It was a bright, sunny day. I found myself scaling Cathedral Rock in Sedona, Arizona with my mom, dad and 5 younger siblings (since I am a homeschooler, I have the privilege to visit some very exciting places in the United States. Such was the case this past March).
As my family and I were hiking up the hazardous ‘path’, a few thoughts crowded my brain. What if my eight-year-old brother fell or slipped in this pass? What if my nine-year-old sister falls down this slab of rock or my mom passes out? Would I know how to help them? Did I have the necessary equipment in my bag? Surrounding me was the beautiful scenery, but more importantly, there were multitudes of families climbing up this same rock that I was. Most of whom had nothing with them except a water bottle!
Many families each year take hikes such as my family did. Nothing happened, and we hope nothing serious ever happens. But, do you know what to do if something goes wrong on your next family hike? What if someone gets seriously injured you pick up your cell phone only to find out that you have no cell signal, or the battery has died, or that you can’t contact anyone? What do you do if you are in a situation where you have no one to contact? Do you know what do if someone gets injured, and the medics are delayed for a long time? Consider the scenario of a third-world country where there is no one to contact in case of a medical emergency, and you are the sole person to administer help until assistance comes.
In this essay, I will endeavor to show you some basic wilderness medicine and rescue skills that will help all those concerned should undesired circumstances strike on their adventure. I want to show three key wilderness medicine and rescue skills that are necessary for the average person to know. You do not HAVE to have a degree, or be an expert! The three keys in this essay are Preparation, Evaluation, and Perspiration. If you can learn the skills associated with these 3 keys, you will most likely have the confidence you need on your next family hike…or adventure!
As with everything relating to survival, preparation is essential. But what does this really involve? First of all, you need to be mentally prepared for anything that may happen. This does not mean that you should worry or be afraid, but, rather, mentally prepare yourself so that you have confidence. If something does go wrong, you know what to do, and you have the means to carry out your plan. The ability to think clearly in the midst of chaos will be invaluable. Mental preparedness will lead to an essential check-list of some items that may be needed on your adventure.
Your gear plays an important role as to whether you just survive, or thrive under the circumstances that you are forced to be in. There are numerous things that can flood the brain that should be in that “house on your back”, but, keep in mind, a more streamlined check-list is advisable. Obviously you will pack different things depending on whether you are spending a month or two in wild, mountain country, or if you are just spending a day or weekend in the woods.
It is humanly impossible to describe everything that you should pack for every adventure. Walter Picket, in his article called “The Rescue Pack”, put it very succinctly when he stated,
“There are few people who can carry a 40lb+ pack and be effective in the mountains. Experience can make a big difference as to what is carried in the pack. Also, sudden weather changes, difficult terrain and victims with serious injuries can place the rescuer in a rather awkward position. One way the rescuer can keep out of that position is to be prepared to cope with any situation that could come up before it happens. Assistance cannot always be called in or it might take them a long time to getting there so a rescuer should be completely self-sufficient for the duration of the mission. That does not mean that you carry everything but the kitchen sink in your pack…There is no perfect gear. No one backpack can fit everyone’s back. Some gear is especially suited for an individual’s need (or is it wants)…” (Pricket article “The Rescue Pack” www.1srg.org)
Organize your gear so that instead of frantically trying to find a something, the most essential items are easily accessible. You could classify your gear into 3 categories: personal gear (clothes, sleeping bag, tent, sunglasses, hat, chap stick, bandanna, extra socks, etc.), survival/rescue gear, and medical gear. Because personal gear is obvious to most of us, the focus of this part of the essay will be in regards to survival/rescue gear and medical gear.
Basic survival gear is a must. Caution must be used when going to an outfitting store and buying a survival kit. One reason for this is that a store’s main goal is marketing and making profit, not necessarily your personal benefit. Some stores will also try to cut costs wherever they can, and you probably won’t be getting the “best of everything.” Furthermore, some people never open their kit and figure out how to use it because they trust it. Also, some kits may contain ‘overall items’ that are not specific to the region, weather, and/or terrain that you will be traveling in, or situations that you might face. These types of stores, however, usually have good reading material that can give invaluable information on necessary items. Ultimately, you must be wise, and make sure that, if you buy a pre-made survival kit, you do your research and figure out how everything works BEFORE your adventure begins.
