You and a hiking buddy are heading down the mountain, and you come across someone unconscious on the trail. Or your buddy sits down at the picnic table and accidentally tips over your pot of boiling water, right onto your lap and you get a nasty burn. What do you do? You are miles, if not hours, maybe even days from help. You’ve got to figure this out with limited first aid resources.
Today we talk Wilderness First Aid and knowing what to do when an accident or injury occurs in the wild.
Kit interviews Casey Marcum, certified Wilderness EMT expert on what types of things we should always keep in our pack, what to do in assorted emergency first aid situations, and when it’s time to call it a hike and simply go home. We learn whether we should stay with the patient or seek help, and so much more on this important show.
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Meet Casey Marcum,
Certified Wilderness EMT
Casey and I met a decade ago, when he led my first hike. Like me, the outdoors has changed his life for the better. Casey left his dreaded mortgage banking job to seek work in the outdoors, and is now certified in Wilderness EMT.
Follow Casey and his amazing photos @WildNCWaterfalls
What is the Difference between City First Aid and Wilderness First Aid?
You have to assume that you are a long ways from help. Whereas a call to 911 when in town may get help in a matter of minutes, IF you have cell service, it may still take HOURS to assemble the often volunteer rescue support. This often means you’ll need to self rescue.
You also probably won’t have the exact tools and supplies you need to address the problem, and may need to improvise. Be sure to sign up to get the Emergency Kit Checklist.
You are likely to be dealing with a more challenging environment, such as inclement weather or temperatures. Perhaps there are physical hazards to deal with.
You may be alone and have to figure things on your own.
And again, for reinforcement, you can’t count on even having cell service to call for help.
If you haven’t done so already, be sure to download the episode on building your Emergency Kit.
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PREPARE TO AVOID A PERILOUS DISASTER ‘SNOWBALL’ EFFECT
Improve your odds of a good outcome by preparing BEFORE you ever step foot outside your home to head into the wild.
STUDY your route. Learn about the terrain and what obstacles and problems you might face. What could go wrong and rig up your Emergency Kit to reflect these risks.
INVESTIGATE the weather. Over pack when it comes to clothes. Never go anywhere without a rain jacket. I even pack a puffy jacket nmo matter what. I found one that stuffs in a sack and fits in the palm of my hand. As you’ll learn in a bit, even if you don’t wear it for warmth, it might come in handy as a first aid tool.
TELL someone your plans. Let someone know where you are going, with whom and when you expect to return. Also let them know when they should sound the alarm. If in a truly remote area, consider a SPOT system to let them know you’re ok or to sound an SOS.
Most bad outcomes are due to a series of bad choices that build like a snowball that races down the hill. A bad choice, followed by panic, often leads to increasingly bad choices, which can make things end poorly.
Plan ahead and head out prepared! Know your body and its limitations and take baby steps as you increase your risk exposure to adventures in the wild. The wilderness is a wonderful place that soothes the soul, but it is not Disneyland.
How to Evaluate the Situation
Whether it’s you, your adventure partner, or a stranger you come across, you need to first evaluate the situation to determine the best course of action.
Initially, size up the scene: are there any life threats present? Are you, yourself, in danger? Casey says his training is that first you must make sure that YOU are safe so that you can safely treat others (similar to putting the oxygen mask over your face before doing so for others on a plane).
Then, unless an urgency, such as gushing blood indicating otherwise, you should do a thorough head to toe assessment of the patient. Check vital signs (see below), and if you believe that outside help is warranted, consider writing the pulse and any other details on some duct tape and taping onto the patient’s leg, so that the details go with the patient.
Mentally prepare a problem list and care plan. Is the problem serious enough to call the end of the trip, or even an evacuation?
Using whatever resources you can manage, begin treatment, including staying calm so you can help the emotional needs of the patient as well.
Monitor the patient and revise treament plan as required.
What to do if you come across someone unconscious or bleeding
Make sure the area is SAFE FOR YOU before you administer aid. If the person is conscious, ask if there is anyone else. Don’t assume there is just one. Sometimes the loudest person hollering is not the most injured.
Look for clues as to the MOI: mechanism of injury. Rockfall? Tripping? Lightening strike? Fall? Animal, insect or snake bite? Knife accident?
What is your first impression of the seriousness of the situation? If (s)he is injured – how badly? Sick? How sick?
Assume the person is contagious and protect yourself. Wear gloves.
If the person is conscious, ask if it’s ok to help treat him or her.
If there is any chance of a spinal injury, DO NOT MOVE THE PATIENT, and keep him still, supporting both sides of the head to prevent further injury.
In general, only move the patient if the risk of further harm by remaining in place outweighs the risk of moving him or her.
Perform a Life Threat Exam: A-B-C-D-E
A: Airway check – Is there anything in the mouth obstructing air?
B: Breathing check – Look at the chest – is it moving? Do you see signs of respiration?
C: Circulation check – Feel for a pulse. Are there any major wounds bleeding?
D: Disability check – If you can’t rule out a spinal injury, protect the head from moving. Any other major limb or body issues?
