Dear Reader,
There’s this meme, featuring a light switch titled “how my brain works,” with the words “utterly obsessed” at the top of the switch and “uninterested” at the bottom. That, dear Reader, is how my interests work much of the time. Do anyone else’s interests swing like a pendulum?
At the time of this writing, I’m super interested in emergency first aid of all things. In fact, I am taking a wilderness first aid (WFA) course in which I am required to complete a series of online modules before our practical hands-on day. Through these lessons, we learn first aid basics like how to conduct a primary assessment of the patient, stabilize or treat the condition, and what preparations should be made if the patient requires immediate evacuation and attention from healthcare professionals.
I don’t usually get excited about online courses but learning practical skills and knowledge (as opposed to all the theoretical…uh, stuff… that I memorize for grad school) did pique my interest.
As a hiker (more here and here), wilderness first aid is especially important to me, however, much of the information can benefit anyone who would like to gain competency in emergency situations and learn life-saving skills like CPR. If you would like to know some of the WFA basics, do read on…
At first, the lessons started out slowly with the most basic of definitions. For example, what is “wilderness” anyway? Simply, it is an hour or a mile or more into a backcountry setting (so, in remote outdoor settings far from hospitals). Also, because we live in the U.S., aka one of the most litigious countries in the world, it’s also very important to learn about the medicolegal aspects including a patient’s right to refuse treatment. For example, adults can refuse treatment if they are mentally competent, sober, and “alert and oriented” (defined by their ability to recall who they are (i.e. by stating their name), where they are, and the time of day (when they are). If a patient is not able to respond correctly (and, yes, there is some subjectivity to “where” and “when”), is unconscious, or is a danger to themselves or others, then you may start treatment operating under “implied consent.” If you don’t get consent (and when consent is not implied), then you can be charged with assault as well as battery (and “battery” in this sense can literally be defined as touching the patient — yikes!). Furthermore, when 1. you have a DUTY to aid, 2. you DERELICT your duty (by carrying out actions that are not up to the standard of care), 3. DAMAGES are caused, and 4. you are the DIRECT cause of these damages, then, you can be charged with negligence (<— those are the four D’s of negligence).
If the above doesn’t scare you away, then you will learn about the precautions that you must take in a first aid capacity. When making contact, it’s important to wear personal protective equipment (like gloves and masks) and learn how to dispose of contaminated substances.
Additionally, you will learn your A,B,C’s or in this case, your A,B,C,D,E’s, which stand for:
- Airways — tilt back the head and pull down the chin to open the airway of a non-responsive patient
- Breathing — listen for breathing (12-20 breaths per minute is considered normal)
- Circulation — take the patient’s pulse (in the radial artery [wrist], if the patient is conscious; in the corroded [neck] if the patient is unresponsive)
- Disability — can the patient respond to your questions logically (if yes, then they are alert)?, can they only respond with moans and other noises (if yes, then they are verbal)?, do they react if you pinch them on the wrist (if yes, then they can respond to pain)?
- Exposure — is the environment safe for the patient, for example, are there risks of hypothermia?
With this information, you can continue with your secondary assessment of the patient by checking them from head to toe, identifying common injuries and illnesses, and administering small treatments (like cleaning surface wounds and applying bandages). You will also learn when a patient should be evacuated and seen by a health care professional (because people with only first aid training are NOT healthcare professionals).
Learning how to stabilize and treat injuries was the most exciting part for me, however, it was also the most gag-inducing. Also, I was faced with some pretty gruesome images in this section (including a photo depicting impalement of an appendage…**faint**).
As the lessons progressed, things got even more graphic. Learning about sprains and fractures was hard to stomach. A sprain can come in three types:
- Grade 1 (least threatening): this occurs when the ligament (tissue that connects bones) is overstretched and there is minimal tissue damage, but bruising and swelling usually occurs. This type of injury usually only requires Rest, Ice, Compression, and Elevation (RICE)
- Grade 2: occurs when the ligament is more badly damaged; more bruising and swelling occurs. This level of injury requires medical attention and a few weeks to heal
- Grade 3 (most threatening): occurs when the ligament is torn; this usually occurs with a popping sound (gross!). It requires immediate medical attention and several weeks to heal.
Fractures are even scarier, especially in the backcountry. When one is just an ambulance ride away from a hospital, these injuries can be quickly assessed, and patients will usually make a full recovery. However, when you are in the backcountry and potentially hours away from rescue, a broken leg left untreated could result in the loss of the limb and in the worst case — death.
Why is this? First, if you are dealing with an open/ compound fracture (where the skin has broken), then the patient is at risk of blood loss and infection. Additionally, this serious injury requires you, the first aid person at the scene, to manipulate the limb so it’s straight and immobilize it with a splint. This is tricky work especially if you don’t have a splint handy (so, you get creative with extra clothing and sticks), the patient is in severe pain, and the environment is inhospitable. Additionally, internal damage (especially if the fracture is not properly splinted) can lead to reduced blood flow in the limb. When circulation is weak for several hours or stops altogether, then the patient can lose the limb.
At the end of the fracture module, we watched a video of a mountain biker who suffered a lower limb fracture. His leg was bent the wrong way. It made me want to projectile vomit all over the screen.
Additionally, in your lessons, you will learn about mammal, arachnid, insect, and snake bites. Regarding snake bites, there was an image showing “necrosis of the leg due to a coral snake bite”…don’t look it up, it just looks like a charred, dead limb with a chunk missing from it.
To make sure you cover all the likely scenarios, you will also delve deeply into environmental hazards like lightening and avalanches, acute conditions like shortness of breath (SOB), asthma attacks, anaphylaxis, strokes, shock (note, this is cardiovascular shock, where the heart fails to provide adequate circulation to the body, NOT psychological shock), seizures, and head trauma.
Honestly, one thing that I found to be particularly disturbing (but also super helpful!?) about the whole program was that we saw videos of many of these conditions. We watched a boy in a hospital bed complaining that he could not breath, before the doctors performed a life-saving intervention. We saw a Youtube video of what looked like a husband filming his wife as she wheezed “I…can’t…breath,” as she struggled to uncap her EpiPen. Finally, we watched as a father (?) recorded his adult daughter writhe on a couch, whimper, and foam at the mouth as she seized.
…and poof! With that, dear Reader, my fascination with emergency first aid has evaporated.
I’m glad that there are people out there who can handle all the above. I salute you! I feel queasy but also feel like I have accomplished something.
The above is just a portion of what one will learn through a wilderness first aid program. If you often go hiking, want to help people, or, god forbid, find that the above appeals to your grotesque or base interests — consider signing up for a class to learn more! A little knowledge can go a long way, especially in an emergency situation.
Be safe out there!
Love,
Raven
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