Wilderness First Aid

[AA]

Don't know if this has been discussed recently, but out of curiosity, are most of you here trained in some sort of first aid or backcountry first aid?

 

Passing Stefan's partner (vegetablebelay?) coming down the trail to get help for him, my head was then swimming with questions: what if that was my partner up there? what if the injury was potentially fatal (ie spinal cord, head injury, etc)? what would I do? would I know what to do?

 

Acknowledging my gumbyness, I realized that if I am going to be climbing or mountaineering, I need to know what to do in a situation like this. I don't have any kind of Mountie training (do they teach this stuff in their courses?) or others, so I made the decision for myself that I shouldn't be out here if I don't have some proper first aid training for a bad situation.

 

So last weekend I took a Wilderness First Aid course, and it was great! But I was surprised again that out of the 25 or so people there, almost all were there to re-cert their WFR's for their jobs, not merely for their personal recreation choices. Any thoughts/comments?? maybe i'm the only gumby...

[Cpt.Caveman]

I have had lots of formal training in 1 aids. I dont have aids though

 

Anyway I used to not carry a 1st aid pouch but now I do. Never know when the unthinkable will happen.

 

Getting training is good. Having a doctor along is probably even better

[Figger_Eight]

It's a good idea. You should get one.

[iain]

The WFR is a good course but is quite expensive and time-intensive for people who are not involved in rescue or guiding in a professional capacity and can be supplemented financially for the tuition. It is considered fairly standard for most guides and mountain rescue these days (though many have less than this training).

 

WFA is a good course, but I would not want to rely on it as the sole responder to an incident. Many of the things you learn in WFR are situations were you can't do much for the person anyways, but it helps to be able to make the diagnosis and provide appropriate care until definitive help is available.

 

-Iain

[Pencil_Pusher]

AA, it's not a gumby thing.

Following KISS doctrine, my suggestion is take a MOFA course and try not to get carried away with the what-ifs.

[Norman_Clyde]

I am a doctor myself, but I also got WFR and wilderness EMT training while in med school, because otherwise I wasn't going to get any specific training in pre-hospital care. There are a few basic principles that everyone in the backcountry should know, mainly about basic assessment of a person's airway, keeping the cervical spine stable if possible, stabilization of fractured extremities,etc. These are likely to be more useful than CPR (since if an accident victim in the backcountry is needing CPR, they're as good as dead already). WFR training is probably the most reasonable way to acquire these skills. Hard to know if first aid is more important than the self-rescue skills that were discussed on a different thread a few months back-- both are the sort of skills we all should have, but I bet most climbers (except professional guides) are not going to have this broad an experience.

[AA]

I'm not necessarily talking about carrying a first aid kit- glad you're carrying one now though Cavey

 

I mean like knowing how to assess if someone's in shock (not always that easy to tell), or how to tell if they have a spinal injury, or if they're internally bleeding. A lot of times even if you do have training, you will not always know these things. If someone has taken a leader fall, and decked, and 'only' have a broken ankle, would anyone/most think to assess a spinal injury as well?

I don't know, I'm pretty paranoid about being in a situation like this I'll admit, but what I learned was that it's very difficult to not get emotionally/psychologically charged if something serious or traumatic has happened, and to try and see if there isn't a more serious injury.

Anyone have any stories of being in a situation like this and what you did? (if it's not too hard for you to discuss) Anyways, I'd recommend the course, $140 but well worth it! (except no new tools for me for awhile )

[AA]

Thanks guys, Norman. There are the basics, that aren't necessarily even just for backcountry 'first aid', I mean, walking down the street seeing someone lying there or if you see someone in a car accident.

 

I was more interested in the WFR, it's just too expensive for now. WFA was a great start though!

[iain]

Problem with WFR / EMT courses, you end up carrying rubber gloves and a facemask around in your back pocket all the time.

[jimmyleg66]

Hey AA, If you're looking for a cheaper alternative, think about joining a volunteer ski patrol. The NSP uses the Outdoor Emergency Care (OEC)manual as their training guide. I'm not sure how the volunteer system is set up in your neck o' the woods, but here is $145 to join, which includes the course manual (Canadian Ski Patrol), instruction (approx. 60 hours of instruction) and some basic supplies. Its easy on the wallet but you have to commit from 14-21 days of patrolling (depending on the ski area). Other advantages are: 1)you get lots of hands on experience, 2) you get to work with experienced patrollers and in some cases ER Doc's and nurses, 3)free skiing! 4)Depending on where you ski, some patrols get pro deals on equipment

 

First aid is just like any skill, once you learn it, if you don't use it you lose it.

[Toast]

quote:

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Originally posted by AA:

Anyone have any stories of being in a situation like this and what you did? (if it's not too hard for you to discuss)

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I was with my friend G at the base of the Tooth many years ago. Climbers above had kicked loose a grapefruit sized chunk of rock. G ducked behind a tree but his hand was exposed and his middle finger more or less got deboned when the rock smashed down on his hand Anyway, the thought of shock and the prospect of getting stuck behind the pass was going through my mind. I was frank with him that this was my concern and that we needed to stop the bleeding and get back to the trail pronto. I dressed his hand in a bandanna, packed with snow and he tried to keep it elevated as we descended. All worked out fine with the exception that G now has a permanent fuck-u finger.

