Reading a New Book on Backcountry First Aid- Opinions? Suggestions?
Given that many of my hobbies (Jeeping, hiking, climbing, camping) put miles and miles of rough terrain between myself and any responders, I have picked up the following book to try and brush up on knowledge and skills I might need for emergency situations that I might encounter while in the middle of nowhere:
Wilderness 911 by Eric A. Weiss, M.D.
Does anyone here have an opinion on this book as well as others that I should look into?
Thanks!
__________________ Ignorance leads to Fear
Fear leads to Anger
Anger leads to Hatred
Hatred leads to WHARRGARRBL!!
One of my hunting buddies is an ER trauma surgeon with a specialty in orthopaedics. He's a West Pointer who also worked in Army hospitals in Germany and gives the Weiss book good marks. Not knowing your level of training I would recommend Red Cross Standard First Aid and Adult CPR with AED. If you are affiliated with Medical Reserve Corps or CERT consider taking the Red Cross Advanced First Aid for First Responder course.
Following is a class outline from a CERT annual refresher:
CERT Traige - Annual Refresher 3Sept09
1) First Traige Victim in Place (prior to rescue) 2) Repeat Traige After Movement (upon arrival at casualty collection point) 3) Do it Again In the Medical area (monitor and periodically reassess)
1) Field traige, in search phase, assess victims as found, prior to rescue
Two-person teams, buddy system, one examines victim, the other logs and tags.
Stay focussed, do the most good for the most people who can be extracted safety, quickly, easily, who will survive
Goal 30 secs. per patient, head-to-toe assessment, tag, log Required PPE: helmet, long sleeves, boots, goggles, double-glove,
Reglove or decon with hand sanitizer or spray wash bottle of water+10% chlorox between victims.
"RPM" = Respirations <30/min Perfusion blanch test nail bed<2secs Mental status understands simple commands
Expedient Field Tagging:
Duct Tape Strip on Victim:Marking Example: Place tape strip on left shoulder: Team ID, Victim No. T3-V5 Condition Red
Duct Tape Patient Log On Pants Leg - 3 overlapping strips of duct tape across, With marker write Team ID, List Victims by location where found and condition Explanation: Team 3, Victim Number. Location Found, Condition T3 V1-1stFloorABcorner-G V2-1stSideB-Y V3-2ndStairs-R V4-2ndC-Y V5-3rdA-R
Traige Sequence - START WHERE YOU STAND
"If you can walk come towards the sound of my voice" Help “Greens” to safely exit and move on, put them to work in medical area if able/willing
Approach victim, Control the head, look them in the face, "I'm here to help you, are you OK? " Is the victim responsive? Ask: "Can you hear me? Where do you hurt?"
Complete head-to-toe assessment before moving patient, check for bleeding, fractures, etc. TALK TO PATIENT DURING EXAM
CONTROL BLEEDING TREAT FOR SHOCK
Don’t splint in the field prior to rescue. Time is of essence. If painful “body splint” – e.g. tape legs together, tape arm across body, etc.
Step Procedures 1 Check airway/breathing. At an arm’s distance, shake the victim and shout. If the victim does not respond: 1. o Position the airway. 2. o Look, listen, and feel. 3. o Check breathing rate. Abnormally rapid respiration (above 30 per minute) indicates shock. Treat for shock and tag "I." 4. o If below 30 per minute, then move to Step 2. 5. o If the victim is not breathing after 2 attempts to open airway, tag Black "DEAD." 2 1. o Check circulation/bleeding. 2. o Take immediate action to control severe bleeding. 3. o Check circulation using the blanch test for capillary refill. 1. o Press on an area of skin until normal skin color is gone. 4. A. good place to do this is on the palm of the hand or 5. nail beds. 6. Time how long it takes for normal color to return. 7. o Treat for shock if normal color takes longer than 2 seconds to return, and tag Red "Immediate." 3 Check mental status. Give a simple command, such as "Squeeze my hand." Inability to respond indicates that immediate treatment for shock is necessary. Treat for shock and tag Red "Immediate."
Radio locations of red and yellow victims found to Command, let extraction team rescue them if there is one, continue your search and move on
2) Traige again upon arrival at the Casualty Collection Point. Assign minimum of two people to Medical from the "gitgo" - buddy system
MedLeader - this person must be well organized, but doesn’t need medical training because he/she will not be performing hands-on patient care. Responsible for setting up the Casualty Collection Point, treatment area, morgue, medical logistics staging areas. Makes traige, treatment and logistics assignments. In minimum medstaff also responsible for patient accountability.
