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Tag Archives: First Aid

A Brief Discussion on Wilderness Medicine

by: Brandon Behymer

Let’s first discuss what differentiates wilderness medicine from urban medicine. In the urban world if you fall ill or have a trauma-based injury, help is usually 15-25 minutes away and you’ll be at a location that can provide definitive care in less than an hour. The people who show up to your bad day are professionals and have a hospital room on wheels that they roll up in. Modern emergency medicine is amazing. In a wilderness setting definitive care is over an hour away, anyone with thumbs can provide some level of care, and you may be your sole provider. Chances are that there will be limited resources and an extended amount of time to endure on your way to the trailhead, ambulance, or emergency department depending on the severity of the illness or injury.

Among the first questions someone asks about treating a patient in the backcountry is generally ‘can I get sued for doing, fill in the blank?’ The answer is yes to whatever you want to fill in the blank with. Use your imagination and be creative. The answer is still yes. The real question is whether or not what they are suing you for will hold up in court. Good Samaritan laws protect you from frivolous lawsuits so long as you act within your scope and if you have no scope, did you attempt to help? You will not get sued for breaking someone’s ribs while performing cpr. One, because there is a slim chance that they actually survive the ordeal and getting sued by a dead person seems like a lot to ask. Second, you tried to help, did you not? Showing up, even if at random, to someone having an emergency and doing nothing is an easy way to potentially have legal action taken against you, and at the very least, be an asshole.

Someone approaches you in the woods with beads of sweat dripping from their beet red face and in a panicked voice exclaims ‘HELP, something bad happened!’ What do you do? Step one is understand that it’s not your emergency. This isn’t to downplay the urgency of the situation. Someone is hurt or sick and needs help. YOU are now involved. The best thing you can do for that person is not panic and keep yourself safe. You are of no use to anyone if you freak out or become another victim that needs saving too.  Think about what you have available in the way of resources. Do you have the requisite knowledge or training to care for a patient in the woods? Do you have medical supplies to help someone when you arrive on scene? The average person usually has neither, but they do have a cell phone, maybe a snack and some water. It’s not much but it may be the difference to someone.

Consider the amount of time it takes to walk a mile. For most relatively healthy adults this task will take 20-30 minutes. How long do you think it would take to travel the same distance while carrying a litter with a 200lb patient complaining about a compound fracture in the lower leg? With dozens of your closest friends it could take two to three hours depending on terrain. Throw in a longer distance, inclement weather and elevation change and you may be looking at 12+ hours of patient care. When you come upon a middle-aged male complaining of a sprained ankle and requesting to be carried off the hill by search and rescue keep those numbers in mind. His day will be better, and the injury treated sooner if he walked off the mountain with minimal assistance (it would be helpful if you wrapped and elevated the sprain for 20 or so minutes).

Education and training are the most important thing you can do to help yourself or someone else out of an emergency in the backcountry. There are many ways to educate yourself in the field of emergency medicine. Books written by doctors specializing in emergency medicine are the most reliable resource. However, reading the accounts of various rescues or talking to a friend who has experience in the field will provide insight as to signs of what to watch out for in the field. Read the accounts of incidents pertaining to the activity you’re taking part in or wish to support.

If you wish to take things to the application level of education there is a broad array of options to consider. First and foremost, due to accessibility, are the very straightforward ‘First Aid’ talks and ‘classes’ given at outfitters large and small across the country. These opportunities are very useful for the family camper or Boy Scout dad wanting more awareness in the field. Classroom time allows for the better communication of ideas from one person to another. One thing to consider of these first aid talks and presentations is the quality and experience of the presenter. Anyone can give a presentation on first aid and charge a few dollars for it so choose wisely or have a conversation with the presenter about the content if time permits. The next step beyond weekend first aid classes is to actually get certified. Many companies offer First Responder training and several offer Wilderness First Responder training. These courses are taught by someone with experience in the field and are certified themselves. Cost can vary depending on company. Having a certification means that, if something bad happens in the backcountry and you are ABLE to help, then you are RESPONSIBLE for helping. Being a First Responder will open some doors as far as getting on with a search and rescue team or being an asset to a local outdoor community. Going further than this step will require a more serious time and financial investment and is usually pursued by those wanting to make a living in the field of emergency medicine.

Some of the companies offering Wilderness First Responder training also offer Wilderness EMT training. SOLO based out of Conway, New Hampshire is where I went to get my certification. I felt that the campus was welcoming and comfortable and the curriculum and instructors were thorough and professional. NOLS also provides highly rated courses and is headquartered in Lander, Wyoming. Having spent time in both geographical locations I can attest that neither suck. This has hopefully helped point you in the right direction if you have ever been in the woods and wondered ‘what would happen if I tripped and broke my, fill in the blank?’.

