Climbing should be fun. But we must consider it is also a dangerous one. NEVER under-estimate the power of the mountains. RESPECT it and you shall be welcomed.
ORGANISING A CLIMB
Mountaineering is one sport that can be enjoyed either with a team, a group of friends, with a partner or even on your own. It is good to experience each one of them once in a while but before one should venture out into the wilderness on his own, it is advised that he first join an organised climb and learn the basic mountaineering skills for safety and enjoyment. It is advisable for an individual to join some mountaineering group where he could learn and experience the basics extensively through the courses they offer. Just be sure that the organisation one joins, offers such services.
This chapter deals with the details of organising a climb. Although most mountaineers love the idea of freedom and spontaneity than rules and organisation, these structures were meant for the climber’s safety and the protection of the environment at the same time thus it’s importance should never be undermined.
The organiser should have mastered the basic skills at the minimum and have a good record of experiences before he leads a group. This is due to the fact that still, mountaineering has dangerous aspects.
PLANNING A CLIMB
In planning a climb here are points to be considered:
- Decide where to go.
- Choose your companion or target participants.
- Collect route information and other useful information on the destination considered. It is advisable to contact local mountaineering group to get current information on the status of the trails, costs, permits, etc.
- Assess the physical fitness of the group.
- Arrange for food and equipment distribution.
- Check weather forecast.
- Acquire permits in advance if necessary.
- Assign climb officials.
- Conduct pre-climb meeting or briefings.
Although there are no rules on the number of persons to join an expedition, three is the suggested least number of people in an expedition. This is because if an emergency occurs, one can accompany the victim while the other goes out for help considering the injured is only one of the participants; or even two if one has only minor injuries. With regards to the number of maximum participants, these should depend on the carrying capacity of the place although there are no set rules. Too many climbers make the team slow and stressful to the environment. Eight is the ideal number based on the principles of a military squad.
Following is a list of basic climb officials and their duties and responsibilities.
- Team Leader
- Lead man (trailblazer, lead packer)
- Sweeper (tail ender)
- First- aiders
- The team leader is the final authority during the climb, and all participants are expected to support and comply with his decisions. Any negative evaluation of his conduct of the climb should be brought out during the post-climb meeting. However, the team leader is expected to consult with the participants before making major decisions that affect the itinerary or conduct of the climb.
- He is expected to exercise good judgement and to consider safety, comfort and fun.
- The team leader assigned for any climb preferably must have had prior climb experience on the same route unless it is an expedition climb, or when a local guide is available. In any event general familiarity with the route is required.
- Consult those who are familiar with the terrain and locality particularly the security situation, trail conditions, campsite limitations and travel restrictions.
- Conduct a survey of the route when possible or when advisable.
- Prepare the climb itinerary.
- Conduct physical diagnostics.
- Objective of the climb based on its nature (initiation, fun, training, induction or expedition)
- General information, historical significance, folklore, etc. of the location of the climb.
- Itinerary and highlights of the climb.
- Route condition and trail hazards.
- Water sources and its condition.
- Main and alternative campsites.
- General weather conditions.
- Local weather conditions or peculiarities.
- Cultural peculiarities of the locale (beliefs, taboos, etc.)
- Contact persons in the locality and residence.
- Special medical precautions on malaria, typhoid, dengue, etc.
- Purchase opportunities in the locale.
- Special equipment checklist and assignments (for overall group equipment such as ropes, harness, etc.)
- Transportation arrangements.
- Review of ethics, policies and Basic Mountaineering Course when necessary.
- Assignments of groupings and climb officers. (it is important to remind all the participants of the functions, responsibilities and authorities of these key climb officers)
- Review of the itinerary. (It is best to distribute copies of the itinerary to all participants. If copies are unavailable, remind them to copy the itinerary as presented)
- In case of any pre-departure change in itinerary or plans, the team leader shall immediately notify all participants. At the pre-departure assembly point, the team leader shall ensure that all present have actually complied with all mandatory requirements that apply to them and shall require compliance with those that are not yet complied with.
- The team leader must prepare a list of participants before departure. It shall be the basis for periodic head counts and allocation of common expenses. If possible, a copy of the list should be left with a contact person at the point of departure in the event that a rescue becomes necessary.
- Before the start of the trek and at every major rest stop. Check the head count and general physical conditions of all participants.
- As needed, consult with the other climb officers or participants any need to modify the itinerary due to weather, injury, unforeseen trail hazards, etc. After consultation, make the decision and notify all the participants.
- Control the overall pacing of the climb so as not to unduly delay the trek without sacrificing safety of any participant.
- Check that proper trail signs are installed at critical places like forks and trail splits.
- At the campsite, ensure that camp protocol and proper practices are observed as well as compliance with organisation ethics, rules and regulations.
- Observe the conduct and comfort of participants.
- Observe and monitor performance of climb officers.
- Ensure that the campsite is left clean before taking off.
- Establish/maintain contact with local community leaders and dwellers along the trail but more particularly at or near campsites.
- In case of any situation requiring extreme deviation from the climb schedule, the team leader shall, in so far as practicable, consult with the participants. In any event, the team leader must make the final decision taking overall and individual safety into consideration.
- In case of incapacitating injury to any member of the party, the team leader must call-off the climb. Steps must be taken to protect and care for the victim/s. If a provisional camp is established to stabilize the victim, a team of at least 2 experienced climbers must be sent ahead to alert the base camp and contact rescue authorities as well as the contact person of the victim. The team leader may allow other members of the party to proceed down while ensuring that experienced and strong climbers are left to attend to the injured member/s until a rescue party reaches them. At all times, the team leader must maintain composure and keep all members calm but alert.
- In case of prolonged lack of contact with tail-enders, the team leader must make the decision on whether or not to send a search party to backtrack and assist the tail- enders as needed. In this case, strong and experienced climbers must be sent while the main body set up a temporary holding camp as needed. The leadsman should be notified to either hold their position or rejoin the main body.
Post Climb Briefing
As soon as possible, preferably within a week after the completion of the climb, the team leader shall take up the following:
Review and assessment of the climb: general conduct, trail, pointers for subsequent climbs, etc.
Comments, admonitions, congratulations regarding conduct of individual participants.
- As much as possible, the assigned leadman should not be team leaders themselves. Exceptions can be made in cases of small groups (12 or less) which are not likely to get separated, climb of short duration, or absence of qualified members.
- He must have prior experience on the particular trail unless accompanied by local guides.
- He should be selected among the stronger, healthier, experienced and patient members of the party. For a large climbing party or a long duration climb, more than one should be assigned.
- He has the duty to put in place the proper trail markers for the guidance of the following groups. When in doubt, or when the possibility of doubt exists, the trail must be marked in such a manner that no confusion could arise in its interpretation.
- He must stop and wait for re-assembly at designated major rest stops, and they must remain within whistle-hearing distance of the next group at all times.
- He should not deviate from the planned route without waiting for the team leader’s decision.
- He shall implement the pacing as instructed by the Team Leader.
- As much as possible, the assigned sweepers should not be team leaders themselves. Exceptions may be made in cases of small parties, (12 or less) which are not likely to get separated; climbs of short duration; or absence of qualified members.
- They must have prior experience on the particular trail unless accompanied by a local guide.
- They must be self-contained as completely as practicable.
