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Chapter 24

Wilderness First Aid

Wilderness First Aid

Wilderness describes situations including:
Occupations in remote areas
Urban areas with overwhelmed EMS
Remote communities
Developing countries

Cardiac Arrest (1 of 2)
CPR has limited use in a
wilderness setting.
CPR is difficult to continue during
a wilderness evacuation.
It is recommended that CPR be
stopped after 30 minutes if the
victim does not respond.

Cardiac Arrest (2 of 2)
CPR for hypothermia victims
Continue for more than 30 minutes
CPR for avalanche victims
Continue for more than 30 minutes if
CPR for lightning-strike victims
Start CPR immediately
CPR submersed victims
If victim has been submersed for more than
60 minutes, do not start CPR

In a wilderness
situation, reducing
some dislocated joints
is recommended.
Reducing is a technical
term that means

Shoulder Dislocation
Recognizing shoulder dislocation:
Victim is in extreme pain.
Upper arm is held away from the
Victim is unable to touch the
uninjured shoulder with the hand
of the injured extremity.
Compare the injured shoulder with
the uninjured one.

Care for Shoulder Dislocation

(1 of 2)

Traction and External

Rotation Method
Gently pull the arm out to
the side while another
provides countertraction
against the chest wall.
Tell the victim to relax.
Pull and gently rotate the
arm into a baseballthrowing position.
Stabilize the arm.

Care for Shoulder Dislocation

(2 of 2)
Simple Hanging Traction
Hang injured arm off
the side of a high,
cushioned surface.
Attach a weight to the
victims lower arm.
Muscles will stretch and
tire, allowing joint to
pop back in.
Stabilize the arm.

Finger Dislocation
Recognizing a finger
Deformity and
inability to use or
bend the finger
Pain and swelling
Abnormal position
of two bones

Care for a Finger Dislocation

Hold the end of the finger with
one hand and the rest of the
finger in the other.
Gently hyperextend the
dislocated joint.
Pull gentle traction.
Push the dislocated bone into
Unbend the finger.
Buddy-tape it.

Kneecap Dislocation
Recognizing kneecap
Patella has moved
to the outside of the
knee joint.
Victim is in pain.
Compare to other

Care for Kneecap Dislocation

Slowly straighten the knee while gently
pushing the kneecap back into position.
Stabilize the leg straight.
With the knee extended and stabilized,
victim may be able to walk with an aid.

Spinal Injury
Recognizing a possible spinal injury:
Is the victim alert and oriented?
Does the victim have any major painful
Victim complaining of neck pain?
Victim have tingling, numbness, or
weakness in the extremities?
Check for neck tenderness.
Determine if victim have sensation in
hands or feet.

Clearing a Spinal Injury

The victim does not need to be stabilized
in one position if:
Completely alert
Not intoxicated
Has no distracting injuries
Does not complain of neck pain
Can feel normal touch
Can move the fingers and toes

Care for a Spinal Injury

Use your hands or knees to hold the
victims head in place.
While kneeling at the victims head, use
your hands or knees to stabilize the neck
in relation to the long axis of the spine.
Avoid moving the victim if possible.

Splinting Femur Fractures

Victims with femur fracture can
easily lose 2 quarts of blood and
develop massive swelling.
If needed, splint the fracture.

Avalanche Burial
Falling masses of snow that may also contain
rocks, soil, or ice.
Number of deaths has increased rapidly since
the 1970s.
Most avalanche victims die of suffocation.
Speed of extrication and existence of an air
pocket are the main factors that determine

Recognizing an Avalanche
Avalanches kills and injure in two
The serious injury victim acquires
while tumbling down the
avalanche path.
Snow burial and suffocation.

Care for an Avalanche Victim

Quickly free victims head, chest, and
Send for help.
Clear airway and check breathing.
If not breathing, begin CPR.
Check for severe bleeding.
Examine for and stabilize spinal injury.
Treat for hypothermia.

Altitude Illness
Occurs when the bodys tissues do
not have enough oxygen
Acute mountain sickness (AMS)
High-altitude pulmonary edema (HAPE)
High-altitude cerebral edema (HACE)

Recognizing Altitude Illness

Typically strikes during the first 12 hours
Symptoms include:
Loss of appetite
Shortness of breath with exertion

Care for Altitude Illness (1 of 2)

Seek medical help if any of the following
symptoms appear:
Persistent cough
Shortness of breath while resting
Noisy breathing
Loss of balance

Care for Altitude Illness (2 of 2)

Most people get better with rest as the
body adjusts.
If condition doesnt improve:
Descend 2,000 to 3,000 feet
Drink plenty of fluid

Lightning injures in five ways.
Direct strike
Ground current
Contact injury
Shock wave

Recognizing a Lightning Injury

Absent breathing
Seizures, paralysis, loss of
Minor burns
Punctate burns
Feathering or ferning burns
Linear burns

Care for a Lightning Injury

If more than one victim has been struck, go to
the quiet and motionless victim first.
Start CPR if victim is not breathing.
If victim is unresponsive, but breathing, place
on side.
Stabilize the spine.
Check for injuries.
Evacuate to medical care even if responsive.

Wild Animal Attacks

Incidence is not known
Perhaps one or two deaths occur each
year in the United States
Most often occur in rural or wilderness
If you encounter a wild animal, try to
remove yourself from the scene quietly
and slowly.

Recognizing Wild Animal

Severe injuries result from victims being
thrown in the air, gored, butted, or
trampled on the ground.
Injuries include puncture wounds, bites,
lacerations, bruises, fractures, rupture
of internal organs, and evisceration.

Care for Wild Animal Attacks

Depending on the severity of the injury,
either evacuate the victim to medical
care or contact local authorities for

Wilderness Evacuation
Determining the best way to evacuate a
victim must be based on several
Victim can be evacuated by:
Walking out
Being carried on a litter

When to Evacuate
Immediate evacuations
Rapidly evacuate when medical care
is needed in 30 to 60 minutes or less.
Delayed evacuations
Medical care should be obtained
within 6 to 24 hours of injury.

Guidelines for Ground

At least two people should
accompany victim if victim is
walking out.
One or two people should be sent
to notify authorities that assistance
is needed if a victim needs to be
carried out.

Guidelines for Helicopter

Evacuate only if the following conditions
Victims life will be saved
Pilot believes conditions are safe
Ground evacuation would be
dangerous or prolonged

Signaling for Help

Signaling aircraft
Construct a large V or
X on the ground
A series of three of
anything indicates Help.
Three shouts, three
shots, three light
Mirror flashes