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
Normal … medical help in the golden hour
– Call for help
– Stabilize Victim
Wilderness First Aid … help is over 1 hour away
but within a few days
– Get help as soon as you can
– Long term stabilization
– Some treatment
Deep Wilderness … you are on your own
Prevention is your best offense
Avoid Risky Behavior!
Hydration
Hypo / Hyperthermia prevention
Get Medical history for all in the group
Avoid blisters
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)
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
Get History of ALL Serious
Conditions
Diabetes
Asthma
Allergies
Seizures
Sleep Walking
Other
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?
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
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
Serious Injuries
(That you are likely to see)
Hypothermia
Dry warm clothing, shelter
– ground cover (your sleeping “PAD”)
Hot water bottle in the pits (underarm /
groan)
Sugar ... replenish fuel / fluids
Eye
Irrigate with sterile water
Puncture wound
– Don't try to remove puncture object
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
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?
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
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
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.
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
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
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!
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
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
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