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Paddling Articles In the Same Boat

Beyond First Aid

Meeting the Challenge of
Backcountry Medical Emergencies

By Tamia Nelson

May 25, 2004

A Note to the Reader  This is a guide to planning and preparation. It is not a handbook of diagnosis and treatment. Your best source of information on medical matters is always your own doctor. If you value your life and health, consult her before you head for the put-in.

The voice on the phone offered me a chance at the trip of a lifetime. I'd been invited to join a group that was headed for the Northwest Territory's South Nahanni — Raymond Patterson's famed Dangerous River. I was understandably excited. It was back in the days before you could book a catered trek to the North Pole just by dialing a toll-free number. Paddling the South Nahanni meant doing it yourself.

The trip leader — I'll call him Joe — was a friend of a friend. I'd never canoed with him, but that didn't worry me. This wouldn't be his first trip up North, and I knew he had a reputation for meticulous planning. Things went smoothly at first. Joe gave me a run-down on the gear he was bringing and told me what I'd be expected to contribute to the group's stores and common equipment. One item was missing from his inventory, however. Just an oversight, I thought, but I decided I'd better make sure. So I asked, "What about the medical kit?"

"Don't take one," Joe replied.

I got the feeling we might have a problem in communication here. I tried again. "You don't take a medical kit?" I said, trying to keep the astonishment out of my voice. "What if someone gets hurt or sick? OK. I think I see. You're telling me you don't have a group medical kit, right? Everyone brings their own, then, or…?"

Joe cut me off before I could think of any other alternatives: "It's like I said. I don't take one. Never do. And I don't see why you have to bring one, either. You bring a first-aid kit, I figure somebody's gonna get hurt. Who needs that? We're planning on running the river and having a good time. We don't need anyone playing doctor."

I could see now that our communication problems were far deeper than I'd guessed. I was about to ask Joe if he didn't plan on taking a life jacket or a spare paddle, either, but by then my Inner Voice had started whispering in my other ear. Why bother? it said. This isn't somebody you want to run a dangerous river with, is it? No way. So all I said to the guy on the phone was, "Thanks, Joe. Sounds like a lot of fun, but I've got other plans. Hope you have a good trip."

I learned later that they didn't, though luckily no medical emergency arose. The trouble lay elsewhere, in what the wilderness educators call "group dynamics." I can't say I was surprised. While no one in his right mind wants to go looking for trouble, it's equally important not to ignore the obvious. Of course that's easier said than done when you're planning a Big Trip. You pour over brochures, guidebooks, and maps, dreaming of all the great things you'll see and how wonderful it'll be to "get away from it all." You don't want to think about broken legs or sudden, unexplained bouts of dysentery. But you should. Even the best organized, most experienced group can come to grief in the middle of nowhere, and when bad things happen to good paddlers, it's important to be prepared.

Are you? To find out, ask yourself if you know…

What You Need to Know

Answer honestly. You're the only person listening. Do you know how to treat soft-tissue injuries — the cuts and abrasions that most paddlers suffer every day, but which occasionally evolve into ugly, infected wounds if not properly cared for? And what if a misdirected knife or ax bites deep? It happens from time to time, even in the best-run camps. Can you stop the bleeding and prevent shock? What about fractures? Rivers and lakes aren't short of slippery rocks, after all. Let's say your partner starts rubbing his chest halfway up Purgatory Portage. Is it just indigestion? Or something worse? And if so, what do you do? There's no ER on Lonely Loon Lake.

Suppose you slipped and fell and hit your head a couple of hours ago. Now you're feeling a little dizzy. What should you do? Or maybe nature starts calling you every half hour. Your canoe doesn't have a toilet. You're already behind schedule. What do you do? Now it's one hundred degrees in the shade, only there's no shade in the middle of the bay. You feel hot — too hot. The sea's flat calm, but the distant shore is dancing up and down before your eyes, and your pulse is pounding in your temples. What can you do? Or maybe you've got a problem of a very different sort. It's a brisk 40-degree day somewhere north of 50. There's a cold nor'easter driving needles of sleet right into your face, with worse to come. You've been shivering for a while. Suddenly, your fingers won't do anything you tell them to. Not even hang on to your paddle. What are you going to do?

