Looking up I note that the trees are beautiful. It’s peaceful here and I love every minute spent in the woods. The leafless tree branches blowing in the wind break the skyline to reveal a miraculously colored dawn horizon just over the nearest ridge. The ground is cool with the remnants of the autumn leaves blowing past my head in the cool winter morning breeze. It is an awe inspiring moment. A moment marked by a loud buzzing in my ears. What is that noise and why does my arm hurt? Come to think of it, why am I observing all of this from the ground? I climbed into my tree stand with my buddy two hours ago for another great hunting day. I wonder if he hears this buzzing too?
As I look to my left and realize he is on the ground with me, my memory becomes clearer. Our tree stand had been damaged in a storm the previous weekend and the retainer strap holding it to the tree had been almost severed. Unbeknownst to us, as we made a quiet and slow ascent into our place, the few remaining fibers had broken loose. Gravity had given us just about a half an hour of peace before it pulled the stand away from the tree and reclaimed its grasp some twenty feet below us as we tumbled with it. We had landed in a crumpled heap of body limbs, tree branches and equipment suffering countless impacts before finding our places back on Earth.
My Grandfather’s words come crashing back into my mind almost as hard and fast as my body to the ground. “It’s never the fall that’ll get you, it’s always the abrupt stop at the bottom.” Words have never rang so true. A quick assessment has me realizing my right arm is broken but all other limbs seem to be intact and functioning. My buddy has an obviously fractured left femur with a large deformed knot showing through his pants leg. I don’t notice any heavy bleeding so the bone must be inside his leg still, somewhat good news given our predicament. We had walked about a half mile without any cell phone service and this is our secret hunting spot. We cherish it and therefore no one knows exactly how to find it or even that we are there. We are both awake and save for the fractures, all of our other limbs are functioning. Now what?
“My Grandfather’s words come crashing back into my mind almost as hard and fast as my body to the ground.“
Joshua Hicks
Falls, impacts, and other blunt force injuries happen. They may be the most common injury sustained in the outdoors not just for hunters but hikers and outdoor enthusiasts alike. They can range from sprains and hyperextensions, bending of a limb or appendage far beyond its normal range, all the way to fractures of major bones and joints which can be open or closed, referring to bone broken but still inside the skin or bone broken and protruding outside the skin. Any of these injuries could result in a catastrophic threat to life or limb for any of us, even the most seasoned woodsman. Having a working knowledge of splinting and securing of these injuries can give a range of motion for self rescue that may otherwise hinder a positive outcome.
Let’s start at the minor injuries and work our way to the major notating the threats along the way for each of them. Sprains and hyperextensions are fairly common. Most these injuries result in localized swelling and discomfort however they may still allow for some weight bearing capabilities if on a lower limb or an annoying hindrance to carrying our equipment if an upper limb is involved. One of the primary issues that result from an injury like this to the upper limbs is the surprise of its global effect on our movement. Attempting to put a shirt on with an injured shoulder is a temper goading issue many athletes have experienced at least once.
We frequently take these mundane daily movements for granted and when we alter them due to pain, it can come as a frustrating shock. A wrist injury, though effectively ruining our ability to hold a rifle or draw a bow string, will probably not give you a massive issue when extricating yourself from the wilderness. An elbow will add a hindrance to balance and general bracing when unsteady footing is added to the equation. A shoulder injury can affect all of the above. As humans God equipped us with instincts to survive in our environment. One of those instincts we hardly notice is self splinting. When the wrist is injured, we will draw it to our core and brace it by grabbing it with our other hand. If its the elbow, we will do the same bracing with the unaffected side while lightly using what force we can express through it with minimal pain to hug it against our core. The biggest self splint instinct I want to draw your attention to is a shoulder injury. Assuming the lower limbs of the affected shoulder are unaffected at best and minimally affected at worst, we will grab the tricep of the affected shoulder with our opposite hand while using the affected side’s hand to grab onto our rib cage and slightly lift up. This relieves the tension and pressure from the weight of the injured limb on the joint of the shoulder itself. We do all these things without even thinking or noticing. As a medical provider, we are trained to secure the limb above and below the injury. Armed with that knowledge, you can easily understand that we were preprogrammed to do this. God knew what he was doing when he made an outdoorsman. But we will need the good limb to make our escape and seek medical help. How should we free our good limb?
“Falls, impacts, and other blunt force injuries happen.“
Joshua Hicks
The answer is a sling and swathe, or just a sling if equipment is limited and you have no help with you. Though a commercially available sling can be purchased cheap and is called a cravat, I travel into the mountains with a bandana. This serves the purpose of many tasks but has a safety feature as well. Folding the bandana into a triangle is your first step. You will have a far corner where the 2 far sides of the unfolded Bandana square meet when this is done. Tie a knot in that side to itself. This will be where your elbow will rest. Now tie the two remaining corners into each other. Work your elbow into the single knot and using your good arm, slip the linked sides over your neck. Congratulations, you have successfully secured your injured arm to your body.
If you practice this in preparation you will know exactly where the linked ends need to be tied so as to hold your arm at a height that alleviates pain. Also good to note is the angle of the supported arms. It should be angled such that the wrist is above the elbow as this will be far better supported into the sling and limit slack which can allow the limb to move more freely resulting in more pain when moving. It sounds ridiculous to practice, but it will seem far less ridiculous if you ever need it. The sling can be slid over the hand if the wrist or elbow is badly injured as well and it will offer some support and relief while also serving as a reminder to not use that arm if you lose foot or fall.
