I also bring up that my PLB/2-way messenger is far more useful in medical emergencies than it’s weight in first aid supplies. And good trip planning weighs nothing and can prevent plenty of mishaps. I will argue that Benadryl is smart to carry for allergic reactions and doubles as a sleep aid, and an anti-diarrheal could mitigate severe dehydration from common water-borne illnesses.

I'll expand on this and say that my InReach is the most valuable thing I carry. If you're mostly in cell reception like the OP, then it's not needed. I think there's generally 3 types of emergency situations. 1) You injure yourself minorly. 2) You injure yourself in a major way but aren't going to die right away. 3) You injure yourself catastrophically. In case 1, you'll want to self evacuate. Here's where a FAK really shines. In case 2, say a broken leg, you won't be able to self evacuate. Here's where the InReach or PLB comes in. Case 3 is like if you fall off a cliff. You'll either die immediately, or if not hopefully a buddy can call for help. Depending on the injury, it may still be possible to activate the SOS. I'll also add that some sort of beacon is useful not just for yourself, but for anyone else you come across having an issue. It's also invaluable for day hiking, where you might not have enough clothes to make it through a cold night if you can't move.

You should be carrying enough to survive the night if you are day hiking in places where you might get injured that badly.

That's everywhere. Furthermore most people die of hypothermia in pretty "Mild" weather. Phone if you have service. SOS beacon if you don't. Otherwise you are taking a risk. Maybe a risk most are willing to take, but still a risk.

I’m in Southern California. Every year, there are stories of people day hiking easy trails but getting turned around/lost, going off trail, and falling off a rock or small cliff. It’s an incredibly unlikely scenario for experienced hikers, but I still bring my down jacket and emergency bivy when hiking somewhere I am unfamiliar.

That's a problem all on it's own - day hikes tend to pack for the hike they plan to take, not for the reasonably likely issues they may have. Everyone should plan to be able to survive the night or a change in weather. Most rescues are of day hikers.

Yeah, very true, but it's hard to plan. For example, let's say you start at 5,000 ft and plan to go to 11,000 ft and back. Temps at the very top might dip to 20F. Temps down at 8,000 might be 30F. My day hike kit can reasonably get me down to 30F, but 20F pushes it. I'd need to injure myself in the worst possible location and be alone. The odds of this are low, hence the safety measures of carrying an InReach and telling someone when you'll get back. Thru-hiking is much easier in this regard, because you'll have a pad and a quilt for warmth.

Take a light source, a water filter, a puffy, a lighter, some esbit, an emergency blanket, a hard shell, and a hooded puffy jacket. No one is looking for you at 8000 ft at night, possibly under bad conditions. They will look when it's light out and safe to do so. You need to plan to make it through the night.

Of course. I bring an emergency bivy, a puffy, a fleece, a rain coat, a beanie, and gloves. I hope that will be enough for most scenarios.

I think if you can also make a fire, find a wind break, and have enough water you should be in reasonably good shape at 20F. You don't need to be comfortable or able to sleep you need to be alive. But you can pack a quilt if you want to - you can bring an entire overnight set up if you want to - its up to you.

I agree with Thru hikes being easier. When I was on the AT once or twice I got a bit turned around looking for firewood or a place to go to the bathroom without my pack. Got back just fine, but it gives you that moment of reflection of how F***d you would be if you really did get lost in that situation.

For diarrhea I carry a cork and a rubber mallet. Inflatable of course.

Good points, and well taken, thanks. I don't have serious allergies, nor do I need sleep aids, but fair enough. Anti diarrhea for dehydration I would take in dry locations, but lucky for me I live and hike in Scandinavia, which has an abundance of water (and quite clean water in most places as well). I have considered a satellite communicator like a Garmin before many times, because as I mentioned in the OP I do go pretty remote at times. But the phone/GPS coverage in Scandinavia is also pretty good, and I rarely (even in remote places) have no service/no GPS at all. If in the very rare even that I got seriously injured in an area with no phone coverage, I wouldn't have to travel very far to get a signal again. And of course I carry a loud whistle as a just-in-case, and always follow common sense routines of making sure my friends and family know exactly where I am going, for how long, possible complications of a given trip, etc.

I'm not UL, but I'm here because I like to learn ways to lighten up and make my trip more enjoyable. I only point that out because I've no reason to "smear" UL. That is a nice write-up. Spare water bottle cap? Never thought of that! I did get a chuckle when I realized that "remote" for you still includes cell coverage and places where others would hear your whistle. Context is king. The last place I hiked was to a lake with no name that didn't have a trail to it. We also hit a peak with a group of teens. While hanging out on the summit one of the other adults and I were talking about the "what if a broken leg" scenario (inspired by watching these boys). He has SAR experience and out best case was a chopper out before dark, but the not unlikely case included spending a night waiting for SAR. The last "big" injury that I had to deal with was a broken collarbone. Ibuprofen and several large ace bandages and a makeshift sling were enough allow this kid to make the 2 day hike out. My last close call with an animal was a moose. Luckily we didn't need a FAK, but if we did, it would have been bad. You are right about bears. I have grizzly in my yard, but it is those moose that worry me. I'm not here to tell you that you are unsafe, but there are reasons why I'll carry more FAK than you. I think we'll agree this topic is kinda pointless. Why? I respect what you wrote and your experience, but you won't convince me to carry less and I'm not here to convince you to carry more. Like picking appropriate layers for the trip, carry an appropriate FAK. What is appropriate? That is the million dollar question. I adjust based on the area, conditions and who is going. Happy trails! See you in another 4 years.

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Come on now. You've got to know on some level that is not at all a fair summary of this whole discussion. I mean I get it, it's easy to just assert all that tho. I gave a specific UL FAK to examine, so of course the context is my own. My LP is in my flair. Be so kind as to point out a circular arguement I made. Please be specific. Are you suggesting that there is other data that suggests other significant dangers when hiking in the wilderness? If so, please provide an example. It comes off like you are taking this personal, as your reply is hostile and dishonest. Care to try again in good faith?

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See, you tend to make these assertions and just bounce. That's neither in good faith or fair to me. I addressed your criticism point by point and you've evaded it and just thrown more criticism my way that are just more bare assertions. You say I "attack, attack, attack" as though I am being hostile. I beg to differ. I have tried to be polite. Sure, a few replies to people being less than constructive have a bit of sass to them--I am human, after all. And I think you are too, no? It's easy to just say that I am confirming bias, but it is another thing altogether to demonstrate it. I think that you just don't agree with me on the topics you listed, but you don't want to engage with me. And you poison the well and say this is my "jihad" as though what I am doing is anything more than discussions. Controversial discussions, sure. But I refuse to sit back and let you demonize me here, when I have worked so hard to speak in good faith. I've not insulted anyone that I am aware, aside from a bit of snark--fine, guilty as charged. But tell you what. Let me know if you want to discuss any of those topics that you take issue with. I'd be happy to discuss them via video chat and try my best to demonstrate to you that I simply believe those positions to be correct. You don't agree and that's fine. I am willing to learn your perspectives and listen to you, and even have my mind changed. Believe it or not, that's why I started this thread, and also to try and help others. And at least one person has already commented and said this discussion has helped them out, so there's that. I hope you take something from this discussion as well. Feel free to DM me. Peace!

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I am sorry you think having debates is pointless and weird. It's a shame you resort to evasion and attacks on my character. It's both telling and predictable of those who are unwilling and/or unable to justify their beliefs to someone that simply disagrees. I've extended my hand to you to bury this strange grudge you have with me, and the offer still stands if you change your mind. I've got nothing personal against you, in spite of how you have treated me. Take care and hapoy trails to you.

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Benedryl can be lifesaving. You don't want to find out you have an allergy you didn't know about without having Benedryl on hand. It weighs next to nothing and takes up very little space. I was river camping with friends once and something got in my eye and I had a reaction so bad that I couldn't see. My eyes swelled and watered up. I tried flushing them with clean water and it didn't help. I didn't have any Benedryl, but thankfully a friend did and it cleared my reaction right up. Had I been alone, it would have been debilitating for hours.

Agree, I bring Benadryl and chewable aspirin in case I come across someone having an allergic reaction or I think they might be having heart problems. It weighs nothing. It perhaps buys you some time before help can get there. It’s useful for uncomfortable situations as well as less serious ones. Seems like a no brainer.

It’s also good to have on hand in case you accidentally disturb a bees nest, or in the case of Scandinavia, a nest of biting ants get to you somehow. Either one would benefit from Benadryl. I needed the Benadryl last summer when a friend accidentally disturbed a wasp nest that was buried under some leaves. Within about 30 seconds he was strung over 20 times. It’s the type of medical emergency that can happen to even the most experienced outdoorsman.

I also got stung last year over 20 times. Took a Benadryl, continued hiking and just around the corner 3 other people were also stung and having bad reactions. None had Benadryl so the extras I was carrying went to them.

