Medical Considerations in the Backcountry

[ADMIN]

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. Read More...

This is a thread for discussion of the article, Medical Considerations in the Backcountry, By Michael Maher. Here you can ask questions or make comments about the article.

 

[mnoland30]

I hunt by myself quite often, and even when I'm hunting with a buddy, I'm often out of RINO contact. If you don't know what a RINO is, it is the best hunting device invented since the rifle. It is a radio/GPS, that tells you where your buddy is every time he keys the switch to talk.

I carry a Personal Locator Beacon (PLB). They cost about $250, weigh less than 5 oz. and tell rescuers where you are and that you're in trouble. As long as you aren't in the very bottom of a deep canyon, it will reach a satellite eventually. I figure it is the cheapest life insurance I can own. It fits in the pocket of my BDU hunting pants, so it is always with me on a hunt. They tried these out in Alaska for a few years and the results convinced them to expand the system. It is a free service from our friendly government agency NOAA.

I'm 60 years old, and the older I get, the more I realize how easy it is to have a debilitating accident in the field. It has never happened, but the odds go up as I get older and my reflexes get slower. I once tried to climb over a very large rock to avoid brambles on both sides. Once I got my weight shifted up onto the rock, the rock started to roll. I grabbed my rifle and jumped to the side in time. The rock crushed a 5" thick tree 5 feet below me. That was an adrenaline rush. When I sat down, my leg was jumping up and down uncontrollably. Back then, I had no way to summon help, but my muscles were young and my reflexes quick. Every hunter should own a PLB.

I carry a first aid kit very similar to the list you have. I seldom use anything but the adhesive tape and the advil, but someday I may need it.

 

[azmetalman]

I also spend some time alone in rugged country each year. My emergency kit is similar to those discussed on this site. I would like to hear from our members which emergency locator the are using and why. I am 67 and it is past time for me to buy one. I have done a lot of research but I rely on LRH for good first hand information.
Let's hear what you are using.

 

[mnoland30]

I use an ACR. This is my second one. The batteries can't be replaced by the user, and are guaranteed for 10 years. The cost of replacement was nearly as much as the cost of a new, lighter, smaller unit. They have a couple of models, depending on whether you need it to float. I keep it in a fluorescent orange bottle cooler that would float if necessary. I wanted it as light and small as possible. My old one was so big that it wasn't comfortable in my pocket, and ended up in my pack. The new one fits great in a pack.

 

[mmaher]

Mnowland, Im glad to hear you 1) have a first aid kit, and 2) confirm what the article says about using the basics more than anything. It does take a little forethought to have prepared a kit and actually be using it. I see so many people unprepared for an emergency. It doesn't always have to be YOU that gets injured, so you are like an insurance policy for your hunting partners. Im glad you mentioned the PLB's. Technology has advanced so much in the last 10 years with the GPS availability, that there isn't much reason not to take advantage of it. Relatively cheap "insurance" given the money we spend on firearms and hunt prices.

AZ, I know Les/Chris in the LRH store have some locators for sale.

It does bear to mention that when I spent a month in the Grand Canyon, the Satellite phone we thought would be the cats meow, was pretty much useless, since we were in a 1500 foot hole in the ground. (not really the equivalent of an outwest hunt geographically, but satellite tech does have its nuances) Make sure you really read the specs on the units before you buy. Making sure you know how to use and read GPS is very important. I was a Flight Paramedic for 10 years. We had many times where "Joe Fireman" turned on the Department GPS, and would give us incorrect data, vectoring us across the county, away form the accident scene. Not what you want if you or your buddy is injured.

Also, do you have a number to contact for help? Does your Satellite phone call 911 for the appropriate authority having jurisdiction or someone states away? It does not work like your normal cellular technology and the closest tower.

I appreciate you guys sharing your ideas.

 

[JP100]

Good article. The PLBs are definitely worth the money.
Alot of areas can 2-3 days walk from the road end and if you fall/slip a broken leg/ankle wont be much fun. A PLB can get a chopper on its way in no time(here in NZ anyway).
Have heard of guys here miss using PLBs which really ****es me off. Guys that are late to work from from a weekend trip so they hit the PLB to get a chopper out of the bush.

