Wilderness First Aid Kits—beyond 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

A good guide has excellent self- and situational awareness, a complete understanding of the terrain and environmental hazards they may encounter and strategies for mitigating their associated risk, together with a reasonable assessment of their clients skills. Despite their training and skill, risk cannot be completely eliminated, and injuries and illnesses can occur. The prudent guide will carry supplies to address both common and unlikely, but possible, scenarios. As the terrain increases in difficulty, the potential for both stable and unstable musculoskeletal injuries increases; and, it makes good sense to add a padded aluminum splint, self-adhering bandages, and perhaps kinesiology tape to the contents of the basic first aid kit. In conjunction with a cloth roll cut from a T-shirt, a padded aluminum splint can be used to stabilize most common extremity fractures—forearm, wrist, knee, and ankle. Self adhering bandages may be used in lieu of a cloth roll to secure the splint or by itself, to support a strain or sprain or hold a dressing in place. Kinesiology tape is a specialized tape with an adhesive backing, and when combined with with Tincture of Benzoin, can also be used to protect against or support a strain or sprain. Maxi-pads can be added as emergency trauma dressings and OTC medications to treat common medical problems like diarrhea, constipation, sinus congestion, acid stomach, etc.

Beyond the Basic Wilderness First Aid Kit
Below are some wilderness first aid kit suggestions for trip leaders working with 2-5 clients or friends for up to one week, possibly two with excellent personal and camp hygiene. All the listed materials fit into our Guide Pack.

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.

Medications

• Epinephrine in ampules, vials, or autoinjector (Rx). Requires training. Carry in the pack's interior zippered pocket.
• 25 mg diphenhydramine caplets (or other antihistamine) for itching associated with allergic reactions and for use in addition to epinephrine for the treatment of life-threatening allergic reactions. Purchase over-the-counter and carry 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 (Advil®) or neproxen sodium (Aleve®) tablets for general pain. Purchase over-the-counter and carry in a 1/4 or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 81 mg chewable "baby" aspirin (OTC) for treatment of suspected heart attack; carry 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.
• For women: 150 mg fluconazole tablets (TC) for vaginal yeast infections; carry in a 1/4-ounce Nalgene bottle in one of the pack's small velcro loops.
• For women if you carry antibiotics: acidophilus tablets to help prevent yeast infections in women taking antibiotics.
• For contact lens wearers, carry an ophthalmic antibiotic ointment to prevent & treat bacterial infections. Repackage and carry in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 120 mg pseudoephedrine tablets (Sudafed®) for use as nasal decongestant. Purchase over-the-counter and carry 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 (Vaseline®) or a petroleum-based antibiotic ointment to protect and promote superficial wound healing; carry in a 1/4-ounce Nalgene bottle in one of the pack's small velcro loops.
• For travel on large bodies of water: Scopolamine tablets or patch (Rx) to prevent sea/motion sickness.
• For travel at high altitude: Rx AMS tablets: Acetazolamide, Dexamethasone, Nifedipine, and/or Tadalafil in 1/2- or 1-ounce Nalgene bottles in the pack's small velcro loops.

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 or in the clear, slash pocket on the front of the pack.
• 5-inch forceps for cleaning wounds. Carry in the pack's interior slash pocket located behind the zippered pocket or in the clear, slash pocket on the front of the pack.
• 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.
• 35- or 60 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, cut, and carry uncut in a 28 ml Snap Top Nalgene container in one of 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-ounce Nalgene bottle in one of the pack's medium 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-ounce narrow-mouth Nalgene bottle in one of the pack's medium sized velcro loops; consider using a 1-ounce dropper bottle if you want to use it as back-up/emergency water purification.
• If space permits, consider carrying surgical soap for washing your hands and the patient's skin prior to flushing a wound. Carry in a 1/2- or 1-ounce Nalgene bottle in one of the pack's small or medium 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 two additional sterile rolls in one the pack's interior zippered pockets.
• Carry ENGO patchs for blister prevention. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Four to ten—depending on assessed need--Second Skin® Blister Pads for blister treatment. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Two to four feet of folded two and 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.
• Four plus of two- and four-inch micro-thin film dressings. Carry in the pack's interior slash pocket located behind the zippered pocket.
• 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.
• Four scalpel blades for lancing abscesses. Carry with or without a handle; the pack will be lighter without the handle; the handle makes it easier to wield the blade.

Extremity Strains, Sprains, & Fractures

• 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. Carry folded in the back zippered pocket.
• Consider carrying two ankle compression donuts if you are hiking in rough terrain; together with a padded aluminum splint and a cloth roll (or self-adhering bandage), you can improvise a very effective walking ankle splint. Carry in the pack's interior slash pocket located behind the zippered pocket. Ankle compression donuts can be cut from any 3/8-1/2 inch foam pad.
• Trauma scissors for cutting clothing, padded aluminum splints, packs, etc.
• Three rolls of 2-inch self-adhering bandages protected by thin-walled PVC pipe. Carry in the three large velcro loops. Alternatively, carry two rolls of the self-adhering bandages and one roll of kinesiology tape.

Additional Supplies

• Two-inch safety pin for use during the focused spine assessment.
• Extended-range digital thermometer for taking a core temperature. Carry in one of the pack's spine pockets.
• Two oral Rehydration Salt packets for treating moderate dehydration in a severe heat challenge. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Space pen or mechanical pencil for taking patient notes. Carry in one of the pack's spine pockets.
• Two plus 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).
• Dental putty (Cavit®) and Oil of Clove for temporary treatment of dental problems. Carry Cavit in one of the internal zippered pockets.Carry Oil of Clove in the pack's small velcro loops.
• Drug log for keeping track of medication use.

Optional Extras (if space permits)

• Two pair of exam gloves to protect the patient while cleaning high-risk wounds. Both pair fit into a single 50 ml snap top vial.
• Two maxi-pads for a pressure bandage to control severe bleeding when combined with an elastic bandage.
• Four blanket pins for improvising buddy splints. Carry in one of the internal zippered pockets.
  

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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.