13. Survival First Aid

Chapter Thirteen

SURVIVAL FIRST AID

Like the animals, you will soon realize that nothing limits your effectiveness in the wild more than an injury. What separates us from the beasts, however, is that we can treat ourselves (although there is evidence to suggest that some animals treat themselves with herbal medicines by eating certain plants when they have upset stomachs).

Although you have a responsibility to yourself and your travel mates to know as much about wilderness first aid as possible, this is something that can’t be mastered by reading a book. I strongly recommend you prepare for your adventure by taking a wilderness first-aid course.

Even then, for all the first aid you may know, a more important factor in survival is injury prevention. All your movements should be planned, methodical, and cautious. If you want to be a TV stuntman, go ahead and leap from cliffs and dash across raging rivers. If you want to survive, then protect yourself against injuries in the first place.

Your Survival First-Aid Kit

AMONG THE MOST IMPORTANT COMPONENTS of your survival kit are the first-aid items. Ensure too that you are familiar with the kit’s contents and know how to use them. See “Survival Kits,” Chapter 2.

Like your complete survival kit, your first-aid kit should be customized for the area you’re visiting and (to a lesser extent) the activity you’re doing.

Herbal Medicines and Healing Plants

WHILE IT’S APPEALING TO THINK that you might be able to heal yourself with plants in the wild, the chances of your doing so are even slimmer than the chances of your finding safe plants to eat. Nor is using plants to heal as simple as picking the plant and either eating it or applying it to your skin. In many cases, complex concoctions require careful preparation.

Healing plants are also region specific and the product of generations of experimentation and use. Near Georgian Bay, Ontario, jewel-weed grows right alongside poison ivy and can be a great traditional remedy as a preventative wash for poison ivy. But to use it effectively, you need to learn how to recognize both plants. When I was in the Amazon, Waorani medicine was helpful in curing the fungus on my feet, but it came from a native woman who drew on her own experience and that of her people.

The Importance of Hygiene

SURVIVAL IS DIRTY, but that doesn’t mean you should ignore basic hygiene, which is an important way to ward off infection and disease, and to prevent minor injuries from becoming major.

If water is available, try to wash yourself daily, with or without soap. Your hands, hair, feet, and armpits are the likeliest areas of infestation and infection; pay special attention to them.

Always keep your hands clean, since germs found there can infect you and your food. Wash them frequently, especially after a bowel movement. Your hair should also be kept as clean as possible to prevent infestation by fleas and lice.

Another significant aspect of personal hygiene is keeping your clothes clean. This may mean making like your ancient ancestors and scrubbing clothing in a river with rocks. If you don’t have a water source nearby, shake your clothes out (especially your underwear and socks) and leave them to dry in the sun for a few hours whenever possible.

Prevent mouth infections and abscesses by brushing your teeth daily, whether or not you have toothpaste. Improvise a toothbrush with a young, green twig, assuming you are sure it’s not poisonous (based on all the excellent pre-trip training you did on the local flora and fauna!). Peel the bark off the end of the twig and chew it until the fibers begin to separate. You can use these fibers to dislodge any food bits that accumulate in your teeth. You can also wrap a piece of cloth around your finger to brush your teeth; small amounts of baking soda, sand, or salt can act as abrasives. Fishing line can double as dental floss.

If you find yourself getting damp and musty but don’t have sufficient water on hand, strip and let your body dry in the air for at least an hour, while wiping yourself (especially the areas I just mentioned) with a clean rag. Be careful not to let yourself cool down too much. It’s better to do a wipe-down early in the day or when the day is at its warmest.

STROUD’S TIP

The four body parts you should protect in survival situations are your eyes, feet, hands, and stomach. All these are vital parts of the body, needed for survival.

Finally, do not soil your site with urine and feces. Choose an area at least 100 yards (91 m) from your camp that will serve as your “outhouse” and use it. Dig as deep a pit as possible and deposit your feces into it, covering it up afterward.

Prioritizing Survival First Aid

ONE OF THE MOST STRESSFUL TASKS you may have to take on in a survival situation is prioritizing first aid, also known as triage. This is where you choose to treat the person with the most life-threatening injury, working your way down the line to the least severe injury.

If you are treating only one injured person, you should take the following steps:

1. Check breathing: Check the victim’s airway. Make sure it’s open and the victim is breathing. If not, start mouth-to-mouth resuscitation.
2. Check for unconsciousness: If the victim is unconscious but breathing, place him or her on one side with the top leg at a right angle to the body. Use his or her hand to support the head and tilt the head back to ensure an open airway.
3. Check for bleeding: Stop any bleeding.
4. Check for shock: Treat shock.

