Wilderness First Aid vs. First Aid at home or in the office - Part 1
Wilderness First Aid vs. First Aid at home or in the office - Part 1: Scene/Initial Assessment
While most of our First Aid certification classes at CPR Seattle cover what to do while waiting for the arrival of EMS (Emergency Medical Services, i.e. the Fire Department, EMTs and/or paramedics), a Wilderness First Aid class addresses patient needs in those situations or environments where EMS is not available, or may be significantly delayed.
This becomes an important consideration when dealing with the initial scene/patient assessment. Illnesses and injuries that might only require a brief examination when help is on the way become much more important when we’re left to attend to the victim for a longer, possibly extended period of time.
In our “Heartsaver” First Aid class, the steps in scene and patient assessment are as follows:
- Make sure the scene is safe for rescuers to approach the patient (and use protective equipment like gloves if available)
- Check the patient for responsiveness (the “tap and shout” method)
- Yell for help and/or have someone call 911 immediately
- Check to see if the patient is breathing (and therefore has pulse/circulation)
- Check for serious injuries (bleeding, broken bones, burns, bruises)
- Check for medical ID jewelry
At that point, rescuers continue monitoring the patient until professional rescuers arrive; in Seattle/King County this should be between 5 – 10 minutes on average.
In a wilderness setting however, there may be more responsibility placed on the first responders, i.e. those who are with the patient when they are discovered or the incident occurs.
In all situations, rescuers need to establish control of the situation – especially if there are those present whose reactions to the situation may impede or adversely affect the outcome. In these situations, two qualities of effective leadership include competence (knowing what to do and acting on it) and confidence (knowing how to do it and how to direct others). Even though you may not feel confident, try to appear and sound confident. Speak respectfully, but authoritatively with the team. And listen.
There are situational hazards present in wilderness environments that we would not encounter on the street or in the office. Rockfalls, icy surfaces, inclement weather, or threatening wildlife can be dangers that rescuers encounter and need to consider. Additional injuries suffered by the rescue party not only result in significant rise in the difficulty of managing the situation, but also mean a loss of resources to use during the rescue. Make sure to adequately address and avoid any perceived dangers. Never create a second patient!
Determining the MOI (Mechanism of injury) will assist with evaluating the patient as well as ensuring scene safety. For example, was there a fall? If so, how far did they fall? What part of the body did the patient land on? Are there any additional falling hazards still present?
Also, are there any ill or injured persons that we didn’t originally notice? A patient loudly demanding attention due to pain or distress may distract from other persons needing assistance who aren’t as vocal (for example, someone bleeding out, or a person with an obstructed airway). Make sure you know how many patients are involved in the situation.
Once the scene assessment is complete, we now need to identify any immediate life-threatening issues and assess the patient(s) for responsiveness to stimuli.
If they appear unresponsive, squeeze or tap the shoulder and call their name loudly. If the MOI indicates a possible spinal or head injury, it is helpful to have an available rescuer stabilize the head and neck in the found position – i.e., do not move the head or neck back to a “normal” alignment after injury. Check for normal breathing, and be prepared to perform CPR if necessary.
If they appear responsive, control the patient and gather relevant information – such as their name, details on what occurred, and any immediate complaints of injury or illness. Introduce yourself to the patient if needed, state your qualifications to provide care, and ask for permission to do so (i.e., my name is Tom, and I’m trained in first aid…may I help you?”).
Assess the “ABCDEs”: (we will be assuming from this point on that we are dealing with a conscious, breathing patient)
- Airway – check for blockages or breathing difficulty. Have the patient spit out any gum or other obstructions.
- Breathing – ask the patient to breathe deeply – is there any pain or discomfort?
- Circulation (and bleeding) – check for a pulse at the wrist; assess whether or not the pulse is too rapid or too slow. Perform a quick scan for severe bleeding. If you find any, treat immediately with direct pressure.
- Disability – specifically, spinal injury. If you suspect a spinal injury (from a fall, or high-speed accident) then someone should stabilize the head and neck.
- Environment (and Exposure of injuries) – injuries may be hidden by clothing. If clothing must be removed, keep in mind that it may be needed later to protect the patient from extreme cold or other conditions.
At this point, rescuers should perform a head-to-toe physical assessment of the patient. Even if the patient has indicated a specific complaint, the complete assessment should be carried out. In our next post, we’ll go into the details of this physical assessment.
Published on November 29, 2016