View Full Version : First-Aid on the trail
canoehead
03-14-2008, 13:23
What If :eek:
How many hikers out there have the needed skills to take care of personal health problems that happen, what do you think the minimum skills should be? Have you had to use you'r skills in the past?
FFTorched
03-14-2008, 13:33
I think some basic skills to know are, how to tourniquet severe bleeding. How to properly bandage a wound. How to splint an injury, and how to make a stretcher. CPR, and how to recognize things like Heart Attack, Stroke, Concussion, different types of shock, and what not.
Really how much more can you carry, or have the legal ability to do. You can't carry things like narcotics, or sharps unless prescribed to you. Pretty much the best you can do is help the breath, stop the bleeding, and get them to a medical facility.
just some info
http://www.wilderness-survival-skills.com/wilderness-first-aid.html
I still remember the basic techniques for bandaging a wound, creating a tourniquet (worst case scenarios only), and treating for shock from the military. But to be honest the only first aid gear I carry are band-aids, anti-biotic ointment and super-glue. Plus, of course, vitamin I.
I have had issues finding answers to some first aid questions.
Arterial sever. Plug it up and H. Close as I can figure.
Oh, humor forum. Sorry.
norman55
03-14-2008, 14:18
I hike with my family of five, which includes a former EMT and a RN. Although our skill level is high, we currently hike with only the very basic first aid supplies. When we started out - the kit was at least a couple of pounds and included sutures and broad-spectrum antibiotics. We soon learned that this was neither practical nor needed. There is just no way to cover all the possible situations that can come up on the trail.
The very nature of hiking makes it a relatively high-risk activity. Hikers intentionally go places where there are few people, limited communications and lots of opportunities to injury ourselves. If more hikers focused on understanding these risks, the fewer injuries they would experience. With better information and improved skills, hikers can reduce the probability of experiencing an injury and reducing their overall risk when hiking.
Risk = Probability X Consequences
(Yeah, OK - I'm in touch with my engineer side. What can I say?)
Cheers,
Take a course on first aid if you feel you are lacking in knowledge. My dad was a first aid captain on the local fire department for 41-years, he was somewhat insistent that we have a fairly good level of knowledge on this issue. He even went so far as to teach it and bring in other experts to help teach it to the Boy Scout troop we were a member of.
I suppose it’s possible to have an emergency that you don’t have any training or may never have prepared for. But a calm thought-out response will help even in the absence of knowledge. And some things you can’t do much about whatever the skills and tools you have. A heart attack comes to mind. In this situation a cell phone or a set of car keys is the best medicine.
mkmangold
03-14-2008, 14:56
What Torched and Bob S said: essentially ABC's and a cellphone. I also carry along moleskin, antibiotic ointment, diflucan (antifungal) tablets, a broad-spectrum antibiotic, a topical steroid, benadryl, and prednisone. And an EpiPen although I think I could get away with a small syringe with epi in it. All depends on how long I will be hiking, where, and the time of year.
Take a course on first aid if you feel you are lacking in knowledge. My dad was a first aid captain on the local fire department for 41-years, he was somewhat insistent that we have a fairly good level of knowledge on this issue. He even went so far as to teach it and bring in other experts to help teach it to the Boy Scout troop we were a member of.
I suppose it’s possible to have an emergency that you don’t have any training or may never have prepared for. But a calm thought-out response will help even in the absence of knowledge. And some things you can’t do much about whatever the skills and tools you have. A heart attack comes to mind. In this situation a cell phone or a set of car keys is the best medicine.
And some regular old aspirin I believe.
Blissful
03-14-2008, 15:28
It's good to know basic first aid whenever you are in the woods.
Esp for cuts, bruises, sprains, strains, bites (snake or otherwise), poison ivy, hypothermia, sunstroke, heat exhaustion, etc
A heart attack comes to mind. In this situation a cell phone or a set of car keys is the best medicine. Moisten two car keys and place them on the chest of the patient, one to either side of the heart. Remove the battery from the cell phone and short it out the across the car keys. The resultant current will jump-start the patient's heart.
Dr. Frosty, MD
mkmangold
03-14-2008, 16:30
Moisten two car keys and place them on the chest of the patient, one to either side of the heart. Remove the battery from the cell phone and short it out the across the car keys. The resultant current will jump-start the patient's heart.
