Wilderness First Aid Kits—the basic kit

Wilderness First Aid Kit Articles
Assembling a first aid kit is a need-dependent process that varies from individual to individual, company to company. We created the following 4-part article series to help guide you. We strongly suggest you read all of them, in order, before making a decision. You may find that you want (or need) multiple kits.

• Part 1, general concepts
• Part 2, the basic kit
  
• Part 3, beyond the basic kit
  
• Part 4, the expedition kit

Statistically, playing in the backcountry is pretty safe; life-threatening injuries and illnesses are rare. Most traumatic injuries are simple cuts, scrapes, and blisters. Environmental injuries, like dehydration, heat exhaustion, sunburn, and cold, are common, uncomfortable, and typically easily treated (and preventable). Since wilderness travelers are healthy, medical problems are minimal and tend to focus on headaches and general aches & pains. Problems in longer trips tend to be related to poor hygiene.

Yet, no matter where you go, it always seems that someone gets a cut or blister. And if bees, wasps, hornets, or fire ants are around, you need to be prepared to treat a life-threatening allergic reaction. Finally, everyone has aches and pains. These are the basics and what I recommend carrying to treat them.

Remember:

• In order to understand and responsibly use the materials discussed below I recommend, at minimum, taking our Wilderness First Aid course—guides and outdoor instructors should take our Wilderness First Responder course—and carrying a field manual.
• The decision on what to put in your first aid kit and how to package them should be based on the general concepts discussed in the first article.
• To discuss all the medications—Rx, OTC, and even herbs—you plan to carry with a physician and phramacist before purchase and use.
• Make an emergency action plan and consider carrying a cell phone, satellite phone, or hot spot for emergency communication.

Cuts & Wounds
You need materials to clean, dress, and bandage a wound to prevent it from becoming infected and to promote healing. Use clean drinkable water to flush the wound free of dirt and bacteria before covering it. Dressings are applied directly to the wound after cleaning and bandages are applied over the dressing to hold it in place. In some cases, a dressing and bandage are one and the same.

• I like cleaning a wound with a syringe; it's easier to use and generally more effective than cutting a corner off a plastic bag. The size of syringe depends on individual preferences and is somewhat dictated by the type of pack you choose to carry. Typically larger syringes are easier to use because of their greater volume (and don't fit into our Minimalist Pack); as their size increases so does their weight. Before flushing the wound, remember to wash the surrounding skin with soap and water or water followed by a povidone-iodine solution to help prevent harmful bacteria from migrating into the wound. A pair of tweezers or forceps can be handy to remove small stones and visible debris as well as cactus spines and splinters.
• I prefer to carry roller gauze, a small bottle of Tincture of Benzoin, white petroleum jelly (Vaseline®) or a petroleum-based antibiotic ointment (Triple Antibiotic Ointment®, Neosporin®, etc.), and flexible medical tape to dress and bandage simple wounds rather than carry an assortment of band-aids (unless I'm on a short trip with young kids, then Dora and Star Wars band-aids have their uses). Neither do I carry individually wrapped gauze pads; instead, I cut what I need from a two-inch gauze roll. After you have cleaned the thoroughly cleaned the wound, paint the skin around it with two coats of Tincture of Benzoin to help the tape stick. Then cut and impregnate a few layers (about a quarter of an inch) with the petroleum jelly or ointment for the dressing and place it over the wound to help protect the wound and promote healing. The Tincture of Benzoin should extend roughly 3/4 of an inch past the edges of the gauze on all four sides. Finally, cut enough flexible medical tape to cover the dressing and Benzoin. Monitor for the signs and symptoms of a local infection: increased redness, tenderness, pain at the site. For clean, shallow wounds, you can leave the dressing in place for up to two days; deeper wounds require more frequent changes.
• For clean shallow cuts, especially to the face, I carry and use steri-strips to close the wound to decrease scaring and promote healing. Never close a deep or excessively dirty wound in the field. Use Tincture of Benzoin to help the strips adhere. To use: approximate the wound edges—avoid overlapping—place the steri-strips about 1/8 of an inch apart.
• If I'm in a wet environment—a place where it rains a lot or I'm paddling—I carry and use a micro-thin film dressing. Micro-thin film dressings are clear, water-proof, and breathable. You can put them directly over a wound, over steri-strips, or over a dressing and ointment.

Blisters
Blisters are the bane of hikers and sportsmen and women everywhere. Fortunately, with a little attention, they are relatively easy to prevent and treat. The BEST prevention, by far, is ENGO Blister Patches. ENGO patches adhere to your footwear, NOT your foot and will last for weeks before needing replacement. If you regularly get blisters in a specific spot, put a ENGO patch on your hiking boot under that spot and PRESTO, no more blisters. No kidding. If you get a hot spot, stop and apply an ENGO patch to your boot and you won't get a blister.

If you get a hot spot and fail to treat it, you will likely get a blister. The simplest solution at this point is to drain the blister, drain it (or remove the lid) and cover it with a hydro-gel dressing from Second Skin®.

Life-threatening Allergic Reactions
Life-threatening allergic reactions, also know as anaphylaxis, are unpredictable and, while rare, can quickly lead to death. Bee, wasp, fire ant, hornet, and other types of stings are common causes, as are food and drug allergies. The ONLY treatment is an intramuscular shot of epinephrine; epinephrine reverses the signs and symptoms. Administer an oral antihistamine if you treat someone with epinephrine.

General Aches & Pains
Most general aches and pains from muscle soreness to headaches can be treated with ibuprofen or naproxen, which ever you prefer. Both are over-the-counter medications available from most grocery and drug stores.

