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 CONTENTS vii

Management 476 Types of Soft-Tissue Injuries 542

Care for Patients in Cardiac Arrest 476 • Hospital Care of Closed Injuries 542 • Open Injuries 545 •
MI Patients 484 • Cardiovascular Patients Who Are Not Burns 549
in Cardiac Arrest 485
Assessment 551
Management 552
Gastrointestinal Direct Pressure 553 • Dressings 553 •
and Genitourinary Tourniquet 553 • Treatment for Specific Soft-Tissue
Injuries 555 • Dressing and Bandaging 558
Emergencies 494
GI/GU Anatomy & Physiology 495 Burns 579
The Acute Abdomen 499
Causes of Acute Abdomen 500 Anatomy and Physiology 580

Common Gastrointestinal Ailments 505 Types of Burns 581

Thermal Burns 581 • Chemical Burns 582 •
Gastroenteritis 505 • Indigestion 505 • Nausea
Electrical Burns 583 • Radiation Burns 584
and Vomiting 505 • Colic 506 • Diarrhea
and Bloody Stool 506 • Viruses, Protozoa,
The Classification of Burns 585
and Bacteria 506 • Constipation 506
Superficial Burns 585 • Partial-Thickness
Assessment 508 Burns 586 • Full-Thickness Burns 586
ABCDs 508 • Physical Exam 509
Liver Liver
Assessment 588
Right kidney Spleen

Management 510
Colon Left kidney
Pancreas Stomach
Gallbladder

RIGHT UPPER QUADRANT

RIGHT LOWER QUADRANT
Colon
Pancreas

LEFT UPPER QUADRANT

LEFT LOWER QUADRANT
Management 591
Colon
Small Intestines
Major artery and vein
Colon
Small Intestines
Major artery and vein Thermal Burns 593
Section 5 to the right leg
Ureter
Appendix

Aorta
to the left leg
Ureter

Chemical Burns 593 • Electrical Burns 594 •

Pancreas

TRAUMA 516 MIDLINE AREA

Small Intestines
Bladder
Spine
Radiation Burns 595

Further Care and Transport 595

Principles of Trauma 516

Kinematics 517 Musculoskeletal

Pathophysiology and Mechanisms of Injury 521 Injuries 601
Blunt Injury 522 • Penetrating Injury 522 •
Rotational Injury 522 • Crush Injury 523 • Blast Anatomy and Physiology 602
Injury 523 The Skeleton 603 • Joints 606 •
Ligaments 607 • Muscle 608 • Tendons 609
The Three Phases of Injury 525
Pre-Injury Phase 525 • Injury Phase 525 • The Physiology of Movement 609
Post-Injury Phase 526 The Healing Process 610

Trauma Systems 526 Common Musculoskeletal Injuries 612

Level I 527 • Level II 527 • Level III 527 • Sprains 612 • Strains 612 • Ruptured
Levels IV and V 528 • Pediatric Trauma 528 Tendons 613 • Fractures 613 •
Dislocations 615 • Multiple Simultaneous MS
Assessment 530 Injuries 616
Management 532 Assessment 617
Signs and Symptoms of Common MS Injuries 620 •
Soft-Tissue Injuries 537 Assessment of Upper Extremity Injuries 622

Assessment of Lower Extremity Injuries 630

Anatomy and Physiology of Skin 539 Hip and Pelvis Injuries 630 • Femur Fractures 631 •
Skin Anatomy 539 • Physiology of Bleeding and Knee Injuries 632 • Tibia and Fibula Injuries 634 •
Clotting 540 Ankle Injuries 635 • Foot and Toe Injuries 636
viii CONTENTS

Axial Skeleton Injuries 638 Management 756

Management of Facial Injuries 757 • Management
Management 639
of Ear Injuries 758 • Management of Eye
Splinting 640 • Caring for Specific Extremity Injuries 759 • Management of Neck Injuries 763
Injuries 649 • Lower Extremity Injuries 659

Boot Removal 670 Thoracic Trauma 770

Stabilized Extrication and Transfer: “Jams and Pretzels” 673

Anatomy and Physiology of the Chest 772

Head and Spine Chest Injuries 774
Injuries 697 Mechanisms of Injury 774 • Types of Chest
Injury 774 • Environmental Factors 782
Anatomy and Physiology 699 Assessment 783
Common Mechanisms of Injury 702 Management 784
Increased Intracranial Pressure (ICP) 703
Coup-Contrecoup Injury 703 Abdominal and Pelvic
Common Injuries 704 Trauma 793
Head and Brain Injuries 704
Anatomy and Physiology 794
Injuries of the Scalp 704 • Skull Fractures 704 •
Traumatic Brain Injury 705 • Concussion 705 • Common Abdominal and Pelvic Injuries 798
Recurrent Traumatic Brain Injury 708 • Cerebral Abdominal Wall Contusion 798 • Liver
Contusion 708 • Cerebral Hematoma 709 • Injuries 798 • Spleen Injuries 798 • Pancreas
Diffuse Axonal Injury 710 • Intracerebral Injuries 798 • Vascular Injuries 799 • Diaphragm
Hemorrhage 711 Tear/Rupture 799 • Intestinal Tear/Rupture 799 •
Impaled Objects 799 • Evisceration 799 • Pelvic
Spinal Injuries 711 Fractures 800 • Hip Injuries 800 • Lower Urinary
Neurogenic Shock 712 Tract Injuries 801 • Straddle Injuries 801 • Genital
Injuries 801
Patient Assessment 714
Mini-Neurologic Exam 715 Assessment 801

Management 719 Management 805

Sizing and Applying a Cervical Collar 720 • Placing a
Patient on a Long Spine Board 720 • Procedure for
Removing a Helmet (Lying Patient) 724
Section 6
ENVIRONMENTAL CONDITIONS 813
Face, Eye, and Neck
Injuries 742 Cold-Related
Anatomy and Physiology 743
Emergencies 813
Facial Structures 743 • Auditory and Balance
System 744 • Visual System 744 • Neck Anatomy and Physiology 815
Anatomy 747 Common Cold-Related Emergencies 818
Frostnip and Frostbite 818 • Hypothermia 819 •
Common Face, Eye, and Neck Injuries 749
Afterdrop 820 • Windburn 821
Face Injuries 749 • Eye Injuries 751 • Neck
Injuries 751 Rescuer Preparation for Cold Weather
Assessment 754 Rescue 821
Assessment of the Eye 754 • Assessment of the Assessment of Cold Injuries 824
Mid-Face and Nose 755 • Assessment of the Frostbite 824 • Hypothermia 825
Mouth 755 • Assessment of the Ear 755 •
Assessment of the Neck 756 Management 827
 CONTENTS ix

Frostnip 827 • Frostbite 827 • Hypothermia:

Prevent Heat Loss 828 Altitude-Related
Evacuation and Transportation 832
Emergencies 896
Altitude Physiology 898
Heat-Related Altitude Classifications 899 • Altitude
Emergencies 838 Acclimatization 902

Altitude-Related Problems 903

Anatomy and Physiology 839
Common Heat-Related Emergencies 842
Heat Illness 842 • Heat-Related Illness
Prevention 845 • Sunburn 845 • Lightning 848
Assessment 850
Heat-Induced Syncope 850 • Heat Cramps 851 •
Heat Exhaustion 851 • Heat Stroke 852 •
Sunburn 852 • Lightning Strikes 852
Management 852
Heat-Induced Syncope 852 • Heat Cramps 852 •
Heat Exhaustion 852 • Heat Stroke 853 •
Sunburn 854 • Lightning Strikes 855
Acute Mountain Sickness 903 • High-Altitude Pulmonary
Edema 904 • High-Altitude Cerebral Edema 905 •
Other Altitude-Related Problems 906
Prevention of Altitude Illnesses 909
Patient Assessment 911
Patient Management 912
General Management 912 • AMS Treatment 913 •
HAPE Treatment 913 • HACE Treatment 913 •
Khumbu Cough Treatment 913 • Treatment of Other
Problems 914

Water Emergencies 919

Plant and Animal
Emergencies 861 Anatomy and Physiology 921
Boyle’s Law 923 • Henry’s Law 923 • Dalton’s
Law 923
Anatomy and Physiology 862
Adverse Effects and Emergencies from Common Common Water Emergencies 924
Submersion Injuries 924 • Barotrauma 927 •
Plants and Fungi 863
Nitrogen Narcosis 929 • Swimmer’s Ear 929 •
Plants Toxic to the Skin 863 • Plants Toxic upon Breath Holding 929 • Trauma 930 • Injuries by
Ingestion 865 • Poisonous Mushrooms 870 Aquatic Animals 930 • Aggravation of Existing
Conditions 931
Adverse Effects from Various Animals 871
Spiders 871 • Scorpions 874 • Ticks 874 • Preventing Water Emergencies 931
Bees, Wasps, and Hornets 875 • Mosquitoes, Fleas,
and Biting Flies 876 • Ants 876 • Patient Assessment 933
Reptiles 878 • Marine Creatures 880 •
Patient Management 934
Mammals 882

