Re-thinking My Backcountry First Aid Kit and Repair Kit


Post by WildSnow.com blogger | August 21, 2017      
Example of first aid kit bag, not waterproof so contents would need to be heavily protected.

Example of first aid kit bag, not waterproof so contents would need to be heavily protected.

I’m conflicted. I’m a fan of carrying a fairly comprehensive first aid kit. But I’ve never used the majority of items. Ibuprofen and tape are the only things that have seen use more than once or twice in my entire life as a ski mountaineer. Yet someday everything will come in handy, and I’m sure I’ll be grateful I lugged it. But can I lug less?

My compact repair-first-aid bag sits in the bottom of my pack on almost every ski tour and gets beat up. I took the whole thing apart, reevaluated the need for each item, and renewed anything necessary. Turns out a lot needed replacing. Most of the pills had been damaged by water, my alcohol swabs were completely dried out, and my roll of tape was gooey and useless.

I carry as minimal a first aid kit as possible. (For a beautifully designed kit that’s of the more complete nature, check out our Denali version from 2010). I like constructing it from scratch rather than buying a pre-built. For one thing, doing so is significantly cheaper. Also, just as writing notes helps internalize info, packing the kit piece by piece means you know exactly what is in there, and (hopefully) how to use each item.

Since I build it myself, my kit is significantly different than most off-the-shelf kits. Weight is reduced by eliminating unnecessary items, and I include a few things that are typically found only in large multi-day kits. The main thing I cut out is band-aids. Most kits are stuffed with them, and they take up a lot of space. Perhaps first aid kit companies include wads of band-aids because they’re a cheap way to make their kits bigger. Who knows. Regardless, a roll of tape and some gauze can be used for anything you might need a band-aid for, and have tons of other uses.

Let’s begin with the foundational item. Whatever you do, carry your first-aid items in a 100% waterproof bag (consider tossing in a few desiccant packs to cut condensation), and package water sensitive items in small ziplocks so when you empty out your kit during a stormy incident, you don’t end up soaking everything. Here at Wildsnow we’re big fans of the beefy UV resistant transparent cases sold to protect things such as phones (test in freezer for low temp durability). We’ve had good results from the E-case or SealLine cases. SealLine E-Series Case (18, Green)

On this round of updating I added a few items to my kit. For one, I didn’t have a CPR mask in my kit for some reason. CPR is at the top of first aid skills (along with controlling bleeding and cervical stabilization), in terms of really saving a person’s life. The breathing part of CPR is definitely doable without a mask, but can be unsafe for the rescuer, particularly if the patient vomits, or is bleeding. I, for one, hope to live my entire life without someone puking into my mouth. Even if you disregard the increased safety, I’ll certainly be less hesitant about giving a stranger mouth to mouth if I have a mask. They are hard to find in a store. This time, found some online, and bought a few.

Another new item is a wire mesh splint. I’ve avoided carrying a SAM Splint, since they are bulky, and only have one function. Granted, they perform that function very well. After hearing stories about how difficult and painful it is to use an improvised splint, I started thinking about alternatives. A friend showed me wire mesh splints, which are essentially a SAM splint without all the bulky foam. Packs tiny, and functions the same as a SAM splint. A sock or gauze or something similarly soft can be wrapped around the bare wire to make it more comfortable for the wearer.

I also removed a few items from the kit. I took out elastic bandages, as they seem bulky and not very useful. I also used to carry high-power prescription pain meds. However, after research, it seems like the potential complications that could arise aren’t worth it. I go back and forth on that one, though. Your comments, dear readers?

In the past I have carried some repair kit items in my first aid kit as well. However, I often found myself using the same first aid kit for trips that didn’t necessarily need any repair kit items (hiking, climbing, etc). Now my first aid kit only has first aid items, and I have a separate repair kit, that I only take on ski trips.

My updated first aid kit, with all the items stored in small ziploc bags. The bag that holds the kit is visible in the lower right as well.

My updated first aid kit, with all the items stored in small ziploc bags. The bag that holds the kit is visible in the lower right as well.

The same kit, with individual items separated. Minimal.

The same kit, with individual items separated. Minimal.

My minimal repair kit. I rarely have ever needed more than this when making repairing ski gear.

My tiny repair kit. I rarely have ever needed more than this when making repairing ski gear. (Not pictured: a small coil of bailing wire). It could be wise to carry these items in a waterproof container as well, or at least in a ziplock inside the nylon bag. Otherwise, the screwdriver bits will rust, and the lighter could be compromised. It’s also a good idea to have a bit of redundancy with your fire source; perhaps carry two lighters or simply be sure other group members have fire starting items as well.

Here’s a list of what I currently have in my first aid kit.

Medications (variety important for different needs, per first aid training):

Wound care:

Miscellaneous:

Here’s what I have in my repair kit:

Anything I missed? I’d love to hear from some more medically experienced types what are some must-have items in in a minimal first aid kit. One heavily questioned item is the EpiPen. Should every kit have one, or at least one per group? Also important: If you tend to ski with the same partners, coordinate emergency and first-aid gear. For example, one of you could carry the wire splint while the other could haul the wound care items. At the least, ask within your group so you know what your resources are. You could do this during the beacon check, or when you’re setting up the 2-way radios.

Bonus pic: Dynafit heel repaired with nothing but bailing wire and a stick (and lots of head-scratching).

Bonus pic: Dynafit heel repaired with nothing but bailing wire and a stick (and lots of head-scratching).

Check out our other first aid kit links.

(Please know this blog post contains affiliate sales links. Thanks for shopping our links and helping support our work here at Wildsnow!)

Example of first aid kit bag, not waterproof so contents would need to be heavily protected.

Example of first aid kit bag, not waterproof so contents would need to be heavily protected.


Comments

72 Responses to “Re-thinking My Backcountry First Aid Kit and Repair Kit”

  1. Bruno Schull August 21st, 2017 9:16 am

    Great post. Like you, I’ve gone back and forth with various things in my first aid kit for some time, and it’s grown smaller or larger over the years. I don’t think there can ever be a perfect first aid kit. I think we all have to find our own “perfect” kit for each trip, for our skills, and for whatever environment we’re in. That said, below are some items that came to mind, in no particular order.

