Wilderness First Aid: Take the Test

[Wandering Daisy]

All "first aid" classes I have taken, including an official class in college for a semester, have dwelled on what needed to be done in the first minutes, hour maximum AND have been very explicit about what I am NOT to do. Even with SPOT, or PLBs, in the mountains it could be days before help arrives. Ask about this in a first aid class, and they just say that is beyond first aid. A lot of us go solo. They do not have a lot to say about first aid on yourself in a first aid class. "First Aid" has a definite end when the ambulence arrives. There is no such line drawn in the wilderness. Here is where I think you get into the sticky legal issues. Obviously you cannot do CPR for two days waiting for help. So when is it no longer "negligent" if you stop? As a lay person I cannot legally administer antibiotics, yet maybe this is appropriate if it will be days before help arrives. And pain medication - if I manage to have prescription pain medicine in my first aid kit (left over from a recent hospital stay) can I legally administer it to someone else? What about herbal medicines? I tore a hamstring and got an arnica ointment rub that really helped. Is that first aid? The ambulance comes, and they splint; I do not carry fancy inflatable splints. So I rig up an improvised splint and accidently cut off some blood. Could I get sued? In a "first aid" situation, you do not move the victim. In the wilderness you almost always have to do this, particularly in a technical climbing accident.

I guess it is a lot a matter of the meaning of words. I was referring to the general public "first aid". I just have always found that Red Cross First Aid classes, and what they define as "first aid" pretty inadequate for the wilderness. There are wilderness first aid classes, but these really are a lot more wilderness medicine and response, including evacuation procedures.

The legal issues are real, particularly for backpackers who are also nurses or doctors. My good friend who is an ICU nurse carries the most skimpy first aid kit I have seen. For fear of liability, even though she probabaly could save a life in some situations with her specialized knowledge and if she bought a few meds, will only administer official layman's first aid, except on her friends who she knows will not sue her.

I have wondered if I could get sued for not carrying what someone else would deem necessary in a "first aid kit". Makes you want to go solo. Cannot sue myself for killing myself with my first-aid mistakes.

[gdurkee]

Well, here's another fine mess you've gotten us into Ollie... .

This seems like one of those down-the-rabbit-hole distinctions with no practical relevance to the real world. At the top of the list are there are darned few lawsuits where a person gave aid in a reasonable way to another. There was one California case that I know of about 5+ years ago. A person quickly pulled another from a wreck. She claimed she smelled gas and feared a fire or explosion if she didn't act quickly. There was further injury (maybe) as a result of not first stabilizing the victim. The California (!) Supreme Court found her negligent. However, legislation was quickly enacted which further defined and protected people rendering aid:

http://knowledgebase.findlaw.com/kb/2009/Oct/32614.html" onclick="window.open(this.href);return false;

Which is all to say that, whatever your training, if you act reasonably, you're likely OK. For all the panic and fear about liability, it just doesn't happen. I've never heard of anyone being sued for rendering aid in a wilderness situation.

The other point is that as a first responder -- whatever your training -- there's just not that much you can do that's definitive. You stabilize them, you protect the airway; you stop bleeding; you keep them warm and protect them from the elements, you send for help or you try to get them to help. And, of course, you try not to make them worse.

There are darned few magic drugs you can carry that make a bit of difference to anyone. If they have meds with them, you can ask and assist them in administrating them (e.g. insulin; Nitroglycerin; ibuprofen, viagra etc.). I've never heard of antibiotics being life saving in most US wilderness conditions. They're nice to give if you or the patient have some and know when and why to give them (several days to get out, the person is a friend or member of your party -- I'd never give them to a stranger). But, really, cleaning and irrigating a wound with soap and water is your best move here.

Sure, you can cut off circulation by improperly applying a splint, but you answered your own question: you're aware of it and would watch for it. You may need to splint to stabilize a break if you have to move the person (for instance, to a safer or more protected place). If you're waiting for an evacuation and better trained people, you may not even have to do that.

It's pretty obvious when to stop CPR. In a wilderness setting with no help on the way, you stop when you're exhausted; when the person is not responding after a reasonable period of time (20 to 30 minutes would be reasonable, I would think, except for cold water drowning and lightening but even then, with no help on the way...); or other signs that it's just not working (rigor, obviously fatal trauma). This just doesn't happen that much and it's not worth looping your brain about it. Know how to do CPR; give it a reasonable try if it happens 'cause it's the right thing to do; but you're not going to be sued.

That's about it. It's really not rocket science and there's no real point in overthinking it. The basic concepts of first aid are the same, whether applied in a city or wilderness. Doctors or nurses or paramedics can't really give much better care than someone with basic first aid training -- the former have better experience, but it comes down to the basics in wilderness.

