Re: Wilderness First Aid
Steven Featherkile (email@example.com)
Mon, 12 May 1997 23:31:27 -0700
Steven Featherkile wrote:
> I agree with all of what you said. However, you are still relying on
> someone to come bail you out.
> eagle911 wrote:
> The idea of a first responder is to stabilize the victim while additional
> help arrives. Nobody is God, not even the EMTs. A severely damaged
> backpacker cannot be moved unless advanced trauma life support arrives via
> a helicopter, for example.
1. What happens if the guy gets better. Take this senario, for
instance. You are 3 days from the trail head. One of the scouts is
knocked out from a blow to the head. He is responsive only to command
only. Because of the mechanism of injury, you stabalize the spine,
bandage the wound, and treat for shock. The accident happened at 1600
local time. You elect to wait until the next morning to send for help.
This is a reasonable decision in a wilderness situation, the last thing
you need is for a adrenaline hyped team to push on throught the night.
You need them to get there, not become casualties themselves. Now
remember, he is responsive to command only, so he has started to slip
down the AVPU scale (Alert, Verbal stimulus, Paniful stimulus,
Unresponsive). And he has a suspected C-spine injury. However, during
the night, he gets better, and by morning, he is left only with a slight
headache. He is fully alert, and oriented to person, place, time and
situation. He denies any numbness or tingling in his extremities, has
full sensation (sharp/dull, 2 point, light touch). His muscle strength
is 5/5 in all groups, and he has no neck pain. In a wilderness
situation, do we do like we would in the city, and leave him packaged
for transport, and send the team out for help? I would not, and here is
why. He has gotten almost well. Helicopters are expensive, and
MEDEVAC's are DANGEROUS to the helo's crew. I cannot justify risking
the crew's safety, not to mention the expense, for someone who has a
headache. I would cancel the rest of the trip, send the team out for
help, but not for emergency help. I would request that someone meet us
at the trail head with an ambulance, maybe send in a ranger with a horse
or two, but that is it. I would also send a treatment note detailing
everything that has occurred, along with a topo map with our position
and route of intended travel. Spread the guy's gear out among the rest
of the crew, and walk him out at his best pace.
> Nevertheless, basic stabilization is essential
> or else the patient will enter in shock and die, no matter how fast you can
> manage to carry him with a group of scouts while ensuring proper
> head-neck-spinal immobilization.
2. Remember, your patinet is not going to stay the same. He will get
better, or he will get worse, but he will not stay the same. Keep
reevaluating him to catch those changes.
> The first responder course is designed to
> teach how to transport a victim, but nobody relies on their own ability. We
> always look for additional help.
3. Granted, but in the bush, we have to provide the transport. The
ambulance is just not coming. How do you plan to package him for
transport using the stuff you have in your packs? Almost all of that
gear can be used to improvise splints, stretchers, dressings, etc.
> If there is any doubt on this, it isn't
> the course's fault by itself. The primal objective is to stabilize the
> victim on-site and wait for support to move it,
4. The helo is not coming. It is raining, has been for the last 2
days, the area is fogged in, with icing conditions. You cannot wait
> or else the patient will
> suffer the consequences, no matter if the personnel is a scout, a first
> responder, a leader, a paramedic, or a doctor. What do you think?
5. This is the kind of course that I want for scouts, one that forces
the leader to think beyond the usual. Almost all of the others rely on
the Emergency Medical System. The EMS just does not extend where I want
to go backpacking.
You asked what I think. There it is. We cannot afford to stay within
the old paradigme. Gustavo, I've been reading your posts, and I have
been impressed. Keep up the good work. BTW, what do you think?