Wilderness First Aid: Take the Test

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Jimr
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Re: Wilderness First Aid: Take the Test

Post by Jimr »

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.
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Re: Wilderness First Aid: Take the Test

Post by Wandering Daisy »

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!
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Wilderness First Aid: Take the Test

Post by ScoobyMike »

Agreed, my point was:
1 - stay informed
2 - render aid
3 - do not certify
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Re: Wilderness First Aid: Take the Test

Post by Jimr »

I don't want to offend anyone. I just feel a pull to argue these points. TIFWIW.
1799.108. Any person who has a certificate issued pursuant to this
division from a certifying agency to provide prehospital emergency
field care treatment at the scene of an emergency, as defined in
Section 1799.102, shall be liable for civil damages only for acts or
omissions performed in a grossly negligent manner or acts or
omissions not performed in good faith.
I could make a better argument in favor of attempting CPR uncertified as a form of gross misconduct.
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".
I cannot fathom how the presence of absence of medical help in transit changes, in any way, whether one is administering first aid or medical treatment. Only the length of time it may be needed. I believe Wilderness First Aid is merely first aid specific to the environment and possible injuries/issues that may be encountered, contrary to an urban environment, with emphasis to the potential lack of immediate help by professional rescue personnel.

Same with all of the SCUBA related first aid. A person in the normal public arena has no use for treatment of pressure related injuries such as air embolisms or bends. Help may be quickly available or not depending on where you are diving when the accident occurs, but the level of care only increases in time.
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Re: Wilderness First Aid: Take the Test

Post by 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.
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Re: Wilderness First Aid: Take the Test

Post by 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
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Re: Wilderness First Aid: Take the Test

Post by 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.
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Re: Wilderness First Aid: Take the Test

Post by 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.
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Re: Wilderness First Aid: Take the Test

Post by AlmostThere »

Jimr wrote: 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.
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Re: Wilderness First Aid: Take the Test

Post by 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.
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