SCENARIO You and your friends are hiking on a mountain trail in mid-August. You are enjoying a beautiful sunny afternoon with a temperature of 72 F. You come across a person sitting on the trail holding his/her right arm. This person is alone and there are no bystanders. You are 5 miles from the nearest trailhead where your vehicle is parked. It is ten miles from the trailhead to the nearest town. There is no cell reception until you reach the town limits. Based on your WFR knowledge and skills what are some of the things that you should do?
SCENE SIZE – UP & INITIAL ASSESSMENT After determining that the scene is safe, you find out the person’s name but he/she does no know what happened. The person is confused and exhibits a slurred speech. They complain of pain while guarding their right arm. No sign of life threatening trauma is apparent. WHAT NEXT?
SCENARIO After asking SAMPLE and taking vitals you find out the following: S: Pain in the right arm, pale, confused, slurred speech. A:None M: None P: Diabetes (Type II) L: Not sure E: Does not recall HR:132 RR: 30 BP: Strong radial pulse LOC:A & 0 X 1 (Alert & oriented to person only) SCTM:Pale, warm & dry CSM: Weak in all four extremities, can feel, does not respond to commands well but has good pulses PERRL:Normal WHAT NEXT?
SCENARIO TREATMENTS Glucose administration while protecting the airway. Splint the arm and check CSM before and after. Head-to-toe exam (reveals nothing) Clear the spine while meeting all criteria Formulate an evacuation plan
Average Score 44% INCOMPLETE SAMPLE INCOMPLETE VITALS NO GLUCOSE ADMINISTRATION POOR AIRWAY MANGMENT 10/23
Participants’ Demographics 34 total F-9, M-25 Age Range Highest WEM Certification – WFR-33, WEMT-1 Age18-2425-3031-3536-4041-5051-5556-6060 up Num.128343112
Study Limitations Not generalizable as it stands due to a small sample size Not randomized design – opportunity sampling Preliminary study – You can get involved with this research – details to follow…
More Demographics First Obtained WEM Certification in years ago: Number of Recertification Courses: Years Ago 234567101115 Num.1241351511 Re- Cert 01234 Num.168432
Still More Demographics The Type of Work They Currently Pursue: Guides – 19 Therapy – 1 Outward Bound – 9 Outdoor Education – 2 Volunteer Organization – 1 Conservation – 1 Field Biologist – 1 Why did you get an WEM Cert. in the 1 st place? Required by job – 29, SAR – 1, Required in School - 3
Results Before the scenario, participants were asked to estimate the percentage of knowledge required to be fully-qualified as a WEM provider they have retained. Answer average: 65%, Range: 17.5 to 90. Before the scenario, participants were asked to estimate the percentage of skill required to be fully-qualified as a WEM provider they have retained. Answer average: 68%, Range: 20 to 90. Remember, accuracy was 44%
More Results After the scenario, participants were asked if they retained as much knowledge required to be fully-qualified as a WEM provider as they thought they would. Answer: Yes – 7, No – 27 After the scenario, participants were asked if they retained as much skill required to be fully- qualified as a WEM provider as they thought they would. Answer: Yes – 18, No - 16
Injuries With Which Participants Dealt: ligament sprain12 Laceration22 muscle sprain13 Sunburn29 Frostbite5 tooth related5 Fracture9 Burn14 Dislocation5 blister(s)25 immersion foot6 bruise, contusion18 Tendonitis6 head injury without loss of consciousness10 head injury with loss of consciousness1 eye injury5 skin abrasions25
Injuries With Which Participants Dealt: near drowning 3 shoulder dislocation7 life threatening bleed0 back injury5 “Other” includes: fish hook, fractured pelvis, sickle cell disease, ruptured spleen, compound fracture, snake bite.
Ideas for Improving Retention Limit rescuer distraction Simplify wilderness medicine curricula Emphasize SAMPLE and information gathering skills in wilderness medicine classes Offer continuing education classes on-line as part of the recertification process Look at other medical industry standards for recertification requirements and lengths CPR NREMT ACLS OEC
More Ideas for Improving Retention Recalibrate rescuer overconfidence Design curriculum giving precedence to the activities with which rescuers are most likely to face in an emergency situation. Shorten the re-certification period. (I know, I know)