Wilderness First Aid

General thoughts on First Aid and Survival in the back country

Wilderness is described as any area in which a person may be an hour or more from any modern conveniences, or medical attention. Wilderness First Aid

In a typical medical emergency, many people are trained in various forms of first aid, and CPR, covering basic trauma’s until an ambulance or emergency medical attention can arrive. In a normal civilized setting, typical 1^st responder time is 10 minutes. When you’re in a wilderness scenario, first aid and medical professionals may be hours or even days away. When injuries occur in this environment, It becomes much more critical in how that injury is handled for both the short term and the long term of both the patient and your entire group. In many cases, it becomes important to not only assess the situation from the patients prospective, but also from the perspective of rescuers and other members of the group travelling with the patient.

In a cold weather environment, when hypothermia or an injury occurs, it may become of critical importance to make sure that a crisis situation does not result in multiple patients. Journeys in the wilderness frequently involve planned stops in safe places, while traversing hostile terrain. A trip to the top of a mountain and back down to camp may be reasonably attempted within a set time frame. i.e. back before dark. When one member of your party becomes injured, suddenly the safety of the entire group can be put at risk. Treatment of that injured party may result in several people being stuck on a mountain, or in a dessert in the worst of conditions. A group standing around waiting for help, is suddenly, themselves subject to hypothermia, frost bite and even death. A patient with a broken leg, is also now subject to a host of serious secondary conditions as well. It becomes important to not only treat the immediate injury, but to also understand the nature of dangers that may present themselves in the any given environment, and what to do to protect from and treat those conditions as well. Any injury, even a minor one, can suddenly become life threatening for the whole group.

Quick assessment of the situation is paramount. If the patient is injured in a cold weather environment, the group may need to immediately find or build shelter for the entire group, and get a fire going. If the trip was a day trip, food and water may be limited. The group may not have appropriate clothing or gear to weather the night. In our modern age, we have become reliant on instant communication. In many backwoods areas, cell phone service may not be available. Someone may need to be dispatched to get help immediately, and that help may not be coming for a long time.

I have personally been involved with and treated a whole host of issues, including mountain rescue in New Hampshire in the frozen heart of February, to dehydration and heat stroke at the bottom of the Grand Canyon, in July. Sometimes, accidents happen, even for the most prepared. The objective is to not do stupid things, and minimize the chance that an injury can become a life threatening situation for an entire group.

Below is just a partial list of some of the things you may be called on to deal with, and while a detailed discussion of each of these conditions will be covered at a later time, we will touch upon them briefly here, in an effort to get you thinking about the big picture. This article is not a substitute for proper training. Remember, 90% of yours and your groups safety relies on a thorough understanding of the dangers, and taking measures to prevent accidents and injuries before they occur, and 10% is a comprehensive understanding on how to deal with them if and when they DO occur.

With that in mind, we’ll start with an ounce of prevention….

FOOTWEAR

I can’t tell you how many times I have had this conversation, and I can’t stress its importance enough. BOOTS are THE single most important thing to think about before any backwoods trek. Anyone that has done any time in the Military can tell you about how important it is to take care of your feet. While I personally did not have the honor to serve this great nation, the rule is the same for all. Without your feet, you are going nowhere fast. It is of top concern that you address footwear far in advance of any extended trip into the back country, and footwear is often tailored to the environment. For all purpose footwear, I am a big fan of high quality leather hiking boots. Waterproof, with GOR-Tex for breathability. At the time of this writing I am currently wearing a pair of Timberlands with at least 500 miles on them. I have damn near worn the tread off of them, but they have taken quite a beating and are still holding together well. I recommend mid-height boots that offer ankle support. Do not rely on sneakers, or low height boots… these are great for roads, and short day trips, but if you are going to be hours away from any help, I prefer something with decent ankle support. A sprained or broken ankle will stop you dead in your tracks, and again I cannot stress enough the importance of protecting your feet. That will bring us to the second most important thing about footwear. Never take a long trip with new boots. If you are going to spend a lengthy period of time on your feet, and possible several days at a stretch, your boots must be thoroughly broken in. If there is one thing I can guarantee you, new stiff boots on a long hike will result in blisters and foot injury. I have seen the flesh of an entire heel fall off after 10 miles of wearing the wrong shoes, or boots that have not been broken in. Don’t do it. Feet must be protected and cared for.

