major cuts in the wild

[carmen]

Has anyone had to leave the wild in order to seek medical attention? A friend of mine had a nasty cut but ended up staying for their weekend trip. After looking at the photos and the aftermath I would have high tailed it out of there to the closest hospital.

[ppine]

I was fishing on the Umpua River in OR on an overnight trip when my close friend sunk a fish hook all the way into his hand. We would have had to push the hook thru his hand and cut the end of the hook off to get it out. He hiked out of the canyon and found a highway and hitchhiked back to Roseburg to get it out. We camped on shore and he came back in about 6 hours.

In 2007 I broke my femur while riding a saddle mule. It was 9 hours by dirt road to the nearest hospital. My friends got me back to camp and drove 100 miles to a ranch airstrip. We were met by a fixed wing airplane and morphine. That was an experience I would rather not repeat. I spent 8 days in a hospital in Bend,OR.

[Grandpa]

Originally Posted by carmen

Has anyone had to leave the wild in order to seek medical attention? A friend of mine had a nasty cut but ended up staying for their weekend trip. After looking at the photos and the aftermath I would have high tailed it out of there to the closest hospital.

Carmen, I know what your intent was and I agree, but I want to deal with the "high tail it out" part, just so there is no mis-understanding with new people in here. In any emergency, the first thing is "calm, cool, collected". Getting in a rush increases the heart rate which with cuts, or venomous bites, etc is bad. While time is important, it is more important to stabilize and move systematically.

Yes, we have had to abort a couple of times as well. The reason I mentioned the calm, cool, part above was another mistake on my part. A fellow worker used to be an avid backpacker but had let himself get terribly out of shape. He desperately wanted to start using hiking for physical conditioning so another friend and I took him on a backpack in the White Clouds, a remote area adjacent to but even higher than the Sawtooths. The first lake is only 1 1/4 miles from the TH so we thought it perfect for him. We had just got our camp set up when I noticed smoke below us and one canyon over. It only took a minute to realize we were going to get out or get trapped. My first thought was to get our slow fat friend packed and on his way, which we did. I knew Darren and I could cope with whatever but we had to get the big boy moving. After Ken was on his way, we hurridly packed and followed. Apprehension set in the first few hundred yards when we hadn't caught up to Ken yet. Wow that guy can hurry faster than I thought was the only answer. We got to the car and no Ken. We dumped our packs in the trunk and started back up.

Ken had not even made it around the lake before he had become disoriented and lost the trail. This happens when you are a) stressed b) pushing harder than your system can get oxygen to the brain. Ken did have the presence of mind to realize he was lost so he sat down to think. Once the oxygen level to his brain had caught up, he could picture what had happened, looked around and saw the lake, walked 100 yards through the trees to the trail and started down. By then Darren and I had almost made it back to him. If this sounds like Ken was a few french fries short of a happy meal, he wasn't. This is what happens when anxiety or panic sets in. This also made me realize to slow down and watch others in an emergency.

The fire was within a hundred yards of the road when we passed. It eventually burned 20,000 acres, but never made it to where we were camped. It was man started.

[Lamebeaver]

Part of the "wilderness experience" is dealing with the realization that you are on your own if you are seriously injured. Death is a distinct possibility. How well you deal with this is a reflection of your resolve and character.

I've known several people who have faced life-threatening situations. It changed them. IMHO they end up with a completey different view of life, and it's usually for the better.

[catspa]

Carmen, that's a darn good question - and one that trip leaders and first aid providers should give some serious consideration. There's a whole spectrum of outdoor injuries, and while minor ones like a skinned knee won't keep you from "staying and playing", ppine's broken femur presented a life threat and needed evacuation. In between are a lot of "maybe" cases where a judgement call is needed, based on the situation.

In my state (WA) the patient makes the final decision, i.e. I cannot legally give first aid treatment to a patient who refuses it or force him/her to accept further medical care (as long as they're conscious and of sound mind). I can however, try to persuade them and/or follow them around waiting for blood loss from a severe wound, for example, to render them unconscious. Then the legal rules change, and I can treat. 'Course, by then a relatively mild medical problem has become a big one, and may exceed my ability...

I'm going to be asking some evaluation-type questions, or at least considering them carefully. They will include:

Is this a life-threatening injury right now? Might it develop into one later?

Where I am, with what I have, can I stabilize/bandage/protect this injury such that the patient likely 1) won't injure him/herself further, 2) can perform or sustain the exertion needed to continue their activity and return to civilization, and 3) the bandaging/splinting will not significantly degrade or allow contamination/infection/other negative factors during the time that's happening?

Are there other complicating factors like weather or distance or other things happening in the area that pose an increased risk to this patient when impaired?

