A Grand Excursion

Had a great opportunity today to take some mental-health time with my friend Scott. He and I kayaked 15 miles on the Grand River. We put in at Veteran’s Boat Launch in Grandville and pulled out at Eastmanville Bayou. Basically, almost half-way between Grand Rapids and Lake Michigan.

Perfect day for it. No bugs, nice temps, and not many others on the river. The water is very high and muddy given all the recent rain. Saw lots of turtles and herons. And a snake in a tree.

All this, in just a hair over five hours.

Home from Quebec: A Reflection on Life, Love & Wilderness Medicine

In the middle of a deep Canadian forest, a ferocious mid-afternoon windstorm knocked down a tree, beneath which five very cold and unprepared people tried to ride out the unexpected weather. The tree’s collapse crushed the group’s not-really-competent tour guide; the blunt-force trauma to his chest killed him immediately. For the people whom the guide had been leading—four novice trainees for an upcoming wilderness adventure race—the windstorm was the last straw in a series of disasters spanning the last 24 hours. The group’s equipment had floated away during a botched water rescue the night before and therefore the entire group hadn’t eaten in more than a day. When the tree uprooted, “Monster,” a 41-year-old habitual drug user just 30 days sober, went running for help, slipped, and had a finger shorn off in the crook of a tree branch, in addition to lacerating his upper arm and dislocating his shoulder. Bobby, the eldest of the group, had suffered an open fracture of the lower left leg and an arterial puncture on his upper left thigh when the tree fell across his leg. His nephew, Hugh, was in severe hypothermia, never having warmed up after having fallen in the river the night before. Eric, Bobby’s friend, had aspirated water while assisting with Hugh’s rescue the previous night and had sprained his ankle besides. After the tree comes crashing down, Eric puts his “bad” foot on Bobby’s arterial bleed while jabbing Hugh with an EpiPen and waving one of Hugh’s free arms to keep circulation moving, in a desperate attempt to do something to help. The shouts from Eric and Monster alert a passing group of hikers, all of whom are trained responders.
Yesterday, this scenario was the final simulation we ran to wrap up our five-day Wilderness First Responder course sponsored by Boreal River Rescue at The Barn just 30 minutes north of Ottawa, in the lovely Gatineau Hills of Quebec.
Lots to cover here. I’ll start by reviewing the WFR course, then reflecting on the “life, love and wilderness medicine” points referenced in the post title before wrapping up with final thoughts.

Wilderness First Responder

The best definition for the WFR role comes from Wilderness Medical Associates, the organization that bestowed my certification:

Wilderness First Responder is the definitive course in medical training for outdoor educators, guides, SAR team members and others who work or play in remote areas. The curriculum is comprehensive and practical, including all of the essential principles and skills required to assess and manage medical problems in isolated and extreme environments.

It’s an 80-hour training that includes basic life support, healthcare provider CPR certification and additional training for specialty subjects including field reduction of some joint dislocations, special CPR protocols, and the injection of epinephrine to treat anaphylaxis or asthma.
The setting—springtime in Quebec!—proved ideal, the 10-to-11-hour drive notwithstanding. Days fluctuated between sunny and 70s F and rainy and 40s F. Our group consisted of 10 WFR students plus four additional WFR recertification candidates who joined us on Day 3. They were a fascinating, beautiful group of humans:

  • Danny, the director at Boreal River and our instructor for the course
  • Caleb, Evan and Alex are all (very) younger guys who will work this summer as professional guides
  • Andrew, Joey and Julien are experienced guides and outdoors enthusiasts
  • Mike and Tom—older fellows—took the course for personal enrichment
  • Jessy, Ben and Chris—also younger guys—took the course for fun in the context of their existing interests
  • Alex and Colin, a couple who live near the training facility and sometimes work with Danny; they’re about to take their teenaged son on a year-long adventure trip, so they recertified early
  • Plus sweet, loveable moi

