If you’re not trained, never attempt to
put a bone back into place.
By Alisha McDarris February 11, 2020
For February, we’re focusing on the body parts
that shape us, oxygenate us, and power us as we take long walks on the
beach. Bony bonafide bones. These skeletal building blocks
inspire curiosity and spark fear in different folks—we hope our stories, covering
everything from surgeries and supplements to good old-fashioned boning, will
only do the first. Once you’ve thoroughly blasted your mind with bone facts, check out our previous
themed months: muscle and fat.
Picture this: While
descending a precarious slope, you lose your balance, land awkwardly on a rock,
and your foot
wrenches sideways. Immediately, you hear a distinct cracking
sound—one you’ll probably never be able to forget—and you fall to the ground in
pain. What moments ago was a pleasant weekend hike has officially become a lot
less enjoyable: you’re in the wilderness with a broken bone.
While an injury like this
means the end to an excursion, it’s rarely a life-and-death situation. In fact,
with the right training, the appropriate tools, and a level head, you can make
it back to civilization in one piece and with a hell of a story to tell.
Stay calm
and assess the situation
The most common
musculoskeletal injury in the outdoors is a sprained ankle, but fractured or
broken bones are also a concern, especially ankles, wrists, and ribs. If this
happens to you or a fellow hiker in the backcountry, stay calm and evaluate the
situation. It is the job of whoever’s not injured to take control and decide
the best course of action to keep everyone safe.
“Try not to make more
patients,” says Dr. Martin Musi, fellowship director of wilderness medicine at
the University of Colorado and director of the Diploma in Mountain Medicine of the Andes.
But before being able to
assess the situation, you’ll need to get closer—and in the wild, that’s often
easier said than done. First, you’ll need to make sure it’s safe for you to
approach the injured person. If they’ve tumbled down a slippery slope or
wrenched an ankle in a boulder field, for example, make certain you won’t
succumb to the same fate by leaping after them. Anchor yourself to a sturdy
tree with a rope before navigating a steep decline, or crawl slowly on your
hands and knees if there’s a chance you could trip and fall as well.
Once it’s safe, approach
the person with caution and check their vitals—make sure they can breathe and
that they’re lucid and aware. Next, look for blood—if there is any, protect
yourself and the patient by using gloves. You should always have a pair in your
first aid kit, but if you don’t, you can improvise them with plastic
bags. Try to control the bleeding by applying pressure with a clean
piece of fabric or cloth. Once you’ve determined the person is stable, move
them to a more secure location if necessary.
Finally, take stock of the
severity of the injury—which is not always easy, according to Shana Tarter, EMT
and assistant director of NOLS Wilderness Medicine. What you may think is a
fracture may be a sprain, strain, or a dislocation, or vice versa. Unless
there’s obvious angulation (when you see a limb bent in a way it shouldn’t be)
or an open fracture (a broken bone protruding through the skin) you often can’t
be sure if it’s a simple fracture or something else.
But when it comes to
treating any musculoskeletal injury, it often doesn’t matter what you call it—keeping
the person safe and stable is the priority. Take your time, keep everybody
calm, and proceed to treatment.
Attend to
the injury
Next, make sure the person
doesn’t have additional injuries. If they do, always tend to the most serious
or life-threatening first. If you’re dealing with a single musculoskeletal
injury, start by performing a complete assessment of the wounded area—this
involves checking circulation, sensation, and motion.
To get a good look, remove
anything that might impede circulation—this includes rings, bracelets,
accessories, and boots. Keep in mind that even if they aren’t causing problems
now, they eventually might. When removing shoes or boots, do so carefully by
loosening them up as much as you can.
First, check for a pulse
below the injured area to make sure blood is flowing correctly. If the arm is
hurt, for example, try the the wrist; or if the ankle is the issue, try the
foot. If you find a pulse, that means circulation is good.
If you see any bruising, swelling, visible bones protruding from the skin, or
any unnatural colors in the injured extremity, this could be a sign of a
circulation issue. These may cause complications like tissue and nerve damage
if the person doesn’t get medical care in a timely manner.
Then, check for sensation
above and below the injury by tapping or lightly scratching the person’s skin.
If there’s a pulse and no numbness or tingling, it means nerves are likely
intact. If not, and you don’t possess the proper wilderness medicine training,
a speedy evacuation becomes the top priority before nerve or tissue damage sets
in.
Lastly, find out if the
person can move or put any weight on the injured area. There will likely be
pain, but if they can move it, it means they may be able to help get themselves
back to the trailhead.
