Monday, 10 December 2012

Re-inventing The Backpack - Part 2: The Medical Kit

When you start to talk about Medical Kits, you must say a few things (actually a lot of things but in this case compacted) about First Aid. Hiking in the mountains can be treacherous and the possibility of injury, no matter how careful we are, is real.

Safety First!....

A similar bag was used as the MedKit
When I served in the Green Berets of the Special Forces in Greece I was assigned as the company's medic (not a doctor). My affiliation with the pharmaceutical industry along with my uncle and my brother being doctors and my aunt a (retired now) nurse helped me a lot. That meant I had a rudimentary, to say the least, training, regarding everyday first aid and medication. I was, also, trained by the Army's doctors to administer certain medication, dress wounds, fractures, and to carry the wounded properly as well as maintaining and taking care of the Medical Kit. If you think Army Medical Kits are similar to the commercial ones most of us carry you are mistaken. A proper Army Medical Kit has medication in it for 40 soldiers. It is packed with various pills, ointments, and surgical bandages and equipment. And weighs about 25lbs or 11kg. So, during our long distance marches of 30km each week, Ι had to lug around my Berkin backpack of 50lbs (25kg weighed in at the first checkpoint) and on my chest the Medical Kit. I am not saying this to show off what a kickass uber-soldier I was. I wasn't. I did my job and gathered experience and knowledge.

I'm saying this story to emphasize the importance of useful Medical Kits in a specialised environment, and to showcase on what knowledge this post is based on.

I am not a doctor, nor will I ever be one. But being near doctors for my whole life has sensitized me on proper medical care. Although this post is based on experience and collaboration with real doctors the information should not be used as a medical reference nor should you take anything here for granted. Unless you ARE a doctor, this post should by no means substitute one. Pay attention to medication instructions and always consider the safest course of action regarding your wellbeing.

As is customary in such posts there has to be a DISCLAIMER: This post and the views and information expressed in it, are not to be used as medical reference. They are therapeutic conclusions based on personal experience and do not represent a trained and certified physician's views or practices. There, I said it, even though the data is collected and crosschecked with real physicians. Lets move on, shall we?

Now, I have witnessed difficult situations like seeing a mortar fuse blow up in a recruit's arms, severing several fingers and making me instantly thanking god that the whole mortar didn't blow up, and foot blisters that I never again want to see. I even treated an idiot who after having a dump in the forest, thought that some stinging nettle was a fern and tried to wipe himself with it... I even got through 1st degree facial burn bacause I tripped in the mess hall with a huge pot of stew in my arms and it sloshed all over my neck and lower face...

These situations helped me realise the importance of good training and well prepared Medic Kits. So, needless to say that having a decent and well thought out Medical Kit is crucial. Most of all, though, the most vital thing to remember is to play it safe...That is, I try to keep myrself out of avoidable danger. In the end of this post you'll find some reference videos regarding First Aid actions...

Without further dealy, I'll cut to the chase and begin by saying a few DONT'S. I hate to do this because I may sound patronizing but it's for good reason. For those who may do something foolish, to protect themselves and for those who already know to remember a few things...

Don't do it Alex!
I DON'T play with mushrooms...NEVER, EVER! I speak with personal experience on the matter (I witnessed a hellish night for a friend of mine in the "mushroom region" of Grevena in Greece that almost cost him his life). Take as many pictures as you want, eat them in restaurants or buy them in markets, but never eat wild mushrooms...

"What's for dinner?"
I DON'T fiddle with wild animals. No matter how small, they can be very dangerous. From bears to mosquitos I am an alien to them, so I try to keep myself away from them and protected. If I know there are bears on my travels, I search the internet for ways to avoid them or what to do when a bear comes amidst my camp.