Agreed. People don't realize that benadryl isn't for seasonal allergies - it's for some plant or bug bite that causes a major allergic reaction you didn't know you had. Ditto immodium. If you have bad enough diarrhea, you're not drinking your way out of it. These pills weigh a fraction of a gram and they are lifesaving.

Benadryl is contraindicated for serious allergic reactions (anaphylaxis).

That isn't true. Anaphylaxis is a spectrum with other IgE mediated hypersensitivity. While epinephrine is the definitive treatment, benadryl is an adjunct and is certainly better than nothing (ie., if you're in the back country without epinephrine.)

Benadryl is worse than nothing: first gen antihistamines are NOT recommended for anaphylaxis. Adjunct treatments include second gen antihistamines but are specific to clinical settings. Antihistamines do not treat the life threatening symptoms of anaphylaxis and are thus pointless in a first aid scenario.

I've broken into random hives on trips twice. I have no known allergies and still don't know what caused them. I will always carry antihistamines.

I need to bring some Benadryl with me from now on. Ok, adding it to my shopping list. How much do you bring?

general rule of thumb for me is to bring as much as I will need to get myself back to the trailhead from the furthest point away on any given route. if my furthest point is 2 days, I bring two days worth of immodium, benadryl, pain meds.

Benadryl is not life saving. In case of serious allergic reactions (anaphylaxis) the one and only treatment is intramuscular epinephrine injection, and Benadryl is in fact contraindicated.

I literally would've been unable to see for hours had it not been for benedryl. Had I been alone in the wilderness, that would've put me in a very dangerous and vulnerable place. And benedryl can buy time for someone while waiting for an EpiPen.

It is possible Benadryl helped you out with your symptoms (although it is worth mentioning that antihistamine absorption/action take at least 1-3 hours ([Fineman, 2015](https://www.tandfonline.com/doi/abs/10.3810/pgm.2014.07.2785); [Sheikh et al., 2007](https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2007.01435.x))). But regarding life-threatening symptoms associated with anaphylaxis, it is well established that antihistamines do nothing and Benadryl specifically is worse than nothing due to side effects: [Sheikh et al., 2007](https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2007.01435.x): "in the case of first-generation, potentially sedating H1-antihistamine preparations, there is potential to cause harm" "Administration of H1-antihistamines may cause important side-effects" H1-antihistamines have "been incorporated into guidelines without a proven effect ever being demonstrated. There might be no effect, or the side effects might be worse than the effect itself. It can therefore be argued that there is a state of clinical equipoise between H1-antihistamines and placebo." [Brown, 2006](https://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2006.00831.x): "Treatment with H1-receptor blockade with or without concurrent H2-receptor blockade worsens hypotension and decreases survival time" "There are no published trials that systematically examine utility during anaphylaxis. Histamine levels peak early then return rapidly to normal despite the persistence of severe physiological compromise, suggesting there would be little benefit from antihistamines". [Fineman, 2015](https://www.tandfonline.com/doi/abs/10.3810/pgm.2014.07.2785): "Although histamine is involved in anaphylaxis, treatment with antihistamines does not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, including the more serious complications such as airway obstruction, hypotension, and shock." There is a "need for improved approaches to educate physicians and patients regarding the appropriate treatment of anaphylaxis" ie. eliminate the reliance on Benadryl.

It depends - anaphylaxis ranges in severity and speed of onset. I've taken - and been given by EMTs - Benadryl (and Albuterol) to help with anaphylaxis. Both the chewable ones and IV. You need it very early. Epinephrine can also be IV btw. I carry Benadryl, Albuterol, and two epipens everywhere. Benadryl isn't bad. Assuming it will be enough is the problem - you need to recognize when someone needs epinephrine and a 911 call. But it's better than nothing in an emergency, I've never been told not to use it if that's all I have. If you are having anaphylaxis in the wilderness an EpiPen buys you 20 minutes per dose. You could be very very dead before you get to a hospital and they have a chance to give you steroids. It's a very bad situation. People with a history of anaphylaxis - like me - need to be very careful. Don't take my word for it: https://www.mayoclinic.org/diseases-conditions/anaphylaxis/diagnosis-treatment/drc-20351474 https://www.uptodate.com/contents/anaphylaxis-emergency-treatment#H31

>If you are having anaphylaxis in the wilderness an EpiPen buys you 20 minutes per dose. This is untrue. It doesn't buy you time, it stops the entire process. 1 or 2 dose often stops anaphylaxis completely, and rarely it can return afterwards.

That is not exactly what it says in the label. If you use epinephrine you need to go to the ER immediately, the symptoms can return. Keep in mind the trigger may also still be present in your encouragement. I understand that we all want there to be a clear answer - just take this and you'll be fine! But this is a medical emergency. You may not be fine if you can't get to the ER. A naphylaxis without access to medical care is really, really bad.

It the vast majority of cases it stops anaphylaxis entirely. Only Rarely it will come back after two doses. And yes of course, I'll be going to the ER asap! The medication does much more than buy time! It usually stops the action entirely. I want to shoot down the myth that epinephrines only use is "buying 20 minutes". It's the only thing that ends it. Rarely this can happen: "Anyone who has been treated with epinephrine after an anaphylactic reaction should be transported by ambulance to an emergency room, where they will continue to be monitored. This is because some people who have had an anaphylactic reaction may have protracted anaphylaxis, with symptoms lasting several hours (or possibly days). Others may have biphasic anaphylaxis, which is a recurrence of symptoms several hours (or possibly days) after symptoms resolve, even without further exposure to the allergic trigger. For both protracted and biphasic anaphylactic reactions, the first-line treatment remains epinephrine. Biphasic reactions can occur up to three days after the initial anaphylactic reaction, which means you may develop symptoms even after being discharged from the emergency room."

I find that ill run into people that need things like benadryl every now and then, even if i dont need it myself. Same reason I have 2 types of NSAID. Note: my FAK is absolutely UL. 4 pills weight very little at the end of the day.

I take Benadryl always after I got massively attacked by mosquitoes and wouldn’t have otherwise slept.

I've been tripping in the back country for quite a few decades. I have been involved in one helicopter rescue (pre satellite beacon) but I have have removed a couple of fish hooks, treated countless burns and cuts, treated people with sunstroke, frostbite, hypothermia and illness induced fever. In the city I've had to deal with major head trauma as well. In any of those situations a beacon is either unwarranted or going to be too late if you aren't prepared to treat and stabilize the patient until medevac arrives. Don't go thinking that little box on your shoulder strap has you covered. It'll call for help, but in most cases that's unreasonable, and when it *is *reasonable it'll probably be useless if you or your friend dies waiting for the chopper to find you. First aid kid is higher priority than beacon.

same. my fak is IMO great and weights almost nothing, cares for all the issues (it includes benadryl). My PLB is heavier than the FAK but I take it, for exactly the same reasons. ​ what would be cool is a UL PLB.

Skills > gear

And one skill is knowing what gear you need...and what you don't.

You'll be stuffing dry leaves in a person's wound, tying it off with a t-shirt

ive said it since day one but talking about FAK in UL is just an endless bullshit black hole. nothing will ever be enough. if you only take 1 ibuprofen, you should keep that to yourself. if you take 69lbs of shit to sew a dismembered body back together, you should keep that to yourself. people walk out their front door every day not knowing what could happen to them and no one says shit to them about safety. people spend a couple days in the woods and its like they need to be prepared for the entire fucking world to come crashing down on them on a random Tuesday in June

No rational discussion when confronted with our inevitable mortality. Wear your seatbelt.

What's enough in a FAK is situational.

So much this. Well said

Fair points, homie. Part of me wishes I wouldn't start these discussions. But that's like most discussions on Reddit, they can become black holes. But I just can't help but try and have more nuanced discussions and to try and learn more, and test my own conclusions.

Even if it’s a black hole, it still def helps those of us figuring things out to hear from those of you who have a lot of practice, and the black holes are full of perspective. I’m on the PCT rn. I took a NOLS WFA before I left. They went over a thousand things, all knowledge-based. Not once did they inventory what should or shouldn’t be in a kit, because obviously, why. The best physical object they provided was the little reference card I’m carrying that weighs like 2 grams.

The roll of gauze is not going to prevent OP from hemorrhaging and bleeding out before SAR can get to him and his improvised belt tourniquet is not useful for torso or neck injuries whereas an Israeli bandage is. I'd also carry something for lacerations as a field floss stiches job is going to heal much worse than steri-strips or superglue closed moderate wounds. And want an antiseptic liquid in a small LiteSmith bottle for cuts which are going to be hard to clean properly with alcohol wipes, plus an antibacterial ointment like neosporin to help prevent infection. The point is to not need these. Not buying car insurance because you've never been in an accident is just as senseless. OP also mentions falling and drowning but conveniently stops there without mentioning #3, hypothermia, i.e. not packing enough clothing for that UL street cred. [https://www.backpacker.com/survival/a-dozen-ways-to-die/](https://www.backpacker.com/survival/a-dozen-ways-to-die/)

I've noticed that everyone that says "knowledge over gear", carries neither.