    -Space blanket/emergency shelter (hypothermia)
    -Re-hydration salts (dehydration)
    -Glucose tablets/gel (hypoglycemia/diabetes)
    -Silicon tarp (ground cover, or for dragging somebody on snow)
    -Large square or rectangular pads to cover wounds
    -Safety pin (lots of uses)
    -Mini tweezers (eye injuries, splinters, punctures)
    -Nasopharyngeal airway and small package of silicon lubricant

    This last was a suggestion from a friend who is an Airforce PJ. If you are a team of two, and your partner is unconscious, and you have to leave them alone to get help, you can put them in the recovery position, insert an airway, and have a slightly better chance of things working out OK. Or if you are with a larger group, and you have to evacuate an unconscious patient and are worried about maintaining their airway. Not ideal, but simple, light, and perhaps a lifesaver in some cases.

    I’ve wondered about the best way to improvise a C-collar. I’ve played around some with a SAM split, but it’s not idea. Would the wire mesh split work? Ideas?

    Last, since you mentioned a repair kit, something else that could easily be considered an integral part of a first aid kit is a means of communication. Cell phone, sat phone, radio, GPS spot, whatever…in this day and age, and despite our best efforts to remain self sufficient, I think this is critical.

    I’ll add more if I think of anything else.

    Thanks again.

  2. Njord August 21st, 2017 9:55 am

    I’ve given up on trying to create a universal or modular kit… I now have 4 different “packages” that I keep in a gear bin ready to go depending on the trip type and length. Yes, it costs more, but it saves on the hassle on loading/reloading or losing/forgetting something.

  3. Foster August 21st, 2017 10:04 am

    Don’t bother improvising a c-collar. Purpose designed c-collars already do a poor job of immobilization, improvised collars are only marginally better than nothing. Better to coach your pt. not to move their neck and report any pain, or if possible, follow spine clearing protocol so they can move under their own power.

  4. Lou Dawson 2 August 21st, 2017 10:39 am

    Njord, that’s where I’ve been going with all this, especially with my repair kits. I have one kit for Colorado wilderness skiing, and an entirely different one for western Europe, consisting of a screw driver and cell phone, which is one more thing than most people there carry (smile). Lou

  5. Rob August 21st, 2017 1:44 pm

    No Compeed? I never leave home without it. Blisters can really ruin your day.

  6. Bob Coleman August 21st, 2017 3:16 pm

    First aid training beforehand proves useful. WFA is the right start and WFR has become popular, but takes more time and money. You and one reader hint at it, but understanding SAR/MR and evacuation for your touring area is valuable in driving the gear setup. Folks that combine those two concepts will be more effective at dealing with the “sick patient”. Covering different types of wounds, using OTC, and having a SAM for someone who can use it are all good calls even for personal care.

  7. Andy Carey August 21st, 2017 3:40 pm

    Great topic! I don’t have any answers, just some observations from the Wilderness First Responder course I had as part of being a XC Ski Patroller. the first suggestion the instructor had: keep your kit small! [presumably so you will always carry it]. 2nd: CPR in the backcountry rarely works because reinforcements/evacuation will take a long time; no longer recommended (at least at that time); that is not to say it will not work with multiple, youthful, skilled resonders. 3rd: do not use iodine, peroxide, etc. or antibiotic creams because they do tissure damage; irrigate with sterile water (carry a large syringe for irriation). 4th: Ibuprofen/Naproxen & benadryl. 5th: Large triangular bandage for immobilizing arm/shoulder injuries, Sam splint for breaks and neck. 6th: a fair amount of duct tape–obvious, sometimes better than bandaids, etc. In fact, once my had slipped while putting on especially stick skins and I laid open a larg gash on the side of my palm as it slid down my nicely shapened metal edges–I closed it with duct tape and ER said that was the best thing I could have down. 7. A array, but not big, supply of various bandaids including some butter fly types and some larger types; of course a roll of gauze. These were his suggestions; I’m not arguing for them or for anything; I started out carrying quite a large kit and worked it down to one of your size.

  8. Andy Carey August 21st, 2017 3:42 pm

    Oh, and BTW, on our 5-10 day whitewater rafting expeditions (and in our vehicles) we carry a large, comprehensive commercial 1st aid kit (weight & bulk are issues).

  9. Jim Moss August 21st, 2017 4:05 pm

    leave the Tylenol behind. No anti-inflammatory value and minimal pain value Ibuprofen and Aspirin are better and fight inflammation, cardio issues, etc. Bug bite stuff while skiing? Water Skiing?

    Grab some butterflies, better to pull wounds together, light weight and keeps the wound open to watch infection, etc. Take more gloves. If you come across someone who needs help you don’t know, you’ll want more. I went pair 4 pair on one person (SLC tornado victim) trying to clear an airway. If you got blood, double glove too.

    Throw a silicone packet (comes with electronics & vitamins, etc.) in too. Absorbs water and weights nothing.

    Leave bleach behind and take a Sawyer filter. Will work for everyone in the group and will never quit, probably as light weight as the bleach and much more effective.

    Benadryl is awesome!!! If you can find the wafer or powder versions take those. If shock victim is unconscious put under tongue, works better than and is legal, than epinephrine.

  10. Joe John August 21st, 2017 5:01 pm

    Louie, when you have kids, you will end up putting the Band-Aids back in your kit. Funny enough it is the first item to go in our first aid kits.

  11. robert lee tomasson August 21st, 2017 5:13 pm

    I always carry some liquiband skin glue, some times on longer trips ill even carry a suture kit and lidokaine local anesthetic,

  12. Michael August 21st, 2017 5:44 pm

    These posts bring up some interesting issues. I’ll give my 2 cents. Andy Carey makes some great points. I agree with the majority of what he said.

    I am an emergency physician.

    My points relate to typical backcountry skiing. Day trips and maybe a night or two out. If you are an expedition going to a very remote place, then this will not apply. The longer you are out, the less my comments will apply.

    WFR courses etc are awesome (and I recommend them) but they are loaded with dogma. We do it this way because that’s how it’s always been done type of thing.

    1. If someone is critically injured (bad head injury, spinal cord injury, bad torso trauma etc) your focus should be on evacuating them ASAP. You will not be able to resuscitate a critically injured patient in the field, so get them out ASAP. That may be self evacuation, that might involve a rescue. Whatever’s fastest and safest for the group.

