Sovereignty Module: Mend the Wounded
Complete Wilderness First Aid: From Assessment to Evacuation
When professional medical help is hours or days away, wilderness first aid knowledge saves lives. This campaign covers patient assessment, wound care, fracture management, environmental emergencies, and evacuation.
Chapter 1: Patient Assessment System
| Step | Action | Time | Purpose | Finding |
|---|---|---|---|---|
| Scene safety | Check for dangers (falling, fire, animals, traffic) | 10 sec | Prevent additional casualties | Safe to approach? |
| Responsiveness | Tap shoulders, shout "Are you okay?" | 10 sec | Determine consciousness level | Alert, verbal, pain, unresponsive (AVPU) |
| Airway | Tilt head back, lift chin, look/listen/feel | 10 sec | Ensure open airway | Open? Obstructed? |
| Breathing | Watch chest rise, count rate | 15 sec | Assess ventilation | Rate: 12-20/min normal |
| Circulation | Check pulse (neck), look for major bleeding | 15 sec | Assess heart function | Rate: 60-100/min normal |
| Disability | Check pupils, movement of extremities | 30 sec | Neurological status | Equal pupils? Can move all limbs? |
| Exposure | Remove clothing to check for hidden injuries | 1-2 min | Find all injuries | Head-to-toe examination |
MARCH protocol (life-threatening injuries): 1) Massive hemorrhage: stop life-threatening bleeding FIRST (tourniquet, direct pressure). 2) Airway: ensure airway is open (head tilt, chin lift, recovery position). 3) Respiration: check breathing (seal chest wounds, assist breathing). 4) Circulation: treat shock (lay flat, elevate legs, keep warm). 5) Hypothermia/Head injury: prevent heat loss, monitor neurological status.
Chapter 2: Wound Management
| Wound Type | Bleeding Control | Cleaning | Closure | Infection Risk |
|---|---|---|---|---|
| Laceration (clean cut) | Direct pressure | Irrigate with clean water | Butterfly strips or sutures | Moderate |
| Avulsion (torn flap) | Direct pressure | Irrigate, replace flap | Secure flap, bandage | High |
| Puncture | Direct pressure (don't remove object) | Irrigate around (not into) | Do not close (drain) | Very high |
| Abrasion (scrape) | Usually minimal | Irrigate thoroughly | Leave open (bandage) | Moderate |
| Crush injury | Pressure, elevation | Irrigate | Depends on severity | High |
| Amputation | Tourniquet | Wrap amputated part (cool, not frozen) | Surgical (evacuate) | N/A (surgical) |
Wound irrigation: 1) Use the cleanest water available (boiled and cooled is ideal). 2) Fill syringe or plastic bag with pinhole. 3) Irrigate wound with pressure (squirt water into wound). 4) Use at least 500 mL (1 pint) for small wounds, more for large. 5) Irrigate from clean area toward dirty area. 6) Remove visible debris (tweezers). 7) Irrigation is the single most important factor in preventing wound infection. 8) Pressure irrigation is more effective than soaking or pouring.
Chapter 3: Fracture and Sprain Management
| Injury | Signs | Splinting | Evacuation | Urgency |
|---|---|---|---|---|
| Closed fracture | Pain, swelling, deformity, crepitus | Splint in position found | Can walk out if leg stable | Moderate |
| Open fracture | Bone visible through skin | Cover wound, splint | Cannot walk, carry out | HIGH |
| Dislocation | Deformity, locked joint, severe pain | Splint in position found (do not reduce in field unless trained) | Moderate urgency | Moderate-high |
| Sprain (mild) | Pain, mild swelling, can bear weight | Wrap (ACE bandage), RICE | Can walk out | Low |
| Sprain (severe) | Severe swelling, cannot bear weight | Splint, RICE | May need carry out | Moderate |
Splinting principles: 1) Splint in the position found (don't straighten deformed limbs unless no pulse below). 2) Immobilize the joint above AND below the fracture. 3) Pad all bony prominences (prevent pressure sores). 4) Check circulation below splint (pulse, sensation, color) before and after. 5) Splint materials: sticks, trekking poles, SAM splint, sleeping pad, clothing. 6) Secure with bandages, strips of cloth, duct tape, belts. 7) Reassess circulation every 30 minutes (swelling may tighten splint).
