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Avoiding and handling medical emergencies in Oregon's wilderness

Adventist Health Fitness and Physical Therapy

One of the things that makes Portland special is its location. With easy access to the coast, the high desert and the rugged Cascade Mountains, Portland is a paradise for outdoor enthusiasts.

Unfortunately, enthusiasm alone will only get you so far. If you are heading out for some backcountry rest and relaxation, advanced planning, preparation and education can go a long way toward helping you avoid accidents — or, if the worst happens, ensuring you know how to handle a wilderness emergency.

Avoiding danger: Plan ahead

As much fun as it may be to take a spontaneous trip, taking the time to make a solid plan for your trip is the starting place for a safe adventure. It's just as important to know who is going on your trip as it is to understand the unique features of where you're going.

Gathering knowledge is key to the planning process. Some important things to consider include:

What is each person's fitness level? Even if you're looking for a wilderness challenge, planning around your least-fit team member will make sure everyone stays safe and isn't pushing their bodies too far or too hard. This is especially key when you're taking your kids or older parents into the backcountry.

"An uber-fit trail-running couple may go 'light and fast' with minimal gear, relying on their fitness as a safety margin," explains Capt. J. Pearce Beissinger, a medical advisor for Portland Mountain Rescue and a physician assistant with Adventist Health's Northwest Regional Heart and Vascular Surgical Associates. But if the rest of your crew doesn't have that level of fitness, it will change what you need to bring with you and how far you plan to go.

Does anyone have special medical considerations? You need to know if anyone has conditions that require additional planning or preparation. Maybe someone is allergic to bees and needs to bring an EpiPen along. Maybe someone else is diabetic and needs to have extra supplies of insulin in case you get stuck longer that you plan in the woods. Maybe you're prone to migraines and need to have your prescription medication along in order to stave off misery. Knowing each person's unique situation will help you pack for a broader range of potential emergencies.

Who is coming should help you decide where you're going too. Both the length of your planned trip and its location may be impacted by what each person can handle. Other things to consider when choosing the location of your adventure include:

Elevation and trail conditions: A 3-mile hike over even, level ground is entirely different than the same distance climbing up steep switch backs or over rough terrain. Read trail reports online so you understand exactly what you're getting into.

AllTrailsGaiaGPS, CalTOPO or OnX are great resource for checking trail conditions, finding information on getting to the trailhead, reading recent reviews, viewing photos of the trail and getting an accurate distance and elevation change. Using the mobile app, you can also download the trail guide for offline use while you're "off the grid" — but don't rely solely on the app's map as your only source of navigation.

In addition, make sure you know the exact altitude at which you'll be adventuring — be aware that above 8,000 feet is where altitude sickness may set in. And if you're traveling with children, make sure you choose trails without steep drop-offs or other hazards.

Seasonal variations: With great variety in elevation and microclimate, popular hiking and backpacking areas in the Columbia River Gorge and Cascades can be impacted by late- or early-season snow. Fall nights at higher elevations can be surprisingly chilly-something to consider even when you're planning a day hike, in case your trip takes longer than you imagine.

Weather and current conditions: As your trip date gets closer, keep an eye on the weather forecast specifically for the area where you'll be traveling. While Portland may be enjoying summer weather, the Cascades can be awash in afternoon thunderstorms.

Preparing and packing

Once you have the perfect location selected, it's time to turn your attention to preparation and proper packing of basic supplies as well as a useful first-aid kit.

Prepare your body: Make sure everyone who is joining your adventure is prepared to make the trek as safely as possible. This includes staying in good enough physical shape to handle the planned trip. Having enough rest is key too-fatigue increases the chances of injury and poor decision-making.

Let someone know where you're going: Whether you are hiking alone or with a larger group, always let someone else know which trail you plan to hike, who is going with you and when you expect to be back. If the trailhead has a register, sign it with the date and number of people in your group. 

Prepare and pack your gear: Take the time to go over all your gear and make sure everything is in working order. Charge up batteries and add extras to your pack. Check straps, laces, soles and latches on your shoes, clothes and backpacks. What you pack will vary based on the length and location of your trip, but some keys include:

  • Navigation: Map and compass or GPS — know how to use them before you go
  • Sun protection: Sunscreen and sunglasses
  • Insulation: Extra and layered clothing, extra socks, water barriers, Mylar emergency blankets
  • Nutrition and hydration: More food (trail mix, granola bars and salty snacks) and water than you think you need, plus a way to treat and boil water in the wilderness
  • Illumination: Flashlights and headlamps
  • Fire: Waterproof matches, lighter, candles
  • Repair kit and tools: Duct tape, zip ties, quality fixed-blade knife, multitool
  • Communication: Whistle, mirror, cellphone, personal beacon/satellite communicator like a Garmin InReach or similar

Pack your first-aid kit: While a few Band-Aids and some ibuprofen may seem sufficient in your car when you drive around town, a minimal first-aid kit won't be enough if you or someone in your team gets hurt miles and hours away from help. Make sure you include the special medications each member of your party may need.

