First aid field guide

[jdemott]

Yesterday I was hiking on Gnarl Ridge and met another hiker who asked if I was a doctor or otherwise medically trained (I'm not). It turned out that he had fallen and dislocated a finger and was hoping I might know how to pop it back into place. Since I didn't know any more than he did, all I could offer him was pain medication.

That got me thinking that it would be a good idea to have some sort of first aid field guide with me to give advice on how to deal with various medical emergencies on the trail. What I would like is something that is available on the iPhone, either as an app or an e-book (Kindle or iBook), so it wouldn't add any weight to what I carry but would still be a useful source of information.

There are a number of choices available, but it is hard to sort through them--quite a few of the apps seem to be information lite--and I would hate to find out I had the wrong one when I actually needed it. The Red Cross has a free app but it looks to be designed like a first aid teaching course with lesson videos and quizzes, rather than a practical checklist approach that would be useful in the field.

Any recommendations?

[Grannyhiker]

Far better to take a Wilderness First Aid course which will teach you what to do in such situations. Books can't substitute for practical training! There are also legal complications of which you should be aware, which are taught in the class. Thanks to recent Oregon court decisions, the good samaritan laws in this state no longer completely protect you from liability for negligence. BTW, giving anyone medications, even OTC medications, is legally a no-no--you'd be liable if the patient had an allergic reaction. That's why everyone should carry their own!

Here's the list of WFA classes offered by the NOLS Wilderness Medicine Institute (the gold standard of WFA), many of which are being hosted by REI. http://www.nols.edu/portal/wmi/courses/wfa/ The next one in Portland is Nov. 10-11 but is almost full so you'll need to sign up really soon. Having taken the class myself, I can tell you it's well worth the time and money!

The NOLS Wilderness First Aid textbook is probably your best bet, but it's part of the materials you pay for when you register for the class, so don't buy it separately. I'm sure the instructors will know of any iPhone apps that would apply to wilderness situations. Unfortunately, most first-aid advice is based on emergency medical services being right around the corner, which is of little use when it's not.

In this case, I'd have done an initial evaluation to be sure the patient had no other injuries (the pain from the finger could mask something more serious) and asked about allergies, current medications being taken and such. After determining that there was no apparent fracture, I would have tried to reduce the dislocation by gently pulling straight (in line with hand and forearm) on the finger. Whether or not successful, I'd have immobilized the hand, rigged up a sling (patient's sleeve plus safety pins) and walked the patient back to the trailhead, making sure he stayed hydrated and watching for symptoms of shock. I would have taken him to the nearest medical facility or found someone with a higher level of training than mine (law enforcement officer?) to do so. I would have tried to use the contents of the patient's first aid kit as much as possible (especially pain meds). That's what we were taught in the class.

[Lurch]

As usual Granny is spot on.

You need to be really careful giving medical help to strangers in the field. Good Sam laws will cover you for a lot, but you cannot go beyond the scope of your training. WFA and WFR courses have a lot of great information in them, but I don't believe either actually teaches how to reduce a dislocation. (Correct me if I'm wrong there).

Personally I would probably only attempt it if there were obvious complications with the dislocation, and the person would be at risk of permanent damage. Discoloration, numbness etc. Fingers wouldn't be as much of an issue, but shoulders can pinch nerves and cause permanent damage if it's not reduced properly. The likelihood of that is admittedly low, and it's a fairly simple process but if Good Sam isn't going to cover me, it's not going to happen. Then there's always the possibility that the finger is broken, not dislocated.

Also be aware that if you start medical treatment on someone, for whatever the incident. You cannot simply up and leave anymore. There is no duty to act initially, you're not required to help, but you cannot abandon someone after you've started treatment, you can only pass them on to someone with equal or higher medical training than yourself.

[jdemott]

Thanks for those replies. I knew I would get some good info here at PH. I will definitely look into the NOLS course, but in the meantime I would also appreciate any suggestions about field guides and any other thoughts.

