Handling Medical Emergencies in Canoe Country

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MINNESOTA OUT-OF-DOORS / JUNE 1990

Wilderness First Aid and Rescue:

Handling Medical Emergencies
in Canoe Country

By Mark Sakry

This is how it happens: You are on your third day out. You've paddled deep into the interior. You pick up the last pack at the portage landing and head down the trail. You are eager to join the others for a quick lunch at the other end. The boulders are slick; it has rained all morning. Suddenly, a canoe bangs loudly, just over the rise ahead. Another fifty paces and you come upon your partner, hunkered-over in the middle of the trail next to her canoe. She had been eager too. Now, her face is drawn in perplexity and despair. Her foot is lodged inside a nest of boulders. Her calf is levered sideways over a sharp edge of stone. Her leg is fractured. Her sneaker fills with blood .
It can happen to the best of us.

WILDERNESS PREPAREDNESS

    The above situation represents one of the most common accidents encountered by cxpeditioners in wilderness canoe country. Sometimes, no matter what we do to prevent such mishaps, Murphy's Law dictates. And we begin to realize that wilderness preparedness extends beyond the parameters of prevention, good judgement, and basic common sense.
    The wilderness seems to have its own set of rules.
    Given the normal encumberances of wilderness travel, and the additional time it takes to reach medical help, the amount of emergency care we're able to administer in the bush becomes increasingly significant. More accurately, the requirements of proper care increase proportionately with the distance we travel from civilization.
    Indeed, if your son's fish plug snags your ear on Disappointment lake, a few miles into the Boundary Waters, you'll experience far less disappointment, to be sure, than if you've just put Yum-Yum portage behind you in Quetico's interior.

EMERGENCY CARE CAPABILITIES

    It goes without saying, someone in every canoe party should at least know basic first aid and CPR (cardiopulmonary resuscitation). This, at the very least. Ideally, two or more people will know; in case one meets with peril, another will be available to administer aid.
    Local chapters of the American Red Cross (also many vocational schools) provide high-level training in first aid and CPR—as well as rescue and water safety—and offer many excellent publications on these subjects.
   If you plan more extended trips into canoe country, you may want to expand your capabilities beyond basic first aid and learn more advanced forms of medical aid—if not only to preserve life …to keep an otherwise enjoyable expedition from possibly being cut short.
   Your home physician can be very helpful in teaching you how to perform such simple procedures as removing a fish hook, suturing a cut, or injecting Epinephrine for severe bee sting reactions. Many vocational schools offer advanced emergency medical training. There are also good books describing such procedures. (See sources at end of article.)
   Your physician may also be able to prescribe (to you) such medications as Epinephrine, mild antibiotics, and pain relievers, with specific instructions on how and when to use them.

FIRST AID KITS

    Your first aid kit should reflect the extent of your group's emergency care capabilities, as well as the distance you intend to travel into the wilderness.
    While that old automobile first aid kit may suffice for short excursions, it will behoove you to expand your kit for more extended expeditions.
    The essential items you need can be bought at the drug store. But a home medical or hospital supplier can equip you with special items you may want to include, such as suture, hemostat, blades, splints, slings, and wraps. These are available without prescription. But, of course, they will only be of value if you or someone in your party has received instruction in their proper use.
    Similarly, prescription medications require specific instruction and authorization by your doctor.
    Keep all first aid items in an individual trail pack, lined with plastic and clearly marked "First Aid." If kept in a box or pouch, make sure everyone in the party knows where to find it … before you embark.

