B U R E A U O F P U B L I C S E C R E T S |
Nowhere more than in the mountains, where the nearest telephone may be miles
away and the nearest doctor two or three days’ journey distant, is it necessary
to always and most carefully observe the first rule of First Aid... Don’t Let
Accidents Happen.
Handle your axe with care, don’t cut twisted and knotted boughs, and keep your feet and hands out of the way. Don’t attempt dangerous climbs unless you are experienced, and then only in parties of at least three people, with a thoroughly experienced leader. Don’t experiment with unknown greens, roots, bulbs and berries. Leave all mushrooms strictly alone unless you know something about them, and then only eat those you are positive you have identified. Use your stock for the business of transportation exclusively, don’t get frolicsome unless you are a rodeo performer or a bull fighter. Don’t try to ford streams of unknown depth or swim when you are hot and exhausted or swim in rough mountain rivers. Build small fires in clean areas away from trees, logs, stumps and brush. Pitch the tent well away from the fire and don’t try to sleep closer than six feet to a small fire. Don’t cook with mosquito netting on your face or with celluloid glasses on, and always use some sort of rag or handkerchief for a pot handler. Use plenty of dried fruit, exercise and persistence to keep your bowels open. Keep your camp free from refuse and your latrine sanitary.
If the first rule of First Aid is Safety First, caution; the second rule is caution again, carried to an extreme length. Do No More Than Is Absolutely Necessary. And in this case absolutely means absolutely. Forget the stories of amputations performed with Bowie knives and successful Caesarian deliveries with the sole aid of a broken bottle, they are untrue. You can’t set compound fractures or probe gunshot wounds without doing the patient more harm than good. Tissues are injured when cuts are drenched with strong antiseptics, even large and continuous doses of laxatives are injurious. Let well enough alone, nature is a better doctor than you could even be. If the situation is serious, make the patient as comfortable as possible and make fast tracks for the nearest telephone.
The third rule is not “Know the herbs and simples of the simple redskin” but, Know Where The Telephones Are. At one time the Forest Service marked all phone lines on its maps. Some tenderfoot draftsman in Washington apparently decided that this was not necessary and few maps now show them. Find out where the phones are and mark them on your topographical sheet. You don’t need to mark the lines, they won’t do you any good anyway. Finally, let others know of your whereabouts. To camp on National Forest land you must have a campfire permit, and to obtain one you must inform the ranger or guard at your starting point of the route you plan to follow and the time you expect to be gone. Such permits are not required in the National Parks, but the same information should be given to the park rangers and, of course, to your packer.
No general compendium such as this book can give more than the sketchiest instructions for first aid. Large parties, or even small parties who can afford the weight, should carry the Red Cross Abridged Textbook on First Aid. If this is impossible each member of the party should obtain the book well in advance of the trip and study it carefully. No one has any business going into the mountains without some knowledge of the emergency treatment of accidents and illnesses.
SHOCK. Most injuries are accompanied with some degree of shock. Over-sensitive persons may go into severe shock following quite slight injury, particularly if there has been great pain.
The skin is pale cold, and the forehead is often covered with drops of sweat. The hands, lips, and fingernails are blue. The pulse is weak and very rapid. Responses are retarded or absent, the patient is insensitive, answers questions with difficulty, is unable to move, or moves very weakly and irrationally. The breathing is irregular and consists of long, deep sighing breaths alternating with very shallow ones. Vomiting and nausea may occur.
Usually shock results from severe injury. The circulation is disorganized and blood stagnates in the body. Injuries accompanied with much bleeding, either internal or external, may produce shock of great severity.
Place the patient on his back with his head low. If the accident happens in camp, cover him with blankets and apply hot rocks, irons, etc., well wrapped in cloths, to the feet and regions over the heart. Be sure these are not too hot or severe burns may result. Test them against the side of your upper arm. Give a half teaspoonful of spirits of ammonia in a half cup of warm water. Allow plenty of time for swallowing and never try to force fluids. If the patient is unable to swallow, allow him to inhale the undiluted spirits of ammonia. Ammonia is caustic and will burn if spilled on the skin. Best pour a teaspoonful on a handkerchief and hold it to the patient’s nose. As soon as he can swallow give hot coffee, tea or hot water. [TG disagrees: “No liquids.”] If the accident happens away from camp, cover the patient with whatever garments are available and rub his extremities, but without disarranging the covering.
