Ultralight First Aid

This article is split into sections:

• Biology 101 - a quick tour of common problems and how the body copes
• Risk - Your own views on risk and will determine what you decide to take (or leave)
• Ultralight First Aid for an Overnight stop - the world's lightest first aid kit!!
• Ultralight First Aid - my own choice of first aid items that weighs only 62g

Here I talk about more general emergency equipment including a 1oz Emergency Kit that I now always carry.

The purpose of these articles is to show that the additional equipment and supplies need to provide some measure of safety and comfort for an emergency situation is not much. In my case, my ultralight emergency kit and ultralight medical kit together weigh less than 100g. 100g is not a lot but chosen wisely it is enough to get you to safety.

Biology 101

Before we begin to look at how to plan a first-aid kit or what products to include it is probably a good idea to look at the human body and what it is capable off.

A lot of 'first aid' products that are sold often offer little beyond cosmetic treatment or reduce risks that were small in the first place to possibly be slightly smaller still.

For this article I will assume that you are in reasonable health and that basic shots such as Tetanus are current. I will also assume that you spend a reasonable amount of time outdoors and do not live live in a sterile environment or have lots of allergies.

Biology 101 - Immune System and Parasites, Bacteria etc

It is easy to forget that this planet Earth is our native planet. We have bodies and immune systems that are already well able to cope with most of what can be found. There are not many things left in the wild that can actully kill you within a week (Brown Bears are one, Gardia Lambia is not).

Now it is also true that there are several things in the environment such as Gardia which can cause you inconvenience or slow you down but beyond that not much. Preventing or avoiding them is about balancing risk.

One issue that we have these days is that we live in artificially clean environments and drink water that is basically sterile. We are not normally exposed to lots of natural flora and fauna that appear in the water and food and are harmless. If you meet these on a trip they may cause inconvenience until your body works out a way to deal with them and then they will never bother you again. For instance, Brown Bears are allergic to bullets.

Fundamentally, your body is capable of dealing with most likely environmental nasties without incident unless you actively seek them out. In the perfect world you arrange gradual exposure to the natural environment. Many thru-hikers on the long American trails will drink bottled water initially and move over gradually to untreated running water over the course of a trip. Many other countries would not bother with water treatment. It's your call.

Over the years I have moved my domestic environment from being obsessively clean to being clean sometimes. My intent (besides laziness) is to allow my immune system to meet everyday hostile bacteria etc so that it can deal with them. If an immune system has nothing to attack it seems to attack itself and you and overreact to everything that is the least bit different - such as pollen grains. I suspect boredom...

Biology 101 - Cuts and scrapes

Cuts and scrapes may hurt a little but they are basically harmless. Your body will naturally stop bleeding after a while and seal the wound with a scab. If the wound is not directly or repeatedly exposed to an infection source (such as cow shit) it is likely to be just fine. Wound infections are actually very rare. The most common place for a wound infection is actually a hospital - because there are lots of hungry bacteria around and all the weak ones have been killed off. In the wild most of the bacteria have had an easy life and not had to deal with hostile chemicals. They are also not around in quantities to be an issue. Hanging around sick people is not healthy...

Deeper cuts - such as those requiring a dew stitches will often close up enough to stop the bleeding or can be made to close by applying pressure and say taping up with Duct Tape or medical tape.

In order to cut yourself deeply in a wilderness you have to be doing something a little unusual such as playing with a knife or falling on or climbing sharp rocks. There is not much around that can cause deep wounds.

Most wounds can get by perfectly OK without any treatment. For most wounds making sure the wound is clean before a scab forms is all that is really required. But again, we are talking about low and very low probabilities of issues.

The fundamental point is that the body can well cope with cuts and scraps in the wilderness and in those very rare cases where a wound becomes infected you still have several days before there is even the remotest risk of a medical emergency. Even so, there will be plenty of warning.

Biology 101 - Sprains

The typical injury for a walker is a twisted ankle. What has happenned is that muscles and tendons have been pulled further and in directions that they have not previously gone. The result is torn muscles (typically) and some swelling - from an influx of fluid as the body seeks to protect the area.

For many mild sprains it is possible to continue walking without treatment even if it does hurt. The issue is that by doing so you may prolong the injury, increase it or cause permanent damange.

If you wish to treat a sprain in the wilderness then you will need to be able to recognise the difference between a sprain that is minor and a sprain that is significant and you will need to have extra items in your first aid kit and be able to use them.

The real reason that we suffer sprains is often that we have bodies that are doing something unusual for them - like a lot of walking or that are not actually in very good shape physically. Very few people sprain ankles whilst shopping.

