In this suit-happy world, the author of this article preferred not to be identified. He’s had first-aid training and is an experienced climber. He is not a medical professional. 

This story and its recommendations are not the final word but the starting point for a discussion with your doctor about medications you should carry into the backcountry.

A few years back I read a story about Jack Tackle. He and his partner were climbing in the Alaska Range on a remote, 3000-foot face. While setting up an anchor, he was hit by a briefcase-sized rock. The rock came from above, did not bounce on the face and, therefore, did not give him any warning. He was on the ledge alone for 40 hours with his incredibly strong will and few strong pain pills. Without the medication, he questions whether he would have survived the ordeal.

This story got me thinking about my own backcountry medical kit. I’m not climbing on deep remote faces at the level of Jack Tackle (yet), but I realized from this story that I needed to beef-up my kit with more than Ibuprofen. In the Cascades, getting into trouble even a few hours could take anywhere from a half day (if lucky), to a few days (if the weather didn’t cooperate with a rescue).

Realizing I needed more horsepower in my kit, I talked to my doctor. I asked him what would be a good pain medication that most people would be able to take without side effects. I felt like a drug seeker, but I asked him for a reasonable quantity. The benefit: Now I have a “narcotic” in my kit with my name on the prescription bottle (important for customs if traveling abroad).

Next I assessed my own personal health requirements. I suffer from sudden and sometimes debilitating muscle spasms. So now I pack a few muscle relaxants. I also swell-up when I’m stung by bees. Not anaphylaxis, but enough to be painful, itchy and annoying so I carry some Benadryl as well. I also sometimes suffer from minor pains in my knees (from hours of pounding descents with a pack) so I still like to carry Ibuprofen, because it takes care of many aches and pains.

Two years ago, a group of friends decided to help me celebrate my birthday on Mount Adams by skiing the peak’s SW Chutes. Near the end of our descent, a member of our group fell. He slid, back-first for 100 feet down a 40-degree slope and piled up into a pile of boulders. In our company were two nurses (who are both pro ski patrollers) and me (who had recently completed wilderness EMT training).

He was badly beaten up but, amazingly, he didn’t seem to be broken. He had aggravated old injuries from a previous car wreck and brought on new injuries but, after careful scrutiny and discussion, we decided we could get him out without a backboard. With the pain medications and muscle relaxants I was now carrying, we reduced his suffering and got him moving. Then as a team we provided support, stability, to get him back to the trail head under his own steam.

The next morning as we were preparing to leave, a rescue was staging at the trail head. A person had broken their ankle and Search and Rescue had been called in. It felt good knowing that through the combination of training and supplies we carried (drugs) we had put only ourselves at risk as we went into and delivered an injured friend out of the back country.


Outdoor enthusiasts who consider the injuries they might incur from their sports and look at their own health issues, along with research the topic independently will all assemble a slightly different back country pharmacy. In my case, here’s what I’ve ended up with. Use this only as a starting point (not a definitive list) and discuss the topic with a doctor who knows your medical history.

    • Ibuprofen. General pain reliever. Reducing fever. Reducing swelling in infection, injury, and sunburn.
    • Tylenol (or acetaminophen). General pain reliever and fever reducer. Not useful for swelling.
    • Pepto Bismal. Some of this will usually get you back to the trailhead and a real diet if digestive ailments and ‘the runs’ aren’t too bad.
    • Diphenhydramine-Benadryl-Antihistamine. Use for allergies and anaphylaxis. Helps for itching, nasal and sinus congestion, nausea, sea sickness, insomnia, and anxiety. Well tolerated for a wide spectrum of activity and use. Causes drowsiness, which can be a good thing if sleep would be helpful.
    • Acetaminophen with Oxycodone – trade name Percocet (RX). Use for moderate to severe pain. Can be combined with Ibuprofen. Can cause constipation and/or upset stomach. Give with fiber and plenty of water. This is a controlled substance, with street value and has the side effects of narcotic. Note: If traveling abroad, keep pills in original containers (as proof you’re not peddling drugs).
    • Cyclobenzaprine or Flexiril (RX). Use as a muscle relaxant. I always carry these based on my history. Good for acute muscle spasms –whether this is from injury or a personal tendency to spasm. Drowsiness is a side effect.

Note: This story and its recommendations are not the final word but the starting point for a discussion with your doctor about the ‘meds’ you should be carrying into the backcountry.

This post was originally published on 3/12/09.

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