Wilderness Medicine: Caring for Wounds in the Wild

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  • #974
    littledoc
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    Marica asked me to post this here, it is also in the Wilderness survival area:

    I so enjoy the field of wilderness medicine, because not only is it useful for remote locations, but also, the principles involved are useful in situations of disaster or pandemic.

    One of my favorite places to learn about the wild tricks of the medical trade is through the Wilderness Medical Society http://www.wms.org/.

    I would like to illicit to some wound management principles that I found in the Journal of Wilderness Medicine in the article “Cuts like a knife, but heals so right,” by Dr. Nancy Pietroski:

    First before I delve into the things, I do need to discuss basic first aid goals and wound handling in the outback.

    In all medical situations, even those within the hospital setting, any medical professional must act according to a certain order of important principles because of their lifesaving nature. We call them the ABCs

    A – Airway
    B – Breathing
    C – Circulation
    D – Disability

    Because this post is dedicated to wound care, I will only just touch on the ABCs, but if you want me to explain them in more detail just post a request here or PM me.

    Airway: Basically, you make sure that they have an open trachea (windpipe) or an open way to breathe. They are not open, they can’t breathe.

    Breathing: You look, listen, and feel for their breathing. This is also where rescue breathing comes in.

    Circulation: Is what this post is all about. The bleeding. Here is where you treat the wounds. You wait until you know that they have an open airway and are breathing before even attempting to begin taking care of their bleeding.

    A lot of times airway and breathing are quite simple. If they are screaming, talking, complaining, or swearing at you like they’re a drunken sailor than they have an open airway and they are breathing.

    Disability: This step is where you check to see if they can move all four extremities and splint broken bones.

    Now for the good stuff: The blood, guts, and gore… Okay, so only a little blood, no guts, and well the gore is up to your perspective.

    When faced with wounds, there are a few goals that you need to focus on, especially out in the boonies.

    1. Control the Bleeding: The whole point of the Circulation portion of the ABCs.
    2. Clean the wound and prevent infection
    3. Reduce comfort and promote healing
    4. Minimize the loss of function
    (we’re dipping into the disability stage here, but still we need to mention it.)
    5. Perform correct care and transport of patient

    Before I get into the nuances of wound care, I would like to stress here that you need to attempt some form of body-substance-isolation (BSI) first. BSI is a full body coverup kit. And I seriously doubt that any of you are carrying a surgeon’s gown mask, and surgeon’s gloves in your backpack. So let’s make one with stuff you might be already wearing.

    Eye cover: Ski goggles or sunglasses or even regular glasses (not as great as those ski goggles, but hey, it’s coverage).

    Gloves: Any water barrier gloves or barrier material, such as those Ziploc sandwich bags your PBJ is sitting in, or the plastic grocery bag that you are carrying to put your trash in.

    Body cover:
    Because some of these wounds can make Old Faithful look like a weak geyser. Parka. Ski Jacket. Big garbage bag with holes for arms. Or that “Kiss the Cook” apron works too.

    Alright, now you’re covered and you throw a tarp down for your poor bleeding patient to lay on. (Remind me to talk about patient transport and lifting some other time.)

    Now you’re ready to deal with the Slasher flick before you.

    CONTROL BLEEDING

    How do we control bleeding? Pressure. Pressure. Pressure.
    Literally, you apply pressure to the wound.Get your gloves in there, if you don’t have gauze, and apply some direct pressure to the wound.

    Direct pressure, elevation of the body part, and packing with a moist sterile dressing or clean cloth
    (if sterile is unavailable) will stop most hemorrhaging, according to Dr. Nancy Pietroski of Wilderness Medicine.

    I, personally, like to add to my wilderness kit a little hemostatic qauze or agents like Celox, Gelfoam, Surgicel, or Jello (non-sterile)… there’s always room for Jello. These speed up the clotting process considerably.

    Stop the bleeding and pad with sterile gauze or clean cloth… or you could even use one of your Ziploc sandwich bags minus the PBJ to dress the wound… than affix it with roller gauze, surgical tape, or that duct tape that you know you tie around your ski poles or walking sticks. Duct tape is your friend.

    CLEAN WOUND AND PREVENT INFECTION

    Irrigation is more than just a farming tool. Basically, you take sterile water and spritz down the wound, washing debris, soil, foreign bodies, etc from the wound. Well, you forgot to shove that liter of sterile fluid in your backpack, but you do have your sports water bottle or canteen.

    Remember your goggles… they come in handy right at this point.

    The journal of wilderness medicine suggests that in situations where you don’t have irrigation available, use a ziploc bag filled with clean water, put a pin-sized hole in it and spray the wound clean.

    Visible debris can be removed with sterile forceps or if you don’t have them, tweezers dipped in alcohol.

    You know, also contact eye solution can be used to irrigate a wound. Not only is it a clean isotonic solution, but it also has some minor elements of bacteriocides within it.

    You can use honey or sugar as a natural antiseptic. Except with the honey, avoid putting the honey on the good intact skin, just put it in the wound then cover it with a sterile or clean dressing. With the sugar, just pour it in. Your patients will say that you’re sweet for treating them so wonderfully.

    REDUCE DISCOMFORT

    There’s more to do than just knock them out with a tree log.

    Stabilize the extremity with the wound. Strips of duct tape can be used to close a wound in place of steri-strips if you don’t have them on hand. Dermabound and its non-sterile cousin, tissue glue can work as well.

    PERFORM CORRECT CARE AND TRANSPORT

    If it’s wounded, get rid of it.

    Seriously, if a person has been wounded, evacuate them. They need to get proper medical care.

    The following is a list of “wound” situations where evacuation of the patient should be as rapid as possible:

    -Infected wounds, deep penetrating wounds, impaled objects, wounds with ligaments, joints, tendons, or bones exposed

    -Animal or human bites. (Yes, it can happen. Some people get awful hungry in the wilderness.)

    -Severe blood loss

    I’ll talk about ways to handle different types of wounds later. So TTFN.

    If you have any more questions, please feel free to post or PM me. Or you can find me at disaster_medicine@yahoo.com.

    Or if you would like more information on these subjects, look me up at http://disastermedicine-christine.blogspot.com/

    Journal of Wilderness Medicine, summer 2009, volume 26, number 3. http://www.wms.org/publications/magazine.asp

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