    2. That being said, I think one of the biggest bang for your buck things you can carry is some kind of locator beacon. Especially in winter, being able to get a hold of someone quickly if needed is paramount. I’m all for self-rescue, but if it’s obviously not possible, starting the rescue process right away seems prudent to me.

    3. Your first aid kit should focus more on scenarios that will be more common – extremity injuries being first and foremost when skiing. Also minor wounds, blisters, sunburn, etc.

    4. I wouldn’t worry much about advanced wound care in the field. Just cover it up and get to a hospital. If you are on an overnighter, just irrigate it as best as possible with clean water and put a dressing on it. Some kind of emollient like Bacitracin ointment or vaseline will keep the wound from getting all crusty if you have it. Butterflies are really hard to use well unless the wound is totally dry. Same with glue. I can’t tell you how many wounds I’ve seen that are all jacked up because someone poured a bunch of glue into it. It’s just a crusty mess. If you know how to use it then it can be beneficial though.

    5. The best evidence as far as I can tell really doesn’t support spinal immobilization. C-Collars are used because that’s how it’s always been done. There’s no great evidence to support their use. Movement doesn’t cause spinal cord injuries, force does. This is a key point. And the force will be applied by the original mechanism of injury. If someone has no neurological deficits and they’re ambulatory, my vote is that they walk out. Delaying definitive care to “follow the rules” of spinal immobilization makes no sense to me when there’s no evidence that it helps at all. So don’t worry about fashioning a C Collar. This doesn’t apply to someone with neurological deficits. That person more than likely needs a rescue.

    6. I have to take issue with Jim Moss’ comment that Benadryl is better than epinephrine. If you’re just a bit itchy or have some poison oak, then yeah, Benadryl is the way to go. But for true anaphylaxis, epinephrine is the only treatment, end of argument. Benadryl is NOT the first line treatment for anaphylaxis, epinephrine is. Anaphylaxis has a lot of definitions, but it’s easy to think of as an allergic reaction that could kill you. Hives/rash plus any airway swelling, breathing difficulty, or cardiovascular effects (low BP). If they have anaphylaxis they need epinephrine. That being said, anaphylaxis is the one critical illness you can treat in the backcountry, so I think an Epipen is a good bang for your buck as well. I think it’s a matter of personal responsibility – if you have known anaphylaxis to environmental triggers like hymenoptera then you should have an Epipen around. Same goes of you have bad food allergies. In winter, it pretty unlikely that stings will be an issue.

    7. CPR is fairly worthless in the backcountry. CPR is meant to get some blood flow to the heart and brain until the underlying problem can be reversed. If you have a primary cardiac event, then it’s not your day. Unless you have access to an AED, there’s not much to do in a wilderness setting. If the victim dies of trauma, CPR is worthless. The one place I’d do it is an avy victim without obvious major trauma. If it’s a respiratory issue like digging someone out of an avy who’s been asphyxiated, then breathe for them and do compressions. But realize it’s a respiratory arrest and you need to reverse the underlying issue of hypoxia, so breathe for them. You’re pretty unlikely to get some kind of blood borne pathogen from rescue breathing. I think a CPR mask is a waste of weight and bulk in the BC. I don’t carry one.

    8. IMO a good repair kit is way, way more important than first aid gear. Equipment breaks and that could leave you stranded in the cold. IME equipment issues are way more common than injuries. You have to be prepared for common equipment issues.

    9. I think a couple tabs of Tylenol is worth it. It’s very light weight. It’s a different class than Ibuprofen/Naproxen and will be a good adjunct to these meds. True, it’s not the strongest pain med, but unless you get a prescription, Tylenol and NSAIDs are all you can get over the counter.

    10. if something is bleeding badly, put direct pressure on it. Tried and true. Resist the urge to just cover it up. All that is going to do is soak up blood. Put 1-2 fingers on the source of bleeding and push down firmly. Don’t let up for 15 minutes. Reassess.

    All of that being said, I think some prudent things to bring would be:

    Tylenol, Ibuprofen, Benadryl, Imodium (worth it!), maybe some nausea meds if you have access to it (Zofran), maybe aspirin especially if you are older or ski with older partners who would have an MI, stronger pain meds if you have access to them. A pair of nitrile gloves is low weight and not a bad idea. Could be used as vape barriers too if you get really cold hands. A few gauze 4 x 4s, some bandaids, Ace bandage (great tool), a small gauze roll, blister care. Tape! Maybe a SAM splint. However I think between poles, skins, and Voile Straps you can rig a decent splint. Maybe an Epipen if someone in the group has serious allergies. Personal Locator Beacon. Repair kit (a whole different topic). I’m sure I’m forgetting something but that’s a good start.

  13. Jack August 21st, 2017 5:48 pm

    The c-collar discussion above prompted me to find a reference: https://www.coloradowm.org/blog/spinal-immobilization/

    Worth a read. They go through the immobilize/don’t immobilize decision and one photo illustrates improvised c-collar.

    I”m in no way qualified to comment on this. The site above looked authoritative.

  14. JCoates August 21st, 2017 5:58 pm

    After 20 + years of medicine both in the hospital and the woods (SF medic, ER PA, etc), I’d say I have my medical-kit dialed in pretty good:
    I usually don’t carry anything.

    Instead I choose my partners wisely–folks that I know won’t huck blind drops, stab themselves with their multi-tools or blow themselves up with their stoves.

    With that said, duct (or is it “duck?”) tape will take care of about anything if you apply it right. I’ll also carry some dissolvable Zofran, loperamide, and maybe a couple of pain pills in my kit if we’re going on a multi-day trip.

    In general (unless you’re a pro and responsible for the whole group), you’re never gonna have everything you need so don’t sweat it and be prepared to improvise.

  15. Michael August 21st, 2017 6:03 pm

    Well said JCoates, well said.

  16. Bob August 21st, 2017 6:46 pm

    Some nice suggestions here. I skimmed so I might have missed some ideas, but I carry narcotic pain relievers because they don’t weigh anything and they have served me well waiting overnight for evacuation, haemostaric powder to stop bleeding because it saves time and blood, dermabond for lacerations because edges, crampons, knives, and ice tools, and second skin to prevent blister. All light weight.

    Fwiw, I’m an EMT.

  17. DavidB August 21st, 2017 7:07 pm

    This is actually my job. I run a large first aid supplies and training company and we supply ski patrol operations.

