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Minute Mysteries: Wilderness First Aid

October 1, 2016
Wilderness First Aid
Michael BlairMountain Leadership School students experience the patient assessment system in a wilderness first aid course pre-trip.

Maybe its been some time since your wilderness medicine training? Test your memory and apply your knowledge to these wilderness medicine scenarios.

Day Hike Damage

You and your friend are on a 11.6 mile hike of Avery Peak and West Peak in the Bigelow Range in Franklin, County Maine. The route includes nearly 3000 feet of elevation gain and above tree line travel. The weather has temperatures in the 60s and cloudy. The forecast for the night includes clearing skies and lower temperatures. You both reach the summit at 3PM. At 3:30PM, while descending on the Fire Warden’s Trail, you friend steps down from a rock and their right ankle rolls out to the side. Your friend loses their footing and comes down to the ground, holding their right ankle. The ankle has generalized pain but no point tenderness. There is minimal pain with weight bearing.

Work through a PAS (Patient Assessment System) to determine your next steps. Find recommendations for care later in the post.

On a Cycling Trip

 You are a part of a cycling group that rides between 20 – 50 miles every Saturday. This Saturday the group rides out on a challenging 40-mile loop beginning in Bartlett, NH, passing over Bear Notch Road and riding along the Kancamagus Highway before returning to Bartlett. The group includes three adults and yourself. The temperature is in the high 70s and low 80s throughout the day with clear skies and sunshine. At 12PM, while stopped at an intersection, a group member complains of an upset stomach. You all decide to take a lunch break. At 1230PM, the same member notifies the group that they have a headache in addition to nausea. They have consumed 1 liter of water and 1 peanut butter and jelly sandwich since beginning the ride. As a group, you decide to continue riding. At 1PM, while riding sweep, you see your fellow cyclist swerve and skid onto the ground. You ride up to this person and they say, “I’m so dizzy.”

Work through a PAS to determine your next steps. Find recommendations for care later in the post.

Paddling Adventure

You are invited on a paddling trip down the Farmington, River in Canton, CT. On the day of the river trip, the water is flowing at 500 cubic feet per second (CFS) which is average for the Farmington River. You are joined by 5 other paddlers. Your group contains 2 canoes and 2 kayaks. You will be paddling a 9-mile section of the Farmington that includes (3) Class II+ rapids. All group members have some experience paddling rivers and the group leader is a proficient whitewater kayaker. The forecast includes temperatures in the 70s, clear skies, and sunshine. The group travels the first 6 river miles to a lunch spot with a rope swing. The group leader briefs the group on the upcoming section of rapids. At 1:30PM, the group continues to move down river and enter the first rapid. The group leader paddles through the first rapid and pulls off to the side to set safety for the other boats. You safely paddle through the rapid and join the group leader. The third boat, a canoe with two paddlers, moves through the rapid but does not anticipate the force of the water and collides head on with a large boulder in the middle of the river. The canoe capsizes and two paddlers are swimming. You paddle out into the river to rescue the swimmers. Upon reaching them, one swimmer is crying out in pain. You tow the swimmer to shore whilst the other swimmer is able to self-rescue. Once on shore you quickly realize that the swimmer is bleeding profusely from their shin.

Work through a PAS to determine your next steps. Find recommendations for care later in the post.

Debrief: Recommendations for Care

Day Hike Damage

After completing thorough Subjective and Objective portions of the SOAP Note, the recommendation for Assessment and Plan include:

Assessment (Problem List):

  • Possible Strain/Sprain Right Ankle

Plan:

  • Use Medical Tape to Wrap Right Ankle in a Supportive Position
  • Monitor for CSMs (Circulation, Sensation, Motion)

The following is a Rescue Plan:

  1. Use trekking poles.
  2. Continue moving along the Fire Warden’s Trail.
  3. As the temperature drops, add warm layers.
  4. Check CSMs of the right wrapped ankle every 15 minutes.
  5. Return to Trailhead and seek definitive care.

On a Cycling Trip

After completing thorough Subjective and Objective portions of the SOAP Note, the recommendation for Assessment and Plan include:

Assessment:

  • Heat Exhaustion
  • Possible Heat Stroke

Plan:

  • Cool down immediately.
  • Remove from heat and sun and rest in a cool place.
  • Hydrate in order to replace lost fluid and salt.

The following is a Rescue Plan:

  1. Hydrate the person with electrolyte enhanced water.
  2. Given the proximity to the Saco River, consider getting the person into a shallow pool of the river.
  3. If possible, once sufficiently cooled and hydrated, continue ride back to the cars.
  4. Otherwise, if you have cell service, call for emergency care.

Paddling Adventure

After completing thorough Subjective and Objective portions of the SOAP Note, the recommendation for Assessment and Plan include:

Assessment:

  • 6”Laceration Along the Length of Left Shin

Plan:

  • Control bleeding by applying direct pressure for at least 10 minutes. Consider a pressure dressing like an elastic bandage if necessary.
  • Clean with copious irrigation due to exposure to river water and debris.
  • Cover the wound with dry sterile dressings.

The following is a Rescue Plan:

  1. If available, secure the dressing with waterproof bandage material.
  2. If the patient feels comfortable, continue paddling to the take out. Consider swapping paddling positions so the most experienced paddler, the group leader, can paddle with the patient.
  3. Monitor patient vitals and CSMs.
  4. Seek definitive care.
  5. Otherwise, if you have cell service, call for emergency care. Consider walking up to the road if you do not have cell service.

In each of these common wilderness medicine scenarios, you are reminded to use the Patient Assessment System (PAS) which includes the primary survey, secondary survey, assessment, and rescue plan. These scenarios can become a reality when recreating outdoors. Be prepared with a First Aid Kit and appropriate training in order to help yourself, friends, and others.

 

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Lindsey Mersereau

Lindsey Mersereau is the Leadership Training Assistant at the Appalachian Mountain Club.