1. Wilderness Emergencies
Slide Presentation prepared by
Randall Benner, M.Ed., NREMT-P

2. Learning Objectives
List the specific information you should have about the wilderness area you will visit before you leave home.
Explain what kinds of information the first aid leader should have about each member of the group.
Outline basic survival techniques for cold weather.
Discuss special ways of handling food and water while in the wilderness.
© 2012 Pearson Education, Inc.

3. Learning Objectives
List the signs and symptoms of the major altitude-related emergencies.
Discuss special assessment techniques to use in a wilderness setting.
Discuss special considerations for managing shock in a wilderness setting.
Discuss special considerations for performing CPR in a wilderness setting.
© 2012 Pearson Education, Inc.

4. Learning Objectives
Discuss special considerations for managing soft tissue and musculoskeletal injuries in a wilderness setting.
Discuss special considerations for immobilizing a victim in a wilderness setting.
Discuss rescue techniques for the victim of an avalanche.
Discuss the options for wilderness evacuations and the factors affecting the decision to evacuate a victim.
© 2012 Pearson Education, Inc.

5. Introduction
“Wilderness” is a remote geographical location more than one hour from definitive medical care
A broader definition includes anywhere definitive medical care is more than one hour away
Special considerations arise for First Aiders confronted with wilderness emergencies.
© 2012 Pearson Education, Inc.

6. Preventing Wilderness Emergencies
Most wilderness emergencies are preventable.
Proper preparation includes being appropriate equipped and educated.
Always have one person in your group who is familiar and experienced with the location.
Terrain, equipment, weather, resources, etc.
© 2012 Pearson Education, Inc.

7. Preventing Wilderness Emergencies
Plan your wilderness trip according to your needs
Adequate and appropriate supplies are essential (including first aid).
Know how to use communication equipment.
Know the basic health status of each person in your party.
If possible, arrange for more than one person on the trip to have first aid training.
© 2012 Pearson Education, Inc.

8. Basic Wilderness Survival
Rule of Three’s
1. Need for shelter
dress appropriately
avoid canyons or valley floors
avoid ridges or mountain tops
2. Need for water
plan for water purification
assure adequate liquids for every team member
3. Need for food
plan for adequate amounts
handle and store properly
protect from predators; avoid strong food scents
store food away from campsite and off the ground
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9. Altitude-Related Problems
Occurs at altitudes over 6,000 to 8,000 feet
Risk factors include
Genetics
General health state
Altitude attained
Rate of ascent
Symptoms of altitude related sickness include
Noisy breathing
Persistent cough
Nausea, vomiting
Confusion, disorientation, loss of balance
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10. Altitude-Related Problems
Acute mountain sickness
Symptoms mimic a severe hangover
Treatments include
Stop the climb
Descend to 2–3 thousand feet
Hydrate
Take aspirin for mild headaches
© 2012 Pearson Education, Inc.

11. Altitude-Related Problems
High Altitude Pulmonary Edema (HAPE)
Fluid leaks into the lungs, diminishes oxygenation
May not present for hours after reaching altitude
HAPE findings
Dyspnea at rest, cyanosis, moist breath sounds, cough with pink frothy sputum
HAPE treatment
Descend immediately
Seek medical care as soon as possible
© 2012 Pearson Education, Inc.

12. Altitude-Related Problems
High Altitude Cerebral Edema (HACE)
Dangerous buildup of fluid in the brain
Intracranial pressure builds, can be fatal
Symptoms of HACE
Headache, nausea, vomiting
Ataxia, dizziness, fatigue progressing to coma
HACE treatment
Descend from altitude immediately
Seek medical care as soon as possible
© 2012 Pearson Education, Inc.

13. Special Wilderness Considerations
Assessing the scene
Determine the cause of emergency, how to respond, and how to keep yourself safe.
Assessing the victim
Primary survey is the same, take more time for secondary survey.
Use CHART for documenting patient care and response.
Determining a plan
Decide how and where to treat and transport the victim appropriately.
© 2012 Pearson Education, Inc.

14. Special Wilderness Considerations
First aid for shock in a wilderness setting
Follow standard shock treatment protocols (see Chapter 6).
Assess and manage any problems with the airway, breathing, and circulation.
Maintain body temperature control.
Replace lost fluids.
© 2012 Pearson Education, Inc.

