Every serious, quasi-regular hiker or climber should have some level of first-aid knowledge. Specifically, unless you’re a guide or outdoor leader, and have your Wilderness First Responder (WFR) or Wilderness Emergency Medical Technician (WEMT) card, you should probably test for your Wilderness First Aid (WFA) card, to include Cardio-Pulmonary Resuscitation/Automatic Electronic Defibrillator (CPR/AED) training. This will empower you to better tend to yourself, others in your party, and anyone you may encounter in the mountains or elsewhere — and specifically the backcountry as it concerns this article. The backcountry is a place where hours could pass before help arrives. You could save a life! That said, you don’t have to have serious medical training to be helpful. If you’ve never had any training, some of the steps below are things you can probably still do — and others you shouldn’t do — that could be helpful in your medical response to a patient in the backcountry. Before practicing anything noted in this article, please be sure to read our disclaimer.
Here’s what you should do…
- DO… assess the situation at a distance before rushing in to help. Look for hazards to you or the patient such as rock or ice fall zones, slick ground conditions, thin ice, avy dangers, swarming insects, “widowmakers” (tree limbs precariously perched above the scene), or anything that looks like it could hurt you or further injure the patient. If it’s apparent, even from a short distance, that there’s an illness or injury, don’t hesitate to have someone call or seek help providing as much basic information as possible, being sure to include location (do this first in case signal is lost). The specifics on doing so are detailed further in this article so please keep reading.
- DO… approach the patient if the scene is deemed safe and announce yourself as you do so. The patient may be unresponsive but might very well be able to hear you. Try to be reassuring. Don’t say stuff like “Oh, boy, mister/miss, you’re a goner” or gasp in alarm. These words or that sound do not improve to the patient’s comfort.
- DO… put on gloves if you merely suspect there may be blood, urine, feces, or any bodily fluid. Know that blood and whatnot can pool underneath out of sight. Use care and practice bodily substance isolation (BSI). If not prepared with nitrile gloves (latex isn’t ideal and may cause an allergic reaction), do your best to stay clear of said fluid while still trying to lend aid or stay away if you can’t.
- DO… observe carefully. What’s your general impression of the scene? Can you determine what happened as you approach? This info can help you decide what to do next. Illness? Injury? At this early stage seek verbal consent to administer care, if responsive (if initially unresponsive but becomes responsive, stop administering care, introduce yourself, and seek the patient’s verbal consent then). With verbal consent given, or if verbally unresponsive, you may begin with an initial patient assessment. At this point in this process you will begin to assess the patient’s immediate needs. To remember what they are, refer to this abbreviation: XABC (or XCAB)…
- X = Is there eXsanguination or severe bleeding? This is a shift in trauma care: The latest mandate is to control the bleeding first. Without blood, any additional steps will become moot.
- A = Is to remind us to confirm that the Airway is open and not blocked by food or an object. Is it possible for the patient to breathe? If not, the blockage needs to be removed. How to do this, however, may require some basic first aid training such as how to perform abdominal thrusts.
- B = Is the patient Breathing (chest heaving; look, feel, hear)? If yes, this confirms A, above. If they aren’t, and not hypothermic, and if a pulse is absent, CPR will become a priority at this point, if you know how. If there is a pulse, apply rescue breaths without CPR. Getting trained beforehand is optimal.
- C = Is the patient Circulating their blood. Is there a carotid (neck) pulse? Checking can be difficult for many people so training is key. If there’s no pulse, and not hypothermic, administer CPR… if you know how.
The ordering of the tasks beyond this point may vary based on a necessary and logical prioritization of care. Every situation is unique and, especially in the backcountry, unforeseen complexities may exist. If not already clear to you, getting trained, even at a basic level, will help you achieve a successful outcome.
- DO… check the level of the patient’s responsiveness. How alert and oriented are they? If verbally responsive, ask for their name, then ask if they know where they are and what day it is. If they know these things, ask them what happened. If they are verbally responsive and seemingly alert and oriented, this is a good time to ask them about allergies, medications, conditions, etc. The more answers they provide, the better off they likely are. Rescuers and responding medical professionals will love to know this information.