E: Expose injuries without moving the patient – Cut away clothing so you can fully evaluate the patient
Obviously, deal with life threatening issues first before methodically going through this checklist.
Try to use clean hands and wear gloves when treating (keep some disposable gloves in your emergency kit). Look for other clues: Do you see any unusual signs, fluids or smells? Does anything seem unusually tender, hard or deformed? If alert, ask if any unusual oddness or numbness and about pain.
Pro Tip:
Carry benadryl in your Emergency Kit in case you have an allergic reaction, or come across someone else having this life threatening reaction.
Check the Patient’s Vital Signs
If you think the patient will be evacuated, write the vital signs on duct tape, and tape to the leg, so that the information goes with the patient. Check the following:
1. Heart Rate – count the beats per minute
2. Respiration Rate – count the breaths per minute
3. Note Skin Signs – Dry or clammy? Pale or flush? Hot or cold? Look on the inside of the bottom eye lid and the lower inside lip and note the color.
4. Note Level of Responsiveness – Is the patient alert or unconscious? Disoriented or clear headed?
Pro Tip:
Use gear and supplies from the patient’s backpack if you suspect (s)he will be evacuated, as you will probably not see your clothes or gear again.
How to Get Clues from taking a Patient History
1. What is the chief complaint? Have they missed any important medicines? Are they dehydrated? What happened and when? What makes them feel better? Worse? Where is the pain located and how severe on a scale of 1-10 is it?
2. What are the symptoms of the complaint? Are there any other concerns or conditions you need to be aware of?
3. Do they have any serious allergies to any foods, medicine or bees? Have they EVERbeen stung by a bee and what kind of reaction did they have? If they have never been stung before, they would have no way of knowing if they are allergic or not.
4. Ask about pertinent medical history and their age.
5. Ask when they last ate and drank anything. What? When did they last urinate or have a bowel movement? A lot or a little? Color, texture or other clues?
6. Ask them to describe events leading up to the problem.
DEHYDRATION
Like blisters, dehydration is common and preventable!
Drink more water than you think you need. If you are doing heavy exertion, particularly in hot weather, you can burn through a liter an hour. You want your pee to be clear BUT, if you are taking in a ton of water, you also want to make sure that you don’t get your electrolytes out of whack. Pack electrolyte tablets to make your own GatorAide-type water. They come in lots of flavors and can save you from getting really painful, debilitating cramps.
I like using a Platypus bladder tank because it makes it easy to access water without taking off my pack. I also keep one or two bottles of water on the backpack side pockets so I always know I’ve got backup water in case I drink all of my bladder belly. Then I can ration while I seek out more water.
Bring a method to treat water and never assume water that ‘looks’ clean, is. I’ve gotten giardia, and it isn’t pretty. Things shoot out of orafices in most unpleasant ways. I lost six pounds of water weight in two days of fluid expulsion. Not fun.
Check out this episode on selecting the best portable water treatment system for you.
HEAT EXHAUSTION & HEAT STROKE
Getting dehydrated and overheated is not just unpleasant, it can also turn deadly. As your body loses its ability to cool off, it could potentially reach the stage where you stop sweating. This becomes life threatening, so never let it get this far!
When you start sensing signs of too much heat, obviously get to a cooler place. Loosen your clothing to allow better air circulation. If available, soak in a cool stream or pool. Drink plenty of cool liquids.
Early signs include headaches, a flush face and profuse sweating. This is when you need to make sure you are hydrated and you need to get out of the sun/heat and cool off. If you start getting confused, you are nearing the danger zone and may require professional treatment, which of course, may not be available where you are. Be smart!
HYPERTHERMIA
Heat’s alter ego is cold, and things can get more serious, more quickly in cold weather. You should ALWAYS keep an emergency heat blanket in your pack. They weigh little and take up the space of a deck of cards.
On one of my first hikes, when I was truly clueless, I was day hiking the Appalachian Trail, in a cotton top and shorts – a BIG no no. Up top, the weather changed from delightfully warm sun to a cold, bitter rain and I had no rain jacket – another BIG no no. I was freezing with chattering teeth. Fortunately, my new friend Gerry, offered me her emergency blanket, which was worth it’s weight in gold to me. I NEVER leave civilization without one!
When you or your adventure mates start showing signs of hyperthermia, the goal is to get them warmed up as quickly as possible. If they are severely cold, warm clothes and a sleeping bag may not be enough. You might have to add your own body heat, a fire, and even more clothes. Do what you have to do, but get them warm fast! And get professional help if the situation is severe.
Symptoms of hypothermia include shivering and slowed, often slurred speech. You get clumsy and confused. Your pulse becomes weak and your breathing is shallow. Your energy level plumments and you might even become unconscious. In the later stages, victims often REMOVE clothing, even though they are literally freezing to death.
Treating Medical Issues – Wilderness First Aid Style
You are probably going to have to be creative, as you are unlikely to have optimal supplies to treat most injuries or illnesses. Be sure that whenever you go away from civilization, that you pack along an Emergency Kit – even if just for a simple day hike. Hopefully you will carry your kit for twenty years and never need it, but IF you do, you will NEED it! Get your FREE Emergency Kit Checklist (and access to ALL checklists and travel planners) HERE.
