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The first and foremost rule when experiencing an accident or when being injured is not to panick. Considering that you might be at a remote location where the nearest settlement is at a few days distance, a place with no medical facilities like hospitals or ambulances, you have to overcome feelings of desertedness and regain your nerves. Panicking won't bring you anywhere. Once you managed to keep a cool head, continue to practice what you have learned at first aid courses. Below are guidelines of what needs to be done following an accident or an injury resulting from the accidents.

Avoid the risk of additional accidents: If you risk your own live while trying to help someone, what good comes out of this for both parties? This is a mistake frequently done by people, having unnecessary accidents themselves while carelessly approaching a person in danger. You might end up falling down while attempting to jump over a viaduct at night, or cause chain accidents because you carelessly jumped out of the car in order to help....Mountain climbers, for example, know that they might end up under the same avalanche or rocks as their partners whom they try to rescue. The same fate awaits the rescuer when trying to rescue someone about to drown. If the rescuer is not tied to the land with a rope or does not have at least a bit of wood to climb on, s/he might drown from exhaustion. Always take into consideration that you yourself might be affected when helping someone poisened from gas, or you might even be subjected to an electricity current when touching someone lying on the ground. Proffesional rescuing organisations recognize the importance of carrying equipment necessary to save their own lives, and of uninterrupted communication with the base.

Call for help: Sometimes a cellular phone, a radio, or a third person might offer you the peace of mind you need on your rescue operation, knowing that help will arrive eventually. Make use of anything that can assist you in calling for help and do not attempt play the lone hero. Bear in mind that more people means a more effective rescue and better transport of the casualty. If you are still keen on rescuing the casualty all by yourself you might soon discover that this is an extremely exhausting job leaving you breathless within 10-15 minutes.

Assess the conditions correctly: If you manage to reach the casualty, race against the time will be crucial. You need to decide the aid necessary and apply within seconds the procedures you have read on these pages for minutes. Cardio-Pulmonary Resuscitation has to be applied immediately, for example, for a person whose heart stopped beating and who is no longer breathing. A wrong assessment, i. e., the person is still breathing and his heart beats fine, and you will end up killing the person.

Examine the casualty thoroughly and find out where the problem is by using all of your senses (well, you may exclude taste). You can apply some emergency procedures, like bandaging, to the person while examining. If the casualty is conscious, converse with him and let him tell you what the problem might be. After all, its his body, he will know the pain better than you. Moreover, ask him to move some parts of his body like the arm or the leg, this will help you to determine whether the spine is damaged or not. This is valuable information if there is a necessity to carry the injured person. Place your hand on the forehead while conversing. This way you will prevent any more damage to the spine, the neck, or the brain when the person makes involuntary moves. If the casualty is conscious but does not understand what you mean, mutters illogical sentences, or has a drunken speech this might be the result of brain damage. Pinch his earlobes to measure his reaction against pain stimulants. If there is no reaction to pain, you have a difficult job in front of you.

Examine the pupils of the casualty by directing a source of light toward his eyes, do not forget to place your hand on his forehead to avoid involuntary moves. To do this open the eyelids with your thumb and forefinger of the hand placed on the forehead of the casualty. If you do not have light, open and close the lids to observe the reaction of the pupils toward light. A healthy person's pupils become smaller when exposed to light, just like the diaphrame of a photographing machine. If there is damage to the brain the pupils do not react, except in extraordinary incidents like the use of morphin (where pupils become smaller) and athropine (where pupils become wider). In situations like these, the eyes might not mirror the soul but they certainly mirror the workings of the brain. When measuring the reaction of the casualty during basic cardio-pulmonary resuscitation, observe whether the pupils are starting to react to light and whether the pulse has come back.

While doing everything explained above you also need to examine the rhythm of the pulse by placing three fingers on the side of the neck and to watch for signs of breathing by placing the ear close to the casualty's nose. Start to apply cardio-pulmonary resuscitation only if there is no chest movement hinting that the casualty is not breathing, if the skin has started to turn purple (the skin colour of a normal human being is pink white; however, it may prove difficult to judge changes in color on dark-skinned people. In this case, determine any change by looking at the mucous membranes of the inner part of the lips), if you can get no pulse, if the casualty's body is still warm, and if his pupils react a bit.

