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mikitta
Jul 30, 2007, 11:00 PM
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This isn't an accident report or a question, rather I would like to address our readiness to offer first aid and assistance if we should happen to be there first when a fellow climber (or a non climbing scrambler) falls and sustains injuries.
First and foremost, the very best thing anyone can do is take a comprehensive first aid course. I would even go so far as to say an intensive First Responder course is an excellent idea for any climber.
Now with that said, if you should find yourself at the scene of a climbing accident, here's a few things you can do to help get the situation under control.
1. Unless their life is in imminent danger (ie, a great big boulder is going to fall right on top of them), NEVER EVER move an injured person. They just fell, perhaps a substantial distance. They could very well have spinal injuries that could result in paralysis if they are moved wrong. Let the EMS personel get a C collar and back board in play.
2. Determine the injured person's ABC's - their Airway, Breathing and Circulation. If they don't have an airway they can't breath. If they aren't breathing, it really dosn't matter if they currently have other injuries. Likewise if they don't have a pulse. They won't be alive in 4 minutes or less and things will be a corpse recovery then. Get training from a qualified teacher to learn how to open the airway on someone you suspect may have Cervical Spinal injuries. Otherwise, what you learned in CPR class should suffice, if you are absolutely SURE they don't have spinal injuries.
3. Stabilize C-spine, splint any fractures and control any bleeding. I used to carry a roll splint in my Ski Patrol fanny pack (it was orange and blue and I can't recall the name off hand), but in the summer, it went in my climbing pack along with 10 triangular bandages and several pairs of thin rubber gloves. The triangular bandages were useful in applying the splint or in holding pressure on a bleeding wound.
To stabilize a fracture, if you only have your hands available - hold the limb on either side of the fracture so that the limb doesn't roll or move - once you do this, you are committed until EMS shows up. To control bleeding you apply direct pressure. If all you have is your hand, you place your hand over the bleeding area and press down. (this is why the triangles and gloves were nice - didn't have to come in direct contact with someone else's blood).
If you suspect the injured person has a C-spine injury - keep their head from moving around at all by holding in position with your hands. Basically, you become married to their cranium until EMS arrives to relieve you of the responsability.
4. Send someone for help. NEVER say to a crowd at large "hey, someone get help". You look at someone specifically, ask their name, then say "(name) , call 911 right away, we need an ambulance for an injured climber.". By asking someone's name and using it, you remove their group anonymity and you assign someone to that very important role - calling for help.
If anyone has anything to add to this list, please do. I guess just seeing all the injury reports and knowing that members of this board have been on the side of being rescued recently, I thought it would be a good idea to discuss this.
Of course, having been an EMT, Ski Patroller and a member of Search and Rescue - it's a subject that is never far below my conscious thoughts wherever I am, and it stays at the forefront when ever I am in the outdoors.
God Bless,
mik
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the_peak_bagger
Jul 30, 2007, 11:21 PM
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I have a roll splint, the name is SAM Splint. do you recomend a place to get WFR or similar?
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time2clmb
Jul 30, 2007, 11:56 PM
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mikitta wrote: 1. Unless their life is in imminent danger (ie, a great big boulder is going to fall right on top of them), NEVER EVER move an injured person.
That totally depends on your level of training. And if the person is face down and not breathing then you have to roll them over...I guess that would be imminent danger but you quoted things like rockfall ect.
In reply to: 3. Stabilize C-spine, splint any fractures and control any bleeding. I used to carry a roll splint in my Ski Patrol fanny pack (it was orange and blue and I can't recall the name off hand), but in the summer, it went in my climbing pack along with 10 triangular bandages and several pairs of thin rubber gloves. The triangular bandages were useful in applying the splint or in holding pressure on a bleeding wound.
So you can't move them if there is a possible c-spine implication yet you can splint up fractures and control c-spine? I find this strange given that most courses that cover splinting techniques normally cover c-spine first (which normally includes how to place their head neutral). If I came across a climbing fall that's bad enough to break bones I would more than likely (depending on situation) take c-spine precautions aswell. C-spine includes placing them supine and holding thier head in a neutral position so that you can do a proper assesment. This more than likely requires moving them in some way or another.
