First Aid Fridays is a new segment Max and I are introducing. Our goal is to provide principles of wilderness first aid in a succinct, memorable format backed by professional medical data. Today’s FAF will focus on wounds.
Between knives, hatchets, sharp rocks, and vicious man-eating raccoons, there are many ways to sustain wounds in the backcountry. Most of these will be small cuts and scrapes, but every backwoods adventurer should be prepared to handle larger wounds.
The good news is, whether a paper cut or a gaping raccoon bite, the principles of wound management are the same.
Priority One: Stop the Bleeding
Use the cleanest material possible to hold pressure on the wound. A 4×4 gauze pad works great. I recommend carrying a few in your first aid kit. Do not constantly lift your hand to see if the bleeding has stopped. Hold a continuous and steady pressure. If the bleeding soaks through the gauze, do not change it, just add a new piece on top. Almost all bleeding can be stopped by holding pressure
If the bleeding is massive and pulsatile, meaning it is rhythmically pulsing out, you may be dealing with an arterial bleed, which is much more serious and life threatening. This is a situation that needs professional help ASAP. Elevate the extremity and apply a pressure dressing. If the wound still continues to bleed profusely, consider a tourniquet. Tourniquets should only be used in life threatening situations because they can cause considerable nerve and tissue damage, and possibly lead to limb loss. If you’re dealing with an arterial bleed, it’s time to bail on your backcountry adventure.
Priority Two: Clean the Wound
Most wound treatment revolves around one single concept: preventing bacteria from taking up residence in your wound. Bacteria need an environment that is warm, wet, dark, and has lots of nutrients for them to feed on. Create an inhospitable environment for them and you will be less likely to experience a wound infection. In the wilderness, infections can get out of hand quickly, so the key is prevention.
Forget everything you ever learned about hydrogen peroxide, iodine, and even soap. The single best way to clean a wound is by irrigating it with clean water using continuous pressure. Yep, you read that right: Plain old water. Clean tap water, when used correctly, is just as effective at reducing microbes in a wound as sterile saline is, and use of soap has actually been associated with a higher level of bacterium present in wounds. Do not scrub the wound – this actually damages tissue and creates a higher risk of infection.
I recommend keeping a 10-20 ml syringe in your first aid kit for these situations. Use the syringe to irrigate the wound with at least 200 ml of treated water (1 Liter is best). The idea here is to manually expel all bacteria and foreign objects from the wound bed, so pressure is an important factor. If you don’t have a syringe handy, you can cut a very small hole in the corner of an unused Ziploc bag and spray your water through it, or hold your water container at a short height from the wound. Make sure whatever you use has some oomph behind it.
Priority Three: Cover
The majority of wounds sustained in the wilderness should not be closed. Once a deep wound is closed, it provides all of the things bacteria appreciate: Warmth, moisture, and lots of yummy damaged tissue to eat. Even large, gaping wounds should be allowed to heal on their own until they can be evaluated by a professional. Leave your suture kit at home, amateur surgeons. Keeping the wound clean is much more important than keeping it closed.
Consider using skin glue for a minor wound in a pesky area, such as the webbing between your fingers or toes.
Dry the wound using clean gauze and cover it with gauze and tape or a bandage large enough to completely encompass it. Most commercial bandages are too small and come off easily. Leave the small, skinny ones behind. You need to stock your first aid kit with a wide variety of large bandages. Chances are you’re going to be sweaty and active, so I recommend keeping Mastisol or Tincture of Benzoin in your kit to help your bandages adhere. A small dab of antibiotic ointment can be applied to help prevent infection. The wound should be cleaned and redressed every day.
Sources and Further Reading:
- A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds
- Medscape: Wound Irrigation
- Wilderness Medicine by Paul S. Auerbach
- Wilderness Medicine Field Protocols
Boring but Necessary Disclaimer
This is not a substitute for professional medical care. First aid is meant to provide assistance to an injured or ill person when medical treatment is unavailable. Do not delay seeking professional help in the event of a serious condition.
If you are interested in learning more about Wilderness Medicine, I recommend enrolling in a Wilderness First Aid course through your local REI.