It’s summertime! That means it is time to get outside and explore your state and national parks, recreation areas, and favorite campgrounds. Before you pack up the kids into the SUV, be sure to review this list of outdoor first aid tips from wilderness safety expert Buck Tilton, who this month joins AMK as a regular blogger. Welcome aboard Buck!
AMK's Newest Expert Blogger Buck Tilton
When you pack for a camping trip, a first-aid kit is a mandatory item. Heck, it has been on the list of Ten Essentials ever since the invention of lists. If your gear includes the Adventure Medical Kits’ Day Tripper with the Easy Care First Aid System, you can handle the most common problems—even without advanced first aid training.
Day Tripper features the Easy Care First Aid System
Cuts and scrapes send you looking for the kit most often. Three goals are worthy of consideration:
1. Stop Serious Bleeding
Almost all bleeding can be stopped with direct pressure: pressure from your hand directly on the wound (preferably with gloves on). Adding a product such as QuikClot to your medical kit will put you in control of more nasty bleeds. You can allow small wounds to bleed to a stop, a process that may help clean them a bit.
2. Prevent Infection
Cleaning Wounds
Proper wound cleaning and dressing will prevent infection in most wounds. Cleaning also speeds healing and reduces scarring. The best method for cleaning is mechanical irrigation delivered from a high-pressure, irrigation syringe with 18 gauge plastic tip. The best cleaning solution is disinfected water—water that’s safe to drink. Draw the solution into the syringe, hold it about two inches above the wound and perpendicular to the wound, and push down forcefully on the plunger. Use at least half a liter, more if the wound still looks unclean. Without an irrigation syringe, you can improvise by using a biking water bottle, forcing water from a hydration bladder, or punching a pinhole in a clean plastic bag full of water. Embedded pieces of gravel and dirt will need to be scrubbed clean from the skin to further reduce the chance of infection.
3. Promote Healing
Dressing Wounds
Wounds heal faster with less scarring if they are kept slightly moist with an antibiotic ointment. Then use a dressing to completely cover the wound and ideally extend a half-inch or so beyond the wound’s edge. The bandage will fix, protect, and further assist the dressing. It can be conforming gauze, tape, elastic wraps, clean cotton strips, or improvised out of anything available. For very small wounds, the dressing and the bandage are available as a unit, often called a Band-Aid, found in all first-aid kits.
Treating Sprains
First aid for a sprain, another common injury, is RICE: Rest, Ice, Compression, and Elevation. Do not use the injury (Rest) for about 30 minutes while you reduce its temperature (Ice) as much as possible without freezing. Without ice, soak the joint in cold water, or carry chemical cold packs, or wrap the joint in wet cotton and let evaporation cool the damaged area. Compression requires an elastic wrap. Wrap it toward the heart and snug but not tight enough to cut off healthy circulation. Elevation refers to keeping the injury a few inches higher than the heart of the injured person. Taking an anti-inflammatory medication such as ibuprofen (200mg - follow directions on package) will help to reduce both pain and inflammation. After 20 to 30 minutes of RICE, remove the treatment and let the joint warm naturally for 10 to 15 minutes before use. If it hurts a lot, don’t use it—and find a doctor.
Treating & Preventing Stomach Ailments
Diarrhea is the most common illness disturbing a family camping trip. You can greatly reduce your chances of contracting diarrhea, if you always wash your hands before eating and make sure the cook crew prepares food with freshly cleaned hands. If soap and water aren’t available, keep alcohol-free Adventure® Hand Sanitizer nearby; it kills 99.9% of bacteria, but won’t dry out the skin like alcohol-based sanitizers do. There are many causes, but with all causes, dehydration is the immediate problem. Mild diarrhea can be treated with water or diluted fruit juices or sports drinks. Persistent diarrhea requires more aggressive replacement of electrolytes lost in the stool, and Oral Rehydration Saltsprovide the best treatment. Rice, grains, bananas, potatoes are okay to eat. Fats, dairy products, caffeine, and alcohol should be avoided. Anti-diarrheal drugs should be considered. If the diarrhea is not under control in about 24 hours, head for your physician.
