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“MILD HYPOTHERMIA
Mild hypothermia has been termed by some experts as “a case of the umbles”: the patient typically first stumbles, then fumbles, grumbles, and later, mumbles. As gross motor skills are affected a stumbling gait begins. Fine motor skills decrease and give rise to fumbling. The patient begins to draw inward, becoming less and less sociable. Designed to function optimally at approximately 98.6 degrees F (37 degrees C), the brain will begin to malfunction when its temperature drops below the ideal. In the case of hypothermia, normal thought processes become impaired. Mild hypothermia could be termed “mild stupidity.” Patients begin to make poor decisions, such as not putting on rain gear when rain begins to fall. Patients typically show increasing confusion and apathy. Fine shivering, relatively controllable by the patient, begins. A healthy sign, shivering is the body’s involuntary form of exercise to increase core heat. But mild hypothermia is insidious, affecting the ability of the patient to think, to be aware of its onset, to take care of self.
When the brain first senses heat loss is gaining on heat production, it stimulates the primary defense mechanism against further heat loss—vasoconstriction of the peripheral circulation (shrinking of the blood vessels in the skin). This vasoconstriction dramatically slows blood flow to the surface of the skin, where it will lose heat into the surrounding environment. The lack of blood causes the skin to become pale and cool. BMR will increase in response to the threat of cold, with an accompanying increase in heart rate and respiratory rate.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
Mild hypothermia has been termed by some experts as “a case of the umbles”: the patient typically first stumbles, then fumbles, grumbles, and later, mumbles. As gross motor skills are affected a stumbling gait begins. Fine motor skills decrease and give rise to fumbling. The patient begins to draw inward, becoming less and less sociable. Designed to function optimally at approximately 98.6 degrees F (37 degrees C), the brain will begin to malfunction when its temperature drops below the ideal. In the case of hypothermia, normal thought processes become impaired. Mild hypothermia could be termed “mild stupidity.” Patients begin to make poor decisions, such as not putting on rain gear when rain begins to fall. Patients typically show increasing confusion and apathy. Fine shivering, relatively controllable by the patient, begins. A healthy sign, shivering is the body’s involuntary form of exercise to increase core heat. But mild hypothermia is insidious, affecting the ability of the patient to think, to be aware of its onset, to take care of self.
When the brain first senses heat loss is gaining on heat production, it stimulates the primary defense mechanism against further heat loss—vasoconstriction of the peripheral circulation (shrinking of the blood vessels in the skin). This vasoconstriction dramatically slows blood flow to the surface of the skin, where it will lose heat into the surrounding environment. The lack of blood causes the skin to become pale and cool. BMR will increase in response to the threat of cold, with an accompanying increase in heart rate and respiratory rate.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“General Wound Cleaning
Note: A rescuer should wash his or her hands and put on protective gloves and protective eyewear before cleaning an open wound.
All wounds acquired in a wilderness environment should be regarded as contaminated and, therefore, require cleansing to prevent infection and promote healing. There are three effective methods of wound cleaning available to the WFR: You can scrub, irrigate, and debride.
Scrubbing: Disinfectants (such as isopropyl alcohol, povidone-iodine, and hydrogen peroxide) and soaps and detergents should not be put directly into wounds because they can damage viable tissue and may actually increase the incidence of wound infection. These substances may be used to scrub around a wound prior to wound cleaning, with soap and water working as well as anything else.
Irrigating: The most effective and practical method of removing bacteria and debris from a wound involves using a high-pressure irrigation syringe. Irrigation syringes that supply adequate pressure are available commercially in quality first-aid kits. Without an irrigation syringe, you can put water in a plastic bag, punch a pinhole in the bag, and squeeze the water out forcefully, or you can melt a pinhole in the center of the lid of a water bottle with a hot needle and squeeze the water out forcefully. These and other improvised methods are not nearly as effective as an irrigation syringe, but they may be the best you can do. Simply rinsing or soaking a wound is inadequate to remove bacteria. The cleanest water available, most preferably water disinfected for drinking, should be used for irrigating. The tip of the irrigating device should be held 1 to 2 inches above the wound surface, and the plunger of the syringe forcefully depressed. Be sure to tilt the wound to irrigate contaminants out and away from the wound. The volume of irrigation fluid required varies with the size of the wound and the degree of contamination, but plan on using at least a half liter of water.
Note: Wound irrigation is the single most important factor in preventing infection.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
Note: A rescuer should wash his or her hands and put on protective gloves and protective eyewear before cleaning an open wound.
All wounds acquired in a wilderness environment should be regarded as contaminated and, therefore, require cleansing to prevent infection and promote healing. There are three effective methods of wound cleaning available to the WFR: You can scrub, irrigate, and debride.
Scrubbing: Disinfectants (such as isopropyl alcohol, povidone-iodine, and hydrogen peroxide) and soaps and detergents should not be put directly into wounds because they can damage viable tissue and may actually increase the incidence of wound infection. These substances may be used to scrub around a wound prior to wound cleaning, with soap and water working as well as anything else.
Irrigating: The most effective and practical method of removing bacteria and debris from a wound involves using a high-pressure irrigation syringe. Irrigation syringes that supply adequate pressure are available commercially in quality first-aid kits. Without an irrigation syringe, you can put water in a plastic bag, punch a pinhole in the bag, and squeeze the water out forcefully, or you can melt a pinhole in the center of the lid of a water bottle with a hot needle and squeeze the water out forcefully. These and other improvised methods are not nearly as effective as an irrigation syringe, but they may be the best you can do. Simply rinsing or soaking a wound is inadequate to remove bacteria. The cleanest water available, most preferably water disinfected for drinking, should be used for irrigating. The tip of the irrigating device should be held 1 to 2 inches above the wound surface, and the plunger of the syringe forcefully depressed. Be sure to tilt the wound to irrigate contaminants out and away from the wound. The volume of irrigation fluid required varies with the size of the wound and the degree of contamination, but plan on using at least a half liter of water.
