Trail Sense

2 - Medical

This chapter covers basic medical knowledge and techniques for common injuries and illnesses in the wilderness.

This chapter provides general educational information only. It is not medical advice, diagnosis, or treatment, and it does not replace professional training, emergency services, qualified healthcare providers, local guidance, or product/manufacturer instructions. Medical conditions and treatment recommendations vary; if you call emergency services, follow their instructions, and do not delay seeking care to consult this chapter.

If emergency services are needed, put the call on speakerphone or have someone else call to avoid delaying first aid.

Be prepared

Gear

Necessities:

• Assorted bandages
• Gauze
• Surgical tape
• Safety pin or needle
• Tweezers
• Antibiotic ointment
• Sunscreen
• Insect repellent
• Prescription medications (including several days' worth of extra doses), contact lenses, and glasses
• Pain relievers (aspirin, ibuprofen, acetaminophen)
• Hand sanitizer
• Epinephrine auto-injector (if you have severe allergies)
• Asthma inhaler (if you have asthma)

Optional:

• Wound closure strips/butterfly bandages
• Moleskin
• Molefoam
• Tourniquet
• C-Splint
• Aloe vera gel
• Antiseptic wipes
• Hydrocortisone cream
• Antihistamine pills (diphenhydramine)
• Super glue
• Cotton swabs
• Antidiarrheal medication (loperamide)
• Gas relievers (simethicone)
• Antacid tablets
• Mirror
• Tampons/pads/menstrual cup
• Dental floss
• Toothbrush
• Toothpaste (store this in your bear bag/container at night)
• Toilet paper and/or portable bidet
• Trash bags/container (check local regulations regarding toilet paper and human waste)
• Trowel
• Soap
• Washcloth/microfiber towel
• Lip balm
• Electrolyte mix

Knowledge and skills

Start by learning how to do the following:

• Perform basic first aid and CPR.
• Calm yourself and others.

Once you have mastered these skills, you should learn how to do the following:

• Perform advanced first aid/wilderness-medicine techniques.

Common medications

This is a list of common medications hikers might carry. It's not a complete list. Only use these in accordance with your doctor's recommendations and follow the package directions. Know the side effects, how much to take, and when to take them before your trip.

• Aspirin: Used to relieve mild to moderate pain and inflammation, reduce fevers, prevent heart attacks and strokes, and reduce the risk of death when experiencing a heart attack.
• Ibuprofen: Used to relieve mild to moderate pain and inflammation, and reduce fevers.
• Acetaminophen: Used to relieve mild to moderate pain and reduce fevers.
• Diphenhydramine: Used to treat allergy and cold symptoms such as sneezing, runny nose, or itching. It is also used to help fall asleep and stay asleep.
• Loperamide: Used to control acute diarrhea.
• Simethicone: Used to treat symptoms of gas such as pain or bloating.
• Antacid tablets: Used to treat heartburn and indigestion.
• Hydrocortisone cream: Used to treat redness, itching, and discomfort of the skin.
• Antibiotic ointment: Used to help prevent infection in minor cuts, scrapes, and burns.

Allergic reactions

Allergic reactions can range from contact dermatitis (like poison ivy) or bug bites to anaphylaxis, a severe reaction that can be life-threatening.

Symptoms

• Rash
• Itching
• Swelling
• Hives
• Runny nose
• Sneezing
• Coughing
• Scratchy throat

Severe:

• Difficulty breathing
• Swelling of the face, lips, or tongue

Treatment

1. Remove the allergen if possible.
2. If there is a rash, apply calamine lotion or hydrocortisone cream.
3. Take antihistamine pills.

Severe:

Severe allergic reactions that affect breathing or cause swelling of the face, lips, or tongue require immediate medical attention. Call emergency services.

If you have an epinephrine auto-injector, use it or help the person with the allergic reaction use it. There are usually instructions on the auto-injector.

If you have asthma and are having an attack, use your inhaler.

Prevention

• Avoid known allergens.
• If prescribed, carry two epinephrine auto-injectors.
• Take precautions for bug bites and poisonous plants (see the relevant sections).
• Tell others about your allergies and where your epinephrine auto-injector is kept.

Altitude sickness

Altitude sickness is caused by low oxygen levels at high altitudes.

