On the Trail Triage: What to Do When the Trail Takes Its Toll

Runners are a group not unfamiliar with the concept of “injury.” In fact, we may have been labeled as injury-prone on an occasion or two. Many of our many injuries are of the repetitive or sport-induced nature: sprains, strains, and errant pains. However, for those of us who wander out into nature in search of many miles and a good dose of solitude, we need to be aware of the more traumatic kind of injuries that are available to us. This article seeks to serve as a quick primer on the injuries you can face on the trail and how to treat them trail-side and after get home. By way of full disclosure, I am trained as a Wilderness EMT and not a doctor. Follow any medical advice contained herein as such and, above all, use your best judgment!

Before you run, it is always a good idea to review your preparations. How many layers do you have? How many can you use if you need to improvise a sling or bandage? Are you carrying a cellphone? Do someone know where you are going and when you will return? Are you carrying an ID? These steps should be second nature, only take a few seconds, and can truly make the difference between a good war-wound and tragedy.

So, you have taken a fall or a branch or a rock or.. or… what’s next?

[Editor’s Note: You might be interested in our companion piece to this article outlining the long-term treatment of trail trauma to prevent compensatory running injuries.]

Bleeds – When You’re Leaking

You’re bleeding. What next? Before you slap a sweaty shirt on top of it, take a moment to figure out the type of bleed of your bleed:

Just a flesh wound

Just a flesh wound… specifically, a capillary bleed.

Capillary BleedsSlow-moving, dark (de-oxygenated) blood – These constitute the majority of the bleeds we will likely see on a trail run. As a general rule, letting capillary bleeds bleed a bit is a good thing. It allows the wound to flush out some of the dirt, rocks, and whatnot. And, it means you can finish your run! However, when you get home, you need to scrub that scab away and get the rest of the junk out.

Venous BleedsFast-moving, dark (de-oxygenated) blood – Venous bleeds put out a good amount of blood and will likely have a hard time clotting if you continue moving. Apply direct pressure to the wound with your hand and/or clean (as possible) absorbent fabric. Continue to apply pressure until the bleed clots or stops. Venous bleeds are a reason to turn-around.

Arterial BleedsFast-moving, spurting, bright-red (oxygenated) blood – If you have a bleed that is spurting, apply direct pressure immediately and consider sacrificing a layer to wrap around the site to help restrict the bleeding. While tourniquets have come back into fashion in emergency medicine, you should be able to control an arterial bleed with a good firm wrap. Do not remove pressure or bandage until you have definitive help. Turn around immediately and get help from anyone else on the trail that you may encounter.

Bumps – When You Thump

Generally, bruises (contusions) are only an irritating byproduct of a fall. Most can be treated with ice and rest after the run. However, there are a few cases where you should pay close attention to that bruise:

Bruising with significant and increasing swelling – This could be a sign of internal bleeding. This means increasing tissue damage and loss of blood.

Bruising with significant and increasing swelling – This could be a sign of internal bleeding. This means increasing tissue damage and loss of blood. If a bruised area continues to swell and do so rapidly, take note. There isn’t much you can do on the trail except to  turn-around and take that trip to the ER.

Bruising to the chest-cavity (front and/or back) – The majority of us run with a minimal amount of fat padding our cores. Bruising to internal organs, damage to the lungs, and internal bleeding are all distinct possibilities if you have a significant bump to the chest-cavity. If you have bruising to the chest coupled with abdominal pain, difficulty breathing, and/or firmness at the site of the bruise, you need to get it checked out by the professionals.  Keep yourself as comfortable as possible (sometimes applying pressure to the area with a balled up layer can help) and avoid any exertion on the lungs or core on your way back out.

Impalement – When You Get Stuck

Nobody wants to think about a stick stuck into a leg or, (deep breath), an eye. But, this happens easier than most of us would assume. Do not remove the impaled object. If the impalement is preventing moving towards home/help, try to break it off closer to the body. Pad around the impaled object with clothing to help stabilize it and keep it from moving and causing more damage. If you take something to one eye, pad it and remember that our eyes are meant to move in tandem. Minimize eye movement to prevent further damage to the eye. If ever there was a case for sunglasses and other protective eyewear…

Breaks/Dislocations – When You Bend the Wrong Way

At the hospital, treatment of a dislocation or a break go two very different ways. But, on the trail, it makes very little difference. Your priority is immobilization. If it is a bone, immobilize the joints above and below. If it is a joint, immobilize the bones above and below. The vast majority of the time it is not advisable to try and straighten the break/dislocation trail-side. Doing so can cause more nerve and vessel damage. Pad to fill gaps and put the limb in a comfortable position and make your way out anyway possible. If you have a compound break (bone through the skin), treat the bleed accordingly.

Conclusion and Call for Comments

Clearly, this is not a complete or definitive guide on trail-side injuries. If anything, hopefully it has whet your appetite to becoming better prepared. Prevention and education are the two best things you can bring to a trail run if you want to avoid and survive a traumatic injury. Wilderness first aid classes are available in most areas, only take up two days (three with CPR certification), and usually cost less than a couple of pairs of shoes.

So, who has a good war-wound picture or cautionary tale to share? We emergency medicine types love the gore.

[Editor’s Note: Check back in tomorrow when Joe Uhan explains what to do for longer-term treatment and rehabilitation for your trail trauma.]

[The contents of this column as well as the author’s comments are provided for general informational purposes only and are not intended as a substitute for professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition.]

Adam Barnhart

discovered from an early age that he loved running , but didn't like starting guns. As a result, he is frequently found wandering the area trails around Anchorage, AK, but only at races after considerable peer-pressure is applied. When not trail running, Adam keeps pace with his wife and kids, works as a pastor and, with the Alaska Mountain Rescue Group.