ER or Not: Breaking a Bone in the BackcountryJul 23, 2014
Serious injury in a remote location can present a real problem. What should you do if you break a leg on a hiking trail? Emergency Room physician Dr. Scott Youngquist talks about getting help. He gives some handy advice about first aid and emergency protocol.
Interviewer: What do you do if you break a bone in the back woods? That's coming up next on E.R. or Not.
Intro: Is it bad enough to go to the emergency room, or isn't it? Find out now. This is ER or Not on the scope.
Interviewer: What do you do if you break a bone in the backwoods? That's today ER Not with Dr. Scott Youngquist from the Emergency Department here at the University of Utah Hospital. So it could happen, right, you're out hiking?
Dr. Youngquist: It does happen sometimes.
Interviewer: And somebody breaks a bone like yourself or somebody you're with. What do you do at that point?
Dr. Youngquist: Yeah. We've had this happen to some of our residents before when they're out mountain biking and breaking a bone, or even some of our faculty members. There's not much you can do to fix the problem, obviously, out in the wilderness. So the main consideration is how do you get out to definitive medical care?
Interviewer: Got you.
Dr. Youngquist: So the question is where's the bone? If it's one of your legs, can be very hard to get out of there, unless you can limp on one leg or something like that. Main treatment in the backwoods is to try to splint it for comfort, so you can mobilize and get out, get to the emergency department. And you can use just about anything, as splinting device.
Dr. Youngquist: You can use a stick, or something like that, that's wrapped around your leg. Something that will hold the bone in . . . or hold the limb in some sort of position of comfort while you move, so that it doesn't wiggle around so much and hurt so much. And that's about all you can do.
Interviewer: So that's a comfort thing. It's not even necessarily a practical thing, huh?
Dr. Youngquist: It's just a comfort thing. It's trying to keep...all the way up.
Dr. Youngquist: If you've got an open fracture, or fracture in which a bone is poking out of the skin or something like that, if you got moist gauze, you can put that over the exposed bone and cover the wound. That's something that's going to require antibiotics and possibly surgery to wash out that area, because it quickly becomes contaminated with bacteria. So you want to avoid contamination as much as possible. Keep that covered. If you don't have gauze, wet gauze or something like that, whatever you have to keep it covered is important. You don't want dirt and things like that . . .
Dr. Youngquist: To get into the womb. That's the main other consideration.
Interviewer: Got you. Are there any considerations, say break a leg, and you said getting out it's the important thing. Can you do some serious damage to that broken bone, just trying to get out?
Dr. Youngquist: You could. You could make a bad fracture worse. You could turn a fracture that's a close fracture, or there's nothing poking out of the skin into an open fracture where the bone pokes out, particularly if you got you know, if your shin bone is broken, your tibia, and it's tempting the skin or something like that. And you're trying to walk on that, you can make things worse by applying pressure to it and moving it around too much.
Interviewer: So what would you do if you were in that situation?
Dr. Youngquist: Well I'd... first thing I'd do is check my cell phone. And I'd be looking for bars on my cell phone.
Dr. Youngquist: See if I can have somebody come and get me. Unless there's someone there with me who could help me out. If I'm all by myself, which I don't recommend you being in the backwoods by yourself, but if you're all by yourself, you got to try and get somebody out there to help you if you can't move obviously. Air Med every year will go out and do some rescues out in the backwoods for people just like this, who can't get out in a timely fashion and can't move, can't walk or whatever and are stuck in the backwoods.
Interviewer: Would it be better if you were somebody to have that somebody go and get help and leave the person with the broken bone there. Especially if it's like a leg there or something that really inhibit their mobility?
Dr. Youngquist: Yeah if there's no way you can move, even without the help of another person, then sending them onto get some help is probably the only way you're going to get any help.
Interviewer: And calling Air Med is okay. Calling 911 for something like this is all right?
Dr. Youngquist: Yeah, that's what we're here for.
Interviewer: We're your daily dose of science, conversation, medicine. This is the Scope. University of Utah Health Science Radio.