Climbers are naturally detail oriented. We compare carabiner weights, argue over gates in or gates out, and research beta down to which way to hold that crimp rail on the third pitch. This level of scrutiny, and the intention that goes into it, makes us more successful on our objectives and helps us manage risk. This is an article about first-aid kits, but let’s not dive right into what to include in a kit. Instead, let’s consider how to think about what you want to carry, and the answers may reveal themselves.

CONSIDER YOUR OBJECTIVE

We carry first-aid kits to mitigate risk. As climbers, whether placing gear or investigating a snowpack or practicing self-rescue, we learn about risks, consider them, and employ strategies to fit them into our own acceptable-risk paradigm. Packing a first-aid kit should be no different.

Risk is a product of probability and severity. The probability or likelihood that an event will come to pass is both objective and subjective. Rockfall risk in the alpine is fairly objective, though the likelihood might change depending on whether there are other climbers above you, time of day, season, etc. The risk of falling on a route is more subjective, and often depends largely upon the chosen objective and your individual skill, comfort, and strength. Severity is related to the outcome should the event in question occur. For example, the severity of being hit by rockfall is generally more significant than falling on top-rope.

The items in your first-aid kit can help you manage the severity of an event, while your good decisions up to that point will have the greatest effect on probability.

RISK/BENEFIT

It would be naive to believe that packing a first-aid kit for a climbing day has only benefits and no costs. Putting together a kit takes time, effort, and financial resources. Carrying a kit on a big climb or a long day in the alpine expends additional energy. If your kit is so large that it slows you down, it may even increase the likelihood of certain hazards.

Thus, the consideration of what to pack in a first-aid kit must include not only probability and severity of various events, but also the utility of each item in your kit. Put another way, the utility of the items is directly related to whether they can affect the eventual outcome of an incident. For example, you will need almost a full roll of one-inch athletic tape to properly tape an ankle, but being able to do so might allow you to self-evacuate in the backcountry, whereas without it you might be calling for help. Conversely, if you sprain an ankle at a roadside crag, you will be able to hobble back to the car regardless of whether you have the tape.

The severity/likelihood chart below lists some common first-aid and survival kit items and the rationale for carrying them. This graph is a good place to start when considering the risks and needs for your objectives. Note that fields for “not severe/ unlikely” and “severe/likely” have been omitted, as it stands to reason that events that are both inconsequential and unlikely do not need to be planned for, and that we rarely knowingly venture into environments where severe consequences are likely.

SEVERE – UNLIKELY

Extremity hemorrhage – tourniquet
Major catastrophe – inReach, phone, PLB
Unplanned night out – shelter, stove, waterpurification
Sprained ankle/broken bone – SAM splint, tape
Anaphylactic reaction – epinephrine

NOT SEVERE – LIKELY

Blister – tape, blister bandage
Splinter – tweezers
Sunburn – sunscreen/lip balm
Hangnail - fingernail clippers
Sore muscles – NSAIDs
Minor laceration – gauze
Cold hands – hand warmers

Another way to consider first-aid and survival kit contents is the PAWS acronym:

Prevention/Procedures knife, water purification tablets, athletic tape, lip balm/sunscreen
Analgesics/Antibiotics/Anaphylaxis – ibuprofen, acetaminophen, diphenhydramine, loperamide, antacid, bacitracin ointment, epinephrine
Wound Care – hemostatic gauze, blister bandage/tape, assorted gauze (2x2, 3x3, etc.), latex-free gloves, adhesive bandages, alcohol prep pad, antiseptic wipes

Survival – whistle, survival blanket, lighter, communication device

PRACTICAL DETAILS

*Every item on the lists above requires knowledge and experience to use. Wilderness medicine training will prepare you to anticipate risks and to react appropriately in an emergency.

*While your first-aid kit may help you stabilize a severe injury, the definitive action for most major accidents will be prompt evacuation to a hospital. Know which communication methods will work where you are going and plan ahead. Emergency devices that allow two-way communication will speed emergency response.

*Pack only what you’re willing to carry. Your kit doesn’t do you any good sitting in the car.

*Items expire, time takes its toll. Check your kit regularly to make sure it’s still functioning and still meets your needs.

Your first-aid kit is more than just tape and gloves. Pack it with intention and adapt it to each objective the same way you would the gear on your harness or the shoes on your feet.

Corey Winstead is a wilderness medicine instructor and physician assistant student living in Asheville, N.C. He is also the assistant chief of the Appalachian Mountain Rescue Team.