My motto has always been to keep them stable and comfortable until I can get them to someone who knows what they're doing... .

George

[Jimr]

A lot of stuff here. I guess I'll preface it all with that we agree the potential for legal issues are real. I would never argue otherwise. I would not let fear stop me from helping as best I can. I find typical first aid classes sorely lacking for the backpacking environment as well. The are not specifically geared for special circumstances. They follow their curriculum and try not to stray too far away from it. You'd be doing well if you could physically keep up solid CPR for over 10 minutes. While your role as a first responder ends when professional help takes over, if none are to be expected, you have to make critical decisions to the best of your ability with respect to the situation. I don't believe you can legally administer prescription drugs to somebody that it has not been subscribed. Herbal treatments are not prescription drugs, so there is a consent aspect. In fact, there is a consent aspect with any adult who is conscious. I have, on occasion, carried leftover Vicodin and would probably offer it to my buddy, but I may think twice if it were a stranger. Not moving a victim is the recommendation (and heavily recommended), but there are exceptions if to leave them where they lay poses a greater risk. Everything is based on an assessment to the best of your ability given the circumstances you're presented. You take the training you have and attempt to apply it to the situation as best you can with the goal, at least, of doing no harm. Your level of confidence or fear will initially dictate to what extent you become involved. I, for one, will not let fear of litigation stop me from attempting to help somebody in trouble and I think I can figure out for myself, given the first aid information I have for others, what I can apply to myself if self-rescue is needed.

It may be semantic for the most part, but personally, I would not call whatever I do medical treatment. I'm not trained in the medical profession.

These are just my thoughts on the subject, give or take a quart.

[Wandering Daisy]

gdurkee- I have been in one situation where it was anything but simple! I look back and see that I could have done so many things differently. There are still a ton of unanswered questions. Simplistic first aid quiz questions could not have helped either. Just about every decision was a "bad" or "worse" choice. The victim WAS a lawyer! For a while we were worried about being sued. My biggest mistake was assuming a good friend knew first aid- he did not! Let me relate this situation to illustrate how complicated things can get.

Four of us, technical climb, my partner and I bail out because things getting over our heads. The other team chooses to continue. We go back to camp. Dark and other team not back. Decide nothing we can do in the dark. Decide if they do not show by dawn, we will take sleeping bags and go look for them.

1AM other team shows up, hypothermic, exhusted and one had a severed finger. They said that blood was dripping for hours, although not now. The two of them did not even know enough first aid to stop the bleeding or hold up the hand. But, they were strong climbers- one literally had to drag and carry the other back.

Dark, only head lamps, wind is howling, cold as hell! Victim is deadpan, acted like nothing happened, pale - shock suspected. We remove wet clothing, pre-warm sleeping bags, put them in, heat water, feed them hot drinks. Get them out of elements, laying down, warmed. Mistake I probably make- they said lots of blood lost (I later found out that you cannot lose too much blood from a finger). I fear tearing open the wound if I remove the glove so just wrap it as is. Victim did not want anyone to touch the finger. I really thought victim would be in a hospital before the day was out. I totally forgot that I should have put the severed finger tip in the snow. I will admit that weather conditions were so severe that getting anything done was difficult. With what I now know, I see that I should have opened the glove, washed the wound, and iced the finger tip. We waited until dawn (4AM).

Dilema 1 (our location- head of George Creek) -by 4AM victim seemed better I worried that once down in George Creek a helicopter rescue would be impossible if anything went wrong. If victim collapsed down further in canyon- helicopter could not even get there.

Dilema 2 - I was the only one who knew much first aid. My partner was directionally challenged- sending him out alone was really not an option (pre GPS days). The other fellow who did know how to get out was too exhusted to send out. I briefly discussed some first aid with victim had partner, but honestly they were so exhusted that I do not think anything sank in. So my partner and I took a day pack and head down George Creek.

Dilema 3- George Creek. We literally run down. Not safe, as I look back. But at the time I just wanted to get out fast. As it turned out, it did not really matter. At one point I literally fall off a cliff into a tree. Really stupid, but did not get hurt.

Dilema 4- No communication. Got to trailhead 9AM. Could not get cell reception. Ended up having to drive all the way to Independence. I myself was not real sure on the seriousness of the injury, so failed to convey urgency. I swear they thought we were being lame not walking out down George Creek. This was not an option even if medical condtion would tolerate it. Victim ABSOLUTELY refused to consider it. I think the statement was "you are going to get me a helicopter, or else!"

