Wilderness and Remote First Aid

1. Wilderness and Remote First Aid American Red Cross Course New material as of June 1, 2010 (formerly Wilderness First Aid Basics) Updated March 2012

2. Course Information • Prerequisite: Adult CPR with AED* • Certification/Completion Requirements Participate in all skill sessions Complete scenario with group JEOPARDY Review or Written exam (80% is passing) OPTIONAL • Certification Length 2 years recommended renewal • Purpose of Certification Philmont trek leadership High adventure leadership Remote preparedness in delayed help activities • Course Outline and schedule See agenda

3. Learning materials • Required text • Reference guide • Pocket guide • Handouts • Self test • Additional reading material

4. Before we get started… • Did you • Provide your BSA number (if you have it) • Check in for roll call • Pick up Participant booklet and quick reference card • Pick up handouts • Silence your cell/pager, screaming child or spouse • Fill out an envelope ** if more than one are in same address, please write names on back to save postage costs

5. Some Delayed Help Activities • Sailing/Boating • Rafting • Skiing • Canoeing/Kayaking • Ballooning • Backpacking/Hiking • Camping • Horseback Riding • Caving • Travelling on highway • Natural Disasters • Man Made Disasters

6. Emergency Action Steps • CHECK • Scene • Patient • Resources • CALL • Plan what to do • Get Help • CARE • Provide Immediate Care • Monitor Patient • Provide additional care

7. Check The Scene • Take charge • Identify/Delegate tasks to be performed • Followership • Approach the patient safely • Do Emergency Moves

8. Is the scene safe?

9. Check The Patient • Do urgent First aid • Initial Assessment • Protect the patient • Prioritize Care • Check for other injuries

10. Check For Resources • Number of people to help • Communications • Water Supply • Food Supply • Shelter • Supplies • Transportation

11. Call For Help • Plan what to do • Get Help • Call for help to come to you • Distress signals • Send someone in your group for help • Leaving the patient alone • Transporting the patient yourself

12. CARE: In a delayed Help Situation • Remain calm • Do no further harm • Monitor the patient • Every 15 minutes at least • Continuously for the seriously injured patient

13. Patrol assignments • Patrol 1 • Patrol 2 • Patrol 3 • Patrol 4

14. THE 10 ESSENTIALS • Boy Scouts of America • SAN DIEGO COUNTY SHERIFFS DEPT • AMERICAN RED CROSS • Map of the area • Compass • Flashlight with extra batteries • Extra food • Extra clothing, including rain gear • Sunglasses and/or sunscreen • Pocketknife • Matches in a waterproof container • Candle or fire starter • First aid kit • THE ELEVENTH ESSENTIAL • Many of you add something you cant live without. Please share

15. Other Important ItemsWhat else do you carry? • Full water bottles • Ground insulation • Shelter • Emergency blanket • Signaling device (whistle, mirror) • Duct tape (the multi purpose tool) • Items for special environments

16. FIRST AID KIT • Include plenty of sterile absorptive material • Water tight compartments • Area specific (what are you likely to need?) • No prescription drugs unless necessary for individual • First aid and rescue directions • First aid report forms and a pencil

17. Water Sterilization • Remove large particles by straining water through cloth • Boil water for at least 1 minute • Rinse container with boiling water and let sit for at least 1 minute • Pour out rinse water and pour boiled water into container • Cover container • Cool water before use on body

18. More ways to disinfect water • Chemical treatment • Filtration • Ultra-violet light

19. PRIMARY (Initial) Assessment First check for life threatening conditions: • Airway • Breathing • Circulation • Disability • Environmental hazards

20. SECONDARY (Focused) Assessment • Head to Toe • Vital Signs • SAMPLE Questions • Special Questions

21. General Principles of Head to Toe Physical Exam • Do no further harm • Be complete and systematic • Use direct observation • Compare body parts • One person does the exam (same person repeats) • Make multiple observations (to check for changes) • Record your findings

22. Head to toe exam • Head • Neck • Chest • Abdomen • Arms • Legs • Back

23. Head to Toe Exam • Depressions • Obvious deformity • Tenderness • Swelling • Also look for: • Pale sweaty skin • Nervousness • Awareness • Position of the limbs

