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EMERGENCIES

        

Reference Guide to Wilderness Medicine



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[Website Author’s Notes: This reference guide to wilderness medicine was written by my close friend, James Morrison. He has 14 years of EMT experience in the field and 45 years of mountaineering and backpacking experience in Alaska, California and Washington State. It is a companion to the Wilderness First Aid: A Step-By-Step Field Guide, also written by him. We suggest you download both guides, print them in a greatly reduced, double-sided version, and then add it to your wilderness first aid kit.  Download links to both guides will appear at the bottom of this article.

What to include in your first aid kit (besides these reference guides or their equivalent)? Doing research on wilderness first aid kits, you will find the experts recommending a surprising number and variety of items. Furthermore, the experts do not come close to agreeing with each other on what to carry. For your consideration, here is a link to an article written by your author that contains a comprehensive list of the items recommended by experts:

  "Recommended Wilderness First Aid Kits" in Word document format.

"Recommended Wilderness First Aid Kits" in PDF format.

Enough on downloads. Here are Jim’s recommendations for dealing with the most common medical emergencies faced in the wilderness.]

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In the article on Wilderness First Aid: A Step-By-Step Field Guide I covered some essential and fundamental things that need to be done quickly when you are first treating an injured or sick person.  In the following material I will cover some conditions that are more specific to particular injuries or illnesses. I selected these particular topics because I believe they are important or there are some possible misconceptions. What follows is not all-inclusive.  It is impossible for me to fully discuss here what is covered more completely in wilderness medicine texts.

Severe Bleeding

If there is severe bleeding it is critical that you stop the hemorrhaging quickly. With severe bleeding you don't have time to search for a pair of gloves or proper bandaging.  Use a bandana, a tee shirt or what ever is handy.  Even the bare palm of you hand can stop the bleeding if enough pressure is applied to the right spot. If the patient is conscious and alert you can have them apply pressure to the wound if it is easily accessible to them. Direct pressure usually works to stop bleeding.  Of course if the wound is on the patient's neck don’t apply pressure in a way that will interfere with his or her breathing.  If the injury is on the scalp and you suspect the skull might be damaged you need to be careful not to push bone into the brain. In that case apply a bulky dressing, but use only light pressure to stop the bleeding. Having stopped or reasonably slowed the bleeding, you need to apply sterile dressings if you have them.  The chance of infection is high in deep wounds, but that is secondary to stopping the bleeding. Apply a pressure bandage over the wound.  To make a pressure bandage apply a bulky dressing directly over the wound and then secure bandage with a roll of gauze, adhesive tape or an elastic bandage. If the wound continues to bleed don't take the bulky dressing off.  Just add more bulky dressings on top if the old.

The bandage should be tight but not so tight to cut off circulation. Check every so often to be sure you haven't cut off or restricted circulation to the distal part (the part furthest from the heart) of the limb. Pinch down your fingernail (or toenail) and see how it has turned white when released and then almost immediately turns pink.  This is an indication of circulation.  If it takes more than a couple of seconds to return to the pink color after being pinched it is a sign that circulation has been compromised and you should loosen the bandage slightly and repeat the process. If it is a wound on a limb it is best to immobilize the limb.

To avoid the possibility of getting a disease transmitted by your patient's bodily fluids (like blood) it is safest to wear latex gloves.  If I know the victim well and don’t believe they have any communicable diseases I personally do not worry too much about that.  If you don't have any open wounds on your hands and if you wash your hands well after treating a patient your chances of infection are significantly reduced. 

Internal bleeding can result from trauma. Ruptured internal organs or broken bones can cause internal bleeding.  Some signs of shock are rapid heart rate, shallow rapid breathing, and weakness. Unfortunately there isn't much you can do for a person with internal bleeding in the wilderness. You need to transport them to a medical facility as soon as possible. Evacuation becomes the highest priority when internal bleeding is suspected.

