Navigating Wilderness Emergencies: What to do!

Drawing from my experiences as a scout leader (yes, ‘Be Prepared’ runs deep!), a trauma nurse in the fast-paced world of operating theatres, and my years as a remote first aid trainer, we’re diving into the world of Remote First Aid in this series. Remote first aid isn’t your typical “grab the kit and go” situation—it’s about navigating unpredictable environments where the stakes are high, and help could be hours, if not days, away.

In this article, we’re going to take a look at the key areas of how to handle critical situations when you’re in a remote area and help may be a while away. We’ll walk through some scenarios and what your management strategies might be in each.

In a critical situation, keeping a cool, calm, level head is going to be paramount. You need to think things through, plan for the worst and hope for the best while waiting for assistance. Let’s break this down…

Assessing the Situation

When you’re faced with an emergency in a remote location, your first step is always to assess the situation thoroughly. This involves two key surveys: primary and secondary.

The Primary Survey: DRSABCD

The primary survey follows the DRABC protocol:

1. Danger: Ensure the area is safe for you and the patient.
2. Response: Check if the patient is conscious and responsive.
3. Send for Help: Using communication means available get help
4. Airway: Make sure the airway is clear and open.
5. Breathing: Check if the patient is breathing normally.
6. CPR: Start CPR if the patient is unresponsive and not breathing. This quick check helps you identify and address immediate life-threatening issues.
7. Defibrillation: may be unlikely given your remote location

The Secondary Survey

Once you’ve completed the primary survey and addressed any immediate threats to life, move on to a more detailed head-to-toe examination. Look for less obvious injuries or symptoms that might become problematic over time.

Managing Resources

In a remote setting, resources are often limited. It’s crucial to:

1. Take inventory of all available supplies.
2. Prioritize their use based on the situation at hand.
3. Think creatively about how to improvise with what you have on hand. A hiking pole can become a splint, a rain jacket can serve as a pressure bandage.

Remember, in remote first aid, resourcefulness is your best friend.

Communication and Signaling for Help

Getting help is often the biggest challenge in remote areas. Here are some strategies:

1. Use a satellite phone or emergency beacon if available.
2. If mobile service is spotty, try sending a text message – it might go through when a call won’t.
3. Create visible signals:
   • Three of anything (fires, whistles, flashes) is the universal distress signal.
   • Use bright colors or reflective materials to attract attention.
   • Clear an area and spell out ‘HELP’ or ‘SOS’ with rocks or other materials.

Decision-Making and Getting Help

In remote areas, getting professional medical help is often the biggest challenge. The decision-making process can be complex and depends on various factors, including the severity of the situation, the size of your group, and your location.

Group Size Considerations

If you’re in a group of three or more:

• At least one person should always remain with the patient.
• Send at least two people for help if possible. This is safer and allows for mutual support.
• Those remaining should focus on patient care and preparing for potential evacuation.

Factors to Consider When Deciding to Go for Help

1. Severity of the patient’s condition
2. Your location and how difficult it is to access
3. Weather conditions and time of day
4. Available supplies and equipment
5. Physical condition of group members
6. Likelihood of being found by searchers if you stay put

If You Decide to Wait for Help

1. Make your location as visible as possible for potential rescuers.
2. Continue to monitor and care for the patient.
3. Conserve supplies, especially water and any medical resources.
4. Be prepared to spend more time than anticipated – help often takes longer to arrive in remote areas.

Providing Shelter

When dealing with a medical emergency in a remote location, providing adequate shelter is essential, especially if you anticipate a prolonged wait for rescue. Proper shelter can protect the patient from the elements, help prevent hypothermia or heat exhaustion, and provide a sense of security.

Quick Shelter Solutions

1. Use what you have:
   • Tarp or emergency blanket: Can be quickly set up as a lean-to or A-frame shelter.
   • Tent: If you have one, set it up to protect the patient.
   • Natural features: Look for large rocks, caves, or dense tree cover that can provide immediate protection.
2. Improvise:
   • Create a debris hut using branches, leaves, and other natural materials.
   • Use backpacks, clothing, or gear to create windbreaks.

