You bring up a good point. I should start off by saying that just because I can build long term shelters that I can live in for extended periods of time does not mean that I always do. Most of the time I string a tarp up and simply use that. As far as leaving traces of my presence, I don't worry about that much since up until recently I camped out on the edge of a swamp where absolutely noone ever goes. It is on private land and from the time I started to this very day, not one single person has ever set foot there except for me, so beautification has really not been an issue so far. Even if it was, I camoflage my camps both while I'm there and when I leave since in a survival situation, I may not want hostiles invading my camp. I dare say you would have a really hard time finding where I've been.
As far as fire goes, how long would it take for the average person to go through all their survival fire gear? When I go out for weeks at a time, I really don't want to carry a ton of fuel and besides, the woods are full of fuel, in fact, the woods ARE fuel. Not only that, but all of my trash can be burnt in the fire and I do mean all of it. Even aluminum cans burn up. I have to show people that one from time to time.
I don't really understand this whole "irresponsible" comment. Everything we do impacts the environment and camping is certainly no exception. Even under ideal circumstances, people leave traces when they leave.If I want to survive, the environment will have to make some adjustments and that is one thing mother nature is exceptional at. For regular camping, I leave minimal impact, but if I am in a survival position, then I will do whatever it takes. Anyone that says they wouldn't is either lying or they will die.
The field surgical kit is a very handy ting to have. It has scisssors, hemostats, a scalpel, two suture kits, and a pen light. I can think of lots of uses for each of these items and yes, I can sew up someone if I have to. I hope that it doesn't come to that but if it does, I'm ready for it.
Just to put things into perspective for you, I plan for the long haul. If I have to bug out for a short time, then I won't problem, but in a worst case survival situation, I have no idea how long I will be there. I don't want to die because I am afraid to make a substantial shelter for fear of disturbing a bunny, or make a fire pit because I am afraid I will spoil the view for someone later. If this is a problem for people, I appologize, but Ive noticed that even Les Stroud builds a fire out on the ground, and even kills animals, not because he has to, but so you have something to watch on TV. That seems a little irresponsible under the terms you've described. I do exactly what I have to, no more, no less. I don't like to complicate things if I don't have to, and I certainly don't want to do alot of work for no reason. I only build a shelter and a fire if I absolutely have to.
I hope that explains my position a little clearer for you.