Backcountry First Aid

[homebrewd]

Had a bit of a scare today out skinning with the lady. Was just a casual skin at Berhoud to get the blood flowing in the legs for longer tours. Just cruising on a downhill stretch and caught a bad rock that had been covered with fresh snow. Put my hand down to brace the fall and ended up catching a granite shard across the knuckles cutting through the glove and causing two lacerations between my knuckles on ring finger and pinky. Didn't even notice it at first, but quickly realized my gloves filled with blood and pulled it off to find the wounds. I have been carrying a skin stapler for 2 years now and never had to use it until now. I figured "meh just in case" but I was able to stop the bleeding pretty quickly until I got in to get them sutured shut. To keep it shorter I'm glad I had that in the day pack even though it was just a planned trip for a couple hours. I'd usually have a decent kit put together with gauze, ace wrap and the rest for a full tour but sometimes I don't even think about it anymore.

Somewhat PSAish, but consider what you pack even for short trips. Shit happens and it's better to be prepared and calm about it than panic and rush back to the truck as fast as you can.

As a forethought curious what others are carrying and wanted to make everyone think about it if nothing else.

[dunfree]

carry what you have training for.

get first aid training. as, or more, important than avy training.

[SkiLyft]

carry what you have training for.

This!! If you don’t know how to use a skin stapler than you should not carry one. Instead carry triple abx, ace, gauze.

Glad you were able to get out okay.

But since you ask: standard stuff + iodide swaps, 5.0 prolene, needle driver and snips. They are lighter than a stapler.



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[homebrewd]

get first aid training. as, or more, important than avy training.

This is also an understated part of Backcountry preparation. Wilderness First Aid is something everyone who ventures into the woods needs to think about but few do. I guess my experience just triggered the need to bring more awareness to that fact. Especially on short trips where you can have a false sense of security. Appreciate the perspective.

[homebrewd]

This!! If you don’t know how to use a skin stapler than you should not carry one. Instead carry triple abx, ace, gauze.

I have plenty of experience using them. It was more of a "shit hasn't hit the fan to that level" statement.

Glad you were able to get out okay.

Appreciate it man.

But since you ask: standard stuff + iodide swaps, 5.0 prolene, needle driver and snips. They are lighter than a stapler.

To be honest this was kind of my main goal with the post. I think there are a lot of younger guys that need to have more awareness and know what they need to have ready to go in a pinch. Training is essential either way, I know there are plenty of avy awareness courses offered but few that actually heavily suggest taking the wilderness first aid in tandem. At the very least knowing essential pieces of first aid and how to use them.

I've been regrettably ignorant to my own preparation.



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[rod9301]

This is also an understated part of Backcountry preparation. Wilderness First Aid is something everyone who ventures into the woods needs to think about but few do. I guess my experience just triggered the need to bring more awareness to that fact. Especially on short trips where you can have a false sense of security. Appreciate the perspective.

I took a wilderness first responder course, 10 days long, about 10 years ago. I thought it was useful, but I'm not sure how much i retained though.

I do remember one thing though. If you get water in your lungs, you're basically fucked. Infection that can't be treated.

Probably learned other stuff too.

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[old goat]

You would have been fine without the stapler. It might have taken longer to stop the bleeding but if anything stapling the wound without properly irrigating it and without sterile conditions increases (slightly) the risk of infection. Bandaids would have been nice but not essential. For me the key things to carry are bandaids (Bandaid Tough Strips are by far the best) for minor cuts and 2 inch athletic tape to tape a sprained ankle--can make the difference between walking/skiing out and being evacuated. Sterile gauze and antibiotic ointment are nice. Unless you're on a major, remote expedition the point of a first aid kit is to allow you to continue a trip despite a minor injury.

If you're on a longer trip a way to close a bigger laceration is nice, if you're willing to carry some antiseptic, sterile gloves, a sterile drape. I'd go with sutures rather than a stapler. Easier to do a good job by yourself, without a surgical assistant. You can get a little disposable suture set with the antiseptic and drapes, needle holder and forceps. Practice. Important--hold the needle in the middle, not the end. Much easier to suture that way and less likely to break off a needle in the wound. Personally, though, in 50 years of backcountry travel I've never taken more than the gauze, bandaids, and athletic tape.

Oh, and if you want to be nice, carry a razor to shave that ankle before you tape it.

[river59]

Anybody have any opinions about haemostatic agents?

Some serious crampon puncture wounds got me thinking about options for controlling bleeding. I was able to control their bleeding with a compression bandage but would have gone the tourniquet route if needed.

What's your plan for stopping a spurter?

[old goat]

Anybody have any opinions about haemostatic agents?

Some serious crampon puncture wounds got me thinking about options for controlling bleeding. I was able to control their bleeding with a compression bandage but would have gone the tourniquet route if needed.

What's your plan for stopping a spurter?

Direct pressure. A "compression" bandage won't stop significant (arterial) bleeding. Place a very light bandage (or none at all) and then a finger or hand directly over the bleeding, press HARD, and hold at least 10 minutes without looking. If it's still bleeding after that resume pressure and call or send for help.

