If a person who has diabetes becomes confused, weak, or unconscious for no apparent reason, he may be suffering from insulin shock (low blood sugar) or diabetic ketoacidosis (high blood sugar).

INSULIN SHOCK (LOW BLOOD SUGAR)

If a person with diabetes takes too much insulin or fails to eat enough food to match his insulin level or his level of exercise, a rapid drop in blood sugar can occur. Symptoms may come on very rapidly and include an altered level of consciousness, ranging from slurred speech, bizarre behaviour, and loss of coordination, to seizures and unconsciousness.

Treatment
If still conscious, the victim should be given something containing sugar to drink or eat as rapidly as possible. This can be fruit juice, candy, or a non-diet soft drink. If the victim is unconscious, place sugar granules, cake icing, or Glutose® paste from your first aid kit under his tongue, where it will be rapidly absorbed.

  DIABETIC KETOACIDOSIS (HIGH BLOOD SUGAR)

Diabetic ketoacidosis (formerly called diabetic coma) comes on gradually and is the result of insufficient insulin. This eventually leads to a very high sugar level in the victim’s blood. Early symptoms include frequent urination and thirst. Later, the victim will become dehydrated, confused, or comatose, and will develop nausea, vomiting, abdominal pain, and a rapid breathing rate with a fruity odor to his breath.

Treatment
The victim needs immediate evacuation to a medical facility. If vomiting is not present and the victim is awake and alert, have him drink small, frequent sips of water. If you are unsure whether the victim is suffering from insulin shock (low blood sugar) or ketoacidosis (high blood sugar), it is always safer to assume it is low blood sugar and administer sugar.

By Buck Tilton

When bullets and arrows start filling the autumn air, we know a few of them will strike a hunter and fewer still non-hunters. Everyone knows the danger of a loaded gun, but gunshot wounds during hunting season—at least gunshot wounds to and from hunters—are on the decline, says the US Forest Service, probably due to mandatory hunter safety courses. While this is not a time to be less than perfectly careful with a firearm — with new hunters hitting the field each year — statistically, depending on where and how you hunt, there may be dangers greater than a rifle or a bow.

1. FALLS FROM TREESTANDS

If you hunt from a treestand, the chance of serious injury from a fall ranks at the top of the risk list. Hunters zeroed in on an animal often slip from treestands. They also fall climbing up and down from the stand, when they snooze in a stand, and when an old or improperly mounted stand collapses. These hunters frequently break something when they land, and injuries to the head and spine sometimes result in death. Remember: always raise and lower your unloaded gun with a rope so you can focus on the climb. Always check the stand carefully before putting your weight fully on it. Old, permanent, wooden stands deteriorate rapidly with age, making them the most dangerous. Once in the stand, strap yourself into a safety harness before hauling up your firearm–and if you have no harness, you may have made a fatal error.

2. HYPOTHERMIA

Most hunters who suffer a dangerous loss of body core temperature spend much longer away from a vehicle or cabin than they intended, and they’re out there longer because they get disoriented. An unexpected night out, even an unexpected afternoon out on a wintry day, and loss of inner heat can quickly reduce your ability to think, leading to even more profound disorientation. Fatigue rapidly overcomes the hunter. Inadequately clothed, without food and water, with no way to start a fire, the hunter succumbs to the cold. Remember: always dress in layers of clothing, removing outer layers when you heat up from exertion to prevent a drenching with sweat and adding layers back on when a chill sets in. Always carry an extra layer or two in your pack, along with snacks and non-alcoholic fluids, and the means to ignite a blaze. Scout the area in which you’ll hunt well before the season. Carry a map and compass, and know where you are on the map at all times. And, if you have cell phone reception, carry your phone, too.

3. DROWNING

The third leading cause of death to hunters threatens those who shoot from boats, who cross rivers, and who step onto ice-covered lakes. In every season, most victims of drowning never intended to get in the water, and that is certainly true of someone carrying a firearm. In icy water, your coordination can drop to nothing in 60 seconds. Remember: always wear a personal flotation device when you’re paddling out to shoot. Do not wade through running water unless the level is well below your knee and you are absolutely sure of the bottom. (You’re never sure unless you’ve crossed that river before!) And never walk out onto ice-covered lakes and ponds. If you disobey the rules and end up in over your head, immediately discard your rifle or shotgun and put all your effort into reaching a safe spot.

In every instance—treestand, cold weather, or deep water—your well being is your business. Luck favors the wise, not the bold.

Recommended Gear List:

SOL Emergency Bivvy – Reflects back 90% of radiated body heat. This pocket-size, ultralight 3.8 oz bivvy is an indispensable piece of equipment – especially for surviving the unexpected night outdoors.
SOL Origin – A self-contained multifunctional survival tool that includes instruments for signaling, navigating, fire starting and food gathering.
Hunter Kit – Containing hospital quality medications and wound care materials for treating the most common hunting and fishing injuries, the Hunter Kit also comes with a smaller detachable Field Trauma Kit, for trips away from base camp or times when space and weight are a factor.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.

Lightning kills more people every year in the United States than all other natural disasters combined. Carrying or wearing metal objects, such as an ice axe, umbrella, backpack frame, or even a hairpin, increases the chances of being hit.

To calculate the approximate distance in miles from a flash of lightning, count in seconds from the time you see the flash to when you hear the thunder, then divide by five.

