Tag Archives: wilderness first aid

Backcountry Impalements

Whether from Sticks or stakes, branches or rebar, impalements can be a backcountry problem to contend with. In the field of wilderness medicine, there are specific protocols pertaining to impalements and how to manage them in a remote setting. These guidelines are attributed to the assessment and location of the impalement injury.

tent stake to the arm

Core impalement. Impalements to the head, face, trunk and other core parts of the body are usually left in place. Primary focus should be on bleeding control and secondary efforts to stabilize the object in place with sterile bulky dressing. Minimizing movement of the impalement will help to reduce subsequent damage. In some cases when the impalement is from a larger object, consider reducing the size of the object to facilitate evacuation. Impalements to the eyes get special attention. Not only does the object require stabilization in place over the affected eye, but the unaffected eye needs to be covered since movement of one eye is linked to the other.
Extremity Impalement. Wilderness medicine guidelines suggest that impalements to the extremities can be removed to facilitate evacuation. If your patient can or needs to self evacuate, prior removal of the impaled object can help. Proper wound management will help minimize the risk of infection. In some cases extremity impalements remain stabilized in place.
Basic Life Support. Any impalement that interferes with a basic life support intervention can be removed. For example, if CPR is indicated based on patient assessment, and an impalement would impede proper CPR, the removal of the impalement is acceptable

Some common impalements in the wilderness result from tree fall and falls onto downed trees, campfire related tools and objects, and slips and falls along riverbanks where beavers have left behind sharp stubs. Recognition of potential threats and prevention can help to reduce the likelihood of impalements.

Southern Sierras: Sierra Rescue Expands presence

Sierra Rescue now has a stronger presence in the Southern Sierras. Sierra Rescue’s Zach Byars recently moved from Northern California and now is based in Ventura, California. This move has opened the door for more rescue trainings on southern sierra rivers such as the Kern and the Kawhea. Combined with the fact that both of those drainages hold running water this year, the southern training grounds are prime. Los angeles based Uber adventures has sent numerous participants to the Kern for whitewater rescue training this spring where participants hone techniques for descending Whitewater Class-C canyons. In addition to canyoneers and other outdoor enthusiasts, Southern California rescue agencies are sending personnel to the Kern for training that is a little closer to home.

The Kern provides an excellent and diverse training location with more than 60 miles of accessible terrain. Whitewater rapids ranging from class 2 through class 5+ affords the right challenge for any adventure seeker. The diverse nature of the river corridor is perfect for the wide ranges of classes that we teach. Between the upper Kern and Lower Kern is the town of Kernville, which serves a jumping off point, and base camp for all sorts of outdoor recreation. We are pleased to maintain a more consistent presence the southern sierras and strive to provide the best possible training courses for our students. Find a class and come train!

souther sierras swiftwater rescue- Kern River

Southern Sierras swiftwater rescue- Kern River

Wilderness Medicine Skills: Splinting

One of the key characteristics that defines a “wilderness” location, apart from the 1 hour away from definitive medial care, centers on the lack of available resources and the necessity to improvise. Though field teams and expeditions may have some first aid / rescue gear with them, in emergency situations there is very seldom a surplus of supplies. “Make do with what you have,” counters the Boy Scout mantra of, “always be prepared.” In the field of wilderness medicine, we teach students how to assess musculoskeletal injuries and treat them. In many cases treatment involves splinting. The focus of wilderness splinting centers on the need to restore good circulation and sensation, prevent further damage while attempting to make an unstable and unusable extremity more stable and more usable.

If you broke down the resources needed to build immobilization splints, they would fall into 3 main categories: 1) Rigid components, 2) Soft padding, and 3) wrappings attachments and coverings.

