Chapter 24Wilderness First Aid

Wilderness First Aid (1 of 2)

• Wilderness describes remote locations more than 1 hour from medical care:• Recreational areas• Occupations in remote areas• Disaster areas with overwhelmed EMS• Remote residences• Developing countries

Wilderness First Aid (2 of 2)

• First aid with a wilderness focus• Injuries and illnesses in the outdoors with

adverse environmental conditions• Delays of definitive medical care• Injuries and illnesses not common in urban

or suburban areas• Need for advanced medical care• Limited first aid supplies and equipment• Need to make difficult decisions

Cardiac Arrest (1 of 2)

• CPR has limited use in wilderness/remote setting.

• Stop CPR if:• Victim revives.• Rescuers are exhausted.• Rescuers are in danger.• Victim is turned over to higher level

personnel.• Victim does not resuscitate within 30

minutes.

Cardiac Arrest (2 of 2)

• Do not start CPR if:• Victim has been in cold water more than 1

hour.• Body temperature below 50°F• Signs of death or fatal injuries• Frozen or has stiff chest wall • Rescuers are exhausted or in danger.• Medical care is more than 3 hours away

CPR for Hypothermia Victims• Very gently handle the victim.• If not breathing, begin CPR immediately• Avoid heat loss.• Seek medical care as soon as possible• Continue until victim is evaluated by

health care providers

CPR for Avalanche Victims

• Avalanche-related deaths are on the rise due to winter recreational activities.

• If not breathing, begin CPR immediately.• Use automate external defibrillator (AED)

as soon as it is available.

CPR for Drowning Victims• Begin CPR with rescue breaths rather

than chest compressions. • Open airway and check for breathing. • Begin cycles of 30 chest compressions

and 2 rescue breaths. • Use AED as soon as possible. • If vomiting, turn victim to side and

remove vomitus from airway.

CPR for Lightning Strike Victims

• An estimated 70 deaths occur from lightning strikes in the U.S. each year.

• Give highest priority to victims who are unresponsive or not breathing.

• Use AED as soon as possible.

Dislocations• In the wilderness, reducing a dislocation

is recommended. • Easier after injury• Easier to transport• Reduces pain• Better stabilization• Reduces chance of circulation problems• Simple and safe

Recognizing a Shoulder Dislocation (1 of 2)

• Anterior shoulder dislocations most common

• Extreme pain• Recurs• Upper arm is held away from body.• Unable to touch uninjured shoulder

with hand of dislocated extremity

Recognizing a Shoulder Dislocation (2 of 2)

• Appears squared-off or flattened

• Bump in front of shoulder

Care For a Shoulder Dislocation

• Stop if pain increases• Stop if resistance is met• Do not pull arm with foot in victim’s

armpit• Check circulation, sensation, and

movement before and after

Traction and External Rotation• Pull arm out to side with traction against chest

wall. • Tell victim to relax.• Position arm in “throwing” position.• Muscles will fatigue; shoulder will reduce.• Stabilize the arm.

Simple Hanging Traction• Victim lays face-

down on raised surface.

• Arm hangs straight down over side.

• Attach a 5-to 10-pound weight

• Muscles will fatigue• Stabilize the arm.

Recognizing a Finger Dislocation

• Minor injuries can dislocate fingers

• Deformity and inability to use or bend the finger

• Pain and swelling• Lump at the joint

Care for a Finger DislocationMethod 1

• Hyperextend with gentle traction.

• Push into place and unbend.

• Buddy-tape in functional position.

Care for Finger DislocationMethod 2

• Pull finger in direction it is pointing. • Maintain traction; bend into normal

position. • Stabilize in functional position.

Recognizing a Kneecap Dislocation

• Patella has moved outside of kneecap

• Victim is in pain.• Compare to other leg.

Care for Kneecap Dislocation • Slowly straighten knee, gently

pushing kneecap into position.• Stabilize the leg straight.• Victim may be able to walk with an

aid.

Spinal Injury

• Full spine stabilization may be impossible or impractical.

• All spinal fractures have at least one:• Midline neck tenderness• Altered mental status• Evidence of intoxication• Separate painful injury

Recognizing a Spinal Injury• Ascertain whether the victim:

• Is alert and oriented• Has been drinking or using drugs• Has any major painful injury• Has neck pain• Feels tingling, numbness, or weakness

• Check for neck tenderness.• Check for sensation in hands or feet.

Clearing a Spinal Injury• Stabilization is not needed if the

victim:• Is completely alert• Is not intoxicated• Has no distracting injuries• Does not complain of neck pain• Can feel normal touch• Can move the fingers and toes

Suspected Spinal InjuryResponsive Victim

• Ask:• Neck and back pain?• What happened?• Can you move/feel arms and legs?

• Look and feel for DOTS• Test strength of extremities

Suspected Spinal InjuryUnresponsive Victim

• Determine the mechanism of injury.• Look and feel for deformity, open

wounds, or swelling along spine.• Obtain information from others.

Care for a Spinal Injury• Use your hands and knees to

stabilize neck in line with spine.• Improvise cervical collar.• Improvise cervical supports. • Avoid moving the victim.

Splinting Femur Fractures

• Victims with femur fracture can easily lose two quarts of blood and develop massive swelling.

• If needed, splint the fracture.

Avalanche Burial• Falling masses of snow that may also

contain rocks, soil, or ice• Dangers due to:

• Snow becomes solid• High pressure of snow

• Factors that determine survival:• Speed of extrication • Air pocket

Recognizing an Avalanche Victim

• Injure in two ways:• Trauma from tumbling down

avalanche path• Suffocation from snow burial

Care for an Avalanche Victim• Survival chances best in first 15

minutes• Free victim’s head, chest, and stomach.• Send for help.• Clear airway and check breathing.• If not breathing, begin CPR.• Check for severe bleeding.• Examine for and stabilize spinal injury.• Treat for hypothermia.

