Wilderness First Aid Kits—the expedition 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

As the size of the expedition group gets bigger or the trip longer, you will need to carry more of the basic first aid kit contents and additional drugs to treat medical problems that typically don't arise on shorter trips due to the one to three week, or longer, incubation period required for most infectious diseases. Our Expedition Pack can typically hold enough supplies for a group of 8-12 people for up to three weeks, more with resupplies. The needs of larger groups (typically found on commercial raft trips) can be met by using multiple packs.

It's important to limit access to your first aid kit to people who are trained. This may mean training your expedition members before or during a trip or simply restricting access to instructors or guides who are already trained. It may also mean splitting your first aid kit and training members to use one pack while restricting access to a different pack to guides or instructors. A common approach is to issue a basic first aid kit to two- to four-person tent or cook groups and train them how to use its contents while the instructors or guides carry a larger first aid kit for more complex problems.  A variation on this approach is for the instructors or guides to carry a first aid pack with all the drugs while a second—and sometimes a third—pack contains supplies to treat wounds, extremity injuries, and/or major trauma. Depending on a number of variables—longer trips, more people, the type of travel, etc.—some companies also carry a central resupply kit.

The Expedition Wilderness First Aid Kit
Below are some wilderness first aid kit suggestions for trip leaders working with 2-12 clients or friends for greater than one week with an evacuation time > 24 hours. Most of the listed materials fit into our Expedition Pack; if you have a larger group or a very long expedition with limited resupply options, you may need multiple packs.

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 capsules or caplets (Rx) 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 neproxen 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.
• 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 if you carry antibiotics: acidophilus tablets to help prevent yeast infections in women taking antibiotics.
• For contact lens wearers: Rx ophthalmic antibiotic ointment to prevent and 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 (OTC) for use as nasal decongestant in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 2 mg loperamide hydrochloride tablets (OTC) for treating diarrhea in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• 25 mg sennosides tablets (OTC) for constipation in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• Opioid emergency pain tablets (Rx) in a 1/4 or 1/2—ounce Nalgene bottle in one of the pack's small velcro loops.
• Broad-spectrum antibiotic (Rx)—doxycycline is a good choice—in a 1/4- or 1/2-ounce Nalgene bottle in one of the pack's small velcro loops.
• Ondansetron tablets (Rx) or promethazine tablets (Rx) in a 1/4- or 1/2-ounce Nalgene bottle to control vomiting > 12 hours in one of the pack's small velcro loops. Ondansetron also comes as disintegrating tablets; carry in blister packs to prevent degradation.
• 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.
• For women: Vaginal suppositories or creams (OTC: miconazole, clotrimazole, tioconazole, butoconazole) for vaginal yeast infections in the fold out zippered pocket along with extra tampons. Or carry 150 mg fluconazole (OTC) tablets in a 1/4- or 1/2-ounce Nalgene bottle or blister pack; dose is one oral tablet.
• 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.
• 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 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.
• Surgical soap for washing your hands and the patient's skin prior to flushing a wound. Carry in a  0.5 oz or 1.0 oz 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 carry 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 Patches for blister treatment. Carry in the pack's interior slash pocket located behind the zippered pocket.
• Two 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.
• Nasal tampons to control anterior nose bleeds at altitude or in dry environments.
• Cyanoacrylate adhesive (Super Glue®, Crazy Glue®, etc.) to close skin cracks due to exposure to heat, wind, salt water, etc. before they bleed.

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.
• If you carry a padded aluminum splint and are hiking in rough terrain: 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.
• 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. Alternately carry two roll 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.
• 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).
• Dental putty (Cavit®) and Oil of Clove or Dentemp® for temporary treatment of dental problems. Carry Cavit in one of the internal zippered pockets and Oil of Clove in one of 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.
• Pocket otoscope (Dr. Mom's Otoscope®) for examining ears, nose, and throat. Carry in one of the pack's spine pockets.
• Remember that you can use multiple packs for a large expedition: Consider using the Expedition pack for drugs, a Guide Pack for minor trauma, including wound cleaning, ± blister prevention & treatment, and/or a Minimalist Pack for individual OTC and Rx meds, ± personal care items. Also remember that you can customize each pack by purchasing additional velcro loop strips (each pack comes with a set of varying sizes) or a mesh pocket. Small velcro strips hold six 1/4- or 1/2-ounce Nalgene bottles; medium velcro strips hold four 1-ounce narrow- or wide- mouth Nalgene bottles or 50 ml snap top vials; large velcro loops hold three pvc-protected self-adhering 2-inch bandages or 2-inch elastic wraps.

Check out our first aid supplies and packs on our webstore.

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.