Wilderness First Aid

1. Chapter 24
Wilderness First Aid

2. Wilderness First Aid (1 of 2)
• Wilderness describes remote
locations more than 1 hour from
medical care:
• Recreational areas
• Occupations in remote areas
• Disaster areas with overwhelmed EMS
• Remote residences
• Developing countries

3. Wilderness First Aid (2 of 2)
• First aid with a wilderness focus
• Injuries and illnesses in the outdoors with
adverse environmental conditions
• Delays of definitive medical care
• Injuries and illnesses not common in urban
or suburban areas
• Need for advanced medical care
• Limited first aid supplies and equipment
• Need to make difficult decisions

4. Cardiac Arrest (1 of 2)
• CPR has limited use in wilderness/remote
setting.
• Stop CPR if:
• Victim revives.
• Rescuers are exhausted.
• Rescuers are in danger.
• Victim is turned over to higher level
personnel.
• Victim does not resuscitate within 30
minutes.

5. Cardiac Arrest (2 of 2)
• Do not start CPR if:
• Victim has been in cold water more than 1
hour.
• Body temperature below 50°F
• Signs of death or fatal injuries
• Frozen or has stiff chest wall
• Rescuers are exhausted or in danger.
• Medical care is more than 3 hours away

6. CPR for Hypothermia Victims
• Very gently handle the victim.
• If not breathing, begin CPR immediately
• Avoid heat loss.
• Seek medical care as soon as possible
• Continue until victim is evaluated by
health care providers

7. CPR for Avalanche Victims
• Avalanche-related deaths are on the rise
due to winter recreational activities.
• If not breathing, begin CPR immediately.
• Use automate external defibrillator (AED)
as soon as it is available.

8. CPR for Drowning Victims
• Begin CPR with rescue breaths rather
than chest compressions.
• Open airway and check for breathing.
• Begin cycles of 30 chest compressions
and 2 rescue breaths.
• Use AED as soon as possible.
• If vomiting, turn victim to side and
remove vomitus from airway.

9. CPR for Lightning Strike
Victims
• An estimated 70 deaths occur from
lightning strikes in the U.S. each year.
• Give highest priority to victims who are
unresponsive or not breathing.
• Use AED as soon as possible.

10. Dislocations
• In the wilderness, reducing a dislocation
is recommended.
• Easier after injury
• Easier to transport
• Reduces pain
• Better stabilization
• Reduces chance of circulation problems
• Simple and safe

11. Recognizing a Shoulder
Dislocation (1 of 2)
• Anterior shoulder dislocations most
common
• Extreme pain
• Recurs
• Upper arm is held away from body.
• Unable to touch uninjured shoulder
with hand of dislocated extremity

12. Recognizing a Shoulder
Dislocation (2 of 2)
• Appears squared-
off or flattened
• Bump in front of
shoulder

13. Care For a Shoulder Dislocation
• Stop if pain increases
• Stop if resistance is met
• Do not pull arm with foot in victim’s
armpit
• Check circulation, sensation, and
movement before and after

14. Traction and External Rotation
• Pull arm out to side with traction against chest
wall.
• Tell victim to relax.
• Position arm in “throwing” position.
• Muscles will fatigue; shoulder will reduce.
• Stabilize the arm.

15. Simple Hanging Traction
• Victim lays face-
down on raised
surface.
• Arm hangs straight
down over side.
• Attach a 5-to 10-
pound weight
• Muscles will fatigue
• Stabilize the arm.

16. Recognizing a Finger Dislocation
• Minor injuries can
dislocate fingers
• Deformity and
inability to use or
bend the finger
• Pain and swelling
• Lump at the joint

17. Care for a Finger Dislocation
Method 1
• Hyperextend with
gentle traction.
• Push into place and
unbend.
• Buddy-tape in
functional position.

18. Care for Finger Dislocation
Method 2
• Pull finger in direction it is pointing.
• Maintain traction; bend into normal
position.
• Stabilize in functional position.

