Off Grid Medic: Surviving Wilderness Emergencies When Definitive Care is Miles Away

by Todd Walker

More and more people are getting back to nature to enjoy its beauty and benefits. The list of outdoor activities seems endless. With these pursuits comes risk of injury. Common injuries like scrapes, sprains, burns, bites, and blisters can turn serious in remote locations. I’ve had my share of bumps, bruises, stings, and close calls. Thankfully, none were life threatening… but could have turned sideways quickly.

Note: All injuries depicted look real but are not. If you’re queasy about blood and guts, you may want to reconsider reading the rest of this article.

A skill set I’ve neglected for years is wilderness first aid. Teaching students outdoor self-reliance skills at RISE spurred me on to train with one of the best Wilderness Emergency Care instructors available, Mark DeJong, owner of Off Grid Medic. We were also fortunate to have Michelle Pugh, an accomplished long distance hiker, author of two books of her adventures, and Off Grid Medic staff instructor teaching our class. Their style of teaching fits perfectly in my “Doing the Stuff” wheelhouse. You won’t sit and watch boring power points in a sterile environment. Courses are held where outdoor enthusiasts roam – the woods. Our class was hosted by Georgia Bushcraft, LLC.

Besides imparting real-world knowledge, Mark works his magical moulage abilities by transforming last night’s rib eye bone into a patient’s open fracture. These realistic injuries aren’t for shock value but to help students “train like you fight.” Discovering a bone protruding from the skin or an impalement in a training exercise will give you a clue as to how you’d respond in a real wilderness emergency.

See what I mean? Some of Mark’s handiwork on “Dutch Oven” Bill.

Wilderness First Aid

Urban first responders are equipped with tools and reinforcements to get patients to definitive care within minutes typically. For wilderness rescuers, hospitals and doctors might be hours or days away. Environmental stressors, evacuation over rugged terrain, limited medical resources, and other unknown variables present unique challenges for patient care and treatment.

If you interested in professional training in wilderness emergencies, contact Off Grid Medic. Below are a few things to consider if you’re ever in the role of wilderness rescuer.

You’re Number One

You can’t rescue a victim if you step into a dangerous situation and become one yourself. Before rushing in, assess the situation, location of patient, and possible hazards; dead tree limbs overhead, steep/loose ground, freezing water, etc., etc. Take care of yourself and team before providing care.

As an example, use the Reach, Throw, Row, Go steps to protect yourself in an open water rescue.

• Reach: Use when victim is close to shore line and can be reached with by hand, pole, paddle, etc. without having to enter the water.
• Throw: Victim is too far away to be reached, throw a line, rope, PFD attached to rope, if the victim is conscious and able to grab the rope.
• Row: Rescuers will use a boat/canoe/kayak if Reach and Throw isn’t an option. Get close enough to use Reach, Throw, or lift the victim into the craft.
• Go: This is the last and least safe option for rescuers. It may be necessary due to the victim being unconscious or unable to grab a rope.

McGyver Mentality

Even if you are a medical professional, the wilderness changes the game. After your initial patient assessment, a typical first aid kit may not contain every item you’ll need in remote emergencies. Be prepared to improvise… a lot.

Space blankets come in many styles. Buy good quality, sturdy blankets.

For a few more ideas on outside-the-box first aid items, this article of ours may help.

Besides a first aid kit, I’ll wager that you probably have the following items in your supplies. If not, consider adding them.

• Emergency Shelter: Start with proper clothing for the rescuer, space blanket (not the cheap mylar sheets), control body temperature, body wrap for victim, shield from elements, signaling device (orange), etc.
• Duct Tape: Wound closure (butterfly stitches), splints/wraps, slings, neck/head immobilization, fire starter, and uses too long to list here.
• Ziplock Baggies: Exam gloves, wound irrigation, occlusive dressing for large burns, sucking chest wound taped on three sides, and more.
• Rope/String: Splinting, litter bed, lashing a litter together, emergency shelter, etc.
• Bandana/Cotton Material: Bandages, sling, splint padding, dressing, wet dressing, etc.
• Metal Container: Disinfect water for hydration via boiling, cooking, warm liquids, hot/cold pack, etc.
• Fire Kit: Emergency tinder, lighter, road flare (not joking), signaling, warm patient and rescuers, comfort, cooking (unexpected stay), water disinfection, etc.
• Knife/Saw/Ax:  Tools to make other items for rescue (litter, fire, etc.), remove insect stinger, collecting firewood, etc.
• Head Lamp: You’ll need your hands free to attend to a patient in dark conditions.
• Compass: Preferable one with a mirror and magnifying lens – all kinds of uses beside navigation.

To Splint or Not to Splint

Sprains, strains, and closed fractures are not always distinguishable. Open fractures are easier to diagnose since the bone protrudes from the skin. A closed fracture may not show deformity in a limb. The rule of thumb is to splint if a limb is painful, swollen, or deformed – this applies to sprains and strains. Immobilize the limb(s) before the patient is evacuated.

Makeshift splint by Mike and Jessica. Interesting note: I taught Mike middle school P.E. in 1985. Man, I’m old!

We learned to splint limbs with resources on hand and materials from the wilderness. Without a modern SAM Splint, you’ll have to get creative. Two sticks, cordage, and a shirt stuffed with leaves will pad and immobilize an arm or leg.

SAM Splints are great to have in your pack.

Mark demonstrating the B.U.F.F. splint – Big, Ugly, Fat, Fluffy – on Michelle.

Slings for an arm/shoulder/collar-bone injure have to offer support and keep the limb secured to the body. Through hands-on experimentation, my partner and I found that zipping her arm inside her light jacket created a snug fitting sling which was comfortable and warm. There’s more than one way to sling a limb.

Another diy sling.

Transporting the Victim

Depending on location and terrain, rescue reinforcements may be far way or unable to respond in remote areas. You’re injured friend will have to be carried out. A makeshift litter can be made from poles and string.

Happy people carrying a litter full of Casey.

Two Litter Options: 

1. Large group of 6-8 people
2. Small group with as few as 3 people with backpacks

Large Group: Cut two saplings about 8 feet long and sturdy enough to carry weight. Cut 5-6 sturdy cross pieces about 5 feet long. Position the two long poles parallel next to the victim. Place the cross poles under the long poles at intervals which support the head, mid back, hips, knees, and feet. Lash the poles together using square lashing or any knots to secure them in place. If time is an issue, or cordage is sparse, use a jam knot with two short pieces of bank line or paracord.

Demonstrating square lashing and jam knot techniques.

Transfer the patient to the litter. Team members lift at the extended cross poles and walk.

Small Group: Use two saplings as above. If sturdy rope is available, wrap the rope around the poles to create a bed. The pole ends are tucked into the lower part of the shoulder straps of two backpacks. This allows two people, with proper fitted backpacks, to transport a victim.

Two poles inserted in the backpacks straps to carry our patient on a rope litter. Obviously, they wouldn’t be facing each other if not in the class.

The culmination of our three-day, 20 hour training was a nighttime rescue. I mentioned that Off Grid Medic likes to keep it real for “train like you fight” scenarios. Mark and Michelle didn’t let up and provided excellent, realistic, hands-on training the entire weekend!

If you’re a camper, hiker, woodsman, or Scout leader, consider learning wilderness first aid. This is an entry-level course into the world of wilderness emergency care. Contact Mark for next-level courses and continuing education. I offer my highest recommendation to the Off Grid Medic team for their professionalism, knowledge, and real-world training.

Keep Doing the Stuff of Self-Reliance,

Todd

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