Note: Wound irrigation is the single most important factor in preventing infection.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“MODERATE HYPOTHERMIA
If the core temperature continues to fall, the brain stimulates an increase in shivering to the point where it is violent and uncontrollable. The patient has now entered the realm of moderate hypothermia. Shivering requires an immense amount of energy. If the moderately hypothermic patient is not properly treated, heat rushes from the patient into the environment. Radiative heat soars into the sky from an uncovered head. Heat conductively floods into the ground from a patient poorly insulated from the ground. A breeze rips heat away via convection. A drop in core temperature is rapid for an unprotected, shivering patient. The “umbles” worsen. A patient may find it impossible to walk, and he or she finds it increasingly difficult to speak and to think. Staring dully with a faraway gaze is not uncommon. Lack of circulation to the surface of the body causes the skin to turn very pale, perhaps a dusky color. Heart and respiratory rate increase further.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
If the core temperature continues to fall, the brain stimulates an increase in shivering to the point where it is violent and uncontrollable. The patient has now entered the realm of moderate hypothermia. Shivering requires an immense amount of energy. If the moderately hypothermic patient is not properly treated, heat rushes from the patient into the environment. Radiative heat soars into the sky from an uncovered head. Heat conductively floods into the ground from a patient poorly insulated from the ground. A breeze rips heat away via convection. A drop in core temperature is rapid for an unprotected, shivering patient. The “umbles” worsen. A patient may find it impossible to walk, and he or she finds it increasingly difficult to speak and to think. Staring dully with a faraway gaze is not uncommon. Lack of circulation to the surface of the body causes the skin to turn very pale, perhaps a dusky color. Heart and respiratory rate increase further.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Debriding: Deeply imbedded, visible debris not removed by irrigation may be removed carefully with forceps (tweezers) sterilized by either boiling or with an open flame, such as a match or lighter. Carbon (the black stuff) left on forceps after holding them in an open flame is sterile. Removal of visible debris from a wound and/or dead skin from around a wound is called debridement.
When the protective layers of the epidermis are opened, the superficial dermal cells dry out and die. These dead cells, together with serum, the watery portion of blood that seeps from the wound, form the familiar eschar (scab). Although wounds heal beneath scabs, the application of occlusive wound dressings, after thorough cleaning, prevents the formation of an eschar by keeping the dermis moist with fluids from the patient’s body, speeding the growth of new skin and wound healing.
After closing and/or dressing a deep wound on an extremity, immobilization by splinting reduces lymphatic flow and the spread of microorganisms. Elevation of the extremity decreases swelling. Both measures reduce the likelihood of wound complications and should be employed whenever possible.
Prophylactic antibiotics are not indicated for most wounds. Many authorities would recommend antibiotics for wounds involving tendons, particularly of the hand, bones, or joint spaces, as well as for wounds heavily contaminated with saliva, feces, or soil containing large amounts of organic material. If antibiotics are used, they should be started as soon as possible after the injury, and a broad-spectrum agent should be chosen. Antibiotics require a prescription, and a physician should be consulted well before you start a wilderness trip. Follow the physician’s instructions precisely when using antibiotics.
Note: Antibiotics should never be considered a substitute for a vigorous wound cleaning.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
When the protective layers of the epidermis are opened, the superficial dermal cells dry out and die. These dead cells, together with serum, the watery portion of blood that seeps from the wound, form the familiar eschar (scab). Although wounds heal beneath scabs, the application of occlusive wound dressings, after thorough cleaning, prevents the formation of an eschar by keeping the dermis moist with fluids from the patient’s body, speeding the growth of new skin and wound healing.
After closing and/or dressing a deep wound on an extremity, immobilization by splinting reduces lymphatic flow and the spread of microorganisms. Elevation of the extremity decreases swelling. Both measures reduce the likelihood of wound complications and should be employed whenever possible.
Prophylactic antibiotics are not indicated for most wounds. Many authorities would recommend antibiotics for wounds involving tendons, particularly of the hand, bones, or joint spaces, as well as for wounds heavily contaminated with saliva, feces, or soil containing large amounts of organic material. If antibiotics are used, they should be started as soon as possible after the injury, and a broad-spectrum agent should be chosen. Antibiotics require a prescription, and a physician should be consulted well before you start a wilderness trip. Follow the physician’s instructions precisely when using antibiotics.
Note: Antibiotics should never be considered a substitute for a vigorous wound cleaning.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“General Guidelines for Wilderness Medical Kits
1. Accept the fact that there is no such thing as the perfect wilderness medical kit. Many factors should determine your choices of specific contents. No matter how much you plan and prepare, someday you will want something that is not there and/or discover you’ve carried an item for years and never used it. When considering the contents of a kit, take into account (1) the environmental extremes you will face (altitude, cold, heat, endemic diseases), (2) the number of people that may require care; (3) the number of days the kit will be in use; (4) the distance from definitive medical care; (5) the availability of rescue services; (6) your medical expertise and/or the expertise of other group members; and (7) preexisting problems of group members, such as individuals with diabetes.
