Wilderness Doc: New Guidelines for Spinal Protection

In Spinal Protection in the Wilderness: What We’ve Been Doing Wrong for Decades the Wilderness Doc talks about the new (Dec. 2019) Wilderness Medical Society Guidelines for spinal cord protection and what it means for wilderness/remote care. Reprinted below is an excerpt, be sure to go and read the whole article so that you aren’t misled into doing something dangerous by the sample.

…If you have been a victim of a traumatic injury over the past 50 years, you have been quickly placed in a cervical collar and strapped to a backboard to “protect your spine”. Countless patients have been tortured (ok, maybe a little overly dramatic but…) for hours on end as they waited for their spines to be “cleared”.

This practice guideline simplifies the use of rigid cervical collars and immobilization all the way down to–don’t use them

You and a friend find yourselves in the mountains of Georgia hiking along a moderate to difficult trail with some steep terrain. Your friend turns to look at an interesting bird flying through the forest canopy and loses his footing sliding off and down the steep embankment. You rush to the edge of the trail to watch as he turns over and over, falling head over heels down the 100-foot slope. Quickly, you slide down the embankment and find yourself at your partner’s side. He is awake and alert, cursing vigorously at his misstep.

You ask, “Are you alright?”

Sitting up, he replies, “Yes.” As he carefully bends his neck to the left, right, back, and front with no indication of pain of any type.

Throughout the last half-century, any physician or provider with the slightest knowledge of emergency medicine would have fainted at the thought of letting a patient go through the maneuvers described above. If asked about what should have taken place, they would tell you the patient had to be immobilized. Immediately upon arriving on the scene, the uninjured party should have counseled their companion to remain still, lie completely flat on the ground, and not move their neck.

After all, there could be an unnoticed and unidentified spinal cord injury.

We must protect the spinal cord. 

Given the guidelines as presented in this paper, the patient above has cleared himself. Being alert and able to safely and without pain mobilize the neck in a full range of motion (without distracting injury) rules out a spinal cord injury. In some instances, it may be desired to provide some form of non-rigid cervical spine motion restriction. However, the rigid cervical collar has been shown to cause more harm than good…

Click here to read the entire article at Wilderness Doc.

American Partisan: First Aid in a Wilderness Setting

American Partisan has a two part article on wilderness first aid by former combat medic.

First Aid in a Wilderness Setting, Part I

Wilderness First Aid, Part II

After having a Positive Mental Attitude to survive, and once you’ve located Shelter, the next on the list of priorities is First Aid. This will likely be in a wilderness environment. Just so we can put a label on this, lets look at some definitions.

Wilderness is defined as “An uncultivated, and inhospitable region.”

First Aid is defined as “help given to a sick or injured person until full medical treatment is available.”

I’ll go a step further with defining this by saying wilderness, medically speaking, is an hour or more from the time the incident occurred, to treatment in a definitive care facility. Wilderness First Aid is also all about Improvising. We often can’t lug around an ALS ambulance with us or pack our gear with with the contents of a paramedic’s trauma bag. We can take minimal supplies and the rest is improvising. We can splint a leg fracture or configure a c-collar with a sleeping pad. We can use a bandana as a trauma dressing.

In a wilderness medical setting as well as the urban setting, we can categorize our patient as either Medical or Trauma. A medical patient in my experience as a former Combat Medic and Wilderness EMT seems to be more subjective, which means they tell you what’s wrong with them more than you can see it objectively. With trauma, it’s the opposite. A person who crashes their mountain bike on a trail and has an open fracture to an arm is pretty self-explanatory.

