While I do enjoy the thriving metropolis of Los Angeles, I always look for opportunities to get out of the city for a breath of fresh air (literally). Many who share this sentiment find great trails to hike or areas to rock climb and boulder. With the great outdoors, however, comes great potential for injury. Injuries in the wilderness are always much more difficult to address than an equivalent injury in the city. If a member of a hiking group slices open his or her leg in the middle of a hike spanning multiple days, there are many more factors to consider than a similar laceration in the city where a hospital is a short car ride away.
One of the concerns that is more common in the wilderness is the environment. How did the individual get hurt? Was it an animal, a falling branch, or something else? Most importantly, is it something that might pose a threat to the other members of the group? Assessing the situation reduces the risk of further injury, either to the original person or to others present. If the cause of the injury is still a threat, then you have to figure out how to remove the injured person, yourself, and the other people to a safer location.
Once the area is determined to be safe, infections and exposure are the largest concerns. If it is the second or third day of the hike, there is plenty of time for an infection to fester during evacuation if the wound is not adequately cleaned and bandaged. The group must quickly address the decision to continue with the trip or turn around and seek medical attention. Exposure includes dangers such as hypo and hyperthermia. Low temperatures combined with blood loss can quickly lead to life-threatening hypothermia. The injured individual should be kept warm. Covering him or her with a blanket or sleeping bag is a good approach if it’s cold on the trip. The other temperature related danger – hyperthermia – can be addressed with fluids and ensuring that the person does not overexert him/herself. Be mindful of how severe the injury is and how much that will affect endurance.
The most important factors in preventing infection are how prepared you are and how well you can improvise. It can be difficult to find a balance between packing enough medical supplies for the trip and packing so much that your hike becomes miserable with the additional weight. If you take some necessities, such as gauze, tape, Tylenol, and tampons (don’t laugh, they’re great at absorbing a lot of blood), then you can reasonably improvise with other gear you bring along. For example, if somebody in your group cuts his or her leg and you want to irrigate it to remove loose debris, poking a hole in a water bottle works as well as a syringe. Similarly, if you do not have gauze or anything to absorb blood while you stop the bleeding, you could use a shirt or a towel. Be as prepared as possible, but also be capable of improvising if necessary.
Being able to properly clean a wound is also very helpful. Of course, the first step is to stop the bleeding. As far as I know, blood transfusions in the wilderness are frowned upon. Applying pressure to the wound will usually take care of the bleeding on minor to moderate wounds. Once the bleeding has stopped, you can use water to irrigate the wound to remove loose debris and bacteria then either covering it with a bandage. In the case of a severe laceration, one approach is to pack the wound with moist gauze, cover it with dry gauze and secure it with a bandage. As long as the wound is cleaned and covered, it will help reduce the risk of infection.
In the case of wounds that won’t stop bleeding, apply a tourniquet and hope you can get back to civilization in time. Assuming that you do not take a combat tourniquet on hikes with you, you can fashion one out of a piece of cloth – towel, pants, shirt, etc. – and a stick. Wrapping the cloth around the limb in question, above the site of bleeding, and the wrapping it around the stick to apply torque and tighten the cloth will hopefully at least slow the bleeding, if not completely stop it. As soon as the bleeding stops, however, you are on a time to get the person to real medical care or they risk losing the limb. This outcome is still better than dying of blood loss, but it is certainly not ideal.
The wilderness is fun, and wilderness medicine is exciting. I’ve only touched on the very basics in this blog post, but I hope that it was interesting or scary enough to consider learning more about the topic before a big trip up into the mountains.