Symptoms

• Headache
• Nausea
• Vomiting
• Fatigue
• Dizziness
• Shortness of breath
• Difficulty sleeping
• Loss of appetite
• Coughing

Treatment

• Take pain relievers (ibuprofen) for headache.
• Do not ascend until symptoms are gone.
• Descend to a lower altitude if symptoms are severe or do not improve within a day.

Prevention

• Ascend slowly.
• Acclimate before ascending further.
• Watch for symptoms above 8,000 feet (2,500 meters).

Bites, stings, and attacks

Animals

Many animals bite when threatened, and some can transmit diseases.

Treatment

1. Wash the wound with soap and water.
2. Apply antibiotic ointment.
3. Cover the wound with a bandage.
4. Seek medical attention.

For severe bleeding, see the 'Bleeding' section.

Prevention

• Do not approach, corner, or feed wild animals.
• Avoid animals with young nearby.

The following is specific to bears but may also apply to other large animals:

• Make noise to alert animals to your presence.
• If approached:
• Don't run, as this may trigger a chase.
• Make yourself look big.
• Make noise (not high-pitched screaming).
• Pick up small children and pets.
• Back away slowly.
• Use bear spray if available.
• Fight back if attacked, except for grizzly bears.
  • Aim for the face and muzzle with rocks, sticks, or hands.
  • If a grizzly bear attacks, play dead unless it stalks you, attacks in your tent, or continues attacking - then fight back.
• Keep your backpack on; it can offer protection.
• Protect your vital areas (neck, head, and stomach).

Leeches

Leeches attach to your skin and suck your blood. They can be found in freshwater lakes, ponds, marshes, and on jungle vegetation.

Symptoms

• Leech attached to the skin
• Bleeding

Treatment

1. Hold the rear of the leech (the fatter end) and pull it taut (but not too tight). If the rear is suctioned to your skin, a fingernail can be used to detach it.
2. Slide a fingernail or other flat object between the leech's head (the smaller end) and your skin to detach it.
3. Flick the leech away before it can reattach.
4. Clean the wound and apply antibiotic ointment.
5. Apply a bandage to control bleeding. It is normal for the wound to bleed for a while.

Do not salt, burn, or pull the leech off, as this can cause it to regurgitate into the wound.

Prevention

• Use insect repellent.
• Wear long sleeves and pants.
• Check for leeches frequently.

Snakes

Always check your path for snakes, especially in areas with tall grass, loose rocks, or logs. In hot and arid regions, snakes may hide in shaded areas, under brush or debris, or in holes. In temperate areas, snakes may be in areas exposed to the sun. Most snakes are nonvenomous, but if you don't know the type of snake, treat the bite as venomous.

Treatment

1. Rinse the bite area with soap and water.
2. Clean the wound and cover with a bandage.
3. Remove any rings or jewelry from the affected limb.
4. If you are bitten by a North American pit viper (rattlesnake, copperhead, cottonmouth), do not bandage or apply compression.
5. If you are bitten by another type of snake (coral snake, cobra, or exotic snake), wrap the limb with a bandage, starting at the bite and moving up the limb. The bandage should be tight but not cut off circulation. You should be able to slip a finger under the bandage.
6. Keep the limb immobilized below heart level.
7. Seek medical attention as soon as possible. Call the hospital ahead of time so they can prepare antivenom if needed.

Taking a photograph of the snake from a distance can help medical professionals identify the species and determine the appropriate treatment.

Do not do the following:

• Cut the wound.
• Suck out the venom.
• Apply a tourniquet.
• Apply ice.

Prevention

• Watch where you step.
• Wear boots.
• Do not put your hands or feet somewhere you cannot first see.
• Do not try to catch or kill snakes.

Insects, spiders, and scorpions

Many insects can bite or sting you, causing pain, swelling, and itching. Some insects can also transmit diseases.

Symptoms

• Itching
• Swelling
• Redness
• Pain

Treatment

Bites

To reduce itching, apply calamine lotion or hydrocortisone cream. To reduce swelling, briefly use a cloth soaked in cold water.

If you were bitten by a spider you believe to be venomous, seek medical attention.

