Basic Wilderness First Aid Every Backpacker Should Know

Anyone who hikes understands that it can be an unforgettable experience, even when those memories come from close calls. While the wilderness can be beautiful, it can also be unforgiving. When you’re alone on the trail, the only doctor available is you. It’s for all these reasons that we highly recommend taking a wilderness first aid course. For now, here's a very general overview of wilderness first aid and how to attend to yourself and other hiking party members on the trail. 

Disclaimer: This post is not a guide for certified medical training. For complete, hands-on experience, please take a wilderness first aid course. 

Wilderness First Aid

Wilderness first aid is a course you can take to sharpen your survival skills and prepare yourself for any potential danger on the trail. Whether you’re backpacking or going for a simple day hike, wilderness first aid training can be vital to the survival of yourself and others. All first aid skills are important, but these courses tend to go beyond CPR and the Heimlich Maneuver. 

There are definitely traditional first aid skills that can be incorporated into the wilderness. However, there are certain skills that are specific to the outdoors, especially in areas where there won’t be access to emergency medical facilities. Wilderness first aid courses help you respond promptly to emergencies, increase self-sufficiency, and potentially enter a career in the outdoors. 

Packing Your Wilderness First Aid Kit 

There’s no right or wrong way to pack a wilderness first aid kit as long as you have the basics. Even so, you should always keep certain details in mind before embarking on an outdoor adventure. Try to think about the length of your trip, where you’ll be going, and the amount of hikers in your party. If you can’t take a wilderness first aid course to learn how to use the items inside your tool kit, safely familiarize yourself with them at home. 

According to NOLS, all wilderness first aid kits should include the following:

• Tweezers
• Safety pins
• Trauma shears
• Oral thermometer
• Medicine guide
• Rescue mask
• Antibiotic ointment packets
• Band-aids
• 2nd skin dressings
• 3 x 4 Non Stick Gauze Pads
• 1-inch Cloth Tape
• Coban Wrap
• SAM Splint
• 12cc Irrigation Syringe
• Gloves
• Antiseptic Towelettes
• Povidone-iodine Solution
• Sterile Scrub Brush
• Wound Closure Strips
• Moleskin Dressings
• Tincture of Benzoin Swabs
• 4x4 Sterile Gauze Pads
• 3-inch Conforming Roll Gauze
• 4-6 Inch Elastic Wrap
• Triangular Bandages
• Transparent Film Dressings
• Notepad and writing utensil

Ankle and Knee Injuries

Soft tissue injuries are among the most common inconveniences for hikers. Generally speaking, upper body injuries tend to be manageable depending on the extent of the damage, albeit annoying. Unfortunately for hikers, it’s much more common for knee and ankle injuries to occur on the trail. 

When your legs are the only way to get to and from a destination, your trip can quickly become a serious situation. When you’re tending to someone’s ankle or knee injury, don’t focus on diagnosing the issue. Instead, try to determine the extent of the injury and see if you’ll need to call for rescue. 

Treatable Injuries

Generally speaking, if the person is able to move and put weight on the area of injury, you can realistically continue with the hike. With that said, upon notice of the injury, securely wrap and support the affected area with an ace bandage or athletic tape. For hikers who live with chronic pain and/or recurring injuries, apply bandages before you hit the trail. 

When you arrive at camp, follow the RICE acronym (Rest, Ice, Compression, and Elevation) to reduce swelling and decrease your chances of irritating the injury further. If your schedule allows it, consider taking a day to stay at camp and let the injury heal before continuing on your travels. 

Severe Injuries

If the person can’t move or put any weight on the site of injury, it’s reasonable to consider that a severe injury. Keep in mind that signs of severe injury can occur once your party starts hiking again or after swelling kicks in. Following confirmation of a severe injury, immediately splint the injury.

Try to pad the injury with the resources you already have: sleeping pads, clothes, e.t.c. Wrap up the affected area with a wide object like a belt and make sure you can fit two fingers into the splint to prevent circulation loss. From there, begin the slow and steady process of hiking back to the trailhead, readjusting the patient as you go along. If the injury is too severe to even attempt a journey back (e.g. a bone protruding from the skin), send someone to call for search-and-rescue. 

