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THE THREE ABCS OF WILDERNESS FIRST AID

 

Excerpt From Dr. Weiss’s Book

There are nine immediate priorities in wilderness first aid, regardless of the injury or illness. The acronym, “THREE ABCs,” is a helpful mantra for recalling the nine priorities. This expanded primary survey is a rapid evaluation of the scene and the patient in which life-threatening conditions, such as a blocked airway, severe bleeding, and cardiac arrest are recognized and simultaneous management is begun.

THE THREE ABCs

A1  – ASSESS the scene

A2  – AIRWAY (ensure an open airway)

A3 – ALERT others

B1 – BARRIERS (gloves, pocket mask)

B2 – BREATHING (check for breathing and perform rescue breathing if necessary)

B3 – BLEEDING

C1 – CPR (start CPR if the victim has no pulse)

C2 – CERVICAL SPINE (prevent unnecessary movement of the head and neck)

C3 – COVER and protect the victim from the environment

A1: ASSESS THE SCENE

Always ensure the safety of the uninjured members of the party first. Assess the scene for further hazards, such as rockfall, avalanche, or dangerous animals before rendering any first aid. The worst thing you can do is create another victim or become one yourself. Avoid approaching the victim from directly above if there is a possibility of a rock or snow slide. Do not allow your sense of urgency to transform an accident into a risky and foolish rescue attempt.

A2: AIRWAY

Speak loudly to the victim as you approach. A response indicates that he is breathing and has a pulse. For infants and children, gently tap them on their hands and feet and call their name. If the victim is unresponsive, immediately determine if he is breathing. If he is face down, roll him onto his back so that the head, shoulders and torso move as a single unit without twisting (Fig. 1). Place your ear and cheek close to the victim’s mouth and nose to detect air movement, while looking for movement of the chest and abdomen (Fig. 2). In cold weather, look for a vapor cloud and feel for warm air movement.

Fig. 2 – log rolling a victim face-up without twisting the spine

Fig. 2 – Check for breathing.

If the victim is not breathing, clean the mouth out with your fingers and open the airway. If you do not suspect trauma, the airway can be opened by placing the palm of one hand on the forehead and tilting the head back while the fingers of the other hand lift the chin.

Fig. 3 – Opening the airway in an uncounscious victim when trauma is not suspected.

(Fig. 3). The most common reason for an airway obstruction in an unconscious victim is relaxation of the muscles of the tongue and throat, which allows the tongue to fall back and block the airway.

A3: ALERT OTHERS

Before becoming more involved with the resuscitation, take a few seconds to call or send someone for help and to alert others to the accident.

Keeping the airway open with the jaw thrust technique ties up your hands. If you are by yourself, an airway can be kept open by pinning the front of the victim’s tongue to his lower lip with two safety pins. An alternative to pinning the lower lip is to pass a string or shoelace through the pin in the tongue and keep it forward by tying it to the victim’s shirt button or jacket zipper.

It sounds barbaric, but this technique pulls the tongue forward and prevents it from obstructing the airway. Any victim who requires this life-saving maneuver will not mind the small holes, and will, of course, not notice the discomfort. It also frees up your hands for other tasks

B1: BARRIERS

Any time you deal with blood or bodily fluids, it is vitally important to protect yourself from blood-borne germs, such as hepatitis and the AIDS virus. One out of every 300 people in the United States is now infected with the HIV virus, and the risk of infectious hepatitis is far greater. Protect your hands with virus-proof gloves and use a barrier device when performing mouth-to-mouth rescue breathing. Even latex gloves can leak, so make sure you wash your hands or wipe them with an antimicrobial towelette after removing the gloves.

WARNING: Five to seven percent of the population and more than 10 percent of all medical personnel are allergic to latex. Latex allergies can produce skin rashes, severe anaphylactic reactions and death. If you suspect that you might have an allergy to latex, use powder-free Nitrile gloves.

B2: BREATHING

If the patient does not breathe on his own after establishing an airway, then begin mouth-to-mouth rescue breathing.

B3: BLEEDING

Check the victim for signs of profuse bleeding. Feel inside any bulky clothing and check underneath the victim. To stop bleeding, use your gloved hand to apply pressure directly to the wound. If bleeding from an extremity cannot be stopped by direct pressure and the victim is in danger of bleeding to death, apply a tourniquet. A tourniquet is any band applied around an arm or leg so tightly that all blood flow beyond the band is cut off. If the tourniquet is left on for more than four hours, the arm or leg beyond the tourniquet may die and require amputation. Damage to the arm or leg is rare if the tourniquet is left on less than two hours.

In the face of massive extremity hemorrhage, it is better to accept the small risk of damage to the limb than to have a victim bleed to death.

Any gloves are better than using your bare hands. Dishwashing gloves make an effective barrier to blood. An improvised glove can also be made by placing your hand inside a sandwich or garbage bag and securing it to your wrist with tape or string.

C1: CPR

Place your index and middle finger on the victim’s throat over the Adam’s apple and then slide your fingers down the side of the victim’s neck to the space between the Adam’s apple and neck muscle to feel the carotid pulse (Fig. 8). Hold your fingers here for at least 30 seconds (60 seconds if the victim is cold or hypothermic) and feel for any pulsation. If you do not detect a pulse, combine chest compression with mouth-to-mouth rescue breathing

C2: CERVICAL SPINE

The spinal cord is vital for life and runs down through the vertebrae in the neck. Spinal cord damage can cause permanent paralysis or death. It is necessary to immobilize the head, neck and torso after an accident which could have broken the victim’s neck, such as a fall, head injury, or diving injury, and if any of the following are present:

• The victim is unconscious;

• The victim complains of neck or back pain;

• There is tenderness in the back of the neck or upper back when touched;

• There is numbness, tingling, or altered sensation in the extremities;

• The victim is unable to move or has weakness in an arm or leg not due to direct trauma to that part;

• The victim has an altered level of consciousness, or is under the influence of drugs or alcohol;

• The victim has another very painful injury that may distract him from the pain in his neck, such as a thigh (femur) or pelvis fracture, dislocated shoulder, or broken rib.

If a cervical spine injury is suspected, the rescuer should immobilize the victim’s head and neck and prevent movement of his torso (See page 63). Avoid moving the victim with a suspected spine injury if he is in a safe location. The victim should be evacuated by professional rescuers.

C3: COVER AND PROTECT THE VICTIM

If it is cold, place insulating garments or blankets underneath and on top of the victim to protect him from hypothermia. Remove and replace any wet clothing. If it is hot, loosen the victim’s clothing and create shade. If the victim is in a dangerous area, move him to a safer location while maintaining spine immobilization if indicated.



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