"My knife shoots lasers! Pew-pew!"
I DON'T try to climb difficult slopes without proper training and gear and generally I avoid feeling like a military or bushcraft specialist (unless one is...). If I am alone I may injure myself and at best I'll worry to death and cause much inconvenience for my family and friends. Worst case, I'll end up dead. A fractured bone will swell, may cause internal hemorrhage and become infected, let alone the excruciating pain it brings. Infected tissue may enter my blood stream causing septicemia resulting in death unless treated professionally. In other words I DON'T try to immitate that "survival" fool whom I've, repeatedly, seen trying to climb down huge trees, steep rocky slopes and generally trying to be an idiot all the time...(you know the one I am talking about...has his own "ultimate survival knife" series from Gerber....??)

Try to hike as a team.
In short I DON'T expose myself to danger that can be avoided altogether...And I learn First Aid.

Also, I try to have a teammate always with me. A friend who also likes to hike. I try to travel in pairs. If I don't have a trustworthy co-traveller and I want to hike alone, I am extra careful and pack a decent Medical Kit.

 Ouch! That Hurt!...


So we come to the point where we may have to deal with some pain, injury or physical inconvenience that needs our immediate attention. What do we carry with us out there in the woods, be that for a day or for a week of hiking? First and most we need some basic knowledge about fisrt aid, even if that means administering it to ourselves. Learning how to tie a bandage, nestle/immobilize a broken limb , treat a fracture and knowing what needs to be done is paramount...This knowledge is also free, and weighs nothing.

Some of the things that we may experience in the woods are:

1. Skin irritations. If we are not clothed properly it may happen. Full sleeves always and in the summer get a pair of trousers with removable legs (can go from trousers to shorts in seconds) Skin irritations can be dealt with, with any kind of anti-inflammatory or anti-histamine ointment or oral medication. They are cheap, most may not need prescription, but generally mometasone-furoate (anti-inflammatory, needs prescription usually) and Fenistil(gel), loratadine, desloratadine (anti-histamine, oral) are best to be near you at all times.

2. Bruises, abrasions, lacerations,  burns. Again proper clothing (wear leather gloves)will protect you from much of this. As for the cuts and scratches if they are not severe they can be treated by applying some antiseptic (Betadine solution) with a sterile gauze, and then covering it up with an elastic bandage or Band-Aid. Mild burns can be treated, first with running cold water for AT LEAST 15 min and then with local application of sodium fucidate (antibiotic) ointment (try to avoid cream..). Then cover them lightly with sterile gauzes and breathable elastic bandage. in case of a nasty 2nd degree burn that forms blisters, calmly treat the burn as above (for the 1st degree) but persistently return to your house or car and call an ambulance immediately! Burns may be more debilitating than initially foreseen, so please be carefull around fire...

3. Pain in general. From a minor headache (because you forgot to pack coffee for the morning) to a migraine and general not-well being, simple analgesics work well. Paracetamol, or ibuprofen are good choices and have very good pain relieving and fever reducing effects. Avoid acetylsalicylic acid at all costs. It is inferior to the above substances for its pain relieving effects and has serious adverse effects and restrictions for use. Plus it acts as an anti-clotting agent and may prove difficult to manage other wounds.

Important: If for any reason you feel really sick, (I'm not talking about some minor flu symptoms such as runny nose or sore throat) pack your things and go home to see a doctor. You might have a microbial infection that needs antibiotics and professional treatment.  

4. Infections. Bacterial or Viral.Viral infections are caused by viruses and most of the time are dealt with by our immune system. Flu is one of them and you catch it by contact with someone who has it. You may come into contact with someone with the flu before your journey, so remember that it takes 2-5 days to develop symptoms. having antibiotics with you won't help either, because antibiotics work only on bacteria. Plus, antibiotics overuse can lead to stronger strains of bacteria and you need a medical prescription. Flu is a virus that makes its way around our system in about 3-5 days. So even with high fever, analgesics and good resting, warmth and comfort food are the only solid choices. Antibiotics don't work on viruses and depending on the type of microbe you'll need a particular antibiotic. Plus check to see if you are allergic to certain pharmaceutical substances (one of the most common is amoxycillin allergy or cefaclor allergy.

