Backpacking Medicine Course

Author: Brad Kinney MD, Emergency Medicine Physician. October 2018.

Summary. The “Backpacking Medicine on the Appalachian Trail” course began at Wilderness Adventure at Eagle Landing – an outdoors adventure lodge in the Blue Ridge Mountains near Roanoke, Virginia – and lasted five days from October 1-5, 2018. The class converged on the lodge that first day for evening lectures, gear check, a course brief, an amazing dinner, and an unofficial meet and greet around an open fire. After breakfast the next morning, we caravaned to the trailhead in Daleville, and staged vehicles at our trail’s end at Dragon’s Tooth – a little over thirty miles of hiking away. For the next four days, we hiked approximately ten miles a day along the iconic Appalachian Trail and set up camp in the evenings at various Appalachian shelters. We carried everything for the hike on our backs including our food, water filtration/purification units, sleeping systems, clothing, etc. We were a diverse class of approximately 25 that included emergency physicians, physician assistants, nurse practitioners, an anesthesiologist, and an architect all from various locations around the US, including Alaska. An incredible couple in their 70s crushed the entire week of backpacking, and were a daily inspiration reminding me that age is just a number. Each evening, the class hosts/instructors delivered wilderness medicine lectures with integrated practical workshops. The last evening, they coordinated a mass casualty scenario utilizing EM residents that evolved into a unique learning evolution. Many of the veteran backpackers contributed their knowledge and experience and essentially saved some of us amateurs from ourselves on multiple occasions. In the end, the course was a phenomenal, beautiful week of hiking the incredible AT with a bunch of new, like-minded friends while earning CME and having a blast. Below is a short YouTube review and a few of my lessons learned.

“Water is Life.” We each consume water at variable rates in the backcountry dependent on the ambient temperature and humidity, level of fitness, hydration status, intensity of exertion, volume of sweat, and a variety of other factors. During the hikes, I drank about four liters, most drank less. Parts of the hike were brutal with steep inclines and temperatures in the 80s, so I was hot and sweaty most days.  Upon discovering that my filter was broken at the first shelter, I realized the gravity of my situation if I were alone. Thankfully, there were plenty of well-prepared individuals in our group who generously shared – an experience that allowed me to explore various water filtering and purification methods, and to learn from the pros. Also, during one of the hikes, an EM physician lectured on the various water filtering/purification methods and explained the pros and cons of each. One of my favorite options was a Katadyn collapsible filter bottle. It was lightweight, relatively cheap, compact, and you could drink from it directly or use it to fill your Nalgene or hydration bladder. Finally, whenever planning a trip to the backcountry, researching the recommendations for water filtration/purification in that specific environment is vitally important to avoid waterborne illnesses. When in the wilderness, water is not only necessary for survival, but also for performance. Water is life.

“Ounces equal pounds, and pounds equal pain.” Hiking steep grades with heavy packs sucks, and much of the AT snakes through mountainous terrain with respectable elevation changes. As a general rule, those with heavier packs traveled slower – myself included – and heavier packs also generally indicated less experienced backpackers. Often, I wished to jettison unnecessary supplies, but they were my burden to carry the remainder of the trail, a salient lesson repeatedly beat into my back and knees. Despite having shaved gear weight prior to the trip, I still brought extraneous supplies that survived the entire hike unused. Simplicity is key, and buying lightweight, quality gear with multiple uses is optimal, and choosing which items are worth their weight in sweat is only learned through experience. Below are two YouTube videos by “Darwin onthetrail” – an avid backpacker with a wealth of knowledge – that I wish I had watched before this course.

Interestingly, the DOD is investing massive research efforts into the development of lightweight, durable warfighting gear and load carrying optimization alternatives. During our hike, we only carried what we needed for subsistence and survival. In combat, the warfighter must also carry ammunition, weapons, body armor, kevlar helmets, radios, medical kits, squad gear and specialized mission equipment. Their gear frequently weighs more than 100 pounds, a weight that crushes performance, dampens mobility, and potentiates musculoskeletal injuries and chronic wear and tear. This situation will continue to plague the military until load carrying requirements change – unlikely, gear weight is optimized, new load carrying alternatives are developed, or an amalgamation of all of these solutions is created.

“Cotton is rotten.” I’ve heard this mantra repeatedly, but decided to ignore the advice. I brought cotton clothing in addition to synthetics and merino wool. A thunderstorm crashed down on us during the first hike, and I spent the rest of the week drying my cotton in the evenings on clotheslines with very little effect. But the modern materials dried rapidly during the hikes and in the evenings, and didn’t smell. Cotton soaks up sweat and water, has no wicking properties, gets significantly heavier with moisture, and harbors bacteria developing wonderfully pleasant smells after being damp for any period of time. Cotton is just a bad idea in the backcountry.

“Buy once, cry once.” Good gear is pricey, but also priceless. The problem with some of the lessons learned above is that it costs money to do things right. Synthetic, modern materials and merino wool are expensive; functioning, quality filtering systems will punch a hole in your wallet; and the weight of quality goods is inversely proportional to the price – for example: clothing, titanium, tents, hammocks, packs, etc. But, in the end, buying “cheap” gear for cost savings often results in money wasted when you must repeatedly buy new gear due to gear deficiencies. So, buy once, cry once, and enjoy quality equipment.

-Special thanks to Jessie, Chris, Stephanie for a great course; Randy for fixing my video audio; Jo Ann, Jasmine, and all for letting me use some of your pics; Mike, Martin, Jasmine, Jo Ann for being awesome hiking buddies.