Considerations When Setting Up Shelter

1. Location:
   • Choose high ground to avoid potential flooding.
   • Look for natural windbreaks, but be wary of falling branches or rocks.
   • Ensure the area is visible to potential rescuers.
2. Insulation:
   • Create a barrier between the patient and the ground using leaves, pine needles, or spare clothing.
   • In cold conditions, focus on retaining the patient’s body heat.
3. Ventilation:
   • Ensure adequate airflow to prevent carbon dioxide buildup, especially in enclosed shelters.
4. Expandability:
   • Consider that rescuers may need to work around the patient. Choose a shelter option that allows for this.

Remember, providing shelter is not just about protection from the elements. It also creates a sense of safety and control in a chaotic situation, which can be psychologically beneficial for both the patient and caregivers.

Now, let’s take a look at some scenarios you might encounter in the wilderness.

Scenario 1: Severe Bleeding in a Remote Hiking Accident

You’re on a multi-day hike when your partner slips on a rocky slope, gashing their leg on a sharp edge. The wound is deep, and blood is flowing freely.

Initial Assessment

1. Ensure the area is safe to approach (watch for loose rocks or unstable ground).
2. Check your partner’s responsiveness – they’re conscious but in pain.
3. The primary concern here is the bleeding – it needs to be controlled quickly.

Immediate Actions

1. Help your partner into a comfortable position, preferably lying down with the injured leg elevated.
2. Apply direct pressure to the wound with a clean cloth or gauze from your first aid kit.
3. If blood soaks through, add more layers without removing the original dressing.
4. If the bleeding cannot be controlled with direct pressure and bandages, use hemostatic gauze or a tourniquet.

Long-term Management

1. Once bleeding is controlled, clean the wound as best you can to prevent infection.
2. Apply an antibiotic ointment if available and dress the wound.
3. Monitor for signs of shock: pale, cool, clammy skin; rapid breathing; weakness.
4. Keep your partner warm and comfortable.
5. Provide small sips of water to prevent dehydration, but don’t give food in case surgery is needed later.
6. Regularly check the dressing and reapply pressure if bleeding restarts.
7. Plan for evacuation – with a severe injury like this, continuing the hike is not an option.

Scenario 2: Suspected Spinal Injury from a Fall

Your climbing partner has taken a fall and is lying at the base of a rock face. They’re conscious but complaining of severe back pain and can’t feel their legs.

Evaluation of the Scene and Patient

1. Approach carefully, watching for falling rocks or unstable ground.
2. Speak to your partner before touching them. Ask them to remain still.
3. Perform the primary survey (DRSABC), paying special attention to their breathing and circulation in their extremities.

Immobilisation Techniques

1. Do not move the patient unless absolutely necessary (e.g., immediate danger).
2. If you must move them, use the log roll technique to maintain spinal alignment.
3. Improvise a backboard if possible – a large, flat piece of wood or several trekking poles lashed together can work.
4. Use soft materials (clothes, sleeping bags) to pad around the head and neck to prevent movement.

Monitoring and Care

1. Regularly check breathing and circulation in extremities.
2. Keep the patient warm to prevent hypothermia.
3. Provide reassurance – psychological support is invaluable.
4. If they can swallow safely, offer small sips of water.
5. Plan for a long wait – spinal injuries require professional evacuation.
6. Improvise shelter above and around the patient.

Scenario 3: Recognising and Managing a Stroke

You’re on a multi-day canoe trip when your companion suddenly develops slurred speech and weakness on one side of their body.

Initial Assessment

Remember the acronym FAST:

• Face: Ask them to smile. Is one side drooping?
• Arms: Can they raise both arms equally?
• Speech: Is their speech slurred or strange?
• Time: If you observe any of these signs, time is critical.