- The sweepers must be selected from among the stronger, healthier, experienced and patient members of the party. For a large climbing party or a long duration climb, more than two must be assigned.
- The sweeper must remain at the tail end of the climbing party at all times. He must be ready to assist lagging climber/s who may need assistance, and must maintain the pace, and control the rest stops of the lagging participants, taking into consideration their physical situations, safety needs, and the climb schedule.
- In case of incapacitating injury or illness, or danger brought about by unexpected weather, darkness or natural occurrence, the sweeper may decide to set-up a temporary camp at his direction. Other members of the group, who are capable of going on, must be sent ahead to notify the team leader of the actions taken, so that the latter may make the necessary decisions. Again, safety is first considered.
- One of the sweepers must be assigned to remove trail markers put up by the lead group.
- Expedition first-aiders should preferably be chosen from among those who had proper training under the auspices of the Red Cross, or had professional medical training. In this connection, the organization shall endeavor to maintain a pool of trained members.
- At least one should be assigned per climb. For large parties, more than one should be designated. If more than one is assigned they should be distributed over more than one team.
- In the event of an injury, the first aider shall have the responsibility for applying the necessary aid, prescribing medication, and recommending corrective action or assistance. If necessary to deviate from the itinerary, he shall make his recommendation known to the team leader for his decision. In the presence of a designated first-aider, no other member shall intervene with the treatment of a victim unless he/she is requested by the first aider to assist.
There is an ever-growing interest in the great outdoors. It is quite heartening to see people get close to nature. However, many are still lacking in awareness of the proper care for the wilderness.
And so, as more and more people take interest in mountain climbing and other similar sports, there must be a continued education on the proper way of treating nature. There are such ways to enjoy the thrill of the great outdoors without substantially withdrawing from the environment.
One word for all campers to keep in mind: LOW-IMPACT. No matter how much advances there may be in the realm of outdoor gadgetry and gears, the basic ethics of low-impact camping must not change:
Take nothing but pictures;
Leave nothing but footprints;
Kill nothing but time. Campers ensue the greatest impact on the environment at the campgrounds. Therefore, one must take utmost care in choosing a campsite and make efficient use of it.
Take home garbage. Do not leave any refuse from cooking and camping at the campsite (as well as along the trail).
As is, where is. Leave the camp ground exactly the way you found it. Campfire’s nice. But do not cut down trees for firewood. Use fallen branches, instead.
Ensure detergent-free Washing. Wash dishes by cleaning first the remnants off the plates and utensils and drying them with cloth (or tissue) or sand, when available. Then rinse with water away from any body of water. Go Organic. Use biodegradable soaps and shampoos.
Silence please. Keep voice tone and volume at minimum, some other creatures need their rest, too.
CHOOSING A CAMPSITE
Enjoying the great outdoors depends mostly in finding a good campsite. For one thing, the itinerary should clearly point out that the campsite must be reached by mid-afternoon in order that the camp is set and cooking dinner is well under way before nightfall. This would also provide ample time for checking the surroundings for possible dangers.
Select an established campground as much as possible. If an established campsite can not be located, choose a place conveniently away from the trail and try not to disturb much the present environment.
Most campsites require that a permit be secured ahead of time. Permits are usually issued by Forest Department. Make sure that you and your group register your names so that mountain rangers and local officials know where to go looking in case of any danger.
Tent. Place your tent on relatively flat terrain, sheltered, and dry. Do not pitch your tent near the inside bend of a river because this area is prone to flooding. Erect your tent with its entrance facing the leeward. You have a choice in erecting your tent either you set it up under trees or open space. The latter is preferable since after a rainfall the sun comes up and everything is dried quickly. Under trees however will only save you if there is heavy downpour but will leave wet for hours since the trees is still dripping the rainwater.
Latrine. Building a latrine is not that quite common to mountaineers and backpackers as well. Usually when the number of people exceeds 12 by all means, designate a common place away from any water source to prevent surface-water contamination. Check for wind direction. Be sure that you dig your latrine downwind.
Fire. For mountaineers, it is not advisable to build a campfire. It will just stress the already damaged environs. Locate the fire close enough to the tent area in order to smoke out insects without creating any risk of setting the tent on fire.
Water. Fetch drinking and cooking water well upstream and away from any campsite.
An ideal campsite would be one with available source of water for drinking and cooking. Actually, it is one of the criteria in choosing a campsite. In the absence of rivers and lakes, water might still be available in the not so obvious places.
Where there is an extensive growth of mosses at the edge of a mountain means that this area has cut across a groundwater source and could possibly be a source of water. River crevices or natural ponds can be source of rainwater. Extra caution, however, must be taken in getting utility water from this origin because these are stagnant water sources. Water can also be located under dried riverbeds.
One must learn the art of pitching a tent quickly and sturdily. This will be certainly necessary in cases when there is a storm coming.
Steps in erecting your Tent
1. Clear the ground of any sharp objects like stones and tree branches. Free the surface of any bumps by spreading ample amount of dried leaves or grasses. Then spread over this area a ground sheet to provide extra covering against any moisture from the ground to enter the tent,
2. Lay down the tent over the ground sheet with the entrance facing the leeward of the wind. Quickly peg down all the corners. Make sure that the pegs are secured enough into the ground.
3. Insert all the poles in their proper position and the tent canvass making the tent stand.
4. Cover the tent with the flysheet. Secure the flysheet into the ground ensuring that tension is equalized around it.
5. Inside your tent. Organize your tent in a manner that you can reach almost anything without leaving the comforts of your sleeping bag.
In places where there is stiff or hard surface, where the pegs could not penetrate, use large rocks, onto which the tent will be tied.
Do not allow the tent and the flysheet to touch in order to maintain an insulating layer of air in between the two.
Fire building is a basic technique all campers must learn. Its importance is not only limited to cooking (especially now that portable stoves are available), but to a large extent on survival. From a source of heat in cold weather, to smoking away insects and to restraining some wild animals to enter the campsite and to signaling positions in order to aid search and rescue teams.
However, campers must check for any restrictions on making a fire in a particular campsite. For as much as it is useful, it can be rendered dangerous in places, which are prone to forest fires.
Starting a fire is different from lighting a fire. Although our basic concern here is the former, it is important to note that there are technologies available now which far more efficient than rubbing two stones together. There is the basic wooden match and butane lighters, never ever leave for the mountains without them. Magnifying glass but this can only be used during daytime. And in very damp conditions, the use of a magnesium fire starter is one safety accessory that must be made available in any camping trips.
Whatever method of lighting a fire you should choose, the next steps in building a fire is as basic as ABC.
First, one must gather more than enough materials to sustain the fire. Fire ingredients include the following:
Tinder. Dried tree bark, twigs and other smaller pieces of wood which are highly combustible. Kindling. Dried leaves and small sticks not thicker than an inch, which is, place at a pyramidal position over the tinder. Wood. Branches and logs which are placed loosely over the tinder and kindling; starting with a slightly larger piece of wood than the kindling and adding much bigger wood in intervals.
Then dig a circular trench not deeper than 30 cm., which would provide protection from the wind for the tinder fire. Place on the center of the trench a generous amount of tinder material. Build a teepee shape with the use of kindling materials. Balancing four sticks in a pyramidal position and adding more and even larger sticks in the same manner does the teepee shape. Strike a match or use a lighter to light up the tinder materials. Add more tinder and kindling material until the fire stabilizes and is able to burn the bigger sticks.