Wash your hands before cooking and eating
Preventing & Treating Insect Bites & Stings
The little biters–mosquitoes, black flies, gnats, even ticks—tend to be the most bother but are the least serious camping problem. Pack to prevent the bites with a DEET-based product such as Ben’s® or go DEET free with Natrapel® 8 hour, containing a 20% Picaridin formula. After a bite, there’s, well, AfterBite, America’s favorite.
Buck Tilton is a wilderness medicine and survival expert and author, who has written 36 books on outdoor safety. Over the past 20 years, he has contributed hundreds of articles and a regular column to Backpacker. Tilton also co-founded the Wilderness Medicine Institute, now WMI of NOLS, which is the largest school of wilderness medicine in the world. This month he joins AMK as a regular blogger.
Everyone has had a toothache at some point in their lives, but what do you do when you are in a remote area, traveling in a developing country, or on a back-country expedition? Below are some tips from AMK’s Founder, Dr. Eric A. Weiss about what to do when you find yourself with a dental emergency far from the nearest dentist…..
The common toothache is caused by inflammation of the dental pulp and is often associated with a cavity. The pain may be severe and intermittent and is made worse by hot or cold foods or liquids.
Treatment
1) If the offending cavity can be localized, a piece of cotton soaked with a topical anti-inflammatory agent such as eugenol (oil of cloves) can first be applied.
2) Place a temporary filling material, such as Cavit® or zinc-oxide and eugenol cement, into the cavity or lost filling site to protect the nerve.
ʻWEISS ADVICEʼ [IMPROVISED TECHNIQUE]
Quick relief of dental pain and bleeding. Bleeding and pain from the mouth can often be relieved by placing a moistened tea bag onto the bleeding site or into the socket that is bleeding.
ALTITUDE ILLNESS (Mountain Sickness)
It is rare to experience altitude sickness below 6,000 feet. Moderate altitude is between 8,000 and 12,000 feet (2,400 and 3,600 meters), High altitude is between 12,000 and 18,000 feet (3,600 and 5,400 meters), and extreme altitude is over 18,000 feet (5,400 meters). High altitude illness is a direct result of reduces barometric pressure and concentration of oxygen in the air at high elevations. Lower pressure make the air less dense, so your body gets fewer oxygen
molecules with every breath. Prevention
Graded ascent is the best and safest method of preventing altitude illness. Avoid abrupt ascent to sleeping altitudes greater than 10,000 feet (3,000 meters), and average no more than 1,000 feet (300 meters) of elevation gain per day above 10,000 feet. Day trips to a higher altitude, with a return to lower altitudes for sleep, will aid acclimatization. Eat foods that are high in carbohydrates and low in fat, and stay well hydrated.
When to Worry
Descend Quickly When…
Progression of one’s symptoms despite rest at the same altitude, or the loss of coordination, mandate immediate descent to a lower altitude (2,000 to 3,000 feet lower). Do not wait for morning to begin descent. An individual who might have been able to walk down under his own power with aid of a headlamp can easily become a litter case in just 12 hours. The single most useful sign in recognizing the progression of altitude illness from mild to severe is loss of coordination. The victim tends to stagger, has trouble with balance, and is unable to walk a straight line heel to tow, as if he were drunk.
Never allow a victim to descend alone. Always have a healthy person accompany the individual.
Treatment
1.) When mild symptoms develop, one should not go any higher in altitude until the symptoms have completely resolved. Watch the victim closely for progression of illness to more severe forms. Usually, within one or two days, the victim will feel better and can then travel to higher altitudes with caution. Symptoms will improve more rapidly simply by going down a few thousand feet.
2.) Administer acetaminophen (Tylenol®) 650 to 1000 mg or ibuprofen (Motrin®) 400-600 mg for headache.
3.) Consider administering acetazolamide (Diamox®) at a treatment dose of 250 mg twice a day.
4.) Minimize exertion.
5.) Avoid sleeping pills.
