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Wilderness first aid

By BRETT FRENCH
Gazette Outdoor Writer

Article Abstract - Billingsgazette.com

Even minor injuries can become big problems in the backcountry. "The same things that happen to us in the front country happen to us in the backcountry, they're just harder to manage," says Shana Tarter, assistant director of the Wilderness Medical Institute at the National Outdoor Leadership School in Lander, Wyo. There's also the worry that events will cascade into bigger problems if poor decisions are made. "In the backcountry, the domino effect of your choices is huge," she says. Wilderness First Aid courses, such as the one WMI teaches, help students learn how to deal with minor and major injuries to help stabilize patients and avoid further injury. "We teach students to make the tough decisions," Tarter says. "We do a lot of scenarios, that's where we spend our educational time with our students." Maybe not so surprising, the most common injuries during outings are pretty minor.

From 20 years of data collected from WMI students, the top three problems were:

Lower extremity athletic injuries such as a knee or ankle sprains;
Soft-tissue injuries like blisters, cuts and small burns;
And gastro-intestinal irritation such as diarrhea, cramping and gas.

Infections are probably the most surprising problem because cuts can infect rapidly overnight," Tarter says. The key to cleaning out wounds is an inexpensive syringe, she says. It's one tool that's difficult to improvise in the woods. With a syringe, wounds can be washed out under high pressure using disinfected water. "It's the pressure that makes the biggest difference," Tarter says. What other first-aid devices should backcountry users pack?

Tarter's basic list is pretty simple:

Athletic tape for supporting ankles;
A fever reducer and pain killer such as aspirin, Tylenol or Ibuprofen;
An antibiotic ointment to keep wounds moist;
Moleskin for blisters (or you can wear liner socks or loosen your boots);
An anti-diarrheal such as Immodium.
Some type of first-aid reference manual.

The best scenario, Tarter says, is when the injury is minimal enough to allow the victim to walk out of the backcountry, avoiding having to carry them or leave them to go get help.

Or an even better scenario is preventing an injury, Tarter says.

"One of the most critical components of everything we do is prevention," she says. "Preventing hypothermia, preventing infection. It's a heck of a lot easier to prevent than it is to manage."

Brett French can be reached at french@billingsgazette.com or at 657-1387.

Blister treatment

Blisters are probably one of the most common problems people face while recreating in the woods or on rivers. Given the unsanitary environment, they can quickly escalate into more serious injuries if not properly treated.

Clean the area with soap and water. To prevent the skin from pulling off, build an elevated donut around the blister to the height of the blister using tape or moleskin.

Shana Tarter of the Wilderness Medicine Institute says if the skin is pulled off to treat it like an open wound. Wash the area and apply an antibiotic ointment before bandaging. Clean it twice a day.

Diarrhea, another common problem, can be easily avoiding by staying hygienic. Don't share your water bottle or use your personal spoon to stir the community pasta. Wash after going to the bathroom.

"GI bugs get passed around very fast," Tarter says.

The best way to treat it, if possible, is to rest and stay hydrated, she says.

"Many times it will be self-limiting," she says. "We tend to recommend anti-diarrheals only if the patient has to travel."

The WMI offers seven courses, everything from 180 hour wilderness EMT training to the 16 to 24 hour wilderness first aid course. For more information, log on to www.nols.edu/wmi.

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