The name for the splint is a SAM splint. Pack strapping or duct tape works just as good as triangulars for splinting. Then you don't need to carry so many triangulars around. If you have a thermarest that's even better.
Learn pressure points for bleeding....direct pressure does not always cut it.
I am not saying for untrained people to do this stuff...quite the contrary. Untrained people should not touch an injured person. CPR people should't try too much either. It's insufficient training for climbing (and most other things) IMO. I am a HUGE advocate for having a bare minimum of a 40 hour wilderness course and working knowledge on how to apply that knowledge.
Simply holding some ones head still while waiting for EMS is not enough knowledge for what we do. It's fine if your in the city or at a bumper belay crag, but it's not good enough for being any farther out than that.
$.02
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time2clmb
Jul 30, 2007, 11:59 PM
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Just a quick note about those "roll" (SAM) splints. Unroll it, fold it in half and keep it in the suspension of your pack. It won't take up any space in your first aid kit and you won't even notice it until you need it.
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mikitta
Jul 31, 2007, 12:01 AM
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SAM, thanks LOL - I couldn't think of that but I could picture the splint clearly in my mind.
WFR .. refresh my memory :) It has been about 12 years since I was in the industry, so to speak.
As for triangular bandages - get ONE triangular from the local pharmacy and use it as a template to make your own - just get some decent, all cotton material from your local sewing store, or use an old, clean cotton sheet. It helps to use a sewing machine and put a zig zag stitch around the edges to keep them from fraying out.
As for buying SAM's - I got mine from an EMS catalog. Not sure of a good retail source for them.
http://www.sammedical.com/ is their home page. I've seen them for sale on Ebay too.
Rubber gloves you can get at your pharmacy too. Always nice to carry a couple pair just in case - you never know these days and a little protection goes a long way :p
God Bless,
mik
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majid_sabet
Jul 31, 2007, 12:04 AM
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So what would you do if that was only you or your partner got hurt and no cell phone coverage to call 911 ?
Would you stay or you would run to get help ?
(This post was edited by majid_sabet on Jul 31, 2007, 4:46 AM)
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mikitta
Jul 31, 2007, 12:25 AM
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If it were only me and the partner up there - Majid, use some common sense. What good would it do for me to stay there and just watch them deteriorate, hoping someone would come by. I would go for help after I made sure, to the best of my ability, to have them securely anchored (assuming we were off the deck) stabilize their injuries and ensure they had some protection from the weather (ie extra clothes, sleeping bag, etc.).
God Bless,
mik
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time2clmb
Jul 31, 2007, 1:21 AM
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mikitta wrote: SAM, thanks LOL - I couldn't think of that but I could picture the splint clearly in my mind. WFR .. refresh my memory :) It has been about 12 years since I was in the industry, so to speak. As for triangular bandages - get ONE triangular from the local pharmacy and use it as a template to make your own - just get some decent, all cotton material from your local sewing store, or use an old, clean cotton sheet. It helps to use a sewing machine and put a zig zag stitch around the edges to keep them from fraying out. As for buying SAM's - I got mine from an EMS catalog. Not sure of a good retail source for them. http://www.sammedical.com/ is their home page. I've seen them for sale on Ebay too. Rubber gloves you can get at your pharmacy too. Always nice to carry a couple pair just in case - you never know these days and a little protection goes a long way :p God Bless, mik
WFR is wilderness first responder.
Trianulars are totally redundant and a waste of weight and take up too much space. The strapping off your pack, duct tape, bottom of shirt pulled up and pinned, webbing, prussiks ect ect ect all do the same kinds of things.
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time2clmb
Jul 31, 2007, 1:22 AM
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majid_sabet wrote: So what would you if that was only you and your partner got hurt and no cell phone coverage to call 911 ? Would you stay or you would run to get help ?
Majid this question has no straight answer. It is totally 100% dependant on the situation.
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jakedatc
Jul 31, 2007, 1:26 AM
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In reply to: C-spine includes placing them supine and holding thier head in a neutral position so that you can do a proper assesment.
this is incorrect.. bind it where you find it.. this applies to C spine as well. If they are at an angle then so be it. This may mean when you backboard them you'll have to add more padding to one side than the other to keep that angle stabilized.
