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Category: Wilderness First Aid

There is nothing worse than being underprepared in the wilderness, especially when it comes to issues that require medical care, treatment, and attention.

Let’s face it, we could all brush up on our wilderness first aid skills and Kim has created a series to take you to the next level.

Start here, to learn how to build and maintain your own wilderness first aid kit. Follow the steps to assemble a stationary, midweight, and ultralight backpacking kit.

Once you have done that, continue with these posts to learn how to deal with common ailments on the hiking trail:

How to Build and Maintain Your Own Wilderness First Aid Kit

This article is part of a series on Wilderness First Aid. Skip to another post:


Intro

A first aid kit is arguably one of the most important things you can pack for a big trip. Whether you are hiking, backpacking, or recreating in some other way, injuries and illness can happen anywhere.

Store-bought, pre-stocked kits are good to have in places where medical care is a phone call away. Unfortunately, they are insufficient for everything you might need, and their contents run out quickly. Maintaining your own first aid kit from your own stock of supplies is a cost effective way to be prepared for any emergency.

This post covers how to build and maintain three different types of first aid kits yourself – a heavyweight version that you can keep in your vehicle or home, a mid-weight version for backpackers, and a slimmed down, ultralight version for those who want just the basics.

A first aid kit
Clear labeling is important!

Maintenance

Labels are extremely important for a first aid kit. In urgent situations, speed and quick thinking can save lives, and labels allow you to rapidly find the things you need.

I have provided the labels I use on my kits for download here. They can be printed on a standard 1″ x 25/8address label form. In return, please consider signing up for our e-mail list or using our Amazon affiliate links to make purchases on Amazon. It costs you nothing and helps us out!

In order for your kit to be effective, it must be restocked after every use. I have a cupboard where I keep large quantities of each item, and before every trip, I take my first aid kit out and replace anything I’ve used.

First aid supplies
A few of the supplies I keep in my “first aid cupboard.”

Your kit should be protected from water and able to withstand abuse. I keep my backpacking kit in a large zip bag with the contents subdivided into smaller bags, each clearly labeled. I have a large first aid kit for our RV in a fishing tackle box. Max carries the minimalist version in a quart-sized Ziploc while he backpacks.

Medications should be clearly labeled with name, usage, and dose. If you have children, make sure you have children’s doses on hand (not covered in this post).

I’ve provided Amazon links for each product so you can see examples and the brands I prefer, but you can also find most of these items at Walgreens. War surplus stores are also a great place to find inexpensive medical gear.

Heavyweight First Aid Kit

This kit contains everything you may need to provide first aid in an emergency. This is designed to be stationary, and is perfect for a car, home, RV, boat, or cabin.

First aid kit
The first aid kit we keep in our RV.

Pharmacy

Common brand names are listed in parentheses. Generic versions of these medicines are absolutely fine. I keep mine in small zip baggies with labels.

The medication compartment of our RV first aid kit
The medication compartment of our RV first aid kit

Rashes, Bug Bites, and Mouth Issues

Wound Care and Closure

Sprains, Strains, Dislocations, and Fractures

Miscellaneous

The contents of our RV first aid kit
The contents of our RV first aid kit

Midweight First Aid Kit

This kit sheds the heavier items but still allows you to be thoroughly prepared. This is a great kit for backpackers.

Wilderness backpacking first aid kit
A mid-weight wilderness first aid kit that I take backpacking

Pharmacy

Bites and Stings

Look for single use packets of these, or squeeze some into small bags.

Wound Care and Closure

Sprains, Strains, Dislocations, and Fractures

Miscellaneous

Ultralight First Aid Kit

This is a bare bones kit that only has the basics for day hikers or minimalist backpackers. Use small zip bags for carrying small amounts of medication or ointment.

Minimalist ultralight first aid kit
Max’s minimalist first aid kit. You can tell it’s seen heavy use!

Pharmacy

Medications for a wilderness first aid kit
Make sure all medications are well labeled

Wound Care and Closure

Sprains, Strains, Dislocations, and Fractures

Miscellaneous

Boring but Necessary Disclaimer

This is not a substitute for professional medical care. First aid is meant to provide assistance to an injured or ill person when medical treatment is unavailable. Do not delay seeking professional help in the event of a serious condition.

If you are interested in learning more about Wilderness Medicine, I recommend enrolling in a Wilderness First Aid course through your local REI.

Preventing and Treating Blisters

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Overview

Blisters. Boring and easy subject, right? That was the assumption I had when I began preparing for this article. Little did I know I was about to find myself ankle deep in a swirling torrent of sock liners, foot creams, and padded insoles.

