Whether you are out for a day hike or a multi-day backcountry* trip, you should carry a first aid kit. You may need help yourself, or you may need to assist someone else. I always carry a small first aid kit in my pack, filled with essentials like the ones I’ve listed below.
To be clear: professional medical care is always the best option for an injured or ill person. It’s still important though to be prepared when you know it might take you a while to reach that care. As a park ranger and a Wilderness First Responder, I’ve learned that accidents will happen, sometimes when you are far from medical assistance.
Most basic first aid kits come with essential supplies for dealing with minor hurts, so I won’t be detailing all of those items here. The purpose of this essay is to explain what you might want to add to your regular first aid kit when in a wilderness setting.
I’ve also included improvised options, to encourage you to think creatively in the wilderness when you find yourself without the right supplies.
*In this essay, I am using the terms “backcountry” and “wilderness” interchangeably. Technically backcountry refers to spaces that are undeveloped and, for wilderness medicine, are a certain distance or length of time from medical care, like an hour’s hike away.
1. Bandages
The things you find in an everyday first aid kit are often still useful for a backcountry kit. Adhesive bandages are essential for any first aid kit but pack extra of varying sizes for your wilderness kit. Strips of clean gauze can also be wonderful for packing or covering larger wounds or for tying up a sling or a splint.
Improvised option: If you don’t have bandages or gauze (or don’t have any large enough for the wound in question), lay strips of clean cloth over a wound and tie it the best you can–rip up a t-shirt if you have to.
2. Disposable Gloves
The backcountry is messy, and after hours or days of outdoor activity, your hands may not be the cleanest. Also, you may not have a way to thoroughly disinfect blood or other bodily fluids from your hands when outdoors. Protect yourself and anyone you are assisting by wearing disposable gloves.
Improvised Option: If you don’t have disposable gloves, put plastic bags over your hands or some other kind of glove (like a biking or kayaking glove)–just make sure you are putting a waterproof barrier between your skin and whatever else you’re touching.
3. Clean Water
You should always have access to clean water when in the backcountry. Pack it in with you, or, if you are on a longer trip, bring a water filter or purifier and know where to find water. Drinking clean water is definitely a way to prevent illness.
Water bladders are awesome (I love mine), but I recommend having at least one water bottle on you at all times. Water bottles are useful for cleaning wounds, washing hands, and storing heated water when you need to warm someone up.
Not only is clean water helpful for washing up, it is essential for hydration. You may need to offer someone else water when they are ill or dehydrated, so having an extra bottle in your pack helps you share while being sanitary.
Improvised option: I once watched a colleague who had military survivalist training demonstrate how to collect water in the desert by rigging up a covered hole in the sand and waiting for hours. It was a nifty trick, but seriously–just bring water. Accessing clean drinking water is not something you should ever plan on improvising.
4. Soap
Soap may not be something you find in your home first aid kit, but it goes along with water in the wilderness essentials category, for similar reasons. Maintaining personal hygiene is a way to prevent medical issues from arising–wash your hands as you would at home, even if you’re outside.
Besides being useful for general hygiene, when dealing with first aid you may need to wash your hands before or after contact with someone or their bodily fluids (especially if you don’t have gloves).
Bring soap. A small bottle of biodegradable liquid soap or some other form of soap, like dried soap sheets, are a must.
Hand sanitizer can be helpful for getting rid of germs, but it can’t clean away dirt or blood, nor should it be used in wound care.
Note: DON’T use soap in large wounds either. Irrigate them thoroughly with all that clean water we talked about.
Improvised option: There’s this cool plant** in the southwestern US that you can beat the roots of and…yeah, no. Don’t try to invent your own soap while in the backcountry. Bring it.
**The roots of most species of yucca (common plants in the southwestern United States) yield soap when pulverized. Good luck with that. (Info from a really cool ethnobotany book called Remarkable Plants of Texas, by Matt Warnock Turner.)
5. Splints
A splint is something rigid that supports an injured body part, say a broken arm or leg bone. When you are far from medical care, it is important to keep broken bones from shifting around.
The injured person may have to help move themselves or they may need to be carried–either way there will most likely be some jostling of that broken bone. Minimize movement by attaching a supportive splint.
