A fellow traveller is climbing a tree so he can jump into the local river, suddenly you hear a scream, turns out he’s fallen from the tree landed just short of the water and it looks like he may have broken his leg. You’re 2hrs from the local hospital and getting a helicopter is not going to happen due to the canopy of the trees overhead. You help stabilise his leg using a couple of branches and reassure him and his friends that he won’t freeze overnight 🙂
No, it’s not a scene from a typical RTW trip, mercifully. It’s just a practice scenario, and part of the High Peak Wilderness First Aid Module 1 & 2 (16hrs) – Outdoor First Aid course with the team at High Peak First Aid, outside the pretty village of Hope in the Peak District.
“Outdoor First Aid is defined as any situation where you are at least an hour from medical care,” explains John, a course instructor. “We call the first hour the Golden Hour, because that’s the timeframe in which treatment can best help the patient survive.”
It was a family friend, an expedition hiker, who pointed me in the direction of Outdoor First Aid, after my friend broke his arm in the middle of bloody nowhere, Papua New Guinea, and I realised neither of us had any idea how to patch up a broken arm – let alone how to move him safely if he’d had head or spinal injuries.
“In normal first aid courses, they’ll teach you never to use a tourniquet,” my friend explained chirpily, over a beer. “In expedition medicine, they’ll teach you to use one in some situations – you’ll lose the limb but save the life.”
Like a lot of Round the World travellers, I’ve routinely been more than an hour’s travel – sometimes a day or more – from any form of medical care, even the most basic and unskilled. You don’t have to be trekking high in the Himalayas, downriver on the Nile or exploring the Uluru on a camel – all it takes is to be on a bus from point A to point B when it crashes, and, bang, you can be hours from help.
A good mate and I are doing the entry level course: In total it’s 16 hours, spread across two days, alternating between the classroom and the muddy wilderness around us. (These courses are not usually open to under-16s, but anyone who is travelling in your group should have a reasonable handle on the principles of wilderness emergencies.)
Over the first day you can expect to cover the management of routine injuries – burns, sprains, fractures, bleeding. We practise CPR and learn how to use a defibrillator. We’re drilled, again and again, on the basic principles of ABC – airway, breathing, circulation – and discover how to assess and monitor a patient. And we learn an impressive amount of physiology and anatomy.
Day 2 takes us out into the muddy, chilly woodland for a range of scenarios. After inadvertently killing a couple of victims, I learnt how to move victims with suspected spinal injuries, how to remove a helmet safely, how bloody difficult it is to keep a victim warm and, importantly, how to patch up a broken limb.
“The reason he’s screaming,” explains the instructor helpfully, as I hastily wrap bandages around the poor guy’s arm in fear of the approaching bandits, “Is that you’re bandaging the wrong bit of his arm. You need to stabilise the break.”
Have I had to use these skills yet? Thankfully, noy. But I have them, and if your Round the World Trip takes you off the beaten track, then it’s highly recommended that you consider acquiring them too.
High Peak Wilderness First Aid Module 1 & 2 (16hrs) – Outdoor First Aid – Course Content
First aid kits
First aid kits and best products for the wilderness environment
Safety
Safety for self, other’s and casualty
Correct PPE for the incident
Hygiene and infection control and prevention
Incident management
Incident management
Awareness of Triage
Awareness of high-risk mechanisms of injury
Communication
Communicate effectively with the emergency services
Summoning Help
999/111/Mountain and Cave Rescue/Coast Guard/What 3 Words
Life threatening (catastrophic) haemorrhage
Recognise life threatening haemorrhage
Understand a stepwise approach to managing a catastrophic limb bleed
Apply a tourniquet competently
Competent in use of haemostats
Spinal Injury
Appreciate high risk mechanisms of injury for spinal injury
Manual inline stabilisation (MILS)
Airway
Inspect and clear airway
Recognise and treat airway obstruction, choking, stridor
Perform a head/tilt chin lift
Manage an airway by postural drainage
Breathing
Identify if the casualty is breathing normally
Correctly assess breathing, rate, depth and quality
Identify life-threatening chest conditions
Basic life support for Myocardial Infarction
Basic life support for Drowning
Competent in the use of an AED
Circulation
Assess presence of circulation
Measure pulse rate and rhythm
Measure capillary refill time
Apply direct pressure
Application of appropriate wound dressings
Elevation of limb where appropriate
Splinting as haemorrhage control method
Disability
Assess AVPU
Identifying indicators of underlying head injury – concussion and compression
Perform a FAST Test (acute stroke)
Exposure
Differentiate cold from hypothermia
Differentiate heat exhaustion from heat stroke
Recognise possibility of and prevent hypothermia
Assessment, treatment and casualty handling of patients exposed to extremes of temperature
The unconscious casualty
Recovery position
Spinal log roll
Primary Survey
Shock
Recognition and treatment of shock
Medical
Recognition and management of Asthma (including life threatening), Diabetes (hypoglycaemia and hyperglycaemia), Epilepsy, Allergic reactions, Anaphylaxis (including application of auto-injectors), Myocardial Infarction, Angina (stable and unstable)
Recognition of sudden weakness/paralysis/abnormal sensation
Recognition of collapse/transient loss of consciousness
Meningitis – early warning signs and late signs
Thermal Injury
Apply appropriate treatment for burns including dressings
Understand immediate simple chemical and thermal burn management
Drowning
Recognition and management of the unconscious drowned patient
Recognition and management of conscious patient after immersion in water
Recognition of late complications of drowning
Minor Injuries
Splinters
Blisters
Grazes
Nose bleeds
Bruises
Eye
Treatment of foreign bodies
Chemicals
Snow blindness
Musculoskeletal
Recognition of possible fracture
Identification of suspected dislocation
Recognition & appropriate initial treatment of soft tissue injury
Poisoning
Recognise and treat poisoning
Bites, stings and envenomation including Lyme Disease
Casualty Handling
Physical Exam
Monitoring of vital signs