Upper limbs, while painful and irritating, rarely cause such severe pain that they limit mobility. Lower limbs are far more complicated. Of the lower limb issues, ankle sprains are likely the most common. They can vary from irritating and uncomfortable, to debilitating and unbearable. If you find yourself unfortunate enough to suffer one of these injuries, fear not. I’m going to give you a game plan. First and foremost, I would always recommend boots when entering the wilderness. Boots will safeguard your ankles, to an extent, in a way that shoes below the ankle will not. You may still suffer an injury though and this is where they can be utilized as a splint. Assess the injury first by determining if you can bear any weight on it. If you find that you can, make sure to tighten the laces to a point that is almost uncomfortably tight. This will limit your ankle mobility and prevent any further injury due to the nature of the now destabilized joint. If you find that it is unbearable, do not try and push through the pain. Take a seat on the ground and do a quick assessment of your surroundings. Find a long stick that is strong enough to support your weight. If this is enough and you don’t need further mobility assistance, begin your hike back to your vehicle or cell service. The key to successful extrication is going to be moving with intent. Slow your pace and find steady footing. If you find the joint needs to be further immobilized, dig out that trusty bandana. Use a knife to cut the bandana down the middle and make two long strips that you can fold thinner for added strength and tie the two strips together. Beginning over the front of your shin, wrap one time above your ankle at the edge of your boot so that you are left with even lengths on either side. Take these two remaining lengths and wrap them under the toe of your boot tying them together on top of the toe of your boot tightly. This should take all the remaining ankle flexion out of the equation for your hike out.
If your knee suffers the injury, mobility will be limited however it will be very difficult to carry equipment out due to the balance and coordination issues that follow. You will not be able to brace the limb and joint straight as that will create more pain while decreasing ground clearance when attempting to elevate the limb while walking using only your hip. Bracing at an angle will be the best option. While you are probably thinking I’m about to tell you to pull out the bandana again, you would be wrong. For this brace you are going to dissect your sock. You will need to cut the toe out of your sock to begin. Next cut up the middle of the sock with 2 cuts and create two stretching pieces of cloth. Tie one of them flat over the lower end of your knee cap to help stabilize it and use the remaining one to go over the upper half of the knee cap. Do this over your pants. While it will not completely immobilize the joint, it will limit the motion enough to make the walk bearable with a good weight bearing stick. If you are hunting with a rifle. It is always an option, just make certain it is unloaded and the safety is on so as to avoid a gunshot wound for which you will need to refer to Part 1 of this series. If you find that you need more bracing than the sock will give you and you did not prepare with an ace wrap in your first aid kit, a t-shirt will provide far more material to wrap a larger area.
At this point we have covered the two best case scenarios if you are to suffer a lower limb injury. Now I want to discuss what we will aptly address as a catastrophic limb injury. That would be the femur and hip. It will not only be a severely painful injury, it can also be life threatening. If you find yourself with a fractured femur and/or hip, you will likely notice a few things immediately. The first will be intense pain. This will be due to a fully fractured femur being pulled past itself by the major muscles of the thighs. Namely the Quadriceps, Adductors, and Hamstrings. Now you have found yourself where the body takes self splinting to an extreme with no prejudice toward your pain. These major muscles will immediately and intensely tighten around the injury pulling the broken bone, now in two separate pieces, through tissue and muscle until it cannot move anymore. The second thing you will notice will be due to this involuntary action; your leg will be clearly shorter than the other and if it is rotated, you can safely assume you also have a hip injury. You may notice a third thing or you may be lucky enough that there is no third thing and that is if the tightening of the muscles or the trauma that caused the fracture itself caused the femur sections to take angle on their path. If this has occurred, you may have a bone protruding from your thigh. The major artery of the thigh can cause severe bleeding and that will need to be addressed before anything else can be done by placing a tourniquet into your groin area as high as you can achieve and above the injury site. For that, you will need to refer to part one of this series.
I do not have a splint for this injury. What I do have in a very slow extrication plan for you. Assuming bleeding is controlled, you will need to do something to protect the area to the very best of your ability. If your pants are not torn, they will suffice. You should be sitting upright and flat on your butt by this point. Movement will be painful and slow but will need to be very deliberate. You should also limit it to just as much as you can to get a signal on a phone or within range to manually signal for help. Set your backpack on your lap with your back facing the direction you intend to move. Now with your legs flat in front of you, use your arms to begin sliding across the ground stopping as you need to ease the pain of motion and take breaths. If you have a good leg, using it to assist the movement can speed up the process but be cautioned that getting in a hurry may cause you to shift weight on your hip and the pain will be intense if you do so. This method will use the ground as a bracing mechanism for the injured leg. As an added environmental caution, sitting on the ground, especially if it is wet, will leach heat from your body and create more complicated issues so do not waste time.
This was a descriptive and long article. I know that we frequently tell ourselves that it won’t happen to us, however the fact of the matter is that it can happen to anyone who enters the unpredictable world of nature. It is my sincere hope that by writing these articles, I am bringing some awareness to the real risks we take to pursue this passion of hunting. Bringing it back to the very first paragraph of part 1. An ounce of preparation will save a pound of suffering. Take the time to build a first aid kit. If you are not hunting with a friend or companion, let someone know where you are going, when you will be there, and when you return. Always take food and water as well as a heavy coat or something to keep dry and warm with. Above all else, risk comes with the territory, fear is a good thing but panic will get you killed. Stay calm and have a plan. More to come in Part 3 so plan on revisiting soon! Safe hunting!