Using Ziploc bags and Sharpie markers, label supplies with their use. Replace medications that are expired, and remove items you don't know how to use. REI offers a useful first-aid checklist to help you plan and pack your own kit.

Keep in mind that your first-aid kit needs to be reviewed and updated for every hike and backcountry adventure. You might take different first-aid supplies on a three-day backcountry trip than you would on a three-hour hike with your kids. 

In addition to preparing and packing your gear, make sure you really know how to work with your gear and supplies. "I have rescued many people who had fancy gear and no idea how to use it," Beissinger says.

Taking time to prepare and pack well will help ensure you have the best shot at avoiding a wilderness emergency in the first place. Most of all, pack your mind full of knowledge and experience. "In general, I would say the 'best piece of gear' carried into the backcountry is not in your backpack; it is between your ears," Beissinger says. "Being able to keep your wits and think your way through a challenge is a key ingredient to success in the backcountry.”

If the worst happens

But what happens if the worst happens and you're faced with an injury or illness far from help? Take some time before your trip to learn what you can do to help stabilize patients while you get them to medical aid or await rescue.

There are several important steps to handling wilderness emergencies:

Assessment: You need to assess the hurt or sick person in order to make any plan for how to help. That includes basic vital signs and observations like:

  • First and foremost, is the patient suffering from a life-threatening issue like uncontrolled bleeding or an airway that is blocked?
  • Are they conscious?
  • Are they having trouble breathing?
  • Do they have an obviously broken bone or dislocated joint?
  • Are they showing signs of shock or allergic reaction?

You also need to assess the physical situation.

  • How far are you from public services? How long will help take?
  • Can you work on the patient where they are, or do they have to be moved to be treated?
  • Are there physical features in the area that will make rescue more difficult-such as no clear space for a helicopter to land?

Communication: If your assessment shows that the patient will need to be evacuated, use your cellphone, beacon or satellite communicator to get in touch with rescue personnel. Be prepared to communicate specific details about the patient and their condition. You also need to communicate with your fellow adventurers and get their help managing the patient, preparing easier access for rescue personnel and keeping each other safe.

Treatment: If the patient has any life-threatening condition, begin treatment immediately. Clear the airway, do CPR if they don't have a pulse, and use compression to stop bleeding.

Minor injuries and illnesses may be able to be treated on the trail so you can continue your trek. These include:

  • Minor cuts, scrapes and burns: Clean the injured area and be careful to remove any particles of dirt or debris in the wound. Apply an antibacterial gel or cream before covering with a bandage.
  • Sunburn: Use aloe gel to sooth the burn, and make sure to cover the sunburned area with clothing or a hat to prevent further burning. Make sure the patient stays well-hydrated.
  • Minor sprains: A twisted ankle is no fun on a hike. If it's a very minor sprain, the patient may be able to continue walking. This is where assessment is so important — don't ask your buddy to continue a long hike unless the sprain is truly minor and the pain eases quickly on its own.
  • Bug bites, hay fever, rash: Though uncomfortable, typically insect bites (like mosquito bites), allergic rashes (such as from poison oak) and nasal allergies (like hay fever) can be treated with medication from the first-aid kit. As long as the patient is comfortable and the reaction is subsiding, you can carry on.
  • Blisters and splinters: Removing the offending splinter and protecting the blistered area from rubbing can usually be handled on the trail.

Other injuries and illnesses can be stabilized while you and your team self-evacuate and seek treatment through urgent care or your primary care physician. Examples of such situations include:

  • Hand, wrist and arm injuries without bone protrusion or joint dislocation
  • Eye injuries
  • Altitude sickness
  • Dislocations you know how to reduce on your own — only if you're trained in how to reduce the dislocation
  • Cuts severe enough in size and depth to require medical attention, but you're able to stop the bleeding and the patient is able to hike out
  • Illnesses like fever and altitude sickness that can be managed with medication and mild enough that the patient can safely hike back to the trailhead

If your injury or illness is going to limit your ability to maintain the highest level of safety as you continue your adventure, it's time to turn around. If you are unable to turn around, it's time to call for help.

Stabilization and evacuation: More serious injuries and illness will require professional rescue and evacuation. Though help may be hours away, your training and well-planned first-aid kit will help you stabilize the patient while you wait.

Conditions requiring stabilization and medical evacuation include:

  • Sudden chest pain or shortness of breath while at rest
  • Seizure of loss of consciousness
  • Major trauma, including broken bones

While you await medical help, continuously check the patient's vitals and reassess their condition. If you're in contact with rescuers, they'll need these updates.

Watch and treat signs of shock. Stabilize the patient's body if there is any chance of a spinal injury, and splint broken bones.

The best wilderness medicine

Prevention is definitely the best medicine. If you plan on taking multiple adventures this year or hike often with large groups, consider enrolling in a wilderness first aid or wilderness first responder course.

Beissinger, who holds a Diploma in Mountain Medicine (DiMM) says, "Knowing how to work through a challenge in the wilderness is improved by mental fortitude that comes with repeat practice or formal training."

He also recommends starting small and growing your experience as you grow your adventures. Now is a great time to start exploring and training so you're ready for even deeper wilderness treks when the weather cools off this fall.