Wilderness First Aid

The History of Wilderness Medicine

A 1975 situation involving wilderness mistakes gave rise to the modern-day field of "Wilderness Medicine". Frank Hubble was helping rescue a boy from Mount Washington in New Hampshire. A severe fraction in the boy's arm, was cutting off circulation to his hand. By the time Frank and the others transported the boy to the hospital, nothing could be done for his hand- it needed to be amputated. The doctor said the boy's arm could have been saved if it had been straightened in the field. Frank Hubbell, went on to found Stoneheath Open Learning Opportunities (SOLO) wilderness-medicine school.

The ABC's of First Aid

There are three things you need to know right away about a victim: if their airway is open, if they are breathing, and if their heart is pumping. If any of these life-sustaining things is not occuring, something needs to be done to ensure they begin soon!

Before beginning this initial Situation Assessment on an unconscious victim, kneel down and try to wake the person up. If you can not wake the person up, call 911 if a phone is nearby.

Put your ear close to the person's mouth and nose, and turn to look at the person's chest to see if it is rising and falling. Listen to hear if air is moving in and out. Feel for the person's breath blowing against your ear. This will tell you if the Airway is open, and if Breathing is going on.

If you can't detect breathing, we figure the airway is blocked. If the person is lying on one side, you'll have to roll him or her back to open the airway. Tip the forehead back, and lift the chin a little. This head-tilt/chin-lift method, moves the tongue and opens the airway. The victim might start breathing as a result of this repositioning. It is important to do a sweep of the mouth by bending your index and middle finger into a cup shape, and quickly sweep through the open mouth.

When we breathe, air is drawn into our lungs, takes oxygen from the air and carbon dioxide is breathed out. If a victim's airways have been open and there is still no air moving in and out of the lungs it is important that some is pumped there soon. This is called rescue breathing, and the best way to learn it is in a First Aid Course.

While giving Rescue Breathing, it is important to hold the person's airway open, pinch the person's nose closed and seal your mask over his or her mouth.

Blow in one full breath, wait until the chest falls down, and blow in a second breath. Watch the victim's chest to make sure it moves, when you blow air in. If not, chances are the airway is not open. Tilt the person's head a little more and try again. You will have to clear the airway if this does not work. Learn how to do this by taking a First Aid Course, offered by your local St. John Ambulance or other community organization.

Circulation is when blood moves through the body, carrying oxygen through the body and food to our cells. To check circulation we feel for the pulse, the thumping sensation means the heart is pumping. The simplest way to do that is to slide your index and middle finger in the valley under your neck, beside your Adam's Apple. Another way to check for a heartbeat is to press your ear against the person's chest.

People who have no pulse have a heart that has stopped beating. They need chest compressions of CPR which can be done by placing hands over the victim's lower third of the sternum. CPR alternates between 30 chest compressions and two breaths and then 30 more compressions. It's a 30-2, 30-2 pattern. The regulations for CPR were recently changed from 15-2 to 30-2, allowing for less time wasted stopping and starting and more time dedicated to saving a life. However, it is important to take a CPR class to learn how to perform CPR effectively.

It is also important to remember that someone who is bleeding severely can bleed to death if we don't stop the blood from circulating out of the body.

It is important to remember that a victim who has fallen, may have broken their neck or injured their spine, and so it is important that they are kept immobile to prevent further injuries.

A victim is stabilized using pack straps and belts on hand and has their ABCs checked.

When Bleeding...

Blood may contain diseases, so it is important to have the victim try to stop their own bleeding, or have gloves available.

To control bleeding, elevate the wounded area above the heart and apply pressure using gauze, a clean cloth, or other materials found such as dried seaweed or moss.

Place pressure on the wound. If bleeding continues, place pressure between heart and injured area at a pulse point.

By standers watch as the paramedics arrive nearly an hour later. It is their intuition that kept this man from meeting his end.

How To Make a Traction Splint

Larger bones, such as the femur in your leg require you to make a Traction Splint, to ensure the broken bones are not rubbing against one another.

Preliminary Traction Splint:

Immobilize the fracture, because any movement can worsen the injury. Apply traction: Have a second rescuer gently pull on the heel to straighten the leg. Maintain traction throughout the entire splinting process. Find rigid material to extend below the crotch to below the knee. Any sticks or pieces of wood long enough will work well. Gather materials to tie the splint in place, such as bandanas, belts, clothing, pack straps or triangular bandages. Make sure the leg is straight. Place the splinting material along the underside of the leg so it extends from the crotch to below the underside of the knee. Fold the splinting material up around the sides of the leg. Tie the splinting material into place below and above the fracture. Make sure the knee is immobilized. Check circulation, sensation and motion beyond the fracture site to make sure the splint isn't too tight.

