Re: [Philmont]: Gear Check

Tom

Keep on your local ARC chapter. If your council has a Health and Safety
Committee, it would be worthwhile to get them into the picture. WFA with ARC
Standard taken as a prerequisite, should be a requirement for all adult leaders on
high adventure treks where it will take a while to get help.

Here is a writeup that I sent to National requesting that WFA be added as the
Venturing First Aid elective.

Venturing First Aid Elective

Wilderness first aid is what happens in the backcountry when someone calls
for help and all they get is you. It is the immediate help that you, as a
Venturer, are able to provide until the arrival of professional medical care.

Each year, people die in the backcountry. Unfortunately, many of these
deaths could have been prevented if only one person in the group had some form of
first aid training. All Venturers should be able to stop bleeding, give CPR,
treat for shock, splint broken bones, and treat burns. However, if you are
going to lead others in the backcountry or participate in long term high
adventure trekking, you should take some advanced first aid training, preferably
training in wilderness medicine. Check with some of the organizations listed below
for availability of advanced first aid or wilderness first aid training
courses.

The single most important item of first aid equipment a Venturer can bring to
the backcountry is knowledge. Knowledge of first aid is absolutely essential
any time you are going to an area where access to medical help is not easily
available.

Special problems can occur while treating injuries or illnesses in the
backcountry, as a result of extended patient management, severe environment, and
limited equipment.

Extended Patient Management
Medical emergencies in the backcountry can be compounded by a delay in
patient transport and evacuation, increasing the time that illness and injury need
to be managed, often under conditions that are less than ideal. As a result of
extended patient management, you may find yourself responsible for a phase of
medical care normally provided by skilled medical personnel in a hospital
environment. Remember, while you are attending to the needs of your patient you
will still be responsible for ensuring the rest of your crew is safe, warm,
well fed, and busy. The demands on you, as both a crew leader and a care
provider will be great, so "Be Prepared" You may designate one of your crew members
to take your place as crew leader, and focus your full attention on patient
care. Finally, remember to take care of yourself. As the primary care
provider for your crew, you need to stay fed and rested so that you are able to make
sound decisions when it comes to the well being of both the patient and your
crew.

Severe Environment
Environmental conditions can complicate the already difficult task of
providing medical care to someone in the backcountry. Cold, rain, wind, heat,
darkness, difficult terrain or a shortage of potable water can compound what might
normally be a simple first aid situation. Minor injuries, such as a broken
bone, a sprain, or laceration can be handled easily in a hospital environment,
but are easily aggravated or infected as a result of cold or dirt in the
outdoors. Extreme weather conditions also have an impact on you, making it far more
difficult to provide quality patient assessment and treatment. The simplest
tasks, like checking a pulse or changing a dressing, are made more difficult
and may be almost impossible to perform under severe weather conditions. Once
you have performed your initial care, it is important to protect both the
patient and the rest of your crew. Get tents up and food prepared so everyone
stays protected and well fed.

Limited Equipment
Venturers will have to improvise with the equipment at hand when treating
someone in the backcountry. The very nature of "going light" means you and your
crew will not have the type of equipment traditionally used to treat a
specific injury or illness. However, if you are resourceful you can improvise, using
materials readily at hand. Straps and metal stays from a backpack and a foam
sleep pad can be transformed into an effective splint. Remember, your
solution doesn't have to be pretty, as long as it does the job it is supposed to do.
 Simplicity and creative improvisation are key to successfully treating a
patient in the backcountry.

Wilderness - The Big Magnifier
Venturers know prolonged patient management time and environmental conditions
will act as a magnifier, turning small and routine medical problems into big
and desperate ones. A simple blister that is easily treated at home, becomes
infected by dirt and grime in the wilderness - turning your strongest hiker
into a patient that must be evacuated by litter. The wilderness turns little
mistakes in patient care into big ones. In an urban environment where a
hospital is only minutes away, an improperly splinted fracture will probably not
cause a problem other than brief discomfort. It is quite a different matter in
the backcountry, where permanent damage to tissues and nerves can occur during
the hours and days it may take to reach a trailhead and professional care.
Therefore, it is important you are thorough in your treatment. Take your time.
Monitor your patient's condition frequently. Ensure wounds are properly
cleaned and dressings or splints are properly applied.

