Experiencing an injury on a mountain bike ride is one of the very real possibilities we face in the sport. Injuries happen, sometimes when we least expect them. Like carrying an extra tube in the event of a flat tire, having a first aid kit can make a huge difference in treating a bite or sting, or wiping the dirt and sweat out of a gash and wrapping it so you can make it back to the trailhead.
Bonus question for the comments: What have you found is the most useful item in your kit?