Wilderness First Responder

I just finished an intense 9-day/80 hour wilderness first responder course through NOLS WMI.  It was hosted by UT RecSports in Gregory gym, so Manuel, Hannah, Ellie, Sebastian, Brad, and I assisted some with the day-to-day running of the course in addition to taking the course.

The course prepared us to handle medical situations in the back-country for extended periods of time (while an evacuation is being prepared), as well as how to decide when an evacuation is necessary, when it should be rapid, and how to communicate our findings and needs regarding the injured patient to front-country 911 operators.

We learned about the patient assessment system, which provides a guide for us to follow which assessing the patient.  And then we practiced applying it in many scenarios as we learned about various medical issues and illnesses that might occur while leading a trip in the back-country.  Prevention was a recurrent theme during the class - it's always easier to prevent an injury or illness.  Along these lines, we learned about how to encourage good camp hygiene (wash hands and pots adequately, isolate illness) and personal care (dry socks, foot checks).

I'm going to completely rebuild my personal first aid kit - especially for international trips. In both Turkey and Peru I suffered non-trivial injuries to a foot and hand, respectively. In both cases, caring for the wounds required multiple trips to pharmacies where it was difficult to convey the types of supplies we wanted (and these supplies were sub-standard, in both cases). Hence, I plan to stock my first aid kit with at least sterile gauze, conforming gauze bandages, occlusive semi-permeable dressings, 1" athletic tape, an irrigation syringe, wound closure strips, Tincture of Benzoin, moleskin, gloves, and two triangular bandages (and certainly more items for some trips).

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.