While treating for shock, look for the cause of the condition. If there is severe bleeding, check the hemorrhage first. If there is a fracture, handle the patient with great care. If he has been bitten by a rattlesnake, apply a tourniquet and cut the bite immediately. [Not advised: see note below.]
FRACTURES. Fractures are broken bones. The most common are fractures of the arms, legs, fingers, toes, wrists and ankles; next are fractures of the collar bones and ribs. Fractures of the skull, spine and pelvis are rare. If the bone does not protrude through the skin the injury is known as a simple fracture, if it does, as a compound one. Compound fractures are exceedingly dangerous injuries and are treated under “Wounds.”
The patient has suffered a blow or fall. There is pain or tenderness at the point of fracture. The limb is distorted and movement is difficult or impossible without great pain. Marked swelling usually appears quickly. In fractures of the skull, kneecap and collarbone the gap can usually be felt by running the finger along the bones. Movement is often accompanied by a peculiar grating sound (crepitus) caused by the ends of the bones rubbing against each other. Fractures of the spine are usually accompanied with great pain, distortion and paralysis below the point of fracture. Some degree of shock follows any fracture; in the more severe ones, particularly those of the head, spine and pelvis, the patient is usually unconscious or soon becomes so.
Put the patient in a comfortable position, taking great care not to puncture the skin with the broken bones (which may be sharp as needles). Hold a broken limb on both sides of the point of fracture. Treat for shock. Don’t try to undress the patient. Cut the clothing away from the body in the vicinity of the injury and fold it back. Straighten the limb very gently and carefully, secure two splints long enough to extend beyond the joints above and below the fracture, pad them with cloth or dry grass, bandage them to the limb, just firmly enough to hold the bone in place.
A broken arm, wrist or hand should be hung in a sling. A patient with a broken leg should be moved as little as possible. In such cases it is a good idea to bandage the two legs together, after the splints have been applied to the broken one. These bandages should be removed after the patient has been brought into camp. Broken ribs can usually be recognized by the pain and crepitus accompanying breathing. The chest should be padded, preferably with a folded piece of blanket, and then snugly bandaged. No attempt should be made to “set” the broken bones of the foot, hand, wrist or ankle. Only a physician can do this properly. The limb should be splinted and the extremity immobilized.
A broken collarbone should be treated by folding a large handkerchief into a small pad, placing this in the armpit on the injured side, putting the patient’s hand on the opposite shoulder, and bandaging in place. If the jaw is broken, the lower jaw should be pulled gently into place until the teeth bite normally and then secured with a jaw bandage.
Fractures of the head, pelvis and back should be interfered with as little as possible. The patient should not be moved if it can be avoided; if possible a doctor should be brought in. Any movement is liable to cause a fractured spine to cut the spinal cord and either kill the patient or paralyze him for life.
Once the injured person is made comfortable and first aid treatment has been given, go to a telephone. Most rangers have been taught how to transport an injured man either on a stretcher or a horse litter; don’t try to do it yourself.
DISLOCATIONS. The jaw, fingers, shoulders and hips are the joints most commonly dislocated. The reduction of a dislocated hip is a surgical procedure and should not be attempted. The leg should be immobilized by a splint extending to the waist and a doctor secured as soon as possible. A dislocated finger can be reduced by holding the hand firmly and pulling steadily on the end of the finger. To reduce a dislocation of the jaw, wrap your thumbs in several thicknesses of cloth, put the thumbs in the patient’s mouth, well back, resting on the lower jaw, and grasp the jaw under the chin with the fingers. Press downward and then back. As the jaws snap closed slip the thumbs off the teeth to the inside of the cheeks.
