Wilderness Wound Care: Cleaning and Dressing Injuries Far from Help

Proper wound care in the wilderness prevents infection, promotes healing, and can prevent minor injuries from becoming life-threatening emergencies. When medical help is hours or days away, these techniques are essential.

Initial Wound Assessment

Stop the Bleeding First

1. Apply direct pressure with cleanest available cloth
2. Elevate wound above heart if possible
3. Maintain pressure for 10-15 minutes minimum
4. Add more dressings without removing blood-soaked ones
5. Consider pressure points only if direct pressure fails

Evaluate Severity

Seek immediate evacuation for:

• Wounds longer than 1 inch or gaping open
• Deep puncture wounds
• Injuries exposing fat, muscle, or bone
• Wounds on joints, face, genitals, or hands
• Signs of severed tendons or nerves
• Uncontrollable bleeding

Wound Cleaning Protocol

Step 1: Clean Your Hands

• Soap and water if available
• Alcohol-based sanitizer (60%+ alcohol)
• Wear gloves from first aid kit
• If nothing available, use cleanest option

Step 2: Irrigation is Key

Best method: High-pressure irrigation removes debris and bacteria

Technique:

1. Use clean water (boiled and cooled ideal)
2. Fill syringe or plastic bag
3. Puncture small hole in bag corner
4. Irrigate from 4-6 inches away
5. Use minimum 200ml (7oz) of water
6. Direct stream across wound, not into it

Water sources (in order of preference):

1. Bottled/purified water
2. Boiled and cooled water
3. Treated water (tablets/filter)
4. Clean tap water
5. Any available water (emergency only)

Step 3: Remove Debris

• Use sterilized tweezers
• Remove visible dirt, gravel, splinters
• Don’t probe deeply
• Leave deeply embedded objects for medical professionals

Step 4: Disinfection (Optional)

• Diluted povidone-iodine (1:10 with water)
• Avoid hydrogen peroxide (damages tissue)
• No alcohol on open wounds
• Rinse antiseptics after 1 minute

Wound Dressing Techniques

Basic Dressing Principles

1. Keep wound moist for better healing
2. Protect from contamination
3. Absorb drainage
4. Secure without restricting circulation

Dressing Materials (Best to Improvised)

Ideal:

• Sterile gauze pads
• Non-adherent dressings
• Antibiotic ointment
• Medical tape/bandages

Improvised:

• Clean clothing (boiled if possible)
• Sanitary pads (excellent absorption)
• Duct tape (closure and securing)
• Super glue (small cuts only)
• Honey (natural antibiotic properties)
• Sphagnum moss (antimicrobial)

Special Wound Types

Puncture Wounds:

• Don’t remove impaled objects
• Stabilize object with bulky dressing
• Control bleeding around object
• Irrigate thoroughly if object removed
• Monitor closely for infection

Abrasions:

• Clean thoroughly (painful but necessary)
• Apply thin layer antibiotic ointment
• Cover with non-stick dressing
• Change daily

Lacerations:

• Approximate wound edges
• Use butterfly closures or tape
• Consider hair tie technique on scalp
• Cover with protective dressing

Wound Closure Techniques

When to Close:

• Clean wounds less than 6 hours old
• Minimal contamination
• Edges approximate easily
• No signs of infection

Closure Methods:

Butterfly Bandages/Steri-strips:

1. Dry skin thoroughly
2. Apply tincture of benzoin for adhesion
3. Start at wound center
4. Space 1/8 inch apart
5. Cover with protective dressing

Hair Tie (Scalp Only):

1. Twist hair from each side of wound
2. Tie together across wound
3. Secure with tissue glue if available

Improvised Sutures (Last Resort):

• Sterilized needle and thread
• Dental floss as thread alternative
• Only if trained in technique

Infection Prevention and Monitoring

Signs of Infection:

• Increasing pain after 24 hours
• Red streaks from wound
• Swelling and warmth
• Pus or cloudy drainage
• Fever
• Foul odor

Daily Wound Care:

1. Clean hands thoroughly
2. Remove old dressing
3. Inspect for infection signs
4. Re-clean if needed
5. Apply fresh dressing
6. Document changes

Natural Antibiotics (Evidence-Based):

• Raw honey (applied topically)
• Garlic (crushed, diluted)
• Tea tree oil (diluted)
• Calendula
• Echinacea

Special Considerations

High-Risk Wounds:

Animal bites: High infection risk, irrigate extensively, don’t close primarily
Human bites: Highest infection risk, always need antibiotics
Dirty wounds: Extend cleaning time, consider leaving open
Diabetic patients: Extra vigilance, evacuate for any foot wound

Environmental Factors:

• Hot climates: Change dressings more frequently
• Wet conditions: Extra waterproof protection
• Cold: Ensure circulation not restricted
• High altitude: Slower healing expected

Evacuation Decisions

Immediate evacuation needed for:

• Uncontrolled bleeding
• Suspected bone or joint involvement
• Wounds requiring sutures
• Any sign of systemic infection
• Facial wounds
• Circumferential wounds

First Aid Kit Essentials for Wound Care

Must-have items:

• Irrigation syringe
• Sterile gauze (various sizes)
• Medical tape
• Butterfly closures
• Antibiotic ointment
• Gloves
• Tweezers
• Bandage scissors

Remember: In wilderness settings, preventing infection is paramount. When in doubt, over-clean rather than under-clean, and evacuate if infection signs develop.