DISCLAIMER: The following information is not intended, nor should it be assumed to be, a substitute for formal training in First Aid treatment and procedures. This information is presented to raise awareness of some medical conditions which can arise on canoeing, camping or hiking trips so that participants may better prepare themselves for all eventualities. The information presented is not intended to replace advice or instructions given by trained professional medical personnel. Information herein is gleened from various professional medical resources including the US Navy On-line Hospital web site, the American Red Cross web site and other reliable resources. It must be realized that improper or inadequate treatment of injuries can result in damages that sometimes are greater than doing nothing at all. Whenever possible and practical the assistance of trained, professional medical personnel should be summoned to administer treatment for serious injuries. The nature of outdoor recreation is such that injuries sometimes occur in remote areas far from available professional assistance. The information in this section is intended to be a helpful guide for treatment of injuries in such cases when getting professional help is not immediate and the nature of the injuries requires prompt attention. Marc McCord is not a trained medical practitioner, and makes no claim of expertise in treatment of injuries. Marc McCord and Southwest Paddler are not responsible for improper treatment of injuries and resulting damages that may occur.
Broken bones are an infrequent, but occasional, occurrence that sometimes happen to paddlers. More often than not, bone fractures will be the result of body slamming rocks or trees while running whitewater or wildwater rivers. They are classified as either simple or compound, a simple fracture being one in which a bone is broken with no abrasion of the outer skin and a compound fracture being one resulting in broken bones protruding through the skin and exposed. Both are very painful, but a compound fracture is worse, by far. In addition to treating the bone break one must also treat the broken skin to prevent internal infection and stop excessive bleeding. Since professional medical help may not be readily available paddlers should have a good knowledge of how to properly field-treat broken bones before transporting a victim to a hospital or other medical service. Another possible side effect of broken bones and blood loss can be shock or a state of shock, either of which must be recognized and treated properly and swiftly.
It is almost always necessary to splint broken bones to prevent further pain and reduce the chances that a jagged edge of a bone will cause internal or external bleeding. Because compound fractures are so serious you should have a basic understanding of blood flow, which must be contained always, and especially in cases where the fracture is compound (open).
Bleeding (or hemorrhaging) is the flow of blood from veins, arteries and capillaries, either internally or externally. Veins carry blood to the heart, arteries carry blood away from the heart and capillaries are the very small channels that carry blood to all parts of the body. Blood flowing from a capillary will be slowly oozing, as from a minor cut. Flowing from a vein, blood will be a steady flow of a red or dark red color. Arterial bleeding will spurt from a wound in a bright red color, and is definitely life-threatening - it must be stopped quickly to prevent death to the victim, but it is also difficult to control, especially without proper medical training. It is important to understand how blood flows, why it flows and what can be done to control blood loss without causing the onset of gangriene, a condition that often results in amputation and/or death.
The body of an adult contains roughly 10-12 pints (5-6 quarts) of blood, and can lose about a pint without serious side-effects, as is the case when donating blood. However, a loss of 2 pints will usually cause on the onset of shock, and losing 5-6 pints will usually result in death. Depending upon the nature and severity of bleeding, prompt actions should be taken to stop the loss of blood and save the life of a bleeding victim. In the case of an internal broken bone determining the presence and extent of bleeding may be very difficult, but with open fractures it is quite evident. Internal bleeding can be diagnosed by observing blood flow from the mouth, eyes, ears, nose, rectum or other body openings. While severe, there is generally adequate time to calmly think and act with measures that will control bleeding and reduce injury to the victim.
For a complete reading on treating bleeding please click HERE .
Bone breaks are bad enough, but rough or improper handling can make them worse and increase pain for the victim, also possibly turning a simple fracture into a compound fracture. Do not move a victim until the suspected or observed broken bone has been stabilized with a splint of some sort. Compound (open) fractures are readily identifiable, but simple (closed) fractures may not be so easily recognized. Symptoms to look for include swelling, severe discoloration, deformity, severe pain or unnatural positioning of body parts. Discoloration is usually the result of internal bleeding, as with bruises.
Splints can be made of just about any rigid material including wood, metal, heavy plastics, or thick folds of newspapers, clothing, paddles, rifles, wire mesh, sticks, tree limbs or anything else that is available and which can be securely attached both above and below the suspected or known break area. Splints should always be paddled to reduce discomfort and prevent further damage. Any article of clothing, blankets, sleeping bags, grass, leaves, newspaper, PFDs or other soft items may be used to pad a splint, which is then secured using pieces of torn cloth, rope, wire or anything else available that will hold the splint in place. It is imperative that open wounds not be exposed to anything that can cause infections, such as using grasses or leaves for padding, and it is also critical that rope, wire or other items used to secure the splint do not cut into the skin or otherwise cause additional injury. The objective is immobilize the injury for transportation to professional medical assistance. Naturally, a pneumatic or tension splint would be optimal, but few paddlers carry those with them.
If a fracture is known or suspected, then follow these procedures:
1. Control bleeding with direct pressure or indirect pressure (use a tourniquet only as a last resort);
2. Treat for shock or a state of shock if victim shows any signs of such condition;
3. Carefully check the airway, breathing, and (blood) circulation (ABCs);
4. Gently cut away any restrictive clothing so that movement of the injured partdoes not occur causing further damage. Remove all jewelry from the injury site unless the victims resists;
5. Check the pulse around the injured part and, if pulse is absent, gently move it to restore blood circulation;
6. Cover all wounds, including open fractures, with sterile dressings. Avoid pushing bone ends back into the skin. Avoid excessive pressure on or around the wound area;
7. Apply a stiff splint - do NOT attempt to straighten broken bones;
a. Apply and maintain traction until the splint has been secured.
b. Wrap from the bottom of the splint to the top firmly but not so tightly as to cut off blood flow and circulation.
c. Check the pulse above and below the injury to ensure that circulation is still present. If the pulse cannot be felt, then loosen the splint until circulation returns. Do NOT move the victim until the injury has been securely splinted.
8. Summon professional medical assistance at once, if possible. All suspected fractures require professional medical treatment. If professional medical help is not readily available, then secure the injury as best you can, immobilize the victim, and prepare to evacuate the victim on a stretcher or using a sling carrying method that will minimize movement of the broken bone area. Carry a bone-break victim downriver in a canoe only if a measure of last resort, and try to avoid running any rapids, dams or other drops that can cause further injury.