Ensure that breathing continues: Check if there are any objects in the airway, the mouth or nose obstructing breathing. If the answer is yes, get rid of the object. Remember to pay attention to your fingers while they are in the mouth of a casualty, since he might involuntarily bite when unconscious. Use a pencils to control biting. After the cleaning process is finished, pull the chin forward with the neck supported with soft clothes in case there might be a neck injury. Try to check for neck injuries by slightly feeling with your fingers. If you cannot any clothes try a bag filled with sand or soil. If you are not sure about abnormalities, compare the organ you consider as damaged with the same organ in your body. This might help to assess the injuries more correctly.

 

AIRWAY MANAGEMENT

Artificial Respiration (Expired Air Resuscitation (EAR) or, more commonly known, Mouth-to-Mouth Resuscitation)
Mouth-to-mouth resuscitation is the method by which a rescuer breathes for a casualty who is in respiratory arrest. It is a most effective method for sustaining life, as a rescuer breathes out sufficient oxygen to supply a casualty with the necessary requirement. Immediate supplementary breathing is necessary, as the brain suffers irreversible tissue damage if deprived of oxygen for longer than about three minutes. The procedure of this type of resuscitationis as follows: Carefully roll the casualty onto his back and ensure the airway is open. Tilt the head and lift the jaw. Completely press the nose of the casualty with two fingers of the hand resting on the forehead of the casualty. Do not move the hand from the forehead. Seal the casualty's mouth with your mouth and breathe five times into the airway through the mouth. Breaths need to be effective, which is evidenced by the rise and fall of the chest with each breath from the rescuer. Make up to five attempts to achieve the initial two effective breaths. If you have achieved effective breathing resuscitate with 15 breaths per minute for adults and 20 breaths per minute for younger children and infants. After one minute (15 or 20 breathes) check for pulse and assess the rise and fall of the chest. Always check the airwayfor obstructions, particularly for vomitus since the force of your breath might direct your breath into the casualty's stomach and cause him to vomit. You may want to gently push to stomach to let the air accumulated in the stomach escape. When obstructions present, clean these as much as you can and continue the respirational process. If no pulse present, continue for another minute with the same amount of breathes. Take additional care when breathing into airways of young children. In this case, modify your breath. If the breath is delivered too forcefully, the air will be directed into the stomach, which may cause the child to vomit.

Cardio-Pulmonary Resuscitation (CPR)
Cardio-pulmonary resuscitation (CPR) is expired air resuscitation (EAR) used in conjunction with external cardiac compressions. It is the singularly most effective form of active resuscitation available, and is used universally by trained first aid providers and medical personnel. At remote location where no proffesional help is available you have to resuscitate yourself. When resuscitating, remember that the rib over the heart will fracture because of the pressure it receives. Always bear in mind that you might damage the heart or the lung during resuscitation. The technique is used to assist in resuscitation of casualties in cardiac arrest, never appply this technique to casualties whose heart is beating, even if slightly. Effective CPR can sustain a casualty until more expert definitive medical treatment is available. It is vital that CPR is initiated immediately on contact with the casualty. A particularly important aspect of CPR is that the rescuer's hands are positioned correctly in relation to the casualty's heart. There are two common methods used to locate the correct position of the heart; the Xiphoid Location , and the Calliper Method. Place two fingers of one hand over the casualty's xiphoid process, the small 'bump' at the base of the sternum. The other hand is then placed with the palm of the hand in the centre of the sternum, above the two fingers. This position on the lower part of the sternum approximates the location of the heart. The middle finger of one hand is placed on the `sternal notch', the depression above the sternum below the throat. The middle finger of the other hand is placed at the base of the xiphoid process. Both hands are then moved together so that the thumbs meet in the middle of the sternum. The lower hand is then positioned palm down across the lower part of the sternum, close to the thumb of the upper hand. This approximates the location of the heart. For adults and older children place one hand in position, the second hand is positioned over the first and the fingers entwined for stability. An alternative is for the second hand to grip the wrist of the first. The chest is then compressed approximately 1/3 the depth of the chest with pressure exerted through the heel of the bottom hand.

The procedure to follow for CPR is as follows: Never do this type of resuscitation on a soft surface. Always place the casualty on a hard, even surface. Tilt the head and lift the jaw. Check the airway, make sure it is open and unobstructed. Check for carotid (neck) pulse, if no pulse present kneel beside the casualty. Be sure you located the heart correctly. Place hands centrally over the heart, fingers entwined and lean over the casualty with arms straight and elbows locked. Commence 15 compressions with even pressure. Give two effective breaths, that is, breath 5 times into the airway of the casualty to achieve 2 effective breaths (see 'Artificial Respiration' above). Check the pulse always from the neck (the carotid pulse) to get a clearer pulse because this is the place where the main vein to the heart, the carotid arteri, is located. If there is pulse present stop resuscitation. If you continue the heart will stop at this point.

