First Aid Primer/ Wilderness Medicine
See also herbal medicine.
Probably the best training to get under your belt before a natural disaster is in first aid and traditional medicine. Nearly all community colleges and adult education programs offer low-cost courses in CPR/first aid, and many have separate Paramedics divisions that teach courses in advanced techniques.
Local chapters of the American Red Cross sponsor a variety of first aid classes, but spend an inordinate amount of time on CPR. Other first aid techniques are equally critical to learn, so if you can meet the prerequisites for paramedics courses, take those instead. (You may find that the wilderness first aid course has no prerequisites.)
Another way to get comprehensive training is to volunteer for local search and rescue units or Community Emergency Response Teams (CERT) in your area
If you're looking for a good text on first aid techniques with photographs, check out First Responder. It's used by schools around the country, so used editions are available for less than $5 online. Where There Is No Doctor is a popular first aid guide used by Americans in third world countries. (Check Allbookstores.com for less expensive, used copies of these books.) For topics specific to the backcountry, several titles are provided on the right side of this page.
Since rescues can involve pulling a victim from water or another hard to access location, wilderness first aid usually includes training in the use of rope, webbing and carabiners. The ability to tie several standard knots is essential.
Sections covered below:
First Aid Kit
Patient Assessment
Life-Threatening Situations
Insect and Animal Bites
Fractures, Dislocations and Other Wounds
Hypothermia, Heat Exhaustion and Altitude Sickness
Burns
Other Illness and Injuries
In addition to a compact first aid manual, here's a list of items of other supplies to assemble:
If you'd like to bring along basic surgical and dental instruments, it's not a bad idea. (Paul Auerbach's guide suggests a scalpel with a #11 blade.) In the movie Castaway, Tom Hanks performs an emergency root canal with the blade of an ice skate, underscoring the importance of medical skills and tools. You can find instrument kits for sale on Amazon and elsewhere. If you know acupuncture (and have a license to practice), you should also bring along a sturdy set of needles. Besides treating chronic disease and pain, inflammations, the flu and reproductive problems, traditional Asian medicine can also facilitate recovery from sprains, fractures, burns and rashes.
To handle both wilderness and urban emergencies, paramedics are taught easy-to-remember terms and acronyms to simplify a job that's often carried out in extreme conditions and under pressure. The most common is ABC, familiar to anyone who has taken a first aid class. It instructs the first responder to make sure the victim has the following: a clear Airway, unbstructed Breathing and normal Circulation. In the backcountry, you can add D for Disabilities (like allergies or hypertension) and E for the Environment.
SOAP - This acronym represents the modus operandi of any rescue or medical emergency. The first responder is charged with assessing the scene, collecting information and providing medical care. Here's what each letter stands for:
Subjective info: This includes initial observations and whatever the patient communicates about his/her condition, and
Objective data: Facts that can be recorded, like pulse and breathing, reaction of pupils to light, body temperature, and the patient's response to palpitation and/or movement his/her head, torso and limbs during a physical examination.
After the exam is finished, the first responder generates the following:
Assessment: A diagnosis of the primary and secondary injuries, and any complicating factors.
Plan: The steps for treating and transporting the victim.
Now here's the SOAP in more detail: After confirming the scene is safe, your first contact with the patient generally consists of an introduction and offer of help. EMT's ask a standard series of questions - "What's your name? What time of day is it? How many fingers am I holding? What happened to you?" The answers enable you to quickly assess if the situation is more serious than it appears -- for instance in the case of a head injury or stroke, where the patient slurs his or her speech.
Until any injury involving the spine is ruled out, you should secure the head, neck and back in a CSPINE position. Meanwhile, if the answers to the four questions above demonstrate a satisfactory level of responsiveness, then the patient is said to be "AO times 4", meaning Alert and Oriented, which is documented on paper as AOX4.
SAMPLE - After the initial introduction and questions, you'll conduct a comprehensive head-to-toe exam to get the objective data mentioned above. The details you need to collect and document are incorporated under the acronym SAMPLE:
Signs and Symptoms: This includes CSM (circulation, sensation and movement), PERL (are the pupils equal and reactive to light?), skin color and dampness, body temperature, pain and tenderness, range of movement for the limbs, any visible wounds, etc. Feel for dampness in clothing, as that can indicate bleeding or other discharge.