    I have two kits one for longer overnight tours and one for everyday.

    Most items have been covered. One that I see missing is “Burnaid” hydrogel. This stuff works miracles on any type of burn. The same company makes a great antiseptic gel which works as an itch and bite cream as well. It’s called Woundaid, so instead of carrying two products for bites and antiseptic, one performs multi tasks.

    Re bandaids I have small envelopes of a couple of different types. They take up no room and do come in handy. I don’t keep any drugs in my kit they are separate.

  18. Jim August 21st, 2017 8:04 pm

    I’m a practicle person who has been involved in first aid for a long time. I believe that there are no wounds that cannot be managed with saran wrap and duct/gorilla tape. Saran Wrap is cheap, never sticks, conforms, compresses and a roll cut down to 1/2 width will deal with many wounds. It can be used to cover cuts, burns or abrasions. With duct tape layered over top it makes a good splint too.
    No need for expensive band aids, compresses, gauze etc that are almost never used.
    On top of all that you can use it to wrap up your leftovers after supper.

  19. kevin woolley August 21st, 2017 10:28 pm

    For short tours, duct tape and a few Voile straps is both repair and first aid kit. Especially if cell coverage exists. All of the major injuries require evacuation and prompt hospital care. This advice is specific to where I tour (Front Range and Summit County Colorado). Would be totally different on a mulltiday wilderness tour or in areas remote from prompt emergency response.

    Prevention is best medicine though.

    I always give an itinerary and time to return to my spouse (unless she is touring with me). I send by text and require response so I know she has it. I make the details specific enough that SAR wouldn’t have to guess where my car is, what creek I’m next to, and what my objective was. I was late on one trip, and will not do that again (wife was about to call out SAR, my phone died so I lost track of time). I’m also very careful skiing alone, especially in trees where a helicopter might not easily see you if you are hurt.

    Weather is the other big safety factor. Aside from trauma or avalanche, hypothermia and frostbite are the major dangers, I stay out of blizzard conditions whenever possible, and take short tours during extreme cold, with a very tight return time. A big trip far from rescue during bad weather just isn’t prudent for me. But then I am a cautious fellow.

  20. atfred August 22nd, 2017 7:14 am

    good advice, Kevin; however, “my phone died so I lost track of time” – ever considered a wrist watch?!

  21. See August 22nd, 2017 7:31 am

    Re. the bonus pic: I’ve seen the spring cup back out completely without the skier noticing until the binding falls apart and pieces get lost, but I don’t understand how that happens. It seems to me that one would notice as the cup unscrews, either because of reduced lateral rv while skiing or when twisting the heel piece to switch modes. In any case, I noticed (thanks to Wildsnow) that G3 recommends cleaning grease off the barrel threads during maintenance/reassembly. Seems like it might be a good idea.

    (Also, a battery powered usb charger is standard equipment for me these days.)

  22. XXX_er August 22nd, 2017 8:10 am

    the rad heel piece blows apart completely because its a bad design and if it does you need 2 of the longest voile straps to hold your boot on the ski so you can limp out

    anybody skiing the rad 1 should carry a couple

  23. Jerry August 22nd, 2017 9:17 am

    Just a word on tape. Duct tape is something most of us carry but it makes a mess, gets gooey, etc. I don’t carry it anywhere anymore. White athletic tape dries out. I have carried BSN Medical Leukotape P Sports Tape for years. It is the skin colored tape your PT uses to immobilize joints. A bit expensive but it lasts forever. Try not to use stretchy tape as it is too easy to over stretch it and cut off circulation.

  24. Coop August 22nd, 2017 9:30 am

    Great discussion here! These are things that we should be hashing out more as a community. I won’t add much, as much of it has been said.

    A great alternative to bandaids is flexible medical tape. Brand name MeFix. Carry a length of it and cut to size and you have any size bandaid you could ever need. Other wound care dressing on top of
    gauze is Coban or vet wrap. Provides some compression, waterproof, and sticks to itself.

    C-spine immobilization is out the door as we know it. If injured person is awake and ambulatory, as long you they don’t have another traumatic incident or fall while evacuating, normal movement won’t exacerbate the injury. Recognizing critical evacuation is the most important.

    A WFR course is a great idea! If you have avy training, next step is medical training.

  25. Matt Kinney August 22nd, 2017 10:07 am

    After buying a new first aid kit to replace the molded remains of the one that has sat at the bottom of my summer and winter backpacks, I promptly stuff it with large dressing bandages and a roll of quality 1″ cloth tape as they seem to be lacking in these kits. Actually in all my years in the BC, I’ve never reached for my first aid kit per-se, and like many, become complacent on the condition of it’s content.

    Large bandages and tape are critical for severe trauma. Most first aid kits seem incomplete on many levels so you have to stuff it with contents specific to the type of injury you could expect, ie bear mauling. The tape they include is not good and minimal. Most seem to be set up for scratches and cuts, etc. I’m certainly not going to carry an EMT trauma kit or a football sized home-grown kit, though that would be ideal if you really want to claim you are prepared for a medical emergency in the backcountry. Where the heck can I stuff it in my heavy airbag with minimal storage? Something has to give!

    When I guided I carried a small tent….and a space blanket. Someone laying injured on the snow is not good unless you have an insulated pad and adequate shelter. This list of scenarios could go on and on…..

    Always good to have ski partner who’s a doctor or an EMT.

  26. Kevin Woolley August 22nd, 2017 2:12 pm

    Afred, ha ha,, yes, I do use a watch now, after that bonehead day. One of those GPS enabled things. I’ve also carried a small extra cell battery since then.

  27. Scott August 22nd, 2017 2:51 pm

    To the Medical folks out there, what are your opinions on the coagulation sponge’s (such as Adventure Medical Advanced Clotting Sponge)?

    Normally I figure like you said rescue if its bad, duct tape for everything else but for a stabbing wound I thought those sponges might be worth the weight and give me a meaningful chance of helping someone that could not be taped up. I thought that getting spiked by a tree or ski pole is somewhat likely skiing.

    Also, while it adds weight outside my pack I have always put my duct tape around my ski poles. Its easy to “refill” and does not stick to anything in my pack.

