                      WILDERNESS FIRST AID

                By George E. Dvorchak, Jr., M.D.

I  began  work on this presentation after receiving a  call  from 
Pennsylvania Hunter Education Instructor Ed Soyke who asked if  I 
would be interested in presenting basic first aid information  to 
his class at the White Oak Rod and Gun Club, Inc.

 This  request came from the same group of dedicated  instructors 
who  volunteered their time and talents when I took  this  course 
two  years earlier. Although I have been a hunter for  nearly  30 
years  and  was a one-time certified handgun  instructor  when  a 
cadet at Valley Forge Military Academy, I learned a lot I  proba
bly would have missed without Hunter Education.

  Besides, this would be an opportunity for me to "give a  little 
back" which hopefully would help someone else.

  I was soon to learn that much of what I took for granted  would 
be  hard  to  put into a presentation that would  only  touch  on 
basics  but would challenge students to enroll in  an  accredited 
first  aid  course. Wilderness first aid also  meant  that  basic 
medical equipment found in many homes would be non-existent  when 
and where an emergency would be likely to occur.

  Pennsylvania's  well  written manual for  this  10-hour  course 
recommends that students should enroll for additional information 
in an accredited first aid course as offered by the American  Red 
Cross.  These  are available through local  rescue/ambulance  and 
fire-fighting organizations. This is the proper approach, but  as 
human  nature has it, I felt that few would enroll due  to  time, 
interest  and the common feeling that an accident can not  happen 
to me.

 Knowing  this,  the instructors wanted  some  added  information 
presented that would review what was covered as well as to possi
bly put a different perspective on a topic that should be  famil
iar  to all. In my opinion, first aid should be a part  of  every 
schools elementary and high school curriculum. I believe that the 
school boards and educational planners are sleeping on this one.

  The following is what I feel is important and basic knowledge a 
hunter  should have concerning the Disorder, Prevention, Signs  & 
Symptoms, Field Treatment & Concerns.

HEAD  INJURIES  - Any injury to this part of the body  should  be 
considered  serious  because of the  delicate  structure  within, 
meaning the brain and its blood supply.

 SKULL  FRACTURE:  By its name this is a break in a bone  of  the 
head.   Because the skull bones are strong and fairly  protective 
of  the structures under them, most fractures as from a fall  are 
usually simple ones.

 Since the bone is only cracked and not punched through the skin, 
bacteria and dirt from the outer layer of skin does not enter  in 
the picture An open or depressed fracture is much more  dangerous 
since  the  broken bones can cut blood vessels  which  then  leak 
blood.  The  result is increased pressure on the brain  from  the 
leaking blood which is now called an epidural or subdural  hemor
rhage.

  Concerning PREVENTION, there is not a lot one can do except  to 
be sure of the surface to be walked-on and to walk slowly when in 
unfamiliar territory or where there are logs, vines and stones to 
trip-on.

  SIGNS  &  SYMPTOMS:  This is tricky since an  injury  that  may 
appear  only as a bump on the head may be serious where one  that 
looks  bad  due to blood loss may not have caused damage  to  the 
brain.  Any signs of a skull fracture could be a deformity  of  a 
bone at or around the injury site, black eyes caused by torn ves
sels and therefore blood collecting in an area under the skin  or 
blood  and/or  clear watery fluid better known  as  cerebrospinal 
fluid leaking from the nose, mouth and/or ears. The pupils or the 
black center of the eyes can be of different sizes.

 These signs as well as being knocked unconscious are serious and 
the victim should be taken to a physician immediately. This could 
be  the  start of a deadly hemorrhage! There is nothing  a  first 
aider  can do here except to keep the victim quiet and  keep  the 
head flat and slightly turned away from the injured side. This is 
done to possibly relieve some pressure to that area. It is impor
tant  to get the injured person to a medical facility as soon  as 
possible.

 CONCUSSION:  This  is a condition associated with  brief  uncon
sciousness  following an injury with the head or  neck  involved. 
Even though there was a disturbance in the electrical activity to 
the  brain which resulted in the loss of consciousness, there  is 
usually  no  other damage. Yet, due to the dangers  of  head  in
juries, call you doctor for advice.

 SIGNS & SYMPTOMS: lack of memory, confusion, blurred vision  and 
vomiting.  Even  though the victim comes out of  it  without  any 
apparent  problems, for the first 24 hours bed rest and  constant 
observation for drowsiness and other symptoms as above are impor
tant.