It is best to just make your own by purchasing the items you need individually. Tailor your kit to the region you will be traveling in, the possible weather you may encounter, and to what kind of activities you are going to be doing. Also, if you are leading a group, make sure you tailor your kit to your group’s possible needs. You may have to help everyone!
Assuming that you are wearing the appropriate clothes for your adventure and that you have appropriate hiking boots, here is a “check-list” of a few essential items to get your brain turning: Personal gear (such as a bandanna or sunglasses…) signal mirror, rain wear, fire starting devices (at least 2), trail tape, map/compass, matches (make sure they don’t get wet),sharp belt knife, solar (space) blanket, duct tape, water and food (be wise, always carry more than you think you might need), 3 sources of light and extra batteries, and at least two heavy duty contractor weight plastic garbage bags (a great source of emergency rain wear, or waterproof backpack liner). A pencil and notebook may also be helpful. Furthermore, I would suggest waterproofing your gear by putting it in plastic Zip-loc bags or containers. You can use your pockets to hold important survival items, like a flashlight or a knife, or you can pack them in a small sack, or belt pouch.
Be sure to adapt your rescue gear to the type of activities that you will be doing, and to the type of region you will be in. Try to bring a good, professional climbing or rescue rope with you. Some people also like parachute cord for rescues. If you do end up doing strenuous rescuing on your adventure, you will probably wish you had a helmet. (As a side note, you should probably pack one in your bug-out bag, or wherever you keep your TEOTWAWKI gear.) I would also highly recommend that you bring some type of work gloves to protect your hands. This will be invaluable if you do need to do any wilderness climbing. Depending on what you are doing, you may even consider bringing an emergency harness or emergency climbing equipment. Also, make sure you bring enough water. The average person needs 64 ounces of water a day. When you are hiking you will need much more. How much you need will depend on the outdoor temperature and humidity, as well as the length of the hike. For most conditions one liter per hour or a half liter per mile is a good rule. If you are involved in a rescue, you may need to give some of your water to the victim. Remember, what you pack could save your life, or a family member’s life!!!
Medical gear also needs to be tailored to the area/region you will be adventuring in and the number of people in your group. Pack your gear in an organized manner. It is a very good idea to pack it in a separate pack so that it will be readily accessible. One of the best books I have found on the subject of wilderness medicine is Wilderness Medicine, Beyond First Aid, 5th Edition by William W. Forgey. On page 215 of this book he gives a list of items that will usually fulfill most of your emergency requirements:
“10 pkg Spyroflex 2”x 2” wound dressings (or carry 2 for each person)
2 pkg Spenco 2nd Skin Burn Dressing Kits (or carry 1 for 2 people)
15 pkg Nu-Gauze, high absorbent, sterile, 2 ply, 3” x 3v, pkg/2
25 Coverlet Bandage Strips 1” x 3”
1 Tape, waterproof
1 Sam Splint 36”
1 Elastic Bandage 3”
1 Elastic Bandage 4”
1 Max Strength Triple Antibiotic Ointment with pramoxine, 1 oz tube
1 Hibiclens surgical scrub, 4 oz bottle
1 Tetrahydrozoline Ophthalmic Drops, 0.05%, 15 ml bottle
1 Hydrocortisone cream, 1%, 1 oz tube
1 Clotrimazole cream, 2%, ½ oz tube [Antifungal cream.]
1 Cavit dental filling paste
2 pair Examination gloves
1 Irrigation syringe
1 Sawyer Extractor [Vacuums the wound. Use to treat insect and bites.]
1 Surgical kit consisting of 1 needle holder, 2 each 3-0 Ethicon sutures,
1 each 5-0 Ethicon suture, and 2 each 3-0 gut sutures
1 Over-pack container for above”
[To update this list, I would add a CPR mouth guard.]