Stings

Remove any stingers, taking care not to squeeze the venom sac. Treat it as if it were a bug bite. See the 'Allergic reactions' section for information on severe reactions to stings.

If you were stung by a scorpion or insect you believe to be venomous, seek medical attention.

Bugs in eyes

See the section on objects in the eye.

Prevention

• Use insect repellent.
• Wear long sleeves and pants.
• Wrap your face with a bandana.
• Wear glasses/sunglasses (to keep bugs out of your eyes).
• Use a bug net.
• Ensure your immunizations are current for bug-borne diseases in the area.

You can make an improvised bug repellent by applying mud to your skin or using fire smoke.

Ticks

Ticks attach to your skin and will feed on your blood. They can transmit diseases such as Lyme disease and Rocky Mountain spotted fever.

Symptoms

• Itching
• Swelling
• Redness
• Attached tick

Treatment

1. Using tweezers or a tick spoon if available, grasp the tick as close to the skin as possible. You may be able to use your fingernails if they are long enough.
2. Pull straight out with steady, even pressure. Do not twist or jerk the tick. Do not squeeze the tick's body.
3. Treat the area as you would for a bug bite.

Prevention

• Use insect repellent.
• Wear long sleeves and pants.
• Check for ticks frequently, especially if using dry leaves and grass as insulation.

Jellyfish

Many jellyfish have small, venomous stinging cells, typically on tentacles. Even dead jellyfish can sting.

Symptoms

• Pain
• Itching
• Redness
• Rash
• Swelling

Treatment

1. Use the edge of a credit card or tweezers to remove the stingers. Do not use your fingers to remove the stingers.
2. Rinse the area with seawater. Do not rinse with fresh water, as this can cause the stingers to release more venom.
3. Soak the area in hot water for 30 minutes.
4. Take pain relievers if needed.

Bleeding

Treatment

Seek medical attention if the wound is deep, bleeding profusely, or shows signs of infection. Infected wounds can be identified by redness, swelling, warmth, and pus.

Scrapes and minor cuts

1. Clean the wound with water.
2. Optionally, apply antibiotic ointment.
3. Apply a bandage.

Deeper cuts

1. Apply pressure to the wound with a clean cloth or bandage until the bleeding stops.
2. Clean the wound and irrigate it with water.
3. Bandage the wound with a sterile dressing.
4. Place new bandages over the old ones if they become soaked with blood.
5. Raise the wound above the level of the heart.
6. Seek medical attention if bleeding does not stop after a few minutes, the wound is deep, or the wound is contaminated.

If the bleeding is life-threatening and you are unable to control it with direct pressure, you can apply a commercial tourniquet. It should be tightened 2-3 inches (5-8 cm) above the wound, and not on a joint, until bleeding stops. It may be painful to tighten. Take note of the time you applied the tourniquet. Only a medical professional should loosen or remove a tourniquet.

Prevention

• Use caution when handling sharp objects.
• Do not cut toward yourself.
• Watch your footing.
• Be aware of your surroundings.
• To prevent infection:
• Clean wounds.
• Use antibiotic ointment.
• Change bandages frequently.

Blisters

Blisters are fluid-filled raised areas of skin that can be painful. They are usually caused by continuous friction or pressure on the skin.

Symptoms

• Red, sore area
• Blister

Treatment

If the blister is small:

1. Cut a doughnut-shaped piece of moleskin.
2. Place the moleskin around the blister, with the blister in the hole.

If the blister is large or painful:

1. Sterilize a needle with hand sanitizer or fire (this may not completely sterilize it).
2. Clean and wash the area.
3. Pierce the blister near the edge and drain the fluid. Do not remove the skin.
4. Apply a bandage and, optionally, antibiotic ointment.

Prevention

• Keep feet dry.
• Wear properly fitting shoes.
• Wear two pairs of socks.
• Check feet frequently for red areas and blisters.
• Stop hiking at the first sign of your skin rubbing against your boots.
• Apply adhesive tape or moleskin to prevent blisters.

Burns

Treatment

First-degree burns

These are about the level of a mild sunburn.

1. Soak with cool water for 5 - 30 minutes.
2. Optionally, take pain relievers.
3. After the burn begins to heal, apply aloe vera gel, calamine lotion, or hydrocortisone cream.

