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Ouch! – Wound Care for Trail Runners

lhoward-artMost of the first aid I’ve had to give when I work aid stations has consisted wound care. Sometimes there’s heat exhaustion, sometimes hypothermia, lots of low sugar, hyponatremia, and blisters, and a good number of strained/sprained knees and ankles.

But really, it’s mostly wounds. Abrasions, gashes, punctures, scrapes — skinned knees and palms — and ugly looking faces.

You really have to volunteer at mountain bike races if you want to see some good trauma. We runners mostly trip and fall at moderate speeds. Now, I’ve seen some nice deep gashes and some really dirty abrasions. And folks are definitely in pain. But bloody wounds aren’t usually a race stopper.

That said, most people who have fallen and gotten bloody do ask for help cleaning and bandaging their wounds. So I thought I’d talk about good wound care in this article. It’s not a sexy skill, but you’ll definitely use it. And if you don’t do it well, you’re setting your runner up for infection and a nice scar.

The key to good wound cleaning is pressure irrigation. You need one of these in your first aid kit.

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It costs about 99 cents and doesn’t weigh anything.

And nothing creates the pressure this thing does. (Go get one.)

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(They also make for good water guns when you’re waiting for runners to come through.)

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You fill the syringe with water (fit to drink) and squirt it just above the surface of the wound.

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This will hurt. A bit. And if it doesn’t hurt, you’re not doing a good job.

But what about the iodine to kill the germs? Alcohol wipes? Soap? Hand sanitizer?The hydrogen peroxide your mother swore by?

Nope.

While all those things do kill germs, it turns out they also damage healthy tissue and slow wound healing. What you want is to blast the germs out of the cut with high pressure water.

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The germs are cleaned out and the tissue isn’t damaged.

Put your sunglasses on before you start squirting, so you don’t get water or blood in your eyes. Remember, you’re trying to prevent infection and scarring.

So when the runner makes this face

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when you press down hard on the end of the syringe, tell them it’s only going to hurt until you’re done. And smile sweetly. (Or if you’re Olga you can give them a withering look and tell them to suck it up.)

Pressure irrigate the wound until it looks clean, or until you’ve used about a handheld water bottle full of water. If you’re cleaning the wound at an aid station mid-race, the runner might not want you to do anything else if the wound isn’t bleeding anymore. Or he might ask you “put something on it.” I usually just cover a wound mid-race with a piece of gauze and hold that in place with some tape.

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If it’s hot out and I’m helping a sweaty runner, I’ll use tincture of benzoin on the skin under the tape. Tincture of benzoin is basically tree sap with a little alcohol. It’s great under tape and anything you want to stick. (Add it to your blister care kit.)

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Knees are hard to keep a bandage stuck to during a race regardless of what you do. (Thank goodness runners rarely land on their knees when they fall.)

If the wound is deep and not gaping open more than about half an inch or so, I’ll use wound closure strips to keep it closed.

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Wound closure strips are just little pieces of tape.

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I’ll put tincture of benzoin around the edges of the wound and then lay down the pieces of tape.

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Then I’ll pull the wound edges closed.

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If I’m not dealing with a knee or an elbow and it’s not crazy hot and humid out, and the runner isn’t particularly hairy, I’ll put a semipermeable dressing over the top of that.

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It’s like Gortex for wounds. Keeps stuff out, but it’s breathable. OpSite & Tegaderm are brand names. You can get them at your local drug store or supermarket pharmacy. If I can’t use a semipermeable dressing because it’s too hot and humid etc., or I want to use less expensive stuff, I’ll just use gauze and tape to cover the wound closure strips.

If I’m doing wound care at the finish line or on a runner who’s dropping, I’ll put some antibiotic ointment on the gauze to keep the wound moist. Moist wounds heal faster and better than wounds that are allowed to scab over and dry out. But didn’t your mom tell you to let your cut air out?

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Well, let’s just say they don’t update the curriculum at Mom School often.

You don’t need to add any antibiotic ointment under a semipermeable dressing if you use that instead of gauze. The plastic keeps the wound moist. And remember, that’s all you’re using the ointment for — moisture. Antibiotic ointment isn’t going to keep a wound from getting infected if you haven’t cleaned well.

Then I’ll tell the runner to scrub around the wound with soap when they shower. They want to get all the race “flora and fauna” off the intact skin so it isn’t a source of infection. And I’ll give them extra supplies to redress the wound if I have them and tell them to reclean the wound a couple of times a day until it heals.

So in a nutshell: High pressure water does the best cleaning. Get one of these.

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Please let me know if you have any questions.

– Liza Howard

About the author

Liza Howard Liza Howard became addicted to ultra running belt buckles back in 2008 and now runs for New Balance and coaches fellow ultra runners. She also teaches for the Wilderness Medicine Institute and is a field instructor for the National Outdoor Leadership School. For more information on Liza, check out the About page where you can learn about her coaching, trail running camp, and daily life musings.

4 Responses to “Ouch! – Wound Care for Trail Runners”

  1. on 19 Jul 2013 at 3:28 pm olga

    I can smile and still say “Suck it up!”. But if you try to do that to me…ain’t happening! http://3.bp.blogspot.com/_6lYTj73OC_g/R8yuhNfc0kI/AAAAAAAACBg/xXQDO3RWe3A/s1600-h/OP50.jpg
    I never let anyone wash it, neither during a race, nor after, was picking up little rocks and sand long after with the scab, and an infection left a lovely scar…But I always say :Scars make a man a more handsome one”…it’s just I am kinda a girl?
    Don’t do what I do, do what Liza says!!!

  2. on 19 Jul 2013 at 4:14 pm Liza

    Oh, “How to Get Good Scars/Good Scar Stories” is a totally different article. Maybe next month. Either that or heat emergencies.

  3. on 20 Jul 2013 at 10:12 pm Jonathan

    That’s gross Olga.

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