S-A-B-A

S-A-B-A stands for “Self-Aid / Buddy-Aid”. Self-Aid sounds easy when we know how we feel and pretty much know we crashed a bike or twisted an ankle on the trail. Except for that, we might have to perform some functions with only one hand, reduced or no vision, and not being able to move around because of trauma to our bodies. I would emphasize to practice applying a dressing & bandage to yourself with the use of one arm or blindfolded. This can be done while sitting on the couch watching TV. Buddy Aid is being able to medically assist another person…

Related:

American Partisan: The Partisan’s First-Aid Kit

Columbia Safety: Wilderness First Aid, Oct. 6, 2018

Columbia Safety will hold a one day Wilderness First Aid class on Saturday, Oct. 6. The fee is $125.

Click here for more information and registration.

An intensive 8- to 10-hour course for those who are involved in wilderness recreation. This course may also meet the needs of volunteers and professionals who lead groups on short trips in relatively low-risk situations.

Most first aid classes assume that an ambulance or other advanced medical attention will be minutes away.  While wilderness first aid still assumes that you will eventually have the same, it also trains for the additional time that you may need to stabilize a patient before that happens. This makes the class good for those preparing for disaster aid situations.

Wilderness First Aid, Kennewick, Sept. 8-9, 2018

Wilderness First Aid Course

Prepare for the unexpected with this fun, hands-on introduction to wilderness medicine, taught over two or two and a half days. If you like to take short trips relatively close to medical resources, work at wilderness camps, enjoy weekend family outdoor activities, or recreate outdoors, this course is for you. This course is great for people of all experience levels, and is best suited for those who recreate outdoors where EMS response can be expected in a timely manner (fewer than eight hours). You’ll learn the Patient Assessment System, how to provide effective first aid treatments for injuries and illnesses common in the outdoors, and how to make appropriate evacuation decisions. You’ll learn both in the classroom and in outdoor settings regardless of weather, so come prepared for wet, muddy, cold or hot environments!
  • Sponsor: REI Outdoor School
  • Location: Kennewick, WA
  • Dates: Sat, 08 Sep 2018 thru Sun, 09 Sep 2018

More info and registration links.

 

Columbia Safety: Basic Wilderness First Aid, Feb. 10, 2018

Columbia Safety will be holding a Basic Wilderness First Aid class on Saturday, February 10th, from 9am – 5pm at their Kennewick facility.

Basic Wilderness First Aid: An intensive 8- to 10-hour course for those who are involved in wilderness recreation. This course may also meet the needs of volunteers and professionals who lead groups on short trips in relatively low-risk situations. $125

Wilderness First Aid classes address patient needs in those situations or environments where EMS is not available, or may be significantly delayed. Possible delay of emergency services becomes an important consideration when dealing with the initial scene/patient assessment. Illnesses and injuries that might only require a brief examination when help is on the way become much more important when you’re left to attend to the victim for a longer, possibly extended period of time.

Columbia Safety First Aid and CPR Classes

Columbia Safety, LLC, located off N. Kellogg St. in Kennewick offers American Heart Association classes for both healthcare providers and non-healthcare providers, including First Aid, CPR/AED, Wilderness First Aid and more.  They are offering the First Aid and CPR classes for non-healthcare providers on two different dates before the end of the year.

Monday, Nov. 20th

AHA HeartSaver CPR and AED class, 8am-10am

AHA HeartSaver First Aid class, 10am-12:30pm

Saturday, Dec. 16th

AHA HeartSaver CPR and AED class, 8am-10am

AHA HeartSaver First Aid class, 10am-12:30pm

The Red Cross recommends that at least one person in every household and place of business receive training in CPR and proper use of an AED. This training can give them the knowledge and confidence to respond during an emergency situation with skills that can help save a life.

Their calendar is also showing an eight hour Wilderness First Aid class on Saturday, February 10th, 2018, but it is not linked to a description, yet. It could be their Basic Wilderness First Aid class, which is an eight hour class or it could be part of a multi-part Wilderness First Aid class — which is usually 16-20 hours in length. Standard first aid classes assume that you may have an ambulance on scene within minutes, whereas wilderness first aid classes assume that you may have to stabilize your patient for hours or more because of remote wilderness locations.