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Minute Mysteries: Wilderness First Aid – Part 2

April 5, 2017


Practicing Wilderness First Aid Scenarios
Practicing Wilderness First Aid Scenarios

For those who prefer the warmer weather, it’s coming – really! And longer days mean more time to play outside. In addition to trading in your snowshoes for hiking boots, why not dust off your wilderness first aid knowledge too? Below are a couple of scenarios to help:

Playtime in the park

It’s a gorgeous day in May. You and the kids decide to walk to a local park to play Frisbee around 4p in the afternoon. The sun is shining, temperatures are in the 60s, and there is barely any wind. There is a big, flat, grassy area in the middle of the park, perfect for the three of you to use. You spread out, and start a low-key game of catch. Once the game is underway, you watch your 10-yr. daughter race across the grass in her running shoes to grab the Frisbee, and the next thing you know, she cries out and goes down. You and your 8 yr. old son run to her, and you kneel down by her side. There is a sharp piece of glass sticking out of the sole of her right shoe.

Work through the Patient Assessment System (PAS) to determine your next steps. Recommendations for care are below.

Spring hiking along the AT

You are co-leading a 7 mile hike along the Appalachian Trail in western MA. The group met at the end point for the hike, and then shuttled together to the start. The day is overcast, with temperatures in the upper 40s. The forecast includes periodic showers, and winds of 10-15 mph. It’s a relatively small group, just 10 people, and most of the participants are novice hikers. The hike begins and the group moves at a moderate pace for a couple of hours before taking its first extended break. During the break, you notice one participant, Daryl, having a tough time unbuckling his pack, and unzipping the pocket where he stashed his snacks.

As you witness this, you think about the past couple of hours, and realize Daryl, who was initially engaging with the group and sharing the occasional light-hearted joke, has grown increasingly quiet over the past 45 minutes or so. You mention this to your co-leader, who is standing nearby, and she says she noticed the same thing. She also points out Daryl, who is dressed in several warm layers, was sweating pretty profusely during the uphill section of the hike at the start of the day. As the two of you are talking, you notice Daryl shivering.

What’s going on here? What are your next steps?

Recommendations for care:

Playtime in the park

Although you aren’t in a “wilderness” setting in this situation, you can still employ your wilderness first aid skills to work through the subjective and objective portions of a SOAP note, before seeking definitive care via an emergency room, urgent care, or primary care physician. The recommendations for assessment & plan include:

Assessment (i.e., problem list):

Possible puncture wound to the sole of the foot – You’ll need to remove the shoe to assess whether the glass shard penetrated the foot, and to what extent.

Treatment Plan:

Evaluate the site of the injury to determine: (a) if the object is impaled in the foot; (b) the depth and length of the wound; and (c) whether wound care can be provided at home or you need to seek out the assistance of medical professionals.

Rescue Plan:

Remember, you are in a frontcountry setting so you may opt to assist your daughter home, with the help of your son, to treat the wound, or, if the wound is more serious, decide to transport her to a local ER or urgent care for additional medical assistance.

Tip: Don’t forget how your son is reacting to this situation and whether or not eliciting the help of both your kids in evaluating and dealing with this situation might help or hinder the process.

Spring hiking along the A.T.


Early signs of hypothermia (getting grumpy, fumbling with buckles & zippers and shivering)

Treatment Plan:

Hydration & nutrition: It’s important to get food & fluids into this individual.


Dry layers

Consider evacuation, if symptoms don’t improve

Rescue Plan:

Right now, your patient is in the early stages of hypothermia. Hydrate with hot liquids if possible, get fuel on board in the form of food, and make sure wet layers are replaced with dry layers, esp. close to the skin. And get this person moving.

You’ll need to monitor the patient and discuss evacuation options with your co-leader if the symptoms persist or become more severe.

In each of the above scenarios, remember to use the Patient Assessment System (PAS). The PAS includes the primary survey, secondary survey, assessment, treatment plan and rescue plan. Being prepared with a first aid kit, and appropriate training, can mean you have the skills and tools to help yourself, family, friends, participants, and others if an incident occurs.

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Kristi Hobson Edmonston

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