Backcountry Wound Care: How to Clean, Close, and Manage Wounds in the Wilderness

A gash on your forearm looks the same whether it happens in your kitchen or on a ridgeline at 11,000 feet. The difference is what comes next. In your kitchen, you rinse it under the tap and drive to urgent care. On the ridgeline, you are the urgent care — and the decisions you make in the next twenty minutes determine whether that wound heals cleanly or becomes an infection that ends the trip.

Prefer to watch? This topic is covered in our free Wilderness First Aid video course:

This is the core principle behind all of wilderness first aid: it's about time. The difference between urban medicine and wilderness medicine is the time you have with your patient until you can get them to definitive care. In the front country, access to definitive care is quick. In the backcountry, it's slow — which means you have to be able to provide care until professional help arrives.

Wound care is the skill you'll use most often. As the AOS Wilderness First Aid course teaches, the most common medical issues in the backcountry are cuts, scrapes, and burns. This guide covers the complete field protocol: how to stop bleeding, how to clean a wound properly, when to close it versus leave it open, how to dress and monitor it, and when a wound means you need to evacuate.

Step 1: Stop the Bleeding

With any soft tissue injury, always stop the bleeding first. The method is simple: direct pressure. Apply a clean dressing to the wound and press firmly. Most of the bleeding you'll encounter in the backcountry will stop with direct pressure alone.

Ideally, the patient holds pressure on their own wound so you can perform other duties — assessing the scene, gathering supplies, or tending to other members of the group. Our bodies start clotting in about two to three minutes. Most of the time, direct pressure is all you need.

Don't get hung up on how a wound looks. Bleeding can appear dramatic — a scalp wound, for instance, can bleed like something out of a horror movie. But when you wipe the blood away, you often find a tiny cut underneath. Assess the wound after controlling the bleeding, not before.

Pressure dressings. If a wound continues to bleed even with direct pressure, apply a pressure dressing. A pressure dressing is held on by something other than someone's hands — an ACE wrap, a gauze pad secured with tape, or roller gauze wrapped firmly around the area. This frees you up while maintaining steady compression on the wound.

Important: If the dressing soaks through with blood, take it off and replace it with a fresh one. The old advice about stacking new dressings on top of blood-soaked ones is wrong. If it's soaked through and still bleeding, there's no clotting happening underneath. Remove it, put on a fresh dressing, and continue pressure.

Life-threatening bleeding. Occasionally you may encounter bleeding that won't stop with direct pressure — bright red blood gushing or pumping from the wound. A tourniquet is the only way to stop this type of bleeding. If you carry a tourniquet and have been trained to use it, apply it without hesitation. Tourniquets save lives, and the fear of causing limb loss is largely overblown — they can stay on for a long time before that becomes a concern. The alternative, doing nothing, is far worse. This patient needs evacuation to definitive care.

Step 2: Clean the Wound

This is the single most important step in backcountry wound care, and it's what separates wilderness medicine from front-country first aid. In an ambulance, the standard is to stop the bleeding, dress and bandage the wound, and take the patient to the hospital for cleaning. In the backcountry, cleaning the wound is on you.

How well you clean a wound directly affects whether you need to evacuate or can keep the trip going, whether the wound becomes infected or heals. Cleaning wounds is an essential component of wilderness medicine, and so is recognizing the signs of infection and complicating factors.

Use water. Only water. This is one of the most important things the AOS Wilderness First Aid course teaches about wound care: if the water is drinkable, it can clean a wound. You do not need to add anything else. No alcohol. No hydrogen peroxide. No betadine or iodine. Throw all of those out.

This surprises most people because those products are marketed as wound cleaners. But anything other than water is cellular toxic — it kills everything, including the healthy tissue surrounding the wound. When you damage healthy tissue, you retard the healing process, prolong wound exposure, and actually increase the chance of infection. You're doing the opposite of what you're trying to accomplish. Even in clinical settings — emergency departments, operating rooms — only water is used to clean wounds.

Pressure is essential. Pouring water over a wound isn't enough. You need pressure to dislodge bacteria and debris from the tissue. The best field tool is a large syringe — fill it with clean water, aim the tip at the wound, and irrigate with force. A syringe lets you control where the water goes and deliver it with enough pressure to actually clean the wound bed.

No syringe? Poke a small hole in the cap of a plastic water bottle and squeeze hard. It's less precise, but it generates enough pressure to be effective.

Use plenty of water. Cleaning the wound needs lots of water and pressure. Many people worry about wasting water in the backcountry, and that's a reasonable concern. Use your judgment — but know that a dirty wound becomes an infected wound, and an infected wound complicates patient care, recovery, and may require evacuation. The water you spend cleaning a wound now can save you an emergency evacuation later.

Step 3: Dress and Bandage

Once the wound is clean, you dress and bandage it. The distinction matters: a dressing goes on the wound, and a bandage holds the dressing in place.

A good backcountry first aid kit must have plenty of both. A properly stocked kit will be roughly 60% dressings and bandages — because wound care is what you'll spend most of your time doing in the field.

Dressings. Use 4-inch dressings, not 2x2s. Most people carry dressings that are too small to be useful on real wounds. A 4-inch gauze pad covers more area, absorbs more fluid, and is far easier to work with in the field.

