[Bill Burke, an internationally known off-road expert and instructor, has extensive training in Emergency Response. He addresses backcountry first aid this issue because off-roading and safety go hand-in-hand. This article cannot replace proper first-aid training; only professional training from qualified agencies will give you the skills and mindset required to render responsible and quality emergency care. – Ed.]

Backcountry First-Aid
I am often asked: “What would you do if someone broke an arm or something on the trail?” My answer comes in two parts: first, keep that from happening by controlling risk and maintaining safe practices; and second, take proper action to render quality first aid. Then I must decide if the person stays on the trip or goes for advanced care.

My first memory of a treatment for an injury comes from the time when I closed the car door on my fingers. My little kid fingers got a real good dose of classic Ford Fairlane American steel and man, did I scream bloody murder! My dad immediately took ice cubes from the freezer, wrapped the crushed pieces in a towel and enveloped my small hand with the icy concoction. Cool, calm and quick – didn’t even have to think – he just acted. My hero!!

While most front country emergencies only require responders to keep the patient calm and dial 911, in the backcountry, 911 might not be an option. Even if help can be contacted, in the backcountry location/weather may inhibit any type of rescue via ambulance or helicopter. As we prepare for the worst-case scenario, we need to approach this issue recognizing the challenges of backcountry first-aid.

Generally backcountry, or wilderness, first-aid comes into play when we are over one hour from definitive medical care. Definitive care is relative to Advanced Life Support (ALS) via ambulance or directly to immediate care from quality emergency hospital services. In the backcountry it may take days, never mind hours, to get your patient to a hospital.

I strongly recommend that anybody who spends time in remote regions receive training from the Wilderness Medicine Institute (www.nols.edu/wmi). There are plenty of choices based on your time, pocketbook, previous skill sets, and geographic location.

Interested? Here’s how Wilderness First-Aid protocols confronts an emergency:

Step 1 – Whether you see the incident or arrive shortly after; Stop and Survey the scene for safety. Before jumping in, look over the scene for hazards or danger to rescuers, bystanders and patients. Try to determine the Mechanism of Injury (MOI) and protect yourself with gloves, glasses – this is called establishing Body Substance Isolation (BSI). Putting on gloves also establishes an air of professionalism that helps calm the Patient (Pt). Determine the number of patients and begin to form a general impression of the extent of injuries. This all happens while you are approaching and sizing up the scene; we have not touched the patient yet.

We now have two options: just think of the Clash song “Should I Stay or Should I Go!” Determine if the patient is very hurt or sick and requires a rapid assessment with immediate transport to an emergency care facility. Ideally the patient is relatively stable and you can do a focused exam to decide if the patient needs transportation to a care facility or if the situation can be managed on site.

Step 2 – Survey the patient –

Identify yourself and level of training and obtain consent. Consent to treatment can be determined verbally by the patient saying “Help me,” or implied, if the patient needs help but can’t tell you.

Establish the patient’s level of responsiveness and check for spinal injuries and the need for Cervical Spine Control (C-Spine control). Emergency response training will teach you these important steps.

The ABC’s

The ABCDE’s of treatment force us to stop to fix any glaring problems and look for hidden ones. For example, a patient screaming in pain might be unaware of a more serious injury. A smashed finger hurts like hell but the bleeding head wound needs more immediate attention. The damaged finger is called a distracting injury – taking our attention away from a more important injury. Follow the ABCDE’s below to identify and address the most threatening issues.

A: Airway – Make sure it is clear and working. Is the patient speaking or not? Look into the mouth and clear the gum, chew or broken teeth from clogging the airway. Don’t just stick your finger in there as this could push that chunk of steak further in. Be careful and gentle.

B: Breathing – Look, listen and feel for adequate breathing. Is it labored like an asthma attack, diminished or wet sounding? Is it shallow, spasmodic or regular? Put your ear near the mouth and listen for breath sounds and watch for chest for movement.

C: Circulation – Check for bleeding, pulse (weak/strong), control bleeding and treat for shock. Sweep your hands slowly and carefully; don’t “paw” the patient. Look for pooling and make sure you don’t move the patient more than needed. There are prescribed protocols for ‘rolling’ the patient on their side to inspect the back (parts hidden by the ground contact). Take training on how to do this move before you need to do it. Be especially careful when dealing with a method of injury that makes spinal damage more likely.

D: Disability – Calm the patient and stabilize the affected body part, especially with spine and neck injuries. For example, hold the wrist carefully if the patient complains of “broken” wrist. Light in-line traction and proper splinting will ease the patient’s pain level.

E: Expose the serious, threatening injury. Be aware of the environment and don’t just cut off clothing. It may take hours or days to finally transport the patient and their clothing may be the only thing keeping them warm. Make sure the wound is exposed in a manner that will allow you to later utilize the clothing for warmth/cooling after the injury has been treated. Maintain the patient’s dignity and privacy.

At this point we have quickly inspected the patient and identified anything that may be life threatening. If necessary, we’ve called for help and made plans for evacuation. Remember to stay calm and professional, introduce yourself and level of training, tell the patient everything you are doing, don’t make promises, show consideration for privacy (kids, opposite sex) and be thorough. There are volumes more of information on this subject and you can never be too prepared. Again, please seek further training as appropriate.

Stay safe out there. See you on the trail.

First Aid Basics

It is impossible to have the perfect kit. Whether you purchase a kit or create one yourself, these recommendations will provide you with a starting point. Keep your destination in mind. Are you going to the city park or traveling in the Darien Gap? It will help determine the availability of emergency services.

A suggested kit:

Equipment: trauma shears, tweezers, safety pins, scalpel, thermometer, BP cuff and stethoscope, rescue mask, emergency blanket, patient assessment forms, irrigation syringe, gloves.

Wound gear: Povidone-iodine solution, antiseptic towelettes, sterile scrub brush, green soap sponges, wound closure strips, tincture of benzoin swabs, 2nd Skin dressings, Moleskin dressings, antibiotic ointment packets (some folks allergic to “triple” use “double” type), 1×3 fabric bandages, knuckle and fingertip fabric bandages, 4×4 sterile gauze pads, 3×4 non-stick gauze pads, 3 inch conforming roll gauze, 3” x 5yd Coban wrap, transparent film dressings (like Opcite), 1 inch cloth tape, 4 inch elastic wrap, SAM splint, triangular bandages, trauma dressings, various OTC meds like Aspirin, Tylenol, Ibuprofen, Benadryl, Sudafed, Bactine to name a few types and brands. If you are going to jungle, high altitude or hostile areas, make sure you have the proper shots and specific meds.

Remember that the most stocked and high-tech kit is not going to save you – knowledge and skill will. Get proper training!

For everything to do with Bill Burke, visit www.bb4wa.com

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