I found dozens of articles, websites, and blogs giving advice on how to prevent these pesky little things, but I wanted to get past the advice and find information that was actually well supported by research. Separating myth from reality turned out to be very challenging.

Sadly, medical literature on blisters seemed to be seriously lacking. The best study I could find on blister care was from 1955. I didn’t want to cite a study conducted in an era when frontal lobe lobotomies were all the rage and children’s cough syrup still contained opium.

When I changed tactics and began searching through military studies, I realized most of the relevant data on foot care for active people has been done on the battlefield. Considerable time has been spent trying to figure out how to keep soldiers from getting blisters on long marches in heavy boots.

I’d hit the goldmine – suddenly I had an overwhelming amount of research at my toe tips. Thank you to all of those soldiers who had to trek in uncomfortable footwear to provide us with this information. Your foot pain wasn’t endured in vain.

I’ve decided to list prevention methods in the following order: From those that are the most well supported and practical, to those that have very little data behind them and may actually be detrimental.

Recommended Methods:

Wear Proper Footwear

When you buy new shoes, take special care to find the right fit. They should feel comfortable when you put them on. Some breaking in will be necessary, but avoid shoes that feel like they are pushing your feet into an unnatural position or squeezing any part of your foot.

Try on shoes with the socks you normally wear during your outdoor activities, not the loaner socks the store provides. There should be 0.5 – 1 inch between your longest toe and the end of the toe box. Buy a new pair of shoes as soon as your old ones start to become uncomfortable.

Break in Your Shoes Gradually

New boots were found to be a major culprit behind blisters in one study. As much as you may love a new pair of shoes, do not take them twenty miles on their first outing. Start by wearing them at home while doing chores for a few hours, then wear them around town, and finally take them on a short hike before you bring them on longer treks.

Choose Socks Wisely

Merino blend wool socks are the most effective at reducing moisture. Pair them with a thin polypropylene liner that will wick the sweat away from your feet. When your socks become extremely moist, change them. See this article by Max for more information on choosing socks.

Tip: We’ve tested a lot of different socks. Read about our favorites.

Condition Your Feet

Everyone’s skin is different, and some people are just more prone to getting blisters. But skin can also be conditioned gradually to build up it’s resistance to the forces that cause them. I’m not talking about running barefoot until you get calluses, as these don’t actually prevent blisters and may actually lead to worse ones.

You are much more likely get blisters if you increase your activity drastically over a short amount of time, like running a half marathon one day when you usually only run a few miles. Increase your activity gradually to protect your feet.

Use Tape

Kinesiology tape can be applied directly to blister prone areas for prevention, like the skin between your toes. The aim of tape is to decrease the friction acting on your foot, so a good tape should be very sticky on the inside but not on the outside. It should stabilize the skin while still allowing it to slide slightly against your sock.

There are many great tapes out there, but I find RockTape to be the strongest and most sweat resistant. Taping correctly can be challenging; take a look at John Vonhof’s book Fixing Your Feet: Injury Prevention and Treatments for Athletes for some great photographic references.

Engo patches are an alternative to tape that are applied directly to irritating places in your shoes rather than you feet. They are easier and faster to apply and are very handy to have around.

Questionable Methods

Anti-Perspirant

A large study using U.S. Military Academy cadets as guinea pigs found that deodorant applied to the feet nightly reduced blister formation considerably. However, the deodorant also caused a high rate of skin irritation among the cadets. The study was fairly limited in its scope and methods.

Lubricants

Lubricants decrease the amount of friction between your foot and your sock, but only for about the first hour. Within three hours, they actually increase friction. They must be wiped off and reapplied frequently to remain effective.

Powders

I found many, many sites suggesting rubbing everything from cornstarch to expensive mineral compounds into your feet. Some runners swear by foot powder, and if it works for you, great. I could not find any evidence supporting its use. In fact, several (admittedly very dated) studies conducted in the British military suggested powder may actually cause more blisters.

Treatment

Moleskin

Once a blister has formed, Moleskin can reduce the discomfort and prevent it from worsening so you can keep on trekking. Cut a piece larger than the blister, and cut a hole in the center for the blister to fit through.

To Pop or Not to Pop?

If you’re a sicko like me, popping that fluid filled bleb can seem so tantalizing. But in the wise words of the great Ice Cube, chickity check yo self before you wreck yo self – popping blisters can lead to infection, especially if you’re out in the backcountry. The top layer prevents the sensitive inner layer of tissue from becoming exposed to bacteria. Avoid it if possible.