Major and Minor Injuries

WILDERNESS INJURIES USUALLY FALL into one of two general categories: major or minor. Luckily, most are minor. Although these will not stop you in your tracks, remember that any minor injury left untreated in the wilderness can quickly become a major one. For this reason, all injuries in the wilderness should be taken seriously.

For example, if you’re in the Amazon and suffer a small cut, you’ll still be able to function normally. However, that little cut can rapidly grow infected and become a major problem. If you are walking and get a blister on your foot, you may be able to keep up the pace (and endure the pain) for a day or two more. But left untreated, that blister can virtually cripple you, preventing you from reaching safety.

I was once in an adventure race with three other teammates, when one of the members of our group began to experience irritation and chafing in her groin. We had to keep moving and didn’t treat her when it was still a minor discomfort, and as a result, within 24 hours it turned into a full-blown infection, to the point where she could no longer walk.

STROUD’S TIP

Don’t ignore any injury, no matter how minor.

Major Injuries and Illnesses

THE KEY TO DEALING WITH MAJOR INJURIES AND ILLNESSES is to prevent them from occurring (to the extent that you can). Should you or anyone in your party suffer from the following maladies, you need to act quickly and decisively; in the wilderness, injuries and illnesses can become life-threatening very quickly.

Dehydration

Dehydration is a serious risk in the world’s hot and dry regions, and one that can kill you within a few days. Finding protection from the wind and sun will slow the rate at which you lose water, but you will eventually need to get to a water source. If your only choice is to drink unpurified water, do it. I’d rather take my chances with parasites than die of dehydration.

Since you also lose valuable salts when you dehydrate, you should consider including an over-the-counter electrolyte replacement product in your first-aid kit. If you don’t have one, add a quarter-teaspoon of salt to a quart (liter) of water.

Dehydration victims should drink frequently, and in small amounts.

Hypothermia and Frostbite

Once again I have asked my friend Gordon Giesbrecht, PhD, professor of thermophysiology, to chime in on how to handle hypothermia and frostbite:

Hypothermia: A hypothermic victim takes a while to become that way (anywhere from one hour to several days). It is critical to treat a cold victim as gently as possible. Quick, rough actions could be fatal due to changes in core temperature, blood pressure, and work required by the heart. Follow these steps:

1. Handle the victim as gently as possible.
2. Keep the victim horizontal.
3. Don’t let the victim walk or struggle.
4. Get the victim to shelter as soon as possible.
5. Once in shelter, consider removing the victim’s wet clothing, usually by cutting it off.
6. Place victim in as much insulation as possible (sleeping bags, blankets, et cetera).
7. If you have any source of heat, apply it to the chest and armpits. This could include a heat pack (fueled by electricity, chemicals, or charcoal, for instance), warm water bottles, or a healthy (that is, a warm) member of the group.
8. If possible, wrap the victim loosely in a vapor barrier such as plastic.
9. Only if the victim is awake and alert, give him or her food or drink with high caloric value (for example, hot chocolate or a chocolate bar). Monitor the victim for problems breathing and signs of worsening condition. Also check the feet and hands to make sure they are not getting cold.

Frostbite: Frostbite can have devastating effects, especially if treated improperly. For more than 200 years, the common remedy for frostbite was to rub the frozen area with snow or submerge it in cold water. This was an overreaction and is no longer recommended. Here are the do’s and don’ts of frostbite treatment:

Never rub frostbite.
Never expose frostbite to anything cold.
Never try to warm frostbite with dry heat from a fire or over a stove.
Never rewarm a frostbitten area if there is a chance it could freeze again (e.g., if you are out in the mountains with several days remaining to walk to safety).
Warm a frostbitten area either by contact with warm human skin or by immersion in warm water at about 99°F (37°C).
Do not burst any blisters that may develop.
Resist amputating dark or even black tissue; in many instances much or all of the tissue may survive, given enough time and tender care.

STROUD’S TIP

Remember this rhyme: fingers, toes, ears, and nose. These are the areas that are prone to frostbite.

