accident response - medical aid
 

I tossed this in here. Maybe it needs its own category. Those who are qualified - please add to this thread. I am EMR trained, a first aid instructor, (including wilderness first aid) and work with search and rescue. I am constantly amazed at how much I don't know (and still am trying to learn) about emergency management. I also am constantly scared shitless at what is put on the web as factual information (usually hearsay other myths), and will probably get someone killed.

Question is what you need to prepare to handle an accident on the road in terms of supplies and actions.
Here is some basics for a start. I will add more to this post when I get time. Hopefully so will others who are qualified to do so.

Actions at an accident scene:
1) Secure the scene. Some one needs to do this quickly. The greatest danger after an accident has happened on a roadway is from oncoming traffic.
Traffic needs to be warned that there is a hazard at least 100 meters on either side of accident scene in a high speed zone (remember: they need time to comprehend and then to slow down. Place hazard markers. Station someone at either end to control traffic if possible. If there is another vehicle, place it next to the accident scene, blocking that lane off and providing protection for the rescuers working there. Make the traffic go around the scene, not through it.
2) check the bike, and anthing else involved, is no-longer a hazard to anyone (like you). Stabilize the vehicles and everything else before climbing in or on.
3) check the casualty. Don't move them. Assume head/injury. Do your ABC'S (airway, breathing, circulation). Control bleeding.
4)Call for help (if someone already hasn't). Make sure they understand what the accident involves. As example, I've see accidents where the 911 call didn't include the fact that one of the injured was TRAPPED in the car. The amublance arrived 45mins later and then had to call for further assistance from an extraction team. That took another 45 min. to an hour to arrive.
5) if the patient is conscious, get a history (signs, symptoms, allergies,meds, medical conditions, last meal, etc. Basic first aid stuff - take the course.). The hospital will need that information.
6)Don't get creative. First aid means keep them alive untill the medical team arrives. Forget what crap you saw on TV. This is real. Take a certified first aid course - better yet; take a emr course. Best two week investment you can make before going on a real trip. Do not try anything you haven't been trained to do and are certified to do. It's called "scope of practice". If all you are qualified to do is basic first aid, then that's all you do. Period. Creative good intentions kill people needlessly.
7)make sure you have a plan to communicate for help if you need it. What ever it takes: cell phone is nice (if it works in the area you are going into), satellite phones are better if you can afford that (I can't), flares, smoke signals (I am kidding) someone going for help, - what ever it takes. Almost forgot. Make sure you know where you are. Sending for help is so much better when they know how to find you.
8)The basic medical supplies aren't much - just well thought out. The training and skill sets are far more important.
9) last note for the moment - helmets - don't take off unless you have to, and if you have to, make goddamn sure you know how to do it properly (take a course).

Peace,
Narly

A very interesting post narly .
Your last comment was about helmets .
Many full face helmets are very snug and would be difficult to remove from a victim's head .
Have you ever performed artificial respiration through a full face helmet ?
I imagine it would be almost impossible .
Would a flip face helmet have an advantage here ?
I imagine that airways and breathing could be checked much more easily if the victim wore a flip front .

As an aside , I have to have industrial first aid training for my work and it is renewed every 2 years .
I am dismayed that over a period of 8 years I have seen the emphasis of the course change so much. Initially the prime importance was the welfare of the victim but latterly the emphasis has changed to litigation avoidance .
In other words ,it seems to me that the attitude is now - "what is the minimum that we can do for this sucker ,without getting the company or the individual into a situation where they /we could be sued " .
The last training was done by the St Johns Ambulance and I was less than impressed .
Is there anywhere in Western Canada where more comprehensive training could be found . I have no desire to go beyond a first aider status ,but I would like to think that I was instructed in the best possible methods to assist my family and friends , should the need arise .

Narly
All good sound advice that really shouldn't be underestimated. Many people haven't got a clue what to do in an accident and often freeze or panic which can be more dangerous than doing nothing.
If you are dealing with a car accident , especally a frontal collision, it's a good idea to try and get the battery disconnected if possible. The likelihood of sparks from a short circuit and subsequent fire from spilt fuel it is very real so diconnecting the battery removes the very real risk of fire.

