Chapter 28: Wilderness First Aid in Emergencies

Be ready for emergencies with these first aid procedures. Feel free to copy these instructions and make them part of your first aid kit.

Severe bleeding
Act quickly. Have the victim lie down. Using a clean cloth, apply direct pressure to wound. Apply cover bandage. If needed, apply second bandage and increase direct pressure. Elevate the wound above heart level. If bleeding continues, apply pressure to appropriate pressure point as well as directly to wound. Pressure points include inside of upper arm, inside arm below elbow, inside and outside of wrist, back of knee joint, crease of groin, and top of foot. Release pressure point once bleeding is controlled. Reapply pressure at pressure point if bleeding recurs. Use tourniquet only as an absolute last resort in a life-threatening situation. Treat for shock. Keep the wound clean.

Breathing stopped
Place victim on back, head tilted backward. Using 2 fingers, lift chin, keeping jaw supported and mouth open. Adult/Child: Pinch nose shut. Place mouth over victim’s mouth. Adults: Repeat 1 breath every 5 seconds. Child: Repeat 1 breath every 3 seconds. Infant: Place mouth over nose and mouth. Give 2 slow breaths, watching for chest to rise. Remove mouth between each breath. Repeat breath every 3 seconds.

Adult/Child choking (1 yr. +)
Conscious: Stand behind victim. Place fist just above navel. Grasp fist with other hand and give quick upward thrusts until object comes out or victim is unconscious.
Unconscious: Lay victim on back. 1) Look in mouth for foreign object. 2) IF seen, sweep finger down inside cheek with hooking motion. 3) Give 2 breaths for adults, 1 for children. IF air won’t go in, re-tilt head, try again. IF air still won’t go in, place heel of hand just above bottom of breast bone. Place other hand on top. Give 15 chest compressions for adults, 5 for children. Repeat all steps until air goes in.

Hypothermia
Hypothermia is defined as having an internal body temperature of under 95 F. Symptoms include shivering, difficult or slurred speech, slow breathing, cold skin, loss of coordination, fatigue, and lethargy. Treatment: Monitor breathing. Get victim out of cold, indoors if possible. Protect from wind, cover head, insulate from cold ground. Remove wet clothing. Dry victim rapidly. Re-warm victim in dry clothing and/or blankets as quickly as possible or place in tub of warm, not hot, water. Give victim warm liquids to drink only if conscious. No alcohol. Don’t attempt to warm the legs and arms. Heat that is applied to the legs and arms forces cold blood back toward the lungs, heart, and brain causing the core body temperature to drop. This can be fatal. Don’t massage or rub the victim. Handle the victim gently, because they are at risk of cardiac arrest. Follow treatment for frostbite. Get medical help as needed.

Frostbite
Get the victim out of the cold. Warm affected areas as quickly as possible. Do not rub affected area or apply heat lamp or hot water. Do not rub snow on frostbitten skin. Warm hands by tucking them under your arms or companion’s arms. If nose, ears, or face are frostbitten, warm by covering with dry, gloved hands. Discontinue warming techniques as soon as the affected area(s) become flushed. Expect swelling and pain after thawing. Gently exercise affected area. Elevate frostbitten areas, but not higher than heart. Get professional help as needed.

Poison
If you have cell phone and coverage, call Poison Control or 911. Follow directions. Keep sample of suspected poison and any vomit. DO NOT give victim anything by mouth or induce vomiting unless directed.

Shock
Lay victim on back with feet elevated. Lay on side if vomiting, unconscious, or having difficulty breathing. Keep victim warm, but not hot. DO NOT give food or drink.

Sunstroke (Heat stroke)
Symptoms may include extremely high body temperatures (106 F or higher), absence of sweating, dry skin, rapid pulse, losing consciousness. Sunstroke is life-threatening. Get medical help as soon as possible. Lower body temperature quickly with cool, not cold, water. Keep the victim cool until the body temperature has returned to normal. Do not give the person stimulating beverages such as coffee or tea.

