Is that an entire roll of duct tape? That seems rather excessive, if so. It's both bulky and weighty. If you really feel you need it, get one of those smaller flat rolls they sell now, which is still probably more than enough for a week.

The 12 tubes of antibiotic is also quite a bit. A very thin amount is all you need and as long as there is a bandaid/bandage over it, it should remain sanitary. Not that they take up much room - but 4 is a LOT. Even with multiple large wounds if you use the right amount that's still plenty. If the concern is open packaging, get one of the mini-size tubes instead.

I know you have dressings meant for changing, but there sure seems to be a lot of it. Maybe take out some of the bigger pieces or one of the bigger rolls. Or start thinking about multiple use. How about a small stack of bleached hankerchiefs or plain white undershirts in a ziploc or vacuum sealed bag instead? Useful for bandages, guaze, hankies, sun protection, warmth, shelter, etc. Plus you could pack those elsewhere and they could still be used for large trauma.

Maybe also consider a spray form of antiseptic and some saline wash - you can't really use pads on a deep puncture or tear, and that many pads is a lot of packaging that goes to waste because you rarely use all the antiseptic for a small scratch and it just evaporates - forcing another pad later on for a dressing change.

I don't see anything in there for sutures. A scalpel blade and handle might be a nice compact addition/substitution for a pen knife too. Potassium pills might not be a bad idea either. And maybe reduce the penlight to something like this: http://www.amazon.com/gp/product/B00006R...mp;amp;n=228013

I also agree with Wildcard - maybe go for a couple or 3 smaller packs. Keep the common use items in a small accessible kit and stow the rest attached to your main pack. Take the kit apart, put aside the 10 most bulky items. See if you *really* need the 5 biggest or if you have adequate substitutions. That should help considerably. You already mention that it's too big to carry for small trips, so maybe even put together a small kit that sits in the big kit. Or just take it down to 2 equally sized kits so you feel prepared for the weeklong trecks with both, but have ample supply in 1 bag for a day trip.

Just like anything, it can't help if you don't have it with you, and if it's cumbersome, you are less apt to take it. Plus, I'm not sure how many dressing changes you are going to want to make on large trauma. As long as it's a clean wound, it's probably better to leave it sealed against the elements. But check with a doctor on that one! I'm just guessing.

OH! Almost forgot. If you have a few smaller packs, you can make someone who didn't bring anything share carry duty. Plus, that's just good sense in case a group splits apart, etc. And it provides an excuse to train others in first aid and get them thinking about preparedness.