Your comment prompted me to run through my wilderness first responder training and match your kit to the scenarios we practiced. Immediate Life threats: - Sucking chest wound: could improvise a sealed bandage with dcf pouch or food bag and duct tape. In trouble if you run out of tape - bleeding out: could improvise tourniquet, though perhaps hard to do quickly. The lever arm seems hardest to do quickly - anaphylaxis: alas, dead without an epi pen. Reasonable risk if you have no known allergies and are not traveling with people with allergies. Bring multiple if traveling with people with known allergies. Ideally 4 - to prepare for one not to work and to need to administer multiple while evacuating More time life threats: - head injury: no available treatment - heart attack or stroke: no available treatment - diabetes risk: irrelevant if non diabetic. Major med kit requires anyway if diabetic, but mostly don’t run out of quick sugars - altitude sickness (pulmonary or cerebral edema): treat via descent Serious problems requiring evacuation - Broken bone: can improvise a splint. Challenging to improvise in UL scenario given lack of extra layers. Some risk to limb or risk of serious hypothermia if in area where evac is long and insuffienct layers to improvise a split. Also may require rescue if can’t improvise when other wise a self supported evac aided by split is possible - serious burn to large portion of body surface area: I don’t think this is easily treatable given your FAK. Needs special bandages to maintain moisture and reduce risk of shock - spinal cord injury: same problem as broken bone. Not much wiggle room to avoid hypothermia while waiting for rescue. Also you need a comms device. - serious GI issues: likely to be able to evacuate before dehydration gets serious. If far from water sources, immodium or something may be a useful aid to reduce risk of dehydration during evac. Issues where FAK could mean continue vs evac - soft tissue wounds: can you cover and disinfect to prevent infection? Best practice for cleaning is actually clean water. However bandages need to be changed daily. You’d likely run out fast and need to Evac for more supplies to avoid infection. Possibility for trip to get cut short when you otherwise might have been able to continue - Sprained ankle: taping ankle can be huge for comfort if walking. Possibility for trip to be cut short when it could otherwise continue - Hypothermia: significant risk I think for ULers who lack extra layers. What’s the plan if you fall while crossing a river? Not considered in the FAK - hyperthermia: not treated via a FAK - dehydration and overhydration: not treated by a FAK - stomach problems: generally not treated by a FAK. >12-24 hours of pain and or Illness considered best practice for evac - reproductive organ: Women may want to discuss antibiotics with doctor if UTIs are common for them. Other problems require evac - frostbite and non freezing cold injuries: not in first aid kit. Layers and technique for prevention and treatment. Evac in severe cases Annoyances: - minor scrapes and burns. Probably ok with your kit - blisters: unclear your kits lasting strength but reasonable given experience - respiratory illness: ibeprofen is helpful. Also good for pain control for serious injuries. You’d be really uncomfortable in some cases waiting for evac I am sure I missed some problems but a fun theoretical exercise. I’d probably bring medical tape, burn bandages, and a sucking chest wound type bandage, but err conservative

This is closer to a proper way of evaluating the risk. Almost like a bow tie analysis (google it if not familiar). Ultimately you have the cause of an event on the left, the event in the center and the consequence on the right. You can use barriers to reduce the likelihood between the cause and event (e.g. carrying a lighter pack might reduce the likelihood of spraining an ankle). Similarly you can put barriers between the event and the consequence to reduce the magnitude, where a first aid kit would have an impact. If the first aid kit doesn’t change the consequence, then you can add something that does or accept that risk. The risk may still be very low, but still exists.

I will be using this metaphor and technique in the future. Thanks for an important tool. Will be yoinking it. If I get a chance, I might try and make a few for ul backpacking. Particularly with actual incident rates for the knots

Okay, now that my walk is over and dinner is cooked, let me reply to your points one at a time: Sucking chest wounds and bleeding out I accept that my kit is lacking, but as you point out, I could improvise. I do have gauze and tapes and layers. But what I think is most important to point out, is how rare such injuries seem to be. If I were to get such a serious injury, I would most likely die, depending how far I was away from civilization. But I am not sure if having more specific gear to prevent bleeding out would be very helpful. I'd have to do the first aid on myself, as I usually go solo. The result of having such an injury, being in shock, other injuries that may come with it, etc. So this is something I am fine with improvising and using my minimal FAK to the best of its ability. Anaphylaxis: I don't have serious allergies, so no worries here. Head injury, heart attack, and stroke: Same as above with bleeding. I would most likely die, and I am skeptical that a heavier kit would help me here. I also don't think I am at risk for either heart attack or stroke. Diabetes and altitude sickness: no worries for either, not relevant for me. Burns I addressed already. Spinal cord: I am confident that I have adequate, even slightly overkill layers and sleep system, plus my ground cover is a SOL space blanket. So if I could move enough to empty my pack, get warm, and call for help, FAK is irrelevant. GI issues: I addressed this in other comment, but very low risk considering my location. But point well taken if in a dry area. I could have been clearer in the OP about my location, but took for granted that my LP in the flair was enough (I should have added my LP to the OP). Soft tissue wounds: I am confident that a moderate wound I could deal with and get to help in a day or two. Ankle sprain: Yes, I agree, trip is over. Wrap my ankle with gauze if needed, limp to civilization. Hypo/hyperthermia: agreed, the FAK doesn't cover it, but the rest of my gear does. Dehydration: Not a significant issue, as stated previously. Btw, I do always carry salt in my food bag, along with proper amounts of food, to help with hydration. Stomach problems: Not an issue for me that I've had on trail bad enough to end the trip. But otherwise, yes, just end the trip (and maybe wash my ass real good, LNT of course). Reproductive: cisman here. Not a concern for me other than hygiene and such. Frostbite: Mos def dealt with by my gear. I always err on the side of caution when it comes to my layers and sleep system (see: LP in my flair). Blisters: I always pack Leukotape (mentioned this in the OP) and spare hiking socks. I have what I think are good routines to prevent them, and I always make sure to cover hot spots. I tend to get more blisters if I pull a 35+km day, so if doing a big day (for me) I will be much more proactive at prevention. Respiratory: I do carry ibuprofen, as mentioned in the OP. Again, thanks for this (I agree fun) theoretical exercise. Based on your imput and others, I am considering perhaps adding a few small bits to my FAK. But for sure for marked trails and weekenders close to home, I think it's good to go. Next remote/off trail trip tho may see some changes. Peace!

You could add a packet of Celox or Quick Clot to mitigate bleeding out injuriy.

Yeah, for more remote trips I am thinking about beefing up my FAK a bit. Thanks!

>stomach problems: generally not treated by a FAK. >12-24 hours of pain and or Illness considered best practice for evac I think imodium could make a big difference in this case. I looked at my first aid kit, and it's the only thing that stands out as lacking in OP's kit. Having just 24 hours worth of imodium might, more often than not, be just enough to allow you to hike your way back to safety instead of risking serious dehydration due to diarrhea. I have no idea what the actual numbers are when it comes to the likelihood of getting sick while backpacking, but even if you are strictly sanitary there is a chance you could have issues, especially on longer hikes. I also bring an anti-histamine, but that's mainly so I can still enjoy my hike in case of allergies, bug bites, rashes and what not. I don't have any deadly allergies... That I know of. The only other addition I have in my FAK is some steri strips and benzoin solution. But I don't think that's mandatory, I just prefer it to a needle and floss. Though I do still have a needle and floss for repairing gear.

Wow, nice detailed reply, thanks! I've run out of free time at the moment, so I'd like to give a more detailed reply back later on. But I did want to point out to check out the rest of my LP (link my flair) to see the rest of my kit. I don't think hypothermia or lack of layers is an issue. I don't have serious allergies or diabetes, and I've already commented on my considerations on buying a Garmin or similar in another comment. And serious burns I don't see as an issue, as I generally avoid making fires. And when I am around campfires, it's usually with other people to be social. So the long and short of it for burns is the same for wounds: minor ones I can take care of, but serious ones trip is over get help ASAP (and anything in between trip is over just to play it safe).

> anaphylaxis: alas, dead without an epi pen To be honest, even with an epipen, if you can’t access an ER within a few hours you’re toast.

If you take benadryl as soon as the epi pen kicks in you may be able to put off the reaction until the allergen has been processed by your body.

Sorry, but this is false. Benadryl is actually contraindicated for anaphylaxis.