If there is no immediate risk to the casualty - leave them in the vehicle. there was a great story in the Uk of some good samaritan who took a casualty from the damaged vehicle and he sat them in his nice shiney Jag whilst waiting for the emergency services. When they arrived there assessed that there was a risk of spinal injury to the casualty so they cut the roof off the nice shiney Jag in order to get the casualty onto a spinal board. I bet Mr Jag felt really good explaining that to his insurance company ! :eek2:

I carry as set of "Cas-straps" 'with me . these are a series of multi purpose velcro straps designed specifically for first aid use. http://www.cas-aids.com/ They are also used by the military and having used them twice ' in anger ' I can say they are a very good bit of kit.
I was first on scene to a young lad who had been run down by a car on a zebra crossing in Holland a few years back. A quick check revealed a clearly broken Femur (thigh bone) . I secured his legs together using the cas-straps and waited for the ambulance to arrive. Moving a casualty with a broken Femur is a very bad idea because there is a high risk of damaging an artery. The paramedics arrived and checked him over and were so impressed with the straps they asked if it was OK for them to leave them on while he was transported to hospital . I thought I'd never see them again but the next day the kids dad brought them round to where I was staying and gave them back to me. I've got to say it felt damn good to be able to do the right thing in that kind of situation.
Get trained - because you never know when you will be able to save a life and standing hopelessly looking on while someone is injured is a very bad feeling.
Ride safe
Gecko

Hi People, nice to see reality and common sense starting to finally creep into accident management of which first aid is only a part albeit a very important one. The comment about helmets and the removal of them to begin EAR is a particularly good example of the prioritization of actions that the first responder trained or otherwise has to carry out; basically if the casualty cannot breathe because of a blocked airway they will die, no argument. If you remove the helmet from an unconscious casualty who may have C spine damage in order to clear the airway you might cause their demise. One positive versus two maybes, means no argument. But as has been mentioned go and see your local paramedic and learn the reccommended way to remove a helmet, the more you practice the luckier both you and the casualty get.

With regard to litigation, most countries have a "good Samaritan" act which means that if you are doing your best to help someone you will be OK, just remember the KISS system and that if you panic you die all tensed up. Ride safe.

Artificial resus
 

It isn't commonly used/practiced unless you are a trained diver, but it is quite possible to perform mouth to nose resusitation. If someone for example has a mangled jaw whilst wearing an open front lid (headstock faceplant.....) the same basic rules apply about the airway, but seal off the mouth and blow through the nose. I had to do this on someone who had a heartattack, got colour back into them but the heart would not restart. it was a lot less messy than mouth to mouth.

As a few people have mentioned, the reason to take a helmet off is if AR or CPR must be preformed. This is life over limb. If it results in spinal injury, so be it. With out air, you are on the way to being dead within 4 minutes. The point I am making is, do not take it off if the casuality is breathing just fine. It's the "I'll just take the helmet off to make you more comfortable" well meaning fool, that worries me. Have seen it, still don't beleive it. It takes two people to properly remove a full face helmet. One immoblizes the head/spine, the other takes the helmet off with a "S" like move.
But like I and others said - If the person isn't breathing - the helmet comes off as best as you can, but it comes off.
The other issue, moving the casuality is very simple - unless the person's life is endangered by remaining where they are - don't. Again, seen it, still don't believe it.
You build what ever shelter is needed around the casuality. Provide shade, insulate from the cold, what ever is needed.
On that note, be aware that an injured person, is more suseptible to environmental injury (heat and cold) than they would be normally. Keep them warm.
The last comment I want to draw attention to (for the moment) is consideration for the casuality. Have compasion. Regardless of what this person was a split second before the accident, they are now an injuried and probably frightened human being. Treat them with compassion and coutesy.

Hey Doger.
If you are disappointed by the constant lowering of the bar for first aid, you will be even more so when you see the new standards to be implimented in January. If you arn't interested in doing an AFA11 or emr course, then I suggest a good wilderness first aid course by a well recommended company. Not being in bc, I'd be hard pressed to recommend anyone.
The wilderness first aid should cover what to do AFTER the first five min. (this is usually what first aid covers - support the patient till help arrives). In the wilderness, you usually are first, second and sometimes, the only aid. If the course doesn't reflect this - look elsewhere. There are some good ones out there.
Sorry I can't be more help at the moment. Some of the SAR folks I know worked in BC. If I get a chance, I will check with them. Perhaps they have some recommendations.