Keep in mind, a first aid provider from an agency is gonna be thinking about their liability and will want to err on the safe side - maybe not so much for the patients friends/partners/companions who want to continue with their activity. I have said to a patient's party, "Look, if you guys want to keep going, I'll take care of your buddy. We'll rest a little bit, and walk out slow, or carry him, or call for more resources if needed. Whatever it takes." Sometimes that alleviates the patient's feeling of not wanting to ruin the trip for others, and keeps him from pressing on when he really shouldn't.

Okay, so you mention a nasty cut. An adult human contains between 9 and 11 pints of blood, and can lose 10% or so without suffering much IF they manage their exertion and hydration and exposure to the elements. When you go to donate blood, they usually take about a pint. Then they make you sit down, eat a cookie, and slack off for a while so your body can recover.

Blood loss more than 15% is going to lead to shock. A femoral hemorrhage, if nothing stops it, can render you unconscious in 30 seconds and dead a few minutes later.

From Wikipedia: "Individuals in excellent physical and cardiovascular shape may have more effective compensatory mechanisms before experiencing cardiovascular collapse. These patients may look deceptively stable, with minimal derangements in vital signs, while having poor peripheral perfusion. Elderly patients or those with chronic medical conditions may have less tolerance to blood loss, less ability to compensate, and may take medications such as betablockers that can potentially blunt the cardiovascular response. Care must be taken in the assessment of these patients."

Basically in order to keep going, the blood loss/contamination/impairment has to be fairly small. If any one or more of these is severe it's time to evac, and if it's life threatening evac RFN (or as fast as you can).

I am not a doctor, and suing me because you followed my advice will be morally and financially disappointing. Further, I may be partially or entirely full of shiite as concerns your specific situation. Let the curious perform their own investigations and take their chances...

Parker

[carmen]

I am in total agreement with the calm, cool, collected but I guess I am just looking for more insight. We have been reading up (intentional and not) on some stories about bad issues when you are out and about. I am personally wondering if we are packing too light when it comes to an emergency kit. Mind you this is the woman who sliced her finger in the kitchen with a pairing knife (do not ask how, I am still trying to figure that one out) and my quick instinct knowing I was out of band-aids and my kit needed to be refilled was grab some gauze and electrical tape.

Of course this is not how I would patch the kids up unless I had to but right now I think I want to be more prepared just in case than totally unprepared if the need comes up that someone needs a little patching. It cut not deep enough for stitches but it was insanely close to the radial artery. I was stuck at home alone and highly upset with myself for such a careless mistake.

[Grandpa]

If you are really worried about severe cuts, don't use knives. They may be an essential survival tool but in normal outdoor activity, they seldom need to be used. I carry two but probably use one of them once or twice a year. Once in a great while, I may need to cut off a chunk of cordage and thats about it.

A length of duct tape wrapped around a trekking pole comes in handy for a lot of things, including taping up a severe cut. Know your basic first aid and apply direct pressure on the wound. Anything can be used for a compress but cleaner is better. A piece of clothing, anything. Bleeding is now, infection is down the road. Deal with the now first. It doesn't have to say Johnson and Johnson on it. Know your pressure points to slow bleeding. You can even apply pressure to those as you are exiting the woods for help.

[Pathfinder1]

Hi...


Catspa and you all have posted some interesting and relevent comments.

I once cut myself while trying to cut an apple in half, and stitches were needed. I won't bore you with the details.

In my course I teach some basic first aid, from scrapes and cuts to broken bones to snake bites to treating major bleeding. I also have no medical degrees. How do I do it? By quoting from the best and latest sources available, and from personal experience. If I need verification or documentation on any medical matter, I have a daughter who is a Nurse Director at a place which employs 1,400 people. My sister is a shrink. One of my neices has a Masters in nursing, and her husband is a MD/PhD, both working in one of the Country's best known hospitals.

Bottom line? There is no thing as being TOO prepared. Even then, nothing is guaranteed. Use your best common sense and skills to utilize the resources at hand.

Here in NY we also have Good Samaratin laws.

Also, this month's (March) Outdoor Life has a special survival issue "Survive Anything", which is most interesting. You may also want to critique it. I found the field-splinting of a broken leg in such a way as to allow the victim to walk was very interesting.

[catspa]

For a person who doesn't want to use a knife, paramedic shears can be a handy substitute. But I like knives enough to put up with the occasional nick. Keep them sharp all the time and treat them with respect (that's my MO for any cutting tool, from razor blades to chainsaws...)

I don't use trekking poles, but I do wrap about 6 feet of duct tape around a Bic lighter, and have bandaged with it. Works for taping up a twisted ankle too, but leaves some sticky residue after the patient rips out his leg hair removing it.

Carmen, I commend you for using gauze and electrical tape, using what you had for what you needed. (I'd commend you again for restocking your band-aid supply).

Parker