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Overview

A hiking trip into the mountains or a kayaking adventure on a raging river can be inspiring and invigorating, but it’s important to be prepared in case of injury or illness.

Yale Medicine’s emergency department doctors are well-versed in caring for patients who’ve been hurt in the wilderness. Here, David Della-Giustina, MD, a Yale Medicine emergency medicine physician, offers tips on how to prevent a catastrophe. 

What is wilderness medicine?

Doctors who practice wilderness medicine are trained to take care of patients in any situation where there are limited resources and evacuation capabilities, at any time of the day, in any weather or climate situation.

Patients who are injured or become sick in the wilderness may end up in Yale Medicine’s Emergency Medicine, whether they go there directly on their own or have been evacuated from a remote area by emergency personnel.

How is wilderness medicine practiced in the emergency department?

Our emergency department specialists are trained to manage frostbite, hypothermia, heat-related illness, lightning strike, poisonous snake or insect bites, drowning, wild animal attack and other conditions that can result from extreme situations in the great outdoors.

The most common ailments occurring in people who camp or explore the wilderness, says Dr. Della-Giustina, are gastroenteritis from improperly treated or contaminated water, injuries such as ankle sprains, broken bones, scrapes and lacerations, as well as heat injuries such as heat stroke or heat exhaustion.”

When someone is rescued from drowning, he or she will be evacuated to the emergency room.

How can people prevent illness or injury when in the wilderness?

Preparation is essential, says Dr. Della-Giustina. It’s vital to plan for bad weather to prevent injury from lightning strikes or from being caught in cold weather for a long time.

“If a group is hiking in the middle of the woods, far from where they're going to be able to get easily evacuated, they should have a way to protect themselves if they get stranded overnight,” Dr. Della-Giustina says. “They should bring appropriate clothing and food in case they get stuck out there for longer than they expected.”

It’s not uncommon to come upon a stranger who has been injured and needs evaluation and treatment, so hikers and campers should be prepared to manage injuries or illnesses not just in their own parties. 

“An AlumaFoam or other lightweight aluminum splint, so that they can splint an injury, whether it's a sprain or it's an actual broken bone, is important,” Dr. Della-Giustina says. “Basic things are important like knowing how to use an EpiPen or having epinephrine available for the people who have anaphylactic reactions.”

It’s also essential to pack materials for water disinfection and an appropriate first-aid kit.

What should go in a first-aid kit?

The contents of a first-aid kit depend on what you're planning to do in the wilderness and for how long.

“In most situations, you're going to be carrying it, so you can't make it too big and all-inclusive, because it's going to be heavy,” says Dr. Della-Giustina.

Critical first-aid tools include:

  • Basic wound management:  Bandages, tape, antibiotic ointment
  • EpiPen, or epinephrine: “That's the one thing that could really save someone's life in the wilderness, if they have an anaphylactic reaction to something such as a bee sting,” Dr. Della-Giustina says. “That's the one time you can make a huge difference.”
  • Splints: AlumaFoam splints are lightweight and good to have for injuries to extremities such as wrists and ankles. “You can also use it as a cervical collar,” Dr. Della-Giustina says.
  • Warm clothing: Proper gear that offers protection from hypothermia or in case you’re stranded overnight
  • Water: Packing water and ways to disinfect water to make it drinkable if necessary.

“The most important thing is to look at what activity you're going to be doing, figure out what kind of illness and injuries can occur, and then pack your first-aid kit based on that,” says Dr. Della-Giustina.

What are some important things to know when out in the wilderness?

Preparing for bad weather can go a long way toward keeping people safe, says Dr. Della-Giustina. People should pack boots and warm clothing instead of tennis shoes and T-shirts, even if the weather is sunny.

Dr. Della-Giustina also recommends learning how to use lightweight aluminum splints for injuries. “You can go online and you can learn how to do 40 different types of immobilization techniques with just an AlumaFoam splint,” he says. “You can use it to help immobilize something that may allow someone to walk out, as opposed to having to be carried out of the wilderness."

The most common wilderness injuries are wounds, so knowing how to clean, dress, and maintain them is vital.

“We can take care of the rest when they get to the emergency room,” Dr. Della-Giustina says.

What is the first thing that you should do when you encounter someone in need of help?

Survey the scene to make sure that it's safe to rescue the person in danger.

“An example would be someone that’s being mauled by a grizzly bear,” says Dr. Della-Giustina. “You're not going to run out and try to rescue them because the grizzly bear will go after you.”

If the scene is safe, approach the patient—ideally from the side, so it's easier for them to see you. Introduce yourself and tell them you're there to help them.

Wilderness medicine specialists at Yale Medicine’s Department of Emergency Medicine teach “MARCH” to remember how to handle a medical emergency.

  • M, for massive hemorrhage. If someone is bleeding, it’s essential to stop it as soon as possible, because there’s no way to give a blood transfusion in the wilderness.
  • A stands for airway—making sure the patient is able to move air in and out of his or her mouth and throat. If not, give the person mouth-to-mouth resuscitation, depending on the circumstance.
  • R stands for respiratory. Check to see whether the person’s breathing is shallow, labored, or too fast.
  • C is for circulation. Check the radial pulse, on the side of the wrist on the thumb side. “If they have a radial pulse, it means that they have at least a good enough blood pressure that they should be perfusing (supplying blood to) their brain and vital organs,” Dr. Della-Giustina says.
  • H is for hypothermia or hyperthermia, and “hike versus helicopter.” This means that the wilderness victim may become very cold (hypothermia) or very hot (hyperthermia) depending on the weather and setting.

A good rule of thumb is that the victim will generally be either colder than you in a cold setting or hotter than you in a warm setting. The phrase “hike versus helicopter” is to get the rescuer thinking whether the victim will be able to be evacuated by walking or will need to be rescued and evacuated by air.

What makes Yale Medicine’s approach to wilderness medicine unique?

“We are a limited group of physicians who train, teach, and provide expertise on wilderness medicine in the state of Connecticut,” says Dr. Della-Giustina.

Yale School of Medicine has one of only 13 fellowship training programs in wilderness medicine in the United States.