When the teepee catches fire, it will then collapse into a bed of ember, which can be fed, with larger pieces of wood.
Eating Outdoor and Food Preparation (Wilderness Kitchen)
Eating in the wilderness is much affected by time. Main meals are usually breakfast and dinner. A heavy breakfast helps to get you going throughout the activities of the day. Short snacks shall be taken intermittently along the trail. A quick lunch will sustain your strength until the end of the day. Do not continue without taking enough sustenance along the trail because fatigue will suddenly fall on you. A substantial and hot meal at night is the best way to replace the calories lost during the trek.
It is always a great sensation to start the day with something hot; hot chocolate, coffee, tea, milk. Hot drinks keeps you company while you are cooking up a large breakfast. Rice, dried fish, eggs or Champorado with processed meat.
It is advisable to take little but often small meals along the trail. Jelly-ace is a sweet source of sugars necessary for giving energy to your body. Fruits like oranges, apples or singkamas give sugars as well as fluids to your body. Salty food like nuts and chips are also necessary to prevent muscle cramps. Taking in salts also re-hydrates your body.
Most of the time, lunch will be taken along the trail, the most typical is having soups and sandwiches. This would require minimal preparation and your body would not be required be as full as it did during breakfast time.
The biggest meal of the day. Usually, you have the luxury of time preparing for this meal. Hence, dinner must have a wide variety of food, a complete course; from soup to main meal to desert.
Make sure that you have had drank plenty of liquids before retiring to bed to prevent dehydration. In cold conditions it is best to have a hot, highly sugared drink to keep you warm throughout the night. It is also advisable to keep warm water ready in a flask for the hot drink of the next morning,
OUTDOOR CULINARY SKILLS
Golden rule is to bring enough food, but not too much. PLANNING the menu is the biggest factor in making outdoor cooking a success. Make a plan as what to eat, how much of each ingredient to bring, and who will be bringing the ingredients as well as the cutlery and plastic containers, plates, pots and pans and stove, and do not forget the matches. Some food items and spices must be kept handy in every trip. These are:
Stock Cubes Pepper Chili Rice
Onion Salt Garlic Egg
Safe Camping (Safety First, as Always)
In the premise that every precaution was taken in choosing a safe campsite, one must then run a safe campsite.
Some safety precautions are:
- Keep fire at a conveniently far distance away from the tent.
- Do not cook inside the tent.
- Have a sand bucket readily available to put out the fire.
- Provide guide ropes in going to the latrine area and provide ample lighting, too.
- Rope off any unsafe areas.
SAFEGUARDING YOUR FOOD.
The smell of food might attract insects, birds, and mammals alike ensuing danger to the inhabitants of the campsite. Make sure that food is sealed in plastic bags and left hanging from a tree branch.
Keep a close guard on some pests, which may cause harm or may be a risk to health.
Flies and Mosquitoes are known to be disease carriers. As much as possible prevent them from getting in contact with your skin and food.
Ants usually come in groups. Always look out for ant nests before you pitch camp.
Scorpion is known to be highly poisonous. Make sure that you always shake your sleeping, boots and clothes as a measure to eject any presence of scorpions.
Snakes are quite a scary danger in the wilderness. When in doubt always check your tent and sleeping bags for any presence of snakes.
Rats always go for your food. Take extra care not to leave food just lying around the campsite.
As a last goodwill gesture to nature and to those who will follow in the trail, ensure that all garbage had been picked up and packed out and taken home away from the wilderness. This etiquette is known to almost everybody but is still often ignored. Unless we take on this responsibility by heart, the following damages of overuse will overtake that which was once beautiful:
Barren, stripped land
Exposed tree roots
Downed plants, or absence of vegetation
Numerous firepits on a single campsite
Absence of ground wood for campfires
Scarred tree where branches have been torn away
Bottles, cans, and plastics, in or near sources of water.
Clearing the campsite, some practical ways of maintaining the beauty of the wilderness:
- Put out fire completely. Scatter the ashes and collect and take unburned debris.
- Packall rubbish in plastic bags and take it home with you.
- Latrine must be filled in, returfed, and labeled to inform future campers
- Dismantle tent and leave site after your equipment is fully packed.
WILDERNESS ETHICS (A REVIEW)
All climbers most especially those belonging to organized climbs should strictly follow the wilderness ethics. Behavior of the group would reflect the kind of organization or the kind of leadership the group has. Here is some internationally accepted wilderness ethics.
Prepare well. Know about your route and the area. Take adequate food. Bring clothing that will keep you dry & comfortable. Know the basics of first aid, navigation and minimum impact camping. Know what to do in case of overheating, hypothermia or landslide danger.
Local practices. Know the local practices in the area. Respect local customs and traditions. Respect other people’s desire for privacy and solitude. Unnecessary disturbances (noise and horseplay) should be avoided.
Trekking. While trekking into the wilderness avoid widening the trail. Stay off the shoulder and walk in the middle of the trail. Suppress the desire to shortcut switchbacks. Cutting switchbacks tramples vegetation and leads to erosion. Use established trail when possible. On rest breaks, select a hardened area to absorb your impact. Select footwear appropriate for comfort, safety and the terrain. Heavy lug-soled boots have an adverse impact on fragile terrain. Use light footwear in camp.
Camping. Select a level campsite with adequate water runoff, and use a plastic sheet under your tent to stay dry without ditching. Locate your site at least 100 feet away from natural water sources. Generally, select a shelter site that has already been used, to eliminate further expansion of the camp. Whenever possible, position your tent so it blends with the environment. Careful selection of campsite helps preserve the atmosphere of solitude even in popular areas. Choose your site and use it lightly, leaving it in as natural state as possible.
Garbage. Carry out all of your non-biodegradable garbage. Bury only biodegradable trash. Pick up litter as you encounter it. Burning of non-paper trash should be minimized since complete cremation is difficult. Remember litter attracts more litter.
Sanitation. Use established latrines if these are provided. Use a cat hole if there are no established latrines. Proceed with a trowel inn hand to an area at least 100 feet away from water sources trail and camp. After carefully removing the surface duff, dig a hole several inches into the dirt. Replace the dirt and duff.
Washing yourself. Even biodegradable soap is a stress on the environment, so do as much of your cleanup without soap. Try a soapless bath or clothes-wash, for all but the most persistent dirt. When using soap, even biodegradable soap, wash yourself, your hair and your clothing at least 100 meters away from water. Pour soapy water into highly absorbent ground. Brush your teeth well away from water sources.
Washing dishes. Try a soapless cleanup. For health reasons, wash dishes with hot water when possible. Wash at least 100 meters away from natural water sources.
Basic Emergency Care in the Wilderness
Adventure through the wilderness is an exhilarating feeling for an avid backpacker and most especially a mountaineer. Either to escape the metro or to be one with nature, the thrill of going into untamed territory tests a person’s skill in coping up with his basic resources.
Certain medical conditions may arise on such events and knowing how to handle them can make the difference of continuing to enjoy the trek or become a full-blown emergency. This chapter deals with such conditions that maybe encountered and dealt with accordingly.
THE FIRST AID KIT
Equipping oneself with the basic medical aid kit is the first step for a less precarious trip in the back country. There are available emergency first aid kits that are sold locally and abroad but you can assemble a set of your own by just knowing the essentials at a lesser cost. The list rundowns the supplies and instruments that you should have on hand.
