The Basics of Wilderness First Aid

Wilderness first aid can be an overwhelming topic to discuss. There are first responders and other medical personnel that study for decades to learn first aid techniques in urban scenarios. So how do we even start to discuss first aid in the wild? There are all kinds of additional complications. I have had lots of injuries and ailments while stuck in the woods for wilderness survival challenges along with normal hikes and hunting trips. I learned basic first aid at a young age and have used that knowledge in dozens of close calls.

It started with my very first wilderness survival challenge in Central Missouri. I had made it through a nasty storm my first night with just minor hypothermia. That was a win for me. However, as I moved into my third day I was completely exhausted. I had built a shelter, purified water, kept a fire going, and caught some fish. I was sleep deprived and lacking the calories I needed for all of these tasks. The combination of my confidence from making it this far along with my physical state made me a bit careless. I was sure I had trimmed all sharp branches off of the roof of my shelter. I stood up quickly and smacked my head on a sharp branch above me. Blood started running down my face.

One of the complications of this injury was that I had been sleeping in the dirt. My clothes were covered in debris that would easily infect a head wound. Both blood loss and infection were a serious concern. I thought for a minute and decided to cut the interior back pocket out of my pants for a bandage. It was clean cloth, so I just wet it with some water I had recently boiled. I used a signal mirror to clean out the wound, twisted out the moisture from the cloth, and then used it as a compression bandage. My hat was tight enough that it worked fine to hold pressure on the bandage. I was able to stop the bleeding and keep it clean until the challenge was over. Thankfully I was just left with a small scar to remind me of the experience.

In this article we are going to cover basic first aid in wilderness scenarios as well as items to pack in a first aid kit. In addition to reading this article, you should consider a first aid course to get certified and a CPR course. Consider keeping a first aid manual with you when in the wilderness. Most importantly, practice your skills. The knowledge alone is not enough. Periodically I like to practice basic skills like applying a splint or a bandage with my wife and son. It will ensure that everyone is ready if there is ever a need for first aid in the wilderness.

What Do I Do?

Your biggest priority with wilderness first aid is to treat the patient until you can get them to a doctor. Most injuries and ailments on backpacking trips are minor and just require a little care and attention to get you through the trip. That being said, you should always be prepared for the worst. Your first priority should be to evaluate the situation. Follow these simple steps:

1. Look for life threatening injuries or scenarios. This can include injuries like severe bleeding that must be treated immediately. You should also decide if the overall situation is life threatening. If the person has fallen in water, is near fire, or is near hazards like falling rocks or down wires you should consider carefully moving them to safety. However, never move an injured person unless you absolutely must. Back and neck injuries can be made worse if you aren’t careful. Finally, do not forget that there could be more than one person in need of help in some scenarios.
2. Slow down and evaluate. Once you know you have handled immediate concerns, do a thorough inspection of the person from head to toe. Look for cuts, bruises, or broken bones. Ask where there is pain and if they have any other unusual sensations. You want to know about every possible injury that could need treatment. If a person falls down a slope or falls in river there can often be multiple issues.
3. Come up with a treatment plan. If you see injuries that you do not know how to treat, check your first aid manual. Decide how to treat each issue and in what order. This should also include a decision as to if the person is fine to continue enjoying the trip, if they need to hike out right away, or if you need to try and call for rescue.
4. Treat the patient. If the person is conscious, tell them the plan and ask their permission. If they are not responsive, do what is needed to keep them safe. Go through your plan and treat all injuries you can to the best of your ability.
5. Monitor the issues. Check with the patient periodically to see how they are doing. Visually inspect injuries from time to time. Continue to clean wounds and change bandages.

Keep in mind that you have some additional challenges in the wilderness. In many cases you are miles from help. Your biggest issues are:

• Time to help – In most normal first aid scenarios you are minutes from a medical professional. In the wilderness you may be hours or in extreme situations even days from help. You must handle these medical issues over a longer period of time.
• Environmental factors – You will likely not have a clean environment for treating your patient. You must do what you can to keep dirt out of wounds and purify water before using it with your patient. Extreme hot and cold temperatures can make things more difficult, and it can always start raining or snowing.
• Resources – While you may have a first aid kit with you, it is always going to be limited. The resources a doctor would have in their office or in a hospital are far better than what you will have. You must be creative and make the best out of what you have.
• Calling for help – There is a good chance that you will not have the ability to call for an EMT if you are deep in the wilderness. This means you may have to hike out or wait until someone finds you and your patient.

Life Threat/Medical Evaluation

One of the most important steps in the evaluation process is deciding if a person’s life is in immediate danger. We should go into more detail regarding the process for this evaluation. You can call this evaluation an ‘ABCDE’ evaluation to help you remember the steps.

A) Airway – Sometimes an issue can be as simple as choking due to an obstruction to an airway. Open the patient’s mouth, lean back their head, and look inside for obstructions.

B) Breathing – Move your cheek down next to the mouth of the patient. See if you feel any breath on your cheek, listen for air movement, and look at their chest to see if it moves up and down.

C) Circulation – Check for a pulse and for any major bleeding. You can check for a pulse on the neck just below the ear or on the inside of the wrist.

D) Disability Decision – Decide if there is any chance of a major neck or back injury. If there is any chance, protect the spine before moving the person.

E) Expose Injuries – As you check over the body for injuries, remove clothing as needed to get a better look.

These steps will tell you if the patient is in immediate need of life threatening first aid. You do not need to necessarily complete these steps in order. Use your best judgement to check the issues you think are most urgent. Once you have taken care of any immediate concerns, you can move on to a secondary assessment. Use all of your senses to find other issues. Look for blood, bruising, and broken bones. Listen for problems breathing or strange noises when moving joints. Feel for breaks, bumps, and tenderness. Smell for unusual odors that could potentially imply an infection. Don’t forget to always ask how the patient feels and if they have any pain or numbness.

To take this a step further, get a pen and paper and write down a few important observations. Note if the person is conscious and if so if they are alert or disoriented. With the wrist note the patient’s pulse and if it is strong or weak. Note breaths per minute and if breathing is difficult. Check over the skin for color, temperature, and perspiration. If you have a thermometer, check the internal temperature of the patient. If the patient is conscious, note their age, symptoms, medications, medical history, allergies, last water consumption, last food consumption, last urination, last bowel movement, and what they think started the medical issue.

Treatments

You now should have most of the information needed to treat your patient. We are going to cover treatments for some of the most common issues you will find in wilderness scenarios. Be aware that a full first aid guide will cover a much more comprehensive list of issues and treatments.

CPR

If you check a patient’s pulse and they have none, CPR (Cardiopulmonary resuscitation) is the appropriate step. This is the process of pressing the chest to either restart the heart or to maintain blood flow to the brain. I would suggest that you take a course to become CPR certified and then recertify as required. This can be done online or in person.

First, you should always have someone try to call an ambulance or find other help while you perform CPR. Place one hand over the sternum on top of the other hand and interlock your fingers. Use your body weight for compressions, not your arms. Press up and down at a rate of two compressions per second. If you want a point of reference, this is the same pace as the song “Stayin Alive”. Make a 30 compression cycle and then check the pulse again. If there is no pulse, continue with CPR. Please note that mouth to mouth was thought to be needed in addition to chest compression for CPR to be effective. It has been determined that chest compressions alone are just as effective in most scenarios. If you take a course, they will discuss appropriate situations for mouth to mouth.

Heimlich Maneuver

An obstructed air passage, or choking, is another life-threatening issue that must be treated. Several years ago, I was forced to use the Heimlich maneuver to save my wife from choking. You may think this is unlikely to happen in the wilderness, but you would be wrong. Often people eat snacks while bouncing down the trail or eat dinner when completely exhausted from hiking all day. These are times when choking can happen. If a person is losing color in the face and not breathing or if a person is holding both hands to their neck, they are likely choking.

Start by sweeping the back of the throat with your index finger to try and dislodge the obstruction. If your patient is still choking, get around behind them and wrap both arms around their abdomen. Make a fist with one hand and grab your wrist with the other hand. Put the fist between the naval and the sternum and thrust in and up several times. Keep going until the obstruction is loose. You can also complete the Heimlich maneuver on yourself by bending over a fallen log or a large rock. Just be sure whatever you use is resting between your naval and sternum.

Hypothermia

In wilderness survival scenarios, hypothermia is the most common cause for death. This is defined as the condition in which the body’s internal temperature drops below 95F (35°C). You will most likely find people suffering from hypothermia in the winter, but it can happen any time a person gets wet. When your clothes are wet, your internal body temperature will drop 20 times faster than when you are dry. You can actually end up with hypothermia in temperatures as high as 60F (16°C). On my first survival challenge the temperature was a moderate 54F (12°C) that night. However, we had a bad thunderstorm with heavy rain and 30 mph winds. I was soaked to the bone and had to use an emergency blanket to survive the night. I still showed signs of mild hypothermia. Symptoms of hypothermia are dizziness, confusion, body pain, nausea, and severe shivering. Sometimes the patient will actually feel incredibly hot and strip off their clothing as the condition becomes life threatening.