Practice Makes Perfect
One of the problems associated with providing care in a wilderness
environment is that first aiders do not get much chance to practice their skills. Sure,
every crew is going to have its share of minor injuries, like blisters or
cuts that are easily treated. But how often will you be faced with a real
life-threatening emergency in the backcountry? That is why it is important for
Venturers to practice their first aid skills on a regular basis. Why not contact
your local first aid training provider or your local rescue squad and set up
an emergency night, where your crew can react to several wilderness first aid
scenarios using the gear you normally carry in the backcountry? Realistic
practice helps to refresh your initial first aid training and prepare you to
handle a worst case situation in the backcountry.

Prevention and Early Treatment
Most backcountry accidents are preventable. They are caused by a lack of
preparedness and judgment errors. Failure to prepare cannot only ruin a high
adventure activity, it can contribute to injury and even death. During your
early trek planning, conduct training sessions to ensure the crew has the right
equipment for the type of wilderness conditions they will face. A faulty stove
or cotton clothing, can become life threatening in cold, rainy weather
conditions. Venturers must be able to handle the more mundane camp chores, including
cooking, dishwashing, water purification, personal hygiene, and the proper
disposal of human waste. If not done properly these lead to illness. Shakedown
hikes are an excellent way to ensure that the entire crew is ready to go.

Judgment also plays a role in accident prevention. Venturers must be aware
of the potential dangers associated with being in the backcountry, and how to
avoid them. A safety briefing conducted each day, identifying possible hazards
that may be encountered on the trail, is a good place to start. Venturers
need to be especially careful when in camp, where most accidents occur. This is
especially true when handling stoves and fuel. A spilled pot is not only a
lost meal - it can cause a severe burn, requiring the immediate evacuation of
the patient. While it is important to have fun, there is no place for
horseplay in the backcountry.

Venturers need to know the importance of early treatment in the backcountry.
If a " hot spot" is treated immediately, the chances are it will not develop
into a blister. But if you wait until the end of the day, you may find
yourself looking at a mighty large blister that will require some serious attention
and may keep you off the trail. The same philosophy applies to minor cuts and
scrapes that easily become infected if left untreated in the backcountry.

Remember, an injury that does not occur needs no treatment, an emergency that
does not happen requires no response, and an illness that does not develop
demands no remedy.

Resources

Emergency Response. American Red Cross, Mosby-Year Book, 1997.

First Aid-Responding to Emergencies. American Red Cross, Mosby-Year Book.

Accidents in North American Mountaineering. Williamson, Jed & Others.
Golden, CO: American Alpine Club, 1998.

A Comprehensive Guide to Wilderness and Travel Medicine. Weiss, Eric A.,
M.D. Berkeley California, Medical Kits, 1992

Basic Essentials of Hypothermia. Forgey, William. Merrillville, IN: ICS
Books, 1991.

Basic Essentials of Rescue From the Backcountry. Tilton, Buck.
Merrillville, IN, ICS Books, 1990.

Medicine for Mountaineering & Other Wilderness Activities. Wilkerson, James.
 Seattle, WA, The Mountaineers, 1992.

Medicine for the Backcountry. Tilton, Buck. Merrillville, IN, ICS Books,
1994.

Mountain Sickness: Prevention, Recognition and Treatment. Hackett, Peter.
Golden, CO, American Alpine Club, 1992.

National Outdoor Leadership School "Wilderness Guide". Simer, Peter &
Sullivan, John. New York, NY, Simon & Schuster, 1983.

NOLS Wilderness First Aid. Lindsey, Linda & Schimelpfenig, Tod.
Mechanicsburg, PA, Stackpole Books, 1991.

Outward Bound Wilderness First Aid Handbook. Goth, Peter & Isaac, Jeff. New
York, NY, Lyons & Burford, 1998.

Wilderness Medicine, 4th Edition. Forgey, William. Merrillville, IN, ICS
Books, 1994

Wilderness Medical Society Practice Guidelines. Forgey, William & Others.
Merrillville, IN:,ICS Books, 1995.

Training

American Red Cross
PO Box 37243
Washington DC 20013
http://www.redcross.org
(or contact your local Red Cross chapter)

Aerie School for Backcountry Medicine
Box 122
Missoula MT 59802

Stonehearth Open Learning Opportunities (SOLO)
Tasker Hill Road Box 163
Conway NH 03818
http://www.stonehearth.com

Wilderness Medical Associates
RFD 2 Box 890
Bryant Pond ME 04219
http://www.wildmed.com

Wilderness Medicine Institute
PO Box 9
Pitkin CO 81241
http://www.wildernessmed.com

Cooper Wright
Associate Advisor, Crew 1519
Warrenton, VA

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Received on Sun Sep 5 11:42:23 2004