  28. Lou Dawson 2 August 22nd, 2017 3:50 pm

    A good tape, that sticks like crazy to skin, Leukotape. I carry it to build blister bandages, etc. Usually I take some off the bigger roll and wind it around a lighter or something. It often does better than duct tape, though I carry that as well. Leukotape sometimes can’t be removed without a solvent, back home. Which is good.

    BSN Medical Leukotape P Sports Tape, 1 1/2 Inch x 15 Yard

  29. Lou Dawson 2 August 22nd, 2017 3:55 pm

    Michael, isn’t Tylenol the best for fever, that you can get OTC? A good fever med in my opinion should be in the kit. Lightweight. It’s not uncommon at huts to have someone get there, then come down with the flu, and need fever control before an evac. I’ve seen it happen, and have heard of other incidents. Nothing to play around with. (Tylenol would seem to be redundant for the daytime trip kit…, if you’ve got Ibu and Aleve). Lou

  30. atfred August 22nd, 2017 4:21 pm

    Actually, some people (like me) can’t do ibu or aleve due to stomach sensitivity to aspirin based meds (had a bleed once), so it’s tylenol for me.

  31. Alex Robert August 23rd, 2017 7:03 am

    Thanks for sharing your thoughts Lou, and to bring a subject that is to often set aside.

    If it can help you leaving that 60cc syringe home, from my point of vue it wouldn’t be appropriate to clean a soft tissue wound by irrigating it in a cold environment. Consequences from heat lost due to contact with water would be greater then the one’s from an infection within the first 24 hrs of an injury. And the odds of having a wound that would need to be thoroughly cleaned by irrigating it are quite low. And if you do really want to irrigate it you can use a plastic bag with a pin hole in it.

    For immobilization, I really like your suggestion of a air mesh splint, it reduce bulk while doing a fair job to immobilize a limb, slight attention tough on the fact that it’s made of metal and would drive the heat of the injured extremity if not properly insulated.

    One thing that can be a great addition on to a first aid kit would be something to treat severe hemorrhage such as a “Quickcloth combat gauze z-fold”. Quite small and light, thus it can stop, with proper application, a severe arterial bleeding within 3 minutes. An simple multi use device as that can accumulate a good amount of blood is a sanitary pad.

    We can add as well to the the list a rescue sled that can be use as a bivy, tarp or shelter. Treating the victim is the easy part, getting him out of there is the real game. A foam pad with warm clothes to isolate your victim from the environment.

    And not to forget the most important thing in a first aid kit, the BRAIN. Possessing the basic knowledge to asses signs and symptoms along with mastering the skills to treat your patient would never replace any fancy bandages that you would carry.

  32. James Clark August 23rd, 2017 11:10 am

    Hahahha Benadryl is better than Epi,,, I mean seriously!! Have you ever given some Epi,, I have probably 100+ times, ya it works betters than benadryl for just about every besides a stuffy nose. If I’m having an significant allergic reaction I’ll take the Epi every single time. Oh and the onset of PO anything is 30 min at very best, with acute anaphylactic reactions that’s about 28 min too long, trust me

  33. XXX_er August 23rd, 2017 2:00 pm

    I have done a lot of skiing
    with an ER physician/anesthetist, I asked buddy if he had 1st aid with him and he replied ” yup, last aid too “

  34. Joel August 24th, 2017 12:13 pm

    Your SOG-multitool modification looks interesting. No need to carry separate bit driver. Any info on the mod?

  35. Paul Diegel August 24th, 2017 3:13 pm

    Based on experience, I agree with carrying a few hydrocodone tabs, aspirin, and imodium. I also carry a few 2x caffeine Gu packs to keep going in an all-night rescue or get me home when I am getting sick and dragging.

    My ER doc sometimes outing partner just carries narcotic painkillers and duct tape. Multiday outings: much different.

  36. Jonathan Moceri August 24th, 2017 5:07 pm

    I completely agree with everything that Michael, the ER doc, said.

    I’m an anesthesiologist, and former paramedic.

    First, the treatment for trauma is transport. Otherwise, I think a few bandaids, betadine swabs, some 4×4 gauze, tape, triangular bandage for an arm sling, OTC pain meds and tweezers, is good. Blister prevention is more important than treatment. No new boots.

    If women are on the trip, they’ll have tampons and pads that make great trauma dressings.

    Other meds to consider: Benadryl (diphenhydramine) and epinephrine for folks who have severe allergies. Think about antacids like Tum’s or Rolaids, and the systemic meds like Zantac (raniditine) for those others who forgot their own or when you might over eat or over drink. But I know that never happens.

    For high altitude trips, I always bring dexamethasone 4 mg tablets. 2 to 4 mg by mouth every 12 hours will make that weekend jaunt up Mt. Rainier much better, as there is no time to acclimatize. Dexamethasone even works great on low altitude trips for every aching back, shoulder or knee that some older skiers may have.

    Sunscreen and lip balm.

    CPR: total waste of time and effort. Except maybe the rare occasion of a quick snow burial and recovery. Just a few minutes to see if they’ll start breathing on their own.

    C-collars: Way over emphasized and used. Here is a good article from JEMS about C-spine precautions.

    http://www.jems.com/articles/print/volume-40/issue-2/patient-care/why-ems-should-limit-use-rigid-cervical.html

    Of course prevention is the best cure. Ski smart, safe and don’t fall. In the PNW, I see lots of backcountry skiers who are really good at going uphill, but are really bad at going downhill. Spend some time at a ski area practicing. And take some lessons.

    Last, nobody should ever backcountry ski without watching the movie “A Dozen More Turns”.https://www.youtube.com/watch?v=w7Pye9f602s

  37. See August 24th, 2017 7:27 pm

    Long ago I compared a multitool with a selection of light individual tools— pliers, knife, bit driver and bits, saw, scissors and so on— and decided to go with an old school tool kit. As I recall, it didn’t weigh any more and was a lot less fiddly. Maybe it’s time to reexamine in light of current offeringso… another vote for a post on multitools.

  38. Jake August 25th, 2017 2:08 am

    Leatherman skeletool CX – 145g, bit driver, pliers & wire cutter.

