David Young

A tiny cut on your leg may seem inconsequential at home, but three days into a wilderness trip, it can make you feel like the central character in a backcountry horror story. 

The skin around the wound grows red, hot, and swollen, and what started as a little soreness becomes a throbbing pain. Eventually, the wound begins to ooze, and the redness spreads farther up your leg. Then come the chills, sweating, weakness, and fever, along with a racing heart. You’re also breathing faster than usual, and instead of feeling better after a night’s rest, you wake up aching and exhausted.

If the infection continues to spread, things can get even scarier. You may become unusually lethargic or confused, have difficulty breathing, or develop signs of shock. These symptoms can signal a potentially life-threatening systemic infection that requires immediate medical attention. And when you’re deep in the backcountry, the nearest emergency room may be hours, or even days, away.

The dangers of an infected wound in the wilderness aren’t merely hypothetical. Consider the experience of a veteran river guide leading a weeks-long expedition through the Grand Canyon. After slipping on a raft, Brad Dimock, a now Hall of Fame river guide, suffered a four-inch gash to his shin that extended all the way to the bone. Two physicians who were traveling with the group he was guiding, cleaned the area and stitched the wound closed, and the expedition continued. 

But several days later, the wound became infected. Despite antibiotics and subsequent efforts to reopen, drain, and irrigate the wound, the infection continued to worsen. Eight days after the injury, Dimock himself arranged an evacuation. He ultimately required hospitalization, intravenous antibiotics, surgical debridement (removal of infected and damaged tissue), and wound-vacuum therapy before making a full recovery.

Dimock’s experience illustrates one of the inherent challenges of wilderness medicine; namely, that an injury that might be manageable with prompt access to medical care can become far more serious when definitive treatment is not immediately available.

Situations like Dimock’s can’t always be avoided, but you can improve your odds and achieve better outcomes by (more…)

Properly operating an oxygen cylinder is among the first hands-on skills every EMT student learns in training. On the surface, it looks simple enough: Just attach the regulator, open the valve, and boom! You’re good to go.

But the apparent simplicity of the operation can be deceiving. For instance:

• A damaged O-ring can cause a leak. 
• An unsecured cylinder can become a dangerous projectile. 
• Failing to check tank pressure can leave you without oxygen just when your patient needs it most. 

Whether you’re a medic in an ambulance or providing care in the backcountry, knowing how to safely set up and operate an oxygen cylinder is a foundational emergency medicine skill. This post brings you up to speed on the fundamentals of administering oxygen.

Oxygen Is Medication: While oxygen may be readily available, that doesn’t mean every patient needs it. It’s a medication that should be administered only when clinically indicated and according to current protocols and each patient’s needs. Before any of that can happen, however, you need to get the oxygen safely from the cylinder to the patient.

When Administering Oxygen, Safety Comes First

All of us learned in middle school science that oxygen makes fire burn faster, so whenever you’re working around concentrated oxygen, take the following precautions: (more…)

Safety first! That short phrase has been a mantra in outdoor adventure and education for as long as I can remember. In wilderness medicine, safety is also, and obviously, a top priority. 

It’s counterintuitive, but the first person you need to protect is yourself, along with other members of your team. Rushing into a scene without first assessing potential hazards can quickly turn one victim into two or three or more.

As part of our emergency medical service (EMS) training here at The National Center for Outdoor & Adventure Education (NCOAE), we are taught to perform a scene size-up before treating ill or injured parties in any situation. We check for hazards, try to determine the mechanism of injury (MOI) or nature of illness (NOI), count patients, and determine whether additional equipment or resources are needed. An example? Grabbing up a cervical collar and stretcher for spinal motion restriction (SMR). 

See our previous post “The Role of Assessment in Wilderness Medicine” for additional details.

One component of the scene size-up that’s often overlooked is the safety check. We’re all taught to check a scene for safety, but few of us perform a thorough one. Even fewer perform a secondary safety check to verify that the scene is still safe after we (more…)