Many folks enjoy the outdoors, hunting, hiking, rafting and countless other adventures that allow us to get away from it all; reconnect to nature and relax. We buy the best hiking boots, ropes and all the gear that we need to accomplish these task, the one thing that many of us forget is a first aid kit. Maybe it is because we never think that something bad is going to happen, or maybe it is an oversight; one of those things we are always going to buy or put together but it never seems to get done. What do we done when something goes wrong and we do not have an emergency kit with us, and we are miles or hours away from help?
Having served as a paramedic for many years, and having been deployed to wide area, multi state disasters, I have witnessed some very ingenious and innovate solutions to emergency first aid that has been initiated in the field. This article is not intended to be a substitute for a certified first aid and CPR course; instead, it is offered to give some practical suggestions to real world situations.
As an EMS provider we are taught over and over again, a patient who is not breathing will not survive. In the event of this tragic situation, the best thing that can be done is rescue breathing and/or CPR. In the event that you find yourself in this situation you must come to the understanding that despite your efforts a favorable outcome may not be achievable. As professional responders, we are taught that the only time we terminate efforts is when:
- Return of breathing, and a pulse.
- When told to cease efforts by a doctor.
- When we become physically exhausted. Even the most conditioned athlete will not be able to do CPR for a long period of time.
The next thing that we must concentrate on is bleeding. When faced with multiple traumas, such as those found in a fall down a hill, we can look at someone and within seconds determine what needs to be addressed first. The hunter who has fallen out of a tree-stand may present with an open fracture on his lower leg, which is going to be painful, but if he is bleeding from an arm injury we must ensure that we control the bleeding. In the ideal world, we would have sterile gauze and bandaging material; however, in this article we have none of that, so we must improvise.
Any type of cloth will do, a tee shirt, an outer shirt, even a plastic bag. You want to make sure it is as clean as possible, but what we want to do is use our improvised bandage and place it over the wound. After it’s in place, we will not want to remove it; let the medics do that once help has arrived. Place the bandage over the wound and apply pressure. How much? You want to apply enough pressure to allow the vessel to clot on its own without shutting off the blood supply below the injury. If a limb is bleeding, we can apply pressure, and if there are no other injuries to the limb (i.e. broken bones), elevate the wound above the level of the heart.
In an emergency situation, one’s sense of time can become skewed; minutes seem to be hours, and it is important to give the body time to form a clot. How long is this? There are many factors that determine that but within 5 minutes you should see a decrease in the blood flow. If the injured part is an artery, we need to be more aggressive in our treatment. We still apply pressure, and it is going to be tight, elevate the limb, but this time we are going to apply pressure to a pressure point. We will locate the pressure point above the injury, and closest to the wound. The points we are talking about are located under the bicep, the armpit, on the inner side of the thigh mid-way up the leg, and the groin. There are others, but these are the main points. Once you locate that area apply firm pressure until you feel the bone. This will slow down the flow of blood and hopefully allow the body to form a clot.
If all of this fails, and the bleeding is heavy and we cannot stop it, our last ditch effort is a tourniquet. Some very important points to remember and do when applying a tourniquet:
- If you apply a tourniquet, remember that the limb below the application site may very well have to be amputated.
- It is also extremely important that you write down or remember what time the tourniquet is applied; this information will be vital to the doctors to determine what treatment needs to be given once the patient gets to the hospital.
- The last and probably most important point is that once a tourniquet is applied, it should never be taken off except by a trained professional medical person.
To apply a tourniquet, the process is simple. Find a wide constricting device, such as a belt, a tee shirt or web belt to name a few, and a sturdy stick. We want to wrap the tourniquet around the limb as close to and above the wound, with the stick inside (tie a half knot around the stick). Tie or otherwise secure the tourniquet, and turn the stick until the flow of blood stops. Once that happens secure the stick so it does not move. If you have something to write with, MARK THE TIME. This can be done by writing it on the patient; put a T and the time on their forehead. Of course if you do not have anything to write with you must remember what time it was applied.
If the injury involves something impaled into the victim such as a hunting arrow, a tree branch etc., DO NOT REMOVE THE ITEM. By removing the object you can do much more damage by cutting arteries, veins or nerves. Secure the object by wrapping around the wound and around the object.
The most common injury facing the outdoor enthusiast is the broken or sprained limb. Generally speaking these are not life threatening but can be very painful. The best thing that we can do for the individual is immobilize the limb.
The first thing we must do when we face this type of situation is to ensure that the limb below the break is still getting blood. To do this we must feel the limb (hand, foot). If practical, remove the shoe or gloves and place your pointer finger and middle finger on the side closest to the body and gently push in. You may have to reposition your fingers a little, but you should feel a pulse. If you do not feel a pulse, the next best thing to do is feel the foot; does it feel warm and can the patient wiggle their toes. If you push gently but firmly on the top of the foot for 5 seconds then release you finger you should see a blanched, or white, area. This area will quickly turn back to pink when your finger is released. This is called capillary refill and if it happens in less than two seconds, everything is good. If the foot is blue, cold, no pulse, we must gently straighten the leg into its normal position. Needless to say it will hurt very badly but it will ensure that the foot or hand will get the needed blood flow and will not die. In the many years that I practiced, I have only had to reduce a fracture a handful of times so it is rare, but it does happen.
Now we must splint the limb, and this can be accomplished in many ways. I personally like the hunter who used his rifle to splint his lower leg fracture; it was ingenious and very effective. Using a drag rope and a rifle, he placed the splint in such a way that it extended above and below the fracture and secured the rifle securely. Needless to say, Mother Nature provides us with fallen trees and limbs, and these can work great. For a leg injury, place one on each side of the leg (same for a lower arm injury) and secure the splint with whatever you have. It must just keep the limb from moving during transport. For an arm injury, responders use a triangular bandage to create a sling and swath. In the field, a shirt works great for this. Place the arm on the shirt and tie the arms around the victim’s neck. It will support the arm and reduce pain. When dealing with an ankle or wrist injury, removing the boot or glove may cause more damage and pain. My best practice, as a citizen in the woods; leave the glove and boot on as they both provide a splint and support while transporting the patient out.
Getting Out or Getting Help
That leaves the last problem facing outdoor enthusiast: How do I get my buddy out of here? Well, much will depend on the injury and the abilities of the companion. If you have the resources to make a litter, several long branches with coats secured between the two has worked. I have also seen one litter made with two branches and 3 drag ropes. However, making a litter may be useless if you physically cannot carry it out. While carrying your buddy out may seem reasonable, remember that now you have twice the difficulty getting out and will expend tremendous amounts of energy doing so.
My suggestion is to ensure that your buddy is in a safe location, sheltered as much as possible from the elements, and you hike in to get help. Depending on your situation, make sure your friend has a fire (with some wood to keep it going easily within reach), water, and if applicable, a way to keep animals away. I understand most people are not going deep into the Alaskan wilderness, but even on a hunt you can be an hour or so from a road. Once you get someplace where you can call for assistance, it is important that you meet the rescue folks to ensure they can find your friend.
This is by no means a comprehensive article about all the dangers someone faces in the beautiful outdoors. It is just a look at the principals of very basic first aid. I highly recommend that anyone who treks into the outdoors go prepared with either a commercial first aid kit or a homemade kit (which I prefer).
In My Kit
- 3 pairs of gloves
- 1 disposable CPR mask
- 5 triangular bandages
- 5 5×9 bandages
- 2 5 foot cling wrap
- 5 4×4 bandages
- 2 rolls of transport tape
- 20 assorted Band-aids
- 1 6 inch wooden dowel
- 1 tourniquet
- 1 paramedic pouch (scissors, forceps, tweezers, flashlight)
- One piece of equipment that I always take with me, no matter where I go, is an emergency blanket. This item weighs about 5 ounces, but if I have an accident in the woods I can make myself a little emergency shelter while waiting for help.
If you are an outdoorsman, please consider taking an advanced first aid course or a wilderness first aid course. They are not that long, but the knowledge that is gained is priceless.
No one expects to have an emergency in the woods, but it happens all across America EVERY DAY. Staying calm, having a few basic items and working through the problem may be the difference between life and death.
Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.
Following his successful career in DRT, he returned to school, graduating with an AS Degree in Business Administration, HR and Law minors. He completed his AS in Paralegal studies in May 2014.
In his off time, Paul enjoys riding motorcycles and is an active member of the Patriot Guard Riders of New York, protecting the sanctity of funerals for military, law enforcement officers, EMS and fire fighters.
On July 4th, 2013, Paul was approached by the Heroes Memorial Foundation, Inc. to assist them with the Granite Mountain Hotshot Team tragedy in Prescott Arizona.Currently he is working as the Public Information Officer responsible for ensuring accurate information is released to news media outlets, and to the appropriate on-line forums.
Paul is currently the town judge of Senaca, NY. Paul is responsible for all media relations regarding Fire & Rescue and Military Heroes.
Latest posts by Paul Hood (see all)
- Surviving the Wilderness Incident: What to Do Before Help Arrives – 31 January, 2015
- Surviving a Disaster: Preparation is Key – 16 January, 2015
- The Demise of America – 27 December, 2014