Dr. Frosty, MD
Right....
How about a low-tech precordial thump?
Anyway, what ARE the most common medical/health events you all have run across? In my experience:
1. Lacerations and abrasions
2. Burns, including sunburn
3. Sprains, strains, and automobiles
4. Corneal abrasions
5. Hypothermia
6. Hyperthermia
7. Fractures
And probably in that order of occurrence.
Moisten two car keys and place them on the chest of the patient, one to either side of the heart. Remove the battery from the cell phone and short it out the across the car keys. The resultant current will jump-start the patient's heart.
Dr. Frosty, MD
I don’t think so!
It takes 35-volts to break skin resistance, a cell phone battery is normally 3.6-volts.
Even when wet 3.6-volts is going to do nothing.
The heart stops because of a clogged up artery (at least that was the case with my attack) you need to thin the blood (aspirin at first and blood thinners in the hospital) and clear out the artery.
A cell battery is going to do neither one.
take-a-knee
03-14-2008, 17:17
Right....
How about a low-tech precordial thump?
Anyway, what ARE the most common medical/health events you all have run across? In my experience:
1. Lacerations and abrasions
2. Burns, including sunburn
3. Sprains, strains, and automobiles
4. Corneal abrasions
5. Hypothermia
6. Hyperthermia
7. Fractures
And probably in that order of occurrence.
I think you about nailed it. I would add arterial/venous bleeding from the injudicious use of a knife. In other words, if you are smart and careful, this is highly unlikely.
I would add building a litter to the skill list. Cutting/lashing poles and improvising kit (tarp, tent fly etc) for the litter body. There may be other uninjured people available to effect an evacuation if a litter can be improvised.
Also another good reason to have good navigational skills and not be a map-less moron.
And some regular old aspirin I believe.
Be careful with the asprin, some people (like me) are allergic to it, it will probably close their throats. :-?
I think knowing basic first aid and how to apply it in an outdoor setting is right up there with having a map and proper equipment.
I'm taking the NOLS Wilderness First Aid course ( http://www.nols.edu/wmi/courses/wildfirstaid.shtml ) this weekend at the University of North Carolina and I also just completed a Red Cross first aid course (with CPR certfication) as well.
All total I'll have about 32 hours of first aid instruction - thats a very small investment of time to learn something that could prove invaluable.
The best First Aid that you can bring on the trail with you is knowledge. The 16 hour Wildernesss First Aid is a good course.
not trained on humans, can only help our four legged counterparts.
saimyoji
03-14-2008, 17:59
How is this thread humor? :-?
AlwaysHiking
03-14-2008, 18:19
Saw tourniquets mentioned a few times. Current teaching is that these are a no-no.
They do more damage by cutting off circulation than they do good by restricting blood flow to a bleeder.
The reason I was given is that backcountry rescues take so dang long, the body part could be lost in that time BECAUSE of the tourniquet.
take-a-knee
03-14-2008, 19:17
Saw tourniquets mentioned a few times. Current teaching is that these are a no-no.
They do more damage by cutting off circulation than they do good by restricting blood flow to a bleeder.
The reason I was given is that backcountry rescues take so dang long, the body part could be lost in that time BECAUSE of the tourniquet.
Paramedics have been letting people bleed to death for decades because of this faulty, potentially fatal advice. A tourniquet is a LIFE SAVING measure, not necessarily limb saving, but the latter isn't always the case. Just because you apply a tourniquet doesn't mean the limb will be lost. In the OR limbs are exanguinated (blood drained) and tourniquets applied for 4-5hr with no adverse effects. If it isn't done right nerve damage from compression can result.
The stopgap first measure is a pressure dressing, which usually should be applied first.
Remember, all bleeding stops...eventually.
Wise Old Owl
03-16-2008, 01:52
This is not funny. - Did I miss this - We are in the Humor section, ahh who cares.
http://i250.photobucket.com/albums/gg275/MarkSwarbrick/funny-1.jpg
Might be fun to practice some first aid next trip out, even on a solo trip. Pretend to sprain and ankle really bad, or break a leg, or dislocate a shoulder, or a really severe cut or burn. Fife and drum optional.
Are there any statistics of what injuries and ailments are most common?
Well they do say laughter is the best medicine.
Might be fun to practice some first aid next trip out, even on a solo trip. Pretend to sprain and ankle really bad, or break a leg, or dislocate a shoulder, or a really severe cut or burn. Fife and drum optional.
Are there any statistics of what injuries and ailments are most common?
Seems to me JAK (especially on WB) that the most common ailment would be 'spring fever' :D
fiddlehead
03-17-2008, 04:48
duct tape, neosporin and aspirin (for hangovers) has pretty much always cured any problems i had out there. i do carry a sewing needle and dental floss but only ever used it for pack repair.
AlwaysHiking
03-17-2008, 09:05
Paramedics have been letting people bleed to death for decades because of this faulty, potentially fatal advice. A tourniquet is a LIFE SAVING measure, not necessarily limb saving, but the latter isn't always the case. Just because you apply a tourniquet doesn't mean the limb will be lost. In the OR limbs are exanguinated (blood drained) and tourniquets applied for 4-5hr with no adverse effects. If it isn't done right nerve damage from compression can result.
The stopgap first measure is a pressure dressing, which usually should be applied first.
Remember, all bleeding stops...eventually.
Sorry man, gotta go with what the trained experts tell me. If they say to stop the bleeding using some other method than a tourniquet, then that's what I'm going to do.
gsingjane
03-17-2008, 09:29
So I took my Girl Scouts away last weekend, we trail ran one day and then the next day hiked up a really slippery, icy, rocky mountain. All the way up, and all the way down, I worried that somebody would take a header or otherwise get bashed up because of my outdoors enthusiasm.
We did have one injury, a girl twisted her elbow and it swelled up and bruised pretty badly (I think she may have injured a tendon or ligament). Lucky for me... and ironically... she injured it playing FOOSBALL!!!!!
Bring on that snow hiking!
Jane in CT
take-a-knee
03-17-2008, 09:46
Sorry man, gotta go with what the trained experts tell me. If they say to stop the bleeding using some other method than a tourniquet, then that's what I'm going to do.
Dude, I was trained as a Paramedic, Univ/TX Health Sciences 99. Before that I was a Special Forces Medic most of my adult life. I've had more live tissue training than any six doctors you know. I said to try a pressure dressing first, IF you know how to properly apply one and have the proper materials, it isn't self evident and you won't learn "on the job". Once someone's blood spills out on the ground there is no getting it back, thankfully such an occurence should be quite rare for a hiker if he is careful but stuff happens.
A tourniquet is like a reserve parachute, if you do what you are supposed to do you are unlikely to need it, but if you do, you'll need it really bad, and you'll need it RIGHT NOW.
Direct pressure will control bleeding in 99% of penetrating injuries likely to befall a hiker. There is that nasty 1% remainder. Also, a LOT of older people are taking blood thinners/clot prevention drugs. Good luck on controlling bleeding on those folks. There is a reason a surgeon won't cut on those folks until they've been off of those drugs several days, and that is in an OR.
AlwaysHiking
03-17-2008, 10:21
Dude, I was trained as a Paramedic, Univ/TX Health Sciences 99. Before that I was a Special Forces Medic most of my adult life. I've had more live tissue training than any six doctors you know. I said to try a pressure dressing first, IF you know how to properly apply one and have the proper materials, it isn't self evident and you won't learn "on the job". Once someone's blood spills out on the ground there is no getting it back, thankfully such an occurence should be quite rare for a hiker if he is careful but stuff happens.
A tourniquet is like a reserve parachute, if you do what you are supposed to do you are unlikely to need it, but if you do, you'll need it really bad, and you'll need it RIGHT NOW.
Direct pressure will control bleeding in 99% of penetrating injuries likely to befall a hiker. There is that nasty 1% remainder. Also, a LOT of older people are taking blood thinners/clot prevention drugs. Good luck on controlling bleeding on those folks. There is a reason a surgeon won't cut on those folks until they've been off of those drugs several days, and that is in an OR.
You can't compare frontcountry emergencies to backcountry. There's a reason that the wilderness first aid organizations teach that tourniquets are a bad thing. Main reason being these ppl in the woods aren't doctors. They can't apply a tourniquet with the knowledge of an MD like your example about the ER.
In the backcountry, patients are hours and hours away from rescue. If a person has cell reception, it's at least an hour for the first responders to make it to the trailhead, then the emergency manager has to get set up and form a plan, then a couple first responders are sent up the trail with limited supplies followed by a team with more substantial supplies... depending on where the patient is, it could be two more hours before the first group makes it to the patient. Another hour after they arrive the 2nd group with additional supplies will make it there. Then they have to treat, stabilize, and decide on the eVAC plan. At that point it's already 3-4 hours after the cell call was made. If the person can't walk out and no emergency vehicles can reach them... well, the hours will pile up and the date will change before the patient ever sees the inside of the ambulance.
If there was no cell phone reception, it would have been even longer b/c someone would have had to hike out, drive to a pay phone or at least drive until they got cell reception... how long does that take if a person is injured in the backcountry? Hiking out to the trailhead up to 2 hours? What if the closest trailhead is not the one the 'runner' is parked at? They have to find someone with a phone or a car and when they finally do it's still at least an hour until the first responders make it to the trailhead.
You just can't compare combat and frontcountry first aid/medical treatment to backcountry first aid. If the authorities on backcountry/wilderness first aid are saying in that application it's a bad thing to use a tourniquet, then I for one am going to heed their advice and stop the bleeding using the methods they recommend.
Right....
How about a low-tech precordial thump?
Anyway, what ARE the most common medical/health events you all have run across? In my experience:
1. Lacerations and abrasions
2. Burns, including sunburn
3. Sprains, strains, and automobiles
4. Corneal abrasions
5. Hypothermia
6. Hyperthermia
7. Fractures
And probably in that order of occurrence.
I'd put blisters and toenail problems first, burns 3rd, and for allot of the folks, Hangovers 5th;)
A tourniquet is like a reserve parachute, if you do what you are supposed to do you are unlikely to need it, but if you do, you'll need it really bad, and you'll need it RIGHT NOW.
Agree. Pressure dressing, and/or pressure points work for most dings.
I reserve the right to use my reserve if needed.
Airblazer
03-17-2008, 11:54
In my Outdoor Emergency Care training (for Ski Patrol rescues), we were taught that tourniquets are only used in extreme cases when the victim would bleed to death otherwise. The majority of the time, the limb cannot be saved. The theory is... Life over limb. I agree - pressure dressings, as well as pressure points (applying pressure to the artery proximal to the wound) are the best course of action in most situations.
I just finished a NOLS WFA course this weekend.
We were taught to attempt to control bleeding in the following order:
1. Direct pressure and elevation
2. Pressure dressing
3. Pressure points
4. Tourniquet.
Nessmuk and I are EMTs and he is an LPN, I have held several positions in hospitals and nursing homes. He makes up and carries the med bag, which is certainly larger than most hikers carry. He headed a wilderness program for several years and knows what health problems occur often and not so often. He carries numerous medicines, including things for giardia, sleep, pain, infection.
He is most likely over prepared, but we are comfortable with that.
Frau
Time To Fly 97
03-17-2008, 12:53
Duct tape, aspirin and neosporin will work for almost everything. However, when it gets serious, you'll quickly realize how laughable these are. Always carry a pressure dressing or two just in case. They weigh nothing and could make all the difference:
I had a buddy (Tweedle) get kicked in the temple by a deer in his sleep on the PCT. Obviously, this is such an incredibly rare situation...but it happened. Needless to say, my duct tape and neosporin were ineffective. A bandana may have worked to some extent. The good news was that another buddy (Hawkeye) was carrying a pressure dressing that we put on Tweedle's head to stop the bleeding which eventually worked. We then treated for shock, went 6 miles for help and the Rangers airlifted him out in the morning. I learned a valuable lesson about carrying a pressure dressing. If Tweedle had lost another pint of blood, there might not have been a happy ending. The pressure bandage is the right tool for the job.
Happy hiking!
TTF
mkmangold
03-17-2008, 13:44
Time2Fly: how about a tourniquet around Tweedle's neck?
