View Full Version : Wilderness Medicine

2003-01-22, 14:41
Any one interested in the possibility of a wilderness medicine forum? As a physician and member of the WMS I would be interested to hear what kind of backcountry injuries people have sustained and what kind of novel improvisation was used to treat/rescue/etc. I would be especially interested in hearing from the ultralighters out there. I have the tendancy (because of my medical training) to assume the worst of all possibilities, and I need to convince myself that the likely hood that I will ever deliver a baby or take out an appendix on the trail is a really remote one. :) It has taken me several years but I have finally pared down my first aid kit to fit in a band-aid box.

just curious if there is any interest out there.

SGT Rock
2003-01-22, 14:44
I think we could expend the Hygine topic to Health, medicine, and hygine since they seem related. Does this sound like a good idea?

2003-01-22, 14:55
You are in charge sarge. :)

I would be happy to participate anywhere, Just point the way.

I really think this would be kind of an interesting topic, because one of the things I hear people complain/wonder about is safety and health on the trail. I get a fair amount of criticism for backpacking solo, usually starting with "what do you do if you fall off a mountain, then what?" fortunately I have never fallen off of a mountain but I am interested in the "then what" portion of the question.


SGT Rock
2003-01-22, 15:02
Look up:rolleyes:

The forum is now called Health, First Aid, and Hygine. I also moved this thread there.

2003-01-22, 20:27
Sundog, you said your kit will fit into a bandaid container. I am interested to know what first aid items you carry.

2003-01-22, 23:46
I just replied on another post regarding meds.

Beyond those meds I take, I agree with rock regarding super glue, I use it to seal cuts (trade name derma bond, which is $80 super glue). I carry a single ace wrap, a bandanna, 4 or five safety pins, duct tape, a couple of alcohol wipes, assorted band aids.

Here is really where improvisation helps, for example, using the stays from an internal frame pack and an ace wrap, I can splint damn near anything, there fore I don't need to carry a sam splint. or plaster :)

another good example, several saftey pins strategically placed on a t-shirt can sling an arm.

Ace wrap can also be used for the splint immobilization technique for treatment of snakebite used by the australians.

duct tape- can be used for warts, for blisters, could also be used to tape an ankle, ribs, or used in a splint. in a real emergency it could also be used on a "sucking" penetrating chest wound.

ensolite pads, also can be used for splints, or for immobilizing a neck injury.

so, really, the stuff that doesn't fit in the box has other primary uses, like my duct tape, or my micra, or my gerber knife, or my sleeping pad. I suppose my most important piece of medical equipment is my brain. regardless all of the primary medical gear fits in the band aid box, and everything has another use.

any way, it is the improvisation angle of wilderness medicine that I am interested in, since the core philosophy is going to coincide with doing alot with very little.


p.s. I am sorry, I am not so much of a gear freak as to have every item weighed. I would guess all told my dedicated medical supplies weight would come in right around 6-8 ounces. however, like I said earlier, improvisation with other items is key. for example, one could eliminate the alcohol wipes and use alcohol stove fuel as an antiseptic. hope that answered some questions for you.

2003-01-23, 00:33
remember this one in boot camp
cellophane from your pack 'o' camels under some type of wrap was the first aid. do you remember or am i really getting old? cape may 1969.
uscg basic.

2003-01-23, 00:48
anything that would effectively seal the wound. in an actual hospital (besides a chest tube) one would use petroleum gauze and a dressing. so cellophane ought to work because it is air tight.


Uncle Wayne
2003-01-23, 09:17
A Thru Hiker in '01 (Rocky) showed us a new way to treat blisters that had gotten big and puffy. She used a needle to pull a piece of sewing thread through an alcohol pad and then through the blister so the fluid would "wick" itself out via the thread. The thread was cut so it was about an 1/2 inch long on either side of the blister. A piece of guaze, some neosporin and duct tape completed the treatment. My son treated a couple of blisters on his toes this way and it greatly helped with the pressure / pain caused by fluid buildup. The "threaded" blisters of one foot treated in this manner healed quicker than those on the other foot that were not "threaded." After the third day, we threaded the other foot's blisters also. YMMV.

2003-01-23, 14:13
Good Idea!

I never thought about that. I would recommend flaming a needle or dipping it into some alcohol fuel first, and watching very carefully for infection. of course if it does get infected, simply lifting the roof off of the blister and exposing the skin underneath should be enough to drain the infection.

Speaking of feet..

Rock, what is the army teaching about trenchfoot these days?
I know it is not an uncommon problem with hikers, generally involving boots that are too tight and wet (cold never helps either)
I have also heard river rats refer to "river rot" when their feet are constantly wet on longer trips.


