Traditional urban first-aid instruction always ends with the same comforting final step: call for help. Treat for shock. Apply direct pressure to a bleeding wound. Clear the airway. Call for help. Help, it is assumed, is always three minutes and a 911 call away. Even the more advanced, EMT-level training falls prey to the “call for an ambulance” advice once an accident victim has received fairly minimal and immediate assistance.
So what happens when there’s no phone to dial 911, and even if there were, help is three days away? I’m not about to pretend to be a wilderness first-aid instructor, but I have some advice for prevention-oriented wilderness travel and some suggestions for supplies that will help get you through the more prolonged response time once you go for help.
Get some training that goes beyond the usual Red Cross town course. There are a number of Wilderness First Responder courses and backcountry first-aid classes that take the discussion beyond the sidewalk and backyard to settings that are remote and rugged. Courses should cover topics like extended care and treatment, search and rescue, evacuation techniques, and wilderness safety hazards. (See appendix 2.)
Do things to stay healthy in the wilderness. Floss your teeth every day, eat well, drink plenty of water, take vitamin supplements. I’ve even heard of people who have had their appendixes removed before a long expedition or have had wisdom teeth out to prevent those potentially trip-ending problems. That’s probably not necessary for shorter journeys, but if you’re off for a year, or going long-term to primitive parts of the world, it’s something to consider. Physical and dental exams are certainly prudent before a prolonged journey.
In the field, factor remoteness into every decision. A trip far from help automatically raises the whitewater rating scale a class, for example.
Rather than concentrating on complicated river rescue training featuring things like Z-drag rope systems, work on more basic techniques and experiences that in the end tend to be more useful and instructive. For example, practice swimming in current with your gear on to really get a feel for what the water is doing. Get out the throw bag and practice heaving it to someone in the water, then switch places and see what it’s really like to catch the rope and get hauled in.
Everything else aside, a three-canoe trip is the safest scenario. If there’s trouble, one canoe can paddle for help while another stays to tend injuries, or two paddlers can duff in the extra boats if a canoe gets lost or irreparably damaged. If you go solo, or even as a two-boat team, that decision has to influence the judgment equation as well.
Be very cautious about open water crossings. They are more dangerous, in my mind, than rapids ever are. Stick to shore if the wind is up, despite the added distance. Capitalize on the times of day that tend to be calm—before dawn and at twilight—to make crossings (see this page-this page).
On tough stretches of water, keep canoes close enough together to respond to difficulty, and designate lead and sweep canoes with the most experienced paddlers.
Approach water as if every trip were a first descent. Different water levels, new obstacles in the river channel, changed weather, and new group makeup are all ingredients that make even familiar routes surprising and challenging.
Pay attention to the energy of the group. Even if you and your partner are solid and confident, others may be paddling at the edge of their ability, or may be fatigued, or might be shivering with cold, or could be operating more on bravado than skill. If the group energy feels strained or dangerous, take the cautious option.
Listen to your intuition. There are times when everything seems objectively good but there’s a niggling voice of doubt whispering in the background. Pay attention. That little whisper is always worth listening to.
Contents of a complete wilderness first-aid kit.
Most often it’s some maddening little thing that needs treatment. Someone gets whacked in the eye by a tree branch on a portage. A fly bite turns into an infected abscess. Someone on the trip has an allergic reaction to peanut butter. It’s rare that accidents are sensational, like a broken leg or a grizzly attack. The essential things to remember in putting together a backcountry first-aid kit are that you are self-sufficient and may have to deal with all manner of unexpected maladies and that it may be a prolonged wait before you get outside medical attention.
My most complete first-aid kit was assembled when Marypat and I took our first yearlong expedition across Canada. A three-day jaunt won’t require nearly the level of supplies we packed along, so adjust the list accordingly. The irony is that, even on trips that last for months on end, that bulky first-aid kit you have to wrestle across portages hardly ever comes out except for the odd Band-Aid. All well and good. When the day arrives that you really do need it, you’ll be mighty grateful it’s loaded in the pack.
complete wilderness first-aid manual (I like Medicine for Mountaineering, but there are a number of good wilderness first-aid books available)
pencil or pen and notebook: it’s important to keep a treatment record of any serious health problem
Band-Aids (lots if kids are along!)
adhesive tape
gauze pads
razor or scalpel
scissors
tweezers (may be the most commonly used first-aid tool)
roller gauze
splint material (inflatable splint or wire mesh)
eye patch and eyewash (eye injuries are surprisingly common)
thermometer
elastic bandage
safety pins
sunscreen or zinc oxide
sterile suture kit
moleskin
compress material (sanitary napkins can be handy for compresses)
cravat bandage
matches
Steri-Strips (for closing wounds that might otherwise require stitches)
a dental pick (for cleaning infected or abscessed gums)
dental adhesive for short-term cavity repair (available in tubes)
betadine wash for external wound cleaning
antibacterial ointment
aloe vera gel (good for sunburn, other burns, and general skin irritation)
epinephrine shot kit for severe allergic reactions
watch (not for an accurate time of day but to keep track of time elapsed during treatment and patient recovery, pulse and respiration rates, etc.)
People should be responsible for bringing any personal drugs they are taking and should let the group know about ailments that require medication. When we’ve taken really long trips, we’ve consulted a doctor and gotten a selection of prescription drugs, with instructions for dosage, to cover common health problems. Our drug kit included prescription drugs to combat severe pain, allergic reactions, soft-tissue infections, diarrhea and constipation, urinary infections, and eye-ear-throat infections.