When I was building my first-aid kit for the Pacific Crest Trail, oh so many months ago, I was aiming for a balance between weight and what my training would realistically let me handle in the wilderness. Naturally, there is a great deal of disagreement and debate on what should be taken for first aid in the outdoor community–both on solo and guided trips. On one side is this perfectly valid point from Andrew Skurka:

Even if I carried 50 pounds of medical equipment and was a certified EMT, I’m still not equipped to treat serious medical problems in the field over the long-term.

Based on this, he goes to one extreme and carries only what he considers the barest essentials. If something more serious goes wrong, he pulls out the satellite phone and calls for help. On the other end of the spectrum, there are organizations like Reed College that have a legal obligation to send their guides out with both a satellite phone and a substantial first aid kit–one with enough supplies to treat the majority of wilderness medical issues, perhaps for days on end.

As a certified Wilderness EMT, who is trained to handle a serious emergency in the field for days, even with minimal resources, the severe minimalistic approach to first aid that most thru-hikers subscribe to is foolhardy. Quite a few head out with no more than duct tape and ibuprofen. Essentially, they are operating under the assumption that nothing bad will happen or if it does, someone else will rescue them. This thin margin of safety would often extend to their food and water. A number of thru-hikers would be out of food the night before their next resupply or would show up at water sources having been empty for miles. While the PCT is reasonably well traveled and usually less than a day away from civilization, there are 5-7 day sections without a single road and no reliable cell service. Further, even if someone does show up within a short amount of time (not always the best assumption itself), it does not mean they will have the materials or skills to help you out. Nature is unreliable and relying on luck is no way to head into the wilderness. The Boy Scount motto rings true: Be Prepared.

Please think clearly about what your skills are and how much you are willing to risk. Humans–and thru-hikers especially–are a hardy and resilient lot. Things do go wrong though and if you are not prepared, it can cost you dearly. Shortly after I finished the PCT this year, a series of snowstorms hit the Cascades. Hikers continued heading out even though they had not adequately prepared for the winter conditions (snowshoes, extra clothes and food). Multiple people had to be rescued, a few by helicopter because Search & Rescue could not safely reach them by foot. They were unprepared for those winter conditions and risked their own lives and the lives of others by their foolishness. Whether you head into the wilderness for a day hike or an expedition, it is grossly irresponsible to be ill-prepared for the conditions and challenges of being out there.

So. The most important part of any first aid kit is your mind: education and knowing what to bring and how to use it. One of the things that bugs me about Skurka's opinion is it seems to gloss over the educational aspect of first aid. You can do more with bare minimal supplies and training than just minimal supplies. I highly suggest that if you are doing any kind of backpacking or hiking, you find a Wilderness First Responder course nearby and take it. You will not regret it and it is often a requirement for any sort of guiding. If you want to get really serious about wilderness first aid and have a free month, look at becoming a Wilderness EMT. I do not recommend taking a Wilderness First Aid course. It is too short and the friends who have taken it did not have a high retention of the material.

PCT First Aid Kit Supplies

One of the critiques that Amelia brought against my original PCT first aid kit was that I designed it not for myself but for everyone else. This is a mindset that I gradually moved away from in the first few weeks. My final first aid kit was designed solely for thru-hiking.

• Mini-tweezers
• Safety pins - Also useful for hanging socks on the back of the pack.
• Mini-Scissors - Far better than a knife for cutting moleskin and gauze. Perfect for trimming dead skin too.
• Ace bandage - Never used. Given the number of joint injuries out there, still seems like a good idea.
• Ibuprofen
• Benadryl
• Loperamide - Trail food has been known to cause intestinal issues.
• Neosporin w/pain reliever - Also useful as a minor lubricant underneath tape to prevent it from sticking to loose skin.
• Mac Smack's Ultimate Fix - Great for cracked and problematic feet. Also useful for burns and minor cuts.
• Johnson & Johnson Sports Tape - The best athletic tape out there. A far better choice than duct tape for hot spots as it sticks better and is also breathable.
• Moleskin
• 2nd Skin Blister Pads - When things go bad, these can really keep you going as the hydrocolloid pad promotes healing and provides light padding. One problem is that thru-hiker miles causes the outside adhesive to fail in only a couple days while the inner part will continue sticking; athletic tape backup was necessary.
• Callous cushions - When moleskin is not thick enough.
• Bandaids - Only had a few, but there are some cuts that really need a bit of protection.
• Gauze pads - I had a few blisters that went really bad. Gauze + athletic tape gives you absorbent, non-stick padding. Also handy for more significant bleeds.
• KT Tape - Discovered this in Kennedy Meadows. It is designed to stick to sweaty skin and provides just a hint of padding. During the desert, I used this quite a bit on my heels.