Major Injuries

Includes: Severe Sprains, Suspected Fractures, Major Falls with extent of injury unknown

For Bleeding Injuries, please see https://cvhikingclub.net/bleeding-injuries/

Strains and Sprains (usually ankle, knee, wrist)

PRICE Protocol (from Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update)

  • Protection: Stabilize the injured area with taping, bracing, or improvised splinting. In the backcountry, splints can be fashioned from available materials such as trekking poles, sticks, or sitting/sleeping pads secured with clothing or straps. Splint the extremity in the position found; do not attempt to straighten if fracture is suspected.
  • Relative rest: Limit use of the injured extremity to prevent worsening. However, patients can still self-ambulate during evacuation when appropriate. 
  • Ice/cryotherapy: Apply ice, snow, or bagged cold water when available. Cycle 10 minutes of cooling followed by 10 minutes of passive rewarming for the first 24–48 hours. 
  • Compression: Use an elastic bandage or improvised wrap, fitted snugly but not so tight as to compromise circulation. Check capillary refill, sensation, and movement of distal extremities regularly. 
  • Elevation: Elevate the injured area above heart level when feasible to reduce swelling.

Suspected Fractures

  • PRICE Protocol, as above
  • If self-ambulation is not possible, call 911/ initiate evacuation.
  • Open fractures (exposed bone) should be identified and any wound covered with a clean dressing to prevent further contamination. Do not attempt to clean.
  • Long-bone fractures and open fractures can cause substantial, potentially life-threatening blood loss — a pale, blue, or purple extremity indicates poor perfusion and warrants urgent evacuation.

Major Falls with extent of injury unknown (ex: falls from a height)

  • Before approaching the patient, assess the scene for ongoing hazards (rockfall, unstable terrain). Risks to rescuers must be weighed against likely benefits to the patient. 
  • Wilderness falls commonly cause lower extremity (47%), head (40%), and spine (36%) injuries.
  • Primary Survey (ABCDE)
  • Airway: Look for any obstructions, listen for fluid or gurgling, feel for air moving in and out of airway. Remove obstructions before proceeding.
  • Breathing: Look to see if chest wall is moving properly, listen for wheezing or unusual sounds, feel for movement of air. Do artificial respiration if not breathing.
  • Circulation: Look for severe bleeding (remember to look for bleeding of torso, and for femur fractures), listen for heartbeat, feel for pulse at neck and wrist. If there is no pulse, do CPR. If there is severe bleeding, control it with direct pressure.
  • Disability/Deformity: Protect the head, neck and back. Use soft padding or clothing alongside the head and neck to help with immobilization. Check extremities for any obvious deformities or injuries.
  • Environment: Prevent hypothermia by removing any wet clothing and covering with heat retaining jackets/clothing. Prevent heat illness by creating shade; do not attempt to give anything by mouth until EMS arrives.

 

(Sources: Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update; Pre-Hospital Trauma Care, The Surgical Clinics of North America, 2024)

The information provided on this CVHC page is for general informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.