Caregiver(s) – Assign people with medical or first aid training or skills here. Responsible for hands-on patient care.
Maintain adequate span of control Ideally 5-7 victims per caregiver, ten as max.
Re-traige victims every ten minutes, update time checked on tag.
Setting up of the Medical Area: Safe stand-off distance Away, Uphill, Upwind from the incident
Accessibility for rescuers to bring in victims, and for emergency vehicles to transport them to medical facilities. Room for expansion.
Position Red and Yellow treatment areas closest to the access control point to minimize patient movement
We no longer place victims head-to-toe, instead arrange head-towards caregiver so can view torso and move between victims w/o stepping over them
Put Greens to work attending victims, applying direct pressure to wounds, making signs, assisting in traffic control etc. If they unable to assist, gather together safely away and assign “able Green” to supervise so they aren’t milling around unaccounted for.
Patient Intake - Access Control Point Patient decon area located outside the treatment zone
Simple patient accountability matrix in Medical Area (separate than that used by Command):
Team Victim 1 2 3 4 5 6 7 8 9 10 ..... M - MedUnit accounts for walk-ins not tagged G G T1 Y G T2 R R Y T3... G Y Y
Establish Medical Logistics (Staging) Area - separate staging areas for sterile supplies, water/food, blankets/shelter
Responder meal, rest, cleanup, sanitation area
Supplies needed / useful, trash bags, biohazard tags, baby wipes, TP, paper towels, soap, water, hand sanitizer, blankets Morgue - discreetly out of sight
3. Re-traige victims every ten minutes. Update tag indicating time last checked and condition. Professional responders will re-traige prior to transport to a medical facility.
Thanks for the response ke4sky, as well as the excellent triage information.
I currently have my FA/Adult and Child CPR/AED certs (I need to re-up the latter next month, tho) and am interested in taking my training on that end to the next level. Aside from the book reading and looking into more advanced courses, my mentors out here (one of whom is a former RN with military medical experience and the other of whom has several years wilderness first-aid experience) have been drilling my butt off.
I'm going to share this info with them. I can see them having a field day with this.
__________________ Ignorance leads to Fear
Fear leads to Anger
Anger leads to Hatred
Hatred leads to WHARRGARRBL!!
This lecture is more advanced, a refresher for Army Reserve combat medics.
Triage – from the French sort
In casualty management sorting of a large number of injured personnel is the 1st stage in establishing order
Triage sets the stage for treatment and eventuates in transport of the injured
Triage is not to be considered with finality
Triage categories change based upon Number of injured
Available resources
Nature and extent of injuries(s)
State of hostile threat
Things change
Number of patients
Extent of resources
Condition of patient Gets better
Gets worse
Transport arrives
If you have only 1 patient
That patient is Pri 1 Immediate regardless of anything else
There is no real need for triage
Once this number increases, the need for triage arises
Categories
Immediate Threat to life/limb A lightly injured is immediate if he can be returned to duty with immediate simple management
Urgent
Patient is at risk if treatment or transportation is delayed unreasonably
Delayed
No risk to life or consequence if more definitive care is not rendered quickly
Expectant
Regardless of the level of care rendered, patient is likely to expire
Tough call to make for unit personnel
START – triage technique
Simple treat/triage and rapid transport
All of you within the sound of my voice Move towards me
Doesn’t work well in no/low light or excess noise
Military Triage
COL Cliff Cloonan
Assistant Professor
Military & Emergency
Medicine Department
Triage
Objectives – Upon completion of this block of instruction the student will be able to:
Triage
Definition – "To Sort"
From the French word, "trier"
Has been defined as "doing the greatest good for the greatest number" BUT triage is simply a sorting PROCESS that when applied creates a situation that allows for "doing the greatest good for the greatest number"
Triage
What are the OBJECTIVES of doing Triage? Rapid sorting of the more serious patients from those less serious to facilitate the rapid care of the more serious patients
When problems exceed resources, triage should facilitate "doing the greatest good for the greatest number"
Bring order to chaos thus facilitating the care of all patients
Triage
What is the PROCESS? Sorting into categories for evacuation and treatment What are the DECISIONS? How will the patients be sorted – who goes in which category?