If you are responsible for a group while in the backcountry, you should be carrying something for splinting with you. SAM splints are lightweight, padded, flexible, yet rigid rolls designed specifically for splinting injuries in emergencies.
Having one on you is a must if you are medically responsible for a group while in the backcountry, especially if you are participating in potentially dangerous activities, like climbing.
Improvised option: Okay, let’s be honest, most of us are not going to carry a splint with us while hiking. I don’t, not unless I am responsible for a large group. Luckily there are many other options for splinting.
Find a few sticks to give structure to your splint (with padding around the wound, of course). Use a book or thick sleeping pad. Use whatever you can find that provides rigid support. Broken bones are no joke–that person needs medical care and moving them will require a splint.
6. Extra Food
I know: food doesn’t sound like a medical supply. Running out of food while days or even hours from help will soon become a medical situation, however. Plan out your meals, and bring extra.
If you are helping someone, even a stranger, while they are out in the wilderness, you may find that part of what they need is food. As with water, sometimes sharing your food is essential to helping another person.
You may also find yourself in a situation where you or another injured person cannot walk and must wait, possibly for hours, for help to arrive.
I have seen folks carried out of the backcountry on litters. Collecting a crew to lift someone takes time, hiking or climbing that crew to the person takes time, carrying a person out of the backcountry takes a long time. You will need extra food to sustain you, whether you are the injured person or a person assisting them.
Improvised option: Do I even need to explain this? No, you are not going to magically find berries and mushrooms that will sustain you in the backcountry. You are not Hermione Granger. Pack in your own food.
7. Extra Layers
You need extra layers for the same reasons you need extra food. If an accident does occur while in the backcountry, you may be stranded for some time waiting for help.
You or the person you are helping may get cold. And, even if the weather is warm, you may need an extra t-shirt or jacket for padding that splint or for wound care like I mentioned previously. Always having an extra layer in your bag is a great idea.
Also, there can be unexpected rain or snow. You may need a waterproof layer to protect yourself or the person you are assisting from the elements. And when someone is hypothermic, for example, one of the best things you can do is switch out wet clothing for dry layers and add a water-repellent layer on top.
Improvised option: You can use a tarp, tent rain fly, or garbage bag to protect from precipitation or wind. Wrap someone in a sleeping bag for warmth.
8. Basic Pain Medication
Unless you are a doctor or other medical professional, you are not qualified to prescribe and administer medications. You can, however, offer people basic, over-the-counter medications, like painkillers or allergy medicines.
Benadryl (an allergy medication) can save a life; it’s a good idea to stock any first aid kit with it. Some allergic reactions can come on suddenly, accidents can happen with food allergies, and there are definitely things that bite and sting in the wilderness that can incite an anaphylactic response.
(If you are qualified to carry or administer epinephrine then awesome, but that’s a whole other level from what I’m covering in this article.)
Basic painkillers–Tylenol, Ibuprofen, Aspirin, etc.–can help someone tremendously over the lengthy time it may take to get help if injured in the backcountry. Follow the directions on the medication. And always ask about allergies to medications and if the person is taking something else that may conflict with the drug you are offering.
If you are medically responsible for a group while in the backcountry, you should always have their medical history information, including allergies, medical conditions, and medications they take. If you are just out with friends or family, it’s still a good idea to know these things about them. Bring over-the-counter medications that you know they can take or may need.
Improvised option: No. You may have heard that chewing the bark of a certain tree will help alleviate pain or some other nonsense. Just, no.
If you don’t have over-the-counter meds available in the wilderness, then you or your patient will just have to suffer.
9. Elastic Bandages or Medical Tape
If you’ve ever sprained an ankle while hiking, you will understand why an ACE (otherwise known as elastic) bandage or medical tape might be helpful to add to your first aid kit. Both are light and relatively small, but they can provide tremendous relief when you or a companion are injured.
Elastic bandages are (as the name suggests) stretchy. They are wonderful for wrapping around splints or sprains. You can tie them or tuck them, and they provide soft but sturdy support.
