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Overseas Travel and Wilderness First Aid

Overseas Travel and Wilderness First Aid

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Published by paulo.virgilio9109

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Published by: paulo.virgilio9109 on Sep 20, 2008
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Overseas Travel and Wilderness First Aid
Note: Copyright
2003 by Jeff Randall and Mike Perrin. This document may only bereproduced in whole or part with the following credit line:“Copyright
2003 by Jeff Randall and Mike Perrin from the book ADVENTURE TRAVEL INTHE THIRD WORLD ISBN: 1581603819”
During our survival training classes and expeditions around the world we always havesomeone trained in emergency care just in case the worst happens many miles from a hospital. Ifyou don't have the luxury of being accompanied by a trained professional, at least get a minimalamount of training in emergency first-aid before your departure. Even the most basicunderstanding of emergency care can save you or others a lot of misery and possibly even savea life. As with every other aspect of adventure travel, preparation is the key to success. Alwaysprepare for the worst and hope for the best.
Issues Surrounding Wilderness First Aid
 Before we delve into treatment, let's look at a few simple ways to prevent serious wildernessmedical problems from arising. One of the best preventives is to always travel with a companionand let others know where you're going and how long you intend to be gone. Always have aprearranged evacuation route and meeting points. Avoid using drugs or alcohol while you're inthe back country. Always carry adequate food and water or at least have safe ways to purify localwater. Anticipate weather changes and carry extra dry clothing. Learn basic navigation and havegood maps of the area. Always ask if your partner or teammates have special medical conditionssuch as allergies to specific medications, food or insects, and if anyone has ever been a heatcasualty. Finally, never approach or provoke wild animals of the region, since 'playing' with theanimals can cost you your life.A good example of this final rule occurred during one of our overseas expeditions. An indig,who had hand caught hundreds of alligators in the past, made a simple mistake and received anasty bite. Swelling and pain due to infection ensued and without proper first-aid treatment andantibiotics he could have lost his hand or even his life, if evacuation had not been possible.The variations of medical problems that can occur in the wilderness are many. Due to lengthrestriction in this book we are directing our attention to the most probable occurrences for back-country travelers. These treatments will be a general overview and should not be used as finalinstruction in first-aid. Anyone wishing to learn proper first-aid should do so through a reputableinstructor.
Lacerations and Bleeding
 Cuts and lacerations are common in the wilderness. The small bleeders are usually easy tocontrol by direct pressure and protected against dirt and debris by using dressings such as sterilegauze pads, Band-Aids, steri-strips, or by taping the wound closed. Rarely should you attempt tosew a wound closed, especially when it cannot be properly irrigated, since debris can be trappedinside the wound with decreased drainage causing severe infections.Serious bleeding should be controlled via direct pressure and pressure dressings. If bleedingis from an extremity, elevate the injured area above heart level while continuing to apply directpressure. Two situations when you would not use elevation are in the case of a fracture orenvenomation. Another method for decreasing hemorrhage is by applying pressure to pressurepoints on the joint above the injury where arteries run over bones close to the skin.
Tourniquets should be used only when arterial or severe venous bleeding cannot be controlledby any other means and the choice is life over limb. Proper procedures for using a tourniquetshould be learned before attempting to save a life with this method. If a tourniquet is applied to anaccident victim ALWAYS mark the letter 'T' and the time and date the tourniquet was applied onthe victim's forehead. This is done so primary care personnel will readily know a tourniquet is onthe patient and can evaluate whether or not the limb may be saved.
 Broken bones are common back-country accidents, especially when hiking tough terrain ornavigating deadfall. Treating fractures can be as simple as applying splints, or as complicated asapplying necessary traction to femur breaks and attempting to control internal bleeding.When analyzing a patient for broken bones look for visual misalignment along the bone and painor loss of motor skills in the affected limb. Compound fractures that protrude from the skin shouldnot be reset in a wilderness environment, since possible internal laceration to the arteries is a riskfrom sharp bone fragments, as well as foreign debris entering the area. A properly splintedextremity must have the joint above and below the fracture site immobilized. Any breakage in theskin should be covered with sterile gauze and tape, or pressure bandages if required.Simple splints can be made from sticks and rags with the idea of keeping the injured part frommoving and creating further damage. All jewelry and clothing should be removed surrounding thefracture site due to swelling and for inspection of further damage and bleeding. All associatedbleeding must also be controlled.Due to the large muscle mass of the thighs, femur fractures are generally the only ones thatusually require traction. Since internal hemorrhaging and severe muscle spasms are frequentlyassociated with femur fractures, traction should be applied when possible. Direct pressure andpressure points (indirect pressure) should be used in an attempt to control bleeding. Oncetraction is applied it should never be released until the victim is in the hands of a primary carefacility.