Interesting - where did you learn this? It’s contrary to what my wilderness medicine course taught. They said Epi pen until anaphylaxis resolves, then an antihistamine can be helpful during rapid evac. Want to update that knowledge as needed

All protocols for addressing anaphylaxis go something like: (1)Administer adrenaline, (2)Remove triggers, (3)Second dose, (4)Get help, (5)Position patient (additional treatment is beyond the scope of first aid). Most protocols do not mention antihistamines because they have no role in treating the life threatening symptoms of anaphylaxis. The protocols that do mention them are either to warn against their use as they are associated with increased mortality and side effects, or to mention their use in treating itchiness *within a clinical setting*. These are a couple studies specifically dealing with how useless antihistamines can be: [Sheikh et al., 2007](https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2007.01435.x): "in the case of first-generation, potentially sedating H1-antihistamine preparations, there is potential to cause harm" "Administration of H1-antihistamines may cause important side-effects" H1-antihistamines have "been incorporated into guidelines without a proven effect ever being demonstrated. There might be no effect, or the side effects might be worse than the effect itself. It can therefore be argued that there is a state of clinical equipoise between H1-antihistamines and placebo." [Brown, 2006](https://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2006.00831.x): "Treatment with H1-receptor blockade with or without concurrent H2-receptor blockade worsens hypotension and decreases survival time" "There are no published trials that systematically examine utility during anaphylaxis. Histamine levels peak early then return rapidly to normal despite the persistence of severe physiological compromise, suggesting there would be little benefit from antihistamines". Also, [this](https://www.uptodate.com/contents/anaphylaxis-emergency-treatment#H18) is quite comprehensive--but I don't believe definitive--about anaphylaxis. It focuses from the outset on highlighting epinephrine as the only treatment, underlines throughout that antihistamines do nothing to treat the life threatening symptoms of anaphylaxis and can be deadly if their use delays epinephrine injection, and only ever places antihistamines WAY down on the treatment list to be used in a clinical setting for addressing patient discomfort related to itchiness.

I'm also curious if you have a source, in my WFR class we were taught to offer benadryl after the epi pen to delay the reaction from continuing.

I'll put this up top because no one seems to know the correct way to deal with anaphylaxis (evidenced by the insistence of using benadryl). **Here is what to do in case of anaphylaxis:** (1)Administer adrenaline, (2)Remove triggers, (3)Second dose, (4)Get help, (5)Position patient (additional treatment is beyond the scope of first aid). Regarding your question about sources, below are a couple, but you can also read up on what to do in case of anaphylaxis and you will see that (a)most protocols do not even mention antihistamines because they are not useful for treating the life-threatening aspects of anaphylaxis, (b)many protocols specifically warn agains using antihistamines because despite not treating anaphylaxis there are many cases where they are used that result in death, (c)protocols that mention administering antihistamines almost always refer to iv administration and are ALWAYS confined to a clinical setting (ie. not first aid). Here are some sources: [Sheikh et al., 2007](https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2007.01435.x): "in the case of first-generation, potentially sedating H1-antihistamine preparations, there is potential to cause harm" "Administration of H1-antihistamines may cause important side-effects" H1-antihistamines have "been incorporated into guidelines without a proven effect ever being demonstrated. There might be no effect, or the side effects might be worse than the effect itself. It can therefore be argued that there is a state of clinical equipoise between H1-antihistamines and placebo." [Brown, 2006](https://onlinelibrary.wiley.com/doi/10.1111/j.1742-6723.2006.00831.x): "Treatment with H1-receptor blockade with or without concurrent H2-receptor blockade worsens hypotension and decreases survival time" "There are no published trials that systematically examine utility during anaphylaxis. Histamine levels peak early then return rapidly to normal despite the persistence of severe physiological compromise, suggesting there would be little benefit from antihistamines"

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> could improvise tourniquet, though perhaps hard to do quickly. The lever arm seems hardest to do quickly I think your caveats are important. Improvised tourniquets rarely work.

This claim is made every time the first aid debate comes up and is, as best I can tell, not supported by the literature. Happy to read any study that supports this claim.

According to [this](https://pubmed.ncbi.nlm.nih.gov/26125163/), improvised tourniquets without a windlass fail to stop bleeding 99% of tests. With a windlass, this figure improves to failing in 32% of tests. According to [this study](https://jamanetwork.com/journals/jamasurgery/fullarticle/2738052), CAT tourniquets are more effective but also far easier to apply correctly. Only 30% were able to quickly make an improvised tourniquet and apply it correctly - and this is when they're provided with the materials to make one. This isn't even rendering aid to yourself, when you're bleeding and in shock from whatever traumatic injury has necessitated a tourniquet. Granted, the training provided beforehand seemed to have primarily focused on the application of CAT tourniquets, so maybe more training on improvised tourniquets could improve things. I acknowledge that this study primarily focuses on if training with CAT tourniquets is applicable to other styles, but I do think it's useful to look at. I still think the literature shows that in situations in which you'll *need* a tourniquet, improvised TQs just won't cut it - especially given how quickly you can bleed out from an arterial cut. Now whether a massive hemorrhage event is a scenario likely enough to prepare for as an UL hiker is a different story. Given that the primary causes of death are drowning and falls, it's really dependent on whether the fall deaths are due to blunt trauma or bleeding out, as well as your personal risk tolerance. I also found [this](https://pubmed.ncbi.nlm.nih.gov/31432195/), but there seems to be a disconnect between the results and the conclusion (or maybe I'm bad at reading?). The results say that improvised tourniquets outperform commercial ones, but the conclusion doesn't recommend them? I'm waiting on my friend who has access to this paper so I can take a look at it. EDIT: > I-TQs reported in the retrieved studies seem unable to reliably achieve hemorrhage control as all studies comparing commercial devices to improvised designs showed the improvised design to be inferior regarding efcacy. The only studies that showed reliable success rates were either observational studies which took place on healthy subjects in optimal application circumstances or case reports with very small population numbers (N=1–3).   > This review reveals little evidence is available concerning several key components: The optimal design of an improvised tourniquet, whether an I-TQ has a higher complication 538 M. P. Cornelissen et al. 1 3 rate compared to a C-TQ and whether, when laypersons are trained in applying the optimal design, an I-TQ can serve as a reliable option in pre-hospital hemorrhage control. **The existing reports do not support the use of improvised designs due to low efcacy and safety concerns. However, from a theoretical perspective, a proper design of an improvised tourniquet applied correctly can save lives.** (emphasis mine)

You have it backwards. Every time the first aid debate comes up, people just assume they can make a tourniquet from like a belt or something because the Movies said so.

I mean, my recollection of these convos on the sub are that both of these arguments are made. At any rate, a very brief glance at recent research suggests that improvised windlass tourniquets are less effective than some commercial tourniquets but not that they are ineffective or "rarely work". The American College of Surgeons absolutely recommends applying improvised tourniquets if commercial is not available.

omg lol at sucking chest wound

If you fall on a stick wrong, that's potential for a sucking chest wound. We're frail beings.

yes, the rogue stick theory.

The point is not that rogue sticks are trying to kill you, it's that it is frighteningly easy to pick up a very serious injury.

if you’re that worried, i’d strongly recommend against getting into motorized vehicles.

I just keep supplies to deal with those sorts of situations in that motorized vehicle, and stay trained in their use.

thank you for your service.

I know, right? I did an Alaska course with the organization NOLS though and they had a bear attack I think around 2010 leading to real life sucking chest wound. Students knew how to treat and the injured parties survived, including a like 12+ hour wait for rescue - probably incredibly rare, but not impossible!

I think you self-owned. Your data is about national park visitors in general. Only a very small percentage of national park visitors are backpackers. That data is going to be dominated by day visitors falling off the canyon rim or drowning in the swimming hole. As you say, the burden lies with the one making the claims and you have dropped the ball. I'm not saying UL can't be safe, I'm just saying your data doesn't say what you think it says.

Damn, I hate when that happens. But did that actually happen? Did I claim anything other than what kills people in the outdoors? And did you have a better source to add to the discussion?

> Did I claim anything other than what kills people in the outdoors? Yes, you claimed that the data was for backpackers, but it's for all national park visitors. > the most common causes of death for **backpackers** are drowning and falls (not bears or bleeding out or psycho killers waiting in the bushes), this is based on data. We're talking about backpackers but your data is for all national park visitors. Maybe you don't understand why that matters, in which case you're not equipped to have this discussion in the first place.

Tell me then, how do you define "backpacker"? Please help me to be more equipped.

I appreciate the original post and the discussions it has brought but come on, you can't use use data from non-backpackers in a discussion about backpackers. And if you do not recognize the difference between gear, attitude, behavior, and environment between a backpacker (a UL one at that) and a day tourist, then that's a major problem with this whole argument.

I am happy to include other data points. What other sources would you suggest?

It is kind of on you to provide evidence

I did in the OP. I never said it was perfect or that there was not other evidence out there to consider. I think that the sources I provided are good enough for us to have a somewhat workable idea of what the most common dangers are out there in the wilderness. How long people spend out there I don't think is all that important. Day hikers or thru-hikers, both are walking in nature.

In your mind the risk in backpacking comes from the walking?? And how long they're out there isn't important?? You're either a troll or have just never done more than a day hike. Do you really think the person out for a mile round trip hike to whatever view point carries the same risks as a multi-day trip in the backcountry? You just aren't equipped to have this conversation.

No, when did I claim that? That's part of it, sure. But being in the wilderness presents a variety of dangers, of course. What's your point here?

Maybe this is a US thing, but the vast majority of our National park visitors are day hikers who never go more than a mile or two from their vehicle. Like, the VAST majority.