Altitude Illness (1 of 3)

• Altitude illness is a variation of hypoxia.• Body’s tissues lack oxygen.

• Types of altitude illness:• Acute mountain sickness (AMS)• High-altitude pulmonary edema (HAPE)• High-altitude cerebral edema (HACE)

Altitude Illness (2 of 3)

Altitude Illness (3 of 3)

• Factors that affect susceptibility:• Rapid ascent• Higher altitude• Health at time of ascent• Individual differences

• Oxygen levels decrease as elevation increases.

Recognizing Altitude Illness• Typically strikes during the first 12 hours• Symptoms include:

• Headache• Loss of appetite• Nausea• Insomnia• Fatigue• Shortness of breath with exertion

Care for Altitude Illness (1 of 2)

• Seek medical if:• Persistent cough• Shortness of breath while resting• Noisy breathing• Loss of balance• Confusion• Vomiting• Symptoms persist after 2 days

Care for Altitude Illness (2 of 2)

• Treatment• Descend 2,000 to 3,000 feet.• Rest.• Drink fluids.• Take pain medication.

• If treatment does not provide relief, consult a physician.

Other Altitude-Related Illnesses• Pharyngitis and bronchitis

• Sore throat and coughing due to dry air• Peripheral edema

• Swelling of hands, ankles, or face

Lightning (1 of 2)

• Fatal in 30% of cases• Victims include:

• Hikers • Campers,• Golfers• Others in outdoor

recreation

© Riccardo Bastianello/ShutterStock, Inc.

Lightning (2 of 2)

• Direct strike• Actually being

struck• Splash

• Strikes a tree/building and jumps

• Contact injury• A held object is

hit• Ground current

• Strikes ground and spreads

• Shock wave• Explosive

force

Generated Electrical Current vs. Lightning

• Lightning contact with the body is instantaneous and leads to flashover.• Current flashes over body• Severe burns are seldom.

• Exposure to generated electrical current is more prolonged. • Thermal tissue damage

Recognizing a Lightning Injury• Absent breathing• Seizure, paralysis, unresponsiveness• Minor burns

• Punctuate burns• Feathering or ferning burns• Linear burns• Burns from ignited clothing and heated metal

Care for a Lightning Injury• Go to the quiet, motionless victim first.• Start CPR if victim is not breathing.• Place unresponsive (breathing) victim

on side.• Stabilize the spine.• Check for injuries.• Evacuate to medical care.

Wild Animal Attacks• Can be avoided by

exiting quietly and calmly

• Fight back if animal attacks.• Play dead if animal

is a grizzly bear or mother black bear

© AbleStock

Recognizing Wild Animal Attacks

• Victims may be thrown, gored, butted, or trampled.• Puncture wounds and bites• Lacerations and bruises• Fractures• Rupture of internal organs or evisceration.

Care for Wild Animal Attacks

• Treat wounds and bleeding.• Evacuate or contact authorities for

evacuation of victim.

Wilderness Evacuation (1 of 6)

• Determine method based on:• Severity of the illness or injury• Rescue and medical skills of the rescuers• Physical and psychological condition of the

rescuers and the victims• Availability of equipment and aid for rescue• Timing• Cost

Wilderness Evacuation (2 of 6)

• Start evacuation of victim if:• Condition is not improving. • Debilitating pain is present.• Inability to travel at a reasonable pace• Passing blood via the mouth or rectum• Serious altitude illness• Infections not improving

Wilderness Evacuation (3 of 6)

• Start evacuation of victim if (cont’d):• Chest pain not caused by rib-cage injury• Severe wounds requiring medical care• Dysfunctional psychological status is

impairing others’ safety.

Wilderness Evacuation (4 of 6)

• Immediate evacuation (medical care required in 30 to 60 minutes or less):• Open fractures• Extremity injuries with deformity• Spinal injuries with no sensation/movement• Severe altitude illness• Decreased level of consciousness• Shock• Severe bleeding

Wilderness Evacuation (5 of 6)

• All bleeding should be controlled.• Clean and irrigate wounds.• Do not remove blood-soaked dressings.• Locate bleeding vessels• Reapply direct pressure

Wilderness Evacuation (6 of 6)

• Delayed evacuation (medical care required in 6 to 24 hours):• Limb injuries with deformity, severe pain, or

inability to walk• Severe frostbite• Open wounds for suturing• Severe hypothermia

Guidelines for Ground Evacuation

• At least two people should accompany victim if walking out.

• One or two people should be sent to notify if a victim needs to be carried out.

• Four to six people litter bearers • Eight carriers over rough terrain, switch off

every 100 yards

Guidelines for Helicopter Evacuation (1 of 2)

• Evacuate only if:• It will save

victim or offer greater chance of recovery.

Courtesy of Mark Woolcock

Guidelines for Helicopter Evacuation (2 of 2)

• Evacuate only if:• Pilot believes

conditions are safe.

• Ground evacuation would be dangerous or prolonged.

Signaling for Help (1 of 2)

•Signaling aircraft• Things are smaller when viewed from air• Construct a large “V” (assistance) or “X”

(medical assistance)•Other signals:

• Series of three means “help”• Smoke by day• Bright flame by night

Signaling for Help (2 of 2)

• Other signals (cont’d):• Mirror

• Direct light in “flicks”