A dislocated shoulder should be set promptly or the muscles will become rigid from the pain of the dislocation and the operation will be extremely difficult or impossible. Lay the patient on his back. Sit down at his injured side. Remove your shoe and place your foot in his arm pit. Pull the injured arm firmly, down and across the body toward the uninjured side, at the same time push upward and outward with the foot in the arm pit. After the bone has snapped into place, bandage as for a broken collarbone. If you encounter any difficulty in reducing a dislocation, stop.
SPRAINS. Sprains are caused by the twisting, violent stretching or breaking of the ligaments about a joint. They are followed by severe swelling, pain and discoloration. They most commonly occur at the wrist and ankle. Elevate the injured joint so it will get less blood and apply hot and cold cloths alternately for several hours, then bandage snugly, but loosen the bandage if the swelling increases. Once the swelling has stopped, the joint may be strapped with adhesive tape. One layer of bandage should be applied first and the tape pulled tightly over it.
Unusual jarring of a joint will cause it to swell (housemaid’s knee). This is common after a long steep descent with a heavy pack. The limb should be allowed to rest, treated with hot and cold cloths and massage. The condition usually disappears in a day or two. Strained muscles should be treated in the same way. Avoid the use of liniments.
BURNS. Severe burns should be bandaged loosely with gauze saturated in cod liver oil. Any foreign matter should be cleaned away with a solution of a quarter teaspoonful of chloride of lime in a quart of warm water before the oil is applied. Cod liver oil is much better than even the best burn ointments and should always be included in the first aid kit. Lacking either the oil or any burn ointment, very strong tea, at least two tablespoonfuls to a cup, is good, or a brew can be made of oak leaves or better still, oak galls.
Blisters should be left alone unless they are in a place where they are sure to be broken accidentally. They should then be drained by soaking a piece of white darning wool or thread in merthiolate, mercurochrome or iodine, sterilizing a needle in a match flame and drawing the thread through the blister. Once the needle has been pulled through and the fluid drained out the thread should be clipped off and left in the blister until it dries. Blisters on the feet should be protected by a prepared bandage strip (Band Aid).
WOUNDS. Wounds in which there are no pus bacteria, for instance aseptic surgical operations, heal very promptly by the union of the severed tissues; infected wounds heal slowly, from the bottom up, driving the pus before them. Some degree of infection is almost unavoidable under the conditions of camp life; however, it can be reduced to and held at a minimum. Wounds should never be touched with the hands unless they have first been thoroughly scrubbed in an antiseptic solution, preferably one tablespoon of chloride of lime to a quart of hot water. They should not be washed unless they are filled with foreign matter, in which case a solution of one teaspoonful of chloride of lime in a quart of warm boiled water should be used, all particles should be removed with a sterile tweezers or with the scrubbed fingers, and the wound then painted with half-strength Lugol’s solution (iodine), or merthiolate or mercurochrome, if it is shallow, or filled with gauze saturated with cod liver oil if it is deep. Merthiolate or mercurochrome may be used before the cod liver oil, but iodine, due to its destructive effects on tissue, is not adapted for use on wounds of considerable depth. In most cases, clean shallow wounds, cuts by a sharp knife or axe, should be painted with iodine (Lugol’s solution, half strength) and bandaged with a sterile compress. Care should be taken that the fingers do not come in contact with the surface of the bandage which touches the wound, and of course all dressings should be left in sealed packages until they are used. If there were no bacteria in the world the human body could stand an indefinite amount of chopping and hacking and survive.
Fortunately, most of the injuries in which the skin is broken that occur on camping trips are no more than slight cuts. Compound fractures and severed arteries are serious matters, but they are rare. Except for one chopped foot, the just desert of a drunken hunter, I have encountered neither in twenty years, two to four months every year, in camp. Earthquakes are unlikely to open chasms under your feet nor are trees given to toppling over on passersby without warning. Axes, guns and knives are inanimate. Almost without exception, serious wounds are the penalty of gross carelessness or foolhardy inexperience.
GUNSHOT WOUNDS. Unless the bullet is immediately under the surface, no attempt should be made to probe for it. The hole should be flushed out with chloride of lime solution, one teaspoonful to a quart, painted with iodine and bandaged, and the patient taken to a doctor. In case of bullet wounds in the chest or abdomen a doctor should be brought in if possible.
