Wilderness 1st Aid for injury scenarios!?!?!

P

Plainsman

Joined
Apr 5, 1999
Messages
1,168
This is one area of concern for me! How about you? I don't know 'how' to handle all situations. I have a general idea on what I would do, but maybe discussing different scenarios would help all of us out.

Even something like a severely TWISTED ankle can lead to a dangerous situation in the woods. Would scenarios related to injuries and 'what to do?' interest forum members?

Comments!!



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Plainsman :)
primitiveguy@hotmail.com


 
This is an interesting topic, and one that can serve us well if it's handled correctly. I've seen similar post's and questions regarding this area, and have been appalled at some of the dopey(IMO) answers. I think a good rule of thumb is that you should carry into the woods, first aid supplies that are commensurate with your skill level in first aid!Why carry sutures and IV fluid if you can't use them?In additon I have seen posts that advocate an amount of supplies that would constitute another separate backpack full of gear. Why? I should state at this point that I believe what you carry is your business, but again I ask, why carry what you don't know how to use or an item that is
superfluous? I am just a lowly EMT and a 91B army trained medic. I carry basic first aid items that I can use, and that I believe are warranted in the type of woods bumming I do.My first aid supplies probably dont' weigh more than a few pounds. Trauma dressings, band aids, anti-biotic ointment, tape, 4x4's, NSAIDS, spint materials,ACE bandage, razor blade,and some other useful odds and ends.If someone can make a case for carrying a load of stuff other than the above, lets hear it, I'm ready to learn.Just make sure you remember it' s for first aid, not a bloody MASH unit.

[This message has been edited by Doc Mac (edited 12 December 1999).]
 
DOC MAC: I understand what you are saying completely! I carry a bag full of stuff, but I know I can use the articles. It is SIMPLE supplies. I have bandages, ace wraps, LOTS of tape, two wire screen splints, gauze, bandaids, some ointments, etc. Nothing complicated. I just want to be able to stop bleeding, cover a wound and/or immobilize a limb. Anything more than that is beyond my ability.

I had a chance to get some suture kits and skin stapler and some other similar more complex items. I seriously thought about it and decided, "I don't KNOW how to use them CORRECTLY!" I understand the 'principle' but don't have the background knowledge. Thus, I didn't get them. If I ever learn, then I will get them.

Would this be a good topic then to ask more questions about?

Thanks!


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Plainsman :)
primitiveguy@hotmail.com


 
I think your aid bag should reflect the size of the party, length of the trip, qualifications of your medic, and most importantly how far you will be from a primary care facility, giving special consideration to the time it would take to evac someone from an area.

Myke Hawkeye http://www.globalunivision.com/ and Jay Stanka http://www.specops.com sent me the following list. Both of these guys are SF medics. Sure, they're working in remote areas, but this goes back to my opening paragraph, so take it for what it's worth.

Wilderness medical kits should be organized into 4 categories with the following being the minimal items carried.

1. Trauma supplies
a. Band Aids® and large sterile gauze pads
b. Steri-strips® for wound closure
c. Tape - two types; hypoallergenic and duct or rigger's tape
d. Footcare - Moleskin and/or gel wound coverings i.e. 2nd Skin®
e. Antimicrobial towelettes and alcohol wipes
f. (2) SAM® splints minimum
g. ACE® wraps large
h. Rubber gloves

2. Tools
a. Tweezers
b. Scissors
c. Irrigation syringe
d. Small Hemostat
e. Needle for lancing

3. Miscellaneous supplies
a. Waterproof pad and pencil
b. Sawyer Extractor®
c. Insect repellent
d. Insect bite treatment i.e. Afterbite or StingEze®
e. Iodine drops

4. Medications
a. Analgesics i.e. Aspirin and Ibuprofen
b. Antihistamine i.e. Benadryl®
c. Anti-diarrheal i.e. Imodium®
d. Constipation relief i.e. Maalox®, Milk of Magnesia®
e. Anti-anaphylaxis i.e. injectable epinephrine (Ana-Kit®)
f. Triple antibiotic ointment
g. Eye wound care i.e. eye drops and bacitracin
h. oral Rehydration salts
i. Hydrocortisone cream 1%
j. Rescue Inhalers i.e. Primatene Mist

Doc Mac makes an excellent point of not carrying more than you are qualified or understand how to use. There are plenty of good instructors and courses out there ranging from Wilderness First Aid (minimal) to Wilderness First Responder.