  39. RCL1 August 25th, 2017 7:38 am

    I’ve been using the Leatherman Crunch multitool for years. In addition to not requiring modification for driver bits, it has a Vice-grip style pliar. I can’t tell you how many times this has proven invaluable. A similarly sized pair of mini pliars such as are contained on other multi-tools will be unable to free a frozen nut, or seize and hold a broken piece, or serve as a handle.

    https://www.amazon.com/Leatherman-Crunch-Multi-Tool-Stainless-Leather/dp/B0007UQ1EC/ref=sr_1_1?ie=UTF8&qid=1503668118&sr=8-1-spons&keywords=leatherman+crunch&psc=1

  40. Lou Dawson 2 August 25th, 2017 7:42 am

    Jake, that’s a really nice tool. Only thing I don’t like is I’d rather it simply took 1/4 hex drive bits, but it appears they sell an adapter? Me, I’d just get the tool and the adapter, then carry standard hex drive bits, as that’s what my whole building gig is standardized on, and they’re much much easier to replace than the special Leatherman bits.

    Leatherman – Skeletool CX Multitool, Stainless Steel with Nylon Sheath

    Leatherman – Bit Driver Extender, (takes both Leatherman and 1/4 bits)

  41. Scott August 25th, 2017 7:47 am

    Before we all totally shun backcountry cpr remember that
    The number one cause of death in the wilderness is drowning and cpr is useful for that (the breathing part anyway). Also not all water is covered while people are skiing.

    Also I am 90% sure wildsnow will have a new mod for the battery on the voltair and then we have backcountry AED!

  42. Patrick August 25th, 2017 8:12 am

    I favor a small first aid kit that deals only with things that can’t wait for the car.

    -CPR Mask
    -SWAT dressing — both a tourniquette and a compression dressing
    -One pair of gloves
    -A small roll of leukotape
    -A few safety pins (these can turn any shirt or jacket into a shoulder sling.

    Ski straps, which I always have a couple of, I also consider part of my available kit should I need to improvise a splint.

    I never carry bandaids, antibiotic ointment, ibuprofen, or trivial stuff like that because
    1) I’ve never wanted to have it and 2) it can wait for the car, you just might have to be slightly uncomfortable for a while.

    I’d never prophylactically carry an epi-pen. There aren’t a lot of bees around during the winter, generally speaking, and I travel with adults, who should be aware of their peanut allergy etc. It is their responsibility to carry an epi pen and inform me of it. Otherwise, it’s just a large and expensive item that’s good for exactly one thing and expires every 2 years

    To the guy who suggested carrying burn gel, your tours are spicier than mine it seems.

  43. Lou Dawson 2 August 25th, 2017 8:23 am

    After many many first aid courses and trainings, as well as knowing all sorts of SAR folks, my understanding has come to be that CPR is indeed very appropriate for a drowning victim that’s rescued quickly, and should be applied in earnest. Same thing for an avalanche victim in respiratory arrest, so long as they’re extricated quickly and don’t have obvious fatal trauma. Where it doesn’t sound that great is for heart attacks and multiple severe trauma, as you need more than just CPR for that stuff, unless the victim is transported to hospital within that golden hour, which is unlikely in backcountry SAR, though it does happen when helicopters are nearby and in radio contact. None of this means it’s wrong to try CPR, just that one has to be realistic about what equipment is carried for CPR use. My understanding is the medical oxygen and a bag mask are key, and we’re not going to be carrying that stuff. Lou

  44. See August 25th, 2017 8:49 am

    Thanks for the suggestions. I guess it’s time I tried some new multitools (can’t pass up a good excuse to get new tools), but I don’t think I’m going to change my bc repair kit just yet. (I agree with RCL1 about the usefulness of vice grips. For what it’s worth: small vice grips, titanium handle lock blade, T handle driver and bits, 200 g.) Re. burns, I don’t know what hydrogel is, but I’ve seen a few stove mishaps over the years.

  45. Jack August 25th, 2017 12:45 pm

    Re: epi-pens. I took a short one-day Wilderness First Aid course and they emphasized that epi-pens are very effective, but require rapid transport to a medical facility. After one hour, the effect is gone and original shock reaction may return. This course emphasized Benedryl as the first line of defense if transport times were long.

  46. Ryan Bougie August 25th, 2017 4:59 pm

    I would always suggest a small titanium pot to melt snow and boil water on a small twigg fire. Hypothermia Kills and having the ability to make hot water bottles to last a night can really be a game changer. As far as analgesics I would also suggest carrying something of a prescription strength. I was in a situation where the person could not move with out pain management in place. We just needed to move a short distance to a landing zone and the drugs were the only thing that allowed for that to happen.

  47. See August 25th, 2017 7:25 pm

    Anyone have experience/recommendations regarding titanium water bottles? I’ve been thinking of getting one to carry water but which can be used to melt snow in a pinch.

  48. See August 25th, 2017 7:33 pm

    I checked out a Vargo Bot recently, but it didn’t look that great for basic hydration which would be its primary function. And theres something about the metal on metal threads that bugs me.

  49. Cassidy higgins August 27th, 2017 7:32 am

    I work as a full time ski patroller in the winter and after hauling lots of injured skiers off the mountain the items I use the most for first aid seem to be a SAM splint, ace wrap, triangular bandages and gauze or a ABD pad for bleeding management. I have used wire splints and I find that the SAM splint works much better. I only bring items that would help stabilize an injury long enough to get out of the backcountry and get to a higher level of care, someone mentioned Coban and I find that after a couple days in the pack it gets crushed and is useless when you need it. I also bring a emergency space blanket and a compressible down puffy on every trip because once someone gets hurt you move very slow and cold is your worst enemy. I would agree that blister treatment is a must as well.

  50. Clyde August 27th, 2017 11:33 am

    Unless you are an MD, giving an epi-pen shot to someone else opens you up to a lawsuit. Might be worth the risk but remember it wears off fast too, be ready for rebound. Benadryl gives longer relief. Those who need epi carry their own.

    Same issue with giving codeine or other RX pain meds, big liability issues. Best to combine acetaminophen and ibuprofen for nearly the same pain relief.

    Nothing you carry can substitute for a tourniquet, period. Either a CAT or Sof-T are the only ones that work (beware the fakes sold on Amazon). One of the few compact items that can truly save a life. An Olaes or Israeli bandage is great for less critical bleeders. QuickClot bandages are good but most people are too squeamish to apply properly (tampons are a joke, never).