Assessment 885 Section 7

Plants and Mushrooms 886 • Spiders and SPECIAL POPULATIONS
Scorpions 886 • Tick Bites 886 • Bee
Stings 886 • Mosquito, Insect, and Ant AND SITUATIONS 942
Bites 886 • Reptile Bites 887 • Injuries Caused
by Marine Animals 887 • Injuries Caused by
Mammals 887
Pediatric Emergencies 942
Management 887
Care of Cases Involving Plant Toxins 888 • Care of Anatomy and Physiology 943
Cases Involving Ingested Plant and Mushroom
Toxins 888 • Care for Cases Involving Biting and
Human Growth
Stinging Creatures 888 • Care of Snake Bites 889 • and Development 946
Care of Injuries by Marine Creatures 889 • Care for The Newborn Stage 947 • Infancy 947 • The
Animal Bites 889 • Large Animal-Related Toddler Stage 947 • The Preschool Period 947 •
Trauma 890 The School-Age Period 948 • Adolescence 949
x CONTENTS

Common Pediatric Illnesses and Injuries 950
Airway Problems 950 • Respiratory Failure and Cardiac
Arrest 952 • Abdominal Pain 953 • Nausea,
Vomiting, and Diarrhea 953 • Seizures 953 •
Meningitis 954 • Poisoning 954 • Sudden Infant
Death Syndrome 957 • Trauma 957 • Burns
and Electrocutions 959 • Child Abuse and
Neglect 960 • Shock 961
Physical Disabilities 1015 • Visually and Hearing
Impaired Adaptive Athletes 1018 • Combined Physical
and Intellectual Disability 1018
Adaptive Equipment 1019
General Equipment 1020 • Snow Sports
Equipment 1022 • Warm Weather Sports
Equipment 1025

Assessment 963 Assessment 1028

Scene Size-Up, MOI, and Consent 963 • Primary Assessing Athletes with Intellectual Disabilities 1029 •
Assessment 965 • Secondary Assessment 966 Assessing Adaptive Athletes with Physical Disabilities 1030

Management 975 Management 1031

Lift Evacuation Considerations 1033

Geriatric Emergencies 985

Behavioral Emergencies
Physiologic Changes of Aging 987 and Crisis Response 1039
Neurological Changes 988 • Cardiovascular
Changes 988 • Respiratory Changes 988 • Anatomy and Physiology 1041
Gastrointestinal Changes 988 • Changes in Renal
Function and Electrolyte Balance 989 • Musculoskeletal
Common Behavioral Emergencies 1042
Changes 989 • Integumentary and Endocrine Medical Disorders 1042 • Chemical
Changes 989 Exposures 1043 • Trauma 1043 • Behavioral
Conditions 1043
Common Geriatric Illnesses
and Conditions 991 Death and Grief 1047
Obvious Signs of Death 1047 • Grief 1048 •
Altered Mental Status 991 • Hypertension 991 •
Post-Traumatic Stress Disorder 1049
Myocardial Infarction 992 • Congestive Heart
Failure 992 • Syncope 992 • Stroke 992 • Assessment 1051
Chronic Obstructive Pulmonary Disease 992 •
Scene Safety 1051 • Patient Assessment 1051
Abdominal Emergencies 993

Medication Use in the Elderly 993 Management 1056

Restraints 1058 • Critical Incident
Trauma Considerations in Elderly Patients 996 Stress 1060
Falls 996 • Hip and Pelvic Fractures 997 •
Traumatic Brain Injury 997 • Cervical Spine
Injury 998 Obstetric
Elder Abuse 998 and Gynecologic
Additional Considerations 999 Emergencies 1068
Artificial Joints 999 • Implantable Devices 999 •
External Openings, Ports, and Apparatus 1000 • Anatomy & Physiology 1069
Advanced Directives 1000 • Communicating with Ovaries 1070 • Fallopian Tubes 1070 •
Elderly Patients 1000 Uterus 1071 • Vagina 1071 •
Perineum 1071 • The Reproductive Cycle 1071
Assessment 1001
Common Obstetrical and Gynecological
Management 1003
Emergencies 1073
Abdominal Pain 1073 • Vaginal Bleeding 1075 •
Gynecological Trauma 1075 • Sexual Assault 1075
Outdoor Adaptive
Athletes 1009 Pregnancy: Normal Physiologic Changes 1077
Complications of Pregnancy 1078
Common Disabilities 1011 Hemorrhage 1078 • Pregnancy-Induced Hypertension
Intellectual Disabilities 1012 • Cognitive (PIH) 1078 • Miscarriage 1078 • Supine
Disabilities 1013 • Intellectual Difficulties 1013 • Hypotensive Syndrome 1079
 CONTENTS xi

Childbirth 1079 Uterus

Placenta

Fundus
Search and Rescue 1118
of uterus

Avalanche Rescue 1120 • Low-Angle

Basic Care of Newborns 1085
Umbilica
cord
Rescue 1123 • Confined Space Rescue 1125 •
Trauma During Pregnancy 1088 Amniotic
fluid
Water Rescue 1128

Assessment 1089 Cervix

of uterus

Rectum
Symphysis pubis
Fire Ground Operations 1128
Urinary bladder

Management 1091 Perineum

Vagina (birth canal)

Section 8
ALS Interface 1136
BEYOND OEC 1100 Advanced Life Support 1138
Transition of Care to ALS Providers 1138 • Advanced
Special Operations Airway Management 1141 • Mechanical
Ventilators 1152 • Metered-Dose Inhaler/
and Ambulance Nebulizer 1153 • Intravenous (IV) Therapy 1156 •
Operations 1100 Cardiac Monitoring and Electrical Therapy 1159 •
Electrical Therapy 1160 • Medication
Administration 1162
Ambulance Operations 1101
Preparing for a Call 1102 • Responding to a Working and Moving as a Team 1165
Call 1103 • Arriving at the Scene 1103 •
Transferring Patients 1105 • Extricating a Patient from Ambulance Stretcher Operation 1165
a Vehicle 1105

Disaster Response 1108 APP A SURVIVAL: The Rule of Threes 1171

National Disaster Medical System (NDMS) 1110 • APP B Student OEC Skill Guide 1173
Medical Reserve Corps (MRC) 1111 • Community APP C Emergency Care Equipment 1175
Emergency Response Team (CERT) 1111
Glossary 1179
Hazardous Materials Response 1111 Answer Key 1198
Mechanism of Action of Nerve Agents 1116 • Index 1219
Recommended Dosing Schedules for Exposure to a Nerve
Agent 1116
 OEC Skills
3-1 Removing Contaminated Gloves, 91 18-9 Bandaging a Finger, 573
5-1 Multiple Person Direct Ground Lift, 160 19-1 Caring for Burns, 597
5-2 Bridge/BEAN Lift, 161 20-1 Applying Sling and Swathe, 676
7-1 Patient Assessment, 248 20-2 Creating and Applying a Figure Eight Splint, 677
7-2 Patient Assessment—Trauma Patient, 249 20-3 Reducing a Posterior Sternoclavicular (S/C) Injury, 678
7-3 Patient Assessment—Medical Patient, 249 20-4 Applying a Blanket Roll Splint to a Shoulder, 678
7-4 Assessing Pupils, 250 20-5 Splinting a Humerus Fracture Using a Rigid Splint, 679
7-5 Assessing Pulse, 250 20-6 Rigid Splint Fixation of an Injured Elbow, 679
7-6 Assessing Respiration Rate, 251 20-7 Splinting a Forearm Fracture, 680
7-7 Obtaining a Blood Pressure by Auscultation, 251 20-8 Splinting to Immobilize the Hand, 680
9-1 Suctioning a Patient’s Airway, 317 20-9 Applying a Traction Splint to a Femur, 681
9-2 Inserting a Nasopharyngeal Airway, 318 20-10 Applying an Airplane Splint, 682
9-3 Inserting an Oropharyngeal Airway, 319 20-11 Applying a Quick Splint, 682
9-4 Oxygen Tank Set-Up and Breakdown, 320 20-12 Replacing a Quick Splint with a Cardboard Splint, 683
10-1 Shock Management, 350 20-13 Immobilizing a Tib-Fib Fracture with Two Rigid Splints, 683
13-1 Auscultation of Breath Sounds, 426 20-14 Removing a Boot, 684
13-2 Assisting with a Metered-Dose Inhaler, 427 21-1 Manual Spine Stabilization, 727
14-1 Administration with an Auto-injector: EpiPen™, 450 21-2 Sizing and Applying a Cervical Collar, 727
14-2 Adiministration with an Auto-injector: Twinject™, 451 21-3 Supine Patient: Log Roll onto a Long Spine Board, 728
14-3 Adiministration with an Auto-injector: Twinject™ 21-4 The Axial Drag, 728
Additional Dose, 452 21-5 Securing the Patient onto a Long Spine Board, 729
15-1 AED Use, 490 21-6 Immobilizing a Seated Patient, 729–730
18-1 Controlling Bleeding, 566 21-7 Immobilizing a Standing Patient, 730
18-2 Applying a Tourniquet, 567 21-8 Removing a Helmet from a Lying Patient, 731
18-3 Treating Closed Soft-Tissue Injuries, 568 22-1 Treatment of an Impaled Object in the Eye, 765
18-4 Emergency Care for an Amputated Part, 569 24-1 Pelvic Stabilization, 808
18-5 Stablizing an Impaled Object, 570 33-1 Physical/Mechanical Restraint of a Patient, 1062
18-6 Using a Self-Adhering Roller Bandage, 571 34-1 Assisting with Childbirth, 1092–1093
18-7 Using an Occlusive Dressing, 571 36-1 Preparing a Set-up for IV Therapy, 1167
18-8 Using a Triangular Bandage Bandana Wrap, 572

xii
Letter to Students
Dear Student:

Welcome to the world of outdoor emergency care. No other program currently on the market offers the specific
training needed to handle outdoor medical emergencies as comprehensively as this one. This text was developed
primarily for the members of the National Ski Patrol. It is, however, relevant to all emergency first responders in
outdoor environments.

