With hiking the Pacific Crest Trail coming up where I could potentially be alone for a long period of time, I decided it was time to learn first aid. So giving up some weekends and evenings, I recently completed my 80-hour first aid course. While I am definitely not an expert, I have been taught based on the latest standards and the knowledge is fresh in my mind. Through this article, I want to share a bit of knowledge with everyone so that it can maybe help you in the future. The purpose of this article is to give you an overview of the principles of first aid and how to recognize and handle some of the common/dangerous conditions you might encounter on your adventures.
If you find this interesting and want to learn more. I took my course from Rocky Mountain Adventure Medicine (http://adventuremed.ca/) so if you are in the Calgary area I would highly recommend doing a course with them.
Main Principle of First Aid
keep them alive and as comfortable as possible until someone with higher training relieves you of your duties as the first aider. Sounds like common sense but keeping this in mind will help you define your priorities.
Six vital steps (no puns intended) to take in every first aid scenario
Step 1. Safety First
Don’t rush into a situation, think about the hazards and if what happened to the person could happen to you. If you are the injured person, number one priority is to stop yourself from getting further injured by inspecting your surroundings and move away from hazards.
Step 2. Identify and Stop the Catastrophic Bleed
- If you see squirting or pooling of blood, nothing other than safety matters, go and stop the bleed. You have about 90 seconds.
- Put pressure on the wound with your hand or apply a pressure dressing.
- Consider keeping a clotting agent in your first aid kit, if you do, know how to use it.
- Most effective method of stopping a catastrophic bleed is to use a tourniquet
Details on how to use a tourniquet
- A commercially available tourniquet is the most effective.
- If that’s not available, take a strip of clothes (triangle bandage, t-shit etc) and tied a knot around the limb, tie a second knot around a stick and turn the stick to crank it as tight as you can.
- Make sure to put it on the side of the injury closer to the heart (duh
), 2 or 3 inches away from the wound. The reason being that arteries contract if severed, you have to be sure that you are not missing it. - If the bleeding does not stop, consider putting on another one.
- When you are done, note the time:
- Limb without blood supply will die within 4-6 hours
- After 2 hours, the tourniquet stays on as there’s now too much toxin in the limb, removing it will cause the toxin to go to the rest of the body.
- If you can switch to clotting agent and pressure dressing within the 2 hours, you can remove the tourniquet
- Make sure you tell SAR that there’s a tourniquet on this person
- I carry a SWAT-T tourniquet because it’s easy to use and doubles as a pressure dressing. (This thing)
Step 3. Check and Maintain Airway and Breathing
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- Next step is to check for airway and breathing, this is very important as the body will not survive long without oxygen.
- If a person is unconscious, they could be blocking their airway with their tongue, try clearing their airway by performing a head tilt, chin lift. If that fails, put them into recovery position (we have all done that at a party 😉).
- If the person is not breathing, start CPR right away.
- It’s a good idea to take a course on how to perform CPR, it’s a good skill to know .
Step 4. Check for Hidden Deadly Bleeds
Sometimes, clothing like Gore-Tex or big puffy jackets hides bleeding so it’s important to get the person down to base layer feel the body for bleeding that might be hidden. Those hidden bleeds could be deadly if not discovered in time.
Step 5. Environmental Protection
- After dealing with those problems, consider moving the patient to a more sheltered location or start packaging the patient.
- Time to use clothes, tarp, sleeping bags, whatever you have at hand to keep the person or/and yourself as warm as possible.
- Hypothermia is especially a real concern for people who lost a lot of blood. Patients can still go into hypothermia even if they are in a 40C (104F) desert so don’t get fooled by the ambient temperature.
Four ways to Lose Heat and How to Address Them
- Evaporation: get them out of wet clothes and into dry stuff
- Radiation: clothes, sleeping bags to stop the heat from radiating out
- Conduction: Get a sleeping mat underneath, one blanket underneath = three blankets on top
- Convection: Build a shelter to shield against the wind
Spinal Consideration
- Anytime there’s a big fall from above the height of the head or a head injury, the spine could be injured.
- Be mindful of spinal concerns but keep in mind, environmental hazards, catastrophic bleeds, breathing and airway trumps spinal concerns. Your number one goal is to keep them alive, don’t get priorities mixed up.