Misconception- rescue soon. When we left our camp, I honestly thought they would be rescued mid-day. If I knew how long it would take, I may have been more inclined to wash the wound. Getting out actually was the easy part. It seemed like hours of buaracratic crap went on before a rescue was started.

Poor timing - week before rescue helicopter crashed on Mt. Shasta. They were now playing it very safe (cannot blame them), wind still howled, helicopter flew over several times but could not land. We wanted to go back up to help but Sheriff refused to let us go. They sent a mountain rescue crew up. We paced back and forth. Found out later that the mountain rescue team were not even allowed to give pain killers or antibiotics.

Bottom line- took 2 more days before the wind died down and the rescue could be completed. Ended up that the finger could not be sewed back on, and a serious bone infection resulted.

To this day I do not know if I over exaggerated the seriousness or not. Could we have dragged the victim down George Creek faster? Probably. Nothing went as expected. Having not seen a lot of injuries, all I could do was base my judegment on the victims statement that "tons" of blood was lost. Probably not the case. But nobody expects to get to the authorities, and then, have nearly 72 hour pass before a rescue can be done. This is why I tell people, push the button on SPOT, but do not expect an immediate rescue.

[AlmostThere]

I have, on occasion, carried leftover Vicodin and would probably offer it to my buddy, but I may think twice if it were a stranger. Not moving a victim is the recommendation (and heavily recommended), but there are exceptions if to leave them where they lay poses a greater risk. Everything is based on an assessment to the best of your ability given the circumstances you're presented. You take the training you have and attempt to apply it to the situation as best you can with the goal, at least, of doing no harm. Your level of confidence or fear will initially dictate to what extent you become involved. I, for one, will not let fear of litigation stop me from attempting to help somebody in trouble and I think I can figure out for myself, given the first aid information I have for others, what I can apply to myself if self-rescue is needed.

I would NEVER give prescription meds to anyone they are not prescribed to. There are very good reasons that some things are not available OTC.

Fear of litigation should not be your major issue - fear of doing more harm than good should be. If you are working beyond your scope of practice you are increasing the risk to the person.

I would ABSOLUTELY move a person, if they were not severely hypothermic or it is impossible to do so.

[rlown]

why is it that when bad stuff happens, the weather always seems to turn against you as well?

I totally agree that you should not share prescription drugs.. have them get a check-up before the season starts, and carry the drugs they need.

[gdurkee]

Looks to me like you did everything exactly right! There's always a decision tree, but all of yours were perfectly reasonable. Even had you chosen somewhat differently, it's really difficult to see on what grounds he might have sued. If the bleeding is stopped on a severe wound, I wouldn't take apart anything to clean it either. Were you to do that without a good reason, the bleeding would very likely have started again (not serious on a finger, but a not unreasonable general rule...).

He made a choice to wait for a helicopter, the wound got worse. It was a toss up and he chose wrong (or,as you say, maybe couldn't get out on his own. Though a partial finger amputation, even with some blood loss, wouldn't prevent that).

Incidentally, you wouldn't have wanted to put the finger remnant in snow. A moist gauze is all you want to do. It's unlikely they could reattach after 12 hours or so (probably far less, especially if it was a crushing injury then amputation). And, even when he got out, a micro attachment like that could only be done at places like Las Vegas, LA, UCSF, Reno etc. So you've talking another couple of hours, minimum, to get to such a hospital. I had a similar case years ago. We actually got the guy out at last light by helicopter; he went to Visalia then to San Francisco -- not even Fresno could do that. He got his finger back. Pretty lucky but I think it was under 8 hours total.

So anyway, even though you're 2nd guessing yourself, that's kinda my point, that even with minimal training, the basics are all there and you did all you could, did it right and stayed well within the parameters of "first aid."

Incidentally, I've been an EMT since 1976 and was a park medic for a couple of years. We take 24 hours of CE each year. That said, I'm not really recommending nothin' here -- take a course (he said in a total cop-out CYA message).

g.

[quentinc]

Most states have "good samaritan" statutes that make it harder to successfully sue someone who attempts rescue in a halfway reasonable manner. People tend to blow things out of proportion based on the few cases (out of thousands) that lead to some absurd result, and of course get all sorts of exaggerated press coverage (because, after all, they have to sell those newspapers, TV shows, etc.). And as much as everyone loves to blame lawyers, it's a jury of your "peers" that are making the decisions here.

My favorite story is about some guy on a Sierra Club trip who fell in Joshua Tree and broke his arm. They put on a makeshift splint. When they got him to the hospital, the nurses cut through the splint to free his arm, cutting through the guy's shirt in the process. They did a great job fixing him up and his arm was fine. So what did he do? He takes the hospital to small claims court, for the cost of his shirt. Unfortunately you cannot legislate away idiocy.