Wilderness First Aid
Posted: Wed Jan 29, 2020 7:41 am
EDIT: When I first wrote this, the top post treated on hypothermia. With the decision to increase the scope of this post, I’ve decided to replace that with a general overview of wilderness first aid as a practice, bumping hypothermia down to a separate section. This may make the first few comments seem a little out of order.
Disclaimer:
Where I can, I draw my knowledge from published, empirical data, with personal experience filling in the gaps. This personal experience comes mostly from training, with (thankfully) very little opportunity to put that training into practice. This is meant as a jumping-off point, and I welcome the expertise of others and heartily encourage anyone who thinks they might need advice on this subject to review other data available on the web and in books. I'm not an expert; just an amateur who's studied enough to get through some tight situations and recognize how easy it is to get into them.
Principles of Wilderness First Aid
Wilderness first aid differs from what’s taught in most first aid courses in a very important respect: you’re usually much further from help. If you find someone lying unresponsive in town or even on a rural road, your first priorities are: 1) alert emergency services and 2) keep the patient’s condition from deteriorating until emergency services arrive.
Both of these goals are much more difficult if you’re, say, a mile and a half from the trailhead with no cell reception—and that’s not even a very long hike! You can’t drive an ambulance up a twisting mountain footpath. Therefore, the principles that govern first aid in an everyday situation change when we’re talking about the backcountry. While alerting emergency services should still be very high on your priority list if possible, you may find yourself in situations where you need to be more proactive, taking risks you would normally eschew in the usual course of administering first aid. This makes the decisions you have to make harder, and increases the risk that they’ll end poorly. For this, as well as many other reasons, I encourage anyone who might need this information (which is to say, anyone on this forum) to take a course in wilderness first aid. Standard first aid courses can often be had for free and are also very useful.
First Contact with the patient: What do do and when
Much of the knowledge in this section is drawn from the NOLS Wilderness first aid course. You can find a lot of this on their website, though I’m supplementing somewhat with my own memory of the course and outside reading I’ve done.
I’ll talk about what to do regarding specific maladies in subsequent posts, but let’s first talk about what to do if you’re not sure what’s wrong. Let’s say you come across someone in distress or unresponsive in the backcountry. What is your first move? Remember the mnemonic, 12345.
The 12345 of situation assessment
1: Look out for number one.
If you are injured endeavoring to help someone else, you are not making a noble sacrifice. You are making a bigger job for the next poor schmuck who comes along. To quote Lois McMaster Bujold, Suicidal glory is the luxury of the irresponsible. Take a moment to remind yourself of this.
2. What’s the matter with you?
Look around for any obvious hazards that may have caused the patient’s current distress. Ask the patient for their status—What happened? Do you need help? Are you injured? If they can respond, this will help you start formulating your next move to A) avoid falling prey to the same hazard and/or B) help them.
3. Don’t get any on me!
Remember that people themselves are hazardous, and that even if the initial cause of the injury is something easily avoided, communicable pathogens are no joke! If you have rubber gloves or other personal protective equipment in your first aid kit (which you should!) put them on now. Glasses (inc. sunglasses) are a good idea, as is a bandanna over your nose and mouth. The Rangers of Ithillien knew what was up.
Likewise, be prepared to dispose of any contaminated materials safely afterward, such as gloves or bandages. Seal them up if you can, or burn them.
4. Are there any more?
Assess, through discussion with the patient or your own reconnaisance, whether there are any more patients. Start thinking about triage.
5. Dead or alive?
Start prioritizing which patients to help first, based on the severity of their injuries, your ability to treat them, the number of rescuers vs. patients, etc.
Once you have a plan on what to do, we’ll move on to the next mnemonic.
The ABCDE of vital threats.
These are “vital†threats. As we go down the list, if any one of these has a problem, we address that first before moving on to the next item. Note: The most current medical literature advises promoting "C" to the front of the list. This breaks the acronym, but makes a fair bit of sense, since trying to get someone breathing when they don't have a pulse is unlikely to be successful. Moreover, recovery rates were shown to be higher when cardiac needs were attended to first. If you can remember "CABDE", that's probably better...but if "ABCDE sticks in your head, it's a lot better than nothing, and frankly, a major cardiac event that would necessitate the rearrangement occurring out in the wilderness has a pretty bad prognosis either way.