    You can improvise a seal for a sucking chest wound but the commercial ones with a vent (Halo) are very light, compact, and work much better (stick on wet skin). Aside from bleeding out, this is one of the few preventable things that can kill before med evac arrives. A CPR mask is pointless.

    Wire splints just don’t work nearly as well as a SAM. But the latter is indeed too bulky. This is something you can improvise. Same with triangle and Ace bandages, just a waste of space.

  51. Lou Dawson 2 August 27th, 2017 12:50 pm

    Thanks for chiming in Clyde. Hopefully, with med, the conversation goes like this “I’ve got some codeine, here, if you’d like it I’ll hand you a couple of pills you can decide to take yourself before we try moving you…”

  52. Clyde August 27th, 2017 2:31 pm

    As long as there is no head injury. Possible clouded judgment plus contraindication for narcotics equals a lawsuit you will lose if things go south. With OTC, not so much. The combo I mentioned is reportedly just as good without the liability.

    Most WFA, WFR, and even WEMT training is woefully out of date. Nonsense like C-collars is finally fading away but they are still far behind the curve on what really works and is worth carrying (evidenced by this thread). Advice from MDs and paramedics is pretty much irrelevant (different set of rules). Still a lot of BS floating around like using superglue, carrying airways, etc.

  53. Bob August 27th, 2017 3:12 pm

    I’m curious that if giving someone an epi injection is a pathway to a lawsuit, then where does that leave you if you’re CPR trained and you don’t carry a CPR mask because you’re not going to give CPR?

    And Clyde’s point about WFA, WFR, and WEMT training being out of date is sort of confusing, since that training seems to carry a responsibility to perform within the training and protocols as given.

    Though, as I mentioned above, I’m an EMT and constrained to act within those protocols, as well as motivated to do the best thing in a given situation, which may differ from what I read in an online blog.

  54. Clyde August 27th, 2017 4:09 pm

    A CPR mask does nothing for the victim and essentially nothing for the provider, plus there is no prescription required. Do it but the outcome is pretty much a given.

    Your best bet is to get the training (I’ve had them all), and then let them expire. Then keep learning. If you’re constrained by protocols instead of Good Samaritan, you’re ***. You can do more without the restrictions.

  55. Bob August 27th, 2017 5:28 pm

    Apparently you haven’t taken BLS CPR, Clyde. The kind required for EMTs.

    But you do have the air of an expert.

  56. Bob August 27th, 2017 5:30 pm

    For one thing, a decent CPR mask will hook up to a ventilation system…which might come in handy.

  57. Bruno Schull August 28th, 2017 3:57 am

    I agree with Bob–Clyde, you’ve made some interesting points and suggestions, but you’re presenting these with a sense of final authority that seems suspicious–who are people supposed to believe? Practicing MD’s, Paramedics, EMT’s, whatever, or you, who profess to have taken all the training courses, and then let them expire. I’m all for individuals exercising their own judgement based on their knowledge and experience–that’s my basic point about first aid kits…build you own based on what you know, what you can do, and what you expect to encounter. But, at the same time, we can all learn from each other. And when people start talking making absolute judgements, without backing them up with some reasonable perspective and discussion, I start to get suspicious. Yes, this is the internet, where opinions are often stated as fact, but it’s also Wildsnow, where a more nuanced and mature perspective is encouraged. If you have nothing to learn, great, carry on, and save lives. For my part, I’m going to consider carefully what different people have said.

  58. Christian August 28th, 2017 1:22 pm

    The best gear repair item I was taught about by my outdoor mentor is to carry some different size sewing needles & dental floss. The needles usually fit inside the floss box and can be used to either crudely or very nicely sew up clothes/gear depending on how much time you take. I’ve repaired/altered a lot of my gear with floss and it is incredibly strong and durable.

  59. Clyde August 28th, 2017 7:43 pm

    Bob, you have the air of a newbie. The only thing different from BLS CPR today and and what was taught 4 decades ago is they keep dumbing it down for the masses. We used to teach precordial thump, which was highly effective when used appropriately. Most of the rhythm changes have more to do with teachability/retainability than actual performance.The only thing really new is AED and I doubt I’ll ever see one in the backcountry. Carrying a useless mask to hook up to a system that will come with one is silly. If anything, airways make more sense and nasal is better than oral (lighter and less size dependent) but that’s more expedition kit IMHO.

    Hell no, don’t take my word for anything. But if you didn’t learn tourniquets and chest seals (plus modern bandages like I mentioned above) in WFR or EMT, even WFA, you should get a refund. Very low probability, high consequences, minimal gear to save a life. Pretending you can make a tourniquet with items like dressings or straps is nonsense. A helmet weighs more than those things and probably has the same real-world utility.

    The worst FA advice often comes from MDs, paramedics, and EMTs who are part of the system. They are too used to fast response/endless supplies and clueless about real backcountry. See above where the doc said direct pressure is good enough and wait for rescue…that might come in 36 hours. Same with epi discussion, most people missed the point. Obviously there are some awesome advanced care folks who can properly educate us plebes but understand their background before accepting gospel.

    The only reason to stay WFR/EMT certified is if it’s a job requirement. You are better off, legally, without. No salvation if you administer RX but Good Samaritan covers most other non-stupid care.

  60. Bob August 28th, 2017 9:48 pm

    Heh. Clyde, you angry bro? Look, I’m a long time emergency management/medical specialist. I retired after 32 years of pro firefighting, and I’ve been earning my living since then as a full time EMT ski patroller. I’m not sure where you’re coming from lecturing me and questioning my training in chest sealing and tourniquets, but it’s kind of an amusing diversion from the topic at hand. I will say if you haven’t taken BLS CPR training for, what?, four decades you may have missed some important developments. It’s more than a job requirement, it’s staying abreast of improvements in medical techniques. For instance, airways are best applied both orally and nasally. I carry both, sometimes.

    FWIW, I spend and have spent considerable time in the backcountry, so thanks for your concern and enlightenment, but I’m feeling pretty good about what I can expect to find out there, as well as what care I’m able to provide and any legal entanglements.

    You’re Clyde Soles, right? If so, you’re a writer, OTOH I’ve spent years earning my living by doing the things we’re discussing in this article/thread. And that includes performing, training, retraining, refreshing, and, perhaps most germaine to our apparent differences, continuing education. I wouldn’t think to tell you the best way to write professionally, though some folks would say writing about things rather than doing them is bullsh*t. I’m just going to leave it at that and let the readers here decide for themselves.

