Earlier this Spring, I made the choice to attend a Wilderness First Responder course in Asheville, North Carolina. I figured with the amount of outdoor activities that I enjoy it would be a good idea to have some medical knowledge in case of emergencies. I learned way more than I expected to and had a ton of fun in the process! If you enjoy doing things outside, especially in areas that are not highly trafficked look into taking this course or at least doing these activities with someone who has. For the next few Wednesdays I will be sharing some of the things I learned at the course, especially things that I believe apply to outdoor activities in the area we live. I truly hope that you never have to apply any of this knowledge but if the need arises hopefully I can help you be more prepared!
First, let’s talk about what makes Wilderness Medicine different from what we call “urban medicine”. The military and first responders use a term called the “golden hour” frequently. Basically, from the time an emergency occurs, patients have one hour to get to definitive care (a hospital) before their chances of survival drastically decrease. This statistic is backed by decades of research and statistics from Vietnam through the War of Terror as well as emergency situations in civilian life. We find ourselves in a Wilderness Medicine situation whenever an emergency occurs and the patient can not get to the hospital within an hour. This can happen 50 miles into the backcountry in Yellowstone or a mile up a trail in Hyalite with no cell service. Wilderness Medicine situations can also occur in an urban environment, for example, in a developing country that doesn’t have the same medical infrastructure as the United States. The goals of Wilderness Medicine and Urban medicine are a little bit different as you can probably imagine. If we see an emergency occur on Main St in Bozeman we are probably not going to do much to intervene except call 911 since trained paramedics can arrive on the scene within 5 minutes. If you encounter an emergency at the top of Hyalite Peak there is not more help coming your way anytime soon. In a general sense the goal of Wilderness Medicine is to stabilize a patient (keep them alive) and get them to a place where they can be handed off to a higher echelon of care. There are a few different categories when it comes to the time domains of patient care. First Response deals with the first 5 minutes that you are on scene (this is where most of the difference is made in life/death situations). Emergency Care covers the first hour of care (the golden hour, evacuation ideally happens here)). Extended Care goes into the first 24 hours and Remote Care covers anything longer than that. Today I want to teach you guys a little about the First Response stage. The acronym DRGXABCDE (I remember it as Dr. G X-ABCDE) is probably the most useful acronym that I have ever been taught which means a lot coming from the acronym infested military community. Knowing this acronym by heart is the easiest way to save a life in the wilderness and pretty much anyone can learn it and employ it! So, let’s get into it! D- D stands for Danger. The first thing you need to do when you approach a scene is survey it for danger. Is the patient in danger of more harm i.e a tree is about to fall on the spot the are laying in? Are you in danger, if someone was attacked by a bear is the bear still around? Is your group in danger? Creating more patients is the fastest way to make a situation worse. Before you rush to help a patient it’s crucial to make sure you won’t be making things worse. R- R is for responsiveness. Here you need to assess the level of consciousness of the patient. Here you’re looking at the basic level of are they responsive or unresponsive? If they are responding this is where you need to get their consent to treat them. If they are unresponsive you normally have what’s called “implied consent” which means you can treat them within your level of training. G- G is for general impression. In this step you are deciding how bad the situation is, is this a life- threatening situation or not? The first 3 steps (DR.G) are called the scene survey. The goal here is to not get tunnel vision on the patient and survey the entire scene before you dive into treating any of their problems. This whole phase should take about 30 seconds to 2 minutes. (the following XABCDE sequence is meant to be followed in order, you will see why as I explain them) X- X is for Extreme Bleeding. The most immediate threat to life is extreme bleeding. Arterial bleeds can cause death in less than 2 minutes. Without getting too in depth here the name of the game is to put as much pressure as possible on extreme bleeds and try to cut off circulation to that part of the body if it’s a limb (torniquet). The way to tell an extreme bleed is if a wound is spraying bright red blood, this indicates an arterial bleed and needs to be dealt with ASAP. A- A stands for Airway. The next thing to check is if the patient has an open airway. The easiest way to do this is through the head tilt/chin life. When the patient is lying down on their back you put one hand under their chin, another on their forehead, and tilt their chin up towards the sky. This is an incredibly effective method to open an airway and will work most of the time. The most common obstruction to an airway is the patient’s tongue, followed by foreign objects. This method will help you deal with both of those problems. B- B stands for breathing. After opening the airway the next thing to check is if the patient is breathing. If not, and they are unconscious and not breathing CPR is the necessary step here. After 6 minutes of the brain not getting oxygen we start to develop brain damage so the goal is to get oxygen to the patient’s brain via CPR or unclogging their airway within that time limit. C- C is for circulation. This is where we check if the patient has a pulse or any bleeding other than arterial bleeding which we may have already dealt with in the “X” step above. The goal here is to stop any other bleeding and identify where a patient may have lost circulation in certain areas which is indicated by a lack of pulse. D- D stands for disability. Here we are looking at the patient’s spine. If the patient is exhibiting severe head trauma or the way they were injured indicated possible spinal damage we want to stabilize their neck and back. Some injuries that could give you this clue are falls from any kind of height, patient complaining of neck/back pain, or obvious head trauma. The goal is to use anything you have on hand to make a collar that stops their neck from moving and a board that stabilizes their spine. E- E is for environment. We do not want the environment to create any more problems for the patient, injured people are more susceptible to environmental conditions (dry/wet/hot/cold). The easiest way to think of this step is you want to counteract the environmental condition you are in. If it’s cold, warm them up. If it’s raining, help them stay dry etc. It may not seem like it but knowing this acronym is an incredibly effective way to save a life in any emergency. I tried to explain this in a basic way but honestly, there isn't a ton more to know in these steps to save a life in most situations. The sequential nature of the acronym helps us to identify and treat the most life-threating problems in the correct order so it’s important to remember it this way. For a lot of us, the reason we do Crossfit is to be able to live more functional lives. This generally translates to spending more time outdoors hiking, skiing, fishing, hunting, or anything else we enjoy in nature. These activities are incredibly important to maintain our mental and physical health but some of them come with inherent risks to ourselves or others. Instead of being fearful of the risk we can prepare for it and go outside with the knowledge that we can deal with anything that could be thrown our way! I hope this blog, and future Wednesday blogs, helps you all feel more prepared. At the same time I sincerely hope that none of you ever have to actually use this information but it can’t hurt to know!
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