One major causes of sprains from a biological perspective is actually muscles and tendons that do not have full mobility. Full mobility is often a lot more than most people recognise. When you have full mobility (or close to it) then what will actually happen is that the particular joint will reach the limit of its natual movement without the muscle or tendon being unable to cope.

Something like Yoga or Pilates or many martial arts will help to give you full joint mobility and help to prevent sprains.

I have found that it is far better to make your body into one that does not suffer sprains except under extreme circumstances rather than try and treat the sprain after the event.

Biology 101 - Blisters (friction not chemical or illness)

A blister is not an accident or a curse. It is something that happens because your body is being abused. If you remove the cause of the abuse the cause of the blister will disappear. A blister is nothing more than the separation of the dermis from the epidermis due to the two being repeatedly rubbed together.

If I spend all year walking around in soft fleece slippers and then try and walk barefoot through a desert you just know there are going to be problems. If I spent all year living barefoot in the desert and then spent a week in fleece slippers there would not be a problem.

Likewise, if I spent all year walking around with a 30lb pack on my back then I would not be getting blisters.

When you do get a blister it is a very good sign that your footwear (typically) is not a good fit or you are just not used to lots of walking.

Again, prevention is easier than cure. Blisters are now so rare for me that I do not bother to carry a blister kit. The worst case of blisters that I ever had was on a recent trip and was due to me taking untested footwear on a trip. On that trip 'treating' the blisters was nothing more than relacing the shoes to minimise further damage. I then carried on walking and relied on the blister to protect itself from too much further harm. It made for an unpleasant 55k of walking but the blisters did not pop.

So, how then do you prevent blisters?

Blister Prevention - Healthy Feet

I spend a lot of time walking around the house barefoot. This allows my feet to spread out to their natural width and to allow the skin on the soles of the feet to develop a natural thickness and toughness. When out and about I will wear shoes or sandals rather than trainers. In this way my feet do not become artifically soft and are able to cope with normal use. Shoes were invented to help us cover terrain in more comfort - that is all.

Keeping my feet healthy in this way has been the biggest positive step I have ever made towards blister prevention.

NB: If the skin on your foot is dry and cracked this is probably a sign of fungal infection rather than 'normal'.

Blister Prevention - Sensible Footwear

A good fit is the most important thing. Your foot should be able to have it's natural movement within the shoe or boot and not be continually rubbing against part of it. In the first instance this means choosing a boot or shoe based on fit and not fashion and secondly it means lacing the shoe for your foot. There is a good chance that the tension on your laces varies in the same way on every shoe you own - maybe loose around the foot and tight at the ankle.

Part of the essentials for a good fit is good socks. It is worwhile to use socks that are called 'hiking' or 'walking' socks and have wool-pile 'padding' around the ankle and toes. This little bit of padding provides both a cushion and a low-friction layer so that if part of your foot is in danger of rubbing against something it will be something very soft.

If you try and wear two layers of socks you will often find that one sock moves and creates a bump that then puts pressure on part of the foot - and causes a blister.

With my recent footwear disaster I was also wearing very thin liner socks and so my feet had no safety margin.

Biology 101 - Insect bites

Most insect bites are harmless - just annoying. The same cannot be said of snake bites or elephant bites. Insects who bite you just want your blood.

Obviously in some areas of the world a mosquito bite is serious and in some jungle terrains lots of insects can bring diseases. In the UK the main issue with insect bites is going to be an allergic reaction.

In the UK Horse-flies are probably the insect most likely to cause an allergic reaction and this will be a large bump (that may be 2 inches in diameter) that may also form a large dome blister. It may hurt but it is basically harmless.

Some Ticks in some areas of the UK carry diseas but again, they are only in some habitats and clothing will stop them.

Insects will not be flying in windy places and will tend to be found very near water and animal livestock. If you avoid their 'hood you avoid them.

Most insect bites do not need treating - if the insect killed it's food source it would have died out long ago.

Insect bites are easily avoiding by wearing long clothing or by using DEET.

If you do get badly bitten by insects I have found that a normal hay-fever antihistimine tablet will make a big difference. [Just make sure that it is one that does not send you to sleep]

Biology 101 - Broken Bones

Broken bones are rare. They typically require a severe fall.

If you break a leg then your trip is probably over. If you break a finger then there is a good chance that you can strap it up and walk to safety. Likewise many other broken bones are inconvenient but they will not stop you walking to civilisation unless there is also internal bleeding.

Unless you have been on (and passed) a first aid course there is no point in trying to repair a broken bone in the field - you could easily do more harm than good and tear open an artery.

If you are alone in the wilderness and break something then pain will be your friend. It will give you limits as to what you can and cannot do. The body sometimes copes with severe trauma by making you unconscious - this stops you doing whatever was causing the pain.