The contributing authors and reviewers are highly respected experts in education in the outdoor emergency care
community. The editors and reviewers, for the most part, have been active members, medical experts, and teachers
in the National Ski Patrol for many years, serving the public at their local ski areas. The vast experience of these
individuals, amounting to a total of over 90 years of EMS work and ski patrolling from the editors alone, has been
incorporated into the chapters of this book, providing you with a learning environment that is rich in practical
knowledge.

When you begin this course, we encourage you to scan through this text and learn how it is organized. Each
chapter provides you with a Case Study; Stop, Think, Understand self quizzes; Chapter Review exercises; and a
Scenario, all designed to provide you the best possible learning environment to practice what you have learned.
You will also find information on the first page of each chapter related to the NSP’s history providing insight on
how and why our organization was founded.

Before the development of this book, many patrollers, OEC instructors, and representatives from other outdoor
programs were interviewed to determine what information would be valuable in this program, and how best to
present it to you. Our primary goal of this textbook was to make the OEC program both educational and enjoyable.
We hope this is the case for you. This book is intended not only as your text during your training but also as a
valuable reference manual you can keep on your bookshelf for future use. The information is current Emergency
Medical System information and will be valuable to you during your future refresher training programs.

We hope you find this text valuable as you enjoy many years of service as an Outdoor Emergency Care Technician.
Good luck to you all.

Editor Medical Editor

xiii
 Preface
W
elcome to the National Ski Patrol’s (NSP) Outdoor Emergency Care, Fifth Edition.
Medical education for ski patrollers has evolved over the years. In 1985, Winter
Emergency Care, the precursor to Outdoor Emergency Care (OEC), was written pri-
marily by Warren Bowman, MD. Dr. Bowman was the principal author for the next two
editions as well. He was responsible for changing the book’s name to Outdoor Emergency
Care, as content began to provide information pertaining to all four seasons. Other emer-
gency medical providers who will benefit from this book can include river-rafting guides,
park rangers, hunting and fishing guides, mountain biking organizations, or first respon-
ders who work in police or fire departments.
As OEC evolved, other prehospital medical authorities have increased their participa-
tion in the creation of the text. In OEC4, editors Dr. Bowman and Dr. David Johe called
on multiple authors and reviewers. In this edition (OEC5), the NSP partnered with a new
publisher—Brady—to develop and evolve OEC to new levels of publishing and perfor-
mance excellence. Now over 40 authors, nearly 100 reviewers, and many other people af-
filiated with the NSP have spent many volunteer hours working on this project. One
individual, Ed McNamara, was the glue and the driving force behind the book. His lead-
ership was instrumental in keeping the team together and focused.
Completion of this project has been a pleasure and a rewarding pursuit that has taken
well over four years. In 2006, Dr. Michael Millin and Ed McNamara proposed the devel-
opment of OEC5 to Larry Bost, National Education Chair, and to the NSP Board. After
receiving approval, they began developing the Table of Contents, recruiting authors, and
starting the manuscript-writing process. Many of these authors are leading authorities in
their respective fields.
In the summer of 2007, Denis Meade was hired by the NSP to serve as its National Ed-
ucation Director, and he immediately joined the OEC5 team. Realizing the need for addi-
tional assistance with the project, Ed McNamara appointed Deborah Endly, Assistant
National OEC Program Director, as Chair of the OEC5 Collaterals Committee, which
brings to you the excellent teaching and student support package beyond this textbook.
Toward the end of the initial writing process, Dr. Millin stepped down as National
Medical Advisor. However, he continued to participate in OEC5, reviewing and complet-
ing several chapters, and was a truly important part of the process. In January 2008,
Dr. David Johe was appointed National Medical Advisor and joined the OEC5 team.
In the fall of 2007, the National Ski Patrol decided to evaluate various noteworthy pub-
lishers throughout the country and to select one that is respected by the EMS profession
and would provide our members the best program possible. After exhaustive research, our
staff recommended that the OEC5 team partner with Brady/Pearson Education.
Although OEC4 was very successful, the team working on OEC5 worked from the
ground up to put the text into one voice and to make all the chapters consistent. This edi-
tion contains all-new material, and each chapter was written and completed using the most
recent evidence-based medical information.
This text contains material that has never appeared in previous editions. It is also a com-
bination textbook-workbook in which users write their answers to questions concerning
core content.
The feature Stop, Think, Understand incorporates workbook-style exercises throughout
each chapter to check the user’s comprehension.
The first chapter includes some of the history of the NSP and OEC and has an impor-
tant discussion of some of the legal aspects that we all face when caring for a patient.
xiv
 PREFACE xv

All OEC Technicians need to be familiar with current EMS language and need to be able
to communicate among each other and with other EMS providers using the same vernac-
ular. Chapters on both communication and documentation are included for this purpose.
Patient assessment is now presented in the same way patients are assessed in the health
care system. In addition, the A&P section has been expanded in each chapter, the for-
mat for case management has been modified for easier use, and skill guides have been
included in many chapters to enable users to readily assess their abilities in the practi-
cal training sessions.
Chapters also contain new information that is up to date with current prehospital pa-
tient care. Some examples include new assessment modules, the use of pulse oximeters,
an expanded role for OEC Technicians in assisting patients with medications, use of
Mark 1 kits, discussions of the enhanced role of tourniquets, some new ways to apply
bandages and splints, and more in-depth discussions of anatomy.
The material in this edition meets—and in many cases exceeds—the National EMS Edu-
cation Standards for Emergency Medical Responders. However, this material is presented
in a format that combines the disciplines of urban EMS and wilderness medical rescue.
In addition, this edition was updated to incorporate relevant 2010 ECC recommenda-
tions for CPR. The editors, with the counsel of medical experts, modified some con-
tent to comply with their interpretation of the new guidelines.
The last chapter of the text, Chapter 36, was authored by a physician who has written ex-
tensively for the wilderness medicine field, and it helps OEC Technicians understand what
advanced EMS providers do. When asked to assist these providers, OEC Technicians—
when legally allowed to do so—can provide this assistance. It is important to note that this
chapter is NOT part of the OEC curriculum and can be taught only by personnel with advanced
training after receiving approval from mountain management, the Mountains patrol Medical Di-
rector, and in compliance with state and local regulations.
Beyond the textbook, students have access to an online resource called myNSPkit. This
web-based tool includes additional exercises and multimedia examples to reinforce con-
tent and skills. Instructors have access to a PowerPoint presentation, a test bank, an In-
structor Manual, and other materials needed to teach this course.
The National Ski Patrol is a unique organization that has provided training and care to
countless individuals in outdoor environments. Originally, it was designed for ski pa-
trollers. As ski patrollers joined other first-responder organizations such as Search and Res-
cue and Emergency Medical Services, they found that the training they received is widely
accepted by those organizations. And in some states successful completion of an OEC
course allows the individual the opportunity through reciprocity to obtain an EMS Emer-
gency Medical Responder card. Because of the strength of the OEC program, many other
agencies now look to the NSP for OEC courses as a primary education program for Emer-
gency Medical Responders. We expect this audience to expand following the release of this
new approach to training.

Special Tribute
National Ski Patrol pays special tribute to Doug Howlett, who was actively in-
volved in the National Ski Patrol from 1971 until he passed away in 2010. As
a member of the Collateral Committee for Outdoor Emergency Care, Fifth Edi-
tion, Doug contributed to the development of the PowerPoint program.
 Acknowledgments
hank you to every writer and participant who brought this teaching package together.

T We would like to especially thank NSP’s Larry Bost, Terry Laliberte, Bela Musits, Bob
Scarlett, and Tim White for providing their guidance and this opportunity.
Representatives from Brady were extremely helpful in providing guidance and direc-
tion in the development and production of this book. In particular, we would like to thank
Marlene Pratt, Editor-in-Chief, and Lois Berlowitz, Senior Managing Editor, for their on-
going support and willingness to provide insight and guidance at any time during the de-
velopment of the program. Finally, we want to thank Susan Simpfenderfer of Triple SSS
Press Media Development, Inc., for her tremendous time and effort in the development,
reviewing, editing, and production process. Susan made herself available to us days, nights,
weekends, and holidays. She constantly provided support, direction, editorial assistance,
and encouragement as we moved forward through development of this book. This project
would not have been successfully accomplished without her dedication and professional in-
volvement. Many thanks to Brady and Triple SSS.

Contributors
We wish to acknowledge the remarkable talents and efforts of the following people who
contributed to this edition of Outdoor Emergency Care. Individually, they worked with ex-
traordinary commitment on this program. Together, they form a team of highly dedicated
professionals who have upheld the highest standards of EMS instruction.