"The "captain" of the team (most medically trained person) stabilizes the head and neck in the position as they were found, regardless of angle...."
Sports injury management, Marcia Anderson Ph.D, LATC
you can find SAM splints all over.. drug stores, EMS, REI etc they are super useful. 10 triangles is a bit much.. i'd say a few would be ok and then you can improvise with shirts, laces, slings etc in a pinch.
gloves are good.. i'd suggest either vinyl or Nitrile.. they are more durable and everyone can use them since they won't have any latex issues.
Also (AB) Circulation includes heavy bleeding.. there is no use doing CPR if you are just pushing blood right out.. gotta control that too.
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time2clmb
Jul 31, 2007, 2:08 AM
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jakedatc wrote: In reply to: C-spine includes placing them supine and holding thier head in a neutral position so that you can do a proper assesment. this is incorrect.. bind it where you find it.. this applies to C spine as well. If they are at an angle then so be it. This may mean when you backboard them you'll have to add more padding to one side than the other to keep that angle stabilized. "The "captain" of the team (most medically trained person) stabilizes the head and neck in the position as they were found, regardless of angle...." Sports injury management, Marcia Anderson Ph.D, LATC
Oh really? Every course I have ever taken starting right from occupational level 2 has always taught to line it into a neutral position. So don't tell me it's incorrect. Advanced wilderness teaches the same. As did my EMS course....
2 years EMS, 9 years first aid, advanced wilderness first aid, now in a hospital.
Must be a difference of training in where we are from.
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moose_droppings
Jul 31, 2007, 2:17 AM
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In reply to: Also (AB) Circulation includes heavy bleeding.. there is no use doing CPR if you are just pushing blood right out.. gotta control that too.
If a person has no pulse, you might not see a lot of bleeding until you start CPR, then it might be prudent to a control the bleeding.
(This post was edited by moose_droppings on Jul 31, 2007, 2:19 AM)
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mikitta
Jul 31, 2007, 2:20 AM
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time2clmb wrote: mikitta wrote: 1. Unless their life is in imminent danger (ie, a great big boulder is going to fall right on top of them), NEVER EVER move an injured person. That totally depends on your level of training. And if the person is face down and not breathing then you have to roll them over...I guess that would be imminent danger but you quoted things like rockfall ect.
Imminent danger means danger of dieing. The first thing that came to mind was rock fall. Of course the necessity of performing CPR because they aren't breathing falls under that category.
In reply to: In reply to: 3. Stabilize C-spine, splint any fractures and control any bleeding. I used to carry a roll splint in my Ski Patrol fanny pack (it was orange and blue and I can't recall the name off hand), but in the summer, it went in my climbing pack along with 10 triangular bandages and several pairs of thin rubber gloves. The triangular bandages were useful in applying the splint or in holding pressure on a bleeding wound. So you can't move them if there is a possible c-spine implication yet you can splint up fractures and control c-spine? I find this strange given that most courses that cover splinting techniques normally cover c-spine first (which normally includes how to place their head neutral). If I came across a climbing fall that's bad enough to break bones I would more than likely (depending on situation) take c-spine precautions as well. C-spine includes placing them supine and holding their head in a neutral position so that you can do a proper assessment. This more than likely requires moving them in some way or another.
It is unwise for anyone untrained to move someone with suspected C-spine injuries because they do not have the training or knowledge to stabilize the area on a move. As was mentioned - stabilize in place till EMS arrives. I feel confident enough in MY training and abilities to move someone - with help - if it is absolutely necessary. HOWEVER, I would only do so if they weren't breathing and I had to give them CPR. Even seasoned paramedics can fudge this move and make someone a parapalegic.
In reply to: The name for the splint is a SAM splint. Pack strapping or duct tape works just as good as triangulars for splinting. Then you don't need to carry so many triangulars around. If you have a thermarest that's even better.
