6 Wilderness First Aid Tips: Be Prepared for Injuries in the Outdoors
Outdoors 101: Top 6 Wilderness First Aid Tips
Imagine, heaven forbid, you or someone you know just suffered an injury on the trail. You’re in pain and your hiking companions gather around. Now what would you rather hear, "wow, that’s bad, what should we do?", or, "someone hand me the med kit, I know what we need to do". It’s clear that one of those phrases it much preferred over the other! While the chances of a serious injury on the trail are slim, it’s best to always be prepared.
We’re not talking about having a medic on every single hike, but simply brushing up on your medical knowledge can be invaluable in a pinch! As a Wilderness EMT, proper medical knowledge is very important to me. I’ve therefore put together a Wilderness First Aid guide for you to familiarize yourself with the basic types of injuries that appear on wilderness trips, and how to deal with them. Starting with #1, the initial size up.
Wilderness First Aid Tip #1: Initial Size Up
First things first, once an injury has occurred, your first priority is to make sure there is no lingering danger that can cause further injury. This fits into the broader phrase ‘scene size-up’. As soon as someone is hurt and needs help, check your surroundings! Is this a safe place to stop? Consider how the patient was injured, will it happen again if you stay, or do you need to move somewhere safe?
Remember, it won’t do anyone any good if you end up getting injured during your valiant attempt to reach the patient without first considering the risks! Once safety has been established, approach the patient and asses the problem. In technical terms, this means establishing the mechanism of injury, or what exactly caused the injury. Fully understanding the injury, and its causes, is vital to treating the injury effectively.
A critical element to any wound care scenario during wilderness first aid is to remember ABCs; or Airway, Breathing, and Circulation. As soon as you can safely get to the wounded person, check to make that sure their airway is open, they are breathing, and their circulation is good. Airway and breathing tend to go hand in hand, and can be checked simultaneously. Kneel down next to the patient and place your ear just above their mouth, while at the same time looking at their chest.
If you can hear/feel air moving from their mouth, and their chest is rising and falling, then airway and breathing check out. And of course, if they’re awake and telling you to get out of their face, then they’re also good to go! If the airway appears obstructed, immediately work to open it! First, check to make sure there’s nothing in the mouth. An unconscious person’s tongue may easily fall to the back of the mouth and would need to be manually moved to open up the airway.
Also, orient the person’s head for optimal breathing. This involves tilting the head until the chin is up and the nose is in the ‘sniffing’ position. If breathing is completely absent, begin mouth-to-mouth rescue breaths for them, and CPR if their pulse is absent; which leads us to the circulation element of ABCs.
In addition to checking for a pulse, circulation also means assessing the extent of the person’s injury, and if that injury is risking their overall blood circulation. For example, a particularly deep gash that is bleeding a great deal may risk circulation because not enough blood is reaching the rest of the body. This brings us to our first specific topic to discuss, how to dress a wound.
2. How to Dress Wounds when Hiking
A common injury in the world of wilderness hiking and adventuring is some form of trauma. From a straightforward cut all the way to more serious lacerations, a well-prepared hiker should have a plan of action!
In the case the scrapes and shallow cuts, the procedure is almost the exact same as back home! Clean the wound with fresh water or a sterile solution (such as saline), apply some form of antibacterial cream (such as Neosporin), and cover with a dressing or Band-Aid. For very deep wounds, this process becomes a little more complicated, however.
For a deep gash during wilderness first aid, it’s very important to make sure that no debris found its way into the wound. Any debris may complicate the healing process, introduce infection, and require the wound to be opened up later to get the debris out. We don’t want any of those to happen! Therefore, your first step is to gently rinse the wound with saline or clean water. Then very carefully look inside the wound for anything that doesn’t belong. This can be gravel, splinters, dirt or other debris. If you spot something hiding in there, very carefully remove it. After you’re done, thoroughly rinse and clean the wound once again.
