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Teaching Wilderness Medicine in the Khumbu

Monday, January 14th, 2019

Tragedy and Purpose

In September of 1999, legendary mountaineers Alex Lowe, Conrad Anker, and David Bridges traveled to Tibet with the goal to ski down the 8,103 m (26,291 ft.) Himalayan peak Shishapangma.  They were part of the 1999 American Shishapangma Ski Expedition. The goal was to be the first American team to ski from the summit of an 8,000 m peak.

Bridges, Anker, and Lowe (left to right)

Unfortunately, tragedy struck on October 5 as they were searching for a route up the mountain.  A large serac broke loose 1,800 m (6,000 ft.) above them, resulting in an avalanche striking all three of them.  Anker survived with multiple injuries, and immediately began attempts to locate and rescue his friends. With the help of others, Anker searched for his teammates for the next two days. Unfortunately, they were unable to locate Lowe and Bridges.

Lowe was survived by his wife Jennifer and their three sons.  Following this tragedy, Anker spent a great deal of time with Jennifer and her three sons.  During this time, the two fell in love and were married in 2001 (Jenni Lowe-Anker wrote more on this in a memoir, it is also discussed in the film documentary Meru).  Together they formed the Alex Lowe Charitable Foundation.  The Khumbu Climbing Center, or KCC, is a result of this foundation and where many of their efforts are focused.

The Khumbu Climbing Center

Located at around 3,960 m (13,000 ft.) in the Khumbu Valley, Phortse is a humble pastoral village that is home to generations of Sherpa climbers and to more Everest summiteers than anywhere else on earth.  Phortse lies off the traditional beaten path to Everest and is often overlooked, as it lies perched among the clouds resting in the shadows of the sacred Himalayan peaks. But if you look across the gaping gorge of the Dudh Kosi River as you ascend to the Tengboche Monastery, you will see a terraced knoll with stone structures scattered about.  It is there that the Khumbu Climbing Center found its home.

Khumbu Valley with Photse visible

Phortse (left mid flat area) with Everest, Lhotse, Nuptse, and Ama Dablam in background

The KCC was founded in 2003 with the mission statement “to increase the safety margin of Nepali climbers and high-altitude workers by encouraging responsible climbing practices in a supportive and community based program.” For 2 weeks each winter, technical climbing skills, English language, mountain safety, rescue skills, mountain geology, and wilderness first aid are taught to students.  Prior student experience ranges from novice climbers/porters to Everest veterans, and to even the famed “Ice Fall Doctors” who painstakingly and courageously find a way through the Khumbu Icefall each climbing season to open the path towards the sacred summit of Sagamartha (Nepali name for Everest).  To date, over 800 students have benefited from this annual vocational training aimed to improve both their quality of life through better employment opportunities and their ability to stay safe as they work high in the Himalayas.

In addition to the annual training that occurs, the KCC has also offered specialized courses over the years including advanced technical rescue and advanced mountain first aid.  The KCC is dedicated to the village of Phortse and over the past years and with countless help, has tirelessly worked to build a permanent building in Phortse.  This building, which is nearing completion, will serve as the home to the KCC and will allow for expanded instruction, will provide access to both visiting Nepali and international climbers year round, and will also serve as a community center, library, and medical clinic for Phortse.  It is but one way that the KCC demonstrates their dedication both to the Phortse and all high altitude workers of Nepal.

Discovery, Reunion, and Collaboration

On April 27, 2016, climbers Ueli Steck and David Göttler were on an expedition to Shishapangma when they spotted two bodies that had partially emerged from the glacier.  Suspicion was high that they were those of Lowe and Bridges.  Shortly after, Anker’s phone rang with news of the discovery and after a description of the bodies, their clothing, and equipment, Conrad and Jenni were convinced that it was indeed Alex and David.

In response Anker said, “It’s kind of fitting that it’s professional climbers who found him. It wasn’t a yak herder. It wasn’t a trekker. David and Ueli are both cut from the same cloth as Alex and me.”

Regarding this discovery, Jenni Lowe-Anker said, “I never realized how quickly it would be that he’d melt out…I thought it might not be in my lifetime.”

Meanwhile in New Mexico, Dr. Darryl Macias, an emergency medicine physician who specializes in mountain/wilderness medicine, was returning home from teaching a wilderness medicine and dive course in Hawaii when he received a phone call.  “Ueli Steck found them!”

Dr. Macias and David Bridges were very close friends and climbing partners that had traveled the continent and Europe together.  Part of Dr. Macias’s desire to focus on, teach, and promote wilderness medicine was inspired and spurned by the death of his close friend David.  Soon after, Anker and Macias contacted each other along with others close to Lowe and Bridges.  Plans were made to travel to Tibet to lay the two to rest, with Dr. Macias serving as the expedition physician.

Shishapangma expedition to recover Alex and David

While emotional, the trip was a success and the group was able to locate Alex and David and lay them to rest according to local custom and practice.  During this trip, Dr. Macias learned about the KCC, its mission/purpose, and was invited by Anker to come and teach at the KCC.   With great enthusiasm, Dr. Macias accepted the invitation and traveled to Nepal in January of 2018.  He traveled there with two other physicians from the University of New Mexico International Mountain Medicine Center, Dr. Jake Jensen and Dr. Hans Hurt, to provide much needed medical education to the amazing group of high altitude workers that call Nepal their home.

(For more on Dr. Macias’s experience dealing the loss of a friend, his journey and experience into wilderness medicine, and his experience at the KCC see his MEDTalk. He starts at 1:31:00.)

Albuquerque to Phortse

Prior to departing, we (Macias, Jensen, and Hurt) discussed what topics we felt would most pertinent for the course. We knew that we would only have 8 hours with each group of 8-10 students, and wanted to ensure that all the information taught would be beneficial.  While we knew we could cover topics such as acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, and hypothermia, we also wanted to teach more commonly encountered conditions.  We reviewed the current literature to make an updated list of the most common complaints encountered during expeditions and treks.  Ultimately, we created a small booklet full of illustrations and diagrams that was written in simple English for each student to keep. The booklet contained topics we wished to teach, along with extra topics we knew we wouldn’t have time to cover.

After traveling halfway across the world from Albuquerque to Kathmandu, we met with a small group of other KCC western instructors and flew to Lukla together.  Lukla is often referred to as the gateway to Mount Everest, as most expeditions into the Khumbu region start there.  It is also home to the world’s “most extreme and dangerous airport” as it lies perched on the side of the steep valley amongst 6,000 meter peaks.  From there we began our 3-day trek to Phortse, stopping in Phakding and Namche Bazaar along the way to acclimatize.  We also enjoyed great views of Everest, Nuptse, Lhotse, Ama Dablam, and countless other peaks, often sipping “chiya” at quaint tea houses.  Our arrival to Phortse was a humbling one, as many locals were waiting at a stupa, which marks the entrance into the village.  We were warmly welcomed with cheers, hugs, and khatas (long flowing silk fabrics to adorn the neck) to mark our newfound friendship.

