You Are the Rescuer

WFR Upgrade/Re-certification clinic 2020

This is a guided discussion format designed for small groups. There are many correct answers and many correct methods to solve
the scenario. Ask yourselves, does the rescue approach discussed meet the standards and practices consistent with your training? Is
there a balance between the risks to the rescuers and the benefit to the patient?
- discuss possible solution in a guided discussion format.
- listen to other possible solutions.
- offer constructive feedback to all suggested solutions in that guided discussion format.

This year, four scenarios have been selected for the exercise. Additionally, we once again invite you to compose your own scenario,
one that is appropriate to your particular environment. Regardless of where the incident occurred—on the slopes, in the water, or
during the summer at an event you attended—the assessment and basic emergency care remain essentially the same. Remember that
we are Wilderness First Responders year round. As you discuss the scenarios, keep in mind that there are many correct answers.
“Solving the problem” is not the primary objective; a guided discussion of all the possible solutions is. Try to adapt the presented
scenarios to your own needs and consider your employment protocols.

Leading questions Discussion points

As you approach this patient, what are your priorities? Describe and discuss what you would do to:
1. Ensure scene/group safety
2. Manage the scene; and
3. Assess the patient.

What possible problems do you think the patient may Identify potential problems/signs and symptoms of each
have? ( look into your crystal ball. Can you see the problem and the anticipated problems associated with each.
future?)

For example:
What resources might you need to manage this 1. Equipment;
patient/situation? 2. Human resources

Describe and discuss:

What emergency care does this patient require? 1. Immediate emergency care needs;
2. Needs during transport;
3. Important considerations.

For example:
What problem(s) might you encounter as you manage 1. Complications with the patient;
the scene? 2. Crowd control; and
3. Challenging terrain.

For example:
What are your transport considerations? 1. From the accident scene to where EMS can access Pt.
When you have completed your discussion please have every group member write up their communication report in the following
simple format:

1. Who is your patient

2. What happened to them ( MOI)?
3. What is wrong with them?
4. Why are you worried?
5. What you need?
Scenario 1

You and a couple of friends rented an Alpine Club cabin and are out on an overnight tour outside of
Pemberton. 3.5 hours into your journey to the cabin one of your group members, Chris, triggers a soft-snow
sluff that carries him about 25 meters into the trees where he stops, partially buried against a large pine. He is
unresponsive and bleeding slightly from a small cut above his left eyebrow and from abrasions below his left
eye. He slowly awakens and is fully alert as you finish digging him out of the snow. Chris is a healthy 26-
year-old male with a history of multiple mild concussions ( former hockey player). He is complaining of a
mild headache and a sore neck. He exhibits limited movement in his left eye when asked to follow your finger
as you move it upward; the remainder of his physical exam is unremarkable. During the focused spine
assessment his spine is non-tender with normal motor and sensory exams; his neck is still sore. His resting
pulse and respiratory rates are within normal limits. You have no cell reception and are about 3km from the
cabin and 7km from the road where your vehicle is parked.

Notes:

1. Who is your patient

a. Chris, 26yr old male
2. What happened to them ( MOI)
a. he triggered a soft-snow sluff
3. What is wrong with them?
a. mild headache, sore neck, limited movement in left eye, non-tender spine, unresponsive, abrasions below left eye
4. Why are you worried?
a. he has a non-tender spine, limited eye movement, unresponsive, abrasions below left eye
5. What you need?
a. EMS, Land transport
 Scenario 2

You are on a three-week canoe expedition in Quetico Provincial park. One of your students, Cathy,
approaches you before breakfast complaining of pain and swelling in her ankles; she thinks it's a reaction to
the black fly bites she received a couple of days ago when she forgot to reapply DEET after swimming.
Yesterday the bite sites were slightly red and itchy. This morning, upon awakening, both her ankles are
swollen with red streaks moving up her lower legs. She is tired and feels sick. Her core temperature is 38.3º
C. It's day 14.

Notes:
1. Who is your patient?
a. Cathy (student)
2. What happened to them (MOI)?
a. reaction to black fly bites
3. What is wrong with them?
a. pain and swelling in her ankles, both ankles are swollen with red streaks moving up her lower legs, feels sick
and tired. her core temp is 38.3 degrees
4. Why are you worried?
a. her body temperature is low, has swelling in both ankles
5. What do you need?
a. EMS, bug spray
 Scenario 3
While mountain biking down Showcase trail at Blue Mountain your friend Chuck catches his front wheel
and is thrown forward with his bike. During the fall the handlebars smash into the left side of his chest.
Chuck has difficulty sitting up and catching his breath and appears to have injured his left wrist. After
assisting him to a sitting position and coaching him to breathe with his abdomen, his respiratory distress
appears to resolve. During your physical exam, he reports a sharp pain in the ribs on his lower left chest
when he tries to take a deep breath. While his left wrist hurts and has a slightly decreased ROM with good
distal CSM, it appears weak: Chuck is unable to easily hold and lift a full 1-liter water bottle. His helmet is
cracked, he reports feeling a bit woozy, and has a headache; the remainder of his physical exam is
unremarkable. With abdominal breathing, the pain in his ribs is manageable. 20 minutes after his accident
his pulse is 94 and regular and his respiratory rate is 22 and remarkably easy; he reports his normal pulse rate
is in the mid-60's and he doesn't know his normal respiratory rate. While awake, he still feels a bit "out of it."
A focused spine assessment reveals cervical pain and tenderness at C-7 with no shooting pain and normal
motor and sensory exams. Chuck is not sure he can ride and it is still about 1.5 km to the bottom of the trail.

Note

- The first stage in this first aid scenario is to determine how serious Chuck's wounds are. According to the
description, he appeared to have head, wrist, and chest wounds. Upon taking a big breath, he has a searing
ache in his ribs and is having difficulties breathing. To aid Chuck's respiratory distress, it's crucial to keep him
seated and instruct him to breathe from his abdomen.

- Because Chuck's helmet is damaged and he has a headache and dizziness, you should keep an eye out for any
symptoms of a concussion or other brain injuries. More investigation is necessary when a targeted spine
assessment finds cervical discomfort and tenderness at C-7. It would be advisable to contact for emergency
medical help given the seriousness of his wounds rather than carry him without the necessary tools. As you
wait for assistance, make sure Chuck is comfortable and keep an eye on his vital signs, such as his breathing
and pulse, as well as his degree of awareness.