While off on an adventure trip, you would very often be in remote areas, usually far away from medical help and most certainly on difficult terrain. There would be a guide or trip leader and he/she would, if the trip is organised by a reliable, reputed and conscientious provider, be trained and qualified as a first aid responder.
Does this mean that you should not bother to learn the basics of First Aid? I would think not. In my own experience when I was on my first hike in the mountains, with my buddy along, I was somewhere in the middle of the group who were scattered over a 2 km stretch. The leader was out in front and coming up last was his assistant. My buddy suddenly tripped and twisted his ankle. Not knowing what to do, I started massaging his ankle. Now I know that it wasn’t the right thing to do and had inadvertently caused more damage. I’ve had several such incidents over my learning years and these prompted me to develop a good understanding of how to deal with medical emergencies in the outdoors.
So it’s really important for everyone in the group to know something about First Aid on Adventure Trips, whenever you are out there doing something adventurous. One also has to remember that improvisation is the key to First Aid and one should be able to utilize whatever supplies or materials that are on hand and depend heavily on common sense.
Where do we start then?
I would think a good place to start is to learn the Three ABCs. It’s a helpful mantra for recalling the priorities whenever you are confronted with a situation where life-threatening conditions such as a blocked airway, severe bleeding and/or cardiac arrest are recognized and dealt with appropriately. The three ABCs are generally referred to as Airway, Breathing and Circulation, but I found a slightly expanded version useful.
THREE ABC’s
A1 ASSESS the scene
A2 AIRWAY (ensure an open airway)
A3 ALERT others
B1 Barriers (gloves, pocket mask)
B2 BREATHING (check for breathing and perform rescue breathing if necessary)
B3 Bleeding (stop bleeding)
C1 CPR (start CPR if the victim has no pulse)
C2 CERVICAL SPINE (prevent unnecessary movement of head and neck)
C3 COVER and protect the victim from the environment
A1 ASSESS the scene
Make sure that the uninjured members are safe. Assess the scene for any more hazards, like rock fall avalanches, wild animals etc. before starting to administer First Aid. Keep in mind that while attending to the victim, you should not become a victim yourself or in trying to reach the victim hurt them (by causing a rock fall for example). Quickly see what materials you have available and who else can help you with the victim. Take charge.
A2 AIRWAY (ensure an open airway)
Speak loudly as you approach, call their name, tap their hands and feet gently to see if you get a reaction. If the victim is unresponsive, find out if they are breathing by taking your ear close to their mouth. If lying face down, turn them over by rolling them over in such a way that head, shoulders and torso move as a single unit without twisting. (See Figure).
If the victim is not breathing, clean the mouth with your fingers, and open the airway. If trauma is not suspected, the airway can be opened by tilting the head back while fingers of the other hand lift the chin. The most common reason for airway obstruction of an unconscious victim is relaxation of the tongue and throat muscles which causes the tongue to fall back and block the airway.
If trauma is suspected, use the jaw thrust technique to open the airway by kneeling down with your knees on either side of the head, placing your hands on the either side of the victims jawbone and pushing the base of the jaw up and forward.
A3 ALERT others
Before you get too involved with the resuscitation or management, call or send someone to inform others about the incident. If possible, give details of where, nature of injury, your proposed action plan, what kind of help is needed and when you would contact them again.
B1 Barriers (gloves, pocket mask)
To avoid getting infected from blood-borne bacteria, it’s important that you create an effective barrier, such as gloves and barrier device for mouth-to-mouth resuscitation.
B2 BREATHING (check for breathing and perform rescue breathing if necessary)
If the victim is not breathing after establishing an airway, start mouth-to-mouth resuscitation.
B3 Bleeding (stop bleeding)
Check the victim for signs of profuse bleeding. Apply pressure with your gloved hand to stop bleeding. If bleeding cannot be stopped, apply a tourniquet. Remember that the tourniquet should not be so tight as to stop blood flow completely. Loosen it from time to time. Beware that if a tourniquet is applied for more than 3 hours it is like that the arm or leg will get severely damaged and may require amputation.
C1 CPR (start CPR if the victim has no pulse)
Place your index finger on the victim’s throat over the Adam’s apple and slide your finger down to the side of the victim’s neck, somewhere between the Adam’s apple and the neck muscle, you will find the carotid pulse. Hold for approx. 30 secs (60 secs if the victim is hypothermic) and feel for any pulse. If you do not feel pulsation, start mouth-to mouth resuscitation. (We will talk about Rescue Breathing and CPR in the next blog)
C2 CERVICAL SPINE (prevent unnecessary movement of head and neck)
The spinal cord is vital for a person’s life and runs down through the vertebrae in the neck. In case the spine is damaged, it can cause permanent paralysis or death. If there is any chance that the victim’s neck is broken due to the accident or if any of the following are present, the head neck and torso have to be immobilized:-
- Unconscious victim
- Complains about neck or back pain
- Tenderness in the neck or back when touched
- Numbness, tingling sensation in the extremities
- Unable to move, weakness in an arm or leg
- Another painful injury, (thigh, shoulder) distracts the victim form the pain in the neck
If cervical injury is suspected, immediately immobilize the head and neck and prevent any movement. If the victim is in a safe location avoid moving him until professional rescuers arrive.
C3 COVER and protect the victim from the environment
If it is cold, cover the victim from above and below. If it is hot, move to a shade and loosen clothing. If in a dangerous place, move to a safer location, maintaining spine immobilization as indicated.
What to do next
Once the primary survey is done, if a life-threatening situation does not exist, do a secondary survey looking for further evidence of injury or illness. Gently push every part of the victim, looking for pain, swelling or deformity. Once you have all the information, it is time to organise a rescue team and develop a plan for evacuating the victim or asking for professional assistance.
Up next in this series, we’ll tell you what to do in life threatening emergencies, CPR, head injuries, shock, burns, fractures, animal bites, cuts and bruises, illnesses and other helpful tips. So while you wait to learn more, stay safe!
First Aid is essential for going out hiking in the bush or on any adventure. First Aid curses can be done in Canberra with us at Canberra First Aid. Book in now.