How to Build a First Aid Kit

I got asked by a guide service I work with to evaluate their first aid kits. This is a great topic and I wanted to share some thoughts on packing your own.

First Aid (FA)kits can be a bit of a black hole topic, with endless variations and items to consider.  You often end up getting confused and settling for a premade kit that you throw in your bag. Often you don’t even know what is in it.

It doesn’t have to be this way, I want to show you a simple structure to follow for all your first aid kits.  If you use this format you will always have the foundation for a good light first aid kit.  A first aid kit that you can fluff out with more should the activity or trip require it.

Founding Principle for a First Aid kit:

You MUST INCLUDE materials and items for THINGS YOU CAN NOT MANUFACTURE from anything else you have with you.

The reality of our first aid kits is that they never are alone.  If we have a first aid kit then we usually have a pack to carry it, our clothes on our backs, etc.   This principle is important because the baseline of every first aid kit shouldn’t be any heavier than necessary.  Heavy FA kits don’t get taken, especially when is an issue (hiking, flying, etc.).

 

The first step is to divide the FA kit into subgroups.

If you make sure you have supplies for each section, you will always have a FA kit that has enough variety to help in an emergency.

 

?Basic Life Support (BLS) & Documentation: This area is where you keep your protective equipment for yourself.  This also includes the supplies to provide CPR and a way to document patient care.

 

?Medications: This area is important because medications are one thing you can’t fabricate in the backcountry.   Typically the medication list will include over the counter meds and anything that is a specific prescription to you.

 

?Wound Care:  This is everything you would need to clean and manage open wounds.  Specifically, cuts or injuries that need more than a bandaid.

 

?Musculoskeletal Injuries: Our arms and legs are easy targets for rolls, tweaks, strains, and fractures.  This section gives you the stools to stabilize these types of injuries.  Helping you get out of the backcountry and into the doctor or physical therapist.

 

?Blister Care: Perhaps the most common thing grabbed from a first aid kit is the basic supplies to manage blisters and simple cuts or scrapes.

 

How you pack for each of these categories depends. How long is your trip? Is it a day trip or overnight? Do you have to carry the kit (aka does weight matter)? Is it international?  How you answer these questions affects what goes into your kit.

 

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Basic Life Support & Documentation

Basic life support is a term for the care we give on the most basic level to preserve someone’s life.  If someone is not breathing, we can breathe for them (you’ll want a pocket mask).  If their heart isn’t beating, we can push on their chest to create artificial heartbeats (CPR).  If they are bleeding severely, we can hold pressure and stop the bleeding (um, gloves first please!).

 

While basic, each one of these actions can and has saved lives.  They also mean we are right up in people’s space.  There is a phrase in medicine- if it’s warm wet and not mine- I don’t want it!

 

Every first aid kit should have the basic supplies to protect you while giving life-saving care.  This includes:

 

?POCKET MASK

?GLOVES

?FACE MASK

?PAPER & PENCIL

Optional:

• Trauma Shears
• Some people might consider bringing a medical field guide or reference materials for helping in an emergency.

 

The paper and pencil is so that you can write down any patient care and important information. Sometimes this is in the moment- like when you take vital signs or an allergy to penicillin.  Sometimes it’s after when there is more time.  Always, get in the habit of writing down patient care provided.  It’s good protection for your patient- by passing on valuable information to a medical provider that takes over.  It’s also good legal protection for you. Take notes and take a photo of your notes before passing them off.

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Medications

My pile of medications in a FA kit is smaller than one might think. I stick to over the counter medications. Obviously, if you have prescription medication needs (epinephrine for anaphylaxis, or an inhaler for asthma) bring them.

 

These over the counter medications have the ability to make someone more comfortable without severely altering the mental status and ability to function in the backcountry. If the emergency warrants heavier duty medications then it’s also going to warrant calling in SAR or other medical personnel.  My basic list includes:

?NSAID: ASPRIN & IBUPROFEN

?ACETAMINOPHEN: TYLENOL

?MIGRAINE MEDS: COMBO NSAID, TYLENOL & CAFFEINE

?ANTIHISTAMINE: BENADRYL

?LOPERAMIDE: IMODIUM

?PERSONAL PRESCRIPTIONS

Optional:

Single-dose medications you know you like having around.  Things like an Alka-Seltzer, antacid, etc.

 

The quantity of medications depends on the length of the trip.  For a day hike, I may have only 1 or 2 single doses.  Expeditions will require more.  If weight is not an issue, then entire bottles might be nice.  Just make sure you at least cover this range of basic medications.

Any international trip should consider adding prescription medications.  Things such as antibiotics, anti-nausea, epinephrine, etc.  You should consult with your doctor to decide on the specific medications that make sense for your trip.  Factor by area-specific needs (ie malaria), access to developed healthcare (do you have to fly to a different country to even get it), and how remote you may be on the trip (how many days would it take to get to a hospital).

