Introduction
Welcome to
HUNTER
MEDIC
A Guide to Accident Management
& Immediate Care:
'First' Aid in the Outdoors
Part 1:
INTRODUCTION
This site is not a medical handbook for mountaineers, expeditionaries, or any of those who venture out. It is quite simply an attempt to place on a database of-sorts information on emergency aid for those who lead outdoors and who use the information contained herein - which may save lives. If you are reading this you are either a leader or an outdoorsman/woman who may have to manage a potentially life-threatening or dangerous situation requiring immediate care - 'first' aid in an emergency. Of course 90% or more of what follows is directly transferable to non outdoor-pursuits emergencies.
The vacuum of time between an accident occurring and professional help arriving can be, in the outdoors, many hours and not minutes as in an urban or suburban area. I simply hope this website's approach will be readable to enable you (and my Team of Instructors) to manage an accident in the outdoors, mustering your wits to better effect and keep him/her from deteriorating until you formally hand over your casualty. Then and only then can you afford yourself the luxury of letting your guard down a bit and relaxing; presupposing that is that you do not place your own self in danger.
Barry Howard
My experience covers over 22 years as a qualified 'First Aider'. Throughout that time I have personally managed trauma emergency aid from sudden-death, impalements, cardiac arrests, and de-gloving of limbs, to trauma cranial injuries, critical hypothermia, major bleeds, and fatal RTAs. In addition for almost ten years I have researched and worked with mountain rescue in the UK and Norway - the latter on a research fellowship from the Churchill Trust - and instructed remote area advanced first aid at a variety of levels; I spent eight years as a survival instructor and medic working for the Ministry of Defence, and 30 years teaching in secondary education, 15 of those running one of the largest outdoor pursuits programmes in the UK for 1800 pupils. I am a trained and qualified Mountain Leader, and a qualified First Response AED Operator. I am Visiting Tutor in First Aid & Safety at a local adult college and spend most of my waking hours working as Chief Instructor and EMT with HUNTER Outdoor Training. I also have an English Springer Search Dog who thinks a scratch on the paw should be classed as a major bleed; we are inseparable.
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Defining First Aid
"First Aid is defined as 'the immediate care given to a person who has been injured or suddenly taken ill.' To you, as a first aider, this means two very important things:
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That the first aid you perform must be IMMEDIATE. In some cases you should respond in less than a minute; in other cases you can wait minutes before doing something. But in nearly every problem encountered in the mountains, the first aid must be started in relatively short time, even though evacuation may be delayed for hours or days.
- First aid is the immediate CARE given. This care includes not only bandaging or splinting the victim's physical injuries and protecting them from the environment, but also caring for the victim's entire mental and physical being. A wound is more than just bleeding. It involves pain, concern, anxiety, worry, and apprehension. All of these mental and emotional as well as physical needs must be attended to by the first aider."
Quote from 'Mountaineering First Aid' Lentz, Macdonald, and Carline. 1990 The Mountaineers Seattle.
SAR recovery from remote bushland in up-sate New South Wales.
Photo courtesy of Dr. Ken Harrison Careflight.
Let me make a few things clear before we get into the technical stuff – if you are a qualified first aider then you will develop a wonderful knack of being in the right (wrong?) place at the right (wrong?!) time to help others – injured – with your skills and knowledge. Second – be aware right from the outset that having passed a cosy ‘Appointed Person’, Basic First Aid, or even the standard four day HSE ‘First Aid at Work’ slog, you need to up your game to handle a first aid crisis in the sort of outdoors that HUNTER regularly works in.This part of the website cannot provide comprehensive teaching on the subject – come on one of our courses for that – but it is included here because it is what we have as a part of our skills repertoire – and it is what you need.Like in many aspects of outdoor work it is the training which is important. An emergency situation frequently robs a person of the sophisticated abilities to solve problems. In the event it must be the practised training which takes over, so procedures are undertaken out of habit.
A syllabus that you need to know if you are undertaking outdoor activities in any serious way includes: Emergency Procedures (Danger Response Airway Breathing Circulation) Recovery Position, Summoning Help (eg ambulance or MRT), Fractures, Bleeding, Shock, Burns, Heart Attack & CPR, Choking, Poisons, Asthma, Epilepsy, Anaphylactic Shock, Cold Injury (Hypothermia), Heat Injury (Heat Exhaustion).Finally along with the training you must understand the equipment you have to hand – the standard rucsac (or even car) kit languishing somewhere at the bottom of your sac – and the knowledge of what’s in it. Always try to build your own first aid kit rather than just buy one off the shelf and look quizzically into it when Albert fractures his tibia.
At the very least therefore: a) be aware of the fact you’ll be working in geographical and perhaps even social isolation x miles from the nearest road-head b) your skills need to be that bit more honed due to a) …….c) get at least some experience learning first aid if not a qualification and d) know what and how to use your first aid kit.As a leader, team-member, or individual you do not go about your everyday business expecting an accident or looking for one; but having contingencies are partly what you must be about when out. HUNTER is well known for developing the concept of ‘what-if scenarios’ nearly two decades ago.
