Gear Up for Success: Pack Supplies for Effective Patient Care in the Backcountry

Paul F Beattie PhD, PT, FAPTA, OCS, WEMT

As a Wilderness PT- what do you really need in your backpack to stay safe and provide patient care?

One of the main requirements of wilderness patient care is that providers must be mobile and need to travel light. This fits nicely with the non-invasive and non-pharmacologic treatment approach used by PT’s- we can do a lot with very little gear. At the same time however, we need to be prepared for the expected and sometimes unexpected challenges that can occur from terrain, weather, animal encounters and many other factors.

Scene safety is always the primary concern when going out in the backcountry, so the first issue is to travel safely, don’t get lost and don’t get hurt. If you get lost or hurt the situation just gets a lot worse. A second big concern is to keep your load light— preferably less than 8kg— while maximizing the versatility of everything you bring. Considering these requirements, here is a go-list that our PT group uses.

Let’s start with clothes and footwear. Always prepare for the most extreme conditions that you might face. For example, at high elevations the weather could be beautiful and warm at midday but could quickly turn cold with thunderstorms or even blizzard conditions. Remember any patients you treat are likely to have some mobility issues and may have greater exposure and impact from weather, so never underestimate the weather. Clothes should be durable, comfortable, and dry quickly. Avoid wearing blue jeans (they don’t dry) or yoga tights (they don’t offer much protection and rip easily). Spend some money and get well-fitting trail shoes or boots that are designed for the terrain. Sandals and running shoes don’t protect your feet and are never a good idea. Always have a good quality rain jacket- in a pinch it can make a great sling for upper limb problems.

Land navigation comes next. “Staying found” is critical. Smart phones are great for trail apps and can provide GPS locations and guidance but be careful and don’t overly count on your GPS and associated apps. These are not always reliable so be sure to have a high-quality map that has topography lines, grids, and coordinates. Always have a compass and know how to use it. Make sure that someone knows of your route and projected return times. Depending upon the group you work with, you might have a two-way radio. Carry a headlamp with spare batteries in case you are out after dark. The headlamp is also valuable when checking for pupil responses to light.

Adequate hydration and nutrition are a must. It is easy to get dehydrated in any type of weather, especially in high country, so bring enough water (not sweetened or carbonated drinks). Portable water filters are a great back-up if you need to fill up from streams. A good lunch is a must. Don’t bring anything too gooey or odiferous if you are in bear country. You probably won’t have time to cook, so a nice sandwich or burrito works great. Also have plenty of healthy snacks including something salty (for hyponatremia) and something with easily dissolved sugar (for hypoglycemia).

A small tarp or poncho and some light paracord can make an emergency windbreak, shelter or stretcher which could save the day and can also be used as ground cloth along with a foam pad for a “treatment table” in the backcountry. A tarp is also important as an outer shell in a hypothermia wrap, and a foam pad makes an excellent splint or cervical collar in a pinch.

Your personal first aid kit can overlap with your PT gear. Key items include ace wraps (useful for tissue compression and most trauma), tape and some basic dressings such as rolled gauze for wounds and cushioning splints. Vaseline dressings are great for non-adherence to open wounds and as a fire starter.

Also bring some 4x4s, Tegaderm, triangular bandages to make slings, a pocketknife and EMT shears. The appropriate use of dry needles can be very effective for back country pain management so consider bringing some if you have the training and dry needling is within the scope of practice for the area you are going to. Medications should include baby aspirin (for acute chest pain), Acetaminophen, Loperamide, and Benadryl. A small lighter should be included.

Your personal protective equipment includes hand sanitizer, alcohol wipes, non-latex gloves, masks for you and your patient if needed, and a hazmat bag for trash. Consider bringing some more specialized items including flexible splints, Coban and Kinesiotape, TheraBand, and a TENS unit with extra electrodes. Finally, be sure to have a pad and pen to document your patient encounters.

When all of your gear is assembled it will easily fit into a medium-sized day pack and you will be ready to have a fun and productive day on the trail providing onsite care.

“Climb the mountains and get their good tidings.” -John Muir