 

*A note on pain

You may have noticed that I don’t ever recommend heavy-duty prescription pain meds.  This is for two reasons.  One is that NSAIDS and Tylenol have been shown in studies to work as effectively as Vicodin for pain management- without any of the brain-altering side effects.  The other is that PAIN IS A SIGNAL THAT SOMETHING ISN’T RIGHT.

It’s incredibly important to listen.  You need to figure out why the pain exists and address the root problem.  The next step is to provide additional pain management, especially to support people resting and sleeping. This is when people’s bodies are able to do their best work on healing.   It’s also ok to give pain medication to assist an evacuation towards the front country and medical attention someone needs.

Resist the temptation to take a pain masking medication so that you can hike, paddle, or push further through significant pain.  I see this far too often.   People taking ibuprofen every 4 hours for knee pain and then hiking up the mountain.  Your knee is telling you that It’s not strong enough to hike that mountain.  Go do some solid strength training and knee support.  Forget the medication.

 

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Wound Care

By wounds, I mean things bigger than a blister/splinter scrape. The type of thing you look at and wonder if it needs stitches. When it comes to taking care of a wound this comes after stopping any bleeding (with well-aimed direct pressure) and assessing for other problems. This is because cleaning and bandaging wounds take time and shouldn’t be rushed.

The goal of wound care is to prevent infections.  This is more of a concern with larger than band-aid size wounds.  It’s also incredibly important when one is far from medical care (offshore sailing, backpacking, etc). In these situations, an infection could set in before you are able to evacuate.

The equipment you need is the supplies to clean and explore the wound plus bandage this list gets longer. You will also want to wear some of the gloves and other protective equipment from your BLS section. Equipment includes:

 

?SYRINGE

?TWEEZERS

?SCISSORS

?GLOVES

?STERILE MOIST & DRY GAUZE

?NON STERILE GAUZE

?POVIDONE IODINE SOLUTION

?STERILE NON-BREATHING BANDAGE (FOR BURNS)

?BREATHABLE BANDAGE

?TAPE

Optional: 

• A syringe with a catheter tip will help create high-pressure flow to irrigate the wounds.
• Hemostatic clamps can act as an extra hand when you must open wounds and irrigate by yourself.

 

Learning how to use all these items will need to be another post or better yet-in person! Everyone can benefit from being able to understand how to identify low vs high-risk wounds and when to call for help. How to control bleeding and clean wounds to prevent infection.

Every Wilderness Medical course including a wound cleaning lab. Even the 2 day Wilderness First Aid class.

 

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Musculoskeletal Support

This area of the FA kit should have the supplies to create rigid and soft support for a variety of musculoskeletal injuries.   It is important to assess injuries for loss of function. This is far more practical than trying to decide if it is a sprain, strain or fracture.  Injuries that hurt but maintain some function are more stable.  Injuries that cannot be moved or used are unstable. Sometimes this can be obvious when you see major deformity or open fractures.

Stable injuries need soft support.  For example, a rolled ankle that can still be limped on.  What it needs is soft support making it less likely to roll again.  A rolled ankle that can’t be walked on is an unstable injury. Unstable injuries need rigid support aka a splint.

Your FA kit should have supplies to create rigid and soft support. The key items include tape.   Much of the other padding or wraps can easily be made by sacrificing clothing.  Once again, if weight isn’t an issue then premade splinting supplies in the optional area are great.  Equipment includes:

?ATHLETIC TAPE

?KINESIOLOGY TAPE

Optional:

If weight isn’t an issue then these items are useful.

• Sam Splint, which is a fancy way to create rigid support for arm injuries.
• Ace wraps are useful in splint building and sometimes for soft support on knees or ankles.

 

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Blister Care

Blister care is all about stopping heat from building up. The heat is created by friction. Approach every blister like a detective trying to find the underlying cause for the heat.  Sometimes the shoe is too loose, making your heel lift or slide. Other times the shoe is too tight and toes are being forced to rub back and forth.  Each of these take a different solution.

Always bring a variety of blister care options.  You never know what one you might need on any given trip. Equipment should include:

 

?BANDAGES (variety of sizes)

?SALVE

?TAPE

?MOLESKIN

?SMALL BLADE OR KNIFE

Optional

• Second Skin a less bulky blister specific bandage than moleskin
• Antibacterial cream can be nice for simple scrapes and cuts.  But shouldn’t ever be put into deeper wounds.

 

*Note on popping blisters  

A safety pin or needle is not on this list.  If you decide to decompress (release the fluid) from your blister slice an opening at the bottom with the knife.  Do not just poke a hole. This technique opens the blister up for infection but doesn’t allow you to clean it out.  A small slice at the bottom half of the blister will drain and still allow the top layer to remain as a natural barrier for the sensitive skin underneath.

 

In Conclusion:

The idea with first aid kits is to make sure you get these baseline items and then add more as needed. If there is something, I didn’t list but you love and use all the time-then bring it. I’m sharing what I have found works for me. I hope my suggestions at least provide a framework and inspiration to tackle your own FA kits.