First Aid staying safe in the wilderness and at sea
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Transcript First Aid staying safe in the wilderness and at sea
First Aid
staying safe in the wilderness and at sea
Ann Marie McCartney, MD
Goals of First Aid
- Preserve life
- Prevent further harm
- Promote recovery
Goals of First Aid
Assess your patient’s condition
Give appropriate urgent treatment
Make decisions regarding medical
evacuation
Provide on-going patient management
Wilderness vs Urban First Aid
PITFALLS
You can’t count on help arriving soon.
Medical care is more than one hour away.
May have to care for your patient for hours or
even days.
Materials & equipment may be unavailable; you
may need to improvise.
In the wilderness, we may need to give care that
would be inappropriate in the urban setting.
First Aid Concepts
CONSENT
You must get patient’s consent to be able to
help them.
Remember to approach from the front of
the patient.
“I am trained in first aid, may I help you?”
If they say “no”, you can not help them!
If unconscious, assume consent.
Try verbal and then pain stimuli if patient
not alert.
First Aid Concepts
PATIENT
Never use the term “victim”.
Use the patient's name – don't speak of
the patient in the 3rd person.
As much as possible, include the
patient in all decisions and discussions.
Don't step over your patient!
(walk around)
PREVENTION
Take necessary precautions to prevent the need for
First Aid
Have a First Aid kit and know its contents and how to
use it
Know your partner’s medical history and what
medications they may need in the event of an injury
or illness
Patient Assessment System
*
Scene
Size-up
Initial Assessment
Stop and Fix
ABCDE
SAMPLE
Head-toVital Signs
OPQRST
toe Exam
Document and Monitor
Scene Size Up
• Scene Safety
– Is the scene safe to enter?
– For you, your partners, and the patient?
• If not, how can you get the patient to a safe
location without causing further injury?
BE CALM AND METHODICAL
Spread calm. Be a good role-model.
PANIC is contagious!!!!!!!
Walk, don't run
Don't make more patients!
Act with purpose and forethought.
Take an active roll and look for ways to help.
Why is it important to know First Aid?
Accidents can be beyond
our control.
Our response to them is
always in our control.
Accident Assessment
Treat life-threatening conditions immediately
Non-life-threats can be treated after the
full assessment is complete.
Steps: A B C D E2
Obtain consent / establish responsiveness
Airway
Breathing
Circulation and Deadly Bleeding
Decision about spinal injury
Environment / Expose injury
INJURIES
Burns
Trauma
Wounds
Burns
Thermal, chemical, radiation, electrical
Tissue injury depends on intensity of
heat and length of exposure
Assess depth and extent of the burn
Burns
Superficial – confined to the epidermis
Skin is red, painful and without blisters
Blanches white with pressure
Heal in 4-5 days with peeling of the epidermis
Burns
Partial thickness – involves epidermis and dermis
Skin is red, mottled, wet, blistered, blanches white
Blisters can develop immediately up to 24+ hours later
Can take 5-25 days to heal or longer if becomes
infected
Evacuate if burns are on the hands, feet, face, armpits
or groin or if greater than 10% of the body
Burns
Full-thickness – penetrate to the subcutaneous tissues
Skin is leathery, charred, pearl gray and dry
Area is sunken with a burned odor
Not painful as the nerve endings are destroyed
Can have painful surrounding superficial burns
Evacuate for these burns
Burns
Location
Head and neck burns are dangerous and can
lead to airway problems
Burns to the hands and feet can lead to loss
of function
Circumferential burns of the extremities can
impair circulation
Treatment of Burns
All types generally treated the same
PUT OUT THE FIRE: stop, drop, and roll
Remove clothing and jewelry which can retain heat
Check the airway – think about inhalation injury
Cool the burn: cool water or wet clothes
Avoid hypothermia. Don’t put ice on skin.
