TRAIL WORK FIRST AID
Trail workers need first aid abilities for two different purposes.
1. To take care of themselves and their own health (Self-help first aid).
2. To care for others with whom they are working or seriously injured people they
meet on the trail.
Parts of self-help first aid are known widely. Matters of particular concern to trail
workers can be self-taught. They are addressed in the Self-help first aid part of this
document. The emphasis is on knowledge that promotes avoidance of serious medical
conditions, and taking care of minor injuries that happen to all of us and to deal with
allergic reactions and hypoglycemia.
Learning and practicing skills to deal with serious injuries or illnesses requires attending
a first aid course that assumes there will be no emergency medical technician or rescue
response within 1 to 8 hours, and perhaps overnight (See the JHA for Trail Workers for a
description of the trail work setting within which first aid skills are needed.). Matters that
need to be learned are outlined in the final paragraph of this document.
Because nature is blind to human needs, environmental conditions may be such that an
injured or ill person(s) who cannot self-evacuate, and those who stay with the injured to
care for them, may find themselves at risk unless they have shelter and some means of
staying warm. Trail workers should be prepared and able to build necessary fieldexpedient shelter.
The principles on which trail worker first aid is based are:
1. Injuries and illnesses can happen. Prevention and avoidance is the wisest course
of action. Each volunteer is responsible for understanding basics about the body
and for acting to prevent their own injury or illness, and to avoid injuring others by
their actions. If minor injuries occur, individuals should be able to treat
themselves, and to self-medicate themselves if they have allergies or diabetes.
Individuals should also be able to recognize the signs of dehydration, becoming
too hot, and becoming too cold, and what actions to take to avoid dehydration,
hypothermia, and heat exhaustion or stroke.
2. Despite each individual acting responsibly, serious injuries or illnesses are
possible. Persons so afflicted may be work party members, or, more likely,
someone met on the trail by the work party. Groups and those who perform
dangerous work should be able to provide first aid survival assistance to persons
who suffer major injuries or who are seriously ill.
SELF-HELP FIRST AID
Self-help first aid requires:
1. Understanding basics of the body.
2. Knowing how to minimize the likelihood of illness or injury, allergic reactions,
and hypoglycemia by acting prior to and during work trips.
3. Ability to spot signs of emerging serious conditions due to diabetes, allergies, lack
of water, heat exposure, and cold, and
4. Abilities to treat minor injuries, keep the body hydrated, adjust to working in the
heat or cold, and if pertinent, how to administer prescribed medications.
BASICS OF THE BODY
Health and strength require functioning and interaction of six systems, called hereinafter
the skin, motive, air, food and water processing, blood, and control systems.
The skin consists of an outer layer and soft tissue cells. It covers and protects the rest
of the body. Blood circulates close to the skin’s surface in small blood vessels called
capillaries. The blood is cooled by radiation of heat to the air and by exhausting water
from the blood through the skin’s pores (sweat).
The air system takes in air through the nose and mouth to the lungs for delivery of
oxygen to the blood, and exhausts carbon dioxide and water vapor from the blood. The
air system contributes to cooling of the blood. Rapid, shallow breathing (panting) takes
in less oxygen and removes less carbon dioxide from the body.
The motive system consists of bones, joints, muscles, ligaments and tendons. These
together give the body the ability to move and do physical action. Water from the blood
lubricates the joints and muscles. Muscle cells store a substance called glycogen taken
up from the blood, and discharge the glycogen when work is done. The glycogen is
converted to glucose and that, combined with oxygen, is “burned” to produce energy.
The production of energy generates heat, which in turn promotes sweating, faster and
deeper breaths, and a faster heart beat.
The food and water processing system consists of the mouth, esophagus, stomach,
associated organs, intestines, and colon. It takes in water and food, digests food, and
discharges solid waste products. Water is required to process food and is included in
solid wastes. Nutrients and water are delivered from the intestines to the blood.
The blood system consists of the heart, arteries, veins, capillaries, kidneys, and
urinary tract. This system pumps blood to the lungs to pick up oxygen and to the
stomach to pick up nutrients and water, thence the system delivers nutrients, water, and
oxygen to all organs, joints, muscles, and cells of the body to provide them energy and
building blocks for life. The blood system cools the body as it flows through its various
parts. Flowing through the kidneys, the blood delivers water to the kidneys and is
cleaned of impurities; waste in the form of urine is eliminated through the urinary tract.
