1. 1 Ch. 27-Wilderness Emergencies

2. 2 27.1 Prevention of Wilderness Emergencies Bring someone who knows: What terrain can be expected What terrain can be expected What special equipment is needed for planned activities What special equipment is needed for planned activities What weather conditions are likely What weather conditions are likely How long the trip will take How long the trip will take What hazards may be encountered and what level of risk is involved in the anticipated activities What hazards may be encountered and what level of risk is involved in the anticipated activities What resources will be available in case of emergency and how to send for help What resources will be available in case of emergency and how to send for help Maximum anticipated delay in getting medical help to the area Maximum anticipated delay in getting medical help to the area

3. 3 PROGRESS CHECK 1. Before entering a wilderness area, you should specifically plan how you will handle ____________. (animal attacks/food shortages/serious medical emergencies) 2. The first aid leader should know the ____________ of each member of the party. (medical history/name/next of kin) 3. First aid in wilderness settings often involves ____________ care. (advanced/long-term/specialized) 4. A wilderness first aid kit should be packed to allow the group to handle a ____________. (trauma/serious medical emergency/disaster)

4. 4 Shelter Stay out of the bottom of valleys or canyons; heat rises, and the lowest area will also be the coldest. Stay out of the bottom of valleys or canyons; heat rises, and the lowest area will also be the coldest. Avoid setting up a shelter on a ridge or the top of a mountain where you would be exposed to wind. Avoid setting up a shelter on a ridge or the top of a mountain where you would be exposed to wind. Place your shelter downwind of some sort of windbreak, such as a large rock, mound of dirt, or bank of trees or bushes. Place your shelter downwind of some sort of windbreak, such as a large rock, mound of dirt, or bank of trees or bushes.

5. 5 Food Store food supplies some distance from your campsite. Store food supplies some distance from your campsite. Store food supplies off the ground; hanging food in stuff sacks is advised. Store food supplies off the ground; hanging food in stuff sacks is advised. Avoid cooking foods with especially strong odors, such as bacon. Avoid cooking foods with especially strong odors, such as bacon. Remember that food refuse also will attract wildlife; burn as much as you can, then keep remaining garbage a safe distance from your campsite and off the ground. Remember that food refuse also will attract wildlife; burn as much as you can, then keep remaining garbage a safe distance from your campsite and off the ground.

6. 6 PROGRESS CHECK 1. A person can survive for approximately ____________ days without water. (2/3/4) 2. The most important factor for survival in cold weather is ____________. (food/water/shelter) 3. When a victim faces a combined lack of shelter, water, and food, the “rule of ____________” goes into effect. (survival/threes/convection) 4. Always try to construct a shelter ____________. (in the bottom of a canyon/downwind of a windbreak/ on top of a ridge) 5. Tents do not provide any ____________. (moisture resistance/security/insulation) 6. The best method of purifying water in the wilderness is ____________. (purification tablets/filtration/boiling) 7. The higher the altitude, the ____________ you should boil water to kill organisms. (longer/less time) 8. To protect yourself from predators, ____________ your food away from your campsite. (bury/hang/cover)

7. 7 27.3 Altitude-Related Problems in the Wilderness Seek medical help immediately if the victim develops any of the following: Noisy breathing Noisy breathing Persistent cough Persistent cough Shortness of breath while resting Shortness of breath while resting Vomiting Vomiting Loss of balance Loss of balance Confusion or disorientation Confusion or disorientation

8. 8 Vocabulary Rule of Threes- A rule stating that survival time is considerably reduced if a victim is without all three factors required for survival: shelter, water, and food Rule of Threes- A rule stating that survival time is considerably reduced if a victim is without all three factors required for survival: shelter, water, and food Billowing- Loss of heat inside a tent when the wind flaps the sides of the tent and warm air is replaced with cold air Billowing- Loss of heat inside a tent when the wind flaps the sides of the tent and warm air is replaced with cold air

9. 9 Acute Mountain Sickness 1. Stop climbing immediately; rest and see whether symptoms improve. 2. If symptoms do not improve within a day or two, descend 2,000 to 3,000 feet as quickly as possible. 3. Prevent or correct dehydration by drinking at least 4 quarts of fluid every day; eat a high-carbohydrate, high-calorie diet while climbing. 4. Use aspirin to treat mild headache.

10. 10 High Altitude Pulmonary Edema The signs and symptoms of HAPE include Severe shortness of breath, even when resting Severe shortness of breath, even when resting Cyanosis (bluish discoloration of the lips, fingernails, and mucous membranes lining the mouth) Cyanosis (bluish discoloration of the lips, fingernails, and mucous membranes lining the mouth) “Moist” breathing that produces rattling and crackling “Moist” breathing that produces rattling and crackling Cough that produces pink, frothy sputum Cough that produces pink, frothy sputum *A victim of HAPE needs immediate medical treatment in a compression chamber. The most important thing you can do is descend immediately and seek medical help for the victim.

11. 11 High Altitude Cerebral Edema Signs and symptoms include the following: Severe headache Severe headache Severe nausea and vomiting Severe nausea and vomiting Ataxia (inability to maintain balance) Ataxia (inability to maintain balance) Dizziness Dizziness Extreme fatigue, progressing to coma Extreme fatigue, progressing to coma *It is critical to get the victim to a lower altitude as quickly as possible.

