A GORP Content Partner Adapted from Wilderness First Aid by GIlbert Preston MD

Wilderness Survival Responding to Backcountry Emergencies and Getting Help

In the backcountry you can't call 9-1-1. You and your companions are all you have to rely on. This can be frightening, especially if you have never been responsible for the immediate care of a seriously injured or ill person. If you attend first-aid courses, CPR classes, and avalanche awareness seminars, you will feel more confident and be more effective in a wilderness emergency situation. You must immediately decide if the victim is alert or unconscious, if she is breathing, and if her circulatory and nervous systems are functioning normally. Once you have made these critical decisions and acted appropriately, take a few deep breaths. Then move on to your evaluation of less critical conditions.

EVALUATING THE ACCIDENT SCENE

1. Calm and compose yourself and others at the scene. Project a sense of self-confidence, cool-headedness, and compassion.

2. As you approach the scene, try to imagine what might have happened. The way in which a victim is discovered at the scene can help you decide what her injuries are most likely to be. Is she lying at the base of a cliff with her right leg bent at a funny angle, or soaking wet and unconscious on the riverbank, with the litter of a broken canoe scattered around her?

3. Decide if the accident site is safe enough to perform evaluation and treatment. In wilderness, the safety of the rescue party takes precedence over ideal medical management of the victim. Are you or the victim exposed to rockfall, avalanche, fire, or dangerous weather conditions?

4. If the accident site is unsafe, remove the danger or remove the victim. Get out of the rockfall zone or away from the river before you render CPR or first aid. If safety dictates you move the victim before you fully evaluate her injuries, do so only after protecting her spine, if there is any chance she has suffered trauma to the head or neck (fall from height, avalanche, rafting accident).

5. Assess how many victims there are. Treat first those who fail an ABC check (Airway, Breathing, Circulation), even if others appear to be in great discomfort.

EVALUATING THE VICTIM

Thoughts on Wilderness Survival? See responses to audience questions by former GORP Guest and Wilderness First Aid author Dr. Gilbert Preston.

1. Ask the victim, "Are you okay?" If she cannot answer, check to see if she is choking or has stopped breathing. Is she clutching her throat and making high-pitched or grunting sounds? If so, treat for choking.

2. If the victim responds with a coherent answer, then the victim is conscious, breathing, and has a pulse. You must ask permission from a conscious victim before administering first aid. The victim has the right to refuse care—disregard this wish only if she appears delirious and self-destructive.

3. If the victim is not choking but is unable to answer, check to see if she is breathing and has a pulse; see the ABCs. If the victim passes the ABC checklist, CPR is not required. If the victim fails the ABC test, administer CPR.

4. If the victim is breathing and has a pulse, but is not conscious, check for head injury and spinal injury.

5. Is the victim bleeding, either inside her clothes or from an obvious wound? Apply pressure with sterile gauze and treat for bleeding.

6. If she is experiencing shortness of breath, paleness, and squeezing chest pain, treat as if she is having a heart attack and be prepared to administer CPR.

7. If the victim is not bleeding and is not experiencing heart attack symptoms, and she has passed the head injury and spinal injury checklists, evaluate for signs of injuries that do not pose an immediate threat to life. Treat injuries or conditions as described in the appropriate chapters.

8. When your evaluation and treatment are finished, decide if the victim requires evacuation from the wilderness and, if she does, can she walk out safely or should someone go for help? If the decision is made to self-evacuate, then continue to monitor the victim for a change in her condition that could require more immediate evacuation.

Getting Help

Knowing which conditions, symptoms, and signs can't be safely treated in the wilderness is crucial. A wise backcountry recreationist knows that few destinations are worth the price of life or limb. Poor judgment on your part may put the lives of rescue professionals or volunteers at risk. You have a moral obligation to evacuate yourself and companions before you have gone past the medical point of no return.

WHEN TO STABILIZE THE VICTIM ON SITE AND GET HELP

If someone is experiencing any of the following:

• Dizzy spells or fainting spells.
• Pulse rate that remains above 110 beats per minute at rest for more than an hour.
• Difficulty catching breath even when at rest.
• Progressive weakness at rest, or with only mild exertion.
• Declining awareness of her surroundings.
• Loss of consciousness for more than two minutes, especially after a head injury.
• Pain so severe she simply cannot continue.
• Chest pain that is very clearly not due to an injury to the muscles or bones.

WHEN TO SELF-EVACUATE, IF POSSIBLE

Self-evacuate if any of the following conditions are present:

• Vomiting or diarrhea that gets worse despite basic first-aid treatment.
• Inability to hold down liquids.
• Vomiting blood or bleeding from the rectum.
• An infection that is spreading.
• A psychological state that endangers the person or other members of the group. Always err on the side of safety— when in doubt, get out or get help!

Getting Out Safely

Rescues in the wilderness are rarely a matter of brave rangers rappelling from a helicopter—they are most often dirty, sweaty, extremely uncomfortable, and dangerous affairs for everyone, especially the victim. If the injury is severe, and self-evacuation is not an option, send two of your party for help, and have one or two members of the party remain to monitor the injured person for life-threatening changes. If the injury is minor and moving the victim won't make the problem worse, then it is safe to self-evacuate. Whenever possible, those who go for help should not travel alone.

Once out, contact trained emergency rescue personnel: it takes six physically fit adults to move an injured person on a litter 100 yards over easy ground, and more than six on difficult terrain. The safety of the rescuers and the injured person's companions takes precedence over what might be considered otherwise ideal medical management.

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