CLOTHING

Socks are also of prime concern. Feet must not be wet. Wet feet result in chaffing, irritation and blisters. A good pair of hiking socks will be wool or a wool poly blend. With socks, pants, shorts, and even underwear…. There is one thing to always remember.
Cotton Kills. Drum it into your head now. If you want to suffer, wear cotton. Cotton socks, pants, jeans, shirt are very good at one thing. Absorbing water. Wearing wet clothes, even if they are just wet from sweat is a sure way to get hypothermia in the most surprising of situations.

You want clothes that will wick water away from you and dry quickly. Cotton is not it. If you want to die quickly, spend a couple of days in cotton. Wear micro fiber or poly, and always dress in multiple layers. Don’t wear a tee shirt and one bulky heavy coat. When you are out and working up a sweat, you might want to strip off a layer. If you have one heavy coat, there is no in between. And Never sleep in the clothes you hiked in. There are a couple of good reasons for that … one of which is wild animals … they can smell you for miles, and you don’t want a bear wandering into your camp in the middle of the night. Another reason again, is hypothermia. Even in the desert it can get cold at night. Those clothes that you hiked in will be wet with sweat, and can suck the heat right out of you. Always go to bed in dry clothes.

ASSESSMENT

When an injury does occur, the first thing you are going to want to do is a patient assessment. If you did not witness the accident, and even often if you did, you are going to want to do a thorough assessment. It is important to remain calm, and keep your wits about you. If you are hiking in a wilderness area, most likely the people with you are going to be friends and family. It can be much easier to remain dispassionate when it is a stranger, but very easy to become emotional and lose your cool when it is a loved one. To combat this, there are several acronym’s you can keep in mind during patient assessment. Where bleeding is possible, always wear gloves to protect yourself. Even if you have to improvise and wear sandwich bags on your hands. I recommend non latex gloves. Many people are allergic to latex, but besides that, if you are in the woods … there is a good chance you or the patient may have insect repellent or sunscreen on, and many of these are oil based. When exposed to oil, latex begins to breakdown, and when that happens it becomes porous and loses its ability to protect you.

If you don’t know the patient, introduce yourself. As important as it is for you to stay calm, it is important to keep the patient calm as well. Watch what you say, so as not to alarm them, even if you are joking. If you are dealing with a leg injury, it might not be a good idea to say “Well, you’re definitely losing the leg.” Trust me, however well intentioned … the patient will not appreciate it.

Ask the patient Who, What, Where and When. Who are you? Do you know Where you are? Do you know what happened? Do you know what day it is? Much of your assessment may hinge on their mental state. Brain trauma, shock, hypothermia, heat stroke and altitude sickness can result in confusion or disorientation. From an assessment standpoint we like to r
emember SAMPLE.

Symptoms
Allergies
Medications
Previous History
Last Intake and output
Events Leading to the injury or illness.

While some injuries may be obvious, others might not be so obvious. Using your gloved hands, carefully conduct a physical inspection of the patient from head to toe.
Apply pressure and feel for abnormalities. Have someone keep written notes of the entire inspection and answers to all questions. Remember DOTS. You are looking for:

Deformities
Open Wounds
Tenderness
Swelling

Check to see if pupils are equal and responsive, make sure there is no blood or clear fluid coming from ears or nose. Clear or yellowish fluid could be an indicator of a major head trauma, and may be spinal or brain fluid. As you conduct your head to toe physical inspection, remember to visually check your gloves for signs of blood from a wound you did not see.

Make sure patient can move their hands and fingers, and squeeze your hand with equal pressure from both hands. Make sure patient can apply pressure against your hand with both feet.

HEAD, NECK and SPINE

If you are in the middle of nowhere, and you suspect patient has a back or neck injury, and you are not trained in spinal injuries … DO NOT MOVE THE PATIENT. With Head, neck and back injuries.. the quality of life for the rest of the patients life, may depend on your next actions. Stay with them and keep them calm and comfortable until help arrives.

BLEEDING

In a case where there is mild bleeding, apply pressure until bleeding stops, clean the wound area and dress the wound. In cases of severe laceration, apply pressure till bleeding stops, irrigate the wound, clean the wound area and dress. Deep wounds may require a butterfly bandage or stitching, but it is always important to get the bleeding to stop. Never apply a tourniquet unless the patient’s life is threatened by potentially bleeding out. If you are going to apply a tourniquet, do so under the premise that they will most likely lose that limb. Losing a limb is always preferable to death, but use it as a last resort.