Allergies: Always ask about this while the patient is conscious. The most common allergies relevant to a wilderness setting are bee sting, pollen, peanuts and shellfish. In some patients, these can cause Anaphylaxis. Unfamiliar foods and hypersensitivity to poison oak/ivy may also trigger symptoms. And find out if the victim is allergic to latex, penicillin, or other drugs.
Medications: Ask what pills the patient has with him/her and the last time they were taken. If you don’t recognize a prescription name, have him or her explain its purpose, any side effects and cautions to watch out for.
Prior Medical History: This information will help you identify complications that the initial injury could trigger. Patients who have asthma, allergies, hypertension or another heart condition often require a speedy evacuation and shouldn’t be forced to walk out on foot.
Last Oral Intake: Includes both food and water. Since the body requires glucose (sugar), fluids and electrolytes (sodium, calcium and potassium), you made need to offer these in small doses every 15-30 minutes. In a wilderness situation, it's essential to "keep the tank filled". (Note: If you're close to a hospital, the rule is not to provide any fluids or food to a patient, since immediate surgery may be required.)
Events Prior: When responding to an emergency, make sure to collect all the details on what exactly transpired leading up to the injury or illness. Also note the weather.
Treating Ailments and Injuries
The following overview of first aid treatments will give you an idea of how emergencies are handled in the backcountry. Note: The American Red Cross and other medical authorities oppose the use of tourniquets, resetting dislocated limbs, incisions into snake bite wounds and other invasive procedures by anyone other than professional rescuers, since these are often done incorrectly and lead to complications.
If paramedics are within reach, always confine yourself to basic CPR/first aid care (i.e. controlling bleeding, maintaining an open airway, monitoring pulse, etc.) and let the experts handle the rest. You are not legally required to intervene in an emergency, but if you do, provide only the level of care in which you're competent.
Make sure the scene is safe before beginning a rescue. Once you lend assistance, you must stay with the victim until other responders take over or the emergency passes. In the case of a conscious victim, obtain consent before providing care. For a child victim, obtain the consent of a parent if one is on scene.
Severe Bleeding – Apply direct pressure on the wound and elevate the area if possible. (In the wilderness, people generally wear heavier clothes, so consider adding a pair of trauma sheers to your first aid kit.) Unless an artery has been cut (or the patient is taking a prescription blood thinner) the blood should clot up automatically from the direct pressure.
After applying a sterile dressing on the wound, wrap it with a bandage. Tie the bandage above the womb area to get extra pressure. Remember to check the patient every few minutes initially to make sure blood circulation hasn't been cut off below the bandaged area. Loosen the bandage otherwise.
In worst case bleeding scenarios, use pressure points if possible to cut the flow of blood to the limb. (Note: For head, neck and torso wounds, you can't use pressure points or tourniquets.) With two fingers, press the artery on the inside of armpit above the bleeding arm. For a leg injury, press the arterial point in the seam between the leg and groin. Verify these points first by searching for a strong pulse in the appropriate spot. When using pressure points, relax pressure occasionally.
If pressure points and direct pressure on the wound fail to stop arterial bleeding, apply a tourniquet directly above the wound on the leg or arm. (See disclaimer above regarding tourniquets.) A 1-2-inch wide, 3-5 ft. length of innertube rubber, cloth or an elastic bandage can be used. A blood pressure cuff will also work. If you resort to a tourniquet, loosen the stick (like a valve) slowly after 30 minutes to see if the blood has clotted. If the bleeding starts up again, re-tighten and wait 30 minutes more.
Use of a tourniquet jeopardizes the entire limb below where it's applied, so it should only be used to save someone from bleeding to death. Tie it just above the bleeding to preserve as much of the limb as possible. Once the blood clots, remove the tourniquet slowly - otherwise the sudden release of blood from the tightened area could burst through the clotting that's developed at the wound site. A trained responder may also try searing the artery shut with a knife that’s been heated red-hot.
