Wilderness First Aid: Minute Mysteries

November 8, 2018
Chilly mornings on trail
Chilly mornings on trail

1: Wet leaves, slippery surfaces

It is late October and you are descending Bear Mountain (2316’), the tallest peak in Connecticut, on the Undermountain Trail. You are with a small group of friends, about 2.5 miles from the trailhead parking lot. The trail is littered with wet leaves and very slippery. While navigating a tricky section, you hear a “thump” and then a grunt. Turning around, you see one of your fellow hikers, Paul, sitting on the trail, holding his left wrist. Paul states he slipped, and landed with his left arm outstretched, palm down, in an attempt to break his fall.  When he tries to move his wrist, he says it feels like something is “grating” or “crunching” and it is very painful.

Work through the Patient Assessment System (PAS) to determine your next steps. You will find recommendations for care later in this post.

2: Chilly morning workouts

An AMC leader organizes a weekly, early morning “workout walk” at a local park. The pace is usually brisk (15 minutes/mile).  Just before sunrise on a November morning, you head out to meet up with the group. Although the park is a short drive from your home, you bundle up because temperatures are in the mid-30s (Fahrenheit). The group is ready to go by 6:45 am, and the walk, which is about 4.5 miles in length, gets underway. You know you’ll warm up quickly, so you shed a layer as you hit the trail. After about 35 minutes, the group pauses for a water break. From your small pack, you grab your jacket and some water. A fellow participant, Bryan, is having trouble putting on his gloves and shivering a bit, even though he’s wearing a warm, puffy jacket and hat. What’s going on?

Work through the Patient Assessment System (PAS) to determine your next steps. You will find recommendations for care later in this post.


1: Wet leaves, slippery surfaces

 Assessment (Problem list):

  • Broken wrist (probable)

Treatment Plan:

  • Check CSMs (circulation, sensation & motion)
  • Splint and immobilize the left wrist
  • Monitor for CSMs during evacuation

Rescue Plan:

  1. Assist patient, as needed, with self-evacuation to the trailhead.
  2. Check CSMs of the splinted wrist every 15 minutes.
  3. Monitor for signs of hypothermia during evacuation. Treat, as needed, if signs/symptoms appear.
  4. Seek definitive care for patient upon return to trailhead.

2: Chilly morning workouts

Assessment (Problem list):

  • Mild hypothermia. When you talk with Bryan, you realize he walked the first couple of miles while wearing his warm, outermost layer. Due to the brisk pace, he began sweating and his layers got wet. When the group stopped for its break, his body temperature began to drop.

Treatment Plan:

  • Getting moving: Get the group underway, and escort Bryan back to his car.
  • Food & hydration: A snack, and drink, preferably something hot & sugary.
  • Dry layers, if available.

Rescue Plan:

  1. Escort the individual to trailhead and his car.
  2. Monitor patient during evacuation for signs/symptoms of worsening hypothermia.
  3. Advise patient to change into dry layers asap, and eat & drink, esp. hot beverages once he gets back home.

Note: The brisk walk back to the parking lot is a perfect time to discuss the importance of layering down before starting a vigorous activity on a chilly morning. If people are determined to start warm, then suggest a short break after 10-15 minutes to shed extra layers before folks get too hot and begin to perspire. Cold temperatures and wet clothes are the perfect combination for hypothermia.

Disclaimer: 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 to help yourself, friends, and others in case of an accident. For a list of Wilderness First Aid courses offered by the AMC, please visit: https://activities.outdoors.org/search/

 

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Kristi Hobson Edmonston

AMC Outdoors, the magazine of the Appalachian Mountain Club, inspires readers to get outside and get engaged. Learn more.