Sep 9, 2017

Gone Huntin’ and Planning on Coming Home 

By: Christopher Wistrom DO, Adam Walton FF/EMT-P 

Anyone who has ever been on a hunt knows that preparation is paramount. It starts with the Boy Scout within us to be prepared…We have 50 shells but only one tag and enough food for 10 people even though it’s only three of us. So, why is it that only in recent years we have just begun to discuss safety? It seems like every season we hear tragic stories of hunters being severely injured or killed from either a traumatic event or a medical emergency.  Whether dealing with a broken bone from a treestand fall, a blood gushing wound from a knife cut or bullet, or finding a fellow hunter overcome by hypothermia, the fact is many outdoorsmen lack basic first aid skills to handle emergent situations.  

Most recently I found myself on a fishing trip with my brother to Canada. We had a great group with three Eagle Scouts, two Emergency Medicine physicians, and two Vietnam Veterans. We had a large laceration, embedded fish hooks, an incarcerated hernia that had to be reduced, some dizzy spells, and insulin dependent diabetic issues. These are just a few examples of what can occur in the field and the preparation that went into that trip all got used. Each year hundreds of hunters in the US and Canada are shot inadvertently, and many are killed annually. All of these reported events are investigated and categorized and almost all of them are preventable (1). However preventable they may be, they still keep happening. Hunting most often requires remoteness, camouflage, isolation and exposure to the elements. For all these reasons it makes coming to a hunters rescue all the more challenging. Here are some life threatening emergencies a hunter may be faced with and some bare basic knowledge of how to overcome the problem. 

Wound Care and Bleeding 

When looking at the obvious causes of medical emergencies the first consideration is of course firearms. In the last 16 years, through the Global War on Terror, we have extensive research on causes of death in regards to gunshot wounds GSW (penetrating trauma). Even better, we have research on preventable causes of death (3). When focused on those causes that are preventable some basic principles apply. 

Rule #1: Air goes in and out, blood goes round and round. Any deviation from this is BAD. 

Rule #2: If it looks “gross” cover it up.  

These two principles will carry you through the first several minutes of caring for any wound.  

If you are treating a penetrating (sucking) chest wound on yourself or someone else, bleeding may be present but air movement is crucial. In this case, creating an airtight seal over the wound/s is the goal. This can be accomplished with simple tools at hand. Easy answers to this problem would be a plastic glove, sandwich bag, trash bag, or anything else that would create an airtight seal.  (See Photos #1 and 2) 

Bleeding is by far the most preventable cause of death in any kind of penetrating trauma (3). There are several ways to control bleeding, for starters see Rule #2. Direct pressure will far and away deal with most bleeding. Simply identifying what is bleeding and applying pressure to that site with or without a bandage will work for most bleeding. Boy Scout medicine would tell you to make gravity your friend and to elevate what is bleeding as high above the heart as possible (4). This makes the pressures that you have to overcome less and therefor easier to stop the bleeding. If bleeding continues despite direct pressure and elevation of the wound, a pressure bandage can be easily made as well. This essentially applies even more pressure while freeing up your hands to work on other issues. 

Another next step in severe hemorrhage control is to pack a wound. It is exactly as gross as it sounds, however it is a very effective way to control life-threatening blood loss. Some sporting goods stores have started to sell packing gauze that contains chemicals to help stop the bleeding. These agents have improved since they were first brought to market and have a place in the bleeding control hierarchy. I would encourage you to do some homework before purchasing these products to find which one is right for you. 

In extreme circumstances or when the above tactics fail, quickly applying a tourniquet may be necessary to stop the bleeding. Tourniquets have been around as long as people have been bleeding. They are very effective, and now are known to be quite safe. In the past, many thought applying a tourniquet meant anything below the application site would be subject to amputation.  However, there is a bulk of research that now states having a tourniquet on for up to 6-8 hours WILL NOT increase chances of an amputation. That is quite a bit of time and this procedure can truly save lives. There are a variety of types out there. The most widely accepted and endorsed are the CAT-T and the SOF-T. A tourniquet can also be made from tools at hand. The basic requirements are:  

  1. A strong material at least one inch wide and long enough to tie two knots. 
  2. A stick or rigid material that can be used to twist. (Called a windlass)

To apply a tourniquet, place high on the extremity that is injured.  Tighten the tourniquet by twisting a windlass of some sort.  Once properly tightened, bleeding will stop or slow significantly and the windlass must be secured to maintain pressure. To secure the windlass on makeshift tourniquets, tie a second knot to keep the windlass from unraveling. To secure the windlass on CAT tourniquets, simply use the attached Velcro strap or locking devices included on the tourniquet strap. These tools do take practice to gain proficiency. After all, you wouldn’t bring your rifle without sighting in the scope (5). On-line videos showing steps of tourniquet placement will do more justice than photos, but the concept can be seen below. 