- Bandage Scissors
- Oral Thermometer (preferably with own plastic case for preventing it to be broken)
- Tweezers (for removing splinters)
- Safety pins
- Snakebite kit (scalpel and suction for the venom)
- Syringe needle gauze 21
- Sterile gauze pads individually packed
- Roll of gauze bandage
- Butterfly bandage or steri-strips (small bandage for facial/gaping cuts)
- Adhesive tape, 1 inch size recommended
- Elastic bandage 3 inch size
- Cotton tipped swabs
- Roll of absorbent cotton
- Hydrogen Peroxide
- Calamine Lotion
- Povidone-Iodine solution
- Rubbing (70% Isopropyl) Alcohol or Bar of plain soap
Over the counter medicines that maybe useful. (OTC Meds)
- Aspirin or an Analgesic (i.e. Mefenamic acid*) or an Anti-inflammatory (Ibuprofen)
- Paracetamol tablets
N.B. Aspirin/Mefenamic/Ibuprofen should not be given to persons with allergic reactions to these medicines. Asking before administration is a must.
Individuals who have specific medications to carry should bring it along, i.e. anti-asthmatic inhalers or anti-allergy meds, and inform their companions of their health status.
- Do not minimize or forego portions of the kit. Doing so will undermine the First Aid Kit’s use and it will be to your disadvantage.
- Place the kit in a water repellant pack to prevent the materials from getting soaked if such occasions arise.
- A Swiss Army Knife or any multi-purpose device that you bring along may already have tweezers and scissors as well as a penlight. This can spare you a few grams off your pack.
Proper taking of the pulse, temperature and breathing is easy but must be done properly. Such vital signs monitor a person’s condition along the trail that guide the one administering the first aid of what to do.
Areas that a pulse can be monitored: Should be taken for one full minute.
- Common Carotid (Neck)
- Radial (Wrist area)
- Femoral (Inguinal /Crouch area)
- Dorsalis Pedis (Top portion of foot)
NORMAL: Resting Pulse of an average Normal adult is between 60 to 100.
- Clean the bulb of the thermometer.
- Hold the thermometer at the stem and shake it until the mercurial reading is at least down to 35C or 95F
- Read the baseline temperature and place the mercurial bulb under the patient’s tongue. Instruct the patient to close his lips tightly.
- Leave the thermometer for 3 minutes after which you remove it and get the temperature reading.
- Clean the bulb and stem of the thermometer before replacing it in its container.
- NORMAL: Average range of a resting individual is between 36 to 37.5 C (96.8 to 99.5 F)
- Monitor the breathing by looking at the chest expansion of the patient.
- Look for any signs of labored breathing such as:
- Gasping for air through the mouth
- Enlarging nostrils
- Use of neck muscles for breathing
- Asymmetry or unequal expansion of the right and left side of the chest
- Monitor for a full minute:
NORMAL: Average range of a resting Respiratory rate is 24/min
WHAT TO Do’s:
Open Wounds: (Scrapes/Scratches, Cuts/Lacerations, Puncture Wounds)
Basic procedures for any of the above injuries are the following:
- Wash your hand or rub with alcohol before treating the wound.
- If there is bleeding, stop or control it. If it is continuous or severe, SEE Management of severe bleeding.
- Remove as much as possible any dirt that is around and within the wound.
- If possible, wash the injured area with soap and water. Plain clean water for washing off dirt will do.
- Sterilize or disinfect any instrument to be used for the care of the wound.
Objectives of managing open wounds are to:
- Stop bleeding
- Prevent contamination and infection
- Seeking medical attention if wound is severe.
After doing the basic procedures. PICT:
- Pat the wound dry
- Place an antiseptic like povidone iodine on the wound.
Large areas of wound or areas most likely to be reinjured or soiled should be covered with sterile gauze and bandage.
- Minor scrapes can be left exposed to the air.
- Watch for any signs of infection
- CUTS (LACERATIONS)
- Primary concern is to stop the bleeding with the basic procedures in mind.
- When bleeding stops, wash the wound to remove the dirt or other foreign materials in and around the wound. Pat the wound dry
- Do not remove foreign objects deeply inserted in the muscle or any deeper tissue, this may cause serious bleeding.
- If no foreign object is imbedded, apply an antiseptic over the wound
- Cover the cut with sterile dressing and use a bandage around it. If cuts are gaping, especially in the face area, apply steristrip or butterfly bandages to appose the wounds.
- PUNCTURE WOUND
This results from a sharp, pointed object that pierces the skin and deeper tissues. Nail, splinter, horn, or teeth/fang marks are samples of puncture wounds.
- Assess the wound if any object had broken off and remained inside the wound (deeper than the skin).
- Do not attempt to remove it since serious bleeding may ensue.
- Do not manipulate, poke or put medication into the wound.
- Cover the wound with sterile gauze and bandage it.
- Seek the nearest medical attention.
- For minor puncture wounds, objects lodged no deeper than the skin may be carefully removed with tweezers.
- Press on the edge of the wound to encourage bleeding to wash out germs inside the wound.
- Cover the wound with sterile gauze and bandage it.
MANAGEMENT OF SEVERE BLEEDING:
Continuous or profuse bleeding is a medical emergency that needs prompt management and control. Bleeding can come from the veins or arteries or both. Venous blood is characterized by a dark red color and flows steadily while arterial blood is bright red and spurts from the wound. Immediate treatment can be done by a.) Direct pressure to the wound, b) application of pressure points or c) tourniquet.
The first and preferred choice to control bleeders. This is usually all that is needed to prevent further lose of blood.
- Apply a thick clean gauze or soft clean cloth, i.e. a towel or handkerchief, directly over the entire wound to act as a compress. In extreme situations, bare hands or fingers can be used to compress the bleeder, but be sure that it should be clean as possible. Keep the pressure steady over the wound.
- Do not remove or disturb blood clots that have formed on the compress.
- Apply another pad over the initial compress if this gets soaked with blood. Do not remove the initial compress. Apply a firmer pressure over a wide area.
- Elevate the bleeding limb/portion above the victim’s heart level. Do not do these if a fracture is suspected.
- Once bleeding stops, apply a pressure bandage to hold the compress in place.
- Placing the center of the gauze directly over the compress does this. Pull it while wrapping both ends around the injury. Tie the knot over the compress.
- The ties should not be to tight that it cuts circulation. Check the pulse distal to the wound or check the nailbeds if they become bluish in color. Any change means it is too tight.
- Keep the limb elevated.
- Pressure Points:
This should be used only if bleeding cannot be abated by direct pressure. This requires pressure on the artery supplying blood to the wound against an underlying bone and cuts off the arterial supply to that area affected. This should be used with direct pressure and elevation.
- Hold victim’s arm bone midway between the elbow and armpit. The thumb should be on outside the victim’s arm. The other fingers should be on the inside of the arm. This places the arm bone in between the thumb and 4 fingers.
- Squeeze the fingers firmly toward the thumb against the arm bone. This compresses the arterial vessel. Do this until the bleeding stops.
- Position the patient by letting him lay on his back. Supine position.
- Press at the front center of the thigh, at the crease of the groin, by using the heel of you hand.
N.B. Pressure point technique is used no longer than necessary. If bleeding recurs, it may be reapplied.
