Wecome To RVs and OHVs

This blog is all about RVs (recreational vehicles) and OHVs (Off Highway Vehicles), camping, sailing, and survival
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Friday, January 21, 2011

First Aid

In my mind, first aid training should be a pre-requisite for purchasing or renting an RV or an Off Highway Vehicle or just going camping. The very nature of OHV and camping activities mean you will often be in remote locations doing things you don't normally do with few, if any, readily available medical facilities. Operating equipment or even just hiking in various kinds of terrains offers its own challenges and potential for injury. Knowing how to treat various kinds of injuries you or your companions may sustain can, quite literally, save a live. At the very least, having sufficient knowledge and supplies can reduce the affects of many injuries, reduce the suffering, minimize injuries, and add to the comfort of the injured. Knowing when and how to evacuate a seriously injured victim is a critical skill.  Proper first aid can prevent minor injuries from becoming major problems.  Lack of treatment or inappropriate treatment can lead to serious infection and/or additional an unnecessary injuries.

Always familiarize yourself with readily available emergency services near your destination, such as rangers and  local law enforcement.  Also know where to find the nearest Emergency Room or Urgent Care facility.   Even after you've done all you can do with first aid,  you or your patient may need professional medical attention.

There are two critical components of proper first aid:  adequate supplies and proper training.   All the supplies in the world won't do you any good if you don't know how to use them, how to assess injuries, and what to do to aid your victims and knowing what to do won't do you much good if you don't have anything to work with.  A completely equipped emergency room would be of little use to someone with no medical training.  And even a doctor will need certain equipment and supplies to be effective in the wilderness.  There is a special program called "Advance Wilderness Life Support" to teach medical professionals how to handle situations outside the hospital.  Of course, with the right knowledge you can often improvise if you're short  on supplies.  In this article we will focus on some basic and  useful first aid skills and procedures.  Another article (First Aid Kits and Training) will give more detail about first aid supplies and training options.

The Red Cross offers first aid and CPR classes in most most communities. Often these classes are often free or have very nominal costs. Check with a local hospital, fire department, sheriff or police department to find out about available classes.  Schools and churches, community groups, and even some employers often sponsor first aid and CPR classes.  Some basic knowledge of life-saving techniques could, quite literally, determine whether a family member or friend lives or dies following an OHV or other outdoor accident. First aid and CPR classes are usually not expensive.  In many cases the classes will be free although there might a charge for processing your certification.

The ABCs of first aid -- Airway, Breathing, Circulation, are key things to remember. Airways: if the airway is blocked, a person cannot breath, and will quickly suffocate -- in about 3 minutes. First aid and CPR classes teach you how to quickly check to see if the airway is blocked and how to clear a blocked airway. Sometime this alone is all that is needed to save a life. Breathing is the second critical function to be checked. If a person is not breathing, they will soon die. If the airway is clear and they are still unable to breath CPR (Cardio-pulmonary resuscitation) may be required until they can breathe on their own again. Circulation refers to the circulation of blood throughout the body. Blood carries lift-sustaining oxygen to the organs and hauls away waste products. Lack of circulation may be due to heart stoppage or to pinched, blocked, or severed arteries and veins. Another life-threatening circulation problem is arterial bleeding. This occurs when an artery has been sliced, ruptured, or punctured. This can be identified by blood spurting from the wound as the heart beats. You may see copious blood flow from other wounds but if it isn't spurting, it isn't arterial. Arterial bleeding and any other severe bleeding must be stopped or the patient will quickly bleed to death.  A person will "bleed out" and die in just a few minutes from a damaged femoral artery.  First aid classes will teach you how to stop bleeding. The preferred method is direct pressure on the wound. Tourniquets should only be used as a last resort and often lead to the loss of the body parts beyond the tourniquet.   Still is is better to lose a limb than a life. Internal bleeding is harder to identify and usually life threatening.  If the abdomen is hard when you press on it, it could be filled with blood from internal bleeding.  Shock, pale skin, and rapid or erratic heart beat may also accompany internal injuries.  Don't underestimate the danger of internal injuries.  I know of a dirt biker who crashed, picked up his bike, insisted he was all right, and finished the ride only to die of a ruptured spleen sitting around camp a few hours later, still claiming he was "fine" until it was too late.

