If we think about the common causes of emergencies in the back country, we could put injuries very high on that list.
It could be anything from a very serious injury requiring a Search and Rescue effort, to something as simple as a mechanical injury to the lower extremities (think foot, ankle, knee) preventing us from walking out as we planned, and that injury forcing us to spend the night, unprepared, exposed to the elements.
Being able to handle those common wilderness injuries in the back country can prevent an emergency from happening to begin with.
In keeping with my motto of “be prepared first, then be prepared to find yourself completely unprepared”, I believe that there are certain items you could and should carry so that you are prepared to handle these common injuries without the need to resort to improvisation.
Improvising is not something we should plan to do on purpose, it should be something we do for when we find ourselves unprepared. For my personal Wilderness Medical Kit, I like to structure it in a way that identifies the possible injury first, and with that information, I can determine what I would need to handle that injury.
Keep in mind there are more possible injuries, but I limit this list to what is most common that the average person with a bit of training and the right equipment can handle.
The most common injuries that I expect to encounter in the wilderness can be categorized into “The 5 B’s”, which are part of the “5×5” system created by my friend Dave Canterbury at the Pathfinder School.
It is a very simple way to remember these categories:
Breaks and Sprains
Bites and Stings
Bleeding is possibly the most severe of these emergencies in that a life-threatening bleed can result in death more quickly than anything else on the list. In my opinion, it is very important to be able to handle this emergency as quickly as possible and not be forced to improvise when its life or death and seconds matter.
Given the fact that most of us in the wilderness are often using sharp tools, like knives and axes, this “bleeding kit” should always be carried at a minimum. If you are going to carry a knife, ax, saw, or firearm, you need to carry this, also.
Wounds could typically be sustained to the extremities, the torso, or junctional areas (where the extremities meet the torso), so you need to create your kit in such a way that you can handle all of those possibilities.
My bleeding kit consists of a proven tourniquet like the Combat Application Tourniquet (CAT). I carried and used this in combat from 2003-2014, so it comes most highly recommended.
I personally carry a minimum of two. If you watch my upcoming film on Wilderness Medical, you will understand why one isn’t always enough. Tourniquets are for extremity wounds and it is important to also have the training to use them. Severe bleeding in junctional areas and some extremity wounds may require wound packing and pressure dressings.
This could be with or without the aid of a hemostatic dressing. You won’t know what you need until you are presented with the injury, so it’s best to carry everything you need to handle any of them.
I prefer QuikClot Combat Gauze for a hemostatic, and S-rolled Gauze for additional wound packing. For the pressure dressing, I like to have the Emergency Trauma Dressing (ETD). This can be used as a simple bandage, as well. Although it is common for folks that are into preparedness to think that carrying suture kits for the average person is a good idea, it
really isn’t. External suturing is more meant to close a wound to facilitate healing and minimize scarring. It is not a method of controlling bleeding. We are not just a bag of blood that we can close a hole in and keep it all in. It must remain in the vessels to be circulated. The exception to this would be the surgeon who can locate the bleeding vessel and either tie to off or suture it with internal sutures.
This is not something just anyone can do and not something you would want to try and do in an emergent field environment. Stop the bleed using appropriate interventions and seek higher medical care for things like suturing. Save your suture kits for gear repair.
Recommended Bleeding Kit:
After bleeding, the most common injury we can sustain is a Break or a Sprain. Typically, what we see is a mechanical injury to the lower extremities. Except for a compound fracture (where you have a bleed as well as a break); or a broken neck, back, pelvis, or femur, the most dangerous part of this injury is not always the injury itself.
It’s the loss of mobility and inability to get ourselves out of the back country. Many day-hikers don’t pack for an unexpected overnighter, and the exposure to the elements that they hadn’t prepared for is what becomes the real danger.
Being able to splint these injuries to prevent further or compounding injury and regain mobility could make all the difference in these situations.
If you have a compound fracture, which is a fracture in which the bone has also pushed through the skin resulting in an open wound and an external bleed, stopping the bleed is the priority over handling the fracture. The bleed is what will kill you faster, so it needs to be handled first. For these injuries, you would fall back to your bleeding kit.
For simple fractures and sprains, being able to splint the injury in a variety of different configurations is likely all that will be needed in the short-term to regain that mobility and get to higher medical
I carry a variety of SAM Splints that can handle splinting most injuries. Although they come in different sizes and it is very convenient to have a variety of sizes available, in the military we typically only carried one size. These splints are foam-covered aluminum that is moldable to fit the injury, and we often cut those to size with our trauma shears or just doubled them over if needed.
These can easily be secured with some elastic bandages. You could also use tape, cravats, or a number of other things to secure them in place, but I like the convenience of the elastic bandages and the fact that they can be used for other applications as well as a bonus.
I also highly recommend carrying a few Triangular Bandages. These are also sometimes referred to as “cravats” and are extremely useful for splinting injuries and immobilizing joints.
I carry five of them since that is the maximum amount, I have ever needed for any injury that I have handled in the field. These are also cotton, so they are multi-functional, as well.
Recommended Breaks and Sprains Kit:
Burns can be very dangerous in that they are a compromise in your skin. Your skin has many functions, not the least of which being providing a barrier between you and your environment.
Any wound that damages the integrity of that barrier will open you up to infection. In addition, to be a barrier, another function of your skin is assisting in regulating your body’s core temperature. That ability is decreased when the skin is damaged.