SEVERE ALTITUDE ILLNESS High Altitude Cerebral Edema (HACE)
Signs and Symptoms
A victim may have one or more of the following:
1.) Severe headache unrelieved by Tylenol® or Motrin®;
2.) Vomiting:
3.) Loss of coordination;
4.) Severe lassitude;
5.) Confusion, inappropriate behavior, hallucinations, stupor or coma;
6.) Transient blindness, partial paralysis or loss of sensation on one side of the body may occur;
7.) Seizures.
Treatment
1.) IMMEDIATE DESCENT of at least 3,000 feet (1,000 meters), or until the victim shows signs of considerable improvement, is the most important treatment. Do not wait to see if the victim gets worse or improves. Waiting could prove to be fatal.
2.) Administer acetazolamide (Diamox®) 250 mg twice a day.
3.) Administer dexamethasone (Decadron®) 8 mg followed by 4 mg every six hours if available.
4.) Administer oxygen, if available.
5.) When descent is not immediately possible, placing the victim in a portable hyperbaric chamber (Gamow Bag) may be helpful in mitigating the effects of HACE or HAPE. When zippered shut with the victim inside, this nylon bag is pressurized with a foot pump, resulting in a decrease in altitude for the victim. The bag takes approximately two minutes to inflate and is labor intensive; it requires 10 to 15 pumps per minute to maintain pressure and to flush out carbon dioxide. The Gamow Bag should not be used as a substitute for descent; it should be used when descent is not possible due to darkness, injury or lack of manpower to carry a victim to lower altitude.
The Golden Rules of Altitude Sickness
1.) Above 8,000 feet, headache, nausea, shortness of breath, and vomiting should be considered to be altitude illness until proven otherwise.
2.) No one with mild symptoms of altitude illness should ascend any higher until symptoms have resolved.
3.) Anyone with worsening symptoms or severe symptoms of altitude illness should descend immediately to a lower altitude.
HIGH ALTITUDE PULMONARY EDEMA (HAPE)
HAPE usually begins within the first two to four days of ascent to higher altitudes, most commonly on the second night.
Signs and Symptoms
A victim may have one or more of the following:
1.) Initially, the victim will notice marked breathlessness with minor exertion and develop a dry, hacking cough.
2.) As fluid collects in the lungs, the victim develops increasing shortness of breath, even while resting, and a cough that may produce frothy sputum.
3.) The victim looks anxious, is restless, and has a rapid bounding pulse.
4.) Cyanosis (a bluish color of the lips and nails indicating poor oxygenation of the blood) may be present.
Treatment
1.) IMMEDIATE DESCENT of at least 3,000 feet (1,000 meters), or until the victim shows signs of considerable improvement, is the most important treatment. Do not wait. Waiting could prove to be fatal.
2.) Administer oxygen, four to six liters per minute, if available.
3.) The prescription drug, nifedipine (Procardia®) may be helpful for HAPE. The dose is 10 to 20 mg every eight hours.
4.) The use of the Gamow Bag, as described above, may be beneficial when the victim cannot be immediately evacuated to a lower altitude.
The Ten Essentials are the key items to have with you on any trip into the back-country -these items could make the difference between life and death in a survival situation.
Check out the article below, courtesy of REI, to learn more about the ten essentials and how to be prepared when you enter the back-country. Our S.O.L. 3 kit is a great start- it includes Medical, Survival, and Gear Repair items in one lightweight, water-resistant kit.
Learn about the tools you need to pack to survive in the wilderness from world renowned high altitude mountaineer Ed Viesturs in our video section.
The Ten Essentials
Knowing the Ten Essentials is good. Carrying the Ten Essentials is better. (more…)
It’s that time of year again! Time to break in the new boots and hit the trail.
Do you know that blisters are one of the top reasons that people abandon their hiking trips? We have all experienced the pain associate with blisters – especially when breaking in new boots – read the tips below, courtesy of REI, to avoid painful blisters and sore feet.
Also remember to stock up on blister prevention and treatment products like AMK’s Moleskinand GlacierGel to treat hot spots and blisters. You can also visit the Adventure Medical Kits video section to learn more about how to prevent and treat blisters.
