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Chap 4
FIRST AID AND EMERGENCIES
Introduction
1.
Well run expeditions and walks rarely end in anything serious. The most
likely first aid scenarios are blisters, nettle rash and aggravation of old injuries.
Nevertheless, it’s worth talking to the cadets about expedition specific hazards:
basically exposure related issues. It’s also worth introducing the cadets to what
to do if something serious happens. It’s not quite the same in the outdoors.
Learning objectives
2.
By the end of this chapter the cadets should understand:
a.
b.
c.
d.
3.
Hypothermia,
Heat exhaustion,
Heat stroke,
Sunburn.
They should also understand how to summon help when trekking.
Aim
4.
Your aim is to make sure the cadets have some knowledge of exposure
and how to avoid the consequences. You are also trying to guide them through
the actions to take in the event of problems.
Classroom Teaching Session
5.
Discuss hypothermia, heat exhaustion and heat stroke. Discuss going for
help without a mobile and calling for help with it. Discuss who should be called
and what you might say.
Time
6.
Spend 40 minutes on this, or incorporate it into the day walk.
Evening Practical Session
7.
One nice way of illustrating the reason not to let yourself get wet, is to get
each cadet to hold their hand out and judge the temperature. Then use an office
fan or a piece of cardboard to waft moving air over the hands. They cadets
should notice how much cooler it feels. Finally get each cadet to dip their hand in
a bucket of water from the tap. They should now perceive the air as cooler, but
the effects of holding the wet hand in moving air should be particularly
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noticeable. Now get them to imagine what it will feel like if they got their whole
body wet and had to stand in a substantial draft all day!
8.
First aid scenarios are a fun way of maintaining and developing first aid
skills. Your local St John Ambulance cadets may be willing to offer an evening of
scenarios. Alternatively, adult instructors can be briefed on the symptoms of
exposure and cadets asked to treat the casualty as if in an expedition setting.
9.
Encourage the cadets to remember that they will be carrying shelter which
can also be rigged as shade. Roll mats will ensure that people don’t lie on cold
or wet ground. The cadets will be carrying water for rehydration and the means
to heat it to give hot drinks.
10.
Heart Start training is very useful.
Alternative Exercises
11.
During the day walk stop and ask the cadets to work through a scenario
including phoning the ambulance and managing the post-incident events.
TECHNICAL MATERIAL
Hypothermia
1.
Is caused by loss of heat. Encourage cadets to take all action to avoid
becoming wet. Layers should be added if cold. Do not put up with any cold that
progresses to shivering – it’s supposed to be fun not endurance. Hot drinks are
excellent, as is making sure everyone is snacking to keep up energy levels.
Morale, motion and clothing will be excellent prevention. Remember that heat
can be lost through conduction (sitting or lying on cold surfaces) and convection
(especially wind chill) as well as radiation (when it’s just plain cold).
Levels of Hypothermia
Mild
2.
Symptoms of mild hypothermia may be vague with sympathetic nervous
system excitation (shivering, hypertension, tachycardia, tachypnea, and
vasoconstriction). These are all physiological responses to preserve heat. Cold
dieresis, mental confusion, as well as hepatic dysfunction may also be present.
Hyperglycemia may be present, as glucose consumption by cells and insulin
secretion both decrease, and tissue sensitivity to insulin may be blunted.
Sympathetic activation also releases glucose from the liver. In many cases,
however, especially in alcoholic patients, hypoglycemia appears to be a more
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common presentation. Hypoglycemia is also found in many hypothermic patients
because hypothermia often is a result of hypoglycemia.
Moderate
3.
Body temperature of results in shivering becoming more violent. Muscle
mis-coordination becomes apparent. Movements are slow and labored,
accompanied by a stumbling pace and mild confusion, although the victim may
appear alert. Surface blood vessels contract further as the body focuses its
remaining resources on keeping the vital organs warm. The victim becomes pale.
Lips, ears, fingers and toes may become blue.
Severe
4.
Difficulty speaking, sluggish thinking, and amnesia start to appear; inability
to use hands and stumbling is also usually present. Cellular metabolic processes
shut down. Below 30 °C (86 °F), the exposed skin becomes blue and puffy,
muscle coordination becomes very poor, walking becomes almost impossible,
and the victim exhibits incoherent/irrational behavior including terminal burrowing
or even a stupor. Pulse and respiration rates decrease significantly, but fast heart
rates (ventricular tachycardia, atrial fibrillation) can occur. Major organs fail.
Clinical death occurs. Because of decreased cellular activity in stage 3
hypothermia, the body will actually take longer to undergo brain death.
As the temperature decreases further physiological systems falter and heart rate,
respiratory rate, and blood pressure all decreases. This results in an expected
HR in the 30s with a temperature of 28 °C (82 °F).
Treatment
5.
You must aim to prevent further heat loss, help the casualty warm-up and
to summon medical help if needed. Remove wet clothing and shield the casualty
from wind and rain. Insulate with blankets or sleeping bags. Send for help and
remove the casualty from the outdoors as best as possible. Do not give the
casualty your clothes.
Heat exhaustion
6.
