News & Articles

This article was published in the Fall 2014 "Backcountry Safety" column of the  Hunt Alaska Magazine.

Story by Jon Hunt

So now what?  Imagine you are in a remote area, hours or days from definitive medical care.  Your friend has been injured but is still breathing.  If your level of training culminates with a basic CPR and First Aid course focused on the urban setting, then you will be quite distressed that you can’t offer your friend much help.

Don’t feel too bad.  Most basic First Aid and CPR training programs are designed for urban setting and focused on the Primary Assessment of the injured.  Ensure scene safety, check for a response (activate 911 if unresponsive), look for severe bleeding, look for breathing, start CPR (cycles of 30 compressions & 2 breaths) if the victim is not breathing, use the AED as soon as possible, and pray.  For a victim of cardiac arrest, every minute that goes by without CPR and defibrillation decreases their chance of survival by 10%.

Where most outdoorsmen lack sufficient knowledge and skills is when they have a victim who is alive, and they have to remain with them for hours or days until help arrives.  In a remote setting, the basic assessment is inadequate, and is usually just enough information to make you feel inadequate, or even hurt the injured person worse.

How do you figure out what’s wrong with your friend?

That’s the focus of the Secondary Assessment.  If no obvious life-threatening problem (bleeding or breathing emergency) is evident, then you begin the Secondary Assessment.  The focus is now directed at identifying the source of the problem and treating the root cause.  In Wilderness programs, hours, or even days, are spent practicing assessment skills.  Two acronyms are often used in many of the Wilderness First Aid courses/forms (American Red Cross & American Safety and Health Institute): “D.O.T.S.” and S.A.M.P.L.E. History.”

If a significant mechanism of injury is present, consider the potential of spinal injury and take necessary precautions when treating the injured person.  Use the D.O.T.S. acronym when conducting a quick (2-3 minutes) head to toe exam to look for:

D.O.T.S:

• Deformities: Look for an obvious deformity on the body. This is most common on the extremities, but possible anywhere.
• Open Injuries: Look for open injuries to the skin.  If possible, expose the wound site to adequately evaluate the injury. 
• Tenderness: Physically palpate each part of the body (unless obvious injury is visible) to identify any area with tenderness.  Do not cause further harm.  Watch for any reaction from your victim.
• Swelling: Check for any obvious swelling?  There may not be any yet, but this can change over the next few hours.  Comparing limbs to each other is an easy way to evaluate swelling.

Record the findings from the D.O.T.S. assessment.  Then continue with collecting data on SAMPLE History, consider these things:

S.A.M.P.L.E History:

• Signs (things the rescuer can see) - For example, I can see that you look ill, are bleeding, pale, sweating, have cold skin to the touch, and are bent over in pain.  I don’t need the victim to tell me this.
• Symptoms (things the rescuer has to be told) - For example, the injured person may complain of a headache, stomach cramps, etc.  The rescuer will probably not know this unless the victim reveals it.
• Allergies - Not only do I want to know what the injured person is allergic to, but also, what happens to him if exposed to that allergen.  Does he need medicine?  If so, what kind, and what is the prescribed dose?  If he has medicine, get it for him.  Keep in mind an Epi-pen may only help to relieve symptoms for 10-15 minutes, then symptoms may re-appear, so having multiple Epi-pens is useful in remote areas.  Once the airway is open and the victim can swallow, he also may need an oral antihistamine (be aware some people are allergic to Benadryl).
• Medications - What medicine and/or vitamins is the victim currently taking?  What dose, and frequency?  Why are they taking the medicine?  For example, an Epi-pen may be prescribed for severe allergic reactions as well as severe asthma attacks.
• Past relevant medical history - A great question to ask is, “Have you ever felt this way before?” or “Has this ever happened to you before?”  Many people taking medicine for a particular condition don’t think they have a medical problem because, in their mind, it is under control with medicine or positive lifestyle habits.  For example, a diabetic person who maintains their condition with proper diet and exercise may not see divulging their diabetes as relevant information.  A cardiac patient who had open-heart bypass surgery may think that the problem is fixed, and therefore of no concern. 
• Last oral intake & output - Find out the last few times the injured person ate or drank anything; don’t forget to ask for a description (color & frequency) of their urination, bowel movement, or vomit.  Dark yellow urine is common in cases of dehydration or for people who take vitamins.  In cases of severe dehydration urine may be brown color, or not be present.  Constipation or diarrhea tells us a lot of valuable information.  Blood in the vomit looks like coffee grounds.
• Events leading up to the incident - Much like the telephone game, the story is often significantly altered after being retold a few times.  An accurate summary of the incident is very helpful.  For example, an “injury from a fall” can mean almost anything.  Instead, “a fall from a 12’ high tree stand while hunting, victim landing on their left side, caused by slipping on a wet metal foot peg” would be more useful information.

Keep in mind, your patient may deteriorate quickly, and you may be the last one to speak to him before he becomes unresponsive.  By recording this data and passing it to more advanced medical providers who may take over, you can greatly enhance the injured persons chance for receiving adequate medical care.  Even more importantly, a thorough patient assessment may help you figure out what is wrong with the injured person, allowing treatment of the problem, not just the symptoms.

Please note, this is just an overview of some of the assessment skills, it is not comprehensive.  When you take a Wilderness based First Aid program you will learn more skills and have time to practice assessing an injured person.  There are other concerns that need to be addressed when caring for a victim in the backcountry.  These include: assessment of vital signs, guidelines for treatment of injuries in the backcountry, and criteria for evacuation.  The best way to prepare for unforeseen incidents n the backcountry is to receiving adequate training in Wilderness First Aid and to practice patient assessment skills.

Safe hunting!