Draining

Sometimes a blister just has to be popped due to its size or the irritation it’s causing. If you’ve decided this is the proper course of action, get a needle or a scalpel. Clean the area thoroughly. Make a small hole in the  side of the blister and gently press all of the fluid out. Apply antibiotic ointment and a pressure dressing to adhere the layers of skin together and prevent it from filling with fluid again. If the blister is filled with white or green fluid, that probably means it’s infected and should be seen by a medical provider.

Sources and Further Reading:

The Blister Prone Athlete’s Guide To Preventing Foot Blisters by Rebecca Rushton

Fixing Your Feet: Injury Prevention and Treatments for Athletes By John Vonhof

Blisters: First Aid, Mayo Clinic

The effect of two sock fabrics on perception and physiological parameters associated with blister incidence: a field study.

Blisters on the battlefield: the prevalence of and factors associated with foot friction blisters during Operation Iraqi Freedom I.

Influence of an antiperspirant on foot blister incidence during cross-country hiking.

How to Break in Your Hiking Boots

Podiatry Today: How to Manage Friction Blisters 

Boring but Necessary Disclaimer:

This is not a substitute for professional medical care. First aid is meant to provide assistance to an injured or ill person when medical treatment is unavailable. Do not delay seeking professional help in the event of a serious condition.

If you are interested in learning more about Wilderness Medicine, I recommend enrolling in a Wilderness First Aid course through your local REI.

Preventing and Treating Nausea and Diarrhea

This article is part of a series on Wilderness First Aid. Skip to another post:


Overview

Ahhh yes, freeze dried entrees. After a day of munching on granola bars and beef jerky on the trail, isn’t a hot meal so satisfying? That is, until it starts coming up in the middle of the night. As you’re kneeling in the dirt outside of your tent heaving up pad thai, certain questions may come to mind: How did I get here? When did I even eat carrots? Why are you doing this to me, Backpackers Pantry? Don’t despair, I have answers for you, and it wasn’t your freeze dried meal’s fault.

Diarrhea and vomiting may not be as fun and glamorous as gaping wounds, but they killed more people than guns during the Civil War, and they are the most common ailment to affect backcountry adventurers, so I’ve taken special care on this First Aid Friday subject.

Priority One: Prevention

1. Wash your hands, wash your dishes

Why is this ahead of water treatment? Because good hygiene has actually been shown to be a  bigger factor in reducing GI illness than water treatment. Wash your hands after nature calls and before you eat. If possible, use bio-degradable soap and water, but if water is scarce you can use a hand sanitizer.

Wash your dishes with soap and water or whatever you have available. (When backpacking, I use wet wipes and a little bit of water) Do not reheat leftovers that have been sitting out all night. The heat may kill bacteria, but the toxins that cause illness will still be present.

2. Water treatment

Still important. Whether it’s Iodine, a water filtration pump, or boiling, you must treat ALL of the water you consume. After trying several different forms of water treatment, my favorite is just straining water through a nylon stocking and treating it with Aquatabs.

Priority Two: Rehydration

Okay, so despite taking pains to avoid it, you’ve found yourself visiting the bush four times a night with the trekker’s trots or barfing up your chicken teriyaki. This is where a well-stocked portable pharmacy can help you recover.

ORS Tablets

Dehydration and electrolyte loss are the greatest hazards associated with GI illness. This is where ORS tablets come in. Not only do they replace your valuable electrolytes, but you can get them in tasty flavors to make drinking a little easier.

Drinking exclusively ORS water is unnecessary. Drink about one third ORS water to two thirds plain drinking water. If you are experiencing severe vomiting, take one sip of ORS water every 15 minutes. Don’t get frustrated if you can’t seem to keep it down. Increase or decrease the time between sips as the vomiting allows.

Priority Three: Symptom Control

Don’t put away your portable pharmacy yet. If you’ve stocked these staples, recovery will be a breeze.

Bismuth subsalicylate (Pepto-Bismol)

Bismuth subsalicylate has a variety of different benefits and should be used in both vomiting and diarrhea. Not only does it relieve GI upset, it actually kills the harmful microbes in your GI tract. The liquid formulation is more effective, but when weight is an issue, tablets can be used instead.

Loperamide (Immodium)

Loperamide slows diarrhea. Take 4 mg after the first loose stool, and 2 mg for each following loose stool. Do not take more than 8 mg in a day. DO NOT take it if there is blood in the stool or if you have a fever over 100.4 degrees Fahrenheit.

Ginger Chews

These can be highly effective in reducing mild to moderate nausea. I also stock ginger tea in my backpack.

