Echoing Tango61’s recent post, and in response to JimShaw’s call for more post addressing the basics, this post addresses how to become prepared to perform first aid in the backcountry. It is based on my own experience (Boy Scout, former EMT, for CPR trainer) and the comments of others. I am not a doctor, and this post does not provide specific medical advice for medical care – it is about being prepared to act when things go wrong.

1) Get a class. American Red Cross, American Heart Association, Boy Scouts, NOLS.

2) Failing a class, or combination with one (better), get a reference and practice. Some references could include:
a. Boy Scouts: Handbook, Fieldbook, First Aid Merit Badge booklet
b. Mountaineering First Aid: A Guide to Accident Response and First Aid Care
c. American Red Cross – First Aid: When Help is Delayed
d. James Wilkerson's Medicine for Mountaineering
e. Any other current handbook on first aid

* Currency of your references matters here. The state of practice in medicine changes over time as doctors learn more about the human body and how to fix it when it breaks.

3) Build a kit that utilizes what you've learned. A kit MIGHT include items from the list below. The list below reflects my own kit, which I am constantly refining. However, first aid kits are a very personal decision. Some backpackers are comfortable carrying much less and others prefer to carry more – I am somewhere in the middle. Remember that you have to know how to use what you have, or it is just extra weight. Similarly, additional knowledge can (within limits) make up for not having a specific item.
a. CPR Mask (Microshield)
b. Rubber Gloves
c. Triangular bandages - 2; these things are all purpose for splinting and bandaging (esp. for big wounds).
d. Ace bandage – (I replaced one of 3 triangular bandages with this b/c I tend to roll ankles)
e. Some roller gauze, 2"
f. roll of two inch tape
g. 4-10 4x4 gauze pads, depending on how long you stay out. Cut these down as needed to deal with cuts, burns, etc.
h. pack of band aids
i. small tube antibiotic
j. personal medications
k. pain meds (Tylenol, Motrin - remember that they do different things and have different side affects, so I take some of each)
l. anti diarrheals (Immodium AD) - one to two courses
m. cold medicine (pills) - usually Sudafed
n. Benadryl
o. Moleskin (for blisters)
p. alcohol wipes (kind you use for prepping injection sites)
q. soap (a better disinfectant than alcohol wipes)
r. tweezers
s. Small nail/bandage scissors (need to cut down moleskin/gauze pads)

*others on this site have suggested a sewing needle for popping blisters, chap
stick, a nail file, and various narcotic painkillers. All of these ideas have merit, and are worth considering based on your own level of training/knowledge.
**Remember to pack all this stuff in zip lock bags or the first time you get caught in a shower you’ll be replacing gear.

4) A minimum kit should address the basics of first aid: Airway, Breathing, Circulation (includes heart and bleeding), Deformities (broken bones), and possibly Extrication (getting the victim to definitive care). There are limits to what you can/should do for each of these, but a good first aid course will address each of these points, and what some of the practical limits are.

5) Note that improvisation based on your own personal knowledge will be key to treating serious injuries. A trained paramedic is NOT around the corner, and you can’t carry everything you might possibly need for the worst injuries. This is why a course, planning ahead, doing additional reading, and continued practice are important.

6) Most basic first aid courses aren’t going to address the use of over the counter (OTC) medications well, and laws in many states prevent you from prescribing medication to others unless you have the proper certifications. Think about OTC medications the same way you would at home, but remember that a pharmacy is not around the corner to get Motrin when you’ve overdone it, and that you really will have to carry everything you put in your pack.

Sincerely

Steadman

"However, first aid kits are a very personal decision."

Definitely, and I'm sure many folks here have seen examples of people going a long ways towards either extreme (too little of the right first aid gear, or too much weight of first aid gear carried).