The control system consists of nerves and the brain. Nerves extend to all parts of the
body via the spine, where nerve clusters are encased in a protective sheath. It controls
some body functions automatically, such as breathing, release of chemicals for food
processing, and heart pumping. Bodily reactions to heat and cold are automatic. Other
functions are consciously controlled. Automatic controls are considered more primitive
than conscious control.
MINIMIZE LIKLIHOOD OF ILLNESS OR INJURY
Problems can happen, but their likelihood can be minimized (Serious problems are
rare, but they do arise). Some of what follows is common sense and very simple.
Inability to take in air means all parts of the body are starved of oxygen. The body
cannot produce oxygen, so a lack is quickly felt. Brain cells start dieing within minutes.
Choking on something you are eating or an allergic response that constricts or closes the
throat are the most likely causes of loss of breath. Follow mother’s advice: take small
bites and chew your food before swallowing. If allergic, take shots to reduce sensitivity
and carry prescribed medications. If breathing becomes labored, sit down, drink water,
and take anti-histamines (per doctors orders).
Insufficient water can cause a host of problems.
1. Blood is 75 percent or so water. Normal loss of water is about ½ to 2/3 Ounces
per pound per day (about 2 to 5 liters per day). Water is lost through body
cooling (sweat), respiration (the breath), and waste discharge (urine and feces).
Strenuous physical exertion increases respiration loss (rapid breathing in the
cold increases loss of water through the breath), and through sweat. About 1.5
liter loss of water in the blood causes about 22 percent loss of endurance and 10
percent loss of oxygen uptake in the blood. At this point you may feel slight
thirst; older people may not feel thirst. You are dehydrated when you lose
about 22% of the water in the blood (Dehydration has been found to be a factor
in about 90% of backcountry medical incidents. It is almost always a factor in
heat or cold related illnesses and exhaustion.). The body can’t produce water
so it must be replenished continually. The body can process about 1 cup per
hour. Therefore, drink at least one cup of water per hour, sipping frequently if
desired.
2. Loss of blood volume thickens blood and slows its flow. Thus, inadequate
delivery of oxygen, nutrients and water to, and removal of waste from, all parts
of the body. The heart will increase its pumping rate, and you may pant to get
more oxygen to the muscles and body cells. Panting results in failure to
completely exhaust carbon dioxide from the body, and hence less oxygen to the
lungs.
3. Your brain will slow its functioning and you will develop a headache. The
judgment function will be the first to become defective, and you may become
confused and disoriented. You may also become dizzy or faint, which might
lead to a fall and serious injury. Muscles lose strength and joints become less
flexible. You will become impatient, this may cause you to hurry and become
careless, leading to a greater chance of serious injury.
4. Slow blood flow decreases the body’s ability to cool the body. Blood is
automatically drawn from the skin (skin becomes pale and clammy) and hands
and feet to supply the brain and core of the body. This promotes heat
exhaustion or heat stroke, and contributes to hypothermia and frostbite or
freezing of the extremities.
5. The kidneys require water to function. If there is too small a water supply, the
kidneys may fail. A test of adequacy of water in the blood is to watch the color
of urine. If it is clear or slightly yellow, then water quantity is sufficient. If it
is dark yellow, or another color, then drink more water more frequently.
In the motive system, ligaments, tendons, and muscles connect bones and joints.
These are built up through exercise, and lose mass and strength (in the case of bones, loss
of calcium and bone density) absent load bearing exercise. Injuries can happen if they
are not strong enough, or if a sudden force is applied, such as a twisted ankle. Load
bearing and balance exercises are key to improving the ability of bone and connective
tissue to withstand the stress of walking to trail sites, lifting and carrying tools and
rocks/logs, and digging in the dirt. Pacing yourself in the accomplishment of trail work is
important to harden the body without injury. Wearing boots that have firm ankle support,
but do not constrict flexibility of motion, is advisable.
Wearing the right clothes is important in preventing overheating or becoming cold.
When you walk up and down mountains and do trail work, your muscles generate a lot of
heat. You will sweat.
