Wound Care In The Wild

Effective first aid begins with the knowledge you acquire before heading into the backcountry.

        Over the course of your life, your skin will be punctured, burned, half-frozen, cut and scraped countless times. In most cases it will heal and continue to do its job with little or no help from you. But skin injuries that occur in the back country are another matter.
The skin’s most basic function is to keep vital fluids inside the body, and bacteria out. When an injury occurs that breaks the body’s protective seal, the blood begins clotting to bring bleeding to a stop. Circulation increases in the area of the injury, bringing white blood cells to destroy bacteria. Normal inflammation walls the wound off from the rest of he body. A scab soon forms, and the wound cleans and drains itself over the next several days. Protective barriers grow stronger, and within six to eight days the wound will be very resistant to external contamination.
But bacteria thrive in the wilderness and the risk of infection is much greater at a time you can least afford it. The primary goal of good wilderness first aid is to assist your body’s natural healing processes while providing you with the skills to control bleed loss, and clean and dress a wound when the situation arises afield.
The first step in managing skin wounds should begin long before you get an injury or step into the backcountry.
Doctors advise that everyone have a tetanus toxoid vaccine at least once every ten years to provide immunity against a lethal disease called tetanus. Tetanus develops as a reaction to a toxin produced by a fairly common bacteria (Clostridium tetani) that usually enters the body through wounds. (If there is any doubt about your tetanus vaccine being up to date see your doctor for a booster now–and certainly before going into the backcountry).
Regardless of the degree of injury, it’s important to attend to the wound as thoroughly and as calmly as possible. If you are treating your hunting partner, instead of yourself, take a few seconds to put on a pair of latex gloves before coming into contact with any blood. Some blood-borne diseases are easily transmittable between people. This simple, quick task may seem strange and awkward at first, but it’s a universal precaution in healthcare, even with first aid and even in the woods.

CONTROL BLEEDING

All skin wounds disrupt blood vessels. In extensive injuries however, significant blood loss can occur before a clot can develop to seal the wound. The most simple, safe, and effective technique for controlling continued blood loss is to apply pressure directly to the bleeding site. Using a clean cloth, bandage, or hand, apply pressure for at least 15 minutes.If bleeding persists, chances are you’re not using enough pressure, or you’re applying it to the wrong place. Remove the bandage, look for the bleeding, and try again. In the case of an injury to an extremity you can alsoelevate the limb above the level of the heart to reduce blood pressure at the wound site.

WOUND CLEANING

As soon as the bleeding has stopped, the wound should be cleaned. Although it is impossible to safely sterilize the wound in the wilderness, you can often reduce the amount of debris and bacteria to a level that is easily managed by the body’s own defences.
First, clean the skin around the wound with soap and water, or an antiseptic. Avoid getting antiseptics, such as iodine preparations, into the wound itself. These chemicals will kill the healthy body cells lining the wound as well as killing the bacteria.
Next, irrigate the wound with water that’s clean enough to drink, pouring it directly into the wound so that it flushes away debris. The more water you use, the better. If dirt, rocks or animal hair is imbedded in the wound, use a small pair of tweezers to pick it out. Pieces of skin or dead tissue which are dead or detached should also be removed. This type of cleaning is called ‘debridement,’ and can take a while. Make yourself comfortable, use plenty of light, and do a good job; it is not unusual to spend several hours cleaning up a mess that only took a fraction of a second to make.
Cleaning may disturb the clot and cause bleeding to resume. If the wound is minor simply reapply direct pressure for a few minutes. Howeverdo not attempt to clean wounds which are associated with life-threatening amounts of blood loss. In these instances your first priority is to control the bleeding, apply a bandage , monitor the injured and wound carefully, and seek immediate medical care.

WOUND DRESSING

In the backcountry setting, all except the most superficial wounds should be dressed open to allow for natural drainage.
Do not apply waterproof ointment or petroleum jelly, or close the wound with butterfly tape or steri strips. And by all means, resist the temptation to perform field surgery with your fishing line or dental floss. Wounds can be sutured in an emergency room or clinic three to five days later, if necessary. And it will be much easier for the medical practitioner to repair a wound which is clean, and healing naturally, than to deal with one that has developed a complicated infection.
Once the wound has been thoroughly cleaned, cover it with a sterile gauze dressing and clean bandage. Inspect, clean and redress daily; more frequently in wet or dirty conditions. If the wound is in an area subject to a lot of skin tension and movement, such as over a joint, use a splint or bulky bandage to limit the area’s range of motion.