Secondary Assessment
Find out more about the patient: Allergies, medical, food and fluid intake, excrements. Those things might point you to a problem
Monitor the patient for development: heart rate, breathing rate, skin condition (dry, clammy, red, pale etc), Level of consciousness (LOC)
Full body check: This is especially important because the most serious injury might not be the most obvious. Someone who is screaming about an injured wrist could also have internal bleeding that needs to be addressed first.
Quick word on calling search and rescue
- Search and rescue can be expensive and you might feel the pressure of not wanting to waste taxpayers money. Please don’t let those reasons stop you from calling SAR if you are not unsure about the condition. Of course, use common sense but it’s better to be wrong and alive.
- Most SAR will only take off half an hour before sunset at the latest. If it’s getting dark and something goes wrong but you are not sure about the severity, start the evacuation call.
- If you have the extra manpower, consider assigning people to clear out a landing area by finding a flat 100x100 feet area, clearing the debris and marking the corners with lights or objects
- I highly recommend the Garmin Inreach, you can get that immediate 2-way communication which could provide you with important first aid instructions. You can also communicate the priority/lack of priority which will ensure an adequate response from SAR.
Common Conditions
We covered a lot of topics in our first aid course, from how to take care of wounds to delivering a baby. Obviously, I can’t cover everything here so I am going to focus on recognition and principles behind the treatments for common/dangerous situations but won’t go into detail of the techniques. I encourage you to do your own research on certain subjects (like how to deliver a baby haha) and/or consider taking a first aid course.
Head Trauma
Learn the difference between major and minor head trauma so you make the call to evacuate right away if you see the signs of serious head trauma
- Major head trauma: Evacuate immediately if the following symptoms occur:
- Unconscious for more than 30 seconds
- Don’t remember at least one of those things: who they are, where they are, what time of day it is or what they were doing
- Vomit more than once (first vomit is allowed)
- Decrease in level of consciousness: alert at first but slowly falling unconscious
- Pupils not reacting to light or the two eyes reacting to light differently
- Minor head trauma
- Unconscious for less than 30 seconds
- Memory returns to normal in a reasonable amount of time
If there’s a minor head trauma, you can choose to not evacuate but continue to monitor their vitals and these signs every hour for 24 hours. That means waking them up every hour or so if it’s at night. If you are not sure and it’s getting dark soon, think about sending the word out for evacuation anyway.
Chest Trauma
Other than a minor cracked rib, chest trauma is an immediate evacuation.
No matter the type of chest trauma, if the patient can’t catch a full breath and rescue is not coming for a long time (overnight, storm etc.). Force the patient take a full breath every hour or so to clear the toxins from the lungs to avoid pneumonia.
Fractured or Bruised Rib:
- Just suck it up, it will be okay. By suck it up I mean suck the air up once in a while. 😛 (Use your judgment, if something other than the rib feels damaged, evac)
Flail Chest:
Two different broken ribs, causing a piece of the chest to break off basically.
Symptoms
- Patient will have problems breathing
- There will be a paradoxical moment on the injury site. As in the rest of the chest moves the opposite direction of the injury site with each breath.
Treatment
- Bulk dressing pressed into the flail chest as far as it will go, lots of tape to hold it in place.
- The goal is to hold the piece in place, like taping a metal spring down when it’s compressed so it can’t move up or down. If you try tape a metal spring when it’s uncompressed, it can still move up and down.
Puncturing chest wounds
Symptoms:
- If a person is having trouble breathing after a big fall, one of the things you should do is look for a puncture.
- Sometimes it’s not obvious, check under the armpit and the back, really feel around as skin might’ve stretched back to cover it.
Treatment:
- Do not plug the hole, loosely tape some gauze on it.
- The reason being if the lung is punctured and leaking and you plug the external hole, the air can no longer escape the body. The pressure will slowly build and push all the organs to the other side, causing a deadly condition.
Abdominal Conditions
There’s not much you can do for abdominal issues other than evacuate.
- If any abdominal condition lasts for more than 24 hours, evacuate at the highest priority.
- If you find yourself in the worst pain of your life, evacuate.
- Abdominal bruising or redness after a fall could mean internal bleeding. Start the evacuation process and observe. You can always cancel if you are sure it’s just a bruise.
Constipation:
- Some treatment includes some dish soap with water, hot coffee followed by a cold drink.
- Put your ear to their belly and listen for bowel sounds (growling, shifting etc) in all areas of the belly. If you don’t hear bowel sounds after a long time listening in all areas, evacuate immediately at the highest priority.
Diarrhea
- Do not treat isolated incidence of diarrhea, it’s a way for the body to clear out bad things, let it happen.