2. Evaluate and repack your wilderness medical kit before every trip. Renew medications that have reached expiration dates. Replace items that have been damaged by heat, cold, or moisture. Remove items that are unnecessary for the proposed trip, such as insect repellent on winter trips, and add items that may be useful on the upcoming adventure.
3. Do not fill your kit with items you do not know how to use. Maintain a high level of familiarity with the proper uses of all the items in your wilderness medical kit.
4. Choose specific items for the wilderness medical kit, whenever possible, that are versatile rather than particular. For example, a wide variety of sizes and shapes of Band-Aids is nice, but wound coverings can be created from pads of gauze and strips of tape. Triangular bandages are useful, but safety pins and T-shirts can be used to make slings. Medical adhesive tape has limited usefulness compared with duct tape.
5. Encourage each group member to pack and carry a personal first-aid kit to reduce the size and weight of the general wilderness medical kit.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
1. Accept the fact that there is no such thing as the perfect wilderness medical kit. Many factors should determine your choices of specific contents. No matter how much you plan and prepare, someday you will want something that is not there and/or discover you’ve carried an item for years and never used it. When considering the contents of a kit, take into account (1) the environmental extremes you will face (altitude, cold, heat, endemic diseases), (2) the number of people that may require care; (3) the number of days the kit will be in use; (4) the distance from definitive medical care; (5) the availability of rescue services; (6) your medical expertise and/or the expertise of other group members; and (7) preexisting problems of group members, such as individuals with diabetes.
2. Evaluate and repack your wilderness medical kit before every trip. Renew medications that have reached expiration dates. Replace items that have been damaged by heat, cold, or moisture. Remove items that are unnecessary for the proposed trip, such as insect repellent on winter trips, and add items that may be useful on the upcoming adventure.
3. Do not fill your kit with items you do not know how to use. Maintain a high level of familiarity with the proper uses of all the items in your wilderness medical kit.
4. Choose specific items for the wilderness medical kit, whenever possible, that are versatile rather than particular. For example, a wide variety of sizes and shapes of Band-Aids is nice, but wound coverings can be created from pads of gauze and strips of tape. Triangular bandages are useful, but safety pins and T-shirts can be used to make slings. Medical adhesive tape has limited usefulness compared with duct tape.
5. Encourage each group member to pack and carry a personal first-aid kit to reduce the size and weight of the general wilderness medical kit.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Was the attack provoked? Rabid animals tend to attack without provocation. Trying to pick up or feed a wild animal and having it take a nip out of your finger is a very natural and unsuspect action. Having it leap from the shadows at your throat is an unprovoked and suspect attack.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“In addition to internal heat production, the human body can absorb a small amount of heat from external sources, such as the sun, a fire, another warm body, the ingestion of hot drinks, and the inhalation of warm air.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Human biochemistry works at its best at around 98 degrees F, and while adaptation to living in and visiting different environments is possible, from the Mojave to the moon, adaptation to altered body core temperatures is not possible.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“All tanning should be considered visible evidence of toxic injury.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Trip plans should include the following:
1.Guidelines for how to respond to emergency and nonemergency situations.
2. Lost person and technical rescue protocols.
3. Special instructions for serious injury, illness, or a fatality.
4. Resource lists—such as rescue services—with names, addresses, and telephone numbers.
5. Maps with roadheads and locations of nearest phones marked.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
1.Guidelines for how to respond to emergency and nonemergency situations.
2. Lost person and technical rescue protocols.
3. Special instructions for serious injury, illness, or a fatality.
4. Resource lists—such as rescue services—with names, addresses, and telephone numbers.
5. Maps with roadheads and locations of nearest phones marked.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“The sooner the event is defused or debriefed, the faster the reactions will ease or disappear. Denial prolongs the pain and can keep the event freshly in mind far longer than necessary. Once a situation has been identified as a critical incident, there are several options for managing the group’s response. During a critical incident, watch for acute stress symptoms. Someone allowed to continue functioning when suffering acute stress can cause additional, if inadvertent, rescue burdens to arise.
Soon after the event, within a few hours, a defusing is likely to help the group. Everyone is brought together and the event is discussed informally. This is not a critique of how the event was handled. A defusing is a time for examining how people are responding to the situation emotionally, physically, and cognitively. It is an acknowledgment that something unusual happened and that unusual responses may be occurring because of it. Defusing these intense reactions allows healing to begin.
As a WFR, you may be called upon to manage a defusing. It is generally best to form the group into a circle with no one hanging back “in the shadows.” Establish guidelines for the defusing. Encourage everyone to speak, but do not allow anyone to cast blame or dwell on things he or she thinks were done wrong. Let no one interrupt while another is speaking. Ask each person to relate (1) his or her role during the incident, (2) how he or she felt and now feels, and (3) what he or she thought and now thinks.
A formal critical-incident stress debriefing requires the assistance of a trained group. Many critical incident stress management (CISM) or critical incident stress debriefing (CISD) teams exist. You may wish to check for local availability even before leaving the trailhead.
A formal debriefing is conducted by a group composed of both peer counselors (in this case, the ideal would be wilderness oriented peers) and mental health workers who have been specially trained in CISM. Only those who were involved are invited. The process usually takes 2 to 4 hours.
The relief of a properly debriefed group is palpable. The ability for an untrained, or well intentioned but naïve, group to cause permanent damage to participants is also very real. Call in only an established, trained CISD group.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
Soon after the event, within a few hours, a defusing is likely to help the group. Everyone is brought together and the event is discussed informally. This is not a critique of how the event was handled. A defusing is a time for examining how people are responding to the situation emotionally, physically, and cognitively. It is an acknowledgment that something unusual happened and that unusual responses may be occurring because of it. Defusing these intense reactions allows healing to begin.
