Rule #1—“The Context Equals the Content.”
There are many excellent first aid kits on the market today. Manufacturers have
done their best to take into consideration many factors, from cost to the actual
contents. That is why there are so many choices in style and content. For many
people, they just want a "good first aid kit in their pack, because they need
one." A good comparison is to look in someone's car. Some people are comfortable
adding oil and jumping a dead battery, so they carry extra oil and jumper
cables, some people do not. It usually is the person who has had experience and
training that carries the appropriate amount with them, either in their car, or
their backpacks. How do you know what to carry? Besides your experience in the
environment in which your traveling, you are now getting training to help you
handle emergency situations. These are by far the most important components.
Now, to put together the "tools" that you will need. As superb as manufactured
kits are, you will probably want to customize one, or build your own kit, using
the context of its use as the major criteria. Other factors include:
The environment in which you travel will help you choose what is needed for
potential problems that may arise, and how to handle an evacuation, if needed.
The activity itself will help you, due to its remoteness, and potential
problems in that environment.
What do you have for other available resources, such as people, gear, and
Who is participating - how many, what is their medical history, knowledge and
What can you improvise for splinting materials, litters, etc.
What can not be improvised.
Remember the Three Mechanisms of Injury:
The First Aid Kit
The kit itself needs to fit the environment and group's needs. Carrying a dry
box on a backpacking trip can really be a memorable experience. Or the "biology
experiment", that greets you when you open up a wet kit in an emergency. The kit
needs to be organized and waterproof, accessible in an emergency, and user
friendly. Some groups, such as commercial raft companies, carry "minor med kits"
on individual boats, and a "major med kit" in the sweep boat. In smaller groups,
usually the person with the most medical training, or the trip leader will carry
the kit. In these situations, it is always good to know whom you have with you
(medical history), and where their medications are, if necessary.
Let's get to the kit -
Carrying Device - One that works best for you, and the environment in
which you travel. Dry Bag/Box, fanny pack, compartmentalized pouch, ziplock
Personal Protection - it is generally a good idea to have these at easy
access. Gloves can be placed in various places in your pack, or on yourself,
such as a lifejacket in a film canister, etc.
Vinyl or Latex Gloves - 2 to 4 pairs per person*
CPR Mask - or at the very least, a CPR Shield
Airways - dependent on level of training
Wound Care - this is probably the most used portion of the kit:
Bandages - 3" and/or 4" rollergauze that stretches and
possibly self-adhering such as Kling, Curlex, and Coban. Like ace bandages,
care should be given to checking CSM at regular intervals and taking care
not to wrap too tight. They are usually reusable for the same injury, so 1-2
per person should work.
Dressings - it is a personal preference to carry multiple
sizes of sterile gauze bandages. But it is always easier to cut a 4" x 4"
smaller than it is to make a 2" x 2" bigger. Although not necessary,
different dressings will help make wound care much more manageable. 2 to 4
per person are minimal.
Non-Stick Gauze Pads - is a great dressing to use directly on
the wound. Wounds tend to "weep", and in long term care, dressings must be
changed. If you have ever removed a regular gauze pad that has "wept" to the
wound, then you will want some non-stick gauze, such as Telfa. 2 to 4 per
General Purpose Gauze Pads - like the name, they have many
uses for wound care, from padding to absorbency. Generally, these are used
more than any other gauze, because of its versatility. Since these have so
many uses, 4-6 per person.
Combine and Trauma Dressing - used where high absorbency
and/or padding are necessary. Larger sizes in these are usually recommended.
Surgipad is the most common. 1-2 per person*
Occlusive Dressings - an excellent dressing when you want to
keep a wound dry in a wet environment. Care must be taken to remove these
dressings during rest periods to help promote healing in a prolonged
context. Examples include Bioclusive and Tegaderm. 1-2 per person*
Bandage Strips - better known as Band-Aids, is really a
bandage with an attached dressing. Strips when used on hands, etc. in a
remote setting will need some help from duct or cloth tape. It is again
important to change these regularly, so bring enough. Usually 6-8 per person*.
Tape - a real necessity. 1" cloth tape is usually all that is
needed in a basic first aid kit. From securing bandages to closing wounds,
cloth tape can do it all. 1 roll.
