Backcountry First Aid - DIY Kits and Advice From a Paramedic

Backcountry First Aid

A huge thanks to Chris Rosa for contributing to this article.  Chris has nine years of experience in EMS between volunteering and full time work as a paramedic. He is currently certified as a national paramedic, Montana paramedic, tactical paramedic, and a Stop the Bleed instructor. Chris is from Montana and is currently working in Afghanistan at a small clinic.  When he is home in Montana, Chris works with St. Peter's Hospital in Helena, MT, and with AMR in Bozeman, MT.

Chris Rosa

Chris Rosa, Paramedic

It Won't Happen To Me

You never get to choose when bad things happens; you're either prepared or you're not!  Even if you are a seasoned backcountry pro, disaster can strike quickly.  Take this story for example:

One of the most unique calls I've had was a woman who was hiking locally at Sacagawea Peak, and had a mountain goat knock off a rock that struck her leg and caused a very large cut to her thigh.  She was unable to hike out so she had to be rescued. She was extremely lucky in that the wound had very minimal bleeding, as she had no form of bleeding control with her or readily available should the cut have been worse. She had no means to self rescue and was incredibly lucky to have a search and rescue team that was able to get her down safely.

- Chris Rosa, Montana Paramedic

Common Backcountry Mistakes

While you may never be gored by an elk or struck by lightening in the backcountry, you still need to be prepared.  Plan out your hike more than a just bringing along a backpack, water bottle, and a dream! Let's take a look at some of the most common mistakes people make and easy ways to avoid/fix them:

  • Being unprepared and uneducated.  Keep reading for ways to avoid this one.  Classes are listed at the bottom of the article if you want further training.
  • Not bringing a first aid kit or emergency gear.  Bring a small emergency kit, extra water, and some warm clothing even if you don't plan to spend the night.  Keep reading to see what essentials Chris packs along on every trip.
  • Not telling anyone where you're going.  This is an easy one to fix.  Simply text or call a friend or family member about your trip location and expected return time.  When going on longer trips, we leave hard copy maps marked up with intended campsite locations and potential alternate hiking routes.
  • Not having a map and other navigation equipment, or having them along and not know how to use them properly.  Take a map, compass, and even a GPS messenger along and know how to use them!  Train yourself - there are lots of navigation tutorials on YouTube if you need a training resource.  We bring along a hard copy map to back up a phone app; don't let dead phone batteries leave you without a map.  Take along a USB power bank along like the Anker Power Core in case your phone dies.
  • Not having the proper clothing or footwear for your trip.  Exposure can happen extremely quickly in the backcountry.  Make sure you have adequate layers to stay warm and dry in the event of an unexpected storm.  You can read more about proper clothing recommendations in our Backpacking Gear List and our Backpack Hunting Gear List.
  • Not having bear spray (or other bear deterrent) when hiking in bear country.  This one is an absolute no-brainer and we shouldn't even have to mention it here.  Buy bear spray and carry it on your chest or hip, period.  Bear attacks occur extremely quickly, and you MUST be able to get to your spray in under 2 seconds.  Practice deploying it as quickly as you can so that if an incident occurs, you can let muscle memory do the work.

Hope for the best, but plan for the worst.  With that in mind, what should you bring along for first aid equipment?

First Aid Gear and Supplies

At a minimum, you should have a way to start fire, a way to clean water, and a way to stop bleeding. An injury to a large artery like the one in your thigh can leave you dead within 90 seconds if it's not controlled immediately!  Specifically for injuries, we recommend at the bare minimum two tourniquets in an easily accessible area, a mild pain killer, and chest seal. Two tourniquets are recommend as one may not be sufficient to stop the bleeding, specifically if the recipient is larger in size.  Tourniquets are especially recommended for hunters, who are more likely to get cut while field dressing an animal or sustain life threatening injuries from mishandled rifles or arrows. We had never even heard of a chest seal before talking to Chris.  They are basically a patch with industrial strength adhesive to seal off the wound.  Chest and abdominal wounds are especially difficult to treat with just gauze and tape.  If you have a chest seal, you just slap it over the wound and you are done.

You can improvise wound packing material with a t-shirt, but improvised tourniquets will fail and may cause additional injuries. When Chris is teaching first aid, he gets a lot of questions about using "tampons for wounds".  This is a very old myth dating back to the Vietnam War. There's more than enough videos that show tampons do not belong in wounds!  So what should you bring instead?

First Aid Kit Bare Essentials

Be aware that premade medical kits (we recommend Adventure Medical Kits) available at stores like REI can be lacking useful items to treat major injuries.  That being said, you can easily supplement premade kits to bring them up to paramedic standards, or create your own DIY backpacking medical kit.

In addition to carrying a premade kit (band aids, tape, gauze, ointment etc.), here are the bare essentials that Chris recommends taking along in order to be able to treat major, life threatening injuries.

The most important part of your first aid kit is going to be education in how to use it.  Your knowledge and kit may be used to prevent and treat a catastrophic injury to you, a loved one, or a random hiker that you encounter who needs help. You never get to choose when bad things happen, you're either prepared or you're not. Use this link to review a full list of tourniquets (like the CAT mentioned above) that are evidence based and proven to work.

Other Essential Items For Every Trip

Chris also carries these essential items in a dry bag that goes on every hike he takes.  If you are lost or stuck in the woods over night, the ability to make a fire, and have clean water can be crucial, not to mention a huge morale boost!

Other Considerations

Food and Hydration

Food and hydration are extremely important - an engine doesn't run without gas! Hiking on an empty stomach will make you miserable, and not being fueled properly will lead to an increase in fatigue and decrease in solid decision making.  In addition, if you are in pain and need ibuprofen, having a full stomach will cause a lot less discomfort.  For more on proper fueling, visit our backcountry food store and meal planning tool.

Hiking With Dogs

One thing that is important that most people who hike with dogs may not have thought about is a way to secure their dog if it becomes injured. Consider bringing a lightweight mesh muzzle.  Hurt dogs bite and you may have to carry your best friend out!

Additional First Aid Training

Chris recommends taking a Stop the Bleed course. They're usually free, quick, and will give you hands on experience in treating major, life threatening injuries.  If you are in the Bozeman area, Chris is happy to put them on for anyone interested for the low cost of a cheeseburger and soda!  Note that Chris took the time to come over and teach us the Stop the Bleed course.  It is very helpful and is recommend by the Alpen Fuel team.

If you are in the backcountry in winter (especially if you are skiing), consider taking an Avalanche Safety course, and carrying along an avalanche shovelbeacon, and probe.

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