ARTERIAL BLEEDING. Spurts of blood mean that an artery has been cut. A tourniquet should be applied between the bleeding point and the heart. Pressure points, where the arteries cross bones, are shown in illustration. [No such illustration is present in the MS.] While the tourniquet is being prepared pressure should be applied with the thumb; if the patient is conscious he can do this himself. Either a soft rubber catheter, with a draw knot above the pressure point, or a twisted handkerchief with a knot, or pad, on the pressure point makes a good tourniquet. Do not attempt to tie the artery, simply paint the wound with iodine or compress it with cod liver oil and bandage it tightly. Do not make the tourniquet too tight, just enough to stop bleeding, loosen it every twenty minutes and allow a little blood to escape. When no more blood comes, the tourniquet may be left loose, but it should be kept in place in case the bleeding starts again. If possible the injured part should be kept elevated above the heart.
BLEEDING FROM THE LARGE VEINS. Blood from the veins flows smoothly and is much darker than arterial blood. Since venous blood is returning to the heart, pressure should be applied on the side of the bleeding away from the heart. The best pressure point is immediately behind the wound, which should be covered with a compress as soon as possible and then tightly bandaged.
COMPOUND FRACTURES. Unskillful handling of a compound fracture may result in the loss of the patient’s limb or life. Do not attempt to set it. Treat the wound. Wash it with chloride of lime solution if it is badly contaminated, paint it and the protruding bone with merthiolate or mercurochrome, or half-strength Lugol’s solution further diluted with an equal quantity of water. Take great care that the protruding bone does not slip back into the flesh. If it does, keep the wound open by inserting a compress of gauze saturated with cod liver oil or with a solution of one teaspoonful of salt in a cup of boiled warm water. In either case, apply a large compress, soaked with either the oil or the salt and Lugol’s solution around the wound and immobilize the limb with splints. Make the patient comfortable and go for help. Keep the dressing soaked until a doctor can be obtained.
ABDOMINAL WOUNDS. Severe cuts in the abdomen, which expose its contents and allow them to escape, should be covered with a large sterile compress. This should then be soaked in the solution mentioned above, and the contents pressed back into the abdomen. If this is impossible, the compress should be secured with a bandage and the whole area kept thoroughly soaked with a weak solution of salt in warm (blood heat) boiled water. Drying of the abdominal tissues is very likely to result in death. Naturally, a doctor should be obtained as soon as possible. Do not try to return the abdominal contents if much have escaped or if you encounter the slightest difficulty; as long as the compress is kept warm and wet and sterile the patient has a good chance of life. In any serious accident of this type, keep calm and don’t despair, the only completely hopeless condition is death itself, and the healthy human body has marvelous recuperative powers.
Always treat for shock in severe injuries. Never wash a wound unless it is grossly contaminated and unless at least a gallon of antiseptic solution or boiled water in available. Never apply adhesive tape, collodion or other impervious dressings to any injury. Collodion is worthless, tape is used only to hold bandages and compresses in place.
CARRYING. In cases of compound fracture, severed arteries and other major injuries, it is wiser to move the camp to the injured man rather than to attempt to move him. However, that may not always be possible. A stretcher may be improvised by turning two coats wrongside out, inserting poles through the sleeves and buttoning up the coats. Three coats are much better than two. The buttoned sides should be underneath, away from the patient. The US Army poncho, lashed to poles, makes a very good stretcher, or blankets may be used. A stretcher is easier to carry, and more comfortable for the injured man, if it is braced with cross bars just beyond the head and feet. Always keep the patient’s head up hill when using a stretcher.
The so-called “fireman’s carry” taught to Boy Scouts is not very good for anyone suffering from shock or severe injury, however it is the only way in which one man can carry another over very long distances. The best carry for short distances is the conventional one, with the injured man held in the arms in front of the body.