This is a measure that is used as a last resort for life-threatening situations where the two above management are non-relieving. Weighing its use is based on fact of either losing a limb or bleeding to death.
Requirements of a tourniquet:
- 2 or more inches wide.
- Length should be enough to wrap around the limb twice with ends for tying.
- Place the tourniquet just above the wound. Wrap it around twice.
- Do a half-knot.
- Place a stick or straight object on top of the half knot.
- Tie then 2 full knots over the stick
- Turn the stick to tighten the tourniquet. This is done until bleeding stops.
- Secure the stick in order to hold its place by tying the loose ends of the tourniquet to the stick..
- Do not remove tourniquet.
- Attach a note to victim’s clothes or body as to what time the tourniquet is place.
- Don’t cover the tourniquet.
The most common type of injury that is sustained from a fall or blow to the body. Small blood vessels break beneath the skin that causes discoloration and even hematoma.
- Assess if there are any broken bones. See Splinting:
- If there are no suspected fractures, apply immediately a cold compress on the affected area to minimize swelling, pain and hematoma formation.
- Apply pressure on the affected area.
- Elevate the part or limb affected
- Stabilize or immobilize the joint as needed.
Burns arising from camping stoves, fires or hot utensils and boiling water are the most common causes one will encounter.
- Cool running water or cold water compress over the burned area is an ideal immediate management which is applied for about 5 to 10 minutes. This is to give pain relief over the site.
- Protect or cover the area with sterile gauze or clean bandage. In less than ideal settings, a clean polyethylene bag wrapped around maybe used.
- DO NOT apply any butter or grease to a burn area. Locals have the habit of placing even toothpaste or powdered antibiotics to the burn site. Just keep the area cleans and protected.
- If blisters form, (sign of second-degree burn), do not puncture or remove the skin covering. This helps keep the wound safe and free from infection.
N.B. Second degree burns that are more than 15% of the body surface for an adult needs medical care immediately. Rough estimate is by using the palm of the hand with the fingers to represent 1% of total body surface that is burned. Injuries covering the face, groin, hands and feet or has inhaled smoke that could have injured the lungs are also included for prompt medical attention.
Usually caused by excessive rubbing of skin over clothing or equipment (i.e. boots).
- Minor, small, unopened blisters that will have no further irritation can be managed by placing a sterile gauze pad and bandage over it. If it was accidentally opened, wash the wound with clean water and cover it with a sterile dressing.
- Puncturing large blisters that are prone to be broken is a last option wherein just sterile dressing will likely fail. Puncture site should be at the lower edge of the blister. A sterile needle is needed to puncture the blister. Press the blister slowly until it flattens. Cover with sterile gauze
- Watch out for signs of infection such as redness or pus. This needs prompt medical management.
- Blisters caused by burns should not be opened. Fluid imbalance may occur if this is done especially if it covers a lot of area.
- Wash the area and clean your hand.
- Sterilize a sewing needle (ideal is a syringe needle) and tweezers by boiling for 5 minutes or holding it on an open flame.
- Splinters stuck inside the skin with a portion exposed can be pulled out gently with the tweezers placed at the same angle as to which it entered.
- Use the needle to loosen the skin around the splinter if it is not deeply imbedded and remove it with the tweezers at the same angle as which it entered.
- Once removed, clean it and cover it with sterile dressing.
- Watch for any signs of infection.
- Foreign bodies in eye/ear.
Foreign particles that are floating in the eyeball or inside the eyelid can be removed with proper care. NEVER attempt to remove particles that are piercing the eyeball. Trained medical personnel should handle such cases. Protect the area and bring him/her down to the nearest medical facility.
Management for foreign bodies that are floating on the eye is as follows:
- Do not let the patient rub the eye.
- Wash your hands.
- Flush the eyes with warm water until particle is removed.
- If particle is still not washed-out and is attached to the inside of the upper lid, ask the patient to look down.
- Hold the upper eyelid down. Place a cotton bud handle horizontally across the outside of the lid. Flip the eyelid backward over the lid causing the inner portion to be exposed with the foreign particle.
- Remove the particle with moistened corner of a cloth or handkerchief.
- If the particle is on the inside of the lower lid, gently pull down the lower eyelid and carefully remove it with the handkerchief tip.
- If particle remains, cover the eye and seek medical attention.
Insects may find the ear canal a tempting place to investigate and buzz over with the result of getting stock and you in anxious haste.
- Placing several drops of oil (cooking, baby) is warranted if the insect is alive and buzzing all over. This will immobilize and kill it. N.B. Do not use oil on foreign objects that may absorb it and make it more difficult for extraction.
- Flushing with warm water may also be a next option for removing insects.
- Attempts to remove clearly visible foreign objects may be tried. Do not poke or proceed if the object is unyielding or goes in further. Seek medical attention.
Nosebleed or Epistaxis
Epistaxis or nosebleeding occurs on certain situations such as high altitudes, hot weather or even persons with high blood pressures.
- Make the patient sit down and lean the head forward. Keep the mouth open.
- Pinch the nose for 15 minutes. Release it slowly, if bleeding recurs, pinch it again for 5 minutes. Check and continue this until it stops.
- Place cold compress/cloth against the nose to help constrict the blood vessels.
- Don’t let the patient swallow the blood or blow his nose
Stings from bees, wasps or hornets can cause local swelling, pain, redness, and a burning or itching reaction to the bitten site. Mostly this is non-life threatening unless the bitten patient is allergic to the venom. Shock may ensue. Backpackers known to be susceptible to such reactions should bring their own medications and instruct their companions on how to use it.
- Removing the stinger is by using a knife blade and scraping it off. Tweezers should not be used since you may squeeze and push the venom into the skin.
- Wash it with water.
- If available, wrap it with a cold compress.
- Calamine lotion, paste of baking soda and water may be used to relieve discomfort.
- Animal bites.
Bites from wild animals carry the risk of bacterial or tetanus infection. Animals infected with rabies may introduce this condition to the ailing victim. Treatment should be sought if this occurs.
- Wash or pour water over the wound for around 5 to 10 minutes to remove as much as possible the saliva and other foreign object introduced with the bite.
- Bleeding should be managed by applying continuous pressure until it stops and sterile dressing placed over the wound site.
Scorpions just like bee stings can cause severe burning pain at the site of the sting. Signs and symptoms that develop vary from the amount of venom introduced to the victim. Adults rarely die from such stings* except that they are particularly harmful to young children* or adult individuals who show signs of shock or convulsions. Numbness or tingling sensation may be felt or even difficulty in swallowing and breathing for extreme cases.
- Immediate treatment by maintaining an open airway and restore breathing should be done.
- Simply clean the wound and the surrounding area with water or alcohol
- Keeping the bitten part lower than the level of the heart will help minimize spreading the venom.
- Place ice compress on the bitten site is also advisable.
- Watch out for any signs of shock or allergic reactions.
- Secure him to the nearest medical center if symptoms progress
Grade I to II scorpion envenomations such as local pain/and or numbness at the site of envenomation or remote from the site of sting are treated symptomatically with oral analgesics. They are observed for 3 to 4 hours to note for any progression of the symptoms.
Grade III and IV such as blurring of vision, hypersalivation, trouble swallowing or breathing, slurring of speech or even jerking of extremities needs immediate medical attention to the nearest health center.
