First Aid/Wilderness First Aid

Caution
	Lack of symptoms does not mean that an animal does not have rabies!

Caution
	Make certain that the patient is not allergic to medication before dispensing.

First Aid

Introduction — Issues in Providing Care — Primary Assessment & Basic Life Support — Secondary Assessment — Circulatory Emergencies

Respiratory Emergencies — Soft Tissue Injuries — Bone & Joint Injuries — Environmental Illness & Injury

Medical Conditions & Poisoning — Advanced Topics — Appendices — Meta content

This section deals with techniques requiring advanced training.
Remember: going beyond your level of training may open you to liability.

Wilderness first aid is the practice of first aid where definitive care is more than one hour away, and often days to weeks away. The practice of wilderness first aid is defined by difficult victim access, limited equipment, and environmental extremes. As such, care can differ radically from that which is provided in other situations. Unlike other areas, those providing care in the wilderness are literally on their own. In the wilderness, independence and preparedness are absolutely crucial, as it may mean the difference between life and death.

Anaphylactic Shock

Anaphylactic shock is where the airway rapidly constricts and is always a serious life threatening condition. It is generally a reaction to allergens and must be treated immediately. Even if the reaction stops, seek medical attention, because return of symptoms has been documented. In a wilderness setting, anaphylactic shock is handled differently, as medical attention is generally not available. The biggest difference is that medications are used, where in any other setting, this might not be the case.

Eliminate or minimize allergen contact.
Keep the patient calm.
Treat for shock.
Tilt patient's head back to keep the airway open.
Use a rescue inhaler with albuterol. (Preferred)
Administer chlorphenamine (Chlor-Trimeton) or diphenhydramine (Benadryl) according to dosing instructions. If available, administer corticosteroids like prednisone.
Evacuate the patient to the nearest medical facility immediately.

The biggest key to treating anaphylactic shock is that the airway must be kept open. To prevent the airway from closing, the preferred method is to administer albuterol. This is the base component of rescue inhalers. Albuterol is a cortiocosteroid that works by increasing respiration, allowing more air to be taken in to compensate for the restricted airway. After albuterol is administered, diphenhydramine should be administered in accordance with the dosing instructions until the patient arrives at a medical facility. ANY CORTIOCOSTEROID OR ANTIHISTAMINE WILL WORK.

Animal bites

Know the venomous animals in your area.

Animal bites can vary in severity from minor to major. Different approaches should be taken depending on the animal. For example, mammal bites may result in rabies. Rabid animals will present with unusual behavior and aggression, but this does not always occur. Do not look for foaming of the mouth. Nocturnal animals that are moving around during the day should always be considered rabid as should bats and raccoons.

For all mammal and nonvenomous insect/snake bites,

Stop bleeding by applying pressure to the affected area's blood supply (if necessary).
Wash the bite area immediately (with soap if possible).
Apply antiseptic (iodine/neosporin/triple antibiotic).
Bandage the bite loosely.
Keep the affected area clean.
Treat for shock (if necessary).

It is important that you monitor the patient's condition and take any appropriate actions. When rabies is a possibility, seek medical attention as soon as possible. If possible, attempt to have the animal caught for testing. If the animal has to be killed, preserve the head. Provided that treatment is provided promptly, rabies can generally be stopped by post exposure prophalaxis (P.E.P.). If the patient reports fever, headache, or malaise, they need to be evacuated to medical attention as soon as possible.

Snakes

Many snake bites, even by venomous snakes, are not envenomed, and these can be treated as normal animal bites. Rabies is never a consideration as only mammals can carry the rabies virus.

There are four main categories of venomous snakes. Snakes are classed as cobras, coral snakes, kraits, and vipers. Snake identification is extremely important to determine which antivenin to give and the treatment method that is necessary. Some polyvalent antivenins are available, but not in every hospital.

Croatilid (pit-viper, such as rattlesnake) venoms cause the bitten area to turn green or purple. Elapid (coral and many other non-U.S. snakes) venoms cause swollen lymph nodes. If symptoms appear; clean with soap and water, keep affected area lower than the heart, never put a cold compress on the bite area as recent research has shown this can possibly cause more harm, and evacuate the victim, on a litter if possible. If a victim is unable to reach medical care within 30 minutes, a bandage, wrapped two to four inches above the bite, may help slow venom. The bandage should not cut off blood flow from a vein or artery. A good rule of thumb is to make the band loose enough that a finger can slip under it.