DROWNING. Mountain lakes and streams are cold and there is always the danger of cramp. Never swim after eating or when hot and tired. Should you be struck with cramp while swimming, don’t struggle, turn over on your back and float. With a bad abdominal cramp this is sometimes impossible, but it is always possible to keep afloat if you don’t get excited and tense. Relax as much as you can, keep your lungs full of air, and holler for help. Never go in swimming alone, and if you can’t swim, stay well within your depth. Every member of a camping party should be able to swim well enough to rescue a drowning person under ordinary conditions. If you don’t know how, spend a few weeks in the winter learning in a pool, you are very foolhardy if you don’t.
Probably the easiest carries are the cross chest and the hair carry. Don’t wait until an accident happens and then attempt to learn rescue methods from a book. Have someone show you how, and then practice until you have acquired skill and confidence.
Once the drowning man has been brought to shore, don’t waste time trying to get the water out of him. Lay the head and chest lower than the feet and begin artificial respiration immediately. The patient should be laid on his belly, one arm extended over his head, the other curled under and supporting the face so that the mouth and nose are free for breathing. Kneel astride the thighs. Put the palms of your hands on the small of the back and along the lower ribs. Hold your arms straight and swing forward slowly, bringing the weight of your body to bear on the ribs. Count four, quick marching time, while doing this. Release your hands and drop back on your heels. Count four and then begin again. Repeat this twelve or fifteen times a minute. Don’t give up hope. Persons have been resuscitated after six hours of artificial respiration. Loosen the clothing and if possible, cover the body with blankets while giving artificial respiration, taking care not to smother the nose and mouth. Once breathing has been restored, treat for shock. Watch the patient carefully. Breathing may return and then stop again. In changing operators be sure not to break the rhythm.
NOSEBLEED. Some people suffer from nosebleed at high elevations. Usually this is not serious and can be stopped by pinching the nose or inserting a plug of cotton or gauze. Cold cloths applied to the back of the neck often help. If the nosebleed occurs on the trail, the sufferer should stop and rest in the shade. Continuous or chronic nosebleed is a sign that the body is unable to adapt to the elevation; return to lower country. Stories of bleeding at the ears, etc., at great heights are legends.
POISON OAK. Learn to recognize poison oak and keep away from it. The poison is a heavy, viscid oil, it is not true that it can be transmitted through the air, although smoke from burning poison oak is extremely virulent. Wash thoroughly with strong soap after returning from a region infested with the plant. Dressings of bicarbonate of soda solution will give some relief, but once you have it, there is really very little to be done about it. If you plan to camp in bad poison oak country, it is a good idea to have your doctor inoculate you before you go. If you have been immune, don’t rely on it. The immunity has a bad habit of deserting you suddenly.
SUNBURN. The actinic rays of the sun are extremely strong in the mountains. Wear a hat and expose your body very carefully, a little each day. A coat of tan acquired on the beach, unless it is very dark, will protect you but little. Cod liver oil is the best sunburn ointment, next is tannic acid ointment; patent preparations like Unguantine are also good.
RATTLESNAKE BITE. Always carry a rattlesnake kit in the pack and at least a clean, unopened razor blade (the single-edged kind are best for the purpose) in a pocket or knapsack. If you are bitten, sit down immediately. Don’t waste time trying to kill the snake and don’t move around any more than necessary. Don’t get excited; even without treatment the bite is seldom fatal. Apply a tourniquet between the bite and the heart. Cut a cross about 1½ inches long and about ¾ of an inch deep across the bite. Milk the flesh to force bleeding and scrub the edges of the cut with a handkerchief to remove as much poison as possible. Then apply suction, either with a syringe if you have one, or with the mouth. Should any poison get into your stomach, it is harmless when taken internally, but be sure you have no cut in your mouth and no hollow teeth. Should the venom get into an exposed nerve in a tooth it is very likely to make you unconscious, at the least. Keep up the suction steadily, loosening the tourniquet every fifteen minutes for a few seconds. After about an hour, it is safe to loosen the tourniquet more often and for longer periods, but the suction should be kept up until all sense of acute depression from the poison has disappeared. Don’t use potassium permanganate or any other caustic or oxidizing substance, modern first aid authorities are agreed they do more harm than good. Under no circumstances use whiskey. If you have a kit, sniff a little aromatic spirits of ammonia to relieve faintness.
