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Backpacker Magazine – October 2013

Survival A to Z: Injuries

Most backcountry wounds simply leave you vulnerable to the elements. These few are serious enough to kill in their own right.

by: Elisabeth Kwak-Hefferan

   Lucky for hikers: You’re less likely to fatally injure yourself on the trail than in the city. “Life- threatening trauma in the backcountry is pretty rare,” says Paul Nicolazzo, director of the Wilderness Medicine Train- ing Center in Winthrop, WA. Sure, sprain- ing your ankle could leave you stranded and vulnerable, but only a few traumas are serious enough to kill in their own right. Here’s the breakdown. 


Head Injury

Likely causes Falls, especially with momentum (skiing, mountain biking) and from a height (climbing, scrambling)—but even short tumbles can smack your noggin.
The killer The brain sits just a milimeter away from the inside of the cranium, so a hard enough blow can knock it around inside your skull like a ping-pong ball. But it’s the resulting bleeding or swelling that will do you in: A swollen, injured brain presses against the skull, eventually squeezing shut blood vessels and starving itself of oxygen. That’s only if the mounting pressure doesn’t squish your brain stem first, pulling the plug on your heart and lungs.
Best shot Treat all blows to the head seriously and evacuate if the victim loses consciousness or responsiveness, even for a minute. Look for a headache, vision problems, dizziness, disorientation, and nausea/vomiting. Signs of a more severe brain injury include loss of coordination; combativeness; and fluid leaking from the nose, mouth, or ears. If symptoms are mild and the victim has no spine injury, you can give acetaminophen for a headache and walk him out to treatment. Suspect spine injury and/or symptoms are severe? Hike to or call for immediate rescue. 

Neck and Spine Injury

Likely causes
Falls (again), especially from more than twice your height, and especially involv ing speed 
The killer The spinal cord acts as a switchboard connecting all your body systems to your brain. Sever it completely, especially at the neck, and breathing might stop altogether. Fortunately, your bones make this very hard to do. More likely: You’ll pinch or bruise the spinal cord, which can lead to permanent paralysis and the loss of bladder and bowel control, sensation, and the ability to breathe on your own. The neck’s smaller vertebrae and lack of support make it particularly vulnerable.
Best shot Don’t let the victim move before assessing him for spine injury: Signs include pain in the neck or spine when touched, a tingling sensation in the hands and feet, weakness, and paralysis. If you suspect an injury, it’s critical to immobilize the person’s neck and backbone. Have someone kneel at the victim’s head and hold the neck still. You can also improvise a cervical collar out of a bulky, rolled- up layer  or a trimmed foam sleeping pad held in place with tape. Or use an empty internal- frame backpack  as a makeshift splint for the spine. Place it under the victim, bottom by his head, and buckle the hipbelt over his fore head, cinching until firm. (Make sure to keep the person’s head, shoulders, and hips aligned when sliding the pack under him. Best bet: Take a Wilderness First Aid course to practice this maneuver.) Keep the victim still and call for help; the only safe way out is on a rigid litter with trained rescuers. 

Internal Bleeding

Likely causes Blunt trauma to the abdomen: You fall on rocks, or a rock (or tree) falls on you.
The killer Solid organs (as opposed to hollow ones like the stomach) bleed when ruptured, causing swelling within the injured organ (bad) or spilling blood into the abdomen (worse). This is especially worrisome when it happens to the liver, which holds 13 percent of the body’s blood at any given moment, and the spleen, another serious bleeder. If the internal tear is big enough, you can bleed out in minutes.
Best shot Inspect the injured area for bruising and pain when touched. Check the victim’s pulse: “If it skyrockets, that’s when you want a helicopter,” Nicolazzo says. A pulse that remains elevated 20 to 30 minutes after the impact, along with rapid breathing and pale, wet skin, indicates internal bleeding; keep the victim still and call or hike for a rescue. 

Broken Femur

Likely causes Falls from height, tree or rock falling on leg
The killer It takes a lot of force to snap the strongest bone in your body. But if you do, the jagged edges along the break can shred nerves and blood vessels, causing severe internal bleeding into the thigh and massive swelling. It’s unlikely that one broken femur will kill you from blood loss—but two might. Muscle spasms can worsen the damage by yanking the bone ends until they overlap, visibly shortening the broken leg. And if the break is bad enough to force one end through the skin—an open fracture—you risk debilitating bone infection.
Best shot Use in-line traction to gently pull the leg into normal, neutral alignment. Then immobilize it with an improvised sandwich splint: Place a sleeping bag on top of a deflated sleeping pad and wrap both around the injured leg (the splint should extend beyond the victim’s foot). Put rolled socks or a hat under the person’s knee to maintain a slight bend. Run two taped-together trekking poles along each side of the leg for stability; tie in place with straps or cloth strips, securing the top of the splint, then the ankle, then the center. 


Gushing Wounds

Good news Spewing arterial bleeds usually require an explosion, gunshot, or chainsaw to truly get going. “You don’t really need to worry about life-threatening external bleeding—it’s very rare,” says Nicolazzo. Still, if it does happen, quick action is imperative: Untreated, an arterial spurter can kill within three minutes.
Treatment Stop the flow with direct pressure on the wound with sterile gauze or clean clothing (put on gloves or place a plastic food wrapper over the dressing). If the dressing soaks through, add another on top. Maintain pressure until bleeding stops, then thoroughly irrigate the wound with purified water and scrub to remove dirt. Dress the wound with clean gauze and secure. 

Third-degree Burns

Good news Typically, it takes something as serious as prolonged contact with a campfire, falling into a Yellowstone hot spring, or getting caught in a wildfire to produce these deep-tissue burns, which sear the epidermis, dermis, and sometimes deeper tissues. Telltale signs: dry, leathery, unnaturally colored (black, brown, white, or gray) and/or charred skin. Any full-thickness burn that covers more than 10 percent of the victim’s body is life-threatening. (For reference: An adult arm is about 9 percent of the body, while a leg accounts for 18 percent.)
Treatment Get the victim away from the burn source, cover the burn with 2nd Skin burn pads, gauze, or clean cloth—don’t attempt to remove clothing stuck to the skin—and evacuate ASAP. Give as much fluid (diluted Gatorade or a salt-baking soda-water solution are best) as the victim can tolerate to prevent dehydration and shock. 

Lung Injury

Good news The most likely result of blunt trauma to the chest is a broken rib—painful, but not life- threatening. But in rare cases, a broken rib can stab into a lung, letting air leak into the space between the lungs and the chest wall. If the air can’t escape (called a tension pneumothorax), pressure builds. First, the injured lung collapses. Then, mounting pressure pushes the heart and blood vessels toward the uninjjured side, compressing them until breathing and/or circulation stop.
Treatment If a victim of chest trauma experiences sharp pain, increasingly struggles to breathe, and his neck veins bulge, carry him (or slowly walk, if that’s the only option) to help immediately. 

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