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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.

Gasoline Geysering on the San Juan River, UT

Friday, January 11th, 2019

Spring of 2018, Canyon Country Youth Corps (CCYC) was asked to work with the Bureau of Land Management on remote sections of the San Juan River, removing and treating the invasive Tamarisk and Russian Olive. The remote work location required CCYC to break out rafting gear and hire a river guide to ensure the CCYC crew could float the lower San Juan safely with all the chainsaw gear, gasoline, and herbicide needed.

Gasoline Geysering

The Southwest gets very hot during the spring, especially with several days without cloud cover. This can create difficulties when working with machines and flammable fuels. Gasoline evaporates as it heats up, which creates pressure in a closed fuel tank, even when mixed with two-stroke engine oil. This pressure buildup in a hot chainsaw has caused a problem known as “geysering.” This is where a literal geyser, or small fountain, of gasoline shoots out of a chainsaw when pressure is released, like when removing the fuel tank cap. This gasoline geysering is exactly what happened while CCYC was working remotely on the San Juan River, a day down river from the put in, and a four day paddle to the take out.

Gas in His Eyes

It was the morning of the second day of work when a Crew Leader walked over to the Field Coordinator and Field Boss and calmly explained, “Will has gas in his eyes and says it’s hard to breathe.” The Crew Leader was advised to inform the River Guide, who was Wilderness First Responder trained.

The field staff grabbed their water bottles and hurried over to Will, who was found shirtless, leaning over a rock and splashing river water over his chest, shoulders, face, and mouth. He claimed his shirt was soaked with gasoline, his skin was tingling, and his eyes were burning severely. When his chainsaw geysered, he was wearing safety eye protection, but the gasoline reached his eyes anyway.

The Field Boss told Will to stand and put his head back, and they started pouring clean water over his eyes and eyelids. Another Crew Leader was advised to retrieve the large Adventure Medical Kit, knowing it contained a large irrigation syringe and eye drops. The Field boss continued pouring clean water over Will’s eyes and eyelids. Just moments later, the River Guide arrived with the Adventure Medical Kit and took over.

The River Guide used the large irrigation syringe to squirt clean water over and directly into Will’s eyes in an effort to wash out all traces of gasoline. Will said his skin was still tingling, especially in the direct sunlight, but his eyes remained the first priority. The CCYC backcountry communication device was on hold, ready to send an evacuation request. CCYC protocol is if loss of life, limb, or eyesight are at risk, an emergency evacuation is organized, which, on a remote section of river, would require a helicopter.

30 Minutes & 2.5 Liters

The rest of the crew waited anxiously; they rinsed Will’s shirt, they checked the chainsaw, and they waited for updates. To many people’s surprise, it took about 30 minutes and 2.5 liters of water for Will to claim the stinging was still present but less severe and his vision was not blurry. The whole crew breathed a sigh of relief. The River Guide advised Will to hold off on work the rest of the evening, to wash his skin with soapy water, and to sit in the shade.

Will rinsed his eyes again after dinner, and then applied saline eye drops. Will confirmed he was feeling better after the end of the day, and an emergency evacuation was not necessary. Thank goodness for the Adventure Medical Kit and for the River Guide who took over when necessary!

The entire crew was surprised at the amount of water and time necessary for Will to feel relief in his eyes. It was an adrenaline-filled morning; however, the entire crew learned a valuable lesson on the dangers of gasoline geysering and how to respond if geysering occurred again. The biggest lesson learned was how to prevent gasoline geysering and injury. Gasoline containers and chainsaws must be placed and stored in the shade when not in use. A STIHL chainsaw fuel tank can be checked through the translucent sides. If a tank is over ½ full do NOT open the tank. Instead, wait for the chainsaw to cool down, then open the fuel tank. When opening a fuel tank, a sawyer must not stand or lean directly over the fuel tank and must instead face away until pressure is released.

Thankfully, Will recovered just fine after the gasoline geysering incident, and the entire crew was able to continue their work on the San Juan River and enjoy floating to the take out. Without a doubt this was one of the most memorable trips for the CCYC spring season.