[The above was long the standard method, but the medical consensus in recent decades has almost unanimously turned against using a tourniquet (which, if put on too tight and left too long, can cause gangrene and eventual loss of the limb), from cutting into the wound (which may actually help spread the poison), and from oral sucking out of blood (which may lead to infection, and which in any case is of doubtful effectiveness). Considering that only about 1% of rattlesnake bites are fatal, it is felt that the old method is likely to do more harm than good. The important thing is to keep the victim calm and get competent medical treatment as soon as possible.]
Once you are able to return to camp, treat the wound as you would any other severe cut, and apply hot compresses to the limb to relieve the congestion and restore normal circulation.
A snake kit should consist of a razor or scalpel blade, a tourniquet, preferably a soft rubber catheter, a suction syringe, preferably of the bulb type, a small roll of one-inch bandage and an ounce of aromatic spirits of ammonia. These should be housed is a small, screw-top mailing tube, and should be used for no other purpose.
MUSHROOM POISONING. If you are unable to distinguish the edible and poisonous species of mushrooms, leave them strictly alone. Should poisoning occur, give an emetic, warm salt water if you have nothing else, force vomiting, treat for shock, and make every effort to keep the patient conscious. Continue giving salt water emetic until the stomach has been thoroughly cleaned, then give strong coffee and finally a stiff laxative. All food poisoning should be treated the same way, no other poisons are likely to be encountered on a camping trip. Large parties should carry an ounce or two of syrup of ipecac in the first aid outfit. One teaspoonful followed by plenty of warm water will usually cause profuse vomiting. If it doesn’t, repeat the dose. Should a patient suffering from mushroom poisoning become unconscious, cover him with blankets, rub the limbs vigorously, and if breathing becomes feeble, give artificial respiration.
SORE FEET. Bathe the feet every night, and if necessary at noon. Be sure your shoes and socks fit well before you start. Tender, sweating feet may be relieved by soaking them in a strong solution of epsom salts, or in water in which tea leaves have been boiled for several minutes, or in an infusion of oak leaves or “mountain misery” [an herb], even fresh pine needles will do some good. Don’t use talcum powder in your shoes.
FREEZING. As long as the sensation of cold is felt, there is little danger of freezing. The first symptom is the loss of sensation, followed by a dead white appearance of the frozen part. Rub vigorously with cold water. Snow, particularly if the weather is very cold, will abrade the skin. Feet and hands should be soaked in a pail of cold water. [Rubbing or soaking with cold water is no longer recommended.] Keep the patient away from fire or warm rooms until sensation has returned. After the part has been thawed out, treat as a burn. Great care should be taken skiing to avoid any constriction of the extremities. Boots should fit perfectly, ski bindings should cross only the hard toe cap, mittens and anklets should fit loosely.
CHILBLAINS AND CHAP. Tannic acid ointment will usually harden a skin subject to chilblains, chap can be relieved by cod liver oil.
FISHHOOK WOUNDS. Never attempt to pull a fishhook out of the flesh. Push it through and cut off the barb with a pair of pliers. Then open the wound with a clean razor blade and paint with iodine.
WATER. Most mountain water is safe. If there is any doubt, it should be purified by boiling, or by the addition of half a teaspoonful of chloride of lime or a pail of water. A similar amount of iodine is also effective. Water so treated should be allowed to stand an hour before using. Never drink water from shallow boggy lakes, or from lakes and streams beside which there are permanent dwellings, or water that has flowed through a meadow. The last, usually harmless otherwise, is almost sure to cause mild diarrhea.
[Unfortunately, mountain water can no longer be presumed to be safe. In order to avoid giardiasis, an amoebic malady that has become prevalent in recent decades, it should routinely be boiled, filtered or chemically purified before drinking.]
Chapter 7 of Kenneth Rexroth’s Camping in the Western Mountains (unpublished manuscript, ca. 1939). Copyright 2003. Reproduced by permission of the Kenneth Rexroth Trust.
Bureau of Public Secrets, PO Box 1044, Berkeley CA 94701, USA
www.bopsecrets.org knabb@bopsecrets.org