 

[hcr]

This is a thread for discussion of the article, Medical Considerations in the Backcountry, By Michael Maher. Here you can ask questions or make comments about the article.

Excellent article. Of great help for those who hunt away from the civilized centers. I thank the author because it has given me great information to consider. Usually mountain hunt deer, wild boars and pumas (live in Patagonia, in San Martin de los Andes) and often alone. Best Regards. Hector

 

[tilsonr]

On Quick Clot
My most recentCombat Lifesaver course stressed that Quick Clot was replaced by a Combatbandage. The powder from Quick Clot was not controlled enough to fill the woundand spread all over the place many times. In addition, most people used theirteeth to rip the package open producing other issues with the clotting materialgetting in the eyes nose and mouth. The CLS bags now contain pressure bandagesimpregnated with the clotting material that not only puts the QC material onthe tissue but backs it with the pressure bandage. Please check with otherTriage specialists and perhaps switch out to the most up to date life savingprotection.
The military Tourniquet described is an extremely good item to have. When the adrenaline is pumping, all fingers turn into thumbs and you are trying to control with one hand and get the control in place with the other while everything is slippery. Important things to remember is to place the
Tourniquet 2 inches (two fingers) above a joint or, above a previous tournequit. The twist bar only has so much slack and if you don't putt the band tight (the slack line within the nylon cover) you may end up breaking a component or not get enough tight to control the bleeding. Sinch with the hand as ticht as possible before securing the bar. Check pulse below the wound to ensure there is none. Now, before you rest or pass out, write on the white band (if the device is a new one) or on your skin in permanent ink, the time. This is important for the triage team so they can manage your life and hopefully save the limb.
Not much time left now, have to get back to work.
JOTC JW-SERE Bob

 

[mmaher]

Hector, sounds like you hunt in places that you are not on top of the food chain! Good reason to keep some med supplies on hand!

Bob, you are exactly right, most of the powdered hemostatics are falling out of favor. For several reasons, two being the exact reasons you mentioned, poor utilization under stress, and the chance to get the stuff in your nose, mouth and eyes, causing issues with the caregiver. Another issue with the powdered hemostatics is in the hospital. A lot of the trauma surgeons do not like the stuff, since they have to get all of the loose powder out of the wound in order to keep the patient from having infections. The picture I included in the article was of the impregnated sponge/gauze that is more prevalent these days.

The use of a tourniquet is usually mitigated by two reasons, 1) you know this patient will bleed to death if not used (most medical situations) 2) or the victim has been shot, and you are in a hostile area and need to place it with no assessment of the wound due to the dangerous situation. It is placed to avoid hemorrhage until you can assess in a safe zone, behind cover. . .

Whatever you choose to use between hemostatics or your TK, it all takes some training or practice before the need arises! As Bob described, under fire, your ability for fine muscle dexterity goes out the window, and gross large muscle movement takes over.

 

[GBA1776]

This is great advice, even though I find the reccomended kit a little lacking, However if you use your head you can do a whole lot with that list.
But like others have mentioned when you are bleeding or someone else is bleeding it can be difficult to take a breath stop and think about how you can rig this or that up using what you have. The right tools for the job can go a long way under the best of conditions, but under critical stress it may be the difference between life and death.

That brings up a really important topic that I feel that article completely missed and that is training. you could have a hospitals resources at your disposal but if you dont know what you are doing, it wont do you, or a person you are trying to help any good. So taking at the very least a basic course that includes CPR and how to treat bleeding, sprains and most importantly shock is IMO essential for anyone going into the woods or anyone for that matter, If you have a first aid kit you need to know how to use whats in it and what to do to treat basic to serious injury. You wouldnt go out and buy a brand new gun and a box of bullets and go hunting, so why would you do that with your lifeline if something goes wrong in the middle of nowhere.

My FAK has some items that are more survival kit stuff, but since I will always take the entire kit with me on even the shortest trips away from camp, It makes sense for me to include them, that with the survival kit in my daypack im pretty well set.

I use 2 1 gallon freezer bags and 6 smaller quart bags for extra protection and organization. I put all of the stuff into smaller bags and press all the air out, this keeps them compact, dry, and helps them to stay closed. that all goes into the first Gallon bag thats pressed as flat as possible, and then it put that in the second gallon bag and Gorrila tape the seal shut.