I parked at The Barn around 9p on Tuesday, May 1. Arrival consisted in picking a bed, sheeting it and getting ready for the next morning. The next few days all ran between 10 and 12 hours long. The first several sessions consisted of basic drills (spine-stable rolls, positive pressure ventilation, using masks, assessing lung sounds, taking blood pressures with cuffs and stethoscopes, splinting, etc.) and mastering the “three triangles” of the Patient Assessment System: Scene size-up, primary assessment, secondary assessment. The course was structured to build on skills iteratively. The drills started first in identifying “emergency or not-emergency” for the circulatory, nervous and respiratory systems. Then we layered in assessing changes in vitals or mental status over time, then performing rapid full-body exams and spine/neuro assessments, then asking the “right” questions for a SAMPLE history—after which the drills added identification of anticipated secondary problems, then treatments, then the administration of treatment via simulation. All the while, we had to keep reasonably good SOAP notes for PAS drills and our simulations so that when Danny brought the video camera into our faces and asked, “What’s your problem list?” we could tick off a few actionable problems or body-system red flags in two or three seconds without pondering or mumbling or speculating about treatments.
The sims became quite complex. In the final sim, I played the role of Eric. Danny (the instructor) gave me instructions as well as makeup for my bruises and a series of if-this-then-that branches while the simulation unfolded. For example, after the rescuers moved me away from my friends, I had to complain of being very, very hungry because I also had mild hypothermia and low blood sugar. Whatever they first fed me, I was allergic to; if they asked in advance about allergies, then I could eat something else, otherwise, I had to develop anaphylaxis after eating the food. My breathing was labored, and I did have to feign anaphylaxis, so ultimately the rescuer had to distinguish anaphylaxis from the fact that I was in respiratory distress (bordering on respiratory failure) from pulmonary edema secondary to submersion—while I was very obviously in acute stress reaction from watching my friends screaming in pain before my very eyes. That information surfaced from asking good questions during the SAMPLE history and then bothering to listen for crackles in my alveoli. And as for “Bobby” (played by Tom)? We actually rigged up a turkey baster and tubing with stage blood, as well as bone fragments applied with surgical wax to his shin. And the hapless guide, played by Colin, chomped a blood capsule as soon as the first responder arrived. Hugh (Evan) had blue makeup on his face and lips. Best of all was Monster’s amputation; Ben (the actor) had full-on wax and blood as well as a mannequin finger still stuck in the tree with blood and bone sticking out of it. Delightfully gross but very realistic looking.
We got to mix things up a lot, too. On Day 4, I was in charge of the scene with a rescuer who had a stroke on a steep hill while we were already trying to rescue a person who evidenced hives and mental status changes. So two rescuers and two patients at first, later joined by several more rescuers. The hives guy resolved with epinephrine administration and a bit of rest; the stroke guy we had to apply good airway management while packaging in an improvised litter and team-carrying him to the “helicopter.” And in our first sim, on Day 3, I was primary medical for a guy with an unstable wrist injury from an ATV crash, who crashed because he was significantly hypoglycemic. So I got to cover the main roles (victim, primary medical, secondary support, scene leader) across all the sims, which was totally freaking awesome because you get a really different view of things depending on your vantage point.
The bottom line is that this was an excellent course, taught well by Danny, with a supportive and focused group of student-colleagues. I am not afraid to tackle a medical emergency in the backcountry. I am also quite happy to recommend Boreal River for any of their programs and education, based on my interactions with Danny and those members of his team whom I was privileged to meet.
(My only real regret is not whipping out my camera at some point. I managed to take an iPhone photo of some of the hills of Quebec on my drive south to Ottawa, which is the cover photo for this post. Otherwise, nada.)

