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ziphius Posts: 911
9/21/2012
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Hey gang. I wanted to pass along my experiences with a 4-day course / certification I completed this week, for 3 reasons:
1) What I learned is pertinent to the Anza-Borrego backcountry and any other activities where you are >2 hrs from 'definitive medical care'.
2) I would not want to spend time in the backcountry with people who lack this kind of training. (I had no concern about this prior to this course)
3) I've never taken a better course IN ANY SUBJECT in my whole life.
The course is offered by Wilderness Medical Associates (link at end of msg) and I've never learned so much from any course in such a short period of time. They also offer a 2-day Wilderness First Aid course. What you come away with from this course could save your own life and the lives of people you run into anywhere you travel. There is a ton of hands-on "patient assessment drills", where you, as the rescuer, come upon the patient, not knowing what is wrong. You are taught basic medical bedside manner and communication so that you can effectively treat patients who might be combative, confused, or unable to communicate with you. We also learned how to diagnose problems for every critical body system (circulatory, respiratory, nervous). The instructors are amazing and they are practicing rock-climbing guides, ski rescuers, river guides, etc. So, they've got real-world "street-cred" dealing with medical problems in the backcountry. The instructors are also gifted in their ability to debunk many medical myths that could otherwise harm patients if implemented. Here's one example (from about 20) of a patient assessment drill that we ran:
Our group of rescuers consisted of 14-15 camp counselors. We had 7-8 kids. The ratio was unrealistically in our favor. Kids were throwing rocks at a hornet's nest in a tree and all of them were stung. Most of the counselors were stung too, because we were stupid enough to rush into the scene to pull the kids away. The kids were already running away from the scene and we should have encouraged them to keep running. Kids are great at running, heh? Each kid had to be quickly evaluated for whether or not their stings and resulting hives were indicative of a mild / severe allergic reaction, or worse, anaphylactic shock. Pulse and breathing were evaluated and monitored. Counselors had to report to the lead medical counselor to request drugs. At our disposal were Benadryl, Prednisone, and epinephrine (Epi-pen form). Only the kids in true anaphylactic shock require epinephrine, all others could be treated with Benadryl and perhaps prednisone. Little kids might hyperventilate because they are experiencing an acute stress response to the stings, but the fact is, THEY ARE STILL ABLE TO BREATHE! Short story is that some counselors panicked, and TREATED FIRST and EVALUATED SECOND, meaning that at least one kid that didn't need epinephrine was given it (not harmful). But that meant that my camper died. The lead counselor only had 2 epi-Pens in the medical bag (which is normal for a group of this size or even bigger groups - we later dubbed our camp name "Camp Cheapskate"). My camper did not initially show signs of breathing difficultly. It looked like a normal allergic reaction. Once he showed signs of breathing difficultly, my colleague ran for the epi-pen. We did everything right. We ended up performing CPR on him, which was useless at that point, because his airways were too constricted by swelling, even after we had administered Benadryl early on. The counselors acted independently with each kid, when we should have communicated between counselors to COLLECTIVELY EVALUATE the kids (essentially field triage). We also put ourselves in danger, because we didn't know if any of the counselors were prone to anaphylaxis. Camps always ask parents to fill out medical forms for the kids, but do the counselors themselves know who among them is severely allergic? During the episode, not a single counselor asked the lead counselor the simple question "Do we have a history of anaphylaxis on any of these kids' medical forms?" A little organization could have gone a long way. Most classes fail this drill. I can't say enough about this course. - Jim
http://www.wildmed.com
<em>edited by ziphius on 9/21/2012</em>
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http://www.coyotelearning.org
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anutami Posts: 491
9/21/2012
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Great stuff, thanks. I always have an epi pen for my daughter who is allergic to bees.
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anutami Posts: 491
9/21/2012
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Ziphius,
Looking at the cost of the course in idywild or Japan..seems expensive! Especially considering I wanted my family (x4) to do this. Will you take us through the course this winter?
Thanks,
Nolan
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ziphius Posts: 911
9/22/2012
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anutami wrote:
Ziphius,
Looking at the cost of the course in idywild or Japan..seems expensive! Especially considering I wanted my family (x4) to do this. Will you take us through the course this winter?
Thanks,
Nolan
Yep, these courses aren't cheap. But they are worth it. What I didn't realize is that much of the material from the course was sitting on my bookshelf at home. Rick Curtis wrote a book called "The Backpacker's Field Manual" which has a first aid section that borrows heavily from Wilderness Medical Associates curriculum. Funny how I read only the sections on dehydration and hyponatremia (and the camp recipes) since I have owned the book. Our instructor concluded our course by making fun of the tendency of campers and hikers to put more thought into what they are going to eat on their trip than issues like what is actually in their first aid kit. Or if they are even carrying a first aid kit. - Jim
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http://www.coyotelearning.org
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dsefcik Administrator Posts: 2622
9/22/2012
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ziphius wrote:
Our instructor concluded our course by making fun of the tendency of campers and hikers to put more thought into what they are going to eat on their trip than issues like what is actually in their first aid kit. Or if they are even carrying a first aid kit. - Jim
Last year I finally put a first aid kit in my pack...still wondering what I will use those alcohol pads and sunscreen for....a roll of duct tape, a staple gun and a bandanna might still be the best kit I have. Of course the Jack Daniels compliments the staple gun and duct tape.
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http://www.sefcik.com
http://www.darensefcik.com
http://www.carrizogorge.com
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anutami Posts: 491
9/22/2012
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You forgot the Item most important than even duct tape or Jack Daniels TWEEZERS!
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dsefcik Administrator Posts: 2622
9/22/2012
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anutami wrote:
You forgot the Item most important than even duct tape or Jack Daniels TWEEZERS!
Actually I just carry a razor blade, it has multiple functions like gouging out something tweezers would work hard at......and if you gouge too deep you always have the duct tape and staples to fix it......
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http://www.sefcik.com
http://www.darensefcik.com
http://www.carrizogorge.com
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ziphius Posts: 911
9/24/2012
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anutami wrote:
You forgot the Item most important than even duct tape or Jack Daniels TWEEZERS!
We did an exercise that simulated cleaning wounds and lacerations (the instructors gave us pigs feet with puncture and laceration wounds). We rolled the pigs feet around in the dirt, jammed sticks into puncture wounds, etc. Tweezers were 'muy importante' in this task. Tweezers help you hold open certain wounds so that you can effectively flush out debris from the wound (drinking quality water is best, as full-strength 10% povodone iodine will kill tissue. 1% povodone iodine is better than nothing, but you should dilute 10% iodine for flushing wounds). Of course, a high-powered syringe filled with water was the second most important piece of equipment in this task. It really allows you to get embedded junk out of the wound. I don't have a syringe in my first aid kit, but will be including one. Underestimating infection risk in the backcountry is a no-no.
Good tips for what to have in your kit: http://www.wildmed.com/blog/building-a-wilderness-first-aid-kit/
<em>edited by ziphius on 9/24/2012</em>
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http://www.coyotelearning.org
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