Happy hiking!!
Breaking in Your Hiking Boots
The key to breaking in new hiking boots is to take things slowly. Remember — your feet aren’t as tough as your new boots, so if you rush things, your feet are likely to pay the price.
Different boots will require different amounts of break-in time. Lightweight models may feel perfect right out of the box, while heavier, all-leather models may require weeks to soften up and form to your feet.
NOTE: Most hiking boots stretch out slightly as they break in. But the break-in process will not turn a poor fit into a good one! Make sure the boots you buy feel snug yet comfortable before you take them home.
The basic break-in procedure
Begin by wearing your boots for short periods of time inside the house. Wear the kinds of socks you’re likely to be wearing out on the trail. Lace your boots up tight, and make sure your tongues are lined up and the gusset material is folded flat. The creases you form as you break-in your boots will likely remain for the life of the boot.
Your new boots will be a little stiff at first, which is fine. But if you notice significant pinching, rubbing or pain right off the bat, you may want to take the boots back and try a different style.
If after several short indoor sessions your boots seem to fit comfortably, expand your horizons. Wear your new boots to the local store, around town or while working in the yard. Gradually increase the amount of time you spend in your boots and the distances you cover. Make sure your boots feel good at each stage before increasing your distance.
NOTE: Make sure your new boots fit comfortably before you can wear them outside!
Be vigilant throughout the break-in process for any pain or discomfort. As soon as you notice either, take the boots off. Remember — small problems can become big ones very quickly. If everything feels good, try adding a little weight on your back as you hike, and/or hiking on more challenging trails.
If your boots feel good throughout the break-in process, but a single pinch or a hot spot remains, you may be able to correct the problem area by visiting a shoe-repair shop or your local REI store. Most have stretching devices that can help alleviate localized boot-fitting problems.
No such thing as a “quick fix”
There is no fast and easy method when it comes to breaking in new hiking boots. To do a good job, you have to put in the time.
Avoid “quick-fix” approaches like getting your boots soaking wet then walking long distances. They’re too hard on your boots and they’ll be murder on your feet. Also make sure you follow the manufacturer’s care and water proofing instructions carefully.
Spring boating season may be here, but water temperatures are still cold enough to cause problems for boating enthusiasts. Adventure Medical Kits’ marine medicine consultant Dr. Michael Jacobs provides tips for surviving cold water immersion.
AMK's A Comprehensive Guide to Marine Medicine inlcudes tips for treating hypothermia.
Don’t fool yourself into thinking the cold water you sail over is dangerous only when it contains pancake ice and glacial runoff; you could be dead wrong. In fact, water temperature as high as 60ºF can kill you just as easily. Fall into cold water without a personal flotation device (PFD; see sidebar below), and you could drown in the span of a few minutes, often within 10 feet of safety. Statistics indicate an incapacitating response that is rapid in onset and prevents individuals from swimming 10 feet to save their lives. Swimming ability does not improve survival.
We now appreciate that sudden immersion in cold water (less than 60ºF) initiates a series of incapacitating reflexes that increase the risk of drowning. Indeed, the most common cause of death from accidental cold-water immersion is drowning, not hypothermia.
The initial response, which affects breathing, heart function, and muscle strength, is called the Cold-Shock Response. This is a series of reflexes that begin immediately upon sudden cooling of the skin following cold-water immersion. The initial phase of the cold-shock response peaks during the first 30 seconds, and lasts just 2 to 3 minutes. During this time, blood pressure, heart rate, and the workload of the heart all increase, making the heart more susceptible to life-threatening rhythms and heart attack. Simultaneously, gasping begins, followed by rapid and deep breathing. These reflexes can quickly lead to accidental inhalation of water and drowning. This rapid and seemingly uncontrollable over-breathing
creates a sensation of suffocation and contributes to feelings of panic. It can also create dizziness, confusion, disorientation, and a decreased level of consciousness.
It is important to realize that this initial phase of the cold-shock response is brief and that your actions during this time can vastly improve your chance for survival.