The next step is to stop any bleeding, and dress the wound. In the case of a deep cut, I recommend butterfly closure strips to help pull the edges of the cut together. These strips may be a little finicky if you’ve never used them before, however. Therefore, here is my best advice for you; first, make sure the skin is as dry as possible before applying the strips. Any moisture can make the strips not stick properly, and fall off. Second, if you happen to have any athletic tape, medical tape, or even superglue, tape or glue the outermost edges of the strips down. This will help hold everything in place long enough for the wound to begin to heal. The last step is to apply a sterile dressing on top of the closure strips and either tape it down or wrap it in a bandage to keep it in place.
In the case of a more serious wound, that can’t be closed with simple closure strips, clean as before, apply a sterile dressing directly to the wound, and apply pressure. It’s this type of scenario that we must remember to continually check for the circulation aspect of ABC. If the wound is bleeding profusely, check the patient’s hands and feet for decreased temperature and a pale appearance. These are tell-tale signs, in addition to the patient becoming dizzy or confused, that you patient is losing too much blood. If this happens, you should consider using a tourniquet to limit bleeding until you can reach proper medical attention.
One final note on the subject, if the initial dressing you applied appears to be soaked through with blood, do not remove it! Simply apply a new dressing on top of the original one. Removing the dressing may open up the wound and bring us right back where we started.
3. How to Splint in the Outdoors
A day outdoors filled with rocky trails, slippery slopes, and steep descents is full of opportunity for a sprain or broken bone. Once again, it’s very unlikely, but best to be on the safe side! In the case of twisted/sprained joints or suspected broken bones, the key is stabilization. These injuries may be exceptionally painful, and quick stabilization/splinting can help alleviate pain while preventing further injury at the same time.
The steps to create a stable splint are thankfully very straightforward. First, locate a rigid object that is about the length of the affected bone. This can be almost anything; a rolled newspaper, a stout stick, a small plank, or a ski pole.
Now place the split along the bone you are trying to stabilize, and secure by placing ties at the joints at either end of the injury. In the case of a broken forearm, this means placing the ties just below the elbow and at the wrist. This prevents creating pressure at the exact injury point, which could cause severe pain.
Tighten enough to keep the splint firmly in place, but not tight enough to cut off circulation. Once the splint is secure, you may wrap the entire limb in bandages or any padding that you have available in order to prevent any unnecessary jarring or pain within the injury. If at all possible, elevate the injury above the heart in order to reduce swelling.
See the section below about improvised litters and carries to learn how to evacuate someone who cannot move on their own.
4. Dehydration & Heat Exhaustion
Hydration and staying cool is crucial while you’re outdoors scaling mountains, hiking forests, rafting, kayaking, mountain biking, or whatever your adventure of choice is. Overheating may quickly lead to a serious medical situation that will ruin your adventure, so let’s not risk it by taking proper precautions and recognizing early warnings!
First things first, drink water with electrolytes! Adventuring is tough work, and you need to stay hydrated. We’re sweating off a good deal of water In hot/humid conditions, so aim to drink about 1 liter of water every hour. Common indicators that you’re approaching dehydration are headaches and dark yellow urine.
Dehydration quickly contributes to several heat related complications as your body begins to move towards heat exhaustion and heatstroke. One of these complications may be heat cramps. These cramps occur due to dehydration and low electrolyte levels (remember we sweat out sodium!). The cramps often occur in the most heavily used muscles for your activity, and can happen during or after intense activity.
If you begin to experience heat cramps, immediately drink fluids containing high levels of sodium chloride and electrolytes. Also remember, our bodies absorb fluids containing carbohydrates faster than just plain water. Therefore, it’s recommend to aim for a drink that contains 20-30 mEq/L sodium and 6% carbohydrates. This will provide your body with the materials it needs to rehydrate, and get you back in action!
If you or a member of your team become seriously dehydrated and overheated, however, you may begin to see the early signs of heat exhaustion. Look out for nausea, vomiting, increased heart rate, and a temperature of 100.4 to 104*F if you happen to have a way to measure temperature. A key point here, the patient will still be sweating! This tells us that their body is still trying to compensate for the heat, but they need a hand.
