Notes from Carl Keller's Presentation

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Carl Keller works for the Ozark Tracker Society a nonprofit organization for wilderness survival. Visit www.ozarktrackers.org. Their email is ozarktracker@gmail.com or call 479-841-8132.

You can also visit www.nols.edu/wmi/ for more wilderness medicine information.

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Wilderness First Aid

-Golden Hour Definitive Care

This is when a person is an hour or more from definitive care (ambulance or helicopter)

            *this is when wilderness survival comes into play

 

Patient Assessment

Scene Safety

*Remember that your safety is your first priority.

This list is the ABC’s of patient assessment and will be done within seconds.

• Airway
• Breathing
• Circulation
• Disability? (Spinal Injury)
• Expose (life threatening wounds)
• Environment (deal with environmental hazards)
• EVAC?
• Head to Toe Exam (Check everywhere on the body)
• Check Vital Signs
• Obtain Patient History

 

Trauma vs. Chronic

 

Shock

1. Cardiogenic
2. Vasogenic
3. Hyopvolemic

 

Wounds

 

Bleeding:

1. Direct Pressure & Elevation (put the bleeding appendage above the heart)
2. Pressure Dressing
   1. Wrap close to the heart to away from the heart
   2. If you squeeze a finger and it stays white, it is too tight. If it goes back to pink, it is good.
3. Pressure Points
   1. Practice finding pressure points (one is underneath the bicep)
4. Tourniquet
   1. This is used when the bleeding won’t stop and it is loose the limb or loose their life, because tourniquets damage the tissue.
   2. It needs to be a wide bandage.
   3. Put it above the wound.
   4. Twist with stick (easier to get it tighter).
   5. Tie off the bandage when bleeding stops.

 

 

Xtended Care:

1. Wash hands & use gloves
2. Clean around the wound with soap & water
3. Irrigate with clean/disinfected water
4. Remove any foreign matter
5. Cover with cleanest dressing available, cover wound with moist AB (antibacterial) coated bandage
6. Keep bandage clean & dry, change at least every 24hrs (more if you can)

 

Infection:

Mild- redness ¼” from wound, warm, swelling, tender, pus

Severe- discoloration & pain, red streaking, swollen lymph nodes, malaise, fever, shock

Treatment-

1. Hot Soaks 20-30min several times a day
2. Clean the wound following the soak
3. Pack the wound open (wet to dry)
4. Anti-biotic and fever reducers

 

Burns-

Superficial = 1^st degree

Partial = 2^nd degree

Full Thickness = 3^rd degree

• Stop the burning!  Soak all burns in cold water.
• Extended Care: debride dead skin around blisters that have drained, clean, Anti-Biotics, clean dressing, do not drain intact blisters
• Pain Meds, Hydration, Watch for Shock

 

Bites & Stings

• Ticks- 12hr tick checks
• Spiders
• Snakes- Px, Don’t cut & suck
  • If you get bit, stay as still as possible to slow down the poison.
  • Hem toxins = pit vipers
  • Neurotoxins = coral snakes
• Bees, Wasps, etc.- watch for anaphylaxis (Epi Pens & Diphenhydramine)

 

Cold & Heat Injuries

• 98.6°
• Layering
• Fitness
• Don’t wear cotton in cold because wet, but wear synthetics or wool.
• Layer instead of one big heavy jacket

 

Hyperthermia

• Rest, Shade, Hydrate

 

Hypothermia

• Acute – fast, like falling in cold water
• Chronic- slow and over time

Mild- Impaired ability, decreased complex motor function & mental ability, Umbles-stumble, mumble, fumble, etc.

Moderate- Uncontrollable shivering, worsening of the “umbles”

Severe- Shivering stops, change in LOR, stupor, shock

• Hypo- Hypo Wrap

 

Musculo-Skeletal Injuries

 

Strains, Sprains & Minor Fractures

1. Assess injury
2. RICE- Rest, Ice (20min), Compression (Distal to Proximal), Elevation (above heart)
3. Pain Meds as needed
4. Allow to Warm
5. Support
6. Continue RICE

 

Fractures & Unusable Limbs

1. Assess
2. Traction in-line, Splinting/Stabilization
3. If it is a neck or spine injure, set in place and DO NOT move it. You may want to use rocks or backpacks to stable rather than your hands. Tell victim not to move at all.

 

Open Fractures

1. Irrigate & clean wounds, prior to traction in-line
2. Pack wounds open, then cover with a dressing
3. Splint in position of function
4. RICE & Pain meds
5. Monitor for shock
6. EVAC

 

First Aid Pack

*Build yourself so you know what is in the pack and feel free to adjust as needed.

1. Wound Mangament Kit
2. Ace Bandages
3. Bandanas (lots of bigger sized ones)
4. See if you can get medicine for a “Bug Out” bag from doctors (some cooperate and others don’t). You can get antibiotics and other general health prescriptions to have on hand.