Entering Phortse

Shortly after arrival, the preparation began for the biggest group of students that KCC has ever had.  We assisted in teaching advanced climbing skill updates to the Nepali instructors and gave them a medical refresher course, as it had been years since many of them had received any form of medical training.   This also gave us a chance to test out our teaching strategies using various scenarios, demonstrations, and discussions prior to students arriving.  Based on their feedback, we made minor adjustments and added a few additional topic ideas to benefit the students.

For the remainder of the course, we taught students basic first aid in groups of 8-10 each day.  We began with personal safety, scene size-up, and going over the MARCH algorithm.  Other topics included wound care, blisters, orthopedic injuries, altitude illness, hypothermia, frostbite, and GI issues.  We opted for topic discussions, demonstrations, scenarios, and hands-on activities, eliminating standard PowerPoint presentations.

Jake Jensen and Hans Hurt teaching scene size up and safety

We found that many students understood English, though with variable fluency. With each class we taught we learned more Nepali, making our teaching even more effective.  At times our Nepali words were not perfect, making for many laughs (the Nepali word for knee is very close to a very different part of the male body). However, they understood us, and appreciated our efforts to use as much Nepali as possible.

Darryl Macias teaching how to splint

Each day to start we would have the group introduce themselves to us.  We would ask where they were from, what their medical training background was, and what their experience was working in the Himalaya. Through this, we found that only around 10% had had some form of medical training in the past.  This number was lower than the number of students that had climbed or been on expeditions to Everest and other 7,000 meter (~23,000 foot) and 8,000 meter (~26,000 foot) peaks.  This solidified the importance of our medical course, as for many it was the first formal medical education they had ever received, and it may be the only training some students ever receive.

Darryl Macias and Jake Jensen giving a lecture

Our main focus in teaching was in line with the mission statement of the KCC.  We continually emphasized safety and self-care during every topic we taught. Overall, our instruction was very well received and students did exceptional during the test day, demonstrating that safety was of the utmost importance in caring for ones-self and others.

We enjoyed our time in Nepal, and were glad we could contribute to the cause.  We were all humbled by the experience, and developed a deeper appreciation, respect, and love for the people, culture, and landscape of Nepal.  We all looked forward to a chance to return, unsure when that would be, and discussed how we could improve their education, preparation, and discussed the idea of teaching a Wilderness First Responder course to the more advanced individuals if we were presented the opportunity.

Macias, Jensen, and Hurt in Tengboche with Ama Dablam and Everest in background

We even recorded a podcast for the Wilderness Medicine Society, Wilderness and Environmental Medicine Live! where we discussed our experiences (starts at 20:03). We all looked forward to returning, but weren’t confident when we would have that chance…

The Return

As plans were being laid for the 2019 KCC course, Dr. Darryl Macias and I were contacted by the directors of the KCC.  We were happy to hear they were pleased with our efforts the year before and asked us if we would return.  We jumped at the opportunity, happy to take what we had learned the year prior to improve the education provided.  We would also take with us Dr. Nicole Mansfield, our current Wilderness, Austere, and International Medicine Fellow.

In addition to teaching a one day basic medical course to ~90 students, we were also asked if we could provide a Wilderness First Responder (WFR) course to ~24-30 of the local KCC instructors who also serve as guides throughout Nepal.  Many of them had approached us the year prior with great interest in a WFR course and we eagerly accepted this invitation to provide them with additional instruction.  While there have been other Wilderness First Responder courses taught in the Khumbu Valley, this would be the first aimed to educate the local population that call it home.

Plans were made regarding how we could improve the education to the basic class and a curriculum for the WFR class was developed.  We created an online video library for the WFR students so they could start their learning prior to arrival.  We also began gathering the supplies that we would need to teach.  It was during that time that we realized that it would be best if we could provide them with a medical kit that would match their level of training.

After reaching out to many individuals and groups, we were thrilled when Adventure® Medical Kits responded and stated they would assist us by providing medical kits to the 24-30 local Sherpa guides that we would be teaching a WFR course to.  These kits, the Mountain Series Explorer, will be the perfect kit for this group.

The Explorer medical kits in the hypobaric chamber

The contents of the kit are excellent and is ideal for the WFR training that this group will receive. This donation will go a long ways to ensuring that this group doesn’t just have the knowledge, but also the tools to care for others in a wilderness/remote environment should the need arise.

Darryl Macias in the hypobaric chamber, supplementing kits with extra gloves and gauze. 

In addition to that, we also received additional funding from another source and will be able to provide very basic medical supplies to the ~90 basic class students and will also be able to add some supplies (survival, fire-starting equipment) to the kits provided to us by Adventure® Medical Kits for the WFR students.

Jensen kids making small kits for basic class students

Things have been extremely busy as we search out the equipment we will need to teach, record videos, refine lesson plans, and gather personal gear, but all in all this year is shaping up to be a fantastic one at the Khumbu Climbing Center, and we cannot wait to arrive and provide this much needed education to this amazing group of individuals.  Stay tuned for a follow up on how things went!

Packing the Explorer medical kits and other supplies

About the Authors

Jake Jensen, DO, DiMM, FAWM

Jake Jensen is an emergency medicine physician who completed a Wilderness, Austere, and International Fellowship program with the University of New Mexico. He enjoys teaching wilderness medicine at all levels and has also practiced and taught medicine in Haiti, Chile, and Nepal with plans to continue teaching nationally and internationally in the future.   He has a very loving and supportive wife who puts up with his antics, travels, and hobbies.  He also has 4 adventurous children that love the outdoors, help him pack for his trips, and look forward to when they can travel more with him.  In his limited spare time he enjoys backcountry skiing, mountain biking, backpacking, and simply sitting around the camp-fire.

Darryl Macias, MD, FACEP, DiMM, FAWM

Darryl is a professor of emergency medicine at the University of New Mexico International Mountain Medicine Center. He has been involved in wilderness and international emergency medicine development in Latin America, Europe, and Asia, and has lectured internationally. He is involved in mountain rescue and expeditions, but also enjoys taking his family on crazy trips throughout the world, seeking new adventures in life. You can hear his lively Wilderness and Environmental Medicine LIVE! Podcasts on iTunes and SoundCloud.

More Information

For more information on the Alex Lowe Charitable Foundation and the Khumbu Climbing Center, click here.

To learn more about discovery of Alex Lowe and David Bridges on Shishapangma (also where quotes from Conrad Anker and Jenni Lowe-Anker were found), click here.

Below are the links mentioned above in the blog post along with a few additional ones. Highly recommend you take a look/listen at these.

