In the city, first aid means keeping someone stable for the ten minutes until the ambulance arrives. In Ontario's backcountry, the ambulance isn't coming — at least not for hours, and possibly not for days. You might be two portages and a lake crossing from the nearest road, with no cell service and deteriorating weather. Wilderness first aid operates in this reality: you are the first responder, and you may be the only responder for a long time.
This guide covers the principles and common scenarios, but it is not a substitute for hands-on training. A wilderness first aid course — ideally a two-day or three-day course from a recognized provider — teaches you to assess, stabilize, and make decisions under pressure in ways that reading alone cannot. If you spend any meaningful time in the backcountry, take the course. It's one of the best investments you'll make.
Take a Wilderness First Aid Course
Several organizations offer wilderness first aid (WFA) and wilderness first responder (WFR) courses in Ontario. The key providers include:
Wilderness Medical Associates International (WMA): Offers the industry-standard Wilderness First Responder (80-hour) and Wilderness First Aid (16-hour) courses at locations throughout Ontario. The WFR is the gold standard for backcountry trip leaders.
Remote First Aid (Canadian Red Cross): The Canadian Red Cross offers wilderness and remote first aid courses that are widely available and well-regarded. Their courses cover the extended care scenarios that standard first aid doesn't address.
Humber College and Algonquin College: Both offer outdoor recreation programs that include wilderness first aid training, and some offer stand-alone courses open to the public.
At minimum, take a standard first aid course with CPR-C certification. Then upgrade to wilderness first aid when you can. The gap between standard first aid and WFA is significant — standard first aid assumes rapid EMS response, while WFA teaches you to manage injuries and illnesses over hours or days with limited supplies.
First Aid Priorities in the Backcountry
The assessment framework used in wilderness first aid follows a logical sequence. When you encounter an injured person (or become injured yourself), work through these priorities in order:
Scene safety: Before you touch the patient, make sure the scene is safe. Is the rock still falling? Is the canoe still in the rapid? Is there lightning? You cannot help anyone if you become a second victim. Secure the scene first.
Primary assessment (ABCs): Airway, breathing, circulation. Is the person conscious? Are they breathing? Is there severe bleeding? These are life threats that need immediate action. Stop major bleeding with direct pressure. Open the airway. Begin CPR if needed (though the reality in remote backcountry is that CPR without defibrillation rarely succeeds).
Secondary assessment: Once life threats are managed, do a systematic head-to-toe examination. Check for injuries the patient may not have noticed due to adrenaline. Ask about pain, check for deformity, assess sensation and movement in extremities.
Vital signs: Monitor pulse rate, respiratory rate, skin colour and temperature, and level of consciousness over time. Trends matter more than single readings — a pulse that's rising and consciousness that's declining indicates a worsening situation that may require evacuation.
Treatment and monitoring: Treat injuries, manage pain, protect from the elements, and monitor for changes. In the backcountry, this phase can last hours or days.
Common Backcountry Injuries and Conditions
Cuts and Wounds
Lacerations from knives, axes, sharp rocks, and broken branches are the most common backcountry injuries. Clean the wound thoroughly with clean water (irrigate with pressure using a syringe or a plastic bag with a small hole). Apply antibiotic ointment and cover with a sterile dressing. In the backcountry, wound infection is a real concern — you're far from antibiotics and surrounded by bacteria-rich soil and lake water. Monitor wounds daily for signs of infection: increasing redness, warmth, swelling, red streaking, or pus.
Burns
Camp stove flare-ups, boiling water spills, and campfire burns are common. Cool the burn immediately with cool (not ice-cold) water for at least 10 minutes. Cover with a clean, non-adherent dressing. Do not pop blisters — they protect the underlying tissue. For burns larger than the patient's palm, or burns on the face, hands, feet, or genitals, plan for evacuation.
Sprains and Strains
Ankle sprains on portage trails are almost a rite of passage. Ontario portage trails are often rocky, rooted, muddy, and uneven — exactly the conditions that cause rolled ankles, especially under a heavy pack. Treat with RICE: rest, ice (cold lake water works), compression (elastic bandage), and elevation. A mild sprain can be taped and walked on. A severe sprain — one where the patient can't bear weight — may require a carry-out or a modified route to avoid further portaging.
Fractures and Dislocations
Suspected fractures need immobilization. Splint the injury in the position found using available materials: tent poles, sticks, foam pads, and triangular bandages. Check circulation below the injury (pulse, sensation, movement in fingers or toes) before and after splinting. Any fracture in the backcountry — other than a minor toe or finger fracture — warrants evacuation.
Shoulder dislocations are relatively common in paddling. If you're trained in reduction techniques (this is taught in WFR courses), a shoulder can sometimes be reduced in the field, dramatically improving the patient's comfort and mobility. If untrained, immobilize with a sling and evacuate.