Shock
Shock is a life-threatening condition, and should not be confused with the flood of adrenaline that accompanies dangerous or fearful situations. The causes of shock are: loss of blood and body fluids, a heart attack, spsis or toxicity (such as blood poisoning), and spinal injuries (due to the reaction of the nervous system to the injury). Shock is a deteriorating condition, and one that does not allow a casualty to recover without active medical intervention. As a first aid provider attending a casualty, you should ask yourself whether the injury appears serious, or whether the injury is likely to get worse. If the answer is yes, treat immediately for shock. Symptoms for shock are pale, cold and clammy-looking skin, rapid and shallow breathing, rapid and weak pulse, nausea and/or vomitting, evidence of loss of body fluids or high temperature, if sepsis is present. If shock follows bleeding, the pulse is more rapid than other forms of shock, due to faster heartbeat to compensate for lower blood pressures. These symptoms should cause red alert in your brain because if they are left untreated the casualty will eventually collapse and remain unconscious. Shock is progressive, it is not a state from which a person recovers on his own. The last stage of shock is the gradual 'shut-down' of the body's vital functions.

In the event of external bleeding shock is very likely to follow. The casualty's life depends on how much blood he is losing and how fast the loss occurs. A male of 1.80 cm height and 80 kg weight can lose up to 6 litres of blood without deteriorating into shock, whereas a female of 1.55 cm height and 50 weight can lose only four kilos of blood after which she will surely deteriorate into a shock condition. Early signs of shock after bleeding manifest themselves as pale, cold and clammy-looking skin particularly at hands and feet.

The pulse at this stage is rapid and shalow and rapid breathing. These are all signs that oxygen levels have dropped due to decline in blood pressure. All organs operate at an emergency level and provide blood to the heart and brain. This is why the urin exit from the body will be little, mounting to an amount of a teaspoonful. The urin has a light colour. If blood loss reaches 40% of the total blood in the body, the following shock will be severe. Severe shock is sure to affect vital organs of the body. The casualty responds to this state of shock by displaying uneasy and irritable behaviour. As the vital functions weaken hallucination sets in, but is quickly followed by a collapse into coma. The first aid of a life threatening external bleeding should be to stop the bleeding.

To stop the bleeding you need to follow these steps: Quickly check the wound for foreign matter and apply pressure to the wound. Apply a non-adherent dressing or, if you have one, a pad. Raise and support the injured part above the level of the heart if possible. Apply a firm roller bandage. If unable to stop the bleeding consider a constrictive bandage. Constrictive bandages are a measure of last resort, and should only be used in a life threatening situation where all else fails and there is no hope of help coming soon. If bleeding has finally stopped treat for shock. To do this position the casualty in a supine state with legs elevated. If unconscious, support the elevated legs. Since blood is drawn to the vital organs muscles are no longer able to maintain body temperature which progressively drops. A casualty in shock from excessive bleeding should be kept warm. Wrap anything you can find around the body, it might also help if a third person lies next to the casualty to provide warmth with his body temperature. Pain contributes to deterioration. Minimize the conditions that cause pain to the casualty. It is not possible to give fluids via veins. While still conscious, make sure the casualty drinks as much fluid as it is possible to prevent dehydration.

 

IMPORTANT NOTES ABOUT FIRST AID IN THE WILD     

With all outdoor activities there is always the possibility of falling from high places or getting hit by objects. The resulting injuries are mainly received to the head, the neck, or extremity organs. If a major injury is suffered to the skeleton system, it is wiser not to move the casualty. A preliminary check has to be carried out, any bleeding stopped and fractures fixed firmly.