Tick bite
Remove tick quickly and carefully. Use tweezers and grasp the tick near its head or mouth. Pull gently to remove the entire tick intact. Keep tick if possible in case you develop illness and your doctor wants to see the tick. Clean your hands and the area around the bite with soap and water. See your doctor if you develop a rash or fever, have muscle aches, joint pain and inflammation, swollen lymph nodes, or flu-like symptoms. Get immediate medical help if you have a severe headache, difficulty breathing, paralysis, or chest pain.

Blisters
Don’t puncture the blister unless it’s painful or prevents you from walking. If you feel you need to drain it, wash your hands and the blister. Clean the blister with an alcohol wipe. Puncture the blister in at least two spots near its edge with a sterilized needle. Carefully press to drain fluid. Apply antibiotic ointment to the blister, especially at puncture areas. Wash and reapply ointment as often as needed to keep the blister clean. Cut an opening the size of the blister in moleskin or molefoam and place around the blister to keep pressure off the painful area. Take pain medication as needed.

Burns
First degree burns are the least serious and affect only the outer skin layer. The burned area usually appears dry, red, and mildly swollen. Cool the burn with cold water. If a large supply of water is not available, use cold compresses. Do not put ice on the burn. Take pain medication as required.

Second degree burns affect the skin’s lower layers. They are painful, swollen, and have redness and blistering. The skin may develop a weepy, watery surface. Second degree burns can be caused by severe sunburn, hot liquids, or contact with hot objects. Cool the burn with water for at least 10 minutes. Do not put ice directly on the burned area. Use antibiotic ointment or other cream or ointment as prescribed by your doctor. Cover the burned area with a dry non-stick dressing to prevent infection. Take pain reliever as needed. Change the dressing daily after washing hands with soap and water. Apply a cool, clean wet compress on the burn for a few minutes each day. Gently wash the burn and reapply ointment. Check daily for signs of infection such as increased swelling, redness, pain, or pus. Avoid breaking any blisters that form. Try not to itch healing skin. Protect burned areas with sunscreen for at least one year.

Third degree burns are the deepest and most severe and always require emergency treatment. They may appear white or charred and extend through all skin layers. There may be severe pain or no pain if nerve endings are destroyed. Do not take off any clothing that is stuck to the burn. Be sure the victim is not in contact with any smoldering material. Do not soak the burn in water because this could cause shock. Do not apply ointment or ice. The burn can be covered with a sterile bandage or clean cloth until you receive medical assistance. The cloth or bandage can be moist to avoid sticking and give relief. Do not use plastic.

This is not meant to be a complete list or solution for all emergencies. You are responsible for all your outdoor endeavors. Be prepared for emergencies. Hike light. Have fun. Be safe.

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The following was sent to us from one of our customers, Robert Matheny, Jr., M.D. We appreciate his generosity in sharing this information and hope you find it helpful.

"The possibility of traumatic injury, justifiably, consumes a tremendous amount of our first-aid planning when venturing into the wild and often precludes other medical planning, however, when considered critically, medical illness often presents a greater immediate threat to life than trauma. Preparation for medical illness can be surprisingly simple and the response gratifying, a few widely available medications and a familiarity with your partner’s medical issues can anticipate and treat a substantial number of problems. I would like to present a brief, but by no means exhaustive, review of significant first aid issues that might arise during an outing and the potential responses that might be available; the ultimate goal of this exercise is to provide information that will allow individuals to review their response to the “wilderness” emergency; a general state of preparation is the most valuable component of any first aid kit … anticipate and your experience will be less eventful.

I will address traumatic injury first; traumatic events may be separated in several categories:

The first pattern of injury is that of trauma that is not survivable. Regardless of preparation and access to emergency services these injuries are lethal. Examples might include: fall from a height with aortic rupture, massive head trauma and high cervical injury (neck fracture) with spinal cord injury. There is no way to prepare for these injuries beyond prevention and treatment in the field is futile, any effort by emergency medical services is simply an exercise in recovery.