Recognizing that this is a beginner forum, I nevertheless hope no one objects if I suggest that with experience some trade-offs can be made in terms of what we carry that don't cut too much into safety to save some weight. To put this another way, I think it's better if folks can think through these trade-offs to consciously have a plan for specific issues, rather than perhaps just dropping some item(s) entirely when they see others around them carrying significantly less ...

So for example, irrigation of a wound is an important thing to be able to do, but one can cut a hole in a ziplock bag and force water out of that, or use a hydration system tube. For a triangle bandage it's possible to simply cut up some sort of clothing item. Rubber gloves can serve dual use as vapor barrier gloves. A very small pocket knife can offer knife blade, scissors, and tweezers, all of which can play a role in an overall first aid system. Rather than a tube of something like, say, antibiotic, a few single-use packets might be lighter weight but sufficient for most situations.

A big issue in backcountry injuries can be just having enough material to stop bleeding; at the risk of the inevitable attempts at humor that follow, a female sanitary napkin is an effective and lightweight thing for people of either gender to carry for this (one or more).

Bottom line for me is that with experience and some forethought, a person can have a pretty complete kit without it weighing several pounds (!).

On another tangent, here's a document written by a backpacking doctor that fairly tersely but effectively gives treatment information for the specific things that tend to happen to backpackers.

I copied this into a Word document, reduced the font a bit and massaged it to fit on a single double-sided page that I keep in a ziplock with my first aid supplies. Perhaps you'll find it useful too.

You are definitely on the right track with suggestions for improvisation. You need a few dedicated items (mostly for sterility) but most of the rest can be fashioned from materials at hand. The most important item, and the lightest in weight, is knowledge.

Case in point. I was climbing with a buddy, and a new acquaintance. We encountered a climber who had just been clobbered right on the forehead with a rock (contusion on the forehead, destruction of his helmet). Right then, the new acquaintance stated that he was an MD and had just finished three years in a local ER. We fashioned a cervical collar from a blue foam pad, and shipped him out. We did have communications, and were able to transport the victim with a nocturnal helicopter hoist.

Our climb then proceeded as planned....

Thanks. That is a great reference.

BrainLe

That is a great reference. I'm still digesting it.

And I really appreciate the feedback.

I know that my kit has several things in it that many others would leave out. However:

1) I plan to need all the clothes I carry. I'd rather carry the two triangular bandages and not use them than have to cut up my clothes when things are already going really wrong.

2) I use the ACE bandage on my ankle more than I want to think about.

3) The gloves and microshield cost a bit of weight and space but (1) I don't want to suck on someone else's face if I don't have to and (2) I don't want to stick my hands in their blood. Likewise, I don't really want others to hesitate to give me mouth to mouth if I need it, or try to stop my bleeding.

I want my kit to both reflect what I need to treat myself, and what others would need to treat me, and what I might need to treat others. I'm willing to pay the extra couple ounces to achieve that.

To turn this idea around, and to give it some personal examples that give my gear choices some life (and I'm not trying to attack you), how would you feel if others looked at your nasty laceration and futzed about with treating it because they didn't have gloves, and thought you might have AIDS or hepitits? Or if you had to trade away a baselayer that you needed to stay warm to staunch bleeding? Or, if while you're doing CPR on your buddy you also had to wonder when the next time it was going to be safe to have "maritial relations", because you don't have a mask.

I agree that the kit should be more balanced towards the low end - cuts, scrapes, blisters, and OTC meds. However, you ignore the high end at your own peril.

At one time or another, I've used everything in this kit, or used that item out of someone elses. So it passes (for me) the use test that this forum continually poses when talking about gear. I don't want to carry one more thing than what I need - but I also don't want to be lacking when I REALLY need something.

Sincerely, and with great respect

Steadman

Brian and Steadman:

Thanks for a great exchange, and an excellent "point/counterpoint" on the tradeoffs between a medical kit that is too light v. too heavy. Your well-written exchange has made me completely rethink my minimalist first aid kit, and it may actually grow a bit. You've both definitely changed my perspective for a solo trip from, "What is likely to happen to me?" to "What might happen to me? What if I come across someone else who is injured?"