Shock

Shock is a natural reaction that occurs in most seriously (and even not-so-seriously) injured people. It can affect you on two levels. The first, the good reaction, is the one that provides you with potentially superhuman strength and helps you get out of potentially dangerous situations. This is the characteristic of shock that lets a person with a broken femur crawl for miles to safety or lift a car to free a trapped child. It’s also called an adrenaline rush. The dangerous part of shock is what comes afterwards—the debilitating part that renders you unable to help yourself.

To treat shock, lay the victim on the ground, insulated from the ground, if possible. If the victim is conscious, elevate the legs about 12 inches (30 cm). If the victim is unconscious, roll him or her onto one side to prevent choking on vomit and other fluids.

Maintain the victim’s body heat, either by protecting against the elements or adding external sources of heat. Give the conscious victim small doses of sugary solution to drink if he or she is able to drink, and if possible, make sure the person rests for at least 24 hours.

Burns

Burns can be dangerous in the wilderness, and are a very real risk, given the importance of fire to your survival. The worst burn I ever saw was on a camping trip when a girl lifted a frying pan with bacon and dumped the grease down her arm.

These types of burns (from oils and grease) are especially serious because they will continue to “cook” under the skin even after you’ve removed the burning material from the body part. Regardless of the cause of the burn, the first thing to do is immerse the area in cold but not freezing water. If you need to cover the wounds (for transporting a victim), apply dressings and rags that have been soaked in cold, clean water. If not, keep drizzling water over the wounds until rescue arrives.

With wilderness burns, there is risk of infection. After cooling, treat all burns as you would an open wound. With a covered wound, change or sterilize dressings daily by boiling. But it is best to keep the burn uncovered and to drizzle cool water on it constantly.

Finally, never apply butter or similar salves to burns. The only creams you should use are antibiotic or burn creams.

Joint Injuries

Joint injuries include fractures (breaks), dislocations, and sprains. They can be among the most debilitating wilderness injuries, since they will prevent you from one of your most important survival goals: moving. Prevent joint injuries by exercising caution at all times.

Fractures: Fractures are the most serious of joint injuries, more so if they are open or compound fractures, where the bone protrudes through the skin. In these cases, it’s obvious immediately that a bone has been broken. If the bone does not break the skin, signs of fractures include extreme pain and tenderness, loss of function, swelling, general deformity of the area, and a grating sound or feeling.

To treat a fracture, you must immobilize and splint the broken bone. A splint is a solid surface, such as a stick, that you tie to the area to keep the bone immobilized.

A stick or pole is best for making a splint, although even rolled-up towels or clothing can work.

Try to pad the splint where it contacts the skin to prevent chafing; tie it tightly enough to secure it, but don’t cut off blood circulation.

Make sure the knots are against the wood and not the skin.

Dislocations: A dislocation is the separation of a bone joint causing it to move out of alignment. This type of injury needs to be treated as soon as possible, to prevent the muscles from seizing up around it. The most complete way to treat a dislocation is to “reduce” it, which means setting the bones back in their proper alignment. Reductions are very painful, but worth the pain if done properly. Even the inexperienced should try to reduce a dislocation, as the alternative is a useless limb.

The only way to tell if a reduction has been successful is by comparing the look of the injured joint to the joint on the opposite side. Other than reduction, your other option is to immobilize a dislocated joint by splinting it.

Sprains: These occur when tendons and ligaments are overstretched. The most obvious signs of sprain are excessive swelling, bruising, and tenderness. Sprains are best treated with the RICE method: Rest, Ice, Compression, Elevation:

1. Rest the area for as long as possible.
2. Ice for 24 hours, followed by heat. Chances are you won’t have ice with you, so search for anything that will cool the area. Water from a cold stream, river or lake works well.
3. Compress by wrapping the area snugly to prevent movement without cutting off circulation.
4. Elevate the area whenever it’s not being used, to minimize swelling.

Heat Exhaustion or Stroke

Heat stroke impedes the body’s natural ability to cool itself, and can lead to death if not treated quickly. Symptoms include hot, dry skin, and a visible lack of sweat, as well as headache, dizziness, confusion, and nausea/vomiting.

If you suspect heat stroke, it’s important to get the victim into the shade. Remove restrictive clothing to allow evaporation to occur, which helps to cool the skin. You must then cool the body by pouring water on it, even if the water is contaminated. Allow the water to evaporate off the skin; you can speed the cooling process by fanning the victim. As with dehydration, the victim should consume water in small amounts every few minutes; large amounts bring on vomiting.

To treat shoulder dislocation, heavy objects can be used to pull the bones back into place. This can be extremely painful but allows for the quickest recovery. Do not attempt this procedure unless you have had proper wilderness first-aid instruction.