Prevention

• When a thunderstorm threatens, seek shelter in a building or inside a vehicle (not a convertible).
• Occupants of tents should stay as far away from the poles and wet cloths as possible.
• Do not stand underneath a tall tree in an open area or on a hill top.
• Get out and away from open water.
• Get away from tractors and other metal farm equipment.
• Get off bicycles and golf carts.
• Stay away from wire fences, clotheslines, metal pipes, and other metallic paths which could carry lightning to you from some distance.
• Avoid standing in small, isolated sheds or other small structures in open areas.
• In a forest, seek shelter in a low area under a thick growth of saplings or small trees. In an open area, go to a low place such as a ravine or valley.
• If you are totally in the open, stay far away from single trees to avoid lightning splashes. Drop to your knees and bend forward, putting your hands on your knees. If available, place insulating material (e.g. sleeping pad, life jacket, rope) between you and the ground. Do not lie flat on the ground.

LIGHTNING CAN CAUSE INJURY BY FOUR
MECHANISMS:

1.DIRECT HIT
Lightning directly strikes a person in the open. It usually does not enter the body, but instead is conducted over the skin surface (“flashover”), producing a variety of injuries. The greatest damage may occur to skin beneath metal objects worn by the victim, such as jewelry, belt buckles, or zippers, which tend to disrupt the flashover and allow current to penetrate. Current may also penetrate the body through the eyes, ears, and mouth, causing deeper injuries to those parts. The victim is exposed to a tremendous elec-tromagnetic field, which can disrupt the workings of the brain, lungs and heart and lead to a cardiac and respiratory arrest. Finally, the instant vaporization of any moisture on the victim’s skin can blast apart his clothing and shoes.

2. SPLASH
A more common scenario is for the victim to be struck by lightning “splash,” which occurs when a bolt first hits an object, such as a tree or another person, and then “jumps” to the victim who may have found shelter nearby. Splashes may also occur from person to person who are standing close together.

3. STEP VOLTAGE
Lightning hits the ground or a nearby object and the current spreads like a wave in a pond to the victims. Step voltage is often to blame when several people are hurt by a single lightning bolt.

4. BLUNT TRAUMA
The explosive force of the pressure waves created by lightning can cause blunt trauma, such as spleen or liver injuries and ruptured ear drums.

TYPES OF INJURIES

1. HEART AND LUNG
Lightning can cause a cardiac arrest and paralyze the lungs. The heart will often restart on its own, but because the lungs are still not working, the heart will stop again from lack of oxygen.

2. NEUROLOGIC INJURIES
The victim may be knocked unconscious and suffer temporary paralysis, especially in the legs. Seizures, confusion, blindness, deafness, and inability to remember what happened may result.

3. TRAUMATIC INJURIES
Bruises, fractures, dislocations, spinal injury, chest and abdominal injuries from the shock wave may occur. Ruptured eardrums can result in hearing loss.

4. BURNS
Superficial first or second-degree burns are more common than severe burns after a lightning strike and form distinctive fern patterns on the skin.

Treatment
Lightning strike victims are not “charged” and thus pose no hazard to rescuers.

1. The immediate treatment of lightning strike victims differs from other situations in which you have multiple trauma victims. Rather than adhere to the standard rescue dogma of ignoring the victims who appear dead and giving priority to those who are still alive, after a lightning strike, treat those victims first who appear dead, because they may ultimately recover if quickly given mouth-to-mouth rescue breathing and CPR. If you’re successful in obtaining a pulse with CPR, continue rescue breathing until the victim begins to breathe on his own or you are no longer able to continue the resuscitation.
2. Stabilize and splint any fractures.
3. Initiate and maintain spinal precautions if indicated.

We’re excited to announce the success of our Summer Outdoor Retailer fundraiser in raising $1,950 for the Rocky Mountain Rescue Dogs, Inc. The popular SOL Origin multi-function survival tool went fast at the special fundraiser price of $15, a deal to bark for compared to the retail price of $60.  130 of the Origin tools were sold, with 100% of proceeds from sales going to the nonprofit Rocky Mountain Rescue Dogs, an organization dedicated to the training of professional search and rescue dog teams in Utah. ”The fundraiser went better than expected,” said Katie Singleton, AMK’s Marketing Channel Specialist, “The importance of supporting rescue dogs really hit home with the active outdoor crowd at the show, who I am sure realized that they could end up benefiting from the dogs one day.”

The nonprofit assists law enforcement agencies in providing 24/7 availability to assist in wilderness, water, avalanche, and recovery searches. As the oldest canine search and rescue organization in Utah, the Rocky Mountain Rescue Dogs serve an important role in backcountry rescues.

We are excited to support such an important organization for the safety of all outdoor users. Visit our furry friends at  http://rockymountainrescuedogs.com/

Search dogs Scout, Envo, and Uintah were in the booth with their handlers.

Shock is a life-threatening condition in which blood flow to the tissues of the body is inadequate and cells are deprived of oxygen. Any serious injury or illness can produce shock. Examples are severe bleeding (either external or internal), thigh (femur) or pelvis fractures, major burns, dehydration, heart failure, severe allergic reactions, or spinal cord injuries with paralysis.

Signs and Symptoms
The skin may be pale, cool, or clammy. The pulse is weak and rapid or even undetectable (in shock produced by a spinal cord injury, the pulse will remain normal or slow). Breathing may be shallow, rapid, or irregular. Mental status may be altered (the victim may be confused, restless, or combative).

Treatment
It is important to recognize shock and to transport the victim to a medical facility immediately.

1) Keep the victim lying down, covered and warm. Remember to insulate him from the ground as well.

2) Stop any obvious signs of bleeding.

3) Loosen any restrictive clothing.