I also printed out that first aid article, and intend to stick it into that kit.

Jimshaw: These two posts should definitely be part of your beginner's series of articles!

Just want to chime in here about the gloves and microshield. I had occasion to tend a victim in the office who collapsed suddenly with grand mal seizures. I had a microshield and gloves in my briefcase which was 50 feet away - might as well have been on the moon when it came to providing immediate attention. I went ahead and gave care (no significant fluids were involved), but I now carry a pair of gloves EDC on my body.

I was very thoughtful when I later learned that my victim had a history of drug use. I think I luckily dodged a bullet.

Glenn I agree that these are valuable exchanges, but I'm just a member, its up to people with authority to do something with them, or to have them become lost.
Jim

Great points, Steadman. In fact, I do carry a pair of nitrile gloves; the only catch is that they might not be sterile if I go to use them, as for me they're primarily a vapor barrier glove. See this BPL forum thread for some thoughts on that if you're interested (not directly first-aid related ...).

But I'm carrying them anyway; they'll protect ME while I'm helping someone, and of course some sterilization can be attempted with purell or whatever.

Cutting up clothing: good point, of course, and particulaly for the light-to-ultralight backpacker who is already weight conscious --- likely they have less spare clothes. In the Army they told us to always use the other guy's first aid kit, so one possibility is that the victim has spare clothes ...
but at the end of the day it could require some careful trade-offs. I figure I could cut up a silnylon stuff sack and leave some stuff loose in my pack as a result (for example), or cut a strip or two off the end of my poncho without leaving me overly exposed to natures tender mercies.

It's so hard to have the "right" first aid kit in that you can't really key off of what other people bring so much. I.e., if I watch what experienced folks use for sleeping bag, tent, etc, that's going to have some experience behind it --- because you use those things on the trail every day. Thru-hiking the PCT in 2008 I went for 2600 plus miles without ever using anything from my first aid kit in terms of actual injury --- I used a little body glide, some duct tape on blisters early on, and of course a little ibuprofin now and again but that was it. So my "experience" at what a person needs in a first aid kit is pretty low despite having a lot of trail miles. My understanding from others is that what first aid kits often lack is enough sterile material to soak up blood and stop the bleeding (hence the female sanitary napkin(s) idea).

Really, it seems to me that "first aid" stuff can be divided into the two categories of "stuff that tends to get used" and "stuff I hope I never use". The former category includes things like moleskin, anti-chafing, anti-monkey butt, pain medication of choice, that sort of thing. It's ultimately the latter that I think is hard to plan for, balancing dead weight carried against dealing with unlikely but potentially severe situations.

As I said earlier, this thread has made me rethink what I'm carrying (which was a lot less than discussed here - that's going to change.)

My hiking buddy is an EMT in Norfolk, Virginia, and has thru-hiked the AT. I have a great deal of respect for his knowledge, maturity, and judgment, and trust him implicitly based on many trips together. (When he was one of my Scouts, I was his backpacking mentor; now the roles have reversed, since he progressed well beyond my recreational level after his stint in the SEALs and his thru-hike.) I ran some of the items I was thinking of adding, and he had this to say about a CPR mask:

"I don't think I would put a CPR shield in my kit because I know the chances of bringing someone back and keeping then alive on the trail is next to none. In those situations you really need medical care that you can not provide on the trail."

He also had this to say: "Latex gloves are a great thing to have, not for you but for the nasty injured you coud find with blood all over him. I will be adding them to my kit after I'm done with this e-mail."

His kit, just to provide another sample list:

(All items are in a ALOKSAK. Its stronger and more water proof than a zip lock.)