CPR and RESCUE BREATHING

There are many places to get CPR training. CPR should be performed by trained personnel. If you are going to be in any situation away from medical aid, make sure a member of your group is trained and certified. CPR certification must be renewed every 2 years.

BROKEN BONES

I recommend a 36” SAM Splint. It is foam covered lightweight aluminum that is moldable to the injured appendage. Immobilize the injured extremity, and wrap with an ACE Bandage. In the case of an arm, a sling can be fashioned out of almost anything from bandaging, to a shirt, to a piece of rope. One of the
key elements of Wilderness first aid, is improvisation. You may not have a splint or a sling, but in a pinch you can immobilize a limb by wrapping it with another limb, like fingers or legs. Sticks, and tent poles make great splint material. When dealing with a foot or ankle, do not remove the shoe, if it can be helped. There’s a high probability you will be walking them out, even if it is with assistance. If you remove that shoe, there’s a good chance it isn’t going back on.

HYPOTHERMIA

Pale skin, blue lips, shivering, confusion, drowsiness may be symptoms of hypothermia. Hyothermia occurs when the body loses heat faster than it can replace it. It is important to get them warmed up as quickly as possible. If the patient is wet, get them into dry clothes, and get them into a sleeping bag. Shivering is one of the body’s mechanisms to generate heat. In dire emergency, one of the fastest ways to warm them up is skin on skin contact. Don’t be squeamish, you may need to strip them and yourself down and climb into the sleeping bag with them. Hypothermia can lead to cardiac and respiratory failure. When a life is at stake, your sensibilities must come second.

HEAT STROKE

Symptoms of heat stroke may include Throbbing headache, dizziness, red, hot and dry skin, muscle weakness and nausea and vomiting. You need to get them into shade. If you are in a desert or above the tree line, you might be making your own shade. Again, there are a dozen creative ways to do this. You have clothes, tarps, or tents with you. Figure it out. Look around and see what you can use. Make sure they are hydrated, and wet them down. Evaporation is cooling process. If they have heat stroke, most likely their body has stopped responding and they are no longer producing sweat as the body’s natural mechanism to control overheating.

DEHYDRATION

In dry arid conditions, the body can sweat out a quart an hour,
and sometimes more. It’s important to replace those fluids. One of the best ways to determine your level of hydration is the color of your urine. Light clear urine indicates you are well hydrated. Dark colored urine is a sure sign of dehydration. Dehydration can kill you. It can cause headaches, cramping, circulatory and respiration issues, and confusion, agitation and loss of consciousness. It happens far more often than you know, and is one of the number one ailments in the back country. STAY HYDRATED. Drink plenty of water. In dry conditions, your sweat can evaporate as fast as your body can make it. You might not even know you are sweating, and thereby not know you are in danger of dehydration. Drink plenty of fluids. I’ve used my fair share of iodine tablets to purify water, and it’s not the best tasting. I often carry powdered Gatorade to mix with it. It’s good for replacing lost electrolytes, and a great way to cover the taste of the iodine.

While hiking in the Grand Canyon I came across an old wooden outhouse in the middle of nowhere. As I got closer I realized there was a guy and a girl sitting in the shadow created by that old structure. They had hiked out across the desert with nothing more than a half a gallon of juice between the two of them, and she had passed out from dehydration. He had dragged her to the only shade available, and they were out of water. My then girlfriend and I ( I later married her ), had about 4 gallons between us. I left them a fair supply, but we were heading down … and they were heading out. We made sure to notify the rangers at the next stop, but it’s a perfect example of what NOT to do.

SUMMARY

While these are just some of the problems you may encounter, it’s a good start to get you thinking. Always remember to use your head. A small injury cannot only threaten your life, it can threaten the lives of all those with you. I have a list that is far too extensive to cover here and each of the above topics warrants a book on their own. Experience, while a great teacher, is often a deadly way to learn. Get trained. Wilderness first aid is a certified course, as are CPR, First Aid and many critical skills. Don’t take any backwoods trip lightly and spend three times as much time preparing and getting educated as you do on your trek.

Till next time, be smart and be safe.