Valu­able On And Off The Trails


We were re­turn­ing from the Easter Sa­fari at Moab. It was a nice drive that Satur­day: sunny and warm but gusty. Then my ra­dio crack­led. Tim, one of my friends, ex­cit­edly re­ported a “ma­jor ac­ci­dent” in­volv­ing a ve­hi­cle that had just passed him in the fast lane.

Caught by a sud­den gust of wind, the Jeep ca­reened into the ce­ment re­tain­ing wall in the me­dian, then bounced off into the guardrail on the other side, flip­ping sev­eral times in the process. Tim man­aged to nar­rowly miss be­ing in­volved in the car­nage.

I stopped as quickly as I could. Grab­bing my first aid bag, I hur­ried to the scene. The Jeep came to rest on its side, with the roll bar pin­ning the driver un­der­neath.

As I be­gan my ini­tial as­sess­ment, I glanced up and saw Tim. Reach­ing the ve­hi­cle first, he had made sure 911 was called, stopped traf­fic, turned off the ve­hi­cle, and checked if there was a pos­si­ble pas­sen­ger. “I felt so help­less,” Tim said. “I did ev­ery­thing I could but I had no idea what to do med­i­cally.”

Value of Wilder­ness First Aid Class

Tim’s re­sponse was very typ­i­cal (and I don’t mean that in a crit­i­cal way). Without the proper train­ing, in­di­vid­u­als don’t know what to do when they come upon an ac­ci­dent or other se­ri­ous in­ci­dent. I am cer­ti­fied as a Wilder­ness First Re­spon­der and have taken nu­mer­ous re­cer­ti­fi­ca­tion classes over the years. So, my re­ac­tion was some­what more mea­sured based on a plan drilled into us.

This in­ci­dent high­lights the value for four-wheel­ers—re­ally, any­one—to learn first aid skills. And be­cause four-wheel­ing takes place in re­mote ar­eas, I sug­gest par­tic­i­pants take the Wilder­ness First Aid class. An added ben­e­fit is that this train­ing will hold you in good stead in ur­ban ar­eas as well.

At the time of the ac­ci­dent, we were about 70 kilo­me­tres from the near­est

com­mu­nity with a trauma hospi­tal. Our def­i­ni­tion of wilder­ness is any place two or more hours away from de­fin­i­tive med­i­cal care. We weren’t at that dis­tance this time, but it was still a sig­nif­i­cant dis­tance. Au­thor­i­ties didn’t take any chances: they dis­patched a he­li­copter to the scene.

Wilder­ness Med­i­cal As­so­ciates teach a Pa­tient As­sess­ment Sys­tem that con­tains a 3-step process to eval­u­at­ing an in­jury or med­i­cal emer­gency. I will tell you a bit about it, but this ar­ti­cle can­not sub­sti­tute for hands-on train­ing.

Scene Size Up

The first step is an as­sess­ment of the scene. Though you’re ea­ger to help, don’t go rush­ing in. Spend a mo­ment just ob­serv­ing. You’re look­ing for haz­ards that could en­dan­ger your life and any­one else’s. These in­clude downed power lines or a ve­hi­cle on a pre­car­i­ous an­gle that could roll over on you.

When mak­ing your ini­tial scene as­sess­ment, de­ter­mine the method of in­jury (MOI). The three cat­e­gories are trauma, med­i­cal and en­vi­ron­men­tal. Although some in­ci­dents fall un­der more than one cat­e­gory, there is a pre­dom­i­nant MOI.

Trauma refers to sig­nif­i­cant in­jury such as the car ac­ci­dent we saw. Heart at­tacks and strokes are con­sid­ered med­i­cal con­di­tions. En­vi­ron­men­tal in­ci­dents in­clude se­vere al­ler­gic re­ac­tions (bee stings, for ex­am­ple), heat strokes, hy­pother­mia and even asthma at­tacks.

