Sunday, June 26, 2011

Wilderness First Aid

Several trip leaders took the SOLO Wilderness First Aid class through Osprey Sea Kayak Adventures. We figured that if there was an emergency on a trip a few of people should have a clue.
The biggest difference between wilderness first aid and standard first aid is the distance between the victim and real medical care. the standard first aid protocols are established around the premise that an ambulance, with highly trained paramedics, tons of equipment, and a radio link to doctors, is a phone call away and can be on scene quickly. In wilderness first aid, the assumption is that an ambulance is at least an hour away and likely cannot get within a mile of the victim's location.
This difference changes the basic dynamics of how to best assist the injured party. In a standard first aid situation, you would do a just enough of an assessment to call for help and then wait for help to arrive. If the injury was bad enough, say choking, heart failure, respiratory distress, you may intervene. In wilderness first aid, you need to do a much more thorough assessment, figure out if outside help is required, and how to treat the injuries while waiting for help to arrive. You also need to determine how to get outside help if it is needed: Can you radio or phone for assistance? Who do you send out? Does the patient need to be moved to a more accessible location?
We covered a lot of ground in two days and ran many scenarios. The first day focused on the basics of patient and situational assessment and patient movement.
In wilderness situations, particularly the types encountered in kayaking, accidents do not happen in places where you can safely manage a patient. An injured person can easily drown if they get a mouthful of water. Because of this, a patient will probably need to be moved to a safe location before anything else can happen. Moving a victim goes against everything in standard first aid, but if a person is injured in the surf zone on the beach they need to be moved. It is not safe for the victim and it not safe for the rescuers. (The most important person in any emergency situation is the rescuers, not the victim.) We were shown a technique called BEAMing. Essentially it means moving the injured person while keeping them immobilized. The general rule is no less than three, no more than six. One person manages the head and spine. The person at the head runs the show. Then as a unit, the group moves the patient to a safe location.
Once the patient is in a safe location, you need to asses the patient's condition. First you need to check for critical issues: attention, breath, circulation, da spine, environment. As you go through the checklist, you annotate move to the next step only after the previous one is cleared. If the patient's airway is compromised, you need to fix that before worrying about the bleeding or if the patient is cold.
Once the critical checklist is cleared, you can move on to a more detailed patient assessment. The detailed assessment should provide enough information for you to start treating the patient and provide revue personnel the information needed to mount a proper rescue. It should include vital signs, pertinent patient history, details of how the accident happened, the condition of the group as a whole, and what you are doing to treat the patient. This should all be written down and sent out with the people getting help. You should also keep a copy with the patient. The patient copy should be updated while waiting for rescue.
We also covered how to deal with injuries and common conditions. Most of this was stuff that outdoor enthusiast already sort of know, but can always be reinforced. I don't think you can ever be reminded how to identify and treat hypothermia, dehydration, or hyperthermia enough.
It was a lot of information to absorb. It was also humbling to know how hard doing this was in a safe, controlled environment. Having taken the course, I fell better about my ability to handle myself in an emergency. However, I also know that I'll probably make a ton of mistakes. At least, I'll be able to do something which is better than doing nothing.

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