Second-degree burns These are burns that blister and can be very painful.

1. Soak with cool water for at least 15 minutes.
2. Take pain relievers.
3. Pat the area dry.
4. Apply a loose bandage.

Do not pop blisters.

Third-degree burns This is a burn that goes through all layers of skin and may be life-threatening. Pain may be minimal due to nerve damage. First- and second-degree burns may also be present.

1. Call emergency services.
2. Run under cool, clean water for 5 - 20 minutes or briefly apply cool, wet compresses to the area.
3. Remove clothing and jewelry from the area unless they are stuck to the burn.
4. Drink water with electrolytes if alert and able.
5. Bandage loosely.

Prevention

• Use caution around fires, especially when wearing synthetic clothing.
• Do not touch hot objects.
• If your clothes catch fire, stop, drop to the ground, and roll to extinguish the flames.

Choking

A person is partially choking if they can audibly cough or speak. They are completely choking if they cannot cough, speak, or breathe.

Treatment

If someone is partially choking, encourage them to keep coughing to try to expel the object.

If someone is completely choking, call emergency services and perform the Heimlich maneuver. If you are completely choking and someone is nearby, place your hands on your throat to signal that you are choking.

Perform the Heimlich maneuver on yourself:

1. If possible, bend over a hard surface.
2. Make a fist with one hand.
3. Place the thumb side of your fist against your abdomen, below your ribcage and above your navel.
4. Grasp your fist with your other hand and press into your abdomen with a quick upward thrust.

Perform the Heimlich maneuver on someone else (only perform this if you know they are fully choking, are upright, have signaled for help, and are over the age of 1):

1. Stand to the side and behind the person.
2. Lean them forward and support their chest with one hand.
3. Use the heel of the other hand to strike between their shoulder blades up to 5 times. Pause between each strike to check if the object has been expelled.
4. If they are still choking, get behind them and reach around their waist.
5. Make a fist and place the thumb side of your fist against the person's abdomen, below the ribcage and above the navel.
6. Grasp your fist with your other hand and press into the person's abdomen with a quick inward and upward thrust. Repeat up to 5 times.
7. Repeat steps 1-6 until the object is expelled or the person becomes unconscious. If they become unresponsive, lower them safely to a firm surface and begin CPR (see the Heart problems section).

Cramps

Cramps can be caused by dehydration, overexertion, or lack of electrolytes.

Symptoms

• Muscle pain
• Muscle spasms

Treatment

• Gently stretch the muscle.
• Massage the muscle.
• Apply heat or cold to the muscle.
• Drink water or an electrolyte solution containing sodium and potassium.
• Eat salty foods.
• Eat potassium-rich foods (such as bananas).
• Slow down or stop physical activity.
• Rest in the shade.
• Take a pain reliever, such as ibuprofen or acetaminophen.

Prevention

• Stay hydrated.
• Replenish electrolytes.
• Stretch before and after physical activity.
• Maintain a slow and steady pace.

Dehydration

Symptoms

• Thirst
• Dry mouth and throat
• Fatigue
• Dizziness
• Dark urine
• Reduced urine output
• Headache
• Nausea

Treatment

Rehydrate by slowly drinking water, an electrolyte solution, or another non-alcoholic beverage. Avoid diuretics.

Prevention

• Drink water frequently, increasing intake during physical activity.

Embedded fishhooks

Fishhooks are designed to penetrate flesh and are difficult to remove without causing further injury. Unless you need to remove the hook to prevent further injury, it's best to leave the hook in place and seek medical attention.

Treatment

Do not attempt to remove a fishhook if it is embedded in the eye.

Method 1

1. Advance the hook through the skin until the barb is exposed.
2. Cut the barb off with wire cutters like those on a multitool or pliers. Beware of the cut piece of the hook flying off.
3. Pull the hook opposite from how it entered.
4. Clean the wound and apply antibiotic ointment.

Method 2

1. Run a fishing line or cordage through the bend of the hook.
2. Grab the ends of the line.
3. Apply downward pressure on the eye of the hook.
4. Quickly pull the line, causing the hook to come out the way it went in.
5. Clean the wound and apply antibiotic ointment.

In some cases, you may be able to use a pair of pliers instead of the fishing line to perform the same motion.

