Wilderness First Aid

Wilderness First Aid HS 223 Wilderness First Aid Introduction

Definition: Wilderness medicine protocols are in effect when you are more than one hour from definitive medical care. Environment: You may be dealing with extreme environments in addition to the injured or ill patient. Communications: May be limited or unavailable Wilderness First Aid Differences between Wilderness and Urban setting: Time with patient: This can be anywhere from an hour to days at a time Improvisation: You may need to create tools for treatment and evacuation from what is available Introduction

Job requires it and you are working • Preexisting Relationship • Once you start rendering First Aid Good Samaritan laws are designed to protect individuals that render first aid. They will be in effect as long as the first aider does what a normal, reasonable person with the same level of training would do. Legal Issues Wilderness First Aid When are you required to render First Aid? Negligence/Good Samaritan Laws:

Informed Consent: When a reliable patient gives consent • to treatment after being informed of • the risks and benefits • Implied Consent: A legal assumption that an unreliable • patient would want help during an • emergency situation. An unreliable • patient is considered to be any patient • who is not fully alert and oriented as to • who or where they are. Implied consent • also applies to minors(under18) whose • parents are not available to give consent I must get back to my ship or Captain Ahab will go fishing without me Legal Issues Wilderness First Aid Consent: There are 2 basic types of consent:

Wilderness First Aid I’m sure glad that Walmart has started training it’s employees in exercise ECG’s • Only do that which you know • Write down everything you do and • observe while treating patient (documentation) • Periodically take a refresher course in Wilderness First Aid Legal Issues GeneralGuidelines: • Try to know basic medical history of traveling companions • Make sure patients level of care does not decrease • Emphasis should always be on PREVENTION

Circulatory CRITICAL SYSTEMS Respiratory Nervous Musculoskeletal Skin Endocrine General Concepts Wilderness First Aid Body Systems Approach Need to know: Structure Function Problems

Heart -Pump Vessels-Arteries, veins, capillaries Perfusion: Forcing fluid across tissue under pressure Shock General Concepts Wilderness First Aid Circulatory Structure: Volume- Blood, cells, other fluids Function: Maintaining adequate perfusion pressure Problem:

Respiratory Neuro drive Respiratory distress/failure General Concepts Wilderness First Aid Structure: Upper Airway -Lips to Larynx Lower Airway- Larynx to Alveoli Alveoli Diaphragm and Chest Wall Function: O2 in, CO2 out Problem:

Nervous Increasing ICP General Concepts Wilderness First Aid Structure: Central Nervous System • Brain & Spinal Cord Peripheral Nervous System • Nerves extending from Spinal Cord Function: System Integration Voluntary/Involuntary Problems: Spinal Cord Injury (Intra-Cranial Pressure)

Musculoskeletal Stable/Unstable injuries General Concepts Wilderness First Aid Structure: Muscle Types- Striated (skeletal) Smooth (Blood Vessels) Cardiac Bone Types- Problems: Long bones Joints Function: Protection Support

Wilderness First Aid Skin Loss of Integrity Thermoregulation General Concepts Structure: Epidermis Dermis Adipose Tissue (FAT) Sweat Glands Blood Vessels Muscle Problems: Function: Protection

Wilderness First Aid Endocrine Structure: Pituitary Parathyroid &Thyroid Glands Thymus Adrenal Glands Pancreas Ovaries Testes Hormone Regulation General Concepts Function: Problems: Increased/Decreased Production

Wilderness First Aid • The body continually tries to maintain homeostasis Shivering Sweating Changes in breathing rate General Concepts Compensation Mechanisms Homeostasis- Relative constancy in the internal environment of the body… • In a wilderness context you must weigh the short term gains versus the long term damage or consequences Examples of ways the body compensates: Changes in heart rate Shell/Core effect Core/Shell effect

Wilderness First Aid Brain is comparable to an onion in that they both have layers that can be peeled away (Injured) = Inner Layers- Basic life functions (Lizard Brain) (Breathing, Heartbeat, Compensation mechanisms) General Concepts Level of Consciousness Outer Layers- Higher function (Reasoning skills, Fine motor skills)

Wilderness First Aid Swelling Curve Anything that irritates the body will cause swelling Hours 1 6 12 18 24 General Concepts Ischemia/Necrosis Ischemia….. Inadequate Local Perfusion Necrosis….... Tissue Death Intravascular • Extravascular • Swelling • Embolism • Angulation • Clot • Pinched/Crushed Bleeding Majority of swelling occurs in first 6 hours Edema (Abnormal Fluid Accumulation) Can continue to swell for up to 24 hours

Wilderness First Aid General Concepts Determining Level of Consciousness A - Alert and oriented to Person, Place, Time and Events (A+Ox4) A - Alert and Oriented to Person, Place and Time (A+Ox3) A - Alert and Oriented to Person and Place (A+Ox2) A - Alert and Oriented to Person (A+Ox1) V - Responds to Verbal Stimulus (V) P -Responds to Painful Stimulus (P) U - Unresponsive (U)

