“I find that case remarkable because she was the guide with the training, but told everybody else what to do [for her own care],” says Webster, a paramedic, expedition medic and Canadian executive director of Wilderness Medical Associates (WMA). By assessing the situation, she was able to get her clients—now her rescuers—to immobilize her properly and evacuate her successfully. And while she sustained multiple fractures to her vertebrae, says Webster, by staying calm that day on the mountain, and with good hospital care, she was able to make a full recovery.
According to the National Search and Rescue Program, rescue workers responded to 8,015 incidents in Canada in 2005. While the vast majority were water rescues—with human error cited in half the cases—there were also 748 non-marine “requests for assistance” requiring medical evacuation or transportation services.
How far are you from proper medical care? Resources, or “really the lack of,” says Webster, is about the equipment, medicines and supplies you have to treat a person at the time of injury. And environment refers to the terrain, weather and access to shelter that impact your decision on what action to take, including whether to evacuate or bring help in.
In the wilderness, where the need to evacuate means resting the limb isn’t always possible, applying ice (which reduces inflammation and swelling), and immobilizing the injury in a splint, are most important. A splint is any device that keeps an injured part secure, and can be purchased before a trip or improvised in the wild. Tree branches, rolled up sleeping bags, blankets or tents, and poles or paddles, are all possibilities, as long as you follow the WMA’s “3Cs” of splinting: comfort, compact and complete. An improvised splint must be comfortable enough to be in use for hours or days, so watch for knots and areas that cause chafing or sweating. Make it snug, with enough padding to absorb movement, but not so tight or cumbersome that it impedes evacuation. If a limb is contorted, the WMA recommends straightening before splinting (if not too painful) as a contorted limb can cut off blood flow and damage extremities. This can also relieve pain since the limb is put into its anatomical position. (Ibuprophen or acetaminophen is best here for pain relief.) It’s important to splint above and below the fracture site.
Without access to an X-ray, says Webster, you can’t, which means relying on other assessment tools. Pain is one—though keep in mind some injuries involve nerve tissue, which make them more painful than they may be severe. (The opposite is also true!) If the patient is conscious or can bear weight—even if in pain—the WMA advises it’s best to evacuate them with you. Conversely, if an injury appears stable—isn’t likely to get worse over time, is not a head injury and doesn’t appear infected—leaving someone warm and hydrated at camp isn’t a big issue. Check toes, fingers and skin around the injury for feeling and colour, a sign that circulation is good and blood is getting to the extremities.
But if the injury may worsen in the next few hours (or you don’t know if that’ll happen), lean toward getting them out and to a hospital. “We do what makes sense,” says Webster, and leaving an injured person often doesn’t, particularly if they’re alone. Why—because they’re at the whim of the elements and it takes enormous effort to bring someone in. (In the Grand Canyon, where Webster worked as a rescuer, it could take 15 people to evacuate one person just a few kilometres.) “If it’s three days before you can get back, you have to determine if the person is well enough to take care of themselves. If not, that’s a problem.”
With spinal or head injuries there are no easy answers—the fear of having to face one could be the best incentive yet to learn wilderness first aid. Getting the patient to a hospital as quickly and carefully as possible makes most sense. Back-boarding a patient—rolling them onto a board to immobilize the injury and carry them out—isn’t always possible. But if it is, do it. Whatever action you take, ensure the back and head remain immobile when moving the patient.
It’s worth noting how many wilderness injuries result from simple gestures or repetitive actions. Too much paddling can cause muscle strain; trekking in shoes without solid support can easily trip you up. And be wary of all that equipment you bring, says Webster—a pocketknife, axe, stove—all are accidents waiting to happen.
For more information on Wilderness Medical Associates Canada or how to take a course in wilderness first-aid, go to www.wildmed.ca; courses are also available through agencies (i.e. Red Cross, St. John's Ambulance), as well as colleges and a variety of private providers.
NOTE: This is a guidance only. Always get individualized advice from a qualified professional or travel health clinic.