If the air is dry and cool, or cold, when you take a break, you will cool down
rapidly. If the air is hot and humid, it will be difficult to cool off. If there is wind,
evaporation of sweat will aid the cooling process. If there is no wind on a hot, humid
day, little evaporation will occur.
Cotton will become soaked with sweat. It dries slowly. This may help cooling on
a hot day, but may cool you too much on a cool or cold day. Synthetic, wick dry clothing
wicks the moisture away from the body. They dry quickly. They are the best choice on a
cool or cold day, and also work well on warm or hot days.
In selecting what to wear, take into consideration the characteristics of the place and
weather conditions where you will do trail work, e.g., altitude, time of day, open or
forested. As a rule, temperatures decrease 5 degrees for every 1000 feet of gain in
altitude. Open areas may be very hot due to direct exposure to the sun. Low lying areas
that are heavily forested may be hot and humid. If an area is rocky, the sun may heat up
the rocks and create temperatures 10 to 15 degrees hotter than surrounding areas. If there
are lots of briars and poison ivy, wear heavier clothing on your legs, or wear chaps. Rain
storms can roll in unexpectedly.
Color of clothing may appear innocuous, but white cloth reflects heat while black
absorbs it. Bright colors attract bees (as do perfumes and scented deodorants or shaving
lotions). Neutral colors such as khaki may be best to wear.
This complex of factors suggests wearing layers of clothing so you can adjust to
changing conditions and maintain your body temperature in a normal range, while
remaining comfortable. What you wear will impact your health.
The ground, particularly in forests, is generally about 55 degrees. You will lose heat
when sitting on the ground, plus often the ground is wet. If you must stay on the trail for
an extended period, this loss of heat could promote hypothermia. To avoid this, carry a
small closed cell section of foam pad to sit upon. This can also be used as insulation if
there is a lighting storm, or as a splint if someone strains tendons or breaks a leg/arm.
ABILITY TO TREAT YOURSELF
A basic first aid kit and basic medical knowledge are needed.
Suggested contents of a basic first aid kit for a trail worker include:
1. Scissors, small knife, water bottle, pain medications.
2. To remove splinters and pick material from abrasions/cuts, tweezers and needle.
3. For wounds and abrasions: antiseptic wipes (4), compression bandage (1), 1”
antiseptic bandages (4), butterfly bandages (4), 4”X4” gauze pads (2), 1-1.5” roll
adhesive tape (1), anti-biotic cream, and 2 pair of latex gloves in a plastic bag.
4. For “something in the eye”, eyewash cup, cotton tipped applicators, small mirror.
5. For loss of a cavity or tooth injury, small bottle of dental analgesic.
6. For blisters, blister pads and needle.
7. For sprains and strains in joints, elastic wrap (1), triangular bandage (1), safety
pins, and splint material.
8. For removing embedded ticks, tick removal kit and small plastic bag (to put tick
in after removal).
9. For insect or snakebite, Sawyer extractor kit in plastic bag, stingeeze pads, and
small bottle baking soda or other itch reliever.
10. A map of the area where the trail and work site are located, a cell phone, list of
emergency phone numbers for emergency medical response, and for search and
rescue organizations if different, a list of trailhead/access points for trail area
where work site is located, directions to trailhead/access points from primary or
secondary roads, and directions to the nearest hospital.
(Note: It is unlikely that those who accompany an overseer will carry their own first aid
kit. The contents of a basic kit are considered sufficient to treat up to four people. If
leading a group of more than four, or if using chainsaws, crosscut saws, or axes, more
serious accidents could happen due to accidents with the tools. The following should
supplement the contents of a basic first aid kit when leading a crew of greater than four
people and when using chainsaws, crosscut saws, or axes:
1. Antiseptic wipes (4), 1” antiseptic bandages (6), butterfly bandages (6), 4”X4”
gauze pads (4), 8”X10” gauze pads (2), compression bandages (2), 2” wide or
greater gauze roller bandage (1 package), large wound cleaning syringe, and latex
gloves (2).
2. Elastic bandage (1), triangular bandage (1).
3. Airway mask for CPR/rescue breathing.)
(NOTE: PEOPLE WHO HAVE DIABETES, ASTHMA, OR ARE ALLERGIC TO
INSECT BITES MUST CARRY AND SELF-ADMINISTER MEDICATIONS
PRESCRIBED BY THEIR DOCTOR (e.g., INSULIN, INHALERS, EPI-PENS).)