I still have a question: Would you rather be with a bee sting kit and dose of injectable epinephrine and have the knowledge of how to use it (even though you are not certified), OR, just let the patient die because you are not qualified to give a simple shot in the shoulder when someone goes into Anaplylactic shock over a bee sting, some food they're hypersensitive to, or other causes. Take into consideration that Anaphylactic shock can kill in minutes.

Ok, I know that any member who is allergic to something should have their own medication but let's take that out of the equation for the sake of conversation and the fact that a lot of folks run on luck.

Plainsman, I agree that simple problems can turn complex, especially if left untreated and primary care is miles away.

Our trips have a trained paramedic instructor along, and the rest of our guys including the indigs are certified in Wilderness First Aid.

Just some thoughts. - Jeff

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Randall's Adventure & Training
jeff@jungletraining.com



[This message has been edited by JeffRandall (edited 12 December 1999).]
 
I still have a question: Would you rather be with a bee sting kit and dose of injectable epinephrine and have the knowledge of how to use it (even though you are not certified), OR, just let the patient die because you are not qualified to give a simple shot in the shoulder when someone goes into Anaplylactic shock over a bee sting, some food they're hypersensitive to, or other causes.
Click to expand...

If you know how to use it, how come you aren't certified?

What's the worst that can happen if you do something wrong?

The above scenario sounds simple enough, but I don't know it really is. Even if it is, there may be similar ones which aren't simple, but may seem so. (For example, I'm surprised how often antibiotics are mentioned here. I hope and think you who mention them know how and when to use them, but they're often misunderstood.)

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Urban Fredriksson
www.canit.se/%7Egriffon/

"Smooth and serrated blades cut in two entirely different fashions."
- The Teeth of the Tyrannosaurs, Scientific American, Sep 1999


 
Could I give a dose of epinephrine? You bet, especially if a life depended on it. Am I 'certified' to give shots? No

Just because you can drive a car doesn't mean you have a driver's license.

The worst that can happen? The patient dies if not treated. In my mind the small risk of screwing something up with an IM or subcutaneous shot is minimal compared to non treatment for this particular condition.

Who mentioned antibiotics? - Jeff

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Randall's Adventure & Training
jeff@jungletraining.com

 
I didn't mean to be so specific, I rather meant what is the worst which can happen if you do give something to someone when you shouldn't. Not what happens if you do nothing.

If this is a harmless drug, then the choice is easy, but I don't think that goes for all those you need some kind of licence to use, nor even all those which can be had over the counter. In the absence of a license, how does one know one knows what's required? (As for driving a car, of course you learn how to drive first, then you wait until you're old enough to take the test. In the medical profession it's of course similar so if you're four years through a five year education you don't have your papers yet, but you do know most of what you need.

Actually you mentioned antibiotics in this thread, and also that one has to take into account the training the medic has.

<small>I certainly hope you aren't "certified" -- the wrong way -- "certificated" is a safer word to use in an international context.</small>
 
Not trying to beat a dead horse, but where did I mention antibiotics? Triple antibiotic ointment? bacitracin?

If we're splitting hairs I'll agree with you, if we're talking prescription antibiotics which are designed specifically for the infection and precribed by a doctor to be taken full course, then I failed to mention that in my threads.

To answer your other question, I've seen one person who had a severe reaction to several stings. There's not much doubt about the onset of Anaphylactic shock since the person is literally smothering to death.

In most cases is comes about suddenly and can have the following symptoms:

Severe itching, sneezing, coughing, wheezing, shortness of breath, tightness and swelling of the throst, chest tightness, swelling of the face, mouth, and tounge, vomiting, convulsions.

Every second counts once this happens, and the only life-saving treatment is epinephrine which works by opening the airway, relieving swelling, and raising the blood pressure.

Bee sting kits are physician prescribed and come with directions. Even the WMS and National Safety Council suggests it to be used to save a life...even if you're not practiced or certified.