WOUNDS
Stop the bleeding. This means putting direct pressure on the wound to encourage clotting. Try to elevate the wound above the heart. If it’s a gusher, stop it first before worrying about cleaning it. Once it’s calmed down, then take care of proper cleaning, Use CLEAN water, not untreated from a stream or you might introduce funky bacteria, etc, even if the source looks clean.
Infections generally appear within the first 24-48 hours. Infections are SERIOUS! Get medical help immediately if the wound appears to be getting infected. Assume ALLanimal bites will become infected and return to civilization immediately.
BURNS
Burns generally happen from cooking spills, so never put your stove on top of a picnic table. If someone sits down roughly, they can tip the stove and pour that boiling meal all over your lap – super painful, and can be a trip ender. Always cook on the ground.
To treat a burn, first cool it off with cold TREATED water (see above about skanky water). Then apply antibiotic cream and gauze. Evacuate or conclude the trip if the burn is severe.
SOFT TISSUE INJURIES: Twisted ankles & knees, etc.
You have to first determine whether the joint is usable or non-usable.
If USABLE: Remember RICE:
R: Rest
I: Ice Alternate 20-30 minutes cool/cold with 15 minutes natural warming
C: Compression, but not so tight as to cut off circulation. Two fingers should fit under the wrap. Pack a compression sock, which can help keep the swelling down until you get back to base camp or civilization.
E: Elevation. Keep the limb elevated to help keep the swelling down.
If UNUSABLE: Make a splint
You may have to get creative, like Casey in the photo above. A hiking pole, or even a strong stick, can act as a brace. Use a puffy jacket or other clothing for padding. Wrap duct tape or an Ace bandage to secure the mess. the padding and compression will give you the rigidity you are looking for. Shoot for keeping the knee bent at a slight 5 degree angle from straight, and for a twisted ankle, you want to keep the foot at a 90 degree angle to the lower leg.
BLISTERS
Blisters are TOTALLY preventable. When you feel that initial ‘hot spot’, STOP!!! Take the couple of minutes to ease the friction causing the hot spot. You can take some mole skin and cut a donut hole where the hot spot is, and put that on to keep that part of your foot from rubbing against your shoe. I’ve used duct or medical tape in a pinch. Compeed patches are wonderful and last for days. I also love wool toe sock liners to prevent the blister I tend to form between my last two left toes. Don’t wear cotton socks – the moisture encourages blisters. Also, let your feet and socks air out when you take a rest break. Pack along a second set of socks, so you always have a dry pair. Tie the wet ones to the back of your pack to dry, so you can switch them as needed.
SOMEONE’S HEART STOPS
If someone has a heart attack or gets hit by lightening and is not breathing, new CPR protocol says to just do the chest compressions now. Since I’m not a doctor, I’m going to refer you to the Mayo Clinic for info on Cardiopulmonary Resusitation (CPR). I’ve taken the class and it’s pretty easy to learn how to do – I recommend it!
Check out the episode on what to do if you get caught in a lightening storm to learn more about lightening safety.
Wilderness First Aid Hacks
We talked about hiking poles as a brace, and duct tape for blisters, and well, for just about everything (keep some wrapped around your hiking poles, and some more around a pencil in your emergency kit). Here are some other fun emergency first aid substitutions:
- Remove splinters by putting glue over the splinter. When it dries, peel off the glue.
- Use Super Glue to close wounds.
- Make a pultice from chickweed, plantain or red rose
- Bandages are in short supply and often don’t fit nicely around a wound. Cut the long sticky part horizontally to make four connect stickums instead of the regular two. The bandage is liable to stay on longer.
- Download a first aid app that works without internet.
NOLS: National Outdoor Leadership School
Take your knowledge to the next level with an online or in person wilderness course! Check them out here.
Calling for or Seeking Help
Try to stay with your patient unless things are so dire that not seeking immediate help is life threatening. Will the trail be busy tomorrow so that you could expect others to come along the trail? Consider adventuring in threesomes, so someone is always available to stay while one can seek help.
EVACUATIONS AND RESCUE
Expect that ANY help will be volunteer and it can take hours (days???) for someone to reach you. If weather is bad, they may not be able to come until the weather improves. Whenever you head into the wilderness, you should expect and be prepared to self rescue and NOT count on others to be able to help you.
You may be expected to pay for your rescue. Consider travel insurance that covers this possibility, if appropriate (and please use my Travel Insurance Comparison link. At no cost to you, you are helping defray the cost of the show and website – thanks!)
When to Return Home
Sometimes, you just have to call it a hike. Casey uses the ‘Fun Factor’ to determine if a sickness or injury should conclude his adventure.
Sure, we all want to reach the summit or achieve our goals. But sometimes, you just need to know when to say when. Are you making your health worse by continuing? Are you at risk of infection? Are you not sure, but too far from civilization to get help if you need it? Are you still having fun? The mountain will be there another day. Think critically when deciding when it’s time to head back to civilization.
Like Casey said, “Your body could care less about your ego”. Use good judgement when deciding whether to return home.
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