Patient Assessment Wilderness First Aid • Gather Information • Organize a Response • Anticipate Problems That May Develop over a Period of Time • Treat Patient as a Human Being Patient Assessment Why: • Learn and use their name • One of the main objectives is to calm the patient down

Patient Assessment Wilderness First Aid Scene Survey Initial Assessment Focused History & Physical Exam Patient Assessment

Patient Assessment Wilderness First Aid M.O.I. (Mechanism of Injury) Patient Assessment Safety • Self Universal Precautions • Rescuers • Bystanders • # of Patients • Patients • # of Rescuers Scene Survey • # of Resources • Triage (pg. 13) Numbers • Trauma (Tends to happen from Speed) • Medical (Tends to develop over time) • Environmental • Spinal (Is it enough to cause Spinal Injury)

Patient Assessment Wilderness First Aid Patient Assessment Circulatory Rules: • Pulse • Treat as you Find • Severe Bleeding • 5 Minute Rule • What do they have that will • kill them in less than 5 minutes • Quick Body Check • (If M.O.I. Is due to Trauma) Initial Assessment Respiratory Nervous • Breathing • Brain/AAAAVPU • Airway • Spine Stabilization

Patient Assessment Wilderness First Aid Focused History & Physical Exam Patient Assessment nset OPQRST rovocation uality Rules: SAMPLE ymptoms adiate History llergies • Complete and then treat Finish everything before you do anything everity edications ime ertinent History ast Intake/Output vents preceding Incident Vital Signs Pulse: Physical Exam Rate, Rhythm, Quality (Adult 60-90) Respirations: Rate, Sounds, Rhythm (Adult 12-20) Head-to-Toe Blood Pressure: Method of Measurement (Inspect, Palpate, Auscultate) Checking for: Skin: Color, Temperature, Moisture Deformities, Contusions, Swelling, Tenderness, Wounds AAAAVPU Check: Temperature Head, Neck, Chest, Abdomen, Pelvis, Extremities, Posterior Body

Shock Wilderness First Aid Shock occurs when the tissues or organs of the body are inadequately supplied with oxygenated blood. Types of Shock: Hypovolemic: Loss of fluid from bleeding, sweating, vomiting, diarrhea and/or severe burns. Cardiogenic: Failure of the heart to adequately pump blood. Vasogenic: Loss of vascular tone resulting in an increased vascular space. ( Spinal Cord Injury, Sepsis, Anaphylaxis) Stages of Shock: Compensatory: Peripheral vasoconstriction, increased HR and increased respiratory rate to keep blood pressure within normal limits to maintain adequate perfusion pressure. Decompensatory: Blood pressure starts to drop and inadequate perfusion begins Irreversible: Organs begin to die from inadequate perfusion Shock

Shock Wilderness First Aid Signs & Symptoms: Early: LOC: Anxious, restless, disoriented HR: Rapid, weak and, thready RR: Rapid and shallow SCTM: Pale, Cool and clammy (may be pink and warm with vasogenic shock) Symptoms: Patient may feel nauseated and may vomit, and may complain of dizziness and/or thirst. Late: BP: Falls, Radial pulse weakens and eventually disappears Pupils: Progressively slower to respond Treatment: Don’t wait for shock. Treat before serious signs develop Look for and treat underlying causes Reassure the patient, keep them physically and emotionally calm, maintain AIRWAY Keep patient warm Keep the patient flat with legs elevated no more than 12 inches when appropriate Administer fluids orally if care is extended and the patient can tolerate them. Monitor the patient closely for deteriorating vital signs. Shock

Shock Wilderness First Aid ASR (Acute Stress Reaction) Parasympathetic Sympathetic Slows down critical systems Speeds up critical systems Temporary vascular dilation Patient will usually faint Problems: ASR mimics true shock Pain masking ASR is a temporary condition controlled by the Autogenic nervous system Differences between True Shock and ASR: ASR goes away after a short period Blood Pressure will increase in ASR (Sympathetic) ASR can trigger other medical conditions i.e. Epilepsy, Diabetes, Heart Disease Shock

Wounds/Bleeding Wilderness First Aid Normal Healing Process 0-24 Hours 7+ Days 0-2 Days 2-7 Days • Bleeding • Developing • Protective • Barrier • Strong • Protective • Barrier • Absorption of • Protective • Barrier • Clotting Barriers to Healing Environmental Mechanism/High Risk Wounds Medical • Crushing Injuries • Open Fractures • Underlying Injuries • Animal Bites • Joint Injuries • Puncture Wounds • Hypothermia • Frostbite • Wet/High Humidity • Diabetes • Smoking • Underlying Medical • Conditions Treat As High Risk Wound Wounds Bleeding

Wounds/Bleeding Wilderness First Aid * Impaled Objects Wound Types Open - High Risk Closed - Specific Wound Types Abrasion Laceration Avulsions Puncture Amputations *Impaled Objects can be removed In a Wilderness Setting if: -Safe & Easy to remove -Cannot be Stabilized -Prevents Safe transportation Wounds Bleeding