I got called a lot to the ER for people bleeding from dialysis access punctures. The ER doc would tell me they couldn't stop the bleeding. They'd be alone on a gurney with a huge pile of bandages wrapped around their arm, bleeding into the bandages. I would take off the bandages and put a finger (or if possible a nurse's or tech's finger) on the bleeding point and it would usually stop.

A tourniquet can be useful for bleeding from a major artery--if you apply it correctly and if the bleeding is truly from a major artery, which requires some experience and anatomic knowledge to determine. Blood freaks out the average person, who will greatly overestimate the amount and rapidity of blood loss. Is it possible that you might encounter penetrating trauma that would require something like Quick Clot to stop? Sure. You could also win the lottery but I wouldn't make that part of my financial plan. The dangerous bleeding is the bleeding you can't see--into the brain, chest, or abdomen. That's the kind of bleeding you are far, far, far more likely to encounter in a hiking, climbing, or skiing accident--blunt trauma.

[new yabyum]

Steri strips, a must for even the smallest kit. The WFA by NOLS or SOLO is a great start to backcountry first aid.

[detrusor]

^^^^^^^^
This. People just don’t hold pressure long enough and can’t help but “look to see if it’s stopped”. If you look and it’s still bleeding the timer starts over.


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[~mikey b]

https://zipstitch.us/

https://youtu.be/UtRuuNTmlzo

[DolphinSki]

I carry a decent first aid kit (not with a skin stapler though) on all my backcountry tours. However, on a similar note I neglected to do the same mountain biking until a similar issue happened. Put my hand down right onto a really sharp chunk of limestone. Had to wrap my shirt around it and bike back in just my jacket. Thanks for the reminder PSA

[krp8128]

OP those staples seem nastier then the original issue, some compression and gause couldnt fix that?

I carry a pretty good amount of first aid gear, including the proffesional quickclot. I hope to never use it, but in a true trama situation wouldn't hesitate.

I'm also slowly working my way through the WFA book also keeping an eye out from also course. I used to be red Cross certied but it has been a few years.

Biggest thing to have with you is a brain. Seems like it could keep you out of most life or death situations.

[garyfromterrace]

So old goat, I'm a 30+ year tourer with a couple of avi courses (CAA 1 for ski ops and a week long refresher). Only basic 2 day first aid course, taken at least 10 times).
Wifey is a 20 year tourer and a former ambulance attendant. I'd say we could each afford to take a companion rescue course OR a wilderness First Aid course each. Which one should we do?
Or should I take the wilderness FA course and mrsGfromT takes the companion rescue course.

I know it's a bit of thread drift but really like to hear your thoughts.

[summit]

STITCHES, STAPLES, ETC: @homebrewd @~mikey b

If you are thinking about definitive wound closure, are you carrying a wound irrigation and cleaning solution? Do you know what happens if you close a wound that hasn't been sufficiently cleaned? A lot of the time its better to not go for definitive wound closure if you cannot do a really stellar job of wound cleaning and debridement which is hard for trained people to do in the backcountry and most untrained people couldn't manage in a procedure room with all the right tools. When I think steristrips, I think prevention from tearing and stabilizing the wound, not fully approximating it. Yes you'll get a bigger scar but you are far less likely to have severe complication of infection.

HEMOSTATICS: @river59

Do you know direct pressure? Do you now how to use a tourniquet? Do you carry one? Do you know how to pack a wound that cannot be tourniqueted and to use a pressure dressing over the packing? If you don't know these things, then don't go and blow $20-60 on a fancy pants hemostatic agent. Take a WFR class (ask if they teach MARCH, they should) or find a Stop The Bleed class. They are mostly free and 1-2 hours and tons of them are available all over the place.

Know what to do now? Here are special hemorrhage control items for your iFAK (individual first aid kit):
Less expensive ($22 total): NAR Sfold Gauze (NOT hemostatic), SWAT-T Tourniquet, NAR 4" ETD
Nicer route ($77 total): Celox Z Fold Rapid Hemostatic Gauge, NAR CAT G7 Tourniquet , NAR 4" ETD
I carry and have used all of these items (at least in training... haven't had to tourniquet anyone for real)

HEMOSTATIC TO BUY: Celox Rapiz Zfold Gauze or another z-folded chitosan impregnated gauze (or regenerated cellulose). Don't buy the outdated granules, don't buy the less effective "sponges", and don't buy the hard to debride mineral based products like quick clot.

I've read a lot of the studies and used hemostatics. I carry them. I do think that hemostatics have decreased chance of rebleed in wilderness patient transport while there is probably less utility in urban environments. .mil has been teaching these in TCCC for some time now. That said, I don't think they are a must have.

Massive external hemorrhage is about the only deadly traumatic injury that 99.9% of people can be made capable to treat in the wilderness. Know what to do about it is key.

Avalanche Rescue vs First Aid @garyfromterrace

I teach avalanche rescue courses and wilderness emergency medical care courses. What you learn in a WFA or WFR can help you in any accident in your life, car wreck, bike wreck, climbing fall, avalanche, ski crash, cut yourself prepping veggies, you get the picture.