Dr. Macias’s MEDTalk regarding his story of loss, journey into wilderness medicine, and what the future holds.  Starts at 1:31:00.

Link to the Wilderness and Environmental Live! Podcast where we discuss our experiences during our first trip to the KCC. Starts at 20:03.

Link to the Wilderness and Environmental Live! Podcast where we have a discussion, with the authors, regarding a recent paper that was published regarding the knowledge of porters in the Khumbu Valley when it comes to recognition and treatment of altitude illness. We also branch off and discuss other aspects of medicine and their well-being. Start at the beginning.

Link to The Mountain Dispatch, a biannual newsletter put out by the UNM International Mountain Medicine Center where we discuss last year’s trip to KCC.

A Few Words on Paddling Safety

Thursday, October 4th, 2018

It is too easy to be prepared – a few words on paddling preparedness. Whether you’re stand up paddle boarding in the Dominican or canoeing in Canada, practicing good paddling safety is easy to do and prepares you for whatever comes your way.

paddling safety gear

What paddling safety equipment do you regularly pack?

Accidents Happen

On a recent trip, I was reminded of the importance of paddling safety. I should have known better as I passed a group of less than thrilled women wading without their kayak. I was paddling to the Atlantic on a janky stand up paddle board (SUP) that I rented from the Dominican Resort we were staying at. As I approached the breakers, I watched a few Scuba instructors pull a sunken Ocean Kayak Fenzy from the bottom onto an old wooden skiff. Apparently the drain plug was missing in action… scary.

A few waves in, I had forgotten about the sunken kayak and was having a blast. On the next set, I saw a decent-size wave coming and started paddling hard. Before I knew it, I had out run the wave and gotten too far ahead of the breaker. The board started to nose dive, and I was swiftly bailing out. I jumped off, thinking I was clear of the sandbar, but I quickly hit the bottom in waist-deep water and got a pretty nasty cut on the bottom of my left foot.

As I paddled in, I pondered the fastest option for access to a medical kit. There was an overwhelmingly large line at the rental stand, and after seeing the quality of the boats, I could only imagine the medical kits.  I opted for walking all the way back to my room for a Mountain Series kit that I had packed in my checked bag. I had to walk a quarter mile back to the room barefoot, as I had left my sandals with my wife back at our chairs in the opposite direction. By the time I got back, my feet were black and the wound was covered in sand. Not good.

Are You Prepared for “What If”?

While my foot did not fall off (and I miraculously made a full recovery before happy hour started), it could have turned out much worse. And I could have been more prepared. What if it was worse? What if the bleeding was not easily controlled? What if I was not at a resort but on a remote lake, solo, deep in the Maine wilderness? Would it have been the same outcome?

Even minor injuries, left untreated, can become major issues in the backcountry

My point is accidents happen, and they can happen to anyone venturing into the outdoors. While experience helps, the outcome can be the same whether you’re a seasoned pro or a newbie who just rented a canoe for a short paddle. Think of all the times growing up or in present day when things could have gone bad but didn’t. Could you have easily been prepared if they had gone wrong? Let me help with some scenarios where a little paddling safety gear would go a long way.

Scenario 1: Family Canoe Trip

It is Memorial Day weekend and you decided to take your kids out for a paddle near the public campsite you rented. You rent a canoe from a teenager who barely got off his phone long enough to hand you the old life jackets and warped plastic paddles. It has been misting off and on all day, so you leave your bags in the car.

Ask yourself: How far do I have to go to reach my medical kit?

You paddle up the quiet, tranquil creek until you reach a large tree with a rope swing. Your overzealous teenager’s canoe reaches the bank before you get there. By the time you paddle up, he is halfway up the steep approach to the swing. Before you even realize what is happening, he is screaming and running back down the sandy slope to the water. As he gets closer, you see the swarm of angry bees converging on his head and shoulders. You think to yourself “at least he’s not allergic.” As the swarm dissipates, you can start to see noticeable swelling. Do you have some diphenhydramine (Benadryl) to help with swelling? Do you have some acetaminophen (Tylenol) for pain? What if he got a large cut on his foot on the run back to the water? While this was likely not life-threatening, having a small medical kit would have made the paddle back much more comfortable for your teen.

Scenario 2: Post-Work Paddling

One more example for good measure. It’s a beautiful summer day in Banff, and you unexpectedly get off work early. You rush home, grab your SUP, and head down to the canoe club for a late afternoon paddle on the Bow River. You paddle a few miles up the gentle current, when you spot an osprey in a tree near the bank. You do your best to quietly paddle over and pull out your iPhone to snap a picture.

Even stand up paddle boarding has its dangers

As you use your second hand to zoom in, you lose your balance on the board and plunge toward the chilly water. In an effort to save your phone, you hold it above your head as you hit the shallow water.

Good news: you save the phone. Bad news: you hit your head pretty hard on a submerged rock. As you run your hand through your hair, you realize it’s bleeding a lot. By the time you get your board on shore, you can feel the blood running down your neck. You take your now-soaked shirt off and tie it around your head. By the time your back to the dock, the blood is soaking through your shirt.

Thankfully, the dock is near the center of town, and you have quick access to a medical kit/professional attention. What if you had been farther up the river? What if you had been in a more remote area? A half-ounce QuickClot gauze pad would have gone a long way.

Paddling Safety Made Easy

Accidents are bound to happen, but this should never stop you from exploring, adventuring, or just enjoying the lake with your kids. In this day and age, it is extremely easy to be prepared. While my preference would always be to have a full Mountain Series Kit in my dry bag, it’s not always practical. However, there are some other fantastic options out there that allow you to keep your paddling safety gear fast and light.

For the past 5 years, I have had a Watertight Pocket Medic kit stowed in the front pocket of my PFD. While I seldom took it out, I knew it was there, and it gave me the peace of mind when paddling out.

Recently, I upgraded this to the Ultralight/Watertight .3 Medical Kit. This kit weighs just over two ounces and can be a huge help when things go south. I couple this with a half-ounce QuickClot gauze pad, which is key for controlling bleeding.

I currently carry the Ultralight/Watertight .3 – it’s compact & waterproof

An even better option, which I think I will switch to, is the Ultralight/Watertight .5. While this kit adds an entire ounce (joking – it’s an ounce, get over it), it includes some key medicine such as diphenhydramine and aspirin. Bonus: the price comes in at just under twenty bucks.

Overall these Ultralight/ Watertight kits are perfect for stowing in a life vest, so you’ll forget they are even there until you need them (in which case, you’ll be glad you have it). When considering the weight, price, and stow-ability of these medical kits, there is really no reason to not be prepared by adding one to your paddling safety gear.

