Exhausted. One word to describe how I am the Monday morning after my weekend of NOLS (National Outdoor Leadership School) Wilderness First Aid course. And this blog post in no means replaces any kind of training at all. I barely scratch the surface and only talk about some of the things we did, learned about and went on. Be sure to get yourself some proper training before trying to perform first aid!

I have done First Aid classes in the past. I always re-up my Red Cross First Aid and CPR every two years. In Boy Scouts we did a couple of First Aid classes with the help of some paramedics. I have read some books on First Aid as well. None of those really even compare to what we did in the NOLS Wilderness First Aid (WFA) course. And this was just the basic version of their course! They have longer and more intense versions as well!

Unfortunately I didn’t take any pictures, especially of the awesome wounds that we were learning to take care off. So this blog will just be a whole lot of words. But for those who tl;dr: Take the course as soon as you can!

Now for the rest of you, here is what our weekend looked like:

Day 1

Morning

Patient Assessment System

Afternoon

Emergency and Evacuation Plans
Spine Injury
Head Injury
Shock
Wilderness Wound Management

DAY 2

Morning

Wilderness Wound Management
Musculoskeletal Injury
Heat Illness

Afternoon

Cold Injury
Lightning
Altitude Illness
Chest Pain, Abdominal Pain
Shortness of Breath, Altered Mental Status
Anaphylaxis

As you see, there was a lot of information to cover in the course. And we would stop the learning part, and put into practice what we learned, which was basically going and finding someone laying around outside and trying to figure out what happened and how best to handle the situation. By assessing the area, the patient and their wound we would determine if we needed to take care of spinal injuries, move them, evac them, or just patch them up and continue on our merry way.

Now, what is the difference, between Wilderness Medicine and Urban Medicine. Basically it boils down to the amount of time you have before professional care can take over looking after the patient. In most Urban areas, you can expect to call a number, like 911 in North American, and expect someone to show up within 15-30 minutes to take over and start administering professional care on the way to a place (hospital) that can look after all the issues without a problem.

In the Wilderness, you don’t have a lot longer until someone else takes over. You have, no cell coverage, no roads, no easy way for anyone to get to you or you to get to them, so possibly 8+ hours before someone with professional training can take over. So, we must learn how to mitigate the issues and try to bring the patient to someplace where the professionals can get to them more easily, and faster.

With that, let’s talk about what happened this weekend….

Saturday morning we show up to the classroom (at Armand Bayou Nature Center, another favourite place of mine!) And we go through the usual get to know everyone schpeel. “Who are you, why are you taking the course and what was your best First Aid you’ve ever preformed?” Okay, not so usual I guess talking about the best First Aid you’ve ever done. And there were some doozies! I talked about how after my hernia surgery, I split back open and had to keep myself from bleeding all over the place waiting on the ambulance.

PATIENT ASSESSMENT SYSTEM – We learned how to size up a situation, and work towards figuring out what had happened and what needed to start to happen to treat and/or evacuate the patient. At first (and second, third, and even twentieth) glance, this seems like a very complex and long drawn out process. You have all these steps to go through to check the area for your and the patients safety, then work towards figuring out what happened, what the patient has wrong with them, and start working towards how to patch them up enough to either carry on, or to evacuate.

But after practicing, this process that seems like it could take 20 minutes, actually can be done in less than 5 minutes with practice. Parts of the process like checking the area to make sure it it safe for you to proceed, and sizing up what could have happened, takes seconds in practice.

It alls comes down to: Checking to make sure it’s safe for you, what happened to them, getting on protection (gloves), figuring out how many people there are to deal with, whether they are dead or not. Moving onto a full body scan to make sure there isn’t more damage than what the patient complains about, and gathering information that will be useful down the road when handing them off to professionals. Yeah, it seems like a lot all at once, but, in practice, very little time is spent on it as it’s all done instantly.

