Wednesday, November 3, 2021

Wilderness First Aid, & Kits Pt I


Over at Captain's Journal, Herschel mentioned an article made some "interesting points", and then excerpted part of the listed first aid supplies recommended.

Which perks our ears up, because we're always on the lookout for new or better ideas. And we haven't done a medical post in awhile.

And after a careful reading of the article in question, we've definitely become interested.

In beating it about the head and shoulders with a stout cudgel. When we find our self saying "No! No!" within the first few grafs, it's not going to be good.

We shall fisk it in (probably) three parts, rather than a mega-post. Because we lead a busy life, and haven't the time to invest in deconstructing it all in one go.

For those similarly time-constrained, the TL;DR version:

1. Your go-to medical texts for wilderness medical emergencies should be authored by someone named ForgeyAuerbach, or Alton. Those are literally the Gold, Silver, and Bronze medalists in the field. There are many other good texts, but those are the reigning champions, IMHO.

2. If you use one of the secondary texts not listed, make sure it is authored by someone with MD, DO, PA, RN, or, ffs, at least EMT-P after their name. There are virtually no "gifted amateurs" in the medical field. Listen to professionals, who've been there, and done that, and not people trying to quote them accurately, from a dearth of professional wisdom.

3. The author of the linked Field and Stream article, Jim Baird, is absolutely an avid outdoorsman, adventurer, and experienced wilderness survivalist. He and his brother beat out six other survival pairs on the fourth season of Alone in 2017, and won by outlasting the coldest fall and wettest winter on Vancouver Island, for 75 days. He's been on many trips in what is absolutely pristine wilderness, far beyond the pavement. The problem is, he knows about half of what he should about wilderness first aid, and there's no way to tell which half he's getting right if you're a novice. I give his article a C- overall, as in barely passing. But that's because the things he gets right, he gets very right, and he definitely knows some of his stuff. If I were in the wilderness, he'd definitely be a handy and experienced guy to have along. Just not as the medic.

4. As a general rule, so-called "outdoors" publications are either too stupid, too lazy, or too cheap, to seek out the three subject-matter experts, above, or anyone similarly qualified, and instead keep asking their regular outdoor writers to contribute articles on topics far beyond their expertise. I don't begrudge the authors, because all that adventuring doesn't pay well these days, so anything for an honest buck is understandable. But the lack of competent editorial oversight is glaringly obvious, and you owe your readers a discount if you're not going to do that job. For this reason, often the best use of any article from an outdoors magazine, in a survival situation, would be to fold it carefully, carry it in your kit, and then, if one were forced to survive, to tear it into small strips, and use them to light one's campfires or signal fires. That act, alone, will probably save lives and limbs.

And with that, on to the dissection:

A good first aid kit ranks highest among the gear that you never want to use. Still, taking the time to research and assemble the best first-aid kit is a must before you venture into remote areas. A good place to start is with a pre-assembled wilderness first-aid kit. Then remove whatever you don’t need from the kit and replace it with the items you will need.

Fair enough. So, which things will I not need?  How do you know that? How would anyone? It's nice to sound like you could know that, but the fact you never explained it leads inescapably to the conclusion that this advice is from hindsight, out of one's tailpipe. Just saying.

Will this cost more than your run-of-the-mill first-aid kit? Yes. Will this customized kit be more useful in treating a serious injury in the backcountry? Hell yes. After you’ve assembled your first-aid kit, the next step is learning how to use the items inside it to treat common outdoor injuries. This story covers some of the most common of those injures. But before we get started, I should warn you:

 Graphic images ahead…

Yawn. They're not that graphic. Get on with it. 


Few meals are more satisfying than a shore lunch at fish camp. This might seem like the last place you’d encounter an injury—but accidents happen. Especially when hot oil and fire are present. Here’s how to deal with a nasty burn:

  • 1. If possible, get the burn on ice. Otherwise, dose it with cool water. Wrong
  • No! NO! NO! You never "ice" burns. Period. Full stop. Got ice? Throw it in the water you soak the burn in. Never put ice on a burn. Water pulls the heat out, 25 times faster than air, and burned flesh continues to burn until the heat transferred into it is pulled out. Dunk the burn, or put clean cloths soaked in cool water on it to pull the heat out. But no ice.