If you fall into cold water, it is imperative you try to bring your breathing under control while keeping your head above the water; your life depends on it! Try to calm yourself, do not panic, and realize these reflexes will pass. Just keep your head above the water and consciously slow your breathing. Swimmers experience difficulty synchronizing their swim stroke with these breathing changes and can easily inhale water and drown, even in calm seas. It is safer to tread water and maintain airway freeboard – distance from the water level to the mouth and nose. Breath-holding time is also reduced in cold-water immersion, making escape from beneath a capsized vessel more difficult; kayakers have less time to set
up and roll their craft upright.
Over the next 30 minutes, the muscles and nerves in the extremities cool. Swimming becomes arduous, weak, and ineffective. Loss of muscle strength makes it difficult to perform basic survival procedures. Boaters who fall overboard are often too weak to reboard their craft, get into a life raft, climb the ladder of a rescue boat, or simply grasp a rescue line. Victims in cold water quickly lose the ability to rescue themselves or assist in their own rescue. In icy water, you have only 10 to 15 minutes of effective
muscle strength.
If you fall into cold water, be prepared for violent shivering and intense pain. You can help slow your rate of cooling, and increase your survival time, by following these guidelines:
Do not undress. The added weight of clothing and boots will not impair your ability to float. Clothing traps water next to the skin where it is warmed, retarding heat loss; this is similar to the protective effect of a diver’s wet suit. Clothing also traps air, which provides some insulation and buoyancy. If a short swim is your best chance of survival, then remove any extra clothing and footwear to reduce drag and improve agility.
HELP. If wearing a life jacket, assume the Heat Escape Lessening Posture: cross your hands over your chest and press your arms closely to your sides; draw your knees up toward your chest and cross your ankles. This position facilitates maximum heat retention by protecting the most vulnerable areas of the body.
Tread Water. If you don’t have a life jacket, move slowly and tread water using slight movements. Exercise wastes precious energy and accelerates the rate of cooling by increasing blood flow to the extremities. Activity also flushes cold water through protective clothing, increasing heat loss. Avoid long swims. You have a 50-50 chance of successfully swimming half a mile in 50º F water. If you must swim, pace yourself with an easy stroke, such as the breaststroke, that keeps your head and face out of the water.
Get out of the water. Always reboard or climb on top of a swamped or capsized boat and await rescue. Once out of the water, stay out, no matter how cold the air temperature or how chilled you may feel. You’ll survive longer out of the water because the rate of cooling in water is 25 times greater than in air at the same temperature.
Wilderness Medical Society (WMS) member Dr. Gordon Giesbrecht, a noted hypothermia expert, summarizes the sequence of events and how much time you have after sudden unplanned immersion in frigid water:
ONE-TEN-ONE
ONE minute of gasping, when you need to control your breath. TEN minutes of meaningful strength to pull yourself out of the water. ONE hour before you lose consciousness.
Sudden immersion in cold water need not be a fatal event. Understanding the physiology and exercising appropriate actions for self-rescue will greatly improve your chances for survival. Do not be intimidated by cold water, but respect the challenge it presents.
Treatment
Victims who avoid drowning still face the risk of acute hypothermia as the body’s core temperature decreases. If the victim is fully awake and shivering, then treatment for mild to early moderate hypothermia is reliably effective and evacuation is unnecessary. The victim is capable of generating internal rewarming heat by sustained vigorous shivering if given fluids and carbohydrates, but fuel is required for continued shivering. If dry, and insulating clothing is not available, provide an extra windproof vapor barrier by dressing the victim in foul weather gear to minimize heat loss. When practical, wrap the victim like a burrito in blankets, sleeping bag, sails, or sail bag.
Treat hypothermic victims by wrapping them in blankets.