About the Author

Andrew Piotrowski is an all-around adventurer residing in Southeast Pennsylvania. He can commonly be found trad climbing in the Gunks, paddling the Chesapeake Bay, or trail running and backpacking in the Catskills. Andrew grew up running and kayaking but fell in love with the mountains on a few trips to the Adirondacks. Since then he has focused on alpine climbing and mountain running objectives in the Sierra’s, Bugaboos, and White Mountains. Andrew’s favorite training partner is his dog Calvin, who has helped him to log countless training miles. When not outside, Andrew enjoys Canadian Lager and gardening.

Mt. Whitney via the East Buttress 5.7 Route: Our 28-Hour Summit Day

Tuesday, July 31st, 2018

This past June, I summited Mt. Whitney via the East Buttress 5.7 route with my friend Joe Miller (whom you may know as a member of #TeamTender). This ended up being by the far the hardest trip of my life……so far. Read more about this grueling but amazing epic below.

Worked, Sore, & Likely Dehydrated

The old saloon doors swung behind us as we made our way through the crowded bar. We had just limped our way around the dusty streets of Lone Pine California looking for a bite and a beer, and we decided on Jacks Saloon. It was June 8th, and we had spent the last 32 hours working our way up and down California’s Mt. Whitney. We were excited to have just summited the highest peak in the lower 48 states but were absolutely worked, sore, and likely dehydrated from the unplanned 28.5 hours tent-to-tent adventure. It was not long before I started nodding off mid-conversation, and before I knew it was lights out back at the motel. The next day we slept in and started our drive back across the desert to catch a red-eye east. As we drove I could not stop thinking about the exhausting but totally rewarding epic we just had.

2 Days Earlier

On June 6th, we left Whitney Portal around 6am and started our approach up to Upper Boy Scout Lake. The approach starts off really mellow with a series of sandy switchbacks and creek crossings, but after a few miles starts to get steep as you approach the famous Ebersbacher ledges. This is a series of exposed scrambles that can be a bit spicy with heavy packs. In one section you have to cross a no more than six inch wide section with a steep fifty foot drop and lots of open air staring you down. Per usual, Joe effortlessly walked across showing zero sign of fear or even mild discomfort. I, however, can remember wondering what the climb ahead would be like if we were already running into this type of exposure.

After a few miles and some poor talus field navigation, we arrived at the Upper Boy Scout Lake. This beautiful alpine lake area is spectacular, covered with scattered pines and surrounded by the Eastern Sierras. We set up camp next to a stream, well protected by a large boulder wall. Outside of some overly friendly Marmots, we ended up having the entire area to ourselves. We had an early dinner and were sleeping before the sun went down. The next day was summit day.

Our camp at Upper Boy Scout Lake

Our base camp at Upper Boy Scout Lake

Summit Day

We woke up before sunrise, sorted gear, and made an attempt to eat. Not sure if it was the early start or the altitude, but I struggled to stomach a Clif Nut Butter bar. We made our way up a short talus field and then to a series of endless moraines on our way to Iceberg Lake. I will never forget seeing the route for the first time when we rounded the last moraine before the lake. Mt. Whitney and the needles towered over the entire valley.

Our plan was to do the East Buttress of Mt. Whitney, which has been rated anywhere from low fifth class to 5.8.  In the weeks leading up to the trip, I spent countless hours reading the guide book and scanning trip reports on Mountain Project. The consensus was that we would need around a half day to complete the route, and we packed accordingly. As we passed Iceberg Lake, we ran into a guide and his client. We chatted with them about the route and made our way to the base of the wall.

The First Pitch

I agreed to lead the first pitch which is supposed to go at a straightforward 5.5. I took a few seconds to decide on the correct start and opted for a steep, left-facing corner. I traversed left out onto a large flake and started working on placing some gear. However, as I transferred my weight, the entire flake started to pull off the wall. As you can imagine, this was terrifying and made for an exciting first pitch. I gingerly traversed back to the start and opted for going straight up the corner.

About a quarter of the way up the wall it was apparent that I was on the 5.8 alternative start rather than the easy 5.5 corner. The corner had a few amazing lay backs and airy moves, and while I usually have no issues on 5.8, the altitude had me breathing excessively hard. I felt my legs starting to shake towards the top of the pitch. The constant grind of the Ice Axe on my pack on rock did not help with the nerves. Finally, I reached a small ledge and built an anchor to belay Joe up.

Joe scaling a rock wall

My climbing partner Joe, nailing it as usual

Gaining Altitude (and Ice)

Joe easily led the next pitch, and we were starting to feel pretty good about our time and even joked about being back in camp for lunch. That’s about the time that we began to start running into some scattered patches of snow and icy cracks. The third pitch looked easy enough, but the icy cracks made everything harder and made for some serious slow going.

Throughout the next couple pitches, we both found ourselves digging out snow and ice before placing gear.  After some route-finding misfortune and many leads by Joe, we arrived at the Peewee. The Peewee is a massive, ominous-looking block that is easily recognizable from a few pitches away. Once we arrived there, we felt a lot better knowing that we were on route. We took a few minutes to eat, and I broke out my Adventure® Medical Kits Hiker kit to take some pain killers for a mild altitude headache. That is when I realized that I had less than five ounces of water left and only a couple ProBar Chews. We looked at the guide book, picked our route, and Joe set off to lead a problematic-looking hand crack.

When the 4th Class Talus Field Becomes 5th Class Climbing

The guide book said to go left after the Peewee, but we must have went a little farther left then recommended. Instead of reaching the easy 4th class talus field, we ended up turning the planned 8 pitches into sustained fifth class 14 pitches. Throughout the upper pitches, we kept expecting to hit the talus field. I must have asked Joe “How’s it look up there?” or “Is it fourth class?” fifty or so times. But each time we ran into more fifth class climbing. Each time we regrouped at the belay and got back after it.

Mt. Whitney – 14,505′

After 14 hours on the wall, we finally reached the summit around 8:30 pm, just as the sun was setting over the High Sierra. After some high fives and obscenity-laced proclamations, we celebrated, threw off our climbing shoes, and snapped some pictures. I was ecstatic to have just finished my longest and most technical alpine climb.

We were running on empty from the lack of water and food a few pitches back. We were so desperate for water that we filled a hydration bladder with snow and shoved it in our jacket hoping for it to melt as we made our way down. Our celebration and sense of accomplishment was short lived when we started to scout our decent route.

On the summit of Mt. Whitney

Pumped to reach the summit of Mt. Whitney as the sun set!

Rerouting Our Descent

Our plan was to descend the Mountaineer’s Route, which is a steep, class three snow gully that dumps you back at Iceberg Lake. We walked over to the top of the route and quickly gave it a collective “nope.” The snow which had been melting all day in the sun had now frozen and was looking more like a W2 ice climb. It would be extremely dangerous to descend frozen at night, and arresting a fall would be nearly impossible.