As a WFR, you may be called upon to manage a defusing. It is generally best to form the group into a circle with no one hanging back “in the shadows.” Establish guidelines for the defusing. Encourage everyone to speak, but do not allow anyone to cast blame or dwell on things he or she thinks were done wrong. Let no one interrupt while another is speaking. Ask each person to relate (1) his or her role during the incident, (2) how he or she felt and now feels, and (3) what he or she thought and now thinks.
A formal critical-incident stress debriefing requires the assistance of a trained group. Many critical incident stress management (CISM) or critical incident stress debriefing (CISD) teams exist. You may wish to check for local availability even before leaving the trailhead.
A formal debriefing is conducted by a group composed of both peer counselors (in this case, the ideal would be wilderness oriented peers) and mental health workers who have been specially trained in CISM. Only those who were involved are invited. The process usually takes 2 to 4 hours.
The relief of a properly debriefed group is palpable. The ability for an untrained, or well intentioned but naïve, group to cause permanent damage to participants is also very real. Call in only an established, trained CISD group.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Of the two environmental temperature extremes, heat and cold, the human body is better adapted to deal with heat. With virtually hairless skin filled with abundant sweat glands, powered by a cardiovascular system of marvelous endurance, humans function well when the mercury rises. You are not, however, a foolproof design. Overheating can ruin your day—and your life.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“When an experience is an unusually powerful emotional event, there may be a series of reactions. These are both common and normal. Signs and symptoms of critical-incident stress include the following:
1. Physical—enduring fatigue, sleep dysfunction (either needing too much or insomnia), change of appetite (eating too much or too little), gastrointestinal upset, headache, backache, chills, nausea, muscular twitches or tremors, shock-like symptoms (especially in acute stress), hyperactivity, or its opposite, underactivity.
2. Emotional—anger, irritability, fear, grief, anxiety, guilt, depression, feeling overwhelmed, identification with the patient(s) in a rescue, emotional numbness, feelings of helplessness or hopelessness.
3. Cognitive—memory loss, especially anomia (the inability to remember names); inability to attach importance to things other than the incident; concentration problems; loss of attention span; difficulties with calculations, decision-making, and problem-solving; flashbacks; nightmares (especially recurrent ones), amnesia for the event; violent fantasies; confusing the importance of trivial and major tasks.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
1. Physical—enduring fatigue, sleep dysfunction (either needing too much or insomnia), change of appetite (eating too much or too little), gastrointestinal upset, headache, backache, chills, nausea, muscular twitches or tremors, shock-like symptoms (especially in acute stress), hyperactivity, or its opposite, underactivity.
2. Emotional—anger, irritability, fear, grief, anxiety, guilt, depression, feeling overwhelmed, identification with the patient(s) in a rescue, emotional numbness, feelings of helplessness or hopelessness.
3. Cognitive—memory loss, especially anomia (the inability to remember names); inability to attach importance to things other than the incident; concentration problems; loss of attention span; difficulties with calculations, decision-making, and problem-solving; flashbacks; nightmares (especially recurrent ones), amnesia for the event; violent fantasies; confusing the importance of trivial and major tasks.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Bacteria begins to form in wounds, even relatively clean ones, after 6 hours. All wounds should be treated as contaminated and require cleansing to prevent infection and promote healing. "Disinfectants (such as isopropyl alcohol, povidone-iodine, and hydrogen peroxide) and soaps and detergents should not be put directly into wounds because they can damage viable tissue and may actually increase the incidence of wound infection. These substances may be used to scrub around a wound prior to wound cleaning, with soap and water working as well as anything else.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Helicopters
Nothing has done more to change the face of wilderness rescue than helicopters. They land in remote areas that were inaccessible to aircraft only a few years ago. If the spot isn’t flat enough, helicopters have been known to land on one skid while a patient is quickly loaded. When there is no spot to land, they have hovered with a rescuer hanging from a rope or cable, a rescuer equipped to attach the patient to the hauling system for evacuation.
Helicopters go where the pilot wants because of the rapid spinning of two sets of blades. The large overhead blades create air by forcing air down. The pilot can vary the angle at which the blades attack the air and the speed at which they rotate to vary the amount of lift. The entire rotor can be tilted forward, backward, or sideways to determine the direction of travel. Without a second set of blades spinning in an opposite direction, the helicopter would turn circles helplessly in the air. Some large helicopters have two large sets of blades spinning in opposite directions, one fore and one aft, but most helicopters used in the wilderness maintain stability with one small tail rotor.
When they are close to the ground, the spinning blades build a cushion of air that helps support the helicopter. This cushion of air varies in its ability to work, depending on its density. Rising air temperatures and increasing altitude reduce air density. So trying to land a helicopter on a mountaintop on a hot day is dangerous, and the weight of one person may prevent liftoff.
Air density also is altered by the nearness of a mountainside. The downward shove of air by the blades can recirculate off the mountainside and reduce lift.
One of the greatest fears of mountain flying is a sudden downdraft of air that can slam a helicopter toward the ground. Downdrafts are not only dangerous but also unpredictable.
Add to air density and downdrafts the possibility of darkness and fog and wind, and you can understand that even if a helicopter is available it may not be able to come to your rescue.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
Nothing has done more to change the face of wilderness rescue than helicopters. They land in remote areas that were inaccessible to aircraft only a few years ago. If the spot isn’t flat enough, helicopters have been known to land on one skid while a patient is quickly loaded. When there is no spot to land, they have hovered with a rescuer hanging from a rope or cable, a rescuer equipped to attach the patient to the hauling system for evacuation.
