Monday, October 17, 2011

A Backpacker's First Aid Kit

Anyone venturing into the woods should carry a basic first aid kit.  But what should be in it? Should I buy a pre-packaged one?  Or build my own?



I'm a Ski Patroller, certified in Outdoor Emergency CareMountain Travel and Rescue, and Red Cross Professional CPR. I recently graduated from the National Outdoor Leadership Wilderness First Aid course. (Which I highly recommend to any venturing away from immediate EMT support). While I want this kit to be as light as practical to keep the pounds off my old knees, I also want to be prepared for what might befall us.  I decided to assess the risks, figure out what I needed to address the most likely issues, and to think thru what can be improvised by using what's in one's pack or on the ground around them.

What are the risks?  Hiking in the mountains, there's lots of injuries from falls.  Mostly from trips, but potentially worst - sprained ankles, broken bones. General aches and pains. Blisters. Stress fractures. Bug bites, ticks bites / Lyme disease. There's snakes out there, but bites are relatively rare. Cuts from mishandled knives. Burns from spilled cook pots. Poison ivy. Stomach nastiness from poor hygiene practices or from drinking unfiltered water. Hypothermia. Worst case scenarios would be a cardio-vascular emergency, or a fall with possible spine or head injury. On the other hand, any point on the Appalachian Trail, is usually no more than a few days away from a hospital. Cell phone coverage is pretty good, and a SAR / helo extraction can be activated if necessary.

Many of the companies selling first aid kits for backpacking, classify them by the number in the group and the length of the trip. Most are packed in clever, but heavy, fold-out nylon pouches that weigh well over a pound. Adventure Medical Kits is now producing an UltraLight line for backpackers, packed in tough, waterproof pouches, that are pretty well outfitted. If you're hiking solo, and not trained in first aid, their Ultra/Watertight .3 or .5 kits are good options.

I didn't find one that had the mixture of tools, bandages and meds I wanted, at a weight I found acceptable. I decided to build my own.

Whiteblaze.net is an outstanding reference resource for those preparing to hike the Appalachian Trail. There's an article on first-aid kits for backpackers written by a nurse.  Between her article, the comments following it, the Wilderness First Aid course I took, and my own experience, I came up with what I thought was a pretty good list to address the risks I identified:

Medications
  Anti-inflammatory
        Motrin (small bottle kept handy in pack) - for inflammation and pain.
        Tylenol (a couple of 2 packs) - Pain with bleeding. (cuts, open fractures)
        Aspirin (2 pack) - To chew up if the ticker decides to stop beating
  Anti-diarrheal
        Imodium A D (Loperamide) (6 pack) - Because diarrhea is miserable, and can get serious
  Antihistamine
        Benadryl (Diphenhydramine) - Allergies, insect bites, bee strings, itchiness, sleep aid
        Hydrocortisone Cream (2.5%) - Localized rashes, itches, poison ivy

Blister Treatment
       Spenco 2nd Skin Adhesive Knit (4 - 3" x 5") - A thin, breathable moleskin for prevention
 
Breaks/Sprains
        Splint materials - Found in nature - Sticks, backpack stays, etc., held with duct tape
        Sling - Bandana (a true multi-use item). Make a large one that'll make a good sling

Wound Care
        Nitrile gloves (2 pr) - Protect me from you, and you from me
        BZK Antiseptic Towelettes - To cleanse and disinfect small scrapes and cuts
        Bandaids (various sizes)
        Steri-Strip Skin Closure (3 packs of 5 - 3" x 1/8") Closing deep cuts
        Transparent semi-permeable dressings (2 3/8 x 2 3/4 & 4" x 4 3/4") For deep cuts
        Spenco 2nd Skin Moist Burn Pads (2 - 2" x 3") for when I spill my cook pot on my hand
        Gauze pads (4-2x2, 3-4x4) Cleaning and dressing wounds
        Adhesive Tape (1 - 1" roll) - Bandaging and wrapping sprains
        Rolled gauze Bandage (1 roll) Bandaging wounds
        Antibiotic Ointment (Neosprin, Bacitracin) - Treat small cuts and scrapes

Tools
        Tweezers - A long, skinny, sharp pair - For splinters and ticks
        Heavy-duty needle - To puncture and drain blisters, and sew torn clothes and gear
        Small pair of sharp, pointed scissors to cut bandages, moleskin, and clean up blisters.
        Syringe - To irrigate deep cuts and scrapes
        Space Blanket - Keep patient warm, line sleeping bag in extreme cold.
        Razor blade - For when you need a sharp blade

        Tincture of Benzoin (1 oz) - An adhesive for moleskin, steristrips and bandages

        One gallon sized baggie - Disposal of used bandages, gloves, and other bio-hazard stuff

I got some of the meds from REI. They come in the kinds of two packs you see in convenience stores, but in lots of 10. I put a couple each in my kit. I got a generic version of Imodium, and put a blister sheet of six in the kit. I figure if you need, em, you'll need more than two.

Given the prevalence of deer ticks in the Mid-Atlantic and New England portions of the trail, and that reports of hikers contracting Lyme are becoming all too common, I'm considering consulting with my GP about a script for four days worth of doxycycline to get me to an ER after symptoms show. Call me paranoid ...  At the very least, we'll be treating our clothing with Permethrin, our bodies with DEET, and conducting thorough tick checks daily when we get into those parts.