Duct, packaging and other tapes make great
securing tools for bandages, splints, clothing, etc. Be careful to watch for
constriction and other circulation problems. Instead of carrying duct tape
on a huge roll, great options such as water bottles, ski poles and lighters
have been adorned with it in case of its inevitable use. 20-30 ft.*
- a must in any remote setting needs to be done well and often. What is needed
now is Povidine Iodine (PI) used in a solution with water, to adequately
irrigate the wound and surrounding area. In many kits, PI is in the form of
pre-soak pads that pack well, but you need quite a few to make the proper
solution with water (looks like weak iced tea). Be careful of carrying it in
bottles, it will leak. And, in cold environments it will freeze. There is are
some people who are allergic to iodine, so check your medical history first.
Alternatives that have an alcohol base usually have a tendency to "sting" or
"burn" if applied directly to a wound. There are some good biodegradable camping
soaps, as well as medical "scrubs" that can be used for cleansing around wounds.
The most important factor here is copious amounts of water for washing off
residue. A irrigation syringe, 12cc to 60cc, works great for washing out wounds,
as well as, a corner cut off a ziplock, which is squeezed like a cake decorator.
Wound closing is an option when the person needs to be able to walk or paddle
with a minor injury. The risk of infection is greater when the wound is close,
so prior wound cleansing is vital. Butterfly bandages, Steri-strips, or even
cloth tape can be used.
Splinting - is probably the most improvised skill there is. Ensolite
pads, lifejackets, packs, paddles, ski poles, etc. all make great splints. The
key here is to make sure you use the injured's equipment first! There is nothing
worse then watching the helicopter fly away, after a successful rescue, with
your sleeping pad wrapped around a person's unstable leg injury. The two best
commercial splints going for extremity splinting, is the 36" Sam Splint (foam
covered aluminum), and the aluminum wire splint. You will also need a way of
securing the splint to the injured. Ace wraps, Coban, Kling, and triangular
bandages all work well. And, don't forget the duct tape. Remember to watch for
constriction, comfort, and compatibility.
Blister Care - the key here is prevention. At the first sign of a hot
spot, care should be taken. Personal preferences include, moleskin, molefoam,
first aid tape, and duct tape to prevent blisters from forming. Once a blister
forms, the care changes to open wound care, with wound cleansing and proper
Hardware - this the stuff that can make someone a hero for being able to
pull out a splinter, or make an emergency shelter.
Tweezers - The "Splinter Grabber" is the best for
compatibility, followed by splinter (really) tweezers.
Pins - both safety and blanket pins have multiple uses.
Mostly, they can be used wherever material needs to be secured such as using
a sleeve as a improvised sling, or securing a tarp as a shelter.
Plastic bags - somewhere in your pack, extra plastic bags is
a good idea. Large ziplocks make great irrigators, improvised glove, or
occlusive layer. Big trash bags are perfect for vapor barriers when wrapping
up a patient, emergency shelter, and to put trash in.
Thermometer - in a cold environment, a hypothermia
thermometer covers most needs, and a normal thermometer makes sense
elsewhere. There are many good disposable thermometers on the market, such
as Tempa-Dot, that are also unbreakable. A digital indoor/outdoor
thermometer with a probe is a good resource to tell temp. variations of a
patient who is either immobilized during or waiting for evac, although not
as accurate as a medical version.
Trauma shears - is a good resource for removing clothing,
cutting improvised splints to size, and just about anything else.
BP Cuff and Stethoscope - although they are added weight and
bulk, they give the first responder vital signs that may help tell a big
deal from not. Generally, expedition or large groups have these as part of
their major med kits. Some first responders carry only a stethoscope to help
them hear lung, heart, and digestive sounds.
Heat/Cold Packs - again usually carried in major med kits,
these will help in short term context. Water bottles with warm water, cooled
wet towels, filled ziplocks, can be improvised heat/cold packs.
Survival Gear - like an ensolite pad, they are not generally
thought of as part of the first aid kit, but are very useful in handling an
Mirror/signal device - a compass with a mirror could save you
a scary and painful trip out of the woods because of a spruce speck in the
eye, or help you locate an adventuresome tick or leech. It can also be used
to signal aircraft or other groups, too.
Whistle - long after a human voice gives out from yelling, a
whistle can still be blown. Some groups even have pre-planned signals, such
as river guides.
Flashlight/headlamp - the majority of overdue hikers are
caused from not having a light, or spare batteries and bulbs. Select a light
appropriate to your activity, and that either has a foolproof switch that
won't turn on in the pack, or that the batteries can be turned around in.