We were left with only one option: to descend the standard Mt. Whitney Trail which leads back to Whitney Portal. For us, this meant hiking back down to the trail junction and then hiking back up to clean up camp at Upper Boy Scout. Since we did not plan to use this route, we had little knowledge of it and had written it off as merely a hiking trail. This ended up being more than 14 miles and meant dropping from 14,505 feet to around 9,000 feet at the trail junction, then back up to 11,350 feet at camp, and then back down to the parking lot at 8,375 feet.

Besides running on no sleep, food, or water, things were going pretty well.  Then around 1am we ran into Mt. Whitney’s famous “chute.” This is a large, steep, and exposed 1,200 foot snow gully. During the day, this route could be easily glissaded, but for us it was frozen wall of ice.

Bivvy at 11,200′

After a few hours, we reached the bottom and desperately searched for water and a flat spot to bivvy. We found some glacial runoff, filled our bottles, and made our way down towards a large rock garden. We found a bivvy spot and began setting up. At this point we had been on the go for more than 19 hours, and the temps had dropped into the low thirties. I put on every layer I had, laid down a Survive Outdoors Longer® Emergency Blanket as a tarp, and then got in my S.O.L. Escape OD Green Bivvy (Joe had the Escape Pro Bivvy). We were extremely fortunate to have the bivvies, as they were key in preventing almost certain hypothermia.

After a few hours of nodding in and out of consciousness, we were disturbed by large swaths of hikers making their way to the chute. For the next 6 hours, we made our way back down, up to our camp, and then down again to the car. We answered the question “how was the chute and did you summit” many times as we passed weary eyed hikers making their way up.

32 Hours Later

We arrived back at Whitney Portal looking worse for wear and settled for the comfort of a burger and cold beer at the Whitney Portal Store. My pants were ripped, my hands looked like raw meat, and I was pretty sunburnt, but overjoyed to have completed the climb. Joe was an absolute monster and just put his head down and pushed through the pain and fear.

This trip solidified the adventure partnership that Joe and I have built over many years of exploring. We pushed each other and ultimately worked in sync to keep it together when things got hard. I am sitting here on a dock over a thousand miles away from Mt. Whitney, but I can’t stop thinking of the beautiful Sierra’s. Now it is time to figure out what’s next.

About the Author

Andrew Piotrowski is an all-around adventurer residing in Southeast Pennsylvania. He can commonly be found trad climbing in the Gunks, paddling the Chesapeake Bay, or trail running and backpacking in the Catskills. Andrew grew up running and kayaking but fell in love with the mountains on a few trips to the Adirondacks. Since then he has focused on alpine climbing and mountain running objectives in the Sierra’s, Bugaboos, and White Mountains. Andrew’s favorite training partner is his dog Calvin, who has helped him to log countless training miles. When not outside, Andrew enjoys Canadian Lager and gardening.

Everest Expedition Day 1: International Mountain Guides Update

Wednesday, March 28th, 2018

International Mountain Guides’ 2018 Everest Expedition is underway! The Everest Expedition Leader sent us the below note from the teams’ first day on the trail. We’re proud to the be the official medical kit sponsor of IMG and can’t wait to hear more about this year’s journey to the highest peak in the world. #BeSafe out there! 

Hey Adventure® Medical Kits!

I just wanted to take a minute and say thank you again for all of the support you give IMG. As the Everest Expedition Leader I can tell you that the kits you give the guides, and the ones we use to cover the overall expedition, are absolutely invaluable. Clearly we hope to never need them, but it’s nice to know they’re there if we do.

Everest Team 1 on the trail to Namche. PC: Greg Vernovage

We’ve only been on the trail for one day but things are going great. The gear checks in Kathmandu went perfectly. We got the first flights out of Kathmandu and all safely arrived in Lukla today, which is huge. We’re right on schedule.  I’m with Team 1 in Phakding right now getting ready to head up to Namche Bazaar.  Getting up the ‘Namche Hill’ will be the team’s first test, but I have a feeling they’ll do just fine. Namche sits at about 11,000ft. so we’ll hang out there for a couple days and acclimatize. We’ll be at EBC in about 10 days. Team 2 led by Emily Johnston and Team 3 led by Craig John & Ang Jangbu aren’t too far behind.

It’s great to see everybody’s hard work come together. Lots of smiles and a good buzz in the air. It’s great to be back in Nepal!

IMG Guides and Sherpas are excited for the journey ahead! PC: Harry Hamlin

Thanks for all you do for us!

Greg Vernovage

IMG Everest Expedition Leader

Trip Safety: Don’t Get Stuck in the Dark

Thursday, March 22nd, 2018

Embarking on a backcountry adventure can be one of the most rewarding experiences. When all the planning, anticipation, and physical effort culminate in awe-inspiring views, you receive a feeling of escape not available in the front country. While one of the greatest gifts you can give yourself is to continually go deeper and find more remote settings, it’s not without its own perils. As a Search and Rescue (SAR) Member, I’ve seen firsthand how a potentially fantastic day can turn into the worst day of your life for you and your loved ones.

Adventures – no matter how amazing – are not without peril

Preparation is crucial for trip safety in your backcountry expeditions. This simple statement has so many layers to it; it’s easy to brush it off and assume you have done enough. Route planning, properly packing your bag, and even preparing your physical and mental fitness all go into preparation. Today I’ll touch on a couple trip safety tips that, when applied, can help prevent common mistakes for everyone traveling in the backcountry.

Trip Safety: Pack the Right Gear

Gear is sexy. You can read a million and half blog posts or YouTube videos on gear.  From reviews to proper load-outs, there is a lot to learn and it seems to keep getting more complex. However, the basics maintain true. Pack your 10 essentials (Don’t know what these are? Go check out REI’s great post on them). While I firmly stand by my alpine “light and fast” style and agree that the ability to move quicker adds safety, there are certain things that are worth the weight.

Illumination

Last summer, there were multiple rescues to aid hikers stuck in the dark. Even if you’re setting out at sunrise and you feel overly confident you can get your hike done in just a morning, please still bring a headlamp. It makes my wife happy when I get to eat dinner with her on a Sunday night, instead of setting out to rescue hikers stuck in the dark.

Pack a headlamp so you don’t get stuck in the dark

In that same vein, bring extra batteries, especially if you’re working on a big day. Fancy headlamps that use built in lithium Ion batteries definitely help cut weight, but when it dies, it’s dead until you get back to a charger. My climbing partner was the victim of exactly this scenario coming down a 30 degree scree pitch off Mount Temple (BANFF, Canada) at 3 am. Our fast decent turned to a crawl when we were reduced to one headlamp. Learn from our mistake.

