Wilderness First Aid: The Complete Guide

Three miles from the nearest road, my hiking partner slipped on wet granite and heard the sickening "pop" of an ankle giving way. In that moment, years of carrying a first aid kit "just in case" suddenly became very real. We were lucky—I knew what to do, had the right supplies, and she hiked out under her own power. Not everyone is so fortunate.

Wilderness first aid differs fundamentally from urban first aid. You can't call 911 and expect help in minutes. You must be self-sufficient, creative with limited resources, and capable of making hard decisions about evacuation. This guide teaches you to handle medical situations when definitive care is hours or even days away.

Wilderness First Aid: Different Rules Apply

In the wilderness, you become the entire medical system. Understanding these key differences shapes every decision:

Extended Care Times

Urban first aid focuses on immediate stabilization until EMS arrives (usually 5-15 minutes). Wilderness first aid may require managing a patient for hours or days. This changes everything:

• Wound care: Clean wounds that you'd leave for the ER
• Medication: Consider giving OTC meds you'd normally avoid
• Splinting: Create comfortable splints for long evacuations
• Documentation: Track vital signs and changes over time

Environmental Challenges

Weather, terrain, and isolation complicate every medical situation:

• Cold patients get colder
• Dehydration happens faster
• Simple problems become serious
• Evacuation may be impossible in bad weather

Limited Resources

You have only what you carry. This demands:

• Multi-use thinking (trekking poles become splints)
• Improvisation skills (duct tape fixes everything)
• Careful rationing of supplies
• Prevention focus over treatment

The Patient Assessment System

Systematic assessment prevents missed injuries and guides treatment decisions. Use this approach for every patient, every time:

Primary Assessment: Life Threats

Secondary Assessment: Find Everything

After addressing life threats, perform a thorough exam:

Patient History (SAMPLE)

• Signs/Symptoms: What hurts? When did it start?
• Allergies: Medications, foods, environmental
• Medications: Prescription and OTC, recent doses
• Past Medical History: Relevant conditions
• Last Intake: Food and water, how much and when
• Events: What happened? Mechanism of injury?

Head-to-Toe Exam

Systematically check every body part:

1. Head: Bumps, cuts, pupil response, facial symmetry
2. Neck: Tenderness, trachea position, spine alignment
3. Chest: Equal expansion, tenderness, breathing effort
4. Abdomen: Soft/rigid, tender areas, distension
5. Pelvis: Stability (press gently once)
6. Extremities: Pulse, movement, sensation in all four
7. Back: Log roll if spine cleared, check thoroughly

Vital Signs

Record initially and every 15-30 minutes:

• Pulse: Rate, rhythm, strength (Normal: 60-100)
• Respirations: Rate, effort, sounds (Normal: 12-20)
• Skin: Color, temperature, moisture
• Pupils: Size, equality, reaction to light
• Mental Status: Alert? Oriented to person/place/time/event?

Common Trail Injuries & Treatment

These injuries account for 80% of wilderness medical problems. Master these, and you'll handle most situations:

Ankle Injuries

Treatment Protocol:

1. RICE immediately: Rest, Ice (if available), Compression, Elevation
2. Assess stability: Can they walk? If yes, tape and continue carefully
3. Taping technique:
   • Horseshoe of padding around ankle bones
   • Figure-8 pattern with athletic tape
   • Stirrup straps for lateral support
   • Test weight-bearing before continuing
4. Improvised support: Use torn t-shirt if no tape available
5. Evacuation if: Cannot bear weight, obvious deformity, numbness/tingling

Knee Injuries

The knee's complexity makes field assessment challenging. Focus on function:

Field Management:

• Compression wrap from mid-calf to mid-thigh
• Trekking poles mandatory for support
• Shorten stride, avoid steep descents
• Consider camping early vs. pushing through

Wound Care

Wilderness wounds need aggressive cleaning to prevent infection:

Blisters

Prevention beats treatment every time, but when blisters happen:

Hot Spots (Pre-blister):

• Stop immediately when you feel hot spots
• Apply moleskin or tape
• Adjust socks, lacing, or add lubricant

Intact Blisters:

1. Clean with alcohol or soap
2. Cut doughnut hole in moleskin
3. Apply around blister to reduce pressure
4. Cover with tape or second layer
5. Monitor for signs of infection

Torn/Draining Blisters:

1. Clean thoroughly
2. Trim loose skin with clean scissors
3. Apply antibiotic ointment
4. Cover with non-stick pad
5. Moleskin doughnut over dressing
6. Change daily

Burns

Camp stoves and fires cause most wilderness burns:

First-Degree (Sunburn-like):

• Cool with water for 10+ minutes
• Aloe vera gel or moisturizer
• Ibuprofen for pain and inflammation
• Protect from further sun exposure

Second-Degree (Blisters):

• Cool immediately and thoroughly
• Don't pop blisters if possible
• Loose, non-stick dressing
• Monitor for infection closely
• Evacuate if larger than 2-3 inches

Third-Degree (Full thickness):

• Immediate evacuation required
• Cover with clean, dry dressing
• Treat for shock
• No ointments or creams