Basic medical knowledge for self- treatment include the following.
1. Splinters. Clean area around splinter. Use sterilized needle to move loose skin
from puncture area. Use tweezers to pull splinter out slowly. Wash and leave
wound open to heal. If working in dirt, wear gloves and a bandage to keep dirt
2.
3.
4.
5.
6.
7.
8.
from open wound. If splinter is deep under the skin, bandage and see personal
doctor for removal (Sometimes white blood cells will form a sort of a blister
around a splinter under the skin and it can be squeezed out. But cutting into the
skin opens the body to infection and is not recommended.).
Minor cuts and abrasions. If bleeding slowly, let bleed for a short period to flush
out material that may be in cuts/abraded areas. Clean and use tweezers and water
to remove dirt and small pebbles from the skin. Put antibiotic on wound and
bandage, but if wound is not bleeding and bandage is not needed to keep dirt from
cut/abraded areas, leave open to the air. A loose dressing might be put over the
wound to keep it clean if you will continue to work.
Something in the eye. May need help from another person. Blink eyes to see if
that removes object. Hold eyelid back and use mirror to try and find object. Fill
eyewash cup with water or saline solution and try and wash out object from eye.
Gently pouring water from one side of the eye to the other while holding lid open
may also flush out object. A wet cotton applicator may be used to try and gently
lift the object from the eye.
Tooth injury. Put analgesic on area where cavity fell out or tooth injury occurred
and it may reduce pain. If tooth knocked out or cap falls off, wash in water, push
back into place, evacuate and see personal dentist.
Blisters. If starting to feel “heat” on one area of foot, put duct tape or moleskin
over area to reduce likelihood of blister becoming worse. If blister has formed,
sanitize needle and pierce bottom of blister, drain and bandage. If hands are
becoming hot, put on gloves or change way tools are being held and used.
Sprains and strains. Allow area to cool and apply ice pack if available. Elevate
joint and muscles affected unless not practical. Rest for a period. Test joints and
ligaments to see if they can be moved and are limber. Bandage with elastic
bandage, or tape, to support joint ligaments and tendons in holding joint in place.
Test load bearing abilities to determine if pain is bearable. If pain is severe, splint
and immobilize arm, knee, or ankle. Walk out using tools as crutches, or cut and
make a crutch out of a tree or branch.
Tick removal. Inspect body for ticks immediately upon completion of a work
trip. Usually it takes 24 hours for the tick to feed and it is after they finish that
they may inject their stomach contents into your blood stream. If a tick is found
embedded, keep this period in mind and stay calm. Use a tick removal kit per
directions. Take care you do not squeeze it with fingers or tweezers. Germs are
carried in the tick’s stomach and may be squeezed into your bloodstream. Tick
removal devices are designed to remove the tick without squeezing them.
Snake bite. If a snake bites you, note as best you are able what kind of snake it
was. Stay as calm as possible. DO NOT RUN. Do not cut open the bite and try
to suck out any venom that might be injected (Many snake bites do not result in
venom injections). If bite is bleeding, let it bleed. Use snake bite kit such as
Sawyer Extractor as quickly as possible after bite, per direction in the kit. Do not
elevate snake bite area above the heart. Evacuate slowly and proceed to the
closest emergency room. If you have a cell phone, call 911 so medics can meet
you at closest evacuation point.
9. Allergic reactions. If allergic reaction starts, use medications prescribed by
personal doctor per his or her directions. If asthma attack occurs, treat yourself
per doctor’s direction and evacuate.
10. Hypoglycemia. If symptoms of low blood sugar manifest themselves, take food
per doctor’s direction, drink water, and rest to restore strength and balance. If
symptoms are severe, eat food, rest, and evacuate carefully so you don’t fall.
Tools can be used as hiking sticks to help maintain balance.
ABILITIES TO TREAT SERIOUS INJURIES/ILLNESS
1. Understand and be able to accomplish:
a. How to take charge and control people at scene.
b. Scene assessment. Determine how person(s) were injured or became ill.
Identify and evaluate conditions, including environment, that pose hazards
to injured or ill person(s) and to members of the work party. Identify
measures to eliminate or mitigate hazards without anyone in work party
becoming injured and without further harm to the injured or ill person(s).