Blisters
Blisters seem trivial until you're three days into a backpacking trip and can barely walk. Prevention is everything: well-fitted footwear, broken in before the trip. Wool or synthetic socks. Address hot spots immediately with moleskin, tape, or blister bandages before they become full blisters. If a blister forms, drain it with a sterilized needle (clean with alcohol or hold in a flame), leave the roof intact, apply antibiotic ointment, and cover with a donut-shaped moleskin pad to relieve pressure.
Hypothermia
Hypothermia occurs when core body temperature drops below 35°C. In Ontario's backcountry, it can happen in any season — a summer rain and wind combination at 12°C can cause hypothermia in a wet, exhausted paddler. Recognize the early signs: shivering, impaired coordination, slurred speech, confusion. Mild hypothermia (shivering, alert) is treated in the field: get the patient out of wet clothing, into dry insulation, into a sheltered location, and provide warm sweet drinks. Severe hypothermia (shivering stops, confusion, loss of consciousness) is a life-threatening emergency requiring gentle handling and evacuation. Handle the patient gently — rough movement can trigger cardiac arrest in a severely hypothermic person.
Heat Exhaustion and Heat Stroke
Less common in Ontario's backcountry than hypothermia, but possible on hot portage days in July and August, especially with heavy loads. Heat exhaustion presents as heavy sweating, weakness, nausea, and cool clammy skin. Move to shade, rest, drink water with electrolytes. Heat stroke — hot dry skin, confusion, rapid pulse — is a medical emergency. Cool the patient aggressively (immerse in lake water if possible) and evacuate.
Building a Wilderness First Aid Kit
Pre-made first aid kits are a starting point, but most need supplementing for backcountry use. A good wilderness first aid kit includes:
Wound care: Sterile gauze pads (various sizes), roller gauze, adhesive bandages, wound closure strips (Steri-Strips), antibiotic ointment, irrigation syringe (20cc or larger), alcohol swabs, tweezers.
Bandaging and support: Elastic bandages (2 or 3 inch), triangular bandage (doubles as sling), medical tape (cloth tape sticks better than paper tape in humid conditions), moleskin, blister bandages.
Medications: Ibuprofen (anti-inflammatory, pain), acetaminophen (pain, fever), diphenhydramine/Benadryl (allergic reactions, sleep), Gravol (nausea), Imodium (diarrhea), personal prescription medications. If anyone in the group has severe allergies, carry epinephrine auto-injectors (EpiPen) and make sure multiple people know where they are and how to use them.
Tools: Medical shears, safety pins, thermometer, nitrile gloves (multiple pairs), SAM splint (lightweight aluminum splint that can be shaped to any body part), CPR pocket mask.
Documentation: A small waterproof notebook and pen for recording vitals, injury details, and treatment given. This information is valuable for rescue personnel.
Pack your kit in a waterproof bag and keep it accessible — not buried at the bottom of your pack. Everyone in the group should know where the first aid kit is.
When to Evacuate vs When to Treat in the Field
This is the hardest decision in wilderness first aid, and it's the core skill that separates wilderness first aid from standard first aid. The general framework:
Evacuate for: Suspected spinal injuries, chest or abdominal injuries, severe allergic reactions (anaphylaxis) after epinephrine use, any fracture that prevents travel, uncontrollable bleeding, signs of serious infection (fever, red streaking), altered mental status that doesn't improve, cardiac symptoms.
Treat in the field and continue: Minor cuts and wounds (cleaned and dressed), mild sprains (taped and manageable), blisters (drained and padded), mild hypothermia (rewarmed successfully), mild dehydration (rehydrated).
The grey zone — injuries that could go either way — is where judgment comes in. A moderate ankle sprain on day two of a five-day trip is a field treatment if the patient can walk slowly; it's an evacuation if the remaining route requires long portages over rough terrain. Context matters.
Emergency Communication
When you decide to evacuate or call for help, you need a way to reach the outside world. Cell phones are unreliable in Ontario backcountry. Your options:
Satellite communicators: Garmin inReach, ZOLEO, and similar devices use satellite networks (Iridium or Globalstar) to send text messages and trigger SOS alerts from anywhere in the world. The SOS function contacts an international rescue coordination centre that relays to local authorities. These are the standard communication device for serious backcountry travel. The cost — typically $15 to $50 per month for a subscription — is negligible relative to the value.
Personal Locator Beacons (PLBs): One-way emergency devices that send a distress signal with your GPS coordinates to the COSPAS-SARSAT satellite system. No subscription fee, but they can only send an SOS — no two-way communication. A PLB is a good backup or a budget option if you can't afford an inReach subscription.
Carry at least one of these devices on every backcountry trip. For more on emergency communication and response, see our emergency preparedness guide.