2 packs of 4x4 sterile gauze
1 sheet of mole skin
6 transparent dressing, (like a second skin dressing that I use for blisters and could be used for some other things.)
3 very large band-aids
7 large band-aids
5 medium band-aids
8 butter fly bandages
4 packs of triple antibiotic ointment
2 iodine prep pads
3 alcohol prep pads
half a roll of medical tape
half a roll of Johnson & Johnson water proof medical tape
finger nail clippers
tweezers
whistle
Ibuprophen
latex gloves

I'm not sure, but I think he carries a mini-tool type knife that has scissors on it; I carry a small Gerber LST knife, so I carry a pair of folding scissors (I think they came from a sewing store.)

Again, many thanks for an excellent, thought-provoking thread.

He is probably right about the CPR shield. Neither of my CPR-involved victims survived. In fact, the autopsy conclusion was that both were dead when CPR was first applied. It might be different for a drowning victim.

I've posted this already elsewhere, but it bears repeating. In my first-aid update last spring (mostly CPR and AED--the latter unsuitable for backcountry use), we were told that less than 5% of cases of cardiac failure can be saved via CPR. The AED (which should be available in most public buildings these days) and having the ambulance just around the corner are far more important. In other words, if you find me lying alongside the trail, don't bother--just let me go in peace.

In cases of lightning strike or cold-water drowning, though, CPR can be a lifesaver and is well worth learning for that reason alone.

To piggyback off the CPR mask topic...

In short, OM is right. With few exceptions, CPR is really only effective when started early, followed by rapid defibrillation and access to advanced life support, and when the cardiac arrest was caused by something that leaves your heart, pipes, and blood mainly intact. So, something like a heart attack or lightning strike. Traumatic causes of death have an incredibly low survival rate, even when they occur minutes from a trauma specialty hospital.

In the frontcountry, CPR is moderately effective because access to defib and ALS are measured in minutes. In the backcountry, they're measured in hours to days. Add to this the likely cause of death (trauma is probably top of the list, but I can't prove that with research), and CPR is pretty unlikely to much of anything. The two main exceptions, as OM said, are lightning strikes (which short-circuit the circulatory and nervous systems) and submersion injuries (which are lack of oxygen-related problems, not a heart/pipes/blood problem).

Just food for thought and individual decision-making about what to pack.

And to agree with both of you but back to the subject of a CPR *mask* - seriously folks, in the really unlikely event that CPR were do to a darn bit of good in the backcountry (i.e. usually in a submersion situation) gimme a break. I'll just take my chances on the liplock.. rather than carry some ridiculous and maybe only marginally effective mouth condom.

If you're dead otherwise I'll take my chances on whatever you've got... and you whatever I've got.

The statistical chances of finding someone who is in the act of drowning or just got struck by lightning and therefore needing CPR are so infinitesimal that I see no reason to carry a CPR mask. If I were taking the first aid kit for a large group, that's one thing, but I travel solo except for my dog, who to the best of my knowledge has neither Hepatitis B nor HIV. (The former disease, by the way, is far more contagious, per the many safety films that were required watching even for the financial accounting department at the HMO I worked for.)

Your mileage may vary, but I'd rather not load myself down with items for a situation that has a less than 1% chance of happening.

Tango61

You've captured one of my points - you have to balance between the "severe but unlikely" events whose consequences are so high that they cannot be ignored and the "not severe but likely" events that you won't want to ignore, or will find ignoring them causes you to not enjoy the trip. Sudafed isn't going to save any lives, but it can make you a lot less miserable.

RE gloves - I'm going for clean, not sterile. Sterile is only necessary in surgery. Mine are rubber gloves that you'd use for cleaning sinks and such - durable and watertight. If I have to use them on multiple victims, I can do so with a handwash in between victims.

Steadman

OM, Gorge Medic, Phat, others

RE the CPR mask

I have a good understanding of the medicine here, and I've failed to revive someone in an ALS environment, but I'll still play for the 5% chance, either for me or someone else.

Why?