As soon as you as the first aid provider suspect any head or neck injury wrap a cloth or a towel around the neck prior to moving the casualty. In a natural environment with no medical facilities, fill a nylon bag with soil, sand, or water and place it under the head or neck for support. Head injuries are usually accompanied by laceration cuts on the head and loss of tissue. These areas should be sealed optimally with sterile pads. If no pads are present, use a clean cloth instead. Take care to seal the wound completely as the most important danger of wounds like these occuring in a natural environment is the risk of tetanus. If you suspect an injury to the neck the casualty is strictly not to be moved by one rescuer alone. If possible, leave the casualty until help arrives and he can be moved by being lifted on all four sides. When fractures are present keep in mind that the limb needs to be kept immobilised, this is why you need to splint the limb. Do not attempt to fix the fracture yourself for you cannot determine what type of fracture the limb has. Use branches or anything solid and straight to splint the limb. You can, alternatively, use the aluminium internal frames of your backpack to immobilise and camping materials to wrap the affected limb.

You don't need medical training to determine most fractures, except perhaps complicated ones to the hips, spine or skull. You can always compare the limb you suspect has fractures with the ones in your body. Your job becomes a lot more easier when the casualty has not passed out and has sufficient consciousness to tell you where the pain is. If the casualty is unconscious everything will depend on your ability and knowledge. To discover a deformed bone, you need to carry out a detailed inspection. An inattentive inspection leads to great damage as the fracture will become an open one when the casualty is moved, and the bone will tear like a knife any limb and vein on its way out. This will also leave the fracture exposed to infections. If you attempt to move a casualty who has a broken leg, place a cotton or anything soft between both legs and wrap them both together. This procedure will alleviate the risk of damage to the healthy leg in case the fracture protrudes outside the leg. Do not forget to provide the casualty with ample pain killers prior moving. Dislocations are not as harfmful to the casualty as fractures. The ideal way to move a casualty with a dislocated bone is to carry him with as many people as is possible.

Fractures
There are three types of fractures you need to be aware of: 1. open-were the bone has fractured and penetrated the skin leaving a wound, 2. closed-where the bone has fractured but has no obvious external wound, and 3. complicated- which may involve damage to vital organs and major blood vessels as a result of the fracture. The signs and symptoms of fractures are pale, cool, clammy skin, rapid, weak pulse, pain at the site, tenderness, loss of power to limb, associated wound and blood loss, associated organ damage, nausea, deformity and crepitus. Care and treatment of fractures relies on immobilisation and adequate splinting of the injury. However, if the fracture is particularly complex, the wound associated with an open fracture is difficult to control. If the pulse to the distal part of the limb cannot be restored by gentle traction, then the limb should be stabilised in its current position. Urgent ambulance transport should be obtained. Do not waste time with splinting. Generally, fractured limbs should be made immobile and left for medical aid. However, in remote areas or some time from medical aid, you may be required to treat as follows: check for distal pulse, if none — gentle traction until pulse returns, treat any wounds, pad bony prominences, apply adequate splint, secure above and below fracture, reassess pulse or capillary return, elevate the fractured limb. Care must be exercised with a suspected fractured pelvis. This injury may have serious complications, especially with regard to female casualties. The casualty should always be transported by ambulance and not by alternative means unless absolutely essential. Prepare to treat for shock.

Head Injuries
Head injuries can easily mislead the first aid provider by not exhibiting the expected signs and symptoms immediately after the incident. In many instances, the casualty has appeared unaffected after the incident only to collapse with life-threatening symptoms some hours later. This may be due to a small bleed in the brain that eventually increases and applies excessive pressure on the brain tissue. As a first aid provider, you should always examine the history of the incident, and the mechanism of injury. If, in your opinion, the incident had the potential to cause serious injury, assume the worst and treat as a head injury. Any casualty that has been rendered unconscious or received a hard blow to the head should always be examined by a doctor. In many cases a head injury displays signs peculiar to the injury. Look for signs of: straw-coloured fluid oozing from the nose or ears (This is cerebro-spinal fluid (CSF), which surrounds the brain), 'Raccoon eyes' and 'Battle's sign,' blurred, or double vision, altered level of consciousness, unequal pupils, nausea and/or vomiting, 'snoring' respirations if unconscious, headache, deformation and/or crepitus of the skull. If the casualty displays any of the signs mentioned above, call for help first. Things you need to do before help arrives is to treat any wounds to alleviate the pain and to avoid infection and tetanus, if unconscious or drowsy, put casualty in the stable side position while supporting the cervical spine, allow any CSF to drain freely, if in stable side position, put that side down with a pad over the ear. If the casualty is unconscious, constantly check for signs of respiration. Start resuscitation as soon as you discover breathing has stopped. Keep the head over the body level and always bear in mind that head, neck and spinal injuries are all related. Any person with a head injury who has a disturbed level of consciousness may have sustained a neck injury as well.

 


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