# Wilderness First Aid Guide: Handling Outdoor Emergencies

A practical guide to wilderness emergency response: checking injured patients with MARCH PAWS, treating trauma, hypothermia wraps, and calling for help.

Wilderness First Aid is different from first aid at home or school. When a hospital is hours or days away, you need to know how to keep an injured person safe, warm, and stable while your patrol arranges for help.

## Checking the Scene and the Patient

Before rushing in to help an injured person, stop and look around. Rescuer safety always comes first.

### The S.T.O.P. Rule
- **S – Stop:** Take a deep breath. Stay calm.
- **T – Think:** Check for danger (falling rocks, lightning, swift water, traffic).
- **O – Observe:** See how many people are hurt and what supplies you have.
- **P – Plan:** Put on medical gloves, make a plan, and assign jobs to your patrol.

![Backcountry Wilderness First Aid Primary Assessment (MARCH PAWS)](https://scouting.university/img/diagrams/march-paws-flowchart.png)

### The Primary Check: The MARCH Protocol

In the outdoors, severe bleeding is the fastest threat to life. Follow the **MARCH** steps for your quick 60-second check:

| Letter | What to Check | What to Look For | What to Do Right Away |
| :--- | :--- | :--- | :--- |
| **M – Massive Bleeding** | Arms, legs, neck, and body | Spurting or pooling blood | Press hard on the wound with clean gauze or use a commercial tourniquet. |
| **A – Airway & Neck** | Throat and breathing passage | Blocked throat; neck injuries | Keep the head still; open airway using the jaw-thrust without bending the neck. |
| **R – Respiration (Breathing)**| Chest rise and breath sounds | Trouble breathing; chest wounds | Cover open chest holes with a vented chest seal; sit patient comfortably. |
| **C – Circulation** | Wrist and neck pulse | Weak pulse; cold, pale skin | Check wrist pulse and nailbed color; keep patient lying flat to treat shock. |
| **H – Hypothermia & Head** | Body warmth and alertness | Shivering, confusion, cold ground | Put an insulated sleeping pad and sleeping bag under the patient right away! |

## When and How to Evacuate

| Situation Level | How Fast to Evacuate | Examples | What Your Patrol Does |
| :--- | :--- | :--- | :--- |
| **Emergency (Life-Threatening)** | Right away / Call Search & Rescue | Severe bleeding, core body temp below 90°F or above 104°F, unconsciousness, severe chest pain | Press SOS on satellite messenger or call 911; clear a helicopter landing zone |
| **Urgent (Within 6–12 Hours)** | Same-day evacuation | Broken bones that are splinted, deep wounds needing stitches, severe sprains | Carry patient in a litter or coordinate with Search & Rescue ground teams |
| **Non-Urgent (Walk Out)** | Hike out when ready | Minor sprains, small scrapes, mild altitude headache, mild asthma | Patrol carries patient's pack and walks out with them to the trailhead |

### Ways to Call for Help in the Backcountry

| Method | How It Works | Signal Needed | Best Way to Use It |
| :--- | :--- | :--- | :--- |
| **Cell Phone / SMS** | Cell towers (Voice/Text) | Low cell service | If calls drop, **send a text to 911** (text messages can send through tiny bursts of signal). |
| **Satellite Messenger** | InReach, ZOLEO, Apple SOS | Clear view of sky | Send your GPS coordinates, patient age, injuries, and what help you need. |
| **Personal Locator Beacon** | Emergency NOAA Satellites | Direct distress beacon | Turn on ONLY in life-threatening emergencies where someone cannot survive without immediate rescue. |
| **Ground-to-Air Signals** | Visual signals on the ground | Aircraft search | Stamp out big 10-foot letters in snow: `V` (Need Help) or `X` (Medical Help), or make 3 whistle blasts. |