SGT Rock
2003-01-23, 14:33
Trenchfoot - mostly prevention. Same old stuff, change socks three times daily, use clean dry socks and foot powder, clean feet daily with soap and water. As a hiker, it isn't always that easy to keep clean dry socks, but you can try. What I do mostly is:

I have three pairs. Two are for hiking which I change once a day, and the third is for sleeping.

Wear a hiking pair in the morning, then change out at about lunch. I like to try and rinse them daily (away from water source) and if possible - sleep with them, the body heat is a great dryer. I wear mostly synthetic liners when hiking without socks, and in cold weather I add Thorlo light hikers. These synthetics dry pretty darn fast. I have a pair of Seal Skinz if it just gets absolutly too nasty and cold.

It isn't the best technique, but it works. In the end, it is just like any other part of the body except that they are the most vulnerable because they get cold and dirty easy. The Army uses an acronym for how to steer clear of trenchfoot and other cold injuries:

C - Clean, wear clean clothes, they insulate better.
O - Overheat, avoid overheating.
L - Layers, dress in layers so you can quickly remove a layer to prevent overheating or add a layer when needed.
D - Dry, stay dry. Cold anything (including synthetics) can kill.

Add to that avoiding cotton socks and such, you should be OK.

2003-01-24, 14:46
Totally related to Sundog's initial post about planning for the worst. As an old (and I mean really old) paramedic, I used to have a first aid kit that weighed well over 5 pounds and would have supported minor surgery. Chalk it up to my training and being an old Eagle Scout, but I was under the impression back in my early days of backpacking that it was my responsibility to be prepared to take care of not only myself but every other hiker I encountered who had a problem. That false sense of responsibility was further reinforced when I hooked up with a boy scout troop back in the 80's and took groups out in the woods. Goofy me ...the boys all carried little zip lock bags with a couple bandaids while I carried enough supplies to stock a small clinic. But it didn't end there ...I also used to carry enough "extra" gear and clothes just in case one of them left something at home, which they often did. Sorry, got a little off topic there.
Little by little I realized that I was teaching them to be "helpless" and I got smart. I haven't reached the bandaid box sized first aid kit yet but I'm getting there. Improvisation is one of the big keys in getting your kit down to size, I think. We all carry items in our packs that could be used in an emergency scenario that aren't necessarily in our first aid kits. Couple examples are duct tape, boot laces and nylon webbing. A few different sized bandaids, a little H202, a couple gauze pads, small roller gauze, antibiotic ointment and a tongue depressor and you've pretty much got the basics covered. I do carry a sewing kit and heard long ago about that needle and thread method of draining blisters. Honesly though, unless I can get things relatively clean I generally don't puncture a blister out in the woods, unless the pressure is totally preventing me from hiking. I try and make it into the next town/hostel where I can lift and drain it in a better environment.

2003-02-19, 16:17
Very cool thead!

Also a doc here... mainly preventive medicine, but with a family practice and operational outdoor bent.

Best and most important piece of equipment: brain, doesn't fit in bandaid box, but it has other uses.

What I always carry: Because I lie awake at night if I do not have it:

- Duct tape - mainly for blister prevention... as soon as it feels hot
- Motrin (vitamin I for my 50 year old frame)
- Erythromycin: too many uses to go into
- Hand cleanser (with toilet paper) Mainly as a reminder
- Polar Pure To always be able to drink and not get dehydrated

Several things which sometimes make the list:
- benzoin (REALLY sticky stuff to put inside a blister which has partly come unroofed) - Learned this one at Nymegen marches
- mirror (to get stuff out of my eye)
- opthalmic antibiotic drops - haven't used since I stopped wearing contacts
- Steri strips (for little cuts too deep to leave open and too shallow to hike to a suture station) (have to also have benzoin to make it work) Oh! how hard it is to treat them well enough for the 3 days it takes for initial healing to take place!
- Sunscreen

That's a beginning.


2003-02-19, 16:31
I use super glue for most cuts. Methlyacrylate (i think) same stuff as dermabond, but much cheaper. the trick is to not fill in the wound but to stretch the ends so it comes together and then cover it with about 3-4 thin layers of superglue. it should peel off in a bout a week and be healed. I agree with the steristrips- I usually carry them as well since they weigh nothing at all and I have ready access to them in my clinic. I don't know that every one would have such good access to them, but I am sure if one was motivated they could find a source outside of medicine.


2003-02-19, 18:06
I have heard that superglue (crazy glue etc) was developed for Vietnam medics... I've never used it, but should work, I agree.