Traction Splint for a femoral injury, using sticks, pack straps, bandanas and other material available.

$fracture$

The wilderness presents numerous opportunities for danger to strike. Be prepared by carrying a First Aid kit with you at all times.

Urushiol Oil, The Source of Itch

Poison Plant rash is an allergic contact dermatitis caused by contact with oil called urushiol. Urushiol is found in the sap of poisonous plants like poison ivy, poison oak, and poison sumac.
It is colorless or pale yellow oil that oozes from any cut or crushed part of the plant, including the roots, stems, and leaves.
After exposure to air, urushiol turns brownish-black. Damaged leaves look like they ave spots of black enamel paint making it easier to recognize and identify the plant.
Only 1 nanogram (billionth of a gram) needed to cause rash
Average is 100 nanograms for most people
1/4 ounce of urushiol is all that is needed to cause a rash in every person on earth
500 people could itch from the amount covering the head of a pin
Specimens of urushiol several centuries old have found to cause dermatitis in sensitive people.
1 to 5 years is normal f


The Cause...	The Effect...

How Do You Get That Itch?

Contact with urushiol can occur in three ways:

1) Direct contact — touching the sap of the toxic plant.

2) Indirect contact — touching something on which urushiol is present. The oil can stick to the fur of animals, to garden tools or sports equipment, or to any objects that have come into contact with it.

3) Airborne contact — burning poison plants put urushiol particles into the air.

What To Do About That Itch

Wash all exposed areas with cold running water as soon as you can reach a stream, lake, or garden hose. If you can do this within five minutes, the water may keep the urushiol from contacting your skin and spreading to other parts of your body. Within the first 30 minutes, soap and water are helpful.

A typical case of Poison Ivy.

Wash your clothing in a washing machine with detergent. If you bring the clothes into your house, be careful that you do not transfer the urushiol to rugs or furniture. You may also dry clean contaminated clothes.

Because urushiol can remain active for months, wash camping, sporting, fishing, or hunting gear that was in contact with the oil.

Relieve the itching of mild rashes by taking cool showers and applying over-the-counter preparations like calamine lotion or Burow’s solution. Soaking in a lukewarm bath with an oatmeal or baking soda solution may also ease itching and dry oozing blisters. Over-the-counter hydrocortisone creams are not strong enough to have much effect on poison ivy rashes.

You can also check out:

A hospital is the ideal place to be during an emergency, but sometimes being in the wilderness leaves you miles from the closest hospital.

Taking Action: In The First Moments

Those first few moments are crutial to the victims survival.Your knowledge of what to do in an emergency could either help remedy the emergency, or make it worse.

Take control. Below is the sequence of actions when dealing with an emergency.

Remain calm, if you are at ease, the victim will be as well.
Keep the patient warm and lying down. Moving the patient may be dangerous because of the extent of outside injuries.
Start mouth to mouth respiration immediately, if the injured person is not breathing.
Stop any bleeding.
Give your patient reassurance, and look out for signs of shock.
Check for cuts and fractures. Be especially attentive of possible head, neck and spine injuries.
Do not crowd an injured person. Do not remove clothing unless it is imperative.
Decide if your patient is able to be moved to seek proper medical care. If not, begin preparing a shelter, with heat and food.

Coping with the Shock of Shock

Shock is a depression of all of the body processes and may follow any injury regardless of how minor.

Factors such as hemorrhage, cold and pain will intensify shock. When experiencing shock the patient will feel weak and may faint. The skin becomes cold and clammy and the pulse, weak and rapid. Shock can be more serious than the injury itself, it may even be fatal.

Move the victim to cover, if there are no neck, spine or back injuries. If there are no head or chest injuries place the patient on his/her back with the head and chest lower than the legs. This will help the blood circulate to the brain, heart, lungs and other major organs. If severe head and chest injuries are present elevate the upper body. If chest injuries are present, elevate the injured side to assist in the functioning of the uninjured lung. Elevate the victim's feet higher than the level of his heart. Loosen clothing at the neck, waist, or wherever it may be restrictive. If the injured person becomes unconscious, place him/her in a face down position to prevent choking on blood, vomit or the tongue. Keep your patient warm and under shelter.

Moving Someone into Recovery Position

It is important for an unconscious victim to be moved into Recovery Position, to prevent choking on blood, vomit or their tongue.

