Wilderness Medicine SMP

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Note: Once I get permission, I will upload the instructional videos up to youtube and link it to this site.
Wilderness Survival and Emergency Care Carderock, MD April 25, 2009
I. Splints:
1. The concept: secure the bones or joints medial AND distal to the particular joint or bone.
2. Before splinting: Always check for CMS (capillary flow, motor control, and sensation under fingernails (To make sure there is no loss of CMS after you
intervened and make you liable for lawsuit).
3. After splinting: Check for CMS again.
4. SAM splinting board is a bendable, reusable & lightweight 2 x 4. To increase its strength and rigidity, try making more little “V-shaped” or “T shaped
bends” along the board.
i. Improvisation: To make a basin, Bend the SAM board into a circular ring and place a waterproof fabric or plastic bag over it.
5. Examples:
i. Traction splint: femur fractures that are not open or penetrate the skin. Basically, you want to lengthen the leg and prevent the splintered ends
of the fracture from injuring nearby vessels & nerves. You can often use hiking poles as splints. The splint should be longer than the leg.
ii. Forearm splint w/ sling: position the wrist and hand in slight dorsiflexion (or the most natural position for a relaxed wrist). Then, use a sling to
secure the forearm in an elevated position. The sling will be a triangular piece of cloth. Make sure there is a knot tie at the 90o angle of the
triangle. The knot will be placed behind the elbow to cushion and secure it. Have the 2 wings of the sling in front of the person and elevate the
forearm (and fracture site) above the heart, so that blood is flowing back to the heart instead of towards the limb. Tie the two ends of the cloth
splint on one side of the neck but never directly behind it, where a pressure point might be located.
iii. Cervical neck splint: use the SAM splinting board. Make sure there is an indentation for the chin.
II. Carrying injured people:

1. One rescuer - Face the patient & bend their knees. Cross your hands, grab their wrists, and make sure your hands are turned with the palm side
facing down. Step on their feet. Squat down with your back straight and chin pointed upwards slightly. Pull the person off the ground and turn to the
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side of your top hand. Make sure the person is lying high up on your back. For tall patients, it’s ok to let their feet drag.
2. Two rescuers - Have the patient in between.
3. Three rescuers - One person on each side and a third person going down in between the legs of the injured person. Carry the patient on your
shoulders and on their back. E.g. for an abdominal evisceration.
4. Four rescuers w/ a litter - 2 long branches with a poncho or fabric wrapped across it. The 2 people at the patient’s feet should lift first. E.g. for a leg
fracture.
III. Important supplies:

1. Water-proof, magnesium matches with striker. Flashlight. Compass. Sharp knife. Ropes. Whistle. Black plastic bag. Vaseline gauze. Always check
and make sure your equipment works before going out into the field.
IV. Water:
1. Bring some water, which will delay the effects of dehydration and the consequences of having to drink un-sanitized water.
2. Most water sources (streams, ponds, rivers etc@) are OK to drink. It might give you bacteria or other pathogens, but you will die of dehydration within
3 days, while drinking bad water will only affect you after weeks.
3. Try iodine tablets before your trip to determine if you can handle its unique taste.
4. If you are running low on water, don’t eat any more of the food (will cause you to dehydrate even more).
5. Water-gathering strategies:
i. Tie a t-shirt or cloth around your legs early in the morning. Then, walk around the fields and try to soak up as much dew moisture from the
leaves and plants as possible into the t-shirt. Squeeze it out to get your water.
ii. Bring plastic zip-lock bags with you on the trip. Crush fresh leaves and seal them inside the bag. Leave it out in the sun and gather the
condensation found on the sides of the bag.
iii. In a snowy environment & inside your shelter: you can dig a trench and slight slope that leads to your cup. Your body heat will conveniently
melt the ice underneath you.
iv. In a snowy environment & outside your shelter: On a sunny day, spread out a black, plastic bag that you can place over a pit. Then, use the
heat-collecting abilities of the black bag to melt any ice that is placed on top of it.
v. Filtering mud or muddy water: Gather the mud in a sock and swing the sock in a circular motion to draw the water out from the mud (via
centrifugal motion). Setup a 3-tier, filtration system made of cloths. Place your cup underneath it. Make sure to have some charcoal on the last
cloth as an extra filter. Squeeze that water out from the sock and onto the top filter, and let gravity do its job.
V. Survival:
1. The rule of threes:
a. Can’t live without oxygen for > 3 minutes.
b. Can’t live without water for > 3 days.
c. Can’t live without food for > 2-3 weeks.
2. Make sure to carry vital tools and items on you. You never know if you will be separated from your bag.
3. Never wander too far from where you got lost or were last seen. It will increase the likelihood of being rescued.
VI. Fire-starting:
1. Dig a shallow fire pit. Make sure there are no roots in the soil underneath the pit. The fire might burn along the roots and come up above ground
somewhere else.
2. Use the soil removed from the pit to build a ring of dirt around the pit with a radius of 2-ft. Also make sure there is no debris inside the ring.
3. At the center of the pit, setup a tepee of small, dry twigs ¾ or almost all around the tinder (start-up fuel).
4. Fluffed-up cotton balls are good tinder for fires. Adding Vaseline will make it burn longer.
5. Using a flint and striker: move the flint stone in an upward motion while holding the striker still. Angling the point of contact will also help direct the
sparks towards the tinder.
6. When the cotton catches on fire, gauge the flame’s size and add more or larger twigs accordingly. Then, try a “log-cabin” system of piling the fuel
around the fire.
7. Trace-less fire: The idea is to minimize your impact on the environment. After putting out the fire, stick your hand into the fire pit dirt to determine if it
is still hot (and can potentially start a new fire). Cover up the pit with leaves and debris.
8. Other sources of fuel: dry leaves. Twigs from the birch tree. Paper (creates a strong smell). Look for fallen, rotting trees. Pitch can be gathered from
where the branches meet the trunk.
VII. Diagnosis:
1. Assess the situation (any immediate danger, condition of the patient for transport, etc@)
2. ABC - Airway, breathing, circulation.
3. First round body exam: circulation and hemorrhage.
4. Second round body exam: start at the head (look for brain injury), face & mouth, neck, chest (pneumothorax), abdomen, and legs.
i. After each body region, check your hands to see if there is bleeding from that area. You don’t want to wait until you’ve checked the entire body,
and not be able to determine where the bleeding is from.
ii. If there is any region with a problem, treat that problem or area first before moving to the next area.
iii. Bleeding around the ear:
i. Determine if it’s from inside or outside the ear.
ii. Fluids from inside the ear can be blood, CSF or a combination. To determine if there is CSF in the fluid, look for the “halo effect’,
where the red blood is pushed out to the periphery and the clear CSF is in the center of the stain (forming a ring).
VIII. Hemorrhages:
1. Bleeding can potentially be the most critical problem after an accident. You can bleed out in less than 3 minutes.
2. Signs: pale face, fingernail-plate capillary perfusion takes more than 30 sec, shallow breathing, fast/shallow pulse, etc@
3. Compression is always the most important 1st step. Apply a clean dressing right over the wound as soon as possible. Then, you can use anything
else; even dirty clothes to provide extra layers.
4. Tourniquets are useful and can stay on an extremity region for up to 6 hours straight.
5. If there are plenty of people in the rescue team, you do not even need a tourniquet. Someone can just apply compression manually.
6. Pelvic hemorrhages: very dangerous and require immediate attention. You can lose one liter of blood into the thigh’s extravascular region, without
noticing any swelling. Try to apply compression by tying a jacket or shirt around the hip region with the knot in front. Slowly, pull on the sleeves to
increase compression and stop the bleeding. It should feel secure and slightly tight.
IX. Wild Animals:

1. Cats like to pounce from a higher place e.g. trees, tops of boulders, etc@
2. If you see a cat approaching, try to make yourself look really big and make a lot of noise. Never turn your back to the animal and try to run away,
because their instincts are to chase after moving objects.
3. If you see a bear approaching, play dead.
X. Shelter:
1. Leaves and snow provide good insulation by creating dead air space.
2. The Site: choose an area of higher elevation.
3. Lean-to: a shelter with only one slanted side. First, tie a long pole or branch horizontally onto 2 nearby trees. The “wall” is first made up of bigger
branches or cut pieces. Then add thinner branches on top to fill in the bigger gaps. Finally, add leaves on top of that and inside the shelter for
insulation.
4. Poncho-tent: tie the poncho’s four corners to stakes and then pitch a short stick into the middle to keep it up. Dig a trench around the poncho, so that
water will not enter the area under the tent.
5. In the desert or snowy environment: dig down into the sand or ice for 2 feet to escape the extreme temp.
XI. Mirror signaling:

1. Buy a compass that has a mirror attached to it.
2. The concept: Create a flashing, bright light using the mirror, sun and your fingers that airplanes can see.
3. Orient the mirror facing the sun and next to your face. Form the peace sign with the other hand, which will serve as “the slit” from which the reflected
light will shine through. Then, slightly but quickly rotate the mirror back and forth, so the reflected light passes in between the space of the 2 fingers
and beyond the fingers on either side, to create an intermittent, flashing pattern.

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8/20/2010 smplog / wilderness

smplog Get your own free workspace log in help

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Wilderness Survival and Emergency Care Carderock, MD April 25, 2009

II. Carrying injured people:

III. Important supplies:

IX. Wild Animals:

XI. Mirror signaling:

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