Medical tape is often used to support athletic injuries like sprains (you may have seen an athlete with taped ankles). It can also be used to keep gauze or other bandage material over a wound. Medical tape sticks to skin but doesn’t take skin with it when removed. Keeping a small roll in any first aid kit (most store-bought kits include some) is essential.
Improvised option: You can use one of those extra layers you brought, like a t-shirt or thin jacket, to wrap or tie around a sprain or injury. Both elastic bandages and medical tape have some give to them, to allow movement and in case of swelling, so remember not to wrap the injury with anything too tight or rigid.
Oh, and don’t use other tape on skin–like duct tape.
10. Duct Tape or Paracord
I know I just said not to use duct tape on skin (do not!), but it does have other uses when in the backcountry. You never know when you might need to hold something together or patch a leaky tent.
And duct tape can be extremely useful when building a litter to carry someone. Using it to wrap a splint or other injured body part is a little iffy for me (you want to be able to easily remove anything you put on in case it’s too tight), but there are still many practical uses for duct tape in the wilderness.
Paracord (or P-cord) is a multi-purpose and lightweight nylon rope that, like duct tape, can be used for a variety of things while in the backcountry. It is also great for tying up a splint, as long as you use some padding underneath.
Improvised option: Most tapes and ropes can be adapted for similar purposes. Grab the cord from your tent stakes or climbing gear, should you need to tie up a broken leg or create a litter to carry someone out. Use what you have.
11. Sun Protection
I am a stickler for sun protection. If you are going to be outdoors, you should have appropriate protection from the sun (and remember that melanated skin still needs sun protection).
Wear hats, sunglasses, and layers. Apply sunscreen regularly. There is nothing fun about getting a severe sunburn one day into a five-day backcountry trip.
Sunburns dehydrate a person, and for a child a sunburn that covers much of their body can even induce shock from lack of fluids.
To reiterate–waiting for medical care in the backcountry can take hours. You may be left in an exposed area with little to no shade. Protect your skin and bring extra sunscreen in case others forget to bring their own.
Improvised option: Find shade. Get yourself or the person you are assisting to shade or create shade with a tarp or tent or pack or extra clothing layer.
12. Sleeping Pad or Camping Seat
If you are camping, you most likely will have a sleeping pad with you. You may not think of it as first aid gear, but a sleeping pad can be useful for providing stability and padding to a leg splint or for reclining on when a person is injured or ill. Most sleeping pads provide protection from the cool and/or damp ground, so they can help keep an injured or ill body warm and dry.
A camping seat–like the popular Crazy Creek chair–can also be co-opted for use in making someone more comfortable, including the person assisting someone else (you may not want to kneel on cold, wet, or muddy ground while building a splint).
Improvised option: Even on day hikes I like to carry a square strip of insulated sleeping pad with me for sitting. It could be used in splints or a variety of other ways in case of an accident.
I know some backcountry enthusiasts who for similar reasons carry around one of those foam pads that you kneel on while gardening–they’re soft, cheap, lightweight and protect your bum wherever you find yourself.
Conclusion
Whew, that’s a lot of stuff! You might be thinking that you wouldn’t bring some of this stuff on your next outdoor excursion. I don’t blame you: you don’t want your back or the belly of your boat to be bloated with things you don’t need.
What I do recommend is to be cognizant of who you are traveling with in the wilderness and what dangers might arise. If you are exploring the desert, clean water will be a huge consideration, and the same for extra clothing layers if you are in the cold.
The best wilderness first aid is planning ahead so you don’t need wilderness first aid.
Also, I hope that after reading this article you’ve gotten a sense that wilderness first aid often requires improvisation. Use what you have, what you find–make things work.
If the person can’t walk, use their shoes for added support in a splint and their shoelaces to hold it together. Support someone’s wounded arm with their own jacket, cinched up with its cords to limit movement.
Just use what you have. Assisting an injured or ill person out of the wilderness and getting them medical care is much more important than using perfect medical gear, which you will never have in the backcountry anyway.
The last thing I’ll mention is that you shouldn’t be overwhelmed by any of the scenarios I’ve mentioned. It is rare that people will have serious injury while out exploring wilderness.
Most likely you will never need to build a splint or a litter. But you will hopefully feel safer and freer to enjoy your time outdoors knowing that you could.