- Snake bites:
Bitten by a snake, entails one to immediately assess if the snake is a poisonous or non-poisonous variety.
Poisonous snakes have slitlike eyes, poison sacs or deep pits between the nostrils and the eyes and sharp long fangs leave a distinctive 2 piercing fang marks. In comparison with non-poisonous snakes that have rounded eyes and no deep pits.
Grading of envenomation by signs and symptoms is helpful in assessing the current state of the patient.
|Dry Bite (Do not result in envenomation)||Minimal||Moderate||Severe|
|Puncture wound, pain, little or no swelling. No systemic symptoms or progression.||Localized pain, edema, ecchymosis or blood clot formation on the site||Progressive pain, edema, ecchymosis. Variable systemic symptoms i.e. nausea, vomiting, diarrhea, perioral paresthesia, salivation, weakness. Stable vital signs||Massive edema, hematoma. Unstable vital signs. Coma, seizure or respiratory distress. Signs of clinical coagulopathy or bleeding.|
N.B. Dry bites produce no signs or symptoms other than the mechanical puncture wound. Sudden severe pain at the bite site followed by progressive swelling and/or numbness is a sign of envenomation.
Immediate care for snake bites:
- Maintain an open airway and breathing if this is affected.
- Position the bitten part lower than the victim’s heart.
- A light constricting band at bites on the arm or leg can be placed 2 to 4 inches above the bite toward the body. It should not be too tight that it cuts circulation to the affected limb. Feel for the pulse on the distal portion. A finger should be able to slip under the band. The wound should ooze.
- Replace the band another 2 to 4 inches above from its previous position if swelling reaches its initial position.
- Do not remove the band until the patient is safely brought to medical care.
- Wash the bite area and immobilize the limb
- For Dry bites, cleaning the wound with vigilant monitoring up to 12 hours should be done to note for any changes or progression of symptoms. Medical attention should be done as soon as possible.
- Loose (lymphatic) tourniquet, incision and suction are probably effective if used within 30 minutes of envenomation but are not substitutes for definitive care in the nearest medical facility.* Reference
- A Snake bite kit is helpful in this situation. A sterile knife should be used to make a one-eight to one-fourth inch deep cut through each fang marks. This should be in the direction of the length of the leg or arm, not across. The incision should not be more than one-half inch long. Do not make cross mark cuts. Incision should be done not any deeper than the skin since muscle or tendon may be damaged.
- Suction cups are then used to draw out the venom on each fang mark. Continue suctioning for 30 minutes. Suctioning the venom by mouth can be used if free from cuts, sores or open wounds. Don’t swallow the venom. It must be spitted out. Rinse the mouth after finishing the suctioning.
- Cover the wound with sterile dressing, keeping the victim calm. Do not let the victim walk unless extremely necessary.
- Do not give alcohol or water if victim is nauseated, vomiting or unconscious. If he/she has no difficulty in swallowing, sips of water is permitted.
- Prompt medical care to the nearest facility is a must.
- Take note of the time of envenomation, vital signs of the patient during the course of management.
- Plant Irritations:
Itching, redness of the skin or blister formation, and even headache or fever can occur if such irritating plants touch the skin of a backpacker. Plants like the poison ivy can have a very annoying effect.
- Remove the clothing and wash the area with soap and water.
- Apply rubbing alcohol to the affected site.
- Application of calamine lotion will help alleviate the itchiness.
- Wash the clothes used to remove unwanted irritants.
Heat and Cold induced conditions
Body temperature is a function of the production and loss of heat.* Hypothermia occurs if heat production fails to balance heat loss. Hypothermia is defined as a core (Rectal) temperature less than 35C (95F). It can be a.)Mild (32-35C) b.)Moderate (28-32C) or c.) Severe (<28C). It can be characterized as acute (<6 hours duration) or Chronic (> 6 hours). N.B. Oral temperature is normally 0.5C lower than the rectal temp
Mild hypothermia causes shivering, difficulty in doing complex motor functions with noted cooling or vasoconstriction of the peripheral area like the fingers and toes. Shivering can be stopped voluntarily.
Moderate hypothermia causes loss of fine motor coordination, apathy “I don’t care attitude” or confusion, slurred speech, and violent involuntary shivering. Shivering increases body temperature by 0.5 to 1C per hour.Paradoxical undressing may happen which is: a person starts to take off his clothes even though he is feeling cold.
Severe hypothermia can make a person shiver in violent waves wherein the interval between shivers increases until it totally stops. This is a telltale sign of a critical condition. The person cannot walk, muscle rigidity develops, the skin is pale, and pupils dilate. The pulse rate decreases too.
Cold, wet weather on high altitude with poor raingear and warming clothes is a sure way to acquire hypothermia. Water dissipates heat away for the body 25 times faster than air. Wet clothes increase the potential for conductive heat loss to 5x normal.
Rules to live by:
heat loss by
- Removing wet clothing and replace with dry ones
- Increase or add more layers of clothing; a large plastic bag covering his body and extremities can help retain heat for the victim.
- Increase muscle/physical activity
- Keep the victim warm and dry in a shelter
- Adequate hydration and food intake
- Carbohydrates are a good source for energy. i.e. bread, rice, candies
- Hot liquids helps a lot in increasing the core temperature
- Never take in alcohol (a fallacy), caffeine or tobacco/nicotine. All of these may aggravate heat loss.
- Add heat by:
- Fire or other heat source
- Body to body contact with dry clothing on.
heat loss by placing a hypothermia wrap. The patient should be dry. A 4″
insulation covering the entire neck, body and extremity should be done using
blankets, sleeping bags, or clothing. A space blanket could be used.
- Give a dilute solution of warm water with sugar every 15 minutes. Severe hypothermic victims’ stomachs usually will not digest heavy, solid food.
- A full bladder increases the loss of core heat. Let the patient urinate but make sure the insulating material will not get wet from the urine.
N.B. Afterdrop – core temperature decreases or drops during re-warming. Peripheral vessels in the arms and legs dilate causing cool blood flow to the core. This is best avoided by just re-warming the core and not the peripheral area (hands, feet)
- Heat Illnesses:
Heat cramps are due to muscle fatigue combined with water and salt depletion.*
Heat exhaustion results from dehydration with inadequate fluid and electrolyte replacement.* This may progress to heatstroke.
Heat stroke is due to severe dehydration with failure of the body’s thermoregulation causing body temperatures above 40C (105-106F).
- Patient may complain of headache, nausea or vomiting, dizziness, weakness and fatigue and even disorientation.
- Find a cool shady place and keep victim there.
- Apply cool clothes. Give adequate ventilation and cool the patient using a fan. Stop if he develops shivers. Do not over cool him.
- Instruct the victim to take in fluids if conscious. Intake of a mixture of 1 pint water with 1 teaspoon of salt every 30 minutes is advisable.
- Don’t give patient alcohol beverages and cigarettes. Do not leave him alone until he is stable.
- Patient may present with mental confusion or disorientation, incoherent speech or even unconsciousness. Victim develops flushed, dry or warm skin with extremely high body temperature.
- Immediately place him on a cool shady place.
- Remove most of his clothes. Apply cool compress if possible. Fan may increase heat dissipation.
