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Wilderness First Aid

Wilderness First Aid. Nick Loy (A very short course). Forward. Full Certified Course 80 hours for ENT or alike Short Refresher Course … 16 / 24 hours This course … 1 hour Doesn’t even scratch the surface !. Wilderness vs. "Normal" First Aid vs. Deep Wilderness.

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Wilderness First Aid

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  1. Wilderness First Aid Nick Loy (A very short course)

  2. Forward • Full Certified Course • 80 hours for ENT or alike • Short Refresher Course … 16 / 24 hours • This course … 1 hour • Doesn’t even scratch the surface !

  3. Wilderness vs. "Normal" First Aid vs. Deep Wilderness • Normal … medical help in the golden hour • Call for help • Stabilize Victim • Wilderness First Aid … help is over 1 houraway but within a few days • Get help as soon as you can • Long term stabilization • Some treatment • Deep Wilderness … you are on your own

  4. Prevention is your best offense • Avoid Risky Behavior! • Hydration • Hypo / Hyperthermia prevention • Get Medical history for all in the group • Avoid blisters

  5. Hydration • Start out well hydrated ... you cannot maintain hydration during a vigorous hot day • "Water shots“ every 15 minutes to 1 hour • Electrolytes / calories • 1/2 OJ / 1/2 water • Lack of hydration can lead to impacted bowls • very unpleasant trip to the hospital • (also do not avoid the outhouse even if it is disgusting)

  6. Hypo / Hyperthermia • Even in the summer hypothermia common and hypothermia KILLS • Every year “experienced” hikers die in the White Mountains. • Symptoms • Poor judgment • “Drunken” like behavior • Shivering

  7. Get History of ALL Serious Conditions • Diabetes • Asthma • Allergies • Seizures • Sleep Walking • Other

  8. RULES • Don't become a second victim! • BFI ... if it is wet and warm or was in another body keep it off you • Evaluate • How critical? • Is the victim “really” ambulatory?

  9. Evaluate • Site … is it safe? • Situation … what happened? How did it happen? • Victim … what is the damage? Are there any priority 1 emergency interventions called for? • Breathing is first … 4 min not breathing = brain damage • Happy patient (examiner) position • Moving the victim to safety • Talk to victim … lead person is at victim’s head • Take notes • Check for secondary injuries in limbs and trunk. Palpate the entire body. • Check core pulse and distal pulse

  10. DON’T • With rare exception ... do NOT medicate • NO goo in a wound! (Except minor cuts, etc and then goo on bandage not the wound) • Except for minor burns ... NO GOO • Do Not Move a non ambulatory victim any distance ... it takes 16 people and good equipment

  11. Serious Injuries(That you are likely to see)

  12. Hypothermia • Dry warm clothing, shelter • ground cover (your sleeping “PAD”) • Hot water bottle in the pits (underarm / groan) • Sugar ... replenish fuel / fluids

  13. Eye • Irrigate with sterile water • Puncture wound • Don't try to remove puncture object

  14. BURNS • Cold 1 hour • Flush with sterile water • Go to hospital if burn size is: 2 hands / 1 hand / dime in size. Genitals and facial more critical • Red • Blistered • Charred / white… may be no pain • Except for very minor burns: • No GOO • Do not cover

  15. Head and Neck • Suspect head and neck injury if: • Fell from more than 2x victim’s height • Direct blow to the head or neck • Asymmetric body signs • Distal pulse • Eyes • Strength • Numbness or loss of strength in lower body (below the neck) • A pain in the neck. • The ground is your “backboard”! Do NOT improvise. Place pads left and right of head. • The “yes” motion of the head is much higher risk than the “no” motion. • If questionable, wait 20 – 40 minutes and re-examine • Can the victim move his head without ANY pain?

  16. Bleeding • BFI … 500 cc is a LOT of blood! • Clean and irrigate wound • tourniquet NO /NEVER / Forget it • pressure bandages ... don't remove old bandages • For an artery … pressure may be required for a long long time

  17. Puncture Wounds • They are much more serious that they seem because they can go septic! • Irrigate • Irrigation needs a little water pressure behind it. • Go to hospital • no goo

  18. Abrasions • Treat as a burn • You do not need 1 hour cold. • Also, clean wound carefully. Get out as much “dirt” as practical. • If minor cover with hydro-bandages, second skin, or alike. The wound will weep.

  19. Broken / Sprained Limbs • RICE • Rest, ice, compression, elevation … avoid swelling • Leg injury … carefully evaluate if ambulatory • Consider terrain and possibility of second injury • Watch for swelling • Think about boots • “Splint”: Big, ugly, cushioned. • Check distal pulse often • Unless trained … no tension splint • To Straighten or not to straighten a compound break? • If no distal pulse and more than 2 hours from help … consider straightening • If good distal pulse and help is soon consider leaving it alone

  20. Heart Attack • At first sign … Aspirin (not Ibuprofen or Acetaminophen) • Pulse ... even if you can't find it is likely there! • Rescue breathing ... YES! • BFI ... don't forget the mouth guard • CPR … good for an evaluation period but cannot be maintained • NEVER with hypothermia • mechanical defibrillation ... long shot but your only chance • Remember … there is not much you can do … don't feel guilty

  21. Anaphylactic Reaction • Epi Pen ... how to • Thru the clothing into the big muscle of the thigh … leave in for count of ten • Do not administer without permission / help • "Primatene" mist can be used if no Epi pen • Benadryl (or other antihistamine / steroid) ... this is the cure!

  22. Shock • Pale, extremities cold, sweaty, lips may be blue, dizzy / fainting … caused by a loss of blood pressure due to too many arterioles opening at the same time. • keep warm, feet up

  23. Other • Diabetic Coma … follow specific instructions if you have them! • Help the person avoid coma … watch for signs. Low sugar leads to poor judgment. • Sudden coma, most likely due to lack of sugar. The goal is to get the victim conscious so that they can advise you. Paste small amount of sugar solution on the lips. • Do NOT administer insulin on your own! • Blisters (other than burns) • Sterile Puncture … on the trail it will break anyhow • Diarrhea … can lead to severe dehydration • Drink lots of fluids including fluids with sugar/salt • Pills … short term OK, long term bad • Choking … Heimlich maneuver • Asthma … use inhaler, hydrate, rest • If can’t talk in full sentences comfortably get help ASAP! • Have them take their emergency steroids/antihistamines. • Keep away from camp fire

  24. THINK! • Do no harm (or as little as possible) • Protect yourself • Keep everyone busy • Have a plan! • Have medical forms and notes in each person’s First Aid Kit • Pin med form and notes / medication / body parts to the victim

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