So back to my orginal question - would the readers of this thread use a bee sting kit to save a life even if they felt they were not qualified to give the injection? - Jeff

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Randall's Adventure & Training
jeff@jungletraining.com

 
I am qualified, not certified. I always carry an ABC (adrenaline, Benadryl, Cortisone) Kit. I have used one on a student and would again. I would rather lose what I have than kill a student through inaction. I can get them later
wink.gif


The same is true for polyvalent croatalie antitoxin (SP?) (Snake bite kit). It is an injectable and is good for all North and South American snake bites. I generally carry 6 units in hazardous areas.

Ron

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Learn Life Extension at:

http://www.survival.com ]
 
Well said Ron. I believe any good guide or trip leader thinks like that.

The biggest worry I have on extended outings with several team members is medical situations. We can always eat, drag ourselves out of the bush, and generally survive, but medical situations are a completely different avenue that even quality survival nstructors, like yourself, cannot always handle without proper equipment and supplies.

Even if you're not certified, if you understand the process it may be the meaning of life and death for a student or friend in a critical situation.

Sure there's law suits possibly waiting, but gross negligence and doing your best to save a life in a critical situation are two different things.

Many folks skimp on medical knowledge and supplies in the bush. We can't afford to.

A buddy of mine, Myke Hawkeye summed it up with this: "In the course of pursuing any study, one should attempt to seek the highest level of authority for the subject matter at hand. Then they should get all the knowledge and training, as is available to them. Then, if feasible, review that which is one or two levels above their means.

In this way, they will have an idea of how best to proceed with their own implementation by knowing how the next courses of action will follow. Hence, know the basics, study the advanced, understand the rest."

Jeff

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Randall's Adventure & Training
jeff@jungletraining.com

 
Ron and Jeff... I agree

I am certified in Advanced Cadiac Life Support (ACLS), Advanced Trauma Life Support (ATLS), Pediatric Advanced Life Support (PALS), and have a fair amount of training in emergency medicine. I lecture on the subject of Wilderness Medicine at several of the local and surrounding hospitals.
Guess what...I do not believe you should have to be certified to perform life saving procedures in the field... Trained...yes...certified no.

All of my instructors are CPR trianed and are EMT's. Does this qualify them to administer epinephrine from a bee sting kit or treat an injury? NO. What qualifies them to do this is the medical briefing I give prior to every trip we take to the field.

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Greg Davenport
http://www.ssurvival.com
Are You Ready For The Challenge?
Are You Ready To Learn The Art Of Wilderness Survival?

 
Just in case you have not heard, on August 31, 1999, Wyeth-Ayerst Laboratories recalled certain lots of Epinephrine Injection, USP 1:1000 in 1 mL Tubex® syringe, which is the preloaded epinephrine syringe used in the Insect Sting Treatment Kit® packaged and distributed by Derm/Buro Inc.; Anaphylaxis Emergency Treatment Kit packaged and distributed by Bayer Corporation as Hollister Stier® Ana-Kit®; and Ana-Guard® packaged and distributed by Bayer Corporation.

The lots were recalled because some discolored, subpotent samples were found during quality control tests; in other words, the epinephrine may not be strong enough to treat insect sting or food allergy reactions.

The specific lots affected are:

--Derm/Buro Insect-Sting Treatment Kits® distributed between June 1997 and February 1999, Lots 0397, 8139, 0497, 11464, 0597, 13239, 8141

--Bayer Ana-Kits® distributed between April 1997 and April 1998, Lots AK344 through AK363, AK366

--Bayer Ana-Guard® distributed between April 1997 and April 1998, Lots G00196 through G00220, G00222, G00223

The EpiPen® and EpiPen Jr.®, produced by Dey Laboratories, were not affected by this recall.

If you carry an anaphylactic treatment kit, you should check the lot number. Bayer has not, as far as I know, resumed production of Ana-Kits, and this means that EpiPens, too, have become hard to obtain.

Of course, you check the expiration date on all the meds you pack before every trip, right?


[This message has been edited by Walks Slowly (edited 14 December 1999).]
 
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