Helicopters go where the pilot wants because of the rapid spinning of two sets of blades. The large overhead blades create air by forcing air down. The pilot can vary the angle at which the blades attack the air and the speed at which they rotate to vary the amount of lift. The entire rotor can be tilted forward, backward, or sideways to determine the direction of travel. Without a second set of blades spinning in an opposite direction, the helicopter would turn circles helplessly in the air. Some large helicopters have two large sets of blades spinning in opposite directions, one fore and one aft, but most helicopters used in the wilderness maintain stability with one small tail rotor.
When they are close to the ground, the spinning blades build a cushion of air that helps support the helicopter. This cushion of air varies in its ability to work, depending on its density. Rising air temperatures and increasing altitude reduce air density. So trying to land a helicopter on a mountaintop on a hot day is dangerous, and the weight of one person may prevent liftoff.
Air density also is altered by the nearness of a mountainside. The downward shove of air by the blades can recirculate off the mountainside and reduce lift.
One of the greatest fears of mountain flying is a sudden downdraft of air that can slam a helicopter toward the ground. Downdrafts are not only dangerous but also unpredictable.
Add to air density and downdrafts the possibility of darkness and fog and wind, and you can understand that even if a helicopter is available it may not be able to come to your rescue.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Wilderness leaders need to understand that there are varying normal responses to a crisis. Until there is time to regroup, behaviors may seem unusual when, in truth, they should be expected. Some behaviors that may emerge in the face of a crisis include:
1. Regression. Many grown people revert to an earlier stage of development. The theory is that, since their parents used to care for them as children, someone else may care for them now if they behave in a childlike manner. In particular, tantrums used to be very effective. Tantrum-like or very dependent behavior is not unusual.
2. Depression. Closing into one’s inner world is another common response to crisis. This is where some people find the sources of strength to cope with an emergency. This is characterized as a shutdown effect: fetal positioning, slumped shoulders, downcast eyes, arms crossed over the chest, and unwillingness or difficulty in communicating.
3. Aggression. Some people lash out, physically or emotionally, at threats, including the vague threat of an emergency. High adrenaline levels may intensify the response, and so may the feelings of frustration, anger, and fear that commonly surround unexpected circumstances. This response is characterized by explosive body language, including swinging fists and jumping up and down.
What one should do about the various behaviors that surface during a crisis depends somewhat on the individual circumstances. As a general rule, open communication, acknowledgement of the emotional impact of the event, and a healthy dose of patience and tolerance can go far during resolution of the situation. Some basic procedures to consider in crisis management might include the following:
1. Engage the patient in a calm, rational discussion. You can start the patient down the trail that leads through the crisis.
2. Identify the specific concerns about which the patient is stressed. You both need to be talking about the same problems.
3. Provide realistic and optimistic feedback. You can help the patient return to objective thinking.
4. Involve the patient in solving the problem. You can help the patient and/or the patient can help you choose and implement a plan of action.
Someone who completely loses control needs time to settle down to become an asset to the situation. Breaking through to someone who has lost control can be a challenge. Try repetitive persistence, a technique developed for telephone interrogation by emergency services dispatchers. Remain calm, but firm. Choose a positive statement that includes the person’s name, such as, “Todd, we can help once you calm down.” (An example of a negative statement would be, “Todd, we can’t help unless you settle down.”) Persistently repeat the statement with the same words in the same tone of voice. The irresistible force (you) will eventually overwhelm the immovable object (the out-of-control person). Surprisingly few repetitions are usually needed to get through to the patient, as long as the tone of voice remains calm. Letting frustration or other emotions creep into the tone of voice, or changing the message, can ruin the entire effort. Over time, the overwhelming responses that generated the reaction may occasionally resurface. This is normal. Without being judgmental or impatient, regain control through repetitive persistence.
A crisis may bring out a humorous side (sometimes appropriately, sometimes not) among the group. When you wish to release the intensity surrounding a situation or crisis, appropriate laughter is one of the best methods. It should also be noted that many people cope just fine with emergency situations and unexpected circumstances. They are a source of strength and an example of model behavior for the others.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
1. Regression. Many grown people revert to an earlier stage of development. The theory is that, since their parents used to care for them as children, someone else may care for them now if they behave in a childlike manner. In particular, tantrums used to be very effective. Tantrum-like or very dependent behavior is not unusual.
2. Depression. Closing into one’s inner world is another common response to crisis. This is where some people find the sources of strength to cope with an emergency. This is characterized as a shutdown effect: fetal positioning, slumped shoulders, downcast eyes, arms crossed over the chest, and unwillingness or difficulty in communicating.
3. Aggression. Some people lash out, physically or emotionally, at threats, including the vague threat of an emergency. High adrenaline levels may intensify the response, and so may the feelings of frustration, anger, and fear that commonly surround unexpected circumstances. This response is characterized by explosive body language, including swinging fists and jumping up and down.
What one should do about the various behaviors that surface during a crisis depends somewhat on the individual circumstances. As a general rule, open communication, acknowledgement of the emotional impact of the event, and a healthy dose of patience and tolerance can go far during resolution of the situation. Some basic procedures to consider in crisis management might include the following:
1. Engage the patient in a calm, rational discussion. You can start the patient down the trail that leads through the crisis.
2. Identify the specific concerns about which the patient is stressed. You both need to be talking about the same problems.
3. Provide realistic and optimistic feedback. You can help the patient return to objective thinking.
4. Involve the patient in solving the problem. You can help the patient and/or the patient can help you choose and implement a plan of action.
