I'm sure this has been gone over before but.. What medications/first aid items would you consider "necessary" to bring with you into the wilderness?
In my own personal context, I'm asking primarily for use on the southern PCT.

This is a tough one. Some people will argue that you need a one or two-pound first aid kit with everything in it. Others argue that they never carry much of anything. YMMV.

What you carry for a long thru-hike must be a little different from what you have for a four-day trip. For example, if you get a skin puncture from a broken tree branch (and assuming that your tetanus shot is current), you might try to ignore it for a few days, and you can always get professional care back home if it needs it. But if you are still out on the trail a week or two later without any professional care, you might have a deep infection that is getting bad. So, you have to think about short-term stuff versus long-term stuff.

What is considered to be the most likely injury to a backpacker? Getting a puncture wound from a broken tree limb when stepping over a tree across the trail. Possibly getting a scalding burn or a scorch burn from a cook stove.

Some people treat foot blisters as injuries. Others toughen up their feet in advance so that they don't happen.

Personally, I carry just about one ounce of good first-aid tape, plus some minor band-aids, aspirin, and maybe a tiny pack of topical antibiotic cream.

When I led group backpack trips, this became a 1.5-pound group first-aid kit.

When climbing in some third-world country, I take a lot more in the way of prescription medications, but that is far outside the scope of your PCT inquiry.

--B.G.--

Just curious, how many of you carry suture kits? Of course you have to know what your doing, but i think its a great idea. Light, and for the problems it can fix, i think worth it.

Blisters also largely depend on pack weight, if your packin heavy, count on more blisters IMO.

Edited by isaac.mouser on 06/17/2010 13:52:43 MDT.

I was thinking a good approach would be to try to plan for the most common hiking ailments and then considering a treatment for it:
Burns
Cuts/scrapes
Insect/spider bites (and itching)
Diarrhea and upset stomach
Headache/pain
Snake bite
Poison Ivy/oak/sumac (and itching)
Splinters
Something caught in your eye
heat exhaustion/dehydration
foot blisters/fungus(?)

Soooo.. what are the best treatments for these?

Edited by thinkpol on 06/17/2010 14:25:24 MDT.

Everybody has their own personal maladies, like foot fungus, so you can prepare for those. Something like a burn is more of an accidental thing. Snakebite is largely avoidable, but I suppose that anything is possible. I believe the current first-aid advice for snakebite is that you should not try to treat it outside of a hospital. I don't know. I just stay away from crawlies.

Poison Ivy/oak/sumac? On the southern PCT? I think you might find some poison oak below 5000 feet, but I think you have to head east to find the poison ivy or sumac.

A lot of those problems can be avoided by being cautious.

If you want to carry a tiny amount of foot powder, load it into 2-inch long pieces of plastic soda straws, and then crimp and tape the ends. They will weigh almost zero, and you can use a tiny bit at a time.

--B.G.--

A friend of mine was out doing a solo week-long trip in the southern Sierra Nevada Range. About five days out, he stepped into a snow void next to a boulder. His leg crashed through and split open his leg badly on the rock. He thought about it, stopped the blood loss largely with an ice pack made from snow, cleaned out the wound using a heavily-iodined water solution, and then sewed up his leg using ordinary sewing thread and needle (he had about a half-ounce sewing kit). When he got out and went to a doctor, the doctor praised him for how neat the sewing had been.

--B.G.--

Yeah, I never really use medications apart from hydrogen peroxide, neosporin and the occasional hydrocortisone which is why I'm asking.

=)

Medications are OK, if you can keep the portion/size/container down to the very minimum. About five grams of neosporin could be handy.

Some of us need to take prescription pills on a daily basis. I package them into tiny ziploc bags to make sure that I get them right.

If you get an ordinary hiker problem ("monkey butt"), you can treat that by washing, followed by a couple of drops of sunscreen lotion on a piece of TP.

--B.G.--

I would tend to forgo the suture kit. Mainly on the premise that I wouldn't trust cleaning out the wound well enough. However, I still think steri-strips would be a good substitute for small to mid-size lacerations. They're easy to remove if infection does occur, and do a pretty darn good job.

Also if the wound gets too big, I'd pack it with moist gauze then bandage over it and evac.


As for what I carry, generally:
1) Irrigation syringe.
By far the most important part of my kit if you ask me. Pressure is what cleans the wound, so as long as you have drinking safe water, you're good to go. Lots and lots of water with high pressure. It hurts but it works. I forgo taking anti-biotic cream because of my trust of cleaning the wound out well enough.
2) Leukotape/athletic tape
Tape up blisters, rolled ankles, hold splints in place, serve as a bandage if you double up the tape to go over the wound, etc. Can even use strips of it like you would steri-strips to close a wound
3) Large sterile gauze pad.
Can cut it up to the size of the wound, use it to stop bleeding, and if I have a wound larger than it, well, some sort of clothing is going to be needed
4) Prescription pain med
Enough to last 24 hours so I can hike out if something really goes wrong. Anything that needs ibuprofen or tylenol I can just suck up while on the trail.

