sophisticated administration techniques and tools than a standard first aider as well, but I haven’t included those in the list.

Summary

From my experience as a first responder, and I’m sure Michael would agree, no one can tell you exactly what to put into a first aid kit. Other paramedics, doctors, nurses and emergency responders will be able to add unique items and items they have found effective in the past.

As someone who practices ultralight backpacking, I can say first aid supplies make up a reasonably small percentage of my base weight (10-20% for me at 10lbs or less) and I would rather cut weight from somewhere else. I’ve been in some tight jams, on and off the trail and its one place I do not like to skimp.

One thing all responders will tell you is “take your brain with you.” Sometimes intelligence means leaving behind things which are unreasonable for the situation you are entering. Sometimes using your brain, means backing down from things which have too high a risk profile, or taking an alternate route and not getting into a first aid situation in the first place.

You cannot always avoid first aid though, and it is important to have it ready for worst case scenarios, even when going ultralight.

To that end, I encourage every backpacker to acquire some meaningful first aid education: e.g., wilderness first-aid, search and rescue, first-aid, and safety courses throughout their journey of traveling light.

Disclosure

Updated September 15, 2018

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