Wilderness First Aid

This weekend I took a National Outdoor Leadership School (NOLS) Wilderness Medical Institute (WMI) Wilderness First Aid (WFA) course at the Austin REI store.  This class was needed in order for me to get hired as a trip leader for UT RecSports.  The course was 16 hours, split across two days.

We learned the triangular patient assessment system, which we are to follow for every wilderness first aid situation we encounter.  First we are supposed to size-up the scene by doing 5 things:

• Survey the scene for hazards - 'I'm #1'
• Determine what night have caused the injury - 'What happened to you?'
• Protect yourself from bodily substances - 'Keep goo off me'
• Determine the number of patients - 'Are there more?'
• Form a general impression of the patient - 'Dead or alive?'

Then we perform an initial assessment, looking for immediate threats to life:

• Identify yourself and obtain consent.  Ask what happened.
• Establish responsiveness and stabilize the spine if there is an obvious mechanism for spine injury.
• Airway management: check for obstructions in patient's mouth.
• Breathing adequacy: Ask patient to take 2 breaths.  Look, listen, and feel.
• Circulation: Check for a pulse, and run hands under the patient's body to check for large amounts of blood.
• Decision on disability: Determine if there is a chance of spinal injury - if so, maintain head stabilization.
• Environment: Expose any serious injuries to skin level.

Next we do a complete head-to-toe physical exam, take vital signs, and record history.

• Head-to-toe physical exam
• Look, ask, listen, and feel
• Check circulation, sensation, and motion (CSM) in all four extremities

• Vital signs
• Level of responsiveness (LOR): awake and oriented, awake and disoriented, or unconscious
• Heart rate: beats per minute, strong or weak
• Respiratory rate: Breaths per minute, easy or labored
• Skin color, temperature, and moisture

• Patient history
• Chief complaint
• Age
• Symptoms
• Allergies
• Medications
• Pertinent medical history
• Last fluid/food intake, last urine/bowel output
• Events

Then we covered a variety of topics in detail.  The lessons were interspersed with many scenarios, in which 1/3 or 1/2 of the class would pretend to be a patient.  The patients would be told exactly how to act and what their symptoms were, as well as given fake cuts or bruises using make-up.  The care givers would then have to go through the entire patient assessment system and gather information that could be used in a radio report or to treat the patient.

We discussed the signs and symptoms of various medical issues, as well as how to treat them in the back-country and when to decide an evacuation is necessary.  Specifically, we learned about:

• Spinal injuries
• Head injuries
• Shock
• Wound management and infection
• Burns
• Injuries
• Including decisions on when an injury is usable versus unusable, learning how to tape an ankle, learning how to splint a leg, and learning how to make a sling
• Dislocations
• Heat illnesses
• Cold injuries
• Lightening
• Altitude illnesses
• Anaphylaxis

The NOLS instructors were great.  All in all, I feel much more prepared to deal with any injures that might occur in the back-country.  Not only am I more knowledgeable after this course, but I also feel confident that I could examine a patient effectively and remain calm while handling difficult situations that I might encounter.  I'm looking forward to eventually extending my knowledge in a Wilderness First Responder course (80 hours) at some point in the future.