 BROKEN  NOSE:  The only sure way to know if the nose  is  broken 
besides  an  obvious  deformity is with an X-ray.   Get  to  your 
doctor  and during transportation, put cold packs or snow on  the 
injury to decrease the swelling.

EYE  - Injuries are common here, especially when in the woods  or 
thick brush when it is dark.

 PREVENTION:  Wear yellow or clear shooting glasses in low  light 
for  protection. When there is a lot of snow in conjunction  with 
bright sunlight, wear sunglasses to cut down on glare and to pro
tect the eyes from wind burn or snow blindness.

 FOREIGN  BODY IN THE EYE: Do not rub the eye since  rubbing  may 
push the fragment of whatever into the soft tissue or cause it to 
scratch  the eye's surface or cornea. To remove a  foreign  body, 
have  someone use the top of a wet handkerchief to gently  remove 
it.

 SURFACE  OR CORNEA OF THE EYE SCRATCHED: Get to your doctor.  If 
something  is still in the eye, hold a handkerchief lightly  over 
the  injured eye to prevent movement. Your doctor  will  probably 
give  you  antibiotic eye drops to prevent the possibility  of  a 
bacterial infection during the healing process.

  An  infection  could lead to a corneal ulceration  which  could 
progress to blindness. When in the field,  you will know when and 
if your eye has been scratched. Walking into a twig is a good way 
to cause this injury. I did that once an hour before day light on 
the one day I forgot my glasses.

BLEEDING WOUNDS - REMEMBER, USE PRESSURE AND DO NOT PANIC.
 LACERATIONS   (CUTS): To stop bleeding, apply constant  pressure 
over  the wound. This will prevent blood loss and help  stop  the 
bleeding  or slow it down if a minor cut. If a major  one,  again 
apply pressure until you get to a doctor.

 You  probably will not have bandages with you so if you  have  a 
handkerchief,  use  that  even if it is not  the  cleanest.   The 
immediate concern is to stop the bleeding, worry about  infection 
later.  If you have nothing with you, then use your open hand  to 
apply pressure over the wound.   How do you know if an artery  or 
vein  has  been  cut: Blood from a vein is bluish  red  and  will 
simply flow or ooze out.   That from an artery will be bright red 
and will spurt out since its pressure is from a pump, the beating 
heart. It takes about seven minutes for blood to clot which  will 
slow  or  stop the bleeding, depending on what was  cut  and  how 
severe.  With  a bad laceration you are going to need to  be  su
tured.

 BULLET WOUNDS: This is serious trouble! TREATMENT: Again,  apply 
pressure  over the wound if possible. If there is a big  hole  in 
the  arm  or leg, you may have to use a tourniquet  to  stop  the 
bleeding.  This  could  be a bandage, shirt, belt  or  deer  drag 
tightened above the wound. Get help! If pressure or a  tourniquet 
will  stop the bleeding, stay with the person and yell  for  help 
since blood loss can push the victim into another bad and  poten
tially  deadly  situation known as shock. The  only  PREVENTATIVE 
measure  for hunting accidents is not to have them happen in  the 
first place. Hunter Education Classes combined with common  sense 
could take care of this category.

 PENETRATING  WOUNDS:  These  are also common  injures  that  are 
unfortunately accidentally self inflicted by being careless  with 
an  arrow, pointed stick or knife. The thing to remember here  is
that you usually should not remove the penetrating object in  the 
field.  Use a bulky dressing as from materials to  stabilize  the 
object  and watch for shock. at to do here is a judgment call  in 
the field with considerations as what is injured and by what, how 
severe  and  where is the victim, etc. Again, a first  aid  class 
will  give you the knowledge to make a correct call on this  one. 
As with any severe wound, you need medical assistance.

SHOCK - There are various types and causes of shock. I will  only 
present information on the type you will most likely encounter in 
the  outdoors, HEMORRHAGIC SHOCK. This is induced by a  reduction 
in blood to the body's tissues. It can be caused by cuts or blunt 
trauma that results in internal bleeding as from a ruptured liver 
or fractured bone which severed an artery or whatever: blood loss 
-> collapse -> coma -> death.

 PREVENTION: USE pressure to stop or slow the loss of blood  from 
a  wound  SYMPTOMS: Cold clammy skin; rapid,  shallow  breathing; 
weakness;  sweating;  pupils of the eye become large  or  dilate; 
pulse is weak and rapid; the victim may be very thirsty and could 
faint.  What  you can not check without equipment  is  the  blood 
pressure which becomes very low due to the loss of blood

 TREATMENT: As with prevention, stop the bleeding! Make sure  the 
mouth  is clear of anything that could interfere with  breathing. 
Let him lay down, keep him warm and get help.