Prevention

• Be careful when handling fishhooks, especially lures with multiple treble hooks.
• Be extra careful when removing a hook from a thrashing or slippery fish.
• Barbless hooks are easier to remove if you get hooked, but it can be more difficult to successfully land the fish.

Fractures

A fracture is a broken bone. A fracture can be closed (the bone is broken, but the skin is intact) or open (the bone is broken and protruding from the skin).

Symptoms

• Pain
• Swelling
• Bruising
• Deformity
• Loss of function
• Inability to bear weight
• Bone protruding from the skin

Treatment

Splint it in place and seek medical attention.

Splinting a bone

1. Remove all jewelry and tight clothing from the area.
2. Apply padding around the fracture.
3. Construct a splint using a rigid object (stick, trekking pole, tent pole). It should extend past the bone break on both sides.
4. Secure the splint with bandages, tape, or cordage. It should be tight but not cut off circulation. If splinting a finger, tape it to the one next to it.
5. Apply a sling if the fracture is in the arm to help immobilize the limb. You can create a makeshift sling by placing your arm in a jacket or cloth and tying the loose ends behind your neck.

Splint:

Sling:

Prevention

• Be cautious when walking on uneven terrain.
• Wear proper footwear.
• Do not overexert yourself.
• Be careful when handling heavy objects.

Frostbite

Frostbite is caused by exposure to cold temperatures, which freezes the skin and underlying tissues. If not treated, it can lead to permanent damage.

Symptoms

Frostnip:

• Redness
• Numbness
• Pale or white skin
• The area is still soft and pliable

Frostbite:

• White or grayish-yellow skin
• Hard or waxy skin
• Numbness

Treatment

Frostnip:

Rewarm the area using body heat (such as placing a hand under the armpit) or warm water.

Frostbite:

Only thaw the area if you can keep it thawed. Refreezing can cause more damage. Do not use a fire to thaw the area. Do not rub the area. Seek medical attention as soon as possible.

1. Take pain medicine before thawing.
2. Prepare warm water (99-102°F/37-39°C).
3. Thaw the area until it is pink/red and soft. If the water cools, change it - remove the area from the water before changing it.
4. Wrap the area in a sterile dressing and keep warm.

Prevention

• Bring and wear proper clothing.
• Keep dry and change out of wet clothing.
• Keep moving.
• Keep warm.
• Stay hydrated and well-fed.
• Treat at the first sign of frostnip.

Gastrointestinal issues

Gastrointestinal issues can be caused by contaminated food or water.

Symptoms

• Diarrhea
• Vomiting
• Nausea
• Stomach cramps
• Gas

Treatment

• Rehydrate with clean water, an electrolyte drink, or tea.
• If you ate something poisonous, seek medical help immediately.
• Take medicine to treat the symptoms.

Prevention

• Properly purify water before drinking.
• Wash hands before eating.
• Cook food thoroughly.
• Only eat foods you know are safe.
• Store food properly.

Headache

Headaches can be caused by various factors, such as dehydration, stress, lack of sleep, eye strain, bad posture, skipped meals, strenuous exercise, or illness.

Treatment

• Take pain relievers.
• Drink water or an electrolyte solution.
• Rest.
• Massage tight muscles in your upper body.

Prevention

• Stay hydrated.
• Replenish electrolytes.
• Wear sunglasses if needed.
• Do not overexert yourself.

Heart problems

To be safe, seek medical attention as soon as possible if you experience symptoms of heart problems.

Symptoms

• Chest pain
• Shortness of breath
• Pain in the arms, back, neck, jaw, or stomach
• Nausea
• Lightheadedness
• Cold sweat

Treatment

1. Stop and sit comfortably.
2. Call emergency services and have help come to you.
3. If you have as-needed heart medication, take as directed. If you are alert and are able to take aspirin, use it as directed.

If someone else becomes unresponsive and you suspect heart problems:

CPR:

1. Check for unresponsiveness and absent or abnormal breathing.
2. Call emergency services and start CPR. You can put your phone on speaker to do the two at the same time.
3. Make sure the person is on their back on a hard, stable surface.
4. Place the heel of one hand on the center of the chest.
5. Place the heel of the other hand on top of the first hand.
6. Interlock fingers.
7. Keep your arms straight and your shoulders directly over your hands.
8. Push hard and fast to a depth of 2 to 2.4 inches (5 to 6 cm) at 100 to 120 compressions per minute.
9. Let the chest rise completely between compressions.
10. Continue until the patient shows signs of life such as breathing, the area becomes unsafe, emergency services arrive, or you are too exhausted to continue.