About Canyon Country Youth Corps

Canyon Country Youth Corps (CCYC) is a youth conservation Corps that trains up to 56 individuals every year on various conservation and restoration techniques. CCYC works across Utah completing projects primarily on riparian restoration removing Russian Olive and Tamarisk, which are common invasive species in Utah that crowd and destroy river banks.

As a result of Tamarisk and Russian Olive establishment, the river banks have become super-stabilized. This is not good for a healthy, moving river, which are supposed to have bends, curves, braiding, slow parts, and fast parts that change over time.

Tamarisk and Russian Olive also shade the river. This extra shade along an entire river results in significant water temperature cooling. This is detrimental to native fish populations that require a specific temperature range for mating and spawning.

With all the negative effects of Russian Olive and no foreseen circumstance of Tamarisk or Russian Olive being outcompeted by native plant species, mechanical and chemical removal has become necessary. This is where Canyon Country Youth Corps comes into play. Throughout the spring and fall seasons, CCYC works along various rivers using chainsaws, hand tools, and herbicide to remove and treat Tamarisk and Russian Olive.

Written by Natalya Walker

4 Employees. 40 Miles. 13,804 ft. – Preparing for Gannett Peak

Wednesday, June 6th, 2018

Tender Corporation – parent company to brands like Adventure® Medical Kits, Survive Outdoors Longer®, Ben’s®, After Bite®, and Natrapel® – has always existed with a simple, unified goal: to help people enjoy the outdoors safely, even in the most remote locations. This July, Tender Corporation is sponsoring a team of four employees on an ascent up Gannett Peak to share how to prepare and train for a high peak expedition.

The Remote Beauty of Gannett Peak

The Wind River Range in Wyoming

Gannett Peak, located in the Wind River Range of the Rocky Mountains, is the highest mountain in Wyoming at 13,804 ft. and represents a unique mountaineering challenge. The broad, snow-capped summit rests upon a rocky base covered in five glaciers, all nestled in the remote wilderness of the Rockies.

View of Gannett Peak

Infamous for its inaccessibility, Gannett Peak requires the longest round trip approach of any state highpoint, with a minimum of 40 miles covered and a 9,000 ft. vertical climb.

Team Tender

Team Tender has been training for this expedition since January. Over the next month, they’ll be sharing tips on how to safely prepare for a journey of this magnitude, including emergency plans, gear considerations, and training regimens. During their week-long journey, they will be putting medical kits, survival bivvies, and insect protection to the test. They’ll also be posting live updates from the trail (and hopefully the summit!) on social media.

The team includes four employees who will be attempting the climb, as well as ground support from Tender Corporation’s Chief Marketing Officer Frank Meyer, who has previously summited Gannett Peak.

For the latest news during the planning process and live updates from the trail, make sure to follow Adventure® Medical Kits on Facebook and Instagram, as well as the different members of the team on Instagram. The team leaves New Hampshire for Wyoming on July 13th. #TeamTender #BeSafeGannett

Meet Team Tender!

Joe Miller – Trip Leader & Photographer

Instagram: @sir_st33zy

I was drawn to the woods from a young age. As I grew up, I kept finding ways to get closer and closer to the mountains, finally moving full time to the White Mountains of New Hampshire in 2015. In the White Mountains, I quickly bagged all the high peaks, learned the ropes of alpinism, and have since used New Hampshire as a home base for bigger adventures such as Thailand, Banff Canada, and multiple other US climbing destinations.  A Search and Rescue Member, I love adding new skills and experiences to my ever growing arsenal of backcountry travel, and Wind River Range is a must do on any outdoorsman radar. The challenge of bagging the highest peak in Wyoming in such a remote setting is intriguing to me in both a logistical and athletic sense.

Ben Pasquino – Official Mule & Gear Junkie

Instagram: @pasquinob1_nh

Name’s Ben Pasquino, 35 years of age, and I’ve been pushing my limits for my entire life. It just makes logical sense to try my hand at mountaineering. Previously an NCAA swimmer, I became an ultra-marathon runner after college. A CrossFit athlete and coach for nearly 5 years, I’m no stranger to hard work and following training regiments with an end goal in sight. Designated as the mule of the group, I’m stoked to test our fitness and see how far we push ourselves on this adventure up Gannett.