Clean and dress the wound; change daily
Watch for signs of infection
Inhalation injury
Occurs with breathing in hot air, gases or particles
Look for soot, airway redness and swelling
Listen for cough and noisy/rapid breathing
Always requires evacuation if suspected
Symptoms may be delayed up to 24-48 hours
Sunburns
UVB and UVA radiation
Water reflects 2% of radiation when overhead and
more when the sun is lower
Clouds filter out infrared heat radiation (your skin
feels cooler) but UV light penetrates the cloud
coverage
Phototoxicity from medications
Sunburns
PREVENTION
Apply sun cream 30 minutes before exposure
Consider sunblock for lips, nose, forehead, ears
Wear a hat, SPF clothing
Sunglasses with 100% UV protection
TREATMENT
Cool, wet dressings
NSAIDs
Head / Spinal Injury
When to consider:
Fall greater than 3 feet, landing on the head,
back/side or buttocks
Falls or impacts associated with loss of
responsiveness/altered mental status
High velocity impacts
Head injury
Numbness or tingling in the extremities
Patient was found unconscious
You did not witness the accident
Spinal Injury
If you are unsure about a
spinal injury, do not move
the patient; immobilize and
seek help
Wounds
Closed Wounds
Contusions and hematomas
RICE
Wounds
Open Wounds
Abrasions: cover with ointment and dressing
Lacerations: need sutures if skin gaps >1 cm
Punctures: leave impaled object in place unless
obstructs breathing, prevents bleeding control
Ensure your Tetanus vaccine is up to date!
Wounds
Treatment for open wounds
Control bleeding
Protect yourself from body fluids: gloves, plastic bags
Direct pressure and elevation
If dressing becomes saturated, add more dressings
Clean the wound – this is a priority!
Irrigate with clean water and rinse with disinfected water
Apply ointment
Bandage without cutting off circulation
Wounds
Monitor for infection for 36 hours
Minor: redness, swelling, pus, heat, pain
Can apply heat and elevate the area
Monitor for progression; evacuate if not improving in 12h
Serious: evacuate
Red streaks radiating from the wound
Fever, chills
Lymph node swelling
Medical Illnesses
Anaphylaxis
Hypothermia
Lightening
Anaphylaxis
Severe immune system response to an allergen
Signs and symptoms
Difficulty breathing
Itching, flushing, hives, swelling
Swelling of face, tongue, and/or lips
Nausea, vomiting, abdominal cramps
Changes in Level of Responsiveness
Anaphylaxis
Treatment
Antihistamine ASAP!
Epinephrine may be required to allow
administration of the antihistamine.
PROP
Position of comfort / Reassurance / Oxygen /
Positive pressure ventilation
Remember ABCs
Initiate evacuation
Hypothermia
Can occur whenever heat losses exceed heat gains
As common in the wind, rain, and hail of summer as
the cold of winter
DON’T LET AMBIENT TEMPERATURE FOOL YOU
Signs:
Shivering: can deplete fuel resources if not corrected
Decreased response times as body cools
Obvious mental status changes as it progresses
Hypothermia
PREVENTION
Treatment is difficult if progresses beyond mild stage
Keep patient dry
Protect from wind
Provide hot drinks
Hypothermia wrap
Lightening
Unpredictable and powerful
Mange risk by reducing exposure
Avoid storms – lightening can strike miles ahead or
behind storms
Lightening
Injuries due to direct hit, lightening splash, direct
transmission, ground current, blunt trauma
Burns can be superficial to full-thickness
The respiratory center of the brain can be injured
Respiratory and cardiac arrest
CPR: heart may restart before breathing resumes
give rescue breaths
Good Samaritan Laws
Legal protection in Oregon and Washington provided by:
“Good Samaritan” laws
Volunteer Protection Act
Laws applicable to “emergency medical assistance”
Care given in patient’s best interest
To protect yourself:
Obtain consent
Stay within scope of training
Prescription Drugs
You can NOT give prescription drugs
Includes sharing your drugs or those of others.
You can NOT administer prescription drugs
You can HELP a patient take THEIR drugs
Includes locating their drugs and preparing dosages.
You can give over-the-counter drugs
Important to check allergies and medications before
administering.
Obtain patient consent and discuss reasons for use.
Psychological First Aid
Stress response to a traumatic event
Physical, emotional, cognitive
Delayed stress responses
Critical Incident Debriefing
Find a qualified mediator
Understand that the reactions to a traumatic event
are natural responses to an abnormal event.