The key areas to cool during heat stroke are where there are major arteries: the neck, wrists, armpits, groin, and head. Cooling the back of the knees is also a good idea. You can also massage the victim’s limbs to move cooled blood from the extremities to the internal organs.

Bleeding

If not stopped, major bleeding can quickly lead to death. Bleeding can be controlled with direct pressure, elevation, or (as a last resort) tourniquets.

The most effective of these strategies is direct pressure applied to the wound. Elevate and hold the wound long enough to not only stop the bleeding but to seal off the wound.

If you’ve injured an extremity, elevating it as high as possible above the heart will slow blood loss. Note that this method doesn’t stop bleeding completely; you need to use it in conjunction with direct pressure.

Although some people recommend tourniquets for bleeding, these should be used only for life-or-death situations, when no other method can control the flow of blood. Tourniquets present a high risk because if they’re left on too long they can cause gangrene and lead to the loss of the limb below the tourniquet.

Minor Injury and Illness

AT FIRST BLUSH, MINOR INJURIES AND ILLNESSES may not seem as important or dire as their major counterparts, but they deserve as much of your attention. These are insidious injuries. Ignore them for too long and they will likely become major before you know it.

Headache

Headaches are a common and potentially debilitating aspect of survival, so carry some ibuprofen or acetaminophen in your first-aid kit. Drinking lots of water and massaging the aching area can also help.

Sickness and Disease

Sickness and disease can be major or minor, but once your defenses are down and your immunity starts to plummet, you’re more susceptible to both.

Once you become sick, your energy levels suffer, as do your survival efforts. The result could be a dangerous snowball effect. If you don’t have the energy to build a shelter, for example, you will increase your exposure to the elements and your susceptibility to conditions such as hypothermia. What you do to treat yourself now will affect what happens in the minutes, hours, days, and weeks to come.

Bites and Stings

Since bites and stings range from very minor to very major events, the best approach is to avoid them by wearing proper clothing and not putting your hands or feet in dark places without first investigating. Check yourself daily to make sure no strange creatures are hitching a ride on your body. Try not to scratch bites and stings, as they may become infected.

For bee, wasp, and hornet stings, the most important consideration is whether you or someone in your group has a severe allergy. If so, you should carry an epinephrine (“epi”) pen and antihistamines.

You can get an EpiPen prescription from most physicians; just explain that you’re traveling to a remote area and there’s a chance you may get stung by an unknown insect. Be warned, however: if you have a true anaphylactic reaction to a bite or sting, an EpiPen will only help to prevent your throat from closing for about 15 minutes or so, the time it would usually take to get a victim to a hospital. EpiPens are expensive and expire after 12 to 18 months, so keep your first-aid kit updated. Carrying two EpiPens is a good idea. Note that while epinephrine opens up the airway, it does not stop the cause of the constriction. You must also take antihistamines to counter the body’s production of histamine, which is what closes up your airways in the first place.

If you get stung by a bee or other similar creature, remove the stinger immediately. This can usually be done by scraping up and away (not pulling out) from the area with a fingernail or knife blade.

Being bitten by a spider or stung by a scorpion is more serious, and little can be done in the way of treatment unless you’re lucky enough to have an antivenin on hand. If a member of your group is bitten or stung by one of these, watch for anaphylaxis, clean and dress the area, and also treat the victim for shock, vomiting, and diarrhea, should they occur. Some spider bites result in ulcerated areas that refuse to heal. Dress the ulcers to prevent infection.

Snakebites can also be serious, if not deadly, though the majority of snakebite victims suffer little or no effects from poisoning. Infection is a real concern, however, due to the bacteria in the snake’s mouth, so clean and disinfect the area immediately. Try to calm the victim and treat for shock, if necessary.

Staying calm after a snakebite is easier said than done. I can’t imagine what I would have done if bitten by a snake in the Amazon. I was miles away from anywhere and it would have been difficult to get out. And that’s the paradox: When you’re bitten by a snake, what you want to do is run for help, yet it’s the one thing you cannot do because it only serves to increase the rate at which the venom spreads through your system.

Try to determine if the snake was poisonous or not. If in doubt, assume it was! Give the victim as much fluid as possible, and remove constricting items such as belts, watches, and bracelets.