However, a more up to date procedure is MARCH Massive Bleeding, Airway, Respiration, Circulation and Hypothermia or Head injury.   A recent presentation during our fire fighter training strongly urged us to use MARCH instead of ABC when dealing with mass casualties.

The most important thing is to have a plan of action and to follow it.   Every incident  you  might encounter requires first of all, some kind of assessment (what happened?  Is the scene safe?  Is it safe to attempt to treat victims?  What are the major injuries?  How can you best help?)  An initial assessment might  determine the scene isn't safe, in which case you should do nothing until the scene can be stabilized by qualified personnel.   Traditional treatment scenarios usually begin with some kind of triage, e.g., sorting the victims by severity of their injuries.  A simplified approach to dealing with mass casualties uses a 2 point system.  As the victim a question.  If you get a reasonable answer, they score 1 point.  If they are conscious and they have a heartbeat, they get a point.  Anyone with 2 points is categories "delayed".  Anyone with 1 point is categories "immediate".  Anyone with 0 points is probably dead or at least beyond help.  Focus medical treatment first on those classified as "immediate", then re-assess the delayed group to see if the status of anyone there  has changed and respond appropriately.  Don't waste time on delayed patients until all of the immediate patients have been taken care of.

Broken bones are not uncommon in outdoor activities. Broken ankles occur often among hikers. OHV and horseback riders can break just about anything when they part company with their mounts and land harshly on rocks and other unforgiving objects.  A simple fracture is one in which a bone is cracked or broken but does not protrude through the skin.  A compound fracture is one in which the broken bone is exposed.  Simple fractures can be identified by pain, discoloration (bruising), and misshapen body parts, like a forearm that is bent in the middle.  Broken bones should be splinted to reduce the chance of additional injury and for the comfort of the patient.  Compound fracture should be washed off with clean water (no antiseptic),  then dressed and bandaged.   The exposed bone should be kept moist if possible.  Splints should be rigid and should be snugly secured above and below the break.  Also immobilize the joints on either size of a break to minimize discomfort and chance of further injury.  DO NOT attempt to set or straighten a broken bone unless you have the proper medical training to do so.  Immobilize the broken bones and transport the victim to a hospital or other emergency medical facility as soon as possible.  Dislocations are also fairly common, with a shoulder being among the most frequent.  Other frequent possibilities include hips and elbows.  The best treatment for a dislocation is to immobilize the joint and get the victim to an appropriate medical facility. However, if the dislocation is causing severe pain, is affecting nerves or circulation, you may need to reduce (put back in place) the dislocated joint to prevent long term damage.  If, for example, a victim with a shoulder dislocation is experiencing numbness in their fingers, they likely have a pinched nerve.   Check capillary refill to test circulation.  Press on a finger nail or toe nail.  The color should return quickly.  If it doesn't, the dislocation is constricting a blood vessel.   Nerve or circulation problems warrant an immediate attempt to reduce the dislocation.   While putting a joint back in place can be momentarily painful, the patient usually experiences almost immediate relief of pain from the original injury.  I have learned techniques for dealing with dislocations but would only use them if there were no other reasonable options.  Field methods usually involve yanking on an arm or leg to pull the shoulder or hip joint back into place. You should not attempt to reduce a dislocation unless you have been properly trained.  Improper attempts to reduce a dislocation can result in additional injuries.  We had a rider in our group who had had a bad shoulder  (I think it occurred during a desert race years before).  He wore a leather brace, but his shoulder would still pop out from time to time and we had to help him put it back on more than one occasion.  It wasn't fun, but it was less distressing (for him and for us to watch) than seeing him slam himself into a tree or other solid object to put it back himself or seeing him in pain.

