Sep 29 2016
A Note to the Reader: I am not a physician, and though I find the approach described in this article useful, there are unavoidable risks whenever a layman* chooses to “play doctor,” whether the patient is himself or a companion. So be sure to consult a trusted physician before employing the techniques outlined here — and then follow her recommendations to the letter.
One more thing by way of reassurance: No writers were injured in the making of this column.
A well‑stocked first‑aid kit is one of the Ten Essentials, and on trips to remote areas, the scope of “first aid” necessarily broadens. When professional medical help is many hours (or even many days) away, canoeists and kayakers may be called upon to become medics, treating problems that would warrant a trip to the ER if they occurred at home. This is why getting formal instruction in wilderness medicine should rank high on every venturesome paddler’s to‑do list.
Deep lacerations are a case in point. The trekker’s world is full of sharp objects: knives, axes, mussel shells, coral, half‑submerged barbed‑wire fences, broken beer bottles… Any of these can slash open your tender flesh in less than a second, and no matter how careful you are, accidents do happen. Standard first‑aid is limited to stopping the bleeding (by direct pressure) and then protecting the wound with a gauze compress or similar dressing. That’s fine if you’re only a 15‑minute drive from the hospital. But what if you’re on a tour of Mongolia or kayaking in Arctic waters, the wind is blowing half a gale (and rising), and visibility is down to 100 yards, with no prospect of improvement in the next 36 hours? Or suppose you’re camping next to a beaver pond, with your car two strenuous days of paddling and portaging away, in an area with no cellphone coverage. What then? You’ve got a deep open wound. And you need to close it. So… What do you do after you’ve stopped the bleeding?
Once upon a time, trekkers in remote areas were encouraged to suture gaping wounds as soon as they’d been thoroughly scrubbed and debrided, and some wilderness medicine handbooks devoted several pages to the technique of stitching human flesh. But that advice has long been consigned to the museum of medico‑historical curiosities. A good thing, too. It’s difficult enough to clean a contaminated wound properly in a hospital setting. Doing so in a riverbank camp borders on the impossible. And stitching a contaminated wound closed is asking for trouble — serious trouble.
Which is why the textbooks now suggest using wound closure strips (“butterfly bandages” or Steri‑Strips). These allow you to approximate the edges of the wound, thereby facilitating healing, while still leaving gaps for any purulent discharge to escape. But in my (limited) experience, neither butterfly bandages nor Steri‑Strips can be relied upon to keep a wound closed if the injured limb can’t be rested — as may well be the case if a trekker’s arm or leg is sliced open when he still has miles to go. In such cases, something more is needed. But what?
Well, how about duct tape?… Read more…
Questions? Comments? Just click here!
* Pace, any campaigners for gender‑neutral language. I’m using “layman” in its conventional, inclusive sense. Neither of the two obvious alternatives appeals to my inward ear: “laywoman” is risible, only one step removed from “laylady” — and I was never much of a Dylan fan. As for “layperson,” it belongs to the same lumpish clan as “chairperson” and “congressperson.” Just typing it makes my back teeth itch. Should you feel strongly in the matter, however, simply substitute either alternative as you read. I won’t mind.