4) Splint all broken bones. If the femur bone is fractured, apply and maintain traction. If a pelvic fracture is suspected, apply a pelvic wrap.

5) Elevate the legs so that gravity can help improve the blood supply to the heart and brain only if the victim has shock from external bleeding which has been controlled, or has fainted. If the victim has internal bleeding, avoid unnecessary movement and keep him lying flat. For heart failure shock, the victim may be more comfortable with his head and shoulders raised slightly.

By Buck Tilton

When the earthquake of 12 January 2010 ended, much of Port-au-Prince lay in ruins and the lives of a quarter million human inhabitants had suddenly and violently ended. Then the hurricane hit, and then the deadly cholera epidemic. Haiti, poorest nation of the Western Hemisphere, has yet to recover. In an area just a little smaller than Maryland, an estimated 9.7 million people struggle for basic health and without hope for much more than that.

Supported generously by Adventure® Medical Kits and by Medical Student Missions, fellow AMK blog contributor Chris Van Tilburg, MD, and I will be traveling in May to near Verrettes, about 50 miles north of Port-au-Prince, to help at the Albert Schweitzer Hospital, the sole source of medical care for the 300,000-plus people of this central, mountainous region. I will also be teaching a Wilderness Advanced First Aid course, donated by the Wilderness Medicine Institute of NOLS. While the challenges for basic daily survival Haiti faces are many, below are the most serious health issues its people are dealing with and for which our team will need to be prepared for during our stay:

Food and Water
A “high risk” label has been attached to Haiti by the U. S. Department of State, partly due to the crime rate, partly to the disease rate. With poor sanitation and rampant germs, food and water often contain pathogens capable of leaving Haitians and visitors with hepatitis, typhoid, and bacterial or protozoal diseases characterized by profuse diarrhea. My vaccinations against the viruses hep A and B are up-to-date, but I did take the oral drug that prevents the bacteria that cause typhoid fever from taking control. This anti-typhoid med should keep working for several years. And more on prevention: Food will be well-cooked and served hot, and fruit will be peeled shortly before consumption. Salads and dairy products will be avoided. Water—for drinking and toothbrushing—will be disinfected prior to use, most often via filtration.

Cholera
Once the bacterium Vibrio cholerae infects the intestines of a person, it is passed in fecal matter. The germ ends up in water, most commonly, but it can also contaminate food if the food server has less than ideal hygienic practices. The Artibonite River Valley, where we’ll be working, is indeed the “epicenter” of the current cholera epidemic. In case of cholera, we’re packing the antibiotics doxycycline and azithromycin—which almost always work. Steps toward prevention will be the same as for any food and/or waterborne illness.

Vectors of Disease
Mosquitoes promise to be not only bothersome in Haiti but carriers of illnesses including, most problematically, dengue fever and malaria. The virus causing dengue makes you miserable, then you get well. The parasite causing malaria, however, can have devastating results. I just started a course of chloroquine, an anti-malaria drug I’ll ingest once a week for two weeks prior to Haiti, during our visit, and for four weeks after we return. For repelling insects, I’m packing Natrapel® 8 hour for application to skin, and I’ll be treating my clothing, before leaving home, with permethrin. My bunk bed reportedly offers the protection of mosquito netting, but it was suggested I also treat a thin sheet from home with permethrin—and I’m going to do that, too.

We will probably stay healthy. Without efficient means to disinfect water, without antibiotics, without vaccinations, without even mosquito netting, the people of Haiti have a far smaller chance of doing so. Anyone can support the efforts of Medical Student Missions, by joining and/or donating. Visit www.medicalstudentmissions.org.

And thank you.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.

By Chris Van Tilburg, M.D.

The Wilderness Medical Society (WMS) recently published recommendations that guides carry epinephrine in outdoor education settings, according to a consensus statement in Wilderness and Environmental Medicine. The reason: allergic shock, called anaphylaxis, can be deadly in minutes. But, the practice of letting lay, non-medical guides use prescription medicine on clients is fraught with difficulties, and some potentially deadly effects.

A Word About Anaphylaxis

Anaphylaxis is a severe allergic reaction that occurs when a person eats an unfamiliar food, takes new medicine or gets stung by a bee. The body reacts with instant inflammation to shut out what it sees as a foreign toxin. No one can predict which people will react to which toxins—making this doubly deadly, especially in the backcountry. The throat swells shut and the lungs spasm; both can lead to death by hypoxia, or a lack of oxygen in the body’s tissues. Epinephrine is a powerful medicine that stops the swelling and restores breathing. It’s used in conjunction with over-the-counter antihistamines, like Benadryl, which block the hormone causing allergic reactions.

Doctors routinely prescribe epinephrine to kids in the form of easy-to-use auto-injectors like EpiPen or TwinJect and teach their parents on proper administration. But prescribing the same medicine to guides is problematic.

First, it’s illegal in most states for a guide to carry a prescription medicine and use it on a third party. A few states provide exceptions. North Carolina lets docs train lay people in epinephrine use. New York allows training for summer camp counselors.

Second, epinephrine is powerful medicine not to be used lightly. Anaphylaxis can be misdiagnosed, epinephrine can cause life-threatening heart arrhythmias, and the rescuer can accidentally inject their thumb if the auto injector is inadvertently used upside down, which can cause potentially limb-threatening decreased blood flow in the rescuer. That means two patients, instead of one.