Ive got a Bleeder bag, Burn Bag, Sticky stuff bag, Mechanical injury bag, medication bag, and a general bag. All of that goes inside the two 1 Gallon freezer bags as i described earlier.
I also have two 6"x2" pill bottles that are outside of the freezer bags since they are watertight and basically crushproof, In them I have a basic kit with small frequently used stuff like band aids, chapstick, sunscreen, antibacterial cream ect, So I dont have to break into the main kit every time someone gets a cut. I didnt list whats in the bottles because its super basic, and Ive got more in the larger kit.

My kit is pretty bulky taking up the entire 10x12 pocket on the bottom front of my pack, but its dedicated to medical except for the 2 road flares I keep in there. and its heavy 4lbs or so, including the pill bottles and a minor surgery kit with a scalpel, hemostats, sutures, scissors tweezers nail clippers, a flashlight ect.

A good flashlight is ESSENTIAL I tossed the crap one that comes in all FAK's and use two AAA penlights one is a Streamlight Microstream, thats in the main kit and in the "Minor Surgery" kit with all the tools I have a Foursenvens Preon 1 80 lumen light that runs 20 hours on a single AAA. I also carry 4 spare lithium AAA's

I also carry 2 each ascherman, halo and bolin chest seals, that may seem nuts but from what ive read, it seems each one has one situation its really good for, and my thinking was if I have to tear open all 6 to get a working seal front and back I dont care. that is about $120 of medical crap right there but its worth it. they are really flat and dont weigh anything.
You can make field expediant seals for sucking chest wounds but Id rather not try when its either me or someone else with a hole/holes on there chest

My FAK contains
4: each 4x4 6x6 and 8x8 kendall drain sponges
2: Isreali field dressings
4: " heavy flow" Maxi pads they are great bandages, cheap, sterile and large
2: 12 oz bags of quick clot (will get hemostatic bandages soon)
2: ace bandages one 4" wide and one smaller 2" wide both 60" long
6: each Assorted bandaids, small, medium, large, large patch, and knuckle
4: elbow/knee bandaids.
12: butterfly closures (better than a suture in the field because yyou will need to clean your wound thouroughly to stitch it up, hard to do in the middle of nowhere)
2: packs of 10 3M Steri strips (its the stuff they use at MMA fights to close cuts)
2: CAT tourniquets
2: Epipen injectors ( rarely one wont work) also pricey but worth it IMO, and you get free replacements if you dont use them before expiration.
1: 18" SAM splint
5: SAM finger splints
2: Heat packs I get the largest Thermacare back pads
4: handwarmers (that and the heatpads for treating hypothermia and shock, the back pad goes on the chest or neck and the handwarmers in the armpits)
2: small instant Ice packs
3 feet of almost every tape, paper tape, nylon tape, waterproof tape (latex free), 3M coband, its self adhesive only stretch tape great for holding bandages on and its easy to change them and re-secure. , (that Mcnetts Camo Gun wrap is very similar).
2: 30' sections of Gorrila duct tape. I wrap the medical tape around small sections of cut up plastic cards and wrap the Duct tape around full plastic cards.
this keeps the tape in nice flat and compact, and Ive found it much easier to use than wrapping tape around itself in a small roll, especially with gorrila tape.
1; SOL space blanket
1; SOL Space blanket bivvy.
12; q tips
1; pack of tissues
10; heavy duty Blue Shop paper towels from the auto parts store
1;; pack of "camp shower wipes"
1; 1oz bottle of nystatin powder (antifungal powder)
1; pack of colgate wisp waterless toothbrushes
1; tube oragel.
Those last 6 items are more comfort than First aid but I dont take my hygene kit out for a day hike, I do take the FAK. and if I get stuck or hurt and have to stay put that simple stuff can do wonders for morale.
10; each alcohol pads, iodine pads, and moist towelettes.
2; 2oz packets of Burn Gel. For minor burns like 1st and 2nd a good minty toothpaste is very soothing if you dont have burn gel

I also keep a chocolte bar (dark chocolate) and 2 Cliff bars (protien and energy bar) and a 12 oz packet of emergency water and 6 packets of powdered gatorade mix for electrolyte replacement, also for flavoring any water I have to treat with tablets (that stuff is awful). a Platypus 20oz water bag, some h20 purification tabs, And an Aquamira Lifestraw water filter