Always take Tylenol with you. This works on fevers and pain, but if you want something that deals with inflammation as well, you will need to take ibuprofen along with you. Additionally, Imodium A-D is a very good thing to bring along, especially if you will be in the tropics or a foreign country (particularly a third-world country).
The preceding list is not exhaustive. You can use this list as a guide. You must alter it to fit your adventure. Also, don’t be afraid to improvise if necessary. Plastic food wrappers or plastic sheeting can be used to cover wounds as it will not adhere to it. Use any kind of tape to hold it in place. The wonderful thing about this is that you will be able to see the wound! A painless way to kill germs in wounds is by placing granulated sugar or honey on the wound. This will kill germs by dehydrating them and it will not injure human cells.
Remember that your equipment is not everything! Skill and understanding is far more important! Learn emergency skills. The last thing anyone wants to be doing is sitting next to their injured partner and having no idea what to do!
The best way to organize your gear is to pack it all into individual “stuff sacks.” I would recommend that you label what everything is, and then put all of your “stuff sacks” inside your backpack. Also, separate your gear into categories, such as, ‘any items critical to survival’…these should be carried on your person (i.e. a knife should be in your pocket at all times). Then any items that you frequently need/use, should be in an outside pocket of your pack, or a belt pocket, or something like a water bottle could easily fit on a hip belt. Keep these items handy, so that you don’t have to stop and take off your pack just to get out your sunglasses or chap-stick. The rest of your gear in your backpack is the third category, which includes your medical pack, and personal items. Make sure you keep your most essential items, like your medical kit, near the top of your pack or somewhere where you can easily find it.
This second key, evaluation, is the word that should be flying through your brain when disaster strikes. Something happens, and now, all of a sudden, you become the rescuer (assuming you don’t need to be rescued first). If you were on a search and rescue team you would have access to equipment and trained professionals. Now, you only have yourself, your companions, and whatever is in your pack. You are the victim’s only hope! The first question will almost undoubtedly come to your mind is this: “Oh no! What do you do?!?” Ah ha! I’m glad you asked! The answer is evaluate! There are two phases for this process, and two ‘C’s to help you remember.
Phase #1: Do not panic!!! Take CONTROL of the situation. Be calm, but confident. Immediately stop, and think “Assess and prioritize!” Assess the situation. Spinal injuries should be a priority. Realize that you will need to protect their neck at all costs until it is unmistakably obvious that the victim does not have a spinal injury, or until you can get it properly looked at by a professional. Also, it is very easy to operate on impulse when you see a family member or friend in danger. DO NOT allow yourself to do this! Plan and think about every decision.
Phase #2: Exercise CAUTION! The last thing you want is to get hurt yourself, or for someone else in your party to get injured. Assess the danger and make it a priority. Look for the safest way to reach the victim, and then make a plan (before you start out) for how you are going to get to the victim (depending on the situation you might want to have a back-up route in mind just in case). Also, you might need to put on some protective gear such as medical exam gloves with a pair of work gloves on top, or extra rain gear. You also may need a helmet, or other equipment to protect you as you reach the victim. If you don’t have extra protective equipment, proceed with EXTRA CAUTION!
Perspiration, the last and final key, refers to the process of reaching the victim, stabilizing the victim, and getting the victim to professional help. This daunting task may take a long time, and it will undoubtedly consist of pressure and lots of hard work-or perspiration. There are seven phases for this process (and they all start with ‘S’).
Phase #1: SET OUT to reach the victim! This may be as simple as walking 10 feet out of the way, or it may be as complex as rappelling down a cliff. Also, depending on the size of your group, it is probably not necessary for everyone to go and reach the victim. Keep control and don’t let anyone panic as you (now the rescuer) reach the victim. Most importantly, you MUST work together.
I want to park here and give you a few techniques that I have found to be very helpful. As I learned this first technique some time ago, I realized that it should only be used if you need to reach the victim quickly.
1. Take your rope and wrap it around a big sturdy tree trunk or boulder, close to the “cliff” (or area that you will rappel down). Do NOT tie any knots!!! Just wrap it around.