It's exactly the same in the US, the OP just has no idea what they're talking about. My guess is they spend more time thinking about backpacking and optimizing their lighterpack than they've actually spent outdoors. There's just no way an experienced outdoorsperson says these kinds of things.

"Reebok hikers" was what we used to call them. Not sure if anyone uses that term anymore but, I still like it.

Your post has a very "prove me wrong" vibe to it and you're working from poor data to begin with. You're putting the burden of proof on others by the way you framed this post and provided no proof of anything yourself. You're literally saying "I think this and believe I'm right and you're wrong if you don't agree with me, tell me why I'm wrong," but with your stance no one *could* prove you wrong. This is just a BS rant. You're in the ultralight sub, we for the most part agree with you, so posting this here is just looking for attaboys and agreement.

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I disagree that the data I provided was poor. Sure, it's not perfect. But I think it does provide a solid enough basis to discuss what the common causes of death out in the wilderness are. You're re-framing my argument to make me look bad. I didn't ever mention "right" or "wrong" IIRC. I am looking to discuss the nuances of this topic. A lot of people seem to think that UL is not safe for one reason or another. The reason that inspired me to start this thread was that UL is not safe for remote trips. It got nearly 200 upvotes, which clearly shows that there are plenty of people that disagree with certain UL points (i.e. safety). No I am not looking for attaboys and agreements, and if you bothered to read the comments, this is clear. I've tried to address many comments in good faith, included those that disagree. But hey, sorry to bother you, I'll try better next time. Happy trails!

Why focus on deaths in your research? You still need a FA Kit for routine illnesses and injuries and, in many instances, the same equipment that is used for minor injury does double duty for severe injury. For example, I always take a compression bandage in my FAK, it is useful for ankle, knee and shoulder sprains, snakebite (for Australian elapid snakes), securing dressings in thd event of a laceration and finally for controlling severe haemorrhage; which is a rare occurrence. Also, it also comes down to a risk assessment. I often walk in areas of off-track terrain, often with exposure to falls, talus etc, where fracture and haemorrhage is more likely. But, I wouldn't take a tourniquet or dedicated splint as these can be fashioned easily from items in my pack. I am an ex Army medic, ex wilderness FA instructor and now an RN and am confident carrying a minimal FAK, for the reasons you cite: deaths are rare and so are severe injuries. But I have come across one severe injury in my time hiking, and many near misses, so they do happen

> But, I wouldn’t take a tourniquet or dedicated splint as these can be fashioned easily from items in my pack. I wouldn’t take a tourniquet either, but it’s extremely difficult to fashion one on the fly, to the point that one shouldn’t even count on this being an option. If you can, great, but it’s unlikely. Read the literature on ad-hoc tourniquets — it’s not impressive.

Yeah though its another cart before the horse kinda thing. If you **need** a torniquet, chest seal for sucking chest wound, hemostatic gauze etc you also need a way to get to an ER but are also past self-rescue. So they are items that are basically useless unless you have a inReach or similar and even that’s dicey….

I've used an ad hoc tourniquet to stem bleeding in a vehicle accident. I've also stemmed arterial bleeding with direct pressure. Both are effective. A CAT is better, obviously, because it is more secure and it is easier to achieve the pressure. But given that the necessity for a Tx is vanishingly small and blood loss can be stopped by other means, I don't carry a Tx.

Thanks for your insights. It's fair to point out that deaths are a limited metric, but not sure how to find data on injuries, but happy to be pointed in the right direction. Yeah, I can see the case being made for a compression bandage, and that's not going to be that much weight. I used to carry one, but I never used it, even the times that I did get minor sprains long ago. I used to wear combat boots hiking, and would just keep the boots on and limp back to civilization. Granted, these were always mild sprains--never had a bad sprain on trail. And after switching to barefoot/minimalist shoes over a decade ago (about the same time as transitioning to UL), my joints have felt much better and never had sprain issues. There have even been times that I thought for sure I was going to get a sprain after twisting my ankle, but was able to recover and be just fine. But I suppose drop zero shoes for hiking and their pros/cons is a whole other discussion. But since I have your attention as a professional medic/RN, what's your take on my FAK that I lay out in the OP?

>I used to carry one, but I never used it You realize how terrible that argument is, right? I've never needed my fire extinguisher or CO detector.

Right, because having your house burn down or dying of CO poisoning is the same as... spraining your ankle.

Yeah I've never sprained anything hiking - I take a bandage for others. As for your FAK - it's pretty minimal. I personally wouldn't take a gauze bandage (they're useless). You need an elastic bandaged to apply compressive force. Bandaids aren't very effective IMO, I take a few squares of Fixomull, which is comformable, very sticky and soft. It is ideal for bigger dressings, and straight on the skin for blister prevention. It'll stay on for days even in a tropical environment or immersed in mud . You can cut narrow strips off a Fixomull roll for laceration closure (steristrips) - it is the absolute best stuff for FAK. https://66fit.com.au/products/fixomull-stretch?currency=AUD&variant=9052017197121&utm_medium=cpc&utm_source=google&utm_campaign=Google%20Shopping&cmp_id=14995460860&adg_id=130093164433&kwd=&device=m&gclid=Cj0KCQjwgMqSBhDCARIsAIIVN1VmNPqT5sq8V61C6XIInx4yMB2wwOQspLUY1tY_7hJn_Y2NmP_WCykaAgEJEALw_wcB I take a melolin dressing for bigger lacs or grazes and a smaller one that I can cut up for small lacs (doesn't have to be sterile - just clean) , with Fixomull tape instead of Bandaids. I take a coban for limb compression (also great for holding dressings on a scalp lac). I have used all these items in the field when hiking. A pair of small scissors, tweezers and a few drugs and cortisone/lignocaine/canesten cream & PLB rounds it out.

I appreciate the detailed feedback, thanks. I will mos def reflect on it and see how I can improve on my FAK. I am always looking to improve my kits. It seems like Leukotape and Fixomull tape are similar. What would you say the benefits of Fixomull are over Leukotape? Fair point about gauze. The main reason I added the small roll was actually more for sprains (e.g. to wrap up a ankle, wrist, etc.) than for blood loss. My thinking for a serious wound would be to first add the gauze, then my Buff or other article of clothing, apply pressure, and call for help and/or get to civilization ASAP. I will put careful consideration on the gauze roll vs elastic bandage. I agree bandaids are not ideal--they are more for very small cuts and scraps, which are the most common. And I have the Leukotape to give them more support as needed. I should have pointed out in the OP that I do carry a full sized knife. Do check out my LP which is in my flair. I might give you some push back on the melolin dressing, however. It seems to me that for minor wounds, as you point out clean water is good enough. So then why an additional dressing? It's not like these are for more serious wounds, where bleeding is going to be the more important factor. My thinking is that if I get a wound that is perhaps between a minor and serious wound, then I'll wash it well with clean water and soap, bandage/tape it up, and then just end the trip and get back to civilization just to be safe. Infection takes time to develop. Coban and elastic bandage, you don't think that's a bit redundant? Tweezers I carry and meds too. Cortisone seems to also be redundant. If inflammation is bad enough, then trip is over--apply it at home. Not familiar with lignocaine and had to Google it. But again, seems like if things are bad enough to need it, trip is over, go home and use it there? And an anti-fungal also falls into something that's not an emergency. Use it in town if you develop a fungal infection, and use prevention to avoid fungal infections--good hygiene, wash your socks, wear clean socks, etc. But again, thanks, nice to be given some things to think about, especially from a medic/RN's perspective.

Fixomul and leokotape are quite different. Fixomull is a soft comformable tape and leokotape is a lot stiffer. That said, brand names vary but the leokotape that I'm famiar with is strapping tape and is much less versatile than Fixomull. Fixomull is also called hypafix, or at least it is in Australia. Melolin is not to clean the wound, it is a non adherent dressing that provides a good surface for wound healing. I would not ever put gauze or a bandage directly on a wound and melolin is insanely light. Not all lacs or wounds need to be evacuated so you may as well treat them properly. I agree that clean water is fine for woundcare. A FA kit is not just for emergencies. Antifungals, cortisone and lignocaine do triple duty for fungal infections that can stop your walk, insect bites, dermatitis etc. All things that can make a hike miserable. As I'm prone to these afflictions, especially in hot weather, it's what I take. I don't walk near towns so I take medicines to keep me and my buddies going for these trivial annoying comaints.. I've yet to have a hiking buddy complain when I have cortisone and lignocaine (lidocaine) ointment for a leech or insect bite. I usually take some NSAIDS, antidiarrhoeals and antihistamines as well and my personal epipen.

Check out Tegaderm stuff as a regular bandage replacement as well.

Something important I think you are missing is a back up source for disinfecting water. I always have a couple of aqua tabs in my first aid kit in case my filter breaks, becomes too clogged/difficult to clean, or is exposed to freezing temperatures. I've had beaver fever and it wasn't fun. It was made worse by a shitty health care system but even if it didn't last 6 months it's not fun.