Heat Related Illness
 One of the most frequent medical situations experienced in the wilderness is heat-relatedillness, which includes heat cramps, heat exhaustion and heat stroke, which is a medicalemergency. These illnesses are caused from dehydration and loss of electrolytes throughsweating and inadequate intake of calories from food. The symptoms for heat exhaustion arecool, pale and clammy skin, weakness, headache, nausea, dizziness, thirst, rapid pulse, chills,slightly raised body temperature and low blood pressure.Treatment should be immediate rest in a cool area, removal of excess clothing, drinking fluidsand wetting the body with cool water. However, if there is not an abundance of water available,remember that water is better "in you than on you." For severe cases use 1/4 teaspoon of saltand 6 teaspoons of sugar to a quart of water and drink in regular intervals. This is the bushequivalent to pre-packaged oral rehydration salts. This technique of electrolyte replacementshould only be done sparingly. The best way to replace sodium is through food.Heat stroke is a serious medical emergency that can kill in a matter of minutes. The symptomsare basically the same as heat exhaustion except the body's core temperature can exceed 106degrees. The victim frequently shows severe personality changes and a lowered level ofconsciousness. The skin will be hot and can either be sweaty or dry. The mental status of thevictim will decline usually with slurred speech and loss of motor skills leading to possible coma.Immediately suspect heat stroke in any person who suddenly collapses when in a hotenvironment.Treatment must be rendered immediately since this is an absolute medical emergency.
Remove all the victim's clothing, spray the entire body with water and fan him vigorously, whichwill release heat through convection and evaporation. If possible, immerse the victim in ice water,or place ice packs under the back of the neck, armpits, lower back and groin. The secret totreating heat stroke is cooling the body immediately and evacuating the patient as soon aspossible. When using this process be sure to monitor the patient's core temperature. Stop thecooling process once the temperature reaches 100 degrees, or else the body can have a reversereaction and become severely hypothermic.
 Diarrhea is another common medical condition for wilderness travelers. Simple diarrhea canbe caused from diet changes, stress, or nervous anticipation associated with new adventures.The more severe forms can be the result of intestinal infections (bacterial, viral, or parasitic,) foodpoisoning and allergies. Usually, simple diarrhea will take care of itself; however, prolongeddiarrhea can be serious and cause dehydration due to loss of fluids and electrolytes.Accompanying the serious cases may be lower abdominal cramping, fever, lack of bowel control,signs of dehydration, and others in your group with the same condition.Treatment consists of drinking copious amounts of clear fluids and a gradual return to anormal diet. Steer clear of milk products and meats for at least 48 hours after the diarrhea hasstopped and avoid caffeine and nicotine since it stimulates the intestine and increasesdehydration. Pepto-Bismol and Imodium AD should be included in every aidbag and used astreatment. One of the best treatments is Oral Rehydration salts which are usually found in goodtravel first-aid kits or you can make the bush equivalent detailed above.
Insect Bites and Stings
 One of the largest adversities in serious bush is insect stings and bites. Mosquitoes, chiggers,flies and a whole host of other creatures love to feast on human flesh. For the most part, they'rerelatively harmless except for those that carry disease. The biggest medical problem usuallyassociated with bites is infection due to scratching with dirty fingernails.Treatment for minor bites and stings is application of Sting-Eze or other product designed toneutralize the venom removing the discomfort. More serious bites such as wasps and spiders canbe treated immediately with a Sawyers Extractor followed by close patient monitoring for furthersigns of envenomation and/or allergic reactions which can produce anaphylactic shock in thosewho are hypersensitive to the venom. Oral Benadryl will help to keep down mild allergic reactions,but will make the person drowsy, and heavy doses can increase the risk of heat-related illnessthrough raising the body's heat output and by decreasing sweating.Some serious bites like those from Brown Recluse and Black Widow spiders may not producepain during the initial bite, however, in most all cases pain becomes evident shortly thereafter.Treatment should consist of washing the bite with soap and water, relieving pain with ice packson the bite, keeping a check on the ABCs (Airway, Breathing, Circulation) and evacuating thevictim to a primary care facility. Don't worry, most insect bites are not fatal if allergic reactions arenot present.The best treatment for insect bites is prevention. DEET is a good insect repellant, but careshould be taken when applying high concentrations directly to the skin, especially in children.Another good preventive measure is applying Permethrin to clothing, however it too has shownsigns of allergic reaction in some people. When traveling in tropical and other mosquito-infestedareas, always use mosquito netting when camping, and apply DEET around the pant legs andboots to keep down chiggers when walking through grassy areas.
Anaphylactic Shock

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