I'd also be inclined to pack a small qty of some kind of prescription-strength acetaminophen/codeine combo for extreme pain.

I got the Spenco products, SteriStrips, and antiseptic wipes from Amazon, Some of the wound dressings came from Wilderness Medical Institute's store. Amazon carries them, but you have to by enough to outfit an ER. Again, just a couple of each went into the kit. The extra meds and bandages will be spread out amongst our drop boxes to resupply the kit.


I used snack-sized baggies to organize tools, blister stuff, wound stuff, meds, and bandaids, and I managed to squeeze it all into a one-quart freezer baggie. Total weight is 13 ozs.

I could reduce weight by reducing the qty of some of the bandages. Maybe eliminating some altogether. I could swap out the 1 oz bottle of Benzoin with ampules available thru Amazon, Eliminate the snack-sized baggies I use to organize the kit. Replace the half tube of triple antibiotic ointment with some of those small foil packets. Get rid of the syringe and use a water bottle to irrigate wounds ...

Maybe I will. I have five months to go. Of course, I already got rid of the EMT shears, sam splint, CPR mask ...

A lot of first aid kits come with a book. I downloaded NOLS Wilderness Medicine from Amazon, and loaded it on my Droid. Now that's a weight savings!

I really want to put those EMT shears back ...

Note:
 I have since updated this kit and wrote about it [here]

"An ounce of prevention is worth a pound of cure."  Benjamin Franklin


9 comments:

  1. Don't skimp on weight when it comes to First Aid, It's too important for that. Most of your listed stuff, I carry also in my kit. You might want to consider a strong prescription pain killer like percocet for broken bones. If you're hiking with a partner (like I do...my wife). If she or I broke a leg, I would like to to make sure we are comfortable, warm and hopefully pain free to combat the anxiety of one or the other having to spend hours waiting for the other to go get help.

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  2. Good idea on the prescription pain killer. In the offshore sailing community, there's Docs who prescribe a full range of meds for their clients, and are on the other end of a sat phone to talk them thru procedures. Shirley, all that's not necessary on the AT, but scripts for something strong for pain, and perhaps appropriate antibiotics for lyme and guardia might be prudent.

    Thanks for your comments Sticks.

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  3. one thing to keep in mind is that even though it is a wilderness experience you really aren't that far from civilization to any great extent. Really serious incapacitating injuries are rare on the trail. As long as you don't do anything silly you should be alright. Duct tape works just as well as adhesive tape.And just keep in mind that you can resupply any time your in town. I rarely used my first aid kit but I also didn't have an issue with blisters. Bottom line is carry what you are comfortable with.

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  4. So let me respond to your blog post with a... blog post. Hope it's not too long winded for you.

    First, I wanted to rundown the most common injuries on the trail and they include in no particular order, superficial cuts and scrapes, blisters, chafing, not to mention heat exhaustion and heat rash. I would concern myself with the heat injuries and dehydration more than anything else. One thing that you might not have considered is jock itch. Have a plan for it. It's not pleasant but it's not something you necessarily need to carry supplies for every day you're on the trail. If you haven't considered supplements as part of your prevention plan the you probably should look at that too.

    Just to give you a little story about myself and trail injury, I came off the trail on Nov 9 with a high ankle sprain which was severe enough to put me into a cast until this past Thursday. While it hurt pretty bad the disappointment that I wouldn't have a chance to finish with less than 300 miles hurt worse.

    I was lucky that I only had to hobble for 15 - 20 minutes and I arrived at a High School emphasizing a point made above by Hitman. Since I was a late season hiker in CT, I could have been by myself for a long time and truthfully I could have withstood the pain a couple of days while hiking out of the woods. In most cases though there are lots of people and if you are in trouble, everyone truthfully wants to help you. Outdoors people and hikers in particular look after each other more than anyone else.

    While meds may make you comfortable and are probably the most valuable items in your med kit, a nice painkiller in a situation requiring one may inhibit your chances for self rescue (the best rescue). I also echo Hitman in saying carry what you're comfortable with in every aspect of packing. The best advice that anyone will offer you is to take your time (all the time) and that is more prevention than anything you can carry in your pack.

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  5. Thanks for the comments. Sorry about your injury stopping you so close to your goal, I can only imagine how much that would suck. I do appreciate your guidance on taking time and staying safe. I plan to minimize time in towns and hike till it's time to hit the rack in order to avoid the pressure of completing by some date. As for the rash, I'm hoping daily hygiene, and my choice in underwear, which provides a slight amount of thigh compression might help me avoid that. If not, I'll have a small amount of hydrocortisone cream, and may just have to carry a small qty of Gold Bond powder...

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  6. For wound care, I added QuikClot. Cheap, light and makes a difference. Never know what could happen. I got bit by a dog which hit an artery and bled profusely. That happening out on the trail could have been a real issue and there's many other potential hazards... hunters, sticks, knives, falls, cuts, car accidents etc. It's one item that's better to have than have not.

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    1. Those are spendy buggers, eh? I might just add one of the 50 G 5x5s to my kit. Thanks for the suggestion, Ryan.

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  7. It’s a wonder that the adhesives associated with the tapes and they are used as the helper during the medical processes and the term FIRST-AID is simply a humble and honest path to any harm if featured practically. It was a great issue before a decade when medical industry introduced the surgical tapes and a cloud of cells and tissue damages were floating all around.

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