Health and Safety – Things Every Backpacker Should Consider

So I rarely make posts and list my educational and professional credentials even when I see some of the most ridiculous posts about medical issues in discussion groups.  However, I will here.  I am an adult nurse practitioner with over 20 years of experience as an NP.  I am a member of the Wilderness Medical Society  I also was certified, now lapsed, through NOLS as a Wilderness First Responder (WFR) (shout out to NOLS for providing outstanding outdoors education). I am also a consumer of health care with a few chronic illnesses that require daily medications and have the ability to complicate a thru-hike from minimally to a lot to ending it in its tracks without my medication.  With that background, I’d like to offer some suggestions on how to plan your thru-hike with an eye to improving your health safety. This planning may likely be more important that your use of the kitchen scale to shave off grams.  We’re talking about your health and maybe even your life.

Stuck in the Desert with Lots of Pain – My Recent Real Life Experience

First, what prompted me to want to write this? Well, this past weekend, I was out with some friends deep in Tonto National Forest – 2.9 million acres of Sonoran desert, pine forest, oak forest, grasslands, and riparian ecosystems- located mostly in Central Arizona.  In the middle of our trip, I developed severe abdominal pain which ultimately resulted in a trip to the emergency room, administration of some serious pain medications, and referral for a series of additional diagnostic tests that are ongoing.  There is something very disturbing when you have severe pain in the middle of the night and are hours away from even having cell phone service.  The Verde River is beautiful to camp by but spending the night worrying about potentially having your spleen explode or dealing with a kidney stone far from any services caused me a lot of anxiety.  As it turned out, it was neither my spleen nor a kidney stone, but it was a serious situation – one that might force me to cancel this year’s PCT thru-hike plans.  Time will tell.

This acute illness in the backcountry was not the first for me in my over 35 years of backpacking.  In the 1980s, I slipped on a wet rock on the AT in Shenandoah National Park and had a right knee meniscal tear that caused my knee to swell to the size of a melon and a lot of problems later in life.  Since the AT and the Skyline Drive are never far apart, it was easy for me to hitch a ride back to my car.  There are sections of the AT that are much more remote than in Shenandoah NP and most of the CDT and large sections of the PCT are far from services including cell service.

To refocus, my episode of intermittent abdominal pain that literally caused me to double over got me thinking about what every hiker and backpacker should carry with them and some forward focused planning about their own trip.

Things Every Backpacker Should Think About Carrying – Most Will Not Increase Your Base Weight

Here are some things that you might consider carrying.  For you gram weenies, you can keep this list in your phone in an added-grams-free manner.  For those Luddites who believe that electronics are the death of backpacking, paper also works.  I prefer my phone.  I love technology.

  • Insurance information
  • Name and contact number for your primary care physician and specialty providers
  • List of medications
  • List of allergies
  • List of medical conditions and past surgeries
  • Personal health care preferences
  • Emergency contact numbers
  • Power of attorney and/or medical power of attorney contact information and a Living Will (Don’t have one? Consider downloading a free form online and doing whatever is necessary to make it official in your state such as getting it notarized). Ideally, you carry a hard copy of these as they are most needed when you are not able to make decisions.

Satellite Trackers and Search and Rescue Expense Coverage

Today there are many backpackers with various “limitations” that are proving to the rest of the world that long distance backpacking is not limited to those in tip-top health but actually can be done safely and with great success despite many personal medical and psychological challenges.  However, backpacking in wilderness and rural areas does decrease access to care and all the associated risks of care disparities common to rural areas. Proper planning helps reduce those risks greatly.

  • Consider use of a satellite tracker that is a full 2-way communicator such as an InReach Mini. If things do go wrong, being able to give some details of what exactly is wrong to an SOS call can go a long way towards saving you and potentially your life.
  • If you have a fragile condition such as Type 1 diabetes, ulcerative colitis, seizure disorder, or any of a long list of other very serious chronic illnesses or are just a belts-and-suspenders, cover-all-bases kind of person, consider purchasing the remote evacuation coverage that is available for your thru-hike. Out-of-pocket charges for search and rescue services can run in the tens of thousands of dollars which is a lot for people in a community that often cram 6 to 10 stinking backpackers into a cheap motel to save money.  Who pays for search and rescue is a complicated topic.  Do not assume that it is a free public service.  It likely is not.  You might be stuck with a bill that can exceed your annual salary.