After prolonged cold-water immersion, generally more than 2 hours, it is prudent to evacuate the victim to a medical facility. These patients are perilously close to losing both consciousness and the shivering reflex. They are incapable of rewarming themselves, and they require more aggressive and sophisticated rewarming methods. Careful monitoring is required because of the many metabolic complications arising from advanced hypothermia. Some sailors have been rescued at sea after prolonged cold-water immersion in an apparently stable and conscious state, only to later collapse while walking around the rescue craft or while taking a hot shower. These people are severely hypothermic and have low blood pressure. Their condition will rapidly deteriorate with activity and during any attempt at external rewarming. They must be kept still, in a supine position, and handled gently in order to avoid physically stimulating the heart to change its rhythm or stop beating. During helicopter evacuation, use a litter with straps so the person can remain horizontal and securely bundled. The rotor blades create a wind-chill from the downwash and can increase the level of hypothermia. Dress and wrap the victim properly during transfer.
Types of PFDs
I:Off Shore Life Jacket: Turns most unconscious people face up in the water even in rough seas, often found on ocean-going boats and commercial watercraft.
II: Near Shore Buoyant Vest: Turns some unconscious people face up in the water in calmer water.
III: Flotation Aid: Common for all purpose boating but will not turn unconscious person face up.
Requires treading water to keep face/head out of water; often these are kayaking, waterskiing, or fishing vests.
IV: Throw Device: Usually a boat cushion or life ring.
V: Special Use: This includes devices that don’t fit in other categories, such as some kayak
or windsurfing vests not approved as Type II or IV.
Special note: for kids, vests should have a groin strap to prevent vest flying off when jumping in water. They should also be sized correctly.
For more info: http://www.uscg.mil/ or http://www.usboating.org.
Michael Jacobs, M.D., is the Medical Consultant for AMK’s Marine Series of medical kits. He is also the MedSail Founder and Program Director: Safety at Sea and Medicine for Mariners Conferences; Medical Director, Vineyard Medical Services, Martha’s Vineyard, MA; a USCG Licensed Captain; co-Author of A Comprehensive Guide to Marine (included in most Marines Series kits) and author of MedicineSurvival at Sea, Textbook of Wilderness Medicine.
AMKs’ BPA-Free S.O.L. Survival Water Bottle – The Only Bottle That Can Save Your Life Even When It’s Empty!
The recent admission from SIGG that the aluminum bottlesit had produced prior to August 2008 contained the chemical Bisphenol A (BPA) has once again put into sharp focus the safety of all water bottles. There is one way, however, you can be sure your next water bottle does not contain BPA or any other potentially harmful chemicals — that’s to select one made from stainless steel, like AMK’s new S.O.L. Survival Bottle.
Made of tough food-grade, 201 stainless steel, the BPA-free S.O.L. Survival Bottle will not dent nearly as easily as aluminum bottles, which contain inner linings which, if broken, can leach chemicals that can potentially contaminate water. AMK’s S.O.L. Survival Water bottle will hold up to 750 ml of water, but its much more than just a liquid container.
Unlike most water bottle manufacturers, which emblazon the exterior of their bottles with a logo or design, AMK used this otherwise ignored real estate to offer valuable information on everything related to water and hydration.
Printed on the outside of the bottle are a multitude of tips and facts — ranging from the useful (“How to find Water in the Desert”; “How to Purify Water”) to the novel (“Number of years it takes for a plastic bottle to decompose”; “Number of plastic bottles thrown away each hour”) — which lend the S.O.L. Survival Water bottle an added level of utility not found in competitor bottles. In reality, it truly is the only bottle that can save your life — even when it is empty!
The S.O.L. bottle is also safe to boil water in and comes with a sturdy screw top and carabiner, allowing you to attach it to your backpack for your next outdoor excursion.
Ugh, it is tick season. As we all know, they are nasty little buggers that carry Lyme Disease and other viruses. Do you know how to protect yourself against ticks?
I’ve been chomped by a tick multiple times, as have most people who regularly tramp in the outdoors. It’s creepy — the tick drops onto your skin, burrows in painlessly, and sucks. Its anticoagulant can cause tick paralysis, and these arthropods carry all sorts of infections: Colorado Tick Fever (a virus), Rocky Mountain Spotted Fever (parasite), Tularemia (a bacteria), and the more commonly known Lyme Disease.