Someone who completely loses control needs time to settle down to become an asset to the situation. Breaking through to someone who has lost control can be a challenge. Try repetitive persistence, a technique developed for telephone interrogation by emergency services dispatchers. Remain calm, but firm. Choose a positive statement that includes the person’s name, such as, “Todd, we can help once you calm down.” (An example of a negative statement would be, “Todd, we can’t help unless you settle down.”) Persistently repeat the statement with the same words in the same tone of voice. The irresistible force (you) will eventually overwhelm the immovable object (the out-of-control person). Surprisingly few repetitions are usually needed to get through to the patient, as long as the tone of voice remains calm. Letting frustration or other emotions creep into the tone of voice, or changing the message, can ruin the entire effort. Over time, the overwhelming responses that generated the reaction may occasionally resurface. This is normal. Without being judgmental or impatient, regain control through repetitive persistence.
A crisis may bring out a humorous side (sometimes appropriately, sometimes not) among the group. When you wish to release the intensity surrounding a situation or crisis, appropriate laughter is one of the best methods. It should also be noted that many people cope just fine with emergency situations and unexpected circumstances. They are a source of strength and an example of model behavior for the others.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“General Wound Management
General wound care needs to reach three goals: (1) control of significant blood loss, (2) prevention of infection, and (3) promotion of healing.
Minor wounds may be allowed, even encouraged, to bleed to a stop, an act that may result in a cleaner wound. Significant wounds require hemostasis (control of bleeding). Attaining adequate hemostasis not only facilitates wound assessment and management but also may be necessary in severe wounds to prevent significant blood volume depletion. Hemostasis can almost always be accomplished by applying direct pressure and elevating the site of bleeding”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
General wound care needs to reach three goals: (1) control of significant blood loss, (2) prevention of infection, and (3) promotion of healing.
Minor wounds may be allowed, even encouraged, to bleed to a stop, an act that may result in a cleaner wound. Significant wounds require hemostasis (control of bleeding). Attaining adequate hemostasis not only facilitates wound assessment and management but also may be necessary in severe wounds to prevent significant blood volume depletion. Hemostasis can almost always be accomplished by applying direct pressure and elevating the site of bleeding”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Long a medical mystery (and still to some degree today), headaches have been blamed on such factors as wimpishness, psychological disorders, repressed emotions, demons, mothers-in-law, red wine, old cheese, and bad karma.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Once irrigation has been accomplished, eyewear is typically not necessary, but the rescuer should still be wearing protective gloves. Remember to wash your hands before and after donning the gloves. Soap, water, and gloves are a tough trio on germs. In the absence of protective gloves, the rescuer may improvise with clean plastic bags over her or his hands. With relatively minor wounds, to prevent sharing germs, the patient may be directed in the management of his or her own wound (including control of blood loss).
Contusion
Bruises seldom require emergency care, but large bruises benefit from cold, compression, and/or elevation. Substantial bruises should cause you to assess the patient for damage to underlying structures, such as bones and organs. Large bruises should be protected from freezing in extremes of cold because a bruised area will freeze sooner than normal skin.
Abrasions
Abrasions are the exception to the rule of wound cleaning: You need to scrub within the wound to achieve adequate cleaning. A sterile gauze pad is adequate for scrubbing. Scrubbing may be enhanced by using any soap, but all soap should be carefully rinsed and then irrigated from the wound after scrubbing. Green Soap Sponges are packaged with soap and water already in the sponge, making them useful additions to first-aid kits. It is important to remove all embedded debris not only to reduce the risk of infection but also to prevent subsequent “tattooing” (scarring) of the skin. With a deep abrasion, self-scrubbing is seldom successful due to the high level of pain associated with the exposed nerves.
After cleansing, abrasions can be kept moist to avoid desiccation and speed healing with microthin film dressings that can be left in place until healing occurs. Without microthin film dressings, a topical agent, such as an antibiotic ointment, can be applied, followed by a dressing of a sterile gauze pad or a roll of sterile gauze to keep the ointment in place. Tape, an elastic wrap, or some other holder may be used to hold a sterile gauze pad in place. Ideally, gauze dressings should be changed twice a day, or at least once a day, as well as any time the gauze gets wet.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
Contusion
Bruises seldom require emergency care, but large bruises benefit from cold, compression, and/or elevation. Substantial bruises should cause you to assess the patient for damage to underlying structures, such as bones and organs. Large bruises should be protected from freezing in extremes of cold because a bruised area will freeze sooner than normal skin.
Abrasions
Abrasions are the exception to the rule of wound cleaning: You need to scrub within the wound to achieve adequate cleaning. A sterile gauze pad is adequate for scrubbing. Scrubbing may be enhanced by using any soap, but all soap should be carefully rinsed and then irrigated from the wound after scrubbing. Green Soap Sponges are packaged with soap and water already in the sponge, making them useful additions to first-aid kits. It is important to remove all embedded debris not only to reduce the risk of infection but also to prevent subsequent “tattooing” (scarring) of the skin. With a deep abrasion, self-scrubbing is seldom successful due to the high level of pain associated with the exposed nerves.
