This article was published in the Fall 2014 "Backcountry Safety" column of the Hunt Alaska Magazine.
Story by Jon Hunt
So now what? Imagine you are in a remote area, hours or days from definitive medical care. Your friend has been injured but is still breathing. If your level of training culminates with a basic CPR and First Aid course focused on the urban setting, then you will be quite distressed that you can’t offer your friend much help.
Don’t feel too bad. Most basic First Aid and CPR training programs are designed for urban setting and focused on the Primary Assessment of the injured. Ensure scene safety, check for a response (activate 911 if unresponsive), look for severe bleeding, look for breathing, start CPR (cycles of 30 compressions & 2 breaths) if the victim is not breathing, use the AED as soon as possible, and pray. For a victim of cardiac arrest, every minute that goes by without CPR and defibrillation decreases their chance of survival by 10%.
Where most outdoorsmen lack sufficient knowledge and skills is when they have a victim who is alive, and they have to remain with them for hours or days until help arrives. In a remote setting, the basic assessment is inadequate, and is usually just enough information to make you feel inadequate, or even hurt the injured person worse.
How do you figure out what’s wrong with your friend?
That’s the focus of the Secondary Assessment. If no obvious life-threatening problem (bleeding or breathing emergency) is evident, then you begin the Secondary Assessment. The focus is now directed at identifying the source of the problem and treating the root cause. In Wilderness programs, hours, or even days, are spent practicing assessment skills. Two acronyms are often used in many of the Wilderness First Aid courses/forms (American Red Cross & American Safety and Health Institute): “D.O.T.S.” and S.A.M.P.L.E. History.”
If a significant mechanism of injury is present, consider the potential of spinal injury and take necessary precautions when treating the injured person. Use the D.O.T.S. acronym when conducting a quick (2-3 minutes) head to toe exam to look for:
Record the findings from the D.O.T.S. assessment. Then continue with collecting data on SAMPLE History, consider these things:
Keep in mind, your patient may deteriorate quickly, and you may be the last one to speak to him before he becomes unresponsive. By recording this data and passing it to more advanced medical providers who may take over, you can greatly enhance the injured persons chance for receiving adequate medical care. Even more importantly, a thorough patient assessment may help you figure out what is wrong with the injured person, allowing treatment of the problem, not just the symptoms.
Please note, this is just an overview of some of the assessment skills, it is not comprehensive. When you take a Wilderness based First Aid program you will learn more skills and have time to practice assessing an injured person. There are other concerns that need to be addressed when caring for a victim in the backcountry. These include: assessment of vital signs, guidelines for treatment of injuries in the backcountry, and criteria for evacuation. The best way to prepare for unforeseen incidents n the backcountry is to receiving adequate training in Wilderness First Aid and to practice patient assessment skills.