CHAPTER 1 Introduction to Michael G. Millin, MD, MPH, CHAPTER 4 Incident Command

Outdoor Emergency Care
Warren Bowman, MD, FACP
Member, U.S. Ski Patrol
National #3537
David Johe, MD
Orthopedic Surgeon
Current NSP National Medical Advisor
Member, Holiday Valley Ski Patrol
Ellicottville, NY
National #8690
Robert Scarlett, Esq.
NSP National Legal Counsel
Member, Ski Liberty Ski Patrol
Carroll Valley, PA
National #8118
CHAPTER 2 Emergency Care
Systems
Denis Meade, MA, EMTP
Former NSP Education Director
Owner, Curriculum by Design
Littleton, CO
FACEP
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University School of
Medicine
Member, Ski Liberty Ski Patrol
Carroll Valley, PA
CHAPTER 3 Rescue Basics
Eric P. Bowman, MD, FACEP,
FAWM
Section of Wilderness Medicine Director
Department of Emergency Medicine
York Hospital
Member, Ski Liberty Ski Patrol
Carroll Valley, PA
Paul Murphy, MS, MA, EMT-P
Paul Murphy Consulting, Inc.
Member, Bear Mountain Ski Patrol
California
and Triage
Denis Meade, MA, EMTP
Former NSP Education Director
Owner, Curriculum by Design
Littleton, CO
Edward McNamara, BS, NREMTP
Executive Director, Central MA EMS
Corp
National OEC Program Director; Sterling
Fire Dept. Dep. Fire Chief
Member, Wachusett Mountain Ski Patrol
Princeton, MA
National #7858
CHAPTER 5 Moving, Lifting,
and Transporting Patients
Jonathan Politis, EMT-P
Member, Willard Mountain Ski Patrol
Greenwich, NY
National #10996

xvi

CHAPTER 6 Anatomy
and Physiology
David Markenson, MD, FAAP,
EMT-P
Chief Pediatric Emergency Medicine
Maria Fareri Children’s Hospital
New York Medical College
Member, Sterling Forest Ski Patrol
Tuxedo, NY
CHAPTER 7 Patient Assessment
Michael G. Millin, MD, MPH,
FACEP
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University School
of Medicine
Member, Ski Liberty Ski Patrol
Carroll Valley, PA
Denis Meade, MA, EMTP
Former NSP Education Director
Owner, Curriculum by Design
Littleton, CO
CHAPTER 8 Medical
Communications and
Documentation
Jonathan Busko, MD, MPH, EMT-P
Medical Director, Maine Region, Eastern
Division, NSP
Medical Director, Hermon Mountain Ski
Patrol
Medical Director, Maine EMS Region 4
Emergency Physician, Eastern Maine
Medical Center
Member, Hermon Mountain Ski Patrol
Stockton Springs, ME
CHAPTER 9 Airway Management
Scott E. McIntosh, MD, MPH
Assistant Professor
Division of Emergency Medicine
University of Utah
CHAPTER 10 Shock
Michael Levy, MD, FACP, FAAEM
Emergency Medicine
Alaska Regional Hospital
EMS Areawide Medical Director
Anchorage Fire Deparment
Member, Alaska Admin Patrol
Alaska
CHAPTER 11 Altered Mental Status
John S. Nichols, MD, PhD, FACS
St. Anthony Hospital
Department of Neurosurgery
Medical Advisor
NSP Rocky Mountain Division
Member, Winter Park Pro Patrol
Colorado
Nici Singletary, MD, FACEP
Clinical–Associate Professor
Department of Emergency Medicine
University of Virginia
Charlottesville, VA
The Medical Clinic of Big Sky
Member, Northern Admin Patrol
National #7474
CHAPTER 12 Substance Abuse
and Poisoning
Maurus Sorg, MD, MPH, FAWM
Diplomate American Board of Family
Practice
Diplomate of American Board of
Emergency Medicine
Member Wilderness Medical Society
Fellow of Academy of Wilderness Medicine
Department of Emergency Medicine
Elk Regional Health Center
Saint Marys, PA
CHAPTER 13 Respiratiory
Emergencies
Fred A. Severyn, MD, FACEP
Associate Professor of Surgery
Division of Emergency Medicine
University of Colorado Denver School of
Medicine
CHAPTER 14 Allergies
and Anaphylaxis
Denis Meade, MA, EMTP
Former NSP Education Director
Owner, Curriculum by Design
Littleton, CO
CHAPTER 15 Cardiovascular
Emergencies
John Latimer, MD
Department of Emergency Medicine
Wachusett Emergency Physicians
Medical Director Wachusett Mountain
Ski Patrol
Princeton, MA
ACKNOWLEDGMENTS xvii
Roxanne Latimer, MD
Assistant Professor
Department of Family Medicine
University of Massachusetts Medical School
Member, Wachusett Mountain Ski Patrol
Princeton, MA
Michael G. Millin, MD, MPH,
FACEP
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University School of
Medicine
Member, Ski Liberty Ski Patrol
Carroll Valley, PA
Edward McNamara, BS, NREMTP
Executive Director, Central MA EMS.
Corp
National OEC Program Director; Sterling
Fire Dept. Dep. Fire Chief
Member, Wachusett Mountain Ski Patrol
Princeton, MA
National #7858
CHAPTER 16 Gastrointestinal and
Genitourinary Emergencies
Denis Meade, MA, EMTP
Former NSP Education Director
Owner, Curriculum by Design
Littleton, CO
Michael G. Millin, MD, MPH,
FACEP
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University School of
Medicine
Member, Ski Liberty Ski Patrol
Carroll Valley, PA
CHAPTER 17 Principles of Trauma
Seth C. Hawkins, MD, FAWM
Assistant Professor, Wilderness Emergency
Medical Care,
Western Carolina University
Executive Director, Appalachian Center for
Wilderness Medicine
Sylva, NC
CHAPTER 18 Soft-Tissue Injuries
David Johe, MD
Orthopedic Surgeon
Current NSP National Medical Advisor
Member, Holiday Valley Ski Patrol
Ellicottville, NY
National #8690
xviii ACKNOWLEDGMENTS

CHAPTER 19 Burns CHAPTER 24 Abdominal and CHAPTER 27 Plant and Animal

Pelvic Trauma
Jane Lee Fansler, MD
Resident Eric M. Lamberts, MD, FAAFP,
Department of Surgery, Division of ASAM certified
Emergency Medicine Far West Medical Advisor
Stanford Hospital and Clinics National Ski Patrol
Clinical Professor Psychiatry
CHAPTER 20 Musculoskeletal University of Nevada School of Medicine
Injuries Member, Sky Tavern Pro Patrol
Emergencies
Joshua Kucker, MD
Attending Physician
Santa Rosa Memorial Hospital Emergency
Department/Trauma Center
Clinical Instructor
Stanford University School of Medicine,
Division of Emergency Medicine

David Johe, MD CHAPTER 25 Cold-Related CHAPTER 28 Altitude-Related

Orthopedic Surgeon
Current NSP National Medical Advisor
Member, Holiday Valley Ski Patrol
Ellicottville, NY
National # 8690
CHAPTER 21 Head
and Spine Injuries
John S. Nichols, MD, PhD, FACS
Neurological Surgeon
St. Anthony Hospital
NSP Rocky Mountain Division
Member, Winter Park Pro Patrol
Colorado
Michael Bateman, EMT-B,
OEC Technician
Member, Winter Park Pro Patrol
Colorado
CHAPTER 22 Face, Eye
and Neck Injuries
Bruce Evans, MD
Assistant Professor
University of Colorado Denver, Division of
Emergency Medicine, Department of
Surgery, School of Medicine
Member, Alumni
Colorado
CHAPTER 23 Thoracic Trauma
James Geiling, MD, FACP, FCCM
Chief, Medical Service: VA Medical Center
Associate Professor of Medicine
Dartmouth Medical School
Member, Dartmouth Skiway Ski Patrol
Hanover, NH
Matthew Fulton, BA, NREMTP
Patrol Director, Dartmouth Ski Patrol
Member, Dartmouth Skiway Ski Patrol
Hanover, NH
Emergencies
Marion C. McDevitt, DO
Emergency Medicine University of Utah
Wilderness Medicine and EMS Fellow,
Emergency Medicine University of Utah
Member, Park City Ski Patrol
Park City, UT
Gregory A. Bala, MS
Chair, Outdoor Emergency Care Refresher
Committee
Member, Kelly Canyon Ski Patrol
Ririe, ID
National # 9128
Colin K. Grissom, MD
Professor Medicine, University of Utah
Critical Care Medicine, Shock Trauma
Intensive Care Unit
Intermountain Medical Center
Member, Park City Ski Patrol
Park City, UT
CHAPTER 26 Heat-Related
Emergencies
Gregory A. Bala, MS
Chair, Outdoor Emergency Care Refresher
Committee
Member, Kelly Canyon Ski Patrol
Ririe, ID
National # 9128
Colin K. Grissom, MD
Professor Medicine, University of Utah
Critical Care Medicine, Shock Trauma
Intensive Care Unit
Intermountain Medical Center
Member, Park City Ski Patrol
Park City, UT
Marion C. McDevitt, DO
Emergency Medicine University of Utah
Wilderness Medicine and EMS Fellow,
Emergency Medicine University of Utah
Member, Park City Ski Patrol
Park City, UT
Emergencies
Luanne Freer, MD, FACEP, FAWM
Medical Director, Yellowstone National
Park
Founder/Director, Everest ER
Past President, Wilderness Medical Society
Member, Yellowstone Club Medical Ski
Patrol
Bozeman, MT
CHAPTER 29 Water Emergencies
Jeffrey Druck, MD, FACEP
Associate Professor, Emergency Medicine
University of Colorado Denver
School of Medicine
Associate Residency Director
Denver Health Residency Program in
Emergency Medicine
CHAPTER 30 Pediatric
Emergencies
David C. Walker, MD, FAAP
Clinical Assistant Professor
Rainbow Babies and Children’s Hospital
Case-Western Reserve Medical School
Member, Ohio Nordics
Concord Township, OH
National #10550
Brigitte Schran Brown, M.Ed, EMT
Clinical Case Manager, Academy Trainer,
Medical Assistant
Washington State Dept. of Social and
Health Services Child Protective Services
Member, Summit at Snoqualmie Ski
Patrol
Snoqualmie, WA
LCA #8205
 ACKNOWLEDGMENTS xix