Not everyone needs to know how to pull traction on a splintered femur or what Cushing’s Triad is, but everyone needs to ask themselves ‘when shit happens, who do I want to be?’

The Complete Incomplete Guide to Blisters

By: Will Babb

If you’ve ever done a fair amount of hiking, then you’ve experienced a hiker’s worst nightmare- blisters or hot spots. And if you haven’t, then you’re either lying about that or you haven’t hiked enough. The problem with that is that despite being such a common problem, they can be prevented pretty easily with the right gear. And despite being such a small and preventable  problem, they can wreak havoc on your hike. A few small blisters can quickly turn a long hike sour and leave you limping to the trailhead or in tears on the side of the trail. If you meet ten different people on the trail and ask them how to treat blisters, chances are you’ll hear about ten different answers. So because blisters are both simple and confusing, I’m here to give you a complete incomplete guide to blisters- their causes and how to prevent them as well as what to do when you get them so that you can hike pain free and fully enjoy all that the outdoors have to offer.

Causes and Prevention

In almost every situation blisters are caused by excessive friction or rubbing on your foot. A hot spot is the start of a blister- when you first begin to feel a burning sensation from the friction, and if left untreated will turn into a blister. The source of this friction is not always easy to diagnose as there are a variety of causes. Often an improperly fitting shoe can be the cause of blisters- both shoes that are too big or too small can cause hot spots and blisters. If the shoes are too big, your heel will slide out the back as you walk and generate a blister on the back of your foot, or even your toes sliding too much will cause blisters. If the shoes are too small, your toes will hit the front of the shoe, especially on steep descents, and can lead to blisters. And if the shoes are too tight on the sides, they can cause your toes to rub against each other and cause blisters between your toes. Your shoes are the most important piece of gear you own, so choosing a quality shoe that fits properly is vital. It is also important to remember that your feet swell a little throughout the day and as you hike so it is often best to leave a little bit of extra space in the shoes to accommodate this as long as the heel doesn’t slip out the back.

Once you get a shoe that fits correctly, choosing the right sock is the next task. Luckily, socks are usually easier to choose than shoes. Again, socks that are too big will cause rubbing or bunching and eventually blisters. For anything from day hikes to long term backpacking trips, merino wool is generally the best way to go with socks. Brands such as Smartwool, Point 6, and Darn Tough all use high quality merino wool in their socks. Merino is superior to cotton for several reasons- it dries quickly, insulates well in winter, wicks moisture in summer to keep you cool, and does not smell as quickly as cotton will. These benefits become essential in preventing blisters. Wet socks are not only uncomfortable but can also, you guessed it, lead to blisters. A quick drying merino wool sock that breathes well so you sweat less will do a much better job preventing blisters than your average cotton sock. I prefer a lightweight merino sock in the summer such as the micro cushion and something a littler warmer and thicker in the colder months. Some people prefer a thin liner sock as an extra layer of protection, but beware because sometimes this extra layer can lead to increased friction. If you have problems with blisters developing between your toes, I find that wearing a toe sock, such as something from Injinji, is a great way to prevent that problem.

The right socks and shoes won’t leave you blister free, but they go a long ways towards reaching that goal. If you do enough hiking, you’ll inevitably get stuck in a rainstorm and hike in wet shoes and socks for a few miles. I find that hiking anything more than a few miles in wet footwear is a sure cause of blisters. I always like to bring along a third pair of socks on backpacking trips for this reason. Sure, I can save on pack weight and get by with only two, but if I get a few days of rain that third pair can mean the difference between dry, happy feet or swollen, red, blistered feet. Other than packing extra socks, there’s no sure way to avoid blisters in this situation, but there’s a few steps you can take to try to hold them off as long as possible. Taking frequent breaks when hiking, and being sure to pull off your shoes and socks when you do, can help you dry out quicker and give your feet a break. If your feet get wrinkled in wet socks like they do in a swimming pool it’s time to take a break and air out your feet, which will be tender and subjective to blisters. Along this same line, bringing along a pair of camp shoes that you can wear without socks at the end of the day will let your feet get additional ventilation and give your hiking shoes a chance to dry out.


Once you determine the cause of a blister, it becomes possible to treat it. If you do some research on blisters, you’ll find that some sources recommend popping blisters in every situation, some recommend leaving them be, and others recommend draining the fluid on a case by case basis. Not popping a blister reduces the chance of infection, so this is often a great way to go if you’re in the backcountry and my personal recommendation. If you choose to go this way, protecting the hot spot or blister so it doesn’t get worse should be your next step and then you can hike relatively pain free. Depending on the location of your blister, sometimes leaving it unpopped will be too painful. If this is the case, you can pop the blister, but be sure to drain it of any excess fluid and clean it well to remove any bacteria using an antiseptic or, if unavailable, clean water. After cleaning it, it is essential to protect it and keep it clean so that the friction stops and infection is prevented. And if you’re uncomfortable with popping a blister, it’s always okay to leave it as is and simply cushion it well until you can get out of the woods and properly care for it- always use whichever treatment method is comfortable for you.

