Downhill All the Way

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Treating injuries miles from the ER is an essential skill, but you don’t need to be a doctor, surgeon, nurse, paediatrician, obstetric gynaecologist, or even a plain old voyeur to learn what it takes to survive in the wild. Brad Chilterns is the founder of Outdoor Medicine, which specializes in teaching underedumacated back-country folk and overeducated city types how to cope with a medical emergency. Usually his courses cost more than a couple of grand, but he’s distilled a lifetime’s experience (he’s now 109) into the tips we present here as all you need to know. Read it, memorize it, swallow it, and shit it out later.

MINOR WOUNDS

We’ll start with the easy stuff. Blisters.

Everyone gets blisters, but not everyone knows how to deal with them. What you have to do is clean the blister first with an antiseptic wipe. Then get a long, sharp pin or needle. A Swiss Army knife is too blunt. Heat your needle over a log fire or a candle until it’s sterile. Then pierce the skin and massage the fluid till it’s all come out or until you want to puke with the pain. Then get hold of a thick book and press it down hard on the skin until you’re totally sure there’s no fluid left. Once you’ve done that, drive the pin further into the skin, until the blood is running freely. Wrap a sock round the wound and wait for a scab to form. After a couple of days, rip off the sock, taking the scab with it, and the blister will be healed underneath. Magic!

Abrasions: Scrub the wound with soap and a gauze pad or bandanna, making sure to remove all debris. This will hurt. Add salt. It’ll hurt some more. Rinse off all the soap and then pour bleach liberally into the wound. Put a plaster on it. Take a swig of the bleach as well, just to be on the safe side.

Burns: Jump into the nearest lake, river, stream, bath, shower, waterfall, cascade, or cataract. If none of these are available, have all your colleagues urinate on the burn. The colder their urine, the better. Failing that, put some soothing 100% aloe vera gel with tea tree oil and camomile on a silk or satin scarf and gently wrap the burn site. Do not be tempted to put peanut butter, Marmite, Nutella, or Activia on the burn. These will achieve nothing. If blisters form, see above for treatment.

ANIMAL AND INSECT BITES

Bees and wasps: If the stinger remains in the skin, take a sharp hunting knife and cut deep into the flesh so that you cut right underneath the stinger, thereby preventing it from taking root. Bury the excised flesh so that the stinger doesn’t try to come back again. Then suck the poison from the knife wound. Be careful to use a clean knife and a clean mouth so as not to give the patient tetanus/rabies/gonorrhea. If the patient has an allergic reaction, give them an antihistamine or let them run it off.

Ticks: These bloodsuckers can transmit disease if allowed inside you, and it only takes them a few minutes to scale your legs, climbing up the hairs, and sneak their way into your most intimate nooks and crannies. So make sure you shave your legs before every hiking and camping trip. Yes, all the way up. Get a back, sack and crack wax to be extra safe. And don’t grow a moustache. They’ll swing off it up your nose while you sleep. If you’re fortunate enough to find one before it makes your innards its home, torture it to find out where its mates are. Then squish it with that book you’ve got.

Venomous spiders: Although they’re called venomous, these spiders aren’t really poisonous. I mean, they won’t kill you. A coma is the worst you’ll experience, and then only if you’ve eaten a bowl of the fuckers. Look for vomiting, diarrhoea, and a sore throat as signs that you have indeed eaten a bowl of the fuckers. Take a dispirin or two and some laxatives. You may not need the laxatives.

Venomous Snakes are another thing entirely. They can dissolve your hand just by breathing on it. It’s like snogging an Australian call girl. If one of your group does get bitten by a snake, keep the victim calm, then take off all their jewelry, watches, and anything else of value or which might offer clues as to their identity. Back away from them slowly and pretend you’re going to get help. Put the bitten limb in a splint if they need further convincing

Mammals: The old wives’ tale about the hair of the dog applies to all mammals. Catch the animal responsible, skin it, and wrap its fur around the wound until the bleeding stops. The natural antiseptic action of the animal pelt and the fact that animals are immune to their own saliva will render any further treatment unnecessary.

GASTROINTESTINAL ILLNESS

Diarrhea: Keep the patient away from your clothes, from the tent, and from all cooking utensils. Giving the patient fluids just encourages the diarrhea, so avoid giving the patient any liquids or food for several days, until his asshole dries up. Then you might consider giving him a banana or some nuts. Providing he behaves.

Vomiting: See Diarrhea, above.

DENTAL EMERGENCIES

Toothache: Use a toothpaste for sensitive teeth from the age of 5 up. If you notice any pain or bleeding in the gums, rush to a hospital. It could be cancer. Bring your dentist on hikes with you in future.

Broken Tooth: Rinse the tooth thoroughly with drinking water, then wrap it in a handkerchief, take it home, and put it under your pillow before you go to sleep. You may not get the full value of the tooth, since it’s broken, but there’s no arbitration board you can appeal to. That’s monopolies for you.