Treatment of less serious injuries is still important. Proper treatment will avoid unnecessary complications such as infection, reduce pain and comfort the patient, and help prevent further injuries. For example, splinting a broken bone may prevent it from become a compound fracture (where the bone is sticking out of the flesh) or prevent additional splintering or fracturing of the damaged bones. Immobilizing a broken bone usually reduces the pain and suffering of the patient right away as well. Proper treatment for cuts and contusions is needed to prevent infection and speed healing. Large, and especially deep cuts, may need to be surgically repaired by a trained physician. Superficial cuts may be cleaned and treated with anti-biotic ointments. Sometimes a "butterfly" bandage or even superglue may be used to close small cuts. If blood is spurting, not just oozing, from the cut, it likely to have penetrated an artery and should be considered very serious and will require professional treatment as soon as possible. A victim with arterial bleeding will probably bleed out and die within a matter of minutes if they don't receive appropriate treatment.  Premature closing (suturing, stapling, or gluing) of wounds that have not been properly cleaned may result in serious infection and improper healing.

Superglue can be a handy way to close small wounds.  There is a pharmaceutical grade version of it known as "Dermabond" made specially for medical uses.  Superglue is a lot cheaper (you can even usually find it at your local dollar store).  It may sting a bit more than real Dermabond, but it will do the job.  Hold the wound tightly together and lay a small bead of Superglue across it.  Wait for it to dry before releasing the wound.  It bonds instantly to skin but it will need a few moments to dry enough for the bead to tie the two pieces of the wound together.  Try not to get it too far down into the wound.  I have used Superglue successfully on cuts on my own fingers.

Recommended treatment of burns has changed over my lifetime. When I was a child we were told never to put burns into cold water.  I soon learned different.  A close friend of mine in high school ignored that rule when his little sister spilled a pot of boiling water all down her arm. He plunged her arm immediately into a bucket of cold water that happened to be nearby. When her arm healed, there was no scarring where her arm had been submerged, but there was significant scarring above the "water line" where her flesh continued to cook from the heat absorbed from the boiling water. Today cooling a burn is the first and perhaps most important thing you can do. Cooling a burn quickly may reduce the amount of long term damage. The folk medicine of my childhood said to put butter on a burn. Another fallacy.  That is NOT recommended today.   Carefully remove any loose debris and gently clean the wound with clean, preferably sterile water.  Burns are common in camping and other off highway activities. They can come from camp fires, cooking stoves, radiators, or hot exhausts. Technically a burn is caused by dry heat. A heat-related injury caused by hot liquid is called a scald. In either case, the first treatment is to cool the affected area dousing it with copious amounts of cook, clean (preferably sterile) liquid. Thorough cooling may take 10 minutes or more. A patient with severe burns is likely to go into shock. Superficial (first degree) burns only penetrate outer layers of skin, kind of like a mild sunburn and usually do not require professional medical treatment. The deeper the tissue damage, the more serious the burns. "Partial thickness" (second degree) burns penetrate several layers of skin and form blisters. Burns of this type larger than the victims hand require immediate professional medical treatment. Smaller burns might need delayed treatment but should be watch carefully.  Partial thickness burns covering 50% of an adult's body may be fatal. "Full thickness" burns (third degree burns) damage all layers of the skin and may extend into nerves, muscle, and fat or even bone. Full thickness burns require hospitalization. Anyone with full thickness burns should be transported to a hospital or other emergency medical facility as quickly as possible after administering immediate first aid.

First, move the damaged area away from the source of the burn and cool the affected area.  People usually remove themselves quickly from the source of a burn, but a severely injured or unconscious victim may need assistance.  Burned clothing may continue to smolder and do additional damage if it isn't removed.   Quickly cut or tear burning clothing away, but don't attempt to remove the remnants that have already seared into the burned skin.

Cover the burn with sterile, non-fluffy burn sheet. A sterile plastic bag or even kitchen plastic wrap may be used in an emergency. The covering is to keep out debris and to prevent infection.

DO NOT apply ointments, lotions, or fat or butter to the injury.

DO NOT apply adhesive bandages to the area. Use only non-stick dressings.

DO NOT break blisters.

DO carefully remove jewelry, watches, and restrictive clothing from the area before it begins to swell.