After cleansing, abrasions can be kept moist to avoid desiccation and speed healing with microthin film dressings that can be left in place until healing occurs. Without microthin film dressings, a topical agent, such as an antibiotic ointment, can be applied, followed by a dressing of a sterile gauze pad or a roll of sterile gauze to keep the ointment in place. Tape, an elastic wrap, or some other holder may be used to hold a sterile gauze pad in place. Ideally, gauze dressings should be changed twice a day, or at least once a day, as well as any time the gauze gets wet.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“Types of Wounds
1. Contusion: A bruise.
2. Abrasion: A wound in which one or more layers of skin are partially or completely scraped away.
3. Laceration: A cut through the skin. A laceration produced by a sharp object, such as a knife, generally produces little damage to the surrounding skin. Lacerations from a blunt injury, however, typically result in a tearing or bursting of the skin, causing ragged wound edges or star-shaped patterns. Because damage to adjacent skin occurs, these wounds heal more slowly, result in larger scars, and are more prone to infection.
4. Avulsion: A partial amputation that leaves a “flap” of body tissue attached by skin, muscle, or tendon.
5. Amputation: A complete separation of a body part, such as an ear, finger, or foot, from the rest of the body.
6. Puncture: A wound that occurs when an object, such as a thorn, fang, or knife, penetrates the body. These wounds may introduce bacteria into deep tissues and are very difficult to clean adequately. As a result, they are particularly prone to infection.
7. Impaled object: A puncture wound with the puncturing object still stuck in.
8. Bite wound: A puncture wound caused by a bite from an animal or another human.
9. Burn: Tissue injury resulting from heat, electricity (lightning), radiation (sunburn), or chemicals.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
1. Contusion: A bruise.
2. Abrasion: A wound in which one or more layers of skin are partially or completely scraped away.
3. Laceration: A cut through the skin. A laceration produced by a sharp object, such as a knife, generally produces little damage to the surrounding skin. Lacerations from a blunt injury, however, typically result in a tearing or bursting of the skin, causing ragged wound edges or star-shaped patterns. Because damage to adjacent skin occurs, these wounds heal more slowly, result in larger scars, and are more prone to infection.
4. Avulsion: A partial amputation that leaves a “flap” of body tissue attached by skin, muscle, or tendon.
5. Amputation: A complete separation of a body part, such as an ear, finger, or foot, from the rest of the body.
6. Puncture: A wound that occurs when an object, such as a thorn, fang, or knife, penetrates the body. These wounds may introduce bacteria into deep tissues and are very difficult to clean adequately. As a result, they are particularly prone to infection.
7. Impaled object: A puncture wound with the puncturing object still stuck in.
8. Bite wound: A puncture wound caused by a bite from an animal or another human.
9. Burn: Tissue injury resulting from heat, electricity (lightning), radiation (sunburn), or chemicals.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“When you’re in need of a rescue the approaching thump-thump-thump of rapidly rotating blades is a joyous sound. To give the helicopter rescue the greatest chance of success, a suitable landing zone will have to be found. The ideal landing zone should not require a completely vertical landing or takeoff, both of which reduce the pilot’s control. The ground should slope away on all sides, allowing the helicopter to immediately drop into forward flight when it’s time to take off. Landings and liftoffs work best when the aircraft is pointed into the wind because that gives the machine the greatest lift. The area should be as large as possible, at least 60 feet across for most small rescue helicopters, and as clear as possible for obstructions such as trees and boulders. Clear away debris (pine needles, dust, leaves) that can be blown up by the wash of air, with the possibility of producing mechanical failure. Light snow can be especially dangerous if it fluffs up dramatically to blind the pilot. Wet snow sticks to the ground and adds dangerous weight. If you have the opportunity, pack snow flat well before the helicopter arrives—the night before would be ideal—to harden the surface of the landing zone. Tall grass can be a hazard because it disturbs the helicopter’s cushion of supporting air and hides obstacles such as rocks and tree stumps.
To prepare a landing zone, clear out the area as much as possible, including removing your equipment and all the people except the one who is going to be signaling the pilot. Mark the landing zone with weighted bright clothing or gear during the day or with bright lights at night. In case of a night rescue, turn off the bright lights before the helicopter starts to land—they can blind the pilot. Use instead a low-intensity light to mark the perimeter of the landing area, such as chemical light sticks, or at least turn the light away from the helicopter’s direction. Indicate the wind’s direction by building a very small smoky fire, hanging brightly colored streamers, throwing up handfuls of light debris, or signaling with your arms pointed in the direction of the wind.
The greatest danger to you occurs while you’re moving toward or away from the helicopter on the ground. Never approach the rear and never walk around the rear of a helicopter. The pilot can’t see you, and the rapidly spinning tail rotor is virtually invisible and soundless. In a sudden shift of the aircraft, you can be sliced to death. Don’t approach by walking downhill toward the helicopter, where the large overhead blade is closest to the ground.
It is safest to come toward the helicopter from directly in front, where the pilot has a clear field of view, and only after the pilot or another of the aircraft’s personnel has signaled you to approach. Remove your hat or anything that can be sucked up into the rotors. Stay low because blades can sink closer to the ground as their speed diminishes. Make sure nothing is sticking up above your pack, such as an ice ax or ski pole. In most cases someone from the helicopter will come out to remind you of the important safety measures.
One-skid landings or hovering while a rescue is attempted are solely at the discretion of the pilot. They are a high risk at best, and finding a landing zone and preparing it should always be given priority.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
To prepare a landing zone, clear out the area as much as possible, including removing your equipment and all the people except the one who is going to be signaling the pilot. Mark the landing zone with weighted bright clothing or gear during the day or with bright lights at night. In case of a night rescue, turn off the bright lights before the helicopter starts to land—they can blind the pilot. Use instead a low-intensity light to mark the perimeter of the landing area, such as chemical light sticks, or at least turn the light away from the helicopter’s direction. Indicate the wind’s direction by building a very small smoky fire, hanging brightly colored streamers, throwing up handfuls of light debris, or signaling with your arms pointed in the direction of the wind.