Airway. Make sure that the patient’s airway is clear. If they’re talking to you, that’s a good bet, but if they’re unresponsive, check their nose and mouth for obstruction. Previous first-aid courses I’ve taken have promoted the use of a “sweep†of the mouth, hooking a finger and passing it through the patient’s mouth in an effort to extract any unseen obstructions, but the most recent literature on trauma and life support at the time of this writing advise only attempting to extract obstructions you can see, to aovid the risk of pushing potential obstructions deeper into the airway. If the airway is clear, move on to:
Breathing. Look, listen, and feel for breathing. If they are breathing, note the nature of their respiration. Are they hyperventilating? Gasping? Wheezing? Or breathing normally? Either way, move on to:
Circulation. Check for a pulse and look for signs of bleeding. If the patient is breathing, they will obviously have a pulse, but you should assess its strength. If they are NOT breathing, then check the pulse before trying to eliminate other reasons for respiratory arrest.
If no pulse is present, or if the pulse is very weak, then beginning CPR is likely the only thing you can do.
You can often see a pulse at the neck, and can check the pulse at their wrist without alarming them by holding their hand. Checking for a pulse at the throat or wrist are very good skills to learn and practice. When you check the pulse, note its speed. Check the pulse in both wrists to ensure that they’re of equal strength. Squeeze a nail on any exposed hand or foot and see if color returns to the nailbed afterward. Check if the extremities are as warm as you’d expect them to be. If their pulse is acceptable and are not bleeding heavily, move on to:
Disability, or Dorsal injury. Do we need to immobilize the patient’s spine? If they’ve had a bad head injury, report numbness or paralysis, or report back or neck pain, it’s a good idea to immobilize the patient’s spine to the greatest extent possible. This means taking great care in positioning and/or moving them such that they’re unlikely to exacerbate a possible spine injury. Even an injury which results in immediate paralysis can sometimes be recovered from if it isn’t made worse, and injuries which could later result in paralysis are not always immediately obvious. If there’s evidence of a neck injury, play it safe. To check for loss of sensation, pinch the patient’s thumb or pinky on each hand, and the corresponding toes on each foot. Ask them to identify the digit you’re pinching. As them to wiggle their fingers and toes, and test their strength by asking them to squeeze your hands. If dorsal injuries seem unlikely, move on to:
Exposure. Consider the patient’s exposure to continued threats to their wellbeing. This could mean external threats such as exposure to heat or cold or falling branches, or it could mean more subtle injuries than the vital threats we’ve discussed so far. Now is the time to move the patient out of harm’s way (making an effort not to injure them further while doing so), and to staunch any minor bleeding if present.
Once we’ve gone through the 12345 and ABCDE of assessing the patient, we can move on to addressing any specific ailments they might have that are of lesser importance, which I’ll cover in later posts. There are, however a few good things to check regardless of the injury.
LORe
The patient’s Level Of Responsiveness can give you valuable clues about their condition. You’ve probably been gauging this to one extent or another throughout your 12345 and ABCDE assessments, but it’s worth paying particular attention to after those are completed. Are they conscious? Do they seem confused? Are they responding to your prompts? Ask them about what happened, what time it is, current events, etc. and judge whether they seem to be ‘all there’. Easy stuff, like “Who’s the current president/head of state?†and “are Istari incarnations of Maiar or Valar?†You know, stuff any normal person should immediately know the answer to.
SAMPLE
If you can, ask the patient about their medical history. SAMPLE helps you remember which things to ask:
Symptoms: What symptoms is the patient showing? Remember, when talking about “signs and symptoms†signs are what we can observe (e.g. bruising) while symptoms are things they tell us about.
Allergies: To things like environmental factors, insects, medications, or food.
Medications: Ask about any medications, including prescription and over the counter medicines.
Previous/Pertinent: Ask about their medical history to discover any pertinent, prior events related to the current injury or illness.
Last intake/output: When was the last time the patient ate, drank, urinated, and defecated?
