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When we look at getting sick or hurt in the wilderness we tend to think of high altitude maladies or bear attacks and snake bites but, in reality, the most common injuries in a wilderness or austere setting are soft tissue or musculoskeletal in nature (i.e. lacerations, sprains, strains and fractures). Though these soft (and hard) tissue injuries are not as eye catching or exotic as high altitude or animal attack injuries, having a basic knowledge of how to handle these injuries is one of the most important things one can do to prepare for wilderness adventurers. Here are a couple of basics to keep in mind when dealing with a musculoskeletal injury in the wild.
Wounds - A large laceration can be a really scary thing in the wilderness. There may be a lot of pain associated with it and there may be some( or a lot of) blood. The first thing to do is not panic. Start by applying direct pressure to the area to help stop the bleeding. If you don’t have gauze, just find a clean piece of cloth - like a buff, bandana or part of a shirt. In these types of situations it seems as if time slows down, so I usually tell my students to time themselves. Five minutes can seem like forever, but if you hold direct pressure on a wound for five minutes straight, most wounds will stop bleeding (NO PEEKING!). If it's still bleeding try for another five minutes and continue until the bleeding stops. The second thing to do (and maybe the most important thing) is to wash out the wound to prevent infection. The truth is that washing a wound out can be done very well in the wilderness provided you have two things:
1. Water that is drinkable - all wounds need to be washed out and if the water is drinkable (filtered or treated water) then it is clean enough to wash a wound out with. It's recommended to wash with about a liter of fluid.
2. The ability to wash out with some pressure behind that liter of fluid. This can be achieved by using a syringe and having a 20 gauge tip (you can get these at REI or in those pre-made first aid kits). Or, next time you're at your doctor's office, ask her for one ... she might look at you funny at first but once she understands what you're going to do with it ... I bet she gives you one. You can also make your own device to irrigate the wound with.
Here's a video about managing lacerations: https://youtu.be/
Strains, Sprains and Fractures - There is a lot of detail here that is far too much for this short blurb but, in a nutshell, splint it! Splinting not only makes it easier for the patient to walk or be carried out but will help with the pain as well. I recommend that everyone know how to use and carry a SAM splint. Trying to make a splint out of branches is possible but is never as good as a SAM splint. SAM splints are available from most outdoor retailers. If you don’t have a SAM splint, the key is to use whatever you have, or can find, to IMMOBILIZE the injured limb. Do not tie it on so tightly that you impede circulation, though!
Here's are two videos on how to use a SAM splint: https://www.youtube.
Content Courtesy of
University of Nevada, Family and Wilderness Medicine
Tony Islas, MD, FAWM, Past President, Wilderness Medical Society
David Fiore, MD, FAWM
