First-Aid situations you've encountered in the backcountry


forgot these incidents ...
skull penetration by hard object during vehicle rollover (fatal), bicycle rider hit by high speed car (fatal), broken toes, cracked bones in feet, snakebite (non-fatal), jellyfish stings, stingray attack (painful), carbon monoxide poisoning.
i'm sure there's more incidents - I'd just have to sit down and remember them all.
if you are out there a lot - you see a lot of stuff happen to people.

Moral: Good training prevents 95% of this stuff happening to YOU!!

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Like to Camp
In a related story, I had one of those basic first aid kits in my Jeep that I bought from an outdoor retailer. While checking a "lake" recently for depth before driving though it, I slipped and cut my hand. Not that bad, but when I went into the kit, I was surprised that it had no large bandaids or anything usable! Upon returning home I pretty much threw out all of the contents and filed the bag with my own kit. :)


We were three days rafting down the Green River on a private trip when my 12 year old son broke his arm jumping around on boulders. We had a paramedic with us on the trip and he said since he didn't have X-rays it was better to just splint it without setting it. It took us four days to get out down through the rapids in Cataract Canyon. Matt took it like a champ but by the time we got him to a doctor they had to re-break it to splint it.


PS And of course 30 years ago I dumped a big pot of boiling grease on my hands and arms one time from a campfire. Not fun. (Note to self: Don't drink too many margaritas again while frying fish.)


Once up in the Sierras there was a gentleman that had a heart attack. Thankfully his son was there and had knew CPR. He was lifted out by a mediflight. 14days later he had a heart transplant. That gentleman was me!!!! Four year later, there's not a day that goes by that I don't thank god my son had that CPR training.

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A broken arm (compound).
A degloved finger.
Two dead bodies. (Believed to have succumbed to dehydration)

My backwoods trauma bag will cover most anything we encounter. Sorry, if you need stuck, IV, anaphylaxis, etc., you're on your own as I no longer carry any certs.


Massive head trauma (human caused)

Heart attach and fell off dirt bike (with additional trauma).

Bee stings

Things in out kit also include epi pen, latex gloves, electrical and duct tape, razor blades, lighter, hardware to stop hostile actions.

Also the knowledge of hand signals to be able to guide in a helicopter to land in rugged terrain was very important.


Expedition Vehicle Engineer Guy
Diabetic shock, some guy with diabetes pushing it and when he got in trouble just decided to sit for a spell without telling anyone (we were all in a group)...took us a while to realize he wasn't around and go back and find him. He was okay.

Not our group, but up in the High Sierra they do these mountain bike trips where you park at the bottom of the mountain and a shuttle van drops you and your bike (or a rental) off at the top. Lots of inexperienced bikers - because how hard could it be to cruise down the hill back to your car, right?

We were driving trails in our trucks and saw numerous bikes go down. Gravel in turns was a big one. Worse was the diagonal cuts in the trail for erosion control. Saw one guy hit it at speed and go flying off trail into a boulder feel. Many broken bones, concussion - hurt bad enough that he was throwing up. If we hadn't had a paramedic in our group and been able to take the victim off the mountain to where they could medevac him out there's a good chance he would have died there. It was not the day we had planned, but sometimes you gotta bag it and just render aid.

We never went back to that area again though.

Christophe Noel

Expedition Leader
My first day as a ski patroller in the early 90s was exciting. I made my first run before the chairs were filled and arrived at the bottom of the lift just in time to see some guy fall out of the lift line like a tree. Heart attack. I was obviously prepared to help, but as luck would have it, they guy next to him, his brother, was a doctor. Whew.

That same season I was standing near the top of a lift and a girl walked up to me bleeding all over herself. She fell with three others getting off the chair and got a ski pole tip jabbed under her chin leaving a nice hole. Thank heavens for baskets! Lucky girl.