2. Pick up the now 2 pieces of rope, close to the trunk. Make sure that the ends of the rope match in length (basically the length of your rope has just been reduced by half).
3. Next, gently let the 2 pieces of rope down the cliff to make sure that your rope is long enough to reach the bottom. Face the tree trunk or boulder and hold both pieces of rope together.
4. Then, pass them between your legs and then around your right leg.
5. Next, pass it up across your chest and over your left shoulder.
6. Hold the rope with your left hand approximately at the middle of your lower back. Let the rest of the rope trail down behind and below you. With your right hand, hold the rope in front of you.
7. Then, SLOWLY let yourself down. Don’t grip with your right hand! Just rest in your left hand and lean your weight on the rope.
8. Finally, once you get down to the bottom, pull on one end of the rope and let the rope come down.
The only possible problem with this is that you will need to have a plan to get yourself and the victim back to safety. As I already stated, this should really only be used when you need to reach the victim quickly. Another option is to learn how to make a harness out of rope or use any emergency equipment that you brought, and have someone belay you. Usually a team of 3 is ideal for safe travel in treacherous country.
If you need to wade across a river or stream, plan before you enter. Currents can be deceitfully strong. Before you enter the water, throw a small stick into the water to see how fast the current is flowing. Make sure you wear shoes when you cross. Also, it is very helpful if you can cut a big branch, or somehow get a big stick to use as you cross to make a tripod effect. This will give you more stability in the crossing, and you will always have one leg and the stick on the ground, as opposed to trying to balance on one leg with rushing currents.
Also, another interesting fact to remember for dealing with serious trauma, is that emergency doctors speak of something called “the Golden Hour”. This refers to a period of time varying between the first few minutes after an accident, to approximately an hour after the accident. If you can get to the victim and stabilize them within this one hour time frame, they will have a better chance of survival. The bottom line is, get to the victim and give care as soon as you can.
Phase #2: SURVEY the victim (some refer to it as the primary survey). This means dealing with life-threatening emergencies. Doctors use the mnemonic acronym ABCDE to help evaluate the victim.
‘A’- airway. Make sure nothing is clogging the victim’s airway.
‘B’- breathing. Make sure that the victim is breathing (look, listen and feel for at least 10 seconds), if they are not breathing you will need to start CPR. These 2 are the most vital.
‘C’- circulation. Check to make sure that their heart is beating (if not start CPR) and check for any catastrophic bleeding. Deal with bleeding immediately by applying direct pressure to the area for 10 minutes by your watch. Use protective gloves, or use a cloth to protect yourself. If there is a foreign body in the wound, apply pressure around it. Only use a tourniquet in life-threatening situations, such as amputations or partial amputations, penetrating wounds, or open fractures. The victim may use the limb. If needed, apply the tourniquet for only 30 minutes and then release it slowly.
‘D’- disability. This part of the exam will place the victim in one of four categories: unresponsive to all stimuli, responsive to pain, responsive to verbal stimuli, alert. If the patient sees you and starts talking to you, he is obviously alert. Otherwise, gently squeeze the victim’s (uninjured) shoulder while placing a hand on their forehead to prevent any neck movement and ask a question like “Can I help you?” or “Where do you hurt?” If they respond, they are obviously responsive to verbal stimuli. If there is no response, pinch an uninjured part of their body to see if they are responsive to pain. If there is no response, you can classify them as unresponsive to all stimuli.
‘E’- exposure. This means protect the patient from hypothermia. Depending on the weather and condition of the victim, you might have to deal with this later.
If/when the victim’s ABC’s are stable, move on.
Phase #3: SHOCK: Shock is caused by an inadequate supply of oxygen reaching the brain or other vital tissues and organs, because of decreased blood circulation. One symptom of shock is that the victim’s skin is cool to touch and they may be sweating (cool, clammy skin). Also, their skin color may be ashen or pale. Some serious symptoms are dilated pupils, fall in blood pressure, increased breathlessness and/or irregular breathing. The main way to correct shock is to identify and treat the underlying causes. A few causes of shock are pain, bites and stings, fractures, burns, dehydration from sweating, and exsanguination. Also, keep the victim still and in a comfortable position where they feel like they can breathe well. Shock can lead to death. Make sure you treat any and all causes the best you can.