 

Falls 

Falls are one of the most common reasons for someone to visit an Emergency Department. Falls are more than bumps and bruises. It’s one of the easiest ways to break an arm/leg, break your neck/back, or cause head injuries. Even low level falls can lead to very serious injuries (2). It is of the utmost importance to check your stand prior to climbing. Look below your stand early in the season and remove any large rocks or branches that you may impact if you fall.  Wear a safety harness. Specific to stands but also generally good advice: Let someone know where you are. Make sure they know where the stand is and how to find it. 

Broken Bones 

Although falls are a common cause for broken bones, other incidents occur that may require splinting. Most people won’t carry actual splinting devices; however there are some inexpensive options out there. If the need arises, anything straight and rigid can work as a splint.  

For broken extremities, simply place a splint alongside the injury if possible and secure it with rope, boot laces, ripped clothing, or whatever else is handy.  When tying a knot, ensure it is against the splint when pulled tight. (Splint Application Step #2 Photo) Lastly, make certain the splint is securely on before moving the victim.   

For a suspected broken neck/back or for any head injury, the victim should not be moved, if possible, other than to ensure their airway remains open. Getting professional medical care is of the utmost importance and should be done without hesitation. If you are in remote location in this situation, having a satellite phone may make the difference between life and death. 

 

Hypothermia 

As we live in Wisconsin, it’s rather cold during much of our hunting seasons. Hypothermia is a killer. Many of the injuries and circumstances that we’ve listed above will lead to an impaired ability to move. When we don’t move we get cold, even if we are dressed appropriately to be outside. Lying on the ground sucks the heat right out a body. If injured, or otherwise incapacitated, it is of vital importance that we are able to stay warm. The acronym C.O.L.D. will help keep you warm (6).  

Clean: being clean helps keep heat in, having clean clothes makes all that technology work the way it is supposed to and keeps you warm 

Overheated: Don’t get overheated, when you work yourself up to be too hot the body tries to get rid of heat. This is a particularly dangerous situation as sweat gets clothes wet and will continue to draw heat away even after your body has returned to normal.  

Lots of Loose Layers: Having loose layers of clothing helps trap body heat and provides better insulation against the cold. 

Dry: Stay Dry!! Being wet is the ultimate enemy when you are trying to stay warm. 

General recommendation is to bring with you something to start a fire and to have a low threshold to do so. It not only can save your life by keeping you warm, but also by making you easier to find.  

Medical Emergencies 

As much as we all love to run to the woods and try to leave the real world behind, the real world often follows us whether we like it or not. Each of us has our own medical history. Some are allergic to bees, some have cardiac issues, some have breathing problems, asthma, etc.  All of us have a responsibility to ourselves and our loved ones to make sure we come home from the woods. Our medical problems don’t stay behind. Make sure you bring your Epi-Pen, your CPAP machine, or your medications to deer camp. Take extra steps to ensure others know how to assist with any of your medical problems, if needed, so you are able to keep coming back to the woods every year. 

As for Canada, well we plan to go back. The hernia is fixed, the laceration healed, and embedded fishhooks are a thing of the past. We made some great memories and because we were prepared, we avoided disaster on several fronts. I must say it was the simplest aspects of first aid that made the difference. I would encourage everyone to spend just as much time preparing to come home from their hunt as they spend preparing to go. Think before you act and never hunt under the influence of drugs or alcohol. Please understand, the information above are bare bone tactics for a just a few of the many emergencies that can occur in the field.  Everyone is encouraged to take more in-depth first aid classes, which are typically offered through tech schools, hospitals and organizations such as the American Heart Association or Red Cross. . “An investment in knowledge pays the best interest.”—Benjamin Franklin.  

Happy hunting and please stay safe. 

Special Thanks to Janesville Fire Department 

 
About The Authors 

Dr. Wistrom is Associate EMS Medical Director for Mercyhealth in Janesville. He is a board certified ER physician and avid outdoorsman. For more information about Dr. Wistrom and the Mercyhealth course offerings, please visit www.mercyems.org or www.mercycasualtycarekits.com  

Adam Walton is the owner of Pike Pole Fishing Guide Service and is a Wisconsin certified firefighter/paramedic. He is also an American Heart Association CPR/First Aid Instructor and offers classes to interested individuals. For more information about Adam or Pike Pole Fishing Guide Service, please visit www.pikepolefishing.com.