Chapter 24Wilderness First Aid

Wilderness First Aid

• Wilderness describes remote locations more than 1 hour from medical care.– Recreational areas– Occupations in remote areas– Disaster areas with overwhelmed emergency

medical services (EMS)– Remote residences– Developing countries

Wilderness First Aid

• Wilderness focus needed in:– Injuries and illnesses in the outdoors with

adverse environmental conditions– Delay 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

• CPR has limited use in remote setting.• Stop CPR if:

– Person revives.– Rescuers are exhausted or in danger.– Person is turned over to higher-level

personnel.– Person does not respond within 30 minutes.

Cardiac Arrest

• Do not start CPR if:– Person has been submerged in cold water

more than 1 hour.– Body temperature below 60F– 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 Person With Hypothermia

• Handle the person very gently.• If not breathing, begin CPR immediately.• Avoid further heat loss.• Activate EMS as soon as possible.• Continue CPR until EMS arrives.

CPR for Avalanche-Related Injury

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

as soon as it is available.

CPR for Drowning

• Begin CPR as soon as the person is removed from the water.

• Use AED as soon as possible.• If vomiting, turn person to side and remove

vomitus from airway.

CPR for People Struck by Lightning

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

• Use AED as soon as possible.

Dislocations

• In the wilderness, reducing some dislocations is recommended.– Easier after injury– Easier to transport– Reduces pain– Better stabilization– Reduces chance of circulation problems– Simple and safe

Shoulder Dislocation:What to Look For

• Extreme pain• Upper arm is held away from body• Unable to touch uninjured shoulder with hand

of dislocated extremity• Appears squared-off or

flattened• Bump in front

© American Academy of Orthopaedic Surgeons.

Shoulder Dislocation: What to Do

• Traction and external rotation method– Pull arm out to side (traction against chest).– Tell person to relax.– Slowly position arm in “throwing” position.– Stabilize the arm.

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• Simple hanging traction method– Lay person face-down

on raised surface.– Arm hangs over side.– Attach a 5- to 10-

pound weight.– Stabilize the arm.

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Shoulder Dislocation: What to Do

Finger Dislocation: What to Look For

• Deformity and inability to use or bend the finger

• Pain and swelling• Abnormal position

of adjoining bones• Lump at the joint

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Finger Dislocation: What to Do (Method 1)

• Hyperextend with gentle traction.• Push into place and unbend.• Buddy-tape in functional position.

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Finger Dislocation: What to Do (Method 2)

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

position.• Stabilize in functional position.

Knee Cap Dislocation:What to Look For

• Patella has moved outside of knee joint.

• Person is in pain.• Compare to patella on

other leg.

© American Academy of Orthopaedic Surgeons.

Knee Cap Dislocation: What to Do

• Slowly straighten knee, gently pushing knee cap into position.

• Stabilize the leg straight.• Person may be able to walk with an aid.• Seek follow-up physician care.

Spinal Injury

• Full spine stabilization may be impossible or impractical.

• A person cleared of spinal injury is able to self-evacuate.

• Suspect a spinal injury when:– Significant cause of injury (COI)– Head injury causing unresponsiveness– Penetrating wounds of the neck or trunk– Diving into shallow water– Fall from a height– Collisions involving recreational vehicles or

bicycles has occurred

Spinal Injury

• Determine if the person is reliable.– Alert, knows name and where he or she is– Not intoxicated by drugs or alcohol– Calm, cooperative– Has no painful, distracting injury

Spinal Injury

• Determine if the person is unreliable.– Unresponsive; altered mental status– Intoxicated by drugs or alcohol– Combative, confused– Has a painful, distracting injury

Spinal Injury

Spinal Injury: What to Look For

• Reliable person with suspected spinal injury– Back pain and leg numbness and tingling– Tenderness/pain when you run fingers all the

way down the spine• A reliable person who fails tests for

sensation and movement

Spinal Injury: What to Look For

• Reliable person who is injured with no neck pain or neurological symptoms

• An unreliable person who has a significant cause of injury

Suspected Spinal Injury:What to Do

• Reliable person with suspected spinal injury– Send for medical help.– Leave the person on the ground and cover.– Place insulating materials under and over the

person.

Suspected Spinal Injury:What to Do

• Reliable person who fails tests for sensation and movement– Stabilize person against movement by placing

person’s head between your knees.– Improvise sandbags and place them on both

sides of the person’s head.

