Differences between Wilderness and Urban setting:

Definition: Wilderness medicine protocols are in effect when you are more than one hour from definitive medical care.

Time with patient: This can be anywhere from an hour todays at a time

Environment: You may be dealing with extreme environments in addition to the

injured or ill patient.

Improvisation: You may need to create tools for treatment and evacuation from what is availableCommunications: May be limited or unavailable

Wilderness and Remote First Aid Topics

• Head (Brain), Neck and Spinal Injuries  • Hypothermia • Allergies and Anaphylaxis • Bone and Joint Injuries • Wounds and Wound Infection • Heat-Related Emergencies • Altitude-Related Illness • Burns • And more...

MEDICAL FORMS

EMERGENCY MEDICAL INFORMATION   Conditions/History

John Smith D.O.B 01/01/1951  Angina, Coronary Artery Disease ,High Cholesterol,

Asthma

111 Anystreet Rd    

Anytown, Pa. 19111   Medications

H- 215-555-1111 C- 215-555-2222   Nitroglycerin 10mg 4/day Lipitor 25 mg 4/day

Any Insurance Company Policy# 1234567890    

    Allergies

Emergency Contact Numbers   Penicillin Mushrooms Peanuts

Jane Smith wife H-215-555-1111 C-215-555-3333    

Bob Smith Brother H-215-555-4444 C-215-555-5555   Card printed 7/1/2011

     

Doctors    

Dr, Bill Doe 215-555-6666    

Dr. John Doe 215-555-7777    

SAMPLE History

to gain essential information about the patient’s medical history, ask the patient questions, such as:• S = Signs and symptoms. What are your signs and symptoms (i.e., what hurts)? Are you experiencing any pain, nausea, lightheadedness or other things that are not visible?• A = Allergies. Do you have any known allergies or allergicreactions? What happens? Has there been any recentexposure?• M = Medications. What medications are you taking? Are they over-the-counter or prescription? What is the medication for?When was it last taken? Where is the medication so we cankeep it with you?• P = Pertinent past medical history. Has anything like this happened before? Are you currently under a health care provider’s care for anything, such as for a cardiac or respiratory condition? Have you recently had surgery? Are you pregnant (if a woman)?• L = Last intake and output. When did you last eat or drink? How much? Are you hungry or thirsty? When did you last urinate and defecate? Were they normal?• E = Events leading up to the injury or illness. What led up to the incident? When did it happen? How did it happen?

7 Cervical

12 Thoracic

5 Lumbar

Sacrum

Coccyx

Moving A Suspected Spine Injured Patient

Only move if necessary

Stabilize Head and Weight Centers

Person on the head makes the calls

Move in Small IncrementsAxial Movement is Usually BestAlways Maintain HOSAvoid Pushing or Pulling (Try to Lift)

IMMOBILIZE A SUSPECTEDSPINAL INJURYINTRODUCTION

The spinal column of the neck and back surrounds and protects the nerves of the spinal cord. If the spinal cord is cut, the muscles and sensations controlled by the portion of the spinal cord below the cut will not function. Always check a patient who may have fallen or been hit in the back for spinal injury. If the patient has suffered a severe head injury, assume the patient also has spinal damage.

IDENTIFY SIGNS AND SYMPTOMS OF AFRACTURED SPINE

• Pain or tenderness of the neck or back.• Cut or bruise on the neck or back.• Inability to move part of the body (paralysis),

especially the legs.• Lack of feeling in a body part.

– Touch the patients arms and legs and ask if he feels your hand.

• Loss of bladder and/or bowel control.• Weak respiration.• Head or back in an unusual position.

MOVE A PATIENT WITH A SUSPECTEDSPINAL INJURY, IF NECESSARY

• Do not move a patient with a suspected spinal injury unless it is necessary to save his life, such as moving the patient from a burning building or positioning a non-breathing patient to perform mouth-to-mouth resuscitation.

• Use a four-man arms carry to move the patient to a place of safety.

• One rescuer will kneel at the patient’s head and places his hands on both sides of the patient's head. This bearer keeps movement of the patient's head and neck to a minimum when the patient is moved.

• This person will be in charge and will give the command to lift on 3.

IMMOBILIZE THE PATIENT’S SPINE

• Do not attempt to straighten the patients neck or back if it is in an abnormal position.

• Tell the patient to keep still and avoid unnecessary movement.

• Send someone to get medical help. (if possible)• If the patient is lying on his stomach, keep him from

moving until medical help arrives.

• If the patient is lying on his back, use padding to help immobilize his back, neck, and head as described

below.

IMMOBILIZE THE PATIENT’S SPINE

• Roll or fold a blanket or similar padding to conform with the normal shape of the arch of the back. Carefully slide the padding under the arch of his back.

