Chapter 24Wilderness First Aid

Wilderness First Aid

• Wilderness describes situations including:RecreationOccupations in remote areasUrban areas with overwhelmed EMSRemote communitiesDeveloping countries

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.

Cardiac Arrest (2 of 2)

• CPR for hypothermia victims Continue for more than 30 minutes

• CPR for avalanche victimsContinue 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

Dislocations

• In a wilderness situation, reducing some dislocated joints is recommended.

• Reducing is a technical term that means aligning.

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.

Care for Shoulder Dislocation (1 of 2)

• Traction and External Rotation MethodGently 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.

Care for Shoulder Dislocation (2 of 2)

• Simple Hanging TractionHang injured arm off

the side of a high, cushioned surface.

Attach a weight to the victim’s lower arm.

Muscles will stretch and tire, allowing joint to pop back in.

Stabilize the arm.

Finger Dislocation • Recognizing a finger

dislocation:Deformity and

inability to use or bend the finger

Pain and swellingAbnormal position

of two bones

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.

Kneecap Dislocation• Recognizing kneecap

dislocation:Patella has moved

to the outside of the knee joint.

Victim is in pain.Compare to other

leg.

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.

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.

Clearing a Spinal Injury• The victim does not need to be stabilized

in one position if:Completely alertNot intoxicatedHas no distracting injuriesDoes not complain of neck painCan feel normal touchCan move the fingers and toes

Care for a Spinal Injury

• Use your hands or knees to hold the victim’s head in place.

• While kneeling at the victim’s 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.

Splinting Femur Fractures

• Victims with femur fracture can easily lose 2 quarts of blood and develop massive swelling.

• If needed, splint the fracture.

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.

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.

Care for an Avalanche Victim

• Quickly free victim’s 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.

Altitude Illness

• Hypoxia Occurs when the body’s tissues do

not have enough oxygen

• Acute mountain sickness (AMS)

• High-altitude pulmonary edema (HAPE)

• High-altitude cerebral edema (HACE)

Recognizing Altitude Illness

• Typically strikes during the first 12 hours• Symptoms include:

HeadacheLoss of appetiteNauseaInsomniaFatigueShortness of breath with exertion

Care for Altitude Illness (1 of 2)

• Seek medical help if any of the following symptoms appear:Persistent coughShortness of breath while restingNoisy breathingLoss of balanceConfusionVomiting

Care for Altitude Illness (2 of 2)

• Most people get better with rest as the body adjusts.

• If condition doesn’t improve:Descend 2,000 to 3,000 feetRestDrink plenty of fluid

Lightning

• Lightning injures in five ways.Direct strikeSplashGround currentContact injuryShock wave

Recognizing a Lightning Injury

• Absent breathing

• Seizures, paralysis, loss of responsiveness

• Minor burnsPunctate burnsFeathering or ferning burnsLinear burns

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.

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.

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.

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.

Wilderness Evacuation

• Determining the best way to evacuate a victim must be based on several factors.

• Victim can be evacuated by:HelicopterWalking outBeing carried on a litter

When to Evacuate

• Immediate evacuationsRapidly evacuate when medical care

is needed in 30 to 60 minutes or less.

• Delayed evacuationsMedical care should be obtained

within 6 to 24 hours of injury.

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.

Guidelines for Helicopter Evacuation

• Evacuate only if the following conditions apply:Victim’s life will be savedPilot believes conditions are safeGround evacuation would be

dangerous or prolonged

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