Again thanks :) I tend to loose words from my memory more and more. They've all been replaced with "STOP TRYING TO DRAG YOUR SISTER DOWN THE STAIRS BY HER HAIR!! OR ANY OTHER BODY PART" and "NO, you can NOT take my good mixing bowl up to the pond to see if you can float in it". Strangely enough, I've developed this strange tic in my left eye...
That is a good point about using what you already have. Thermarest pads are very versatile, as is webbing and pack straps. I just carried the 10 traingles because that is what we were required to carry by the mountain in our ski patrol packs and I just transfered everything over in the summer from one pack to the other.
In reply to: Learn pressure points for bleeding....direct pressure does not always cut it.
EXCELLENT point! And worth a small discussion. For those reading who don't know what a pressure point is - it is a point in line with a bleeding injury that if you apply pressure to it, it will slow or stop the bleeding. Basically, you are compressing an artery. Most vienous bleeding can be stopped by direct pressure, but arterial bleeding (bright red and frothy, possibly squirting out) needs pressure point control. This is something you will be taught in a good first responder course.
In reply to: I am not saying for untrained people to do this stuff...quite the contrary. Untrained people should not touch an injured person. CPR people should't try too much either. It's insufficient training for climbing (and most other things) IMO. I am a HUGE advocate for having a bare minimum of a 40 hour wilderness course and working knowledge on how to apply that knowledge.
Untrained people CAN stabilize an injured person in place (ie make sure they don't move), treat for shock (put a coat over them, raise the feet 6 inches if there are no injuries or prior position preventing that) and get help.
I, also, absolutely advocate a good first responder course - wilderness first responder if you can get it, just plain 50 hour FR course if you can't. Basic info is the same, just the environment specific details won't be there in the regular FR course.
In reply to: Simply holding some ones head still while waiting for EMS is not enough knowledge for what we do. It's fine if your in the city or at a bumper belay crag, but it's not good enough for being any farther out than that. $.02
I can understand what you are saying - however, with even a small amount of first aid information (ie knowing that an injured person shouldn't be moved, checking to make sure someone can breath and treating for shock) can mean the difference between life and death before the medics arrive.
When you say even a CPR trained individual shouldn't try too much - how many rescues have you been on where the EMS got to the crag within 4 to 6 minutes, let alone to the patient within that time frame? I'm just saying :)
Again, find out when the First Responder courses are in your area, folks. You will always be wealthier for having taken it :)
God Bless,
mik
(This post was edited by mikitta on Jul 31, 2007, 2:38 AM)
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mikitta
Jul 31, 2007, 2:49 AM
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Thanks :)
As I mentioned above, I keep loosing words I used to know ... something about having a hyperactive 9 year old boy and repetitively screaming at him to stop what ever he's doing before he kills someone or breaks something :p
God Bless,
mik
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zuegma
Jul 31, 2007, 2:53 AM
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Its kinda weird...I was down at seneca this past weekend and we had a similar discussion. THe jist of it was about various types of WFA courses. One of the guys i was with had just taken it and said the main thing he got from the course was that unless the victims' injuries are minor and its not a "bumperside crag" then there chance of survival is minimal. One of the other guys was guides for some company and said he pretty much agrres in that some WFA courses had really taken a turn for the worst and pretty much instilled in your head that if the person is in serious condition there isn't really to much you can do unless you have a some advanced type of medical equipment nearby which isnt the case in most serious wilderness accidents. I mean its been said on here before but if someone enters cardiac arrest and your hours away from help, if after 5 minutes of CPR they don't come back whats the point of continuing. or say for example your climbing with a man (more likely to have a heart attack and enter cardiac arrest) and your halfway up a bigass wall with no ledges around and he enters cardiac arrest CPR would pretty much be impossible if not ineffective.
just some thoughts that came to mind when i read through this thread.
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moose_droppings
Jul 31, 2007, 3:15 AM
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^^
Totaly correct, as said before, its all situational. But sometimes you can do something, and this is the jist of this thread, knowing what to do when you can and getting familar with basic life support.
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mikitta
Jul 31, 2007, 3:19 AM
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Those are good things to consider.
I do disagree with the assumption that a person in a wilderness setting is screwed if they aren't within 10 minutes of advanced life support if their issue is trauma, however.