1) Because I'm not telling a buddy's wife and kids that I didn't try because of the percentages, and I'm not looking at his friends and family at the funeral when I didn't try. Also, my kit has a mask because I'd appreciate it if he tried if the situation were reversed.

2) If it doesn't work, I can quit. If I've got no results after an hour or so, and no hope of relief, then I can start figuring out how to get my buddy home.

3) Further, the mask I'm carrying costs less than $10 and weighs almost nothing: http://www.mdimicrotek.com/prod_cpr-microshield.htm

Compared the consequences of not carrying it (both for doing CPR, and for not catching a disease doing it), I can't see how it makes sense to not carry one in a group, or to not carry one in your kit if you are going alone. You make it easy to help someone else, and easier for someone else to help you.

But then, your calculation of risk vs reward might be different than mine.

Sincerely, and with great respect

Steadman

If I've got no results after an hour or so

If you can do continuous CPR for anything close to an hour, my hat's off to you. You would have to be in fantastic shape to do that.

I, too, have failed at revival (twice). I completely agree with your reasoning. In fact, the first time I flunked, the victim's friends and companions were there. No way could I say forget it.

I would never say forget it! (unless the victim is me) I only was pointing out that the chances of revival of a heart attack victim with only CPR are pretty small. I would still try! Most people can't keep going for more than about 10 minutes, though.

My point was, what are the statistical chances of a solo hiker actually encountering someone out in the wilderness who is unconscious and not breathing, but not already dead?

randomly encountering? probably quite small - but again, in referring to the mask I'll go back to a very simple observation. I'm CPR trained at least. (although admittedly a while ago and I hear there are new "trends")

1) I don't carry a mask in my pocket or computer bag day to day.
2) I'd bet my chances of encountering someone requiring this are significantly higher in the city than on the trail.

My point is not that you shouldn't attempt it. my point is at least from my perspective, I'm not carrying a mask. If I wouldn't pack it around in the city why on earth would I pack it around on the trail. I don't feel it's necessary from a risk point of view. Just like I don't carry lots of other things like a johnny rambo knife and ak-47 in case the commies invade while I'm on the trail..

OM/Phat

I hear the statisitical probablity argument.

My point is that the high consequences of not having the gear when you need it outweighs the low costs (in weight and money) of carrying it.

But then, I do have a mask in each car and at home as well, but that level of prepardness comes from my background - once I've made the decision to intervene (in advance) then the question becomes "how do I do this safely." The mask is part of intervening safely.

To juxtapose another extreme, I don't carry a 10lb, $500 AED with me, nor do I own one. It costs too much for the return on investment right now. If I was 60 and had a bad heart, I might change my mind, however, and keep one around the house.

We've neatly illustrated how different people fall in different places in the continuum of risk and cost. Thanks, it's been a fun conversation.

Steadman

Aimless/OM

Refering to the CPR technique question, the trick to being able to do CPR effectively over long periods is to let your upper body weight compress the chest. The pivot point for the lever is your lower back (at the waist) raising your torso and "dropping" it on your extended arms, which are in the right position to drive the victim's sternum into their spine (compressing the heart in between). Your hands, obviously, never leave the chest until you find a new landmark. If you try to do push ups on the victims' chest, you'll wear out before EMS shows up, even in the city.

Sincerely

Steadman

Steadman
Did I miss an important part of this? Ok so I'm barely first aid trained - I know what a tourniquet is because I made one out of my boy scout bandanna once. I can do mouth to mouth because I was trained to do that in scuba diving (since I was the youngest in class and only 18 I got to have the prettiest girl as my training partner giggle). Anyway So I came along the trail and here's somebody who doesn't look quite dead, I know enough about the heimlich maneuver to see if their breathing passage is clear and I try a couple squeezes and blow air into them for a minute. Can I legally stop? Am I liable for stopping? I mean I can't do that for a day or two waiting for someone to come along and go call for help. If I try and they die do I Tell the sheriff that I tried? Does it matter what state I'm in?
Jim