Life

I left The Barn at 6:15 p.m. on Sunday, May 6, and drove non-stop back to Grand Rapids, arriving at 4:25 a.m. So, quite a hoof. Turns out, Toronto is the half-way point, time-wise. Both directions, I routed through Port Huron/Sarnia (I-96 to I-69) and took the southern route across Ontario (highways 402/401/416) and Autoroute A-5 in Quebec. Didn’t get tired the whole way back. Three stops in Ontario to pee and visit Tim Hortons at ONroute facilities significantly helped, as well as a late-night food stop at a McD’s just past Flint. But I didn’t get drowsy or even yawn all that much, because my brain was firing at a mile a minute as the kilometers ticked by.
So, lots of time to reflect on my way home. Three things pop out—just like the buds did in my absence. When I left, no green on the trees and the wind was chilly. When I got home just before dawn, the birds were chirping and it was warm and I saw leaves. Everywhere. In just a week. It felt like a triumphant welcome home. But I digress.
First, fitness. Holy hell. I did okay, but during the first simulation, Danny recorded the three different scenes. I saw my report-out about my patient’s problem list and expected evacuation requirements during our debrief the following morning. After seeing that video I said to myself, “Self, you have additional opportunity to augment your cardiopulmonary fitness.” Although in my head I might have used more colorful language.
For me, weight and fitness have always been directly correlated with stress. A big stressor lately (the day job) has been taken off the table. Today, I’m just so remarkably serene about everything that I’m looking forward to getting into a new set of habits now that my life has been completely shaken up. I sit here typing this blog post with the windows in my home office open, birds chirping, a gentle breeze passing through and sun passing obliquely over the shelves, bathing both the room and the cats with a warm pale glow. I did a fair amount of heavy breathing over the last week. So now, I sit here, and I feel good. Good. And I went grocery shopping this morning. Bought fish and veggies. No carbs. No junk food. Turns out, I actually like cooking, and the foods I really like are tasty and nutritious. What a shame it took me 41 years to figure this out.
Second, experiences. I loved hearing the stories from the folks in the group about the things they’ve done or hope to do. Many of the guys were really quite funny and remarkably accomplished for their ages. Everyone was so chill about everything. There wasn’t a sense of one-upmanship at the table. If someone said, “I did this cool thing in this remote place” then other people would be like, “OK, I’d love to try that some day myself, so can you give me any tips?” The stories were so respectful, honest and non-competitive that you could (and I did!) just immerse joyfully in the stories.
I bring this up because I’m so accustomed to dealing with people angling for advantage that spending a week with people who just wanted to share was rejuvenating. It’s a good reminder to reflect how I approach conversations as well as to think about the level of venom I’m willing to tolerate in my dealings with others.
Third, May 2. That’s the day the WFR course started. It was also the official last day of my employment with Priority Health (slash Spectrum Health System) after nearly 18 years of service. It’s the day I started working for myself instead of for someone else. That evening, after the first-day classes had concluded, I sat down with a book. But I wasn’t really reading that much. Instead, I was just reliving highlights of my career. Lots of stuff went right, over the last 18 years. Lots of failures, too, most of which were self-inflicted. I sat for hours, tracing the steps from my middle-school days at St. Anthony to my trajectory at West Catholic High School to my choice to attend Western Michigan University and the ways that my life shaped from the choices I made in those years. In the working world, I think I did okay, despite this occasionally half-hearted dual pathway in health care as well as freelance editing and publishing. I don’t think I would have picked this life when I walked out of the door of St. Anthony in 1990, or W.C. in 1994, or even WMU in 2003. But I’m happy with how it turned out to this point. They key take-away is that the next time I’m at a pivot point like this, that the subject of my reflection should not be me being okay or not-okay with “how it turned out” but rather assessing results given that it’s the outcome that I planned for and executed instead of merely allowing to occur.
Seizing the reins of one’s own destiny, as it were. Which, as a self-employed consultant as of today, I must do without a safety net. But I think the chance to decompress in Quebec was one of the best possible ways to make this transition. Not only was WFR certification on my bucket list for several years, but the experience of achieving it kicks off my consulting work on the right emotional foot. (And believe me—the last few weeks have been an emotional roller coaster.)

Love

Love is a funny thing, and it can be evidenced in funny ways. My landlord, who very kindly looked upon my feline overlords in my absence to ensure they didn’t lock themselves in cabinets or otherwise get themselves into trouble, told me this morning that they got “pissed” when they heard rustling at the back door, ran into the kitchen then found that it was him instead of me. So that was sweet. But love evidences itself in other—human—ways, too. During our first big simulation, I eventually moved to a different scene and served in a supporting medical role. I helped Alex (the female one, who was a patient at the time) with head stability given a traumatic brain injury and obviously rising intracranial pressure. So I kept reassuring her: “You’re in good hands.” “I know it hurts, we’re doing our best to help you.” And so on. In our post-scenario debrief, she specifically called out that gentle attention as a big deal to her. And when I was “Eric,” I made a point of getting despondent and almost crying about my friends—and it was that expression of grief that prompted my primary rescuer (Caleb) to really just stop and go into full reassurance mode instead of just ticking off the boxes on his SOAP note. Bedside manner matters. A lot. And not just in a wilderness rescue situation. I know it sounds trite, but it’s true: Being a decent human being is hard, rare and worth it. Empathy is a skill significantly stressed by the ubiquity of smartphones.
While dining and conversing with my fellow students, I heard some really wonderful stories about their adventure travel over the years. Colin and Alex had gone to Kilimanjaro in January; Andrew is going in August. Julien came to Quebec from Patagonia—a four-day journey. Most of the non-teen group had stories about South America, or Africa, or Asia. Wonderful, engaging stories. And you know why? Because it’s their passion. It’s what they love. Do what you love, and happiness and success will follow. Do what you love, and your heart will fill with love.
In WFR training we learned about toxins and venoms and such. I believe that comfort is a toxin. So is fear of the unknown. Aversion to loss and resistance to habit disruption are such powerful instincts that they affect us even when we’ve got nothing to lose and a ton of stuff to win. I’m not ashamed to admit that on the first night I was in Quebec, before we even started the course, I sat in the common room at The Barn and was thiiiiiiis close to packing up and leaving. On the spot. A dozen rationalizations passed through my mind: The cats would be lonely. I’m not the “type” to be a rescuer. I wouldn’t fit in with the others. I might fail. You know: A noxious blend of Jonah Complex and Imposter Syndrome distilled and bottled at cask strength.
I stayed. I got through it. I’m a better person for it. But even with all that preparation and anticipation, it was different enough to be scary. And think of all the times that we confront this kind of “scary” on a daily basis. When we think it’s better to keep quiet than to stand up to a bully. When we think it’s easier to do what pays the bills instead of what fills the heart. When we find an excuse to avoid a necessary lifestyle change because we can do it “tomorrow.”
Before you can do what you love, you must love yourself enough to believe you’re worthy of the investment. For a lot of people, that’s a difficult proposition.

Wilderness Medicine

The WFR course reminded me of a few life lessons, as applicable in the backcountry as they are in the boardroom:

  • Never let the perfect become the enemy of the good. You don’t need to arrive at a differential diagnosis of cerebral hemorrhage of the left hemisphere to know that you’ve got increasing intracranial pressure (or, ahem, whether someone was bitten by a Black Widow). The rising ICP is the emergent problem, regardless of its source. To wait to treat (e.g., to evacuate to a hospital) while fine-tuning a diagnosis means you’ll likely kill your patient. Similarly, waiting for all the stars to align—when enough stars have already aligned—is an invitation to inertia. Sweet, comfortable, toxic inertia.
  • Assess the situation, not the problem. Then treat the problem in its context. A rescuer who sees a person with a head injury can leap into action to conduct a spinal exam and check for a traumatic brain injury, without realizing that the source of the injury is the very, very unstable pile of huge rocks on the ledge above them both. Similarly, identifying some area of self-improvement (e.g., weight loss) that’s undertaken as if “weight gain” were a problem severable from its environmental, emotional and psychological context, is futility. Almost no problems worth solving occur in isolation without any mix of direct and indirect causes or downstream consequences. To fix the problem, you must understand its causes and effects and only then can you develop a solution designed to succeed.
  • Lead when you can. Follow when you should. Protect your command when you must. In the scenario were I served as scene leader, I radioed the RCMP (i.e., talked to Danny’s video camera) to arrange a specific evacuation plan. Then, I had to assemble the troops, tell them the plan, assign roles and oversee execution. So far, so good. Then we had new responders arrive who started barking orders. That was bad form, but understandable given the adrenaline and the training exercise. To keep control of the scene and to minimize harm to my patient, I had to assert leadership so that the existing plan wouldn’t be threatened by delays or miscommunication. Similarly, you must master Gillikinism #28: “Master the sword—when to wield it, when to sheathe it and when to fall upon it.” When leadership is necessary, supply it. When it’s not, don’t horn in. When you’re in charge and someone tries to knock you off the hill, kick him in the nuts and continue your benevolent leadership. Because sometimes, lives really are at stake.

What’s Next?

I’m doing some assorted catch-up this week as well as fine-tuning the official launch of Gillikin & Associates. Very exciting. I have some editorial work to do with Caffeinated Press and just a lot of “what am I going to knock off my major-goals list in May?” planning to complete. I no longer have a Mon-Fri, 9-5 kind of job, but I obviously still have to work. The question of how I integrate work and enrichment and whatnot still requires forethought.
From the WFR perspective, my goal is a bit broader. I’m increasingly drawn to outdoors activity. I’m not really interested in a full-time career change into the outdoors industry, but here’s the thing. In addition to being a WFR and a reasonably experienced backcountry hiker (at least, in hemiboreal climates), I’m decent on my kayak and I’m a scuba diver. I want to blow that out a bit—more dive training, more (and more complex) kayak trips, more deliberate backcountry hikes. Maybe do some whitewater rafting training. Go places. I might not visit every cool hotspot between Banff and the Amazon or between Iceland and the Outback, but I can do a major guided activity every year or two. I’m thinking about it.
Otherwise, I look at the trip to Quebec as a door. On one side of May 2, I had one life. On the other side, I have a new one. My first life was mostly accidental. My next life? Not so much.

Jason's Hiking Gear: A Comprehensive List, Organized by the Complexity of the Trip

I’m a fan of the “onion” approach to risk mitigation — consider your situation and your expected time to rescue, then plan your route and your gear accordingly, while assessing everything in terms of overlapping systems of support.
I start with a waist pack or a vest for a half-day trek, then augment as complexity and duration extend in concentric circles of time, environmental risk and estimated time-to-rescue. So the lists that follow are, for the most part, additive, and aligned to the 10 Essentials in the context of the humid continental climate of the Upper Midwest, where I normally adventure. I plan for five different levels of complexity.
I should note, for my gear-porn readers, that I’m not especially enamored of the ultralight approach. Part of this is pragmatic: It’s been my experience that much “ultralight” stuff on the market lacks an essential durability and versatility that I’d prefer. Part of it is also experiential: I used to be much heavier than I am now, so my knees, hips and spine don’t bat an eyelash at a few extra pounds in the pack. They’re accustomed to far worse!
My approach to first-aid planning and the inclusion of some apparently odd items on my list is informed by my certification as a Wilderness First Responder. Even on a well-trafficked area of the NCT, if someone experiences a medical emergency, that person usually must be brought to the ambulance. EMTs are not equipped to evacuate people from the middle of the forest — that’s what SAR teams do. So as a WFR, I also carry “extra stuff” that most people don’t, because if I happen to be present for a genuine medical emergency, I’m trained to either support a compromised hiker in place while reinforcements arrive or to supervise packaging and transport to an evac site where EMTs can then take over.

Attention! I do not recommend gear lists. The choice of what to bring or what to not-bring on a hike is a purely personal consideration. I share my thinking because it’s (a) iterative based on expected complexity and (b) an insight into how I think about risk mitigation in the field. It’s not intended to serve as a best-practice recommendation. The links, below, are not affiliate URLs. Just data to help you contextualize what I’m talking about.

Originally posted 17 Feb 2018; revised 02 Feb 2019.

Complexity Level 1

A nature walk of less than a planned four hours in a place like a well-trafficked public park (e.g., the Kent Trails system in West Michigan) where cell coverage is solid and emergency services remain readily available.

  • Everyday carry items — Leatherman Wave multitool, butane torch, Fisher space pen, pocket inspection light (yes, I carry those things on my person religiously, except in the presence of your friendly TSA screener)
  • Wallet, iPhone, Apple Watch and AirPods
  • Bottle of water

Add the obvious: comfortable shoes, clothing attuned to the weather, sunscreen and sunglasses if appropriate, etc.

Complexity Level 2

A full or partial day hike in a place where you’ll occasionally encounter other people and are reasonably close to rapid medical evacuation, but where cell service may be spotty or nonexistent. For example, a section hike of the North Country Trail in Newaygo County.
I wear a rugged Coyote paintball vest supporting seven molle-secured pouches:

  • Attached to the vest independently, or stuffed inside the back panel:
    • Whistle
    • Small LED light with red and white lamps and a swivel clip (attaches to hat brim)
    • Four 25×7 KN locking climbing carabiners
    • Sunglasses
    • Buck 119 fixed-blade knife
    • Heavy-duty, extra-large waterproof rain poncho
  • Pouch 1 (comms):
    • Yaesu VX-6R submersible radio with water-resistant microphone (I’m an amateur radio operator; plus, I’ve programmed relevant frequencies into the radio, including the frequencies used for local search-and-rescue teams and club repeaters)
  • Pouch 2 (personal):
    • Space for my phone, ID card, car key, cash
    • Sanitation items — travel tissues, hand sanitizer, wet wipes
    • Pepper spray (dog defense!)
    • HikerSnax — granola bars, nuts/gorp, etc.
    • Green chemlight stick
    • 1-qt. freezer bag for trash pack-out
  • Pouch 3 (first aid):
    • Just inside for easy emergency access:
      • The Field Guide of Wilderness & Rescue Medicine — annotated with helpful tips
      • Freezer bag with a dozen non-sterile exam gloves
      • Cloth triangular bandage with pins
      • EMT shears — the good kind that actual EMTs use, not the cheap plastic ones you get in the drug store
      • Emergency CPR mask
      • Timex watch (timing a pulse or respiration with an Apple Watch is a fool’s errand; you need a persistent second hand)
    • Zipped, hard-shelled first-aid kit containing:
      • Tweezers and sticky tape
      • Pills (loperamide hydrochloride, diphenhydramine, ibuprofen, glucose, calcium carbonate)
      • Drops (liquid bandage, lubricating eye drops)
      • Triple antibiotic ointment
      • Assorted small sterile gauze pads, bandages, sterile gauze rolls, cotton swabs, sting-relief pads, alcohol pads, moleskin
      • (To be added — Narcan, epinephrine ampules, syringes)
  • Pouch 4 (navigation):
    • Flashlight (Fenix PD35) with fully charged battery
    • Suunto MC2 compass
    • Rite in the Rain pencil, pen and all-weather notebook — because you do need to take notes in all conditions!
    • Maps (I print them in advance through CalTopo, on Rite in the Rain 4.7-mil waterproof paper) — 1:24000 scale, covering the planned itinerary
    • 1:24000 UTM grid
    • Laminated quick-reference cards (identifying my emergency contact info, radio reference, primary patient assessment quick reference, SOAP note template, etc.)
  • Pouch 5 (survival)
    • Gerber Suspension multi-tool
    • Several chlorine dioxide tablets for water purification
    • Duct tape (1.25-inch by roughly 20 feet)
    • Heavy-duty flint-and-tinder
    • Small, heavy-duty, half-ounce Tupperware container with cotton balls smeared with Vaseline
    • Emergency “space blanket”
      • Significant space blankets are useful. However, the tiny little fold-up 4-foot-square versions you buy at the supermarket that collapse into packs sized like a deck of cards, are practically useless. But I include one of the cheap ones to serve as fast-accessed ground cover for someone who’s injured and needs to lay on damp or dirty forest floors, or who needs a quick waterproof or sunproof cover during medical triage.
    • Bandana
    • Pair of backup AAA batteries for the clip light, taped together
    • Backup battery and red/green/blue lens filters for the Fenix light
    • Insect-repellent wipes (some with DEET, some with Picaridin)
    • A half-dozen foot-long plastic zip ties
    • MapTools ruler
  • Pouch 6 (water)
    • 1L wide-mouth Nalgene bottle
  • Pouch 7 (cordage & shelter) [it’s a bigger pouch, on the back of the vest]

This kit, fully assembled, weighs in at 10 lbs without water. And yes, I know I look a bit like a prepper. Nevertheless, I’ve found that the vest (even though it is, by far, the heaviest part of the setup) more evenly distributes weight over my hips and knees than either a backpack or a waist pack. I can — and have! — done easy 6-mile treks along the NCT with this setup and never felt pain or discomfort anywhere, whereas smaller daypacks (without good hip straps) and waist packs really irritate my lower back. Most importantly, everything I need to access, I can access without removing a backpack or digging for stuff. The only downside is that it’s a wickedly efficient insulator, so a fast hike at the peak of summer might induce heat stress.
Apparel

  • Obviously, dress for the weather. I’m a fan of my light leather boots in all conditions because they offer just enough ankle support. If it’s super hot and the trail is in good shape, I’ll wear my trail-running shoes.
  • Hats! In the summer, I wear an oiled cotton fedora with a chinstrap. It offers “face space” if I need to bring a mosquito net. In the winter, I wear my Ukrainian ushanka. It looks funny — a giant Siberian-style fur hat! — but it’s toasty and with the flaps up, it’s not too hot, either.
  • I always carry a 5-foot hickory hiking staff with a brass point. It’s literally saved my life before. No joke. I cannot imagine using collapsible trekking poles.

Considerations
Some things many people carry on day hikes, but I do not —

  • Lighters and matches. Both can fail, particularly in adverse weather conditions. A flint-and-tinder, with an appropriate ignition source, will not.
  • GPS units. Often fail, and they sometimes prove inaccurate depending on conditions. Never, never, never, never, never go on the trail without an appropriate map and compass. Print maps at 1:24000 scale and learn how to orient yourself and to navigate with maps and compasses. It’s an essential skill, one that can’t be magically done for you by a piece of delicate, energy-sensitive electronics.
  • Portable emergency communication devices. It’s rare you’ll encounter an emergency on a day hike that justifies such a device. A radio that can transmit on 2m and 70cm frequencies (provided you’re licensed, that is!) can help in emergencies as well as in non-emergency situations if you’re out-of-range of cell towers. Plus, if another person in your party is a radio operator, you can better coordinate leading and sweeping on spread-out hikes.
  • Firearms.

Complexity Level 3

A weekend excursion in the non-remote backcountry, where emergency evacuation may be expected within 120 minutes of a distress call. Likely includes a mix of hiking on established and primitive trails and camping at planned but rustic sites, or basic off-trail bushcrafting.
The vest goes away at this point because wearing the vest with a backpack is a recipe for shoulder-friction agony. I keep all the stuff from the vest but redistribute it between my backpack and a waistpack. So assume that everything at Level 2 also appears in Level 3, but I won’t belabor it by listing things twice.
Here’s the thing about the waistpack: I treat it like a medical fastpack. It contains my version of the survival 10 essentials plus medical triage stuff (gloves, notepad, shears, CPR mask). It only comes off when I’m in the sleeping bag. If I leave the bag, even to pee at 2 a.m., the waistpack comes with me. Because what if you get turned around in the dark?
Packing

  • I’m a fan of the Kelty Coyote 80 because it fits my hips in just the right way where it doesn’t feel like I’m carrying a monkey behind my shoulders. (I own the much more robust 2011 version, not the 2016 redesign, which seems to be a significant step backwards. Mine features heavier-weight material and more durable zippers and stitching than the current iteration.)
  • Pack rain cover.
  • Appropriate netted bags or compression sacks to consolidate, segregate and compress the gear inside your main pack.
  • Waistpack. I use a Kelty Oriole, a now-discontinued 6L lumbar pack that I wear facing the front.
    • The stuff from bags 2, 4, and 5 from my vest go into the waistpack. The items individually attached the vest do, too. The radio clips to a side strap. The material from bags 6 and 7 go into the waistpack. Very few first-aid items (triage only) goes in the waistpack; the rest hides in the backpack.

