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Author’s note: It’s strongly encouraged for anyone interested in wilderness first aid to enroll in a related course and receive appropriate training. The author assumes no responsibility for misuse of the following information.

The topic of first aid for wounds in a wilderness setting comes up frequently in bushcraft, survival, and related forums. Too often, advice is offered in an authoritative fashion from folks who clearly do not have a background in any medical field, and their advice demonstrates a fundamental misunderstanding of human anatomy and physiology, disease processes, fundamentals of wound management, and the scientific process.

I’d like to address a few points commonly seen in online discussions. Forums I frequent tend to attract folks eager to declare independence from modern medicine, seemingly unaware of the vast improvement in length and quality of life it has afforded us. Too often there are recommendations to apply all sorts of crushed plants, fungi, and home remedies to open wounds- yarrow, plantain, birch polypore, alcohol, hydrogen peroxide, iodine, kerosene, and many other substances. These are offered in the belief that they will promote wound healing, control bleeding, decrease chances of infection, and other claims.

I see no reason whatsoever to apply any sort of foraged plant or fungi to a wound. They are certainly not sterile; you don’t know what’s happened to that plant before you got there, what’s crawling on it, what’s brushed against it. Mashing a dirty plant and leaving it to sit and fester in a wound is ill-advised, regardless of whether any compounds exist in that plant that might otherwise have provided a benefit. Irrigants like alcohol, hydrogen peroxide, iodine, and others are recommended by these folks, attempting to sanitize the wound and reduce infection. It should be noted that alcohol is not used in a clinical setting on open wounds; it’s used as a skin prep before the skin is broken. Hydrogen peroxide is no longer recommended for wound care for the same reason as alcohol: these substances will kill pathogens, but also kill your own tissues that need to be healthy and viable so they can begin delivering immune and clotting factors to the wound site. Hydrogen peroxide has been suggested to be dangerous for other reasons as well. Solutions of iodine are indeed sometimes used for wound irrigation in a surgical setting, but this is unnecessary for first aid wound cleaning, and there’s little need to pack iodine in a first aid kit. Those points aside, I think the last thing you want to do in the event of a severely bleeding wound, is run around the woods trying to find the right plant to mash up and put in it, when the proper technique doesn’t require running anywhere.

In addition, one should never attempt to suture their wounds closed. The vast majority of folks are not trained in suturing, wound closure principles, or sterile technique. I’ve seen people even recommend using sewing thread, dental floss, or fishing line for sutures. Such misguided and unnecessary attempts to treat a wound only result in an untrained person poking holes through a cut and dragging filthy, unsterile material straight through the wound bed, depositing whatever was on that thread inside the wound and significantly increasing chances of infection, while attempting to solve a problem that has a much easier and more sensible solution. Tampons also are not appropriate to control bleeding. Open one up and you’ll see they consist of basically two 2×2 gauze pads, which will absorb about a tablespoon or so of blood, far from adequate for this purpose.

This point should be given emphasis and remembered: The only things you should put in or on an open wound are potable water and a sterile or clean dressing. That’s it.

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First Aid Kits

Since many bushcraft and survival activities involve swinging sharp metal objects around, it only makes sense that one should also bring gear to manage a wound inflicted by these tools. The following items should be considered for inclusion in a first aid kit, depending on space available in the kit (this list is specifically focused on wound treatment and is not a comprehensive first aid kit):

Items in bold are linked to Amazon for purchase (no affiliation- I just grabbed one of the first links I saw)

Of the above items, I would give priority to a small ziploc bag with assorted band-aids and steri-strips, a large bore needleless syringe, gauze pads, medical tape, and tourniquet. This will allow you to manage small wounds in the field, and allow you to manage a massive wound long enough to get to a hospital. Stock up especially on gauze and tape, you’ll be surprised how much you go through even with a rather minor laceration. Cloth tape is my favorite. Paper tape if you’re sensitive to adhesives, though it’s the bane of nurses everywhere since it doesn’t tend to stay put.

