Transcript First Aid staying safe in the wilderness and at sea Ann Marie McCartney, MD.

First Aid
staying safe in the wilderness and at sea
Ann Marie McCartney, MD
Goals of First Aid
- Preserve life
- Prevent further harm
- Promote recovery
Goals of First Aid
 Assess your patient’s condition
 Give appropriate urgent treatment
 Make decisions regarding medical
evacuation
 Provide on-going patient management
Wilderness vs Urban First Aid
PITFALLS
 You can’t count on help arriving soon.
 Medical care is more than one hour away.
 May have to care for your patient for hours or
even days.
 Materials & equipment may be unavailable; you
may need to improvise.
 In the wilderness, we may need to give care that
would be inappropriate in the urban setting.
First Aid Concepts
CONSENT
 You must get patient’s consent to be able to
help them.
 Remember to approach from the front of
the patient.
 “I am trained in first aid, may I help you?”
 If they say “no”, you can not help them!
 If unconscious, assume consent.
 Try verbal and then pain stimuli if patient
not alert.
First Aid Concepts
 PATIENT
 Never use the term “victim”.
 Use the patient's name – don't speak of
the patient in the 3rd person.
 As much as possible, include the
patient in all decisions and discussions.
 Don't step over your patient!
(walk around)
PREVENTION
 Take necessary precautions to prevent the need for
First Aid
 Have a First Aid kit and know its contents and how to
use it
 Know your partner’s medical history and what
medications they may need in the event of an injury
or illness
Patient Assessment System
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Scene
Size-up
Initial Assessment
Stop and Fix
ABCDE
SAMPLE
Head-toVital Signs
OPQRST
toe Exam
Document and Monitor
Scene Size Up
• Scene Safety
– Is the scene safe to enter?
– For you, your partners, and the patient?
• If not, how can you get the patient to a safe
location without causing further injury?
BE CALM AND METHODICAL
 Spread calm. Be a good role-model.
 PANIC is contagious!!!!!!!
 Walk, don't run
 Don't make more patients!
 Act with purpose and forethought.
 Take an active roll and look for ways to help.
Why is it important to know First Aid?
Accidents can be beyond
our control.
Our response to them is
always in our control.
Accident Assessment
 Treat life-threatening conditions immediately
 Non-life-threats can be treated after the
full assessment is complete.
 Steps: A B C D E2
 Obtain consent / establish responsiveness
 Airway
 Breathing
 Circulation and Deadly Bleeding
 Decision about spinal injury
 Environment / Expose injury
INJURIES
Burns
Trauma
Wounds
Burns
 Thermal, chemical, radiation, electrical
 Tissue injury depends on intensity of
heat and length of exposure
 Assess depth and extent of the burn
Burns
 Superficial – confined to the epidermis
 Skin is red, painful and without blisters
 Blanches white with pressure
 Heal in 4-5 days with peeling of the epidermis
Burns
 Partial thickness – involves epidermis and dermis
 Skin is red, mottled, wet, blistered, blanches white
 Blisters can develop immediately up to 24+ hours later
 Can take 5-25 days to heal or longer if becomes
infected
 Evacuate if burns are on the hands, feet, face, armpits
or groin or if greater than 10% of the body
Burns
 Full-thickness – penetrate to the subcutaneous tissues
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Skin is leathery, charred, pearl gray and dry
Area is sunken with a burned odor
Not painful as the nerve endings are destroyed
Can have painful surrounding superficial burns
 Evacuate for these burns
Burns
 Location
 Head and neck burns are dangerous and can
lead to airway problems
 Burns to the hands and feet can lead to loss
of function
 Circumferential burns of the extremities can
impair circulation
Treatment of Burns
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All types generally treated the same
PUT OUT THE FIRE: stop, drop, and roll
Remove clothing and jewelry which can retain heat
Check the airway – think about inhalation injury
Cool the burn: cool water or wet clothes
 Avoid hypothermia. Don’t put ice on skin.
