I recently went backpacking in Aravaipa Canyon which, if you haven't been there, it's crazy beautiful and a requirement for southern Arizona residents, like a smaller accessible version of the Grand Canyon. My friend who came with me was pretty reactive to bee stings. She got stung once on a river trip and her ankle swelled into a cankle (calf + ankle, when it swells up so big you can't tell the difference) for over a month. I on the other hand have virtually no reaction to bee stings--no swelling at all, and not a lot of pain. In building my first aid kit, I would not have thought to put bee sting treatments in there; after all, I've never needed them. But it's a good thing I had the Adventure Medical Kits Ultralight .3 kit with us on the trip, because my friend got stung by two bees, and luckily the AMK folks threw in some antihistimines for me. She took them right away, we carefully pulled out the stinger with precision tweezers, and she swabbed the stings with After Bite, which is really mostly ammonia, a base, that neutralizes the acid in the poison. The pain went away immediately, and her hand only swelled a teeny bit. I was kind of impressed and happy to have the tools to avoid minor tragedy in my med kit. But I was missing one key first aid staple, and that was duct tape. I had moleskin for blisters, but when you're hiking through water for three days in sandals that rub just a smidge, nothing will stay on your feet and protect your skin better than duct tape.
An ounce of prevention worth a pound of cure in this tiny little package: Adventure Medical Kits' Ultralight / Watertight .3
It got me thinking about how functional first aid kits can really be. I once saw a simple band-aid and some antibacterial ointment heal over a feud on a trail when two dog owners had their pets off leash and one got a tooth puncture on her hand from her dog as she pulled it from a scuffle. She was furious at the other owner for having the bigger dog off leash, but being able to patch her up softened her fire a little. So often I've thrown my kit in my pack as that random accessory I'll never pull out, and so often I've brought it out for simple, helpful things. What if there were actually some useful things in there? So here's a little checklist of some of the things I've found to be practical additions to a stock first aid kit.
Nail clippers: It may seem a little prissy to bring nail clippers into the wilderness, but it's a handy cutting tool that can snip things off close to the skin, like hangnails and peeling callouses--those run of the mill annoyances that can become full-on sores in the backcountry. Plus, if you're a nail biter you won't want to be doing that with dirt under your nails; clip 'em off.
Precision tweezers/forceps: Most kits come with these, but if they don't, quality tweezers are a must and they're probably the most oft-used tool in the desert. They remove cactus spines, splinters, insect stingers (always be careful of the poison sac), and they can help you pull out ticks by the mouth parts, limiting your chance of infection.
Alcohol wipes: You get some in a standard med kit, but never enough. I stock mine with several extra, because any situation that requires a first aid kit will also require clean hands.
Super glue: It's not made of the nicest chemicals to put on your skin, but super glue was used for emergency sealing of wounds during the Vietnam war. In a pinch, it's useful for stemming bleeding and keeping bacteria and debris out of a clean cut when nobody's around to stitch you up. Its FDA-approved counterpart, Dermabond, is a lot more expensive but much better on skin; run-of-the-mill super glue can be irritating. Please note: I'm not medically trained in the least, and some medical professionals would definitely NOT recommend this advice. I'm speaking only from what has been handy in my experience.
Extra butterfly closures: Most med kits stock you with two of these, but these are especially handy for mountain bikers, who tend to get deep cuts from falling off bikes into sticks, getting pedal-chopped in the shins, or taking a chainring to the calf, all of which I've done. Sometimes you just need to close two flaps of skin together, and if you've got enough butterfly closures you can zip up a wound temporarily without having to glue yourself together (see above).
Classic Swiss Army knife: Though the other tools are handy, I keep this mostly for the scissors. Several times I've needed to bandage a deep cut with a smaller piece of cotton dressing than what they give you in the package, and scissors are really the best tool for that.
Chlorine tabs: In the book "Born to Run", author Christopher MacDougall describes going on a run with a group of people in Mexico; two of the runners got lost, ran out of water, and were found dazed and delirious drinking out of a putrid mud puddle under a rock. After I read that scene, I figured there was no reason not to keep emergency chlorine tabs in my med kit; I need a back up for my water filter anyway.
Emergency whistle: It's a small thing that I would forget to bring otherwise, so I keep one in my med kit. If you needed to drum up some help getting yourself or someone else out of the backcountry, it could be a way to signal for help without having to leave the injured person alone.
Extra ibuprofen and acetametaphine: Both these medications are handy because they perform in different ways. Ibuprofen relieves pain by reducing inflammation, so it's effective for injuries. Acetametaphine is not an anti-inflammatory, and instead blocks pain receptors, making it the better choice for headaches. Both will reduce fever.
Duct tape: The most universal fixer-upper known to man. It will stick to skin even through hours of sloshing through water, so it's a good blister-preventative and band-aid cover inside sweaty boots or for sandaled feet in Aravaipa. It also doubles as an emergency patch kit for for tents, rain jackets, packs, and sleeping pads. I used to make a little roll sticking it to itself, until a few hot days welded the layers together and it became useless. Now I take Lucky Duct, a little section of tape on a paper backing, available for 99 cents.
Standard contents are on the right; my useful additions and extras are on the left. Amazingly, it all still fits.
All these extra things fit in my Ultralight Watertight Medical Kit .3, a small enough kit that there's no good excuse not to carry it, which is important for me; I could build a kit that would be more inclusive, but then I might talk myself out of bringing it on small day trips. The best med kit is worthless if it's sitting in your bathroom cabinet while you're on the trail. This one I bring every time.