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Join Date: Oct 2011 Location: upper left corner Posts: 317
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Hey, y'all. Getting in on this late, because I got called to work out of town this week and I couldn't get internet signal where I was staying. Sorry.
Big-a$$ disclaimer: I can't speak for my agency. Don't sue them (or me) because I told you to do something stupid and you did it. Wilderness activity is inherently dangerous and if you perish, somebody else'll get your stuff.
In addition, back-country treatment is unique to factors bearing on the particular case, including where you are, what you've got, what else you can get, and how soon you can evac, so it's not easy to give one-size-fits-all advice. I'll tell you what I do, but you do what you need to do. I am not a doctor, I'm not even a paramedic or EMT - I'm just a guy with some stuff in a backpack who's gonna try and keep you alive until we can get you down off this mountain (and I deliberately don't have enough assets to make me worth suing).
Okay. First thing is LeadOp, if I had conditions like you describe, I'd think long and hard about going to places far from EMS access. I would accept the fact that those conditions put me more at risk than most people, and a severe femoral or brachial injury could mean the end of me. I'm not saying don't go, just make an informed decision.
No experience with Celox, but QuikClot is good stuff, and we have it available for use. The cost and expiration date keep us from depending on it very heavily. And truly, it's seldom needed as almost all bleeding we encounter can be stopped with pressure, elevation and pressure on the upstream artery.
I'll discuss tourniquets, with the understanding that we're talking about a case where in my primitive opinion, this patient's bleeding is a life threat and isn't responding to other means. Traditionally, we were taught that a tourniquet is what you apply when you're sacrificing a limb to save a life, that you lock it and leave it, and the downstream tissue dies and gets toxic. In wilderness medicine, that idea is changing.
Now it's being considered to use a tourniquet as a "valve", to restrict but not entirely occlude circulation to the wounded limb, Irrigate and dress snug, and slowly release the TQ in 15-30 minutes and see if the wound holds. Your body wants to clot blood, it's trying hard and maybe we can lessen the pressure just enough to achieve that.
The other thing is, first aiders were always taught never to remove a bandage, just pile more dressings on top and wait for the ambulance. If I have you for a long time before real help can arrive, I'm going to be removing that dressing at least every 12 hours and checking the wound for signs of infection (which if I see them, it's going to ratchet up the urgency of evac considerably to get you to somebody who can administer antibiotics).
Unless I use some of the new transparent dressings made by Second Skin (and probly others, that's just the brand I have) that allow monitoring wound condition without removing. Those are kinda expensive too, but you're worth it. Thing about wilderness EMS is, it's never a sterile environment - it's always dirty and muddy and full of contamination, so that's why we irrigate the wound 'til your screaming disturbs the surrounding wildlife and dress immediately.
I agree with JudyAnn about attending a wilderness first aid course. The NOLS/WMI one that I went to was excellent. But the fact is, if an ordinary person is risking (x) by venturing beyond quick EMS care, your risk is greater (x times the severity of your conditions). Just no gettin' around it, and only you can decide how much risk you're willing to accept. I commend you for what you're doing already, and hope your additional precautions don't become necessary.
Parker
simple man in a complicated world
Last edited by catspa; 01-26-2012 at 05:04 PM.
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