Re: Wilderness First Aid
Jonathan Dixon (dixonj@ROCOCO.COLORADO.EDU)
Mon, 12 May 1997 13:58:12 MDT
From: Steven Featherkile <firstname.lastname@example.org>
> 1. Good so far. Now, realistically, what is the backcountry ranger
> going to be able to do, that you cannot do for yourself? What are the
> chances that the ranger is even there?
The way I worded my answer I intended that I only go for the ranger
station if I am pretty sure that there is someone there. Otherwise
the choice is to go back over the pass (or with a large enough group,
send people both places). The backcountry ranger will have some means
of calling for medical resources, which is what I didn't have.
> Chances are that the injury did
> not happen next to a decent LZ for the helo. How do you plan to
> transport the patient to the LZ.
I plan to wait for someone with a backboard to show up. I am not
going to move a person who has fallen 15 feet without a backboard
unless I am absolutely sure that there is no chance he has spinal
> Do you know what a decent LZ is?
> What ethics are involved in sending a helo into a wilderness area that
> bans all forms of mechanical devices? What if it starts to rain and the
> temperature drops to 40 degrees with a 20 knot wind? What if you do
> call for a helo, how does the helo know where to come, assuming that you
> found a decent LZ, and that you know how to direct a helo into the LZ?
I would find the most wide-open area I could, and have them make a
first pass to deliver the backboard (and hopefully a medic or two).
Then I would strap the person to a backboard and carry them down to
the designated LZ. The LZ would be chosen before sending off the
people to get help, and preferably marked on the maps each of them
will carry out. If the weather becomes unsuitable for the helo to
come, I would set up shelter for the injured person and keep them
comfortable, then have the rest of the crew set up camp. And frankly,
I don't think I'd be too concerned about the ethics of having the
helicopter in a wilderness area.
> Helo MEDEVACS are dangerous, both to the crew and to the patient. They
> are also prohibitively expensive. What if during the 4 or 5 hours you
> mentioned (a more realistic time estimate is 3-4 days), what if the
> patient gets better? What if his condition is not as serious as you
> first thought. Who pays for the helicopter? You called it in. You are
> responsible. I don't have that kind of money. Before I call for a
> helo, I must be certain that the benefits far exceed the risks.
Carrying out an injured person is also dangerous to the crew and the
patient. Especially in the backcountry, where the trails are not as
good so it is not unlikely that a carrier could lose footing and fall
(possibly breaking/spraining an ankle, as well as dropping the
patient). Unless I can be absolutely certain that there is no spinal,
cranial, or other internal injuries, the patient needs to go to a
hospital. It doesn't matter how good they are feeling (I've heard
enough stories on how fast a person can go from feeling fine to
practically dead). The helo will either be payed for from public
funds for such rescues, by specific backcountry medical insurance, by
the injured party's medical insurance, by my own insurance, or by BSA
trip insurance, depending on the particular local laws that apply.
When the risk is the death of a person (even if that isn't very
likely), then I'm not really that concerned about the costs.
> Do you know how to straighten an angulated fracture? Carrying
> someone out with a fracture "splinted in place" will do great damage to
> the soft tissue, severing arteries, veins and nerves, not to mention
> making hamburger out of the muscle tissue.
I would think that without proper equipment and a LOT of training,
straightening a fracture is likely to do considerably more damage
(since you are moving the sharp ends around through those tissues
again). The point of splinting is to immobilize the bone ends so that
they don't do further damage. And I don't plan on carrying much of
anyone out unless it is absolutely necessary (since that is quite
If a wilderness rescue team comes in with sufficient equipment and
decides that extrication by carrying is the most appropriate, then
that is fine. But I don't have the equipment (and MacGuyver
notwithstanding, jury-rigged equipment isn't what I want to trust
someone's life to if there is any way to avoid it) with me when I am
backpacking so apart from basic first aid and a bit of TLC there is
not much I can do before others arrive.
Terry Howerton Sakima Group, Inc. SCOUTER Magazine Kansas City