Your best bet for heat stroke is to have your patient immediately stop all exertion, and sit down. Get them to a shaded spot, or provide shade if you can, and have them drink water or a drink like the one described above for cramps. If possible, wrap ice in a towel or other cover and place on their neck or armpits where we have more blood flow.
If heat exhaustion isn’t recognized and treated immediately via wilderness first aid, it may lead to the much more serious situation of heatstroke. Body temperature will rise above 105∞F, accompanied by a loss of coordination, confusion, disorientation, increased heart rate, and perhaps no sweating. The treatment steps here are almost identical to heat exhaustion, and must be completed immediately. Heatstroke is a life-threatening emergency.
If at all possible, immerse the patient in cool water to facilitate cooling, or spray with tepid water and fan them. As soon as possible, the patient must be evacuated to proper medical care. All these heat related problems don’t sound fun, do they? But they can be avoided by taking a few precautions! I said it earlier, and I’ll say it again, drink water! Lots of it. We often under estimate just how much moisture we lose while sweating and working hard, so do your body a favor and keep it hydrated! I recommend a hydration backpack like a Camelbak. Also remember to take breaks and eat snacks high in sodium and electrolytes.
As I’m heading to Nicaragua soon to guide volcano ascents in 90*F+ conditions, you can bet that I’ll be taking these precautions too!
5. Burns While Camping
Campfires, stoves, and lighters offer any number of opportunities to get a nasty burn. Some are simply little reminders to be more careful, but others may need some proper medical knowhow. With that in mind, let’s cover a few different types of burns you may encounter, and how to treat them.
Wilderness First Aid - 1st Degree Burns
The most common form of burn is superficial, or first-degree. This involves only the uppermost layer of the skin, and will appear as a reddened and painful patch. Your best course of action is to cool the burn with cool water for several minutes, and then clean the skin thoroughly with antibacterial wipes or cream. Aloe Vera (at least 60% concentration) may also be applied thanks to its antimicrobial and pain relieving characteristics.
2nd Degree Burns
If the burn extends down into the dermis layer of skin, then it is classified as a second-degree burn. In this case, you will see blisters form immediately after the injury, or perhaps several hours after. The skin will either be an inflamed red or a mottled pink and white. It may be sensitive and cause pain or discomfort to the patient when touched.
For second-degree treatment, start out the same as a first-degree by thoroughly washing with clean water. If any blisters are about 1in. or bigger in size, drain them and trim any dead skin. The smaller, and thicker, blisters can be left alone! Now apply an antibacterial cream, such as Neosporin, along with Aloe Vera if available. Lastly, cover with a non-adhering dressing, and secure it in place with either tape or bandages. Make sure the dressing(s) covers the entire burn area!
3rd & 4th Degree Burns
The last two burn classifications are third and fourth-degree. These are serious burns and require professional medical attention as soon as possible! To identify these types, take a close look at the burned skin. If it is ‘leathery’, firm, and/or visibly charred, then it qualifies as one of these two categories. Follow the same cleaning instructions as a second-degree burn, but hightail it to proper medical facilities as soon as possible!
On closing for this topic, let me offer this last bit of advice. Immediately after a burn occurs, before you even start cleaning and treating, remove any jewelry or constricting accessories! In many cases the area around the burn may swell, and these items may either become stuck, or at the very least cause additional pain and discomfort.
6. Improvised Carrying Methods
Often times a serious injury may prevent someone from reaching definitive medical care on their own, and will require help in order to get out of the wilderness safely. The list for improvising ways to carry or transport someone is nearly endless, but I’ve compiled a brief list of my favorites for you to consider.
Read on and provide a MacGyver like show of improvisation if the time comes! Wilderness first aid carrying methods may broadly be broken into two categories; those that require additional spinal stabilization, and those that do not.
No Head or Spinal Injury
I’ll start with the easier situation where there is no risk of spinal injury. These involve cases where the person did not suffer any head or spinal injuries/impacts when they were hurt. A couple examples are heat exhaustion or a sprained ankle. But please please please remember; if there is even the slightest suspicion that they may have hurt their head, neck, or spine, use the additional spinal stabilization option. Always better safe than sorry!
