Raging Black Bears Show Fangs Before Hibernating.

They do what? That is actually a mnemonic I use to remember the priorities of treating the most important to the least treatable in a combat or wilderness environment. I used this mnemonic as a Combat Medic and it actually crossed over to the wilderness environment. Although head injuries are serious, there’s very little we can do to treat a head injury. This is how I remember what to treat first.

R- Responsive
B- Breathing
B- Bleeding
S- Shock
F- Fractures
B- Burns
H- Head Injuries

Responsiveness is documented using AVPU. A few ways to test for responsiveness is to talk to them and look for a response. If no response, tap them or lightly shake their shoulder then move onto more aggressive techniques. A very effective way of checking for responsiveness to painful stimuli is a sternal rub. You take your knuckles and with light pressure, rub your knuckles up and down along the sternum. You will likely get a response out of that.

Breathing can be checked with the following:

  • Look for the chest to rise and fall.
  • Listen for the air exchange, and
  • Feel their breath.

You will lower your head close to their head while you turn to face their chest. Your ear should be close to their mouth. If no air exchange, a simple repositioning of the head using the head tilt-chin lift might be all you need. If nothing, give a couple of breaths.

Bleeding and Shock

Bleeding can be controlled with a dressing and bandage. What about closing a cut? I have experience in suturing, stapling, butterflies and steri-strips. Suturing isn’t complicated but requires more gear, such as locking hemostats, to hold the needle so it can be pushed through the skin. I felt I needed a third hand to suture. The better alternative is a surgical skin stapler which comes in a sterile package and can be readily purchased for about $10.00 online.

Another style of wound closure is steri-strips. I have used these more than anything else. It takes up no space in a pack or pocket. You can also make butterflies to close a wound. I have just taken a strip of tape, placed it on a water bottle and cut them out for use.

A few years ago, I was out in the wilderness with a few guys in a wilderness survival course. We were making primitive bows and one guy received a pretty good cut on the hand. He could not get it to stop bleeding, so I located some Yarrow Achillea millefolium. Caution should be used when identifying this plant since it looks a bit similar to Hemlock. Another look-alike is Queen Anne’s Lace, which is edible. Once I gathered a small amount of Yarrow, I placed it on the bleeding cut for a few minutes until it stopped bleeding. This was the same medicinal plant that was carried by Achilles who carried it into battle to treat battle wounds.

Shock comes from a wide variety of reasons. It can come from blood loss, injury to the central nervous system and infection. The traditional way to treat shock is to loosen clothing and regulate the patient’s temperature. Get the patient off the ground by using a sleeping pad or blanket. I’d say, if you were to leave the person to get help, the Recovery Position might be a good option. Have a blanket available for any temperature changes, even if it’s just a space blanket.

Fractures (and Sprains) can be treated by splinting or wrapping. Another one to remember is R-I-C-E which means Rest, Ice, Compression & Elevation. An excellent improvised splint is a sleeping pad. Be sure to splint the injury by immobilizing the joint above and below. Check for a distal pulse which means there is blood flow beyond the splint and injury.

You might have to assist the patient out of the area by fashioning a litter. That can be completed by using a full-size sleeping pad to help with the size on the litter. Place the litter on the ground and then find sturdy pieces of wood on each side and one on each end. You will then lash the 4 corners. After lashing the corners, take a rope or long piece of paracord to lace in the bed. Use the sleeping pad as the bed for the patient. Consider securing the patient to the litter if there is a concern.


Burns in a wilderness or remote environment, even though it might look minor may have more serious concerns. When assessing a patient for the possibility of burns, we should look for singed hair or redness to the skin. Burns can come from extended exposure to the sun, flames from a campfire, or even chemical burns. The first step is to remove the patient from the source. That could mean removing clothing or removing the patient away from the source. A good rule to follow is to assume airway burn if there is singed facial, nasal or chest hair. This is an emergency and you should check the airway. Other signs would be coughing or wheezing. Apply cool water to the burns to stop the heat. Keep in mind that you do not want too cold of water since that may cause the patient to become hypothermic. Some larger burns will cause poor circulation.

Clean the burns and apply loose and dry dressings to cover the burn because you are trying to prevent infection. Change the dressing daily.

Head & Spine Injuries

Head & Spinal Injury is assumed when a person falls from 1 ½ times their height or when there are other signs & symptoms such as a cracked helmet, Raccoon Eyes, Battle’s Sign, or leaking of spinal fluid from the ear. Other classic signs of head & spinal injury are difficulty breathing, weakness or paralysis along with numbness & tingling. Loss of control of the bowel and bladder are others.

As usual, you want to immobilize the patient’s head & spine. Use a pair of boots with one on each side of the head. I’ve used a military sleeping pad by folding it in half lengthwise then rolling up a Nalgene bottle on each end. This makes a large roll for each side of the head. Using a backpack frame as a short spine board is another thing to consider. If you have to move the patient, keep the head, neck and spine in alignment. There is a technique being taught in the wilderness medical world call, BEAM. That stands for Body Elevation And Movement. Essentially, its where a group gathers around the patient and there is a synchronized lift of the patient. There are a number of books and videos showing the details of this maneuver. In further detailed training in wilderness medicine, a student will learn a Focused Spinal Assessment. That assessment, among other in-depth training, can’t be covered here since this is a limited article.

First Aid Kits are best when they are self-made since you know the contents. You have specifically decided on what you consider important. I have a number of items that have more than one use and some items are self-made for medical use. I have a cut to fit roll of Saran Wrap which is excellent for use as a bandage or occlusive dressing. I have a small container of potassium permanganate which serves as a wound disinfectant and water treatment. On the note of wounds, the potassium permanganate can be mixed in a disposable water bottle. Cut a few small holes in the lid and squeeze for high pressure irrigation for cleaning wounds.

Additional Comments

I encourage everyone to take a wilderness medical course since it is the type of training I wish I had as a Combat Medic. It is all about long term care in a variety of injuries. It is filled with useful information that can be used more realistically.

I encourage learning about medicinal plants and using them. A really easy one is Plantain Plantago major. Its commonly found in yards and coming up in the cracks of sidewalks. It’s great for drawing out poisons such as stings and bites. To prepare it, you just shred it to release the juices. Some have even chewed it into a “spit poultice”. Apply the poultice on the bite or sting and the poison will be drawn out.

I recommend a few additional reading materials that are good to have in your library. The first one is The Herbal Medic by Sam Coffman who is a former Special Forces Medic. The book is written as a textbook and full of valuable information. Another set of books to have Where There Is No Doctor and Where There Is No Dentist.

All of wilderness medicine can’t be covered in one article but I hope I hit the high points and will encourage you to study more and add to your library. The next article in this series will be on fire and its importance.


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