First Aid for the Outdoors

Disclaimer:  Move along... this isn't ready for primetime.  Even if this page was complete, I am not a doctor or a medical specialist.  I plan on taking a refresher of WMI Wilderness Advanced First Aid  and WMI - Wilderness First Responder, both of which are periodically held in Santa Cruz.  Keith Conover is and has a number of useful resources on his web site.  A big change since when I first learn advance first aid that is in most cases it is recommended to stabilize and evacuate, rather than attempt treatment in the field. Survival Medicine has some useful information, especially using local materials for treatment.


Wounds:  For really serious wounds, don't attempt to suture in the field, pack the wound to permit draining, and evacuate.  Let a professional sew the wound up later.

Actcel and Hemcon KytoStat bandages


Bites and Stings

MosquitoesIn my opinion, the best way to prevent being bit is to use physical barriers like headnets and to use is DEET based repellent.  See Mosquitoes and Mosquito Repellents and Comparative Efficacy of Insect Repellents against Mosquito Bites and a brief article about the effectiveness of Picaridin. for more information and EPA's list of active ingredients. Recently Picaridin has entered the US market. Picaridin has a number of advantages over DEET: it doesn't destroy plastics, it doesn't smell bad, and doesn't leave that icky feeling. From the studies I have read Picaridin is slightly less effective than similar concentrations of DEET. I have found that 8% Picaridin is effective against moderate mosquito pressure for a few hours. In the US, only low concentration Picaridin based repellents are currently available, so if you are going to face fierce mosquitoes, I would recommend the time released 33% DEET such as Ultrathon or something with even more DEET. I have tried a number of the natural insect repellents. Lemon Eucalyptus seems to have been the most effective. In locations which have only minor mosquito problems they can be effective, but if you are somewhere with lots of mosquitoes (say in the Sierras when the snow is melting, Canada during the summer, etc), you will get eaten alive if you use "natural" repellents.

Ticks:  Start with prevention.  Spray your cloths with Permethrin and use DEET based repellent if you are in a location which has a lot of ticks. You should remove ticks by gently pulling them off with a pair of tweezers or using one of the special tick removing devices which are designed to lift ticks off your skin (such as the Pro Tick Remedy).  Using  hot match, Vaseline, nail polish is extremely counter production.  Not only do these techniques risk killing the tick and leaving part of the tick in the victim, but ticks will often expel their stomach contents when distressed, the very thing you want to avoid.  There is a belief that Lyme disease isn't transmitted for 24 hours, so make sure you do a tick check each night.  If you have been bit by a deer tick, check with a doctor.  There is now an anti-biotic treatment which is more than 80% effective. I collected some info about tick removal tools from forum. Of course, treating clothing with Permethrin helps keep ticks away.

Snake bitesIn an average year less than 6 people died from snake bites in USA.  More people died from lighting strikes each year.  Most snake bites are the result of young males putting their limbs in locations that would violate basic common sense. So if you are hiking in US, don't get freaked out about snakes. Making incisions and above the bite is ineffective, and now you have a wound which must be tended. The only semi effective treatment in the field is Sawyer's Extractor which will remove ~35% of the venom if used within three minutes.  Even the extractor is being questioned.  These days the best recommendation to to extract people for medical treatment if possible, and if not keep them calm and well hydrated and be prepared to sit around for 2-3 days while they are really sick.

Sport related

sprain, break, etc

Dr. Pribut's Sports Page

blisters: start with prevention. minor just cover. worse, drain, seal and cover.  Really bad donut cushion. Fix Your Feet.

"saddle rash": start with prevention. treat with utter balm


Cold: Prevention is best.  Start by learning How to Stay Warm, Medical Aspects of Cold Weather Operations- A Handbook for Medical Officers.  Treatment: Hypothermia info. Treatment for Raynaud' Disease. Blog entried from Wilderness Medicine Newsletter tagged hypothermia and frostbite.

Heat: WebMD - Heat-Related Illnesses, Heat Acclimatization Guide - Ranger & Airborne School Students

Attitude:  For most people, 8000ft is where people might start having issues.  Ideally you should do incremental acclimatization, 2000ft / day or so.  Of course, many of us aren't willing to take that time, so we risk attitude sickness.  There are a few things you can do to lower the risk of problems.  Most important is to stay hydrated.  Eat low fat  meals, avoid alcohol, tea & coffee, move slow enough so that you never let yourself get out of breath, and if you start to have any symptoms at all, stop and take many deep full breaths (maybe 50 to get lots of oxygen into your system).  The High Altitude Medicine Guide and High_Altitude Illness by Hackett and Roach published in NEJM have a lot of useful information.  Medical Problems in High Mountain Environments- A Handbook for Medical Officers

Sun: 3oz lasts 4 days for me.  Good review of sun protective lotions





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