De­ter­mine how many pa­tients, how many res­cuers, and the num­ber of by­standers.

Pri­mary As­sess­ment

Next, per­form an as­sess­ment of the pa­tient. Us­ing the BLS (ba­sic life sup­port) pro­to­col, you check cir­cu­la­tion, res­pi­ra­tion and the ner­vous sys­tem. Find any is­sues that will kill your pa­tient if not fixed right now – e.g. not breath­ing, se­vere bleed. A bro­ken arm is not ur­gent if he is not breath­ing.

Note any ob­vi­ous bleed­ing or in­juries. If pos­si­ble—and with gloved hands— in­spect the vic­tim thor­oughly for se­vere bleed­ing.

In the above in­ci­dent, the driver was talk­ing and mov­ing about. It was ap­par­ent he was con­scious and breath­ing, and (most likely) did not have a spinal cord in­jury but not worth tak­ing a chance. Spinal in­juries, by the way, are a big con­cern in ve­hi­cle crashes or other vi­o­lent in­ci­dents. Try to keep the pa­tient still. Peo­ple of­ten want to get up and move around. Un­less they’re in im­mi­nent dan­ger—say, the ve­hi­cle is on fire or they’re in traf­fic—keep the per­son still.

In an ur­ban en­vi­ron­ment with EMS on the way, BLS is about all you can and have time to do. In a wilder­ness con­text, you move to the next step. You de­lay calling for help un­til you com­plete the sec­ondary as­sess­ment so you know what help is needed and the level of ur­gency.

Sec­ondary As­sess­ment

The third step is known as a sec­ondary as­sess­ment. There are three ma­jor parts. They are not al­ways done in a spe­cific se­quence. The sit­u­a­tion may dic­tate which step you do first.

At this stage, you’re try­ing to get more in­for­ma­tion from the vic­tim. De­tails such as medicine they’re on, al­ler­gies,

symp­toms, per­ti­nent med­i­cal his­tory, what they re­call about the in­ci­dent and so forth. This is all use­ful in­for­ma­tion in de­ter­min­ing your ac­tion plan and an­tic­i­pated prob­lem.

On my prob­lem list was

• MOI spine - an­tic­i­pated prob­lem spinal

cord in­jury: • MOI In­ter­nal in­juries – an­tic­i­pated

in­ter­nal bleed­ing; • Trau­matic brain in­jury (TBI) – an­tic­i­pated in­creas­ing in­ter­nal cra­nial pres­sure (ICP); • Bro­ken right arm – an­tic­i­pated prob­lem

nerve and cir­cu­la­tor is­sue; • And the weather (cool & windy) –

an­tic­i­pated hy­pother­mia.

In the sec­ondary as­sess­ment stage, you have time to check vi­tal signs (pulse, res­pi­ra­tion, level of con­scious­ness, etc.) at reg­u­lar in­ter­vals. Vi­tal signs are one of a few tools we have in the field to de­ter­mine what is go­ing on in­side the body.

And you have time for a phys­i­cal exam head to toe. In­spect, lis­ten, and pal­pate (means touch). Find out where it hurts or ten­der and to what ex­tent. Edi­tor's Note (Perry Mack): Where to find a first aid class First aid classes are of­fered by a host of or­ga­ni­za­tions. I re­ceived my ini­tial train­ing and ex­pe­ri­ence as a vol­un­teer ski pa­trol with the Cana­dian Ski Pa­trol. Cour­ses and cer­ti­fied providers of first aid train­ing in­clud­ing Wilder­ness First Aid can be found at:

St. John’s Am­bu­lance Cana­dian Red Cross­

Tom Severin, 4x4 Coach, teaches 4WD own­ers how to con­fi­dently and safely use their ve­hi­cles to the fullest ex­tent in dif­fi­cult ter­rain and ad­verse driv­ing con­di­tions. Visit www.4x4­train­ to de­velop or im­prove your driv­ing skill.

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