- DO… start a deeper investigation now that their basic life needs have been addressed. With verbal consent given, or if verbally unresponsive, you may begin with an initial patient assessment. Begin by putting your hand on their forehead and tell them as you do this (even if unresponsive) you are here to help. Maybe you can or can’t, but the reassurance might calm them. The reassurance may calm you both! At this point in this process.
- DO… try other techniques if they aren’t seeming to respond, if they’re not voice-responsive, or moan after you speak, or give any sign. If the answer is no, introduce painful stimuli by pinching the loose skin on the back of the arm, though don’t jostle them. If still unresponsive they may be unconscious, or worse. Quickly check their vital signs if uncertain, if you know how. Training, training, training.
- DO… call for help. Try your phone. Even if you don’t have cell service. There might not a be a cell tower for miles, no bars, no G, but there could be a 9-1-1 repeater piggybacked onto a USFS relay or another tower on a nearby ridge. It’s worth trying! If you do reach 9-1-1, try to speak with them out of earshot from the patient. Texting is also an option. Newer smartphones may also be satellite-capable. Moreover, these devices may be used to obtain your Lat./Lon. or UTM position. Rescuers will need to know where you are.
- DO… send for help. No service? Older device? Not even reaching 9-1-1? Well, hopefully you’re part of a party of four people so you can stay with the patient while you send two runners to find help or find a signal. In fact, if others are with you, some of these steps may be carried out simultaneously.
- DO… try to further assess to see if the patient has a back, neck, or head injury or if they’ve had a high-impact, high speed trauma. The nature of the incident could be obvious. If not, be careful in handling them. Also note that distracting injuries, intoxication, and other factors may make the patient themselves unreliable if they are responsive. Look for fluid from the ears, bruising behind the ears or around the eyes, bleeding, dysfunction of any sort, or any physical sign or possible cause of head, neck, or back trauma. Consider what they were doing: slow hiking or snowshoeing versus fast mountain biking or alpine skiing.
- DO… roll them over to get a sleeping pad or other temperature barrier under them, no matter the ambient temperature. Even if they have a potential spine injury, it is always okay to do this while keeping their body normally aligned. Gently move any patient into supine anatomical position or into whatever position of comfort works best. The responsive patient will limit their own movement so allow them to do as much of the moving as they can. From here, if the patient does not have an injury from the pelvis down but the method of injury (MOI) indicates possible spinal injury, either get trained in how to assess the need for use of spinal restrictions or allow the them to rest in an anatomical or other position of comfort until advanced providers arrive to determine if they can walk out or need a litter carry.
- DO… cover them to keep them warm (unless there are signs of heat-related illness then cool water and shade are your friends). If they’re hypothermic or worse, keep them from getting colder. Do not thaw or warm if frozen or beyond the earliest hypothermic levels. If only shivering and possibly cold stressed, give them food — ideally sugar in liquid form — give them layers, and get them moving. To better understand the terms used in this paragraph and the appropriate levels of care, refer to the diagram, inset — (source).
Click thumbnail for larger view of image.
- DO… stay with the patient, monitor them, note how they look, take vitals if you can and record them if possible so as to detect any trends, try to keep them with you, talking, awake. Reassure them the best you can while you wait.
- DO… look for identification if unresponsive and an illness is suspected. Make a quick search for a medical bracelet or necklace as a diabetic might have (give them sugar, ideally in liquid form). Also look for other items such as an inhaler, Epi-Pen, or any known medications. These things can provide important answers or clues.
- DO… get trained in the difference between simple allergic reactions and full-on anaphylaxis. While Benadryl and other simple antihistamines will relieve some minor annoying allergy symptoms, anaphylaxis is a life threatening emergency only reversible with epinephrine (Epi) and advanced treatment. As epinephrine has no significant harmful side effects, treatment in the backcountry far from definitive care might be best early on. Be aggressive to be safe, especially if you’re unfamiliar with the differences between the two conditions or patient history. Learn how to administer an EpiPen or the new, more economical, easy-to-use and equally effective nasal spray “Neffy.” Both may be prescribed to anyone by their primary care physician (PCP) and usable on patients with any level of responsiveness. Also, if the patient is suffering chest pain as a sign and symptom, aside from trauma-induced chest pain, give them aspirin. As a rule-of-thumb, aside from epinephrine, only give over-the-counter meds.