We then took a break for lunch. Being at Armand Bayou, it was a great place for breaks! They have a lot of wildlife and nature stuff going on there, as well as an old homesteading place. Where they have black smithing, carpentry, sugar cane pressing and boiling and a bunch of that pioneering kind of thing. And on Saturday they actually did have black smithing going on, with some kids getting after it. It was pretty cool to see that happening. It was too cold for the reptiles to be out and about, but I did get to see some fun birds like cardinals, chickadees, pileated wood peckers, tit mouse, and ruby crowned kinglets. Then lunch was over and back to the learnings!

EMERGENCY AND EVACUATION PLANS – For this part of the course, we talked more about how to avoid needing to evacuate and needing emergencies, as it is better to prevent than to have the need for emergencies. But we did talk about what you should do if the need arises. Things like knowing where you are going and letting others know when, where and how you will be around there and when to expect to be back.

Part of that is also knowing who to contact when you are out there, and have an emergency. Local rangers, SAR (Search and Rescue) and the like, have their numbers, radio frequencies and the like, so you can contact them. But, again, the best way to prepare, is to avoid having an emergency in the first place!

SPINE INJURY – Here we finally start to get into the various injuries that we need to treat and figure out how to take care of. A lot of the training was more geared towards preventing the issues from even happening, since it is much better to never have to deal with the issues to start with. We talked about what could cause a spine injury and how do we figure out if we need to treat the patient like they have one.

HEAD INJURY – Head injuries are a tricky one. They can be either hidden and you won’t know about them, until you put a hand on it, or you can see blood gushing out all over the place. The gushing blood head injuries are actually not that bad, just bloody, and easy to put a cloth to and stop the bleeding.

Those other head injuries where you don’t know they are there until you feel them are a different beast. They can be a death sentence to the patient if you don’t give it some treatment and get the heck over to emergency care as fast as you can.

SHOCK – When talking shock, we weren’t talking electrical shock. Although it could cause shock. Basic shock is when the body starts to shut down on itself because of a lack of oxygen to the vital organs. We talked about things that would cause it, and how to prevent (again prevention is so much better than having stuff happen!) and how to treat for it if it wasn’t prevented. Again, most of this stuff was mostly working towards keeping the patient around long enough to get them to proper emergency care, so they would have a much better chance at full recovery.

WILDERNESS WOUND MANAGEMENT – Was a lot of fun. One of the instructors must have been, or currently is a horror movie makeup artist. I really wished I had thought to take pictures of the wounds that she gave people, as they were looking as real as you can get without actually creating the real thing. It was sort of sad though, as they were talking about the different types of wounds, I realized there was only one that I’ve never had. And it’s the one I hope to never try. Abrasion, laceration, puncture, avulsion, and amputation. Can you guess which one I’ve not had yet? We talked about how to clean and dress the wounds so that we could either keep on going, or having to evacuate because the wound was just too serious.

And that was the end of day one. At which point I had to race off to check into my hotel, and go to where I was meeting some outrigger canoe friends, that I hadn’t seen in like a couple of years, for dinner. This could be some foreshadowing to future outrigger canoeing as well, so stay tuned!

A crappy sleep at the hotel was definitely not what I wanted. But that’s what I got, thanks to how super dry the room was, causing me to wake up every 45 minutes to gulp down some water as my mouth was drying out to almost cracking. But, got through it and it was time for Day 2’s events!

WILDERNESS WOUND MANAGEMENT – Today we started off with blisters and burns. Once again, the fake wounds that the instructors created were amazing! The burns looked like the flesh had been cooked away, just without the smell. And then of course we talked about how to treat the burns and get them cleaned up enough to determine if the patient would need to be evacuated or would be able to continue on with whatever we are doing in the first place. If they were real bad of course, evac would be necessary to make sure the burns were properly taken care of.

Blisters, are also a lot of fun. Anyone that has done any amount of running, hiking, or the like will have known a blister or two, and we learned how to prevent them (again best practice!) and how to deal with them as needed whilst out in the middle of no where. Remember, some blisters are best left untouched as they are just fine and don’t need to be popped!