PERIL ASSESSMENT

    There are four levels of peril involving medical emergencies in the wilderness: 1) minor accident or illness—which does not require outside help or removal of victim; 2) minor accident or illness—which requires medical attention but allows for transport of the victim by canoe; 3) major accident or illness—which requires immediate medical attention and removal of victim by airlift; 4) death—which generally requires investigation by authorities (at the location) and subsequent airlift of the victim.
    How you assess, and ultimately handle, a medical situation in the wilderness will be determined largely by the cumulative knowledge, judgement, and capabilities of your group. Your level of preparedness will determine, in many instances, whether your trip will continue or not. For example, a superficially embedded fish hook will certainly require transport of the victim to a doctor by canoe …. unless somebody in your group has the ability to remove it themselves (actually a simple procedure using a needle-nose pliers with a sidecutter).
    Short of death, the worse situation involves immediate emergency medical aid and rescue. Here again, however, you may not need to go to all extremes, depending on your group's capabilities and how far out you are.
    If your group is capable—and you are only a few hours from help—you may opt to transport the victim by canoe after administering first aid. If not … well, you'd do better to follow the guidelines which follow.

EMERGENCY RESCUE

    Emergency rescue in the BWCAW is coordinated through the sherrif's department in the county where assistance is needed (dial 911). In Quetico, a helicopter team is presently dispatched by authorities out of Nym lake.
    In most instances, the nearest Ranger's cabin, entry station, or outfitter's resort will be your fastest means of obtaining emergency rescue and medical assistance. Send a team of two, by light canoe, if you can spare the manpower. They should be prepared to report the details of the situation and specific location. Never leave a victim unattended. And do not attempt to transport the victim until a rescue team has arrived if there is any chance of further complications.
    Ground-to-air signals in any combination of three—such as three smudge fires (or signal flares) on a point of rock—represent the universal SOS message and will alert any nearby patrol aircraft of your peril and/or location
    Also, don't look past the possibility of engaging help from other parties. Groups from the Charles L. Sommers High Adventure Base on Moose lake, for instance, carry one-way radios which have helped any number of times in the emergency rescue efforts of others

Mark Sakry is the son of the late Cliff Sakry, who originated Minnesota Out-of-Doors in 1954. He lives in Brimson.

RECOMMENDED SOURCES

Being Your Own Wilderness Doctor by Dr. Russel Kodet and Bradford Angier (New York: Simon & Schuster, 1972).

Standard First Aid and Personal Safety prepared by the American Red Cross, 2nd Ed. (New York: Doubleday, 1980).

The Expedition First Aid Kit

The following first aid kit is recommended for extended trips into the border country wilderness. Some items, requiring either prescriptions or more advanced skills (such as suture and hemostat), may be omitted if your abilities do not warrant their use

Bandage compresses (variety 1"-4")
Non-stick gauze pads (3" X 3")
Gauze roller bandage (variety 2"-4")
Absorbent gauze (24" X 72")
Cotton pads/sanitary napkins
Cotton eye dressing
Waterproof tape (1/2" -1")
Elastic bandage wraps
Q-tips
Tampons (for gunshot and stab wounds)
Petroleum jelly (for "sucking" chest holes)
Butterfly closures (for minor open cuts)
Mosquito hemostat (clamp)
#11 and #16 Bard-Parker blade
Three-0 nylon w/cutting needle attached
Three-0 plain catgut (for deep cuts)
Five-0 nylon (for face)
Razor blades
Scissors
Tweezers
Needle-nose pliers w/sidecutter (for removing fish hooks)
Elastic ankle wrap
Finger splints (variety: short, long, plastic, aluminum)
Arm sling
Moleskin/corn and bunion cushions
Foot powder
Talc (for rash)
Eye drops
Water purification tablets
Antiseptic bar soap
Mycitracin (antibiotic ointment)
Sting-Eze (for insect bite relief)
Cortisone (for more severe insect bites)
Genahist (antihistamine capsules for mild allergy)
Prednisone (for severe insect sting allergy)*
Insect sting emergency kit (Epinephrine w/syringe)*
Erythromycin (general antibiotic for infection)*
Pyridium (for bladder infection)*
Aspirin and Tylenol
Tylenol #3 (pain reliever w/codeine)*
Lomotil (for severe diarrhea)*
First aid manual
Pencil and notepad

*Prescription required