Guide to remote first aid

By Caroline Faucher | September 9, 2010

Be prepared with this practical first-aid guide for everything from blisters to heart attacks.

BY THEIR NATURE, WILDERNESS activities have risks, but proper training and thoughtful preparation means you should be able to handle most minor emergencies on your own, without having to call in the cavalry.

First-aid knowledge and training is always recommended, particularly for those adventuring in isolated environments. Rescuers working in remote areas cite lack of preparation as the primary, preventable reason for most rescues. According to Stuart Clark, managing director for All Aid, the key to a successful wilderness trip is the rule of P – Planning Prevents Poor Performance.

“Prepare for the worst – plan for the best,” he says. By knowing any medical history of your group and ensuring that all participants have the necessary skills, fitness and equipment, adventures in remote locations can be done in relative safety.

David Czerkies, senior training officer for St John Ambulance Australia, says that just like going out to a party, “you need to know where it is, where you are going and what to bring”.

TIPS FOR PLANNING A SAFE TRIP
* Travel in a group
* Know each other’s medical history and needs before you set out
* Assign a group leader to prepare route plans, check weather reports and organise medical and first-aid gear
* Seriously consider taking an emergency beacon, particularly if going into areas where mobile phone reception can be limited or non-existent. If you don’t own one, remote beacons can be rented from 4WD rental companies, some outdoor shops, and the manufacturers themselves
* Include enough food, water and clothes to spend an extra night or two in the bush if needed
* Let someone know the route taken, and discuss the precise steps they should take if you do not return from your activity by a particular time

FIRST AID PRIORITIES
Dr Edi Albert from Equip Wilderness First Aid Institute says knowing and following an accident management plan is the most effective way to manage emergencies in remote areas. It can help you make critical decisions on how to treat the patient, and what order to take steps. In its simplest form, you should:
Step 1. Take charge
Step 2. Safe approach/ scene assessment
Step 3. Systematically assess and treat life-threatening injuries. One easy way to remember priorities is ABCDE.
              Airway
              Breathing
              Circulation/CPR
              Deadly bleed
              Environment – the patient may get cold or overheated depending upon the conditions.
Step 4. Plan and treat for shock.
Step 5. Conduct a second, more thorough assessment of the patient – vital signs, history and head-to-toe examination
Step 6. Longer-term nursing care
Step 7. Evacuation

In most cases, a patient should not be left alone, especially if unconscious. However, Albert says that in remote areas it is sometimes crucial – as a last resort – to go and find help if you know that rescue is not going to look for you. Leaving the patient should only be done after assessing the problem and making sure they are comfortable and not in a life-threatening condition. Albert says that if you do need to leave, “make sure that the injured has shelter, food, drink and is as comfortable as possible”.

Ideally, if travelling in a group, smaller teams can be created so that one group will stay with the injured person and the other will seek help. This helps ensure that there are no other emergencies created, such as losing a person in the bush.

Czerkies says an important part of a rescue plan is to reassure the patient, especially in more serious cases. “You need to give the reassurance they need,” he says. “They may already think they are going to die.”

If someone becomes unconscious, continue with the accident management plan and contact emergency services as soon as possible. An unconscious person can suffer a cardiac arrest, in which case they will need Cardio Pulmonary Resuscitation (CPR).

WOUNDS
Before treating someone else’s wound, you must clean your own hands. Dirty wounds should be cleaned with saline solution or, if not available, cooled boiled water, to reduce risk of infection. Then it should be dressed and covered with an appropriate bandage. The bandage should not be too tight as it can block circulation. In warmer weather, check dressings more frequently, as wounds can easily become infected.


FRACTURES, DISLOCATIONS, SPRAINS

Signs of fracture or dislocation include pain near the injury site, difficulty of movement, loss of power, deformity, tenderness, swelling and bruising. Pain, swelling and bruising are also the main signs for sprain and strain. Looking for fractures will often determine if the person can walk or not, but it is often difficult to diagnose the correct injury. If in doubt, it is best to treat the injury as a fracture. Make sure the patient avoids walking or moving the injured body part.

Tips
* After following the ABCDE plan, control any bleeding. Clean and cover wounds with a bandage.
* To immobilise a fracture, use broad bandages as it limits movement at the joints. Padding can also be added along the injured part.
* To complete the immobilisation, place a splint along the injured area. There are many things that can be used as improvised splints; skis, walking poles or branches. Padding, such as clothing and pillows, can then be added to create some relief between the splints and the body.
* Check the bandage regularly as it can become loose or be too tight, affecting circulation.


HEAT AND COLD

Unlike wounds or musculoskeletal injuries, which usually occur suddenly, some factors can add up over time to cause heat or cold illnesses. Environmental factors such as the temperature and weather mixed with some personal factors such as the length of the activity, the type of clothing and the consumption of alcohol, can all contribute.

Here, prevention is critical. To prevent heat illness, St John Ambulance Australia recommends to drink water until no longer thirsty, then a little more and to rest often in the shade. Urine should be pale in colour, not dark and thick.

Heat exhaustion is the most common type of heat illness. Its symptoms include feeling hot and exhausted, headache, thirst and nausea. The skin can also look pale and be cool and the person can experience shortness of breath. At this stage they are still sweating.

The other extreme, cold illness, can be prevented by staying dry when adventuring into cold temperatures and wearing adequate layered clothing that covers extremities such as hands and feet. Feeling cold, shivering or acting irrationally can be signs of an initial temperature drop and can lead to more serious cold illness.