## Taking Notes on the Patient (SOAP Note)

A SOAP note helps you organize your notes and give clean information to paramedics or Search & Rescue teams:

| SOAP Section | What It Means | What You Write Down |
| :--- | :--- | :--- |
| **S – Subjective** | The Patient's Story | Name, age, time of injury, where it hurts, and **SAMPLE** notes (Signs, Allergies, Medications, Past medical issues, Last food/water, Events leading up). |
| **O – Objective** | What You Find | Findings from your head-to-toe check (**DOTS**: Deformities, Open wounds, Tenderness, Swelling) and vital signs (Time, Pulse rate, Breathing rate, Skin warmth). |
| **A – Assessment** | Problem List | List the problems in order of danger (e.g. 1: Broken lower leg; 2: Mild hypothermia; 3: Scraped elbow). |
| **P – Plan** | What You Did | Treatments you gave (splinting, bandages, warm wrap), how you plan to evacuate, and when to re-check vitals. |

### How Awake Is the Patient? (The AVPU Scale)

| Score | How the Patient Responds | How to Check |
| :--- | :--- | :--- |
| **A – Alert** | Wide awake; knows who they are, where they are, and what time it is | Ask simple questions: *"What is your name? Where are we?"* |
| **V – Verbal** | Drowsy; opens eyes or speaks only when you talk loudly | Speak loudly near their ear |
| **P – Pain** | Responds only to pinch or rub; does not speak | Gently pinch the shoulder muscle |
| **U – Unresponsive** | Completely unconscious; does not respond to voice or touch | Check breathing and neck pulse immediately |

## Treating Injuries in the Field

### Severe Bleeding & Tourniquets
If direct pressure with gauze pads cannot stop severe spurting bleeding on an arm or leg:

> **Safety First!**
>
> **Tourniquet Rules:**
> 1. Put the tourniquet **2 to 3 inches above the wound** (between the cut and the heart). Never put it directly over a knee or elbow joint.
> 2. Pull the strap as tight as humanly possible before turning the windlass rod.
> 3. Twist the rod until the bright red bleeding completely stops.
> 4. Lock the rod into the clip.
> 5. Write the exact time (like `TK 2:30 PM`) on the patient's forehead or on the white tourniquet tag.
> 6. **NEVER loosen or take off a tourniquet once it is applied.** Only hospital doctors should take it off.

### Broken Bones & Sprains: Checking CSMs
Always check **CSMs** before and after you put on any splint:
- **C – Circulation (Blood Flow):** Check for a pulse past the injury (wrist or foot). Make sure the fingers or toes feel warm.
- **S – Sensation (Feeling):** Have the patient close their eyes. Touch a toe or finger and ask: *"Which toe am I touching?"*
- **M – Movement:** Ask the patient to wiggle their fingers or toes.

| Splinting Step | What to Do |
| :--- | :--- |
| **1. Shape First** | Splint the limb in the position you found it. |
| **2. Immobilize Joints** | Support the joint **above** and the joint **below** the broken bone. |
| **3. Pad the Splint** | Place soft clothing or fleece between the splint and the skin. |
| **4. Leave Toes/Fingers Out** | Keep fingers or toes uncovered so you can re-check CSMs every 15 minutes. |

## Cold, Heat, and Altitude Emergencies

### Hypothermia & The "Burrito Wrap"

Hypothermia happens when body temperature drops below 95°F.

| Level | Signs & Symptoms | What to Do |
| :--- | :--- | :--- |
| **Mild Hypothermia** | Shivering, feeling cold, "Umbles" (stumbling, mumbling, fumbling, grumbling) | Put on dry clothes, windproof jacket, drink warm sweet drinks, do gentle walking. |
| **Moderate Hypothermia** | Shivering stops, slurred speech, confusion, clumsy movements | Build a full Hypo Burrito Wrap, place warm bottles on chest/armpits, handle gently. |
| **Severe Hypothermia** | Unconscious, barely breathing, very weak pulse | Immediate Hypo Wrap, do not shake or move roughly, call Search & Rescue ASAP! |

![Hypothermia Hypo-Wrap ('Burrito Wrap') System](https://scouting.university/img/diagrams/hypothermia-burrito-wrap.png)

> **Safety First!**
>
> **Warm the Chest First:** Never put hot water bottles directly on cold feet or hands. Always warm the **chest, neck, and armpits** first. Warming cold arms and legs first can send cold blood rushing back to the heart, which is dangerous.

