Hey folks, there are a plethora of first aid & common injuries to write about which can occur in the wilderness & away from home. I figured that a good place to start my first blog would be on how to handle a broken bone when there is no “formal” medical attention readily available. Obviously, if one is injured at home or on the road a call to 911 would be prudent, but what do you do if your hiking or communication capabilities are not functioning?
Here are a few tips:
- Stop any bleeding if present: Apply gentle, yet consistent pressure to the wound and bandage the area securely. If you don’t have a first-aid kit, rip a T-shirt into bandage like strips.
- The scenario becomes tricky and the medical care advice is controversial if the break is severe enough to cause a bone to protrude though the skin (Compound / open fracture). One train of thought is that the bone protruding through the skin allows for clotting to occur around the bone and the bone helps to “seal” the wound. If one tries to relocate the bone and push it back into the skin several things may happen. For one, more damage can be caused to blood vessels, nerves and other tissues. Secondly, if the bone is in fact “corking’ the wound – placing it back into the skin may cause increased bleeding or may cause bleeding to resume after it had stopped. The other train of thought lies with a more aggressive approach & that would be to immediately reset / relocate the bone and then deal with the bleeding which ensues (if any). By doing this, it’s postulated that there is a better chance of the bone healing in a more anatomically correct position. This furthermore decreases chances of infection since there isn’t a huge wound with the bone marrow exposed to air. In my opinion, this is fine in an ER, but not in the field as there are too many variables. I would prefer to control bleeding, then rinse the wound out of any debris with water which has been boiled or some sort of other antiseptic solution and then have the wound dressed / covered. The bone should be reset in the field ONLY if the circulation to the area farthest away from the wound is compromised. You can tell if this is the case if the area appears blue, pale, or cold as compared to the area precedent to the fracture. For example, if a person breaks a leg or an ankle and the toes get blue or cold – that’s a red flag; similarly, if an arm or wrist is suspected to be broken and the fingers get blue.
- Check for a pulse. If it’s an arm or a wrist break, you can check the radial pulse (where your thumb / hand meet the wrist); a leg or ankle fracture requires you to check for the tibial pulse (right behind the ankle bone on the inside of your leg above the heel bone).One needs to check for a pulse since a broken bone can compress or even cut one of the arteries to the anatomical locations mentioned above.
- Watch for signs of shock: cover the victim with a blanket and monitor consciousness, excessive sweating, excessive thirst, and shivering to name just a few.
- Apply a splint: Gather materials to make a splint to stabilize the broken bone. An arm, lower leg or ankle break, are the most common of broken bones. Sticks, sections of a backpack frame, tent poles, or even tightly rolled up newspaper can act as splintage
material. Apply your splintage material on either side of the break and secure with whatever cordage you have. If you have no cordage, strips of t-shirt material or a bandana can help. Make sure to not tie so securely so as to cut circulation off.
- The location of the fracture is important when you are ready to move / transport the victim. If it’s an arm or a wrist, you can make a sling with a blanket, t-shirt, or a multitude of other items Legs / ankle fractures are more complicated. You don’t want weight bearing or excessive motion to the injury site. You can make crutches with two long tree branches which are “y” shaped; another idea is to drag the victim on a tarp with them lying on their back.
- The only pain medications which are acceptable are acetomiophine (Tylenol) based as aspirin or ibuprofen (Advil / Motrin) may cause increased bleeding.
The key imperative is getting the victim to professional medical care as fast as possible – which may be difficult depending on how “deep” you are in the wilderness or in the event of some sort of cataclysmic event where first responders are not available or overwhelmed.
Until next time, happy trails & stay healthy!
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