Nonetheless, in the WMS’ view the risk is worth it, as epinephrine can save lives, especially in remote settings. Each year, anaphylaxis causes 1500 deaths in the U.S., but we really don’t know how big the problem is in the wilderness. The National Outdoor Leadership School database cites two cases of anaphylaxis in 2.5 million participant days, spanning 20 years. A separate study published in 1996 reported 8 cases in a 16-month span in Sequoia and Kings Canyon National Park, suggesting it’s more common.

For now, the WMS advocates lobbying state medical boards and state lawmakers to allow the drug to be carried by guides for use on clients. But even that can be problematic legally, because a guide trained in one state may be leading a trip in another. Perhaps the best option is to push to change laws at the federal level, as was the case with Canada’s Sabrina’s Law, which mandated anaphylaxis training in Canada’s school system. That 2006 law requires that teachers and school staff learn how to recognize symptoms of anaphylaxis and how to properly inject epinephrine.

Q. What do you think? Should there be a federal law allowing guides to carry and administer epinephrine?

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

It’s your gear—closer to you than many people, as familiar as that face in the mirror. Maybe that’s the problem: Familiarity. It breeds contempt, and we forget gear can cause injuries. So, take heed of these pointers before hitting the trail this spring:

The Pack and Your Back: A clean-and-jerk of your pack looks impressive but can drop you to the ground in low-back agony. Good news: The torn muscles usually heal on their own. Bad news: A miserable way to spend the next few days. As soon as you can do it pain-free, start walking. Lying around delays healing. When you do rest, do it on your side or on your back with something beneath your knees to keep your lower back relaxed. Take ibuprofen, with food and lots of water. A massage of the hurting muscles may add relief. Beware, and find a doctor, if the pain won’t go away or if it shoots down a leg.  Prevent the pain: With your legs flexed, pull the pack up onto one thigh. Slip an arm through a strap, and gently flip the load onto your shoulders. Better: Get someone to hold your pack up while you slip into it.

The Pack and Your Knee: Throwing a heavy pack toward your shoulder can put a twisting, sideways pressure on your knee. The result can be torn ligaments: a blown knee. ASAP get some RICE (Rest; Ice; Compression; Elevation) on the joint to reduce swelling and boost healing. If the knee remains relatively stable, keep hiking—but RICE it several times a day. An elastic wrap around your knee will provide a little support, and remind you to be cautious. If the knee feels unstable, find a doc. Take it easy on your knees with the same preventative pack-handling steps you use to take it easy on your back.

In-Tents Pain: In the struggle to get the tent pole into the final grommet, you lose control and the pole pokes you—usually no big deal, unless it hits you in the eye. Get someone to examine your eye carefully. Don’t worry about redness and swelling—common results. Worry about loss of vision and/or a cut in your eye, both of which you should have a doc look at ASAP. Rinse the eye gently with water safe to drink. If there’s a cut in the eye, and fluid is leaking out, stay still, stay semi-sitting, and get someone to go for help. And in the future make sure the pole is pointing toward no one when you make the final shove.

Stakes Too High: Hard ground, dull tent stakes, and a big rock: a combo asking for a smashed finger. Torn skin should be cleaned and kept clean–but what about that painful pool of blood underneath a nail bed? Clean the nail, heat up the sharpest tip you have, and gently drill through the nail. As soon as blood bursts out, quit drilling. Soaking the finger in water will encourage the blood to drain. You’ll get a big relief from pain, but you need to be more careful next time. Or have someone else hold the stake while you pound it in.

Tricks Poles Play: Adjustable trekking poles have brought a new face to trail injuries. The problem: They may adjust on their own. You end up with your face planted. The possible injuries are too numerous to mention—but prevention, ah, there’s the answer. After the poles are set for your height (with your arms bent at about 90 degrees), take a turn of duct tape around the pole beneath the release point. If it releases unexpectedly, it won’t go far—and neither will you.

Recommended Gear List:

Ultralight/Watertight .9 - Contains ibuprofen for treating muscle and joint pain, elastic bandage for supporting a strained knee and essential wound care materials for properly cleaning and treating cuts and scrapes. Also features a  2″ x 50″ roll of duct tape for repairing gear. Suitable for 1 to 4 people for trips lasting 4 days.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.

By Buck Tilton

To combine the three essential elements–oxygen, heat, and fuel–successfully into a fire requires more thought than usual when white stuff cloaks the ground.

Assuming you’re carrying a source of heat,  finding fuel will be the great challenge. Dry tinder, kindling, and larger pieces of fuel are not only harder to find, but wood with its moisture frozen inside may appear deceptively ignitable yet fail to burn.

Tinder

Any type of material with a low flash point, will ignite with a bare minimum of heat, with even, sometimes, only a spark. The drier the tinder, in most cases, the more easily it ignites. You may be able to find dry grasses with tops standing above the snow. Dead evergreen needles are also excellent, even though they take a bit more heat to ignite than dry grass. Once needles ignite, the resin inside causes them to burn hotter than grass does. Although not as widespread, peeling birch bark is another great source of tinder. The dry inner bark of many species of trees will make good tinder, some of the best being aspen, basswood, cedar, cherry, cottonwood, elm, sage, willow, and walnut.

Tinder may also be, but is not limited to: tiny twigs (if they’re dry), the crushed fibers of dry dead plants, pitch from pine or another sap-rich conifer, crushed fir cones, seed down (such as cattail, milkweed, thistle), wood dust from trees bored by insects, and the lining of abandoned bird and rodent nests—and all may be available in winter. Even in the snowiest conditions you can often find dry tinder beneath the low-hanging branches of dense evergreens and beneath trees that have toppled almost to the ground. And you could find paper and small clumps of lint in a pocket of your clothing.