Just to clarify several points:

1. Although my experience with another hiker on the trail yesterday was the trigger for my question, my reason for wanting a field guide would likely be to treat myself and members of my family, not strangers. (Of course, if I encountered someone who was seriously injured on the trail, I would do my best to help them--I can't imagine walking away from a life threatening emergency regardless of legal interpretations.) In many years of hiking, I think this is the first time I've been approached by a stranger about a medical issue, but I have had to deal with the usual assortment of minor issues (cuts, sprains, etc.) with family members and myself.

2. I have had a first aid course, albeit many years ago. A field guide would be a useful memory aid, even if I take a refresher course. It's unlikely any course for the general public (people like me) would cover everything, but it would be useful to have some reference even if it is just to say "don't attempt this procedure in the field."

3. The injured hiker yesterday didn't seem to have any issues other than a swollen, misshapen finger. He said he had fallen at the lower Newton Creek crossing and had decided to continue his hike up to Elk Meadows and then to Gnarl Ridge, where we first met him, so the injury obviously wasn't holding him back. After we talked for a few minutes, he spent some time taking photos and we waited to make sure he was okay. As we headed back down, he stayed within a couple hundred yards of us until he passed us when we stopped for lunch. He said he was going to stop at Kaiser on his way back to town and have the finger attended to. He said there wasn't much pain and he said he didn't need any pain meds (he just couldn't use the finger, but he was using the other fingers on that hand). Based on his conversation and appearance, I didn't have any concern about his ability to get home on his own.

[Grannyhiker]

Lurch is correct here. We did have some material in the WFA course I took on reducing dislocations, especially a gravity method that often works on shoulder dislocations. We were warned that if that doesn't work, don't try anything else, because pulling at the arm can lead to a permanently disabled shoulder. Notice that I said "gently" in reference to the finger! If it doesn't slip back in place right away with little effort, far better to leave it alone and immobilize it. A lot depends how long it's going to be until the patient can get to medical care. If it's going to be several days, then carefully attempting to reduce the dislocation would be more appropriate, IF it reduces easily. In this case, relatively near the trailhead, it would have been better not to try (thanks, Lurch!).

Thanks also, Lurch, for mentioning that once you offer aid and it's accepted, you are legally required to stay with the patient (we're not supposed to call them "victims" anymore, it seems) until you can hand him/her off to someone with a higher level of skill. You do have the right to refuse to lend aid, assuming your conscience allows you to do so, but once you start, you can't quit. We were told this the first half hour of our class. So if jdemott had attempted to reduce the dislocation, he'd have had to stay with the guy, even though he wanted to finish his hike.

Without training, it's far better to do too little than too much. That's especially true if there's any possible chance of spinal involvement (which has to be suspected in all falls and head injuries). We spent over half our class time doing spinal assessments!

[EMTStolz]

Informed, a company based in Tigard, makes field pocket guides and phone apps for EMS, nursing, fire fighting, law enforcement, etc. They even have a pet emergency pocket guide. Didn't see anything strictly pertaining to wilderness though. You should suggest to them to make a wilderness first aid pocket guide!

http://www.informedguides.com/

[renegadepilgrim]

I work in healthcare and hope to someday get my WFR (no money and no time at the moment). I offer bandaids and other basic FA to people on the trail...if they decline, I move on. I don't do anything outside my scope of practice or training (I'm a CPR/FA Instructor, plus a Medical Assistant and an ED Tech), even though I might have "knowledge" to do things like relocate fingers or do sutures.

Last summer, I came across a biker on the Banks-Vernonia Trail with blood down his leg from an elbow wound. He had endo'd on a steep slope and had kept going. I cleaned him up, dressed his wound and gave him a ride back to Banks to his vehicle and friends who had no idea he was hurt. I recommended he go get checked out in the ER, as well as get a new helmet since he had hit his head. Good thing I did, because he called my work the next day to let me know he had a few broken ribs and a pneumothorax. So much for my assessment skills! I have gotten rusty since leaving a Trauma ED. To be fair, he wasn't complaining of chest wall pain or difficulty breathing but it was a valuable lesson to learn.

If you have an iPhone or Droid, then go to the app store and put in "wilderness first aid" for the search. There are some low cost apps. I don't have anything on my iPhone because I figure if it can't be fixed with duct tape or a maxi pad, I can't help you much anyways... The more people trained in FA and CPR the better off we will all be!!!!!