• Slide a roll of cloth under the patient’s neck to help support and immobilize his neck.

• Keep patient’s from moving.

Cold EmergenciesFrostbite

Frostbite is local freezing of the tissues of the body. Generally the fingers, toes, cheeks, ears and, nose are most vulnerable.

Types:Superficial:

Partial Thickness: Upper layer tissue damage. Usually no significant tissue loss

Full Thickness: Significant damage to outer layers and can go into muscle and bone.

Definition:

It must be freezing (actual temp.) in order to get frostbite

No permanent damage to the affected tissues

Cold EmergenciesFrostbite, cont.

Signs/Symptoms:

Superficial: Mild tingling/pain, followed by numbness.Appears whitish/yellowish, waxy looking.Cold and pliable. No damage when thawed.

Partial Thickness: Mild tingling/pain, followed by numbness.Whitish/yellow waxy looking skin. Pliable but “dents”when palpated.Warm, swollen and tender after thawing. Within minutesto hours after thawing blisters will develop. Blisters maybe clear to reddish-blue in color.Area may remain numb after thawing.

Full Thickness: Tissue appears cold, pale and is frozen hard.Described as feeling “wooden”.After warming area becomes deep red, cyanotic or, mottled.Numb, cold and bloodless. Gangrene, mummification develops rapidly

Cold EmergenciesFrostbite, cont.

Treatment:Superficial/Partial Thickness:

Give Ibuprofen about 1/2 hour before starting, if possible

Warm affected area:Ideally, submerse the affected area in water 1040 to 1080

and leave it in until completely flushed.

Protect from refreezingNever massage/use radiant heat

Full Thickness:

Avoid field rewarming. Allow patient to walk out if prudent.If evacuation delayed consider field rewarmingProtect from refreezing

Administer STRONG pain med’s, if available. (Include ibuprofen to reduce tissue damage)

Evacuate ALL full thickness frostbite

Evacuate if blisters form

Cold EmergenciesHypothermia

Definition: A lowering of the core temperature of the body to the levelthat brain function is impaired.

Causes of Hypothermia:Acute Exposure: Immersion/Submersion in water.

Occurs in less than One hourBody loses heat 25 times faster in water

Sub-acute Exposure: Occurs in One - Twenty-four Hours

Chronic Exposure: Common in elderly or homeless populations.Occurs in One - Several days

Signs/Symptoms of Hypothermia:

Mild: Loss of fine motor/reasoning skillsShivering“Umbles” Begin

“UMBLES”FumblesMumblesGrumblesStumbles

Moderate: Uncontrollable shiveringWorsening of “Umbles”

Cold EmergenciesHypothermia, cont.

Signs/Symptoms of Hypothermia:

Severe: Shivering stops, muscles become rigid, unconsciousness, pulse and respirations drop to undetectable levels, high risk of ventricular fibrillation

Treatment of Mild/Moderate Hypothermia:

Change environment, seek shelterRemove wet clothing and replace with dry

Insulate patient from cold (Hypothermia Wrap?)

Keep patient moving if ableCreate external heat source: Fire, stove, heat packsGive warm, sweet fluids (No caffeine, alcohol)(Only if they can drink without assistance)Have patient eat if possible

Food Chain for RevivalTo stoke the bodies furnace compare it to starting a fire

KindlingSmall sticks

Logs

Simple sugarsComplex carbs.Proteins/Fats

Cold EmergenciesHypothermia, cont.

Treatment of Severe Hypothermia:

Treat very gently (Very high risk of myocardial infarction)

Do not try to re-warm, protect from further heat loss

Cut off wet clothing (Even if it’s expensive)Place patient in a Hypothermia Wrap

Add heat (Insulated, warmed rocks, heated water bottles near hands, feet, groin, armpits, neck)

Evacuate as gently and rapidly as possibleCold Weather Guidelines:Know your environment and be preparedPay attention to yourself and your companionsDress to maintain warmth and drynessStay well fed and well hydratedStay dry. Avoid overexertionCarry emergency food and clothes

Avoid tight clothes and bootsDo not sleep with wet, cold feetAvoid alcohol,caffeine, nicotine and other vasoconstrictors

Chest Injuries

Open chest wounds• Object penetrates the chest wall• Fractured ribs break through the skin

Closed chest wounds• Generally due to a blunt object

Chest Injuries:Signs and Symptoms

Difficulty breathing, including shortness of breath and pain when breathing (especially deep breathing)

Pain at the site of the injury Obvious deformity Pale or bluish skin Coughing up blood Protruding neck veins Drop in blood pressure

Sucking Chest Wound:Care

Cover with an occlusive dressing, taping it in place on all sides except for one side that should remain loose.

Use a folded cloth or, as a last resort, a gloved hand if occlusive dressing not available.