Shock - Severe injuries lead to shock, an automatic reflex of the body to preserve the core area around the heart. The pulse will be rapid and weak, the skin pale and clammy, and LOR will be minimal. Treat shock by elevating the legs and getting a conscious patient to take a little water and food every few minutes. If the situation worsens and the patient loses consciousness and vitals, you may have to provide rescue breathing and CPR - alternating 30 compressions and 2 breaths. Shield the victim from the ground with a blanket or other material to maintain body heat.
Head Injury or Stroke - Signs and symptoms of a head or brain injury include severe headache, deformity of the scalp, bleeding, loss of consciousness, nausea, raccoon eyes, unequal pupils, amnesia and/or seizures. If the patient hasn't suffered any blunt-force trauma to the head but complains of the worst headache of his or her life, it may be a stroke. Other stroke indications include slurred speech, blurred vision, a weak and rapid pulse, and disorientation or confusion.
In either case, C-Spine the patient (i.e. immobilize the neck), keep the head elevated to reduce any cerebral edema, and be ready to log roll if he or she needs to vomit. Evacuate to a hospital immediately.
Anaphylactic shock – This is a life-threatening allergic reaction that causes the airway to constrict and prevent breathing. Most sufferers are already aware of their susceptibility to bee stings, peanuts, shellfish or other triggers, so they carry Epinephrine (a.k.a. Novacaine) syringes and Benadryl capsules. The patient's self-administered Eppy injection provides temporary, quick relief. The Benadryl kicks in more slowly and may not undo the damage that's already occurred. Continue monitoring breathing and pulse in case CPR becomes necessary.
Symptoms of anaphylaxis include dizziness, increasingly labored breathing, swelling, blueness of the skin, vomiting, diarrhea, abdominal pain and an irregular pulse. Hives commonly develop, and if you feel both sides of the neck, you'll likely find that they aren't symmetrical. Primatine Mist is an over-the-counter medication that can be included in a first aid kit for victims who forget to bring their injectors along.
Other than the victim, only trained health care personnel are authorized to administer an Eppy. The injection is commonly inserted into the leg (straight through the pants) and left in for at least ten seconds. The injector is then retracted and returned to its container. Since relief last only 25 minutes, a speedy evacuation is paramount. The patient may not recover for several days.
Insect bites, stings or skin rashes – Make a paste of baking soda with water and apply on affected area to stop the itching and cool the skin. When the blood gets heated, it causes the rash and itch. Keep the affected areas cool. For stings, flush with water or use an extractor to remove venom. Poison oak or ivy should be immediately scrubbed off with soap and any exposed garments washed with an extra dose of laundry detergent. Avoid skin contact with dogs and horses that have followed the same trail.
The Black Widow (hourglass mark on belly) and the Brown Recluse are spiders whose bites are venomous. In the case of the Widow, excruciating adominal pain is common, as well as nausea, chills and heart palpitations and swelling. The Recluse causes the skin to turn purple, then black. Irrigate or flush the bite with clean water. Mark the area with a pen so you can track the extent of discloration and swelling. Photograph the insect if possible. Painkillers can be given if the victim's vitals are normal. Evacuate to a hospital.
Ticks – Only a few species carry Lyme disease or Rocky Mountain Spotted Fever. The worst case scenario is an egg-heavy female burrowing into the base of the skull and depositing the eggs there. Respiratory paralysis may ensue in this case.
Treatment involves removing all parts of the tick. Avoid killing it while it's still attached to your skin. Apply light heat to its backside by lighting amatch, then blowing it out and holding it near the tick. (Don't tap the tick with the hot match.) Alcohol/gas/shaving cream are also used to get the tick to back out willingly. Use pincer forceps or slide a knife between skin and tick to ease it out and remove. Rather than smash a tick between your fingers and risk further exposure, toss it into a fire or smash it on rock with another rock. Then wash your hands and the impact site thoroughly.
For a more serious exposure, lance an area 1/8 inch deep and apply suction with an extractor, or flush the area with clean water. A hot salt or wet-grain poultice can then be applied to the site for ½ to ¾ hours. Alternatively, clean the site with an antiseptic or iodine, allow it to dry, then cover with a bandage.