[Lurch]

This may have changed recently, so someone please correct me if I'm wrong, but the woofer (Wilderness First Responder) certifications isn't actually recognized in Oregon. There is good knowledge in there that can obviously be used in an emergency, but I don't believe it's considered in the "scope of your training".. Although that's a fishy area, for a civilian working under Good Sam you would probably be good to go.

Any lawyers want to comment?

[Grannyhiker]

I suspect that it's qualifications for specific jobs rather than state recognition. I know that almost everyone in my WFA class was there because their jobs required WFA certification (I was sort of odd person out since I wanted it only for personal reasons). Some had come from as far as Idaho. It was one of the first WFA classes that REI offered in this area, and it was right after it that REI partnered with NOLS to offer frequent classes all over the country.

I don't know all the ins and outs or what states recognize, but here are the course levels that NOLS' Wilderness Medicine Institute and several other outfits such as Wilderness Medical Society offer, which are now considered standard throughout the outdoors professions:

Wilderness First Aid: 16 hours
Wilderness First Responder: 80 hours; must pass written and practical exam
Wilderness EMT: 200 hours; must pass written and practical exam.

Of course, the longer the course the more expensive; WEMT is several thousand dollars.

The second two courses include CPR; WFA does not. For WFA you need to obtain CFR certification separately. This is easy to do with the American Red Cross and many workplaces offer CPR for free. I think the reason is mostly that enough is crammed into that 16 hour, 2 day class that there isn't time for another couple hours of CPR without going into a third day or evening.

Back in the 1980's, before all this standardization, I took a class (I think it was 20 hours including CPR) offered by a hiking/mountaineering club where I lived and patterned closely after the Mountaineering First Aid classes offered by the Seattle Mountaineers. I was really anxious to take another course both to get updated and to practice rusty skills, mostly because I take my grandchildren out. For anyone else who took first aid a long time ago, I strongly recommend another. A lot of protocols have changed drastically over the last 10-20 years (snakebite is one), and it's amazing how much I had forgotten even though I tried to keep up on my knowledge with my ER physician son-in-law.

[renegadepilgrim]

http://www.oregonlaws.org/ors/30.800

That's the most recent info I could find through a simple Google search on the OR Good Sam Law.

Whether you are a WFR, a FR, a EMT-B, a WEMT, EMT-I, EMT-P, RN, MD, NP, PA or whatever set of letters you possess after your name, you have a scope of practice for your certification. Whether the state of OR recognizes WFA or WFR, I do not know. I do know that if you are a WEMT, you DO have your EMT-B at a minimum which means you are recognized by the state and you do have a very specific scope of practice. Act outside that scope of practice and kill someone and you may just get yourself in trouble. However, if you are acting in good faith, you should be fine. I am not sure what the requirements are in legal-speak for determining grossly negligent, but you would have to be pretty damn stupid, IMHO, to do anything that will seriously harm someone. So don't go trying to trach someone with a ball point pen and you should be good!

The important thing about being an emergency responder is to know your place. Some people want to be a savior and think that those letters after their name mean more than they do. Know your scope and follow it. Stray from it and pay the consequences, sometimes with another person's life...

I remember a few years ago, I was at a roller derby bout (I used to mascot for the Heartless Heathers back when they first got started) and one of the girls took a skate to the face. There was an Ortho PA giving her medical advice about her jaw (without ever really examining her!). This was outside his area of expertise, though not entirely outside his scope of practice. He advised her to go home, take some NSAIDs yada yada...meanwhile, I'm talking with her mom and noticing she is having trouble getting her jaw and teeth to come together. Her bite was off...a sure sign of a jaw fracture. I called over to my ER, found out there wasn't much of a wait and told her mother to take her over there, if she wanted to. I didn't want to step on the PA's toes since I'm just a "dumb ER Tech" so I just strongly encouraged them to get evaluated in the ER by a MD. So they did. Guess what? Broken jaw and transferred to OHSU for OMFS MD's to take a look at her. I always err on the side of caution...it's better to be safe than sorry.