The Challenge of Remote Medical Care

When you're miles from the nearest road — let alone a hospital — your knowledge and preparation become your most important medical resources. Envenomation from snakes and insects is one of the more common serious hazards outdoor enthusiasts face, and the actions taken in the first minutes and hours significantly affect outcomes.

This guide covers what to do (and critically, what not to do) when these encounters happen in the backcountry.

Snake Bites

Identifying a Venomous Bite

Not all snake bites inject venom — many are "dry bites." However, you should always treat any snake bite as potentially venomous unless you can positively identify the species as non-venomous. Signs of envenomation may include:

  • Immediate, intense pain at the bite site
  • Swelling and bruising spreading from the bite
  • Nausea, vomiting, or dizziness
  • Difficulty breathing (in severe cases)
  • Blurred vision or numbness (neurotoxic species)

What to Do After a Snake Bite

  1. Stay calm and keep the victim still. Increased heart rate speeds venom absorption. Panic is your enemy.
  2. Get away from the snake — do not attempt to handle or kill it. A photo for identification is helpful if safe to obtain.
  3. Remove constrictive items — rings, watches, and tight clothing near the bite site before swelling begins.
  4. Immobilize the bitten limb at or below heart level.
  5. Evacuate immediately. Antivenom is the definitive treatment — get to medical care as quickly as possible.
  6. Note the time of the bite and monitor and document symptoms as evacuation proceeds.

What NOT to Do

  • ❌ Do not cut and suck the bite — this is ineffective and causes additional injury.
  • ❌ Do not apply a tourniquet — it can cause more damage than the venom.
  • ❌ Do not apply ice — cold can worsen tissue damage.
  • ❌ Do not give alcohol or medications unless directed by medical personnel.

Insect Stings

Mild to Moderate Reactions

Most stings from bees, wasps, or hornets cause localized pain, swelling, and redness. These can be managed in the field:

  1. Remove the stinger (for bees) quickly by scraping it out with a fingernail or card — do not squeeze it.
  2. Wash the area with soap and water.
  3. Apply a cold pack or cool cloth to reduce swelling.
  4. An oral antihistamine can help reduce itching and minor allergic response.
  5. Hydrocortisone cream can ease local inflammation.

Anaphylaxis: The Life-Threatening Reaction

Anaphylaxis is a severe, systemic allergic reaction that can develop within minutes of a sting. This is a medical emergency requiring immediate epinephrine injection.

Signs of Anaphylaxis

  • Hives, itching, or flushing over large areas of the body
  • Swelling of the throat, tongue, or lips
  • Difficulty breathing or wheezing
  • Rapid, weak pulse
  • Dizziness, fainting, or confusion
  • Nausea and vomiting

Treating Anaphylaxis in the Wilderness

  1. Use an epinephrine auto-injector (EpiPen) if available — inject into the outer thigh immediately.
  2. Call for emergency evacuation.
  3. Position the person lying flat with legs elevated (unless breathing is easier sitting up).
  4. A second EpiPen dose may be used after 5–15 minutes if symptoms don't improve.
  5. Even if symptoms improve, the person must be evacuated — secondary reactions can occur.

Prevention in the Field

  • Wear long sleeves and pants in snake country; watch where you step and place your hands.
  • Use insect repellent and avoid brightly colored or floral clothing near hives.
  • Anyone with known severe allergies should always carry an EpiPen in the backcountry.
  • Consider a Wilderness First Aid (WFA) or Wilderness First Responder (WFR) course for extended backcountry travel.

Preparation and calm, methodical response are the cornerstones of wilderness medicine. Know your risks before heading out, pack accordingly, and always have an evacuation plan.