12. 12 PROGRESS CHECK 1. Altitude-related illness is caused by a lack of ____________. (oxygen/fluids/nutrients) 2. Acute mountain sickness causes symptoms much like those of a severe ____________. (cold/hangover/migraine headache) 3. High altitude pulmonary edema is characterized by ____________, even after rest. (fatigue/muscle soreness/difficulty breathing)

13. 13 27.4 Special Wilderness Considerations Assessing the Scene Assessing the Scene Assessing the Victim Assessing the Victim Determining a Plan Determining a Plan

14. 14 Vocabulary Acute mountain sickness- An altitude related illness that resembles a severe hangover Acute mountain sickness- An altitude related illness that resembles a severe hangover High altitude pulmonary edema (HAPE)- An altitude- related illness that causes fluid to go into the lungs from body cells High altitude pulmonary edema (HAPE)- An altitude- related illness that causes fluid to go into the lungs from body cells High altitude cerebral edema (HACE)- An altitude- related illness that causes swelling of the brain and increased pressure inside the skull High altitude cerebral edema (HACE)- An altitude- related illness that causes swelling of the brain and increased pressure inside the skull Foramen Magnum The opening at the base of the skull that houses the brain stem Foramen Magnum The opening at the base of the skull that houses the brain stem Ataxia Inability to keep balance Ataxia Inability to keep balance

15. 15 C-H-A-R-T C- Chief complaint (What did the victim tell you?) H- History (What happened?) A- Assessment (What signs and symptoms did you find?) R x - Treatment (What did you do for the victim?) T- Transport and disposition (After you cared for the victim, where did the victim go? Did the victim leave? Was it on foot, in a car, in an ambulance, in a helicopter?)

16. 16 Determining a Plan 1. You can treat the victim where you are until the victim has recovered enough to walk out on his or her own or with minimal assistance. 2. You can carry the victim to help, either on an improvised litter or with any of a series of carries. 3. You can send a pair of people to get help—or, in a critical enough situation, you can leave the victim alone while you go to get help. 4. You can stay with the victim and call for help by cellular phone, radio, or signal; talking to emergency medical personnel by phone or two-way radio can be an excellent source of information as you work to care for the victim as well as plan for evacuation.

17. 17 First Aid for Shock 1. Increase and maintain the effective circulating volume of blood 2. Reduce the oxygen debt being incurred by the body. You need to place the victim in the correct position, maintain a normal body temperature, and replace lost fluids. *Special considerations in the wilderness setting include the following: Maintaining temperature Maintaining temperature Replacing fluids Replacing fluids

18. 18 Cardiopulmonary Resuscitation Generally, you should stop chest compressions if the pulse does not start after 30 minutes of CPR, unless: The victim has hypothermia The victim has hypothermia The victim has been submerged in cold water for less than one hour The victim has been submerged in cold water for less than one hour The victim was buried in an avalanche (these victims generally die from either suffocation or blunt-force trauma) The victim was buried in an avalanche (these victims generally die from either suffocation or blunt-force trauma) The victim was struck by lightning The victim was struck by lightning You should not begin CPR if: The victim has been in cardiac arrest for more than 30 minutes, and there have been no efforts to resuscitate him or her The victim has been in cardiac arrest for more than 30 minutes, and there have been no efforts to resuscitate him or her The victim has an injury that is obviously fatal The victim has an injury that is obviously fatal The victim’s chest is frozen The victim’s chest is frozen The victim’s core temperature is lower than 60°F The victim’s core temperature is lower than 60°F The victim has been submerged in water for longer than 60 minutes The victim has been submerged in water for longer than 60 minutes Proceeding with CPR will place the rescuer at risk Proceeding with CPR will place the rescuer at risk

19. 19 First Aid for Soft-Tissue Injuries 1. Irrigate the wound immediately to flush out as much bacteria, dirt, and debris as possible. 2. If tissue has been completely avulsed, wipe or scrub it away with a gauze pad and sterile water or saline; if an avulsion is only partial, clean the tissue thoroughly and place it in its normal anatomical position. 3. Bring the edges of the wound together as closely as you can to the position they were in before the skin was separated. 4. Dress and bandage the wound. 5. If dressings get soaked with blood, remove the blood- soaked dressings, locate the bleeding vessel, and apply direct pressure to stop the bleeding.

20. 20 First Aid Care for Musculoskeletal Injuries Shoulder Dislocation Shoulder Dislocation Kneecap Dislocation Kneecap Dislocation Finger Dislocation Finger Dislocation Splinting a Fracture Splinting a Fracture

21. 21 Death of a Victim Death of a Victim Immediately following the death, provide emotional and psychological care to survivors, who will undoubtedly be disturbed by the death Immediately following the death, provide emotional and psychological care to survivors, who will undoubtedly be disturbed by the death Depending on the religious beliefs of others in the group, some sort of ceremony may be appropriate and comforting Depending on the religious beliefs of others in the group, some sort of ceremony may be appropriate and comforting Note the time, cause, and location of the death Note the time, cause, and location of the death Protect the body from predators and from the elements until you can transport it or until authorities arrive Protect the body from predators and from the elements until you can transport it or until authorities arrive Notify authorities as quickly as possible Notify authorities as quickly as possible

22. 22 PROGRESS CHECK 1. When assessing a victim in the wilderness, spend more time on the ____________ survey than you otherwise would. (initial/primary/secondary) 2. To manage a shock victim, insulate the victim from ___________. (the air/the ground/moisture) 3. Replace fluids in a shock victim by giving the victim ____________ of water. (small sips/one glass/large amounts) 4. Wound management in the wilderness involves cleaning the wound and ____________. (removing dead tissue/suturing the wound/changing the dressings) 5. Whenever you splint a fracture or immobilize a victim to a backboard, pay special attention to ____________. (strapping/padding/lashing) 6. If a victim dies in the wilderness, it’s easiest to ____________. (have authorities come to the scene/carry the victim out)