High Sierra Topix

Jimr wrote: This ain't happening when help is much more than a hand full of minutes away. Very few, if any, actually revive through CPR. In these instances, the best one can do is perform it to the best of their ability until they can go no longer.

Hand full of minutes.. then why are we even talking.. everyone knows their personal risk going in.. We're hours if not days away from help. Pretty sure we can all patch a wound or splint an arm/leg. we should probably rule out cardio incidents for the discussion. You both state clearly they're gonna die..

It's true that CPR has an incredibly low success rate -- even in a hospital setting. Yet there's enough successes to make it worth a try (2 at Grand Canyon last year). The situation where it can definitely have a positive outcome, even in remote terrain, is when the person has been hit by lightening. The thing to do, as protocols recommend, is to check for a pulse & breathing every two minutes (??).

I think the protocol for bystander (vs. professional) CPR did change to not using rescue breathes because statistics showed it wasn't making an obvious difference. It was circulation that was the main problem and doing compressions at 100 per minute without interrupting for a breath seemed more important.

On the other hand, I took the test and think I got 3 or 4 wrong -- so what do I know? (I disagreed with some of the set ups and their choice of answer. Looks good on paper but not always practical... .)

g.

Yep, although odds are low, doing nothing reduces it to basically nothing. A very helpless place to be. I think cold water drownings have probably the best odds for success. Lightning, I think, would fall into the same category. An otherwise healthy body whose heart was stopped, but minimal damage otherwise. I acknowledge the potential damage from the above injuries, but different from the damage of a busted up/bleeding body or a diseased circulatory system.

I think the most important thing is to know the odds you're dealing with rather than having a false idea of efficacy. If for nothing else, as a rescuer, to understand what you were up against in the first place, living with the idea that you did everything you could instead of living with guilt that you must have done something wrong because it didn't work.

When I was doing divemaster training, we used a local beach (RAT beach) because of it's long surf zone. I had the best time at 8 minutes from standing on the beach, to reaching the victim, doffing gear, hauling the body in while breathing for the victim (this is real fun doing ventilation through surf) and onto the shore to assess circulation and begin mock CPR. It was immediately clear to me that if there was no heartbeat, that this was merely an exercise in body retrieval. This would not change the way I performed, but it would help in the aftermath and I would still perform CPR until I could no longer do so or until help arrived because that is what you do when you decide to take action.

Jimr wrote:I think the most important thing is to know the odds you're dealing with rather than having a false idea of efficacy. If for nothing else, as a rescuer, to understand what you were up against in the first place, living with the idea that you did everything you could instead of living with guilt that you must have done something wrong because it didn't work.

My Abalone dive buddy has an arrhythmia. he knows it; I know it. They wanted to do an ablation. still hasn't signed up to do it.. One day off Pt. Arena, he's standing on a rock 120 yds from the beach and breathing how he does to arrest the AR. His doc told him that his AR is not going to kill him, which I knew as well. Well, we had our Ab's. We got him off the rock and in the car for his 5 hr ride home. He was still trying to calm his heartbeat to something normal by his own method.. He refused to go to a hospital until the next morning when his wife asked, "why did you sleep on the couch?"

This was at sea level. It took a couple different drugs to settle his beat. Yes, he's one of my backpacking buddies as well.

To your point, it's important to know your conditions as well as those you dive/hike with. It gives you a starting point.

Yes. A diving/hiking buddy is a more intimate relationship than the relationship of a divemaster to each person in a group of divers on an organized group trip. My current hiking buddy happens to be my Hapkido instructor with 5 black belts in the art and 20 years my youth. What he and I had no idea of is that he is very sensitive to elevation above 10K. We found this out at Desolation Lk. 2 years ago when his headaches would not go away despite an overnight at 9.5K before the hike and another night and day above 10k. It turned into a slight feverish feel and nausea, though he did not feel feverish. Since we were to head over Alpine col. the next day, I suggested that he keep me fully abreast of his condition because I'd much rather take him down Paiute pass to the car than take him deeper into the interior under his current condition. It worked out well as the nausea subsided with food and water, but he suffered from the nagging headache the whole trip. I suggested that his camel back, although convenient, was of no good if he merely drank sips when he felt thirsty and that he should consider drinking much more water before he ever feels thirst.

