Backcountry Emergency – AMC Outdoors

May 4, 2009

People were lying on the snow, howling in agony. Legs were fractured, and victims were unconscious. The scenario was staged, but the surge of adrenaline I felt was real enough. So was that initial feeling of helplessness. “What do I do?” Years of experience hiking couldn’t help me, but basic first aid could.

BEYOND THE GOLDEN HOUR For every quarter mile you hike into the woods, it will take approximately one hour to be rescued and brought to a hospital. A two-mile hike, therefore, could translate into eight hours between an injury and the benefits of modern medical technology. That’s the first thing I learned at a two-day Wilderness First Aid (WFA) course taught by instructors from Stonehearth Open Learning Opportunities (SOLO), a Conway, N.H.-based provider of wilderness medical training.

The mock victims I encountered had, in theory, hiked much farther than a quarter mile from the road, as most of us would. They were therefore beyond the boundaries of the “Golden Hour,” the window of time after a trauma when hospital care can significantly influence patient recovery. Go beyond that hour, and the odds may stack against you.

Find upcoming WFA courses.

AN OUNCE OF PREVENTION The most common back-country injuries are cuts, bruises, scrapes, strains, and fractures, but even seemingly minor injuries can lead to shock, dehydration, or hypothermia if left untreated. Bringing the right equipment and clothing, knowing the weather forecast, studying trail maps, having (and ably reading) a map and compass, and picking a route that fits the ability level of everyone in the group is often what keeps us safe—and keeps our first-aid skills on the shelf.  

Safety also stems from proper nutrition. On an average day, your body requires a minimum of two liters of fluid. When doing something strenuous, you may need up to three liters per hour. Drink too little and trigger either hypothermia or heat stroke depending on the weather conditions. You’ll also burn at least 3,000-4,000 calories on the trail, so pack carbohydrate-rich foods. Wilderness rescue personnel often carry Jell-O packets to mix in warm water. The high sugar content is an instant energy boost to a fatigued body.

THE POUND OF CURE  Accidents still happen. As I walked to where our “patients” were lying, I stopped to assess if the scene was safe. Rushing over can seem heroic, but if the area presents dangers (rock slide, avalanche, angry bear), you could be at risk and no help to anyone else. Paul Petzoldt, founder of the National Outdoor Leadership School (NOLS), was famous for saying that the best thing you can do when faced with an emergency is to sit down and have a cigarette. He wasn’t advocating smoking; he was suggesting that we not let panic push us into bad decision-making. Our brain, after all, is the only real tool we have in the backcountry.

Once the scene is safe, I learned to first check a patient’s ABCs— is an Airway clear, is she Breathing, what’s the status of her Circulation (is there a pulse or severe bleeding)? A person, after all, can survive days without water but only six minutes without oxygen. It’s also helpful to know the average resting heart rate (60 to 80 beats per minute). A higher or lower rate might, over time, indicate a change in condition. Taking a pulse at the carotid artery is easy, but try it with pulse points on the wrist or ankle to see if the blood is circulating to the body’s extremities. Bring a watch to do this properly.

A pad of paper and pencil in your first-aid kit wouldn’t hurt either. You need to capture information to share with rescue or hospital personnel. Professionals call this a SOAPnote, which stands for Subjective (patient perspective), Objective (vital signs and patient exam), Assessment (what’s wrong), and Plan (what to do). Another thing for the first-aid kit: Benadryl. This antihistamine can counter an unexpected allergic reaction. Something I hadn’t considered.

There’s more to wilderness first aid—a lot more—and it’s essential backcountry training. You never know if or when you’ll be called upon to stop…and have a cigarette.

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