 

In hindsight, I think we did an okay job. I've taken a MOFA class since and now know there are other things I should have checked. Yes, these classes are extremely time consuming, and much of what they teach is common sense. However, they do drill on fundamentals that can help keep you and your partner's ass alive in grim circumstances.

 

Maybe it's just me, but I kinda think its a no brainer that all of us should have some kind of first aid knowledge... even if it's only from reading a book. I'd get a little pissed if you let me bleed to death because you forgot to check

[Norman_Clyde]

A few things to keep in mind in case of an accident:

 

1. Make sure the scene is safe. No matter your sense of urgency, don't put yourself or others in greater danger by rushing prematurely to the rescue.

 

2. The ABC's of Airway, Breathing, Circulation. These fundamentals should be re-visited periodically during every rescue situation. Make sure the victim's airway is not blocked, perform artificial respiration if victim not breathing, CPR if no pulse. In the backcountry, CPR is less likely to be useful, but repositioning an unconscious victim's head (carefully)to open the airway is an extremely simple maneuver that can be lifesaving.

 

3. Direct pressure is the best way to stop bleeding. Don't worry about tourniquets and other nonsense-- unless someone is actually missing a limb.

 

4. If there is any chance of cervical spine injury, do not let the injured party move. Stabilize the cervical spine to the best of your ability. WFR courses will give you some practice in rigging systems for this, using pack waist belts around the victim's forehead, etc.

 

5. If someone is sufficiently injured that he/she can't walk out, but is alert, make every effort to keep the person warm and hydrated. There may be a gray area here for someone with abdominal injury, but for the most part, anyone with a traumatic injury is going to be better off if they tank up on fluids. This can stave off shock and renal failure, especially if there is a long wait before rescue.

 

The above is not a substitute for an actual WFR course or actual medical advice. Climbing is dangerous, etc. Your mileage may vary. (MattP, TheLawGoddess, all you legal types, help me out with a disclaimer here!)

[Beck]

Everyone should take a MOFA course. The "scenario" approach to first/extended aid instruction via the overnight field trip is INVALUABLE and worth the guilders spent in GOLD.

Learn emergency skills in real life settings!

Rain, fatigue, cold, wet, dark, on a hill, in the trees, THIS is when an accident occurs, and learning how to cope with THESE situations make MOFA tops for recreational backountry user.

 

The Mounties require it for basic climbing class graduation.cost, 150-180 or something therabouts. Call Red Cross for details.

[iain]

quote:

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Originally posted by AA:

Anyone have any stories of being in a situation like this and what you did?

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A partner and I were shelled by a big rock avalanche from Yocum Ridge on a traverse on the Sandy Headwall on Mt. Hood a few years back. My partner got a tv set in the pelvis and I was hit in the helmet hard several times and beat up my hand which was shielding my face. I could see that my partner was bleeding profusely as he had some light-colored pants on and it was spreading over his leg. He was still conscious and moving so we both just ran for it to get to lower ground and below the Sandy G. bergschrund (which had swallowed some of our gear in the rockfall). We got to just below an ice fall on the right when my partner pretty much collapsed and said he was going to throw up. Shortly after that he said he was going unconcious and wanted to help me use his VHF radio to get some help before he did so. This led to some increased stress on my part. Since he was in bad shape and we were still under an active ice fall I laid out a tarp and dragged him down the glacier to an area where it looked like a helicopter could land and that was free of rockfall. This was fairly exhausting and I could only use one hand as my other has damaged by rocks. My partner was shivering uncontrollably at this point (it was very hot on the glacier) so I tried to treat for shock but I was not sure if he had serious adominal injuries (potential life threat) or merely a superficial break at or near the pelvis (not quite so bad). He had a big gash at the iliac crest which refused to stop bleeding w/o constant direct pressure. I placed a dressing on it and yanked his belt up over the gash and cinched it down as tight as possible. His VHF was not helpful, so a Motorola Talkabout was tried. We actually got ahold of some kids in McMinnville playing in their yard (~80 miles away), they got their dad on the radio, and we relayed instructions to the county sheriff via the dad. We were picked up by the air force and dropped off in Portland (which was the craziest part, hanging out in downtown portland at 1600 in full glacier setup after hanging out on the Sandy Headwall since 0730). Anyways, it really pays to have the training, but as you can see it really was not used much apart from controlling bleeding, treating for shock, and realizing when you need help getting out. Nothing the WFA doesn't cover. Could've been a lot worse though, we both consider ourselves lucky to be alive.

[sherpajeff]

quote:

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Originally posted by Norman Clyde:

<snip>(since if an accident victim in the backcountry is needing CPR, they're as good as dead already).

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Not if they were struck by lighting.

 

I was in AA's WFA course this weekend. Our instructor had some interesting stats.

 

As we know, only .003% of cardiac arrest victims who receive CPR but not a defibrillator survive.

