Wilderness First Aid

Types of Incidents

Type	Description	Examples
Minor	non-trip ending	blisters, splinters, cuts
Major	trip ending, self evacuated	sprains, small arm fractures, reasonably minor burns
Critical	trip ending, assisted evac	major fractures, major burns, major lacerations, any spinal stuff

Scene Assessment

• is it safe?

  • fire, wire, gas, glass, bugs, drugs

• what happened?

  • mechanism of injury?
  • spinal injury?

Primary Survey

level of consciousness

• alert
• verbal
• pain (pinch shoulder)
• unresponsive

ABCs

• Airway (normal is 12-20 breaths per minute)
  • is it open?
  • is it clear?
• Breathing
  • is it regular?
  • is it laboured?
• Circulation
  • is there a pulse?
  • is there bleeding? extremities cold, gray/pail, cold sweaty
• Deadly Bleeding (check via rapid body survey)
  • Rapid Body Survey
    • pat head to toe (then arms)
    • check hands with each pats
    • look for life threatening injuries
    • look for medical alert tags
• Spinal/Shock
  • low blood pressure
  • shunting (blood moves to essential organs)
  • pale, cool, clammy skin
  • rapid breathing
  • Treatment:
    • keep dry and warm (for wilderness, do this even with spinal injury)
    • calm and reassure
    • keep resting

Secondary Survey

• trick: to check breathing, pretend to check pulse

• capillary refill: press on nail, should return to normal in 2 seconds

• pupils: should be equal and reactive (cover one eye, then the other)

• check pulse/breathing for 15s, then multiply by 4

• for irregular heart rate check for 30s and multiply by 2

• SAMPLE history

  • Signs and Symptoms
  • Allergies
  • Medications
  • Past Medical History
  • Last Oral Intake
  • Events Leading Up To Incident

• OPQRST history

  • Onset
  • Provocation
  • Quality
  • Region
  • Severity
  • Time

• SOAP notes

  • Subjective
  • Objective
  • Assessment
  • Plan

Choking

• if they can cough, let them cough (and encourage)
• if they can’t cough:
  • ask if they are choking, and if they want help
  • Repeat while concious:
    • do 5 back blows
    • do 5 abdominal thrusts
    • do 5 chest thrusts

Self Choking

• call 911, tap 3 times
• use gravity to help abdominal thrusts
• use a chair or table to help back blows

CPR

• 30 compressions
• 2 breaths
• repeat until 30min (at this point assume dead)
• use an AED if available

