Wilderness First Aid: Take the Test

Grab your bear can or camp chair, kick your feet up and chew the fat about anything Sierra Nevada related that doesn't quite fit in any of the other forums. Within reason, (and the HST rules and guidelines) this is also an anything goes forum. Tell stories, discuss wilderness issues, music, or whatever else the High Sierra stirs up in your mind.
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AlmostThere
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Re: Wilderness First Aid: Take the Test

Post by AlmostThere »

Jimr, statistically speaking, CPR is generally ineffective. The percentage of people who have CPR and live is pretty low. The current "no breathing" protocol may be due in part to people doing it wrong - not tipping the head far enough to open the airway means you're inflating the stomach, not the lungs. Maybe they figure the victim is better off just having compressions? I'll ask the instructor at my next recertification.

Rescue breathing still has a place tho - if someone hits their head on a rock, the heart is going strong, but respiration stops - do rescue breathing but know that you will be doing it for a long, long time in a wilderness setting. It's possible that the person has brain damage to the area of the brain that controls respiration, so until medical help gets there...
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Re: Wilderness First Aid: Take the Test

Post by Jimr »

Right!
But, done correctly, it's better than nothing, even if the best that comes out of it is that you, as a rescuer, did everything you could rather than just watching somebody die and feeling helpless.

A beating heart is a much better situation than full arrest, for sure.

I think full blown CPR is generally ineffective because of exactly what you said; people are doing it wrong. There is no way one can take a 4 hour course every couple of years and hope to be effective. The only reason I became and instructor many years ago was because I knew it much better than any of the instructors I'd ever taken it from, so I was talked into it. During divemaster training, we did many mock scenarios, both through long surf zones and from boats out at sea. They used to teach checking the carotid artery for a pulse, bull crap!! It was immediately evident that in cold water, there is no way you could feel even a strong carotid and if you could, with certainty, know that the heart had stopped, what was one to do about it floating at sea? Nothing but waste time. We offed that procedure for these scenarios.

If done correctly, it could buy enough time until emt arrives. 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.
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Re: Wilderness First Aid: Take the Test

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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..
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Re: Wilderness First Aid: Take the Test

Post by gdurkee »

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.
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Re: Wilderness First Aid: Take the Test

Post by Jimr »

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.
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Re: Wilderness First Aid: Take the Test

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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.
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Re: Wilderness First Aid: Take the Test

Post by Jimr »

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.
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Wilderness First Aid: Take the Test

Post by bheiser1 »

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?
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Wilderness First Aid: Take the Test

Post by bheiser1 »

Oh sorry I see you already included a NOLS link. Sorry... I will check it out.
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Wilderness First Aid: Take the Test

Post by ScoobyMike »

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.
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