Immediate Actions

1. Move off the water to shore.
2. Help them into a comfortable position, supporting any weak limbs.
3. Check their airway and breathing – be prepared to start CPR if necessary.
4. If they’re conscious, keep them calm and still.
5. Do not give them anything to eat or drink, as this could lead to choking.

Long-term Management

1. Monitor their level of consciousness and breathing constantly.
2. Keep them warm and comfortable.
3. If they lose consciousness but are breathing, place them in the recovery position on their affected side.
4. Prepare for urgent evacuation – every minute counts with a stroke.

Scenario 4: Handling a Heart Attack in the Wilderness

During a strenuous hike, your friend complains of chest pain, shortness of breath, and feels nauseous.

Initial Assessment

1. Help them stop all activity immediately and sit or lie in a comfortable position.
2. Loosen any tight clothing around their chest and neck.
3. Check their responsiveness, breathing, and pulse.

Immediate Actions

1. If you have a wilderness first aid kit with aspirin, and they’re not allergic, give them a single 300mg dose to chew slowly.
2. Encourage them to take slow, deep breaths.
3. If available, assist them in taking their own heart medication (like nitroglycerin).

Long-term Management

1. Keep them as calm and comfortable as possible – anxiety can worsen the situation.
2. If they become unresponsive and are not breathing normally, begin CPR immediately.
3. Plan for urgent evacuation – a heart attack requires immediate professional medical care.

Psychological First Aid

In all of these scenarios, managing the psychological state of both the patient and yourself is crucial:

1. Stay calm and project confidence, even if you don’t feel it.
2. Explain what you’re doing and why – this helps keep the patient involved and can reduce anxiety.
3. Be honest about the situation, but remain positive and focused on the steps you’re taking to help.
4. If you’re waiting for rescue, keep the patient (and yourself) mentally engaged. Tell stories, play word games, or discuss future plans.
5. Remember to take care of yourself too – take breaks if possible, stay hydrated, and eat if you can.

Empowered and Prepared: Your Remote First Aid Action Plan

Remote first aid situations are challenging, but with the right knowledge and a cool head, you can make a real difference. The key points to remember are:

1. Always ensure your own safety first.
2. Conduct thorough primary and secondary surveys.
3. Use your resources wisely and creatively.
4. Communicate and signal for help effectively.
5. Stay calm and provide psychological support.
6. Be prepared to manage a variety of situations, from severe bleeding to strokes and heart attacks.

Remember, in remote areas, you might be the only help available for hours or even days. Your actions in those critical moments can be lifesaving. Stay prepared, stay calm, and trust in your training and instincts.

In our next article, we’ll dive into how to prepare a comprehensive remote first aid kit and the essential skills you should master before venturing into the wilderness. Until then, stay safe and be prepared!

Take Your Skills to the Next Level: Join Our Remote First Aid Course

Reading about remote first aid is a great start, but nothing beats hands-on experience and expert instruction. At My First Aid Course, Brisbane, we’re passionate about equipping outdoor enthusiasts, adventure seekers, and professionals with the skills they need to handle emergencies in remote locations.

Our Remote First Aid course goes beyond basic first aid. Here’s what you can expect:

1. Practical Scenarios: Experience simulated emergencies that mimic real-world situations you might encounter in the wild.
2. Extended Care Techniques: Learn how to provide care for extended periods when help is hours or days away.
3. Resource Management: Master the art of improvising with limited supplies and making critical decisions under pressure.
4. Environmental Challenges: Understand how to deal with extreme weather, terrain, and other environmental factors that complicate remote first aid.
5. Communication and Evacuation: Practice effective communication techniques and learn when and how to initiate evacuations.
6. Psychological First Aid: Develop skills to manage stress and maintain morale during prolonged emergencies.

Don’t wait for an emergency to wish you were better prepared. Equip yourself with the knowledge and skills that could save a life – including your own – in the great outdoors.