CHAPTER 31 Geriatric CHAPTER 34 Obstetric and Howard “Mike” Laney

Emergencies Gynecologic Emergencies
Ricky Kue, MPH, MD, FACEP Nici Singletary, MD, FACEP
Associate Medical Director Cl. Associate Professor
Boston EMS Department of Emergency Medicine
Assistant Professor, University of Virginia
Boston University School of Medicine Charlottesville, VA
The Medical Clinic of Big Sky
Member, Northern Admin
CHAPTER 32 Outdoor Adaptive
Athletes National #7474
Bruce Evans, MD CHAPTER 35 Special Operations
Assistant Professor
and Ambulance Operations
Division of Emergency Medicine and
Emergency Services Denis Meade, MA, EMTP
University of Colorado Denver, Division of Former NSP Education Director
Emergency Medicine, Department of Owner, Curriculum by Design
Surgery, School of Medicine Littleton, CO
Member, Alumni Michael G. Millin, MD, MPH,
Colorado FACEP
Assistant Professor
CHAPTER 33 Behavioral
Department of Emergency Medicine
Emergencies and Crisis Response
Johns Hopkins University School of
Medicine
Matthew J. Levy, DO, MS,
Member, Ski Liberty Ski Patrol
NREMTP
Carroll Valley, PA
Chief Resident
Department of Emergency Medicine Rick King
Johns Hopkins University School of Patroller–NSP MTR Program Director
Medicine Member, Perfect North Slopes Patrol
Member, Donner Ski Ranch Lawrenceburg, IN
Norden, CA National #9998
Patroller–NSP Avalanche Program
Director
Member, Sugar Bowl Ski Patrol
Norden, CA
National #4411
Frank Rossi
Patroller–PACNW MTR Advisor
Member, Summit East Ski Patrol
Snoqualmie Pass, WA
National #3459
CHAPTER 36 ALS Interface
Jamie A. Jenkins, MD
Attending Emergency Department
Physician
Washington Hospital Center/Union
Memorial Hospital
Ultrasound Fellow
Paul S. Auerbach, MD, MS, FACEP,
FAWM
Redlich Family Professor of Surgery
Division of Emergency Medicine
Stanford University School of Medicine
Stanford, CA
Co-Founder and Past President,
Wilderness Medical Society
Medical Committee, National Ski Patrol
System
Consultant, Divers Alert Network

Reviewers
The following reviewers were commissioned by the National Ski Patrol. We wish to thank
them for providing invaluable feedback and suggestions in preparation of Outdoor
Emergency Care, Fifth Edition. Individuals with gold star by their name are recognized for
reviewing and providing feedback on a significant number of chapters.

Larry Bost Micaela Saeftel, MBA David Hemendinger

Chairman, National Education Committee European Division OEC Supervisor EMARI Regional OEC Administrator
National #9538 OEC Instructor, OEC IT OEC Instructor, OEC IT, EMT
U.S. Ski Patrol-Admin. Heidelberg Ski Patrol Yawgoo Valley Ski Patrol, RI
Denver, CO Bill Cathey, JD Karen Anderson-Hadden, RN, BS
Bill DeVarney, CSP, EMT OEC IT; Northern Division Director Bronson Methodist Hospital,
Eastern Division OEC Chief Kalamazoo, MI
Keith Tatsukawa, MD
Administrative Supervisor Central Division OEC Supervisor,
Far West Division (FWD) Medical
National #9170 OEC IT
Advisor
National #8329
Carol Fountain, RN, MN, ONC FWD OEC Supervisor
TimberRidge Ski Patrol Gobles, MI
OEC Instructor, OEC IT Squaw Valley, CA, Ski Patrol
Instructor Development Instructor, ID IT Squaw Valley, CA Robert L. Andre, DVM
National #5980 OEC IT
Chris Fletcher
Boise, ID Sr OEC TE
OEC Instructor/OEC IT
Hunt Hollow Ski Patrol
Paul D. Brooks, BS, MS, MICP Instructor Development Advisor
Naples, NY
OEC Supervisor, Alaska Division Wachusett Mountain Ski Patrol
National Appointment #7751
OEC Instructor, IT
Pro Patrol, Alyeska Resort
xx ACKNOWLEDGMENTS

Paula Knight Teresa T. Stewart, BHS, MHS, Ian Archibald, MD, FAAOS, FACS
Southington Public Schools CEM(c), EMT-B Carolina Orthopedics and Sports Medicine
Southington, CT Administrative Officer—NDMS/SC-1 Clinic, Gastonia, NC
Gifted and Talented Resource Teacher Senior Auxiliary, Division ID Supervisor, Medical Advisor, Southern Division NSP
OEC Assistant Supervisor Eastern OEC IT, Southern Cross Snowshoe Ski Patrol, WV
Division; OEC IT Hawksnest/Smoky Nordic Patrols John B. Woodland, MD
National #7249 Charlotte, NC Vail Valley Emergency Physicians
Mount Southington Ski Patrol Charles L. Lentz Vail Pro Patrol
Scott R. Rockefeller, MA OEC Instructor, Instructor Development Vail, CO
EMT-B, EMT Instructor, EMT- Instructor Milton (Skeet) Glatterer, Jr., MD,
Examiner National #8320 FACS
Lee Volunteer Ambulance Squad Appalachian Ski Patrol, Southern Division Cardiothoracic and Vascular Surgery
Eastern Division OEC Assistant Boone, NC Mountain Rescue Association: Chairman,
Supervisor Cathy LaMarre Medical Committee
LCA #8345 OEC Instructor, EMT-B Alpine Rescue Team, Evergreen, CO
Ski Butternut National #10464 OEC IT
Barrington, MA Appalachian Ski Patrol Copper Mountain Ski Patrol, CO
Randy Harrison Boone, NC Forest Harris, MD, FACP
Regional OEC Advisor Jennifer Laitala, AS, EMT Medical Advisor, Ski Liberty
OEC and Nordic IT OEC Instructor, Sr OEC TE Fairfield, PA
Southern Idaho Region, PNWD National #10738
Boise, ID Thomas Pulling, MD
Wachusett Mountain Ski Patrol Sports Medicine
Michael Parnell, DVM, PhD Princeton, MA Maine Medical Center
Northern Division, OEC Supervisor E.M. “Nici” Singletary, MD, FACEP Portland, ME
Miles City, MT Associate Professor of Emergency Medicine OEC Instructor
Dan Schaefer University of Virginia Alpine and Nordic Ski Patrols
Northern OEC Assistant Supervisor Charlottesville, VA Portland, ME
Huff Hills Ski Patrol James R. Kopp, MD, FACS James A. Margolis, MD
Mandan, ND Orthopedic Surgeon OEC IT
Steven L. Thompson Medical Advisor Pacific Northwest Medical Advisor ESR
OEC Instructor, OEC IT Division LCA #8387
National #4668 OEC Instructor, OEC IT, Homewood Ski Patrol
Montana Snow Bowl Ski Patrol National #8504 Homewood, CA
Missoula, MT Anthony Lakes Ski Patrol James Brady, MD
La Grande, OR
Bill Mills MedExpress Urgent Care
OEC Instructor, OEC IT Kathy Mahoney, MD, FACOG Arkansas Valley Regional Medical Center, CO
National #6007 Assistant Clinical Professor of Medicine Medical Associate, OEC Instructor
Lost Trail Powder Mountain Tufts University Seven Springs Ski Patrol
Darby, MT Boston, MA Champion, PA
OEC Instructor
William Lay Kristi A. Ball, MBA, RN, NREMT-B
Okemo Mountain Resort Ski Patrol
OEC Instructor, OEC IT Emergency Department Manager
Ludlow, VT
National #14924 ISJ-Mayo Health System
Great Falls Ski Patrol Eugene Eby, MD, FACEP OEC IT, Nat. #10112
Great Falls, MT EMS Medical Director Littleton, Porter Three Rivers Park District Ski Patrol
and Parker Hospitals Bloomington, MN
Kim Lees
Medical Director Littleton Fire
Central Division, SW Region ROA Chuck Clements II, MD
Department
Seven Oaks Ski Patrol Professor of Clinical Medicine
Denver, CO
Boone, IA Director of Wilderness Medicine
Pamela Bourg, RN, MS, ANP, CNS Marshall University School of Medicine
Robert B. Scarlett, Esquire
Director Trauma Services Program Winterplace Ski Patrol
Volunteer National Legal Counsel
St. Anthony Central Hospital Huntington, WV
Ski Liberty Ski Patrol, PA
Denver, CO
Carroll Valley, PA
OEC Instructor
Copper Mountain Ski Patrol, Denver, CO
 ACKNOWLEDGMENTS xxi