Basic Wilderness First Aid Kit
In summary, at the very least you should consider carrying a basic wilderness first aid kit to treat the problems listed above. If this is all you carry, you can fit everything listed below (except where noted) into our Minimalist First Aid Pack. If you want to carry more medications and supplies, consider our Guide or Expedition Pack.

Medications
Make decisions about what drugs to carry in conjunction with a physician; not all those listed below will fit into our Minimalist Pack.

• Epinephrine in ampules, vials, or autoinjector (Rx). Requires training. Carry in the pack's interior zippered pocket.
• 25 mg diphenhydramine caplets (OTC) for itching associated with allergic reactions and for use in addition to epinephrine for the treatment of life-threatening allergic reactions in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 10 mg or 20 mg prednisone tablets (Rx) to help prevent a biphasic inflammatory reaction after epinephrine administration for a severe systemic allergic reaction especially when the evacuation time is > 8 hours; it is used in conjunction with diphenhydramine, ideally with a physician consult. Carry in a 1/4 or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 200 mg ibuprofen or naproxen sodium tablets (OTC) for general pain in a 1/4 or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• For women: 100 mg phenazopyridine HCl tablets (OTC) to relieve the pain associated with a urinary tract infection in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops. Note: Phenazopyridine HCl does NOT treat the infection but permits a relatively pain free self-evacuation.
• 81 mg chewable "baby" aspirin (OTC) for treatment of suspected heart attack in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• Opioid emergency pain medication (Rx) in a 1/4 or 1/2—ounce Nalgene bottle in one of the pack's small velcro loops.
• White petroleum jelly or a petroleum-based antibiotic ointment (OTC) to protect and promote superficial wound healing in a 1/4-ounce Nalgene bottle in one of the pack's small velcro loops.
• Aloe vera & vitamin E gel for sunburn. Carry in 1/2- or 1-ounce Nalgene bottle in one of the pack's small velcro loops.
• Post-exposure soap for removing poison ivy, oak, or sumac resin.

Wound-Treatment Supplies

• Surgical scissors to cut gauze rolls, ENGO patches, flexible medical tape, and Second Skin®. Carry in the pack's interior slash pocket located behind the zippered pocket.
• 3.5-inch forceps for cleaning wounds. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Uncle Bill's Silver Gripper Tweezers to remove cactus spines, splinters, and embedded debris. Attach it to the interior zipper with a small steel split-ring.
• 12 cc irrigation syringe to flush wounds. Put it in the elastic loop designed to hold it.
• Cotton applicators (Q-tips®) to apply Benzoin, PI solution, or ointment to skin; carry in a 28 ml Snap Top Nalgene container in the pack's interior zipper pocket.
• Tincture of Benzoin to help tape and steri-strips adhere to the skin. Purchase and carry in a 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 10% povidone-iodine (PI) solution to help clean and disinfect the skin around a wound; it can also be used to purify water. Purchase and carry in a 1/2- or 1-ounce narrow-mouth Nalgene bottle in one of the pack's medium sized velcro loops.
• Two-inch roller gauze for wound cleaning and dressings. Carry in a 50 ml Snap Top Nalgene container in one of the pack's medium sized velcro loops. Consider carrying a second sterile roll in the pack's interior zippered pocket.
• Carry ENGO patches for blister prevention. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Four Second Skin® Blister Patches for blister treatment. Carry in the pack's interior slash pocket located behind the zippered pocket.
• 1- to 2- feet of folded two and/or four inch flexible medical tape for holding gauze dressings in place over a wound; I carry both sizes. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Two 2-inch micro-thin film dressings. Carry in the pack's interior slash pocket located behind the zippered pocket. Add two 4-inch micro-thin film dressings if you use a Guide or Expedition pack. Do not fold.
• Three each of 1.5- and 3-inch packets of steri-strips for closing shallow facial wounds. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Two scalpel blades without a handle for lancing abscesses; the pack will be lighter without the handle. Note: The handle makes it easier to wield the blade.

Additional Supplies

• Two-inch safety pin for use during the focused spine assessment.
• Space pen or mechanical pencil for taking patient notes. Carry in one of the pack's spine pockets.
• One WMTC Patient SOAP note for documenting a more serious problem. Carry in the pack's interior slash pocket located behind the zippered pocket or download our digital SOAP note to  your phone (or tablet).

Optional Extras

• Extended-range digital thermometer for taking a core temperature. Carry in one of the pack's spine pockets.
• Surgical soap for washing the your hands and the patient's skin prior to flushing a wound. Carry in a 1/4-ounce Nalgene bottle in one of the pack's small velcro loops.
• Nasal tampon(s) for dry air (especially at altitude); carry in the internal slash pocket.
• Four blanket pins for improvising buddy splints. Carry in one of the internal zippered pockets.
• Oral Rehydration Salt packet for treating moderate dehydration in a severe heat challenge. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Post-exposure soap for removing poison ivy, oak, or sumac resin (Technu®, Goop®)
• DentTemp if you anticipate a fractured tooth (often from paddle rafting), lost filling, or crown.
• Padded aluminum splint for a sprained ankle or unstable extremity. If you are engaging in an activity where you might break a bone or injure a joint—climbing, talus running, etc.—consider bringing one. NOTE: a padded aluminum splint is too large to fit into our Minimalist Pack; if you decide to carry one, you'll need our Guide or Expedition Pack.
• If you carry a padded aluminum splint and are hiking in rough terrain, bring two ankle compression donuts. In conjunction with a padded aluminum splint and a cloth roll (or self-adhering bandage), you can improvise a very effective walking splint for a strained or sprained ankle; the compression donuts minimize swelling.
• Trauma scissors for cutting clothing, padded aluminum splints, etc. Again, only consider if you are engaging in an injury-prone activity.

Check out our webstore and purchase first aid packs and supplies online.

Want more information on this and other wilderness medicine topics? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.