Avalanche rescue will make you more effective in an avalanche rescue.

There are significant differences in time commitment:

WFA: 16 hours usually 2 days
WFR: 80 hours usually 5 days with an online component
Avalanche Rescue: 8 hours usually 1 day

I hate to think of this as an either/or! You have your CPR already right? That should only be about 3 hours! I'll put it this way, I love to see my partners have CPR, WFR, Avalanche Rescue, and Avalanche Level 1 Rec! :-)

[cmcrawfo]

It's already been mentioned, but...

There is a significant risk to closing wounds in the back country. It's extremely difficult to properly clean and irrigate a wound in the BC. Closing a dirty wound is going to yield far worse results than leaving it heal on its own.

Clotting agents can also pose a risk, and if your local health care facility isn't familiar with them, you are in for a nightmare.

The best interventions are the simplest. And simple interventions are easy to pack and train with.

Spend time thinking about evac and extrication plans rather than advanced medical interventions.

And I say this as someone who has lugged plenty of high end gear around and used almost none of it. Despite providing treatment for everything from lacerations to arrests.

[SumJongGuy]

Medical grade super glue..

[summit]

Clotting agents can also pose a risk, and if your local health care facility isn't familiar with them, you are in for a nightmare.

You post was great! I just wanted to say on hemostatics that you should always tape the hemostatic wrapper to the patient so the receiving facility knows what was used. However, if you avoid old quick clot and avoid granules, there is no major risk from hemostatics. If you avoid quickclot (kaolin mineral based) then you avoid the nightmare surgical debridement problems. Chitosan and regenerated cellulose hemostatics wash away and dissolve with simple NS irrigation.

[summit]

Medical grade super glue..

Dermabond has similar infection risk to other wound closure (staples etc) when used in the wilderness on improperly cleaned wounds, except good luck getting it off!!!

I really do like the Liquid Bandage products like New-Skin because, unlike cyanoacralate superglues, it is easily dissolved by the evaporating solvent that is mixed in the container and is far less dangerous. It has a lot of utility for high wear areas and immersion where bandaids won't stay... MINOR SHALLOW cuts, well cleaned, the antiseptic nature of the New-Skin helps (and stings like a bitch).

[Meadow Skipper]

It's already been mentioned, but...

There is a significant risk to closing wounds in the back country. It's extremely difficult to properly clean and irrigate a wound in the BC. Closing a dirty wound is going to yield far worse results than leaving it heal on its own.

Clotting agents can also pose a risk, and if your local health care facility isn't familiar with them, you are in for a nightmare.

The best interventions are the simplest. And simple interventions are easy to pack and train with.

Spend time thinking about evac and extrication plans rather than advanced medical interventions.

And I say this as someone who has lugged plenty of high end gear around and used almost none of it. Despite providing treatment for everything from lacerations to arrests.

Good post, really good post.

[garyfromterrace]

STITCHES, STAPLES, ETC:

Avalanche Rescue vs First Aid @garyfromterrace

I teach avalanche rescue courses and wilderness emergency medical care courses. What you learn in a WFA or WFR can help you in any accident in your life, car wreck, bike wreck, climbing fall, avalanche, ski crash, cut yourself prepping veggies, you get the picture.

Avalanche rescue will make you more effective in an avalanche rescue.

There are significant differences in time commitment:

WFA: 16 hours usually 2 days
WFR: 80 hours usually 5 days with an online component
Avalanche Rescue: 8 hours usually 1 day

I hate to think of this as an either/or! You have your CPR already right? That should only be about 3 hours! I'll put it this way, I love to see my partners have CPR, WFR, Avalanche Rescue, and Avalanche Level 1 Rec! :-)

Great info Summit, thanks. It got me looking more closely at courses, time commitment and cost. Companion rescue is only $150 so we can afford to both take that (as we should). A 2 day WFA course is also about $150 so we'll both take that as well. Next year when we're both retired we'll bite the bullet and take a WFR course together. old goat, go back to drinking cheap whiskey and passing out. Your help is not required here any more.

[Bronco]

See if you can take a WFR class in the early spring in the snow. I took one at Snoqualmie Pass in early April a few years ago and it was pretty realistic scenario for dealing with an avalanche victims first aid treatment.

[SumJongGuy]

Ski edge cuts used to be pretty common back in the safety strap days. Back in the old days I'd just grab a hand full of snow (in your glove) and press it against ski edge cut firmly. Seemed to stop the bleeding well enough. Does that push dirt deeper in to the cut or does the melting snow flush the would clean?

[homebrewd]

OP those staples seem nastier then the original issue, some compression and gause couldnt fix that?

In hindsight the skin stapler was a lazy way to handle it. Compression wrap and gauze would have been a better option, removing fresh staples hurt like a bitch. Where it was on the knuckles made it tough to get an adequate pinch with the skin. I was just fortunate I brought it with.

I'm also slowly working my way through the WFA book also keeping an eye out from also course. I used to be red Cross certied but it has been a few years.

I am putting WFA on the top of my to-do list. It would be kind of great if we could put together a maggot recommended bc first aid kit.