What will be done to/with the patients when sorted? What factors AFFECT/CHANGE the decisions? Resources
Circumstances
Triage
Triage
"Military" Disasters Occur In Civilian Settings
Triage
And… "Civilian" disasters occur in military settings
Triage
Military vs. Civilian – Are there differences? Continuing risk to medical care providers Can occur in both situations
More common in combat/military triage Resource limited Can occur in both situations
More common in combat/military triage "Reverse" Triage Situation Care provided first to those who when treated can be quickly returned to duty
Usually only in a military situation but could occur in a civilian MASCAL situation (when "Group" survival is at stake)
TRIAGE
- A DYNAMIC
NOT
A STATIC PROCESS
WITHIN THE MILITARY ECHELONED
MEDICAL CARE SYSTEM, TRIAGE OF
CASUALTIES OCCURS (OR SHOULD), AT A
MINIMUM, AT EVERY ECHELON
Triage
Surgical Prioritization Involves - Recognizing Which patients require surgery to save life/limb/sight Knowing Numbers of OR’s, doctors, nurses, expendables, blood (Resources) each operation requires
Resources (manpower, equip, expendables, blood etc) required to provide post-op care How long each operation will take (Time as a resource)
The resources that each operation will consume (Must consider manpower as a consumable resource)
Probability of successful surgery
Triage
The Goal of Surgical Prioritization Selection of cases with the highest probability
of success that consume the least amount
of resources.
Make a decision - - and go with it! Once a MASCAL situation has been declared don’t wait for the situation to evolve further before making a decision.
Making decisions is more important than what decisions are made. Respect the Triage Decision
Triage
Triage Categories used in ICRC Hospitals Category I – Priority for Surgery Patients who need urgent surgery and who have a good chance of satisfactory recovery Category II – No Surgery Patients with wounds so slight that they do not need surgery AND…
Patients who are so severely injured that they are unlikely to survive Category III – Can Wait For Surgery Patients who need surgery but not urgently
Triage
MILITARY TRIAGE DECISIONS ARE INFLUENCED BY: NUMBERS OF PATIENTS AND THEIR MEDICAL PROBLEMS
NUMBERS OF EXPENDABLE AND NON-EXPENDABLE MEDICAL SUPPLIES AND CAPABILITIES OF MEDICAL TREATMENT FACILITIES
NUMBERS AND CAPABILITIES OF MEDICAL PERSONNEL
Triage
MILITARY TRIAGE DECISIONS ARE INFLUENCED BY(CONT): NUMBERS AND CAPABILITIES OF EVACUATION ASSETS
TACTICAL SITUATION
WEATHER
OTHER
Triage
EVACUATION PRIORITIES PRIORITY I – URGENT EVACUATION WITHIN 2 HOURS PRIORITY IA - URGENT SURGICAL EVACUATION TO NEAREST SURGICAL FACILITY WITHIN 2 HOURS PRIORITY II – PRIORITY EVACUATION WITHIN 4 HOURS PRIORITY III – ROUTINE EVACUATION WITHIN 24 HOURS PRIORITY IV - CONVENIENCE
MASCAL
Field Response What / Who do you send to the disaster site? Equipment Type – Stick with the basics
Dressings
Backboards/litter with straps
Tourniquets
Airways / suction devices
Quantity (lots) Personnel Type (Surgeon, EM…)(MD, Nurse, PA, EMT-P…)
Quantity
MASCAL
Actions on the scene Safety and site security FIRST
Survey the scene Estimate number and type of casualties quickly
Transmit brief initial report to Med Tx Facility
Request additional equipment (#/type) and personnel (#/type) as required
MASCAL
Actions on the scene (cont) Quickly choose a casualty collection point based upon: Proximity to patients
Proximity to potential helicopter landing site
Safety – Distance from potential hazards, secure
Geography – Large enough and appropriate for conduct of Geographic Triage) Separate sites for - Immediate (next to transportation)
Delayed
Minimal
Expectant
Deceased (out of sight of other victims)
MASCAL
Actions on the scene (cont) Collect all ambulatory patients at CCP by instructing them to walk to CCP These patients are mostly in the minimal category although some may be delayed What they are NOT is in the Immediate / Expectant (except in some burn cases) / Dead categories
MASCAL
Actions on the scene (cont)
Put one of the "walking wounded" in charge of ambulatory patients if limited manpower at scene Most important responsibility is to maintain accountability and keep patients from leaving CCP If more than one medical responder divide the scene into areas of responsibility and proceed to rapidly assess / treat / triage all remaining patients who were unable to walk to the CCP
MASCAL
Actions on the scene (cont) Initially treat ONLY readily correctable airway problems and obvious external, potentially life-threatening, bleeding
No treatment for pulseless /apneic patients.