Mosquitoes – Like heat-seeking missiles, the insects are attracted to your body heat. For some reason, they're also drawn to the color blue. Wear loose clothes and apply cool mud or repellant to your exposed skin. Alternatively, you can use the reddish dirt from ant mounds, as it contains Formic acid. Stay close to a river breeze or walk along a cliff ledge, areas mosquitos usually avoid.
Animal Attacks - Make sure the scene is safe before intervening. If the victim is conscious, ask about the animal's behavior and appearance for possible symptoms of rabies or other illness. If there's a lot of bleeding, that flowing out will initially clear the poison, but you'll have to stop the bleeding quickly with direct pressure and other means if necessary. (See Severe Bleeding.) Flush each wound with lots of clean water before dressing it. If the attacking animal is large, the victim may also have suffered a spinal injury, so consider a C-Spine as well. Administer anti-biotics and evacuate to a hospital.
Snake bite – The only poisonous snakes in North America are rattlers (a.k.a. pit vipers), the coral, moccasin and copperhead. In the west, rattlesnakes are the most common problem snake. They have triangular-shaped heads, rattles (unless they're juveniles), and are fat at the center. In addition, the rarely seen Gila Monster in Nevada is poisonous. In the southeast U.S., reptiles and snakes pose a greater threat, so you should check with local park service personnel in advance of a wilderness trip about precautions and treatment.
There are a mere 12 deaths per year nationwide from snakebite. Moreover, paramedics say the victims are primarily male, 14 to 28, with a stash of alcohol or drugs with them. That's why, enerally speaking, humans are more likely to be attacking the snakes than the other way around. Young children are considered most vulnerable to fatality because of their small size.
If a bite occurs, keep the victim calm and motionless in order to slow the blood absorption of the venom. Tie a constricting band just above the bite mark and keep the limb or body part LOWER than the heart. Remove the band (which is not a tourniquet) every 10 minutes for about a minute so you don't jeopardize circulation. You should also be able to slip your pinkie inside the wrap when it's tightened. Flush the wound with water as soon as possible. Although the wilderness medicine experts insist nowadays that it does no good, you can try using an extractor to suction out contaminated blood and poison. (The Sawyer brand is recommended.) Then clean the skin with iodine or soap.
Sun glare/Snow blindness – Rub charcoal above and below eyes, use sunglasses or make birch bark goggles with slits. To treat, bandage eyes and keep in darkness for several days, even inside tent, where UV rays still penetrate. At onset, bathe eyes with cold weak tea. Or use compresses or antiseptic, anesthetic eye ointment.
Parasites, Infection and Fever – Giardia and other parasites usually cause intense abdominal distress, diarrhea, nausea, fever and malaise. Treat with antibiotics or golden seal 3-4 times every 24 hrs, then half dose for two days (sometimes longer) after the fever breaks. (Note: Some people are allergic to Penicillin so always ask before providing it.) The diarrhea may last a week or more so it's essential to drink plenty of water. If the fever doesn't break after a few days, discontinue use of one antibiotic and try another. In addition, since antibiotics destroy healthy bacteria, add pro-biotics to the patient's diet (yoghurt, sauerkraut, etc.) to prevent yeast infections.
Tetanus – Also known as lockjaw, tetanus is produced by a bacterium called Clostridium tetani, often found in soil. It enters the body through an open wound, burns, frostbite, gangrene, a contaminated intravenous injection or crush injury. The bacterium generates a neurotoxin which causes muscle spasms (usually beginning in the jaw) and can lead to death. Emergency treatment involves administration of antibiotics and other medicine to control the muscle spasms. Hospital care is required.
Tetanus is rare in the United States due to widespread immunization. The booster shot is good for ten years and all prospective backcountry visitors should make sure theirs is up to date. Neonatal tetanus can be prevented by making sure pregnant women are immunized, by delivering babies in sanitary conditions, and by proper umbilical cord care.
Eye irritation – Apply eye ointment (antiseptic/anesthetic) before trying to work out splinter or object. Sterilize a needle in blue flame of a match. If it turns black, wipe it with sterile gauze. Then hold it parallel to eye and bring it up from the side to tap the edge of the object and flick it out.