Wounds/Bleeding Wilderness First Aid Treating Open Wounds Well-Aimed Direct Pressure Elevation Tourniquet Last resort.. Only if everything else fails Cleaning a Wound Supplies needed: • Universal Precautions • Filtered Water • Tweezers • 10-15 ml syringe with an 18 gauge catheter Wounds Bleeding

Cold Emergencies Wilderness First Aid Frostbite It must be freezing (actual temp.) in order to get frostbite Definition: Frostbite is local freezing of the tissues of the body. Generally the fingers, toes, cheeks, ears and, nose are most vulnerable. Types: No permanent damage to the affected tissues Superficial: Partial Thickness: Upper layer tissue damage. Usually no significant tissue loss Full Thickness: Significant damage to outer layers and can go into muscle and bone. Cold & Hot

Cold Emergencies Wilderness First Aid Frostbite, cont. Signs/Symptoms: Superficial: Mild tingling/pain, followed by numbness. Appears whitish/yellowish, waxy looking. Cold and pliable. No damage when thawed. Partial Thickness: Mild tingling/pain, followed by numbness. Whitish/yellow waxy looking skin. Pliable but “dents” when palpated. Warm, swollen and tender after thawing. Within minutes to hours after thawing blisters will develop. Blisters may be clear to reddish-blue in color. Area may remain numb after thawing. Full Thickness: Tissue appears cold, pale and is frozen hard. Described as feeling “wooden”. After warming area becomes deep red, cyanotic or, mottled. Numb, cold and bloodless. Gangrene, mummification develops rapidly Cold & Hot

Cold Emergencies Wilderness First Aid Frostbite, cont. Treatment: Superficial/Partial Thickness: Give Ibuprofen about 1/2 hour before starting, if possible Warm affected area: Ideally, submerse the affected area in water 1040 to 1080 and leave it in until completely flushed. Protect from refreezing Never massage/use radiant heat Evacuate if blisters form Full Thickness: Administer STRONG pain med’s, if available. (Include ibuprofen to reduce tissue damage) Avoid field rewarming. Allow patient to walk out if prudent. If evacuation delayed consider field rewarming Protect from refreezing Evacuate ALL full thickness frostbite Cold & Hot

Cold Emergencies Wilderness First Aid Hypothermia Definition: A lowering of the core temperature of the body to the level that brain function is impaired. Causes of Hypothermia: Acute Exposure: Immersion/Submersion in water. Occurs in less than One hour Body loses heat 25 times faster in water Sub-acute Exposure: Occurs in One - Twenty-four Hours Chronic Exposure: Common in elderly or homeless populations. Occurs in One - Several days Signs/Symptoms of Hypothermia: “UMBLES” Mild: Loss of fine motor/reasoning skills Shivering “Umbles” Begin Fumbles Mumbles Grumbles Stumbles Moderate: Uncontrollable shivering Worsening of “Umbles” Cold & Hot

Cold Emergencies Wilderness First Aid Hypothermia, cont. Signs/Symptoms of Hypothermia: Severe: Shivering stops, muscles become rigid, unconsciousness, pulse and respirations drop to undetectable levels, high risk of ventricular fibrillation Treatment of Mild/Moderate Hypothermia: Change environment, seek shelter Remove wet clothing and replace with dry (Hypothermia Wrap?) Insulate patient from cold Keep patient moving if able Create external heat source: Fire, stove, heat packs Give warm, sweet fluids (No caffeine, alcohol) (Only if they can drink without assistance) Food Chain for Revival Have patient eat if possible To stoke the bodies furnace compare it to starting a fire Kindling Simple sugars Small sticks Complex carbs. Proteins/Fats Logs Cold & Hot

Cold Emergencies Wilderness First Aid Hypothermia, cont. Treatment of Severe Hypothermia: Treat very gently (Very high risk of myocardial infarction) Do not try to re-warm, protect from further heat loss Cut off wet clothing (Even if it’s expensive) Place patient in a Hypothermia Wrap Add heat (Insulated, warmed rocks, heated water bottles near hands, feet, groin, armpits, neck) Evacuate as gently and rapidly as possible Cold Weather Guidelines: Avoid tight clothes and boots Know your environment and be prepared Do not sleep with wet, cold feet Pay attention to yourself and your companions Dress to maintain warmth and dryness Avoid alcohol,caffeine, nicotine and other vasoconstrictors Stay well fed and well hydrated Stay dry. Avoid overexertion Carry emergency food and clothes Cold & Hot

Wilderness First Aid Moving A Suspected Spine Injured Patient Only move if necessary Stabilize Head and Weight Centers 7 Cervical Person on the head makes the calls Move in Small Increments Axial Movement is Usually Best 12 Thoracic Always Maintain HOS Avoid Pushing or Pulling (Try to Lift) 5 Lumbar Sacrum Coccyx Spine Injury

Wilderness First Aid

Wilderness First Aid