    But hey, if you want to hit some BC lines in the southern Rockies sometime, get ahold of me. I’ll bring a tourniquet and bio-occlusive dressings, but we can decide about a CPR mask at the trailhead.

  61. Rob August 28th, 2017 9:49 pm

    Airways, commercial tourniquets & chest seals, and the SAM splint should all be strongly considered for any first aid kit. They take up very little space and weight. A CPR mask is also useful, if only to ward off its necessity. The odds of resucitation from the backcountry, particularly if the loss of pulse is due to trauma, are very small.
    The precordial thump was taken out of CPR guidelines not to dumb it down, but because more than being ineffective, it actually caused patients’ heart rhythms to convert to rhythms with less favorable outcomes, ie: it does more harm than good. See here https://canadiem.org/the-precordial-thump-good-bad-or-ugly/ for a good write up looking at multiple studies and a summary.
    And finally, please do stay current with your training. The knowledge base of prehospital emergency medicine is constantly growing, and most people really don’t get enough practice. If you are trained, and not acting as a professional (guide, ski patroller, etc.), you shlould be protected from liability if you act within your training by Good Sam laws. If you are w/in training and in a professional capacity, you should be protected by your employer’s insurance company.

  62. Lou Dawson 2 August 29th, 2017 9:05 am

    Appreciate the passion about this stuff, thanks for the comments! Quite a few people read these threads, this one could save a life, or several…

    In my opinion, the most important thing is indeed getting training, every few years. I’m due. The training gets you pretty certain about what you feel is appropriate to carry as kit, and with some thought you realize that almost anything you could reasonably carry and find useful can be improvised, though a few things clearly are better carried as dedicated FA items, as reading the threads here does indicate.

    Lisa and I already started our refresher course by binge watching old episodes of ER. Interesting to see medical care without cell phones or computers.

    Lou

  63. Bruce Goodlad August 30th, 2017 4:02 pm

    As a guide one of the most useful things in my first aid kit is an Israeli bandage. Originally designed for gunshots wounds it is super versatile and it comes in a robust vacuum packed wrapper.

    You can buy them all over but check them out here.

    http://www.israelifirstaid.com/israeli-emergency-bandages/?gclid=CjwKCAjwxJnNBRAMEiwA8X_-QenHXUGgsp2EOgSsucbGSxsGipxZ202vEo9PRNYOQxE9qCNSMQ2AcRoC-2sQAvD_BwE

    and having broken a leg in Antarctica you can never carry enough morphine.

  64. Louie Dawson 3 September 1st, 2017 12:09 am

    Wow! awesome comments guys. I just got back from a few days offline. Lots to think about here.

  65. dmr September 1st, 2017 4:08 am

    I really have nothing to add since I’m not a doctor (and I don’t even play one on TV), just wanted to say thanks for all of the interesting comments and info.

  66. Joe September 9th, 2017 8:34 pm

    I just took a WFR course from NOLS and it was fantastic. The instructors talked all about improvising things like Israeli bandages from common first aid tools. Best educators I’ve seen in a long time.

  67. Jim September 16th, 2017 2:14 pm

    After hypothermia, loss of blood is the greatest cause of death. I carry CETOX and blood coagulator that staunches blood flow. With a compound fracture bleeding is an big contributor to death. After compression, load in the cetox and staunch the blood until help arrives, or evacuation is accomplished.

  68. VTskier September 16th, 2017 8:40 pm

    Like Matt Kinney , I ski with an ER physician most backcountry trips. We’ve kayaked rivers for years too. I’ve seen a few dislocated shoulders on paddling trips quickly reduced by skilled partners.
    Having a conservative yet highly skilled ski/paddling partner is key. For day trips a group of 2 or 3 -4 is ideal. One other friend I ski with won’t go with a larger group. Too many variables, skill level, endurance etc.
    As the temperature and isolation of a trip increases dial back the lines skied or what rapids you decide to carry..always stay aware of how much daylight is left.
    On a recent day ski trip I too bad a dynafit heel piece blow up. No problem just ski out with Telemark turns ! Now I have a spare Speed Turn heel I would take on a hut trip.

  69. VTskier September 16th, 2017 8:44 pm

    I meant above as temperature ‘decreases” or isolation increases on a trip dial back the lines skied or what rapids you decide to carry.

  70. Jonathan Moceri September 16th, 2017 9:00 pm

    VTskier,

    Thanks for bringing up the dislocated shoulder scenario.

    While I’ve never come across it, one of my best skier friends has seen it twice. First was a snowboarder at Stevens Pass. The injured party had multiple shoulder dislocations and instructed my friend how to reduce it. So he did and all was well.

    Then, a few years later, my friend was rafting down the Grand Canyon, the raft flipped, and somehow, he dislocated his shoulder. Once on shore, he instructed the raft guide on how to do the relocation.

    Since shoulder dislocation seems to be a common backcountry injury, I would recommend that folks seek instruction, or study the many youtube videos that describe how to relocate a dislocated shoulder.

  71. atfred September 17th, 2017 9:19 am

    One caveat re a dislocated shoulder (from personal experience), if you’re just hours from an ER, it would be better to package the victim as comfortably as possible, and get down to the cars.

    Relocating a dislocated shoulder in the field is not always as easy as it may seem.

  72. JCoates September 18th, 2017 1:41 pm

    I agree with atfred. I’m about 50% success rate with shoulder reductions in the field. Out of the 4 times I’ve attempted it, 2 ended up having proximal humerus fractures…not dislocations (oops). So unless your ski buddy is one of those guys like Mel Gibson in Lethal weapon who dislocates his shoulder as a party gag, or you are 3 days away from a hospital, (or you’re just a sadist), I’d try to get them to the ER for some confirmatory Xrays before trying to yank on their shoulder.





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    Welcome to Louis (Lou) Dawson's backcountry skiing information & opinion website. Lou's passion for the past 50 years has been alpinism, climbing, mountaineering and skiing -- along with all manner of outdoor recreation. He has authored numerous books and articles about ski touring and is well known as the first person to ski down all 54 of Colorado's 14,000-foot peaks, otherwise known as the Fourteeners! Books and free ski touring news and information here.

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