Friday, August 1, 2008

Canyoneering First Aid


* Contaminated water: Iodine, Water filter.

* Sprained ankle: ACE bandage, tape, trekking pole as cane.

* Abrasion: Band-aid, butterfly dressing, tape, Neosporin, Betadine.

* Blisters: mole-skin, scissors, gauze, clean socks.

* Sliver: tweezers

* Diarrhea: Pepto-Bismol, Imodium, soap to wash hands before preparing food for you non-diarrheal buddies.

* Pain: Tylenol, Ibuprofen, Naproxen, narcotics. (Avoid Aspirin in kids as it may cause Reye's syndrome).

* Insomnia: Benadryl


-The first rule of a significant rescue is not to make the problem worse than it is. Folks sent out ahead to call Search and Rescue can end up as fatalities when they become lost or exposed, while the injured hunker down and are eventually rescued. Exposing yourself to additional risk in a rescue effort must be weighed against increased hazard to the entire team if further injury occurs.

-All big deals require urgent transport to medical facility. You should know where the closest hospital is and how to get there. If members of the party are sent ahead to call Search and Rescue, pencil and paper are useful to record location of injured people and injuries. Cell phones expedite evacuation, but often have poor reception in canyons/desert. Reflective mirrors are also useful, but few people know how to use one.

* Laceration: Quick Clot(tm) Field dressing, gauze pads, gloves, trauma shears, steri-strips, super-glue/Durabond (use with care-Durabond less irritating to skin than industrial superglue), triangular bandage. Think pressure, lots and lots of pressure.

* Fracture: SAM splint, ACE bandage, Popsicle-stick (finger fracture), tape. Trekking pole for cane. Injuries compromising blood flow or sensation (neurovascular injury) require emergent evacuation and orthopedic evaluation.

* Snake bite: Betadine, soap, gauze, maybe venom extractor (no cowboy cut and suck technique please).

* Hypothermia: dry fleece jacket and hat, emergency blanket/bag for all party members, lightweight stove and bullion/ramen, hard candy, extra energy bar, magnesium strip, and lighter. Fire starting skills. Willingness to accept a forced bivy and warm up rather than push on. Watch for the 'umbles: mumbles, grumbles, tumbles, stumbles, fumbles.

* Flail chest: Lots of tape, rolled up sweater to brace chest.

* Pneumothorax: If you don't know what it is, don't carry the 16 gauge needle to treat it, petroleum gauze and tape to make one-way valve. Monitor vitals, if breathing or pulse gets worse, patient may have tension pneumothorax. This will require emergent evacuation and treatment. Effective diagnosis and treatment in the wilderness is difficult under the best of circumstances.

* Burn: petroleum gauze, more gauze, hydration, pain management.

* Falls: Danger of spinal injury. DO NOT move the patient or the patient's head unless you want to paralyze them for life. If person moved already, they may still have a spinal injury. A first-responder should immobilize the patient's head to prevent unintentional movement.

In any trauma, spinal injury, internal bleeding, respiratory distress, and hypovolemic shock (even if you can't see any wounds) are a real danger. Seek help immediately.

-There are other big-deals dealing with the ABC's (airway, breathing, circulation). You could carry some airway protection device, a guard for mouth-to-mouth, knowledge of CPR/basic life support/advanced life support. However, it is difficult to imagine situations when someone healthy enough to descend a canyon could develop a condition requiring aggressive intervention in the wilderness and benefit from it. You simply aren't equipped in the wilderness to deal with respiratory failure due to tracheal injury, drowning/aspiration, status asthmaticus, or cardiovascular collapse due to arrhythmia, massive myocardial infarction or shock. There are portable cardioversion devices available, but none light enough to justify carrying it in the back-country. A trial of CPR followed by urgent evacuation is really the only solution. Always consider the safety of the rest of the group when starting a rescue effort.

Wilderness Pharmacopeia:

* Pain:

Tylenol, Naproxen, Ibuprofen. Avoid aspirin in kids.

* Wounds:

Triple antibiotic with lidocaine. Betadine.

* GI issues:

Iodine, Water filter, Pepto-Bismol, Imodium, Ex-lax for your buddy's brownies.

* Asthma:

Albuterol inhaler for anyone who has ever had one.
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