- Don’t give fluids, alcohol to incoherent or unconscious victims. Don’t overcool him by causing shivers. Monitor the patient until he is stable. Transporting to the nearest medical facility is warranted if condition does not improve. Do not give medications for lowering fever, it is not effective.
Sprain is an injury to the supporting ligaments of a joint while strains are injuries that occur on the muscle or tendon. Sprain occurs commonly on the ankle for backpackers when there is poor hold of the foot while stepping on slippery surfaces. Strains usually occur at the lower back during sudden lifting of the packs from a forward bending position at the hip area.
Assess if the area affected is just a sprain or a broken bone. If there is high suspicion of a fracture, treat it as a fracture. (See Splinting)
- If possible, place cold compress on the sprained area 15 to 30 minutes intermittently. Do not apply warm compress for the first 24 hours since this will aggravate the swelling or edema. Note for the amount of swelling and or any signs of hematoma formation. Sudden enlargement of the joint due to swelling and presence of a hematoma are signs of a severe ankle sprain or a possible broken bone.
- Keep the affected part elevated to minimize further swelling.
- Bandage or support with a blanket the site. Loosen the bandage if numbness or increased swelling is seen. The bandage is then to tight at this point.
- If victim need to walk, minimize bearing weight on the affected foot, secure a sturdy stick or wood that can be used as a crutch or cane. General rule is placing the stick opposite the affected limb, this will serve as a support during walking. When going downhill, the bad leg first before the good one. Uphill is good leg first before the bad. Easier to remember is by the saying “Good leg to heaven, Bad leg to hell!”
- Medical attention should be done as soon as possible.
- If possible, place cold compress on the sprained area 15 to 30 minutes intermittently. Do not apply warm compress for the first 24 hours since this will aggravate the swelling or edema.
- Just like in the ankle, elevate and bandage/support the area. A supporting bandage can be used for the wrist
- Seek medical care as soon as possible.
- Victims may have a difficult time in moving the area, especially if it occurred at the back. Rest it immediately. Apply cold compress if possible. No warm compress for 24 hours.
- Look for medical assistance if pain or swelling is severe.
N.B. Anti-inflammatory over the counter medications like “Alaxan”, which is a combination of Paracetamol/Ibuprofen, can be tried to help alleviate the pain. DO NOT give it if the victim is known to have allergic reaction to this medicine or to aspirin. Ibuprofen is usually the culprit for such allergic reactions. DO NOT also give it if victim is known to have a stomach ulcer. Oral intake of the medicine is contraindicated.
- Hematoma under toenail: Subungal hematoma
Injuries of the toes either by tripping on a rock or root or heavy object falling over the boots can cause hematoma formation below the nailbed. Prolonged walking causing contusion of the toe over the inner portion of a poorly fitted shoe can also cause this. Options for this condition is either letting it as is and place cold compress on the nailbed affected or to evacuate the hematoma if there is severe pain.
Draining the blood.
- Clean the nail and toe.
- Use a sterile needle and gently press the nail doing a screw-like motion. Do this until you feel a ‘give’. You have then reached the inner end of the nail. Another option: If you have a straightened paper clip, heat it up until it turns red. Apply the heated end to the nail and it will bore through the nail with minimum pressure.
- Drain the blood by pressing on the sides of the nail.
- Apply povidone-iodine and cover it with a dressing.
N.B. Consider delaying in doing the removal of the blood if you will still go over a lot of mud or dirt trail that may soil or infect the toe. If needed, make sure you always clean and apply a new dressing to the punctured
The “Limatik” or “Linta” in the common dialect is notorious for its stealth like feature. It has a covert way of attaching to the skin and sucking blood without ever knowing it until you bleed. This is very common especially on the wet season, wet forest areas or after a rain in the woods.
- DO NOT pull off the leech, its suckers may be left attached to the skin.
- Apply a hot material, knife or any metal object put over a flame, on the leech. This will make it detach by itself. Application of rubbing alcohol may also do the trick.
- Bleeding over the site of attachment will be noted. This is due to the anti-clotting factor that the leech uses for to get the blood. Some itchiness maybe noted. Wash it thoroughly.
There are many causes for diarrhea. Trying to deduce through the victim’s history would help in knowing the probable culprit. This may range from food poisoning, intake of medications, emotional stress, excessive alcohol beverage, and viral or bacterial infection.
Assess the victim if there are any signs of dehydration. The victim is dehydrated if the mouth and tongue is dry, restless and irritable attitude and very thirsty.
- Replace the same amount of fluid solution (1-liter clean water, 1-teaspoon salt and 1 tablespoon sugar) with the amount of loose stools.
- Vomiting may also be present. Let the patient sip the fluid solution gently and slowly to avoid further vomiting.
- Loose stools that are blood tinged or bloody or even black in color warrants immediate medical attention. These may be an internal bleeding or an infectious type of diarrhea.
Techniques in bandaging, Splinting, basic cardio-pulmonary resuscitation. CPR:
Practice makes perfect, is the key ingredient for proper use of medical materials. With limited resources in the backcountry, you must make use of this in the most efficient way.
- Circular Bandage: Placed over the sterile gauze covering the wound to keep it in place and avoid further contamination.
This is used on areas that have a relative uniform width, like in the forearm or leg.
- Place the end of the gauze over the affected part. Make 2 to 3 turns around the wound at the same spot. This serves as the anchor for the bandage.
- If the site to be bandaged is large, make additional turns by overlapping the bandage strip one from the other by around 3/4 the width of the previous turn. This is done until all of the area to be protected is covered.
- Secure the bandage by applying tape or safety pin. If it is not available, tie a knot by rolling out the gauze for about 8 inches in length from the underside of the arm/leg. By using the thumb or any finger, place it in the middle of the rolled out gauze and pull the half section back under the wrist to the opposite side. Then tie the knot with double gauze on one side (the one with the loop), and single gauze on the other side
- Figure of eight bandage:
Its use is for the ankle, wrist or hand that need stability and a little mobility.
- Anchoring the bandage is first done at the distal (toe area). Make 1 to 2 circular turns around the same area.
- The bandage is then brought diagonally across the top portion of the foot and around the ankle.
- The bandage is continued across the top of the foot and passing under the arch.
- Follow the #2-3 procedure with each turn overlapping the previous one by 3/4 of its width.
- Continue this until the foot, ankle and lower leg are completely covered. Make sure the bandage is snugly in place. DO NOT cover toes in order to assess if the bandage is too tight. Bluish discoloration of the toes is indicative of a too constrictive bandage.
- Secure the bandage with clips or tape.
- Finger Bandaging:
Suspected fracture or injury to the finger could be immobilized by using the buddy taping.
- Appose the affected finger with the adjacent good finger.
- Use a tape or gauze to anchor the two together. Make sure the tape is placed at the farthest/distal end as well as the portion near the base of the fingers. This secures the fingers. Tape between this if needed.
- A cut tongue depressor or flat wood can by used to secure the palm side of the finger for better stability.
- Triangular bandage:
Can be used as a shoulder sling.
- A 40-inch square cloth cut diagonally from corner to corner makes two equal triangular halves.
- One end is placed over the non-injured shoulder. This makes the base and the other end is hanging down over the chest. The point should be under the elbow of the injured shoulder/arm.
- Position the hand 4 inches above the level of the elbow
- Wrap the injured forearm/arm/elbow by lifting the lower end of the bandage over the shoulder of the affected extremity. Tie the two ends over the side or back of the neck.