Lyme Disease can be scary. Lyme Disease is caused by an inoculation of the bacteria Borrelia burgdorferi. Ticks around the world carry it: In North America it’s transmitted by deer ticks (Ixodes scapularis) and the Western black legged tick (Ixodes pacificus). It was first identified in Old Lyme, Connecticut, after a group of kids complained of having a strange pain in their joints and an odd rash. So one might think, No problem — bacteria can be killed by antibiotics. But, there is a problem: Lyme is hard to kill and it can turn chronic. A single bite from a Lyme-carrying tick can require years of treatment and recovery.
THE REAL SCOPE OF LYME DISEASE
Lyme Disease is a widespread, global disease that is poorly understood. According to the CDC, in 2007 there were 27,000 cases in the U.S. and, because of the sometimes-vague symptoms, it may be dramatically underreported. While West Nile Virus, Dengue Fever, and even Swine Flu have gotten press lately, they account for much less illness. For example, in 2007, there were only 3,600 imported cases of West Nile Virus.
HOW TO PROTECT YOURSELF
Outdoor adventurers should follow standard insect, tick and arthropod preventions when traveling in the backcountry or abroad. Ticks don’t jump or fly, they drop or fall onto humans from trees or grasses. So, long sleeve shirts and long pants tucked into socks is a great start.
Insect repellents, including ones containing DEET like Tender’s Ben’s 100® pump and Ben’s® 30 wipes, work well at warding off Ticks. For people looking for a DEET-free alternative, repellents like Natrapel® 8-hour, which contains 20% of the active ingredient Picaridin, provide protection that’s as effective as DEET. Insecticides with Permethrin also work, and can be sprayed on clothing or impregnated into the fibers of garments.
When in tick country, remember to check your entire body after the day’s hike. Often you have two or three hours before a tick burrows. If it does, your chance of getting Lyme is low if you remove the bugger right away.
HOW TO SAFELY REMOVE A TICK
Once burrowed, ticks are tricky to remove. Don’t try those old wives tales like fingernail polish or a match. The best technique is to use tick or splinter-removal forceps, grabbing as close as possible to the head, and pulling the tick out with slow, gentle pressure. Sometimes I’ve had to wiggle the head gently to unclasp the tick’s pinchers. Unfortunately, many people sever the body from the head. I’ve had to dig out many tick heads in the emergency room. Like all wounds, clean thoroughly with soap and water.
RECOGNIZING THE SIGNS OF LYME DISEASE – WHAT TO LOOK FOR
How do you know if you have Lyme Disease? First, you will see a circular rash that looks like a target or bull’s eye called erythema migrans, which slowly enlarges. Then, the Lyme bacteria can spread to your body causing fever, fatigue, malaise, muscle and joint aches, headaches and swollen glands. Some patients have these symptoms for several months or years. That’s the big problem with Lyme Disease: It affects multiple parts of the body and may be difficult to diagnose if the initial symptoms go unnoticed. The symptoms can take anywhere between three days to one month or longer to emerge. Twenty percent of people who do not receive treatment develop severe complications within weeks or months after the bite, ranging from heart and neurological problems to severe attacks of arthritis.
If you think you need treatment, see your doctor and let him or her know that you have been bitten by a tick. Antibiotics are the mainstay of treatment, but don’t try to treat yourself at home with an old prescription in your medicine cabinet – treatment requires a specific antibiotic, like Doxycycline, with a longer course than typical.
For more information on avoiding bug-borne diseases, visit www.tendercorp.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.
There are two classes of poisonous snakes in the United States:
• Pit Vipers (rattlesnakes, cottonmouths [water moccasins], and copperheads) have a characteristic triangular head, a deep pit (heat receptor organ) between the eye and nostril, and a catlike, elliptical pupil.
• Elapids (coral snakes) are characterized by their color pattern with red, black, and yellow or white bands encircling the body. The fangs are short — these snakes bite by chewing rather than by striking.