Kindling
This is the wood used to raise the heat from the burning tinder until the temperature is high enough to ignite larger fuel. It, therefore, should ignite with only a little heat. You can often find great kindling under coniferous trees where small, dead branches remain on trees or have fallen and been protected by the overhanging living tree. If the wood is about the diameter of a pencil, and dry, it’s probably good kindling. Any wood that has been split, should you have a sturdy blade to do the splitting, will burn more easily than round pieces because it’s drier inside and more surface of the wood is exposed to the flames. And with a knife you can shave off the damp exterior of small pieces of wood to expose the dry inner wood.

As you gather tinder, kindling, and fuel, I strongly suggest you collect at least twice as much as you think you’ll need—especially tinder and kindling. If you fail at your first attempt at making fire, you’ll be glad you have more material close at hand. Once a fire rages, propping larger pieces of damp fuel over the heat allows drying and, later, ignition.

Other Burning Issues
A further complication of fire-building in snow is finding a proper surface on which to make fire. In shallow snow you may be able to dig down to an acceptable surface. In deep snow, you may be able to make fire on a log “raft,” a layer of larger pieces of wood set on the surface of the snow.

Be patient, add some knowledge, and you can build a life-sustaining blaze on any winter day.

Recommended Gear List:

SOL Fire Lite with Tinder Quik – This fire starter provides 5000 sparks and comes with 4 pieces of Tinder Quik for building a fire in any weather. Each windproof and waterproof tab will burn for up two to three minutes.

SOL Core Lite Survival Tool – Featuring a knife with a short folding AUS-8 steel blade, this multifunctional tool was specifically designed to excel at survival tasks such as whittling wood for kindling. The Core Lite also features an embedded 10 Lumen LED light, ideal if you’re trying to collect fuel or build a fire at night.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.

By Christopher Van Tilburg, MD

With 2011 not quite two months old, we thought it high time to look at some big trends that are poised to impact wilderness medicine and safety this year. Here are five that may affect you:

1. WFR standardizations. For guides, rangers, and search and rescue teams, the de facto course for medical training beyond first aid has long been the Wilderness First Responder course. The week-long “woofer” course is offered by a number of schools, but they differ in content, instruction, and length. Right now, there is no formal standardization on content, schools, or teachers, but work is underway to homogenize WFR. The task, however, is fraught with the difficulty of trying to reconcile widely varying state laws, student needs, and teaching styles. WHY IT MATTERS: You may soon be able to get a WFR card recognized around the nation.
2. FEMA trickling down to Podunk. The post 9/11 changes with Homeland Security continue to improve disaster preparedness at the local level. Small-town volunteer search and rescue units have already seen regulations creeping into their protocols. What was once a rag-tag group of volunteers heading into the backcountry is slowly transforming into teams with medical and crime scene training, online incident response courses, and background checks. WHY IT MATTERS: New regulations can add a significant amount of time to what is traditionally a volunteer activity, which may deter participants. The upside: FEMA improves quality and resources for SAR missions.
3. Need help in the backcountry? Swipe your credit card. A once-subtle notion of sending a bill to someone needing rescue is now a rising trend. Diverting the cost of search and rescue to the rescued party is not new, but it’s increasing due to a slow economy and decreasing municipal budgets. The camp in favor of charging a fee per rescue argue that it’s long overdue that irresponsible backcountry users pony up and cover the cost of their reckless behavior. Those fighting against the pay-per-rescue trend counter that there are plenty of alternatives to charging rescued people directly, including: adding user fees in the form of permits, raising taxes, restricting access altogether, and mounting public safety campaigns in an effort to reduce accidents. WHY IT MATTERS: While we all recognize the budget pressures many states and municipalities are facing, charging people for rescues may lead them to delay calling for help, making rescues even more dangerous.
4. No go uphill or side-country. Winter resorts are changing their rules with regards to inbounds uphill traffic and side-country access, stemming from the burgeoning interest in skimo (aka ski mountaineering, alpine touring, and randonee). Of late, many mountain resorts have limited uphill travel or stopped it altogether for safety reasons. And many mountain resorts, which once had open or intermittently open boundaries, have restricted out-of-bounds travel. Rising costs to add ski patrollers and increase insurance coverage is one factor.  Another issue: some skiers and snowboarders are unprepared for or don’t follow rules and laws of side-country travel. In fact, many mountain resorts now don’t let ski patrol go after backcountry skiers or snowboarders in trouble; if they do, they may send a bill (see #3). WHY IT MATTERS:  We may be sending inexperienced skiers and snowboarders, who enjoy the added exercise of uphill travel, outside of the safe confines of the ski area to places they are unfamiliar with.
5. Tech’s Take-Over of the Outdoors. GPS-enabled smart phones, digital cameras, avalanche beacons, wrist- top computers, — we’ve got a lot of high tech gadgets for a walk in the woods. WHY IT MATTERS: The plethora of these gizmos—many of which demand our undivided attention to use—can detract from the very solace we seek in the backcountry. Of more serious concern, as a member of an SAR team, I fear that the proliferation of these technogadgets is leading to a false sense of security. “If the battery dies on your smart phone in the backcountry, do you have the basic survival skills necessary to make it back alive?” It’s a question I’m not so sure most people can answer in the affirmative.