Suspected Spinal Injury:What to Do

• Reliable person with no suspected spinal injury– Treat other injuries.

• Unreliable person with significant COI– Assume spinal injury exists.– Stabilize person against movement.– Have person remain as still as possible.

Splinting Femur Fractures

• A person with femur fracture can easily lose 2 quarts of blood and develop massive swelling.

• Best to let EMS personnel apply traction splints, if possible.

Avalanche Burial

• Falling masses of snow that may also contain rocks, soil, or ice

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

Person Injured by Avalanche: What to Look For

• Injured in two ways– Trauma from tumbling down avalanche path– Suffocation from snow burial

Person Injured by Avalanche: What to Do

• Free person’s head, chest, and stomach.• Send for help.• Clear airway and check breathing.• Check for severe bleeding.• Examine for and stabilize spinal injury.• Treat for hypothermia.

Altitude Illness

• 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

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Altitude Illness

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

• Oxygen levels decrease as elevation increases.

Altitude Illness:What to Look For

• Typically presents within first 12 hours– Headache– Loss of appetite– Nausea– Insomnia– Fatigue– Shortness of breath with exertion

Altitude Illness: What to Do

• Seek medical care for:– Persistent cough– Shortness of breath while resting– Noisy breathing– Loss of balance– Confusion– Vomiting

Altitude Illness: What to Do

• Have the person rest for a few days.• If person ascended above 6,000 feet and

does not feel better in 1 to 2 days, see a physician.

• Descend 2,000 to 3,000 feet, rest, and drink plenty of fluids.

Altitude Illness: What to Do

• If rest and medications do not provide relief, consult a physician.

• If HACE or HAPE is suspected, early descent is wise.

Other Altitude-Related Illnesses

• Pharyngitis and bronchitis– Sore throat and coughing because of dry air

• Peripheral edema– Swelling of hands, ankles, or face

Lightning

• Fatal in 10% of cases• People injured include:

– Hikers– Campers– Golfers– Others in outdoor

recreation

© Riccardo Bastianello/Shutterstock.

Lightning

• Direct strike– Being struck

• Splash– Strikes a

tree/building and jumps

• Contact injury– Held object is hit

• Ground current– Strikes ground and

spreads• Shock wave

– Explosive force

Generated Electrical Current versus Lightning

• Lightning contact with the body is instantaneous and leads to flashover.– Current flashes over body.– Seldom produces severe burns

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

Lightning Injury: What to Look For

• No breathing• Seizure, paralysis, unresponsiveness• Minor burns

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

Lightning Injury: What to Do

• Go to the quiet, motionless person first.– Start CPR if person is not breathing.

• Place unresponsive person on side.• Check for and treat 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

Wild Animal Attacks:What to Look For

• Puncture wounds and bites• Lacerations and bruises• Fractures• Rupture of internal organs or evisceration

Wild Animal Attacks: What to Do

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

evacuation.

Wilderness Evacuation

• Determine method based on:– Severity of the illness or injury– Rescue and medical skills of the rescuers– Condition of rescuers and injured person– Availability of equipment and aid for rescue– Timing– Cost

Wilderness Evacuation

• Start evacuation of person if– Condition not improving– Debilitating pain– Unable to travel at a reasonable pace– Passing blood via mouth or rectum– Serious altitude illness– Infections not improving

Wilderness Evacuation

• Start evacuation of person if (cont’d)– Chest pain not caused by rib-cage injury– Severe wounds requiring medical care– Person’s dysfunctional psychological status is

impairing safety of others.

Wilderness Evacuation

• Immediate evacuation– Open fractures– Extremity injuries with deformity– Spinal injuries with no sensation/movement– Severe altitude illness– Decreased level of consciousness– Shock, severe bleeding

Wilderness Evacuation

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

Wilderness Evacuation

• Delayed evacuation– 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 a walking person.

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

• Carrying a litter:– Four to six litter bearers– Eight carriers over rough terrain

Guidelines for Helicopter Evacuation

• Evacuate only if– It will offer greater

chance of recovery.– Pilot believes

conditions are safe.– Ground evacuation

would be dangerous or prolonged.

Courtesy of Mark Woolcock

Signaling for Help

• 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

Signaling for Help

• Other signals (cont’d)– Bright flame by night– Mirror

• Direct light in “flicks”

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