The greatest danger to you occurs while you’re moving toward or away from the helicopter on the ground. Never approach the rear and never walk around the rear of a helicopter. The pilot can’t see you, and the rapidly spinning tail rotor is virtually invisible and soundless. In a sudden shift of the aircraft, you can be sliced to death. Don’t approach by walking downhill toward the helicopter, where the large overhead blade is closest to the ground.
It is safest to come toward the helicopter from directly in front, where the pilot has a clear field of view, and only after the pilot or another of the aircraft’s personnel has signaled you to approach. Remove your hat or anything that can be sucked up into the rotors. Stay low because blades can sink closer to the ground as their speed diminishes. Make sure nothing is sticking up above your pack, such as an ice ax or ski pole. In most cases someone from the helicopter will come out to remind you of the important safety measures.
One-skid landings or hovering while a rescue is attempted are solely at the discretion of the pilot. They are a high risk at best, and finding a landing zone and preparing it should always be given priority.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
“There is an expectation that a trip into the wilderness—even just for the weekend—entails certain risk not found in daily life. A good trip entails a lot of physical effort and teamwork. People expect to be able to cope with the usual demands of the wilderness, and, thus, they develop unusual coping mechanisms. Sometimes, however, for some or all of the people on the trip, events surpass standard coping mechanisms. Then a wilderness-style critical incident has occurred.
A critical incident is almost any incident in which the circumstances are so unusual or the sights and sounds so distressing as to produce a high level of immediate or delayed emotional reaction that surpasses an individual’s normal coping mechanisms. Critical incidents are events that cause predictable signs and symptoms of exceptional stress in normal people who are having normal reactions to something abnormal that has happened to them. A critical incident from a wilderness perspective may be caused by such events as the sudden death or serious injury of a member of the group, a multiple-death accident, or any event involving a prolonged expenditure of physical and emotional energy.
People respond to critical incidents differently. Sometimes the stress is too much right away, and signs and symptoms appear while the event is still happening. This is acute stress; this member of the group is rendered nonfunctional by the situation and needs care. More often the signs and symptoms of stress come later, once the pressing needs of the situation have been addressed. This is delayed stress. A third sort of stress, common to us all, is cumulative stress. In the context of the wilderness, cumulative stress might arise if multiple, serial disasters strike the same wilderness party.
The course of symptom development when a person is going from the normal stresses of day-to-day living into distress (where life becomes uncomfortable) is like a downward spiral. People are not hit with the entire continuum of signs and symptoms at once. However, after a critical incident, a person may be affected by a large number of signs and symptoms within a short time frame, usually 24 to 48 hours.
The degree or impairment an event causes an individual depends on several factors. Each person has life lessons that can help, or sometimes hinder, the ability to cope. Factors affecting the degree of impact an event has on the individual include the following:
1. Age. People who are older tend to have had more life lessons to develop good coping mechanisms.
2. Degree of education.
3. Duration of the event, as well as its suddenness and degree of intensity.
4. Resources available for help. These may be internal (a personal belief system) or external (a trained, local critical-incident stress debriefing team).
5. Level of loss. One death may be easier than several, although the nature of a relationship (marriage partners or siblings, for example) would affect this factor.
Signs and symptoms of stress manifest in three ways: physical, emotional, and cognitive. Stress manifests differently from one person to the next. Signs and symptoms that occur in one person may not occur in another, who has responses of his or her own.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
A critical incident is almost any incident in which the circumstances are so unusual or the sights and sounds so distressing as to produce a high level of immediate or delayed emotional reaction that surpasses an individual’s normal coping mechanisms. Critical incidents are events that cause predictable signs and symptoms of exceptional stress in normal people who are having normal reactions to something abnormal that has happened to them. A critical incident from a wilderness perspective may be caused by such events as the sudden death or serious injury of a member of the group, a multiple-death accident, or any event involving a prolonged expenditure of physical and emotional energy.
People respond to critical incidents differently. Sometimes the stress is too much right away, and signs and symptoms appear while the event is still happening. This is acute stress; this member of the group is rendered nonfunctional by the situation and needs care. More often the signs and symptoms of stress come later, once the pressing needs of the situation have been addressed. This is delayed stress. A third sort of stress, common to us all, is cumulative stress. In the context of the wilderness, cumulative stress might arise if multiple, serial disasters strike the same wilderness party.
The course of symptom development when a person is going from the normal stresses of day-to-day living into distress (where life becomes uncomfortable) is like a downward spiral. People are not hit with the entire continuum of signs and symptoms at once. However, after a critical incident, a person may be affected by a large number of signs and symptoms within a short time frame, usually 24 to 48 hours.
The degree or impairment an event causes an individual depends on several factors. Each person has life lessons that can help, or sometimes hinder, the ability to cope. Factors affecting the degree of impact an event has on the individual include the following:
1. Age. People who are older tend to have had more life lessons to develop good coping mechanisms.
2. Degree of education.
3. Duration of the event, as well as its suddenness and degree of intensity.
4. Resources available for help. These may be internal (a personal belief system) or external (a trained, local critical-incident stress debriefing team).
5. Level of loss. One death may be easier than several, although the nature of a relationship (marriage partners or siblings, for example) would affect this factor.
Signs and symptoms of stress manifest in three ways: physical, emotional, and cognitive. Stress manifests differently from one person to the next. Signs and symptoms that occur in one person may not occur in another, who has responses of his or her own.”
― Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry
