Notice right off that there's the word "Wilderness" up there in the title of this page.  There's a reason for this.  In the wilderness often enough we're more than two hours away from technical help - such as ambulances, medical professionals, and all their fancy technical gear.  Wilderness first aid, put simply, is maintainin' the patient's body systems until that technical help arrives.

Now folks, you gotta hear me out on this one.  I'm a survival instructor, not a medical professional.  Sure, I've got several courses in wilderness first aid under my belt and a fancy patch on my sleeve to show it.  Read my lips on this one ... in-depth teachin' on this here subject needs to be done by a bonafide wilderness first aid instructor.

The way I figure it, the best ol' wilderness first aid instructors in the USA hang their hats with Wilderness Medical Associates.  Their instructors are some serious, no-nonsense, and intense folk who travel around the country a providin' courses at all skill levels.  For more info on these fine people, click here to go to their web site.  At a minimum, consider enrollin' in their weekend, 2-day WFA course.  It's an awesome and informin' experience.

For readin' and havin' a good reference text, I recommend the "Outward Bound Wilderness First Aid Handbook."  It's the classic in the industry and is written by Jeff Isaac, a Wilderness Medical Associates faculty member.

Every day in the cozy neighborhoods where most of us live we hear sirens - loud, silence breakin', night shatterin', disturbin' sounds blastin' out from police cars, fire trucks, rescue vehicles, and ambulances.  There's an emergency somewhere and they're respondin' in their proper manner.  They're goin' to help someone with life-savin', state-of-the-art equipment.  They have radios, phones, computers, and scanners.  Their lines of communication are open and clear.  The hospital is minutes away, complete with equipment and a highly-skilled medical staff.

Deep in the wilderness, we hear the rustlin' of leaves, the babblin' brook, the ol' bird chirp, maybe a squirrel a chatterin' away, the wind, and most of the time, silence.  There ain't no sirens, there definitely ain't no hospitals, and there's nary a ambulance a runnin' down the trails.  Sometimes, like most of the time, our cell phone lacks a signal.  From our location there's no way were gonna reach a 9-1-1 operator.  Technological help out in the boonies is not minutes away.

If you're gonna play in the woods, go on and get the proper medical trainin'.  Even more scarier than a bear, more scarier than the darkest of nights ... is the thought of not bein' able to help a friend or a person in the backcountry.  "Specially one who's got a serious medical problem.





Common Terms


Them ol' wilderness medical instructors put right much stock in their fancy vocabulary, as most medical folks do.  Here's a few wilderness medical terms you can pack in your ol' beaner.




The Big Three.  Our three main body systems:  Circulatory, Respiratory, and Nervous.  In the boonies we want to keep a patient "stable" until technological help arrives.  To do so, we must understand the body's structure and functions.  Speakin' ordinary, we're jawin' about the lungs, heart, and spinal cord.  All are immediate threats to havin' someone pushin' daisies 'fore they know it.

Mechanism of Injury.  The cause of the problem.  Pissed off bees, slippery rocks, a shark.

Assessment.  The process of identifyin' the problems and their severity.

Treatment = "Stabilization" of the patient.  The diagnosin' equipment we're gonna use is our hands, eyes, and ears.




Gatherin' Info

The Scene Survey Right off the bat you're a determinin' the dangers, the mechanism (or cause) of injury, and the number of patients.  Do not rush in.  Only fools rush in.  Be dern sure you ain't gonna be another casualty.  You ain't gonna help no one if you're hurt too.  Stop ... look around.  Ask yourself:  "What's tryin' to kill me?"  Frigid water?  Boulders rollin' down a hill?  More wasps comin' out of the nest?  Sasquatch?  Once you're safe, look for any further threat to the patient(s).  What's tryin' to kill 'em?  Stabilize the scene by movin' danger from the patient or the patient from danger.  Then, look around and see what caused the injury.  Just make dern sure you don't overlook others that are injured in a rush to treat the most obvious.

The Primary Survey


This here is the initial patient examination.  You're a checkin' the Big 3 usin' the ABCD's for any life-threatinin' problem.  A is Airway - nose and mouth clear.   B is for breathin' - air goin' in and out.  C is circulation - there's a pulse and there ain't no blood runnin' out all over the ground.  And, D is for disability - the spine is stable and you've checked the patient's level of consciousness.







The Secondary Survey


As long as the situation don't go and require Basic Life Support, you can move on to this survey.  You've purty much determined that the patient ain't got no medical problems that are gonna kill 'em right now.  The scene is stable.  The patient's stable.  Do the ol' body exam and be gentle.  Touch and look at everything.  Look and feel for abnormalities, like swellin', bleedin', tenderness, bruises, and deformity.  Start at the ol' head and neck and move to the chest, abdomen, pelvis, back, legs, and arms.  Get some vital signs.  You can do this without openin' the hood and takin' the engine apart.  Check the ol' guages on the dashboard.  Vital signs are like that - they serve to draw your attention to any deviation from normal.  And, check 'em at regular intervals 'cause that will tell you if'n the patient's decayin' or improvin'.  Pulse in beats per minute (60-100), respiratory rate in breaths per minute (12-18), consciousness and mental status, skin color, and the patient's temperature are all important.  Don't be fancy.  Measurements become relative - pulse is "fast" or "slow", temperature is "cool" or "warm".



The final step of gatherin' information is the history assessment.  Ask questions.  Got any allergies?  When and what did you eat last?  Takin' any medications?  What the hell happened?





Backcountry Injuries





Dehydration


This here one's a right common injury in the boonies.  Matter of fact, seventy-five percent of Americans are chronically dehydrated.  Maybe that's a sayin' we ain't drinkin' enough water ... whether in the woods, at work, or sittin' on the couch.  What happens is most of us mistake the thirst mechanism for hunger pangs.  Then, we go and grab somethin' to eat.

In a survival situation or even trekin' in the backcountry, you gotta be strong.   Water will make you strong.  When a person don't drink enough water, they become weak.The telltale sign is a headache right at the temples.  Don't take a Tylenol, drink water.  Your body wants water ... lots of it.

Also, your urine output is a sign of fluid status. If you're a peein' clear or light yellow at a normal and healthy rate, you're a gettin' enough water.  If your body is tryin' to conserve water, your pee is darker.   That means there's one thing you gotta do ... drink water.

Wounds


Gettin' cut by a knife is a right common happenin'.  The good news is the bleedin' will stop ... sometime.  I always enter the wilderness with a red bandana in my backpocket - it works great as a handy folded compress.

Treatment:  Stop the bleedin' by applyin' direct pressure and elevatin' the wound above the heart.  Then, clean and bandage accordingly.







Unstable Injuries


Out in the boonies, we ain't got no x-ray machine, so it's hard to tell sometimes if a bone is broken.  Possible fracture = fracture.

Signs and symptoms:  Patient can't use, move, or put weight on the injured part within an hour of when the injury occured. There's gonna be immediate pain and swellin', and a snap or crack may have been heard.

Treatment:  Stabilize usin' a splint and figure this injury's gonna be a painful one.





Stable Injuries


These are the ones where there ain't no fracture - the sprain, the strain, the twisted ankle or knee.  There's gonna be pain, but no symptoms of a fracture.

Signs and symptoms:  Injured part can be used, moved, and weight can be put on it less than one hour after the injury.  No snap or crack was heard and there will be "slow" swelling.

Treatment:  This here's where we use R-I-C-E, another one of them wilderness acronyms.  R is rest or limited use.  I is ice or cold applied for 24-hours.  C stands for compression, such as a wrap of some type.  And, E is elevate above the heart.





What will kill you first in the outdoors is your core body temperature becomin' too cold (hypothermia) or too hot (hyperthermia.)  A few degrees of fluctuation can severely compromise your ability to survive.  What I'm a sayin' is your body really enjoys stayin' at 98.6 degrees.




Hypothermia


This here condition will make a person numb.  And, they'll get stupider than a person buyin' screen doors for a submarine.   Prolonged exposure to cold, wind, snow, rain, and/or cold water leads to this condition.  Bein' sweaty or wet in the cold and wind ain't good.  And hear me on this one, it don't have to be freezin' cold.  Most deaths happen when the air temperature is between 30 and 50 degrees.

Early signs and symptoms:  Shiverin' and the skin is pale and cool-to-the-touch.

Treatment:  Reduce the cold challenge by shelterin' the patient from wind and wet, remove wet and cold clothin', and build a fire.  Get some heat retention a goin' by placin' the patient in a sleepin' bag.  And, make this person produce some heat by a usin' some quick calories - simple sugars, like twinkies, candy bars, and hot chocolate, etc.




Hyperthermia


Heat Exhaustion.
Believe me, this ain't nothin' to fool with.  This here problem has kicked my butt more times than I can remember.  It's a mix of dehydration and hot environmental conditions - a simple recipe for the beginnin' of trouble.

Signs and symptoms:  Weak, a lot of sweatin', nauseated, dizzy, increased pulse, and the skin is cool, pale, and moist.

Treatment:  Move the person into some shade.  Fan 'em and stop any physical exertion.  Get some water in 'em.


Heat Stroke.
This here's the bad boy.  A true medical emergency requirin' some serious attention.  The person's body core temperature is a bustin' 105 degrees.

Signs and symptoms:   The skin will be hot, dry, and red.  There will be a lack of sweatin'.   There's gonna be a severe mental change - possible seizures and hallucinations. 

Treatment:  Radical field treatment is essential.  Intense coolin' is required.  Put 'em in a lake, stream, etc.  If no body of water is present, pour any available water over 'em and  fan 'em.  An IV is ideal for fluid replacement, but you probably ain't gonna have one.  You gotta try and replace fluids.  Even if you save the person, you must get them to a hospital as soon as possible.  This here's a severe injury and there may be some brain damage.




Insect Bites

This here one is a good topic to take heed of, 'specially for all of you that are hikin' and a campin' out in the boonies - hell, for that matter, just visitin' a dern state park.  Sure there's plenty of bugs out there roamin' around, flyin', and a bitin'.  But, I wanna talk about the ones that could put a whompin' on you and cause a serious problem.  The most ornery types of bugs that come to mind are ticks and yellow jackets.



Ticks


These here weird bugs freak a lot of folks out.  But me, I'm just plumb over 'em.  Shoot fire, havin' gone more than 5,000-miles through the brush usin' a map and compass, I bet I've had just shy of a gazillion ticks on me.  Don't bother me none.  I just pluck 'em off with my tweezers, hold 'em over my Zippo lighter, and roast the bastards.  I double roast the ones that had the nerve to get near my privates.  More of a nuisance than anything, 'specially them little tiny ones.  Never let a tick stay on you for more than 48-hours.  Why?  "Cause if'n you do, you got a good chance of maybe gettin' Lyme disease.  Not a good thing.  Listen to me good on this one.  Do a tick check durin' the day and at night right 'fore crawlin' in your sleepin' bag.  Use a buddy system and look each other over for them rascals and get 'em off you.  

Prevention:  Had an 'ol farmer tell me to have my students spray WD-40 all over themselves to keep ticks off.  I looked at that 'ol farmer and said, "Really? That'll work?"  He said, "Hell no it won't work, but they sure won't squeak when it rains."  I'd skip that 'ol fart's advice and try this.  I've been satisfied over the years a usin' Deep Woods Off, packin' a punch of 27-30 percent DEET.  Keep a can or two handy, 'specially in the spring, summer, and early fall.  'Fore I step a foot in the woods, I'm a grabbin' that can and a sprayin' me body.  I spray inside my sock tops and all around my boots and lower legs.  Then, I hit it a lick on my waistline, front and back.  Arms and neck are next.  Now, I stink so bad my friends won't even get near me, let alone ticks.  Wear light colored clothin', that way you can spot those rascals easier.   Long-sleeved shirts and long pants.  And, avoid sittin' on the ground, 'specially in dry leaves or duff.

Treatment:  Always carry tweezers on your person durin' tick season.  If an 'ol tick is a crawlin' on you, just flick it off.  If the rascal is attached, grab it as close to its entry point as possible with your tweezers.  Pull it out with steady pressure.  Be right careful not to squish its body, 'cause its body fluids will enter the wound.  'Ol Lyme disease lives in its gut, so don't increase your chances of gettin' infected.  Clean the bite site with some antiseptic soap.  Now don't be goin' and usin' a hot match head, finger nail polish, or any of them old-fashioned ways to get a tick off.  You're just gonna maybe make the tick throw-up into the wound.  Think tweezers.  And, keep an 'ol eye on your bite sites ... a lookin' for a rash, a red ring around it, or a gettin' the flu, fever, or muscle aches.  Go visit your doctor, just to be on the safe side, if any of these reactions occur.

Yellow Jackets These here critters scare the shit out of me when I'm with folks in the boonies, 'specially when were way out there and far from technical assistance ... and, 'specially if it's a warm, sunny day.  The damn things can cause anaphylaxis shock ... a scary, massive reaction of the immune system that can kill you.  Listen to me when I say this:  if'n anyone enterin' the wilderness with you is allergic to bee stings, make sure they have their bee sting kit with them.  If not, send them wherever to get it before a headin' into the boonies.  'Cause there are more deaths in the US from the sting of a bee than by snakebites.  Anaphylaxis don't have no mild symptoms.  It produces swellin' in the larynx - this is an airway obstruction that can lead to death ... and, it can happen quickly. Signs and symptoms:  Rapid pulse, a rapid fall in blood pressure, rash, itchin', hives, swollen and red eyes, difficulty in breathin', swellin' of the feet and hands, nausea, vomitin', and abdominal pain. Treatment:  Get the patient away from the offendin' environment.  Administer an Epi-pen (epinephrine, a prescription medication, i.e., the bee sting kit).  If the Epi-pen is not available, your only defense is an oral antihistimine, such as Benedryl - a very important item to have in your first aid kit.  Call 9-1-1 ... get technical help immediately.

Poisonous Snake Bites


A lot of folks are a scared of snakes, 'specially a dyin' from gettin' bit.  Hear me out on this one.  Woodsily speakin', you got more a chance of gettin' killed from bees and lightnin'.  That snake there in the picture, the Copperhead, has the dubious distinction of bitin' more people in the US than any other poisonous snake.  The bite is rarely fatal, but it will hurt like hell.  Copperheads, rattlesnakes, and water mocassins are pit vipers.  Keepin' it simple, that means they got two fangs a packin' some venom.  My students figure I'm crazy sometimes, but I tell 'em to look a snake in the eyes.  That's a good way to tell if'n it's a pit viper. Think this way.  Round pupil = good snake ... vertical pupil = ornery pit viper.

Signs and symptoms:  Let's say a fella comes up to me and says he's been snake bit, in the hand, while a fetchin' firewood.  Number one.  This dude ain't gonna be all that calm.  He'll be a bit touched in the 'ol noggin' with the freakin' snake crazies.   Number two.  I don't give too big a hoot about what the snake looked like.   Don't endanger yourself and waste precious time a lookin' for the culprit.   All I wanna see is the wound ... the bite site.  I'm a lookin' for one or two puncture wounds ... probably with a little bit of blood a oozin' out.  Why only one puncture wound maybe?  The snake coulda been cross-eyed and missed with one fang.  If it's a non-poisonous snake bite, the snake's teeth usually leave multiple small rows of scratches.  Now, sometimes a snake don't inject any venom ... called a dry strike.  If'n there's venom in the wound, there's gonna be intense, burnin' pain and swellin' around the holes.

Wilderness treatment for a venomous snake bite:  Calm the patient and remove any constrictive items, such as rings, bracelets, etc.   Keep the affected limb at heart level or below.  Your goal here, followin' a snake bite thought to be poisonous, is safe and rapid transport without delay to a hospital for professional evaluation.  Keep the patient quiet and hydrated durin' evacuation.  Activity, stress, and anxiety accelerate the venom's absorption.   Walk the patient on out and get to the hospital.  Now, wilderness medicine is dynamic.  That means treatments can change over the years.  We do not "cut and suck" anymore.  No knives.  No razor blades.  Some folks do pack a Sawyer Extractor in their first aid kit.  This is permissible.  Studies show that up to 30% of the venom can be removed if applied within 3-minutes after the bite.   That's some purty quick action.  Hell, probably take most folks 20-minutes to find the damn thing.  Remember, suction from the Extractor is applied without incision.  Professional treatment.  Folks who are bitten are gonna usually be under observation at the hospital for 8 to 12-hours while doctors do tests and assess the venom's effects.  Antivenom therapy is the only specific treatment for poisonous snake bite and  is administered only in a hospital with a team of doctors standin' by.





The First Aid Kit

It is absolutely crazy to enter a wilderness area without a first aid kit.  A couple of bandaids in your billfold ain't gonna cut it.  How you gonna help someone that's a hurtin' in the woods when you ain't got your first aid kit?  Always plan for and pack items that can help in the event a medical problem occurs in the boonies.  Not only for yourself, but all others in the group.  'Specially think of any one with you a takin' medicines and prescription drugs on a daily basis.  Make sure they're a packin' their meds.  And, think of 'ol Tommy's who's a goin' hikin' with you, who's had a sore tooth a buggin' him lately.  Make sure you bring along some tooth medicine in your first aid kit ... for him.

How much first aid equipment you carry is a function of how you carry it, how many people you're gonna be responsible for, where you're a headin', and what you know.  Always be a askin' questions of those you're goin' into the wilderness with ... before you go.  Any new boots?  Then, mole skin might not be a bad idea to tote along.  Think ahead and be prepared.

Put all your medical supplies in a soft, flexible bag, like the one above in the picture.   Don't use a hard container 'cause you can't stuff it as full.  Then, put your soft first aid bag in a fanny pack and keep it nearby.  Or, better yet, wear it on your waist.

Contents of the Kit Go out and buy a soft kit already made up.  Then add goodies to it.  Like Visine for smoke in the eyes, etc., mole skin, examination gloves, Benedryl capsules, sunscreen, emergency flashlight, water purification tablets, tweezers, insect repellant, and whatever else fits your needs ... each trip into the wilderness.  Always update the kit and customize it to fit each trip.  And, put a wilderness first aid handbook in it to reference.  I recommend the Wilderness and Rescue Medicine Field Guide by Wilderness Medical Associates.  Twenty dollars of pure good stuff.  There's 100-pages packed full of the information you'll need to handle most emergencies.   And, the neat thing, it's printed on waterproof and tearproof paper.