If you're headed into the backcountry, you need to know basic wilderness medicine skills—and be able to separate fact from first-aid fiction. We've got your back. Here's how to survive snakebites, drowning, and two other common injuries. Plus: how to build your own first-aid kit.
As Mark Jenkins knows, wilderness first aid can hurt. (Just ask his patients.) So he finally did what everyone should do: he took a class from real experts.
Snakebites: Whiskey shots aren't the answer
No topic in wilderness medicine is so laden with folklore remedies as the snakebite. Incision, suck-and-spit, mechanical suction devices, ice-water immersion, tourniquets… The truth is, none of those methods have been proven to work. Even worse, they waste precious time. The only real cure for a venomous bite is the appropriate antivenom from a medical facility.
The best steps to take if you’re bitten by a rattlesnake or coral snake, two of North America’s most common venomous snakes:
- Retreat out of striking range of the snake, which is at least its body length.
- Look for distinguishing traits that might help identify the species, like a rattle or facial pits, slight depressions between the eyes and nostrils that help detect infrared heat. If you have a digital camera or camera phone, consider taking a photo, ensuring you maintain a safe distance.
- Splint the bitten body part to limit unnecessary motion that might promote the spread of venom, making sure to allow room for swelling within the splint.
- Transport the victim to the nearest hospital immediately.
Flesh Wounds: Don't take them to the river
Next to muscle strains and sprained ankles, minor wounds—cuts, blisters, scrapes, burns, and punctures—lead the list of injuries in the outdoors. They hurt and bleed. In the past, many first-aid courses would recommend cleaning the wound with any available water, like the soothing contents of a river, pond, or lake, but we now know that germs present even in clear water can cause serious infections. So using treated drinking water is always the best option.
Still, there are times when a dip in the river might be worthwhile. Here is the best method for cleaning a cut or other skin injury sustained in the wilderness:
- Manually remove dirt and debris.
- Assess whether the benefit of cleaning the wound with water is worth the risk of creating an infection if that water proves to be contaminated. Is there mud or debris still visible in the wound after manually cleaning it? If yes, the water looks clean, and you’re near someplace where you can thoroughly address the wound, it’s probably OK to flush it out in a stream. But if you’re in the wilderness for a week or more—enough time for an infection to take hold—wait until you can boil and cool water or otherwise disinfect it.
- Apply a thin layer of an antiseptic ointment, such as bacitracin, under the dressing.
Drowning: The Heimlich maneuver won't save you
The Heimlich has been used for decades to clear the airways of choking victims. For that purpose, it has proved to be a lifesaver. However, the medical community is now advising against its use in drowning cases—despite the claims of Henry Heimlich, it has never been established that the technique can remove water from the lungs. Instead, it may cause a victim to regurgitate and then inhale his or her vomit.
The best thing to do if someone has drowned:
- Remove the victim from the water, ensuring that you and others remain safe.
- Check for breathing by feeling around the mouth and nose and watching for a rising chest.
- Open the mouth and sweep it clean with two fingers, then align the victim on his back on the ground, his head flat or tilted slightly downhill of his body.
- If the victim shows no signs of breathing, begin mouth-to-mouth.
- Check for a pulse and begin chest compressions if there is still no sign of life.
- If hypothermia or a broken neck is a concern, cover the victim with blankets or protect neck movement, then transport the victim to the nearest hospital.
First-Aid Kids: DIY is better
You can buy a preassembled medical kit from your favorite outdoor retailer, but you’ll usually want to add something to it, and inevitably the supplies will dwindle, forcing you to replace them.
The smarter option: build your own, making sure you understand the uses for each item before you add it to your kit. A do-it-yourself approach allows you to easily adjust what you pack based on the location, the number of participants, the duration of the trip, and how much weight you wish to carry.
Keep your stuff safe from the elements (particularly moisture) by packing it in ziplock bags, and make sure all members of the expedition know where the medical supplies are stored and how each item should be used before departure.
Finally, try to choose multipurpose supplies, like medical-grade adhesive tape, which can both secure a bandage and, in a pinch, close a wound. The more versatile your tools, the fewer you need to bring.
Two-Person Weekend Medical Kit Checklist:
• EMT shears
• Duct tape
• Safety pins (for fashioning a sling)
• Needle and thread for stitching
• A Copy of Medicine for the Outdoors—surprisingly effective at reassuring people
• Ibuprofen (ten) for pain, inflammation, and fever
• Antihistamine pills (two) forallergic reactions
CPR and bleeding
• Trauma pad
• Nitrile gloves
• Antimicrobial hand wipe
• 20cc irrigation syringe for cleaning wounds
• Povidone-iodine (one ounce) for creating disinfectant solution
• Wound-closure strips (five)
• Tincture of benzoin
• Antiseptic ointment
• Three-inch-square gauze pads (four) for cleaning and covering wounds
• Adhesive strips (five) for covering wounds
Burn and blister care
• GlacierGel blister pad
• Moleskin (ten precut pieces)
Fracture and sprain care
• Elastic bandage to reduce swelling and provide support
View a complete list of backcountry-first-aid courses.
Head Injuries: More difficult than you think
Until recently, the standard method for estimating the severity of a head injury, which is surprisingly common in the outdoors—think mountain biking and climbing—has been the Glasgow Coma Scale. But the GCS, still popular in the medical community, was not devised to evaluate people with head injuries; it was for use in neurosurgery units to assess changing levels of consciousness. The better method today is the three-point Simplified Motor Score, wherein a first responder assesses the patient’s responsiveness using three criteria: ability to obey commands, to determine where the pain is coming from, and to withdraw himself from painful stimuli. From a practical perspective in a wilderness environment, the best approach if someone has sustained a head injury is this: Protect the airway and cervical spine (i.e., neck) to make sure that the patient can breathe and that there will be no further damage to the spine. Carefully observe any victim who has lost consciousness briefly (less than one minute) for at least a few hours. Transport to a hospital anyone who shows worsening signs related to head injury. These include severe headache, blurred vision, nausea and vomiting, any change in mental status (declining alertness, ability to converse, or ability to follow commands), seizure, bleeding from the ears, bruising behind the ears or under the eyes, clear fluid draining from the nose, unequal pupils, or weakness in an arm or leg.