Wednesday, October 3, 2012

Dan Crane: Wilderness First Aid Lessons

Discovering an injured person in the wilderness is probably a common nightmare amongst those intrepid souls journeying into the Adirondack backcountry. The only situation more dreadful is actually being the one in need of assistance when there is not another person within miles.

A myriad of questions run through one’s mind when imagining such an emergency. What should I do? Help the injured person? Run for help? Just run and hide? Faint and let the next person to come along deal with two injured individuals?

The only way to deal with such an unpleasant situation is to be prepared. Preparations for an emergency event start at home, long before ever leaving for the backcountry. Familiarizing yourself with first aid texts, carrying a personal locator beacon and keeping a well-stocked first aid kit handy are just a few ways to equip oneself for a potential backcountry emergency. The single best way to prepare for such an event may be to attend a wilderness first aid class, which is exactly what I did recently.

My attendance was not for completely altruistic reasons though. It was not merely a masturbatory educational exercise either. Although my reasoning for attending such a class clearly involved both of these concerns, since anyone traveling into the backcountry should be aware of first aid issues, at least at some rudimentary level, if not for their own safety, than for the safety of others.

However, the driving force behind my recent participation was the class’s requirement for applying for a New York State guide license. Of course, this makes perfect sense. Anyone responsible for taking others out exploring the great public lands of the Adirondacks must be prepared for an emergency, if such an occasion ever presents itself.

Despite my suspect motivation, a wilderness first aid class should be part of every backcountry enthusiast’s training before heading out on the Adirondack trails, and certainly for those entertaining the thought of stepping off the trails and bushwhacking to the untrammeled and rarely visited remote places. The probability of an injury, anything from twisting an ankle to being impaled on a spruce branch while climbing over a blowdown, should be motivation enough for attending at least one extensive wilderness first aid class during a backcountry career.

The good folks from the New York State Outdoor Guides Association (NYSOGA) sponsored the class I attended. It lasted nine hours on a recent Saturday, including several breaks, with snacks and lunch provided. Although giving up an entire Saturday was difficult, it was well worth it. Other wilderness first aid classes are available, and with greater frequency, from the American Red Cross and the Adirondack Mountain Club, but these classes typically entail 16-hour commitment over two days. The content of all these different classes is most likely equivalent, although the longer classes probably contain more extensive hands-on demonstrations, and therefore might be well worth the time and expense.

Many interesting factoids came up during the course of the wilderness first aid class.

Apparently, there is a requirement to obtain consent before treating anyone, regardless of an emergency or not. This is a no-brainer, since no one should be required to accept assistance from a complete stranger within the backcountry. Although, if a victim is unconscious, then permission is implicit, suggesting that perhaps an Acme rubber mallet should be standard equipment in every first aid kit.

NEVER administer a medication to an injured person, regardless if such a treatment may save their life. Blame the highly litigious nature of our society for this guidance. A suggested way around this is to communicate to the injured party that the medication is helpful in such situations, that the medication is in your first aid kit and that your first aid kit is right next to them. If they take it on their own, then it is their responsibility. Apparently, placing the medication next to them or in their hands is akin to leading a witness.

Always use an injured person’s equipment to treat them during an emergency. Not only does this prevent you from ruining your own gear, but also because there is little chance of ever seeing the stuff again after an evacuation. Who wants someone else’s blood all over their equipment anyways?

The recommendation to place two naked people within a sleeping bag when one of them is suffering from hypothermia is outdated. Apparently, this just results in two naked and cold people within a sleeping bag. It is best just to place the naked hypothermic person in two sleeping bags instead. This probably provides great relief to the homophobic outdoor enthusiasts among us.

One aspect in which the wilderness first aid class was greatly deficient in, and I imagine all other such classes would be as well, is in the area of self-administered first aid. As a solitary backcountry bushwhacker, I find would find this topic especially useful. Unfortunately, little information appears to be available on this topic.

Fortunately, I never had a necessity of using most of what I learned in the wilderness first aid before. My history of backcountry injures include such innocuous emergencies such as a burst blister, a skinned knee, a bruised thigh or an occasional hand scrape. Whether this is due to my exceptional balance, aversion to risk, or just plain dumb luck, I do not know. At least now, I have rudimentary knowledge of what to do in an emergency, whether I can recall it in all the excitement of an actual event is anyone’s guess. That is why they make crib sheets, after all.

Has anyone else taken a Wilderness First Aid class before? What was your experience? What parts worked best? Least? Have you ever had an actual opportunity to put what you learned into use? How did you react in an emergency? Please feel free to share your experiences in the comments section.

Photos: A blowdown in the Five Ponds Wilderness by Dan Crane.

