Chapter 24

1. Chapter 24 Wilderness First Aid

2. Wilderness First Aid • Wilderness describes situations including: • Recreation • Occupations in remote areas • Urban areas with overwhelmed EMS • Remote communities • Developing countries

3. Cardiac Arrest (1 of 2) • CPR has limited use in a wilderness setting. • CPR is difficult to continue during a wilderness evacuation. • It is recommended that CPR be stopped after 30 minutes if the victim does not respond.

4. Cardiac Arrest (2 of 2) • CPR for hypothermia victims • Continue for more than 30 minutes • CPR for avalanche victims • Continue for more than 30 minutes if necessary • CPR for lightning-strike victims • Start CPR immediately • CPR submersed victims • If victim has been submersed for more than 60 minutes, do not start CPR

5. Dislocations • In a wilderness situation, reducing some dislocated joints is recommended. • Reducing is a technical term that means aligning.

6. Shoulder Dislocation • Recognizing shoulder dislocation: • Victim is in extreme pain. • Upper arm is held away from the body. • Victim is unable to touch the uninjured shoulder with the hand of the injured extremity. • Compare the injured shoulder with the uninjured one.

7. Care for Shoulder Dislocation (1 of 2) • Traction and External Rotation Method • Gently pull the arm out to the side while another provides countertraction against the chest wall. • Tell the victim to relax. • Pull and gently rotate the arm into a baseball-throwing position. • Stabilize the arm.

8. Care for Shoulder Dislocation (2 of 2) • Simple Hanging Traction • Hang injured arm off the side of a high, cushioned surface. • Attach a weight to the victim’s lower arm. • Muscles will stretch and tire, allowing joint to pop back in. • Stabilize the arm.

9. Finger Dislocation • Recognizing a finger dislocation: • Deformity and inability to use or bend the finger • Pain and swelling • Abnormal position of two bones

10. Care for a Finger Dislocation • Hold the end of the finger with one hand and the rest of the finger in the other. • Gently hyperextend the dislocated joint. • Pull gentle traction. • Push the dislocated bone into place. • Unbend the finger. • Buddy-tape it. • Splint.

11. Kneecap Dislocation • Recognizing kneecap dislocation: • Patella has moved to the outside of the knee joint. • Victim is in pain. • Compare to other leg.

12. Care for Kneecap Dislocation • Slowly straighten the knee while gently pushing the kneecap back into position. • Stabilize the leg straight. • With the knee extended and stabilized, victim may be able to walk with an aid.

13. Spinal Injury • Recognizing a possible spinal injury: • Is the victim alert and oriented? • Does the victim have any major painful injury? • Victim complaining of neck pain? • Victim have tingling, numbness, or weakness in the extremities? • Check for neck tenderness. • Determine if victim have sensation in hands or feet.

14. Clearing a Spinal Injury • The victim does not need to be stabilized in one position if: • Completely alert • Not intoxicated • Has no distracting injuries • Does not complain of neck pain • Can feel normal touch • Can move the fingers and toes

15. Use your hands or knees to hold the victim’s head in place. While kneeling at the victim’s head, use your hands or knees to stabilize the neck in relation to the long axis of the spine. Avoid moving the victim if possible. Care for a Spinal Injury

16. Victims with femur fracture can easily lose 2 quarts of blood and develop massive swelling. If needed, splint the fracture. Splinting Femur Fractures

17. Avalanche Burial • Falling masses of snow that may also contain rocks, soil, or ice. • Number of deaths has increased rapidly since the 1970s. • Most avalanche victims die of suffocation. • Speed of extrication and existence of an air pocket are the main factors that determine survival.

18. Recognizing an Avalanche Victim • Avalanches kills and injure in two ways. • The serious injury victim acquires while tumbling down the avalanche path. • Snow burial and suffocation.

19. Care for an Avalanche Victim • Quickly 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.

20. Altitude Illness • Hypoxia • Occurs when the body’s tissues do not have enough oxygen • Acute mountain sickness (AMS) • High-altitude pulmonary edema (HAPE) • High-altitude cerebral edema (HACE)

21. Recognizing Altitude Illness • Typically strikes during the first 12 hours • Symptoms include: • Headache • Loss of appetite • Nausea • Insomnia • Fatigue • Shortness of breath with exertion

22. Care for Altitude Illness (1 of 2) • Seek medical help if any of the following symptoms appear: • Persistent cough • Shortness of breath while resting • Noisy breathing • Loss of balance • Confusion • Vomiting

23. Care for Altitude Illness (2 of 2) • Most people get better with rest as the body adjusts. • If condition doesn’t improve: • Descend 2,000 to 3,000 feet • Rest • Drink plenty of fluid

24. Lightning • Lightning injures in five ways. • Direct strike • Splash • Ground current • Contact injury • Shock wave

25. Recognizing a Lightning Injury • Absent breathing • Seizures, paralysis, loss of responsiveness • Minor burns • Punctate burns • Feathering or ferning burns • Linear burns

26. Care for a Lightning Injury • If more than one victim has been struck, go to the quiet and motionless victim first. • Start CPR if victim is not breathing. • If victim is unresponsive, but breathing, place on side. • Stabilize the spine. • Check for injuries. • Evacuate to medical care even if responsive.

27. Wild Animal Attacks • Incidence is not known • Perhaps one or two deaths occur each year in the United States • Most often occur in rural or wilderness settings • If you encounter a wild animal, try to remove yourself from the scene quietly and slowly.

28. Recognizing Wild Animal Attacks • Severe injuries result from victims being thrown in the air, gored, butted, or trampled on the ground. • Injuries include puncture wounds, bites, lacerations, bruises, fractures, rupture of internal organs, and evisceration.

29. Care for Wild Animal Attacks • Depending on the severity of the injury, either evacuate the victim to medical care or contact local authorities for evacuation.

30. Wilderness Evacuation • Determining the best way to evacuate a victim must be based on several factors. • Victim can be evacuated by: • Helicopter • Walking out • Being carried on a litter

31. When to Evacuate • Immediate evacuations • Rapidly evacuate when medical care is needed in 30 to 60 minutes or less. • Delayed evacuations • Medical care should be obtained within 6 to 24 hours of injury.

32. Guidelines for Ground Evacuation • At least two people should accompany victim if victim is walking out. • One or two people should be sent to notify authorities that assistance is needed if a victim needs to be carried out.

33. Guidelines for Helicopter Evacuation • Evacuate only if the following conditions apply: • Victim’s life will be saved • Pilot believes conditions are safe • Ground evacuation would be dangerous or prolonged

34. Signaling for Help • Signaling aircraft • Construct a large “V” or “X” on the ground • A series of three of anything indicates “Help.” • Three shouts, three shots, three light flashes • Mirror flashes