I do not personally think it is wise to pump yourself full of pain-killers in order to ignore a serious injury there is a chance that you could turn that injury into a life-threatening one.

I enjoy solo walking and that means that even with first aid training there are limits as to what I could do with something as serious as a broken bone and obviously some bones could not be self-treated.

With that in mind my viewpoint follows that of the Mountain Rescue teams: If I think there is something broken (because my leg has a second knee for instance) then I will make an assessment as to whether or not I can walk to civilisation safely and whether or not doing so would be more dangerous than staying put. For instance if I am in an exposed place in winter it might be safer to move.

I also figure that if something is serious enough to require immoblising (and I can reach the bone) then I should be able to do that using an adhoc splint made out of say not-in-use clothing or a tarp fragment or whatever. Something might be do-able.

If I do not feel that I can safely walk to civilisation then I am going to try and seek help from my current location using my whistle and/or a mobile phone. In many places in the mountains neither option will work.

The fundamental point here is that a broken bone is rare but it could be life-threatening.

Biology 101 - Food Poisoning

This one is not always easily avoided. Basic personal hygiene will take care of most of the causes of food poisoning as will choice of foods taken.

For food it's best to think old-skool and choose items that are not going to be affected by temperature - typically dried foods and sealed foods. Even so you may still be unlucky.

My worst ever bout of food poisoning was on day 1 of a 7-day backpacking trip. The culprit was a dodgy meat pie eaten at a popular pub. The result was 4 days of tough walking with a slight fever and no energy left at the end of day. It was a grim walk but the food poisoning did not stop me, it only slowed me down.

That is really the issue, food poisoning has to be very serious before it is going to be an issue. Before that point the impact on you will be a loss of performance, a loss of endurance and an increased needs of fluids. Depending on where you are hiking, any of these three things on their own could turn an otherwise 'harmless' bout of food poisoning into a life-threatening situation.

Biology 101 - Predators

It's best to avoid them.

Biology 101 - Summary

Lot's of natural hazards are relatively rare, relatively minor and well within a healthy bodies' capability. The more serious hazards are even more rare and mostly avoidable.

Risk and Planning

The Biology 101 was necessary in order to make clear what the typical risks are and to differentiate between life-threatening, inconvenient, irritating and harmless.

The reason for this is obvious. The rare life-threatening ones generally require specialist knowledge, bandages and a skilled partner to apply them. If they are rare is it worth (maybe less than once in your lifetime) then is it worth planning for?

Insect bites may be irritating but that in general is all - so carrying something to prevent them is nice but not essential. One pack of antihistimine tablets will take the [ahem] sting out of most bites for a week.

A typical first aid kit contains lots of things that serve no real purpose. A plaster may cover a wound but if the wound is at risk of infection a plaster will not make make difference unless it completely covers the wound and is not subject to accidental removal.

Most first aid kits that you buy are filled with things that have little real purpose and are not essential. They are really about making people 'feel good' and feel like they are 'treating' something rather than actually addressing a biological need.

I did go through a phase (with a risk averse partner) where I carried a minimal 'real' first aid kit with some bandages, wound dressings and so on. It weighed aroud 1/2 lb. We were both trained in first aid and could use the kit. It made her more comfortable to go walking. It was not essential...

If you look at the first aid kit for a scout leader or a wilderness team leader you will see a lot of things in there. Most of them will never see the light of day. They exist either to meet a statuatory or insurance requirement or more usually to ensure that the carrier does not get sued. It is not about dealing with probable risks.

On this basis my first aid kit consists of things that can treat things that can happen (or have happened to me in the past) that are not life threatening and will allow me to continue a trip in comfort.

My kits are based on damage-limitation - providing a temporary fix until I can reach civilisation where something more permanent can be done. I have assumed that for many things I will still be able to walk - albeit slowly and albeit in pain - to safety. If I cannot walk then I might need to call for help.

Now lets' look at some first aid kits and examine why I take what I do:

Ultralight First Aid - Overnight Kit

For an overnight trip I take nothing at all!

The logic is quite simple. There is a very low risk of anything happening on such a short trip, I will by definition be near to civilisation since overnight trips tend to be shorter walks and anything that is less than life-threatening can be ignored for up to a day without much risk or if necessary a trip could be aborted.

Ultralight First Aid - 1+ Week, 60-80g

The breakdown for this is now here.

My first aid kit varies with the seasons and with where I am going. One of the big variables is whether or not I think I will be able to pick up replacements and how far I might be away from a road or access to civilisation.

Here are three typical kits:

1. Minimialist first aid kit (shown above)
2. Basic first aid kit
3. 'Luxury' first aid kit