Rigid Components. Don’t overthink this one. Something that doesn’t flex too much will retain rigidity and support the injury. Sticks, Poles (trekking / skiing / tent) can do just that.
Soft padding is the key to comfort. It protects the appendage from further damage and occupies dead space in the splint. Gauze, clothing, foam, pads, moss, are some of the materials utilized for this purpose.
Wrappings and attachments are the key to a good splint, without which would fall apart. Ropes, string, braided vines, straps, strips of clothes all can be used to hold the splint together. Ideally the attachments are adjustable in some capacity. A few basic knots can really enhance your ability to build good splints.

Materials you may find in a first aid kit for splinting are a SAM splint, ACE bandage, and tape. These materials can get you started, but there may be a need for more. Devise and improvise.

If you’re taking the time to build a splint in the field, take the time to build it right the first time. A good splint should: Look good, Feel Good, and Work. A splint that works provides support and stability to the patient’s injured area and maintains or restores good circulation and sensation. Splint-building should be a fun puzzle and challenge yourself to make the best one you can. Your patient will thank you.

Winter Instructor Training?

One of the greatest things about being a co-owner of Sierra Rescue, are the incredible folks that we get to work with. Although Abigail and I are the only employees of Sierra Rescue, we get to work with the absolutely most INCREDIBLE Independent Contractors, and have an amazing Sierra Rescue family that extends beyond National and International borders. Our network of folks that we talk with, work with, and are friends with makes me one of the luckiest people in the world!

Here is a quick check in on where some of our amazing affiliates are, and what they are up to right now.

Zach Byars is on one of the most incredible journeys of ALL! Lila Marie Byars was born a couple short weeks ago, and is already in training as the next generation! Zach and Tessa have moved to Ventur Zach and Lila a, and Tessa is now a very important part of Patagonia https://www.patagonia.com! A Company we believe in and support 100%. Although Zach is very happy to be at home now, he is getting out next week to teach an Awareness course sponsored by a UASI grant, http://www.sandiego.gov/fm/annual/pdf/fy14/vol2/v2ohs.pdf, to help keep the folks down in San Diego County more safe! Congratulations Zach!

Don and Theresa exploring!

Don Lester After teaching a Wilderness Medicine https://sierrarescue.com/course-info/wilderness-first-aid-courses/ and Whitewater and River Rescue https://sierrarescue.com/course-info/swiftwater-rescue-courses/ Instructor course for our Malaysian affiliate, Nomad Adventures nomadadventure.com and Rescue 3 Asia http://rescue3asiapacific.com over near Kuala Lumpur, Don is currently exploring the islands off the coast of Indonesia, with his wife Theresa! As I write, they are most likely Stand Up Paddleboarding around the Island of Komodo checking out the Komodo Dragons. Don will be back in February to start a full season of teaching!

Jessica Stoll is usually in Chile at this time of year working with the incredible Long Family! http://cascaderaft.com. Tren, Chad and Kenneth, who are also Rescue 3 International and Sierra Rescue Instructors, are currently training for the OLYMPICS! Yes, it is true! OC1 and OC2

Jess! Always smiling!

Tren, Chad and Kenneth can be supported at their Facebook page. https://www.facebook.com/longfamilyracing/

Jess is currently working at Sierra At Tahoe http://www.sierraattahoe.com as a ski patroller in preparation for Paramedic school this summer. Today, she is in Angels Camp teaching a WFR recert to OARS www.oars.com Grand Canyon guides. As always, she is permanently smiling and loving life!

In other news! Aaron Root is just back from a pack rafting expedition with the owner of Salt River Rafting http://www.raftingsaltriver.com, James, and will be back with us this month, and out on the Salt River during the AWESOME season that is happening out there.

Abigail and I are headed to New Zealand to reunite with one of our favorite people in the WORLD! Rachael Moore! Rachael works to keep New Zealand rivers safe, and keep the river guide requirements in New Zealand some of the best in the world! Can’t wait to see you Rachael!

More coming soon on other Sierra Rescue https://sierrarescue.com/about-us/our-instructors/ and Rescue 3 International http://rescue3.com Instructors!