- If Diarrhea lasts for more than 24 hours, dehydration is a real concern so manage that and evacuate
Wound Care
Four steps:
Stop bleeding
- Tourniquet, pressure dressing, clotting agent, gauze
Clean the wound and keep it clean
- Scrap all the dirt out no matter how much it hurts
- Clean the wound with water clean enough for drinking
Help the healing process
- Edge of the cut pulled together
- Change dressing regularly
- Do not use antibiotics unless it is necessary, unnecessary use hinders healing
Preserve the function of the injured area
For example, don’t bandage all their fingers together for injury on one finger
Blisters
- Ahh our favorite injury
- Prevention is the key. Address hot spots before they become blisters using tape, blister kit etc.
- If a blister develops, pop it or else your shoe is going to do it for you with a lot more mess
- Use a sterile needle, safety pin or knife, poke the base and let the liquid leak out, then dress it.
Bones and Joints (Not the fun kind)
When a bone is broken, a large part of the pain is from the muscles contracting to maintain the structure that the bone provided
- Principle of splinting is to provide the structure through external means
- A splint should immobilize the joint above and below the injury site with either something rigid or a sling
Pelvis Fracture:
- As the result of falling from a seated position. Leg splayed apart, displaying intense pain.
- Pelvis fracture can cause deadly internal bleeding so it should be treated as soon as it’s discovered in the primary steps.
- Use a tarp or wide piece of clothes to wrap around the hips like a belt and bind tightly with a stick like a tourniquet. The material should be wide enough to cover the entire hip bone.
Shoulder dislocation:
- A dislocated shoulder should be relocated as soon as possible unless there’s also bone damage to the arm or if the shoulder dislocates backward. The longer you leave it out the more serious the damage will be.
- I recommend learning how to relocate a shoulder. There are multiple ways, the easiest is passive relocation. The key is to relax the muscles so it will allow the joint to slide back in. There’s a good video on how to passive relocate it. https://www.youtube.com/watch?v=kYYI1fN3gRU
Environmental Sickness
Radiation sickness:
Kidding, not that applicable
Cold
Hypothermia:
there’s a difference between true hypothermia and cold stress. We have all been cold before and will do things to fix the issue, but if the patient is no long demonstrating ability to take care of themselves, assume mild hypothermia.
- Hypothermia is slow, takes many hours or days to set in. Prevention is key
- Shivering good, not shivering bad. If the person stops shivering and is losing conscience, do not attempt to move them as rough handling could cause cardiac arrest. Call for help
- General idea is to stop activities, warm the person up and encourage shivering. If there’s no way to maintaining heat, call for help.
Frostbite:
Re-warm at ~40C (104F) water and give ibuprofen, dress in bulky dressing. Treat frostbite if only you are confident about it not re-freezing. Otherwise, self-evacuate or call for help.
Cold water submersion:
- Do not panic, keep afloat and let the initial shock stop before attempting to self-rescue.
- You now have about 2-5 minutes to get out before you lose your strength. 10 minutes until you lose conscience.
- This professor explains it better than I do, watch this. https://www.youtube.com/watch?v=Wz3gy5XyaBo
Heat
Heat exhaustion:
Fatigue, cramps, dizziness. Move to shade and rehydrate and cool down
Heat stroke:
- Heat stroke is a very serious condition, it’s heat exhaustion that goes unchecked.
- People will exhibit loss on consciousness, hot red skin and fast heart and breathing rate
- Keep the person breathing, cool with anyways possible, dip in cold water is the best (no longer than 10 minutes), call for help
Dehydration
- This goes beyond I am feeling thirty
- Headaches, nausea, vomiting and not drinking water over a very long period. It’s basically what a hangover is.
- Water obviously but add electrolytes to the water. Use small amounts of salt and sugar, but not too sweet as it may cause vomiting.
- If the person can’t retain the water (vomiting, Diarrhea), evacuate.
Altitude
Best way to deal with any altitude related sickness is to descent, simple as that
Acute Mountain Sickness feels like a hangover, take a few rest days until it gets better. if it doesn’t, descent.
There are a few serious conditions called High Altitude Pulmonary Edema and High Altitude Cerebral Edema, I won’t go into details but basically
- One is a condition on the lungs and one is on the brain.
- If there’s any unexplained wetness in the lung and breathing problems or head trauma at altitude, especially if the person experienced a large change in altitude. Descent and re-evaluate/evacuate