[Note on Bandages, Compresses and Dressings: For the purpose of clarity let me define three terms that are often confused.  A bandage is a strip of cloth that is used to hold a dressing, put pressure over a compress or immobilize a limb.  A compress is a soft pad or cloth used to apply heat, cold or drugs to the surface of the body and it can be placed over a wound to help control bleeding. A dressing is a sterile covering that you apply directly over the wound.]

Shock

Shock can be a confusing subject.  There are many kinds of shock.  One type of shock you might have to deal with in the wilderness is called hypovolemic shock. (Also called hypovolaemia.) Hypovolemic shock is caused by reduced blood flow. Bleeding, internally or externally can cause hypovolemic shock.  Dehydration and severe burns can also cause it.  Whenever you treat an ill or injured patient you should look for signs of shock.  This information can provide critical information to other caregivers. Look for rapid breathing, and pale or cool clammy skin. The patient may feel faint, dizzy or nauseated.  The pulse may be higher than normal.  The patient may become unconscious because of hypovolemic shock.  Be sure to report any of these signs and symptoms to SAR or 911 because they are important clues as to the urgency of the patient’s clinical condition.  

Another type of shock that can be an issue in the wilderness is anaphylactic shock (also called anaphylaxis).  Anaphylaxis is a life-threatening type of allergic reaction.

Certain people are severely allergic to bees, wasps, hornets and their brethren.  These stings can be life threatening. Insect stings can cause an allergic reaction of the skin, nose, lungs, or throat or all of those. If the airway is compromised the reaction is considered severe.  Severe reactions must be treated quickly.  The reaction in the throat can block breathing.  Typically people who are severely allergic carry an Epipen or an Ana-Kit (epinephrine) that is prescribed by their doctor. Both are mechanisms to inject epinephrine into the patient to counter the reaction.  It sounds simple, but it isn’t.  A second injection may be necessary when the first wears off.  The patient should see a doctor as soon as possible after being treated with epinephrine. Read the literature that comes with the kit and if at all possible discuss the procedure with a doctor before injecting the patient. For less serious allergic reactions Benadryl or Chlo-Amine can be taken.  These are “over the counter” (OTC) oral antihistamines, and there are other similar products. Again, as with all drugs, read the precautions before taking them.

While less than one percent of the people in the United States suffer severe reactions to insect stings, it is important to know what to do. [Note: Conventional wisdom says that a bee stinger should be scraped off and not pinched.  However now it has been suggested that there is no basis for that claim.  Getting the stinger out quickly is much more important than how it is removed. For more information, see article: Bee Sting Removal.

Treatment of shock

Treat a shocky patient the same as any seriously ill or injured person.

·      Don’t leave the patient unattended. 

·      Reassure the patient.

·      Keep the patient lying down on an insulating pad.

·      Loosen or remove any tight clothing or jewelry that might be constrictive.

·      Shelter the patient from the elements;, rain, sun, wind or snow.

·      Insulate the patient with a sleeping bag or clothing or both.

·      Be alert to changes in the patient’s condition (breathing, pulse, skin color and level of consciousness).

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 The above information provides an introduction to the complete article available as a free download in Word or PDF format by clicking on one of the following links.

Click on this link to download the "Reference Guide to Wilderness Medicine" in Word document format.

 Click on this link to download the "Reference Guide to Wilderness Medicine" in PDF format.

The sub-topics listed below are developed in this complete article. 

Severe Bleeding

Shock

Suturing Larger Wounds

Fractures and Dislocations

Splints

Head Trauma

Neck and Back Injuries

Treating Minor Wounds and Abrasions

Pain Killing and Anti-Inflammatory Drugs

Diabetes

Burns

Blisters

Eye Injuries

Muscle Cramps

Hypothermia

Wind Chill

Frostbite

First Aid Kits

Some Final Thoughts

The companion Wilderness First Aid Field Guide can also be downloaded by clicking on one of the following links:

Click on this link to download the "Wilderness First Aid: Step-By-Step Field Guide" in Word document format.

 Click on this link to download the "Wilderness First Aid: Step-By-Step Field Guide" in PDF format.

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