Watch for signs of shock and be prepared to begin immediate treatment for shock.

Shock.  First you need to be able to recognize the symptoms of shock.  The victim may experience or exhibit one or more of the following symptoms:

  • decrease in blood pressure.
  • rapid, weak, or absent pulse.
  • irregular heart rate.
  • confusion.
  • cool, clammy skin.
  • rapid and shallow breathing.
  • anxiety.
  • light headedness.
A primary cause of shock is low blood pressure, which results in many of these symptoms.  A victim with multiple symptoms is almost surely going into shock.

Treatment for shock.  Treating shock can be life saving.  Without treatment, your victim may die.  Unless you suspect the victim has a spinal injury, have them lie on their back with their feet elevated to increase blood flow to the brain and vital organs. DO NOT raise their head.  If they have leg or back injuries or if raising the legs causes pain, let them lay flat.  Loosen any tight clothing and cover them with blanket to keep them warm.  Administer first aid for any wounds or obvious injuries.  Do not give them liquids by mouth, even if they complain of thirst because there is a risk of choking if they experience a sudden loss of consciousness, which is not uncommon in cases of shock.

Minor injuries such as contusions or bug bites can usually be adequately treated using good first aid practices. Clean the wound with clean water. Avoid harsh antiseptics like alcohol and hydrogen peroxide. While they are effective in killing germs they are also effective in killing skin cells in addition to being painful. Here is a rather unusual tip: if you have no sterile water to clean a wound, you can use urine! Unless the donor has a urinary infection, urine is sterile. Someone asked the nurse in a first aid class I attended about using soda pop and she told them absolutely not -- it would be much better to use urine! Club soda would be OK, but it would not be good to use any of the sugar-rich flavored sodas or fruit juices. Quickly taking care of small wounds or bites can reduce the chances of infection and prevent them from become large sores.  Some bites benefit from an application of alcohol, ammonia, or baking soda.  Ammonia is the active ingredient in many "bite sticks".  Tooth paste and even ordinary mud can help take the sting out of insect bites, but you run the risk of infection from germs in the mud.  Stopping the itch is more than a comfort issue.  Itching causes the victim to scratch, usually creating a larger wound and introducing infection.  Even if mud might contain germs, using it to stop the itch is probably safer than letting them scratch and make things worse as well as making them more comfortable.

A critical component of first aid is being first.   What you do in the first few minutes after an injury can be a significant factor in making the victim comfortable and avoiding further injury or infection.  Simply being there with proper skills and confidence will help calm victims, making it easier to treat them and take care of their needs.  Knowing what to do first is essential.  Too may would-be rescuers skip the first and often most important step:  size up or assessment.  Before beginning any kind of first aid treatment you need to assess the situation.  First of all, is it safe for you to approach and treat the victim?  Next, if it is safe, assess their situation and their injuries.  If they are trapped in a burning car your first priority is to either put out the fire or get them out of the flaming vehicle.   If they're hanging off the edge of a cliff,  you obviously need to pull them to safety or find a way to support them so they don't fall any further.   Once you have accessed their situation and determined you can safely assist them without putting them or yourself in further danger, then you can approach them to begin treatment.  If they are conscious, you should obtain their permission.  If they are unconscious, you can usually assume "implied consent".  One of my C.E.R.T. classes proposed addressing conscious victims as follows:  "Hi.  I'm (your name) and I'm medically trained.  It is OK with you if I treat your injuries?".  This simple statement helps you assess your patient's mental status based on their answer as well as obtaining their permission to treat them.  Note that you are not claiming to be a doctor or nurse, just "medically trained".  First aid certification qualifies as "medically trained".  If you lack first aid certification, don't claim being trained.  It can be comforting and reassuring to an injured person that the one offering to provide treatment has proper training.  In an emergency, people are anxious for knowledgeable help.  I donned my C.E.R.T. vest and hard hat following the Northridge Earthquake in California to check on some friends and neighbors and everywhere I went I was immediately thronged by people looking for assistance and information.

Be FIRST in first aid!

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