Indigestion. Use ¼ tsp of baking soda in half a glass of water. You can also use it for gargling and as a mouthwash.
Diarrhea or chronic stomach trouble – Try a purge of 1 tsp of salt in a quart of water on an empty stomach or consume cold spring water during your morning dip in a river or lake.
Carbon monoxide poisoning - Poisoning is treated with fresh air and stimulants like coffee, tea and chocolate. Keep the victim relaxed and warm while their blood detoxes. In frigid weather, never sit in a car for long periods of time with the engine running and the windows shut tight. Don't cook inside a tent or other shelter without ventilation.
Epileptic seizure – Allow the victim to go through the course of the seizure, monitoring for any mucus discharge or vomit that might obstruct the airway. Don't stick a pencil or other object in the mouth. If necessary, check for a swallowed tongue and use your forefinger to hook it upward, making sure the victim's jaw won't clamp shut on your fingers. Rescue breathing and CPR are only necessary if the patient stops breathing or has no pulse.
See also herbal medicine.
Copyright 2009-2010 TheCityEdition.com
(for low blood surgar)
rehydration salts
sterile gauze pads (4x4)
roll of wide sterile gauze
2 triangle bandages
(40 X 40 X 56 inches)
Band-Aids
elastic bandages
trauma pads
gauze sheets
moleskin
(protects skin from blisters)
medical and Duct tape
60 cc syringe
(for irrigation of bites and wounds)
Cavit or candle wax
(cavity filling material)
safety pins
magnifying glass
matches
signal mirror
trauma shears
pocket notebook
tweezers
Homeopathy remedies:
Rhus Toxicodendren
(poison oak/ivy)
Nux Vomica
(gas/indigestion)
aspirin/ibuprofen
antibiotic or Golden Seal
Benadryl
iodine or benzoin
2-4% lidocaine
(topical anesthetic)
eye ointment
aloe vera or burn ointment
biodegradable laundry soap
(to scrub poison oak/ivy)
multi-tool w/pliers
thermometer
snake bite extractor
nitrate gloves
small scissors
sanitary napkins
(for nose bleeds, or to clean up wounds)
baking soda
Ipapac syrup
(induces vomiting)
Charcoal Suspension
(absorbs poisons remaining in stomach)
Tiger balm or Eucalyptus oil
(muscle aches and sprains)
oil of cloves
(for toothache)
needle and hook needle
(for stitches)
More Resources
Recommended Books
First Responder by J. David Bergeron, Gloria Bizjak, George W. Krause and Chris Le BaudourComprehensive Guide to Marine Medicine by Eric Weiss and Michael Jacobs (Applicable on shore as well, this handy pocket-sized book is sold with Adventure Medical Kits.)
Wilderness Medicine, Beyond First Aid by William Forgey
Field Guide of Wilderness & Rescue Medicine by Jim Morrissey
Field Guide to Wilderness Medicine by Paul S. Auerbach, Howard Donner and Eric Weiss
Where There is No Dentist by Murray Dickson. Text online.
Where There Is No Doctor by Carol Thuman, Jane Maxwell, et. al. Text online.
A Book for Midwives. Text online.
Schools and Training
American Red CrossClasses offered through local chapters.
Community Emergency Response Team (CERT)
FEMA's training program for responders
Emergency Services Nationwide
U.S. Search and Rescue
Community Emergency Response Teams (CERT)
citizencorps.gov
Urban Search and Rescue (US&R)
FEMA. See also: List of participating agencies.
Various Training Programs
Groups affiliated with WMS
Wilderness First Aid
Limited to several eastern/southern states
Other wilderness first aid program links
From Open Directory
U.S. Search and Rescue Task Force
Scroll down page for lots of links.
Wilderness and Environmental Medicine Journal
First Aid Tips
Backwoods Dentistry
By Gary F. Arnet, D.D.S.
The human skeleton
Enchanted Learning
Anatomy and Physiology
Getbodysmart.com
Making a traction splint video
How to make a splint
MedlinePlus
Applying a cervical collar video
Treating Burns
MedlinePlus
How to Treat a Punctured Lung video
How to Treat Frostbite video
Other First Aid Videos
ExpertVillage.com
Lightweight First Aid Kit Checklist
Idaho State University Outdoor Program
First aid kit list
Survival-center.com
Backcountry Health Topics
Backpacking First-Aid Checklist
R.E.I.
