Backcountry Medicine- AT Style

Before I embarked on my thru-hike I sat down and put some serious thought into trail emergencies and first-aid. I pulled ideas from my EMT training and wilderness survival courses. I hemmed and hawed, unsure of whether or not I should carry a full-on med kit. I am a trained Wilderness EMT and carry a set of skills that allows me to care for the injured in the back-country; however, hiking the AT is not a job, but rather something I elected to do. I felt that carrying a full med kit for myself and others would be way too much extra weight. I also thought that if a hiker wasn’t responsible enough to carry first-aid supplies for them self, why should I have to carry it for them? So I decided, against my conscience, to only carry the necessary med-kit for myself.

It didn’t take long for the guilty conscience to take over. It felt contradictory to be a W-EMT and not carry the stuff to help others on the AT. It didn’t become an issue until the day I needed to pull out my skills and provide care to an injured hiker.

Trekking poles wreaked havoc on the trail this year. I know of 3 situations where a hiker’s trekking pole got stuck causing the hiker to fall. I came upon a hiker that split their head open from a trekking pole induced fall. That was the first time I got to break out the gloves; it was pretty exciting. I won’t go through all the boring details of their treatment. I was on the lookout for evidence of head trauma and spinal injury. Once I ran through my standard protocols and such, I treated the laceration on the hiker’s head. The butterfly strips did the trick! I also insisted that the hiker stay at our camp for the night so that I could monitor them for any delayed signs of head trauma.

Right before I completed the trail I came upon an injured day-hiker in Maine. They had fallen on some wet rocks, separated their left a/c joint and fractured their left humerus. The weather was getting really bad and we were about 6 miles from the nearest road. I assisted the two medics that were on seen until the remainder of the rescue team arrived. I focused on keeping the hiker calm and comfortable, covering him with a warm sleeping bag and immobilizing his spine.  I worked with the medics for about 45 minutes until the rest of the team got there; I then moved down trail to assist the rescue team. We prepared to carry-out the patient in a litter. Due to the patient’s intense pain and anxiety, medications were administered and it was another 2 hours before we were able to start moving the patient out.  Meanwhile, it started raining, hailing, and lightening. It was all very exciting and I was glad to be able to help.

After the first situation, I beefed-up my med kit with additional items for others. I carried a few extra gloves and a lot more butterfly strips. Albeit, these extra items were unnecessary for just me, but I felt a strong moral obligation to be prepared to help others. Should all hikers carry big med kits? No. But, all hikers should carry a few first-aid supplies.

Keeping in mind the principle that everything you carry while hiking should have at least two purposes, these are some essentials I recommend for a thru-hiker’s med kit:

  1. butterfly strips/steri-strips- lots of them, one box of strips doesn’t even weigh an ounce. These are quite versatile and if you get into a really bad situation, needing stitches, the strips do a pretty good job of holding it together-temporarily. Remember this is not a front-country protocol nor an official back-country protocol (per SOLO Wilderness Medicine or Wilderness Medicine Institute of NOLS), but this is a great tool for any thru-hiker who is focused on carrying the lightest weight possible.
  2. gloves- at least 1 pair. I know this sounds ridiculous! You should carry a pair of medical gloves; they weigh less than one ounce. If you aren’t an EMT like myself and don’t plan on treating any injured people, consider the fact that the person helping you will probably want to wear gloves; consider the fact that if you have a gaping wound, you too will probably want the person treating you to wear gloves (you don’t know what kind of junk is on their hands while they are out there in the woods).
  3. iodine- one 2 ounce bottle will do; this can be used to clean out shallow cuts or abrasions. Remember that “double purpose” thing I mentioned- iodine can be used as a water purifier. The standard recommended ratio is 3 drops of iodine per liter of water. Using iodine for water treatment is fine for short periods of time; however, if you hike all-the-time you may consider an alternative water treatment as ingesting large amounts of iodine can affect your thyroid function.
  4. gauze pads- just a couple 4×4’s; can you see the theme I am going for here? Items 1-4 are for situations where blood and broken tissue are involved. This is because these situations will require sterile, clean bandaging. Remember–we are going for light-weight here!

In total, these items placed in a ziploc baggy only weigh 2-3 ounces. That’s pretty good for a thru-hiker. Don’t waste space with bandaids; you only use them for little things and trust me, they won’t stick to your dirty body. I carried some sort of pain reliever (acetamenaphine or NSAID like ibuprophen). I didn’t include that on the list for a few reasons. I carried a bottle of tylenol; my feet hurt, my joints ached, sometimes I got headaches, whatever. When you start hiking your body is going to hurt! So do yourself a favor and just carry the bottle. I didn’t keep mine in the med kit, but on my hip belt for easy, quick access. By the time I got to Maine, I popped tylenol around-the-clock just because my body had taken so much abuse.

I feel I should reiterate the fact that I am writing this with thought to thru-hikers. If you are some sort of outdoor trip leader or wilderness guide, follow your company protocols. When I work on the river, we carry a full-on med kit with all sorts of goodies. Also, I mentioned the items that I used the most frequently and carried the most value. There are many other things you could carry out there on the AT. The key word there is *carry; remember that you have to carry everything that is in your pack, so don’t go too crazy packing unnecessary stuff.

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