The second pattern of injury would be injuries that are not immediately lethal but that have the potential to become so over time. Examples of these injuries might include: head injury with gradually expanding intracranial hematoma, gradually expanding pneumothorax, significant lacerations with ongoing blood loss, and solid organ injury (predominantly liver and spleen). These injuries can only be treated by rapid extrication with care to not extend the pattern of injury i.e. proper immobilization to protect the axial skeleton, etc... Field treatment consists of control of overt bleeding by direct pressure, the airway is maintained, injured areas are immobilized and rapid activation of the emergency medical system is undertaken. Once again, beyond basic first aid, there is very little that can be accomplished in the field; first do no harm then evacuate.

The third pattern of injury would be injuries that either are a threat to limb integrity or raise concerns of the presence of more serious, underlying injury but are not, in and of themselves, immediately life threatening. Examples might be an open fracture with a fall from a height or the fracture of an extremity with significant threat to the local vascular or neurologic structures. The treatment for these events consists primarily of keeping the injury site clean and maintaining some degree of immobilization. Prevention of further injury to critical areas such as the axial skeleton and to the vascular supply of the injured extremity takes immediate precedence; however, once again, extrication is the treatment of choice.

The fourth pattern of injury is that of trauma without significant associated injury or deformity. These injuries are addressed by immobilization and extrication with care to avoid making things worse. The time frame for treatment, safely, goes to hours.

Distilled down trauma either kills you outright or it doesn’t. In a few cases it kills you over the “golden hour” following the injury; however, your field options in these cases are generally limited to extrication to advanced care. Your only effective field intervention in most cases consists of prevention of the initial injury; once an injury has occurred minimizing the possibility of further, iatrogenic, injury becomes the priority. Regardless of preparation or equipment, in most traumatic events for which field intervention is available, the event and extrication may be unpleasant but survival is the rule. Immobilization of the majority of these injuries requires no special gear beyond tape a stick and bits of your pack and rack; the only planning that is required is the education to prevent further injury and some idea as to extrication and evacuation.

Medical issues, that is, cardio-respiratory issues, i.e. those that interfere with ventilation (breathing) and circulation (apart from trauma) can be rapidly lethal without appropriate intervention. However, even minimal intervention, as described below, can markedly increase the likelihood of survival. Examples of medical problems might include, but are not limited to: heart attacks, allergic reactions and asthmatic attacks. Immediate interventions potentially available for these sorts of events are inexpensive, portable, simple and widely available. These interventions do not substitute for appropriate, definitive treatment; however, they can allow for potentially effective initial field therapy providing the time to access that level of definitive care. Aspirin and Benadryl provide immediate treatment options for several medical urgencies. Aspirin given as a single, chewed, 325 mg tablet has the potential to provide initial treatment for virtually all cardiovascular events, including heart attacks, strokes and “blood clots” of any sort. Benadryl, as one to two opened or chewed 25 mg capsules, is the initial treatment of choice for virtually all allergic responses. In the absence of allergy to these medications, they are indicated for all suspected cardiovascular and allergic responses, respectively, and have the potential to be life saving. These are light weight, easily employed and require no special training to utilize. They are widely available without a prescription and should be part of all outdoor medical kits.

Further additions to the basic medical kit should be guided by the medical issues likely to be encountered by your group: i.e. is your partner diabetic and prone to hypoglycemia? (Pack “glucogel” or glucagon, available by prescription). Does a member of your group have life threatening allergies? (An epipen might be a reasonable addition to your medical kit, available by prescription). Is there an asthmatic in the group? (Pack an inhaler … be certain that it contains medication, an epipen might also be considered). Are there medical issues that are unique to you or your partner? Pack appropriate medications and be certain that more than one person in the group is aware of the potential for problems and knows what to do in the event of a problem.

Act to avoid injury, anticipate to avoid problems, be aware of your surroundings and you are unlikely to have to use any of this information."

(Used with permission from Robert Matheny, Jr., M.D. )