Outdoor first aid

Pre-first-aid – Know your four most valuable tools

 

In the wild, an injury can be dangerous. We know, animals are aware of it. So we carry a first-aid kit, wishing not to put it to use. We are designed not to think of dangerous or frightful situations all the time. For that reason, we are capable of enjoying things. In short, life, which would otherwise be shocking.

In wilderness areas you are on your own – beware of postponed trouble

But, then again, never say never. In wilderness areas, you are on your own and you have to be prepared to take appropriate action in case of an emergency situation. First-aid measures need to ensure that the patient is stable, followed by getting the patient out of there and to a doctor. This kind of emergency is an instant threat, a dangerous situation to deal with immediately. A falling rock that hits you and breaks your leg, a head injury, a bee or wasps sting if you have an allergy to stings. Out there, these circumstances are classified as life-threatening. But most of the time postponed trouble, less dramatic but nevertheless a potential risk, causes the real problems. This kind of outdoor trouble is the sum of all things added up, to the point that nuisances and minor failures tell you are running out of luck.

 

No problem can be solved from the same level of consciousness that created it (Albert Einstein)

 

Therefore, before you set out on a hike, or whatever wilderness travel adventure, consider your four most valuable tools. Our physical health (and mental health – this goes without saying) is a strong indicator of our effectiveness in the wild places. What precedes basic medical treatment skills is an understanding of the most valuable tools you have.

 

Your four most valuable tools: eyes, hands, digestive system, feet

 

Your mind is undoubtedly the most important of all. Thoughts, ideas, and plans all originate from the brain: the organ that controls thought, memory, feelings, and activity. Putting your thoughts to work, especially in an outdoor environment, requires tools. Tools that have to be cared for because without them your brain and the will to execute your plans will be seriously compromised.

There are many approaches to first aid. This one is based on the four crucial physical tools that have to be safeguarded under all circumstances: eyes, hands, digestive system, and feet. It has become quite a long list of do’s and don’ts, blame the complexity of our body for it. Nonetheless, spend five minutes reading.

 

1. Eyes – the brain’s best friends

 

Your first crucial tool is the eyes. Bringing the outside world within reach of your reason, they allow you to sense, anticipate, connect and understand events around you. They also spark, through visual information, new ideas and solutions for all the challenges that may lay ahead of you.

In the outdoors the function of the eye is self-evident. Enjoying the scenery, doing your chores – the eye detects and monitors all your activities. They truly partner up with your brain when asked for feedback.

Protect your eyes = priority number 1

Protecting them is the first priority for the traveler in the wild. Protect them against excessive light, branches, insects, and sparks from a campfire. Always use a good pair of protective glasses and in extreme weather consider goggles.

In particular, pay attention to the threats coming from the sides of the trail. We are very good at deflecting threats directly in our field of vision but perform poorly when it comes to the periphery of vision; exactly the same area where that fatal branch will poke in the eye. Modern protective glasses wrap around your eyes, thus maximizing protection.

Do not underestimate the damaging effect of dust and particles. They will collect in the eyes and on the eyelids, thus clogging up the paths for necessary fluids. Regularly rinse your eyes with fresh and, possibly, decontaminated water.

In the event of a wound or irritation of the eye, do not hesitate and seek medical care as soon as possible. In the meantime flush the eye with a sterile saline solution or clean the eye with decontaminated water and cover it.

 

2. Hands – the proud workers

 

Hands are everything. Try taping your thumb against your hand and now perform your daily tasks – you’ll perform poorly.

What the eyes see and the brain processes swing into action with your hands. Making a fire, unsheathing a knife, adjusting your sunglasses – countless times the tasks go through your hands.

But even the hands have a leader and that’s the thumb. Fingers may be injured and the hand can still perform. Lose your thumb and the hand becomes virtually useless. Protecting your thumb, coincidentally also the finger most prone to accidents, is crucial.

The main threats to your hands are abrasions, cuts, burns, strains, and, rarely, fractures. As always, prevention is the key to a successful trip in the wilderness. Carefully consider what you do with your hands, always think ahead when using your hands, and wear gloves whenever you think your hands are in harm’s way. Use lightweight gloves that do not hamper dexterity. Poor-fitting gloves will not be worn and therefore are useless.

The biggest problem with abrasions is the risk of infection and pain. Flush the abrasion immediately and cover it with loose and open gauze. Let your body take care of the tissue repair and inspect the wound regularly, keeping it clean. Do not disturb the healing process. Apply small amounts of zinc oxide ointment or Vaseline to sustain the flexibility of the healing tissue.