Tending to Blisters

As a general rule of thumb, blisters are rarely medical emergencies unless they’re turning into an infection. If it’s manageable, the best way to treat a blister is to leave it alone, especially if it’s not on the foot. It just so happens that they tend to be one of the most common annoyances for hikers, even experienced backpackers. For people who want to treat their blister, the best thing to do is slowly and gingerly drain it and then approach it as a minor wound. Here’s how to safely drain a blister:

1. Wash the area with water or an alcohol pad.
2. Sterilize a sharp point by holding it over a flame or with alcohol.
3. Hold the sharp point parallel to the foot’s skin and slide up into the bottom of the blister’s roof. The blister skin should be dead, so the patient shouldn’t feel any pain. 
4. Leave the rest of the blister alone while applying light pressure to let fluid drain from the lanced area.
5. To prevent infection after drainage, cover the lanced blister with antibiotic ointment and apply moleskin to keep it in place. 

Treating Wounds

Bleeding Control

The first two rules of bleeding control include direct pressure and elevation above the heart. Always wear gloves when dealing with blood and instruct the person to put pressure on their wound while you put them on. From there, start applying gauze. If the gauze is getting saturated, don’t remove it from the wound, keep applying more. If your hands need to be free, create a pressure bandage by placing gauze over the wound and tightly wrapping it with an ace bandage. Make sure you’re able to place two fingers under the wrap to prevent circulation loss. 

Infection Prevention

If the bleeding has been successfully controlled and you plan to move forward with the hiking trip, the next step is preventing infection. To prevent infection following a significant wound, take the following steps:

1. Irrigate (wash) the wound with a half a liter of clean water using a high pressure syringe or backwash pump. Carefully remove any large pieces of dirt with tweezers.
2. Wipe alcohol along the skin around the wound, no inside of it. From there, apply antibiotic ointment and securely wrap clean gauze around the cleaned wound. 
3. Check the wound 1-2 times a day, reapplying antibiotic ointment each time. 
4. Regularly check for signs of infection. Swelling, redness, warmth, and pus are normal. 
5. Signs of infection include bright red and hardening skin that’s extremely hot to the touch and painful for the patient. If these symptoms appear 24-48 hours after treatment (or you can’t control the bleeding), stop the trip immediately and evacuate the patient. 

Tending to Burns

Between building fires, boiling water, and sunburns, backcountry burns are very common. To treat a burn, remove the heat source and immediately apply cold, clean water. Continue this process until the burning has subsided. Once the affected area is cooled off, consider scrubbing the burn with clean water and mild antibacterial soap. Proceed to apply antibiotic ointment to the burn along with fresh gauze. If the person is in significant pain, administer ibuprofen when needed. Evacuate the hiker immediately if they show signs of a severe burn: 

• The burn is completely around a limb, otherwise known as circumferential.
• The burn is located on the groin, armpit, face, hands, or feet. 
• Several layers of skin or bone are exposed. 
• The burn affects the person’s entire leg, arm, or torso. 

Approaching Shock

Going into shock is incredibly life-threatening and must be treated immediately. The body goes into shock when there’s not enough blood flowing to vital organs. Although shock usually occurs because of another trauma like extreme blood loss, you’ll need to treat the shock symptoms first. Here’s what to do if someone goes into shock:

1. Try to stay as calm as possible to assure the person in shock and lower their heart rate. 
2. Lay them down on a comfortable surface like a sleeping bag and elevate their feet on a backpack to keep blood flowing to the center of their body. 
3. Even if it’s not cold, keep the person warm and away from any moisture. 
4. If they’re capable of drinking on their own, keep them hydrated. If they’re unable to ingest water on their own, don’t force them to drink in case they choke. 
5. Complete shock treatment requires professional medical assistance. Once the patient is stabilized, stop the trip and call for search-and rescue immediately. While you wait for rescuers to arrive, keep a log of their heart rate and mental awareness every 10-15 minutes. 

Overcoming Hypothermia

When someone experiences hypothermia, it means that their body temperature has dropped to a dangerously low level. When anyone’s exhibiting signs of hypothermia, it’s important to act fast, as it can be extremely life-threatening. To overcome hypothermia, try to get out of the elements that are causing the body’s temperature to decrease. Get them to a heart source like a fire and remove any wet clothing. To increase the body’s temperature, cover them with an emergency blanket or any other dry, insulated material.