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I have always felt that Wilderness First Aid is one of the most important pieces of knowledge you can bring with you on the trail. Accidents happen, more often that we like to think, and in the wilderness even the smallest accident can ruin your trip or even become fatal if you don't know how to deal with it. This article will offer you some of the knowledge you need, but as with any knowledge, remember to practice these techniques as well.
This is a long one, but worth the read!
One appeal of outdoor adventure is that you get to unplug and enjoy quiet time away from the city. Because that also means you’re farther from emergency responders and urgent care clinics, it’s important to be well-versed in wilderness first aid. Think of it as your opportunity to become more capable and self-sufficient. The vast majority of incidents outdoors are minor and easily treatable. When providing aid in the wilderness, most of the time your goal is to keep a condition from worsening so you can continue with your adventure. That said, it’s important to be prepared for any situation.
The first thing you learn in a wilderness first-aid course is how to evaluate a patient, which includes the following steps:
Size up the scene
Identify life threats
Do a focused exam: head-to-toe check, vital signs and patient history
Make a problem list and care plan, which includes an evacuation decision
Treat the patient, providing both medical and emotional support
Monitor how the patient is doing
We recommend you take a wilderness first-aid class to learn both basic patient assessment and how to treat a variety of medical conditions. It is also very helpful to get a reference book and study up as often as necessary. NAC NOTE: Check with Wilderness Medical Associates of Canada to find a Wilderness First Aid Course. They can even be done online. The book I would recommend is Outward Bound Wilderness First-Aid Handbook by Jeffery Isaac, this is the text book I personally use and the one I was trained with. Another great resource is the waterproof field handbook, The Field Guide of Wilderness & Rescue Medicine by Wilderness Medical Associates. Get one and keep it in your first aid kit!
Wilderness First Aid Vs. “City” First Aid
If you’ve already had some general first-aid training, it’s worth noting how wilderness first aid may differ. There are four primary factors:
Time: It’s a long way to the doctor’s office and wilderness search and rescue personnel simply can’t respond as quickly as when we dial 9-1-1 in the city. In the backcountry it could be hours or days until your patient gets professional care, so you need to be ready to render emergency aid and to care for that person for an extended period of time.
Environment: You may face extremes of weather and different types of physical hazards than you would encounter in the city.
Resources: When you’re administering aid in the backcountry, you’re limited to what’s in your pack and what you can use from your surrounding environment. A good wilderness medicine class should cover what to carry in your first-aid kit (see last weeks Adventure Weekly).
Communication: Even with expanding cellphone coverage, your ability to call for help from the backcountry is limited; that means your providing care might be the patient’s only option.
Preparing to Give Wilderness First Aid
Say you’re out hiking and come upon someone who is bleeding and unconscious. Your first instinct might be run to them to offer aid. However, you need to ensure you don’t become a casualty yourself, and that you understand the situation before rushing to begin treatment. That’s why you need to follow these steps before doing anything else:
Determine whether the area is safe: Ensure no further harm is imminent—for both patient and responders. If a rockslide caused the injury, for example, you might need to move the patient out of the path of additional rockfall.
Identify the Mechanism of Injury (MOI): Look around to determine what might have caused the accident or injury. That provides clues to the type of injuries that might be present.
Form a general impression of the seriousness of the situation: If the patient is injured, how injured? If the person is sick, how sick?
Determine the number of patients: Don’t assume that the most obviously injured person is the only one in need of assessment and care.
Protect yourself: Prudent caregiver practice is to assume all people are infectious. Put on gloves and a mask, and wash hands thoroughly before and after patient contact. [Body Substance Isolation (BSI)]
Wilderness First Aid: Initial Patient Assessment
Once you’ve determined that it’s safe for you to begin treating your patient, your next actions should be to identify any immediate threats to the patient’s life. Before you begin a preliminary life-threat exam, begin with two quick steps:
Obtain consent to treat (if the person is conscious): Ask the person if you can help. If the answer is "yes," then ask their name, symptoms and what happened.
Establish responsiveness: Attempt to wake the patient if they aren’t responding. (If there is any possibility of a spine injury, you also need to carefully place your hands on either side of the person’s head and keep the patient still.)
Next, you will begin your life threat exam. NOLS calls this an “ABCDE” exam, using the mnemonic device to help you remember the steps: NAC NOTE: NOLS (National Outdoor Leadership School) is a highly recognized agency for providing outdoor education to outdoor professionals. However, for Wilderness First Aid, I recommend Wilderness Medical Associates as your main source of information. The following exam is called the ABCDE exam by NOLS, but different agencies have different terminology for the same procedures. Use the one that you will remember best.
1. Airway check: Look in the mouth and check the airway for obstructions.
2.Breathing check: Look closely at the chest; listen and feel for signs of respiration.
3. Circulation check: Check for a pulse and for major wounds that are bleeding.
4. Disability decision: If you can’t rule out a spine injury, continue to protect it.
5. Expose injuries: Without moving the patient, open up clothing covering serious injuries so you can fully evaluate and treat them.
Whether you check for major bleeding (C) first or for breathing issues (A and B) first depends on your initial judgment at the scene. If you suspect a major wound, check and stabilize it first. Deal with any immediate life-threatening conditions found during the ABCDE exam. Those might include removing airway obstructions, doing CPR or applying direct pressure to major bleeding. Once the patient is out of initial danger, you can begin a more thorough examination.