The same thing happened last year, but the symptoms never got any worse than a constant headache and a bit of nausea that subsided with food. We eventually made the summit of Langley. This year, I decided to take him to Tehipite Valley so he could enjoy the trip without all the elevation issues.

Another incident I had was with a dive buddy I had been diving with for 5 years. I knew he went through air like it was going out of style, so I would dive with a 72 cylinder and he with a 90. One particular dive, he ran out of air and we surfaced. I had over half of a tank left, so he suggested I continue the dive and he would surface swim back to the boat. I got back to the boat and searched for him, but he was not there. I found him far astern waving his arms in a kelp bed, so I went after him. He was exhausted, so I hauled him back to the boat. While I should have aborted the balance of my dive, after 5 years, I had no clue he could not follow a direct line to the boat, allowing the current to take him so far off without ever looking up and getting a visual.

I guess some things only make themselves known when they happen. But, I agree, it is important to be aware of known issues before the fact.

Thanks, Maverick, for posting this. I scored 88/100 (2 wrong out of 16) but it worries me that I didn't score 100%. If something happens in the wilderness there is no margin for error.

I recognized the shock symptoms but didn't know the remedy. And I didn't recognize the concussion or know the remedy.

This worries me because I do solo trips... with a SPOT transmitter, yes, but I don't count on it. I consider it to be a tool of last resort (except to send "bread crumbs" to my people while I'm hiking), for their piece of mind more than anything, and so they will have a general sense of my whereabouts.

This is a good reminder to study up on this stuff, and/or as you suggested, take a wilderness first aid course. At least my Boy Scout training from 35 years ago helped but I'm due for an update.

Any suggestions for where to find that course in the Bay Area?

Oh sorry I see you already included a NOLS link. Sorry... I will check it out.

Last time I got certified was late 90s. Part of the class was about legal liability. An uncertified individual trying to help is protected by good samaritan law whereas a certified individual can be held liable if aid is "improperly administered". As mentioned above, will one remember how many compressions per breath? Logical people realize ip probably makes no difference however we live in a litigious society, and logic does not take presedence.

The good Samaritan law used to covers only emergency medical care, not non-medical. This excluded the average citizens (whether CPR/First Aid certified or not) trying to help in an emergency, but there was and is plenty of case law to the lay person's benefit. The GSL has since been expanded to protect the lay citizen as long as there was no gross misconduct or willful or wanton misconduct. Not remembering the exact number of compressions to breaths or the like does not constitute gross negligence or willful or wanton misconduct or even medical care. Especially now, since the American Red Cross now teaches no breath compression techniques.

Unfortunately, none of this will prevent you from being sued and incurring legal bills to defend your conduct. Personally, I would not let any of the potential legal ramifications deter the fact that I would help to the best of my ability, regardless. The basic rule in first aid is "do no harm" or "never leave a victim in worse shape than when you found them". I believe I can do that, at least. If it comes down to defending my actions, so be it. I could never walk away and leave somone to die or stand there and do nothing.

missed 2- the snake question and CPR breaths/compressions. I have not taken CPR in a while so cannot recall the answer.

There is no such thing as "wilderness first aid". First aid is to stabilize someone when medical help is nearby. In the wilderness you are really doing "wilderness medicine". Some of those questions would be answered differently if I were out by myself with no communication. I have walked out 8 miles on a sprained ankle for fear of not being able to walk out at all if I waited until morning. Some of the questions imply that you have a partner nearby. And if hit by a rock on a climb, you may have to move the victim (or yourself) out of the rockfall area immediately. Sometimes getting to a safe location has to be the first action, before doing any wilderness medicine. And of course, the first rule is not to endanger yourself. If you are drowning, do not expect me to rescue you; I cannot swim!