"What the...."
5. Physical wear and tear. Foot blisters, back aches, muscle pains. Assuming you are a regular traveller and wear suitable and tested shoes or boots, such inconveniences will rarely occur...Foot blisters are best treated at the stage of the mild burning sensation. Removal of footwear and socks and cold water dousing for 5mins will soothe the area, but try to keep the spot protected from friction. Keep the foot aired and avoid heat. Rest well without socks for the night and keep an eye out for that red spot before a blister forms. A good, sturdy, big Band-aid with Betadine applied at the spot (sometimes even two band-aids) will act as a cushion if you simply MUST move on towards your designated camping area. If a blister forms...well, embrace yourself because you will have to burst it (but not peel it off completely), apply Betadine and keep pressure on the spot to fuse the skin layers quickly together. Big Band-aids and sterile gauzes will keep the blister aired and cool for the night. You must consider on such an occasion a 1 day delay in your journey to see how well the blister is healing, otherwise when you can walk start the return trip if the blister persists...I know this sounds contrary to what most are saying but you dont have 1 week of comfortable living out there to spare for a blister. The general trend towards non-bursting comes from poor disinfection techniques and improper dressing. The choice is yours, but I have tested this again and again and it works. As for back aches and muscle aches, either you are carrying too much stuff with you and you are using an unsuitable backpack, or you haven't done this in a long while and your feet hurt and your leg muscles burn from the lactic acid of tiredness. Try to get a good rest and repeat outdoor trips to weather yourself to such conditions.

6. Cold and Cold Weather. In cold weather it is absolutely crucial to have proper clothing and proper sheltering. Here, I won't go into details about what to wear. You can find excellent clothing techniques at Woodtrekker's Blog so I won't go into that now. Nor will I discuss extreme enviroments. I am sure there are hundreds of special blogs and sites for that. The only thing I will comment on is, have a small towel with you to wipe sweat, and keeping your neck and scruff warm is important. When you excert yourself, even in -10C, you will start to sweat but your neck is exposed and since it hasn't any large working muscles it gets cold. So, when you get cold you might catch a cold...but most probably you may experience symptoms of hypothermia and dehydration. Make sure you pack a tent or other light,windproof shelter with you, suitable sleeping bag and always have a fire around your camp. Keep it tidied up and well stoked, and have the means to start one quickly and easily. Also some instant hand warmers may be handy in cold weather.

"Your trousers are so tasty!"
7. Animal Bites. I am just stating this because there will be someone who thinks a grizzly is Winnie the Pooh. I have no comment on this as they will get what's coming to them. Other than that, if you're in bear country, you can only take precautionary measures such as wiring up your camp area with string and improvising an alarm with fishing bells(they are dirt cheap) or bear bells. You might also consider keeping your food away from the campsite. Or if you are trained and licensed you can carry a rifle and travel in pairs so that you can stand watch over each other. Regarding smaller critters, wear your leather gloves at all times, even with the friendly ones as they might bite you and you don't know if they brush their teeth regularly... Also double check if you are allergic to bee or hornet stings. and carry the suitable medication with you.

These are basic afflictions that may or may not happen to you and are based on my experience and discussions with experienced mountaineers. The list is not absolute nor final.
If you think I left something out that is commonplace elsewhere please comment and I will see if it can be included in the guide along with directions.

The Medical Kit.

After having said all the above, I think it is time to review the items in a well prepared, casual hiker's Medical Kit.

1. Sterile gauzes. Usually they come in packs of 10 and they are small and light. They come individually packed. They are used to clean and dress wounds.1 pack of 10 (or 12 in some cases) is enough.
Sterile Gauze - 5 pack

2. Self adhesive sterile gauzes. Individually packed, they can vary in size. Usually 2 palm sized are enough. 
Self Adhesive Sterile Gauze

3. Hansaplasts or Band-Aids. A packet is enough to last you years or until they expire. Make sure there are big ones in the packet. Also some specific finger-hansaplasts and rubber finger protectors are good items.