Place comatose patients in lateral decubitus position – then move on
Apply triage tag to identify location in CCP where patient is to be taken
MASCAL
Actions on the scene (cont) Have non-medical bystanders and uninjured or minimally injured patients at the scene act as litter bearers (at least one experienced litter bearer / team) and move patients to CCP
Triage Officer at CCP sorts ("triages") patients into separate geographic location based on tags Performs rapid reassessment and changes triage category as required
MASCAL
Actions on the scene (cont) Move rapidly from one patient to next – only identify and if possible quickly treat life threats
Identify ALL patients
Avoid becoming involved in prolonged procedures
Avoid becoming distracted by distraught, minimally injured patients
Pay attention to administrative concerns – Keep track of ALL patients (Trust me – you’ll be glad you did)
MASCAL
Actions on the scene (cont) Transportation Considerations / Decisions Do you put all immediate patients on the first available ambulance?
Do you send one of your health care providers if there is no medical care on the transport
To what facility do you send the ambulance? Travel time
Level I, II, III trauma center? Do you wait for a helicopter?
How secure is the route of travel?
MASCAL
Medical Treatment Facility Actions Maintain Communication with the response team Identify the scope of the problem
Identify the need for additional resources at the scene Medical
Security
Administrative
Transportation – Ground / Air Arrange for helicopter transportation as appropriate
MASCAL
Medical Treatment Facility Actions (cont.) Notify higher HQ and other medical facilities of the situation and request that they standby
Activate Medical Treatment Facility disaster response plan Call in additional staff / keep staff in hospital at end of shift
Clear receiving area of all stable patients and set up additional beds as required
Cancel any non-emergent surgery
Clear OR’s ASAP
Prepare hospital beds Request higher echelons preposition ambulance at your medical treatment facility.
MASCAL – Major Teaching Points
When ability to provide medical care is overwhelmed – Bringing organization to the disaster site is the most important action.
Avoid the overwhelming impulse to rush in and being to take care of first patient you come upon
Make sure that you do not become a casualty yourself
MASCAL – Major Teaching Points
Remember – All the resources that you have to deal with a disaster did not come with you to the scene
Supervising medical care and ensuring the proper evacuation order and disposition of patients may not be glamorous but it will ultimately be the most important
Keeping track of the disposition of patients may seem like a waste of manpower but its not – trust me.
Triage
Immediate (examples – not all inclusive) Airway Generally either must be addressed immediately at which point patient becomes either DELAYED
DEAD Some exceptions Breathing Correctable on the scene – ie. tension pneumothorax which when treated may turn patient from IMMEDIATE to DELAYED
Uncorrectable on the scene – ie. large pulmonary contusion/flail chest with hypoxia Needs URGENT EVACUATION
Triage
Immediate (cont.) Circulation Exsanguinating hemorrhage External – usually correctable with a tourniquet and/or direct pressure at which point patient becomes DELAYED Internal – URGENT EVACUATION Cardiac Tamponade Even when treated with pericardiocentesis patient remains IMMEDIATE because underlying cause is wound to the heart
Triage
Immediate (cont.) Disability Closed head injury with deteriorating mental status
URGENT EVACUATION required
Triage
Delayed (examples – not all inclusive) All injuries that require surgery but for which a delay of 4-8 hours will not cause loss of life/limb/sight Penetrating abdominal wounds – hemodynamically stable
All fractures requiring ORIF – hemodynamically stable
Spinal cord injury – hemodynamically stable
Triage
Minimal (example – not all inclusive) Minor soft tissue wounds not requiring surgical intervention
Non-displaced, min. angulated, closed fractures of the upper extremities or digits
Triage
Expectant When resources are adequate no patients are made expectant
The creation of this category presumes inadequate resources and the types of patients included in this category is largely dependent on the ratio of resources/patients – the lower the ratio, the more patients in this category.
Examples: > 50% TBSA 2nd and 3rd degree burns
Unresponsive patient with an open head wound and exposed brain
Documented exposure to > 500 RADs and immediate signs of radiation sickness
S.T.A.R.T. - Triage Classification Protocol
S
imple Triage And Rapid Treatment (adapted from Super, G: START instructor’s manual)
The other book I always suggest as a backup is the Boy Scout Manual. It has not only basic first aid, but also a LOT of survival information that can help you if the squishy REALLY hits the fan.
__________________ Marlin & Calico Specialist
I'm not just Trigger Happy, I'm Trigger Ecstatic!!