Swiftwater and Flood Rescue Training for El Nino

BORSTAR Commanders training together with RDC, River Boards, and Rafts

As we head into the potential of an El Nino year, our Sierra Rescue classes are filling up with Lifeguards, Fire Fighters, and many Government employees being sure they are as prepared as possible for the hazards that an El Nino year may bring with it. Our Swiftwater and Flood Rescue courses teach such skills as self rescue, hazard assessment, flood search and rescue, vehicle rescue from floods, and other useful skills to review for the rescuers involved. With the current low flows, it takes creativity to help rescuers prepare for floods and rivers that soon may not be safely accessible for the rescuers at all.

Self Rescue practice in Swiftwater Rescue Training

Besides Swiftwater and Flood Rescue Advanced training, Surface Water Rescue is an important component to being ready for more water in the West. Lakes, ponds, and inland waterways become inundated with water, and knowing how to safely use adjuncts, effective search techniques, and having exposure to the rescue tools available can great increase the “tool box” for the rescuer.

Surface Water Rescue Training with a rescue board

CPR, First Aid, and even Wilderness First Aid skills become essential for assisting once the rescue is complete. The more members of the public that are trained to recognize the hazards associated with immersion, submersion, and hypothermia, the more help there will be, and the better chance that more people will be able to prevent further complications once someone is safely on shore.

CPR, First Aid and Wilderness First Aid training along the banks of a river in winter.

Due to the PET ACT passed by Congress after Hurricane Katrina, more technical animal rescue training has become available for rescuers. Floods and high water years can cause sink holes in some areas of the Country, and a higher exposure for horses, cattle, and other large animals to get stuck in the mud. Great tools are now available to help with relieving suction as well as getting a wide harness around an animal. Also, due to the PET Act, rescuers are much better prepared to bring along all the family pets.

Technical Large Animal Rescue training in the mud.

Motorized boats become a great tool for accessing folks after the initial phase of flooding is over, and the speed of the water settles into a safely navigable waterway. There are many Flood Rescue Boat Operators that are updating their skills, and preparing their boats for quick deployment.

Wilderness First Responder

This spring we have been busy with our wilderness first responder courses. Beginning this past January we have taught 6 full first responders and 4 WFR re-certs. Most recently we hosted a Wilderness First Responder in Coloma, Ca. Consistent with most of our wilderness medicine classes, the WFR was a fast paced, hands-on action-packed 10-day study of back country medicine.

Students hailed from a variety of California locales with a few joining from out of state. As an instructor it is really rewarding to watch the training unfold and to see the students’ progression. We strive to make the scenarios realistic and relevant to the places that the students spend time. In this past class we had a burning man collapse, an avalanche multi- victim burial, and an icefall incident, to name a few. Navigating the patient assessment system, and jumping into responder mode isn’t necessarily an easy transition, but with time and practice, theses guys made good progress.

Another highlight of the WFR is the night search operation. Usually this drill takes a few hours and lets students navigate the difficulties of working at night. Bottom line is that communication and lighting are huge impediments to working at night. hazards are heightened, and even simple things become difficult. If you spend time working or recreating in the wilderness, the WFR certification is for you. It has become the gold standard industry-wide. Come train and practice your backcountry first aid skills, sharpen your patient assessment technique, and and hone to stabilize and improvise. We’ve got several courses coming up this spring and several more this fall. Check out our website, www.sierrarescue.com, for schedule and upcoming courses.