Is caused when the body can no longer get rid of excess heat. Again
cadets who feel hot should be encouraged to drink and remove layers of clothing.
Again they should regulate their temperature before it becomes a problem. Slow
down if the weather is warm. In very hot days keep the pace down and consider
an easier route.
7.
Warning signs of heat exhaustion include: heavy sweating, paleness,
muscle cramps, tiredness, weakness, dizziness, headache, nausea or vomiting,
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fainting. The skin may be cool and moist. The victim's pulse rate will be fast and
weak, and breathing will be fast and shallow.
Treatment
8.
You must aim to replace fluids, cool the casualty and get medical help if
needed. Place the casualty in the coolest place available. Give fluids. Advise
the casualty to see a doctor, even if they recover.
Heat Stroke
9.
Is caused when heat exhaustion goes untreated and progresses.
However, whereas heat exhaustion can be treated by a good expedition group,
heat stroke is a medical emergency and must be cause to summon professional
assistance: Ring 112.
10.
Some individuals can develop symptoms of heat stroke suddenly and
rapidly without warning. Different people may have different symptoms and signs
of heat stroke. But common symptoms and signs of heat stroke include: high
body temperature, the absence of sweating, with hot red or flushed dry skin,
rapid pulse, difficulty breathing, strange behaviour, hallucinations, confusion,
agitation, disorientation, seizure, coma.
Treatment
11.
You must aim to lower the casualty’s body temp and get urgent medical
attention. Wrap the casualty in wet clothing or sheets. When the casualty’s body
temperature falls below 38, replace clothing with dry clothing and keep cool.
Remember this is a medical emergency and 999/112 is essential.
Sunburn
13.
The sun in Britain is quite capable of burning, even in winter. It is quite
possible to be burned under a layer of clouds. Sunburn is completely avoidable
and cadets should be encouraged to see it as avoidable. Sunburn is damaging
and can be very painful. Cancer Research UK has active campaigns running to
raise awareness of the hazards of being burned. They also advise that damage
is fairly extensive even when no burn is apparent. The exact level of danger can
be judged from the met office website. In conditions of high hazard you should
insist that sun-cream is worn with a SPF of at least 30 and preferably nearer to
50. A hat with a brim will add a lot of protection to the neck and sun glasses will
make the day much more comfortable.
Blisters
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14.
Are caused by pressure and friction. They will begin by a feeling of
soreness or pain localised in one point on the foot. Eventually they will progress
to a fluid filled blister and become increasingly painful. They can cause a cadet
to endure rather than enjoy an expedition and may cause the cadet to drop out.
Encourage cadets to discuss foot pains as soon as they start. Use of blister
pads such as compeed is very effective and can stop things before they develop
to being actively painful.
Cuts and Grazes
15.
Are common and often caused by falls or paths overgrown with brambles.
Occasionally inept use of cooking implements will result in a more serious cut.
The wound should be washed with clean water and a plaster or bandage applied.
Stop any bleeding with pressure.
Major Injuries
16.
These are rare. It’s impossible to categorically list every eventuality, but
the following must be viewed as requiring medical attention:
Bone breaks, head injuries, burns worse than 1st degree, burns to hands-feetface, burns bigger than the casualties own hand, any injury to the eye, heat
stroke, any decline down AVPU scale, moderate or severe hypothermia, severe
allergic reactions.
17.
Your exact course of action will depend on the exact circumstances, but
the following should be borne in mind:
112 is a better number than 999 in the outdoors.
18.
The team should make contact with the emergency services if needed and
then talk to their supervisor. Discourage cadets from ringing home. They may
be a long way from their parents or guardians and a phone call that offers no
solutions or outcome will be distressing to no purpose. Family must be notified,
but this is best done when the cadet is under professional care and you have
something to say.
19.
If the situation is life threatening (bearing in mind that in wild country
rescue may take 5 hours) you must phone 112 and ask for the police. They will
initiate any rescue.
20.
Why 112 and not 999? There are three good reasons to phone 112:
a.
Firstly, it will initiate a mobile phone triangulation that may help the
emergency services locate you if you get cut-off.
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b.
Secondly, it will go through to a local centre which might mean that
you talk to someone with more local knowledge.
c.
Finally, if you are abroad in Europe, 112 will work (999 might not)
and may help by putting you through to an English speaking operator.
d.
All that said – 999 will be fine in the UK.
Being Lost
21.
Being lost is in itself not an emergency. In fact, with food, cooker, tent and
sleeping bag on your back, you’re still in pretty good shape. So the first thing to
do is; think. You must have a fairly shrewd idea roughly where you are. Things
have gone very seriously astray if you can’t put your finger in a 1 km grid square
and say ‘we are in here’. Take a look round you and match things up to the
ground. If really confused try a re-section based on bearings to prominent
markers. There’s nothing wrong with asking someone either.
Nightfall
22.
If things go very wrong you might be faced with imminent nightfall while
still not at the campsite. Again, take time to think. This is not an emergency yet.
You have water, food and shelter on your backs. Get in touch with your
supervisor and let them know what’s happened, where you are, and what you’re
going to do about it. Do not ring your parents and worry them before discussing
things with your supervisor. S(he) will be able to contact your parents on your
behalf.
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