First Aid Kits

First aid kits are our specialty here at Adventure® Medical Kits, and I love the fact that I have so many supplies at my disposal to build kits. I’m a huge fan of our Mountain Series Day Tripper Lite kit. It’s perfect for day trip adventures and isn’t overloaded with unnecessary supplies. It also has great organization and labeling; in a rush, you can find exactly what you’re looking for. Another option is the custom bag from the Mountain Series, which lets people like me build their own kit and label it as needed.

My med kit for day hikes: the Day Tripper Lite, QuikClot®, an elasticized bandage, and a C-Splint™

Regardless of if you build your own kit or use a premade version, go through it often. It’s incredible how quickly you forget you used something in the middle of your climb when things start going well again.  A couple things that I mandate in even the smallest med kit are an elastic bandage, some form of a splint, Diphenhydramine, Ibuprofen, a couple big gauze pads, a small roll of medical tape, and an emergency blanket. Knowing what is in your kit is almost as important as knowing how to use it! I highly recommend that every backcountry enthusiast takes a Wilderness First Aid course (WFA), where you’ll learn the necessary skills to administer basic first aid in the backcountry. This can make the difference between a scary and stressful hike out and a confident, enjoyable return to your car.

Footwear           

The Mountains are a rugged place. They require rugged footwear. Most likely your road runners are not going to cut it, and your designer flip flops won’t make it even half a mile. Choose a stiffer, more supportive shoe to give you better protection. Unless you have seriously trained your body, a minimalist shoe can cause you long term issues. Not only does having a supportive shoe protect your feet, but your knees, ankles, and hip will also thank you. Having proper footwear ensures your body is taken care of. There are tons of debates on whether it’s better to have waterproof shoes or not in the summer. Some argue the non-waterproof will dry quicker and breathe better.  In the winter it’s almost no question – go waterproof.

Allow stiffer boots and trail shoes some time to break in. Once they do, you’ll never want to buy a new pair.  The break in process shouldn’t be overlooked; the first couple outings should be a bit easier than your usual hike, as both your feet and shoes need to adjust. Definitely bring some extra moleskin or GlacierGel® for blisters during your break-in period. At the end of the day, waterproof or not, find a shoe which really protects your foot and ankle, gives you good traction, and fits well.

Clothing              

Dressing for a hike is similar to dressing for other athletic activities; however, you must take exposure into account.  Your clothing must work well for extended periods in inclement weather, high wind, or extended sun exposure. The age old saying in the backcountry is that “cotton kills,” as once cotton is wet, it doesn’t insulate anymore.

Take into account ridgeline walking, where exposure to the wind and weather can be intense

In the mountains you can get hypothermia year-round. To combat cold any time of year, dress like an onion – layers layers layers! There are three basic layers: a base layer to move sweat away from body, an insulation layer, and an external layer to protect from elements. The specifics obviously all change depending on the season, but the principals stay the same.

Pest Control

Know the pests in the general area. Bug bites are a really annoying. A bear bite can be catastrophic. Understand that you probably should bring some form of deterrent for bugs and bears if they are known in that area. Ben’s® Clothing and Gear is fantastic to treat you gear before heading out.

From bear spray to head nets to bug repellent, pack for the pests in the area you’re visiting

Packs

One thing the 10 essentials fails to bring up is how to carry all those things. A good fitting backpack is necessary. It’s worth investing in a durable pack to get you through years of adventures. The biggest aspect of any pack should be its fit. Different disciplines have slightly different requirements. For instance, my hiking bag has large, cushioned hip straps, so that the load will sit on my hip bones. My technical climbing pack has minimal hip straps as it will get in the way of my harness. Figuring out the proper size pack is also important (I’ve blown zippers in the backcountry from stuffing my pack too tight). I’ve also had back pain from under-filling a big pack and having the contents rattle around on a decent. Having a number of packs for different outings will keep your back happy and pain-free.

Choose a pack appropriate for your activity – consider both size and fit

Trip Safety: Know Before You Go

Having fun and enjoying the outdoors is best achieved when you are properly prepared. While carrying the proper gear will help mitigate potential issues, there are intangible things that are invaluable in preparing for a hike.

Know what the climate is like where you are going.

In the early spring my SAR team might have 4 rescues in a day, while mid-summer we get 1 in a weekend. Why is this? In the White Mountains, we’re only 2 hours away from Boston on the interstate.  On early spring weekends, weather in Boston may be sunny and warm, with no snow; however, weather in the Whites includes waist-deep snow and raging rivers fueled by the spring melt.  Check the weather and trail conditions where you’re going – don’t assume it’s the same as what you see from your front door.

Seasons can look quite different in different places – like snowy springs in the White Mountains

We live in a wonderful age where Facebook communities, Sub-Reddits, and Instagram posts can help you deem what true current conditions are.  Weather has different patterns in different locations; do some research and see what generally occurs in the area you will be traveling. The weathermen do their best but are often wrong. Getting caught in a surprise summer thunderstorm in the alpine is life threatening. Learn the basics in reading the weather and apply those skills with knowledge of the local weather patterns.

Set a turnaround time before leaving the house.

This should be a firm time in which you know you need to turn back. A turnaround time keeps you honest with how quickly you are actually moving. The mountains will be there another day, and setting the time before leaving the house keeps the emotions in check.

Let someone not on the hike know of your planned route.

Text/call right when you set off and right when you return. In some places people will put detailed notes on their car dash. This is especially helpful for technical routes, as it lets other parties know what line is going to be most crowded.

Account for elevation change.

Elevation gain is not easy, neither is elevation loss. Remember getting to the top is optional, getting down is mandatory.

Don’t just check the mileage – check the elevation change!

Don’t discredit what elevation change is on the hike. The general rule of thumb is every 1,000 feet of elevation change will feel like another mile on the hike. For example, if I hike 4 miles to the summit with an elevation change of over 2,000 ft., that will feel like 6 miles. So a seemingly 8 mile roundtrip hike can really feel like a 12 miler. Plan your hike accordingly. Know your party members and what constitutes a fun day.

Be realistic on where you and your party is at physically.

If you haven’t had a cardio day in months, and you don’t know what leg day is at the gym, pick a more introductory hike. Check your ego and build up to that big hike. There is no shame or pain in hiking something under your threshold. A carry out on rugged terrain with broken bones is pretty miserable. Even hiking a couple miles hungry and exhausted will make you not want to return to the mountains for a while.

Plan for sunshine, prepare for thunder.

You may blow through your hike as fast as you think, but you might not. Bring enough food and water for some extra hours. Think about exposure to the elements: some extra time in the sun or wind or getting caught in a rain storm can make for a miserable outing.

Conclusion

Backcountry travel is no easy task. There are so many variables which go into a good adventure. I’m constantly re-evaluating gear and travel techniques to help keep me safe and have a good time. From gear to pre-adventure prep, there are plenty of trip safety actions you can take to ensure you have a great next adventure.