 

However, 70-90% of lightning victims who go into cardiac arrest and receive CPR survive.

 

Jeff

[sketchfest]

Iain,

I remember that story when it happened. I remember thinking, "holy crap, those guy's got lucky, I need to get me a couple a talkabouts.

[remlec]

I teach MOFA for the Mtnrs. It's the same course as the Red Cross WOFA (in Pierce County) but much less expensive. MOFA is required for graduation from all Mtnr climbing/scrambling courses and all climbing personnel from Pierce County Search and Rescue also run through and re-cert. I've have a lot of feedback on the value in real life situations. I highly recommend something on this order to all outdoor people. These are very basic and take 4 days (also includes Red Cross first-aid and CPR) but give you some place to start in an emergency and as importantly, some organizational priorities. First responder courses are more intense but are really spendy, take more time and you're still just giving first aid. Even if you're trained and licensed medical practitioner in town, proceedures change when you can't call 911. 'course, the best is to climb with a doctor who's a first responder.

[Norman_Clyde]

Sherpajeff, you are completely correct-- It's hard to sum up even first aid principles into a simple set of rules, hence my disclaimer. Lightning strike is one scenario where, from a triage point of view, the dead are resuscitated first, since anyone who is breathing after a strike is likely to keep breathing, but those not breathing may have had a respiratory arrest from the strike. However, often they still have a heartbeat, and will resume breathing on their own within a few minutes, as long as someone delivers oxygen to them while their system recovers from the shock.

[SEF]

A little point of clarification on what others have said: The Mountaineers MOFA course costs $85 for Mountie members and $100 for nonmembers. Instructors are volunteers like remlec. The fee includes the Red Cross first aid books.

 

“Wilderness First Responder” is a first aid course sanctioned by the Wilderness Medical Associates, is offered by a number of organizations, and will vary in the range of 60 to 75 hours of instruction. Many guide services require it. A Wilderness EMT course is also offered.

 

Perhaps the most important part of such training is learning a methodology to use in accident scenarios, and well worth the money spent.

[iain]

quote:

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Originally posted by sketchfest:

Iain,

I remember that story when it happened. I remember thinking, "holy crap, those guy's got lucky, I need to get me a couple a talkabouts.

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Yeah it got a lot of publicity. Got an article in People magazine and was on NBC nightly news. Insane! All of it would have been mitigated if we had a cell phone.

[erikwilker]

Definitely agree that it is worth having enough basics to feel like you know what to do in an emergency. I took a 60 foot tumbling fall through granites ledges, never lost consciousness, and coached my partner through a full medical assessment (I had an expired EMT and he only had and expired CPR card).

 

Would have been even more dire for him and me if he had to deal with me on his own.

 

Have to put in a plug for carrying some sort of blood-stopping pressure dressing materials in the kit. Saved my life.

[iain]

yeah I agree, I've found lots of gauze and dressings are some of the most important things to have. Pretty much all I carry. Those orange seattle marine vinylove freezer gloves are killer for mountain medical stuff, as they are totally sealed and warm, and close to disposable afterwards. It is a pain at a bloody scene where your mitts soak up all the blood because you can't get nitrile over your insulation.

[iain]

Just an aside, but if anyone is interested in mountain rescue and lives remotely near Corvallis, Oregon, I'd like to invite you to one of the unit meetings for Corvallis Mountain Rescue, one of several MRA units in Oregon. I would like to see some new faces who are both interested in climbing and helping out other climbers. Send me an email if interested. Climbing experience, is of course, appreciated.

 

-Iain

[rbw1966]

quote:

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Originally posted by iain:

quote:

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Originally posted by sketchfest:

Iain,

I remember that story when it happened. I remember thinking, "holy crap, those guy's got lucky, I need to get me a couple a talkabouts.

---

Yeah it got a lot of publicity. Got an article in People magazine and was on NBC nightly news. Insane! All of it would have been mitigated if we had a cell phone.

---

Did anyone give you grief for NOT having a cell phone? As I recall, if you don't have a cell phone on Mt. Hood you are (at least theoretically) required to have MLU's.

[iain]

quote:

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Originally posted by rbw1966:

Did anyone give you grief for NOT having a cell phone? As I recall, if you don't have a cell phone on Mt. Hood you are (at least theoretically) required to have MLU's.

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The only time the issue was publicly raised was in Accidents in N.A. Mountaineering (incorrectly labeled as "Fall on Rock"). The VHF radio proved very valuable for helping organize the rescue effort and guiding in the helicopter, but this was only after the resources were on-scene. A cellphone would have been much more appropriate, and we were planning to bring one, but it was left behind at Timberline.

 

We could have been prosecuted under the revised statute since we did not have cellphone/MLU but one would have to prove gross negligence. I don't consider the MLU very valuable unless you are a first-time out-of-towner heading out in a sketchy forecast.

 

Since it became a military operation, any charges were quite unlikely. There was the usual crap in the Oregonian, as after every Mt. Hood incident with a Blackhawk photo and a big "WHO PAYS" nearby. The point was not raised that both of us carried AAC rescue insurance.