When it comes to backwoods injuries, clichßs abound. "Nobody goes into the wilderness expecting to get hurt." "Why do bad things happen to good people?" "But everything was going so well...!" Well, that's why they call them accidents. The point is that people do get injured out there, which means you need to respond quickly and effectively. That's why a well-equipped first-aid kit is probably the most important item in your pack.
The question is, what does "well-equipped" mean? Enter Howard Donner, M.D., a former professional river and mountain guide who's now an emergency-room physician in Telluride, Colorado, where he's also medical director of the San Miguel Search and Rescue. In his spare time, Dr. Donner is a medical kit designer for NASA's space shuttle and space station projects. Oh, and he's worked as a physician on Denali (aka Mt. McKinley) in Alaska, as well as with the Himalayan Rescue Society. In other words, the man knows about first-aid in places where help is more than a phone call away, and he is infinitely qualified to field the "well-equipped" question.
Dr. Donner's answers involve the two types of first-aid kits found in most packs:
- Those that have been around a while and are well used; this includes both homemade and store-bought models that have seen their share of trail miles.
- Brand new kits that are currently on outfitter shelves, waiting for a buyer.
Make A Good Kit Better
What you carry in your stained, dirty, old war horse of a first-aid kit is generally up to you. Some people are prone to cuts and carry a lot of adhesive bandages. Others have allergies and need their personal medication. But according to Dr. Donner, there are three essentials absolutely no one should leave home without:
- A full-size SAM Splint, which is basically a thin, flexible aluminum frame covered by malleable foam. "SAM Splints are far superior to any alternative" for immobilizing sprains and broken bones and stabilizing neck injuries, says Dr. Donner. A SAM Splint can conform to support just about any broken or wrenched extre-mity, though it won't work unless it's properly shaped to provide the required stiffness.
- One roll of 1-inch-by-10-yard tape for securing splints and bandages and closing wounds. "It's one thing," Dr. Donner says, "I have yet to figure out how to improvise." Cloth is best, since it won't sweat off immediately.
- Pain medication, preferably ibuprofen, to handle everything from pain and inflammation of sprains and muscle strains to headaches. Aspirin can be hard on the stomach, and acetaminophen (Tylenol) isn't an anti-inflammatory. People who take any of these medicines should stay well-hydrated to minimize risk of kidney damage. Dr. Donner says that with these three items, almost anything else you need can be improvised. That is, if you know how. Given that most of us don't have an expert level of wilderness medical training, he recommends a few other essentials:
- An irrigation device, preferably a syringe, and Betadine swabs, for cleaning wounds. "The solution to pollution is dilution," says Dr. Donner, and dabbing at a wound just won't do the job. A high-pressure 18-gauge syringe (preferably one that holds 12 to 20 ccs) filled with diluted Betadine or iodine solution is critical for preventing infection. One Betadine swab dropped into a half-liter of river water makes a tea-colored solution that's just right for irrigating wounds. (Avoid straight Betadine because it kills healthy tissue.)
- An elastic compression wrap like an ACE bandage. An ACE won't stabilize a sprain, but it is the "compression" part of the all-important R.I.C.E. recipe: Rest, Ice, Compression, Elevation. Just as significantly, it's a constant reminder that you have an injury that needs to be babied.
- Surgical gloves, which are critical in this age of HIV and hepatitis B and C. Some people react to latex, so Nitrile gloves, which are hypoallergenic, are preferable. Include a pair for every member of your party.
- A gel-type dressing such as Spenco's 2nd Skin for treating ulcerated blisters and burns. This can make the difference between being able to walk and not. First-aid dressing is "something else you can't improvise," says Dr. Donner.
- Precision tweezers with a sharp tip. Dr. Donner recommends Splinter Pickers or Uncle Bill's, which are available from Chinook Medical Gear.
- A pencil (not a pen, which can leak or freeze). Writing down signs, symptoms, and treatment is a critical step in the chain of medical care.
Buy A New Kit
The advantage of opting for a new, commercially made first-aid kit is convenience. While most will set you back more than a few bucks, they do come with almost everything. No need to buy adhesive bandages in bulk or spend time searching for hard-to-find items, like a SAM Splint.
"I like premade kits because they give me a place to start," Dr. Donner says. "Most of us don't want to spend half a day at Walgreen's putting it all together."
Another advantage is the container itself. The better kits hold items firmly in place and display everything in a highly visible, accessible fashion-far preferable to digging through loose items floating around in a stuff sack.
Dr. Donner's advice for assessing any first-aid kit's contents is this: You have to weigh the likelihood of using an item against your ability to improvise if you don't have it, then factor in the weight and volume it'll add to your load. For Dr. Donner, that means the critical items mentioned previously make the cut, but a triangular bandage doesn't. Likewise, most preassembled kits are filled with a variety of bandages, gauze wraps, and other M.A.S.H.-style material that Dr. Donner finds nonessential. "It's not that I think those things are unnecessary," says
Dr. Donner. "I don't think they're critical. If I have an ACE wrap and a splint, I can handle it."
Following these principles, we reviewed first-aid kits that leading manufacturers say are appropriate for two to five people on a backcountry trip of up to 10 days. We focused on the accessibility, utility, and ease of use of the contents.
These kits should cover the needs of all but very large groups and extreme trips. If you're heading out solo or with a partner for a long weekend, simply pare down the contents. Add or subtract items according to environmental concerns, personal needs, and your
tolerance for weight. Always carry
Dr. Donner's "Kit Essentials."
The bottom line: Which kit you take-or whether you build your own-depends on you. What you're doing (dayhiking in Arkansas, peak bagging in Banff) is a big factor. So, too, is the personal tradeoff between weight, bulk, and your need to feel more or less fully prepared. Because I'm paranoid, I like to carry a pretty hefty kit. But I rarely use it. Customize the kit if you want; remember, the goal is to create a first-aid kit that gets the job done...no more and no less.