Environmental Emergencies

Heat Exhaustion

Treatment:

1. Move to shade immediately
2. Remove excess clothing
3. Active cooling: wet clothing, fanning
4. Hydrate with electrolyte solution
5. Rest minimum 30 minutes before continuing
6. Monitor closely—can progress to heat stroke

Heat Stroke

Emergency Treatment:

• Cool by any means: water, ice, wet clothing
• Focus on neck, armpits, groin (major vessels)
• Fan vigorously while skin is wet
• Do NOT give fluids if altered mental status
• Prepare for seizures or vomiting
• This is life-threatening—evacuate ASAP

Hypothermia

The "umbles" progression: Stumbles → Mumbles → Fumbles → Tumbles

Treatment for Mild:

1. Remove from cold/wet environment
2. Replace wet clothing with dry
3. Insulate from ground
4. Warm sweet drinks (no alcohol/caffeine)
5. Light exercise if able
6. Monitor closely for progression

Treatment for Severe:

• Handle VERY gently (cardiac risk)
• Horizontal position
• Insulation package: sleeping bags, pads, etc.
• Prevent further heat loss (don't actively rewarm)
• No oral fluids
• Immediate evacuation

Altitude Sickness

Prevention through proper acclimatization beats any treatment:

Acute Mountain Sickness (AMS)

• Symptoms: Headache + nausea, fatigue, dizziness, poor sleep
• Treatment: Stop ascending, hydrate, rest, ibuprofen
• Decision: Improve = continue, worsen = descend

High Altitude Pulmonary Edema (HAPE)

High Altitude Cerebral Edema (HACE)

Lightning Injuries

Prevention is everything—but if someone is struck:

• Scene safe? More strikes possible
• Check ABCs—cardiac arrest common
• CPR immediately if needed (they're NOT electrified)
• Look for entry/exit burns
• Neurological assessment critical
• Evacuate all lightning victims

Medical Conditions in the Wilderness

Allergic Reactions

Mild Reactions:

• Localized swelling, itching, hives
• Treat with antihistamine (Benadryl 25-50mg)
• Monitor for progression
• Remove allergen if possible

Anaphylaxis:

Anaphylaxis Treatment:

1. EpiPen in outer thigh (through clothing is OK)
2. Call for evacuation immediately
3. Second dose after 5-15 minutes if needed
4. Benadryl after epinephrine
5. Position flat, legs elevated if conscious
6. Monitor airway constantly

Asthma Attacks

• Sit upright, encourage slow breathing
• Assist with their inhaler
• Calm environment crucial
• Hot drinks may help
• Evacuate if no improvement with meds

Diabetic Emergencies

Low Blood Sugar (Hypoglycemia):

• Sudden onset: shaky, sweaty, confused
• Give sugar immediately (glucose tabs, candy, juice)
• Follow with complex carbs
• Improvement within 15 minutes

High Blood Sugar (Hyperglycemia):

• Gradual onset: thirsty, frequent urination
• Fruity breath, nausea
• Needs insulin and medical care
• Hydrate and evacuate

When in doubt, give sugar—hypoglycemia kills faster

Heart Attack

Treatment:

1. Rest in comfortable position (usually sitting)
2. Give aspirin 325mg (chewed)
3. Assist with their nitroglycerin if prescribed
4. Calm reassurance
5. Immediate evacuation
6. Prepare for CPR

Stroke

F.A.S.T. Recognition:

• Face: Drooping, uneven smile
• Arms: Weakness, can't raise both equally
• Speech: Slurred, confused
• Time: Note when symptoms started

Treatment:

• Keep calm and still
• No food or water (swallowing risk)
• Document symptoms and time
• Immediate evacuation
• Position on affected side if unconscious

Building Your Wilderness First Aid Kit

Your kit should match your skills, group size, trip duration, and remoteness. Here's a comprehensive system:

Personal Mini Kit (Always Carry)

Item	Quantity	Purpose
Adhesive bandages	6 assorted	Minor cuts
Moleskin	2" x 4" piece	Blister prevention
Ibuprofen	10 tablets	Pain, inflammation
Antihistamine	6 tablets	Allergic reactions
Alcohol wipes	4 packets	Cleaning wounds
Duct tape	2 feet	Everything

Day Hike Kit

Add to personal kit:

Category	Items	Notes
Wound Care	Gauze pads (4), roll gauze, medical tape, antibiotic ointment	Handle larger wounds
Medications	Aspirin, antacid, anti-diarrheal, electrolyte packets	Common issues
Tools	Tweezers, safety pins, nitrile gloves (2 pair)	Wound cleaning, splinters
Wraps	Elastic bandage, triangular bandage	Sprains, slings

Backpacking/Group Kit

Comprehensive kit for multi-day trips:

Wound/Trauma Supplies

• Sterile gauze pads: 2x2" (10), 4x4" (6)
• Non-adherent pads: various sizes (6)
• Roll gauze: 2" and 4" widths
• Medical tape: 1" and 2" rolls
• Steri-strips or butterfly closures
• Tegaderm or similar transparent dressing
• Irrigation syringe (35cc)
• Wound closure strips
• Tincture of benzoin (adhesive helper)

Medications (Label Everything!)

