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Wilderness Emergency Care
The Wilderness Medical Kit
Steve Beyer

This is not a list of stuff you absolutely should have with you in the wilderness. There are already a gazillion such lists circulating around, and they are all different. Instead, what I try to give below is a way of thinking about your wilderness medical kit, outlining the tradeoffs among risk, weight, and bulk, and listing the considerations that should determine what you bring and what you leave behind.

Should you just buy a commercial prepackaged medical kit? Frankly, most commercial first-aid kits are pretty worthless. They can be a poorly packaged and more-or-less random collection of odds and ends – a couple of aspirin tablets, some Band-Aids, a roll of gauze. In most cases, useless things are included and important things are left out.

In addition, commercial first aid kits often cost more than if you buy and package the contents yourself. For example, a Kotex pad is a really good bloodstopper bandage.

Most important, putting together your own first aid kit makes you stop and think about what situations you are likely to encounter, what equipment you will need for those situations, what equipment you actually know how to use, what skills you have, and what skills you should acquire.

When you put together your own kit, it will change with your own experiences. Is there any chance you will be caring for an injured child? Toss a small really cute stupid-looking stuffed animal into the kit to let the child hold while you clean a laceration. You won't find that in a commercial kit.

Here are the questions you might want to think about.

Who is going to use the kit? What is his or her level of training? It makes no sense to pack things that the caregiver is not trained to use, or is not trained to use under adverse wilderness conditions.
Where you are going? What conditions are you likely to encounter? Will there be venomous reptiles? What sorts of wounds and injuries do you anticipate?
Who is the kit is for? How many people? Are there any special needs – pregnant women, diabetics, small children, dogs, llamas?
How long will the kit have to provide medical care? Is the kit for a 12-hour SAR operation or for a two-week jungle expedition? Under what circumstances is resupply possible?
What is an appropriate weight for the kit? How heavy a load can you reasonably carry? You might be comfortable with a heavy pack, or you might be an ultralight backpacker who cuts down his toothbrush handle and trims the edges off his maps to save half an ounce. How much ground will you be covering in a day? Will you be packing your full load every day, or will you be able to leave a big kit at base camp and take a small kit out on hikes or patrols? Who will carry a heavy kit if you are injured?
What is an appropriate size for the kit? How bulky a load can you reasonably carry? A kit that will have to be carried through crawlways in a cave rescue is going to have to be smaller than one to be packed on a mule.

And here are a few suggestions that apply to every kit.

Don't put anything in the kit you don't actually know how to use. It takes up space and, worse, in the heat of an emergency, you may be tempted to use it anyway.
Split up and distribute the kit among the group members. That way, if a pack gets lost in a river crossing, or dropped off a cliff, it will be a difficulty rather than a disaster.
Think about every item in your medical kit in the light of your experience and skills, not simply because it appears in someone else's list.

Here is an example for this last point – EMT shears. I guess EMT shears would be nice, and they certainly appear on some lists. But in the wilderness environment there are additional considerations. EMT shears are not weightless and dimensionless. There are likely to be lots of other cutting implements around. An inexperienced caregiver should not be encouraged to cut people's clothes off where hypothermia is a present possibility, even on a balmy day. An injured person is likely to get very pissed off when you use the EMT shears to cut off his $600 Patagonia jacket. Thus, instead of shears, you might consider, if you want to carry anything along these lines, a seam ripper. A seam ripper is small, light, and lets you reassure the patient that both his arm and his jacket can be reassembled after evacuation.

I guess my concern is that lists of contents of medical kits is very stuff-oriented, while wilderness caregiving is really very knowledge- and skills-oriented. The rule is: No matter what you pack, the one thing you need won't be in there. But what you always have is your understanding of the principles that underlie your care, and the skills that you have practiced under actual – or realistically simulated – conditions.

Also, when listening to general recommendations, I think we have to bear in mind that wilderness caregivers – both those who have been forced into the role by circumstances as well as those who have been trained for it – differ greatly in their training and skills, and the circumstances under which care is given can vary greatly. It is one thing for an experienced ER doc to suture a wound; but I am not sure that having stitched together a capote is sufficient qualification. On the other hand, the best plastic surgeon in the world might, without considerable wilderness experience, have trouble suturing a wound in a muddy shelter on a dark night in the rain. As always in the wilderness, good judgment, and a knowledge of one's own limitations, would seem to be the key to survival.

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