MUSCULOSKELETAL INJURY – That’s a big ole word, musculoskeletal. But simply put, it’s anything from twisted ankles, sprains, dislocated joints to broken bones. Anything that is muscle or bone or tendon related. We did quite a bit of practicing of bandaging for protection of making it so that people could walk out of the wilderness on their own. Since you know, it’s a lot easier if a person could walk out, versus carrying them out!

HEAT ILLNESS – Heat is definitely nothing to play around with. Heat exhaustion and heat stroke are some serious things that can cause some serious issues. Once again, the best thing to do here, is to prevent them from happening. But we did learn what needs to happen when they do happen and how to get people on the move as quickly as possible if they are dealing with heat stroke. Which is, cool them down fast!

And then once again it was time for lunch! Sunday was much warmer and as such, there were turtles out on the ponds and even got to see a small (3 foot) alligator swimming. Of course by the time I got my camera ready, it had dunk under the water and disappeared. But it was a very pleasant lunch just chilling out watching the rest of the wildlife around the ponds.

And then we were right back at things after lunch!

COLD INJURY – Things like frost bite, and hypothermia can be very serious issues when you are out in the cold. I personally have had a little bit of frost bite on my fingers, and it is really not fun. I have known people that have had to be evacuated during Winter Scout camps because they ended up with hypothermia. It is definitely nothing to mess around with. So we talked about how we would go about treating these issues as needed. And of course as always, we talked about the best way to prevent getting into a situation where a cold injury could happen.

LIGHTNING – We talked mostly about the prevention of being struck by lightning. Where you go to wait it out, how to wait it out if you cannot flee from it to a safe structure, like a building or vehicle. Things like just getting as small, low to the ground and comfortable as you can be during the storm.

ALTITUDE ILLNESS – Another issue out there in the wilderness is when flat landers start going up the mountains. Altitude illness happens. Even with non-flat landers it can be a thing. The quickest thing you can do for altitude illness? Go back down to a lower altitude! Often the patient will feel 100% again as soon as they hit a certain point. Where you can hang out for a bit and then attempt going back up the hill slowly again.

CHEST AND ABDOMINAL PAINS – Are not to be messed around with. If you can’t figure out why those pains are there, you need to get to a doctor immediately! Even if you do know why those pains are there, you probably should start heading back to civilization and seek treatment!

SHORTNESS OF BREATH and ALTERED MENTAL STATE – Can be caused by a wide range of things. I’m very very familiar with shortness of breath having been diagnosed with Asthma when I was 2 years old. I can control my breathing and get myself back to normal without medication, but it’s not fun and takes a while. Medication, makes it so it doesn’t happen to start with for the most part (prevention again!) or like an emergency inhaler, can work within minutes of breathing issues.

Altered mental states can be caused by many things, like drugs, bad foods, temperatures, lack of oxygen, pressure, stress, etc. If you can’t figure out what is causing the mental issues, then, it’s best to high tail it back to seek medical attention quickly.

ANAPHYLAXIS – This was an interesting lesson. We talked a lot of about allergies and what causes them and the severity of it all. Things like insect bites or food allergies that cause someone to go into anaphylactic shock. We also talked about how to use Epinephrine Auto-Injectors, or Epipens.

And that was the class. Wow that was a lot of information in a very short time. But it was a lot of fun. Learning all the different things and actually getting to put those learnings to use in different scenarios. The final scenario that we did, we had to do as a solo rescuer:

You are sea kayaking for several hours to your favourite island for several nights of camping. As you approach, you see there is already a kayak there. Bummed that someone beat you to your favourite spot, you continue on anyways. You don’t see anyone around yet, as you pull your kayak up onto shore. You get your gear ready to go up and prepare your camp. Then you see a form on the sand. Just laying there motionless….

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