If there’s visible
angulation, and you’ve been trained in wilderness first aid, Tarter recommends
attempting to put the extremity back in its normal anatomical alignment. Doing
so will most likely improve circulation, sensation, and motion. If that is the
case, you can make your way to civilization safely and calmly. But if you can’t
be certain the bone is broken, you lack training, or straightening the limb
doesn’t improve circulation and sensation, emergency evacuation becomes the
absolute priority. Leave this procedure to the trained professionals.
Immobilize,
manage pain, and make an exit
If the injured extremity is
usable, you may be able to stick to managing symptoms, like pain, and helping
the person hike back to the trailhead. Treat symptoms by administering
painkillers like ibuprofen. If you’re hiking in the winter or
at high altitudes, you can also use snow or ice in a bag or bandana to
alleviate pain and swelling. Immersing a limb in a cold creek will also work,
but only for brief periods of time so the person doesn’t end up with frostbite.
But if it’s not usable, you’ll
need to make a splint so the patient doesn’t hurt themselves worse. Some
first-aid kits include a packable splint, but a little improvisation can
work, too. Use sticks, trekking poles, even the suspension system
from your backpack (if it has one), to create a rigid structure around the
injured limb. Thoroughly pad the space between the skin and the splint with
clothing or gauze, then use elastic bandages, strips of clothing, or paracord
to hold the splint snugly in place.
Immobilize the joint above
and below the injury, but make sure to fix it in a natural position. If the
forearm is the issue, make sure the wrist and elbow are both immobilized but
that the elbow is bent and the hand rests in a curved position.
It’s important to ensure
the splint is sturdy and durable in case of inclement weather, but don’t use
tape unless absolutely necessary—if the splint becomes too tight or
uncomfortable, having it secured with tape won’t allow you to easily adjust it.
After splinting, check for a pulse below the injury once more to ensure you
haven’t worsened the situation by cutting off blood flow before you make your
way back.
Open
fracture: a hiker’s true nightmare
The type of broken bone
people often fear most is an open fracture—and for good reason. Fortunately,
these kinds of fractures, especially those that involve dangerous amounts of
blood loss, are fairly uncommon in the backcountry. In fact, the biggest risk
with an open fracture is the risk of infection.
To prevent that from
happening, use an irrigation syringe—the kind found in most comprehensive first
aid kits—to squirt clean, drinkable water on the end of the exposed bone,
rinsing it clean. If you don’t have an irrigation syringe on hand, improvise by
pouring or squirting water from a water bottle. Then, only if you have the
training, attempt to straighten the broken bone and get it back into the skin
before you create a splint.
If you don’t have any first
aid training in this area, cover the exposed bone end with a moist piece of
gauze so it doesn’t dry out, wrap the area with a bandage, splint the limb, and
evacuate. You will want to get the person to a hospital as quickly as possible.
Get help
After you’ve assessed the
injury, made a splint, and treated some of the patient’s symptoms, it’s time to
figure out how to get help. If the affected limb is even remotely unusable,
that means leaving the backcountry is the next step.
If you have an emergency
beacon or satellite phone, use it to call for help. If Search and Rescue (SAR)
is available, give them your location; if not, call to inform authorities that
you’re hiking out and need help. If the trailhead isn’t far and the person can
walk, even slowly, help them hike out, keeping a close eye on them and
regularly checking for circulation issues.
As Tarter points out,
self-evacuation, if at all possible, is often the safest option, as it doesn’t
put rescuers or fellow hikers at risk. Besides, Musi says, SAR may not be
available in all locations and circumstances, so attempting to be self-reliant
is often the best course of action.
If the person can’t walk,
they must remain in place while you or someone who’s able goes out looking for
help. Make sure they are comfortable, in a safe place, and have plenty of food,
water, and shelter. And before your hike out to get help, make sure you know
their location as accurately as possible—you will need to describe their
position and surroundings to rescuers, and every detail counts.
If you’re the injured party
and hiking alone, use tools like a whistle, mirror (to reflect light as an
emergency beacon), or even a small fire to signal that you need help.
Get
training
Before you attempt to
straighten or treat a bone you think may be broken, make sure you get the
proper training. In fact, according to Musi, anyone who often treks out into
the backcountry should have some level of first aid training.
If you spend any amount of
time in wilderness situations, sign up for a backcountry first-aid training
course from an organization like NOLS or
at an education center near you. That way, if you find yourself in a situation
where you or a companion must deal with a broken limb far from medical care,
you’ll know how to treat it and make it out of the woods in one piece.
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