19. Recognizing a Kneecap
Dislocation
• Patella has moved
outside of kneecap
• Victim is in pain.
• Compare to other leg.

20. Care for Kneecap Dislocation
• Slowly straighten knee, gently
pushing kneecap into position.
• Stabilize the leg straight.
• Victim may be able to walk with an
aid.

21. Spinal Injury
• Full spine stabilization may be
impossible or impractical.
• All spinal fractures have at least one:
• Midline neck tenderness
• Altered mental status
• Evidence of intoxication
• Separate painful injury

22. Recognizing a Spinal Injury
• Ascertain whether the victim:
• Is alert and oriented
• Has been drinking or using drugs
• Has any major painful injury
• Has neck pain
• Feels tingling, numbness, or weakness
• Check for neck tenderness.
• Check for sensation in hands or feet.

23. Clearing a Spinal Injury
• Stabilization is not needed if the
victim:
• Is completely alert
• Is not intoxicated
• Has no distracting injuries
• Does not complain of neck pain
• Can feel normal touch
• Can move the fingers and toes

24. Suspected Spinal Injury
Responsive Victim
• Ask:
• Neck and back pain?
• What happened?
• Can you move/feel arms and legs?
• Look and feel for DOTS
• Test strength of extremities

25. Suspected Spinal Injury
Unresponsive Victim
• Determine the mechanism of injury.
• Look and feel for deformity, open
wounds, or swelling along spine.
• Obtain information from others.

26. Care for a Spinal Injury
• Use your hands and knees to
stabilize neck in line with spine.
• Improvise cervical collar.
• Improvise cervical supports.
• Avoid moving the victim.

27. Splinting Femur Fractures
• Victims with femur fracture
can easily lose two quarts of
blood and develop massive
swelling.
• If needed, splint the fracture.

28. Avalanche Burial
• Falling masses of snow that may also
contain rocks, soil, or ice
• Dangers due to:
• Snow becomes solid
• High pressure of snow
• Factors that determine survival:
• Speed of extrication
• Air pocket

29. Recognizing an Avalanche
Victim
• Injure in two ways:
• Trauma from tumbling down
avalanche path
• Suffocation from snow burial

30. Care for an Avalanche Victim
• Survival chances best in first 15 minutes
• 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.

31. Altitude Illness (1 of 3)
• Altitude illness is a variation of hypoxia.
• Body’s tissues lack oxygen.
• Types of altitude illness:
• Acute mountain sickness (AMS)
• High-altitude pulmonary edema (HAPE)
• High-altitude cerebral edema (HACE)

32. Altitude Illness (2 of 3)

33. Altitude Illness (3 of 3)
• Factors that affect susceptibility:
• Rapid ascent
• Higher altitude
• Health at time of ascent
• Individual differences
• Oxygen levels decrease as elevation
increases.

34. Recognizing Altitude Illness
• Typically strikes during the first 12 hours
• Symptoms include:
• Headache
• Loss of appetite
• Nausea
• Insomnia
• Fatigue
• Shortness of breath with exertion

35. Care for Altitude Illness (1 of 2)
• Seek medical if:
• Persistent cough
• Shortness of breath while resting
• Noisy breathing
• Loss of balance
• Confusion
• Vomiting
• Symptoms persist after 2 days

36. Care for Altitude Illness (2 of 2)
• Treatment
• Descend 2,000 to 3,000 feet.
• Rest.
• Drink fluids.
• Take pain medication.
• If treatment does not provide relief,
consult a physician.

37. Other Altitude-Related
Illnesses
• Pharyngitis and bronchitis
• Sore throat and coughing due to dry air
• Peripheral edema
• Swelling of hands, ankles, or face

38. Lightning (1 of 2)
• Fatal in 30% of cases
• Victims include:
• Hikers
• Campers,
• Golfers
• Others in outdoor
recreation
© Riccardo
Bastianello/ShutterStoc
k, Inc.