It depends on the trauma. Broken bones - arms, legs - those can be splinted and people can and have hobbled out of the mountains on them. Even first aid for altitude sickness is effective if initiated immediately. (get them lower ...)
Most of first aid is so much about common sense and staying calm. Surely if you have an incident (like the 15 yo who fell last week in Oregon), you need to get immediate hospital attention for them - their injuries are serious enough that more than 2 to 4 hours between initial injury and Critical Care at the regional Trauma Center will mean death if not permanent disability.
MOST of the crags we frequent here in the US (with notable exceptions for the Alpinists and the really backwater areas) are within 2 hours of trained EMS. Stabilizing a trauma victim during those 2 hours can mean the difference between life and death. Shock is a #1 killer in trauma. If you can treat and manage shock by establishing the ABC's, managing C-spine and splinting fractures (and that means even just stabilizing them with your hands so they don't move around), you give that patient a better chance for survival until the professionals arrive, and a better chance for recovery down the line.
Keep the discussion coming :) I'm enjoying thinking about these things and discussing them again!
God Bless,
mik
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jakedatc
Jul 31, 2007, 3:25 AM
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time2clmb wrote: jakedatc wrote: In reply to: C-spine includes placing them supine and holding thier head in a neutral position so that you can do a proper assesment. this is incorrect.. bind it where you find it.. this applies to C spine as well. If they are at an angle then so be it. This may mean when you backboard them you'll have to add more padding to one side than the other to keep that angle stabilized. "The "captain" of the team (most medically trained person) stabilizes the head and neck in the position as they were found, regardless of angle...." Sports injury management, Marcia Anderson Ph.D, LATC Oh really? Every course I have ever taken starting right from occupational level 2 has always taught to line it into a neutral position. So don't tell me it's incorrect. Advanced wilderness teaches the same. As did my EMS course.... 2 years EMS, 9 years first aid, advanced wilderness first aid, now in a hospital. Must be a difference of training in where we are from.
congratulations you've just possibly shoved a piece of vertebrae through their spinal cord by moving it.
that quote is directly from my Athletic training text book written by one of the most respected athletic trainers in the country and some parts of the world. Has been an athletic trainer for over 25 years including at least 1 if not 2 Olympics
http://www.bridgew.edu/MAHPLS/faculty.cfm#anderson
American Red Cross first aid:
what to do:
1 check scene, check person
2 obtain consent
3 call 911
4 minimize movement
5 Manually support head AS FOUND. If head is sharply turned towards one side, DO NOT move it. Support IN POSITION FOUND
Renooooooooooo
(This post was edited by jakedatc on Jul 31, 2007, 3:26 AM)
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mikitta
Jul 31, 2007, 3:37 AM
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Jake - if someone is not trained in C-spine maneuvers - you are absolutely correct.
For those of us who have had the advanced training (for me ... EMT-1 for 6 years, Basic Ski Patroll for 3 years), we do know how to move a patient and maintain C-spine integrity. But it takes team work (at LEAST 2 people to keep the spine in line) and even seasoned paramedics can screw it up.
Unless someone has that training, it should not even enter their thoughts unless the life of the patient is in imminent danger if they aren't moved :)
God Bless,
mik
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coolcat83
Jul 31, 2007, 4:02 AM
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i've been an emt-b, first responder, so i've had emt tarining and training specific to what to do when you are first on scene and alone till help arrives. first abc's abc's abc's, without that there's no point. that said you do need training, untrained people can help but a lot of training and experience i've gained in ems stems from what hasn't worked, and what not to do as much as what to do.
there are some states that have ems training funds, here in nj if you get a local squad to associate with the state will pay your emt training. my course a few years ago was aroung $550 if i had paid (i volunteer in my county). well worth it i think. also if oyu have the time joining a swuad and riding wit hthem will get you great experience and help you control your fear and panic in an emergency.
you don't need cravats (triangular bandages) unless you are used to them, they are light, and if you feel comfortable with them use em. but a lot of ems is improvising and efficient creative problem solving.
and if you or the person you are saving are not in imminent life threat don't move them. if they are face down in a puddle yes move roll them, but do it with help if others are right there and as a unit, ie all at once.