### Heat Exhaustion vs. Heat Stroke

| Condition | Body Signs & Skin | How the Scout Acts | What You Must Do |
| :--- | :--- | :--- | :--- |
| **Heat Exhaustion** | Heavy sweating, pale cool clammy skin, headache | Normal thinking, tired, thirsty | Rest in shade, loosen clothes, sip cool water with electrolytes, fan with hat. |
| **Heat Stroke (Emergency!)** | Hot red skin, sweating may stop, very rapid pulse | Confused, dizzy, fainting, seizures | **Cool First, Move Second!** Douse with cold water, fan aggressively, place ice/cold packs on neck and armpits, call 911/SAR! |

### Altitude Sickness
When hiking above 8,000 feet, thinner air can cause altitude sickness:
- **Mild Mountain Sickness:** Headache, upset stomach, tiredness, trouble sleeping. *Rest, drink plenty of water, and do not climb higher.*
- **Severe Mountain Sickness:** Trouble breathing while resting, coughing, slurred speech, or unable to walk a straight line.
- **The #1 Rule of Altitude Sickness:** **"GO DOWN!"** Hiking down 1,000 to 2,000 feet is the fastest, safest cure.

### Snake Bites (North American Pit Vipers)
1. Keep the patient calm and sitting still (moving fast spreads venom).
2. Take off rings, watches, and boots before swelling starts.
3. Keep the bite at **heart level** (not elevated, not hanging down).
4. Draw a circle around the swelling with a pen and write the time; check every 15 minutes.
5. **NEVER** cut the bite, suck out venom, apply ice, or use a tourniquet.
6. Get the patient to a hospital right away.

## Patrol First Aid Kit Checklist

**Patrol Wilderness First Aid Kit Checklist** — Pack these items in your patrol first aid pouch

- [ ] 6 pairs of nitrile gloves (non-latex) and CPR face shield.
- [ ] 1 commercial tourniquet (CAT or SOFTT-W) and trauma shears.
- [ ] 2 pressure bandages and 10 sterile gauze pads.
- [ ] 1 SAM Splint (36-inch) and 2 triangular bandages (cravats).
- [ ] 1 roll of elastic athletic wrap (Ace bandage) and medical tape.
- [ ] Blister moleskin, hydrocolloid pads, and assorted band-aids.
- [ ] Antiseptic wipes, clean water flush syringe, and triple antibiotic ointment.
- [ ] Waterproof notebook and pencil for SOAP notes.
- [ ] Tick tweezers and digital thermometer.
- [ ] Emergency space blanket or thermal bivvy.

> **Tip**
>
> **Wound Cleaning Tip:** Clean water is the best way to clean a dirty scrape on the trail. Use a clean plastic bag with a tiny pinhole (or a clean water bottle) to squirt water with pressure into the scrape to wash out dirt and gravel before bandaging.

## Related Merit Badge Guides & Rank Requirements

Merit Badge Guide: [First Aid Merit Badge Guide](https://merit-badge.university/merit-badges/first-aid/guide/): Emergency triage, CPR/AED protocols, wound management, and hurry-case wilderness care.

Merit Badge Guide: [Emergency Preparedness Merit Badge Guide](https://merit-badge.university/merit-badges/emergency-preparedness/guide/): Develop family emergency response plans, search-and-rescue protocols, and disaster readiness.

- [Tenderfoot Rank Guide: Basic First Aid & Wounds](https://scouting.university/scouts-bsa/ranks/tenderfoot/guide/req4a/)
- [Second Class Rank Guide: Hurry Cases & Shock](https://scouting.university/scouts-bsa/ranks/second-class/guide/req6a/)
- [First Class Rank Guide: Advanced First Aid & CPR](https://scouting.university/scouts-bsa/ranks/first-class/guide/req7a/)