About the Author

Joe Miller is an alpinist residing in the White Mountains of New Hampshire. He serves on the Pemigewasset Search and Rescue team, which has received some fame from the television show North Woods Law. Joe loves everything about the outdoors and can be found taking full moon laps up Cannon Cliff, ice climbing classics in Crawford notch, and slaying powder on his splitboard. Joe started working at Tender Corporation in 2015, as he loves the proximity to the mountains. When not outdoors, Joe lets his inner geek flag fly; he can be found holed up with his dog and cats tinkering with electronics and computer systems.

Multi-Day Wilderness Trips: Choosing a Medical Kit

Wednesday, September 27th, 2017

We asked a wilderness guide for tips from his experience on how to be medically prepared for trips into the wilderness. He provided us with great questions to ask yourself before you choose a first aid kit for a multi-day adventure, as well as insight into his personal process. – Adventure® Medical Kits

Backpacker headed out on a trip.

Have you covered the other basics (food, shelter, survival)?

As I get organized to lead a group into the wilderness, being prepared fills my mind as a top priority. Once I have my bases covered on the topics of shelter, food, and clothing, I consider the smaller items that can easily get overlooked. These items cover the topics of safety and comfort and include things like lighting, cleanliness, evacuation (typically a satellite communication device), and first aid. I don’t need to bring a survival kit on my multi-day foray into the wilderness, since my tent, sleeping bag/pad, clothing, food and camp kitchen are the greatest survival kit of all times. I do, however, need to bring a medical kit.

Does your medical kit have supplies to treat common injuries?

Those who enjoy the wilderness need to have some lessons in first aid and a reliable medical kit, as the best way to know what to bring as far as first aid material goes is to first be educated in how to address a variety of medical situations in the backcountry. This will help you identify what items you need, but you also need to understand what your highest priority medical items are based on the most likely injuries to occur.

The best medical kit is the one that can manage the most common injuries that occur in the woods and mountains. Having spent thousands of days in the wilderness over two decades and having been a full time guide for the past 7 years, I have found the following issues to be the most common ones that occur and need treatment:

  • Blisters
  • Cuts
  • Scrapes
  • Burns
  • Knee/ankle injuries

To manage most of these issues, keeping them clean and dressed can be the difference between a nuisance and a major infection. A medical kit needs to be fully stocked with alcohol prep pads, sanitizing wipes, gauze pads of various sizes, and a syringe for irrigating cuts. Along with these, adhesive bandages of various sizes, as well as athletic tape, need to be included to dress a skin deep medical issue.

Adventure Medical Kits Mountain Backpacker Kit

The Easy Care First Aid Organization System found in Adventure Medical Kits features injury-specific compartments with clear labels.

Can you find the first aid supplies you need quickly?

One thing that is often overlooked in medical kits is the layout. If someone is being treated, efficiency is important. To be efficient, the kit needs to have everything labeled and organized. When you head out there and review the details of your medical kit, or if you are purchasing a new one, make sure it meets the following criteria:

  • Has adequate amounts of high quality material, appropriate for your trip
  • Is organized and labeled
  • Contains a booklet for reviewing proper treatments
  • Is made of durable material
  • Is not too heavy

In an ideal world, we go out there into the backcountry many times and never touch our medical kits. In the event that we do need it though, it needs to be the right thing, so don’t hold back when preparing or purchasing this crucial wilderness item.

About the Author

Daniel Laggner has been a full-time guide and wilderness survival instructor for 7 seasons and has over 20 years experience in outdoor sports and the outdoor industry. He has conducted several long-term expeditions, spending weeks in the remote wilderness of the Colorado Rockies, Sierra Nevada, and northern Patagonia. He is currently Lead Guide and Co-owner of Treks and Tracks.

What Experts Pack: The Mountain Series Recharged

Thursday, September 14th, 2017

With over 30 years of guiding experience on the world’s greatest mountains, International Mountain Guides (IMG) is the definition of #adventureequipped! IMG guides know how to lead expeditions safely, which is why Adventure® Medical Kits is proud to have partnered with them for over 20 years. We’re excited to share this note we received from them during their Mt. Rainier season, where they’ve been testing out the Mountain Guide Kit from the Mountain Series Recharged. – Adventure® Medical Kits

Mt. Rainier

IMG climbers above the clouds on Mt. Rainier

Tye Chapman here at International Mountain Guides reaching out on behalf of our guides to say “Thank You” to Adventure® Medical Kits for the new med kits they provided this year and their continued support over the years.

Choosing to Be Prepared

With over 50 guides guiding close to 1500 climbers and trekkers on all 7 continents, on over 150 climbs, treks, and expeditions around the globe each year, you can imagine we take the safety of our climbers and guides seriously.  Simply put, that is why we work with Adventure® Medical Kits. There’s no better partner to ensure that our guides and expeditions are fully prepared for medical emergencies.

What We Pack

IMG climbers on summit of Mt. Rainier

IMG climbers on summit of Mt. Rainier

So what are we packing? Well, at the Guide level all of our guides are equipped with the new Mountain Series Mountain Guide Kit. What we like about these kits are the Find It Fast Map and the semi-transparent and secure pocket. These features make it easy to find supplies when we need them.

At the Expedition level, we carry a few different kits depending on the duration of the expedition and number of climbers or trekkers involved. A few examples include the Mountain Series Mountaineer Kit and the Professional Series Expedition, Professional Guide I, and Mountain Medic kits.

Everything We Need & Nothing We Don’t

While it’s impossible to prepare for every possible scenario, Adventure® Medical Kits has spent years dialing these kits in to provide us with exactly what we need, and equally as important in the mountains, nothing we don’t! Thanks for the continued support Adventure® Medical Kits. Although we hope never to need your emergency medical supplies, it’s nice to know you’re there when it counts!

Putting the Mountain Series to the Test

IMG climbers headed up Mt. Rainier

We’re in full swing on Mt. Rainier with climbs coming and going every day now. I’ve heard it many times already this summer, from several of the guides, that the Mountain Guide kits are perfect. They’re so well thought out and are the perfect size for our groups on not only Mt. Rainier but around the world. The kits you sent this spring have already been in Nepal, Russia, Bolivia, Mongolia, Europe, Tanzania, and Alaska with upcoming trips to Mexico, Ecuador, Argentina, Chile, Nepal, and Antarctica to name a few.

IMG Guide Jonathan Schrock is calling in on the radio from the summit of Mt. Rainier as I type this note. After 10 years at IMG, I still love getting that radio call!

Stay safe this summer!

Tye Chapman

International Program Director

www.mountainguides.com

Photo Credits: Austin Shannon, Senior Guide

How to Prevent & Treat Blisters

Tuesday, September 20th, 2016

Did you know blisters are one of the most common injuries in the outdoors and the most common injury for hikers? Within hours, a small rub in your boots can turn into a painful blister. However, with a few basic preventions tricks and early treatment, you can protect your feet and keep a blister from interrupting your adventure.