Mami Aiello Iwamoto, MD, FACS Brigitte Schran Brown, MEd, MA, Neil P. Blackington, EMT-T
Ophthalmic Consultants of Boston EMT Deputy Superintendent–Commander of
Instructor of Ophthalmology Foundation for Care Management Support Services
Harvard Department of Ophthalmology Vashon Island, WA City of Boston Emergency Medical Services
Boston, MA National #8205 OEC Instructor
OEC TE, S&T TE Summit Central Ski Patrol Bradford Ski Patrol
Sunday River Ski Patrol Snoqualmie Pass, WA Haverhill, MA
Newey, ME John J. Clair Carrie L. Vondrus
Cassandra H. Proctor, RN National Chair, 1996–2000 OEC Instructor, OEC IT
Orthopedic Nurse EMT & OEC Instructor OEC Supervisor, 2006–2009
Sparrow Health Systems National #4115 Intermountain Division—Alumni
OEC Instructor Brighton, UT Ski Patrol Ogden, UT
Caberfae Peaks Ski Patrol Jay Reidy, MA, PhD Jeffrey P. Burko, EMA-II, EMT-I,
Edith McNamara, RN, EMT OEC, CPR Instructor ACLS-P
Sterling, MA Pasadena, CA OEC Instructor
OEC IT, Senior EMM TE, S&T TE Peak Emergency Response Training
Bernie Goddard
National #8068 British Columbia, Canada
National #7535
Wachusett Mt. Ski Patrol OEC Instructor, OEC IT Stephen Francisco
Princeton, MA Summit at Snoqualmie, OEC IT
Jamie A. Jenkins, MD Snoqualmie, WA National #8928
Emergency Ultrasound Fellow June Mountain Ski Patrol
Michelle R. Landry, MPH
Department of Emergency Medicine June Lake, CA
Project Director, Center for Health Policy
Washington Hospital Center/Union & Research, Paul Rauschke
Memorial Hospital UMASS OEC Instructor
Washington, DC Worcester, MA Colorado Mountain College
Bryant F. Hall, MBA, BS (MT), OEC Instructor, Senior EMM T/E Leadville, CO
NREMT-P Wachusett Mountain Ski Patrol, Erik Forsythe
Monongalia Emergency Medical Services, Princeton, MA EMT-P, OEC, WALS
Paramedic Karen Majors, RD Professional Division OEC Supervisor
Tucker County Emergency Medical Wild Mountain Ski Patrol Director, Crested Butte Professional Ski
Services, Paramedic Taylor Falls, MN Patrol
National #10076 Crested Butte, CO
OEC Instructor, OEC IT Susan Mullenix
Canaan Valley Ski Patrol OEC Instructor John E. Mirus, MBA, EMT-I
Davis, WV Central Division Section 2, OEC IT
Lutsen Mountain Ski Patrol Keystone Ski Patrol
Jim Derzon Lutsen, MN Keystone, CO
OEC/S&T Instructor
Ski Liberty Tom Olander, BA, NREMT-P Col. John J. Teevens (USAF Ret.)
Carroll Valley, PA National #6198 BS, MA, NREMT-P, OEC
OEC Instructor Instructor NSP National #10800
Steve Donelan Massanutten Ski Patrol Keystone Ski Patrol
OEC Instructor, OEC IT Harrisburg, VA Keystone, CO
Pinecrest Nordic Ski Patrol
Pinecrest, CA Cheryl Gall Tiernan Frederick Fowler, EMT-P
OEC IT Executive Director
John T. Henderson, Jr., JD, EMT National #8622 Southeastern Massachusetts EMS Council
New Cumberland Fire Department Central Division, Section 1, Western Middleboro, MA
New Cumberland, PA Michigan Region Past Member—Willard Mountain Ski
Liberty Mountain Resort Ski Patrol Bittersweet Ski Patrol Patrol
Carroll Valley, PA Ostego, MI Middleboro, MA
Jack D. Bogdon, BS, EMT-B Elizabeth (Liz) Dodge Walt Alan Stoy, PhD, EMT-P
OEC Instructor OEC Instructor, OEC IT Professor and Director, Emergency
Camelback Mountain Ski Patrol National #6464 Medicine Program
Tannersville, PA Region Director, NW Region, PNWD University of Pittsburgh
Timothy R. Thayer, BS, EMT-B Summit At Snoqualmie–Central Ski OEC Instructor
EMS Instructor Patrol Hidden Valley Ski Patrol
Anoka Technical College, Anoka, MN Snoqualmie, WA Hidden Valley, PA
OEC Instructor
Afton Alps Ski Patrol
Hastings, MN
xxii ACKNOWLEDGMENTS

Diane M. Barletta, MEd, EMT-B Wesley R. Shifflett, EMT-P Steven Hauser, EMT-P
Assistant Director EMT Instructor Director
Central MA EMS Corp. Page County Fire–EMS Strategic Emergency Response Training
Holden, MA Luray, VA and Consultation
Bob Elling, EMT-P, MPA Mark Podgwaite, NREMT-I, Sheridan, CA
Clinical Instructor, Albany Medical Center NECEMS I/C Bela Musits, EMT-B
Paramedic—Colonie EMS Department Training Coordinator Gore Mt. Patrol
Paramedic—Whiteface Medical Services Vermont EMS District 6 National #7175
Area North Creek, NY
Charles L. Parmley
Lake Placid, NY
Program Coordinator Stephen Simi
David P. Fending, NREMT-P North Tech High School Fire/EMS OEC IT
Faculty, Pickens Technical College Academy Far West Division
Adjunct Faculty, Arapahoe and Red Rocks
David Jay Kleiman, NREMT-P,
Community College Aurora, Lakewood, NSP Office Staff
CCEMT-P
and Littleton, CO
Paramedic Instructor
John J. McAuliffe, LT/EMT Timothy G. White
Melissa K. F. Johnson, BA, Executive Director
Sterling Fire Department Dive Rescue
NREMT-P National Ski Patrol
Public Safety Diving Instructor and Ice
AHA Instructor–BLS and ACLS Sol Vista Ski Patrol
Rescue Instructor
PHTLS Instructor Lakewood, CO
Sterling, MA
PEPP Instructor
Derrick Congdon, EMT-P VA EMT Instructor and ALS Coordinator, Carol Hudson, AA-Science
Assistant Regional Director EMS Captain Education Assistant,
Mass Region 4 EMS James City County Fire Department National Ski Patrol
Burlington, MA OEC, Auxiliary Patroller
Robert E. Sippel, MS, LP, NREMT-P Sol Vista Ski Patrol
Janet L. Read, EMT I/C, NSP IT, Assistant Professor Granby, CO
EMT-B University of Texas Health Science Center
EMT Educator San Antonio, TX Denise D. Cheney, BS
Training Specialist Outdoor Recreation, Cal Poly, Pomona
Evelyn D. Barnum, CCEMTP/IC, Executive Assistant, National Ski Patrol
American Red Cross of Central Mass
PhD OEC Instructor, Senior Auxiliary
Worcester, MA
Lansing Community College Loveland Volunteer Ski Patrol
Stephanie Dralle Health & Human Services Loveland Basin, CO
Disaster Preparedness/EMS Coordinator Lansing, MI
Advocate South Suburban Hospital Contributing Medical
Richard Davis, JD
Hazel Crest, IL
Rocky Mt. Division Legal Advisor Editor
Marc A. Minkler, NREMT-P,
Robert Ferris, AAS, FF2/NREMT-P
CCEMT-P Michael G. Millin, MD, MPH,
EMS Specialist
Paramedic/Firefighter FACEP
Memorial Health System
Maine State EMS Instructor Coordinator Assistant Professor
Black Forest Fire Rescue
Department of Emergency Medicine
Adam Lee Taylor-Vaughan, MS, Colorado Springs, CO
Johns Hopkins University School of
RN, ACNP, BC, NREMT-P,
Ann Gassman Medicine
CCRN-CSC
Rocky Mt. Division OEC Supervisor
Instructor of Surgery/Paramedic/Acute
National #7602
Care Nurse Practitioner
 ACKNOWLEDGMENTS xxiii

Collateral Committee
We wish to thank the following instructors and physicians who worked on development of the
text’s appendices, the art and photo program, and the student exercises, as well as on the prepa-
ration of instructor resources that accompany Outdoor Emergency Care, Fifth Edition.