Phase #4: SECOND (secondary) SURVEY: Once the victim is for the most part stable, perform a secondary survey. This will help figure out the cause of the victim’s problem or it will help you figure out if there are any further problems you may not see right away. This survey may also help determine more underlying causes of shock.
1. Check the victim’s vital signs: Recheck their level of consciousness. Are they alert, responsive to verbal stimuli, responsive to pain, or unresponsive?
Check their pulse (quality, rhythm, and rate). If a limb is injured, check the pulses on the uninjured and the injured limbs and then compare them. The normal pulse for the average adult at rest is approximately 60-100 beats per minute and the normal pulse for the average child at rest is approximately 70-130 beats per minute. Well trained athletes may have a resting pulse closer to 40 beats per minute.
Check their breathing (rhythm, rate, and quality i.e. labored, pain, noises like gasps).Adults breathe approximately 12-18 times per minute at rest. Children breathe faster.
Check their skin color. Also see if it is moist/dry or hot/cold (refer to shock).
Finally, if at all possible check their blood pressure. Systolic blood pressures ranging from 100-140 are normal.
2. Next, do a rapid head-to-toe exam. Check for other major injuries. Try to communicate with the victim. Ask questions like “Does this hurt?” Start at the head and neck: Look for any bruising around the ears. Make sure their collarbone is not broken. Also, check for clear fluid from the victim’s nose or ears. This is a sign of a head injury with an open fracture. Gently feel along the cervical spine for pain (if conscious). Also ask about any abnormal sensations.
Chest: Look for damage. Keep your hands wide and compress the ribs from both sides. Ask about pain (possible bruised or broken rib).
Spine and Back: If at all possible, without moving the victim, gently press along their spine. Stop immediately if there is any pain or significant tenderness.
Abdomen: Spread your hands wide, and gently press at the four corners and the center of their abdomen. Look for tenderness, rigidity, muscle spasms, tenderness, or swelling. Stop if there is any pain or significant tenderness and assume that there is an abdominal injury/problem, or a spinal or pelvic injury.
Pelvis: Placing a hand on each Pelvic crest (hipbone) press them backwards, and then towards each other gently. Stop if there is any pain and splint immediately (splint by tying legs together-not too tightly. Make sure you place padding material between the legs and between the legs and the tying material. If/when you need to move the victim, you must do so by stretcher).
Arms and Legs: Run your hand down each arm/leg slowly, gently squeezing as you go. Note any movement in the fingers/toes or lack of sensation or circulation. Check for deformities, swelling, and color changes (loss of circulation). Also, check for pain in the joints. (If you must splint an arm or leg, check for circulation, movement, and sensations (tingling, numbness, pins and needles) about every 30 minutes. You may need to remove the splint if there are any sensations or if there is a loss of circulation or if movement in that limb suddenly decreases.)
Phase #5: Your SOLUTION: This means that now that you have somewhat figured out what the problems are-figure out what you are going to do! Define problems and then figure out solutions. Apply splints to immobilize fractured or broken bones. If there is any bleeding, watch for infection. It may be necessary to repeat the Second Survey.
Phase #6: SAFETY: Retreat to safety. If you cannot move the victim without further injuries, leave them where they are and protect them from the elements.
Phase #7: STABILIZE the victim. Whatever the case may be, keep the victim stable until you can get them to help, or get help to them. This may mean that someone in your party has to run for help, while you stay and administer help to the victim. Also, you must get professional medical attention if necessary. This may prove crucial because sometimes it takes the eye of a trained professional to catch serious problems.
It is easy to get worried when prepping for or while on an adventure. You can minimize potential fears by familiarizing yourself with these 3 wilderness medicine and rescue keys: Preparation, Evaluation, and Perspiration. You don’t have to be an expert! Anyone can help a friend in an emergency! If you learn to apply these skills, you will have confidence to fight against the odds. So, are you going to just survive your adventure, or are you going to thrive under EVERY circumstance?