Events: What has led up to the incident in the last few days? Gathering this information is crucial to your assessment and plan for handling the situation.
With all that out of the way, We'll move on to various common wilderness maladies and how to treat them!
Disclaimer:
Where I can, I draw my knowledge from published, empirical data, with personal experience filling in the gaps. This personal experience comes mostly from training, with (thankfully) very little opportunity to put that training into practice. This is meant as a jumping-off point, and I welcome the expertise of others and heartily encourage anyone who thinks they might need advice on this subject to review other data available on the web and in books. I'm not an expert; just an amateur who's studied enough to get through some tight situations and recognize how easy it is to get into them.
Principles of Wilderness First Aid
Wilderness first aid differs from what’s taught in most first aid courses in a very important respect: you’re usually much further from help. If you find someone lying unresponsive in town or even on a rural road, your first priorities are: 1) alert emergency services and 2) keep the patient’s condition from deteriorating until emergency services arrive.
Both of these goals are much more difficult if you’re, say, a mile and a half from the trailhead with no cell reception—and that’s not even a very long hike! You can’t drive an ambulance up a twisting mountain footpath. Therefore, the principles that govern first aid in an everyday situation change when we’re talking about the backcountry. While alerting emergency services should still be very high on your priority list if possible, you may find yourself in situations where you need to be more proactive, taking risks you would normally eschew in the usual course of administering first aid. This makes the decisions you have to make harder, and increases the risk that they’ll end poorly. For this, as well as many other reasons, I encourage anyone who might need this information (which is to say, anyone on this forum) to take a course in wilderness first aid. Standard first aid courses can often be had for free and are also very useful.
First Contact with the patient: What do do and when
Much of the knowledge in this section is drawn from the NOLS Wilderness first aid course. You can find a lot of this on their website, though I’m supplementing somewhat with my own memory of the course and outside reading I’ve done.
I’ll talk about what to do regarding specific maladies in subsequent posts, but let’s first talk about what to do if you’re not sure what’s wrong. Let’s say you come across someone in distress or unresponsive in the backcountry. What is your first move? Remember the mnemonic, 12345.
The 12345 of situation assessment
1: Look out for number one.
If you are injured endeavoring to help someone else, you are not making a noble sacrifice. You are making a bigger job for the next poor schmuck who comes along. To quote Lois McMaster Bujold, Suicidal glory is the luxury of the irresponsible. Take a moment to remind yourself of this.
2. What’s the matter with you?
Look around for any obvious hazards that may have caused the patient’s current distress. Ask the patient for their status—What happened? Do you need help? Are you injured? If they can respond, this will help you start formulating your next move to A) avoid falling prey to the same hazard and/or B) help them.
3. Don’t get any on me!
Remember that people themselves are hazardous, and that even if the initial cause of the injury is something easily avoided, communicable pathogens are no joke! If you have rubber gloves or other personal protective equipment in your first aid kit (which you should!) put them on now. Glasses (inc. sunglasses) are a good idea, as is a bandanna over your nose and mouth. The Rangers of Ithillien knew what was up.
Likewise, be prepared to dispose of any contaminated materials safely afterward, such as gloves or bandages. Seal them up if you can, or burn them.
4. Are there any more?
Assess, through discussion with the patient or your own reconnaisance, whether there are any more patients. Start thinking about triage.
5. Dead or alive?
Start prioritizing which patients to help first, based on the severity of their injuries, your ability to treat them, the number of rescuers vs. patients, etc.
Once you have a plan on what to do, we’ll move on to the next mnemonic.
The ABCDE of vital threats.
These are “vital†threats. As we go down the list, if any one of these has a problem, we address that first before moving on to the next item. Note: The most current medical literature advises promoting "C" to the front of the list. This breaks the acronym, but makes a fair bit of sense, since trying to get someone breathing when they don't have a pulse is unlikely to be successful. Moreover, recovery rates were shown to be higher when cardiac needs were attended to first. If you can remember "CABDE", that's probably better...but if "ABCDE sticks in your head, it's a lot better than nothing, and frankly, a major cardiac event that would necessitate the rearrangement occurring out in the wilderness has a pretty bad prognosis either way.