Depending on the length of the trip, I might throw in some immodium or benedryl if I know someone has a bad allergy.

Clothing and other materials you have can serve as slings or ties for splints as well. Sleeping pads are the perfect splint, so between all my other gear, I feel comfortable treating almost anything.

Cheers,

Thomas

Edited by TWard on 06/17/2010 14:58:16 MDT.

The most important thing to pack is some training.

I take some form of first aid course every few years. That knowledge will allow me to make proper decisions so that my minimal first aid kit will get me by.

--B.G.--

Everyone I've ever talked to who does first aid either in an urban or wilderness setting has advised against suturing in the field. Closing a wound deep enough to require stitches in non-sterile conditions is a great way to promote an infection. Better to carry an irrigation syringe for cleaning and steri strips and Tegaderm dressings to cover this kind of injury.

It's a good idea to take both regular and wilderness first aid to get the training and know what is in the scope of acceptable treatment...

I just finished taking a 16-hour Wilderness First Aid class so have fresh information.

Small gaping wounds (like an inch or two long) can be thoroughly--extremely thoroughly!--irrigated with an irrigation syringe (using treated water) and closed with sterile strips. Put a thin layer of antibiotic ointment over it and a transparent bandage (Tegaderm or similar) so you can see if the wound is getting infected without having to remove the bandage. You usually can continue the trip. Check several times daily for signs of redness--if any, it's time to bail out.

Large gaping wounds can't be cleaned thoroughly enough to risk closing without serious infection. Irrigate as much as you can and just pad over the wound; don't try to close it. Definitely do not suture--the first thing that will probably happen in the ER is that the doc will remove the sutures and give you a severe lecture (if the doc is my son-in-law, he most certainly will!) Obviously someone with a wound of this type needs to bail out on the trip, although they can usually walk unless there has been a lot of blood loss.

The same is true of puncture wounds--irrigate and cover and get yourself out to medical attention. Such wounds are about 100% sure to become infected. If it becomes infected, it will take far longer to heal, and you're risking a generalized infection.

Abrasions (i.e. skinned knees and elbows), a more common injury, may have to be scrubbed thoroughly to remove imbedded dirt despite the pain. Scrub, irrigate, scrub some more. If not too painful, trip can be continued, but monitor closely for infection.

Wounds with severe bleeding, once you've stopped the bleeding, obviously need to be evacuated. If the patient (they're not "victims" any more, it seems!) hasn't lost very much blood, they may be able to walk out with assistance. If there is severe blood loss and shock, though, it's time for SAR and a helicopter.

Also, stuff like alcohol, iodine, betadine (a form of iodine), hydrogen peroxide, etc. that once upon a time was used on cuts and scrapes should be used only on the skin around the wound, not on the wound itself. It damages raw tissue and retards healing. The same is true of antibiotic ointment--don't put it down in a gaping wound.

The first aid kit you take for yourself will probably be pretty small. I've never had any injuries in the back country except small cuts/scratches on my hands (to which I'm prone), an occasional blister or mildly skinned knee or elbow. My personal first-aid kit therefore consists mostly of bandaids (mostly the water block type), a couple of elbow/knee bandaids, antibiotic ointment, a little moleskin and the inevitable duct tape. Additional items I take are a couple of Tegaderm pads, a couple of sterile gauze pads, an irrigation syringe, small tweezers, a tiny mirror, foam self-adhering wrap--called veterinary wrap in a farm store (where it's lots cheaper!) and "first aid tape" by REI (lighter substitute for elastic bandage), tylenol (for headache & fever), ibuprofen (for muscle and joint aches), buffered aspirin (for my dog), benadryl and lotromin. Everything but the tylenol and ibuprofen (poisonous to dogs) will work on either me or my dog. For the dog only, his pack contains an extra, too large bootie in case of cuts on his pads.

For a group, there should be a group kit which would contain more. One irrigation syringe per party (as long as everyone knows where it is!) would be sufficient. You could even take a SAM splint for a large group.

It's a good idea to go through the first-aid stuff at least yearly to replace expired meds and bandaids whose wrappers have turned yellow and the foam self-adhering vet wrap, which, I found, after a couple of years will have fused together to the point that it's useless.

I'd just like to second the idea of taking a first aid class (preferably wilderness). The knowledge you get is empowering, and I've found that with more knowledge of first aid you carry a lot less and feel more comfortable to address a myriad scenarios. I recently took a W-EMT course through WMI and they did a fantastic job, so I wholeheartedly recommend them. I've heard good things about SOLO and WMA as well.

Cheers,

Thomas

I have never had an injury that required more than a bandaid, small gauze, first aid ointment, or tape. Not to say it cannot happen. Just pay attention and don't take unneccessary chances.

Burns
Usually minor. Just let it blister. Bandaid if needed.

Cuts/scrapes
Bandaid.

Insect/spider bites (and itching)
Just deal with it, unless allergic to them.