 Clean and dress the wound; change daily
 Watch for signs of infection
Inhalation injury
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Occurs with breathing in hot air, gases or particles
Look for soot, airway redness and swelling
Listen for cough and noisy/rapid breathing
Always requires evacuation if suspected
Symptoms may be delayed up to 24-48 hours
Sunburns
 UVB and UVA radiation
 Water reflects 2% of radiation when overhead and
more when the sun is lower
 Clouds filter out infrared heat radiation (your skin
feels cooler) but UV light penetrates the cloud
coverage
 Phototoxicity from medications
Sunburns
 PREVENTION
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Apply sun cream 30 minutes before exposure
Consider sunblock for lips, nose, forehead, ears
Wear a hat, SPF clothing
Sunglasses with 100% UV protection
 TREATMENT
 Cool, wet dressings
 NSAIDs
Head / Spinal Injury
When to consider:
 Fall greater than 3 feet, landing on the head,
back/side or buttocks
 Falls or impacts associated with loss of
responsiveness/altered mental status
 High velocity impacts
 Head injury
 Numbness or tingling in the extremities
 Patient was found unconscious
 You did not witness the accident
Spinal Injury
If you are unsure about a
spinal injury, do not move
the patient; immobilize and
seek help
Wounds
 Closed Wounds
 Contusions and hematomas
 RICE
Wounds
 Open Wounds
 Abrasions: cover with ointment and dressing
 Lacerations: need sutures if skin gaps >1 cm
 Punctures: leave impaled object in place unless
obstructs breathing, prevents bleeding control
 Ensure your Tetanus vaccine is up to date!
Wounds
 Treatment for open wounds
 Control bleeding
 Protect yourself from body fluids: gloves, plastic bags
 Direct pressure and elevation
 If dressing becomes saturated, add more dressings
 Clean the wound – this is a priority!
 Irrigate with clean water and rinse with disinfected water
 Apply ointment
 Bandage without cutting off circulation
Wounds
 Monitor for infection for 36 hours
 Minor: redness, swelling, pus, heat, pain
 Can apply heat and elevate the area
 Monitor for progression; evacuate if not improving in 12h
 Serious: evacuate
 Red streaks radiating from the wound
 Fever, chills
 Lymph node swelling
Medical Illnesses
Anaphylaxis
Hypothermia
Lightening
Anaphylaxis
Severe immune system response to an allergen
 Signs and symptoms
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Difficulty breathing
Itching, flushing, hives, swelling
Swelling of face, tongue, and/or lips
Nausea, vomiting, abdominal cramps
Changes in Level of Responsiveness
Anaphylaxis
 Treatment
 Antihistamine ASAP!
 Epinephrine may be required to allow
administration of the antihistamine.
 PROP
 Position of comfort / Reassurance / Oxygen /
Positive pressure ventilation
 Remember ABCs
 Initiate evacuation
Hypothermia
 Can occur whenever heat losses exceed heat gains
 As common in the wind, rain, and hail of summer as
the cold of winter
 DON’T LET AMBIENT TEMPERATURE FOOL YOU
 Signs:
 Shivering: can deplete fuel resources if not corrected
 Decreased response times as body cools
 Obvious mental status changes as it progresses
Hypothermia
 PREVENTION
 Treatment is difficult if progresses beyond mild stage
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Keep patient dry
Protect from wind
Provide hot drinks
Hypothermia wrap
Lightening
 Unpredictable and powerful
 Mange risk by reducing exposure
 Avoid storms – lightening can strike miles ahead or
behind storms
Lightening
 Injuries due to direct hit, lightening splash, direct
transmission, ground current, blunt trauma
 Burns can be superficial to full-thickness
 The respiratory center of the brain can be injured
 Respiratory and cardiac arrest
 CPR: heart may restart before breathing resumes
give rescue breaths
Good Samaritan Laws
 Legal protection in Oregon and Washington provided by:
 “Good Samaritan” laws
 Volunteer Protection Act
 Laws applicable to “emergency medical assistance”
 Care given in patient’s best interest
 To protect yourself:
 Obtain consent
 Stay within scope of training
Prescription Drugs
 You can NOT give prescription drugs
 Includes sharing your drugs or those of others.
 You can NOT administer prescription drugs
 You can HELP a patient take THEIR drugs
 Includes locating their drugs and preparing dosages.
 You can give over-the-counter drugs
 Important to check allergies and medications before
administering.
 Obtain patient consent and discuss reasons for use.
Psychological First Aid
 Stress response to a traumatic event
 Physical, emotional, cognitive
 Delayed stress responses
 Critical Incident Debriefing
 Find a qualified mediator
 Understand that the reactions to a traumatic event
are natural responses to an abnormal event.