Expedition Leader
X2 - we were on the Outer Banks fishing and some kid (not mine) stepped on some rocks in the water and cut both feet badly, his dad was diving/snorkeling??? but couldn't be found. We went through the whole first aid kit patching feet. I went the next day and built my own with larger bandages - I can make large small, but can't make small become large. On the East Coast, I figure like others have said, my kit is to stop bleeding, comfort until we move to medical help (or go find Beth)

In a related story, I had one of those basic first aid kits in my Jeep that I bought from an outdoor retailer. While checking a "lake" recently for depth before driving though it, I slipped and cut my hand. Not that bad, but when I went into the kit, I was surprised that it had no large bandaids or anything usable! Upon returning home I pretty much threw out all of the contents and filed the bag with my own kit. :)


Wish people would keep puitting answers. I learn a lot more by reading than doing it with my mouth moving. After more than a quarter of a century of backpacking the wilderness, it's easier ti list the things I haven't seen; but here os one of the happenings I had the toughest time with:

2 on my trip we're washing dishes. One washed, the other rinsed. On one dish, the rinser spotted a reason to rewash. With tongs, he pulled the item out of the just-recently boiling water. He didn't dump all the water out. As he passed it over the washer's hikong boot, anoud a 1/4c poured onto the ThorLo sock behind the tightly-laced tongue.

I just happened to turn that way as the water was poured. In spite of the small amount, the damage was horrendous. Just getting the sock off was tough. In less than 15 secs, the synthetic fibers had already begun to melt and get into the skin. The wound didn't look bad at that time. First aid for a bad burn is try to get the fire put out under the skin by slowly cascading water over it. The idea is have the water absorb some heat as it passes and to lower the outer skin temp. We did; but in spite of this, we just couldn't stoo the continued subcutaneous burning. We took him to a nearby lake to immerse it. That didn't work much better because the water at the burn was not circulating. Eventually, we loosely applied non stick pads and loose gauze. We changed every 2 hours. He took as much Tylenol as I could safely push; but wasn't enough. Next day, he was better and hiked w an unlaced sneaker. By mid afternoon he developed intense nausea without throwing up. His pain got to the point of waili g and some tears. This persisted thru the night. We finally got him to an evacuation point the following day.

I've never felt so helpless in the face of a body trauma. I treated burns before and after this; but I never had one I couldn't do almost anything for.


Luckily I haven't ever needed to use most of the items in my first aid kit, but it has definitely come in handy on multiple occasions. I have two kits, one stays in the truck and contains the items recommended during RedCross and NOLS wilderness first aid classes. The other is a small one that I carry on a daily basis. The most commonly used items are bandaids since we always seem to be out of them at work and people manage to cut themselves.

I've been involved in a couple first aid situations. None were very serious, but they all had the possibility of escalating if not attended to.

While hiking on a fairly remote beach in northern California (no cell service, ~1 mile from nearest road, no other people around) we ran across a woman who had recently had knee surgery and had just re-damaged her knee. She was in a lot of pain and couldn't walk, and the only route back to the road required you to climb up a collapsed bridge to get back up on the bluff. She and her companion were at the bottom of the bluff trying to figure out what to do. We ended up getting her back up onto the bluff, and then took turns doing a fireman carry to get her the 1mi back to their car. No first aid supplies were used, just some training.

Last year a friend of mine stepped on an in-ground hornets nest and several people in our group wound up with multiple stings. This was of course very painful, but the concern was that a couple of them had never been stung before and didn't know if they were allergic or not. I suggested they take benadryl and we kept an eye on them for signs of anaphylactic shock while we headed back out the trail. This was a low risk, but it's the kind of thing that can be a major problem in a remote area.

While skiing with my brother we came across a kid (~9 years old) who had fallen and broken his arm. He had removed his glove and jacket to nurse the injury, which was unfortunate since it was a very cold day. He was sitting in the middle of a trail under a blind crest, I had my brother go up and wave off any on coming skiers, and after checking for any risk of spinal injury I moved him to the side and tried to keep him warm. There was no way to get the glove back on without causing pain, so I stabilized his arm under his jacket. Again, no cell service. Eventually another skiier came by and we told them to go have a lift attendant call the ski patrol, who took 30 minutes to arrive. The big risk here was exposure due to the weather. No first aid supplies were used.

In the US the vast majority of "overland" trips are never really all that far from advanced help (say 12 hours or less). There are three basic classifications of injuries.

- An "ouchie" or discomfort situation such as a minor cut, burn, stomach upset, headache, etc. It's nice to have supplies to lessen these kinds of injuries, but no specialized equipment or medications are really needed. Flush wounds with clean water, cool burns, wait for stomach upset or headache to pass.

