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First Aid staying safe in the wilderness and at sea Ann Marie McCartney, MD.

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Presentation on theme: "First Aid staying safe in the wilderness and at sea Ann Marie McCartney, MD."— Presentation transcript:

1 First Aid staying safe in the wilderness and at sea Ann Marie McCartney, MD

2 -Preserve life - Prevent further harm - Promote recovery Goals of First Aid

3  Assess your patient’s condition  Give appropriate urgent treatment  Make decisions regarding medical evacuation  Provide on-going patient management Goals of First Aid

4 PITFALLS  You can’t count on help arriving soon.  Medical care is more than one hour away.  May have to care for your patient for hours or even days.  Materials & equipment may be unavailable; you may need to improvise.  In the wilderness, we may need to give care that would be inappropriate in the urban setting. Wilderness vs Urban First Aid

5 CONSENT  You must get patient’s consent to be able to help them.  Remember to approach from the front of the patient.  “I am trained in first aid, may I help you?”  If they say “no”, you can not help them!  If unconscious, assume consent.  Try verbal and then pain stimuli if patient not alert. First Aid Concepts

6  PATIENT  Never use the term “victim”.  Use the patient's name – don't speak of the patient in the 3rd person.  As much as possible, include the patient in all decisions and discussions.  Don't step over your patient! (walk around) First Aid Concepts

7  Take necessary precautions to prevent the need for First Aid  Have a First Aid kit and know its contents and how to use it  Know your partner’s medical history and what medications they may need in the event of an injury or illness PREVENTION

8 Patient Assessment System Vital Signs Scene Size-up Initial Assessment Stop and Fix ABCDE Document and Monitor Head-to- toe Exam SAMPLE OPQRST Trauma Medical **

9 Scene Safety – Is the scene safe to enter? – For you, your partners, and the patient? If not, how can you get the patient to a safe location without causing further injury? Scene Size Up

10  Spread calm. Be a good role-model.  PANIC is contagious!!!!!!!  Walk, don't run  Don't make more patients!  Act with purpose and forethought.  Take an active roll and look for ways to help. BE CALM AND METHODICAL

11 Accidents can be beyond our control. Our response to them is always in our control. Why is it important to know First Aid?

12  Treat life-threatening conditions immediately  Non-life-threats can be treated after the full assessment is complete.  Steps: A B C D E 2  Obtain consent / establish responsiveness  A irway  B reathing  C irculation and Deadly Bleeding  D ecision about spinal injury  E nvironment / Expose injury Accident Assessment

13  Burns  Trauma  Wounds INJURIES

14  Thermal, chemical, radiation, electrical  Tissue injury depends on intensity of heat and length of exposure  Assess depth and extent of the burn Burns

15  Superficial – confined to the epidermis  Skin is red, painful and without blisters  Blanches white with pressure  Heal in 4-5 days with peeling of the epidermis Burns

16  Partial thickness – involves epidermis and dermis  Skin is red, mottled, wet, blistered, blanches white  Blisters can develop immediately up to 24+ hours later  Can take 5-25 days to heal or longer if becomes infected  Evacuate if burns are on the hands, feet, face, armpits or groin or if greater than 10% of the body Burns

17  Full-thickness – penetrate to the subcutaneous tissues  Skin is leathery, charred, pearl gray and dry  Area is sunken with a burned odor  Not painful as the nerve endings are destroyed  Can have painful surrounding superficial burns  Evacuate for these burns Burns

18  Location  Head and neck burns are dangerous and can lead to airway problems  Burns to the hands and feet can lead to loss of function  Circumferential burns of the extremities can impair circulation Burns

19  All types generally treated the same  PUT OUT THE FIRE: stop, drop, and roll  Remove clothing and jewelry which can retain heat  Check the airway – think about inhalation injury  Cool the burn: cool water or wet clothes  Avoid hypothermia. Don’t put ice on skin.  Clean and dress the wound; change daily  Watch for signs of infection Treatment of Burns

20  Occurs with breathing in hot air, gases or particles  Look for soot, airway redness and swelling  Listen for cough and noisy/rapid breathing  Always requires evacuation if suspected  Symptoms may be delayed up to hours Inhalation injury