Chelsea Miller – Logistics Guru & Chef

Instagram: @mtnchels

I’m always scheming my next adventure.  Whether it’s this weekend’s hike or an after-work mountain bike ride, I’m constantly daydreaming about my next chance to get outside.  I love trip planning, maps, and lists; after ticking off NH’s 48 4,000 footers, I know the trails of the White Mountains like the back of my hand.  The opportunity to plan a trip to the Wind River Range is unbelievable. I’ve hiked and climbed all over New England and taken a number of trips across the country and the world to hike and climb. Taking on a high peak is an exciting next step on my mountaineering journey. Already, training for this expedition has pushed me past my perceived limits, and I’m excited to see what we’ll be able to accomplish as a team!

Jenny Hastings – Social Media Coordinator

 

Instagram: @jenpen_95

I fell in love with hiking from spending hours in the White Mountains with my dad, where my childhood tendency to dart ahead and scramble unnecessarily over rocks earned me the nickname “Mountain Goat.” As the mountains have gotten bigger as I’ve grown, I’ve been excited to meet each new challenge and reach each new summit. Gannett Peak represents the next step forward for me in my passion for mountains and will be my highest summit to date. At 5’1’’, I’m having to put on some muscle for this trip, but I’m training hard and enthusiastically rising to the challenge. I’m in charge of sharing our adventure with you through social media, and I can’t wait to share our journey and what I learn! As John Muir said – “The mountains are calling, and I must go.”

Frank Meyer – Expedition Coordinator (also our boss!)

Instagram: @ftmeyer50

Over 30 years ago, I co-founded the Adventure® Medical Kits brand to meet the need I saw and personally experienced for medical kits designed for people that are heading into remote locations and have to care for themselves. An avid skier, backpacker, and whitewater kayaker, I have put these first aid kits and other Tender Corporation products to the test both in my native Montana and on mountaineering expeditions, including a trip up Rainier and a previous summit of Gannett Peak with my son’s Boy Scout Venture Crew. I’m excited for Team Tender to experience Wyoming’s Wind River Range and attempt a summit of Wyoming’s highest and glaciated Gannett Peak (13,804′). I am looking forward to the feedback they give from extensive product testing in a range with quite volatile weather.

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.

Lifetime Outdoor Enthusiast. Completely Unprepared. – Lessons in Wilderness First Aid

Thursday, November 9th, 2017

Ever wonder what you’d do if a medical emergency happened while you were out in the wilderness? One of our employees recently took a course in Wilderness First Aid at SOLO Schools. She’s extremely excited to share what she learned! – Adventure® Medical Kits

My dad and I after hiking up Mt. Lafayette

My dad and I after hiking up Mt. Lafayette

An avid hiker, I grew up scaling the White Mountains of NH with my father without injury (excluding your normal blisters and scrape). Though I lacked personal experience with first aid in the wild, I knew wilderness emergencies weren’t uncommon.

I remember the day my father came home from a hike and said he’d spent 20 minutes near the top of Mt. Lafayette helping a stranger descend only a few hundred feet of the trail. The stranger fell and shattered his kneecap on the rocks, making every step excruciating. Thankfully, they bumped into a rescue team on a practice climb that quickly became real, and my dad continued down alone.

My dad and I on top of Mt. Jackson

My dad and I on top of Mt. Jackson

Since that day, I’d often wondered what I would do if faced with an injured hiker on the trail. Would I be able to offer any help at all? Miles from professional care surrounded by trees and mountains, I wasn’t equipped to be someone’s best chance at survival, and what if that someone was my dad?

This year, I was given the opportunity to attend a Wilderness First Aid (WFA) course at SOLO School of Wilderness Medicine. Walking onto the campus, I was unsure of what to expect out of the next two days. If nothing else, I was excited for the chance to learn a few first aid tips from wilderness experts. I learned much more than that.

Wilderness First Aid: Day 1

“Is anyone NOT ready?”

When you have five people about to attempt lifting an injured companion, you don’t ask “Is everyone ready?” You may not here the responding “no” over all of the “yes’s.” With a possible spinal complication, missing something and dropping your injured friend is not an option.

“Okay… one, two, three, lift!”