  SPRAINS  - These are caused by a partial tearing of a  ligament 
around a joint or injury to the joint's capsule.  This is usually 
from a sudden and not anticipated movement.

 SYMPTOMS:  There is usually immediate pain and then swelling  in 
the area injured.

 TREATMENT:  To  the injured area, apply snow or put it  in  cold 
water. It is also important to rest the area and try not to apply 
weight. NEVER USE HEAT! Its use would be similar to putting  fire 
to  fire! Get to your doctor if there could be any chance of  the 
sprain really being a fracture. If in doubt,  treat it as a frac
ture. The only sure way to distinguish between the two is with an 
X-Ray  In  both, the area above the injury  will  usually  become 
black and blue, bruised. This discoloration is caused from  blood 
leaking into the tissue after the injury.

  Careful with bandages! If too tight it will act like a  tourni
quet by compressing the blood vessels which will greatly restrict 
the blood flow. If the ankle was sprained, you should not put  an 
ace bandage completely over the toes because they should be visi
ble  so that changes in the color of the tips of these  could  be 
easily observed for indications that the bandages are too tight.

FRACTURES  -  Usually a bone is broken across its  width.  Types; 
OPEN  (compound): Here a piece of bone sticks through  the  skin. 
CLOSED   (simple):The broken bones are kept within the  skin  and 
due to less movement of the broken part, less tissue is  damaged.  
A chance of infection has been greatly reduced since the skin  is 
intact.

 TREATMENT:  Do not to put the bone back if a compound  fracture. 
Immobilize the extremity of a fracture to present further  injury 
and  get the victim to the hospital. It is important that you  do 
NOT move or put pressure on an injured area since you could cause 
nerve and tissue damage. If it is a spinal injury which is usual
ly  in the neck area, DO NOT MOVE the victim. Keep him  warm  and 
get  help since he should be moved only by professionals. You  do 
not want to do more damage when trying to help.

MYOCARDIAL  INFARCTION (HEART ATTACK) - PREVENTION: This  is  the 
smart  way to present a possible disaster when in  the  outdoors. 
Risk  factors  to consider are some of  the  following:  smoking, 
overweight,  diabetes, hyperlipidemia or a  cholesterol  problem, 
high  blood  pressure, stress, family history of  heart  disease, 
lack of physical activity, exertion and cold weather  (associated 
with  hunting  seasons),  being under medical care  for  a  heart 
condition and not taking the medicine.

  What usually causes the death of someone with a heart attack is 
a type of heart beat called VENTRICULAR FIBRILLATION. Its uncoor
dinated  beating and therefore pumping action does not allow  the 
heart, which is a muscular pump, to circulate blood. This can  be 
controlled  in a hospital with drugs and  electrical  defibrilla
tion.   Therefore,  you have to get the person  to  the  hospital 
without scaring him to death if conscious.

  Stay  calm! If the heart has stopped beating, then I  hope  you 
know  CPR.  Now is the time to learn  cardiopulmonary  resuscita
tion.  Being  prepared and not having to use something is  a  lot 
better  than having to do something to possibly save a  life  and 
not knowing what to do.

  SIGNS  &  SYMPTOMS: General findings in someone  with  a  heart 
attack could be the following; severe pain in the chest, can  not 
get  your  breath,  a feeling of  apprehension  or  simply  being 
afraid, could be sick to your stomach and even vomit, in a  sweat 
or even become unconscious.

HYPOTHERMIA OR DANGERS FROM THE COLD - Hypothermia simply means a 
fall in the temperature of the body from the normal oral range of 
between  96.8 to 99.3 degrees Fahrenheit. When the body  tempera
ture  falls  below  95 degrees F., this is  a  potentially  fatal 
condition known as hypothermia.

  Careful, since the belief that to get caught in this situation, 
you have to be lost in a wilderness area where the temperature is 
below  zero, is false.  This condition is possible in  about  any 
state where hunting or outdoor activities take place.

 PREVENTION:  Dress in layers when in the cold outdoors  so  when 
stalking,  a  layer can be removed to prevent  overheating  which 
will  cause the body to perspire and therefore wet the  clothing. 
When sitting for long periods you want to apply an extra layer of 
clothing for added protection against the elements. Therefore, if 
you  get  lost, do not panic, run around,  sweat  and  eventually 
freeze.