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Kit Use

I’ll skip detailing a few of the above items, assuming the reader is familiar with use of band aids, gauze, tape, gloves, and shears. I’ve included a link to the headlamp included in my kit, and will just note that I’ve had enough first aid situations in the dark to find this inclusion useful. It’s very handy to not need to look for yet another piece of gear in the event of an injury, and have a backup light with your medical kit. I’m particularly fond of the offering from Petzl linked above for compactness.

Steri-Strips

These convenient, adhesive strips are fantastic for quick wound closure. Using them is easy- open the package, and remove the backing from one end of the strips. Press the ends of several strips onto one side of the wound, pull edges of the wound closed, and remove backing and apply the rest of the strip over top of the wound. Note, wound closure should be done only after controlling bleeding and cleaning the wound.

Large bore, needleless syringe

This item is used solely for irrigation of a wound with potable water. Draw water up into the syringe, and use it to spray water vigorously into the wound to wash it out. This will hurt. It’s better than an infection. Use several syringe-fulls to flush a wound out. The pressure and volume of the irrigant is more important than strict sterility. The syringe needs to be kept clean, of course. A sterile syringe is ideal, but an opened syringe can be sanitized by immersing in boiling water, and drawing up and expelling boiling water from the syringe several times. In the absence of this device, a wound can be irrigated by holding a container high above the wound, and pouring it in slowly, allowing gravity to provide pressure.

Tourniquets

There is a lot of debate about the appropriate use of tourniquets in the field. The fact is, use of these devices has certainly saved many lives threatened by massive blood loss. Old attitudes towards tourniquets regarded them as a risky approach that threatened amputation, though new evidence suggests these dangers have been vastly overstated, and recommendations for tourniquet use in civilian settings are becoming more common. I personally have not been unfortunate enough to need one in an emergency, though have experience with their use in a hospital and clinic setting. In conversations with military medics, their use tends to be more frequent than in a non-combat setting. I’m assuming this is due to time constraints and prioritizing evacuation of the casualty away from a combat zone, over a tailored approach to wound treatment. For the civilian, tourniquet use should be reserved for cases of life-threatening, massive hemorrhage that can’t be controlled with direct pressure and elevation. Detailed information on proper tourniquet use can be found here. In short, the tourniquet should be applied just above the wound site, and tightened to control bleeding. There are many types of emergency/combat tourniquet available, and in the list above I’ve linked the CAT (Combat Application Tourniquet), my personal favorite. Other offerings include the RATS, SOF-T, SWAT-T, and others. I’ve experimented with several, and have found the CAT is the easiest to quickly apply, especially when using one-handed. Others may have different experiences. In the absence of a dedicated tourniquet, the current recommendation is not to attempt improvising one, but to continue applying direct pressure to the wound with both hands and full body weight. I strongly encourage anyone interested to enroll in a Wilderness First Aid course, especially one that includes training on the appropriate use of a tourniquet. Though to address concerns of advocating untrained civilians to use and employ a tourniquet when indicated, I’d like to offer sources one and two, the latter stating:

We documented a much higher (20.8%) unindicated TKT rate, but the majority of these unindicated TKTs (60%) were applied by untrained bystanders and not by a trained emergency medical team. Regardless of the circumstances of TKT application, there were no adverse sequelae related to emergency TKT use among any patient who received a TKT in our study. We would argue that the liberal use of TKTs in the civilian setting poses a much lower risk for adverse sequelae than the risk of fatal exsanguination.

If a tourniquet is applied, do not remove it, and note the time and communicate this to medical personnel. It should be stressed here: if you need to apply a tourniquet, you also need to get to a hospital immediately.

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Israeli Bandage

There’s some debate on this device as well, and some experienced medics prefer different products. This bandage consists of a roll of elastic band, an absorbent pad, and a hard plastic device near the end. Using the technique detailed on the package, the plastic device applies very firm pressure directly to the wound.