There are a few organizations that provide membership and some coverage for search and rescue operations.  GEOS works with InReach and Spot satellite devices automatically if you push the help/SOS button.  GEOS contacts local search and rescue organizations to come to your assistance.   A GEOS membership, not included with satellite plans,  will help cover any search and rescue costs as gap coverage meaning that they might provide coverage for whatever is not covered by your health insurance or other insurances.  There are lists of exclusions and limitations that everyone should carefully review especially those with any chronic illnesses or recent acute illness.  For GEOS membership, click here.  The membership is very inexpensive at around $30/yr. or even less.  Again, it is vital to review the terms of service and/or discuss you needs with a salesperson to make sure you are getting what you need.

Global Rescue is also a membership plan that has its own unique features.  First, Global Rescue is the primary payer for search and rescue services rather than a gap coverage.  They have a number of plans, and you likely need to talk with a sales rep to get the right plan for someone who is a US citizen thru-hiking entirely in the USA or whatever your specific personal circumstances are. Again, there are exclusions and limitations which vary somewhat on timelines (no hospitalization or change in the management for X condition in Y number of days/weeks/months, for example).  The plans from Global Rescue are more expensive,  I was quoted a price of $329 for a full year of domestic travel but, again, this is the primary payer and, to me, some of the medical restrictions and exclusions seem to a bit less restrictive.  OF NOTE:  Global Rescue uses its own network of search and rescue teams which is more limited than GEOS which contacts the appropriate local search and rescue for your needs.  These differences might impact response times which can be an important consideration in some situations.  Minutes and hours count in many emergencies.

Some organizations include a limited search and rescue member benefit as part of the annual dues.  For example, the American Alpine Club offers some search and rescue coverage for members along with additional membership benefits.  There are additional clubs that provide similar benefits.

Make a Medication Plan

Finally, let’s talk briefly about medications.  Being a 61-year-old with a number of chronic diseases, I carry a lot of medicine and that weight adds up.  The can be no shaving of grams with essential medications.  I have learned that I really need to divide my medicine into two batches as one of my cardiac drugs is 100% necessary for me to hike at all.  So here is what I do:

  • Hoard drugs/build a stash of extra medications. If you can, get auto-refills for you prescription medications which all the big chains offer if your insurance allows it.  Over time, you slowly build up a reserve of meds.    That helps with planning.  Consider asking for a vacation override which some insurances also allow.  This is an OK for a month’s worth of medicine ahead of time.  That gives you a larger amount or of medication to have on hand and for backup at home.  To be honest, I am not fully aware of the laws about mailing prescription meds with resupply.  It is clearly a don’t ask, don’t tell situation on my part.  I am not a lawyer.
  • Consider using national pharmacy chains or mail order pharmacies. If you do not already use a big national pharmacy chain, consider moving your prescriptions to one that has services at least near portions of your trail. In reality, prescriptions can be moved from one pharmacy to another with little work on your part other than making that request if you happen to be due for refills at a pharmacy different than your own.  Most pharmacies will ship your medications.  Check before you leave as this can be a very useful service that is provided for a low cost, or in some cases, for free.
  • Do not carry all your meds in your backpack. If a bear or some lowlife runs off with your pack (it happens) or it falls off a cliff Cheryl-Strayed-boot-style, you are hosed.  I mean totally hosed if you are a type 1 diabetic, severe asthmatic, or have a condition like mine that is 100% dependent on medication on a daily basis to be able to hike at all.
  • Keep a separate emergency supply at all times. I kept a 5-day supply of the most necessary medications in a waterproof bag placed in my pants pocket with a zipper when hiking the AT.  So pants and shorts must have a zipper or other way to secure my emergency medications in my clothes.  It is the gram-cost of being safe in the wilderness.  Yes, we pack our fears, but we also pack for success and pack to avoid unnecessary drama on our trip. If you are out on the CDT or the PCT, your supply might need to be several days longer that what is need on most parts of the AT. What you need is enough medicine to get you from one town to another town where there is a pharmacy.  I’m a bit neurotic, so I plan for a day extra in case you arrive when the pharmacy is closed.  Remember, services in rural towns might be limited and access to a hospital can be hours away which is very different than having 24-hour services like I do in Central Phoenix within several blocks.
  • Carry a reasonable amount of medication.  If resupply is a chore, and it often can be when stores are closed or the post office is closed for a federal holiday that was not on your radar, resupply of meds is a much larger chore.  I typically just carry a month’s worth of drugs, if not more.  The added weight is worth the lack of finding and dealing with pharmacies in trail towns for the most part.  It is a balance of times savings vs. gram savings.