39. Lightning (2 of 2)
• Direct strike
• Actually being
struck
• Splash
• Strikes a
tree/building and
jumps
• Contact injury
• A held object is
hit
• Ground current
• Strikes ground
and spreads
• Shock wave
• Explosive
force

40. Generated Electrical Current
vs. Lightning
• Lightning contact with the body is
instantaneous and leads to flashover.
• Current flashes over body
• Severe burns are seldom.
• Exposure to generated electrical current
is more prolonged.
• Thermal tissue damage

41. Recognizing a Lightning Injury
• Absent breathing
• Seizure, paralysis, unresponsiveness
• Minor burns
• Punctuate burns
• Feathering or ferning burns
• Linear burns
• Burns from ignited clothing and heated metal

42. Care for a Lightning Injury
• Go to the quiet, motionless victim first.
• Start CPR if victim is not breathing.
• Place unresponsive (breathing) victim
on side.
• Stabilize the spine.
• Check for injuries.
• Evacuate to medical care.

43. Wild Animal Attacks
• Can be avoided by
exiting quietly and
calmly
• Fight back if animal
attacks.
• Play dead if animal
is a grizzly bear or
mother black bear
© AbleStock

44. Recognizing Wild Animal
Attacks
• Victims may be thrown, gored, butted,
or trampled.
• Puncture wounds and bites
• Lacerations and bruises
• Fractures
• Rupture of internal organs or evisceration.

45. Care for Wild Animal Attacks
• Treat wounds and bleeding.
• Evacuate or contact authorities for
evacuation of victim.

46. Wilderness Evacuation (1 of 6)
• Determine method based on:
• Severity of the illness or injury
• Rescue and medical skills of the rescuers
• Physical and psychological condition of the
rescuers and the victims
• Availability of equipment and aid for rescue
• Timing
• Cost

47. Wilderness Evacuation (2 of 6)
• Start evacuation of victim if:
• Condition is not improving.
• Debilitating pain is present.
• Inability to travel at a reasonable pace
• Passing blood via the mouth or rectum
• Serious altitude illness
• Infections not improving

48. Wilderness Evacuation (3 of 6)
• Start evacuation of victim if (cont’d):
• Chest pain not caused by rib-cage injury
• Severe wounds requiring medical care
• Dysfunctional psychological status is
impairing others’ safety.

49. Wilderness Evacuation (4 of 6)
• Immediate evacuation (medical care
required in 30 to 60 minutes or less):
• Open fractures
• Extremity injuries with deformity
• Spinal injuries with no sensation/movement
• Severe altitude illness
• Decreased level of consciousness
• Shock
• Severe bleeding

50. Wilderness Evacuation (5 of 6)
• All bleeding should be controlled.
• Clean and irrigate wounds.
• Do not remove blood-soaked dressings.
• Locate bleeding vessels
• Reapply direct pressure

51. Wilderness Evacuation (6 of 6)
• Delayed evacuation (medical care
required in 6 to 24 hours):
• Limb injuries with deformity, severe pain,
or inability to walk
• Severe frostbite
• Open wounds for suturing
• Severe hypothermia

52. Guidelines for Ground
Evacuation
• At least two people should accompany
victim if walking out.
• One or two people should be sent to notify if
a victim needs to be carried out.
• Four to six people litter bearers
• Eight carriers over rough terrain, switch off
every 100 yards

53. Guidelines for Helicopter
Evacuation (1 of 2)
• Evacuate only if:
• It will save
victim or offer
greater chance
of recovery.
Courtesy of Mark Woolcock

54. Guidelines for Helicopter
Evacuation (2 of 2)
• Evacuate only if:
• Pilot believes
conditions are
safe.
• Ground
evacuation would
be dangerous or
prolonged.

55. Signaling for Help (1 of 2)
•Signaling aircraft
• Things are smaller when viewed from air
• Construct a large “V” (assistance) or “X”
(medical assistance)
•Other signals:
• Series of three means “help”
• Smoke by day
• Bright flame by night

56. Signaling for Help (2 of 2)
• Other signals
(cont’d):
• Mirror
• Direct light in
“flicks”