4. Elastic Bandages. I cannot begin to describe the importance and versatility of this item. It will bandage wounds, keep injured limbs firmly in place, dress a sore foot or a sprained ankle. The ideal size is no.10 displayed in the photo.

5. Small scissors. This one is from fishing accesories and is an excellent choice for 3$(2 euros). You can find small treasures in the weirdest of places.

6. Small soap. Either get one for free at a hotel or buy one from hotel acessories. Ultra cheap and useful to sanitize your hands and face.

7. Dental floss. A material that can be used to clean your teeth, sew cloth, tie up bags etc. Can be ommited in the final cut...

8. Betadine Solution. Povidone Iodine 10% is a must have... Besides it's main use as wound dissinfectant, it can be used as a water purification means. Usually 4 drops per litre is enough. Water may become somewhat sweet flavored but it's safe to drink and it's better than chlorinated water. Check out these Water Purification Methods
Povidone Iodine 10%

9. Burn dressings. These are a must. Sodium Fucidate soaked gauzes for treating burns or wounds or WaterJel packs for soothing burns. If your Pharmacy has specific burn dressings get some. 2 are enough if you are so careless as to burn yourself.

10. Antibiotic Ointment or Cream. Sodium Fucidate is one of the best and quite cheap. May need prescription.

Important: Don't open containers just to see what the substance looks like because the expiration date gets set at 2 to 6 months after opening, whereas they can be stored for mare than 2 years. Check expiration dates on purchase to get the maximum shelf life out of your medication. 

"Psst....I have some Immodium if you want..."
11. Diarrhea Medication. If you haven't purified your water properly or eat non-treated food (unkown or unwashed berries for example) you may experience the "joy of diarrhea". Diarrhea medication may need prescription but usually it doesn't. It comes in 2 schools. The one that slows bowel movement to help solidify feces (and the one I suggest and pack with me) and the second that accelerates bowel movement to flush the cause of dysentery from the gastrointestinal tract. The second is used primarily for food poisoning. The first is used as a means to supplement a therapy for gastroenteritis (bacterial or viral infection). If you encounter symptoms of diarrhea take 2 Immodium tabs after the first visit to the woodland WC and 2 more after the next "bowel movement". Do not exceed 4 tabs daily. However, this does not counter the cause of the diarrhea. It will merely help you to return quickly to civilised land and seek medical care without much fuss. 6 tabs will get you through 2 days. Water is vital in diarrhea because you get dehydrated real quick.

12. Nasal decongestant. Any one will do, as long as it doesn't contain steroids in it. Usually they don't need prescription. Their capillary dilation action makes sure you can breathe right if you get sick and need to return home quickly.

13. Paracetamol, analgesic. I use dispersible in mouth tabs that need no water. Each tube contains 8 tabs of 500mg of paracetamol. As per the SPC, dosage can vary from 500mg x 3 times daily to 1000mg x 3 times daily to a maximum of 4000mg daily dosage.

14. Sulfonamide or similar powder. A great and tried antimicrobial powder. Sprinkled on a bleeding wound will help clot the blot and dissinfect the wound. Usable on open wounds where cream or ointment application is impossible.

15. Adhesive tape for medical use. 1 roll of hypoallergic adhesive, easy-cut tape.

16. DDT Insect repelant. For those "friendly" insects that want to sleep with you...

Poison Ivy skin rash
17. Antihistamine Medication. Loratadine is taken orally, once daily, causes little or no drowsiness and acts in about 1hr for urticaria (hives or skin rash). Needs no prescription in the US. Desloratadine, acts within 25mins, causes little or no drowsiness and is also taken orally once daily. Desloratadine is the successor to Loratadine and as newer medication may require prescription. Local skin use of anti-histamine gels (Fenistil) or other bite relief products such as ammonia gel are used for mosquito and insect bites.