Your leadership status, role, and experience should mean that you can automatically log in to a repertoire of situations to manage accidents in the outdoors, that is you’ve actually handled and managed successfully a range of different situations where one of your team or a third party has needed relatively urgent care on the hillside, coast, or in the forest where immediate advanced professional emergency care will not be available in the same way as an urban area. My personal list fills an exercise book with over 20 years of leading two first aid teams – and it makes interesting reading! I recount some situations here to give you a flavour of what you have to expect will occur at some time in your outdoor career / hobby..
Example 1 :
In very dense woodland a girl on a District Cross Country running competition disappeared; I was leading a survival skills course about 100 metres from the main track through the woods – deep enough into the greenwood not to notice people quietly running along – when we were noticed and asked to help; the young people I was instructing set up a line search then corridor search and eventually found the girl almost unconscious suffering a quite severe asthma attack – where she’d been for a long time; apart from the leadership awareness of the event organisers in allowing an asthmatic to run out of sight of marshals through dense woodland – an interesting risk assessment, we had not only a standard first aid situation, but an addition second layer of complexity of location, and a third of recovery; there was no 4x4 ambulances in the county NHS fleet, and the only police 4x4 was 18 miles away having its gearbox changed – and anyway getting such a vehicle through these woods driven by someone who was not a local would add an extra component of delay or risk even if it did arrive.
We got our Defender 110 with a stretcher on board through the complex ‘tracks’ and had a police officer on foot run to get a nebuliser and extricated the casualty to the roadhead. One of my Team stabilised the casualty whilst all this was going on – and the Police Range Rover arrived just as we were leaving having driven 18 miles in 18 minutes.
We’d dealt with many asthmatics before; we’d practiced search patterns before (my ML Training week included an almost identical scenario to this in the forest to the south of Plas-y-Brenin), and we were in the right place at the right time with the right knowledge and a plan.
Example 2 :
A particularly cold April day on southern Dartmoor; with a staff team of six – all in radio contact with each other I had 40 teenagers spread over some 30 sq kms between Western Beacon and Eastern White Barrow; only one group of four lads were however north of Three Barrows – outside or our area of remit – quite legitimately as they’d arranged with me to get some work done up north of Red Brook Mires close to Knatta Barrow. I’d arranged to rv with them at 14.30 at the Barrow.
I nav’d up to Three Barrows leaving my 2 i/c and staff in charge of the remaining groups; however as I climbed to the summit it started to snow; well over five hours earlier than it’d stated in the morning’s forecast. I radio the staff to be prepared to evacuate all the groups off the Moor to a pre-arranged emergency rv (Leigh Lane) should the 2 i/c consider that at his lower altitude it was becoming difficult to work.
I was faced with navigating northward into a driving 40 knot north wind with heavy snow ‘falling’ – and I was solo. Using the Stone Row I worked my way round to Knatta Barrow – only a metre high blister on an otherwise featurless plateau edge….but no lads – and they did not arrive – me waiting for over an hour in a driving blizzard.
Unknown to me – or any of the other staff they had run off on their nav legs once out of sight of the staff team – and a couple had fallen into a bog – got changed but were then unsure of where they were; asked a farmer, misinterpreted his correct information and landed up at a point on the Moor where they thought Knatta Barrow was.
I eventually found them some three hours after my original rv time. However one was hypothermic – and this on top of the extra ‘layer’ of responsibility of getting them out of a relatively inaccessible location – at altitude, in a blizzard, I had to move fast to treat the casualty. A rapid shelter build with tarp and bivvi bag, plus a brew on and added clothes managed to save him from the worst. The ‘problem’ did not of course end there; the other three lads were potential hypothermia victims too – and we still had to get off the Moor in fading light and falling temperatures.
Managing an accident / casualty at the point in the day where you as leader or responsible team member are running down on energy is all part of the extra pressure of leadership – the day is not over until it’s over! You may not expect a hypothermic teenager to be part of your day – but on the other hand in a way you must dovetail this possibility into your ‘what-ifs’. So you carry stove and fuel and food and drink…and the capability to survive and manage others’ survival too.
HUNTER Outdoor Training, through its component websites, offer first aid advice based upon its experience and qualifications of over 35 years in the outdoors. This information is NOT intended as as a substitute for a first aid course with a recognised Voluntary Aid Society. Also be aware that the treatment, care, and procedures mentioned in HUNTER's various pages here are intended for use in the outdoor contexts described. HUNTER Outdoor Training and its instructors disclaim any liability for injures that may result from the use of this information, correct or otherwise.
Barry Howard B.Ed [Hons] C.Geog [Econ] FRGS ML Churchill Fellow
Chief Instructor Hunter Outdoor Training
Hunter Medic is an information website for Instructors of Hunter Outdoor Training, and is compiled solely to be a teaching resource for the Team, and it's linked voluntary-organisations: Duke of Edinburgh's Award Scheme, Uniformed Organisations, and schools..
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