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

A: If you are planning on administering care to other victims, you will want a kit with enough contents to treat a large group and an organization system that is easy to use in an emergency. For this reason, I recommend ourMountain Series Comprehensive kit, which contains a wide range of wound care supplies for trauma scenarios like those encountered during an earthquake, as well as our Easy Care organization system that organizes contents in injury-specific pockets with quick-reference instruction cards. The Comprehensive makes a great home preparedness kit as well, since it contains a number of specialized medical instruments that are difficult to improvise and might be impossible to obtain during an extended disaster scenario.

By Buck Tilton

Not all snow is created equal—it can be soft and dry, heavy and wet, hard as rock—but most snow can be shaped into a quick shelter and, in an emergency, a shelter may save your life.

Make Use of What the Terrain Offers

First, look around: an emergency shelter in snow-covered conditions can sometimes be found. There may be a hollow space under a downed tree, as long as the tree is held firmly in place by something other than snow. If snow supports a large tree, you could find yourself buried or squashed, or both, especially if you get a fire going. Space often lies beneath the low-hanging limbs of a large, dense evergreen. In rocky terrain, you may be able to crawl into a space created by an overhang. Some movement and shaping of snow is often required to make one of these natural shelters fit you better.

Construct Shelter out of a Snow Drift

You can dig a small snow cave in a drift, one just large enough for you to fit inside. Forget an official tunnel entrance—but if you can start low and dig up slightly before scooping out the room, you’ll trap more body heat within the finished product. Without a shovel, improvise: dig with a pot, a ski, a snowshoe, a signal mirror, a limb, even your gloved hands. If you have a pack, place it in front of the entrance hole as a door. A candle would be great, brightening the interior and adding several degrees of warmth. Remember: if you light a candle in a snow cave, you’ll need a small vent hole above it. Without a sleeping pad, you can lie on extra clothing or, if you’re in a forest, evergreen boughs.

Create a Snow Trench

In the open or without a drift, dig a trench in the snow. If possible, make it about three feet deep and as long as your body plus a few inches. Pile the snow from the trench on the windward side of the trench as a break. You can roof it with blocks—if you have the leisure time and know-how to make them. You can roof it with evergreen boughs. You can roof it with a tarp, an emergency blanket, a large garbage bag. Cover whatever roof you create with snow to add insulation, leaving an opening on one end just big enough to squirm through.

Dress Appropriately

Pace yourself as you dig. Prepare by losing a layer or two of clothing to reduce sweating, but wear a waterproof, or at least water resistant, shell to stay as dry as possible from melting snow. A damp body from either sweat or snow will make survival more problematic.

If you think people will be out searching for you, make your shelter site as visible as possible from the ground and the air by placing bright-colored clothing nearby or stomping an unusual pattern—such as H-E-L-P–in the snow. Remember when you are inside the shelter your ability to hear what is happening outside will be reduced to almost nothing. The temperatures may drop and the storms may rage, but if you construct a simple shelter–and carry basic emergency gear– you can be safe and secure in your shelter in the snow.

Recommended Gear List

Heatsheets Survival Blanket – This 2-person survival blanket retains up to 90% radiated body heat and doubles as an excellent ground cover or shelter for a snow trench. The blanket’s bright orange color, which features survival instructions printed on the exterior, makes it easy for rescue craft to spot from the sky.

Pocket Survival Pak PLUS – Includes essential tools for fire starting, food gathering and signaling – all contained in a 5 oz waterproof pouch that will fit in your breast pocket.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.

By Christopher Van Tilburg, MD

The final week of 2010 was bittersweet for snow sports enthusiasts. Massive storms pummeled the Western mountains in North America with big fat flakes. Skiers and snowboarders flocked to the pow on holiday break.  Unfortunately, in a five-day span, five died in deep snow and tree wells. A sixth death occurred just after the New Year. The unlucky were found inbounds, out-of-bounds, and in the backcountry; they were skiers and snowboarders of various skill levels. The two commonalities that link all of their deaths: deep snow and stormy weather.

Although still being investigated, the six deaths in California, Montana and British Columbia were likely caused by snow-related suffocation. This condition, known as Snow Immersion Asphyxiation (SIA) or Non-Avalanche Related Snow Immersion Death, is a little known mountain hazard. Although that may soon change, as mountain resorts and snow sports professionals push to raise public awareness on this issue.

HOW SIA HAPPENS

SIA occurs when skiers and snowboarders fall upside down in deep snow or the cavernous holes around big conifers, can’t right themselves, and suffocate. Death can occur quickly — as fast as 15 minutes. The problem is that if you find yourself stuck in a tree well or snow bank upside down, there just aren’t a lot of great options. It is very difficult, if not impossible, to extricate oneself. Struggling can cause one to sink deeper. Removing skis doesn’t seem to help either.

KEYS TO PREVENTING SIA

The primary key to safety is preparation:

• Always ski and ride trails that are within your skill range.
• Use the proper tool — big powder means big sticks, so choose long wide skis and snowboards, which will provide better flotation and thus better control.
• Employ a buddy system—stay in voice and visual contact, which you should be doing anyway.

If you get sucked into a tree well or fall in deep snow try to tuck, roll, and land upright, grab the tree trunk or a branch, and yell to alert your partner. If buried upside down, stay calm and create an air pocket, which could buy you some precious minutes of oxygen.

Rapid partner rescue is really your only chance of survival. Avalanche safety gear may speed rescue if your location is unknown. The woman who died in British Columbia was found with a beacon, but unfortunately it was too late. Once you have removed the person from a tree well, immediately starting CPR — if they’re not breathing — is vital too. A life was saved in Washington State a few years back when a partner started CPR and rapidly brought a buried, non-breathing skier back from the brink of death. If you don’t have formal CPR training, do Hands-only CPR: push hard and fast on the center of the chest.

For more info on SIA, check out the comprehensive journal paper published recently in Wilderness and Environmental Medicine or the website www.treewelldeepsnowsafety.com.

Christopher Van Tilburg, MD, is the editor of Wilderness Medicine and the author of eight books on safety in the outdoors. His most recent book, Mountain Rescue Doctor: Wilderness Medicine in the Extremes of Nature, is now available in paperback.

Snow blindness is a sunburn to the eye from intense ultraviolet radiation at high altitude or while traveling in the snow which results in a corneal abrasion.

Unfortunately, you are unaware that the injury is occurring until it is too late, because signs and symptoms of snow blindness are delayed by about six hours from the time of exposure to the light. Wearing adequate eye protection (100% UV blocking sunglasses with side protectors) can prevent snow blindness.

Improvised Sunglasses
If you forget or lose your sunglasses, you can cut slits in a piece of cardboard, such as one side of a cracker or cereal box, or a piece of duct tape folded back over onto itself. These should be just wide enough to see through. Tape or tie this around your head to minimize the amount of ultraviolet light hitting your eyes.

The clear covering over the front of the eye, called the cornea, is easily scratched or abraded.

Signs and Symptoms

1) The victim will feel as if he has sand in his eye.

2) The eye will usually appear bloodshot, and there is often tearing and slight blurring of vision.

3) Intense pain, made worse by blinking the eyes, may occur, and there is sensitivity to light.

4) Close inspection of the cornea may show a slight irregularity on its surface.

Treatment

1) Check the eyes carefully for foreign material, making sure to examine under the upper lid.

2) Cool compresses may help relieve some of the irritation.

3) If available, apply antibiotic drops such as Tobrex® every two to three hours while awake for two to three days.

4) Administer pain medication to the victim and have him rest his eyes as much as possible. Most of the time, the injury heals by itself in one to two days.

5) Patching the eye with an eye patch or a bandage for 24 hours may help to reduce pain. If an eye patch or other bandage is not available, the eye can be taped closed or the victim can wear sunglasses. An eye should not be patched closed if there is any sign of infection.

I get a headache when I hunt elk from a camp at 11,000 feet, despite
living at 5,700 feet and cross-country skiing at 10,800 feet with no
symptoms. Is there a threshold when it comes to altitude illness?

Thanks in advance, Marilyn.

Hello Marilyn,

There is a threshold, but unfortunately it is different for everyone. While one person may experience a high altitude headache (the cardinal symptom of acute mountain sickness) at 11,000 feet, others may get a headache at 8,000 or none at any elevation in the lower 48.

If you know your personal threshold, you can help minimize the effects of a high altitude headache by staying fit and hydrated. As an additional measure, take ibuprofen; the latest research shows it works equally well as prescription acetazolamide at preventing a high altitude headache.

Hope you have a safe hunting trip.

Best,

Christopher Van Tilburg, MD

Buck Tilton

A simple fact towers above all others: if you aren’t prepared to survive an unexpected night outside in winter, you probably won’t. In ideally bad conditions, cold will suck out enough body heat in a couple of hours to disable you—and chill you off beyond recovery in three.

How did you get in this situation? You were backcountry skiing, or hunting, maybe hiking on a pre-snow, cold afternoon. Your story could be like CNET reporter James Kim’s whose drive in Oregon mountains with his family on a winter day, almost exactly four years ago, turned fatal.  You didn’t anticipate the snowfall, or the blinding wind—and wasn’t the sun supposed to be up at least another hour?

Plan Ahead & Prepare

Yes, you can predict the weather. Or at least someone can, and you can read the forecast. Leave home prepared for the worst possible conditions. If your intended route has ever had six feet of white and 40MPH winds, it could have them again while you’re there. And how do you know the record snowfall and wind speed? You chose and investigated your route well in advance of setting foot, ski or tire on it. Then you left a copy of your route, with details, in the hands of some trustworthy people. They know when you are expected back, when to call for a search, and who to call.

Personal Protection

Winter survival is all about personal protection: your clothing first, a shelter, and, in the best-case scenario, a fire. Dress like an onion—okay, something like an onion. It seems as if everyone who wanders outdoors on purpose should know this by now, but just in case: wear layers of loose-fitting clothing. The clothing needs to be synthetic (or perhaps wool) so it holds in body heat even when damp. The layers allow you to ventilate and take off clothing, then add the clothing back on, in order to control sweating. (Sweat equals wet! Stay dry to stay warm.) You also want to add layers back on before you chill off. It’s easier to save your body heat than to restore your body heat.

Snow, especially when it’s old and compacted, provides material for the protection of excellent shelters. But that’s a tale to be told later. For now, pack something—a small tarp, a small sheet of plastic, an emergency blanket —that you can erect as a wind and/or snow break. Twenty feet of strong cord will make that job easier. Add an insulating pad to sit, or better yet lie, on so you don’t lose heat into the cold ground. A piece of an old sleeping pad, cut to fit in your pack, will work fine. Or, heck, pack the whole pad.

Relatively unprepared folks have survived mighty cold nights out when they got a fire blazing, and kept it blazing. Be sure you always have two means to start a fire. At least one of those means should be waterproof. And pack a fire starter that burns even when wet. Properly dressed, with snow and wind blocked, and a fire burning, you will survive.