HYOH: blisters, sure. I believe in draining them, applying antibiotic ointment, then dressing them. If they are already deroofed, treat like an abrasion. And what is this about hikers and hangovers? Have we been dipping into the Everclear?????
Sorry man, gotta go with what the trained experts tell me. If they say to stop the bleeding using some other method than a tourniquet, then that's what I'm going to do. As a trained nurse with a rather extensive background in trauma care, I have to agree with TAK on this one. Should you try and control bleeding another way other than a touniquet first? Absolutely. But if direct pressure, "the golden standard" for controlling bleeding, doesn't work, then a touriquet should be used as an absolute last resort. A tourniquet is a life saving measure, but not necessarily limb saving and should only be applied with severe, profuse bleeding, usually arterial in nature. How do you know it's arterial? It's bright red and usually spurts with the patient's hearbeat.
As far as backcountry first aid is concerned, I think each of us in undertaking a trip into the backcountry, have a certain responsibility for knowing how to help not only ourselves, but others that may be injured as well. I think that each hiker that ventures into the backcountry should, at the very least, have a basic working knowledge of basic first aid and both adult and child CPR. Carry a first aid kit that is stocked with the basic supplies you may need along with any medications that one would need for chronic medical conditions that you may have such as diabetes, hypertension, coronary artery disease, asthma, etc. In addition, if you have an anphylactic reaction to anything, be sure to carry and epi-pen with you. As an example, my hiking partner is asthmatic, so we both carry a rapid acting inhaler and an inhaled steriod in our first aid kits, should his asthma act up while we are out.
This then spurs a debate as to whether one has a duty or obligation, per se, to assist an injured or ailing hiker. I think any reasonable person would have no problem with doing so, but so many are caught up with the thought of our society being so litigious. So many worry that they'll do the wrong thing and be sued. Most states have so-called Good Samaritan laws to keep that from happening. And that's all I got to say about that.......:D
Blissful
03-17-2008, 14:26
Remember, all bleeding stops...eventually.
Well it didn't for the Redskins football player who essentially bled to death from a gunshot wound to his leg (think it was behind the knee). Good to know different techniques for bleeding as an arterial bleed is by far much more dangerous. Unlikely on the trail of course, but you never know what can happen out there.
take-a-knee
03-17-2008, 15:29
Well it didn't for the Redskins football player who essentially bled to death from a gunshot wound to his leg (think it was behind the knee). Good to know different techniques for bleeding as an arterial bleed is by far much more dangerous. Unlikely on the trail of course, but you never know what can happen out there.
Oh yes, he stopped bleeding ... when his heart stopped. That was my point.
About the only two scenarios I can envision an AT hiker getting in spot this tight would be to do something REALLY STUPID with a cutting implement or to have a stove explode and send a piece of shrapnel through an artery. In other words, it ain't likely, especially if you are careful...so be careful.
AlwaysHiking
03-17-2008, 16:55
As a trained nurse with a rather extensive background in trauma care, I have to agree with TAK on this one. Should you try and control bleeding another way other than a touniquet first? Absolutely. But if direct pressure, "the golden standard" for controlling bleeding, doesn't work, then a touriquet should be used as an absolute last resort. A tourniquet is a life saving measure, but not necessarily limb saving and should only be applied with severe, profuse bleeding, usually arterial in nature. How do you know it's arterial? It's bright red and usually spurts with the patient's hearbeat.
But you have extensive training. And you work under the supervision of a doctor. Take you out of that environment and stick you out in the woods alone for several hours with a patient and the procedures have to change. You're still certainly a lot more qualified than most, but you have to adjust how you would treat a patient. Backcountry emergency medicine is a different beast altogether.
All I'm saying is current wilderness first aid is to not use tourniquets because Joe Hiker in the woods with a bag full of bandaids is not qualified to tie a tourniquet and leave someone for hours on end while he runs for help. The whole reason SOLO was started in the first place was b/c the founder treated someone who lost their limb which could have been avoided b/c back then they treated as if everyone would fall within the golden hour. They used frontcountry emergency medicine in the backcountry and it simply didn't work. They now teach save life and limb.
But moving on from that discussion, what are other misconceptions or standards that have changed over the years?