If this thread has enough interest, perhaps myself and others can put up most of the content for a first aid course with motorcycle travel in mind. (I teach such a course). By necessity, it does include many of the elements from the wilderness first aid.
It also wouldn't hurt to put up the tried and true elements for a good travel first aid kit. I know it had been done before, but it would be good to put up such a thread again.


Peace,
Narly

GECKO - thanks for the link. I'm sure any such help and suggestions of tried and true equipment is appreciated by all.

Good stuff, thank you for bringing this up so clear and thoroughly.

One small tip to keep this thread even more usefull, try to use exact simple language, maybe even explain the abbreviations at the bottom of your post. This would make the posts a bit clearer for non-native english speaking viewers and people not used to the terms used in your part of the world. For instance I have to guess what's mend with AR, CPR, EAR, (try this in google) I think KISS will also be aplicable here (KISS = Keep It Simple Stupid).

but thanks again, these kind of threads brings your feet back on the ground

useful thread, thanks
 

Any recommendations on where to get wilderness first aid training in the UK? Also expected cost/duration.

Hi All

great thread topic - very, very important.

I personally did a little more than basic First Aid course before going on my trip, and used my fairly basic skills on a number of ocassions, and wished they were better. Learnt quite a bit from an ex-paramedic out in Zambia then on my return to the UK, I took a "Wilderness" course which was booked thru and run at the Royal Geographic Society in London. Great course, run by really helpful, knowledgeable and Interested people - all Doctors, Nurses or Paramedics - I must say that I would happily retake the course to re-new/refresh my skills and also be interested in the next step.

Will try to find the name of the company the course was run by.

Regards

Chris

Will try to find out info on approx numbers needed and cost to take course - if we then got enough people interested we could organise it

Regards

Chris

Glad to see this
 

As a Emergency Medical Services professional for a number of years, I am glad to see the post on medical care. I've received training in urban, rural and wilderness settings as well as mountain and avalanche rescue. I must say that the time and money for these courses has made a difference on more than a few occasions. It seems as though a lot of people don't think about what they would do in the case of a medical or traumatic emergency in a time where most think of their cell phone as a med kit. I would recommend at least a basic first aid class for all who travel, especially to wilderness areas. The National Ski Patrol offers an excellent course for advanced first aid, it deals with emergencies in a rural and wilderness setting's the cost and time requirements are minimal, with a lot of opportunities to further your medical knowledge and skills.

Here in the states there are a number of courses that can be taken through colleges and also through the community colleges, the latter run by the Public Safety Institute.

Some of the things below may be of some help should the need arise.

Scene safety is a concern for all people in the area. In case of a motorcycle or vehicle accident, check under the automoble or motorcycle for any fluids leaking. Make sure there are no down power lines or damaged electrical or gas terminals or lines.

Again as said above the ABC's are your first priority with the injured person or persons after the scene has been assessed. If there are multiple people injured do a quick assessment of everyone to see the extent of their injuries. After that, tend to the most criticle injuries first.

The acronym SAMPLE may help too.
S is for Signs and symptoms. The signs are what you see of the injury if visible or, for example, if a person is holding their ribs, the may have fractures or internal injury to the torso. The symptoms are what the person tells you that they are feeling.
A is for allergies to medications. A number of people are allergic to Sulfa Drugs or certain antibiotics as well as many ofthe medications.
M is for medications that the person may be taking or have taken.
P is for past medical history. Has the person had any recent surgery or do they have a heart condition. Diabetes is quite common.
L is for last oral intake. When was the last time they ate or drank. Very important for people with diabetes. They may have taken their insulin but didn't eat anything. Anyone can experience low glucose levels, (sugar) levels with low oral intake. Dehydration can be debilitating in all weather conditions, not just hot and humid conditions.
E is for the person to explain what happened, if possible. You will get a better idea of whats going on from the actual person than you will from bystanders.

Another acronym for assessing injured people is DCAP-BTLS
D is for deformities. The frature may be displaced,(out of wack from normal). Look at the other limb or other side of the body and make a comparsion. Check to see if the fracture is through the skin.
C is for contusions. Is there brusing around the area of complaint. If there is a large dark bruise, especially in the abdomen, may be a sign of internal bleeding.
A is for abrasions. Like road rash.
P is for punctures or penetrations. If they are impaled by and object, see if it went through all the way. If there is an exit wound dress both sides. If not, try to secure to object so movement of the object is limited.
B is for bleeding and burns. Control bleeding with gauze compress, shirt, etc. Apply direct pressure. Also, ice or an ice pack will help constrict blood vessels to slow bleeding, use over the dressing.
T is for tenderness. Check for damaged tissues under the skin by feeling it, or when the person says, "don't touch that, it hurts".
L is for lacerations. Cuts to the skin and underlying tissues.
S is for soreness. Usually dealing with fractures, tendons, ligaments or muscle damage.