BTW, if you want to give people a picture, since they always seem to be asking, sundog, here is one of the best:



2003-02-19, 19:34
that is a great pic! :eek:

I first heard about the phenomena in about 1990 on a rockline interview with Rush after presto had been released. Neal Peart (the drummer and lyricist) described seeing them in canada and how he ended up using them in a lyric. After that I read about them and adopted it as my handle on BBS systems (still in existence back then) and for gaming online later. it finally evolved into my trail name. it is unusual enough that I am usually asked for an explanation. thanks for that pic.


2003-02-20, 08:01
Hey Sundog or Flyfisher, I'm planning a thru-hike of the Colorado Trail in August. I read the section on altitude sickness in the Wilderness First Aid book and I have a couple of questions if you don't mind. The first 35 to 40 miles go from 5500 feet to about 9000 feet. If I cover this distance in 3 to 4 days would this qualify as acclimatization? I live at 550 feet elevation. I've never had problems with altitude before but I've never hiked this high and this long before. Also are Diamox and Decadron prescription? I'm hiking solo so I try to be careful and prevent problems. The high point on the trail seems to be around 13000 feet. Thanks for any advice you would care to give. The list of proposed articles sounds good.

2003-02-20, 12:03
Reference: Environmental Emergencies and the Wildnerness Medicine Journal

Usually, Acute Mountain Sickness (AMS) does not occur below 7000 feet. For your trip, and my son had a similar trip a couple years ago, I gave him the same advice:

It is best if you can stay about 3 days at the 5500 foot level. Day hike around the trail head and sleep at this lower altitude. Then tackle the higher elevations... By then you will know if you are having the headache charastic of mild AMS. It's also great prevention to make sure you enjoy the rest of the trip. After several days at 5500 feet, a slow walking ascent to 9000 feet over 3 days is likely possible, though I would advise sleeping as low as possible each night.

The trip to 13000 feet will be quite a hike and in my experience, I would get a headache from such an ascent in most cases. The headache will clear after returning to a lower elevation and a good night's sleep - and with some Vitamin I.

The meds for AMS are both prescription and not a bad idea to have on hand.

There are two severe (life threatening) forms of mountain sickness: Acute Pulmonary Edema and Acute Cerebral Edema. Don't play around with either. If you are having symptoms of anything beyond mild headache and some interrupted sleep, I would hightail it back to lower elevations.


2003-02-20, 12:29
I agree. I would probably start diamox 48 hours before going up. you also need to avoid alcohol at elevation. there are case reports of HACE/HAPE, the life threatening versions of altitude sickness at 8000 feet, but this is not the norm. most people get headaches and have trouble sleeping at around 10,000 feet, (i.e. breckenridge colorado) A decent as little as 2000 feet can alleviate the symptoms. the biggest piece of advice I can give you is don't over do it the first couple of days, because you will hurt your self. Don't expect to clock the same milage that you do at sea level as at altitude. I suspect that you will notice the difference after you get past 5000 feet.


2003-02-20, 17:37
Sundog and Flyfisher, Thanks for the quick responce and good info. It will help in planning the trip. From looking at trail profiles 10000 feet seems to be about average for most of the trip. Breckenridge happens to be one of my planned resupply points. Thanks again and good hiking. Hafdome

2003-02-20, 18:00
probably the most innovative item in my FA kit is co-flex, you med types have seen it, I'm sure. I go the REAL cheap route and get it at Fleet Farm, you get a wider roll, and it's cheaper than dirt....
Horse leg wrappings. 4 rolls is about 2.00 I think, many colors and light and cheap. It's a heck of a lot lighter than an ace or anything like that, easy to adjust tension, and grips like crazy to itself, and only itself, big bonus points for hairy areas.

2003-02-21, 02:30

neat colors and kind of stretchy?

thats a good idea, I think I will steal some from the blood bank...


2003-02-24, 15:21
I had a hernia repaired, last July, and the cutter put some kind of clear, perforated tape over the incision. It stood up to showers and perspiration, like duct tape to a rusted fender. Would that be the same material you are calling Steri-strip?

2003-02-24, 15:32
Just did a search for Co-flex, and found this online supplier. Many colors, at only $1.29 for 4" x 5 yd. rolls. Looks like a pretty good deal, to me.


2003-02-25, 09:57

Steri strips are little pieces of tape about 2-3 inches long and 1/8 to 1/4 inch wide (several sizes) They take the place of sutures (stitches) for some applications.

http://multimedia.mmm.com/mws/mediawebserver.dyn?iiiiii6pAuxiC4JiW4JiiiJDjujfUWd b-

2003-02-25, 10:32
Thanks, that was much nicer than my wife's (an MSN)comment, that if I'd stop thinking of brook trout, once in awhile (actually, she also added something a bit more colorful - something about removing my head from my butt) I'd realize that not only had "butterflies" been improved upon, but that I would also probably recognize that people weren't driving '55 Chevys, anymore.:D