I know a lot of people still think it's standard to hold a person down and stick something b/t their teeth if they're having a seizure. I also know from a friend of the family that only ends in broken clavicles, busted ribs, and broken teeth. She needed a set of dentures before she even turned 35. Well intentions from the guy in the grocery store who 'helped' her, but he did more harm than good.
But you have extensive training. And you work under the supervision of a doctor. Take you out of that environment and stick you out in the woods alone for several hours with a patient and the procedures have to change. You're still certainly a lot more qualified than most, but you have to adjust how you would treat a patient. Backcountry emergency medicine is a different beast altogether.
All I'm saying is current wilderness first aid is to not use tourniquets because Joe Hiker in the woods with a bag full of bandaids is not qualified to tie a tourniquet and leave someone for hours on end while he runs for help. The whole reason SOLO was started in the first place was b/c the founder treated someone who lost their limb which could have been avoided b/c back then they treated as if everyone would fall within the golden hour. They used frontcountry emergency medicine in the backcountry and it simply didn't work. They now teach save life and limb. Does being in the backcountry really change how you reat someone from a basic first aid standpoint that much? Not really. Bear in mind, we're talking basic first aid here and not any type of basic or advanced trauma care, just the good old fashioned first aid you learned in the Boy Scouts, Girls Scouts, Army, Marines, etc. Teaching how to save life and limb is a nice concept and ideally, it would work every time. But ideal situations are simply not always possible. Choices and decisions have to be made sometimes that may affect whether or not someone keeps a limb or not, but that is a decision that is made by physicians after the patient is delivered to definitive care, not by Joe Knucklehead in the backcountry. If I'm laying there with a wound that is gushing blood that can't be controlled by direct pressure, then I'd want someone to tie on a tourniquet, whether they were "qualified" to do so or not. I'd rather have my life than bleed out. But, as TAK said, the odds of needing to apply a tourniquet in the backcountry are pretty slim, barring something either pretty stupid or pretty weird.
AlwaysHiking
03-17-2008, 18:02
Yes, they are different enough. One, you don't have the convenience of delivering a person immediately to 'definitive care'. Two, if standard first aid training were enough, then why do we have WFA?
Does being in the backcountry really change how you reat someone from a basic first aid standpoint that much? Not really. Bear in mind, we're talking basic first aid here and not any type of basic or advanced trauma care, just the good old fashioned first aid you learned in the Boy Scouts, Girls Scouts, Army, Marines, etc. Teaching how to save life and limb is a nice concept and ideally, it would work every time. But ideal situations are simply not always possible. Choices and decisions have to be made sometimes that may affect whether or not someone keeps a limb or not, but that is a decision that is made by physicians after the patient is delivered to definitive care, not by Joe Knucklehead in the backcountry. If I'm laying there with a wound that is gushing blood that can't be controlled by direct pressure, then I'd want someone to tie on a tourniquet, whether they were "qualified" to do so or not. I'd rather have my life than bleed out. But, as TAK said, the odds of needing to apply a tourniquet in the backcountry are pretty slim, barring something either pretty stupid or pretty weird.
saimyoji
03-17-2008, 18:12
Lets forget the tourniquet argument for now. Most people with a basic course in 1st aid, CPR will have adequate knowledge for most accidents that occur in the woods. The occasional fallen tree on the tent, or rolled boulder on the leg will happen, but you are at much greater risk driving to the trailhead for serious injury.
.......if standard first aid training were enough, then why do we have WFA?Because those courses cost money and they are usually presented by companies that are for-profit. Need I say more?
Saw tourniquets mentioned a few times. Current teaching is that these are a no-no.
They do more damage by cutting off circulation than they do good by restricting blood flow to a bleeder.
The reason I was given is that backcountry rescues take so dang long, the body part could be lost in that time BECAUSE of the tourniquet.And a life could be lost because of a lack of tourniquet. Backcountry rescues do take longer, and a person could easily bleed to death if a tourniquet isn't applied. The whole point of a tourniquet is to retrict blood flow by impeding circulation. In other words, that's their purpose.
AlwaysHiking
03-17-2008, 20:11
Because those courses cost money and they are usually presented by companies that are for-profit. Need I say more?
What first aid course doesn't cost money? I'd like to take them for free so if you know of any, pass them along.