The list goes on and on. If it sounds melodramatic, it's not. It's all happened to someone, somewhere. It's all happened to Farwell and me, in fact. And you don't have to travel very far to get into trouble. People get sick on Golden Pond, too. If they and their companions know what to do, things usually turn out all right. But if not.…

OK. You've asked yourself the hard questions — war-gamed a few emergency scenarios, in disaster-planning-speak. Not happy with your answers? Wish you (and your partner) knew a little more about meeting medical emergencies? Then it's time to…

Get Help

You may have earned a First-Aid Merit Badge when you were a Scout, but that was probably a few years back — maybe quite a few years. You've forgotten a lot of what you learned, and a lot more has changed. It's time to upgrade your skills. But how? Well, the Red Cross offers a range of first-aid courses. They aren't cheap, though, and much Red Cross training assumes that you only have to keep your "patient" alive until the ambulance arrives. This can take quite a while even on Mud Pond. It'll be a whole lot longer on Hudson Bay. Still, the Red Cross is a good place to begin. Call your local office to find out what they have scheduled.

Colleges and paddling clubs — and commercial outfitters, too — often offer similar instruction. Sometimes they even have "wilderness first aid" courses, for those days when the doctor's never in, and those places where you can't dial 911. These can be very good indeed, and they frequently cost no more than the Red Cross offerings. Check them out.

Whatever course you choose (or can afford), if it includes hands-on drills and realistic practical exercises, you won't be wasting your time. Coping with medical emergencies is best learned by doing. Book-learning, while certainly useful, can only take you so far. That's why it's important to practice the skills of examination, diagnosis, and treatment under the guidance of a competent teacher. My first formal training in wilderness medicine came when I enrolled in a month-long Outward Bound "expedition." While much that I learned back then has been superseded by advances in medical knowledge, the systematic approach to evaluation and treatment inculcated in me by my instructors — and reinforced by very realistic field exercises — has endured. It's served me well many times.

Don't think you can neglect book-learning altogether, though. Medical science is in a constant state of evolution, and books help you keep up. They also fill in the gaps that you'll find even in the best-organized courses. Unless you're already a practicing physician, nurse-practitioner, paramedic, or EMT — and perhaps even if you are — you'll benefit from a little not-so-leisurely reading. To begin with, get a good backcountry medical handbook. And don't just let it gather dust on a shelf. Read it carefully. Make notes in the margins. Annotate the index. Then carry it with you on all your trips. Someday, you'll be very glad you have it.

Does this sound like a lot of trouble? It is. But I'll bet it won't seem like much of a nuisance if your life hangs in the balance. And how about the lives of your family and friends? The most important item in any paddler's medical stores is the knowledge in her head. Without that knowledge, even a well-stocked first-aid kit is all but useless. With it, you can work wonders with nothing more than your hands, a sharp pocket-knife, and the clothes on your back. Ignorance is bliss only when somebody else is taking care of business. More often than not in the backcountry, you and your party are on your own, at least until the chopper touches down. And sometimes, as Dr. James A. Wilkerson reminds readers in his introduction to Medicine for Mountaineering,

The doctor is not coming.

Period. Of course, when trouble strikes, you'll be better off if you have more to work with than just your pocket-knife. You need…

A Little Black Bag

That's what doctors carried with them back when they made house-calls. It had all the tools a general practitioner needed to diagnose and treat common complaints and meet medical emergencies, along with most of the medications he regularly prescribed. Nowadays the black bag has gone the way of the house-call. Still, with a bit of help from their family physicians, paddlers can easily assemble their own. It ought to be waterproof, obviously, but it needn't be black. In fact, bright, high-visibility colors are better. Whatever the color, though, there should be one in every boat on any group trip. If not, and if the boat carrying the group's pooled medical supplies is lost, you're back to working with your pocket-knife. That's not good.

I prefer to stock my black bag myself — Medicine for Mountaineering has a good guide — but you'll also find plenty of ready-made first-aid kits in every catalog. Your doctor can advise you about prescription drugs and help you obtain what you need. If you have a chronic condition of any sort, don't forget to lay in a generous supply of maintenance medications, too. Belt-and-suspenders types will want to bring twice as much as they think they'll need for a trip, and then divide the supply between two packs or, better yet, two boats. You should give some thought to storage, as well. On a sunny summer day, temperatures in closed packs can easily top 100 degrees Fahrenheit (38 degrees Celsius). That's too high for many medications. Keep them somewhere cooler. A wool sock pulled over a Nalgene® water bottle and soaked in the river now and again makes a pretty good "pharmacy": evaporation keeps the contents of the bottle cool in everything but the hottest and most humid conditions. A canvas-covered Arctic Creel works well, too. Just don't forget to put your medications in a waterproof envelope before dunking the creel in the river.