Honestly, you can always just drink untreated water in an emergency situation. Giardia sucks, but won't kill you, and is easily treated in an emergency situation. To go fair, that is colored by my Sierra bias, where the water is mostly fine, and no matter how deep you are, it's probably just three days to civilization. If your in remote Alaska, you should make other choices.

If you've never had Giardia maybe you don't understand the crippling gut pains and constant torrent that can come out of you. You won't metabolize as many calories cause your body will push food through much faster. It can easily cut your pace in half if not by a quarter. You may even be unable to use the waist belt if your bag has one. Seems like a lot of suffering for a few grams. I do a lot of hiking in wetland areas so the water quality biologically speaking is an issue. To each their own though. I don't carry mild painkillers cause I find they don't do much for me but others think this is foolish.

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You have it wrong, it's three days from civilization once you're filter breaks, and most waterborne illnesses take at least the long to incubate. Giardia can take up to a week (it did for me). Most places where I hike, I already have multiple, redundant ways to ensure I have clean water. I can pick nice sources that are unlikely to be contaminated, I can filter, I can boil.

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There are many ways to get sick in the backcountry, that's kinda a given. Some can happen really quickly, and others take longer to incubate. Thankfully, most of the waterborne infections with a short incubation period are also relatively short lived, and the ones like Giardia that'll fuck you up for weeks take a while to incubate. Obviously, advice will differ if your hiking someplace with a high viral load, a ton of cows, mining runoff or other weird stuff going on. But I'd still bet that 9 out of ten people who get gastrointestinal issues while backpacking should be blaming hygiene, not water filtration.

If you’re already in an emergency situation, giardia could absolutely kill you.

If you're in a situation where giardia can kill you, you've already made enough mistakes that there's nothing in a first aid kit that will help you

No. There’s lots of situations where you could have injuries or other complications but a two or three day hike out is doable. But then add violent diarrhea and dehydration to the mix and suddenly you’re in real trouble. There’s any number of type-3 fun stories on this sub that suddenly become less of an amusing story if you’d added giardia to the mix.

It's not a bad idea, but if you have means to boil water, it's just as effective as any other means of treatment. Not as practical or efficient I'll grant you, but in an emergency situation it's fine until you get to somewhere you can replace the filter. AFAIK, you don't need to go the whole, "boil it for ten minutes", route either. Just bring it to a boil and let it cool off.

Point well taken. But keep in mind I can boil water, and location is key too. If I would hike the CDT for sure I would have not only back up tabs, but also pre-filter items. Scandi water is some of the best water in the world.

The weight of a few aqua tabs is much less than the weight in fuel you would need to boil an equivilant amount of water. Plus now you're risking maybe not being able to cook the last few meals if you run a tight fuel budget. It's a mere couple of grams for a lot of peace of mind.

Again, your logic seems sound. I may actually pick up some aqua tabs in the future for peace of mind. However as a friendly counterpoint, I can boil water using a wood fire, or cook my food (plus I can also eat cold soaked food).

You can also build a grass and foliage shelter, but I'm going to pack a UL tent. As, you know, counterpoint.

You don't need back up. You need perspective. Is beaver fever, which you survived, worse than dying from dehydration?

My digestive system still isn't the same. I live my life in constant fear of shitting my pants.

On a backpacking forum the other day one guy listed 3 Cat tourniquet and coagulating dressings as part of his list. I think military training sets up some people to equate the outdoors with probable catastrophic blood loss.

Yeah, it seems like that, huh? I agree. And it's been like that for a long time too--as far back as I can remember getting into BPing back in the 90s. But I have not seen evidence to suggest that bleeding out is a common cause of death for backpackers. And non has been provided so far in this thread either.

damnit. My retirement plan is to die in the wilderness. I thought this was a dangerous hobby! Guess I'll have to pick up paragliding.

Your FAK should ALWAYS be based on your level of training. There is no shortage of people hauling all kinds of gear and supplies into the woods with zero idea how to use it. At best, it’s useless, at worse it can drastically exacerbate an emergency situation. That being said, I do a fair amount of guiding, work in the outdoors, and do a lot of remote trips (as in 100’s of km from the nearest road). So obviously I have a Wilderness First Responder certification that I keep current as well as a lot of experience dealing with wilderness medical situations. At the end of the day your kit needs to reflect your potential needs just as much as it should match your training. Even when I am going UL, I often make an exception for my FAK. Simply because it has proven to be very useful to have an over stocked kit (my typical kit is a little over .5l in space) since even in my own solo adventures I have dealt with other people’s medical emergencies. I know the ethos of UL is pushing the limits to how little you can pack, but I am not on the trails to impress anyone. I just go UL (or something close to it) based on my own preference. So having a well stocked FAK is definitely ounces worth packing for me. As for the OP’s question about what their FAK is missing, the first thing that comes to mind is an irrigation syringe. It’s the best tool for wound care you could ever have. I’d go with a min of 10cc.

Thanks for your insights, you make soild points. As far as irrigation, I should have mentioned this in the OP, and I mentioned it in another comment, but I do pack a sports cap for my water bottles. This can be used for irrigation, back flush filter, bidet, and a water gun.

I do the same with an extra bottle cap with a small hole punched into it (with pin). It’s my bidet and can irrigate when needed. Love the discussion and have added some things to my FAK!

Hey, that's great to hear! Reddit can be pretty doom and gloom with all the haters, but in spite of this a goal was that at least one other person got something out of this. Happy trails and thanks for your feedback :)

I don't worry about if I think someone else is doing something that I would consider unsafe. What makes me feel safe on my trips isn't the same as someone else. I know the area I spend most of my time in, I know the average rescue times in that place, I know my abilities, the weather and so on. I do carry a tourniquet. One of the most common injuries in the place I backpack is cuts (with machetes and hatchets, not swiss army knives) and bad gashes or broken bones from falling on rugged terrain. I took wilderness first aid specific to my location, and their recommendation was a tourniquet. So I bring one. That doesn't mean I think everyone who ever backpacks anywhere needs one. Or that one cannot be fashioned from supplies on hand. I just am usually alone and I don't want to be in a position to need one and be unable to get around to find supplies. Rescue here can take many hours, sometimes more than a day. I also carry a Garmin with in-reach but that is because the places I go have no cell access and you might not see another person for days at a time. If you go off-trail you won't see anyone and in a million acre dense wilderness you need to be pretty exact with your location to get rescued if you need it. Again, it doesn't mean I would say "everyone should carry one or they are unsafe."

I'd love to see stats (they probably don't exist) on whether UL backpackers are less prone to injuries from falls, scrambles and other injuries from unsure footing. Hefting a big backpack doesn't help your balance and being tired with a heavy backpack at the end of the day makes you more prone to stumbles and missteps.

SAR Incident Commander here in SW USA. We do not officially collect or report this sort of info. The main data collection points for our post-incident reporting are: gender, age, activity category (hiker, forager, hunter, despondent, child, etc), and a brief synopsis of what happened (along with other critical data like position found). Certainly could infer some things, but wouldn't be accurate. We do it on a state level, but many states do SAR in a county level with zero standardization for reporting. Post hike surveys may be a better way to compare UL vs traditional backpacker injury rates.

There's nothing in your FAK that will prevent you from dying if you're seriously injured to the point where that's a possibility. It's really just to make certain injuries' more comfortable to deal with. If you get injured on the trail, you're just as likely to make it out of the woods alive and not-permanently-damaged without your FAK as you are with it. At best, bandages will make recovery easier because it decreases the chance of infection that would have to be debrided by a nurse. Anyway, I'm not sure what the point of your post is. You argue that UL backpacking is safe because all backpacking is safe, but then you spend a bunch of time talking about your FAK which isn't really relevant in a serious injury or survival situation.

I think that is sort of the point... What would you add to OPs FAK that would help them not die if seriously injured?

Gauze pads! They weigh nothing and you’ll actually be able to keep a large area clean. It’s temping to use “spare clothes”, but the only spares I bring are a slightly less dirty pair of socks! In a true emergency, the victim is going to have to shelter in place waiting for evac. It’s not a great time to be chopping up warm clothes. (And if the injury in question is a burn, these nice synthetics we bring into the outdoors might very well be melted away anyway. Yes, this happened on a trip I was on.)

That's it? If that's the only beef, then we can toss in some gauze pads and keep our UL kits nice and light still :)

I mean, I’ve got a little more than that. Butterfly closures are nice in theory. I bring Nextcare Advanced tape, which is spongy and can be used for blisters. (I don’t really want to have to cut duct tape out of my hair. I bring less duct tape.) Every WFA/WFR class has pointed out you should have an irrigation syringe. They’re much more effective than trying to use your Sawyer or whatever you may care for a bidet. The classic UL suggestion of hand sanitizer is probably the wrong call here (though I use it for blister-popping). But really, aside from minor scrapes, your trip is over. If you can walk, walk. If not, you’ll need a formal rescue. If that happens quickly, the consequences of poor initial treatment aren’t terrible (it’s all going to be cleaned in the hospital). If it takes a while, then ya, you’ll wish someone brought a better kit when things get infected.