In that context, where burns differ from something like a puncture or laceration, is the surface area of the skin that has been damaged and is now open to the environment is usually greater. Burns are categorized by degree, as in thickness/layers of the skin that are damaged. They are also
categorized by the amount of Total Body Surface Area (TBSA) that has been damaged.
Smaller TBSA burns will typically be handled with a “wet dressing”. This has a cooling, soothing effect and is much more comfortable for the patient, and because it is a smaller surface area that is damaged, increasing the risk for hypothermia is less of a concern.
Larger TBSA burns are much more susceptible to hypothermia, so a “dry dressing” is most appropriate, even though it will be less comfortable for the patient. The most common burn I encounter in the wilderness is a small TBSA burn. It could be something as small as the fingers or the palm of the hand from grabbing something hot out of the campfire. I prefer to carry a smaller BurnTec Dressing for those injuries and will carry a Dry Sterile Burn Cravat as well.
For a “wet dressing”, I can use the BurnTec against the wound and cover it all with the Dry Sterile Burn Cravat, and for a large TBSA I would simply not use the BurnTec and cover the wound with some dry compressed gauze (from my bleeding kit) and the Dry Sterile Burn Cravat.
Blisters are much less serious. They can be extremely painful, and they can become infected. Prevention is the best practice, of course. Wearing footwear that is well broken-in being the first key, followed by stopping and addressing any “hot spot” that is beginning to form on your feet before they become a blister.
Carrying a bit of “moleskin” and possibly some Tincture of Benzoin to help that adhere is usually enough to prevent hot spots from turning to blisters, and to protect blisters that have formed from getting worse. The moleskin can be cut to size and shape using your trauma shears.
Tincture of Benzoin
Bites and Stings can be dangerous depending on what type of critter delivered the bite or sting. A bite from a venomous snake is dangerous to everyone, whereas a sting from a bee may only be dangerous to a person who is allergic.
For venomous snake bites, time is critical. Your best “kit” is your car keys and cell phone. The car keys to get you to the hospital as quickly as possible, or your cell phone to call for help, or a combination of
Snake Bite Kits that are essentially just bug syringes that supposedly extract venom are not recommended. All they do is cause more damage to the tissue and delay you getting in your car and getting to the hospital where actual help can be obtained.
All the other myths out there include sucking out the venom with your mouth, icing it, and I have even read “electric shock” in some places. None of this will help and will likely hurt more than anything. Just get to the hospital or call for help.
If you are allergic to bees, make sure you get with your doctor and are carrying what is prescribed for that instance that you get stung. Your doctor will be the best source of advice for that and they will make sure you have what you need.
Regulation of your Body Core Temperature is often a function of your Fire Kit and your Shelter Kit (which would include appropriate clothing for your environment and conditions). Keeping yourself from getting too hot (hyperthermia) or too cold (hypothermia) can usually be accomplished with those.
When you are injured, particularly with a bleed that results in hypovolemia (too little blood volume), this can lead to hypovolemic shock (more specifically hemorrhagic shock in that example). One of the keys to managing and preventing shock is to maintain that core body temperature. As we used to say in the military “keep the casualty from chilling or overheating”.
In addition to the Fire and Shelter Kits, especially in cold weather environments like I am in, I like to carry a Hypothermia Prevention and Management Kit (HPMK). This can be useful for both shock prevention and preventing environmental injuries like hypothermia. The HPMK consists of a Heat Reflective Shell (HRS), and a Ready Heat Blanket.
The HRS is essentially a thermal blanket shell with a hood that wraps the patient similar to how a “mummy” sleeping bag would, and the Ready Heat Blanket is self-heating (without external power or batteries) that lasts for up to 10 hours. Depending on how cold your environment is, you could tailor this to meet your needs. In warmer climates, you may only need the HRS.
Hypothermia Prevention and Management Hit (includes both items) If you are a person who regularly carries a firearm, be it for your profession or personal protection, you should also be carrying an Individual First Aid Kit (IFAK).
If you carry a firearm with the expectation that you want to be prepared in the vent you should have to use deadly force against another person, you have to also have the expectation that the reason you would be using that deadly force is in response to them attempting to harm you or your family by using the same deadly force.
As the saying goes, “everyone wants to EDC (a firearm), but nobody wants to IFAK”. This logic just doesn’t pass critical thinking. There are several options for IFAKs that you could choose based on your situation and training level. The absolute is that you should be carrying one. It is just as important as your EDC.
It should go without saying, but in addition to having the gear you need readily available when and if an emergency happens, having the training to use this gear is at least as important (if not more).
While you can and probably should carry these items so that they can be used on you in an emergency by someone that has the proper training to do so, you should seek out the proper training as well.
Not only would you be able to handle yourself and your family, but you may be that person for someone else. I encourage you all to attend a Wilderness Medical Course, either a Wilderness First Aid or a Wilderness First Responder.
In addition, if you regularly carry a firearm, look for opportunities to take either a Tactical Combat Casualty Care (TCCC) or Tactical Emergency Casualty Care (TECC) course. More skills will always be better than less skill.
At the very least, I recommend you look for and get my newest film coming out soon about Wilderness Medicine. Admittedly, video training is not always a replacement for actual hands-on training, but it still has tremendous value as a reference and a primer for actual physical training.
The information that can be gained, especially when it can possibly save the life of you or someone you love, can be priceless.