Get a Physical Examination Before You Leave

Is this overkill?  Not at all.  I had a close friend literally fall over dead from a heart attack in his early 40s and a kid in my high school died in gym class. This really is good advice for anyone headed out for months of extreme physical exertion.  Little League and cheerleading require an MD’s ok, right?  Why would backpacking be any different?  Depending on your primary care provider, you might or might not get the stamp of approval for a thru-hike.  Some providers are like my parents were and want you to stay on the porch, safe and sound in a bubble far away from all those imagined nasty unknowns we almost never encounter.  NOTE:  “Almost never” is a key phrase here; there are thru-hikers who do indeed suffer serious trauma, unexpected illnesses, and even death every year on long distance trips.  My attitude is totally “Screw That” when it comes to saying on the porch which is pretty much the universal attitude of thru-hikers – my people.  However, if you have chronic illnesses or not, you might want to have a clinic visit before you head out on a 4 to 6 month trip.  You might also consider using a sports medicine doc as your primary care provider.  They might be much more supportive of an active lifestyle and have better insight into your needs.  Personally, I am very lucky to have both a PCP and cardiologist who support my backpacking obsession.  They see it for what it is…a great way to improve health and fight progression of chronic illnesses.

This Applies to All Hikers Regardless of Age or Health Status

In reality, all long distance hikers, regardless if they are 18 or 72,  need to consider their health beyond what is carried in a first aid kit when planning a long distance trip.  That reality increases when you have a chronic illness or as you age (Sorry Boomers, we can’t be teenagers forever!).  In reality, any of us can suffer a compound fracture or head injury or an unexpected serious illness that might require being transported by helicopter.  A little health planning can potentially save all of us a lot of unnecessary expenses and complications.


DISCLAIMER:  This advice is not intended to replace or substitute for any professional, financial, medical, legal, or other professional advice.  If you have specific concerns for a situation in which you require legal,  professional, psychological, or medical help, you should consult with an appropriately trained and qualified specialist.

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Comments 10

  • Fritz Miller : Feb 9th

    I am a rural family physician with 27 years experience in the backcountry and outdoors. Dave is spot on. The only thing I can think to add is use a little common sense by not taking chances for poor reasons.

    • David Smith : Feb 9th

      Thanks for the endorsement. It means a lot to have this. I think the great news, what you likely see in your practice on a regular basis, is that many people find ways to do things that my parent’s generation would have never even attempted. I think our society has learned that, with proper planning and willingness to accept some risk, many of us have learned to adapt our personal circumstances to have a life full of exciting adventure. Personally, I feel very fortunate to have the life I have.

      One of the most amazing things I have ever witnessed witnessed was a trail race between kids in wheelchairs that were adapted for trail use. What a total shot of inspiration!

  • pearwood : Feb 10th

    Good stuff, David. Thank you.
    I had thought of most of this (being seventy will do that), but the idea of keeping a five-day reserve separate from the pack is a new one for me, and an excellent precaution. I can scrounge most thing in an emergency or do without. Med resupply takes time.
    Steve / pearwood

  • Russ1663 : Feb 10th

    Thanks David, working this into a checklist/spreadsheet. Good thought process and long range planning. Working on a fall section on AT. Oh, I’m 71, have a safe trip

    • David Smith : Feb 10th

      That is beautiful. I hope my article gave you some ideas that are helpful. Enjoy the fall on the AT. I did 152 miles on the NC-TN border on the AT in October. It was beautiful and the acorns added a new dimension to hiking!