Below are several common products out there that are often used for blister treatment. Over the course of several years spent hiking and backpacking at Philmont Scout Ranch, local trails, and 2,200 miles on the Appalachian Trail I’ve tested out most of these products and figured out which ones I can come to rely on time and time again.

I have found that the absolute best method for both prevention and treatment of blisters is Nexcare absolutely waterproof tape. It is a stretchy, soft tape that can easily be found in almost any store. Unlike almost any of the other treatment methods here, this one works great in early and late stages and can keep you on the trail longer. This was my go to treatment method this past year on the Appalachian Trail. If I felt a hot spot coming on, a few strips of tape would eliminate the problem. If I did get blisters, a folded up piece of toilet paper or a piece of moleskin beneath the tape would protect the blister so it could heal. The tape stayed on even when wet and didn’t fall off after 20 and 25 mile days, although it was still easy to peel the tape off at the end of the night and didn’t leave any sticky residue, as duct tape or gel pads will. Although not specifically meant for blister treatment like moleskin or specialized gel pads, this method worked way better for me than any of those listed below and can be used for a variety of other backcountry uses, even just holding a band-aid on either on or off the trail.

The most common method of treating a blister is moleskin, which can be effective it is used properly. It works great in situations when the shoe or sock is rubbing too much because it protects the blister or hot spot well. On the downside, I find that it doesn’t stick to skin very well, especially as you continue to hike, but that can easily be solved with a few strips of tape. To use moleskin, simply cut off a small square of moleskin and cut a hole in the middle where the blister is and apply it. The moleskin is great because it doesn’t cover up the blister itself and allows it to breathe while still eliminating the friction around the area. Moleskin works best when you can get it on early, as a hot spot is forming, even before the blister has formed.

Another option is a gel pad or a “second skin” treatment. They work great at preventing hot spots from becoming blisters and I’ve also used them on blisters that have been popped with decent results, although they won’t keep your blister clean or allow it to heal properly, so they are only great in this situation for short intervals to alleviate pain as you finish a hike. My problem with the gel pads is that they can actually be too sticky and difficult to remove and leave a residue on your skin and socks. I prefer not too spend the additional money on a specialized product such as this when I can use some gauze and waterproof tape to fix the same problem.

Many marathon runners swear on using Vaseline on their feet to prevent blisters. The Vaseline won’t eliminate rubbing, but it will eliminate the friction that builds up from the excessive rubbing. Similarly, clear nail polish works the same way. I learned from a former RRT employee and the current Wilderness First Aid instructor that applying this will create a smooth, friction-less surface on the hot spot. Both of these methods allow you to continue hiking on an existing blister or hot spot, but it isn’t universal. This method won’t work for everyone- sometimes it can actually accentuate the problem. My other problem with Vaseline is that it doesn’t allow a blister to air out, so again, it should only be used short term and won’t do anything to help the healing process.

Tape is another option for treatment, one that works best in conjunction with moleskin or a band-aid, two methods that can work well on treatment but won’t stick well on their own over time. Athletic tape and duct tape are two options- some people tape directly over a hot spot or unpopped blister but I think it’s best to tape over top of moleskin or gauze or even a piece of toilet paper. You can even apply duct tape to the inside of your boots to eliminate rough spots that might cause blisters. As sturdy as duct tape might be, I’ve found that it too is pretty much worthless if it gets wet and after long miles, even for high quality duct tape. Another tape option is Leukotape, which is a little hard to find and a little more expensive but works way better than duct tape. It will work all day, even when wet, and holds well. I don’t use it because I prefer a tape that I can easily find in stores when I need it. My problem with using tapes like these, rather than the Nexcare waterproof tape I mentioned above, is that they often leave a sticky residue on your feet and socks that can be hard to remove.

Band-aids can be extremely useful because they come in a wide variety of sizes, some small and rounded to specifically cover up blisters, but again they don’t stick well and should be used in conjunction with a quality tape.

One more piece of advice, one that probably doesn’t need said but I’m going to throw out there anyways- please don’t get a pedicure before you go hiking. Your feet won’t appreciate it and you’ll end up in a lot of pain. Save the pedicure for once you’ve returned from your trip.