 

blister on foot

Blisters are the hiker’s #1 injury

Blister Prevention

To keep blisters from developing in the first place, eliminate as many contributing factors as possible. Simple actions taken before you hit the trail and once you’re on the trail can make a huge difference.

Before You Hit the Trail

The first step in preventing blisters it to make sure the gear you’re putting on your feet isn’t causing the problem. Here’s five steps you can take before you hit the trail to stop blisters in their tracks:

  1. Make sure your shoes fit properly. If your shoes are too tight you’ll have pressure sores, while shoes that are too loose lead to friction and irritation. Outdoor retailers like REI often will be able to measure your foot and help you find the right size using a calibrated fit device. A good check you can do yourself though is to pull the insoles out of your shoes and stand on them. You should have a thumb’s width of clearance between the end of your toes and the insole. You want that extra space in the front of the boot so you don’t end up jamming your toes against the toe box on the way down.
  2. Choose your socks with care. As a rule, avoid cotton socks and opt for water-wicking materials like merino wool or synthetics. Everyone has unique feet, making it important to find what works for you and your boots. Sock height, cushioning, and fit all contribute to giving your feet the best in-shoe experience. REI gives some great advice on choosing the sock that’s right for you.
  3. Break new boots in. Even the right footwear can still cause blisters if you don’t break it in. Before heading out on a trip, make sure to spend some time in your new boots, ideally while wearing the socks you’ll use on the trip. You might look funny walking around your home or the office in hiking boots, but your feet will thank you later. Once you’re ready to hit the trail, best practice says start with a short hike – you don’t want to find out you didn’t break them in enough when you planned a 15 mile day.
  4. Avoid prolonged wetness. Moisture breaks down your skin and predisposes it to blistering (that’s why choosing the right sock is so important). Keep your feet dry, and pack an extra pair of socks so if you’re first pair get wet (those mountain streams are everywhere), you can swap out for a dry pair right away.
  5. Protect problem areas. No one knows your feet like you do – if you are prone to blisters in a certain area, be proactive about protecting that area from harm. Before hiking, apply moleskin to sensitive areas where blisters are likely to occur. The moleskin will reduce the friction against your skin, effectively stopping blisters and hot spots before they can even start.

Even if you put moleskin on your feet before setting out, it’s always important to pack more in case the unexpected occurs. If you are prone to nasty blisters, consider adding GlacierGel to your first aid kit as well, as the hydrogel dressing is ideal for stopping the pain from and protecting fully-formed blisters. The Blister Medic contains both moleskin and GlacierGel, making it a lightweight addition to your pack that keeps you prepared. Make sure to go through your first aid kit before setting out to make sure you don’t need to re-stock blister items

On the Trail

Once you hit the trail, there are still things you can do to prevent blisters. Hot spots are sore, red areas of irritation that develop into blisters if allowed to progress. Identifying hot spots early to stop them from becoming blisters will save you miles of pain.

The key message? Pay attention to your feet. It’s easy to ignore slight irritations or brush them off in order to avoid having to stop on the trail, but take our word on it: you don’t want to ignore hot spots. If you think you feel a hot spot, take the time to stop and address it sooner than later.

Treating Hot Spots

If you catch a hot spot early on, you can easily stop it from becoming a blister by covering it with a small piece of moleskin.

covering a hot spot with moleskin

Treat small hot spots by covering them with moleskin, which is included in the Hiker kit

For more irritated hot spots, you can cover them with GlacierGel or use moleskin. Whichever you use, make sure to prep the surrounding skin using an alcohol wipe for maximum adhesion. If you use moleskin, make sure to grab a donut-shaped piece (you can get them pre-shaped here or simply cut a small hole in the center of a rectangular piece).

Position the moleskin so the hole is over the hot spot, making sure the adhesive surface isn’t touching the irritated skin. This raises the area around the hot spot, preventing further rubbing. If necessary, you can secure the moleskin in place with medical tape from your medical kit.

Blister Treatment

Sometimes blisters occur despite our best efforts. Properly treating the blister can help minimize pain and further damage to the area.

For Small Blisters

If the blister is still intact, do not puncture or drain it. Instead, follow the same steps outlined above on treating serious hot spots by protecting it with GlacierGel or moleskin. If you’re using moleskin, you may need to use several layers, as the moleskin doughnut needs to be higher than the blister to be effective.

moleskin doughnut on blister

You may need to use several layers of moleskin to get above the blister

For Large or Ruptured Blisters

If the blister is large but intact, puncture it with a clean needle or safety pin at its base and massage out the fluid. The fluid contains inflammatory juices that can delay healing.

Once you’ve punctured the blister (or if you’re dealing with one that’s already ruptured), trim away any loose skin from the bubble and clean the area with an antiseptic towel or soap and water. You should then apply antibiotic ointment and cover the area with a non-adherent dressing or GlacierGel to prevent contaminants from entering the wound and to promote healing.

applying glaciergel

GlacierGel dressings help protect and heal ruptured blisters

You can then use moleskin (or molefoam) to protect the wound from further rubbing. Use a doughnut-shaped moleskin to raise up the area around the blister – remember to use enough layers to raise the moleskin above the height of the blisters with its dressing. Secure the moleskin in place with medical tape.

You’ll want to change the dressing every day and keep a close eye on it for infection. Signs of infection include redness, swelling, increased pain, or a cloudy fluid under the dressing. If infection occurs, remove the dressing and allow the area to drain. Consult a doctor as soon as you are able.

  • Trim away any loose skin from the bubble and clean the area with an antiseptic towel or soap and water.
  • Apply antibiotic ointment and cover with a non-adherent dressing or other dressings like Glacier Gel.
  • Utilize Moleskin to protect the area. Take a small piece of moleskin and cut a circle in the center approximately the same size as the area.
  • Center the oval over the hot spot and secure into place with tape. This will act as a buffer against further rubbing. Change the dressing every day.
  • Inspect the wound daily for infection-this includes redness, swelling, increased pain, or cloudy fluid under the dressing. If infection occurs, remove the dressing and allow the area to drain. Consult a doctor as soon as you are able.

Gluing a Blister

If you are far from help and must continue walking for an extended period of time, an alternative treatment is to glue the blister in place. This method is initially painful but can be effective in backcountry scenarios, especially if you’re low on typical blister first aid supplies.

Begin by draining the blister of fluid. Then, place a small amount of tincture of benzoin (or glue if that’s all you have) in the drained blister. Press the loose skin overlying the blister back into place and cover the site with a suitable dressing. The extreme pain produced by the benzoin on your skin will only last a few minutes.

glueing blisters

Tincture of benzoin is included in the Ultralight/Watertight .7 kit