With one smooth motion, we lifted our patient from the cold ground to waist level, all without moving his spine. Surprised at our success, we froze for a moment, before the team leader (holding the patient’s head) followed up with, “Okay, we move on three!” We traversed the rough ground and safely placed our friend onto a foam pad. Thrilled at our success, we listened to feedback from our instructor and “injured” friend on how they felt our practice had gone.

Practicing making splints at a SOLO course

Practicing making splints at a SOLO course. PC: SOLO Schools

We’d only met each other earlier that morning, but as we stood outside the main building in the afternoon sun, our group was already beginning to turn into a team, forged by a common desire to learn and to be prepared to help others. Like me, my fellow classmates were driven by this desire to take the WFA course at SOLO. None of us were disappointed.

In 2 Days, There’s a Lot You Can Learn

Over the course of those two days, I was immersed in an innovative, hands-on learning experience. I learned how to improvise splints out of coats and bandanas, immobilize a victim’s spine with backpacks and baseball caps, and treat wounds ranging from lacerations to serious burns with items like honey and rain jackets. We covered assessing both unconscious and conscious patients, including identifying and treating life threats, monitoring vital signs, maintaining a soothing presence, and making an evacuation plan.

Improvising a leg splint. PC: SOLO Schools

How often should you change burn dressings? How do you recognize potentially life-threatening infections? When should you be concerned about a spinal injury? What should you do in a lightning storm? What are the early signs of shock, and how can you treat it? These are only a handful of the questions we learned how to answer.

New Skills to the Test

 

Assessing and caring for a patient.

Working as a team to practice assessing and caring for a patient. PC: SOLO Schools

Not only did we learn though – we also did. Hardly an hour of lecture would pass before our instructor had us outside practicing our new skills, with some of us acting as patients and some as caregivers. Outside, lifting companions, assessing broken bones, and applying pressure to stop major bleeds, our class of about 20 learned how to manage difficult patients, quickly assess scenes, and rule out spinal injuries.

Course Highlights

So out of this whirlwind weekend of knowledge and skill application, what did I enjoy most? This is gonna take a list:

  • Our instructor. Seriously – she was awesome! An amazing resource for both professional medical knowledge and practical ideas for when situations actually occur. From improvisation techniques to a great sense of humor, I couldn’t have asked for a better teacher. And she encouraged questions!
  • My classmates. I emerged out of that class with new friends who love the outdoors like I do, yet have a variety of experiences and backgrounds to speak out of. They asked relevant, insightful questions of our instructor that contributed to everyone’s learning. From a grade school teacher who leads the school’s hiking club to a wilderness first responder getting recertified, our differences and similarities worked together to make learning fun and effective.
  • Learning what’s left to learn. Headed into the WFA course, I knew I didn’t know enough… but I didn’t know how much I could know! Now, I have a firm grasp of what wilderness emergencies I’m equipped to handle and which I’m not, and I’m excited about the possibility of furthering my knowledge with another SOLO course in the future.
  • Packing recommendations. Ever wonder what you should be carrying for first aid supplies? Or have a first aid kit but only a vague idea how to use it? That’s part of what makes this course so great – throughout the day, we got tips from our instructor and each other on the most useful supplies to pack and when and how to use tools like an irrigation syringe, triangular bandage, tourniquet, and more.

Choosing to Be Prepared

 

Hiking down Mt. Washington with my dad

Hiking down Mt. Washington

Whether you’re a trip leader or just an outdoor enthusiast looking to become more prepared, I highly recommend the WFA course at SOLO as a great starting point to build a foundation of first aid knowledge that could save your life, a friend’s, or a total strangers. If you own a first aid kit and haven’t taken the time to look through it, this course is a must for preparing you in how to use what’s inside. A bit of advice I learned from my course: first aid supplies are only as effective as the person carrying them.

About SOLO

The oldest continuously operating school of wilderness medicine in the world, SOLO offers wilderness medicine education on a variety levels for everyone from outdoor enthusiasts to trip leaders to trained professionals. The WFA course is a 16-hour course that provides a 2 year certification and covers the basics of backcountry medicine. On the other end of the spectrum, SOLO’s Wilderness Emergency Medical Technician (WEMT) course lasts a month, and participants who pass emerge with the national EMT certificate and thorough training in wilderness-specific medicine and long-term care. Courses can be attended on their campus in Conway, NH, or at off-site locations across the United States.

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.

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