Lighter/ waterproof matches- if you are traveling in wet,
cold environments it is also good to carry a fire catalyst, such as fire
ribbon, or fire gel.
Flagging tape - can be used to give wind direction to
helicopters, making out a bushwhack trail, signaling. Blaze orange and neon
blue seem to show up best on land.
Parachute cord - strong and light, 100' of p-cord could
secure an improvised shelter, build a litter, and even mend a broken paddle.
10 to 15' of mechanic's wire make a good addition for stronger repairs.
Survival blanket - there are 2 good
alternatives here that both accomplish the same job of vapor barrier, heat
reflector, emergency shelter. The fiberglass reinforced Sportman's Space
Blanket holds up to high winds and multiple uses. It makes an excellent
shelter, and when put behind you is an excellent heat reflector from a fire.
The original Space Blanket is a great lightweight alternative that is
compact and light, but impossible to ever repack to original size. This
blanket is reported to be a good emergency replacement if sunglasses are
lost, as you can see through the blanket. The actual UV protection is the
only question. The silver reflective surface also makes a space blanket a
great signaling device.
the legalities of using medications should not be taken lightly. Adequate
training, written policies and procedures and medical control should all be
considered. The big problem is that it is much easier to put the medicine in,
then it is to take it out.
Topical antibiotic cream - such as Neosporin, has been proven
to promote healing in shallow wounds and help maintain a good barrier.
Analgesic, Antipyretic and Anti
inflammatories - such as Tylenol, Ibuprofen, and aspirin. It is personal
preference to what has worked best for you.
Antihistamine - such as Benadryl and Sudafed
Antacid - Mylanta, Gelusil, Pepto Bismol, Maalox
Antidiarrheal - Pepto, Keopectate, Immodium, Lomotil
Anticonstipation - Metamucil,
Antifungal/yeast - Tinactin, Mystatin
Dental Problems - pain relief from clove oil, Orabase
Temporary dental filing material such as dental wax or Cavit
Special Needs and Medications - such as prescription
antibiotics, asthma inhalers, altitude meds, epineherine, etc.
Glucose - liquid glucose in a single use tube
Oral Electrolyte Replacement Solution - such as Gookinaid,
Tincture of Benzoin - helps keep bandages attached
Syrup of Ipecac
General amounts for the usual
day trip or weekend trip. If you can not be resupplied easily, such as a month
long expedition or voyage, it is probably good to triple all these amounts.
Program first aid kits that have youth at risk for clients will probably have
more wound care materials than a expedition group of experienced participants,
etc. There are no hard and fast rules to quantity, only your experience, your
training, and your judgment. So, after looking over your kit, and you don't see
"enough" povodine iodine pads, you are customizing your kit to your needs.
Putting This All Together.
The First aid kit must be well organized, weather proof, accessible in an
emergency, and user friendly. There are many good ways to approach this concept.
The simplest way to organize is to separate your bandages, dressings, meds, etc.
with ziplocks, or some sort of waterproof dividers. Writing what's in the bag
can help when the adrenaline is pumping, or some people even color code what is
what. Having gloves, pocket mask, and other protection readily available is very
important. Knowing what you can improvise with can also make an accident
situation go more smoothly. Being able to quickly grab the ensolite, duct tape,
and shears can greatly reduce the stress of the moment. Not only is the first
aid kit itself important, it is how easily you can assemble all your resources.
Suggested Personal First
Aid Kit List
1 - roll 1" cloth tape
4 - 4" x 4", or 3" x 3" general gauze pads
2 - non-adherent gauze pads
1 - 8" x 7" combine (bulk) dressing
8 - band-aid bandages
2 - 3" or 4" stretch roller gauze
3 - 3" or 4" occlusive dressings
2 - triangular bandages
1 - 4" ace wrap
1 - Sam Splint or wire splint
4pr - vinyl exam gloves
1 - CPR pocket mask w/ 1 way valve or shield
1 - Airways, nasal and/or airway
1 - blister kit (personal preference)
5 - povodine iodine packets
1 - trauma scissors
1 - splinter tweezers
1 - thermometer
1 - med kit (personal preference)
1 - blanket pin
2 - safety pins
1 - 12 to 60cc syringe
1 - 20-30' duct tape