Step 1

Put one arm out, and fold the other over their chest.

Step 2

Support their head and lift their knee. Keep your knees close to the body of your friend and gently roll them away.

Step 3

Recovery Position

Coping with the Broken Truth

There are two types of fractures:

1) Simple (closed)

$fracture$

2) Compound (open)

$fracture$

Sign of a fracture:

Pain in the affected area. The area may or may not be deformed. The victim is unable to place weight on the limb without experiencing intense pain. A grating sensation during motion of the injured area.

Treatment of a fracture:

Always treat an injury as a fracture to prevent the victim's condition from worsening. Splint the joint above and below the fracture. If the fracture seems to penetrate the skin, apply traction to straighten the deformity. Pad the splits. Be sure the splints do no hinder circulation. Cover all open wounds with clean dressings before splinting.

Warning!

Maintain traction at all times: Muscle spasms tend to pull against the traction that the second rescuer is applying. Without traction, these spasms yank the broken bone into angulation, causing extreme pain and risking heavy bleeding.

Femur fractures are often associated with heavy bleeding. Maintaining traction can reduce bleeding.

$fracture$

A fracture victim who has fallen off his bike was stabilized by his biking partner until help arrived.

How To Make a
Traction Splint (Part Two)

Completing the Traction Splint:

Making an ANKLE HITCH

Cut two holes in the shoe on the foot of the injured leg.
The holes should be 2-3 inches long and 1/4-inch tall, just above the sole on either side of the foot at the arch. The idea is to be able to thread a cravat under the arch of the foot.
Fold the bandage into a thin strip
Thread the cravat through the holes passing under the arch of the foot.
Cut away the toe of the shoe and sock underneath to monitor swelling.

Making the SPLINT

Place one end of the pole into the empty boot from the other foot.
Place the boot against the crotch, padding well. The pole should extend at least 12 inches beyond the sole of the foot.
Pull one end of the ankle hitch around the snow basket at the lower end of the pole. Pull on both ends of the hitch until traction on the leg is at least equal to the manual traction that the second rescuer is applying.
Tie the ends of the hitch, taking care not to release any traction during the proess.
Place padding up and down the leg between the leg and the pole. Be careful to pad the femoral pressure point.
Back up any suspect knots.

Poison Ivy - Leaves of Three, Let them Be!

The History of Urushiol

Derived from urushi, Japanese name for lacquer.

Interesting fact:

When the Japanese restored the gold leaf on the Golden Temple in Kyoto, they painted the urushiol lacquer on it to preserve and maintain the gold. Guess you could say that you would be caught red handed if you stole it.

Get the Facts Straight!

MYTH: Poison Ivy rash is contagious.

FACT: Rubbing the rashes won't spread poison ivy to other parts of your body (or to another person). You spread the rash only if urushiol oil -- the sticky, resinlike substance that causes the rash -- has been left on your hands.

MYTH: You can catch poison ivy simply by being near the plants.

FACT: Direct contact is needed to release urusiol oil. Stay away from forest fires, direct burning, or anything else that can cause the oil to become airborne such as a lawnmower, trimmer, etc.

MYTH: Leaves of three, let them be.

FACT: Poison sumac has 7 to 13 leaves on a branch, although poison ivy and oak have 3 leaves per cluster.

MYTH: Breaking the blisters releases urushiol oil that can spread.

FACT: Not true. But your wounds can become infected and you may make the scarring worse. In very extreme cases, excessive fluid may need to be withdrawn by a doctor.

MYTH: I've been in poison ivy many times and never broken out. I'm immune.

FACT: Not necessarily true. Upwards of 90% of people are allergic to urushiol oil, it's a matter of time and exposure. The more times you are exposed to urushiol, the more likely it is that you will break out with an allergic rash. For the first time sufferer, it generally takes longer for the rash to show up - generally in 7 to 10 days.

MYTH: Do not worry about dead plants.

FACT: Urushiol oil stays active on any surface, including dead plants, for up to 5 years.

Look Out!

Prevent the misery of poison ivy by looking out for the plant and staying away from it.

You can destroy these weeds with herbicides in your own backyard, but this is not practical elsewhere. If you are going to be where you know poison ivy likely grows, wear long pants, long sleeves, boots, and gloves.

Remember that the plant’s nearly invisible oil, urushiol, sticks to almost all surfaces, and does not dry. Do not let pets run through wooded areas since they may carry home urushiol on their fur. Because urushiol can travel in the wind if it burns in a fire, do not burn plants that look like poison ivy.