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jakedatc
Jul 31, 2007, 4:02 AM
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"EMT-1, represents the first component of the emergency medical technician system. An EMT-1 is trained to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-1 has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies."
hmmm plus you stated that you've been out of the game for 12 years.. I would have to believe things have changed since then
also, i'm sure those maneuvers are best done after they are spine boarded. i'm guessing not many folks carry around a board with them. which means you either have to wait for a rescue team to bring you one or stabilize things like any other bone (bind it where you find it) for them to be carried out
"and even seasoned paramedics can screw it up"
great you need 2 advanced trained people in these certain things that are not recommended by 2 organizations that specifically deal with athletic injuries and trauma victims AND it's not a sure bet.
please don't move my neck. Thank you.
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cj8
Jul 31, 2007, 4:34 AM
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jesus christ. this was the worst idea for a post ever. are you aware of how much has changed since you have been in the "industry". giving directions on a forum? giving advice about c-spine?
Come on. Working for AMR, and being a full time ski patroller, i can tell you that the worst thing i come across is people like you. LEAVE IT FOR THE PROFESSIONALS. Obviously if you are out in the middle of no were, thats a different story.
Why dont you retire from your position of first aid specialist, and save some lives that way.
Also-- pretty damn funny that you carry 10 triangular bandages in your pack. You making a hamock?
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moose_droppings
Jul 31, 2007, 5:18 AM
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cj8 wrote: jesus christ. this was the worst idea for a post ever. are you aware of how much has changed since you have been in the "industry". giving directions on a forum? giving advice about c-spine? Come on. Working for AMR, and being a full time ski patroller, i can tell you that the worst thing i come across is people like you. LEAVE IT FOR THE PROFESSIONALS. Obviously if you are out in the middle of no were, thats a different story. Why dont you retire from your position of first aid specialist, and save some lives that way. Also-- pretty damn funny that you carry 10 triangular bandages in your pack. You making a hamock?
If every thread needs a jerk, no one else need not apply. This thread just acquired one.
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mikitta
Jul 31, 2007, 5:37 AM
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Jake, I am sure there have been a LOT of changes in the last 12 years, but basic first aid really doesn't change that much. Treat for shock, imobilize the patient, and get help.
So far, with one exception, I think the discussion has been profitable.
As to managing a patient with C-spine issues - in order to board them, you have to have them straight (or as reasonably straight as physically possible) - which is best left to the professionals when they arrive. Yes it is something even Paramedics can screw up - it has happened to seasoned veterans. Ergo - don't move the patient unless their life is in imminent danger.
I think that has been stated several times by now :) It is worth repeating.
Cravats - thanks - another word I lost along the way :)
On the patrol, we used them for everything - slings for dislocated shoulders and broken arms, compression dressings, securing patients to the back board, setting up traction splints - perhaps techniques have changed, but at the time, we were required to have 10 cravats in our fanny pack on the hill, and in the summer time, I just transfered my Ski Patrol stuff to my climbing pack so I had it at hand. All my partners were ski patrollers and SAR so we had quite the first responder prep ready in case of emergency :)
God Bless,
mik
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jakedatc
Jul 31, 2007, 6:10 AM
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mik.. if you hadn't gathered.. i consider myself a professional. I have more schooling in athletic injuries than EMTs and have had advanced training in spine boarding between Athletic Training and lifeguarding. Do i wait for EMT's to spine board athletes.. yes. because they are updated with the latest training and techniques. Do I help and assist them with the adjustments that need to be made with helmets, pads etc? yes because i've been trained to deal with that issue.
no one said basic first aid has changed. Techniques have changed.
you are being a typical old school emt.. i've worked with them and it's damn annoying. so set in your ways even though you haven't done jack shit in years and you're trying to tell people who are doing stuff NOW how it's "supposed" to be done.
open your ears and you might learn something. i quoted 2 examples of current teaching that says that you DO NOT change the angle of the neck if it is not straight. what you got? please date your source.
hey guess what.. you don't Roll people onto spine boards anymore.. did ya know that? (as long as they are not face down at time of boarding)
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