Also a "rite in the rain" 3x5 waterproof notebook and one of the super compact space pens.
Thats for keeping treatment notes or just writing or drawing to keep spirits up and your mind off of whatever is going on at least temporarily. thats what the chocolate is for too

I also have a small basic first aid handbook and a laminated sheet of contents of the FAK and a Basic Do's and Dont's of first aid. Thats so anyone going into my kit to save my *** will know what ive got and where its at, and at least some basic first aid instructions for those who didnt know in the first place or someone who does (myself included) but the situation has got you so stressed/overwhelmed your brain just inst working, and you cant remember your name let alone how to treat shock.

The assorted pills, Pain meds, antibiotics, antihystamine pills and cream, asprin, Ibuprofin, naproxin,Antiinflamitory, Anti diarrhea pills, Antacids.

I saved this for last because of a very important not I wanted to make.

Either buy pre packaged travel medications that are sealed and usually waterproof or if you buy bulk, or if you stock your kit from the medications you have at home especially prescriptions ensure they are clearly labeled, with the name of the drug the dose and what its for. I label any bags with a Sharpie then use clear packing tape over the writing so it wont wear off

SUPER IMPORTANT, Keep all the pills that are not individually sealed, Seperated from one another, Dont throw a handfull of asprin, tylonol, and ibuprofen in a bottle.
If someone is severely allergic to asprin and you stopped them from bleeding to death, it would be a shame for them to die because some asprin dust got on the Ibuprofen you gave them to help with any pain.

thats also important if you have any personal medications, it may have ingredients someone is allergic to or cause a reaction with some medication they are on.

That may sound stupid but Ive seen it happen, my buddy had a really bad reaction, because the asprin and other stuff in someones FAK was just tossed in a bottle. He was handed some Ibuprofen after he sprained his ankle, and within a minute he couldnt breath and had swollen up considerably and had to use his epipen. the only allergy he has is Asprin. and its also important to note that if he had a traumatic wound and had some pretty bad blood loss and the same thing happened, the epinephrine injection could easily send someone in a weakened condition into shock. and that would probably kill them.

Sorry for the really long post (its probably longer then the article) but Its a really important subject.

 

[Sully2]

Your FAK contains about 4 times more than whats needed in 99% of cases an at least 95% more than the avg stalking hunter wants to carry

 

[GBA1776]

Thats very true my FAK is large and heavy, And Ive never had to use any of the more serious stuff in it, I hope I never do. And its much more than most want to lug around, Hell I wish it was smaller and lighter.
You could get away with cutting the amount of each item down by 3/4, and ditching the minor surgery toolkit, thats about a pound on its own, and if you dont have allergies ditch the epipens. Im not allergic to anything but still like to have them.

If you really customize a FAK for your needs you could get it pretty small and still be able to do alot.
If my kit is overkill for you, It most likely is, you can use it as a guidline and just dont have near so much of each item.
My kit rides in my Car everyday in a daypack with some survival gear, then I take it with me anytime I go into the woods. I designed my FAK to be a life saver in that worst case multiple injury/multiple injured situation, and I pay for that peace of mind with size and weight.

I did forget to include the NPA and a few sets of rubber gloves.

Buying a Marine Corp, or Army IFAK is a good start to any kit.

My fak is so comprehensive (overkill) because I had been in a situation where someone was seriously hurt, and the kit i had was "standard" and laughable.
I came up to a pretty nasty car accident on my way home from work, a guy on a Motorcycle and a Tahoe met on a narrow windy two lane back road, the driver was hurt, but pretty much ok, he was just stuck in the car, it was off the side of the road and in a ditch on its side at about a 45 degree angle, with the driver door on the ground and the passenger wheels in the air.
He started yelling for help when he heard me pull up and get out. If I remember right He had a broken arm Collar bone and a rib or two, but he was talking and not bleeding, he told me that he called an ambulance already, and asked me about the other guy. I told him the other guy should be fine,I didnt want to panic him.
The guy on the bike was a complete mess, he was down the road about 50yds, I will never forget what he looked like for as long as I live. I will save you the gruesome details, but he had a severely broken arm, and a worse off leg, thats where the bleeding was the worst.
I had a basic store bought "Emergency First Aid" that was in a 12"x6" square case that you will find in alot of peoples trunks and it was a joke. It was crammed full of garbage, like little triangular reflectors,flares and a crap flashlight, and a few other dumb things, It had a "trauma kit" in it as well but that was 2 6x6 and 4x4 pressure bandages and some other stupid small stuff only suited for scrapes and bruises, It was no more capable in that situation than a ziploc bag full of bandaids, maxipads and neosporin.