Hypothermia: kicking the cold

Weather and water can be unpredictable, and often paddlers are caught off-guard by an unexpected storm or an unplanned swim. With cold related problems, good prevention is key, and understanding how to manage hypothermia is an important skill for guides and paddlers alike. Different texts define the stages of hypothermia in slightly different ways, the discussion below focuses on the signs that may be visible in your guests and paddling partners.

thermal protection to prevent further heat loss

Keep in mind the 4 ways that a body can loose heat:

Radiation – we “emit’ heat much like the sun gives off heat
Convection – heat loss is 25x greater when submersion in water.
Evaporation – moisture interacting with air and thus reducing body temperature (sweating or splashes on the skin)
Conduction – contact will transfer heat until the temperatures reach equilibrium

In the early stages of hypothermia the patient is awake and visibly cold; their body is burning any available ‘fuel’ and is taking steps to stay warm. Remember that shivering is a way for the body to try and create heat.

The “umbles” As heat loss eclipses heat production, the body starts to prioritize blood flow to the core of the body and decreases circulation to the extremities resulting in loss of fine motor skills (dexterity) and speech. We call the resulting signs the umbles; mumbling, stumbling, bumbling and fumbling.

Hypothermia is life threatening, and if a person continues to loose heat, the core temperature will to drop as hypothermia progresses into later stages. Shivering will become violent and uncontrollable before it eventually stops. As the body’s last-ditch effort to warm itself is exhausted more pronounced changes in the level of consciousness are visible.

If your patient is awake, get the person up and moving to increase metabolic output. Give this person fluids and feed him/her, starting with simple carbs and then progress to more complex foods. The best way to start warming someone up is from the inside out, starting his or her internal engine. Prevent further heat loss by removing any wet clothes and replacing them with dry insulating layers. Don’t forget that even a small thin wet layer can continue to suck heat out of the patient. Use of a hypo-wrap with vapor barriers and waterproof materials can help keep heat in, and radiant heat sources can be added such as warm water bottles or rocks.

Lastly, here are a few hypothermia tips for commercial raft guides

If you are cold as the guide, your guests are freezing. Remember they get the brunt of the water and splash and are cold.
Keep guests hydrated and fed even on warmer trips to keep those fuel sources stocked.
Assess your crew and identify poor layering choices like cotton before hitting the water.
Look for the signs and catch it early.

Hypothermia can strike anywhere anytime, and given the temperature of the water that people flock to for recreation, it always a potential problem. Have the right gear, and be aware of problems before they arise.

Wilderness First Aid: Improvised Splints

Splints: The good the bad and the ugly

Building a good splint takes time and thought. In our wilderness first aid courses some students do lots of both and still the end result leaves something to be desired. This post discusses improvised splints and gives some tips to building your own. Over the last 6 years teaching Wilderness First Aid, I’ve seen it all. I have also made some useful splints in my 10 years guiding commercial wideness raft trips.

What makes a good splint

A good splint satisfies three main criteria:

It is comfortable. That is to say that it fits well, and feels good to the patient.
It is functional. A good splint should provide that stability and support, while immobilizing the affected area.
It should look good. Style points for splints that look good and stay looking good during an evacuation. this means that they don’t fall apart or come undone overtime.

Get wise and improvise

knee splint with pfd

Improvisation is one of the key components to being good first responder in the wilderness setting. The bottom line is that we don’t have all the gear we wished that we did when a situation arises. The ability to assess and address with what is available to you in the backcountry is a skill that can be taught, but is more likely honed over time spent in the field. “RGI” or River Guide Ingenuity as guides like to call it takes creativity and critical thinking. Find a way to make it work.

Here are a few improvised uses of common place items on a boating or backpacking trip for splinting.

Raincoat / jacket
Crazy creek chair
ski /trekking / tent pole
lifejacket pfd
t-shirt / sweat shirt
paddle
Backpack / belt pack

Splint Style and Construction

From a materials standpoint, a splint has three parts: padding, rigidity, and something to hold it together / cover it up. The classic “sandwich” style splint utilizes these three layers in the above mentioned order to immobilize an injured area. The bigger the bone you are trying to immobilize the more holding power you’ll need. Security is a huge deal. Sure NRS straps work great because you can tension them and adjust them, but we don’t always have them, so be prepared to use string, rope, shoe laces t-shirt strips to secure the splints you build.

