Tag Archives: wilderness first responder

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

tent stake to the arm

  1. 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.
  2. 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.
  3. 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.

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.

IMG_9819_2 IMG_8577_2

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. 

  1. 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.
  2. 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.
  3. 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.

IMG_7559splinting

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.

IMG_5851

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 VenturZach and Lilaa, 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 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!

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!

 

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 EMT training Unitek Educationbackground 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.

EMT gear

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.

MVA EMT training

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.IMG_2477

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

WAFA with HRR: Springtime in the Grand Canyon –

WAFA- Wilderness Advanced First Aid  with the  HRR – Hualapai River Runners in Peach Springs, AZ

Abi and I drove the Sierra Rescue rig down through Nevada across the Colorado River at Hoover Dam and into Peach Springs, AZ for two weeks of wilderness advanced first aid (WAFA) and swiftwater rescue training with the Hualapai River Runners. We’ve been running trainings for the Hualapai for quite some time now, and its always good to get back to the big ditch.

HRR WAFA group shot

The group showing off their hypo wraps

WAFA: The group inside the warehouse, after arts and crafts with splints

The group inside the warehouse, after arts and crafts with splints

Wilderness first aid hypothermia wrap

All bundled up and warm in the hypo-wrap

WAFA skill: reducing a shoulder

That’s one way i wouldn’t advise reducing a shoulder

It was a great four days of WAFA (Wilderness Advanced First Aid Training). On the fourth day we finished the class with a big mass causality  incident involving a simulated train vs buss collision. Trauma! Moulage! Fun! Students had to triage and figure out some difficult extractions from the broken down bus where we staged the scenario. Weather was great, a gave us the first taste of spring.  Julie and Zach swapped places and Julie will join Abi along with a few flagstaff locals for the swiftwater rescue portion of the course which will involve 2 days of on-site  training and a downriver overnight from Diamond Creek to Pierce Ferry.  Load up those big blue pontoons and have a some fun!

Wilderness First Responder Course in Flagstaff, AZ

Julie and Abi just returned back from Arizona. They had a bunch of great courses down in Flagstaff and on the Salt River.

They ran two Wilderness First Responder Recertification courses (WFR-recert) for both Canyon Explorations and Arizona Rafting Adventures (AZRA Discovery).

The Can-X class had it’s challenges with the weather as it snowed heavily for the first two days. AZRA lucked out the following weekend with sunny days. You’ve got to love the classic Flag spring weather. Below are some images from the classes.

Check out the use of cam straps to really get a patients hips down. It works great but does take a bit of practice!!

Thanks to everyone for welcoming us into your warehouses, your homes and of course your minds. We love being down in Flag, it is a home away from home.

Thanks to both Cam, Laurie and Garrett Staveley and Justin Saloman over at Can-X and Alex and Fred Thevinin and Dennis Smoldt over at AZRA for continuing to support us and use Sierra Rescue/Rescue 3 West as their go-to Wilderness Medical provider.

Huge hugs to you all and see you next year!!