First aid is mentioned over and over in various articles in the blog. It is a basic skill everyone who participates in outdoor recreation should have. I would even go so far as to say no one should ever venture out into remote outdoor recreational activities without at least basic first aid knowledge, skills, and supplies. Anytime you are going to be any significant distance from immediate medical assistance you should be prepared to administer first aid. If you participate in high-risk activities, such as dirt biking, mountain biking, or rock climbing, you should seek advanced first aid training to be prepared for the kinds of injuries you and your companions may encounter. As a minimum that should include knowledge of how to control bleeding and how to splint broken bones. Also when and how to move an injured patient.
Because many of our outdoor activities take us to remote places it may take some time for EMS help to arrive. We need to be prepared to take care of ourselves and our associates until professional help reaches us. In many remote locations that could take hours! Here is a link to my post on Getting Emergency Medical Services When Camping for more information on preparing to obtain EMS services in remote locations.
To some extent it is assumed that most people have a pretty good idea of what "first aid" means. However, individual perceptions seem to vary quite a bit. There are at least two recognized levels of first aid: basic and advanced. As a volunteer firefighter and EMR I have had the chance to learn and use both basic and advanced first aid and have found the skills as useful in camp and out on the trails as they are on a fire department call. I have splinted broken bones, dressed wounds and abrasions, and prepared patients for transport to the emergency room on several occasions while dirt biking. I even spent about an hour removing cactus spines from a rider's arm using the needle-nose pliers from my tool kit. Not exactly life-saving, but certainly necessary.
The basic definition of first aid is: help given to a sick or injured person until full medical treatment is available. Sometimes first aid is all that is needed and full medical help is not required, such as dealing with minor cuts and scrapes or a common cold. More advanced first aid may be required to assist someone with more serious, even life threatening injuries or illnesses, pending full medical support. In times like this first aid will almost always make the patient more comfortable and reduce the chance of additional complications. In some cases first aid can be life saving, such as performing CPR, stemming arterial bleeding, warming a hypothermic (frozen) patient, or cooling a hyperthermic (heat stroke) patient.
Basic first aid skills are important for just about everybody. You are likely to use them at home as well as during outdoor recreational activities. Getting and maintaining good first aid skills is especially useful for outdoor enthusiasts who are likely to find themselves in remote locations where access to medical assistance is limited. At home you can probably ask a neighbor for help if you encounter a problem you can't handle or, in more severe situations you can call "911". Sometimes you can call "911" when you are camping, but often the remoteness of camping, boating, RV, and OHV activities is out of cell phone range. Even if you can make the call, it will probably take some time before any Emergency Medical Services (EMS) personnel can reach you and you will be the only one who can help the patient(s) until they arrive. What you do during that time can sometimes save their lives! I once read that "You are the only first responder you can really count on." Know your best options for getting help where ever you go. There were signs scattered over the area we often went dirt biking near California City giving the local police department number. In talking with police we learned that 911 calls went to a state police office hundreds of miles away and often took extra time getting routed to a local response team while calling the local number got you connected to a local agency right away and significantly reduced response time. Reduced response time will always mean less suffering for your patients and can literally mean the difference between life and death in life-threating situations.
Advanced first aid skills may be needed to tend to severe injuries in remote areas while you wait for EMS folks to arrive. Advanced skills can often reduce the suffering and prevent secondary injuries. In some cases advanced first aid may even be lifesaving! You should seriously consider getting advanced first aid training if you are involved in any kind of vigorous activities that can lead to serious injuries, such as rock climbing, mountaineering, mountain biking, riding OHVs, and riding horses. Knowing how and when to perform CPR, how and when to control bleeding, and how to splint broken bones are among the fundamental advanced first aid skills that may be needed during outdoor recreational pursuits. Knowing when and how to move an injured patient can be critical. Basically, only move an injured patient if they are in an unsafe situation. If you must move someone, be sure to stabilize their spine including the cervical spine neck) and splinting or otherwise securing broken limbs before moving them. Then move them very carefully. Being able to deal with heat and cold related injuries like hypothermia and heat stroke can be life-saving skills. Hypothermia is fairly common in winter activities but can also occur in relatively warm environments when the patient is in wet clothing. Whenever you are dealing with a victim of a serious impact (vehicle accident or fall) always check for ABC. That's Airway, Breathing, and Circulation. Airway means making sure their throat is clear so they can breath. Breathing means listening or feeling the breath from their nose and mouth and/or watching their chest rise and fall. Circulation means looking for any obvious signs of bleeding and checking the extremities to make sure blood is reaching them. To check circulation, pinch fingernails and toenails and watch for the color to return. Color should return in 1-2 seconds. If it doesn't, something is affecting blood flow. It might be a severed or pinched blood vessel that must be taken care of to avoid loss of the affected area.