Tips for treating heat exhaustion
* Lie the patient in a cool, shady place with circulating air (or fan the patient)
* Remove any extra layers of clothing
* If possible, sponge the person with water and give fluids to drink 
* Place feet slightly higher than head
* If the casualty vomits, stops sweating or does not seem to recover, the person may be suffering from heatstroke, a potentially lethal condition. In this case, follow ABCDE and seek help immediately.

Tips for extreme cold

* Remove the person from the cold environment
* If frostbitten, warm the body part using 42ºC water. Dry heat sources, such as heaters, can cause burns
* If the person is hypothermic, get into a sleeping bag or heat blanket with them

DEHYDRATION AND DIARRHOEA
“You can go without food for a number of days, but you can’t go out without water for a number of days,” Czerkies says, emphasising the importance of bringing enough water when adventuring in remote areas. Dehydration can lead to very serious conditions. It is most often caused by a lack of fluid intake, but diarrhoea and vomiting can also lead to it.

Diarrhoea can be caused by a change of diet, food intolerance, food poisoning or viral infections. Food poisoning and viral infection are common causes for vomiting. However, vomiting can also be the results of head injuries, altitude sickness or motion sickness.

Tips for dehydration
* To treat diarrhoea, the patient must eat only bland or dry foods for at least 24 hours and avoid fruit and vegetables. Drinking cooled boiled water or clear fluids can prevent the person from dehydrating
* If diarrhoea persists for more than 48 hours or if it is associated with vomiting, evacuation should be considered
* To treat vomiting, give the ill person small sips of clear fluids at regular intervals. Should the person become too dehydrated, evacuation is recommended
* Lactose-based ingredients should not be given to someone vomiting


RESPIRATORY PROBLEMS, INCLUDING ASTHMA

People practising outdoor activities are usually aware of any respiratory problems they have and can usually control them. However, in some cases asthma or hyperventilation can occur, particularly in stressful or exhausting situations.

Symptoms of asthma are often obvious. The person, unable to inhale sufficient air, can become progressively more anxious. As the person becomes shorter of breath, coughing and wheezing are good indicators. If not treated quickly, the person can become pale and blue near the mouth and ears and eventually lose consciousness.

The key element in treating asthma lies in response speed. Commence first-aid by following ABCDE. If unconscious, seek emergency aid. If conscious, reassure the person and sit them down, making sure the area has flowing air. Then assist with medication, such as a puffer, by giving four puffs if required.Hyperventilation can be treated by making sure the casualty returns to a calm state and takes deep, slow breaths.

BLISTERS
Although rarely the cause of serious injuries, rescuers admit that blisters are a common cause of casualties. According to St John Ambulance Australia, a blister can take up to seven days to properly heal. Long walks, burns, insect bites, sunburn or fungal infection of the skin are among the causes of blisters.

Tips for treating blisters
* Clean the affected area with saline solution if possible
* Puncture the edge of the blister with something sterile, then press on the fluid, making sure that the skin surface is not removed
* Cover up with some non-sticky sterile dressing and apply padding and tape near the edge
* If redness or infection occurs, seek medical aid as soon as possible

SNAKE AND SPIDER BITES
Snake and spider bites are a rare, yet ever-present danger in the Australian bush. Edi says that while it is something to be aware of when adventuring into remote areas, in reality the chances of having to deal with this sort of emergency are quite low.

However, the response to snakebite must be quick, because it can lead to respiratory and cardiac arrest. Look out for signs such as nausea, headache, blurred vision, drowsiness and tightness in chest.
Spider bite treatment depends on the species. If in any doubt, call emergency services and follow the ABCDE. Calm the patient and apply a firm bandage from one extremity of the bitten limb to the other. Making sure the casualty does not move, apply a splint to immobilise the bitten limb. Frequently check circulation.

An icepack should be applied if the patient has been bitten by a red-back spider, but this may not be possible in the bush.

Tips for snakebite
* Check vital signs and follow the ABCDE
* Keep the patient calm and still
* Apply a bandage from one extremity of the bitten limb to the other. Make sure the bandage is tight, then immobilise the limb with a splint. Place the bitten limb lower than the heart and head
* Contact emergency services as soon as possible
* Never try sucking the venom out
* Do not wash the skin, as the retained venom will assist in determining the most appropriate antivenene


CPR

Cardio Pulmonary Resuscitation (CPR) is a technique for rhythmically compressing the heart in order to keep it pumping blood around the body (that’s the ‘cardio’ part), while at the same time giving rescue breaths (the ‘pulmonary’ part). The advised ratio of chest compression to breaths has changed many times over the years, but data from a few years ago suggests that it is better to keep a much higher number of chest compressions.

Those doing CPR are therefore advised to give with two breaths, then 30 compressions (to the rhythm of the BeeGees song, “Stayin’ Alive” – honest!),and repeating until the patient recovers. Techniques change for infants and babies (including smaller puffs and breathing into the mouth and nose) and if you haven’t done a course in CPR for some time, you are advised to do a refresher – it could save someone’s life.

Tips for doing CPR

* Check the airway is clear of obstacles like the tongue
* Give two short breaths, if the person is not breathing normally
* Give 30 chest compressions to the rhythm of the BeeGees song, “Stayin’ Alive”, followed by two breaths
* If there is more than one rescuer, regularly change those who are doing the chest compressions to prevent exhaustion
* Keep going until there are signs of life, qualified help arrives, or it is impossible to continue
* The Australian Resuscitation Council has more guidelines at www.resus.org.au


Source:
AG Outdoor September/October 2009