The first aid for Australian elapid snake bites is the same as that used for Funnelweb Spiders, cone shells or Blue-ringed Octopus bites (see section below on spiders); the bandage should be as tight or tighter than that used for a sprain. Never wash the bite site for bites from Australian elapid snakes. This is because in Australia there is a Snake Venom Detection Kit (SVDK)(produced by Commonwwealth Serum Laboratories Ltd), which used swabs from the bite site to obtain minute samples of snake venom; these samples are then tested in the SVDK, which is a simple and effective ELISA assay, to determine whether the venom comes from the Brown Snake (Pseudonaja sp), Black Snake (Pseudechis sp), Taipan (Oxyuranus sp), Death Adder (Acanthophis sp) or Tiger Snake (Notechis sp) groups. This can tell the treating physician which of the 5 CSL antivenoms to use; antivenom is only administered if the patient shows definite signs and symptoms of clinical envenoming. Some other Australian elapid species such as Whip Snakes (Demansia sp), Broad-head Snakes (Hoplocephalus spp) and others may give unusual results with the SVDK. There are also many highly venomous Sea Snake species occurring in Australian waters, particularly the tropical regions; there is also a CSL antivenom for sea snakes.

Spiders

While all spiders have venom, only a handful can cause problems in humans. Nonvenomous bites should be treated by washing the bite and applying antiseptic.

The Sydney funnel-web spider of Australia is one spider that is frequently dangerous to adults, and it resides only within 100 miles of Sydney, Australia. Treatment is identical to that of a snake-bite. The first aid treatment for the Sydney Funnelweb Spider (Atrax robustus) and closely-related dangerous Australian Funnelweb spiders such as Hadronyche versuta, Hadronyche formidabilis and Hadroyche infensa is the same as the first aid for Australian elapid snake bite. However, this treatment differs from the US technique mentioned above for coral snakes. The symptoms of envenomation by the dangerous Australian elapid snakes may include neurotoxicity (nervous system disorders, coagulopathy (blood clotting problems), Myotoxicity (effects on muscle tissue), general systemic symptoms, and occasionally death. The method used in Australia for first aid for elapid snake bites (e.g. Common Brown Snake (Pseudonaja textilis), Taipan (Oxyuranus scutellatus) and others is the Pressure-Immobilisation Technique. This is the technique recommended by the Australian Resuscitation Council and endorsed by medical authorities and the major authoritative Australian national first aid organizations such as Red Cross Australia, St John Ambulance Australia and Surf Lifesaving Australia. It has been shown to be effective. For a description of this technique see the Australian Venom Research Unit website at http://www.avru.org/firstaid/firstaid_snake.html and http://www.avru.org/firstaid/firstaid_pib.html, or the CSL Antivenom Handbook at http://www.toxinology.com/generic_static_files/cslb_index.html.

In North America, the Brown Recluse and Black Widow spiders are considered dangerous to humans. While effects may not be as pronounced in adults, untreated bites in children and the elderly have a high probability of fatality. It is strongly recommended that all bite victims receive prompt medical attention and the administration of antivenin to prevent nerve and skin damage. Although toxins are different, treatment is the same.

Treat for shock.
Capture spider if safe/possible.
Clean and expose the bite.
Transport to hospital.

Ticks

Ticks are small parasitic arachnids. They are generally black, gray, brown, red or a combination of these colors. They require the blood of mammals to survive. When hungry, they are extremely small and difficult to see. As they feed on a host, their body expands and they become more noticeable. Normally ticks wouldn't be a problem, but they have been identified as a vector for disease. Tick Encephalitis, Lyme Disease and Rocky Mountain Spotted Fever can be spread by an infected tick. Also, the opening they create in the skin provides easy access to the body for airborne pathogens.

The best way to prevent these diseases is to make it difficult for ticks to attach to your skin. Minimizing the amount of skin visible will minimize the amount of skin for ticks to feed on. Check before you travel to see if ticks are a known danger in your area. When you stop in a tick infested area, have a partner do a visual inspection for them. This can further aided by wearing light colored clothing, which makes ticks stand out more. Avoid brushing against hanging foliage as ticks love to wait there for a host to come along.

Generally, medical attention is not necessary to handle tick bites. However when you discover a tick, effort should be made to remove it as soon as possible. If you are unable to remove it and it does require medical attention, seek such attention promptly. Every moment that the tick remains in your body increases the chances of getting a disease.

Gently grasp the tick's mouthparts with forceps - be very careful not to grab the body.
Pull the mouthparts straight back in the direction they entered the skin with even pressure.
The mouthparts are quite difficult to remove, and are often very long; be patient and use steady, even pressure.
Pull gently but firmly; if you pull with too much force, you will detach the mouthparts from the rest of the tick. If the mouthparts stay embedded in the skin, they can very easily kindle an infection.
Do not use substances such as nail polish remover or bug spray.
Flame can be used (if accepted in your area).
If you must, use fingernails to grasp the tick's mouthparts.
Wash the area and your hands thoroughly with soap and water once you've finished.
Wipe area with antiseptic/antibiotics.
Bandage and keep the bite clean.

Using antiseptic or antibiotic on a bite decreases the chances of infection, but antibiotic prophalaxis is recommended.

Advanced Topics

Wilderness First Aid — Marine First Aid — Extended Assessment

Airway Management — Oxygen Administration — Automated External Defibrillation — Triage