There are many good books that provide instructions for basic first aid. There are even some for advanced first aid. However, having a hands on course will make you much better prepared. You can usually find local first aid classes offered by the Red Cross or by your local fire department. They are usually inexpensive or often even free! Many fire departments now offer Community Emergency Response Team (C.E.R.T.) training that includes emergency medical triage and light search and rescue in addition to first aid and fire suppression. Reading a good first aid book is a good start and keeping them handy for future reference is a good idea. Getting hands on training is critical to actually being able to perform the required duties in an emergency situation.
Basic first aid will usually be enough to take care of splinters and minor cuts and scrapes but you might need advanced first aid to handle life threatening injuries. Knowing how to control bleeding could save someone's life. Being able to splint a broken bone will almost always make a patient more comfortable and reduce their suffering as well as preventing secondary injuries.
When looking for a first aid course or book, here are some of the primary treatments you should look for in any basic first aid instruction for the following issues:
- Minor cuts and scrapes
- Blisters
- Insect bites
- Heat cramps
- Sprains
- Minor illnesses (e.g., colds etc)
As you learn more or if you are regularly involved in high-risk outdoor adventures such as dirt biking, mountain biking, or rock climbing, you should look for advanced first aid training that covers these situations:
- Controlling bleeding
- Splinting broken bones
- Recognizing strokes and symptoms of head injuries
- Heat Stroke (Hyperthermia)
- Hypothermia
It is always a good idea to maintain CPR certification. You never know when someone is going to have a heart attack or suffer some injury that causes heart problems. Drowning victims often need CPR. CPR certification is usually good for 2 years before it needs to be renewed and you should faithfully get your renewals. Not only will you refresh your memory you will usually learn new techniques or practices that have been developed as CPR continues to evolve. The best way to get CPR certification is to take a formal training class from the American Heart Association or the American Red Cross. Click on the links provided to find a course near you. You can also find online CPR classes, but they will obviously lack the hands-on practice you get from an instructor.
Proper first aid training will also give you the ability to better access whether more advanced medical treatment is necessary and how urgent it might be. You probably don't need to call "911"or rush a patient to the ER for a sprain but they might need advanced treatment urgently for a broken bone. Compound fractures (those in which the broken bone penetrates the skin) are more serious than simple fractures, which can be very painful and debilitating but not as subject to infection or bleeding. Being able to discern the difference between a suspected appendicitis and an ordinary tummy ache or indigestion would help you decide what to do to ensure your patient gets proper care without an unnecessary trip to the ER, which in itself can be traumatic and expensive.
Basic first aid courses usually don't take very long, typically just a few hours. Expect to invest a little more time to gain advanced first aid skills. You will find it to be a good investment. Even if you never have to use it, knowing you could if you had to can give you a lot of peace of mind. Your confidence in your skills will be a significant factor in calming down any person you may have the opportunity to assist. Police and fire fighters are usually certified as Emergency Medical Responders (EMRs) and that would be a good level to shoot for. That may take 40 hours or so of training. More advanced training is required for Emergency Medical Technicians (EMTs) and Paramedics. While having that level of training would never hurt, obtaining it can be time consuming and expensive and is probably more than you would need or ever use in normal outdoor recreational activities. If you have the time, money, and inclination, by all means get as much training as you can! In addition to my EMR certification I completed a course in Advanced Wilderness Life Support that gave me skills I might need during remote outdoor activities or during a wide scale natural or man-made disaster.
If you venture into the wild or want to prepare for a long term disaster situation you might want to look into natural remedies. My favorite is an easy one: willow bark (or poplar or aspen bark) can be used as a substitute for aspirin. It contains salicylic acid, which is similar to acetylsalicylic acid, which is the chemical name for aspirin. Aspirin is actually a synthetic version of salicylic acid. Other "back yard" or natural sources of medicine abound. Seek out information about what useful remedies can be found where you live or play.
First aid training is not a one time thing. You will learn that certifications have an expiration date. There are two very good reasons for that. First of all, you need to reaffirm your knowledge of many first aid skills on a regular basis. Most people don't use their first aid skills frequently and will need regular refreshers to maintain proficiency. Secondly, medical science continues to make advances and new or better techniques often become available. When I was growing up I was taught a technique for treating snake bikes than involved making an "X" shaped incision over the bite and sucking out the venom. Modern medical protocol says not to do that, but to just elevate the bite if possible and seek professional medical help as soon as possible. Working with outdated protocols could significantly limit the level of help you could give and might even have liability issues. Plan on scheduling yourself to get updated training at least every couple of years at the very least. The more frequently, the better!