If you are fully trained in CPR, perform rescue breathing after 30 compressions. Otherwise, just do compressions.

Rescue breathing:

1. With the airway clear, tilt the head back and lift the chin.
2. Pinch the nose shut.
3. Give two breaths, each lasting about 1 second and causing the chest to rise.
4. Repeat the cycle of 30 compressions and two breaths.

Prevention

• Stay hydrated.
• Do not overexert yourself.
• Talk to your doctor about your heart health and risk factors.
• Seek medical attention if you have symptoms of heart problems.

Heat exhaustion and heatstroke

Heat exhaustion and heatstroke are caused by exposure to high temperatures and dehydration.

Symptoms

Heat exhaustion:

• Pale skin
• Sweating
• Fatigue
• Rapid heartbeat
• Dizziness
• Nausea or vomiting
• Muscle cramps
• Headache

Heatstroke:

• Same symptoms as heat exhaustion, but more severe
• Confusion
• Seizures
• Unconsciousness

Treatment

Heat exhaustion:

1. Move to a cool place.
2. Slowly drink a lot of water or an electrolyte solution.
3. Loosen or remove unnecessary clothing.
4. Cool yourself with water.
5. Call emergency services if symptoms persist or worsen.

Heatstroke:

1. Call emergency services.
2. Move to a cool place.
3. Remove excess clothing.
4. Cool yourself with water. Ideally, immerse the person when someone else is present to prevent drowning.
5. Be cautious when rehydrating, as seizures and vomiting can lead to choking.

Prevention

• Stay hydrated.
• Wear proper clothing.
• Stay in the shade.
• Take breaks in the shade.
• Avoid physical activity during the hottest part of the day.
• Do not overexert yourself.

Hygiene

Washing

Use soap and clean water to wash your hands:

• Before and after preparing food.
• Before eating.
• After urinating or defecating.
• Before dressing a wound.
• After touching something likely to carry germs or be poisonous.

If you only have hand sanitizer, rub it over all surfaces of your hands until dry. Wash your hands with water first if they are visibly dirty or greasy, then dry them and apply hand sanitizer.

You can use clean water to wash if you do not have soap or hand sanitizer, but it will not be as effective.

Teeth

If you do not have a toothbrush, you can clean your teeth with a small hardwood stick (fray it by chewing on one end). An inner strand of paracord can be used as dental floss.

Feet

Do the following to prevent foot problems:

• Change and wash socks daily.
• Wash, dry, and massage your feet.

Clothing

Keep clothing clean and dry. Wash clothes with water and soap. To dry clothes, lay them in the sun on rocks, or hang them in the sun or near a fire (not too close).

Bowel movements and urination

• Dig a hole 6 to 8 inches (15 to 20 centimeters) deep for bowel movements and cover it with dirt.
• If you do not have a trowel, use a stick to dig the hole.
• Local regulations may require that you pack out toilet paper in a waste bag rather than burying it.
• If you do not have toilet paper or a bidet, use non-poisonous leaves, moss, or smooth rocks to clean yourself.
• Always wash your hands after using the bathroom.
• Do not defecate or urinate near water sources, campsites, or trails (at least 200 feet/60 meters away).

Hypothermia

Hypothermia occurs when your body loses heat faster than it can produce it.

Symptoms

• Shivering. If shivering stops and you have not warmed up, it is a sign of severe hypothermia.
• Coldness
• Impaired coordination
• Memory loss
• Slurred speech
• Drowsiness
• Slow breathing and heart rate

Treatment

• Change into dry clothes.
• Increase layers of dry clothing.
• Add insulation into clothing (such as dry leaves or grasses).
• Consume warm liquids.
• Warm near a fire.
• Use a sleeping bag or blanket.
• Use the body heat of another person.
• Call emergency services if symptoms persist or worsen.