Diphenhydramine (Benadryl)

This little pink multi-tasker has so many uses beyond just treating allergies! It is also effective in controlling nausea and vomiting. It’s a mild sedative that can help you sleep, take the edge off of a backcountry panic attack, and can even be taken safely by dogs.

Sources and Further Reading:

Epidemiology of wilderness-acquired diarrhea: implications for prevention and treatment

Influence of Hygiene on Gastrointestinal Illness among Wilderness Backpackers

Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years.

Boring but Necessary Disclaimer:

This is not a substitute for professional medical care. First aid is meant to provide assistance to an injured or ill person when medical treatment is unavailable. Do not delay seeking professional help in the event of a serious condition.

If you are interested in learning more about Wilderness Medicine, I recommend enrolling in a Wilderness First Aid course through your local REI.

Treating Cuts and Wounds

This article is part of a series on Wilderness First Aid. Skip to another post:


Overview

Between knives, hatchets, sharp rocks, and vicious man-eating raccoons, there are many ways to sustain wounds in the backcountry. Most of these will be small cuts and scrapes, but every backwoods adventurer should be prepared to handle larger wounds.

The good news is, whether a paper cut or a gaping raccoon bite, the principles of wound management are the same.

Priority One: Stop the Bleeding

Use the cleanest material possible to hold pressure on the wound. A 4×4 gauze pad works great. I recommend carrying a few in your first aid kit. Do not constantly lift your hand to see if the bleeding has stopped. Hold a continuous and steady pressure. If the bleeding soaks through the gauze, do not change it, just add a new piece on top. Almost all external bleeding can be stopped by holding pressure.

If the bleeding is massive and pulsatile, meaning it is rhythmically pulsing out, you may be dealing with an arterial bleed, which is much more serious and life threatening. This is a situation that needs professional help ASAP.

If you are dealing with a pulsatile bleed, elevate the extremity and apply a pressure dressing. If the wound still continues to bleed profusely, consider a tourniquet. Tourniquets should only be used in life threatening situations because they can cause considerable nerve and tissue damage, and possibly lead to limb loss. If you’re dealing with an arterial bleed, it’s time to bail on your backcountry adventure.

Priority Two: Clean the Wound

Most wound treatment revolves around one single concept: preventing bacteria from taking up residence in your wound. Bacteria need an environment that is warm, wet, dark, and has lots of nutrients for them to feed on. Create an inhospitable environment for them and you will be less likely to experience a wound infection. In the wilderness, infections can get out of hand quickly, so the key is prevention.

Forget everything you ever learned about hydrogen peroxide, iodine, and even soap. The single best way to clean a wound is to irrigate it with clean water using continuous pressure. Yep, you read that right: Plain old water. Clean tap water, when used correctly, is just as effective at reducing microbes in a wound as sterile saline is, and use of soap has actually been associated with a higher level of bacterium present in wounds. Do not scrub the wound – this actually damages tissue and creates a higher risk of infection.

I recommend keeping a 10-20 ml syringe in your first aid kit for these situations. Use the syringe to irrigate the wound with at least 200 ml of treated water (1 Liter is best). The idea here is to manually expel all bacteria and foreign objects from the wound bed, so pressure is an important factor. If you don’t have a syringe handy, you can cut a very small hole in the corner of an unused Ziploc bag and spray your water through it, or hold your water container at a short height from the wound. Make sure whatever you use has some oomph behind it.

Priority Three: Cover

The majority of wounds sustained in the wilderness should not be closed with stitches or staples until you can be seen by a clinician. Once a deep wound is closed, it provides all of the things bacteria appreciate: Warmth, moisture, and lots of yummy damaged tissue to eat.

Even large, gaping wounds should be allowed to heal on their own until they can be evaluated by a professional. Leave your suture kit at home, amateur surgeons. Keeping the wound clean is much more important than keeping it closed.

Consider using skin glue for a minor wound in a pesky area, such as the webbing between your fingers or toes.

Dry the wound using clean gauze and cover it with gauze and tape or a bandage large enough to completely encompass it. Most commercial bandages are too small and come off easily. You need to stock your first aid kit with a wide variety of large bandages. Chances are you’re going to be sweaty and active, so I recommend keeping Mastisol or Tincture of Benzoin in your kit to help your bandages adhere. A small dab of antibiotic ointment can be applied to help prevent infection. The wound should be cleaned and redressed every day.

Sources and Further Reading:

Boring but Necessary Disclaimer

This is not a substitute for professional medical care. First aid is meant to provide assistance to an injured or ill person when medical treatment is unavailable. Do not delay seeking professional help in the event of a serious condition.

If you are interested in learning more about Wilderness Medicine, I recommend enrolling in a Wilderness First Aid course through your local REI.