For most of us the
concept of wilderness has little to do with the notion of access to
medical care, and everything to do with the sense that only in
wilderness are our spirits truly free. Nevertheless, every time we enter
the wilderness, we risk injury, illness, or worse. Injuries and illness
to backcountry visitors are quite common. We face greater risks to life
and limb driving to our backcountry destination, it is true, but few of
us would venture down the road to the trailhead in our sport utility
without training and experience in the fine art of safe automotive
travel, even if the law allowed it. Yet, millions of folks each year
enter the wilderness areas of North America, and for that matter the
rest of the world, with little more than a bandage, a dab of antibiotic
ointment, and a prayer. More than a few forget the ointment and the bandage. I have practiced primary care medicine in rural Montana for
more than twenty years, yet all of that, and six years in my youth as a
Boy Scout, wasn't enough to drum the point about always being prepared
into my head. It took a fairly common injury to my young son to drive
home the error of my ways.
We
were in the backcountry of a friend's ranch, near the end of a two mile
walk to a remote section of otherwise inaccessible trout stream.
Climbing the last fence before we reached the creek, my son's boot foot
waders caught the top wire, he tripped, fell, and broke both bones in
his wrist. The truck was back at the house, the meadows were flooded
with irrigation water and undrivable. I did not even have a bandage with
me, let alone any useful first aid equipment for the field treatment of
a fracture. On that long walk back to the ranch, my seven year old son
bravely cradling his broken wrist in his hand, I promised myself I would
not ever again venture into the wilderness unprepared.
If you work or seek
recreation in the wilderness, simple sense dictates you must, at least,
be prepared for the most common injuries and illnesses you will
encounter. A Red Cross approved course in CPR, and Basic First Aid is a
sensible minimum. Further training in wilderness first aid is highly
desirable, and is widely available from a number of professional sources
around the country. The basic principle is this: ordinary people are
capable of doing more than they think they can in an emergency. With a
little instruction, and a measure of experience, you can acquire the
knowledge to successfully manage first aid treatment of a wide variety
of emergencies. Please note that many conditions and illnesses can be
easily prevented with careful planning and preparation. Emergency
preparedness is the key to a safe trip.
The critical role of
proper nutrition, and hydration in preventing accident and illness
during any wilderness trip cannot be overemphasized. If you think of the
human body as a soft machine, then the importance of fuel (nutrients)
and engine coolant (water) become obvious. Season after season, any
number of major and minor wilderness catastrophes can be traced back to
the failure of backcountry travelers to eat and drink adequately, and to
carry the right clothing for the conditions they are likely to
encounter. The consequences of dehydration and inadequate calorie intake
play a major and inter-related role in frostbite, hypothermia, shock,
burns, the healing of wounds, infection, illness due to heat, high
altitude illness, diarrhea and constipation. Virtually all of our
wilderness trips increase the amount of water and fuel needed for each
day's activities. Back home, working at our desks, we require roughly
two thousand calories a day to maintain body weight, and to account for
the day's energy expenditure. Backcountry adventures, in one form or
another, can easily increase the body's need for fuel to four or five
thousand calories a day, or more. Extreme exertion at high altitude can
raise that figure significantly. That is quite a lot of freeze dried
beans and rice. The same calculations hold true for our water
requirements. It takes about two liters (quarts) of water to maintain a
proper state of hydration over the course of a day's work at the office.
This figure only accounts for the water vapor lost through breathing,
perspiration (we are always perspiring, or losing water vapor through
our skin), and urination. Exertion above and beyond the sedentary
minimum can double or triple our daily water requirement. This includes
the water consumed in food, fruit drinks, and carried in canteens.
A balanced backcountry
diet for trips below ten thousand foot altitude should include forty
percent of calories derived from carbohydrates, thirty percent from
protein, and thirty percent from fat. Above ten thousand feet, seventy
percent of your calorie intake should come from carbohydrates, with the
remaining calories evenly divided between protein and fat sources.
Balancing protein, fat, and carbohydrates in this way provides your
engine with a smooth and continuous flow of fuel, and allows for the
storage of more calories than can be accomplished with higher
carbohydrate diets. The human body can only store a few thousand
calories from carbohydrate, in the form of glycogen maintained in the
liver. On the other hand, we can easily store several tens of thousands
of calories as fat. Protein in the diet of the wilderness adventurer
serves to prevent the metabolic breakdown of muscle which takes place
when energy from carbohydrates runs out. The dietary recommendations for
travelers above ten thousand feet is based on a number of inter-related,
and complex physiologic factors, including the increased difficulty of
digesting fat at the low oxygen levels found above ten thousand feet,
and the body's need to maintain a stable acid base balance, factors not
as critical at lower altitudes.
If
you wait until you make camp, or feel hungry and thirsty before you eat
and drink, you will always be behind in fuel and fluid balance, and will
soon exhaust yourself. Prudent drivers don't wait until the car runs out
of gas and overheats to fill the radiator and gas tank. Your body
deserves the same consideration, or like your car, it will fail you when
you need it the most. Get into the habit of eating small amounts of
food, and drinking lots of water continuously throughout the day. Time
tested gorp (my personal favorite is sunflower seeds, yellow raisins,
and bittersweet chocolate chips), or one of the new protein,
carbohydrate, and fat balanced energy bars, bagels, salami, or jerky all
work well on the trail or down the river. The specific role of nutrition
and hydration in the prevention of illness and injury in the backcountry
are discussed in more detail in the chapters devoted to Shock, Burns,
Wounds, Heat Illness, Altitude Sickness, Hypothermia and Frostbite.
Realistically, of course,
there are a number of things that might happen to you or your companions
on a wilderness trip that even a trained medical expert would not be
able to treat in the field, but fortunately, they are not the most
common of injuries and illnesses. With knowledge and an adequate
wilderness first
aid kit in your pack, you can do at least some good for almost everyone
you encounter who requires first aid treatment in the backcountry.