Table of Sucky Things

Name	Causes	Symptoms	Treatment
Hypothermia (cold stressed)	cold	shivering, blue lips, sluggish, slurred speech, cold extremities, complaints of cold, numbness, lack of coordination, poor judgement, irritability	warm liquids, add clothing, keep dry and warm, get them moving, add heat, feed them, warm the core
Hyopthermia (mild)	cold	95-89F cold, numb, tingling, stinging, aching, burning, red, white, blue, black, hard, waxy, stiff	same as cold stressed, except rest, no movement (to conserve energy)
Hyopthermia (moderate)	cold	89-82F shivering stops	same as cold stressed, except treat as a critical emergency active warming, managing shock
Hyopthermia (severe)	cold	82-68F unconscious, breathing and pulse measured at 60s	“warmer faster better” and to be careful with skin on skin contact because they can easily take all your own body heat
Asthma Attack	allergens, exercise, temperature, smoke, stress, altitude	wheezing, coughing, shortness of breath, chest tightness, rapid breathing, increased heart rate, sweating	calm and reassure, help them take their medication, sitting down is better than standing, if they have a spacer, use it
Hyperventilation	anxiety, stress, panic, altitude, exercise, pain	rapid breathing, chest tightness	calm and reassure, box breathing (something to focus on), slow breathing
Panic/Anxiety Attack	anxiety, stress, panic	rapid breathing, chest tightness, sweating, increased heart rate, trembling, dizziness, nausea	calm and reassure, box breathing (something to focus on), human connection
Anaphylaxis Shock	allergens, insect stings, medications, food, exercise	hives, swelling, itching, flushing	#### Epipen - remove the blue cap - hold the pen in your fist - press the orange end against the thigh - hold for 10 seconds - massage the area for 30 seconds - another dose may be required in 5-15 minutes - Benadryl afterwards #### Benadryl - 25-50mg
Seizures	epilepsy, head injury, drug withdrawal, shock, temperature	phases: aura, tonic/clonic, postictal	protect the head, get into recovery position, calm and reassure, don't put anything in their mouth, don't hold them down
Stroke	blood clot, bleeding, high blood pressure, high cholesterol, diabetes, smoking, obesity, lack of exercise, poor diet	face drooping, lopsided arm weakness, speech difficulty	call 911, calm and reassure, keep them comfortable, keep them warm
Heart Attack	smoking, high blood pressure, high cholesterol, diabetes, obesity, lack of exercise, poor diet	chest pain, shortness of breath, nausea, lightheadedness, cold sweat	call 911, calm and reassure, keep them comfortable, keep them warm
Diabetic Emergency	low blood sugar, high blood sugar	low: confusion, irritability, sweating, shaking, fast heart rate high: thirst, frequent urination, fatigue, nausea, vomiting, shortness of breath	low: give sugar, then protein high: give water, then insulin
Heat Exhaustion	dehydration, heat, humidity, poor physical condition, poor diet	heavy sweating, weakness, cold, pale, clammy skin, fast weak pulse, nausea, vomiting, fainting	move to a cool place, remove excess clothing, cool the body, give water
Heat Stroke	dehydration, heat, humidity, poor physical condition, poor diet	hot, red, dry skin, rapid strong pulse, confusion, unconsciousness, seizures	call 911, move to a cool place, remove excess clothing, cool the body
Spinal Injury/td>	trauma, falls, car accidents	immediate pain (as opposed to deferred pain)	keep them still, minimize movement, stabilize the head

burrito wrap

• zig zag a rope the length of the patient
• lay a tarp down
• lay a sleeping pad down
• lay a sleeping bag down
• lay the patient down
• pad the patient with extra clothing
• wrap the patient in a mylar blanket
• wrap the patient in the sleeping bag
• wrap the tar around the sleeping bag/patient
• tie the rope around the patient
  • starting at the feet
  • new through the old loop back and forth
  • tie a not at the head

Spinal Injury

To hand off:

• elbow on chest, hold cheeks
• stabilize your wrist with your other hand
• wait for another person to grab the head
• remove the temporary support

Different ways of stabilizing head

• hold traps, and elbows hold head
• long+short

Different ways to move (last resort)

• elbow up, slide arm through
• cross leg
• roll onto side (difficult)
• cradle head and finish the roll

Major Deadly Bleed

• REDDT (todo: flesh out)
  • Rest
  • Elevate
  • Direct Pressure
  • Direct Pressure
  • Tourniquet

Tourniquet

• 2-3 inches above the wound
• 2-3 inches below the joint
• tighten until bleeding stops
• write the time on the forehead
• don’t remove it (sepsis risk)
• don’t cover it

Sucking Chest Wound

• we don’t stack gause, we replace so the saturated gause does not prevent air leaving the chest cavity.

Impailments

• don’t remove the object (unless…):
  • it prevents us from handling something more critical/life threatening
• leave the object in place
• stabilize the object

Musclature and Skeletal Injuries

Bones are more sever, so if unknown, treat like bone.

symptom	more likely
Slow onset	muscle
sharp pain	bone
reduced motion	bone
imediate nausea	bone
heard a crack	bone
deformed	bone
accute tenderness	bone
large area tenderness	muscle

RICE

• Rest
• Immobilize (splint/sling)
• cold (reduce the swelling, use Ibuprofen)
  • 20min on
  • 40min off
• elevate