Diarrhea and upset stomach
Stay hydrated. Plan on lots of cat holes. Usually goes away in 24 hours. Diarrhea in snow storms sucks.

Headache/pain
Advil or similar.

Snake bite
Unlikely. No field remedy. Need anti-venom.

Poison Ivy/oak/sumac (and itching)
Maybe poison oak. Just know what it looks like and stay away from it.

Splinters
Work it out with your finger nails. Tweezers in small knife. I usually just cut it out with a small blade, if finger nails do not work.

Something caught in your eye
This is very possible. I wear sunglasses most of the time.

heat exhaustion/dehydration
Water. Proper planning should eliminate this.

foot blisters/fungus(?)
Blisters, condition feet first. Any blister will be minor. Tape hot spots before they blister. Fungus on so PCT should not happen, or be very minor. Wear mesh trail runners.

First aid knowledge is critical. A course would be great. Amazing what you can substitue from your gear or stuff laying around.

Nick said,

"Poison Ivy/oak/sumac (and itching)
Maybe poison oak. Just know what it looks like and stay away from it."

Nick, this is prevention, not treatment! :P

I do know that Nick Gatel said he brings some small gauze along for treatment, and this with a popped advil can stabilize you while you exit the trail before you need to discard all of your hiking gear for fear of contamination.

A friend of mine, former backcountry ranger, said he used to carry a big first aid kit like the one he carried as a ranger, but then he realized that you generally need, as he put it, "either a band-aid or a helicopter". So now he just carries band-aids. I do the same, in a variety of sizes, plus a little moleskin for blisters, vaseline in case of chafing, and Ibuprofen.
And yes, a well-trained brain is absolutely the best first-aid item you can bring along.

Let me frame my response with the fact that I usually don’t hike anywhere I can't get out of in a day or less.

On a long trip I may take some gauze pads which I secure with the duct tape already in my pack. I have patched up a friend using this method. Taking the tape off sucks. You also have to make sure the tape is not adhered anywhere near the cut (by using a wide gauze area) so you don’t re-open the cut when removing it.

A few waterproof band-aids - lately I've carried none

Ibuprofen - works for me on headaches, fever and muscle pain

Imodium - This is the best insurance policy you can carry in your meds. I get the Walgreen's brand. If you cut the package down 1 pill weighs about a gram. Maybe you won't need it but if you do, the pay-off is high. 1 or 2 should plug you up for 8-12 hours. This can make the difference from horrible to tolerable bowel issues, so you can carry on. Also if you are really sick it's hard to bail out if you need a cat hole every 10 minutes (think about it).

Famotodine pills 1 or 2 - These kill heartburn for 24 hours and weigh nothing. I get heartburn sometimes from the combo of dehydration, crappy food and physical activity (oh and whisky can put quite a fire in the belly). Baking soda is good for heartburn but I don't carry it.

Pink Bismuth tabs - ditch the famotodine and Imodium as the pink tabs can be used for heartburn and diarrhea. I find it multi-use but less effective on either ailment.

Whisky - cures boredom and insomnia (I guess it could be considered a med but not really first aid)

Dayquil - In certain seasons (mid-spring and fall) I carry 2 dayquil pills. They dry my nose up better than anything I have every used and don’t make me sleepy.

All pills kept in one of those tiny zip bags. The bigger stuff goes in a sandwich zip bag.

I plan to add a irrigation syringe, of which I have plenty. I get a fresh one in a sealed package every time one of my kids gets a liquid prescription. It makes sense that irrigating even a small cut would help it heal faster.

Fortunately I do not seem to be allergic to poison ivy.

"Famotodine pills 1 or 2 - These kill heartburn for 24 hours and weigh nothing."

I had to quit those acid reducers and switch to generic Prilosec which has little ball-shaped granules inside a gelatin capsule. I can take half of one capsule and get good results.

In a group first aid kit, I carry Dramamine as a light, general-purpose sedative. I've had to use that on backpackers after they've been overly anxious from other maladies.

Pink Bismuth (Pepto-Bismol) tabs can be quite handy after a bout of nausea and vomiting. I used that on a climber during an air flight.

I generally carry one prescription grade painkiller, one prescription grade broad spectrum antibiotic (GI), and Diamox if I am going to high elevation.

--B.G.--

--B.G.--

The southern PCT isn't the moon. You will hardly be very far from civilization. Not more than 4 days between resupplies with a possible bailout point more often than that.

Here's what I brought on the PCT. A star indicates I actually used it:

A few doses of antibiotic for infection, the rest in bounce bucket
A few doses of antibiotic for diarrhea, the rest in bounce bucket
A few doses of vicodin, the rest in bounce bucket
One dose of immodium
*One dose of alka-selzer
*A sample-sized packet of antibiotic
*Flexible fabric bandaids
*Athletic tape
*Gauze
A small amount of mole skin
*Foam toe bandages
*Ibuprofen
*Needle and dental floss

Edited by sbhikes on 06/28/2010 15:30:16 MDT.

Could you use your hose/bladder in place of the irrigation syringe?