KINDS OF INJURIES

Common injuries include abrasions which affect the outer layers of skin and should be treated in much the same way as deeper wounds. But it often takes a few days for abrasions to clot. Applying a layer of antibiotic ointment directly over the wound after cleaning it will help prevent infection and promote healing. Apply a new dressing — which includes irrigating, cleaning, and putting fresh ointment on the wound — daily. Once the wound is able to scab over on its own, the ointment is no longer necessary. (And resist the temptation to pick the scab off! You will just destroy the new skin growing underneath.)
Such minor wounds that involve only the skin and underlying fat should do well with conscientious field care. And there is no reason to perform a hurried or hazardous evacuation just to get stitches. In most cases professional medical attention can be delayed until it is safe and convenient, if necessary at all.
Unfortunately, you don’t have this luxury with wounds which are very deep, dirty, or complex. Such ‘High Risk’ wounds include Dirty Woundswith imbedded debris such as dirt, rocks, clothing fibers, or animal hair; Ragged Wounds which have a large amount of crushed, shredded, or dead tissue; Complex Wounds which involve joints, tendons, muscles or bones; Bite Wounds, either human or animal (any wound exposed to human or animal saliva constitutes a bite wound); and Puncture Wounds that have a small opening with a wound track that goes deep, depositing bacteria in areas which are impossible to clean and drain properly. Puncture wounds can look minor at first, but become a big problem later; the most common example  is the nail which goes through the bottom of your boot and into your foot.
These ‘High Risk’ wounds harbour bacteria which are difficult to dislodge, and are prone to infection and complications even with the best field care. The initial treatment is the same — control blood loss, clean if not life-threatening, and apply field dressing — but they should receive professional medical attention within 24 hours, if possible.

INFECTIONS

Within three or four days after an injury the normal pain, redness, and swelling associated with a wound should begin to subside. But if something goes wrong, and the body’s defensive and healing mechanisms are overwhelmed, invading bacteria may multiply and infect the tissues surrounding the wound.
As the body attempts to reestablish barriers and fight the infection, local inflammation — redness, pain, and swelling — begins to increase. Pus will often accumulate, and either drain or form a pocket (abscess) under the skin. If the infection is not controlled, it can spread through the lymphatic ducts and glands to the general circulation, causing a systemic infection. The early symptoms of this serious illness, sometimes called ‘blood poisoning,’ include red streaks and general swelling in the extremity as well as swollen glands, pain, and fever.
In the long-term care situation, pain or the threat of systemic infection may make it necessary to reopen and drain a wound which has formed an abscess. This is safe to do as long as the pus pocket is easily visible and close to the surface. Usually a small nick with a sharp knife is all that is necessary. Once the abscess is open, clean and irrigate it as you would any other wound. Because the continued spread of infection can cause a life- or limb-threatening emergency, any wound that becomes infected in the back country should be considered High Risk and be attended to by a doctor as soon as possible.
Like most backcountry skills, quality wound care demands a lot of patience and a few simple tools. Most of the medical supplies you’ll need in the field will fit comfortably in your coat pocket. But the real first-aid kit is the knowledge and experience you carry with you.

WOUND CARE KIT

This day kit for wound care in the wild can fit in a small band-aid box, which should always be kept in your field coat. –J.I. 

– sterile scalpel blade

– two 4×4-inch sterile gauze dressings

– two 2×2-inch sterile gauze dressings

– one 2×2-inch gel dressing for blisters

– six adhesive band-aids

– one 1-inch roll of tape

– one small tube of antibiotic ointment

– one small bottle of liquid soap

– one pair of tweezers

– one pair of nail clippers

– one pair of scissors

– water purification tablets

– 1-gallon plastic bag (holds water for irrigation; poke a small hole in the bottom to make it squirt)

– one pair of latex gloves