Chapter 4: Environmental Emergencies
| Emergency | Signs | Treatment | Prevention |
|---|---|---|---|
| Hypothermia (mild) | Shivering, confusion, poor coordination | Remove wet clothes, insulate, warm drinks, gentle exercise | Layer clothing, stay dry |
| Hypothermia (severe) | No shivering, unconscious, slow pulse | Handle gently, insulate, body-to-body warming, evacuate | Same + recognize early signs |
| Heat exhaustion | Heavy sweating, weakness, nausea, headache | Move to shade, cool with water, drink electrolytes | Hydrate, rest in heat, acclimatize |
| Heat stroke | Hot dry skin, confusion, high temp (>104°F) | EMERGENCY: cool aggressively (immerse in water), evacuate | Same + recognize heat exhaustion early |
| Dehydration | Thirst, dark urine, headache, fatigue | Drink water with electrolytes (salt + sugar) | Drink before thirsty, monitor urine color |
| Altitude sickness (mild) | Headache, nausea, fatigue | Rest, hydrate, descend if worsening | Ascend slowly (1,000 ft/day above 8,000 ft) |
| Altitude sickness (severe/HACE) | Confusion, ataxia, unconsciousness | DESCEND IMMEDIATELY, oxygen if available | Same + recognize mild symptoms early |
| Drowning (near) | Coughing, difficulty breathing | Clear airway, rescue breathing if needed, warm | Water safety, PFDs |
| Lightning strike | Burns, cardiac arrest, confusion | CPR if no pulse, treat burns | Avoid ridges, isolated trees, water during storms |
Chapter 5: Evacuation Decision
| Factor | Stay and Treat | Evacuate |
|---|---|---|
| Airway compromise | Manageable with positioning | Cannot maintain airway |
| Breathing | Normal or slightly fast | Severe difficulty, rate <10 or >30 |
| Bleeding | Controlled with pressure | Cannot control, signs of shock |
| Fracture | Stable, splinted, can walk | Open fracture, spinal injury, cannot walk |
| Consciousness | Alert, oriented | Deteriorating, unresponsive |
| Environment | Shelter available, weather stable | Exposure risk, weather deteriorating |
| Distance to help | Help coming to you | Must move to reach help |
| Time | Hours until help arrives | Days until help arrives |
Improvised litter (stretcher): 1) Two poles (6-7 ft long, strong). 2) Thread poles through jacket sleeves (2-3 jackets, zipped closed). 3) Or: wrap tarp/blanket around poles (fold edges under). 4) Test with heaviest rescuer before loading patient. 5) Minimum 4 carriers (6 is better for long distances). 6) Rotate carriers every 15-20 minutes. 7) Carry feet-first downhill, head-first uphill. 8) Communicate: "Ready? Lift on three. One, two, three, lift."
Reference Card
- Stop the bleeding first (massive hemorrhage kills in minutes; control bleeding before anything else). 2. Irrigate wounds thoroughly (pressure irrigation with clean water prevents more infections than any antibiotic). 3. Splint it where it lies (don't straighten deformed limbs; splint in the position found unless there's no pulse below). 4. Check circulation below every splint (pulse, sensation, color; swelling can cut off blood flow under a tight splint). 5. Hypothermia kills quietly (confusion and poor judgment are early signs; by the time shivering stops, it's severe). 6. Cool aggressively for heat stroke (heat stroke is immediately life-threatening; immerse in water, pour water over body). 7. Descend for altitude sickness (the only reliable treatment for severe altitude sickness is to go lower immediately). 8. When in doubt, evacuate (if you're unsure whether the patient needs professional care, they probably do; evacuate).