On Drinking and Eating

You can survive extremes of cold without a fire if you’re dressed right, sheltered, well watered and well fed. The body heat you’re striving to preserve comes from metabolism of the things you swallow. Simples sugars (say candy) burn quickly, and complex sugars (starches) more slowly. Fats burn the slowest of all, like large logs on well-made conflagration. Good metabolism requires adequate hydration—so drink up, from the water bottle. To keep the water bottle full, pack a small metal container, something in which you can melt snow.

When dawn breaks, you can follow your tracks through the snow back to your vehicle. If the tracks have disappeared under a blanket of new white, and you’re not absolutely sure which way to travel, stay put and wait for the rescue your trustworthy friends set in motion.

Recommended Gear List:

Heatsheets Survival Blanket – Made from a tough, rip-resistant vacuum metalicized Polyethylene-based material, this 2-person blanket reflects up to 90% of radiated body heat. It can also be used as a wind shelter or as a snow-trench cover.
SOL 3 – The hybrid SOL 3 kit contains essential gear repair, first aid and survival components, including a flint steel fire starter and windproof and waterproof tinder.
SOL Survival Bottle – This stainless steel BPA-free bottle, featuring hydration and water purification tips printed on its exterior, is an ideal container for liquids and can also be used for boiling water or melting snow in.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.

By Buck Tilton

Encounters between humans and bears are rising in number. Why? The weather partially explains it. Warmer temps keep bears active longer. But the main reason, all things considered, is more likely to be the increase in the number of bears. Wyoming, for instance, estimates triple the population of grizzlies (about 200 to more than 600) in the Yellowstone ecosystem since the mid-1970s. As Brian DeBolt, the bear management officer for Wyoming Game & Fish, told the Casper Star-Tribune: “. . . if you’ve got more bears, you are going to have more conflicts.” And hunters top the list of possible victims because they walk around quietly, stalking game in bear country, and smelling like dinner.

Statistically, your chances of being killed by a bear, thankfully, are slim, but, to reduce the chances to an absolute minimum, here are three basic rules concerning bears:

1. Hike and camp in a manner designed to avoid bears. In known bear country, avoid areas that are used often by bears–trails with bear tracks and bear scat, trails through berry patches, and trails through dense brush and thick forest. Avoid areas that smell of decaying meat. Bears like to cover their uneaten food and camp nearby to finish it off later. If possible, camp in the open. Cook food at least 100 yards from sleeping sites. If camping near a river, sleep upriver from the cook-site. Night breezes tend to blow down river, pushing the food smells away from the sleeping bags. Camp cleanly: Avoid wiping food-stained hands and utensils on clothing. Avoid spilling food on the ground. Avoid fish and greasy food. Pack food and other odorous stuff (such as toothpaste and gum) in a separate bag so the smells don’t get into pack and clothing. Hang the food at night, if possible, out of bear-reach from the ground and from the trunk of the tree.
2. Hunt in a group large enough to ensure a measure of safety. Bears like a measure of safety, too, and have not attacked a group of four or more in recent history.
3. Strive to never surprise a bear. Bears, particularly grizzlies, do not accommodate people up close and personal. Mother bears need even more room. Push their comfort zone, and they tend to either attack or run away. Once smelling or hearing humans, almost all bears will run away.

Surviving a Bear Encounter

A surprised bear that has seen the surpriser cannot be predicted to act in a certain way. Hopefully, he or she will turn and run. If the bear doesn’t run, speak in a calm, quiet voice. Back away slowly, but do not run. Running encourages the bear to play chase, a game the bear will win. If the group of people is four or more, it usually works best to maximize the threat to the bear. The people should stand close together, raise their arms, speak in a reasonably loud and assured voice, identifying themselves as humans, the age-old nemesis to the bear. Statistics say the bear will retreat. Bears who feel threatened turn to the side, displaying their size.  They will often woof aggressively. They may charge toward the threat, and suddenly stop. These are invitations for the human to retreat. It is advisable to do so, but, remember, no running. It is best to back off slowly and keep speaking in a calm voice (which may be difficult by now). Humans without backpacks may benefit from turning to the side while backing off, an act that makes you look smaller and less intimidating. Climbing a tree is seldom worth the effort. Black bears climb like squirrels, and grizzlies will climb into the lower branches at a very fast rate. Avoid eye contact with the bear, an act of aggression.

Surviving a Bear Attack

If the bear actually attacks, different tactics are called for depending on the species of bear. Black bears seldom attack seriously unless they are hungry. They are not used to having food fight back, and it is statistically best to counter-attack, doing all possible to convince the black bear to dine elsewhere. If the bear is a grizzly, assuming a least-threatening posture–playing dead–is the best tactic. Curl up to guard vital parts, clasping hands protectively behind neck. The brown bear may take a few bites, but then leave you alone. If, however, a grizz does not soon lose interest, fight back as aggressively as possible. Remember, the best offense is a good offense!

Recommended Gear List:

First Aid Kit – AMK’s Outfitter. Includes a wound irrigation system and enough wound care supplies and pain medications to treat to 1 – 14 hunters on trips of up to two weeks.
Hemostatic Bandage – AMK’s Trauma Pak with QuikClot®. The US Military-approved QuikClot® stops serious, even arterial,  bleeding in as little as five minutes.

Buck Tilton has authored 36 books on outdoor safety, including Wilderness First Responder, which won an award for excellence in medical writing from the American Medical Writers Association. For the last 20 years, Buck has contributed hundreds of articles on wilderness safety to Backpacker. In addition to his writing and journalism, Tilton also co-founded the Wilderness Medicine Institute (now WMI of NOLS), which remains the largest school of wilderness medicine in the world.