- An "ok, this injury makes the trip no fun" situation such as a sprained ankle, broken bone, concern of infection, more serious illness, etc. These aren't immediately life threatening, but you want to get the person back to civilization for treatment (slow evacuation). The key here is stabilizing the person and making them as comfortable as possible during transport.

- A SHTF situation where someone's life is in immediate danger (rapid evacuation). These are the scariest and the least predictable. You could be facing a massive injury, heart attack, hyperthermia/hypothermia, velocirapter attack, or who knows what. It's impossible to plan for all possibilities, and even an ER doctor wouldn't be able to help in all cases. This is part of the risk we assume by being away from advanced help. Personally, I carry a CPR mask, gloves, children's Tylenol, a tourniquet, lots of big bandages, and the realization that if something catastrophic happens your chances of success are fairly low.

In all of the situations I described above the thing that helped most was simply asking "do you need help" and then keeping the victim calm. It is also important to be able to determine which of the 3 classifications the injury falls under (stay, go slow, go fast). And the bottom line is that some training and a willingness to help are much more important than what is in a first aid kit.

- Matt


New member
Over 20 years of prehospital/wilderness emergency medical experience. Started in boy scouts, then open water life guarding, ski patrol (500-700 volunteer hours / yr), currently volunteer SAR. We see about 400 calls per year and I roll on about 1/3 of them.

A recent training presented an interesting perspective that I had not considered, the exact statistics are immaterial but the idea is important. 40% of trauma victims will die no matter what we do, 40% will live no matter what we do, the 20% in the middle is where rapid effective first aid makes a difference.

The first 40% Dead Right There
I have seen more dead people than I can remember. First was a lightning strike at the beach I lifeguarded. After giving rescue breathes, the 'exhaled' air had smoke tendrils. I still have nightmares from that incident, 20 years later.

The last 40% Probably gonna live..
Lots of these in boy scouts, life guarding and first aid. A lot of these are still emergencies but as some one else said, we can slow walk these ones. Slips with knives. Broken arms. One guy walked into a stationary boat prop and cut his leg open. One woman at a ski hill messed up unloading from a chair, fell in a squating position onto her freshly sharpened snowboard edge and proceeed to lacerate the ever loving crap out of her labia majora. That one was akward...

The 20% Gotta act fast
Many femur fractures at ski areas and atv/snowmobile accidents. One of these was bad enough the femoral artery was lacerated and a tourniquet not a KTD was what saved her life.

Exposure. Had a lost diabetic guy this deer season. Storm coming and he was in a bad way. He would not have made the night. Located, rewarmed and evac'd.

Burst appendix in the BWCA and no air medivac available. We ended up gathering every available outfitter, granola cruncher and boy scout in Northern St Louis County; staging them at the portages and relay racing her out of the wilderness. I think we set a record for quickest human powered evac from Boulder Lake.


Expedition Leader
Lots of yrs back country packing. My dad did big backcountry stuff as a packoutfit cowboy during his summers.

Most of the semi severe stuff I saw was self inflicted deep cuts, knife or hatchet miss use. Even when I was 5yrs old I remember my dad being called to another camp to help patch someone up or stabilize them etc. He was med school in college. The human body is pretty tough. The worst cases sierra plane crash by camp. Nothing could be done. Church group kids climbing a rocky cliff a kid fell about 20ft. He didnt make it.

My dads biggest save was before me. He had a pack customer suffer a heartattack about 8hrs into a big pack trip. He managed to get him back and breathing. Loaded the victim on the Mule my dad always rode "mules are more sure footed and smoother ride old cowboy trick" Then hightailed it for the packstation. He had to pull the guy down a few times and do cpr on the trip back. Even my dad figured he would have a dead man before reaching the pack station. The guy lived!

Biggest rule my dad enforces is risk mitigation. There is no ER in the backcountry.


Regular Dude
Witnessed a 13 Year old girl on a snowmobile get struck by a jeep towing a trailer going about 30mph in a freak white-out blizzard. I am an EMT, and was on the patient within about a minute. Long story short, she lived with some paralysis on the left side of her body. Injuries sustained were head trauma, several broken ribs, tension-pneumothorax, and a broken pelvis. Took about 45 minutes for an ambulance to arrive because of the weather. Her parents were riding their own sleds too, so it was tough for them to watch, not being able to do anything. Witnessed a helicopter crash once. Machine just fell out of the sky. That was wild.

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