21  UVB and UVA radiation  Water reflects 2% of radiation when overhead and more when the sun is lower  Clouds filter out infrared heat radiation (your skin feels cooler) but UV light penetrates the cloud coverage  Phototoxicity from medications Sunburns

22  PREVENTION  Apply sun cream 30 minutes before exposure  Consider sunblock for lips, nose, forehead, ears  Wear a hat, SPF clothing  Sunglasses with 100% UV protection  TREATMENT  Cool, wet dressings  NSAIDs Sunburns

23 When to consider:  Fall greater than 3 feet, landing on the head, back/side or buttocks  Falls or impacts associated with loss of responsiveness/altered mental status  High velocity impacts  Head injury  Numbness or tingling in the extremities  Patient was found unconscious  You did not witness the accident Head / Spinal Injury

24  If you are unsure about a spinal injury, do not move the patient; immobilize and seek help Spinal Injury

25  Closed Wounds  Contusions and hematomas  RICE Wounds

26  Open Wounds  Abrasions: cover with ointment and dressing  Lacerations: need sutures if skin gaps >1 cm  Punctures: leave impaled object in place unless obstructs breathing, prevents bleeding control  Ensure your Tetanus vaccine is up to date! Wounds

27  Treatment for open wounds  Control bleeding  Protect yourself from body fluids: gloves, plastic bags  Direct pressure and elevation  If dressing becomes saturated, add more dressings  Clean the wound – this is a priority!  Irrigate with clean water and rinse with disinfected water  Apply ointment  Bandage without cutting off circulation Wounds

28  Monitor for infection for 36 hours  Minor: redness, swelling, pus, heat, pain  Can apply heat and elevate the area  Monitor for progression; evacuate if not improving in 12h  Serious: evacuate  Red streaks radiating from the wound  Fever, chills  Lymph node swelling Wounds

29  Anaphylaxis  Hypothermia  Lightening Medical Illnesses

30 Severe immune system response to an allergen  Signs and symptoms  Difficulty breathing  Itching, flushing, hives, swelling  Swelling of face, tongue, and/or lips  Nausea, vomiting, abdominal cramps  Changes in Level of Responsiveness Anaphylaxis

31  Treatment  Antihistamine ASAP!  Epinephrine may be required to allow administration of the antihistamine.  PROP  Position of comfort / Reassurance / Oxygen / Positive pressure ventilation  Remember ABCs  Initiate evacuation Anaphylaxis

32  Can occur whenever heat losses exceed heat gains  As common in the wind, rain, and hail of summer as the cold of winter  DON’T LET AMBIENT TEMPERATURE FOOL YOU  Signs:  Shivering: can deplete fuel resources if not corrected  Decreased response times as body cools  Obvious mental status changes as it progresses Hypothermia

33  PREVENTION  Treatment is difficult if progresses beyond mild stage  Keep patient dry  Protect from wind  Provide hot drinks  Hypothermia wrap Hypothermia

34  Unpredictable and powerful  Mange risk by reducing exposure  Avoid storms – lightening can strike miles ahead or behind storms Lightening

35  Injuries due to direct hit, lightening splash, direct transmission, ground current, blunt trauma  Burns can be superficial to full-thickness  The respiratory center of the brain can be injured  Respiratory and cardiac arrest  CPR: heart may restart before breathing resumes give rescue breaths Lightening

36  Legal protection in Oregon and Washington provided by:  “Good Samaritan” laws  Volunteer Protection Act  Laws applicable to “emergency medical assistance”  Care given in patient’s best interest  To protect yourself:  Obtain consent  Stay within scope of training Good Samaritan Laws

37  You can NOT give prescription drugs  Includes sharing your drugs or those of others.  You can NOT administer prescription drugs  You can HELP a patient take THEIR drugs  Includes locating their drugs and preparing dosages.  You can give over-the-counter drugs  Important to check allergies and medications before administering.  Obtain patient consent and discuss reasons for use. Prescription Drugs

38  Stress response to a traumatic event  Physical, emotional, cognitive  Delayed stress responses  Critical Incident Debriefing  Find a qualified mediator  Understand that the reactions to a traumatic event are natural responses to an abnormal event. Psychological First Aid


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