    2.Blisters will form; don’t pop them. The fluid under the blisters is sterile and, when left intact, your chances of infection are less likely. 
    3. When the blisters pop on their own, you face a serious chance of infection forming between the dead skin of the blister and your body. Using a sharp, small, and sterile pair of scissors, trim the dead skin off as close to the outside of the burn as possible. 
    4. Wash the wound thoroughly. Soap and water will disinfect the wound as well as anything, but make sure to boil your water first. And then let it cool off before you wash with it! 
    5. Keep the wound covered. Dirt or other debris or unsterile water can lead to infection. Keep these things out of the wound by covering the burn thoroughly and changing the bandages daily. Non-adherent gauze pads will create less pain and won’t open the wound when changing bandages.

    Duct tape can help secure and waterproof bandages. Remember to bring lots of bandages in your first-aid kit.

    We use non-adherent dressings. Bring lots of those. Bandages are what we use to hold dressings in place. Dressings get changed, either daily, or when they're wet/dirty/saturated. Bandages can be cleaned and re-used. Duct tape should be kept the hell away from any burned tissue, unless you want to risk removing the intact skin as well as the burned tissue. Skip duct tape; get some good first aid tape in the first place. Paper, plastic, and silk, and probably the mega-sturdy white heavy-duty first-aid tape.

    6. Bring clindamycin—the type of antibiotic most commonly used for treating infections. If the burn starts to become infected, begin taking the antibiotic right away and make immediate plans to get out.

    Burns are on the outside. The only antibiotic you should be worried about using is either OTC Neosporin, or, if you have/can get it, Silvadene ointment, which is an Rx item. Put that on the burn. Nothing else. Not butter, grease, Crisco, or any 57 other Granny's Homemade Cure ideas that sound like a good idea at the time. The patient, and the burn nurse who has to scrub all that crap out of the burn, will both thank you later.

    And the go-to antibiotic for an infected burn is penicillin, or erythromycin. Resistant strains are another problem entirely. So basically, forget every bit of Item 6, except in case of spreading infection, "make immediate plans to get out." The rest is pure crap.

    We would also suggest that it's a lot easier to prevent burns than to treat them. Wear stout leather gloves. You'll lose a fraction of your dexterity, but you'll prevent a boatload of problems by letting your gloves literally take the heat, instead of your fingers and hands. And keep your face out of things that flare up, like lanterns and stoves. Eyebrows grow back, but eyes don't and burn scars are forever.

    It gets better: almost the entire section on Frostbite can be used without revision. One correction is redlined.


    When temperatures drop, inadequate or damp boots or gloves are common causes of frostbite. In extreme conditions, taking your gloves off for even a short period of time can be all it takes to cause frostbite. On windy days, your face is equally at risk. Prevention is paramount. Being prepared with the right clothing and keeping it dry is your first defense against frostbite. But if conditions get the best of you, here’s what to do:

    1. Find shelter out of the wind. Set up a tent and get inside. No tent? Duck behind some sort of natural wind block—or build one. Do whatever it takes to get your frostbitten skin out of the cold.
    2. Gently warm the frostbitten area. Keep in mind that rubbing the frostbite or walking on it (if it’s your feet) to warm up the frostbite can create further damage. Use warm water or body heat to warm the frostbitten area. For example, tuck frostbitten fingers in your arm pit. Refrain from using a hot pad, stove, or hot water to warm the area, because frostbite makes the area numb, you could burn it.
    3. Continue to keep the frostbitten area warm and dry. Elevating it will help curtail any painful throbbing, and consider taking ibuprofen.

     Post Frostbite Tips: An area of your body that has suffered frostbite never fully heals, meaning it will react to the cold more easily in the future. So, if you’ve had frostbite of any severity, be extra prepared the next time you venture into cold temperatures. The following are also good extra steps to take:

    • Hot pads for your feet and hands are very helpful.
    • Line your bare feet with a plastic bag or (nope; dumb idea. Sweat in the bag turns into ice, turns into re-frozen frostbite. Gangrene. Bye bye feet.) GoreTex socks before putting on your socks and boots is a good idea.
    • Mittens are warmer than gloves. They work best without glove liners; that way they allow your fingers to touch for skin-on-skin body warmth. 
    • Carry a balaclava to protect your face when it gets windy.

    We'll leave it here for now, and continue with the second part momentarily.

    And then the third and final part, including our suggested kit list.


    1. Good points.
      I find that long tools are great at avoiding fire/ stove problems.

      I wonder if he for the frostbite section right because he's had to use it?

