Medical Considerations in the Backcountry
By Michael J. Maher, NREMT-P
Tactical Paramedic
When you think about it, being alone in the backcountry can be quite dangerous. We take 911 for granted in modern times. They are a phone call away to whisk us to the medical facility of our choice when the unexpected happens. In the backcountry, we don't have that luxury, and first aid is often a forgotten part of planning for our hunting and fishing trips in the wild.
Coming to the table with 20 years of pre-hospital experience, including but not limited to being a flight paramedic and working with SWAT as medical support on an entry team, I have seen the result of poor planning. This is probably the one factor that YOU can have control of when an emergency happens. This reminds me of my old Boy Scout days and their motto: Be prepared.
Don't be this guy! An unprepared gentleman with duct tape on his heels. This is actually a guy we went down the Grand Canyon with.
There are many considerations to be made when preparing a first aid kit for an outdoors adventure. We look at our pack and try to figure out where we will place our layers of clothing, extra food and water, binoculars, ammo, and all of our other equipment, and it is so easy to forget that we are the only ones in charge of our destiny when it goes wrong "out there". With a little forethought, you can make a small first aid kit that will meet your needs during most any incident. Packing everything in a Ziploc gallon bag assures that your equipment will not get scattered nor will it get wet and unusable during a thunderstorm.
When we discuss first aid, we need to be able to triage first aid conditions. Most of us will encounter minor issues that we can fix with a Band Aid or an Advil, and it's a mere inconvenience to us. More important issues we may face require us to be a bit more prepared in the given situation. The two most life threatening situations are loss of airway, (our ability to breath), and hemorrhage. We will discuss many issues and levels of acuity in this article, and attempt to divide them into two categories, Medical and Trauma.
We will begin with what we might need for our everyday "emergencies". You should always keep some basic medications in your pack. Some of your basic anti-inflammatory medications such as Advil or Aleve can make a day of walking and crawling around looking for game and shooting positions a little more comfortable. If you are in remote locations, anti-diarrheal medications (Imodium) can help save a hunting trip if or when a gastrointestinal disaster strikes. The experienced sportsman always remembers toilet paper, but that's another story. If you will be out in the sun, sunscreen can also be your friend. Having a few tablets of an antihistamine such as Benadryl can also be very important, in case you or one of your party were to have an allergic reaction during your trip. This is also handy if you come in contact with poison ivy to relieve some of the itching.
Trauma is a common occurrence in the field. A running joke from my EMS career including managing the Medical Support Team for our local college football games and large outdoor gatherings downtown, both with 30,000 people at each event: the most used piece of equipment is "the Band Aid". More than likely your fellow hunters that come ill prepared will appreciate your preparation. Simple scratches and cuts can be handled with a quick wash with soap or sanitizer and a Band Aid. When you have a more involved cut or laceration, it may be a bit more complicated to dress.
Bandaging materials are good to have to dress and wrap small injuries in the field. 4X4 pads are very handy to cover wounds in the field. This allows a base dressing for the clotting materials in our blood to adhere to and make a clot. Running water over a laceration, although it is our instinct, washes out all of our natural clotting materials. This increases clotting time, which allows you to bleed more. If the wound continues to bleed, you may add more dressings and apply direct pressure to the wound.
A roll of 4 inch wide gauze is very handy to wrap wounds and comes in a very small package. It is usually easier to use than its smaller 2-inch counterpart. This is a pressure dressing to wrap around your initial 4X4 bandage and hold it in place. When teaching self aid/buddy aid courses to law enforcement, we also teach keeping a roll of gauze in the driver door pocket of their cruiser to stuff in wounds if the need ever arose. Another option for the roll gauze is some of the newer bandages that are available from companies like Tac Med Solutions. They offer bandages such as the Olaes bandage that are packaged in vacuum packaging. This allows the hunter to save space in his kit. The Olaes bandage is the same bandage that the Armed Forces carry in their IFAK (Individual First Aid Kit). There are many distributors selling old military surplus medical items at gun shows and surplus stores. Picking up a few of the "emergency bandages" is another cheap option for your first aid kit. Just be aware that many of these items are out of date. So, buyer beware. Personally, I don't mind using out of date materials such as bandages, but that is my personal opinion.