Home doctoring
Homestead.org
Pet first aid kit
Canismajor.com
Cholera Fact Sheet (PDF)
Hesperian Foundation
Hypothermia, Heat Exhaustion and Altitude Sickness
Hypothermia - When the core of the body chills, hypothermia results. The effects of moderately cold weather are intensified by wind and lack of food, so sheltering from the elements and waiting out bad weather is often the best defense. The first symptom is uncontrollable shivering, followed by the "umbles" - fumbling objects, mumbling speech and stumbling on the trail - all because of stiff muscles. Occasionally a patient may engage in what's called "paradoxical undressing". In a severe case of hypothermia, the shivering stops, the pulse diminishes and the victim loses consciousness. He may even appear lifeless, but it's still possible to revive him, so be patient.
If necessary, remove any wet clothes, build a fire or wrap the victim in a tent, tarp or sleeping bag. Stick heat packs inside bandages or towels and set these against the victim's body. (The packs can burn the skin so don't place them on the skin raw.) Another method is use the body warmth of a fellow traveler or pet. If possible, provide tea, soup or food. Professional rescuers use the adage "feed 'em and beat 'em" to treat hypothermia. Calisthenics help circulate and warm the blood, which in turn speeds up recovery. In the worst-case scenario, extreme cold causes a patient's heart to go into V-Fib, necessitating defibulization with an AED, which will likely be unavailable.
If you've just fallen through the ice, immediately undress. In this case it's not "paradoxical", since wet garments can prove the death knell of hypothermia. After undressing, rub the inside of your jacket in the snow powder, which absorbs moisture, then put it back on. Get out of the wind, apply heat packs to your body and/or start a fire. Hang or place your boots and garments near the fire to dry -- but not to close to the heat to threaten their insulating properties. The drying garments can also serve as a windbreak.
Even dry garments that soak up sweat can be deadly, which is why non-cotton underwear is recommended for cold weather.
Frost Bite - It's extremely important to keep your hands and feet warm and functioning at all times. Toes and cheeks are typically first to freeze, and you may not even realize it. Moreover, without your hands, you can't move or function, as Jack London dramatized in his classic short story To Build a Fire.
In the most dire of circumstances, if your hands are nearly frozen and there's no other source of warmth, you may have to sacrifice an animal. Cut into its belly and shove your hands there inside.
Before frost bite sets in, you can treat its pre-cursor, "frost nip", by sticking your fingers tightly in your palms, then wrapping your hands inside your shirt or under your armpits. Also watch out for your ears.
Don’t apply alcohol, gasoline or other fluids to a frozen limb or rub it to create friction, as these methods only make matters worse. Don't stick frozen body parts next to a fire or exhaust pipe of an idling vehicle.
Once a body part has frozen, experts say not to start re-warming it unless you're sure there's no chance of it refreezing again. For instance, if you must transport the patient through the cold before you reach safety, leave the limb frozen. Experts say the worse part of tissue damage comes from the process of freezing, rather than being frozen for some length of time.
First degree frostbite involves numbness, discoloration and edema (i.e. swelling). In 2nd and 3rd degree frostbite, you should see blisters and mucus on the skin.
To treat the victim, replace restrictive or wet clothing with dry, loose garments or wraps. Always monitor for shock. Elevate the extremities and leave blisters intact. Once you're sure you can maintain warm surroundings and the frostbite won't refreeze, you can start "rapid re-warming" of any frozen limb. Submerge the body part in hot (but not scalding) and constantly circulating water, like a hot tub with the jets on. You can spreading Aloe Vera jel on the skin afterward, but do not massage or rub the body part. Apply a sterile dressing on any blisters and give analgesics (especially Ibuprofen) to reduce the pain and inflammation. When the skin softens, the thawing is complete.
Heat Exhaustion and Hyponatremia - This condition typically begins with cramps, then progresses to nausea, vomiting, high temperature and disorientation. If untreated, heat sickness can progress to heat stroke and seizures. The body temp may exceed 105 degrees farenheit, the sweating will stop, and the patient may hallucinate. In the worst case, the heart could go into V-Fib, necessitating CPR and use of an AED (if you have one).