In treating snakebites, avoid the following:

Cutting: Opening the wound is ineffective in removing the venom, and the open wound might become infected.
Alcohol: Similarly, this is ineffective for wound or patient.
Tourniquet: Constricting the bite might cause more damage and pain, and even after the loss of a limb if applied incorrectly.

To treat snakebite, follow these steps:

1. Calm the patient and keep him or her still.
2. Apply a broad bandage (crêpe) tightly around the whole limb, as for a sprained ankle. This will retard absorption of the venom but still let blood through to supply the bite-wound with needed blood.
3. Check vital signs.
4. Immobilize the limb with a splint.
5. If it’s not possible to reach a doctor within hours and you have antivenin, test for allergic reaction first by injecting a little under the victim’s skin or inject antihistamine first. (Always carry an injectable antihistamine in your first-aid kit.)

Diarrhea

Diarrhea is common in survival situations and is another minor sickness that can become major.

There are two important things to understand about diarrhea. First, diarrhea is your body’s way of ridding itself of an irritant. Let it run its course for 6 to 12 hours. However, diarrhea can also rapidly lead to dehydration. Through it, you lose valuable water and electrolytes, which need to be replenished.

The best way to replenish yourself is to drink some water, preferably clean and purified. Drink small amounts frequently (which will help your bowel absorb the fluid) rather than drinking a huge amount at one sitting (which will overwhelm your stomach and trigger more diarrhea).

If you’re in a group, keep in mind that diarrhea can be embarrassing for the person who has it, so try to create an environment of understanding and comfort. You might also designate a private place for that person to go, to reduce awkwardness.

Charcoal is an effective remedy for diarrhea because it is highly absorbent, and will absorb drugs and toxins from the gastrointestinal tract. Grind a teaspoon of charcoal from your fire and mix it with water. Consume this a few times a day, as necessary.

If you have electrolyte replacement powders in your first-aid kit, they will help replace the electrolytes lost through diarrhea. Loperamide is also useful to have in your kit; it can plug you up in cases where the diarrhea just won’t stop. I’d let the diarrhea run its course for at least a day before resorting to loperamide.

Blisters

Blisters also rank high on the list of problems that start out minor but can become major. The best way to treat blisters is to prevent them from happening in the first place, by keeping your socks and feet dry and clean.

If you do develop a blister—particularly on your foot—do not puncture it or otherwise open it, as this makes it susceptible to infection. Rather, apply some sort of padding to relieve pressure and reduce friction. Stay off your feet as much as possible until the blister subsides. If you have a blister that breaks open, treat it as an open wound.

Wounds

Wounds can be minor or major. If they’re major, the biggest risk is excessive bleeding. The most significant risk from minor wounds is infection, so clean the wound immediately and cover it with a clean dressing. Change the dressing at least once a day to prevent infection. If you don’t have any extra clean dressing material available, you can reuse the existing dressing by boiling it for at least three minutes to sterilize. Allow it to cool before applying. Let the wound air dry during that time. Gaping wounds can be closed with the butterfly sutures in your first-aid kit.

If you have antibiotic cream, apply it to the wound. Antibiotic pills should be used only for treating wound infections, not for preventing them.

Infections

In a survival situation, there’s a very good chance that a wound may become infected. You can tell by the redness that appears around the wound and the consistent discharge of pus.

Treat infections by applying warm compresses on the area for 30 minutes three or four times daily. Change the compress as it cools. You can also drain the wound by opening and poking it with an implement you’ve sterilized, such as a knife tip held in a fire and then allowed to cool.

Altitude Sickness

Depending on how high you are, altitude sickness can range from mild discomfort and shortness of breath to life-threatening cerebral edema. Symptoms range from drowsiness and weakness to persistent rapid pulse and vomiting.

The best way to cure altitude sickness is to get the victim to lower altitudes immediately. Some victims of mild altitude sickness can control symptoms by consciously taking large, exaggerated breaths.

Group Versus Solo Survival

IF YOU’RE INJURED, YOU’RE FAR BETTER OFF in a group because you’ll have people around who can help you. Members of the group can lift and move a sick or injured person.

One difficult decision you may have to make in a survival situation is whether to leave an injured person or stay with them. If you are in a group of two, leave only if your travel partner’s injuries are life-threatening, you can’t help him or her, and you know where safety and help lie. Before leaving, stabilize the victim, place him or her comfortably in a shelter, and mark the area so that you can find it on your return.

In larger groups, send the fastest and most capable travelers for help while others stay behind to tend to the wounded. Again, those who leave should do so only if they are sure they will be able to reach help.