Disposable water container and water treatment tabs

I chose to include these, since they’re inexpensive and compact. Including them in a kit provides an option to hold and treat water such that it can be safely used as a wound irrigant. Of course, ideally you’d have your potable water nearby, but again as with the headlamp, having everything you need in one medical kit is nice.

SAM splint and coband or ACE wrap

Sometimes, a wound might occur on a joint, and maintaining these can be tricky. Regular flexion of the joint can cause the wound to dehisce (pop open), and continue bleeding and open it back up to infection. In these cases, a splint can be used to immobilize the joint after the wound is treated. SAM splints are handy, and can be cut using your medical shears to fit the injured body part. Secure the splint with tape or wrapping with the coband or ACE.

QuikClot sponges

These are an optional addition that I include in my kit. They’re a gauze pad impregnated with kaolin, which accelerates the clotting process. Would be nice for scalp cuts or other spots where it’s tricky to bandage well and keep good pressure.

Hemostats

Should you be able to see the end of a gushing blood vessel in a severe wound, a hemostat can be used to clamp it shut and buy some time on your way to the hospital.

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Wound Treatment

The first step in appropriate first aid of a wound is to control bleeding. If bleeding is severe or otherwise difficult to control, immediate evacuation to a hospital is needed. If the wound is minor and bleeding easily controlled, the wound should be cleaned. Wound closure can be achieved with steri-strips, and a sterile dressing applied.

Bleeding

Control bleeding by applying pressure with sterile gauze, ABD pads, or hemostatic sponges from your kit, or use the cleanest thing available such as a clean shirt. Elevate the wound above the heart if possible. If the wound bleeds through the dressing, add another on top- do not remove the old dressing. If pressure and elevation do not stop bleeding, apply a tourniquet just above the wound and continue applying pressure. If bleeding is difficult to control and/or a tourniquet is applied, get to a hospital immediately. Do not apply any manner of plant or other substance to the wound. If pressure and elevation do not stop the bleed, no plant is going to either, and you are wasting valuable time trotting around the woods looking for plants while you should be applying pressure and seeking help.

Wound Cleaning

The best way to prevent infection is to ensure a clean wound and let your immune system do its job. This means first irrigating the wound with clean water- if it’s clean enough to drink, it’s clean enough to irrigate. Studies one and two suggest far more important than sterility of an irrigant is that adequate volume and pressure are used. You want to use a lot of water, and you want it moving fast. The water removes contaminants mechanically, by splashing around inside the wound and flushing dirt and pathogens out. This also leaves your own tissues healthy and ready to start healing. This is the time to use the large bore syringe mentioned above. Draw up a syringe full of water and spray into the wound. Use several syringes of water. If you have no syringe, a container can be held high above the wound and water poured in. Do not use alcohol, hydrogen peroxide, iodine, kerosene, or anything besides plain, potable water to irrigate.

Wound Closure

If necessary, wound closure should be achieved with non-invasive closure methods such as steri-strips or butterfly closures. Do not attempt to suture your wound, nor do I recommend using super-glue to close small cuts. If the wound is too large to close easily, cover it with a sterile or clean dressing and get to a hospital immediately.

Covering and Monitoring for Infection

Once the wound has stopped bleeding, is cleaned and closed, cover the wound with a sterile or clean dressing and change the dressing daily. Monitor the wound for signs and symptoms of infection. These include redness, warmth, swelling, and pain. If you see these, do not put plants or other home remedies in the wound. Do not try the old antibiotics from a past injury or use fish antibiotics (yes, I’ve seen people suggest this). See a doctor. Of note, a 2012 study suggests antibiotic ointments such as Neosporin offer no lower rates of infection than plain petroleum jelly.

All treatment recommendations in this post are as applicable in a hospital as they are in the woods. No improvisation with home remedies is necessary in the field, as the most appropriate items are simple and readily available.

As for my background, I’ve worked as a registered nurse in a variety of clinic and hospital settings over the past 12 years including med/surg, ER, trauma, and ICU.

Jason Timmermans RN, CCM

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