Wilderness First Aid

Nick Loy

(A very short course)

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Full Certified Course– 80 hours for ENT or alike

Short Refresher Course … 16 / 24 hours

This course … 1 hour– Doesn’t even scratch the surface !

Wilderness vs. "Normal" First Aid vs. Deep Wilderness

Normal … medical help in the golden hour – Call for help

– Stabilize Victim

Wilderness First Aid … help is over 1 hour away but within a few days– Get help as soon as you can– Long term stabilization– Some treatment

Deep Wilderness … you are on your own

Prevention is your best offense

Avoid Risky Behavior!

Hydration

Hypo / Hyperthermia prevention

Get Medical history for all in the group

Avoid blisters

Hydration

Start out well hydrated ... you cannot maintain hydration during a vigorous hot day

"Water shots“ every 15 minutes to 1 hour

Electrolytes / calories – 1/2 OJ / 1/2 water

Lack of hydration can lead to impacted bowls – very unpleasant trip to the hospital

– (also do not avoid the outhouse even if it is disgusting)

Hypo / Hyperthermia

Even in the summer hypothermia common and hypothermia KILLS– Every year “experienced” hikers die in the

White Mountains.

Symptoms– Poor judgment– “Drunken” like behavior– Shivering

Get History of ALL Serious Conditions

Diabetes

Asthma

Allergies

Seizures

Sleep Walking

Other

RULES

Don't become a second victim!

BFI ... if it is wet and warm or was in another body keep it off you

Evaluate – How critical?– Is the victim “really” ambulatory?

EvaluateSite … is it safe?Situation … what happened? How did it happen?Victim … what is the damage? Are there any priority 1 emergency interventions called for?– Breathing is first … 4 min not breathing = brain damage

Happy patient (examiner) position– Moving the victim to safety– Talk to victim … lead person is at victim’s head– Take notes– Check for secondary injuries in limbs and trunk. Palpate the

entire body.– Check core pulse and distal pulse

DON’T

With rare exception ... do NOT medicateNO goo in a wound! (Except minor cuts, etc and then goo on bandage not the wound)Except for minor burns ... NO GOODo Not Move a non ambulatory victim any distance ... it takes 16 people and good equipment

Serious Injuries(That you are likely to see)

Hypothermia

Dry warm clothing, shelter– ground cover (your sleeping “PAD”)

Hot water bottle in the pits (underarm / groan)

Sugar ... replenish fuel / fluids

Eye

Irrigate with sterile water

Puncture wound– Don't try to remove puncture object

BURNS

Cold 1 hourFlush with sterile waterGo to hospital if burn size is: 2 hands / 1 hand / dime in size. Genitals and facial more critical– Red– Blistered– Charred / white… may be no pain

Except for very minor burns:– No GOO– Do not cover

Head and Neck

Suspect head and neck injury if:– Fell from more than 2x victim’s height– Direct blow to the head or neck– Asymmetric body signs

• Distal pulse• Eyes• Strength

– Numbness or loss of strength in lower body (below the neck)– A pain in the neck.

The ground is your “backboard”! Do NOT improvise. Place pads left and right of head.The “yes” motion of the head is much higher risk than the “no” motion.If questionable, wait 20 – 40 minutes and re-examine

– Can the victim move his head without ANY pain?

Bleeding

BFI … 500 cc is a LOT of blood!

Clean and irrigate wound

tourniquet NO /NEVER / Forget it

pressure bandages ... don't remove old bandages– For an artery … pressure may be required for a

long long time

Puncture Wounds

They are much more serious that they seem because they can go septic!

Irrigate– Irrigation needs a little water pressure behind it.

Go to hospital

no goo

Abrasions

Treat as a burn – You do not need 1 hour cold.– Also, clean wound carefully. Get out as much

“dirt” as practical.

If minor cover with hydro-bandages, second skin, or alike. The wound will weep.

Broken / Sprained Limbs

RICE– Rest, ice, compression, elevation … avoid swelling

Leg injury … carefully evaluate if ambulatory– Consider terrain and possibility of second injury– Watch for swelling

• Think about boots

“Splint”: Big, ugly, cushioned.– Check distal pulse often– Unless trained … no tension splint

To Straighten or not to straighten a compound break?– If no distal pulse and more than 2 hours from help … consider

straightening– If good distal pulse and help is soon consider leaving it alone

Heart Attack

At first sign … Aspirin (not Ibuprofen or Acetaminophen)Pulse ... even if you can't find it is likely there!Rescue breathing ... YES! BFI ... don't forget the mouth guardCPR … good for an evaluation period but cannot be maintained– NEVER with hypothermia

mechanical defibrillation ... long shot but your only chanceRemember … there is not much you can do … don't feel guilty

Anaphylactic Reaction

Epi Pen ... how to– Thru the clothing into the big muscle of the

thigh … leave in for count of ten – Do not administer without permission / help

"Primatene" mist can be used if no Epi pen

Benadryl (or other antihistamine / steroid) ... this is the cure!

Shock

Pale, extremities cold, sweaty, lips may be blue, dizzy / fainting … caused by a loss of blood pressure due to too many arterioles opening at the same time.

keep warm, feet up

Other

Diabetic Coma … follow specific instructions if you have them!– Help the person avoid coma … watch for signs. Low sugar leads to poor judgment.– Sudden coma, most likely due to lack of sugar. The goal is to get the victim

conscious so that they can advise you. Paste small amount of sugar solution on the lips.

– Do NOT administer insulin on your own!Blisters (other than burns)

– Sterile Puncture … on the trail it will break anyhowDiarrhea … can lead to severe dehydration

– Drink lots of fluids including fluids with sugar/salt – Pills … short term OK, long term bad

Choking … Heimlich maneuverAsthma … use inhaler, hydrate, rest

– If can’t talk in full sentences comfortably get help ASAP! – Have them take their emergency steroids/antihistamines.– Keep away from camp fire

THINK!

Do no harm (or as little as possible)Protect yourselfKeep everyone busyHave a plan!Have medical forms and notes in each person’s First Aid KitPin med form and notes / medication / body parts to the victim