If a pad thermal rest or float bag is available you can try the “jelly roll’ splint. This style you roll up bulky padding and tension it (often with a rigid component inside) around the affected area.

Splint Tips: a few reminders.

Check circulation sensation and mobility before and after you build splint. Continue to monitor CSMs.
Immobilize the bone above and below a joint injury and the joint above and below a bone injury.
For leg immobilization the rigid components should be as long as they can without interfering with walking. (for example: hip to toe on the outside)

Zach’s EMT Course. Front-Country vs. Backcountry Medicine

This past fall, I took my first EMT course. It was a fast-paced intensive class that took place in Fremont, California and was offered through Unitek College. I loved it. I found that my background and experience as an instructor of wilderness medicine with Sierra Rescue gave me an upper hand in some of the BLS and patient assessment aspects of the course. Other arenas I was pushed to the max to find space to cram lots of new information.

My favorite part of the entire 3-week course was ‘trauma Sundays.’ On these 3 days, we ran mass casualty incident (MCI) scenarios all day long –12 hours worth. The instructors brought on additional proctors and lots of volunteer patients. It was an exhausting marathon of triage, treatment, and transport.

Staged and ready for Trauma Sunday. EMT training

One of the Trauma Sundays featured a crane moving cars for motor vehicle accident (MVA) scenarios, ALS and BLS ambulances arriving on scene for transport, and a surprise arrival of Stanford’s Helicopter. I haven’t spent much time operating with helicopters and it was impressive to see how chaotic the scene can become when the ALS ship arrived.

staging the first scene of Trauma Sunday. Unitek Education EMT course

Throughout the course I kept trying to draw ties to the ‘wilderness’ component which pertains more to my life and the courses that I teach. It was interesting to see firsthand how much front-country medicine relies on two things: diesel and oxygen. If it’s serious you ‘load and go,’ and you almost always give oxygen. These two mainstays of front country medicine are almost never available to us in the wilderness. Transport is hardly ever “rapid” and the best “oxygen supply” we typically carry is in the air we breathe. Given these parameters, when faced with a serious incident in the backcountry. the importance of getting the help you need early in the is paramount, as is the ability to provide treatment and keep your patient as stable as possible.

Overall, it was an awesome course. It gave me some good perspective, provided me with some additional teaching tools, and allowed for my first experiences as a ride-along on the ambulance. It peaked my interest in continuing down a medical path and the possibility of paramedic school. I’m looking forward to teaching my next Wilderness First Responder course this fall.

Post by: Zach Byars, Instructor

Swiftwater Hazards: Strainer Face

Strainer Face: Up Close and Personal

This past spring our strainer swim self-rescue drill (aptly named ‘Strainer Face’) became a prominent feature in our social media and photo posting. For those of you that have been on the upstream side of the log in the training you can speak from experience. For those of you that haven’t, “a picture is worth a thousand words.” #strainerface gets lots of hype and from a teaching standpoint, is a great way to demonstrate the power of water and the extreme danger strainers present to the unsuspecting swimmer. Avoid anything that acts like a strainer at all costs, and know where the potential strainers locations are on the rivers you run. Here are some standout Strainer Face photos. We have several more albums up on our facebook page and you can come participate in the strainer drill by taking one of our many swiftwater rescue courses. We’d love to see you out there. -ZB 7/2014

We hope you enjoyed the above Strainer Face photos. Strainer Face strives to capture the impact moment of the swimmer and the log and the expression that accompanies that precise moment. Strainer Face is typically captured during the first phase of the strainer drill where students float into the strainer in a feet-first defensive position letting their legs sweep under the strainer. From there they attempt to get up and over the strainer. This segment usually provides exceptional photos of anguish and grimace while the student gives all he or she has to try and defeat the strainer. It truly is and eye-oppening experience. See you on the water!