Airway. Make sure that the patient’s airway is clear. If they’re talking to you, that’s a good bet, but if they’re unresponsive, check their nose and mouth for obstruction. Previous first-aid courses I’ve taken have promoted the use of a “sweep†of the mouth, hooking a finger and passing it through the patient’s mouth in an effort to extract any unseen obstructions, but the most recent literature on trauma and life support at the time of this writing advise only attempting to extract obstructions you can see, to aovid the risk of pushing potential obstructions deeper into the airway. If the airway is clear, move on to:
Breathing. Look, listen, and feel for breathing. If they are breathing, note the nature of their respiration. Are they hyperventilating? Gasping? Wheezing? Or breathing normally? Either way, move on to:
Circulation. Check for a pulse and look for signs of bleeding. If the patient is breathing, they will obviously have a pulse, but you should assess its strength. If they are NOT breathing, then check the pulse before trying to eliminate other reasons for respiratory arrest.
If no pulse is present, or if the pulse is very weak, then beginning CPR is likely the only thing you can do.
You can often see a pulse at the neck, and can check the pulse at their wrist without alarming them by holding their hand. Checking for a pulse at the throat or wrist are very good skills to learn and practice. When you check the pulse, note its speed. Check the pulse in both wrists to ensure that they’re of equal strength. Squeeze a nail on any exposed hand or foot and see if color returns to the nailbed afterward. Check if the extremities are as warm as you’d expect them to be. If their pulse is acceptable and are not bleeding heavily, move on to:
Disability, or Dorsal injury. Do we need to immobilize the patient’s spine? If they’ve had a bad head injury, report numbness or paralysis, or report back or neck pain, it’s a good idea to immobilize the patient’s spine to the greatest extent possible. This means taking great care in positioning and/or moving them such that they’re unlikely to exacerbate a possible spine injury. Even an injury which results in immediate paralysis can sometimes be recovered from if it isn’t made worse, and injuries which could later result in paralysis are not always immediately obvious. If there’s evidence of a neck injury, play it safe. To check for loss of sensation, pinch the patient’s thumb or pinky on each hand, and the corresponding toes on each foot. Ask them to identify the digit you’re pinching. As them to wiggle their fingers and toes, and test their strength by asking them to squeeze your hands. If dorsal injuries seem unlikely, move on to:
Exposure. Consider the patient’s exposure to continued threats to their wellbeing. This could mean external threats such as exposure to heat or cold or falling branches, or it could mean more subtle injuries than the vital threats we’ve discussed so far. Now is the time to move the patient out of harm’s way (making an effort not to injure them further while doing so), and to staunch any minor bleeding if present.
Once we’ve gone through the 12345 and ABCDE of assessing the patient, we can move on to addressing any specific ailments they might have that are of lesser importance, which I’ll cover in later posts. There are, however a few good things to check regardless of the injury.
LORe
The patient’s Level Of Responsiveness can give you valuable clues about their condition. You’ve probably been gauging this to one extent or another throughout your 12345 and ABCDE assessments, but it’s worth paying particular attention to after those are completed. Are they conscious? Do they seem confused? Are they responding to your prompts? Ask them about what happened, what time it is, current events, etc. and judge whether they seem to be ‘all there’. Easy stuff, like “Who’s the current president/head of state?†and “are Istari incarnations of Maiar or Valar?†You know, stuff any normal person should immediately know the answer to.
SAMPLE
If you can, ask the patient about their medical history. SAMPLE helps you remember which things to ask:
Symptoms: What symptoms is the patient showing? Remember, when talking about “signs and symptoms†signs are what we can observe (e.g. bruising) while symptoms are things they tell us about.
Allergies: To things like environmental factors, insects, medications, or food.
Medications: Ask about any medications, including prescription and over the counter medicines.
Previous/Pertinent: Ask about their medical history to discover any pertinent, prior events related to the current injury or illness.
Last intake/output: When was the last time the patient ate, drank, urinated, and defecated?
Events: What has led up to the incident in the last few days? Gathering this information is crucial to your assessment and plan for handling the situation.
With all that out of the way, We'll move on to various common wilderness maladies and how to treat them!