15. Special Wilderness Considerations
Cardiopulmonary resuscitation
Difficult to perform in the wilderness
No easy access to ALS care
May need to provide aggressive and prolonged CPR
Consider stopping CPR after 30 minutes unless the following pertain
Hypothermia is suspected
Victim was submerged in cold water for less than one hour
Victim was buried in an avalanche
Victim was struck by lightning
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16. Special Wilderness Considerations
Lightning deaths and injuries
Preventing injury
Know local weather forecast.
Get away from, out of, or off of water.
Put down any metal objects you’re carrying.
Seek shelter – avoid the highest point in area.
First aid care
Follow standard lightening strike treatment protocols (see Chapter 24).
Additionally, in a wilderness setting
assess victim as soon as possible.
begin CPR if in cardiac arrest.
if multiple victims, prioritize those who are quiet or motionless.
© 2012 Pearson Education, Inc.

17. Special Wilderness Considerations
First aid care for soft tissue injuries
Protect yourself from injury.
Assess and manage airway, breathing, and circulation functions.
Use standard treatments for common problems (lacerations, burns, fractures, etc.).
Assess injury periodically if you’re a day or more away from medical care.
Treat wound infection if present, and reapply fresh dressings and bandages.
© 2012 Pearson Education, Inc.

18. Special Wilderness Considerations
First aid care for wild animal attacks
Keep yourself safe and free from attack.
If confronted, slowly and quietly back away
Provide first aid care for soft tissue trauma.
Support ABC’s as needed.
Get the victim to medical care as soon as possible.
© 2012 Pearson Education, Inc.

19. Special Wilderness Considerations
First aid care for musculoskeletal injuries
May be necessary to reduce or align injury (except hip or elbow)
Reducing dislocations should be done as soon as possible after the injury
Stop reducing if excessive pain or stiffness of the joint occurs
Types of injuries the First Aider may have to reduce
Shoulder dislocation
Kneecap dislocation
Finger dislocation
Splint a fracture
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20. Special Wilderness Considerations
Signs and symptoms of spinal injury
Follow standard spinal injuries protocols (see Chapter 13)
Commonly there is pain, weakness, or loss of sensation to arms/legs
First aid care for spinal injuries
Use an improvised backboard if needed.
Provide plenty of padding for comfort.
Keep the victim's body aligned as best possible.
© 2012 Pearson Education, Inc.

21. Special Wilderness Considerations
Avalanche rescue
Avalanches kill by causing suffocation and/or blunt force trauma.
A victim not fatally injured can be rescued if the following pertain
Some kind of air pocket surrounding them
Rescuers act with great speed
There has been no fatal blunt force trauma
Victim is not buried too deeply
© 2012 Pearson Education, Inc.

22. Special Wilderness Considerations
Surviving an avalanche
If alone, search for victim before going for help.
If others present, send someone for help while you search.
Mark where the victim was last seen.
Move to area below this spot, probe the snow with a stick to asses likely burial spots for other victims.
Use a beacon to help find others.
© 2012 Pearson Education, Inc.

23. Special Wilderness Considerations
First aid care for avalanche victims
Keep yourself safe.
Uncover the victim’s head, chest, and stomach.
Assess airway, breathing, and circulation, and support any lost function.
Assess for and treat any external bleeding.
Stabilize the victim for possible spinal injury.
Keep the victim as warm as possible.
© 2012 Pearson Education, Inc.

24. Special Wilderness Considerations
Wilderness evacuation
Call or send for help
Decide to evacuate (rapid or immediate)
Decide how to evacuate (walk, carry, air lift)
© 2012 Pearson Education, Inc.

25. Special Wilderness Considerations
Death of a wilderness victim
Provide emotional support to survivors.
Consider if and how to address survivors' need for some type of ceremony at the scene/time.
Note the time, cause, and location of death.
Protect the body from predators and elements.
Notify authorities as soon as possible.
© 2012 Pearson Education, Inc.

26. Make clear plans on what to bring (food, first aid, etc.)
Summary
Never enter the wilderness without an experienced leader who knows the terrain.
Make clear plans on what to bring (food, first aid, etc.)
Be alert for signs of altitude sickness if traveling to higher terrains.
First aid care often requires you to be resourceful with items available at hand.
Carefully assess and treat the victim, they may be under your care for days.
© 2012 Pearson Education, Inc.