- Fold the point forward and secure it with a pin on the outside portion.
N.B. Fingers should not be included in the covering to assess if there are any circulatory compromise.
Fractures of the arm and leg should be immobilized during transport. This is to protect it from further harm during the travel to the nearest medical facility.
- If necessary, gently straighten the injured extremity. Stop if pain increases during the procedure.
- Place padding such as folded blankets between the victim’s extremity.
- A board placed underneath is the most ideal way of immobilizing the affected extremity. If not available. Using sturdy wood placed on both sides of the extremity may be used. Length of the board/wood should stretch from the heel to the buttock area. Secure it by tying it at the following areas.
- Just above the ankle
- Just above and below the knee
- Above the thigh, near the groin.
- DO NOT tie directly over a broken area
- Another alternative is to tie the injured extremity to the uninjured extremity with the ties at the same positions in securing one with a splint.
- Watch for signs of circulatory compromise, bluish toenails, poor distal pulses
This follows the same principle like in the lower extremity.
- Use a sturdy board or stick to immobilize the injured area. A rolled blanket may be used.
- Tie it at both ends and in between, just below and above the elbow.
- Don’t cover the fingers. Watch for any circulatory compromise.
Suspected fractures on the neck is a possible life-threatening situation. Any wrong movement of the neck can result to paralysis or death. Seek medical assistance.
- If the victim’s life is of immediate danger in the vicinity and needs to be moved, immobilization of the neck is a MUST. Do this by placing a rolled towel or blanket around the neck and tie it in place. The tie should not interfere with the breathing. If a flat wide wood is available, place it behind the neck and back. Secure the neck by tying the board to the victim around the forehead and under the armpits.
- Lifting the head is done together with the shoulders and upper trunk with no twisting motion (Log rolling technique). The one giving the first aid should position himself at the top of the victim’s head. Place both palms of the hand at the back of the shoulder with the forearms at the side of the head. Press the head to secure it by using the forearms. Once it is secured, lift the head and neck together with the shoulders.
- If there is difficulty in breathing, slightly tilt the head backward to maintain an open airway.
- Place the victim in a secure location and seek for medical assistance.
- Rigid boards or a make shift stretcher must be used for transport of the victim.
- Cardio-Pulmonary Resuscitation (CPR)
A life-saving procedure for victims not breathing and has no pulse. The first priority in suspected arrest is that if the patient is breathing or not. Remembering the “ABC” of CPR that stands for Airway, Breathing and Circulation are the basic steps for CPR. First assess if the patient is conscious or not. Then do the following if unconscious.
- Lay victim on his back on a firm surface, such as the ground.
- Check the mouth and airway if there are any foreign objects i.e. dentures that may block the airflow.
- Assess if there is a suspected neck injury.
- If this is suspected, gently tilt the head with the head-tilt/chin-lift procedure. Place one palm of the rescuer on the forehead of the victim with the other hand, using two fingers, under the chin. Simultaneously, tilt the head back with the hand/finger in place. This is to clear the airway.
Breathing. If not breathing
- Keep the head tilted
- Feel and see if the patient is breathing. Placing an ear of the rescuer near the nose of the victim such as the rescuer is facing towards the chest will help him detect if there is breathing from the nose and lifting of the chest. If there is none then continue the procedure.
- The hand that is placed on the victim’s forehead is used to pinch the nose using the thumb and index finger.
- The rescuer takes a deep breath in order to blow air into the victim’s open mouth (mouth to mouth). Make sure it is effective by noting a rise from the chest with your mouth completely sealed during the blowing. Inflate the lungs rapidly for 3-5 times. (Take deep breathes in between)
- Feel for the carotid pulse. If pulse is present, continue blowing air at the rate of 12 per minute.
Mouth to nose resuscitation may be warranted if the victim’s mouth is blocked for free air passage.
Circulation: If pulse is absent
- Feel for
the carotid pulse. If pulse is absent begin cardiac compression. General rule:
- One rescuer: 15 compressions then 2 quick breaths.
- Two rescuers: 5 compressions then one breath
- Palpate with the index finger one of the victim’s lowest ribs then slide upward until the sternum or breastbone is felt meeting with the rib. Keep the index finger there.
- Use the other hand’s heel by putting it over the breastbone above the index finger. This is where compression is done.
- Place the other hand over the other one pressed on the breastbone. Keep your elbow straight, lean over the casualty and press down vertically and release. Depress the sternum approximately 4-5 cm.
- This is done until spontaneous pulse returns.
The table below lists the diseases to watch out for.
|Disease||Source of infection, How it is transmitted||Sign and Symptoms|
|Typhoid||Contaminated food and drinks from infected stools. Transmitted by fecal to oral route.||Fever for days to weeks, headache, vomiting, even diarrhea. Abdominal pains|
|Malaria*||Female anopheles mosquito. Introduction of malaria parasite into the blood||On and off chills, fever and sweating with feeling of well being in between. Headache, anorexia, nausea, vomiting.|
|Hepatitis A||Fecal to oral pathway with stool/urine of infected individuals contaminating food and water.||Fever, anorexia with urine becoming dark yellow; skin, eyes become icteric (yellowish in hue)|
|Cholera||Ingestion of food or water contaminated with stools or vomitus of infected individuals||Abrupt onset of diarrhea, profuse watery “rice water-like” stools. Stools may be odorless or fishy in character. Vomiting, may lead to severe dehydration in a short span.|
|Tetanus**||Spores of bacteria entering a wound. Found in the soil, rusty materials, nails, pins.||Fever, Stiffness of muscle of the jaw, extremities.|
|Rabies||Saliva of rabid or infected wild animals, i.e. bats, wild cats||Fever, loss of appetite, nausea, vomiting, restlessness, agitation, confusion, hallucinations* Lethal disease if left untreated.|
*Malaria prophylaxis is advised on locals that are endemic with the disease. Locally available medications are Fansidar (Pyrimethamine/Sulfadoxine) and Chloroquine. Consult a physician on its proper use and precaution. Some individuals may have adverse reactions to these medicines i.e. rashes, tinting, deafness.
**It is advisable to secure a tetanus shot from your physician and remembering when was the last booster shot. This would help the attending physician in knowing the recommended form of tetanus immunization once the situation arises.
Emergency Signals: Signaling for help.
A. Ground Markers
Using ground markers for aircraft to spot the signal is a good way to send your message across. Make sure signaling the serious injury marker is used with utmost importance. There is no room for false information.
Creating a campfire and signaling using its smoke may be used to attract attention. Windy or rainy situations limit the capability of this type of signal.
A mirror or a heliograph (reflective surface with a hole in the center) can be effective in seeking attention from flybys. Use the sun to reflect a bright beam focused on the vehicle’s cockpit. Move the reflected beam to and fro to catch attention rather than focused on one place.
D. Morse Code:
An international standard of transmitting messages that still has its use. It takes time to know it by heart, but it is worth the effort.
Practice it with the following phrase:
“The quick brown fox jump over the lazy dog”
It is an alphabet signal using arm/hand positions for transmitting messages. A person deciphering the message needs binoculars if the person signaling is at a very distant location. Do it slowly. Flags (Square with red and yellow divided diagonally) are held with arms extended.
The arm patterns are fashioned like a clock but with only ten positions, Up, Down, Out, High, Low each for the left and right.