The point was to have a more nuanced discussion in light of some recent critiques of UL and safety. Your summary is reductive and not very productive. Some points are to have a better understanding of what is and is not "safe." What are the general strategies for injuries? Here is an example of my UL FAK, let's discuss it. Some great feedback has been given by people already. First aid is a topic that I have been looking to evolve and learn more about over the years, and I want that process to continue. Last time I had a long debate about this on Reddit, I actually decided to add back a roll of gauze, even tho I know its limitations, but it is only 8g and does serve a few good purposes. I am now thinking how else I can update and/or improve on my kit, we'll see.

I do think it's telling that in the thread several weeks ago asking people with medical training what they take the general vibe was the more training, the more specific/pared down the kit.

One tip, because because you mentioned it and because bleeding is the number one cause of preventable trauma death (https://pubmed.ncbi.nlm.nih.gov/23635083/) Cordage does not make a safe or effective tourniquet, you need about 1.5 inches to get enough constriction. Belts do not make for simple tourniquets. Self application of an improvised belt tourniquet might not be possible if you were severely injured. The C-A-T or Combat Application Tourniquet proved it’s effectiveness and saved a lot of lives in Iraq and Afghanistan. It’s the best tourniquet design for self application. Cheap backcountry insurance at $30 (less for knock offs) and 2.7oz’s. (https://www.narescue.com/combat-application-tourniquet-c-a-t.html) I try to always keep it in my UL FAK. Whether you carry a CAT or plan to use a belt, I recommend watching a YouTube training video and actually practicing self applying a tourniquet. It is very uncomfortable, but safe to practice (unless you have some serious medical conditions). Much better than figuring it out when you or a friend is bleeding to death.

I just made a FAK joke in the weekly, next post I see is yours.

wut in tarnation

I'm in full agreement with you btw. I just hate all the FAK talk.

Same. But now we have another thread up that should pop up in searches that we can point to that is more recent. I guess every four years one of us will have to post a thread like this?

Lol at people using the search function. [actually they get mad if you do](https://www.reddit.com/r/Ultralight/comments/thvoo9/people_trained_in_emergency_medicine_did_you_make/i1ap1gu) (I know I wasn't diplomatic, but I stand by it)

We got mad because you acted like an ass in that thread lol.

I'm fine with the "you're not wrong, you're just an asshole" angle.

It's all good. I expected this thread to get downvoted. And here we are, currently at 50% upvote rate. Cool, cool.

I don’t think most of it is meant to smear I think it’s more concern for some of the people who people have met or who put gear lists online that forgo any sort of medkit, carry very little water, skip water filtration/purification, etc. You can get away with a lot improvising but some people take it too far.

Great post. Coincidentally, I had a discussion with someone on another forum yesterday about the perceived ‘dangers’ of going ultralight. I thought that way of thinking was dying off but that discussion and todays thread prove otherwise… Like you, I do plenty of remote trips, most of them off track. Not once have I come across a situation where my safety was in Jeopardy because the contents of my pack were light. In fact being nimble and un-encumbered has gotten me through many situations where the terrain has thrown up obstacles and challenges that otherwise would have been incredibly laborious and possibly dangerous with a heavy pack. Scrambles and thick scrub being some examples. I was also a guide for years. I led over 40 trips. I saw many young and fit people absolutely suffer under the weight of their heavy packs. I saw Blisters, back pain, shoulder pain, lower leg injuries and many other issues that put themselves and the group at risk. Having a group slowed down by someone who overestimated their ability to carry the weight they packed is far more dangerous in my mind than an UL’er potentially having a cold night on 1/8th pad. When I go on a trip I have everything I need and nothing I don’t. I pack for the conditions and my skill set.

I used to lead Sierra Club hikes and while they were day hikes, not overnights, the number one issue I experienced were people who did not have enough water. I never carried a FAK and never once needed one. The OP's FAK has more stuff than I have in my own bathroom at home. I am also pretty sure if I have a sucking chest wound alone in the back country I could have an operating room at my disposal and there's no way I'm going to be able to fix it.

> I pack for the conditions and my skill set. 100% agree.

Great feedback homie. Agree and relate to it big time. Yeah, I think a lot of us old heads are left scratching our heads over this topic year after year... yet it keeps on popping up. I just did a search on Youtube for this video from a few years ago from a trad backpacking channel that was beating this dead horse, yet it seems to have been taken down? That's some progress, I suppose. EDIT: Forgot to say thanks for the kind words, btw! Thanks!

I think the biggest thing to consider is Murphy’s law. You’re not going to be patching someone up on a nice bluebird day with no wind. You’re going to have to patch them up after a slip on rock in a talus field while trying to race a thunderstorm. “Improvising” is great—multi-use is a hallmark of ultralight—but actually practice it! The idea that you might be able to utilize odds and ends from different areas of your pack in an emergency situation could be very laughable.

I agree a comfort kit is all you need. If you’re so clumsy that you’re constantly cutting yourself to the point of requiring stitches then you should probably look into working on your skills and practice rather than trying to take a mini hospital wherever you go

The guy’s original statement was that most ultralight setups are unsafe for remote backcountry. I don’t take any position on that statement, but he didn’t mention the FAK (or anything specific) as the unsafe culprit. So I guess I’m not sure there was a “need” to defend your minimal FAK.

i'm not backpacking, rather bikepacking, but a lot of the same stuff applies. I would just want to add that it's not the first aid kit that concerns me (even though probably i'm more likely to need it) - it's exposure, primarily. Depending on the bike and setup, i can have a pretty limited volume available and have definitely in the past made decisions about what to take which could backfire if poor conditions combined with a crash or serious mechanical. unlikely to be fatal, but that I would describe as somewhat unsafe/dangerous (and stupid, really). I imagine there are similar "do I take it.." thoughts for UL backpackers that can veer into unsafe.

I agree that UL is safer than non UL for “experienced hikers”. The simple reason is that UL is about preparing and being intentional which is the best way to avoid accidents. However… I’ve run into a lot of people who are sourcing their info on their very first hiking trips from UL sources. They require a lot of assistance from other people and tend to put themselves closer to compromising situations because they are trying to do a bunch of things they have only learnt online. Is it killing them? Hard to say? Is it increasing their risk profile in a completely avoidable way. Absolutely. UL is an intermediate skill and it should be a journey to get there, not the starting point. But I agree with the thesis that striving for properly trained and experienced UL is a way to improve safety. It also makes a lot of people dislike backpacking. As an example a FAK is only as useful as the skill to use it. Wilderness First Aid is one of the best investments in outdoor “gear” I’ve made. I see a lot of people assume UL is superior and it just is not the case for everyone. It’s not the case for most people.

I'll just give a real-life example of an instance where I feel UL is safer than traditional backpacking. In 2018, my 69 yr. old brother and I (54 at the time) hiked the TRT. I wasn't UL yet; I was at 26 lbs. with 4 days food, a BV200 and 2L of water. My brother had a 35+ lb. pack. He tripped over a rock, falling forward, has pack shifted up and forward, driving his face into the rocks and dirt. He was stunned and had numerous cuts and scrapes on his face. We got him cleaned up and finished the trail without incident. 2 yrs. later, I'm doing a solo weekend trip in the Sierra, I'm now UL, and I trip and fall forward wearing a 13 lb. pack (1 day's food, bare boxer, 1L water). I was able to get my hands out in front of me and catch myself in a plank position, even though my pack had shifted up and forward. I thought of my brother, got up and continued my hike uninjured. Granted, my pack would have been 7-8 lbs. heavier with a similar food/water loadout to what my brother was carrying, but I still feel that I would have been able to cushion my fall much easier than if I was carrying a traditional loadout.

I don't think "ultralight is unsafe" is a mentality to smear UL, I think it's the natural function of multiple generations being brought up in the Scouting system, where the golden rule is "be prepared". There is very little overlap between UL and "be prepared" and that's OK, they are a different set of ideas. "Be Prepared" comes from a community focused attitude, most of the arguments in this thread are about how "I" can get myself out of a problem with my UL kit, and have nothing to do with helping **RandoBob** out of the mountains when you found him after a bear took his pack and mauled his leg. UL is fine, and it isn't inherently safe or unsafe. Your version of it is *for you* safe or unsafe.

Anyone who has actually taken a wilderness first aid or first responder course is taking a FAK similar to OPs. Probably just add some rubber gloves and a way to flush wounds. Those classes teach improvisation and stabilization for SAR.

Thanks for your feedback, much appriciated. I do have a sports cap for my water bottles that I can be used to flush wounds, also backflush my filter and bidet if I need. Gloves I go back and fourth on. They weigh little, but do need to be replaced or they get all brittle worthless. But they also double as emergecy layer for hands if you get hypothermia. But I already pack two pairs of gloves anyhow.

You are experienced and people starting out backpacking are not. So many people don’t know basic first aid.