  Instead, stay calm and if it looks as though you are stuck  for 
the night, use the remaining light to build a shelter and dig  in 
for the night.

  Also, be particularly careful around water since when wet,  the 
body  looses heat fast. Even if in water that does not appear  to 
be  that  cold as 65 degrees, it will draw heat  from  that  98.6 
degree body and therefore, overtime lower the temperature.

 SIGNS  AND SYMPTOMS: Shivering, an attempt of the body  to  warm 
itself;  fatigued,  due to the body using energy  to  stay  warm; 
slurred  speech; apathy; you may stumble and fall a lot which  is 
also  a  good way to get ahead injury;  have  hallucinations  and 
become  disoriented.  Later  on you want to sleep  which  due  to 
freezing may be one rest you will not awaken from.

 TREATMENT:  Find  or make a shelter so you can get  out  of  wet 
clothes  and  warm  up. Give the person some hot  water  as  from 
melted snow to drink. Rest in bed and you will usually recover.

FROSTBITE - This common injury affects skin parts  insufficiently 
covered as the ears, nose, fingers and toes.

 PREVENTION obviously consists of covering exposed areas when  in 
very cold temperatures.

 SYMPTOMS  AND SIGNS: white and glossy skin caused by  the  blood 
vessels constricting to save heat, if pain is present it  happens 
before the skin is numbed by the cold, the fingers get stiff  due 
to  a lack of elasticity in the tissue, blisters form.  Later  on 
from  the vessels constricting and therefore reducing the  amount 
of blood to the tissue, gangrene is a possibility.

 TREATMENT:  Warm the tissue in warm water. Do not soak  the  af
fected  area  in cold water, rub the tissue in snow  or  rub  the 
affected  parts  hard or you will cause tissue damage.  Taking  a 
shot of alcohol only conveys a false sense of warmth. Leave  that 
myth with the movies.

COMMERCIAL FIRST AID KITS- Recently Jon Becker who is the  presi
dent  of  AARDVARK Enterprises at 133 Naomi Ave.,  Unit  I  Suite 
201G,  Arcadia,  California 91007,  (818) 577611; sent  me  their 
best medical kit to evaluate. This kit, called the COMPREHENSIVE, 
is  specifically designed to meet the needs of someone  traveling 
or hunting in a wilderness area.

  This  kit  comes with supplies such as A SAM  SPLINT,  a  light 
weight  splint  of  dense foam padding that can be  bent  in  any 
direction  to secure any fracture; HYPOTHERMIA  THERMOMETER  that 
can record the lower body temperatures of this deadly disorder; A 
SAWYER  EXTRACTOR for removing venom from snake or insect  bites. 
Other supplies are oral hydration salts, iodine tablets to disin
fect  water, various non prescription medications, wound  manage
ment items and best of all, a handbook and manual well written to 
guide someone in the use of the items provided. This bag  retails 
for About $120.

  Next in line is one retailing for $80 and called the  BACKCOUN
TRY  with  the  FUNDAMENTALS for $45. And the  most  compact  and 
lightest  called  the DAY TRIPPER which sells for  $22.   If  you 
still  have  some reservations about first aid in  the  outdoors, 
then  there is an AARDVARK video for $30 called Medicine  in  the 
Outdoors.

 All those who spend time away from medical care should have such 
a kit available and obviously know how to use it in the event  of 
an accident.

 These  kits  from AARDVARK are sold at  discount  to  recognized 
public organizations and outdoor professional as licensed outfit
ters  and guides. It is about time Someone cuts a break to  these 
people!

COMPASS AND MAPS To avoid getting lost it pays to know how to use 
a compass so you can get back to base camp or your car. By  being 
properly  prepared  for low temperatures, you  can  avoid  deadly 
situations  as hypothermia. One of the best video courses I  have 
reviewed  on this topic is available from Brunton, 610 E.  Monroe 
Ave., Riverton, WY 81501;  (307) 856-6559.

  This 25-minute video presents actual outdoor situations as John 
Street  shares his expertise on how to read maps and use  a  com
pass. Although originally produced to be used in conjunction with 
Hunter Safety Instruction courses, it is now available for anyone 
to  use.  The video also comes with a compass and  workbook  that 
includes instruction and sample questions. 

Reprinted with permission from:

AMERICAN SURVIVAL GUIDE/OCTOBER 1991                    