• Pain: Ibuprofen, acetaminophen, aspirin
• Allergies: Diphenhydramine (Benadryl), loratadine
• GI: Loperamide, bismuth tabs, antacid
• Topical: Antibiotic ointment, hydrocortisone cream
• Other: Throat lozenges, cough drops, electrolytes
• Prescription: Consider broad-spectrum antibiotic, strong pain meds (with training)

Tools & Equipment

• Trauma shears
• Forceps/tweezers (good quality)
• Thermometer (hypothermia-reading)
• Nitrile gloves (6 pairs)
• CPR face shield
• Safety pins (various sizes)
• Duct tape (full roll)
• Pencil and paper (documentation)

Specialty Items

• SAM splint
• Elastic wraps: 3" and 4"
• Triangular bandages (2)
• Emergency blanket
• Chemical cold packs (2)
• Moleskin (full sheet)
• Medical information forms

Kit Organization Tips

• Use clear zip-lock bags labeled by category
• Keep frequently used items accessible
• Include instruction cards for complex procedures
• Inventory and expiration check before each trip
• Consider pre-made kits as starting point
• Customize based on your medical training
• Weight matters—balance completeness with packability

Making Evacuation Decisions

The hardest wilderness medicine decision: stay or go? Consider these factors:

Immediate Evacuation Required

• Altered mental status from any cause
• Difficulty breathing not resolved with rest/meds
• Chest pain suggesting cardiac issue
• Uncontrolled bleeding
• Suspected spinal injury
• Open fractures or dislocations
• Signs of serious infection
• Severe allergic reaction
• Lightning strike
• Temperature emergencies not improving

Evacuation Methods

Walk Out: Best if patient is stable and able

• Go slow, take breaks
• Lighten their pack
• Have strong hikers assist
• Choose easiest route, not shortest

Carry Out: For non-ambulatory patients

• Requires 6-8 people minimum
• Improvise litter with packs, poles, rope
• Rotate carriers frequently
• Very slow—plan accordingly

Stay Put and Signal: When carry-out isn't feasible

• Activate emergency devices (PLB, satellite messenger)
• Prepare landing zone if possible
• Make patient comfortable
• Send two people for help if needed

Documentation

Write everything down for medical professionals:

• Time of injury/illness onset
• Initial presentation and vital signs
• Treatments given and times
• Changes in condition
• Medications administered
• Patient history (SAMPLE)
• Your contact information

Injury Prevention: Your Best First Aid

An ounce of prevention truly beats a pound of cure in the wilderness:

Pre-Trip Preparation

• Fitness appropriate for planned difficulty
• Gear shakedown hikes
• Share medical conditions with trip members
• Bring personal medications plus extras
• Leave trip plan with emergency contacts

During the Hike

• Hydration: Drink before thirsty
• Nutrition: Eat regularly, maintain blood sugar
• Pacing: Start slow, maintain reserves
• Layers: Adjust before too hot/cold
• Breaks: Regular rest prevents exhaustion
• Feet: Address hot spots immediately

Hazard Awareness

• Weather: Check forecasts, watch skies
• Terrain: Slow down on technical sections
• Fatigue: Most accidents happen when tired
• Group dynamics: Speak up about concerns
• Ego: "Summit fever" causes poor decisions

Training Resources

This guide provides knowledge, but hands-on training builds confidence. Consider these courses:

Recommended Certifications

• Wilderness First Aid (WFA): 16-hour weekend course, perfect for most hikers
• Wilderness First Responder (WFR): 70-80 hour comprehensive training
• Wilderness EMT: For professional guides and SAR teams
• CPR/AED: Basic life support skills everyone needs

Training Providers

• NOLS Wilderness Medicine
• Wilderness Medical Associates
• SOLO Wilderness Medicine
• Remote Medical International
• Local outdoor clubs often host courses

Practice Scenarios

Run through scenarios with hiking partners:

• Patient assessment on each other
• Splinting with improvised materials
• Loading a mock patient for evacuation
• Kit familiarity drills
• Communication and leadership under stress

Final Thoughts: Confidence Through Preparation

Wilderness first aid can feel overwhelming, but remember: doing something is almost always better than doing nothing. Start with the basics—control bleeding, maintain body temperature, evacuate when in doubt. Build your skills progressively through training and practice.

The goal isn't to become a wilderness paramedic overnight. It's to develop the knowledge, skills, and judgment to help someone (maybe yourself) when far from help. Every bit of preparation improves outcomes.

Most importantly, don't let fear of medical emergencies keep you from the wilderness. Statistically, you're more likely to need these skills in your daily life than on the trail. But when you do need them in the backcountry, you'll be incredibly grateful for every minute spent learning.

Stay safe, hike smart, and remember: the best first aid kit is the one between your ears.

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Have wilderness first aid questions or experiences to share? Join the discussion below. For serious medical questions, always consult healthcare professionals. Consider taking a hands-on wilderness medicine course—your future self will thank you!