Mountain Survival kit

An unconventional and idiosyncratic (or idiotic) approach to mountain first aid kits for day trips and expeditions.

The following is an extended piece I wrote for the Irish Mountain Log magazine (I do regular features on safety), which might be a bit disjointed (I’ve amalgamated two pieces), but might make others think about the humble first aid kit.

One type of expedition member that always creeps me (perhaps unfairly) out is the individual who’s gone beyond a basic one-day first aid course, the type of thing the Red Cross or Saint Johns Ambulance run, and instead has invested in a week-long advanced or wilderness first aid course. With the former minimalist training, you learn how to do CPR, cuts and burns, choking etc., and for less than a hundred euros, it is something everyone should do. With the latter, you learn open heart surgery, brain transplants, and limb amputation, or at least that’s what you’d imagine when you look through this person's med kit, or should I say med luggage. Although such an investment should be saluted, what creeps me out is that in my experience, such wilderness first responders have an almost fundamentalistic fervour for martyrdom, only not theirs, but yours! They cannot wait for someone to get a deep gash so they can stop sewing up bits of chicken and sew up a person instead or be so close to death they require an IV, which, if nothing else, will reduce the weight of their ambulance sized med kit by a kilo or two.

The first time I met one of these first aid jihadis was on a trip to Greenland when it appeared we were so overloaded with food, fuel and kit that we could not even take a book, and yet could carry bags of IV, which I pointed out, would freeze rock solid as soon as we stepped onto the ice (and they did). I tried to bring this person, who was probably marching around with a stethoscope around there neck – she did have a stethoscope and a sphygmomanometer (google it) in the first aid kits – that I’d been on many expeditions far from help and beyond a roll of duck-tape I’d never ever carried a first aid kit. In the end, we carried it all across Greenland, but when it came to the primary injuries we faced, which were related to skin rubbing against skin, and pulled muscles, the first aid supplies had nothing to offer.

At the other extreme, you have people like my mate Paul Ramsden, a health & safety professional, a man who’s been on more trips than Marco Polo, whose overall view on first aid is just to take nothing that your body will deal with the pain long enough for the rescue to get to you. If they can’t, then you’ll die anyway. In truth, he tends to carry some hospital-grade pain relief in case you’re forced to lay in a tent for a few days with a broken leg and then some low-dose pain relief for toothache, a common problem on expeditions, probably due to high sugar drinks and altitude and cold, stuff for diarrhoea (although it’s best to get it out), and that’s it. Such a minimalist approach is one in which you forgo the plastic airway and face shield and just safely pin the casualty's tongue to their lip.

Closer to home, and for Irish hills, you tend to get a number of first-aid types. First, you have the majority who don’t carry any kind of first aid kit; after all, with a phone, you can just call the mountain rescue out, right? Then you have the ones who carry a first aid kit they bought in Halfords, but have no clue what’s in the bag, even though they’ll lug it around for years on end, just in case. Such people tend to be more of a liability, as this kit gives them a false sense of security, and they will be bewildered when that day finally comes when the kit is needed, and they break the wrapper, only to find it contains a warning triangle, hi-vis vest, and tow rope.  Store-bought kits are better than nothing, but they’re just a starter for something that is going to work. And then you have the people who, as the wilderness qualified, take it a bit too far and carry a first aid kit that’s so heavy and bulky that they end up collapsing due to exhaustion, and someone has to use it to bring them back from the dead, or just call the MRT.

Maybe I read the Lofty Wiseman Survival handbook too many times as a kid, but I’ve always approached the first aid kit concept as more of a survival kit. What is a first aid kit? First, I think you need to both make your own kit from scratch and make a kit that solves a myriad of problems, to repair or keep both body and gear and ambition going forward. First aid kits are always designed to hit the cheapest price point, and so making your own allows you to ditch all the fluff and make what you carry - which is still minimalist - do what’s necessary when necessary.

The following is my approach to such a kit, and it is just a guide, and although I might make adjustments for a longer trip, the idea is you just carry this kit all the time and forget about it when a problem comes up, be that a tick on your leg, a broken head torch, or a compound fracture. Note that is is not for alpine climbing or multi-pitch climbing, where something much smaller would be carried (or not), but rather for general hill/crag use in the UK and Ireland.

Kit Pouch

Your kit needs to be in an easily identified, robust, waterproof roll-top bag around 1 litre in size (Sea-to-Summit, Exped, Life Systems). You will subdivide the contents into zipped colour-coded ditty bags (Tuff Bag or search Etsy), linked together and connected to the main bag, and subdivide again using small ziplock bags. Mark the bag with contact details and add a lanyard and medium-sized wire gate karabiner so it can be secured inside the lid of a pack or to a belay or pack in high winds. Add Stuk Glow tape to the buckles so you can find it in the dark without a torch.

Ditty Bag

Contents

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Emergency bandage, aka “Israeli bandage” 

Although the classic bandage has been around for thousands of years and is a central component of a first aid kit, wrapped in its little crinkly plastic wrapper, the modern emergency bandage, Invented by Israeli military medic Bernard Bar-Natan in the 80s, should now be viewed as the standard for all kits. Part bandage, part field dressing, and is designed to be far more effective at applying pressure to a wound and much easier to secure in place due to its elasticity, width, and closure bar. The closure gives the user a way to apply extra pressure on the wound or twist it to create a Tourniquet. Although you might get shot by an irate farmer, such a tactical bandage is very appropriate for the type of messy head and limb injuries outdoor casualties suffer, the design helps to keep the bandage in place if you have to get yourself out of trouble and walk off the mountain. Speaking of trouble, an emergency bandage is also much easier to apply to yourself.