  • Katie Houston : Feb 12th

    Very interesting article, David! Thanks for sharing. Will have to keep all of this in mind. Hopefully I’ll never need to use any of it while on trail but just having the peace of mind is worth it. My hiking partner on the AT fell down a slope and cut his hand on a broken beer bottle in Massachusetts… that warranted a trip to the emergency room and 13 stitches. We were in and out in about 2.5 hours and the nurse made us a kit to take on trail and instructed us on how to keep the wound clean for the weeks after and he removed the stitches himself in a parking lot. A real trail story, glad he got the care he needed so promptly and had all of his information readily available, like you said!

  • Harry Campbell : Feb 14th

    I appreciate the time and thought that has gone into this. I’m currently contemplating a long distance hike, a sort of flip flop AT-but starting by simply redoing the Maryland section that I’ve done in parts with my kids in the past, then Shenandoah north to HF etc. These sections having relatively modest terrain. Start with that, see how it goes. Hope to continue on from there in more or less month long excursions. I have to take care of some of my life responsibilities and so need to be able to go on and off the trail as situation dictates. We’ll see how it goes. I’m set up for a blog here but haven’t taken care of the details yet.

    I too have a chronic illness that requires some meds and possibly some off trail trips for treatments. One of the reasons for the revived idea of a long distance hike is the continual motion, the metabolic experiment, aside from the reasons why anybody considers this, just because. But I would say when you have some life challenges there are a few more reasons added to the list, seeing what you still have in the body and spirit, or rather enlivening the body and spirit.

    Good practical advice, I have of course already considered much of it, the InReach, the meds etc. It’s important that people plan and take responsibility for ones self and what potential situations one might find themselves in, and I agree, people of all ages.

    I have long had this idea that if I were to get into trouble in say the Presidentials in winter I would be sure to have a healthy donation made to the local emergency rescue team who would need to extract me, whether living or not, as those missions are expensive and dangerous. Still need to take care of that small detail in my will, updating this week.

  • Lauren : Feb 21st


    And thank you for an insightful post with a lot of good information! My name is Lauren. I’ve been a pretty avid hiker since about 2016. I am going to be attempting a portion of the AT mid may with a small group of friends for about a week or so. I also have a very rare heart condition called pulmonary arterial hypertension that has me hooked up to specialty IV medication that constantly infuse via pump into a hickman line in my chest. I have held myself back from every doing any hikes like the AT b/c the half life of my drug is 4 hours before its a medical emergency. I had a long discussion with my PA a few weeks back and essentially got permission to proceed with this trek. I am game planning the best that i can in order to get ready. I can really appreciate all of your information listed in what to do, coverage, etc.
    Thanks again!

  • Firefly : Mar 4th

    Spot on advice for any age, like you said! Especially for folks hiking the pct or cdt, where exits are often much further apart, and many are just a small town or gas station. I actually made a video on this topic covering what you just said, back in 2019.. and it was crazy the amount of attacks I got in the comments at the time.. people saying “oh give me a break, you’re way over thinking it etc..” things like that.. anyway…

    but then slowly as people started their hikes, many came back and retracted their once neg comment.. and expressed thanks..

    Anyway, the one main thing I wanted to add that I didn’t see in your list was:
    many people forget/oversight getting a dental cleaning/check up before they leave for trail..

    Again, Especially for people hiking the pct or cdt where often the towns are very small, and few and far between..

    I met one guy in 2019 on Trail who lost 3 weeks dealing with some dental issue, trying to find a dentist, getting the apt etc.. plus he was miserable on Trail for weeks. There was one girl I met last year on a section hike, that also had got knocked of trail due a dental both cases when I asked them about when they had last seen their dentist; it was a year +

    This is especially important for people who don’t live anywhere near the trail you plan on hiking.. much easier to take care of dental stuff before you leave, than during a thruhike! Just my thoughts..

    Anyway, I’m also hiking the pct this year! Maybe I’ll see you out there! Take care, and good luck with your hikes!

  • Doug : Jul 2nd

    A little off topic, and apologies if this has been addressed elsewhere, but with your background I would love to know what you have in your first aid kit. Asking on behalf of my son, age 18, who is taking on a AT thru hike in 2022.


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