As you learn more about first aid you will also learn more about the equipment and supplies you need to provide appropriate treatment. Training and supplies go hand in hand. Neither is of much use without the other. You could have a fully equipped mobile emergency room and it wouldn't do you any good unless you knew how to use the equipment and supplies. You could be a fully qualified paramedic but your options for helping someone would be limited by the availability of proper equipment and supplies. If you do reach EMT or higher training levels you will probably purchase your own personal emergency medical kit you can take with you where ever you go and that would ensure you could always use your training to best advantage and provide the best possible care for your patients. Minimum first aid supplies for everyone should include dressings, bandages, splints, and antiseptics. I like to include some basic OTC pain relievers, but be aware that there are times you should NOT give pain relievers. It is usually a good idea to give a person experiencing a heart attack about 325 mg of aspirin (4 children's tablets or one adult tablet) unless they have ulcers or are allergic to aspirin. Do not give anyone any medication they are allergic to. Be sure to ask them, if they are conscious, or ask a family member or friend. Never attempt to administer any kind of oral medication or even water to an unconscious person.
In addition to the knowledge and the physical skills and equipment and supplies needed to perform first aid, you need to be psychologically prepared. Fortunately, unless you work in an emergency room, you probably aren't exposed to a lot of injured persons. Most of us are not used to seeing injuries to human bodies and many people have strong negative reactions to the sight of blood or deformed body parts. To be effective in providing first aid you must be prepared to accept the injuries and proceed to take the appropriate actions, regardless of how gruesome or frightening they may be. You need to remain calm and present a confident and positive attitude in order to provide proper care for your patient(s). I, for one, have never been particularly bothered by the sight of blood, but twice I have nearly passed out viewing close relatives being given injections of anti-pain meds to repair their injuries. I don't mind getting shots myself, but for some reason watching the needles being poked into my sister and my son made me light headed! Since becoming a volunteer firefighter I have forced myself to watch our EMTs introducing IVs and watching the techs draw my own blood for lab work to mitigate my reaction. Any sign of panic or unusual excitement by an emergency responder can introduce a negative affect on your patients. Try to remain calm and confident in all you do and never attempt anything that is beyond your training and skills.
A very important psychological aspect to giving first aid is to be confident in your own abilities. Patients can see and/or sense if you are apprehensive and that is NOT a good thing! Your patients need to feel secure in what you are doing and that means YOU must be secure in what you are doing. That is one of the reasons keeping your first aid training up to date is critical. When you are faced with an emergency, let your training guide you and accept your role as provider and your patients will accept you -- and benefit from your treatment. In C.E.R.T. training were taught to approach potential patients using the following statement/question: "Hi, I am (name). I am medically trained. Is it OK for me to help you." Saying you are medically trained does not mean you are a doctor or a nurse but you should only use the phrase if you are in fact at least trained in first aid. Of course all of our C.E.R.T. people were properly trained in first aid.
If your patient in conscious you should get their permission to treat them before you start any treatment beyond a visual inspection. As mentioned above, in our C.E.R.T. classes we were taught to say something like, Ï am (your name), and I am medically trained. Is it OK if I treat your injuries?" Of course you should only say you are medically trained if you have in fact been trained. The training we got in C.E.R.T. and most basic and advanced first aid certifications would allow you to say you are medically trained. You shouldn't claim to be a doctor or nurse or other medical professional unless you are currently licensed as such. If you are working on a family member or someone you know well you probably don't need to mention your medical training, but it is a comfort and will be of value to strangers to know that you know what you are doing. Most people who have been injured are going to grateful for any assistance and will agree to treatment. If they do not agree, you should not touch them. However, if you observe life threatening situations (arterial bleeding or they are in a situation that places them in danger of life-threatening injuries) you should advise them of the situation and the risks and attempt to convince them to accept your help. If they continue to refuse you may eventually be able to treat them under the concept of "implied consent" after they have passed out. The law recognizes implied consent for an unconscious person since most normal people would consent to treatment for life-threatening injuries if they were able to do so, even if they had previously refused treatment. Of course it is better to begin treatment as soon as possible as in some life-threatening situations, seconds count!
What are your risks in providing first aid? Some people are reluctant to get involved in helping an injured person for fear of legal repercussions. Pretty much all states have "Good Samaritan" laws that protect people who come to the aid of injured parties. That being said, you do have an obligation to act appropriately and within the scope of your training. If you attempt something you have not been trained to do you could be held liable but you should be OK, for example, performing CPR if you have been trained in CPR and your certification is current. Personally I would not hesitate to assist to the best of my ability. I would rather have to justify my actions than live with my inactions if my help might have saved a life! Of course you can be held liable if you attempt to provide treatment for a patient who has refused treatment and is still conscious or if you attempt procedures that are beyond your training. I have heard of highly trained military corpsmen being prosecuted for practicing medicine without a license when they used their very good and appropriate medical skills to assist accident victims because they were not licensed EMTs in that jurisdiction! BTW, that was a jurisdictional problem, not a medical or even ethical issue! So, always work within your certified skills and the legal scope of practice your training allows. As a volunteer firefighter and EMR I have to keep up with and limit my actions to the scope of practice for EMRs here in Oregon, which tells us exactly what we can and cannot do. Note: there are sometimes exceptions when you may be asked by a higher trained medical professional to perform a task under their direction, but never try anything outside your training without authorization by a qualified provider.
Know what you can do and do it!
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