18. Personal Medication. If you are allergic to bee stings, pollen or other natural phenomena or have some other affliction that need special medicine always have your medication with you.

19. Anti inflammatory Ointment. This may need prescription from a doctor but the safest of them all is a steroid called mometasone furoate. Ointment is vaseline rich and helps keep the skin moisturised. Apply 2 times daily to the affected spot. DON'T use on open wounds. (It may be ommited from final kit if you feel unsure of its use...).

20. Snake bite kit. Carry only if you know there are poisonous and dangerous snakes in your area and you happen to go poorly clothed in a snake riddled enviroment.

21. Baby wipes. Small travel pack or sanitizing mild antibacterial wipes for travel. They are a must if you can't find a good water source to wash your hands or face. They are practically magical. Have used them in the army for gun cleaning to boot shinning to personal hygiene purposes...

22. Sterile surgical gloves. I suggest one packed pair of your size.

23. Stitches and scalpels. Adhesive sutures or 2 packets of self absorbing needle-threaded sutures size 3-0 are important to have with you. Also 2 sealed scalpel bits are needed.

24. Sodium Choride 0,9% Solution. 500ml is enough to wash wounds and use as natural tears.

25. Syringe. One syringe of 5 or 10 ml cpacity with big needle. The syringe goes with the sterile Sodium Chloride solution and is used to extract liquid from the bottle and to spray at the wound or eye. You stick the needle in the plastic bottle, draw liquid and pull the syringe from the needle. Needle stays stuck at the bottle and you can spray or jettison the solution safely without the risk of puncturing yourself. Caution: Don't get those "insulin syringes" that are super thin, because they have a hair like needle which is useless for our purposes.

26. Triangular Bandage. 1 bandage is enough for you. Pack 2 if you travel with a friend.

And after all that we come to the end of this analysis.

 The Medical Kit is kept simple with only the most essential provisions that relate to the dangers ahead. Sure, there are larger and more elaborate or expensive Kits out there, but let's be honest, we're not trying to equip an ambulance here. Unless you are a surgeon you won't need anything more. This medical kit has the essentials to help you cope with common mishaps that may happen even to the most careful of us. And I leave to you the possible containers for this small kit, as you may subtract or add stuff depending on the scale and the conditions of your trip but I suggest you keep these items as they are. Total weight for the kit is 700grams or 1.4 lb (approx.) without the Sodium Chloride Solution. With the 500ml solution it gets to about 1,4kg or 2,8lbs. If that is too much for you, feel free to remove any item you think that won't be usefull for your trip. For example in the summer you won't be needing nasal decongestant, or you may skip the dental floss.

So, if you have any questions, tips or whatever please comment.

Notice: All the suggested dosages and indications in this post are taken from the product SPC's of these drugs. 

These links provide some good videos on first aid. Although all are not that recent, they are directed to untrained work personnel, and they are directly correlated to the possible dangers in the wild. For example a laceration from a splintered wood or a misused tool/knife is still a laceration. or a burn from a fire ember or coal is still a burn...
First Aid: Injury Management.
First Aid: Burns1, Burns2, Burns3.
First Aid: Arm Laceration
First Aid: Severe Bleeding
First Aid: Minor Wounds
First Aid: Triangular Bandage

Also this PDF file may come in handy to have printed with you. Its a ship captain's Medical Guide but it is generic and has solid guidelines. Plus it is very comprehensive about what to do.

I leave you with the only safe advice I can give about medication :



  1. That’s one nifty backpack! It’s very important to have safety kits and a safety backpack when travelling outdoors. Knowing the mobility of the backpack is crucial. I always see to it that I have all the important things I need before I travel, with each item on its own designated pockets.
    - Kisha Kitchens

  2. I came accross this website to read more info on medical-kit: