Wilderness Medicine and First Aid

[VoodooTitan]

I did two searches to make sure a thread on emergency medicine or first aid wasn't already covered. I've created this in general discussion for the purpose of capturing the most attention, sort of like an all points bulletin.

After reading [MENTION=101600]hour[/MENTION] thread on being stuck in argentine pass in CO, I got to thinking... had he really been stuck out there for a few days, or worse, injured... what would he have done, and does he have the know how to help himself in a worst case scenario situation. I haven't read any horror stories on here about people being injured or in terrible scenarios, but I thought it would be beneficial to put the info out there, after all this is a forum.

Some background about me: I'm an Independent Duty Corpsman in the US Navy. My skillset is most comparable to a physician assistant. In a clinic environment, I see my own patients, order labs and special testing, perform full physical examinations and assessments, perform minor operations, prescribe medications, and recommend diagnoses. I also have an extensive background in emergency medicine. I've served 2 tours in Afghanistan providing austere medicine at the front line. My record is 20/21 (saves/loses). The lose was a local militant who was beyond saving due to blood lose.

With my personal and professional experience, I want to share some things I've learned, tricks of the trade, time savers, money savers, and things like that. I want to cover down on injuries, expedient/field treatment, and minor life saving procedures.

***DISCLAIMER***
I am not offering professional medical advice. I am suggesting things to consider when making your own first aid kit, and offering some guidance on basic life saving techniques you can use in worst case scenarios. Majority of this information can be found online, in official medical text, or survival books.

1. Injuries

These are some types of injuries that can potentially create a bad to worse scenario, drastically reducing your survivability. These can result from being outdoors or from your vehicle.
1. Burns
2. Electrical shock
3. Poisonings
4. Musculoskeletal injuries (breaks, fractures, disolcations)
5. Soft tissue damage

Soft tissue damage can result from a number of things. Penetrating trauma, crushing trauma, animal attacks, and movement on uneven terrain. Some of the serious concerns with soft tissue damage are infection and blood lose. I'll briefly discuss managing wounds later.

Burns can be classified as thermal, chemical, or electrical. All of these are real world when considering that we're dealing with various fluids from vehicles, high temperatures, and by products (such as battery acid). There are 4 stages to burns. Superficial, partial thickness, full thickness, and the 4th and uncommonly used is deep (typically reaching the bone). First degree burns are sunburns. Second degree burns are painful and typically result in blisters. Third degree burns are painless due to nerve damage, but are the most important to treat and most difficult to recover from. 3rd and 4th degree burns cause the body to have difficulty regulating temperature, resulting in hypothermia. This is a major concern when outdoors.

Poisoning can result from brushing against poisonous plants, coming in contact with poisonous insects, ingesting poisonous foliage, or overdosing on medication.

Musculoskeletal injuries are important because an injury of this nature can reduce your mobility and ability to protect yourself and get yourself into a better off situation. They are primarily due to trauma. Times to be careful are: when dismounting your vehicle on uneven terrain, using recovery tools such as winches or straps, moving on foot on uneven terrain, and traversing landscapes in search of help or to help someone. It is imperative you never place yourself between or underneath a vehicle that needs to be recovered without having something to support the weight in the even the vehicle becomes dislodged.

Soft tissue injuries. In long term scenarios these are the most life threatening. They can result in blood lose, infection, and potentially invite unwanted guests.

Electrical Shock. This is probably a one shot one kill type of scenario. Remember that electricity arcs, and there will always be an exit wound for the ground. If you survive an electrical shock, or are near someone who is shocked before doing anything else make sure you or the person are clear from the hazard. Lose cables, terminals, or wires are culprits. After doing this, check for the exit wound and dress the wound accordingly. I will discuss treatments later on.

This run down should provide some basic, routinely overlooked risks. Below i'll discuss treatment, and building a home-made first aid kit.

 

[VoodooTitan]

Treatment

1. Burns - As mentioned above, burns are classified into 4 classes. For superficial or 1st degree burns, prevention is key. Sunblock and cover will do the job. Treatment is time. Aloe can help with the discomfort. For 2nd degree burns, the important thing is protecting the underlying layer from infection. When the epidermis is separated from the dermis, a fluid filled blister forms. When the blister breaks, the raw dermis is exposed, at risk for damage and infection. 3rd degree is bad. Both layers are damaged and the burn reaches the muscle. Nerve damage occurs resulting in lose of sensation, primarily pain. The skin can take on a leather like appearance. If this occurs, the skin will tighten causing loss in circulation. If its on the chest, it can compromise breathing. If this occurs, and escherotomy is required. The primary take away for 2 and 3 degree burns is to clean the site, create an artificial barrier, and monitor body temperature. Heat loss occurs through the skin. When the skin is damaged, regulation of heat lose isn't controlled. A topical ointment like Neosporin is best. Saran wrap placed on the burn in squares or sections is a perfect artificial barrier. Never wrap a burned area of skin. Hydration is also a must. Sip water but consume lots of it.

2. Musculoskeletal injuries and soft tissue injuries- Common injuries may be rolled or broken ankles, dislocated joints or shoulders, cuts, punctures, bites, open or closed long bone breaks of fractures. For musculoskeletal injuries, the most important thing is assessment. Can you still use it? Is there a pulse? Do you have motor skill in the fingers or toes? Do you have feeling? Can you distinguish between sharp and dull or hot and cold? These questions are important because they'll help you determine if the injury gets better or worse. Is sensation returning? Is it diminishing?

With a dislocation, you should have muscle movement but pain. Numbness is normal due to nerve compression. Dislocations occur at joints where breaks and fractures occur elsewhere usually along long bones. If you have a dislocation, you can attempt to bite down and relocate. Fingers and toes are easy. Try to wiggle the digit; if you can, you might have just sprained it. To relocation: If you can, apply distraction by pulling the limb straight out, and easing it back into the joint. Afterwards you should have a sensation of relief. If there was numbness, sensation should return. If there was pain, it shouldn't be as bad. If relocation is successful, splint the joint to prevent re-dislocation.

A break or fracture should only be manipulated if there is a lose of sensation or blood flow. Otherwise you should splint the injury in place.

All soft tissue injuries have the same concern priority. INFECTION. Any soft tissue injury should be thoroughly cleaned. and bandaged. Direct pressure is the most effective way to control bleeding. A pressure bandage can be created with almost anything. When bandaging a wound, place the bulk of the bandage directly over the wound, or the nearest artery, and make sure to tie off the bandage over top of the wound.

3. Poisoning- This will occur topically most likely. Brushing up against Ivy or oak, or coming in contact with an insect. Being stung by something poisonous is a different story. If you're stung, get somewhere visible or call for help and give your location and DO NOT MOVE. Poison in the system moves with blood flow. The faster your heart rate and the more you move, the faster the poison is distributed. Try to remain conscious. If you come in contact with something poisonous, the most likely symptoms will be local irritation and inflammation. This is where the Benadryl comes in handy. It will help mitigate irritation, causing you to scratch, potentially breaking the skin. Rinsing the area thoroughly will help.

This should cover down on some minor injuries and help

 

[VoodooTitan]

First Aid Kit

Here I'll list some great things to toss into a homemade first aid kit to pack away into your vehicle. I'll also teach you how to make some home-made emergency items.

To start, remember that the brighter the color of items or clothing you have, the better chances you'll get recognized. I would suggest getting some reflector tape and either a hunting vest or crossing guard vest. You want to be visible. Another thing to consider is where to store everything. A great option is an EMT bag or box, in the bright orange. North American Rescue is a popular brand. But for the adventurer on a budget, some great alternatives are fanny packs (yea I know), fishing boxes, or tool boxes. Something where you can keep everything organized and accessible. Remember, LABEL EVERYTHING. This way someone else will know what it is if you need to direct them to get you something.

What goes inside...
Some purchase worthy items I would definitely invest in can be found online, prior to posting I searched these on amazon.com.
1. SAMS Splint
2. Activated Charcoal
3. H&H Gauze (purchase the packages squares. they are most versatile and the roll is LONG)
4. High intensity flash-light. Tactical military flash lights are great.

Other items
4. Saran wrap
5. fishing line, a small gauge, sythentic line is best.
6. Sewing needles (If you can, put a crescent bend in them, they are useful for suturing)
7. Tylenol, Ibuprofen, Benadryl, an epi-pen if you have documented medical allergies, and an anti-biotic if you can get ahold of them.
8. Triangle bandages - can be made by cutting up a sheet into large squares
9. Neosporin
10. Tape. 4 inch Medical tape is best. Skin tape will suffice too.
11. Rubbing alcohol, peroxide, or betadine
12. ACE Wrap (elastic)

***Note about anti-biotics***
If you've never taken them you could be allergic to them. Talk to a doctor prior to. When building a home first aid kit, you want something that is broad-spectrum and covers down on MRSA (Methicillin-resistant Staphylococcus aureus). Bactrim DS is a great option.

Bulk items:
1. Blankets - preferably thick enough to retain heat
2. Water
3. Carbohydrate heavy food source. Stay away from anything high in polysaccharides (sugars) They cause rapid elevations in insulin and create waves of energy and exhaustion, exhaustion being the dominant feeling. This is also how diabetes starts!

Ok... now that we have our list... here's the applications

1. The Neosporin and saran wrap are for burns. Not 1st degree. 2nd and above. The Neosporin will keep the skin moist while also providing relief and promoting healing. Tear or cut the saran wrap into tiles and place it over the burn. Never circumferentially wrap the burn site. Burns, cause swelling. Swelling causes constriction. Constriction reduces blood flow. Then tape the edges of the saran wrap.

2. Activated charcoal is for poisoning. typically ingested poisoning. But you can never be too careful.

3. Small gauge fishing wire and needle is for suturing. You can google search how to suture and different techniques. The basic premise is to thread the wire through the eyelet, tie it off, and the closing the wound. There are two types of techniques. A running suture or a mattress suture. Running is best if you're doing it solo... starting at one edge, ending at the other. (remember to clean the site first with alcohol or betadine). In theory, you could use fabric to suture, but my argument with that is the tensile strength and if it's fabric it has the potential to absorb bacteria and it can fester deep in the skin causing infection. The crescent bend in the needle is for easier manipulation when feeding the needle through the skin. It's easier to angle the bent needle vs a straight needle. You can watch videos on youtube and practice on pig ears from the butcher at your local grocery store if you're that into practicing. Pig ear skin is similar to human skin, so making a small incision and then suturing up is good practice.

4. Triangle bandages are most useful for sling and swath. This is a technique used for managing should injuries or dislocations. This can also be used for other applications like securing a splint to a leg, securing a pressure bandage in place, and making a home-made tourniquet.

Now, the moment you've all been waiting for... How to make a home-made tourniquet. This is for medical emergencies only, when massive blood lose is occurring. The most important thing is to get direct pressure on the wound and minimize blood lose. You can do this by leaning on a rock or applying a pressure bandage while you get the tourniquet ready.

Items needed:
1. triangle bandage
2. a stick or something rigid, about the length of a pen or pencil, and that won't break under stress
3. a sturdy O-ring. The best example is the piece of plastic that remains on a Gatorade bottle after you take the lid off. The piece that remains behind under the lip of the bottle mouth.

1. Begin with a triangle bandage. Something along the lines of 16x16 inches should be more than enough. Fold the square into a triangle and roll it up.
2. About 1/4 way in from the edge of the rolled up bandage, tie a knot around your rigid beam.
3. place the rolled bandage inside the "O-ring" so that the o-ring is floating freely around the bandage. Bring it close to the rigid beam.
4. Wrap the bandage around the injured limb (we'll use the leg) about two to four inches above the wound. For better pressure, do it about 4 fingers below the skin fold of that limb. When you tie the edges of the bandage make sure the rigid beam is on the outside of the limb.
5. Once you've tightly secured the bandage to the leg, begin cranking away at your rigid beam. Confirm circulation has ceased by checking the distal pulses. The can be found in the wrist, ankle, or top of the foot.
6. When circulation is stopped, or to be more accurate, BLEEDING HAS STOPPED, use the O-ring to hold the rigid beam in place, preventing it from unraveling.

Remember, tourniquets only go on the upper leg and upper arm. The reason being, there are 2 bones in the lower leg and lower arm. The artery runs between these bones in both instances making it extremely difficult to get the artery between the bone and the tourniquet.
Viola!

 

[Fishwerks]

Good post. Thanks for taking the time to write it.

 

[VoodooTitan]

It was my pleasure. Thanks for appreciating it.

 

[hour]

Most excellent thread, great job of explaining things. Looks like I have a few more essentials to grab. I remember thinking "If I twist my ankle, I'm screwed". Had zero service within 100 yds of where I was stuck :tape2:

And thank you so much for mentioning labeling things. I received all my amazon gear yesterday to make myself feel a little better about getting stuck, should it ever happen again, but didn't label anything. A bunch of ammo cans and similar looking things, could never explain to someone which one I'm talking about - and probably couldn't find anything quickly myself either despite being the one who packed it.

 

[Doc2012]

Great write up HM1.

I managed to get a bunch of stuff while in AFGHAN, before I left 2/8.

-minor surg kit
-combat gauze(probably expired now)
-1L NS/LR
-18-20ga IV needles w/ tubing
-SAM splints
-CAT tourniquets
-Gauze
-bunch if other stuff.

When you get back, might have to come up to the BAS and restock a bit.

 

[VoodooTitan]

Great write up HM1.

I managed to get a bunch of stuff while in AFGHAN, before I left 2/8.

-minor surg kit
-combat gauze(probably expired now)
-1L NS/LR
-18-20ga IV needles w/ tubing
-SAM splints
-CAT tourniquets
-Gauze
-bunch if other stuff.

When you get back, might have to come up to the BAS and restock a bit.

yea it's easy for us to stock up on stuff. I have 2 pre-made CLS bags. 1 is in my garage and 1 is in my truck. I keep it in there in the event. There have been 2 occasions where I've pulled people out of their cars after a crash, while I was minding my own business. 1 time I was golfing, riding in my cart, looking for my ball and all of a sudden we hear tires screeching and see this Honda civic rolling, literally, down the street into an embankment. Just kinda drove the cart over to her car and pulled the door open and got her out. Never know what can happen.

It's like going on a mission... "Do I REALLY need my pistol...? Guess I better have it and not need it than need it an not have it."

 

[VoodooTitan]

Most excellent thread, great job of explaining things. Looks like I have a few more essentials to grab. I remember thinking "If I twist my ankle, I'm screwed". Had zero service within 100 yds of where I was stuck :tape2:

And thank you so much for mentioning labeling things. I received all my amazon gear yesterday to make myself feel a little better about getting stuck, should it ever happen again, but didn't label anything. A bunch of ammo cans and similar looking things, could never explain to someone which one I'm talking about - and probably couldn't find anything quickly myself either despite being the one who packed it.

That's a good spot. I'd get some tape and put it on that panel and put "FIRST AID KIT" so people know it's behind that panel if they need to get it for you.

 

[iBison]

Good share VoodooTitan. I took the wilderness first aid class a couple years ago with the girls in our Venture crew. It was a very good class with real word examples. It would be a great class for anyone that backpacks or spends time away from civilization. I got a couple of great books from the class that I can't put my hand on right now, but if I find them I'll post them.

 

[Desert Dawg]

Thanks VoodooTitan; great information and spot on! I always think about what I might need for both on- and off-road trips I take (first aid, emergency water and food, communications, recovery gear, etc.). But I honestly only have a fundamental understanding of field treatment (mostly from my Boy Scout days and some Navy field training...lol) so definitely have overlooked a few things. Your thread is timely for me (new off-road coming) and very helpful. Thanks!

 

[92-SR5]

Great post!
This should be a sticky. Just sayin'

 

[fo' runnin']

Agreed! ^

[MENTION=66624]KCcarguy[/MENTION] [MENTION=65827]MasonT4R[/MENTION] [MENTION=84479]Petromaniac[/MENTION] [MENTION=92563]ReconRunner[/MENTION] [MENTION=102057]4bt40[/MENTION]

 

[VoodooTitan]

Thanks VoodooTitan; great information and spot on! I always think about what I might need for both on- and off-road trips I take (first aid, emergency water and food, communications, recovery gear, etc.). But I honestly only have a fundamental understanding of field treatment (mostly from my Boy Scout days and some Navy field training...lol) so definitely have overlooked a few things. Your thread is timely for me (new off-road coming) and very helpful. Thanks!

Well if you ever have any questions or need any material I think I have some digital stuff I can send your way. One thing I would highly recommend from Amazon is

Special Operations Forces Medical Handbook: Department of Defense: 9781616082789: Amazon.com: Books

it'll cover anything you might encounter.

 

[iBison]

Also, the red cross has a first aid app you can download for to your phone.

 

[Titanpat57]

#1....thanks for your Service:usa2:

#2....GREAT idea!

#3....I don't have the stones to ask you to write one more sentence...but any idea of a "must have" first aid kit that includes the must haves and maybe some "should haves".... Thanks for documenting this.

 

[VoodooTitan]

#1....thanks for your Service:usa2:

#2....GREAT idea!

#3....I don't have the stones to ask you to write one more sentence...but any idea of a "must have" first aid kit that includes the must haves and maybe some "should haves".... Thanks for documenting this.

Thank YOU for the support. I have no problem writing more.

When we talk about should have's, these are more of sustainment things. I'll provide a short list, this stuff is more likely to go into a small backpack or something that you'll keep on you.

1. Zip lock bags. Keeps stuff waterproofed and sandproofed. And it's inexpensive. Great for money, cell phones, etc.

2. Extra water bottles or some iodine or chlorine tablets for water purification. Running water is safe to drink but you should purify it anyway. Stagnant water can be consumed if you treat it, but I wouldn't recommend it. Pack sugar and salt for electrolyte replacement.

3. String or 550-cord. 550-cord is supposed to be rated for 550lbs for ft of use.

4. A small tarp or something that can be folded up and compacted but that will act as a shelter.

5. Matches. Water proof matches, AND a lighter. Remember, fire is the most basic thing you need. You should also have a stone to create spark.

6. A carbohydrate source. "Calorie mate" is a great thing. It's got a decent shelf life, it's compact, and they aren't too bad.

7. A compass.

8. A compression sack with 2 pairs of socks, and long sleeve clothes, and a microfiber towel. If you're out in the wild and get stuck off-road and no one is around, and you have to abandon the vehicle to look for help, you should change into long sleeve clothing and also carry extra socks in case you have to traverse water. If you have to traverse water the best thing to do is pack all your clothes and shoes into the waterproof compression sack, cross the river or water, dry off, and get dressed.

 

[iBison]

2. Extra water bottles or some iodine or chlorine tablets for water purification. Running water is safe to drink but you should purify it anyway. Stagnant water can be consumed if you treat it, but I wouldn't recommend it. Pack sugar and salt for electrolyte replacement.

Personally the only time I would drink untreated water is when I can see it coming out of the ground. Too much risk of Giardia for me. I'd rather not spend a week feeling like I just ate at Taco Bell. Much safer IMO to carry a cheap life straw or a steripen.

 

[VoodooTitan]

Personally the only time I would drink untreated water is when I can see it coming out of the ground. Too much risk of Giardia for me. I'd rather not spend a week feeling like I just ate at Taco Bell. Much safer IMO to carry a cheap life straw or a steripen.

Yea I don't recommend drinking untreated water. You should only consume water that is treated. You can also boil water if you only have fire and some type of steel canteen or something like a steel cup. You need to boil the water then hold it at a rolling boil for at least 15 seconds. If available I would recommend boiling followed by chemical treatment. Another option is to make a system for trapping fresh rain water or condensation. That's in extreme situations though... like, survival situations. Getting into that is kinda getting off topic. If we were to do that we'd venture into what types of plants and insects are ok to consume, as well as small animal trapping.

 

[mscot]

I'm personally being a big supporter of CBD oil as they improve all aspects of your health, so you learn more about them on bestaniccbdoil.org so make sure to check that site out if you want to know how CBD oils can. improve the quality of your sleep, memory and all other functions of your body.

I use CBD from mj so it has a small THC % but I think it's more effective than hemp based CBD. It helps on nights where I'm having trouble sleeping.
That's all I use it for though. I still think a lot of it is snake oil (anti-inflammatory properties for example)

Thanks for this post [MENTION=101228]VoodooTitan[/MENTION]