Treating hypothermia involves warming the body from the inside out if possible. Wet clothes must be removed to dry the skin with a towel or a fire. Wrap the patient in a blanket and keep them near a fire if possible. If you have no fire, it has been proven that stripping clothing and getting in a sleeping bag with the patient can transfer some of your body heat to them. Drinking warm water will help with the process, so heat some over the fire if possible. Movement is always a good thing. Squats, jumping jacks, or walking in circles can help warm the body and keep the blood pumping.

There are other complicating factors to consider. Dehydration, hunger, and other conditions can add to the likelihood of hypothermia and vice versa. Drinking water and eating are good ways to keep the body warm. However, try to avoid eating ice or snow. Frostbite is another issue to evaluate. Extremities like the nose, ears, fingers, and toes are often first to be affected. As the skin and other tissues freeze and die, they turn black and cause the victim extreme pain. Eventually the pain is replaced by numbness, but the damage continues. It can lead to amputation if the patient does not get medical treatment. It can also cause other complications such as sepsis and gangrene. At the first signs of frostbite the person must move their extremities to keep blood flowing. They should also wrap up and warm the body gradually. Never dip frostbite in hot water. Try to seek medical attention as quickly as possible.

On my first winter challenge I found myself with more severe hypothermia. The air temperature dropped to -1F (-18°C) and we were dealing with 15-20 mph winds. I had tried to get a fire started, but all of my tinder material was wet from a heavy snow earlier that day. I had tried to build a shelter large enough to have my fire inside. Without a fire, it was just a drafty structure with little insulation. I was walking back and forth to get water from the pond and stay warm. Despite my tracks in the snow, I kept forgetting which way to walk on the trail. My hands and feet had gone from pain to numbness, and I was shivering violently. I had brought a thermometer to monitor my internal body temperature, and I was now past 95F (35°C). I decided to tap out and hike out to safety. I was cold for days after that and had numbness in my extremities for weeks. If I had not hiked to safety when I did, I may not have survived the night. Take this condition seriously.

Treating Open Wounds, Burns, and Bites

Any kind of open wound in the wilderness creates two different issues. One is the risk of blood loss which can lead to shock and eventually low blood pressure causing cardiac arrest. The other is infection which can lead to sepsis, a life-threatening form of blood poisoning. If a person is impaled, never remove the object from the wound. The impaling object is often limiting the blood loss by holding veins and arteries partially closed. Instead you can try to cut the impaling object to free the patient or move them easier. For severe bleeding, you must stop the blood loss first. Press a clean cloth on the wound and hold it there while elevating the wound above the heart if possible. For wounds on limbs, you can also tie cloth or cordage above the wound to slow blood flow without cutting it off. This is different than a tourniquet which will completely arrest blood flow. After a while the blood flow should slow to the point that you can clean the wound and bandage it.

If the wound is smaller you can go ahead and clean it with purified water. Be sure to wipe out or wash out any debris you see in the wound. Apply a clean bandage and tie it or tape it in place. Be sure to clean the wound and replace the bandage periodically. If it soaks through with blood, it will do little good. Go through this same process after the bleeding is controlled for bigger wounds. Butterfly bandages or stitches can help close the wound before applying a topical bandage if the wound will not stay shut. Smaller burns can be treated the same way until you can find medical treatment. Burn cream can help keep the wound clean and reduce the pain. Major burns are urgent and require treatment at a hospital.

If this process does not stop the bleeding and the patient might die, you can use a tourniquet. As with the pressure wrap, you will tie cloth or cordage above the wound. Then place a stick inside the wrap and twist it until it will not turn anymore. Tuck the end of the stick inside the tourniquet to hold it secure. Remember that applying a tourniquet may cause the patient to lose part of that limb, so only use it to save the life of the patient.

Snake bites are typically just treated like a small wound. Reptiles do have lots of bacteria in their mouths, so disinfect the wound well. However, if you see the snake and know it is venomous you must treat it differently. Also, if you start to see the skin around the bite swell and change colors or the person complains of severe pain, dizziness, nausea, or rapid heart rate you can assume it is a venomous bite. Do NOT try to cut the wound or suck the venom out of the wound. This has been proven to just make the bite worse. Treat the wound and get the patient to medical help as quickly as possible. Only antivenom will help. You can use a permanent marker to write symptoms on the person’s arm along with their heart rate, temperature, and the outline of the red area as it grows. This will all help an EMT treat the person properly.

Hyperthermia

Hyperthermia is the opposite of hypothermia and is common in wilderness scenarios. I was working to build a shelter on a survival challenge a few years ago and noticed some symptoms. It was around 100F (38°C) and I was in direct sunlight with a high humidity. I had been trying to drink water, but apparently I got overheated. I started feeling dizzy, light-headed, and noticed a very rapid heartbeat. My face was red, and then I stopped sweating and turned white. I had no way to cool down except to get into the shade, rest, and drink cool water. On another instance I had similar symptoms and went to the ER. I was told I needed at least 2 Liters of fluids before I could head out again.

The technical definition of hyperthermia is having an internal temperature above 104F (40°C). If you are working in the heat, pay attention to the symptoms I mentioned previously. Try to wear a hat along with long-sleeved, loose fitting clothing to protect your skin. Always wear sunscreen if possible. If you do not have long clothing or sunscreen you can use mud to protect exposed skin. At the first sign of hyperthermia symptoms, get out of the sun and rest if possible. Sip cool water and wrap a cool, wet cloth around your neck to help cool the blood. Often this condition is brought on by dehydration, so be sure to hydrate long before you notice symptoms.

Broken Limbs and Joint Injuries

Broken limbs and injured joints are fairly common in wilderness survival scenarios. It is easy to slip on wet leaves and fall or twist a knee. First, look for compound fractures. If bone is sticking out of the skin, it should be treated like any open wound first. Once bleeding is treated, try to straighten the bone and then splint it for transport. You will often need to splint injured knees, ankles and elbows while using a sling for injured shoulders and wrists. To build a splint properly you need three sticks or boards. Place the supports evenly along the straitened limb and use cordage to tie them tightly in place immobilizing the limb. You may need to adjust the tightness periodically to keep the person comfortable. Slings can be made with cordage or any large piece of cloth. Wrap under the forearm holding the arm in a comfortable ‘L’ shape. Then tie it up around the back of the neck to support the weight.

Foot Care

You may think that foot care is not a huge priority for first aid, but if you have ever done long hikes over several days you know that is incorrect. If your feet have issues and you have a hard time walking, you may not be able to get to safety. There are two primary issues with feet that are common in the wilderness. Blisters can be a huge issue if they get out of control. You should always have well fitting boots with dry, wool socks if possible. If you feel a blister starting, you should tape up the area to protect it. At the end of the day, you should remove fluid from the blister. Do not simply pop it open. Use a sterilized blade to cut a small slit in the blister and squeeze out the fluid. Stay off your feet for a few hours and keep the area clean. It will often heal back shut and be much better by morning.

The other potential issue is trench foot. This is where moisture gets inside of your boots and causes the skin to soften and rip. It can lead to nasty infections making it impossible to walk. At the end of my long distance challenge a few years ago, my feet were unrecognizable. I mistakenly only brought one pair of socks and they were soaked on the first day. Try to bring multiple pairs of socks. Also, dry out your boots and socks over the fire whenever possible. When making camp for the night, expose your feet to the air so they can dry and toughen up again.

First Aid Tips

• Hydration, food, rest, warmth, and good hygiene will help with any of these medical issues.
• If you have an upset stomach, eating charcoal can help ease your stomach.
• Avoid caffeine, alcohol, and unneeded drugs as they can dehydrate you and complicate other issues.
• Inform the person of your medical plan as you go to keep them calm.
• Try to check your first aid kit and keep it stocked before and after every outing.
• Be sure to include needed medications for anyone attending the trip.

Building a First Aid Kit

You can buy a variety of different sizes and types of first aid kits. It’s a good idea to start with a compact first aid kit and then adjust the content based on your needs. Dig through it adding items it might be missing and removing items that are not pertinent. You can also easily build one from scratch. Here are items I feel would be important for a wilderness first aid kit:

• Gauze and bandages of various sizes
• Antiseptic wipes
• Antibacterial ointment
• Medical tape
• Pain relief medication such as Ibuprofen (can also help with fevers)
• Antihistamine for allergic reactions
• Butterfly bandages
• Tweezers
• Thermometer
• Moleskin for blisters

You can also add to these basics with items such as:

• Eye drops
• Quick clot for stopping bleeding in severe wounds
• Poison ivy treatment
• Stomach medicine such as antacids
• Surgical gloves
• Emergency blanket
• Medical staple gun or suture kit
• Sunscreen, lip balm, and bug spray
• Compact splint
• EMT style tourniquet

As you can see, I have had to get through lots of close calls as well as little cuts and scrapes. It just comes with being in the wilderness. Eventually injuries and other medical issues will happen. It is vital in these situations that you remain calm and keep everyone else calm as well. Only clear minds can get through situations like this. With the right knowledge, training, and supplies you can be confident you can handle most of the medical issues you might run across in the wilderness.

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