Re: [Philmont]: Gear Check

Medicine for Mountaineering & Other Wilderness Activities has been updated with a fifth edition copyrighted in 2001. Excellent resource.
  ----- Original Message -----
  From: CoopWright@aol.com
  To: Multiple recipients of list philmont
  Sent: Sunday, September 05, 2004 11:28 AM
  Subject: 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 20:18:03 2004