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By Michael J. Maher, NREMT-P
Tactical Paramedic
When you think about it, being alone in the backcountry can be quite dangerous. We take 911 for granted in modern times. They are a phone call away to whisk us to the medical facility of our choice when the unexpected happens. In the backcountry, we don't have that luxury, and first aid is often a forgotten part of planning for our hunting and fishing trips in the wild.
Coming to the table with 20 years of pre-hospital experience, including but not limited to being a flight paramedic and working with SWAT as medical support on an entry team, I have seen the result of poor planning. This is probably the one factor that YOU can have control of when an emergency happens. This reminds me of my old Boy Scout days and their motto: Be prepared.
Don't be this guy! An unprepared gentleman with duct tape on his heels. This is actually a guy we went down the Grand Canyon with.
There are many considerations to be made when preparing a first aid kit for an outdoors adventure. We look at our pack and try to figure out where we will place our layers of clothing, extra food and water, binoculars, ammo, and all of our other equipment, and it is so easy to forget that we are the only ones in charge of our destiny when it goes wrong "out there". With a little forethought, you can make a small first aid kit that will meet your needs during most any incident. Packing everything in a Ziploc gallon bag assures that your equipment will not get scattered nor will it get wet and unusable during a thunderstorm.
When we discuss first aid, we need to be able to triage first aid conditions. Most of us will encounter minor issues that we can fix with a Band Aid or an Advil, and it's a mere inconvenience to us. More important issues we may face require us to be a bit more prepared in the given situation. The two most life threatening situations are loss of airway, (our ability to breath), and hemorrhage. We will discuss many issues and levels of acuity in this article, and attempt to divide them into two categories, Medical and Trauma.
We will begin with what we might need for our everyday "emergencies". You should always keep some basic medications in your pack. Some of your basic anti-inflammatory medications such as Advil or Aleve can make a day of walking and crawling around looking for game and shooting positions a little more comfortable. If you are in remote locations, anti-diarrheal medications (Imodium) can help save a hunting trip if or when a gastrointestinal disaster strikes. The experienced sportsman always remembers toilet paper, but that's another story. If you will be out in the sun, sunscreen can also be your friend. Having a few tablets of an antihistamine such as Benadryl can also be very important, in case you or one of your party were to have an allergic reaction during your trip. This is also handy if you come in contact with poison ivy to relieve some of the itching.
Trauma is a common occurrence in the field. A running joke from my EMS career including managing the Medical Support Team for our local college football games and large outdoor gatherings downtown, both with 30,000 people at each event: the most used piece of equipment is "the Band Aid". More than likely your fellow hunters that come ill prepared will appreciate your preparation. Simple scratches and cuts can be handled with a quick wash with soap or sanitizer and a Band Aid. When you have a more involved cut or laceration, it may be a bit more complicated to dress.
Bandaging materials are good to have to dress and wrap small injuries in the field. 4X4 pads are very handy to cover wounds in the field. This allows a base dressing for the clotting materials in our blood to adhere to and make a clot. Running water over a laceration, although it is our instinct, washes out all of our natural clotting materials. This increases clotting time, which allows you to bleed more. If the wound continues to bleed, you may add more dressings and apply direct pressure to the wound.
A roll of 4 inch wide gauze is very handy to wrap wounds and comes in a very small package. It is usually easier to use than its smaller 2-inch counterpart. This is a pressure dressing to wrap around your initial 4X4 bandage and hold it in place. When teaching self aid/buddy aid courses to law enforcement, we also teach keeping a roll of gauze in the driver door pocket of their cruiser to stuff in wounds if the need ever arose. Another option for the roll gauze is some of the newer bandages that are available from companies like Tac Med Solutions. They offer bandages such as the Olaes bandage that are packaged in vacuum packaging. This allows the hunter to save space in his kit. The Olaes bandage is the same bandage that the Armed Forces carry in their IFAK (Individual First Aid Kit). There are many distributors selling old military surplus medical items at gun shows and surplus stores. Picking up a few of the "emergency bandages" is another cheap option for your first aid kit. Just be aware that many of these items are out of date. So, buyer beware. Personally, I don't mind using out of date materials such as bandages, but that is my personal opinion.