Prevention

• Wear proper clothing.
• Keep dry.
• Keep moving, but avoid exertion that causes sweating.
• Keep warm.

Objects in the eye

It is common to get objects in your eye while in the wilderness, such as dirt, sand, bugs, or an eyelash.

Symptoms

• Pain and discomfort of the eye
• Redness of the eye
• Excess tearing
• Difficulty keeping the eye open

Treatment

1. Avoid rubbing the eye.
2. Using clean water, irrigate the eye by pouring water into the eye.
3. If the object is still in the eye, use a mirror to locate it and attempt to remove it (only if it is on the white of the eye) using a damp cloth or cotton swab. Be very gentle.
4. If the object is under the upper eyelid and you have a partner, have them place the tip of a cotton swab in the middle of your upper eyelid and gently fold the eyelid over the cotton swab. They can then remove the object using a damp cloth or cotton swab.
5. After the object is removed, if the eye feels scratchy, place a cold, damp cloth over it, keep the eye closed and rest, or use eye drops.
6. Seek medical attention if the object is not removed or symptoms persist.

Prevention

• Wear glasses or sunglasses.
• Don't lift objects with dirt or loose debris on them above your head without eye protection.

Panic attacks and calming techniques

Symptoms

• Rapid heartbeat
• Sweating
• Trembling
• Shortness of breath
• Hyperventilation
• Chest pain
• Nausea
• Dizziness
• Fear
• Numbness or tingling

Treatment

1. Sit down.
2. Close your eyes.
3. Do one or more of the following:
4. Take slow, deep breaths in through your nose, out through your nose or mouth.
5. Count to 10.
6. Recite a calming phrase.
7. Visualize a calming place.
8. Meditate.
9. Tense up and relax each muscle starting at your head and working down to your feet.
10. Listen to music or white noise.
11. Assure yourself that you will be okay.

Poison ivy and contact dermatitis

Contact dermatitis can be caused by contact with poisonous plants, such as poison ivy/poison oak, poison sumac, stinging nettle, and many other plants around the world (always check what is dangerous in your area).

1. Poison ivy: A toxic plant with three usually glossy, pointed leaflets, commonly found in forests, fields, and along trails. Contact with its oil causes itchy rashes and skin irritation.
2. Stinging nettle: A plant with serrated leaves and tiny stinging hairs, commonly found in moist, shaded areas. Contact causes a painful, itchy rash.

Symptoms

• Burning, reddening, and swelling rash
• Itching
• Blisters

Treatment

1. Wash using soap and water, rubbing alcohol, or poison ivy/oak/sumac wash. Then rinse with water.
2. Dry the area.
3. Apply calamine lotion or hydrocortisone cream to reduce the itch.
4. Optionally, take antihistamine pills to reduce itching.

If you touched stinging nettle, wash the area with soap and water or with a clean cloth. You can use tape to remove any remaining fibers.

Some plants, such as wild parsnip or giant hogweed, have compounds that react to sunlight and can cause a sunburn-like rash. Wash with soap and water and wear protective clothing to hide the area from sunlight.

Avoid scratching the rash, as it can cause infection. Leave blisters alone.

Seek medical attention if needed, especially if the rash is severe, widespread, or on the face or genitals.

Prevention

Learn to identify and avoid contact with the following plants:

• Cowhage
• Poison ivy
• Poison oak
• Poison sumac
• Rengas tree
• Trumpet vine
• Stinging nettle
• Gympie-gympie/stinging tree
• Wild parsnip
• Giant hogweed

Research and learn to identify other dangerous plants in your region.

If you come into contact with these plants, wash the area with soap and water as soon as possible. Do not wait for a rash to appear. Do not burn these plants, as the smoke can cause irritation.

Sleeping

Falling asleep can be difficult in the wilderness, but getting adequate rest is important for maintaining energy.

Treatment

• Calm your mind, perhaps using meditation.
• Take a sleep aid.
• Block out noise using earplugs.
• Turn on calming background music or white noise.

Prevention

• Avoid strenuous activity, heavy meals, and caffeine before bed.
• Adjust your bedding and shelter so that you aren't too hot or cold.
• Make your sleeping area comfortable.
• Use a pillow by stuffing spare clothing or a stuff sack with dry leaves or other soft materials.
• Keep light levels low as you prepare for sleep.
• Consider using a sleep mask to block out light from the moon, campfire, or other campers.