All states except Maine, Hawaii, and Alaska have at least one species of venomous snake. The states with the highest incidence of snakebites are North Carolina, Arkansas, Texas, Mississippi, Louisiana, Arizona, and New Mexico. About 90 percent of snake bites occur between April and October, because snakes are more active in warm months of the year. Your chance of dying from a venomous snakebite in the wilderness is extremely remote — about one in 12 million.
Snakes can strike up to one-half their body length and may bite and not inject venom (dry bite). No poisoning occurs in about 20 to 30 percent of rattlesnake bites, and fewer than 40 percent of coral snake bites result in envenomation.
Pit Vipers
Signs and Symptoms of Envenomation
• One or more fang marks (rattlesnake bites may leave one, two, or even three fang marks).
• Local, burning pain immediately after the bite.
• Swelling at the site of the bite, usually beginning within five to 20 minutes and spreading slowly over a period of six to 12 hours. The faster the swelling progresses up the arm or leg, the worse the degree of envenomation.
• Bruising (black and blue discoloration) and blister formation at the bite site.
• Numbness and tingling of the lips and face, usually 10 to 60 minutes after the bite.
• Twitching of the muscles around the eyes and mouth.
• Rubbery or metallic taste in the mouth.
• After six to 12 hours, bleeding from the gums and nose may develop and denote a serious envenomation.
• Weakness, sweating, nausea, vomiting and faintness may occur.
Treatment
The definitive treatment for snake venom poisoning is the administration of antivenin. The most important aspect of therapy is to get the victim to a medical facility as quickly as possible.
First Aid
1) Rinse the area around the bite site with water to remove any venom that might remain on the skin.
2) Clean the wound and cover with a sterile dressing.
3) Remove any rings or jewelry.
4) Immobilize the injured part as you would for a fracture, but splint it just below the level of the heart.
5) Transport the victim to the nearest hospital as soon as possible. If you pass by a telephone, stop and notify the hospital that you are bringing in a snakebite victim so they can begin to locate and procure antivenin.
6) It is not necessary to kill the snake and transport it with the victim for identification. If the snake is killed, it should not be directly handled, but should be transported in a closed container. Decapitated snake heads can still produce envenomation
7) Extractor pumps designed to provide suction over a snakebite wound are sold in many camping stores and endorsed by some as a first aid treatment for snakebites. Based on recent scientific evidence, these devices are no longer recommended. A study published in the Annals of Emergency Medicine in 2004 showed that these devices remove an insignificant amount of venom, and may also be harmful to the victim. The best first aid for snakebite is a cell phone (call the hospital that you are going to so that they can procure antivenin) and a car or helicopter to get the victim there as quickly as possible.
Other First-Aid Treatments That May Be Beneficial
Immediately wrapping the entire bitten extremity with a broad elastic bandage (the “Australian Compression and Immobilization Technique”) has proven effective in the treatment of elapid and sea snake envenomations only. It is only recommended when the victim appears to have suffered a severe envenomation and is several hours from medical care.
The wrap is started over the bite site and continued upward toward the torso in an even fashion about as tight as one would wrap a sprained ankle (Fig. 60). Monitor the color, pulse and temperature of the hand or foot to make sure that there is adequate circulation. If circulation appears compromised, loosen the wrap. Otherwise the bandage should not be released until after the victim has been brought to a medical facility. The limb should then be immobilized with a well-padded splint.
Things Not To Do
1) Do not make any incisions in the skin or apply suction with your mouth.
2) Do not apply ice or a tourniquet.
3) Do not shock the victim with a stun gun or electrical current.
Coral Snake
Signs and Symptoms of Envenomation
• Burning pain at the site of the bite.
• Numbness and/or weakness of a bitten arm or leg develops within 90 minutes.
• Twitching, nervousness, drowsiness, increased salivation, and drooling develop within one to three hours.
• Within five to ten hours, the victim develops slurred speech, double vision, difficulty talking and swallowing, and difficulty breathing. The venom may cause total paralysis.
Symptoms may sometimes be delayed by up to 13 hours after the bite.
First Aid
Treatment is the same as for a pit viper bite. Early use of the pressure immobilization technique is highly recommended because it is both effective and safe (coral snake venom does not produce any local tissue destruction).