    2. Here is the problem with first aid kits. Most are not much more than band aids and antibiotic cream, throw in a diverse bunch of over the counter pills. Almost anything that this kit could treat could also be ignored. A more comprehensive kit will have the same things but about 5 lbs and 100 cubic inches of other stuff to treat burns, broken bones, serious wounds, bleeding, etc. Being a hiker I carry a first aid kit. I have half a dozen of them in various places. But the comprehensive kit is too big and too heavy to carry around and the light convenient kit can only treat those things that I can ignore for a day or two or three and it heals itself. And that is a simple fact of life; that more than likely when you need that item in your comprehensive kit you won't have that kit with you or within 15 miles of you because it's too big and bulky to carry around.

      So! What do I carry with me when I go out into the wild? A tourniquet and an Israeli bandage. It isn't really "light" but lighter than a comprehensive kit. It is likely that I will never need it but if I do I will REALLY need it and seconds will matter.

    3. Auerbach...wellll... I dunno. I have his "Medicine For the Outdoors" and, good as it is, my opinion (for what it's worth) is that to follow his teaching, one would need a Huey load of equipment following them on a week long canoe trip. Or a string of African safari porters over loaded with equipment. Still, a good read.

    4. Thank you for the review Aesop, and especially the book recommendations. I have added the "Gold" one to my list of things to buy.

      One confusing note, and only because of industry experience: in my past, clindamycin has been used for things like acne related products (in combination with Benzoyl Peroxide). The Wikipedia page suggests a larger scope of usage; I have not encountered before in this sort of use (mostly, of course based on children growing up and what they were prescribed, etc.)

    5. Good stuff. Thank you again. Never thought about the plastic bags or gortex before socks unless you mentioned it before and my old ass forgot.

      1. Plastic bags. No go. Feet sweat. Got to remember that moisture transfers heat 25x that includes sweat.

    6. Copy
      and paste(d)

      Thank You

    7. Clinda can elicit C. Difficile: bad enough in town. On the trail/in the boonies? Very bad.

      Wonder where he got *that* piece of counsel?

    8. Agreed.
      I meant to swat that dumb idea too, but I was concerned with first aid, and overlooked it. That's more along the lines of prevention, equally valid. And now corrected.
      Gore-tex socks = good.
      plastic bags = bad.

    9. RIP Paul Auerbach - have the 1st Ed. "Wilderness & Environmental Medicine" textbook we helped him with - I believe he was with Vanderbilt at the time but finished out his career w/Stanford - cancer does officially suck...

      For the 'plastic bags' - long time high-altitude mountaineering hack - but needs context. You use a thinner layer - wool or poly - next to the skin. 'Plastic bag' layer between that and your insulation layer - the thicker wool sock

      Keeps your immediate perspiration away from your skin AND from the insulation layer (it's NOT sealed...perspiration still escapes) but obviously works best in dry environments such as high-altitude

      In that case it makes sense - just not everywhere - I sort of looked at this as the same as why bother with Gore-Tex in coastal will be wet...

    10. @jim,

      At altitude, relatively dry cold, that method would be a bit more sensible, but that's not the way he wrote it.

      And yeah, Gore-tex requires there to be a gradient from wet inside to dry outside.
      If outside humidity is 100%, the water vapor has nowhere to go. In coastal Alaska, just like in the tropics, even with Gore-tex or a poncho you're either wet from rain, or wet from sweat, but either way, you're wet, and the only solution is spare dry socks.

      1. This is the idea behind open cell foam clothing. It gets wet you wring it out and now the air pockets begin to insulate. Natives had this idea in mukluks. All good stuff. Maybe you can address some basic vitals assessment.

    11. I've had good experiences with water-jel type burn dressings. I keep them in the kitchen, and while I thankfully haven't had a bad burn, I've had some that I was sure would be second degree burns but for immediate (<30 seconds) application of a water-jel bandage. Took it off in an hour or so and was left with a very minor 1st degree/sunburn patch.

      Any opinions on them? Right now I'm a true believer and have one in every blowout kit.

    12. re: plastic bags on the feet. This is a really old-school cheapo take on vapor barrier clothing for extreme cold - not the 1960's "let's wear bread bags in our shoes to go sledding" sort of deal.

      The author presents it poorly and doesn't really explain it at all, and it's not applicable for most areas of the lower 48 in the first place. You're going to sweat and it'll be annoying, but the idea is that you're not going to sweat an unlimited amount and the barrier preserves the insulative properties of your clothing. If you're only doing your feet then Gore-tex socks are a superior method for the temps most of us will face.

    13. @Phelps,

      The water-jel burn dressings are superior, and in a balls-out kitchen-sink kit, I'd definitely include them.
      In a minimalist IFAK-only set up, where space and weight are a premium, not so much.