Associate Editor for Collateral Deborah Foss, RT, EMT Traci Tenhulzen, BS
Student and Instructor Materials West Boylston, MA Exercise Physiology/Ergonomics
Deborah A. Endly, BA, DH, OEC IT, CPR Instructor American Red Cross CPR/FA/AED
NREMT-B National #9824 Instructor
Senior Investigator, State of Minnesota Wachusett Mountain Ski Patrol Woodinville, WA
Minneapolis, MN Princeton, MA Summit at Snoqualmie Central Ski Patrol
National Assistant OEC Program Director Snoqualmie Pass, WA
Student Exercises
Three Rivers Patrol-Hyland Janet Glaeser, BA, MEd
Bloomington, MN Brigitte Schran Brown, MEd, MA, National Board Member, Education
EMT Committee
Appendices Medical CME Boston Mills/Brandywine Ski Patrol
Foundation for Care Management Parma, OH
Chuck Clements, II, MD
Vashon Island, WA
Professor, Clinical Medicine Douglas W. Howlett, BA, MS, EdD
OEC IT, OEC Refresher Committee
Director of Wilderness Medicine Former National Instructor Development
Summit at Snoqualmie Pass Central Ski
Marshall University School of Medicine Program Director
Patrol
Huntington, WV Former OEC IT
Snoqualmie Pass, WA
Southern Division Medical Committee Somerdale, NJ
Winterplace Ski Patrol Timothy Thayer, BS, EMT-B Spring Mountain Ski Patrol
Ghent, WV EMS Instructor Mount, PA
Anoka Technical College
Kathleen A. Mahoney, MD, FACOG Alida Moonen
Anoka, MN
Assistant Clinical Professor of Medicine Boston Mills/Brandywine Ski Patrol
OEC Instructor
Tufts University Sagamore Hills, OH
Afton Alps Ski Patrol
Boston, MA
Afton, MN Matt Kurjanowicz
OEC Instructor
Okemo Mountain Resort Ski Patrol Instructor Manual Summit at Snoqualmie Pass Central Ski
Ludlow, VT Patrol
Kathy Glynn, LPN, NREMT-B Snoqualmie Pass, WA
Jeannine Mogan, EMT-B Eagan, MN
Alpine Patrol Supervisor OEC IT, Central Division OEC Supervisor Nancy Pitsick, BA, MT (ASCP)
Three Rivers Park District Three Rivers Patrol-Hyland Vice President, Immunology
Plymouth, MN Bloomington, MN Division Manager ARUP Laboratories
Patrol Representative, Central Division Salt Lake City, UT
Supervisor-Introduction to Patrolling Vicki R. Zierden OEC Refresher Committee
Three Rivers Patrol-Hyland Bloomington, MN Brighton Ski Patrol
Bloomington, MN OEC IT Salt Lake City, UT
Three Rivers Patrol-Hyland
Mary Ellen Walker, MD, MPH Bloomington, MN Test Program
Family Physician
MyNSPkit and PowerPoint Program Shelia Daly, RN, MS, CPHQ
Seattle, WA
President and CEO Clinton Hospital
Geoffrey S. Ferguson, MD Clinton, MA
Art and Photo Program Director, Vascular and Interventional OEC IT, Assistant Patrol Director
Catharine V. Setzer, BS, MEd Radiology Wachusett Mountain Ski Patrol
Slippery Rock, PA Evergreen Hospital Medical Center Princeton, MA
OEC IT, OEC Refresher Committee Kirkland, WA
Boyce Park Ski Patrol Medical Auxiliary Ski Patrol, Snoqualmie Scott R. Rockefeller, MA, EMT-B
Pittsburgh, PA Pass EMT Supervisor EMT Instructor & Examiner
Alpental Ski Patrol American Heart Association Faculty
Edith S. McNamara, RN, EMT Member, Fairview Hospital
Snoqualmie Pass, WA
Sterling, MA Lee, MA
OEC IT, Sr OEC & S&T Examiner Steve Achelis, WEMT-I Eastern Division Assistant OEC
CPR Instructor Software/Book Author Supervisor
National #8068 Salt Lake City, UT Ski Butternut
Wachusett Mountain Ski Patrol OEC Instructor Lee, MA
Princeton, MA Brighton Ski Patrol
Brighton, UT
 About the Editors
EDWARD C. MCNAMARA, BS, NREMT-P
Edward C. McNamara is a Founding Incorporator and Ex-
ecutive Director of the Central Massachusetts Emergency
Medical Systems Corporation, where he has served for
the past 34 years. In addition, he is Deputy Chief of Ster-
ling Massachusetts Fire Department and Safety Officer/
Paramedic for Massachusetts 2 DMAT (Disaster Medical
Assistance Team). He has also served as an EMT since 1974
and as a National Registry Paramedic for the past 12 years.
Before beginning his career in Health Administration,
Mr. McNamara received his BS in Education from Nor-
wich University and then spent three years in the Army. In
2001 he retired as a Colonel from the Massachusetts Army
National Guard after 30 years of service. He currently
serves as the Chair of the MA Central Region Homeland
Security Council, a member of the state’s Interoperability
Executive Committee, and on other EMS-related commit-
tees. Mr. McNamara was also a paramedic instructor at the
community college level and is an AHA Regional Faculty
member.
For the past eight years, Mr. McNamara has served as
the National OEC Program Director for the National Ski
Patrol, and as a member of the NSP Medical Advisory
Committee. Mr. McNamara, a 30-year patroller, is also a
former Eastern Division OEC Supervisor, Patrol Director,
Regional Director, Regional OEC Administrator, and
Chief Senior OEC Trainer Evaluator. He is the recipi-
ent of 2 purple, one blue and several yellow merit stars and
the Distinguished Service Award. He was the winner of the
2005 National Administrative Patroller of the Year, and he
currently patrols at Wachusett Mt. Ski Area in Princeton,
MA. He has been awarded National #7858.
Personal Acknowledgement: I would like to thank my
wife, advisor, and best friend Edee for her tremendous sup-
port and extraordinary patience these past five years during
the production of this book.
xxiv
DAVID H. JOHE, MD
David H. Johe, MD, is an orthopedic surgeon in private
practice, Saint Mary’s, Pennsylvania. He has practiced or-
thopedics in northwestern Pennsylvania and western New
York since 1982. He attended medical school at West Vir-
ginia University, Morgantown, West Virginia; completed
his internship at Hartford Hospital, Hartford, Connecti-
cut; and completed his residency at University Hospitals of
Cleveland, Cleveland, Ohio. David is currently affiliated
with Elk Regional Health Center, Saint Mary’s, PA; Al-
legheny Health Systems, Bradford Division, Bradford, PA;
and Kane Hospital, Kane, PA.
David is a member of the American Medical Associa-
tion and the Pennsylvania Orthopedic Society, and is a
Founding Board Member, EMCO East, which provides
prehospital care to northwestern Pennsylvania.
David has been a member of the Holiday Valley Ski Pa-
trol, Ellicottville, NY, since 1990. In addition, he is an
OEC Instructor, is the National Medical Advisor for the
National Ski Patrol, and is Chairman of National Medical
Advisory Committee National Appointment (NSP) #8690.
David’s other interests include restoration of antique
cars and raising Braque d’Auvergne bird dogs.
Personal Acknowledgement: For Roslyn, a very special
thank you for your support.

DEBORAH A. ENDLY, BA, DH, NREMT-B
Deborah A. Endly has been a Senior Investigator for the
State of Minnesota and Compliance Officer for the Min-
nesota Board of Dentistry since 1995. Ms. Endly received
her A.S. degree in Dental Hygiene and a B.A. in Business
Administration and Human Resource Management. She
has also taught university-level dental hygiene courses at
Argosy University, Eagan, MN.
In addition, Ms. Endly is a Minnesota-licensed Dental
Hygienist as well as an NREMT-B and a Basic Life Sup-
port Instructor for the American Heart Association. Prior
to earning her EMT licensure, Ms. Endly was registered in
the State of Minnesota as a First Responder. She also has
served on and has training in her local Citizen Emergency
Response Team (CERT) and currently serves as one of the
blood-borne pathogen trainers for Three Rivers Park Dis-
trict in Minnesota.
Ms. Endly has been a member of the National Ski Pa-
trol since 1993. She has served as the Chair of the Collat-
eral Committee for Outdoor Emergency Care, Fifth Edition,
ABOUT THE EDITORS xxv
since August 2007 and was appointed National Assistant
OEC Program Director in August 2008. Before accepting
these national positions, Ms. Endly served as the Central
Division OEC Supervisor for eight years and also served as
the Region OEC Administrator before her Division ap-
pointment.
Additional National Ski Patrol positions include local
patrol refresher Instructor of Record and OEC candidate
class. Ms. Endly is also an Instructor Trainer in both OEC
and Instructor Development and was one of the team
members who developed the OEC Practical Final and con-
tinues to work with that team. She has been the recipient
of multiple Yellow Merit Stars, the Central Division Out-
standing Supervisor Award, the Region Director Award,
Region Outstanding Administrative Patroller, as well as
Outstanding Instructor and Patroller at the local level. She
currently patrols and serves as a shift leader at the Three
Rivers Patrol-Hyland, in Bloomington, MN, National
#8305.
Guide to Key Features
Historical Timeline
Multiple Choice
Each chapter begins with a visual timeline that documents Choose the correct answer. c. pathogens
history and key events from the National Ski Patrol’s archives. 1. Which of the following is not a physical response to
stress?____________
d. antibodies
4. When dressing for outdoor winter activities, what is the optimal
a. nausea number of layers to wear?____________
b. rapid breathing a. 4
c. dilated pupils b. 3
d. constricted pupils c. 2
2. When the core body temperature drops below 98.6°F, numerous d. 1
events take place to conserve body heat and increase heat 5. Which of the following is not a recommended way to purify
Introduction to production. What of the following events does not help with heat
production or heat conservation?____________
surface water?____________
a. boiling
a. shivering stops
Outdoor b. shivering increases
c. metabolism increases
b. iodine tablets
c. chlorine dioxide tablets
d. solar radiation

Emergency David Johe, MD

d. blood vessels in the skin constrict
3. Which of the following are leukocytes?____________

