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quick action
What to do first
¦ In the city, nobody has to worry about
how to handle injuries or wounds beyond
the first few minutes. In most cases,
we slap on a Band-Aid or, if it’s serious,
head to a hospital emergency room or
even call 911.
But if you’re out scouting the next set of
rapids somewhere really remote way up
the Ottawa River, the situation is different.
Suddenly you slip. You can see your tibia many deeper layers of fibrous tissue (called with lots and lots of drinking-quality water
poking out through torn flesh, and a lot of fascia) and fat which cushion, insulate, and under pressure. Improvise pressure with a
blood. What happens then? Or suppose provide body substance and shape. squeezable bike bottle or a 60 cc syringe
: W
you’re mountain biking near Calabogie They all act like nature’s Gore-tex, keeping with a catheter tip – store one in your
and your 10-year-old takes a tumble, and good things in, and not so good things out. first-aid kit. Add a few drops of Betadine,

you’ve got to handle some painful, grimy Superficial wounds involving the an antiseptic iodine. It won’t damage live
road rash? epidermal and dermal layers require tissue.
When a hospital is hours or even days treatment about the same as you get back If there are no signs of infection
away, any quick fix can turn ugly, and home. Stop the bleeding, then give a quick (inflammation, swelling, pus, increased
deeper wounds can turn into a catastrophe wipe from an antiseptic pad and put on pain), walk out to the trailhead and drive
if not treated with care. a simple dressing. That’s about all that’s calmly to the hospital. If infection is
How do you decide on just what that needed. If it’s more serious, get the bleeding present, it can spread body-wide with
care should be, and whether to think under control through direct pressure, and fever, mental confusion, and red streaks
about possible evacuation in the remote then think about infection. Infection in the (called lymphangitis). This situation is life-
outdoors? bush means the cold can slow circulation, threatening and needs the quickest possible
Start by learning what a wound is, wetness can degrade tissue that’s healing, attention with outside help; use whatever
and what it does to you. A wound is and altitude can cut off oxygen from means of communication you’ve got to call
damage to skin structure and tissue. The reaching the wound – all these increase the for help, including sending your buddy to
main functions of skin include: providing odds for infection. get it while you wait it out.
sensation, retaining fluids, controlling Some specialized dressings and Avoid antiseptics such as hydrogen
temperature and giving protection from bandages work well for the outdoors. peroxide. They are too strong for open
microbes. Skin damage could threaten all of Colloidal dressings retain enough moisture wounds and could destroy or damage tissue.
these. Skin is made up of layers, with the for wound healing, and allow the rest to Likewise, no antibiotic creams or ointments
thick, protective epidermis on the outside, evaporate. Clear bandages such as 3M’s for large wounds; all they do is make a large
an inner layer filled with blood vessels and Nexcare have a breathable film with a built- sticky mess which collects dirt.
sensory fibres (called the dermis), and in gauze pad that helps keep water out. To Sutures, steri-strips or anything that
hold gauze in place securely, try Coban, an closes a wound are a bad idea because a
elastic, water-resistant bandage that sticks closed wound breeds anaerobic bacteria
to itself without tape or adhesive, so you and it cannot be reopened and cleaned.
can readjust it easily. Contrary to the urban myth, a wound can
Larger wounds are obviously risky. be sutured in hospital more than 24 hours
Deep punctures, bites, open fractures, after the accident.
wounds right down to the fascia layer, and
Mike Webster is executive director of
dirty wounds with crushed or dead tissue
Wilderness Medical Associates Canada,
require hospital attention and antibiotics. In
which aims to educate the public and medical
the field these wounds should be cleaned
professionals in remote medicine. OTTAWA >> SPRING/SUMMER 2008 27
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