Splints for injured limbs. As stated in some of the posts, an anatomical splint, (i.e. using the body or uninjured leg as a splint for injured limbs), is quite effective when nothing else is avaliable. Branches and tent poles work well too. For a good plastic splint, get an empty bottle of bleach or washing detergent, cut out a four to five inch wide piece from the middle of the bottle. It rolls up small when not in use and doesn't weigh much. If the person is able to straighten an injured limb, it will help with blood flow, unless there is bleeding below the fracture, then just keep it the way it is.

Bleeding control. Traditional gauze dressings 4x4, 5x9, etc. are quite well, for their size over small wounds. Maxi pads or kotex work well too and with the sticky side to be stuck to roller gauze for field dressings.

As for the removal of a helmet, it should not be attempted by one person or by persons not trained in the proper way of removing it. However, if the injured person is not breathing, the possibility of spinal damage then becomes the lesser of the problems.

These are just a few things I figured I'd pass along. I'll say it again, get proper medical training by experienced instructors, it just may save your own life or somebody elses.

A course at Nelson 2007 maybe ?
 

I think it would be of enormous value to have a motorcycle orientated First Aid course at some of the HU traveller's meetings , maybe at Nelson next year if narly could attend and if the organisers were willing .

Sounds like a great idea. I'd be interested in this.

(Just so We have a guideline of what aspects of what topics might be to be addressed, I am putting this up. Please expand or give tried and true information where possible.)

If I was headed off for an extended trip, here are the basics I would want in a first aid/emergency course. Unfortunately, the average first aid course isn’t quite enough because its main focus is on injury. Being able to recognize illness early enough to keep it from progressing to something serious enough to require medical aid, is also important.

1) Preparation for the trip – what type of injuries are likely/possible in the environment where you are going. What medical conditions/physical limitations of the travelers. Remember that there are two primary concerns on the road. One is injury and the other is illness. Do you know what is normal for yourself and your traveling partners? When are they ill? What means of communications do you need and what kinds are possible?

2) Emergency scene management – motor vehicle accident in remote location – how to secure the scene and assess the type of injuries to be expected.
How to do the basics – scene survey, primary survey (abc’s), rapid body survey.
This also means knowing what is the norm for a healthy person. This, sadly, doesn’t get enough attention in first aid courses. What is the normal: heart rate, breathing rate and sound, temperature, skin condition, level of consciousness, motor response to stimulation and fluid intake/elimination? How do you know when the person is dehydrated?

3) Basic first aid injury treatment skills – these must include treatment and protections from environmental injuries. Hypo and hyperthermia are serious issues after an injury.

4) Rescue carries – Because you are in a remote and potentially hazardous location, moving the casualty may be necessary for their and your safety. This also means stretcher carries.

5) Secondary survey and a more extensive assessment of injury and illness. Because you are in remote locations, you very much need a patient history including how the patient feels right at this moment. You will need the “baseline” of their condition to be able to assess if their conditions is improving or getting worse.

6) Continual care – do you know when an injection has progressed from a local injection to systemic? Has their temperature increased? When is it becoming dangerous? Do you know how to clean a minor wound and assist it in healing? Do you know enough about nutrition and hydration, for a person who is ill, to ensure they have the best chance for rapid recovery.

7) The basic supplies and kit needed for wilderness trips. This differs from your basic first aid kit. You need to consider: personal medications, environmental protection (shelter and fire), light sources, thermometer, cleaning solutions, and emergency water and food rations.

8) Knowing: what conditions require delaying or canceling the trip (dental), when to call for emergency medical intervention (medivac), what the different routes of infection are and how to protect yourself.

9) In addition to the basics, you also need to know about the environment you are going into in terms of hazards. Are there parasites, or poisonous animals and plants? Are you prepared to recognize and treat these injuries? What do you need in order to avoid infection or injury?

There is much more that one needs to know, but these are essentials I would feel ill prepared without.