Wilderness First Aid 

In my continuing effort to not die while out on the Pacific Crest Trail, or in general,  I recently attended a NOLS Wilderness First Aid class, which was hosted by REI, with my girlfriend Cristina. The class was two full days and covered everything from treating blisters to what to do when someone is struck by lightning.  Luckily this class was nearby and didn’t require a long drive to some shady place like my ice axe class.

One of first things we learned  is how to perform a patient assessment (PAS), which was full of of  lists and acronyms.  When performing a  patient assessment you first want to check the scene, identifying any hazards, determining the method of injury (MOI),  put on gloves to protect yourself from any bodily substances (BSI), determine the number of patients and the general state of the patient.  In an emergency situation it may be difficult to remember all this so the provided us with our first list, which rhymes! (who doesn’t love a rhyming lists?)

  • 1 – I’m number 1 – Check for hazards to make sure it’s safe to provide assistance
  • 2 – What happened to you? –  Try to determine what happened
  • 3 – Not on me – Be sure you have your gloves on
  • 4 – How many more – Look for additional patients
  • 5 – Dead or alive  – Don’t say this one loud enough for the patient to hear

Once you make it through the list, guess what comes next? That’s right, another list!  The next thing to check the patient for any life threats, after introducing yourself and gaining consent from the patient of course.

  • A – Airway – Check for anything blocking the airways
  • B – Breathing – Look and listen to asses breathing
  • C – Circulation –  Check for pulse and any bleeding
  • D – Disability – Stabilize neck and head if chance of a spinal injury
  • E – Expose – Expose any serious wounds

Unfortunately the next section isn’t part of a list let alone one that rhymes.  First, perform a head to toe exam using your hands (appropriate touching! hands slightly curved and thumbs up (Our instructors explained that none of our scenarios would include any injury to the genitals so we skipped that area, which was for the best.) Talk to the patient asking them if they feel any pain or discomfort as you as you perform your exam.  Ask them to squeeze your fingers, push  their feet against your hands and then pull their toes against your hands with their feet.  After your head toe exam take the patient’s vitals, noting the time they were taken including:

  • Level of Responsiveness (LOR) –  Awake and oriented (AO), Awake and disoriented (AD) or Unconscious (U)
  • Heart Rate (HR)  – Including rhythm and quality
  • Respiratory rate (RR)  – Including rhythm and quality
  • Skin color, temperature and moisture (SCTM) – Pink / Pale, Warm / Cold, Moist / Clammy

The final part of the PAS is the SAMPLE (Yay! another list!). After asking the patient what their chief complaint is and cause of injury / illness gather the following, asking clarifying questions as they answer :

  • S – Symptoms – How they’re feeling beyond their chief complaint.
  • A – Allergies – Food, medication, plants / animals
  • M – Medications – What they are currently taking and when they last took it, including supplements or performance enhancing / recreational drugs
  • P – Pertinent medical history – Medical conditions or recent illness / surgeries
  • L – Last intake / output – What did they last eat / drink and when.  When was the last time they went to the bathroom and if there was anything unusual (heh. poop.)
  • E – Events leading up to the injury / illness –  What happened? Did they fall, drink some untreated water, or get abducted by aliens?

If you want to see what a full PAS looks like here is a great video by NOLS. After completing the PAS you will provide treatment and make a decision around evacuation. Even if you don’t know what to do with this information it’s good to gather it if you’re in an emergency situation as it will be helpful when help arrives.

After we learned about how to perform a PAS we got to practice! We split up into groups where one group would play the patients and another would be the rescuers.  The instructors would provide the patients with a scenario and pertinent information, sometimes we even had fake wounds.  We covered falls, head  and spinal injuries, dehydration, shock, burns, infection, musculoskeletal injuries, dislocations, hypothermia, frost bite & non-freezing cold injuries, heat exhaustion and many more scenarios.

On the second day we moved into practicing treatment, mainly around musculoskeletal injuries. I was lucky enough to be the recipient of an arm sling  and an awesome improvised leg splint. I will admit, the main reason I volunteered to be the patient in this scenario was due to the fact that it involved laying down and the instructor looked pretty exhausted after demonstrating the improvised leg splint.  I did however practice taping up a sprained ankle, which is the most common injury in the backcountry.

In one of the last scenarios Cristina and I were both patients and  paired up as a couple. The scenario was that we just flown from Seattle to Denver, hopped into a car and drove up to Pike’s Peak, essentially going from sea level to 14,000 feet in a matter of hours and resulting in altitude sickness. I had walked around a rock to go pee and ended up tripping dislocating my knee.  Things got fun when the instructor told us that one of our symptoms was irritability and that we had to argue with each other.  Now, I wouldn’t characterize Cristina as an angry person, she is very outgoing, friendly and kind.  So, when she started yelling “This is all your fault, I didn’t even want to come on this dumb trip! I hate hiking!!” I couldn’t stop laughing even though I was supposed to be irritable myself, not to mention in extreme pain. I’d try to regain my composure and yell back, saying something like “This wouldn’t have happened if you would have just stopped at a gas station so I could go to the bathroom instead of having to go behind a stupid rock!”. We, and our rescuers, ended up laughing a lot during the scenario, so much so I didn’t even feel any pain from my dislocated knee.

I’m really glad I invested the time to go to the class, I feel much more prepared to help out if I come across an injured person and really glad that Cristina is trained as well so she can help me when I do something dumb like trip over a rock. I’d highly recommend the class if you spend a lot of time outdoors, check the classes at your local REI or NOLS if you’re interested.