- DO… observe circulation, sensation, and movement. If they broke something like a lower leg, for example, can they wiggle their toes and feel your touch? Is there circulation or a white, bloodless foot? Rescuers will love to know this stuff, but don’t try to address a break unless you’re trained or given instructions.
- DO… try to prioritize, remain calm, and use your head. And do take care of yourself and encourage any others in your party that remain to do the same or keep them busy doing something (i.e. erect a shelter). Remember, one patient is better than two, three, or more. How is everyone else doing? Is the scene still safe?
- DO… your best. Even as the trained professionals we are, not being exposed to these scenarios regularly, we will get rusty, unpracticed, even unsure. That’s natural (or we hope it is so we don’t feel like we’re the only ones).
- DO… get trained. If you’re out there playing in the mountains or backcountry fairly regularly, you should seek some basic wilderness medical training. You never know when you might need it.
Here’s what you shouldn’t do…
- DON’T… approach the patient if the scene is not safe. Even if it’s a loved one, one patient is better than two. Not approaching could be incredibly difficult to do, but you need to find the restraint for safety reasons.
- DON’T… forget the patient’s basic needs such as food and water, if responsive, and warmth. Provide comfort.
- DON’T… panic. This does nothing for anyone. If you can’t keep your head, don’t help. Nobody is expecting you to be chill or calm on the inside, but you must outwardly keep your composure and keep your mind focused.
- DON’T… rush. There is an expression: “Slow is smooth, and smooth is fast.” Understand this and live it. Akin to panicking, rushing will do nothing for anyone and every task will likely end up taking longer than it would if you worked calmly and methodically.
- DON’T… say horrible things. As noted above, even an unresponsive patient may be able to hear you. Be a calm, smooth professional even if you aren’t. Be a friend. You’ve seen professionals on television… act like them.
- DON’T… make knots if you tie on bandages to stop bleeding. Make a bow so it can be adjusted and the area can be checked later on. Know this: “pros make bows.” Seriously.
- DON’T… step over the patient. This action can lead to further injury for you or the patient and it’s just not the right thing to do. Show your respect and walk around the patient.
- DON’T… diagnose or make any declarations. Unless you’re a doctor, don’t try to diagnose the patient and pronounce anyone dead, even if you can’t get vitals. That said, if it’s obvious the patient has an angulated fracture of the arm, or you can’t get vitals, you should certainly make it clear to rescuers what you’re observing.
- DON’T… hesitate to build a small fire if you will be on scene for a while or benighted and you know how to do so safely. A fire provides warmth, light, and a sense of comfort. This advice came right from the Fish and Game Department during a training session. They advised not worrying about starting a blaze in the “asbestos forest.”
- DON’T… get in the way once trained personnel arrive on scene. Stay close by and let them know you’re willing to help, and do convey any and all information you may have, but stand clear unless asked to do otherwise. If you find you really must do something, be crowd control making sure others don’t get in the way.
But, wait, there’s more…
There is not much more you can do unless you’re actually trained. So do get trained! You can, however, seek help, be a friend, be comforting, be patient, and follow at least some of the guidelines above. Be attentive, be aware, try to keep talking to pass the time. And do remember to take care of yourself and others in your party while doing all this. Use the patient’s layers and gear on the patient so you can use your layers and gear for yourself. To be effective it is imperative that you do not become a patient yourself.
Important disclaimer
NOTE: Every situation is unique. The content of this article, while hopefully helpful, is not meant to be a tutorial or to serve as medical advice. Nor is it a substitute for proper medical training from a certified educator. As has been mentioned time and time again within this article, we do recommend getting trained!