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Dan Crane writes regularly about bushwhacking and backcountry camping, including providing insights on equipment and his observations as a veteran backcountry explorer. He has been visiting the Adirondacks since childhood and actively exploring its backcountry for almost two decades. He is also life-long naturalist with a Master of Science in Ecology from SUNY ESF and 10+ seasons working as a field biologist, five inside the Blue Line.

Dan has hiked the Northville-Placid Trail twice and climbed all 46 High Peaks but currently spends his backpacking time exploring the northwestern portion of the Adirondacks. He is also the creator of the blog Bushwhacking Fool where he details his bushwhacking adventures.

5 Responses

  1. Paul says:

    “The recommendation to place two naked people within a sleeping bag when one of them is suffering from hypothermia is outdated.”

    Great. There goes that strategy!

  2. Gillian says:

    We took a WFA class after assisting in the rescue of a woman who had fallen on Chimney Mountain, resulting in neck and back injuries. We felt pretty helpless and could only try to keep her comfortable and warm as we waited for the EMT crew to climb up the mountain and set up the helicopter rescue. I don’t know that the WFA training would have prepared us any better for her fairly serious injuries, but we did start carrying better gear in our packs. The result was that when we came upon our second injured person a year or two later, a mountain biker with a broken ankle, we were able to provide the EMTs with enough gear to make a good splint and to fashion a litter to carry him to the lift-out spot (their ATV broke down on the way up the trail so they didn’t have a thing) and to explain to them how the helicopter rescue would work.
    Also, I agree on using the injured person’s gear when possible – they promised to send the fleece used to pad the ankle back, but we never saw it again.

  3. Pete Nelson says:

    I wrote about first aid some months back in a Dispatch. I might as well get myself in trouble with a couple of comments.

    I have a fair amount of first aid training and lots of experience, though no recent comprehensive retraining. Things always change as we learn more. However I am intrigued by the comment that warming a person with another person is “outdated.”

    There is no question that rewarming will occur more rapidly with a second person in the bag – that’s simple physics. I suppose that the objection could be twofold: one, in severe cases warming too fast can be bad, and two, the cold person will bring down the temperature of the warm person, possibly leading to two hypothermic victims. That last one is the one Dan actually mentions.

    I gotta admit neither makes sense to me. In the case of the first, external rewarming (a warm body, warm water bottles under the arms, etc) is the least effective method of rewarming; it’s hard for me to imagine that this method of rewarming could go too fast. but I’m no expert, I’m just being a skeptic. I could easily be wrong on that for severe cases.

    In the second case, however, my math and science side leaves me simply not buying it. The laws of thermodynamics would tell you that in a closed system a body at 80 degrees and a body of 100 degrees would achieve equilibrium at 90 degrees. So a victim with SEVERE hypothermia, say at 82 degrees body temp, exchanging heat with a 98 degree rescuer would theoretically bring both to 90 degrees, mild hypothermia, as a worst case. But that’s not the situation we have. The hypothermic victim and the rescuer are both GENERATING heat. The hypothermic victim is doing is much less well as their energy stores are depleted, so the rate at which the rescuer is generating heat is significantly greater. It’s also dynamic, striving to keep their body at 98.6 degrees – otherwise we’d always freeze to death in cold winter. Additionally, the heat that would normally be radiated into space from these generators is being partially reflected by the sleeping bag. So the rescuer is going to win that thermodynamic tussle big time. In short, there’s no way on earth that they’d meet in the middle. Sure, the rescuer will get a little cold: so what?

    I’ll say this: I’ve had experience with hypothermia, it is extremely serious, you must proceed with deliberate focus and care as a life is on the line. You do what you can, all that you can. Providing insulation is first, so the victim can begin to rewarm themselves. Enhancing it with a warm body always made sense to me. Internal warming aids are effective: give them warm water to drink (sugaring the water adds energy-making power).

    Now, as to this admonition to never give medication to a victim even if it would save their life… let me see… lawsuit versus life saved. I’ll take life saved. Seriously, kids? Are we going to let litigiousness rob us of morality?

    Here’s what I’ll say: never give medication unless you are trained in first aid, in the medication itself and in administering it. All three are necessary or you can as easily kill as cure.

    Finally, medication is way down the line anyhow and rarely important. Get some training, follow the protocols (which I won’t list here, but your safety, their safety, ABCD’s, etc.). Keep your head. Focus on your attitude. Use your common sense. Be patient.

    All this is doubly true if you are treating yourself.

  4. Paul says:

    The most important thing is in Pete’s last 4 sentences. Shock is what you don’t want to be in when you are in the woods alone. Adrenaline can be good but shock is very bad. It can make a bad situation fatal fast. Most injuries do not require immediate evacuation. It is hard to stay calm but you can practice. Get out in the woods in the dark and get used to it. Many people only spend time in the woods during daylight hours so they panic easily when it gets dark and cold.

  5. TiSentinel65 says:

    When it comes to hypothermia, fire building skills are essential. Never go in the woods without matches or a means to start a fire.

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