One of my more memorable mountain rescues started out as a recreational climb - three couples on an overnight climb near Tucson, AZ. I was just chatting with a guy I had just met about archeology, when we got word of a serious accident up the trail ahead of us. We raced to the scene and arrived, finding a climber who had just suffered serious head injuries - a falling rock had fractured his climbing helmet and left a nasty contusion dead center on his forehead. At that point, the new guy, who had followed us up said, "Don, I didn't tell you what I do for a living. I am an MD and I just finished three years working in an ER." I thought I had died andgone to heaven. Funny thing, none of had a cervical collar in our packs either. We improvised a very acceptable C collar from a foam pad. Improvisation is a key skill in wilderness first aid. You can't carry all the stuff you will need, and even if you do carry it, you will run out when you encounter other than a fairly basic situation.