It's best if everyone in your group knows where all of the party's black bags are located. And if anyone suffers from a medical condition that could create a hard-to-diagnose problem or special hazard, it's a good idea for her to let the other paddlers know before the start of a trip. Are you allergic to insect bites or stings? Are you a diabetic? Or maybe you suffer from a seizure disorder? In an emergency, your friends can save precious time if they know your medical history. Personal privacy is important, of course. If you prefer not to tell your companions about everything that ails you — and I admit it can make for mighty dull conversation — you can always carry some sort of medical alert on your person. The custom "dog tags" sold by many military surplus outlets are great for this. So are the ankle bracelets worn by some cyclists. Just be sure your friends know where to look should the need ever arise. After all, when you travel with others, you're all in the same boat.

Whatever you do, don't pack your black bag and forget it. Medications deteriorate over time. Sterile dressings don't stay that way forever. Adhesive tape loses its stick. Take stock at the end of every trip. Replace anything you've used, along with any drugs or supplies that are past their prime. Then you'll be ready for your next excursion.

It all comes down to being prepared. However good a job you do, though, someday you may encounter a problem that you and your black bag can't handle. That's when you'll need…

Wilderness 911

The microchip has revolutionized communication. You can now phone out for a pizza from the summit of Everest. Despite this, there are still plenty of shadowlands where cell phones and satellite phones are just mute lumps of plastic. And you don't need to travel to the ends of the earth to lose yourself in one. Some of them are right on the fringes of suburbia. So check before you leave home, and make your emergency communication plans accordingly.

In many places, radio remains your best bet. But which radio? That's the big question. It's not an easy one to answer. It involves complex technical and legal considerations, and it's best left for another time. There's a new kid on the block, however: the Personal Locator Beacon, or PLB. This little brother to the mariner's 406 MHz EPIRB (Emergency Position Indicating Radio Beacon) is small enough — and light enough — to take along on any outing. Yet despite PLBs' diminutive size, they can alert a rescue coordination center within minutes of activation, and then guide searchers to your position. It seems like the answer to a wilderness paddler's prayer, and maybe it is. Time will tell. Two things are already clear. These miracles of technology don't come cheap. The least expensive PLB will set you back about as much as a new canoe. And they're not toys. False alarms can be very costly, as one hapless New Yorker has already learned. Playing with your PLB can be the most expensive fun you've ever had.

That's not all. Even if your signal goes out loud and clear, help won't always reach you quickly. Bad weather can keep aircraft on the ground. Regional Search and Rescue assets may already be committed. And sometimes you're not even heard. No technology is 100-percent reliable. Batteries have been known to fail, and "water-resistant" electronics can drown. The moral of the story? Don't depend on the kindness of strangers. Depend on yourself, instead. When you head off into the backcountry, plan to meet emergencies with your own resources, and be sure you and your companions have the knowledge you need to do so. Don't call for help unless you really need it.

And when that day comes, if it ever does? There's still plenty for you to do while you're waiting for the Good Guys to arrive. Most important of all, you need to remember the real-estate agent's watchword:

Location is Everything

You can't get help if you can't be found. Your PLB, if it has a GPS capability, will guide rescuers to within a hundred yards of your camp. If you don't have a PLB, however, or if your PLB doesn't have an integral GPS, you'll need a stand-alone GPS receiver to pin-point your position. GPS not working? I hope you've kept up your skills with map and compass. No matter how much faith you have in electronics, it doesn't hurt to have a back-up plan. And even 100 yards can be a long way in some terrain. So make your camp conspicuous. A smoky fire helps, but be sure to build it in a safe place. There's nothing like an out-of-control wildfire to complicate a medical evacuation. Is it too dry to risk any fire? A mirror can catch a pilot's eye on a sunny day. So can a brightly-colored tarp or tent, even when clouds cover the sun. The important thing is to be seen. Once you've made the decision to call in outside help, you can't afford to be shy. You want to be found. That's what makes for happy endings.

No one likes to think about medical emergencies. A canoe or kayak trip is supposed to be fun, after all. If you can't turn off the worry tap at least some of the time, you might as well give up paddling and take up bingo or billiards. But it's just as important not to let Pollyanna make all the decisions in your life. Bad things do happen to good people. And when they do, a little preparation goes a long way. Which is better? Sweating the details before you leave the put-in, or breaking out in a cold sweat when things go wrong — and when you're hundreds of miles from home and help?

I know which I prefer. Plan. Prepare. Relax. That's the way to have a good time on the water, whether you're running Deadmen's Canyon or just exploring Golden Pond. So be safe. And have fun!

Copyright 2004 by Verloren Hoop Productions. All rights reserved.

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