Although twice the price of a standard bandage (€10 versus €5, which is why they’re not part of a standard first aid kit), these bandages are packed very robustly, so they are ideal for a mountain kit and will last for approximately eight years. I would get a 4-inch version and buy two in order to open one for you and your partners to practice with (before it’s needed for real).

Burn shield

Any trip that involves using stoves runs the risk of burns, both directly from the stove itself or from spilt boiling water. Tired people can also set themselves or tents alight or pick up red hot pans or stoves with bare fingers. In my climbing life, I’ve seen it all. Having some form of treatment for minor burns is important, so a few small packets of Burn shield (10cmx10cm).

3M Transpore Tape

There are many kinds of tape you can carry, such as paper micropore, Elastoplast, Mueller fabric tape, but Transpore tape (5cm x 0.9 m) works best due to being very sticky, tough, waterproof, and breathable. This can be used like a makeshift plaster or for securing a dressing, but it will most often be used to cover hot spots on your feet or frost nip on your face. Store in a ziplock. 

Tuff Cut Scissors

Although you can probably use a pen knife, if you have a pen knife at just 10 grams, having a pair of paramedic scissors comes in very handy. Get a set with bright-coloured handles so you can spot them easily on the ground.

Wound Cleaning

Carry five alcohol-free wipes in a ziplock for wound cleaning, but add a small plastic bottle plastic (30ml) of iodine.  This has too many uses to mention, from treating wounds, athlete’s foot, to nuclear radiation.

Dressings

Carry two sterile 10cm x 10cm dressings in a ziplock bag, and ideally make one a QuikClot style haemostatic dressing impregnated with a coagulant. This latter style of dressing is highly desirable with a head wound, as you tend to get a lot of blood. Ziplock.

Plasters

Strip of water-resistant Elastoplast/bandaid to cut to size, plus a mixture of waterproof plasters, including Opsite waterproof plasters (often used by Tattoo artists) and Compeed. Ziplock. 

Pain Meds

Paracetamol (Panadol) should be your standard over-the-counter (OTC) relief for pain, colds and fever, as it has the least side effects, which is important if you’re giving pain meds to someone else. Ibuprofen (Nurofen), being an anti-inflammatory, is often recommended for muscle pain, but I would only use it if the pain has to be relieved in order to get down (such as shin pain); otherwise, your body is inflaming for a reason, so leave it. Codeine is the strongest OTC pain relief you can get and will be combined with paracetamol (Tramadol). If you want the strongest OTC pain relief, you can combine variations of paracetamol, ibuprofen and codeine, paying attention not to double dose with paracetamol (so not Panadol and Tramadol). If you want heavy-duty perception drugs, such as opioids, you should have some form of appropriate first aid training, such as a wilderness cert. Ziplock, along with a laminated card detailing dosages. 

Bad guts

Carry a sheet of water purification tablets and Imodium if the germs get in. Katadyn Micropur MP1 are the most effective tabs, but they’re expensive, so a cheaper chlorine dioxide tab (Life Systems or Portable Aqua) are better for emergency use. Two Dioralyte sachets come in handy post-sickness or if you get heat injuries like heat exhaustion or sunstroke. Ziplock.

Cream

Savlon Cream (15g) and Glide Anti-Chafe cream (22g).

Hardware

Carry a few medium safety pins (which can be used as pins when sewing), plus one nappy and one kilt pin, as these have multiple uses, especially if the zipper busts on your jacket, sleeping bag, or tent.  Sterile, individually wrapped surgical blade. Tick Remover (card or tweezer). Victorinox micro tweezers and toothpick. 

LED Light

In terms of survival and accident/rescue avoidance, a light source is one of the best tools in your armoury. Carrying the smallest but most effective mini LED lights in your kit is recommended. This can act as a backup to your or a partner’s light (broken, lost, dead battery), but it is also at hand if you need to find items in your kit in the dark. The Petzl E+Lite (26g) or Black Diamond Flare (27g) are ideal choices or go for a non-headtorch micro keychain design, like the PrincetonTec 'Pulsar (7g) or AtomLight (5g). Oh, and carry a spare battery.

Fire Steel

Although viewed as bushcraft kit for bearded men who hang out in the woods, a micro ferrocerium rod (30mm x 4.5mm/0.01g) can be struck with a ceramic razor blade to create a spark that will light both gas or petrol stoves. This will save your bacon when your lighter is wet (fire steel works wet or dry), or not if you’re cooking bacon. The ceramic razor can do anything a razor can, but it will not rust. Due to their tiny size, join both items with a short length of bright fishing line or thread.

Sewing Kit

Needle threader, several needles (#7 embroidery and #18 chenille needles, or sail repair needles) in a sewing needle tube, rubber thimble, 2 buttons, small strip of velcro and patch of fleece, extra strong thread on machine bobbin. 

Odds & Ends

Cut down spork (spoons are magic, they just disappear). Pencil wrapped in gaffer tape (heat the tape over a flame to make air matt patches). Write as Rain 3 x 2 notebook. 5m #36 bank line and 5m 1.18mm micro Kevlar cord wrapped on card spool. 1m 550 cord (shoelace). Mini Signal Mirror, used for tick hunting and checking skin/frostnip damage. 8cm hacksaw blade. Ear Plugs. Whistle. Stove pricker. Zip tie.

On an expedition, I would include a small multi-tool like the Gerber Dime, as well as a small file, Alan key, spare crampon bail etc. Micro Kevlar cord wrapped on card spool. 1m 550 cord (shoelace). Mini Signal Mirror, used for tick hunting and checking frostnip damage. Ear Plugs. Stove pricker. Zip tie.