Evaporative cooling is the recommended treatment for heat exhaustion. To do this with a sponge bathe the skin, and then fanning the wet skin with a towel or other cloth. When the patient begins to shiver, stop for 2-5 minutes, then repeat the process. Give sips of water but no caffeinated drinks or alcohol.
Hyponatremia can set in when someone becomes cranky and stops eating due to the high heat, although they continue to drink water. This often happens on a hot day with a hiker who drinks a lot of water but skips meals. The extra fluid dilutes an already unnourished bloodstream. Eventually, the absence of electrolytes (sodium, potassium and calcium) can cause fainting and trigger a bad heart rhythm. Implore the patient to eat some healthy food immediately.
Altitude Sickness –Although the amount of oxygen in the air above 7,000 feet is the same as at sea level, the pressure is much less, so the circulatory system has to work harder to get the O2 through the alveoli in the lungs and into the bloodstream. Acclimating slowly to higher altitudes allows the body to develop more blood cells, which in turn increase the amount of oxygen received with each breath.
Sickness is more common with younger people than older. Anyone with a history of hypertension or other pre-existing conditions is also more susceptible. An early symptom is feeling out of breath while resting and a pounding headache may develop.
When fluid starts filling the lungs, the condition is known as High Altitude Pulmonary Edema (HAPE). The victim spits up a pink frothy sputum and can only sleep sitting up. Edema (swelling) in other parts of the body may occur, and you may wake from a sound sleep feeling as if you're drowning from the inside out.
The general rule for treating altitude sickness is "Descend, descend, descend." The patient shouldn't be allowed to sleep during the critical period of the illness. Drugs that help include Oxygen, Diamox and Viagra. Don't give caffeine, though.
A related condition is known as High Altitude Cerebral Edema (HACE). Symptoms of this are Ataxia (as in the victim stumbles along like they need a taxi...), headache, nausea and DIC (Disoriented Irritable Combative) behavior. HACE is treated by descending in altitude, giving oxygen and/or Decadron (a steroid).
Fractures, Dislocations and Other Wounds
Fractures - It's advisable to secure the victim's entire body in a C-SPINE position pending a determination of whether spinal injury is suspected. The sound of "crepitus" indicates that two bones are grinding together. Ideally a team of responders will lift the patient in unison during the physical exam, or when it's time to BEAM (i.e. move and transport). You'll want to fashion some sort of C-Collar around the neck, but initially one responder can hold the base of the skull (behind the ears) steady while the SAMPLE is conducted.
If possible, turn a fractured limb back into correct anatomical position. (The sooner the better, because muscle spasms and swelling exacerbate the situation.) Unless it's necessary to remove them, leave a patient's shoes on, since they provide warmth and protection, and you may not get them back on once the swelling starts.
If you're alone and fracture your femur (i.e. the upper leg bone), you can try tying your foot to a tree for traction. Then hook an arm around another tree and pull slowly but forcefully to overcome any muscle spasms and realign the bone as much as possible. To get more traction, use your free foot and second hand and push.
Splints - The purpose of a splint is to hold a fractured limb stationary. If the injury is to the ankle, the splint may also need to be durable enough for the victim to walk out on. Install a rigid material like bark around the limb (and any clothing), from the joint above the fracture to the joint below it. Tie it in place with Duct tape, a belt, rope, vines or gauze bandages. (A lightweight Sams Splint is a product routinely carried by paramedics for securing injured limbs.)
For wrist, hand or arm injuries, fashion a sling around the splint to hold the arm steady and aloft. You can use a triangle bandage for this purpose or fold the victim's shirt over the splint and secure it with safety pins.
If you don't have hard material to make a splint, you can create an "anatomical" splint, which refers to an adjacent body part (e.g. finger or leg) that can hold the fractured bone in place. A "Soft" splint is a blanket, towel, piece of foam or other soft material folded around the injured limb and tied into place.
