Wilderness First Aid

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 victims 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
Care for a Spinal Injury

• Use your hands or knees to hold the victims head
  in place.
• While kneeling at the victims 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.

16
Splinting Femur Fractures

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

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 victims 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 bodys 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 doesnt 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
• Victims 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