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Medical Considerations in the Backcountry - 2
When discussing trauma, we should not fail to mention ballistic trauma due to the nature of our long range hunting pastime. With wartime medicine having such an impact on civilian pre-hospital medicine, the use of tourniquets has come back into favor. This piece of equipment is another part of vital gear carried by today's warfighters. The most common tourniquet found is the Combat Application Tourniquet. It is readily available, and could make the difference between life and death in the remote areas we all hunt. The average person can hemorrhage his entire blood volume in 2-3 minutes if a tourniquet is not applied. This is a valuable part of a first aid kit that, given the right environment, can save you or your buddy's life when applied quickly and correctly. I would like to mention here that belts are commonly mentioned as impromptu tourniquets. As a general rule, they are too wide and do not make a good device. But anything would work if you have the ability to tighten it enough. Once applied, the tourniquet should be left on and be tightened enough to stop all external hemorrhage.
The Combat Application Tourniquet, the most widely used field tourniquet in the world.
Another hemorrhage control tool is a hemostatic agent. Most of you have heard of QuikClot. There are several hemostatic agents on the market, and we have coined the term QuikClot for all of them (like Xerox for copiers). These are usually an impregnated sponge or gauze pad with clotting agent. This can be placed in a severe wound and stop the bleeding with a chemical reaction. These are effective if used properly, but require some skill and training.
The easy to use hemostatic agent QuikClot helps control bleeding until help arrives or you can get to an appropriate medical facility.
Hemostatic agents are available for the civilian consumer and are usually a good addition to your kit. These materials are applied deep in the wound, so it is not for the faint of heart. The material makes an artificial clot and it has a reaction to blood. If the product cannot be placed directly on the bleeding vessel, it will not place the clot in the correct location and the bleeding will continue. Direct pressure and dressings must be added to the application of hemostatics. The first generations of hemostatics had a pretty aggressive heat reaction to the wound. The newer models of the hemostatics are not nearly as caustic.
Think about gunshot wounds like a trashcan. If the bleeding is at the bottom of the trashcan and all you do is put a lid on it, the bleeding will continue. If you pack the trashcan, then force the lid on it, you will stop the bleeding. Putting pressure down in the wound at the site of bleeding is imperative.
This may seem like an unlikely article in which to quote Plato's book, The Republic, but his words, "Necessity is the mother of invention," can be applied to medical incidents, since they are not often planned. While teaching several Special Operations groups from Iraq and Afghanistan, I have seen photos of tourniquets made out of bandanas and sticks, ratchet straps, and all sorts of impromptu materials to achieve hemostasis. If by chance you forget your first aid kit, do not hesitate to utilize a t-shirt or bandanna or rifle strap, or whatever you may find. Sterility is not an issue in dire circumstances. Antibiotics are readily available at the hospital; it is your job to stop the bleeding and to get the victim to a facility.
A few other odds and ends you may include are a pair of EMT scissors, safety pins, chem light, SAM splint, and a foil blanket. All of this kit can be thrown in your one gallon Ziploc and stowed for use. Most all of these can be purchased at your local drug store.
Assurance that someone always knows where you are when out on a trip is very important. With the common usage of satellite phones and SPOT transmitters, keeping aware of your location with handheld GPS, and the ability to forward that information to rescuers can be imperative to your survival in the wild. With the recent story of the family in Colorado surviving after their Jeep accident in subzero temperatures, always think about "what if" you had to stay in the backcountry longer than expected.