Watch out for your own knife – don’t play with it

Cuts can be avoided. Stop playing with that knife, use gloves, and always consider the follow-through path of the blade. If you cut yourself, avoid putting the injured finger in your mouth. The oral microbiological life is likely to infect the wound and this will prolong the healing time by almost a week. Instead, flush the wound, stop the bleeding by closing the edges of the wound and apply an appropriate wound closure device such as Band-Aids or gauze. Pressure is key during the first phase of wound treatment but be careful not to limit blood flow.

In the – very unlikely – event of finger amputation, flush the amputated finger with a sterile solution and keep it gauzed in a double plastic bag, ideally in ice. Never keep an amputated finger in direct contact with ice and always try to reach a hospital; a thumb reposition is indicated without exception.

Burns are nasty. We all love to make a fire and more often than not it’s not the fire but what we heat with it that will cause a burn. Severe burns have to be treated in an appropriate facility. Manageable burns can be easily dealt with by cooling the tissue and applying some sugar to the moist skin. Applying sugar will limit infection risk, relieve pain, and will reduce the healing time of the affected tissue. Always cover burns with loose and sterile gauze.

Strains can affect all the articulations of the hand and the wrist. The basic principle for the treatment of strains is PRICE: Protection, Rest, Ice (cooling), Compression, and Elevation.

One hand equals 27 bones and they can fracture. Fractures, especially given the impact this may have on the long-term function of the hand, have to be treated in an appropriate facility. In the event of a fracture, it is crucial to immobilize the affected area and control the pain.

 

3. Digestive system – the engine room

 

Protecting your digestive system is often forgotten when enjoying the great outdoors. Although the potential threats and the effects of intestinal problems are terrifying, more often than not we do not care enough for prevention. A problem with your digestive system, for example, food poisoning, can lead to fever, dehydration, pain, loss of energy, and a complete disability to perform the most basic tasks. Watch the movie, based on a true story ‘Into the Wild’.

Avoid infections from viruses, bacteria, and protozoa by purifying water and proper, i.e., hygienic food handling. Check your food stores, cook your outdoor meals, ready to eat means thoroughly cooked. Prevent cross-contamination due to improper handling of raw food and cooking utensils.

Be aware that, next to parasites, toxins are a significant risk as well. Be it poisonous plants, animal toxins, or the secretions of micro-organisms, the effects are as severe and often worse than a typical parasitic infection.

As always, prevention is key and common sense is the way to go. Remember the parental warnings: wash your hands, do not put dirty stuff in your mouth, and last but not least, keep your kit clean.

Common sense is the way to go

If ever you caught an infection or poisoning, the first solution is coal. Be it mashed coals from your campfire or activated carbon pills: take it and prepare yourself to throw up the bad stuff. Avoid dehydration by drinking water, replenish your electrolytes with a pinch of salt plus a teaspoon of sugar and, if available, treat diarrhea with Imodium. Also, do not forget to move and walk a little: this will activate your bowels.

It is obvious but often forgotten: the mouth is part of the digestive system, it all starts right here. Teeth are assigned many different jobs. They help us to chew and digest our food, we need them to talk and pronounce clearly. And they give our face that healthy, bright smile. Therefore caring for your teeth is essential. We all know the drill: brush your teeth twice a day, use floss or interdental brushes once a day, no sugary foods and drinks, regular dental check-ups. Stick to this disciple at all times and in case a toothbrush isn’t available, improvise one. Note that it’s more likely to find a doctor amongst other hikers or visitors to a mountain station than a dentist, apart from the absence of adequate equipment – and the same goes for the rangers, responsible for lodges in remote areas. They are trained in wilderness medicine but cannot handle severe dental problems.

 

4. Feet – the quiet servants

 

It all has been great, up until now. The weather has changed without warning, sunshine has gone and rain sweeps over the hills. The trail with its cobbled stones has become a stream of mud. It feels like you’ve been walking for ages until you realize there is a truth in it: you’re lost. Your feet hurt, you feel cold and miserable. Most of the time this kind of mild hardship will turn out all right.  But it can be worse. For instance, try to get home with your feet in shambles – the evidence of their impact on your effectiveness will be made crystal clear. The feet have to support the whole body. Tough as they might be, they have their weak spot as well. Moisture, friction, and compression are a menace.

There’s no instantaneous damaging effect of moisture. Moisture will soften your skin and nails slowly. In this vulnerable condition, the proliferation of microorganisms will be a fact. Furthermore, moisture increases the effects of the cold. It will creep on you without notice and only a good deal of discipline will keep moisture under control.