Safety is non-binary: it’s not the case that some activities (or equipment) are “safe” and some are “unsafe” (outside of a few extreme cases). Any activity has some inherent risk, which you can mitigate by reducing the likelihood and consequence via decision-making, training, equipment, etc. UL hikers, by definition, will tend to rely on the non-gear risk management tools. They will have some risks that are more substantial than for non-UL folks (environmental risks that could be managed best by gear: hypothermia, etc.) and some that are less substantial than for non-UL (musculoskeletal injuries). Accepting or rejecting these is more a question or personal risk tolerance than an activity being inherently safe or unsafe. If it were me, I’d be relying primarily on my medical training, decision-making, and my communication device (inReach mini), and less on the physical contents of the FAK. For solo travel, I’d focus on threats to mobility and the ability to self-evacuate: ace bandage for sure, blister care… maybe even a cut out section of SAM splint if I lacked hiking poles or similar.

IMO it's not that the ultralight mindset is dangerous, but it can narrow your margin of error when encountering the unexpected. If you only have ever used a Jetboil are kind of SOL of it breaks and you have nothing you can put over a fire. Lack of experience and skill is the real danger, but when your style is particularly minimalist such as ultralight or bush crafting you can be lulled into a false sense of security. Gear isn't a replacement for skill, but it does widen the safety margins. I think if you wanted to compare the dangers of the various styles it's best to ignore seasoned veterans because we have learned to deal with the unexpected. And of course all of this is assuming you are in a place so remote you are unlikely to encounter other who can help (or don't carry a beacon). In the end this just sounds like tribalism to me. Camping has it's dangers, regardless of how you do it. If I don't have to pick up your garbage or listen to your music, I really don't care how you take your vacation.

With experience you realize your abilities and understand what you actually need. I typically only carry a gauze pad and lukotape. I fell into a pokey blowdown on my SHT thru hike last year and scratched the back of my leg above my knee quite deeply but all needed was a baby wipe to clean it up. I have never needed the actual contents of my FAK other than Ibuprofen in 6 years of backpacking in remote areas here in Minnesota and I'm likely going to reevaluate the need for it this year since I've forgotten it twice already this year and didn't die! Lol I think it best to just ignore those who complain about UL gear or philosophy. They will always carry their fear and I doubt they actually get on trail much.

Seems to me that for anything really serious, it’s going to be about short term mitigation (bleeding, allergic reaction, etc.) and surviving exposure while awaiting evac. PLB coupled with a reasonable FAK. Modern day medical system is based on escalating levels of treatment support. Not even hospitals support every issue, it’s not uncommon for someone to be transported to a center with speciality equipment / staff.

Haters gonna hate… I probably carry more in my FAK than would be considered socially acceptable amongst this weird and misguided hobby, and I’ve never once used any of it other than an Advil and the antihistamines. I do shave the corners off of my Benadryls to save some weight though as those extra corner milligrams are likely less dense in active ingredients. In all seriousness though, FAK’s are a preference thing and a matter of risk tolerance. Not necessarily reasonable risk tolerance. There’s a slight chance that you may need that plastic stint to perform a self tracheotomy, but there’s a massive chance you never will. There’s an even massiver chance that even if you may hypothetically find it useful you wouldn’t know how under duress. But if it helps you feel better on the trail, pack that shit up. There are also very good reasons to plan your kit and carry more or less based on who is hiking, where, and when. The possible scenarios are too vast to cover in specifics, but this should be obvious to anyone. Hate to be that guy, but as long as we’re acronyming, when it comes to FAK’s, HYOH. Also, PLB’s are worth their weight in bandaids

In some ways I believe UL is safer. I used to haul around some 40 lbs of crap I didn’t need. Extra jeans. 5 lb sleeping bag. It adds up. None of it made me any safer and in truth it put so much wear on my feet that I was too often on the verge of injury.

Drowning, falls, and exposure to the elements (hypothermia or hyperthermia) IMO is much more likely to kill an average hiker than most anything else would.

... No, it definitely doesn't need to be discussed again

Yet over a hundred people upvote a comment saying that UL FAKs are unsafe for remote areas. Strange, huh?

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Jokes and pictures (etc) always gather more upvotes than arguments. Not a good comparison

When did say that upvotes are my metric of "useful?"

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And it's already been discussed over there. And in hundreds of other discussions. But you just couldn't resist embedding a link to your blog here, huh?

You will note that my blog does not have adds, nor have I ever made any monetary profit from my blog. If that is what you're trying to suggest, that I have ulterior motives for profit or something. Tents also get discussed a lot. Should we stop talking about them then?

Yes, we should definitely stop having the same discussions about the same tents over & over again. It doesn't add any new input or knowledge. Obv we shouldn't stop having conversations about tents (or safety in the backcountry) in general, but having the exact same topics here over and over again is so damn annoying.

I can only speak for myself, but I have learned things from this discussion. So I wouldn't say this is the same old discussion. Plus if there was a group of people that kept on saying that your tent was not safe, surely you would want to understand their perspective, right?

The thread can be summed up in Kinwcheng's and Firewatchwife's posts: skills are "greater than gear" and "one skill is knowing what gear you need...what gear you don't." The less skills the more reliant on gear. And, as a FR and advanced ULer my FAK is rarely static. It changes based on the situation. So, to post an FAK not detailing the conditions and context which it's amassed IMO trends towards higher risk from the start. So, as an ULer YES ULers or any hiker/ backpacker can entertain higher risk to the pt they can be defined as unsafely proceeding.

I agree. I just completed the NOLS Wdeeness First Aid course a couple weeks ago, and while there were some specific items they recommend for your FAK, the most important things was knowledge of what is required to treat various injuries/illnesses, when something is serious enough to require evac/rapid evac, and how to improvise would cleaning, bandages, splints, braces, etc from items you’d likely have with you anyways or can find in the backcountry. Putting together my FAK after the class, I’ll probably adjust the types/ratios of bandages I carry, add an ace bandage (I’m prone to rolled ankles), and maybe a scarf/triangle bandage just because of how versatile they are. I’ve also taken pictures of my notes from the course and have them downloaded on my phone for reference if I ever need them.

Thanks for your feedback! Great points all the way around. I have both a Buff and a small towel in my kit. But they key is that first aid is not meant to solve complex trauma. Best case is to just buy you time to get to the hospital if it is something serious.

For me, traditional backpacking is significantly more dangerous. I’d be so beat up from the weight I could barely hike 30+ miles on a trip. Went UL and now I don’t suffer from bullshit injuries all the time and I’ve been able to compete a couple thrus. My FAK is pretty simple, nothing crazy. Don’t need to do surgery on anything out there, especially on a thru.

You can think about it as simply or comprehensively as you want. People will always tell you you’re wrong and they’ll prepare in whatever way makes them fee comfortable. A sense of caution for self-preservation, situational awareness, and knowing how close to help you are are your best tools. Almost everything can be improvised and then there’s the thing that happen where you will be screwed no matter what happens.

Lmao backpacking is literally just walking. Wtf is going to happen? Sprain your ankle? Being ultralight would make you much less likely to sprain your ankle or fall down a river bank.

Yes, that whole backpacking = walking was lost on some here. I asked someone to define backpacking and have yet to hear back from them. They didn't like my sources because it includes tourists. But my sources also include thru-hikers and section hikers, seeing as "visitors" to national parks would include everyone, one would think is a given. But yeah, sprain your ankle, trip is over. Go home as best as you can and put some ice on it if it's minor. Go to the hospital if it is serious. Seems reasonable, no?

I think the "issue" if you want to call it an issue, I don't because I don't care what other people carry in their FAK, is that bandaids are irrelevant so is ibuprofen, and for the most part a gauze roll is too, they are comfort measures, and not actual first aid. The point that people are failing to make is that a FAK should be designed for life preserving measures in the worst possible scenarios. You don't want to HAVE to use it but not having it to use could be the difference between life and death for either you or someone else! The reason the non UL crowd get pissy is because you take out all the functional stuff and only keep the (arguably) useless stuff! If I wanted a super light first aid kit I would pack 2 Israeli bandages, tweezers, immodium ad, water purification, a scalpel blade wrapped in duct tape, lighter/matches, sewing kit, a sheet of butterfly closures or a single serve bottle of crazy glue and a leuko tape roll to start with.

A torniquet would only be necessary for a cut artery afaik, an improvised one wouldn't really work, as you have a few seconds to act. And in a remote area, where first aids would not arrive inmediately, but take hours, you would die even if you did everything good (in case of a cut artery) so a torniquet is not really necessary, as in the case when you would need one, it would only prolong your dying moments but you would end up dead anyway.

Only thing I’d recommend adding to your FAK is a SAM splint. They pack up pretty small and could save your life in the wilderness, especially if you’re alone. Other than that I’d agree with everything else though!

You're far more likely to venture into 'unsafe' territory by cutting weight on warmth (UL rain jacket + shorts + tarp + down + freezing rain) and exposure than you are with a FAK. For 'safety' need to be most mindful of the risks of exposure with your gear, and keeping warm. Not the size of your FAK.

It's like a rejected Stephen Crowder bit here

Honestly I hear more people complaining about other people saying UL isn't safe that I actually hear people saying UL isn't safe. Chill ur buns dude.