Wilderness Medicine, First Aid, and Outdoor Skills

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US Army First Aid Manual
Fundamental Criteria for First Aid
Basic Measures for First Aid
First Aid for Special Wounds
First Aid for Fractures
First Aid for Climatic Injuries
First Aid for Bites and Stings
First Aid in Toxic Environments
First Aid for Psychological Reactions
Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary

Trauma Pictures

After reading this article, be sure to visit our trauma section to see our fracture pictures.


What is a fracture? When the integrity of a bone is compromised with a crack or break, it is called a fracture. I will often ask patients if they have a history of any broken bones. They will often say “no, just a crack.” The “crack” they are referring to is a fracture. When there is a break in the skin along with a fracture, it is called a compound or open fracture. The bone may be sticking out--the classic example of a compound fracture. What most people do not realize is the following is also a compound fracture: A log or rock falls on your toe or finger, the bone is broken and the skin is lacerated and open. This is a classic “blowout” laceration and it is an open fracture or compound fracture. This is important because these individuals need to be protected with a course of antibiotics. The last thing one wants is a bone infection, called osteomyelitis. Compound fractures take a long time to heal and are notoriously a problem. When there is a doubt of a fracture or dislocation, always splint the site in question and transport for x-rays.

The most common fracture before age 65 is a fracture of the wrist. We trip, fall and reach out to support ourselves, hence the broken wrist. After the age of 65, hip fractures are the most common.

Pathophysiology of bones

To keep this as simple as possible, let’s review what happens inside bones. Bone marrow is the spongy substance found inside bones. It is where stem cells are born. Stem cells are immature red and white blood cells and platelets. When bones break they bleed, and blood loss can be a significant factor, especially if a bone lacerates a nearby artery or vein.

Fracture Symptoms

Now that we have reviewed some basic physiology we know what to look for in the outdoors. When bones break, they bleed. The individual will have pain and swelling due to tissue damage, and swelling due to blood leaking out of the bone. Blood underneath the skin is called a hematoma. This will not cause a blood clot to the brain, heart or lungs. Many patients are fearful in this regard, and reassurance needs to be given if they bring this issue up. There may or may not be angulation of the extremity compared to the other side of the body. Check for color distally or farther away from the fracture site. Also check for sensation. Do they have feeling farther away from the fracture site? You want to document and be aware of possible damage to nerves or arteries.

Fracture Treatment

Pain management in the outdoors:

  1. Ibuprofen comes in 200 mg. tablets or capsules. An adult can take 4 tablets, that’s
    800 mg., with food to avoid stomach irritation, with 2 Acetaminophen (Tylenol) at the
    exact same time. This works very well as a pain reliever in an outdoor setting.
  2. Ice if available at the site of injury.
  3. Reduce or not to reduce? Please see our dislocation article, as much of the dislocation content also applies to fractures. In reviewing this article via phone with many orthopedic surgeons, the consensus is as follows:
      1. If you feel there is neurological or vascular compromise, attempt to reduce as follows: Straighten the extremity. This is not a sudden jerking motion, but a slow, deliberate pressure with counter-traction if possible, and splint in position. See our splinting section and photographs.
      2. If you are greater than 4-5 days out before treatment at a healthcare provider, attempt to reduce the fracture site and splint.
      3. If you can transport and get to a healthcare provider in less than 4 days, splint in position, ice, elevate and transport.
      4. Irrigate, irrigate, irrigate. Direct pressure to stop the bleeding, splint in position and once again, if greater than 4-5 days to transport to a healthcare provider, attempt reduction and splint.



1. Wilderness 911, Weiss, M.D., Eric
2. Wilderness Medicine, Auerbach

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