Administer emergency oxygen, if available, and take steps to minimize shock.

Have patient sit or lie in a comfortable position if no spinal injury is suspected.

Impaled Object in the Chest:Care

Never remove the object unless it interferes with chest compressions.

Stabilize the object to prevent further damage. Remove clothing to expose the wound. Control bleeding by applying direct pressure to

the edges of the wound; avoid direct pressure on the object.

Use a sterile, bulky dressing to help hold the object in place, carefully packing the dressing around the object.

Secure the sterile bulky dressing in place with gauze, a cravat or tape.

Burns

Severity of a burn depends on the―• Temperature of the source of the burn.• Length of exposure to the source.• Location of the burn.• Size of the burn.• Patient’s age and medical condition.

Classifications of Burns

Depth Extent Respiratory involvement Body part burned Cause

Depth of Burn Superficial

(involving epidermis)

Partial thickness (involving epidermis and dermis)

Full thickness (destruction of epidermis and dermis and any or all underlying structures [fat, muscle, bones and nerves])

Extent of Burn Rule of Nines

• 11 sections, each comprising 9 percent of the body’s skin coverage

• 1 percent for genital area

Lund-Browder diagram for children

Respiratory Involvement

Soot or burns around the mouth, nose or rest of face

Hoarse voice Inhalation of superheated air or smoke and

toxic gases Circumferential burns

Thermal BurnsSigns and Symptoms

Superficial burns:• Painful, appear as a reddened area that turns

white when touched, do not produce blisters and have skin that appears moist

Superficial partial-thickness burns:• Painful; have a red area that turns white to

touch; the skin may have mottling, blisters and may appear moist; and the hair is still present

Thermal BurnsSigns and Symptoms (cont’d)

Deep partial-thickness burns• May or may not be painful (nerve endings

may be destroyed); moist or dry (sweat glands may be destroyed); may or may not turn white when the area is touched; and hair usually is gone

Full-thickness burns• Painless, no sensation to touch, pearly white

or charred, dry and may appear leathery

Thermal Burns: Care

Scene size-up for safety Removal from burn source Primary assessment; physical exam Cooling of burn area Covering of burn area Minimizing shock

Altitude Sickness –Although the amount of oxygen in the air above 7,000 feet is the same as at sea level, the pressure is much less, so the circulatory system has to work harder to get the O2 through the alveoli in the lungs and into the bloodstream. Acclimating slowly to higher altitudes allows the body to develop more blood cells, which in turn increase the amount of oxygen delivered into the circulatory system with each breath.

Altitude sickness is more common with younger people than older. Anyone with a history of hypertension or other pre-existing conditions is also more susceptible. An early symptom is feeling out of breath while resting, or a pounding headache.When fluid starts filling the lungs, the condition is known as High Altitude Pulmonary Edema (HAPE). The victim spits up a pink frothy sputum and can only sleep sitting up. Edema (swelling) in other parts of the body may occur, and you may wake from a sound sleep feeling as if you're drowning from the inside out.

The general rule for treating altitude sickness is "Descend, descend, descend." If you have access to oxygen, use it. The patient shouldn't be allowed to sleep during the critical period of the illness. However, caffeinated drinks should not be given.

A related condition is known as High Altitude Cerebral Edema (HACE). Symptoms of this are Ataxia (remembered as: the victim stumbles along like they need a taxi...), headache, nausea and Disoriented Irritable Combative behavior. HACE is treated by descending in altitude, giving oxygen if you have it.

Mountains

Baldy Mountain- 12,441 ft (This is the highest and most visited peak within Philmont Scout Ranch)

Touch-Me-Not Mountain - 12,044 ft (This peak is just outside of Philmont's property)

Mount Phillips - 11,736 ft (This mountain is named after Waite Phillips, the founder of Philmont)

Comanche Peak - 11,303 ft

Big Red - 11.020 ft

Garcia Peak - 10,929 ft

Black Mountain - 10,889 ft

Bear Mountain - 10,662 ft

Bonito Peak - 10,610 ft

Cimarroncito Peak - 10,475 ft

Trail Peak - 10,250 ft (This peak has a B-24 bomber crash site on it)

Burn Peak - 9,936 ft

Lookout Peak - 9,927 ft

Apache Peak - 9,856 ft

Rayado Peak - 9,790 ft

Crater Peak - 9,730 ft

Shaefers Peak - 9,413 ft

Hart Peak - 7,975 ft

Mesas

Fowler Mesa - 9,419 ft

Wilson Mesa - 8,602 ft (Part of this mesa lies outside of Philmont property)

Urraca Mesa - 8,531 ft

Midnight Mesa - 8,326 ft

Deer Lake Mesa - 8,261 ft

Antelope Mesa - 7,624 ft