In the case of a fractured femur, a "traction splint" is employed to fend off muscle spasms that cause the bone to slip out of alignment. To create traction, a long stick is set alongside the patient's leg and tied near the hip. Then an "ankle hitch" is created, so that a rope on the other end of the stick can be pulled through it and tightened. To create the hitch, simply wrap a gauze bandage or some other fabric in a figure eight shape around the ankle and extend it around the sole of the shoe (See video links above.)
Whenever a splint is used, monitor it frequently to make sure blood circulation isn't cut off anywhere on the injured limb. For instance, numb, cold, tingly or blue fingers or toes indicate that the splint needs to be loosened.
Open fractures - When a bone breaks through the skin, the fracture is considered "open". In a wilderness situation (or when EMS personnel will not be available for a long time), you should try to ease the limb back into an anatomically correct position, so the bone's no longer sticking out. However, there's a risk involved in this procedure, including severing an artery or damaging tissue, so do so with caution. You can also administer a half-dose of antibiotics to guard against infection.
Dislocation - As described above under Fractures, you want to restore the limb to its anatomically correct position pronto. If you dislocate your own shoulder, try pressing against a tree to pop it back in place. If you're a responder, maneuver the arm back in place while the victim stands or sits. If he or she is lying down, press your bare foot into the armpit and pull the arm out slowly and steadily at right angles, turning it from side to side until it gently slips back into place through the torn ligaments. Afterwards, monitor for swelling and circulation problems.
Severed Body Part - Stick it in a clean plastic bag or wrap it with sterile gauze then put it on ice. Avoid contact with the inner tissue and evacuate the part with the patient. In most cases, it can be reattached if surgery takes place within several hours.
Embedded Object - In most cases, it's better to let a trained professional remove anything that gets stuck in the victim. Pulling out the object can trigger excessive bleeding, damage tissue or organs, or leave a hole in the lung that causes it to collapse. In a wilderness situation, however, there are exceptions to this rule. For instance, if the object is causing the victim to freeze, it will have to come out. Extractions must be performed carefully and with precision, lest internal damage result or part of the object breaks off inside and can't be reached.
Forest fires, cooking or gas lamp accidents commonly lead to serious injury in wilderness settings. Even too much sun can cause a first-degree burn. The skin turns scarlet red and is sensitive to touch. Cool it immediately with aloe vera gel, burn ointment or ice. (Stick the ice in plastic or wrap it in cloth first.) Aloe vera is a cactus juice that draws out heat from the body when applied to a recent burn.
Second and third-degree burns penetrate deeper beneath the skin and can be the result of fire, acid, a scalding liquid or a lightning strike. Flush with cold water to stop the burning quickly - except, of course, in cases where a live electrical line may be active. After cooling down the burn, you may opt to cut away any easy-to-remove clothing or dead skin with a scissors. This job is usually reserved for trained medical personnel, but if help is far away, you'll have to take more pro-active steps to reduce the chance of infection.
Third-degree burns leave the skin white or black and can lead to shock. Nerves may be exposed. Don't use ice on these burns. Treat the patient for shock and any remove jewelry and clothing near the burn site in advance of swelling that will likely develop. Wrap the exposed area gently with sterile gauze and elevate any burned limb. Needless to say, the patient should be evacuated to a hospital as soon as possible. Skin grafts may be necessary.
Always consult your doctor before making any changes to your health regiment. Discuss any first aid or medical issues before undertaking a wilderness expedition and corroborate any advice gleaned from written sources before implementing them.
Shorthand for Wilderness Paramedics
To make communication easier, many medical and other terms are reduced to abbreviations. This is also useful when documenting the patient and injury. Remember to write down times (e.g.last oral intake, vitals taken) as this help you or subsequent responders ascertain the "trend" of the patient's recovery. Here are a few examples:
C-SPINE – Secure cervical spine
CSM – circulation, sensation, movement
AOX4 – patient is alert and oriented
LOR – level of responsiveness
PERL – pupils equal and reactive to light
POP – pain on palpitation
RR – respiration rate
PR – pulse rate
RICE – Rest, Ice, Compress, Elevate
(or Rest, Immobilize, Cold, Elevate)
BEAM – Body Extrication And Movement
stokes litter – basket used for rescue and airlift
LZ – landing zone