Wilderness First Aid: Secondary Patient Assessment
After you’ve done your initial patient assessment, you’ll gather information to make your treatment plan, inform your evacuation decision and to pass on to medical professionals who later care for the patient. You might also choose to relocate the patient to a more stable, more sheltered site at this time. The procedures below highlight key stages of the secondary exam. A wilderness first-aid course will take you through the process involved in each procedure:
Do a Head-to-toe Exam: Start by ensuring your hands are clean, warm and gloved. Then explain to the patient what you’re doing: methodically going over all areas of the body looking for clues about potential injuries or illness. Your analysis includes several methods of detection:
Look: for blood and other bodily fluids, discoloration or unusual shapes
Listen: for airway noises or unusual sounds when joints are moved
Feel: for wounds, deformities and unexpected hardness, softness or tenderness
Smell: for unusual odors
Ask: if anything hurts or feels odd or numb
Check Vital Signs: Check the time and write all of the vital signs down. One helpful tip is to write them on a piece of tape and place it on the patient’s leg so the information travels with them when additional help arrives. Here’s what you’ll take notes on:
Level of responsiveness: Is the patient awake and oriented? Awake and disoriented? Or is your patient unconscious or unresponsive?
Heart rate: Using the wrist pulse, check the number of beats per minute and note whether the pulse is strong or weak; regular or irregular.
Respiration rate: Check the patient’s number of breaths per minute and note whether the breathing is easy or labored.
Skin signs: Look at skin color, temperature and moisture. The inside rim of the lower eye or inside the lower lip are good places to check for color. Is it pink or pale? Is the rest of their skin warm and dry vs. cool and clammy? If possible, also record the patient’s temperature with a thermometer.
Do a Patient History: Ask questions to learn valuable information to help you with your assessment and treatment. For example, you might find that your patient missed taking important medications or didn’t drink enough water on a hot day. To cover the important topics, ask them about the following:
Chief complaint: Ask the following questions: What is your most significant concern? When did it start? What makes it worse or better? Where is it located? How severe is it?
How old are they?
Symptoms: Ask if the patient can provide additional details about the chief complaint, or if they have other conditions or concerns.
Allergies: Are there severe ones? (Food and medicine are common ones; also ask about bees.) What are the patient’s reactions to their allergies?
Medications: Get as many details as possible for both prescription and over-the-counter drugs.
Pertinent medical history: Find out if they have any medical conditions that require them to see a doctor for treatment.
Last fluid/food intake, last urine/bowel output: How long ago and how much?
Events: Ask if they know what caused the event and for details leading up to it.
Wilderness First Aid: Making a Treatment Plan
Go over all of the information you’ve gathered and make a treatment plan, including anticipated problems. Then follow your plan while monitoring the patient’s health closely and ensuring that they are as comfortable as possible.
Treating Medical Issues: Depending on the type of medical issue and severity of the problem, you may be able to treat your patient and you can both continue on with your wilderness adventures. Taking a Wilderness First Aid class will help you learn about a variety of medical issues, and what you should do for them, including:
Spine and head injuries
Shock
Wounds and infections, burns and blisters
Bone and soft-tissue injuries
Heat exhaustion and heat stroke
Hypothermia and frostbite
Altitude illness
Lightning-related injuries
Allergic reactions (including snakes, scorpions and insects)
Chest pain, shortness of breath, altered mental status
Making an Evacuation Decision: Whenever a condition is serious, you have to decide whether to evacuate and by what means: helicopter, carried by rescuers or with you and the patient walking out under your own power. That’s a complex decision based on specific symptoms, how the patient is doing, the availability of rescue resources and the remoteness of your location, among other things.
Wilderness First Aid Tips
If possible, have someone of the same gender perform the head-to-toe exam
Have someone help the examiner by writing down observations and vital signs
Assign other tasks, like boiling water for drinks or setting up camp, so that the patient feels like care is orderly and all rescuers have a role
Try to keep the patient clean, warm and comfortable at all times. If you are waiting for help to arrive, things like shelter, sustenance and general nursing care will be key to maintaining patient well-being.
Fluids are more important than food; avoid caffeinated and sugary drinks
Offer emotional support and empathy
Inform the patient about all aspects of care and involve them in evacuation decisions
Resupply and/or supplement your first-aid kit before each trip (consider a larger tube of antibiotic ointment or more dressing materials, among other things)
Featured on REI Expert AdviceN.A.C. News
(Sunday, April 11, 2021)
Good Morning everyone,
Keep up to date with the Vaccination progress; Canada Vaccination Data Ontario Vaccination Data
Well, here we are again. Stay at Home Order number 3! I remember just over a year ago, receiving an email from Niagara Casinos, on my birthday no less, telling me that I was being Laid Off for 3 weeks to "Flatten the Curve". Well, the curve has become a roller coaster, and the 3 weeks have become 13 months, and we're not done yet. During this time, I decided to spend as much time as I can on the club, organizing as many events as I could, building a new web page, and recruting new subscribers. Well, I have about half of the new web page done, I have gained just over 100 new subscribers, and in 2020 we did more hikes than any previous year. So far, 2021 has been a bust with two stay at home orders, we have only completed 3 hikes so far. But, on the bright side, vaccinations are ramping up, and within the next 25 days, 40% of Ontario should be vaccinated. And then we start the slow journey to recovery. No one knows what the new normal will look like, but it will be better than this, I promise. As soon as we can get back to it, I will start planning hikes again. Our 3 day Backpacking trip was cancelled, but I am hoping I can still get it in between the end of this Stay at Home Order and before Black Fly season. Excercise is permitted under this stay at home order. So, if you need any advice on where to hike in your community, please reach out. I have many resources for finding trails, and I would be happy to help you find something close to home.
That's all the news for this week. As always, stay safe, and happy hiking! Lenny Burch Niagara Adventure Club