HEAVY BLEEDING

If the blood is gushing, make a tourniquet using a stout stick, a pair of children’s trousers, and your muscles. Keep pressure on the wound until the bleeding stops or the patient passes out. Do not apply tourniquets to neck wounds. Once bleeding has stopped, pack the wound with mud and cloth. If blood continues to seep through, keep packing on the mud until you can’t tell blood from mud. For a gaping wound, press the edges together and stick them in place with sellotape or brown paper and spittle. If you have string and a tent peg handy, you might be able to stitch the wound temporarily. Then apply Germolene or Sudocrem, sit quietly, and wait for the patient to die. Check all wounds regularly for signs of infection.

ENVIRONMENTAL THREATS

Snowblindness: Redness, teary eyes, and a rough, sandpapery pain when opening or moving the eyes are all signs of sunburned corneas. Put the patient immediately in a dark tent and get them to think of dark things, such as cellars, Darth Vader, nighttime, and a cool dark bar on a hot Arizona summer’s day. Don’t let them rub their eyes, because they’ll discover they’re blind, and the discovery could lead to flailing panic, jeopardizing the safety of the whole group, especially if the mountain is particularly slippery or inhabited by venomous snakes or Serbian death squads. Give the patient strong opiates, then try hitting him across the eyes with a wet fish, the way Jesus did, and see what happens. If nothing else, you’ll get a laugh out of it.

Hypothermia: The first sign of hypothermia is that the patient complains of being “bloody freezing.” After that, they say very little. More advanced hypothermia patients exhibit what are commonly referred to as “the umbles”: stumbling, fumbling, mumbling, tumbling, jumbling, bumbling, grumbling, and qumbling. Get the patient into warm, dry clothes and place him in a sheltered area, such as inside of a tent. Don’t have a tent? You should have thought of that, shouldn’t you? Give the patient water and simple sugars, such as chocolate or hot rum butter cinnamon cocktails, to generate quick body heat. For more advanced cases, a group cuddle can’t do any harm. Then set fire to him so he won’t tell.

Altitude Sickness: Feeling hungover? Don’t climb mountains pissed then. But if you haven’t had a drink, and if you’ve got a headache, nausea, insomnia, lack of appetite, and fatigue, it could be Acute Mountain Sickness. The best thing to do under the circumstances is to take ibuprofen for the headache, drink lots of water, and do some light exercise around camp, such as sprints, jumping jacks, or naked wrestling. If these fail to work or if you get an erection while naked wrestling, head down the mountain immediately to avoid possible brain damage.

Attitude Problem: Tell them to shape up or ship out. It’s highly unlikely they’ll have a ship with them.

Frostbite: Cold, pale, numb, and rigid skin means that tissue has frozen. Rapidly warm the area in a container of water heated up to between 99° and 102° Celsius, monitoring and adding more hot water as needed to make sure the temperature is constant. Give Ibuprofen for the pain. If blisters form, treat as above. Note: If you notice the tissue refreezing, scrub all of the above. Do NOT, I repeat, Do NOT warm the injury. Instead, keep it frozen until you can get the patient to a doctor. But it’ll probably be too late.

REMEMBER: WASH YOUR HANDS!

A 2006 Journal of Handwashing report found that 61 percent of six Adirondack Trail hikers who “rarely or never” washed their hands after a bathroom break got diarrhea, compared to just .000007 percent of those who did scrub. When you’re planning on doing any form of outdoor surgery, hygiene has to be your priority. Here’s how to wash up right:

(a) Wet hands (water is best) and add a drop of nontoxic soap.
(b) Work up a lather and scrub for 30 minutes, paying particular attention to the between-the-fingers and the fingerprints, where the sneakiest germs try to hide.
(c) Rinse, repeat three times, then dry hands on leaves, trousers, dishcloth, whatever else you have to hand.

FINALLY: BE PREPARED.

Here’s what you need to pack (suitable for four to six people on a weekend trip).

24 sterile, 3- by 3-inch or 2- by 2-inch gauze pads to clean and cover wounds
5 1- by 3-inch adhesive strips to cover cleaned wounds
1 roll of duct tape to silence sentries
1 pair tweezers for removing splinters and ticks
1 pair medical gloves, cleanroom protective suit, autonomous breathing apparatus, and portable isolation chamber to protect you and the patient from contamination
1 pair of pliers for recalcitrant locals
1 roll tape (1/2 inch by 5 yards) to hold dressings on wounds
1 ball of string one mile long to measure miles
36 200mg tablets ibuprofen for pain, inflammation, and fever
2 packets antibiotic ointment to cover wounds before dressings
1 set of jump leads in case of cardiac arrest
1 swab tincture of benzoin to make adhesive bandages stickier or hold wound closure strips in place
1 panda
3 antimicrobial hand wipes to clean hands and around wounds
1 safety pin
1 hairpin
1 bowling pin
1 table tennis table, 4 table tennis bats and 1 table tennis net. For morale.

From the February 2010 issue of Amateur Hiker magazine.

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