Insulation (organized in backpack)

  • Appropriate footwear—broken-in boots or shoes for trekking and light camp shoes for lounging at base or crossing small streams
  • Wool socks and appropriate undergarments (x2)
  • Appropriate hiking shirt, long sleeve (x2)—fishing shirts with quick-dry material and roll-up sleeve loops work well, as do the kind with built-in sun protection
  • Appropriate hiking pants (x2)—I like the kind with heavier material, quick-dry, with pockets and zip-off lower legs
  • Gaiters as needed
  • Light sweater in case the night gets breezy
  • Fingerless gloves, to protect your hands against abrasions
  • Two-piece breathable rain suit, if the forecast suggests a storm, or an oversized poncho just in case

Bag 1: Cooking & Hydration

  • Camp stove with 4 oz. fuel for every day of the trip
  • Mug-slash-pot for boiling water, mixing soups, etc.
  • Spork
  • Containers for 3L of drinking/cooking water per day, plus an additional liter for every five miles hiked (however, individual needs vary) — I use a 2L hydration pack with a bite valve, with a pair of backup 1L nalgene bottles carried in external pouches

Bag 2: Food

  • Food for one day longer than you plan to be out on the trail — fast one-small-pot meals that you can eat hot or cold — with calories sufficient to support each day’s exertion
  • Easy-to-access snacks for energy on the trail
  • Coffee or tea

Bag 3: Sanitation

  • Small spade for digging catholes, if outhouses aren’t available along your planned route
  • Small roll of camper’s toilet paper (remember: bring a heavy Ziploc bag on the theory that you pack out all your inorganic waste to Leave No Trace)
  • Biodegradable camp soap
  • Moist towelettes
  • Quick-dry towel, if you expect to get wet
  • Toiletries kit for your specific needs (contact lens stuff, feminine hygiene products, toothbrush, medications)
  • Bug spray (I prefer 100 percent DEET)
  • Sunscreen
  • Decent multi-purpose gloves for working with wood, debris, cordage, hot pots around the fire, etc.
  • If you suspect there’s a reason (snow, rain, bugs, fear of trash pandas) you won’t want to leave your tent in the middle of the night to urinate, consider a bottle with a cap
  • Additional heavy freezer bags for packing out trash

Bag 4: Fire, Water, Light & Tools

  • Black Diamond Storm headlamp plus a set of replacement batteries
  • I sometimes bring my 12×25 compact glasses if it’s an especially scenic trip
  • Camp lantern, if you wish (I’m a fan of the small/light candle lanterns—just enough lumens to read by)
  • Mosquito headnet, if the season calls for it
  • Method of normal water purification (depending on context, I’ll carry either a travel hiking filter or a UV treatment kit)
  • Small beeswax candle in a tin, with waterproof matches inside
  • Additional firestarter material
  • Small hand saw
  • A few extra chemlights

Bag 5: First Aid
I augment my stock first-aid kit with additional materials depending on where I’m going, when I’m going, with whom I’m going and who else has some degree of first aid or medical training. It varies every time. I base it off a proprietary list shared with me by a small Canadian adventure-sports organization, which optimized the list for WFR-prepared explorers in light of expected-time-to-rescue for different climate conditions.
Shelter & Environmental Protection

  • Groundsheet (I use a 6-foot-by-8-foot tarp I bought at Meijer — and get the blue one; nothing’s naturally blue in nature like that, so you’ll be more visible if you need rescue)
  • Tent or bivy or hammock
  • Sleeping pad (I use a now-discontinued Therm-a-Rest inflatable model)
  • Light blanket or heavy blanket or 0°F sleeping bag, depending on the season
  • Sunglasses
  • Small inflatable travel pillow (optional)
  • Sitting pad (optional)

Complexity Level 4

Between three and six nights in the remote backcountry, especially in a period where it’s likely to become cold. Evacuation is expected than four hours after contact and immediate recourse to emergency services (by cell phone or ham radio) may or may not be possible. The trail may or may not exist, or may be challenging to pass in places given terrain or environmental conditions. Camps may be established at existing primitive sites, or you’ll need to clear your own camp. Example: Isle Royale National Park in the off-peak season.
Assume everything listed for Level 3, with exceptions/substitutions noted below.
Insulation

  • As the temperature drops, you’ll need to plan for base layers (wool or technical material)
  • A cold-weather hat and mittens protect against the chill
  • Heavier-weight wool socks
  • Gaiters, if you’re forging your own trail
  • A windproof and water-resistant shell jacket
  • Medium- or heavy-weight wool sweaters or technical fleeces to layer up while wicking away moisture
  • A balaclava, if you expect it to get really cold
  • Rain gear, regardless of the forecast