Snow blindness

Snow blindness is caused by overexposure to sunlight reflected off snow, ice, or water into your eyes.

Symptoms

• Eyes are red, scratchy, and watery
• Blurry vision
• Sensitivity to light
• Headache

Treatment

1. Remove contact lenses.
2. Rest with your eyes closed. You may also place a cold cloth over your eyes.

Prevention

• Wear UV-protective sunglasses or snow goggles.
• Wear a wide-brimmed hat.

If you do not have these, see the "Craft: Sunglasses" section or put soot under your eyes to reduce glare.

Splinters, thorns, spines, and needles

Splinters and thorns can be painful and may lead to infection if not removed.

Treatment

If the splinter is deep or very large, seek medical attention and do not try to remove it yourself.

1. Inspect the splinter to see if any part is exposed and determine which direction it entered.
2. If no part is exposed, sterilize a needle with hand sanitizer or fire (this may not completely sterilize it) and gently dig at the skin to expose one end of the splinter.
3. Use tweezers to grab the exposed end of the splinter, preferably pulling in the opposite direction from how it entered.
4. Slowly pull the splinter out.
5. Repeat if any pieces remain.
6. If the splinter drew blood when removed, treat it as you would a cut.

Thorns, spines, and needles can be removed the same way as splinters. Some thorns may be easy to remove without tweezers.

For urchin spines, soak the area in hot (not scalding) water for 10 to 90 minutes before removal.

Prevention

• Use caution when handling dry wood or thorn bushes.
• Avoid walking through thorn bushes.
• Wear long sleeves and pants if going off-trail.
• Wear footwear.
• Don't touch animals or plants with spines or thorns.
• Watch out for urchins if walking in the ocean.

Sprains and strains

Sprains are injuries to a ligament, while strains are injuries to a muscle or tendon.

Symptoms

• Pain
• Swelling
• Bruising
• Loss of functional movement
• Reduced range of motion
• Muscle spasms and cramping
• Muscle weakness
• Joint instability
• A pop or tear may be heard or felt during injury

Treatment

1. Rest the injured area.
2. Ice the area for 15 to 20 minutes at a time every 2 to 3 hours for the first few days. You can improvise using a cloth soaked in cold water or filled with snow/ice. Do not apply snow or ice directly to the skin.
3. Compress the area with a bandage and, if needed, splint to help stabilize it.
4. Elevate the area.

Prevention

• Warm up before physical activity.
• Wear proper footwear.
• Do not overexert yourself.
• Watch your step.

Submerged in water

Falling through ice

If you fall through the ice and are still at the surface of the water, do the following:

1. Turn back the way you came.
2. Kick your legs to push yourself onto the ice.
3. Roll away from the hole.
4. Crawl or slide on your stomach to safety.
5. Move to a safe, warm location as quickly as possible.
6. Get out of wet clothes and into dry clothes.
7. Use leaves or dry grass as insulation and warm up near a fire.

Rip currents

If caught in a rip current, swim parallel to the shore until you are out of the current. Then, swim back to shore.

Sunburn

Sunburn is caused by overexposure to the sun's ultraviolet (UV) radiation.

Symptoms

• Redness
• Pain
• Swelling
• Blisters

Treatment

1. Get out of the sun.
2. Run cool water over the burn or apply a cold compress.
3. Apply aloe vera gel, calamine lotion, or hydrocortisone cream.
4. Optionally, take pain relievers.
5. Drink extra water.

Do not pop blisters.

Prevention

• Wear sunscreen with an SPF of at least 30.
• Wear a hat.
• Wear long sleeves and pants.
• Stay in the shade.
• Take extra precautions on days with a high UV index.

Craft: Sunglasses

You can make "sunglasses" using a piece of cloth or birch bark with slits cut in it. This helps protect your eyes from UV rays and glare.

Resources

• Cloth or birch bark
• Cordage

Instructions

1. Trim a piece of cloth or birch bark large enough to cover your eyes.
2. Cut small rectangular slits over where your eyes will be. Don't cut the slits while wearing the mask.
3. Attach cordage to both ends of the mask and ensure it fits snugly on your face.