First, use appropriate footwear. By saying this, we stumble into a discussion. In this practical context, the summary must be like this: footwear must be water-resistant and ventilate at the same time, and it has to dry quickly when wet. The first thought is obviously Gore-Tex. Is it or isn’t it the best choice? We are not expert gear reviewers, but dare to share personal experiences. The ‘Gore-Tex only’ approach is probably the biggest misconception on outdoor footwear. Simply because your feet will be flooded out: perspiration has nowhere to go. When wet, the inside of these – often ‘technical’ – boots will take ages to become dry again. Simple shell boots paired with appropriate woolen socks and insoles are more suitable. In case your feet get wet (moisture from the outside or inside), simply change socks and walk them dry again.

Appropriate footwear, including good socks are really important

Second, choose good socks. Wool is the best material and layers work fine: go for a pair of liners and a pair of outer socks with as much dead air space as possible.

Third, hygiene. Change socks daily, wash your feet in cold water, dry them thoroughly and keep your feet aired for as long as possible. Avoid airing them in direct sunlight: your feet are covered most of the time and won’t react well to intense sunlight. Although some still find that sandals are designed exclusively to be worn by women and children, a pair of those lightweight straps around the feet are the real treat after a long trek.

Friction is the second enemy and easy to prevent. Wearing appropriate footwear, taping pressure points, and using zinc ointment as a preventive measure will allow you to walk without problems. In case they do occur: don’t hesitate but act swiftly. Take a break to inspect what’s wrong and apply moleskin or Compeed to the threatened tissue.

Compression is a threat that is often ignored. Your feet are continuously under strain and pressure. Add 20 or 30 kilograms and then walk over uneven terrain; that’s the great outdoors for your feet. Practice walking properly and pay attention to what your feet are signaling during a trek. Rest the feet, find a cold stream to wash, and cool them. Problems that mostly arise from compression are strains and inflammations of the joints of the foot and ankle. Here the same rule as for the hands applies: PRICE. Remember to be extra careful with compression, do not hinder proper circulation in the lower limbs.

 

Exposure considerations

 

Hands and feet are very sensitive to cold because they are at the end of the circulatory system. In cold circumstances, blood is shunted from the periphery to the interior, where it is needed most. Therefore they quickly cool down and cannot function effectively anymore. Proper care and protection are crucial to prevent this. The test: touch your thumb with your pink. If it’s impossible or difficult, the extremities are too cold.

The eyes are less sensitive to cold but they will nevertheless be damaged by extreme cold, especially in combination with the wind. Obviously, extreme sunlight will make you temporarily blind, this can happen in summer and in winter. When you suffer from painful eyes or feel discomfort, give your eyes a rest.

The digestive system, although quite well protected in the core of the body, has a high sensitivity to cold. Avoid direct exposure from your groin to your neck. In very cold weather add an extra layer over your belly area, especially when you’re moving against the force of a strong wind. Weather can be hard on your health – the digestive system literally will come to a halt with very cold temperatures.

 

Medical kit – Take care of your tools and they will take care of you

 

Last but not least, the basic medical kit. You should have one and know how to use it. In regard to the protection of the four primary tools as mentioned before, the first aid kit has to include:

 

• Flushing water, ideally sterile saline fluid. E.g. injection fluid. Ideal for abrasions, cuts, and flushing your eyes.
• Antiseptic fluid or pads, apply after flushing wounds and abrasions. Alternatively, use chlorine tablets in filtered water.
• Band-Aids and sterile gauze.
• Butterfly closure strips.
• Adhesive sports tape. For the fixation of gauze and bandages, immobilization of small fractures and protection of friction areas of the feet.
• Compression bandage for large, profusely bleeding wounds.
• Sugar, for the treatment of burns and as a supplement in case of dehydration when combined with salt.
• Activated carbon and Imodium.
• Zinc oxide ointment for the treatment of feet sores, small abrasions, and other skin irritations.
• Gloves must allow dexterity otherwise they will not be used.
• Protective glasses or goggles.
• Water filtration device. Ideally a Sawyer filter and/or a Steripen; remember to handle the container properly in order to avoid cross-contamination.
• Woolen socks and woolen sock liners.
• Hygiene kit. Antiseptic soap, tooth cleaning set, comb, towel, Vaseline.
• A clean bandana can be used for almost anything in case of need, with a bit of inventiveness.

More medical kit is always advisable and only limited by the knowledge and experience of its user.

 

Outdoor trouble can be avoided but not always. If you spend enough time out there it’s a matter of calculated risk: sooner or later you will have to deal with a critical situation. Despite the best way to learn is by experience, to inform yourself of important facts in advance works fine as well. At least you’ll be a bit more prepared. We have tried to unite personal experience (including failures and mistakes) and on the strength of that, professional healthcare advice.

 

Let’s be careful out there.

 

Featured image: J. van Marsdijk