Learn how to treat the most common wilderness maladies with our guide to dealing with everything from bellyaches to broken bones.
In the backcountry, anything can go wrong at any time. Unfortunately, “anything” is hard to prepare for. We dug into the numbers from the National Outdoor Leadership School (NOLS) database of medical incidents to figure out what you really need to worry about out there. Here’s how to save your trip—and maybe even your life.
Strains & Sprains
Strains affect muscles while sprains involve ligaments and tendons (for hikers, that usually means ankles and knees). Either way, expect pain, swelling, or restricted range of motion, often after a snap or pop. Because they require rest to heal, these injuries can be trip-enders.
Pack - Ibuprofen or acetaminophen
Prevent - Strengthen joints, stay fit, and warm up and stretch before hiking. Wear sturdy boots if you’re prone to rolled ankles, use trekking poles, and step carefully.
Treat - Your goal is to reduce swelling.
1. Soak the injury in a cold river or lake, ice it with packed snow wrapped in clothing, or apply a cool, damp cloth as needed for short-term pain control.
2. Wrap in an elastic bandage (loosen if circulation is impaired). Massage and gently stretch muscular injuries.
3. Elevate the limb above the heart during rest (about 20 minutes for a mild case; all night for a serious one).
Evacuate if the affected limb is unusable.
The trouble with a bellyache is that it can be a symptom of anything from gas to a GI infection to kidney stones, which makes it hard to diagnose in the field. Some of these are serious, some—not so much.
Pack - Antacid, Pepto-Bismol, thermometer to check for fever
Treat - Alleviate symptoms by assuming the fetal position to relax abdominal muscles until you can get help to address the underlying issue. Drink plenty of fluids and eat bland foods.
Evacuate if pain:
Is localized (more than just a general crampy feeling) and persists for more than 12 hours.
Coincides with blood in the urine, feces, or vomit or a fever of 102°F or higher (which can indicate anything from shock to appendicitis).
Might be related to pregnancy or internal injury.
Intensifies with movement, and/or the abdomen feels rigid or painful to the touch.
Doesn’t go away within 24 hours.
Most reported reactions are due to either preexisting allergies like hay fever or run-ins with poisonous plants. (Bee stings aren’t included in this category.)
Pack - Tecnu, a skin cleanser, to wash off oils; topical cortisone or antihistimine for itching
Prevent - Learn to ID the area’s dangerous vegetation (for a primer on poison ivy, check out backpacker.com/poisonivy). Wear long pants and sleeves when walking through underbrush, and avoid touching those clothes (wash them post-trip; experts aren’t sure how long oils remain active).
Treat - Wash up ASAP. Urushiol—the oil found in poison ivy, oak, and sumac—takes 10 minutes to bond to skin. Avoid scratching, which can cause infection or spread oils.
Evacuate if the rash/blisters get infected (look for severe oozing, swelling, heat, and spreading red lines).
Nausea, Vomiting, & Diarrhea
It’s easy to blame Giardia for this unholy trinity, but your hand-washing habits (and those of your campmates) are the more likely culprit.
Pack - Pepto-Bismol, acetaminophen, Imodium (for short-term stoppage), thermometer
Prevent - Wash dishes with soap and hot water. Wash hands with soap and scrub for at least 20 seconds, attacking all surfaces—including under fingernails. Generously globbing hand sanitizer on dirt-free skin works, too.
Treat - Rest and hydrate (drink when you’re thirsty; don’t skimp on the electrolytes), and wait it out (usually 24 to 48 hours).
Evacuate if cramping pain lasts 24 hours, you can’t keep liquids down, or your fever tops 102°F.
Toothaches & Chipped Chompers
Bacterial dental infections happen, but overambitious chewing and face-first falls are the more common cause.
Pack - Dental wax
Prevent - Check food for windblown grit or sand before biting down (it happens more often than you’d think).
Treat - Bite down on gauze to stop bleeding, then flush with treated water. Cover exposed nerves with a temporary filling (like Cavit), ski wax, or gum. Lost tooth? If you’re close to the trailhead, gently clean it, stick it back in its socket, and hurry—you only have about an hour to save it.
Evacuate to save a lost tooth or if you spot symptoms of infection (red or swollen gums).
Frostnip & Frostbite
Look for white, waxy skin and a tingling feeling (signs of frostnip). Skin that feels hard and numb and dents with pressure, or is frozen solid, indicates frostbite (especially on the fingers, toes, and face).
Pack - Ibuprofen, gauze bandages
Prevent - Keep warm and dry, and avoid restrictive clothing or boots.
Treat - Immediately rewarm mild cases with skin-to-skin contact in your (or a partner’s) armpit or groin. Deeper frostbite? Immerse in water just above body temperature until all numbness fades, then bandage. Don’t rub frozen tissue or use radiant heat (like from a fire or camp stove) for thawing—it’s easy to burn yourself when you can’t feel your skin.
Evacuate all but the mildest cases.
Flesh Wounds - Blisters
Most reported soft tissue injuries involve cuts, scrapes, burns, or blisters, but blisters are by far the most common.
Pack - Bandages, duct tape, moleskin, antibiotic ointment
Prevent - Break in footwear, keep feet dry (change socks after accidental submersions or big sweats if necessary), and address hot spots immediately.
Treat - Apply duct tape, medical tape, or Moleskin to hot spots. Too late?
1. Clean bubble-ups with soap and water.
2. If you think it’ll burst in your boot, pop with a flame-sterilized needle or knife.
3. Apply antibiotic ointment. Bandage with a donut-shaped piece of moleskin.
4. Cover in tape.
Flesh Wounds - Cuts and Scrapes
Pack - Bandages, gauze, antibiotic ointment
Prevent - Cut away from yourself when prepping food or firewood, and store sharp objects in your pack with care.
Treat - Flush grit from the wound with about a liter of water (nip the corner off a plastic bag, fill with water, and squeeze to create a jet). Got a bleeder? After cleaning, hold gauze over the wound and apply firm pressure. If the gauze soaks through, add more. When bleeding stops, bandage to hold the gauze in place.
Pack - Bandages, gauze, antibiotic ointment
Prevent - Cook on a flat surface, and arrange all ingredients and utensils in a semicircle within arm’s reach to prevent accidental knock-overs
Treat - Run cold water over the burn for 10 minutes to cool, then clean, apply antibiotic ointment, and wrap with gauze.
Evacuate if you get a severe infection—you’ll see little red lines trailing away from the injured area, a sign of inflamed blood vessels. Plus, it’ll be painful to the touch.
Pack - Ibuprofen or acetaminophen, cough drops, thermometer
Prevent - Wash hands frequently. Cover your mouth when coughing, and don’t let anyone reach into your gorp bag.
Treat - It’s the same in the backcountry as it is at home: Rest as much as you can and stay hydrated.
Evacuate if you have a fever above 102°F for more than 48 hours, headache with a stiff neck, or a throat so sore it’s hard to swallow.
If it burns when you pee, you probably have a UTI. Nasty itching in the lady parts? It might be a yeast or bacterial vaginal infection.