Is There a Doctor in the...Woods?

As a young survival instructor trainee fresh out of basic training, I was eager to prove myself. On my first big trip to the woods, that eagerness caused me to neglect safety, and I ended up burying an axe in my foot. My instructor stabilized the wound, and two of my fellow trainees carried me 200 yards to an extraction point, where a field medic further evaluated and packaged the injury. From there, I was taken by Jeep and then helicopter to the base emergency room. In time, I recovered and completed my training.

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How would this have played out if I had been alone or with only one other person?

Everyone who bowhunts faces the possibility of an injury in remote country, far from help. For this reason, preparation and knowledge of first-aid principles are important.

Over the years I've taken a few wilderness-based first-aid courses, but new techniques are always being developed. I contacted the Wilderness Medical Institute (WMI), a part of the National Outdoor Leadership School based in Colorado. Gates Richards, who serves as the Director of Wilderness Emergency Medical Technician Training, helped me develop the following guidelines.

First Things First
In all cases, preparation is the key to dealing with injuries, and it comes in two forms: training and equipment. Regarding training, the American Red Cross (www.redcross.org) offers basic, advanced, and wilderness first-aid courses in most communities. Companies like WMI (www.nols.edu/wmi) offer specialized training, which I highly recommend.

Finally, good books, like A Comprehensive Guide to Wilderness and Travel Medicine by Eric Weiss, can help you do the right things in emergency situations.

Regarding equipment, remember to take the basics with you on every trip: materials necessary to control bleeding, clean and package wounds, and deal with personal medical conditions. Now, put yourself in the following situations and ask yourself: How would you deal with them?

Scenario #1-- Your partner is bitten by a venomous snake
The old guidance to cut X's over the fang holes and suck out the venom with your mouth is absolutely discouraged. Cutting just creates another injury to deal with. Tools like the Sawyer Extractor help remove venom, but they must be applied within three minutes of the bite to be most effective. Avoid using tourniquets or applying ice -- the ice can further damage the tissue, and it does not slow the absorption of venom.

Most importantly, stay calm. Then clean the bite site and immobilize the affected extremity. "Evacuate the patient, ideally without making them walk," Gates added. "Do everything possible to slow the spread of venom in the bloodstream."

Scenario #2 -- While packing out a load of meat, you roll your ankle, causing sharp pain and swelling
Treat joint and musculoskeletal injuries with great caution. I've observed that most people try to tough it out and hobble on injuries back to camp, which usually only aggravates the injuries. Lacking an X-ray machine, diagnosing fractures, sprains, dislocations, and similar injuries can be difficult.

Gates explained that instead of trying to diagnose a particular injury, evaluate the damage based on the victim's ability to manipulate the joint or bear weight on the injured extremity. If the patient has a mildly painful twist but can bear weight on it and walk, tape the joint for support. If the patient cannot stand on an injured leg, take a more careful approach. "Create a well-padded splint that immobilizes the injury," Gates said. "This usually means immobilizing the bones or joints above and below an injured joint."

Scenario #3 -- You are shivering uncontrollably
Hypothermia is a medical condition. You would not ignore a bleeding injury; likewise, you should not ignore the fact that you are so cold you can't stop shivering. Even though shivering marks the early stage of hypothermia, toughing it out won't help. Drinking warm liquids won't stop it, either. "Staying hydrated is important, and warm liquids are more appealing in cold weather," Gates stated. "But the warmth of your 16 ounces of hot chocolate has no measurable effect on your core temperature."

However, sugary liquids will add calories to your system and get your metabolism going, and that can increase body temperature slightly. So will foods that are high in carbohydrates. The best treatment, however, is to stop, build a fire, and warm up. Protect yourself from the weather, dry any wet clothes, and get into a sleeping bag if possible.

Scenario #4 -- While field-dressing an animal, your knife slips and cuts deep into your arm
"The vast majority of bleeding can be controlled with direct pressure and elevation (above the heart)," Gates said. It might be necessary to keep pressure on a wound for up to 30 minutes to stop the bleeding, and in this case, a pressure bandage will be helpful. It is important to stay calm and not rush through your evaluation of the wound. According to Gates, that's where a lot of people make mistakes.

Once you've stopped the bleeding, take a look at the incision. Clean the wound with high-pressure irrigation, using water clean enough to drink. This is best done with a small syringe minus the needle -- you can find these in most drugstores. To improvise, fill a plastic sandwich bag with water, poke a hole in one corner, and squeeze the bag t

o create a pressure stream.

If an incision is more than a half-inch wide, pack it open using clean, moist gauze inside the cut and dry dressings on top. "This will make it easier to keep the wound clean and minimize infection during evacuation," Gates explained. Then, protect the injury from outside contamination. Check the wound often for signs of infection -- redness, swelling, or pus build-up. If you see these signs, cleanse the wound thoroughly and re-bandage with clean dressings. You can improvise gauze strips by cutting up a clean T-shirt or similar clothing.