the few "compress" bandages of each type were soaked in blood pretty much as soon as they came out of the package, and they were nowhere near good enough to stop decent bleeding in one spot, let alone major bleeding in two spots.
But i did manage to get the bleeding slowed down and almost stopped on the guys leg with my hooded sweatshirt, I tied the arms into like a pretzle after I put it inder his thigh.
Thank god he was knocked out, I stepped on his inner thight on the femoral artery with my foot and tightened the sweatshirt arms as much as possible, used a large screwdriver I had as a tourniquet bar and ran it trhough a belt loop to keep it tight, Since the sweatshirt was Cotton I had to keep tightening it as it sretched.
I then used my knife to cut off the rest of the chest part of my Hoodie and used that as a bandage because my makeshift tourniquet wasnt stopping all the blood.
I used my Tshirt to tie off his arm, and used another screwdriver in the same way which got the arm to completly stop bleeding.
I was there by myself for what felt like hours, after I stopped/slowed the bleeding, I sat right next to him, I was half naked covered in blood and soaking wet, listening to the guys slow ragged breathing over the heavy rain , it was in reality probably more like 10-15 minutes.

I had no cell signal, but thankfully the Tahoe was onstar equipped and that worked so the driver was able to call an ambulance. I dont know for sure how long they had been there before I pulled up, but with how badly the one guy was bleeding I must have drove up right after it happened.
The Ambulance crew was confused to see me there no shirt on in 45 degree rainy weather and covered in blood. They thought I was the driver of the Tahoe At first. After checking the guys vitals they immediatley gave the guy a saline IV to get his blood pressure up, Then loaded him onto a stretcher and into the ambulance leaving one EMT there to look after the Driver of the SUV. And they immediatley left for the hospital

I was told to follow a cop to the hospital to get cleaned up and checked out and to give a statement .

I was told later by the EMT who stayed behind the guy on the bike was in critical condition when the Ambulance crew arrived because he lost a whole lot of blood but, they were able to stabilize him on the way to the hospital so he should be fine.
And he said the two tourniquets certainly saved his life, Even though I should have put them lower on the limbs, both breaks were below the joint so i should have put one just above the knee, and the other just above the elbow. I had put the one on the leg at the groin, and the one on the arm at the top of his bicep.

They wouldnt tell me anything else about the guy on the Motorcycle because I wasnt family. And since I didnt see the accident happen I dont know if they went to court or any details about the driver or the guy on the bike.

Now if I had been out in the middle of nowhere with no reception and no onstar, I would have had to drive the guy to the hospital myself, and since I didnt stop the bleeding he probably would have bled to death. Or I would have killed him just by trying to put him in my Camaro

Lets move that serious break and bleeding out to where I would be hiking even just a few miles away from my car or a road, If I had to get half naked to stop the bleeding on someone else, or worst case myself, Id probably be looking at an overnight stay, Or if it was someone else Id have to leave them there with makeshift touriquets and bandages, And go out for help. And in that situation Hypothermia could kill me Or them . Hell even on a nice day say 65 degrees during the day and no rain, without a shirt and jacket at night even with a fire hypothermia is a threat.

Im not trying to say everyone needs a kit that serious, but if you do plan on going out on a day hike/hunt I at the very least Reccomend an Army Surplus IFAK so a tourniquet, bandages, and a NPA, some sort of space blanket preferably a Bivvy sack.

One experience with being woefully uprepared and unequipped to deal with a serious injury, even for just 15 minutes with an ambulance on the way opened my eyes.
And I will not be put in that same situation again because I didnt make some simple preperations. Circumstances may limit what ive got but the knowlage Is just as important.

Thats why Im now CPR certified and have taken a half dozen of more involved and more in depth medical courses, that are available all over and are very cheap to attend.