Putting together a small first aid kit could mean the difference between an enjoyable hunt with relief from a slight headache, to saving a friend's or your own life during a catastrophic accident. It's the best piece of gear you hope you will never use, so dedicate a pocket on that pack to a small insurance policy.
And be that Boy Scout: Be prepared.
• One gallon Ziploc bag
• EMT Shears
• Chem light
• Safety Pins
• Moleskin
• 4x4 gauze pads
• 4 Inch roll gauze or Olaes bandage
• Travel size medications (Benadryl, Advil, Tylenol, Imodium)
• Travel size sunscreen (even in winter)
• SAM Splint
• Foil emergency blanket
• Extra personal medications
• Medical or Duct tape (wrap several feet around itself)
• Bandanna
The Combat Application Tourniquet, the most widely used field tourniquet in the world.
Another hemorrhage control tool is a hemostatic agent. Most of you have heard of QuikClot. There are several hemostatic agents on the market, and we have coined the term QuikClot for all of them (like Xerox for copiers). These are usually an impregnated sponge or gauze pad with clotting agent. This can be placed in a severe wound and stop the bleeding with a chemical reaction. These are effective if used properly, but require some skill and training.
The easy to use hemostatic agent QuikClot helps control bleeding until help arrives or you can get to an appropriate medical facility.
Hemostatic agents are available for the civilian consumer and are usually a good addition to your kit. These materials are applied deep in the wound, so it is not for the faint of heart. The material makes an artificial clot and it has a reaction to blood. If the product cannot be placed directly on the bleeding vessel, it will not place the clot in the correct location and the bleeding will continue. Direct pressure and dressings must be added to the application of hemostatics. The first generations of hemostatics had a pretty aggressive heat reaction to the wound. The newer models of the hemostatics are not nearly as caustic.
Think about gunshot wounds like a trashcan. If the bleeding is at the bottom of the trashcan and all you do is put a lid on it, the bleeding will continue. If you pack the trashcan, then force the lid on it, you will stop the bleeding. Putting pressure down in the wound at the site of bleeding is imperative.
This may seem like an unlikely article in which to quote Plato's book, The Republic, but his words, "Necessity is the mother of invention," can be applied to medical incidents, since they are not often planned. While teaching several Special Operations groups from Iraq and Afghanistan, I have seen photos of tourniquets made out of bandanas and sticks, ratchet straps, and all sorts of impromptu materials to achieve hemostasis. If by chance you forget your first aid kit, do not hesitate to utilize a t-shirt or bandanna or rifle strap, or whatever you may find. Sterility is not an issue in dire circumstances. Antibiotics are readily available at the hospital; it is your job to stop the bleeding and to get the victim to a facility.
A few other odds and ends you may include are a pair of EMT scissors, safety pins, chem light, SAM splint, and a foil blanket. All of this kit can be thrown in your one gallon Ziploc and stowed for use. Most all of these can be purchased at your local drug store.
Assurance that someone always knows where you are when out on a trip is very important. With the common usage of satellite phones and SPOT transmitters, keeping aware of your location with handheld GPS, and the ability to forward that information to rescuers can be imperative to your survival in the wild. With the recent story of the family in Colorado surviving after their Jeep accident in subzero temperatures, always think about "what if" you had to stay in the backcountry longer than expected.
Putting together a small first aid kit could mean the difference between an enjoyable hunt with relief from a slight headache, to saving a friend's or your own life during a catastrophic accident. It's the best piece of gear you hope you will never use, so dedicate a pocket on that pack to a small insurance policy.
And be that Boy Scout: Be prepared.
• One gallon Ziploc bag
• EMT Shears
• Chem light
• Safety Pins
• Moleskin
• 4x4 gauze pads
• 4 Inch roll gauze or Olaes bandage
• Travel size medications (Benadryl, Advil, Tylenol, Imodium)
• Travel size sunscreen (even in winter)
• SAM Splint
• Foil emergency blanket
• Extra personal medications
• Medical or Duct tape (wrap several feet around itself)
• Bandanna