Cooking

  • Meals-in-a-mug are okay for a day or two, but if you’ll be out longer, or you’re out with friends, a more robust cookware set makes sense — a stackable pot, pan and kettle set opens the door to other kinds of meals or cooking for more than one

Nutrition

  • Pack for a day extra than you’re planning, and remember that hiking burns more calories than normal, so higher-calorie, denser foods offer a better weight-to-volume ratio than a bunch of crap
    • A set of emergency ration bars can be a life-saver; a compact, vacuum-sealed brick offers 3,600 additional calories while taking up 1.6 lbs and just a handful of cubic inches of space
  • You’ll need a bear canister if you’re venturing far enough north

Hydration

  • Enough consumables (batteries, drops/tablets) to keep your water clean for an extra day or two longer than you plan to be on the trail
  • Even Nalgene can either crack or vanish under adverse conditions, so consider packing an extra collapsible water bottle just in case

Sanitation

  • The longer one’s on the trail, the more likely it is that some method of bathing will prove valuable

Fire

Navigation

  • A portable GPS unit that can summon help or check-in with loved-ones makes sense — I use the Garmin InReach Explorer+, which includes a (rudimentary) GPS mapping tool with satellite-based text messaging and global SOS services

Illumination

  • Enough consumables (batteries, candles) for an extra day or two of unplanned trail time

Repair & Support

  • If you plan to stay in the same place for a while, you might bear the extra weight of a camp chair
  • A small fishing kit, if you’ll be by water and are inclined (and are lawfully allowed) to fish for your supper
  • Seam/patch repair kit for your tent, in case the tent gets a puncture or a tear

Complexity Level 5

Extended time in the remote backcountry of a week or longer, where challenging terrain and isolation are expected and there is little to no recourse to emergency services within the first twelve hours after a critical incident. Example: Zone hikes at Denali National Park. 
As with Level 4, with the following amendments:
Packing

  • You’ll be carrying in a ton of food (and maybe a bear canister!) so more of your gear may have to be attached to the outside of your pack—and as such, your pack should have enough straps and loops to get the job done
  • Consider a pauk if you’re going in the snow

Insulation

  • Three complete changes of clothes (i.e., two in the pack and one on your body)
  • Wear boots and bring gaiters to protect against snakebites, ticks and wet vegetation
  • Plan for significant temperature variation for the place and time of the hike

Nutrition

  • Deliberateness about food choices is crucial — balance variety, nutritive value and caloric density against weight/volume in the pack
  • Plan for two extra days’ food if you’re extra-special isolated from rescue

Sanitation

  • You will need to clean yourself at some point, whether it’s with at least moist towelettes or with a solar shower

Shelter

  • An understanding of the terrain is crucial before you depart. Will a normal tent work, or should you carry a bigger tent in case of unplanned camp days on account of weather? Will you need a hammock if you’re stuck traversing very wet ground?

Navigation

  • GPS units and professional-grade topographical maps matter, as does redundancy—relying on one electronic device that could lose its juice or break on a rock is much more dangerous than using that device but having a backup map and compass handy as well as some basic orienteering skills

Repair & Support

  • Your first-aid kit will probably shift a bit in terms of what you’d carry, based on the need to stabilize and assess injury before evacuation—e.g., you might add a tourniquet but ditch a rescue breathing mask

Special Considerations

I keep some stuff handy that aren’t a default part of my equipment list, but are available if special circumstances warrant it:

  • If I think I might be near a place with a non-trivial fire risk, I might bring an N-95 mask. For example, if I knew I was going to do section hikes of the Pacific Crest Trail, I know that wildfires are an unpredictable hazard, so the mask will help if I’m downwind while I need to evacuate to safety. Likewise, if winds will be brisk and sand plentiful, some sort of eye protection makes sense.
  • Cold-winter travel often requires specialized tools like an ice axe, snowshoes, crampons or snow goggles.
  • Travel through swamp or marsh terrain would benefit from a hammock instead of a tent. Don’t forget to check for leeches!
  • Travel in very hot terrain—lookin’ at you, desert Southwest!—might require an umbrella for shade and extra oral rehydration salts.
  • Light sleepers might pack some earplugs. Nothing like being alone in the forest with 100 billion very loud insects singing you to sleep.
  • Adventuring in bear territory? You’ll need a bear canister for your food and plan your campsites appropriately to minimize human-ursine interaction. Grrr.
  • Speaking of bears, you will probably want to also carry bear spray.
  • I do not “pack heat” but some folks carry a pistol in the backcountry. Careful with this, especially if you venture into Canada.
  • Group travel means some gear might be distributed differently. For example, one person could carry the group first aid kit, another the group cookware, etc. Minimizes the need for individuals to fully self-provision everything while traveling in a pack. (Of course, you’ll want to carry survival basics on your own.)