Assign tasks to work party to test, treat, and care for injured or ill
person(s) and to accomplish rescue/evacuation. If necessary, put victim
head in traction and move to safe area.
c. For conscious person, ask about allergies, medications, past relevant
medical or injury history, last oral intake (food, water, medications, etc.),
and what they understand happened to cause their injury or illness
(AMPLE). This is the subjective description of the case by the injured or
ill person(s).
d. For unconscious person, assume possible spine and head injury. Check in
order breathing, heartbeat, and look for bleeding. Look at and feel skin.
Immobilize head to extent possible and, if not breathing, examine for
something obstructing airway and if clear seek to restore breathing. If
heart not beating, apply CPR for about 30 minutes, with due recognition
that it is not likely to be successful. Stop bleeding and bandage wounds.
e. Periodically make physical exam. Check Airway, Breathing, Circulation,
and Disability (sensation, motion, range of motion of joints) (ABCD).
Measure and record vital signs (Respiratory rate, pulse rate, skin color,
temperature, moisture, (SCTM), and level of conscious evaluations (Alert,
Verbal, Pain, or Unresponsive (AVPU)), and what different signs and
changes in them mean. This is the objective determination of the injured
or ill person(s) condition.
f. Record subjective and objective results, prepare a written list of problems
to address, outline a treatment plan, or the measures taken quickly to treat
the person(s) who were injured or became ill, plan to send for rescue,
including how to communicate with potential rescuers, how rescuers can
reach trailhead, where rescuers should enter trail, distance rescuers must
travel, and key information about injuries and illness of person(s) needing
rescue. If work party must move person(s) injured, what must be done to
prepare for and carry or escort person(s) to the trailhead or to a place
where rescue is possible. If injured person(s) must stay with some work
party members on trail for several hours or overnight, how shelter, water,
and warmth will be provided during adverse weather conditions.
2. Injuries of primary concern. Broken/fractured joints or limbs, crushed toes/feet
and fingers/hands, chest bruising and broken ribs, head concussion, neck and
spinal injuries, severe bleeding, branch or rock in eye, impalements on tools or
limbs, person not breathing, shock, hypothermia, heat exhaustion/stroke,
unconscious person found on trail. Internal bleeding and heart attacks are of
concern, but when medical abilities to treat such injuries are limited and response
times for qualified persons are long, they are important to understand while
recognizing that not much can be done to save the injured person’s life.
3. Primary skills needed.
a. How to make injury scene safe to treat injured person. How to remove
injured person(s) from under rocks or trees/limbs without further injury to
them. How to move injured person from steep slope area where they may
have fallen while protecting neck and spine from injury.
b. What order to treat serious injuries, how to test body and mental state,
how to take vital signs, and what changes in physical and mental state over
time mean, why to record data and what information medics will need
when injured person is delivered to them.
c. How to check and clear airways. How to check and restore breathing for
adults. Methods to stop severe bleeding. How to recognize internal
bleeding. What to do with limbs that may be cut off when no ice is
available. What to do about and how to treat impalements. How to apply
traction for suspected neck and spinal injuries when moving people and
when turning them on their side, how to check for neck and spinal injuries
with a conscious person, and how to immobilize, using material on scene,
back and neck to prevent further injury/paralysis.
d. How to put bones into alignment, including fractures that penetrate the
skin, splinting and immobilizing limbs and joints using material on scene,
bandaging rib injuries.
e. How to do CPR, with due recognition that after 30 minutes, unlikely to be
successful under conditions on trails.
f. Signs of incipient dehydration, hypothermia, heat exhaustion/stroke, and
shock. How to treat people with these conditions.
g. How to treat person(s) who have been bitten by a poisonous snake or who
are going into anaphylactic shock from insect venom.
h. How to make emergency stretchers from material on hand and in woods,
and to evacuate or move injured people down trail when necessary.
i. How to build a safe shelter from materials on hand and in the woods for
injured people and those who are with them when they must stay in woods
for several hours to one or more days under adverse weather conditions
(cold, rain, snow).
j. Methods of communications with emergency response personnel and what
data they need to have to reach injured person for evacuation and to treat
them when they arrive.
k. What to do if a dead person is found or if someone dies after an injury.