Bandages. Six-inch roller gauze is the workhorse. Make sure you have enough to wrap the dressing securely. As with splinting, you're concerned with ease of application and functionality, not form. It needs to work.

Tegaderm is another excellent option. It's a transparent film that's breathable, waterproof, and lets light into the wound. This matters because air and light are the enemies of infection. Tegaderm provides both while keeping the wound dry. It takes some practice to apply correctly, so familiarize yourself with it before you need it in the field.

Band-aids. If you carry them, make sure they're big ones — minimum 2-inch size. The small 1-inch variety won't do much for a real backcountry wound.

Step 4: Decide — Close or Leave Open?

Wound closure in the backcountry is more nuanced than most people realize, and the default should lean toward caution. The course book is clear: we do not stitch wounds in the backcountry. That's a job for the emergency room, where a doctor can close the wound layer by layer with no trapped pockets for bacteria to grow.

What we do have are butterfly bandages and wound closure strips. These are not wrong when applied correctly — but they must be applied correctly. The key principle: take the strips and bring the edges of the skin close together but not closed. The wound must remain open enough for air and light to circulate. If you seal a wound completely with closure strips, you create a dark, warm, moist environment — ideal conditions for bacteria to grow. That's the exact opposite of what you want.

Never close animal bites. Animal bites are highly prone to infection. Puncture wounds are already susceptible to infection on their own, but the bacteria from an animal's mouth add additional risk. Clean thoroughly, dress and bandage, but do not close.

The antibiotic cream question. Antibiotic creams like Bacitracin are everywhere, and they're marketed as if they belong on every wound. They don't. Antibiotic cream is only meant for abrasions and surface-area injuries, and even then it's usually unnecessary. The only reason these products exist is because of poorly cleaned wounds. If you clean the wound properly with water and pressure, and change the dressings and bandages regularly, antibiotic cream adds very little.

Worse, people often put antibiotic cream into deep cuts thinking it will prevent infection. Instead, it creates a dark, warm, moist pocket that allows bacteria to grow — accomplishing the exact opposite of preventing infection. Don't do this.

Step 5: Monitor for Infection

Once the wound is dressed and bandaged, your job shifts to monitoring. Change your dressings and bandages at least two times a day — morning and evening — or whenever they become wet, dirty, or blood-soaked. Do not set it and forget it. We've all left a bandage on for multiple days only to find the skin underneath wrinkled and unhealthy. In the backcountry, that kind of neglect leads to infection.

Keeping wounds clean and changing dressings frequently is often the difference between continuing a trip and having to evacuate.

Local infection signs. When watching for infection, you're looking for the area around the wound becoming red and warm or hot, increasing pain, swelling, or pus production. These signs indicate a local infection. To treat it, you need to get rid of the infection — if the wound has closed up or sealed over, you may need to open it back up. Use alcohol wipes or hand sanitizer to sterilize a blade, then reopen the wound to let the pus drain. Clean it, dress it, bandage it, and stay on top of it. If the infection lingers despite good wound care, the patient may be more prone to infections, or something else is going on.

Systemic infection signs. A systemic infection happens when a local infection is improperly cared for and spreads to the body. You're looking for one or both of two things: a fever secondary to the wound, or red streaks from the wound moving toward the body. For instance, if a wound is on the patient's arm and you start to see red streaks moving up the arm toward the torso, this is becoming a systemic infection. A systemic infection requires evacuation — this person needs antibiotics and a hospital.

When to Evacuate

Even if a wound isn't infected, you may still need to evacuate based on the wound itself. The type of wound — puncture, impalement, avulsion, or laceration — matters less than what you discover when evaluating it. Use your OPQRST and SAMPLE assessment frameworks to get the full picture, then evaluate the wound's depth, width, and length. The more significant the wound's size and depth, the more definitive care the patient will need.

Pay special attention to location. Wounds on some regions of the body cause lifelong problems if not brought to definitive care quickly. The critical areas are wounds on or over joints (which are difficult to immobilize and prone to reopening) and wounds that expose bone, muscle, or tendons.

Evacuate for any of the following: life-threatening bleeding that won't stop with direct pressure; wounds exposing deep structures; wounds showing signs of spreading or systemic infection (fever, red streaking, expanding redness); animal bites (all should be evaluated for rabies risk); wounds with embedded foreign objects that can't be removed; or any wound where the patient has lost sensation or motor function below the injury.

For everything else — the minor cuts, scrapes, and lacerations that make up the vast majority of backcountry wound encounters — proper cleaning with water and pressure, good dressing technique, and diligent monitoring will get your patient through the trip safely. As the course teaches: wound care is relatively straightforward. Clean the wounds and stay on top of them.

Build Your Wound Care Skills

Reading about wound care is a useful start, but practicing it under guidance is what turns knowledge into competence. Every protocol in this guide — bleeding control, wound irrigation, dressing technique, infection monitoring — maps directly to hands-on skills taught in the AOS Wilderness First Aid course.

Training a Team?

When your team works in remote environments, everyone needs the same wound care protocols. Group WFA certification starts at $112/person — volume pricing for camps, guide services, universities, and outdoor programs.

Ready to learn the complete system? Take our free online Wilderness First Aid course — 16+ hours of video instruction covering wound care, patient assessment, splinting, environmental emergencies, and more. No cost, no signup gate. Optional certification available.