I hope that you’ll find at least one of these blister treatments works for you and that you’ve learned something to make your next hike in the woods blister free and enjoyable. I tried to include as much information as I could without writing a textbook, and I think I covered all of the most popular treatments that I’m familiar with, but I’m sure I still missed a few. If there’s a home remedy or secret treatment that you think is the fountain of youth, or in this case of blister treatment, don’t hesitate to let me know- I’m always looking for more camping hacks I can take into my outdoor pursuits.


Backcountry Safety

Backcountry Safety
Tips for Staying Safe in the Great Outdoors
Written by: Chris Broughton-Bossong

There is an endless list of reasons that people feel motivated to get back to nature. Whatever it is that brings us to venture off the beaten path, it is generally to find some kind of reprieve from our daily grind and escape the worries of the week.  The best way to enjoy our outings as much as possible is to stay as safe as possible.  Whether we are veteran backpackers or getting ready for our first day hike, we all need to keep safety in mind and remind ourselves that we are out of our element.

Even though it is bears and broken bones that seem to get the most attention with regards to backcountry emergencies, they comprise a small minority of the backcountry emergencies responded to each year in the US.  In general it is injuries related to exposure that pose statistically greater risk to us when we are in the outdoors.  Dehydration, hypoglycemia (low blood sugar), hyper and hypothermia (elevated and diminished body temperatures), superficial burns, sprains, and blisters are not only some of the most common conditions we can face but are also some of the easiest to avoid.

Dehydration is an easy pitfall to avoid but we often don’t realize how effortlessly our bodies consume water.  Of course, everyone realizes there is fluid loss through perspiration. But think about exhaling on a mirror; the fog that it leaves behind is our exhaled water vapor.  So the more we breathe, the faster we can dehydrate.  Coupled with our body’s consumption of fluids, is our management of critical nutrients and electrolytes. Our body does not store natural spring water, but rather stores and uses water mixed with sodium (salt) and other electrolytes and nutrients.  So, the activity that is causing us to breath heavier is also causing us to burn more fuel and thus use up more sugars, which will eventually cause us to “crash” or become hypoglycemic. It is not only important to make sure that we are well hydrated before and during our excursion but that the fluids we drink are actually helping to replace some of the nutrients we are using up (salts, sugars, vitamins, etc.).  In short, if you’re not drinking regularly, you’re not drinking enough.

As most of us already know, sweating is our body’s primary method of cooling down or thermoregulation.  As effortless as this function may be, it is still something we need to pay attention to during our treks.  As we discussed above, if the fluids and nutrients we sweat and breathe are not replenished, this will eventually cause us to “crash”. This also increases our chances of facing an inability to cool down (heat exhaustion and heat stroke, respectively).  On the opposite end of this spectrum is hypothermia or a decreased body temperature.  Although adequate heed to the weather and proper layering are the best ways to avoid this, one slippery slope is when we begin to exert ourselves on a chilly day. We are bundled up, start hiking, start warming up, feel ourselves start to sweat, peel off some layers and are now damp and more exposed.  Remember, it is much easier to retain body heat than it is to regain it.  If it’s hot, stay hydrated.  If it’s cold, stay insulated.

While we are thinking about thermoregulation, consider the most common first-degree burn suffered outdoors: the sunburn. As with any burn, sunburn means it is more likely that our body’s surface temperature is increased as well.  Thankfully this is perhaps one of the most easily avoided injuries. The simple solution: keep covered with clothing or protective lotion.

Lastly we come to the sprains, strains, and blisters. We are most commonly predisposed to sprains and strains when we are traversing rough or uneven terrain and push ourselves too far (too fast or while fatigued), especially if we are not in properly designed footwear.  Remember, you are there to have fun.  Slow your pace a bit and pay close attention to both footing and handholds. Blisters can be avoided with footwear designed for the task at hand.  The great thing about blisters is that they don’t sneak up on you.  We will almost always feel a rubbing or chafing that leads to the blister forming.  When you feel that you are getting a “hotspot,” take a second and loosen your boots if need be. Increased pressure (shoe tied too tight) + motion (hiking/walking, etc.) = more friction (blisters). Apply moleskin, duct tape, or nail polish, prior to the blister forming, to reduce friction on the skin.  Treat the blister before it’s even there.

So in conclusion, when we take the time to listen to our bodies when we feel thirsty or worn down, chilly or starting to heat up, soreness or aching setting in, we are able to prevent or inadvertently treat many of the most common back country calamities that we are faced with.   Although there some schools of thought that toughing through it is what it’s all about, I believe preventing incidents and injury so that we can make the most of our valuable time spent with nature is what will keep us coming back.  The safer we can stay, the happier we will be and the longer we can enjoy our outdoor adventures, whatever they may be.