In the case where it’s just you and an injured friend. The most basic method is a blanket drag. Simply spread a blanket or mat on the ground, load up your immobile friend, and drag away. A word of caution, however. this method can be very uncomfortable for the patient bouncing over rocks and sticks! Therefore, add padding to the blanket with clothing and save this method for shorter or very smooth stretches of terrain. Otherwise, you be receiving a few unpleasant comments from your passenger!
A second method for a single person carry is the fireman’s carry. This involves standing the patient up, or having them lean against a tree. You then kneel in front of them bringing your shoulder to the area between the waist and belly button. Then drape the patient over your shoulder with feet in front and torso behind. Stand up and wrap your arm around the back of their knees to keep them stable, and begin walking. This method may be more suitable for terrain where a blanket drag is not practical; but again, be aware of the energy that this takes on your part, and the comfort of the patient.
Now let’s move on to team moving techniques. If you have just two people to complete the carry, try a linked backpack carry. First find 3-4 stout braches, about 1-2 inches in diameter, and lash them together. Now slide them between the carrier’s backpacks, at the base of the pack straps behind the carrier’s backs. Once this is done, a small ‘bridge’ will connect the two carriers when they are standing abreast of each other and 2-3 feet apart. The patient will sit on this bridge and keep their arms around the carrier’s shoulders. Ski poles or ice axe shafts can also be used for this maneuver.
When you have a team of three or more, consider a 3-person wheelbarrow carry. The patient places their arms over the shoulders of two people that are standing on either side of them. Then the patient’s legs should be placed over the third helper’s shoulders, who will be standing in front. The evenly distributes the patient’s weight, and can be used for long carries through difficult terrain.
Head or Spinal Carry
In the case where the patient has, or may have, hurt their head, neck, or spine, please always arrange for professional evacuation! They will have the proper equipment and experience to limit any additional damage during evacuation. If the patient absolutely must be moved out of a dangerous environment, or to shelter, you must take extreme care to fully immobilize the spine!
One method to do this is to use a standard hiking pack as an improvised neck stabilizer. Empty the pack, and lay it next to the patient where the base of the pack is at their head, and the top of the pack is pointing downwards towards their feet. The hip straps of the pack will act as a head stabilizer, while the rigid frame of the pack will stabilize the spine.
Next, slowly and carefully slide the pack beneath the patient until their forehead is level with the hip straps, and the pack is centered down their shoulders and back. While doing this, one person should hold and stabilize the patient’s head to avoid any jostling. Now place rolled mats or clothes (or any other padding) on either side of the patient’s head. Additionally, add firm padding beneath the chin to keep the patient’s head from rolling forward (a fanny pack works for this application). Now bring the pack hip straps around the padding on either side of the patient’s head, across their forehead, and fasten. This set up effectively immobilizes the neck and spine.
This alone is not enough to move the patient, however. Now we need to put together a rigid stretcher or carrying platform. Hiking packs again prove their almost endless use here as well. The rigid frames from multiple packs can be removed and secured together to form a passible rigid stretcher to move the patient if absolutely necessary. Two frames would be sufficient, but three or four can make for longer and more rigid platforms.
Don’t forget that kayaks and canoes can make excellent litters too. In the case of a kayak, remove the seat, any panels, and use a serrated knife to remove material until you have a continuous and mostly rigid surface. For a canoe, simply remove the seats and any other obstacles until there is enough space for the patient.
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There you have it. We’ve covered basic wound care, splitting, extreme heat, burns, and evacuation techniques. You now have a sturdy foundation on which to build your wilderness medicine knowledge, and tackle any situation that may come your way! In closing, I highly recommend investing in a wilderness medicine manual that will cover everything I’ve discussed, and much more! My personal recommendation is the Field Guide to Wilderness Medicine by Paul S. Auerbach, this is the reference text that I used for my Wilderness EMT certification.
Have fun and be safe, eh?