24. Vital Signs • Breathing (rate, rhythm, quality) (12-20) • Skins (color and temperature) (warm, dry) • Pulse (rate, rhythm, quality) (60-100) • Eyes (pupils = PERRL) • Level of consciousness • (Awake, responsive, non responsive)

25. Vital signs – pupil response dilated constricted

26. Levels of Consciousness • A - Alert • V - Responds to verbal stimuli • P – Responds to painful stimuli • U – Unresponsive to any simuli

27. SAMPLE History • Signs and Symptoms • Allergies • Medications • Pertinent past medical history • Last food or fluid intake • Events leading up to accident/illness

28. Special Questions • Ask questions that relate to the Mechanism of Injury or Chief Complaint • For example: • “Have you ever experienced (this) before?” • “What did you eat?” • “What makes the pain worse/better?” • “Can you walk on the injury?” • “Is there anything unique about your (body part) ?” • “Do you need help with your medicine?” • “You said you are allergic to bees. What happened when you were last stung?”

29. Skill Practice

30. Calling for help and evacuation considerations • Where are we? • Can we call with a radio or signal for help? • Should we send someone for help? • Can we transport the patient to help? • Should we care for them until well enough to travel?

31. Providing care while waiting to evacuate? • Leaving them alone • Transporting considerations • Temporary shelters

32. Deciding to evacuate Things to consider… • Terrain to be crossed • Strength of the members of the party • How long before help arrives • Extent of injuries • Distance of travel • Weather conditions • Equipment

33. Shelters Lean -to

34. Shelters (cont’d)snow caves

35. Shelters (continued) Tarp tent Bivouac

36. Group assignment: Scenario

37. Warning: The remainder of this presentation contains actual photos that may be too graphic for some audiences. (Parental supervision may be advised – That is to say some parents must be supervised by their children) T

38. Shock • Definition: The body’s inability to perfuse tissues with blood to provide oxygen and nutrients • Early stages: • Patient is aware, restless, anxious • Skin is pale, cool, clammy • Heart and respiratory rate is rapid • Patient is thirsty or nauseous

39. Shock: An illustrationA loss or damage to any one of these components can create shock

40. Shock (cont’d) • Later stages: • Patient is lethargic, apathetic, or unconscious • Skin is gray, cool and damp • Heart rate is weak and irregular • Respiratory rate is rapid and very shallow or low in volume • Eyes are dull and dilated

41. First Aid Goals: Shock • Ensure patient is breathing • Stop any obvious causes of shock • Maintain body temperature • Treat patient gently • Replace lost fluids • Elevate legs 12 inches (if no injury conflicts) • Monitor continuously • Evacuate ASAP

42. Shock in a Delayed Help Situation • If patient will be able to get to hospital in a few hours, do not give food or fluids • If longer, give sips of fluid at rate of 4 ounces (1/2 cup) to an adult over 20 minute period • Give child ½ that much, infant ¼ • Do not give fluids if unconscious or if there is a head or abdominal injury

43. Heart Attack • Signs and Symptoms • Pain or discomfort, sub-sternal chest that may radiate up or down left side • Shortness of or difficulty breathing • Profuse sweating • Nausea • Unexplained fatigue • Flu like symptoms without fever

44. Heart Attack • Steps to treat • Stop any activity • Calm and comfort • Call 9-1-1 or send for help immediately • 81 mg Aspirin • Assist with their own medication (nitroglycerine) • Monitor ABC’s and use CPR or AED if needed.

45. Chest Injuries • Two common type: • Penetrating • Rib fractures • First Aid goals: • Assess seriousness • Prevent further injury • Help increase ease of breathing • Watch closely for changes • Evacuate immediately

46. Penetrating chest injuries are immediate evacuation Move slowly, but immediately

47. An impaled object must be stabilized Keep it from moving by applying padding or holding it steady

48. Sucking chest wounds must be plugged immediately! Then bandage to allow air to escape but not reenter chest cavity.

49. Specific Chest injuries • Rib injuries • Lung injuries • Flail chest • Sucking chest wound

50. Causes of Neck and Spinal Injuries • Direct blow to the spine • Blow to the head • Falls on the buttocks, transmitting force to the spine • Fall of a distance greater than the person’s height • A broken helmet • Any diving mishap • Unconsciousness for unknown reasons • Severe blunt force to the head or trunk • Motor vehicle crash (especially if not wearing safety belts) • Person thrown from a motor vehicle • Lightning strike