Care Warren Bowman, MD

Robert Scarlett, Esquire
a. red blood cells
b. white blood cells

Fill in the Blank

+ OBJECTIVES
1. During the “fight or flight” response, blood flow increases to the____________ and ____________ muscles.
Upon completion of this chapter, the OEC Technician will be able to:
2. ____________, ____________, ____________, and ____________ can weaken the immune system.
1-1 Describe the evolution and purpose of the National Ski Patrol’s OEC program.
3. ____________ clothing has no insulating value and takes a long time to dry, and thus it is a poor choice for outdoor winter activities.
1-2 Describe the history of the National Ski Patrol.
1-3 Identify the founder of the National Ski Patrol. 4. Heat always transfers from the ____________ object to the ____________ object.
1-4 Describe the role of National Ski Patrol in the formation of the U.S. Army’s 10th Mountain
Division.
Matching
1-5 Compare and contrast the OEC textbook and OEC course/curriculum.
Match each mechanism of heat transfer with the correct description at right.
1-6 Describe the organization of the OEC worktext and its use during an OEC course or OEC
refresher course. __________ 1. conduction a. the transfer of heat when a gas or liquid moves past your body
1-7 Describe the OEC certification and recertification processes. b. the transfer of heat when a liquid becomes a gas
__________ 2. convection c. the absorption or reflection of electromagnetic waves
1-8 Contrast the standard of training and standard of care.
continued __________ 3. radiation d. the transfer of heat from a warmer object to a cooler one through direct contact
__________ 4. evaporation

Chapter Overview
Society today has many varied outdoor activities, especially sporting ones, during
which injuries or illness may occur. Among the many winter sporting events, most
people enjoy either skiing or snowboarding. The National Ski Patrol (NSP) has
created a course called Outdoor Emergency Care to provide emergency medical
care for individuals injured outdoors. The Outdoor Emergency Care program is
the backbone of the National Ski Patrol’s medical training program. It is also the
Stop, Think, Understand
standard of training for other organizations involved with outdoor recreation.
continued These exercises (including multiple-choice, matching, true/false,
and short answer questions, and labeling activities) make this a true
Minnie Dole breaks his Frank Edson dies due to Minnie Dole publishes an “work-text” where readers can test and internalize their knowledge.
1/2/1936

3/1936

1936

ankle on ski slope in injuries suffered in a crash article in an annual American

Stowe, Vermont. His during ski race. ski publication summarizing
friend, Frank Edson, and ski accident causes and
others transport Dole down the slope prevention.
using a piece of corrugated tin roofing.

Chapter Objectives
Also placed in margins, these appear
CHAPTER 5 MOVING, LIFTING, AND TRANSPORTING PATIENTS 127 Key Terms next to content that meets the objective.
5-11 Describe and demonstrate how to safely move when near a helicopter.
5-12 Describe the use of CPR during transport.
These are listed with page references at
+ KEY TERMS the start of each chapter. Additionally, 1-1 Describe the evolution and
basket stretcher, p. 131
body mechanics, p. 128
lift, p. 143
long spine board (LSB), p. 131
semi-Fowler position, p. 146
stair chair, p. 152
each key term is placed in the margin purpose of the National Ski
carry, p. 131
drag, p. 136
move, p. 135
orthopedic stretcher, p. 131
Trendelenburg position, p. 146
with its full definition, next to where it is Patrol’s OEC program.
high-Fowler position, p. 146 patient package, p. 127
landing zone (LZ), p. 155 Rothberg position, p. 146 first covered in the text.
Of all the tasks performed by OEC Technicians, moving, lifting, and transporting
patients present some of the greatest challenges and risks. The reason is that OEC
Technicians must perform these tasks under difficult conditions, often with limited 1-2 Describe the history of the
resources. In addition to moving and lifting patients from awkward positions, OEC
Technicians often must carry, lift, or transport a patient package weighing more than
300 pounds. Even when this weight is shared between two or more rescuers, carry-
patient package the combination
of the patient, any equipment needed to
National Ski Patrol.
ing and/or sliding a heavy weight over snow, ice, and uneven terrain is tough, back- care for the patient, and the device used
breaking work, even under the best of circumstances. to transport the patient. CHAPTER 1 INTRODUCTION TO OUTDOOR EMERGENCY CARE 3

Figure 5-1a Sometimes injured patients can assist with their

extrication.
Copyright Scott Smith
1-3 Identify the founder of the
You are ski patrolling alone for the first time after having completed all of your OEC training. You receive a call to
respond to an accident in the parking lot of a condominium complex next to the resort. Although this condominium
is not part of the ski resort, your management has an agreement to provide medical coverage to adjacent proper-
National Ski Patrol.
ties such as this because most guests staying there are also guests of the resort.
The call involves an eight-year-old girl who apparently was hit by a car that has left the scene. Upon your arrival,
you find the child lying on the ground holding her leg. She is crying and asks repeatedly for her parents. An adult
man says he was walking by and found the child. He states that he is not related to the child and has never met her.

What should you do?

niche of prehospital care. River rafters, cavers, park rangers, mountain bike race per- prehospital care any medical care
sonnel, search-and-rescue personnel, rescuers at large sporting events, cruise-ship rendered by trained personnel prior to
Figure 5-1b This injured alpine skier must be transported by toboggan. medical personnel, and medical rescuers at large outdoor concerts will find the infor- arrival at a hospital.
Copyright Scott Smith
mation in this text invaluable when providing care for patients.
The prospective OEC Technician will learn how to function with minimal equip- 1-1 Describe the evolution and
ment in outdoor environments while assessing and caring for the sick and injured. As purpose of the National Ski
Patrol’s OEC program.
important as medical knowledge is the demeanor of the OEC Technician in dealing
with patients, the public, and other emergency personnel. This text emphasizes the
OEC Technician’s ability to interact well with patients and their families, the public, 1-2 Describe the history of the
peers, management, and other medical personnel (Figure 1-2䊏). National Ski Patrol.
This chapter opens with a brief history of the National Ski Patrol and Charles
Minot “Minnie” Dole, its founder. It also includes the history of OEC and of 1-3 Identify the founder of the
Dr. Warren Bowman, the man who is credited with its inception. The last portion of National Ski Patrol.
the chapter gives a brief overview of the medical-legal issues that OEC Technicians
confidentiality the nondisclosure
may encounter. We will review ethical considerations, reporting requirements,
of personal information except to an
confidentiality, negligence, and abandonment.
authorized person with the need to
know.

Figure 1-2 An OEC Technician giving emergency care to a mountain biker.

Copyright Mike Halloran
 Case Study
Threaded through each chapter, these are introduced as the
It is a chilly afternoon with moderate cloud cover. You have just entered the mid-mountain lodge and are looking
Case Presentation, followed up in the Case Update, and
forward to a well-earned bowl of hot soup when you are summoned to respond to a skier who has fallen approxi- concluded in the Case Disposition.
mately 30 feet from a chairlift. The skier reportedly landed on a rock pile and is unconscious. You notify dispatch that
you are responding.
Upon arrival, you see that the patient has fallen into a ravine, and that extrication will require specialized equip-
ment and other rescuers. Two other OEC Technicians are already on scene and have initiated care of the patient. One
of the technicians is Peter, the newest member of your patrol, who has been assigned to you for mentoring. He is at
the patient’s head while the other technician is assessing the patient for injuries. You note that Peter is wearing only
a sweater and a lightweight outer shell.
As you approach, Peter looks up, smiles nervously, and then gives you a brief report on the patient’s condition.
As he speaks, you note that he is shivering slightly. It is then that you realize that Peter is not wearing a hat and that Reaching into your pack, you hand Peter your spare wool hat and a dry set of waterproof gloves. You then assist the
his gloves appear to be soaked. A light, freezing rain begins to fall. other technician in treating the injured patient. Still other rescuers arrive and begin setting up a rescue plan. As you
continue to work, the weather becomes more severe as a mixture of snow and hail begins to fall. The temperature
Do you have one patient to address, or two?
starts to drop and the wind increases. Peter’s coat is not waterproof, and within minutes he is soaked. His fingertips
are becoming numb and he repeatedly takes off his gloves to blow on his hands. You are about to say something
to him when his stomach growls loudly. Embarrassed, he looks at you and says, “It was a late night last night, and
I skipped breakfast.” Glancing at your watch, you note that it is 1:30 p.m.

What is the best way to help both the patient and Peter?

Pulling Peter aside, you instruct him to remove his wet jacket, and you give him your backup waterproof jacket. You
also hand him two of your energy bars. As the rescue efforts continue, Peter realizes that he was not prepared for
the scene. You instruct another rescuer to take Peter back to the ski area first-aid station so that he can be checked
and warmed up. A few minutes later, Peter is heading to the first-aid room on the back of a snowmobile, covered
with a wool blanket. Although Peter survived this event without any major complications, he learned some valuable
lessons about being appropriately prepared, both physically and mentally.

CHAPTER 9 AIRWAY MANAGEMENT 319

OEC SKILL 9-3 Inserting an Oropharyngeal Airway

OEC Skills
Many chapters end with a OEC skill, a visual
guide to the skills covered. Some conclude with c

Skill Guides—checklists for skills performance.

Size the airway by measuring from the corner of the mouth to
the ear.
Copyright Scott Smith

324 SECTION 3 CRITICAL INTERVENTIONS

Date: ____________
(CPI) ⫽ Critical Performance Indicator
Candidate: ______________________________________
Start Time: ______________________________________
End Time: ______________________________________

Inserting an Oropharyngeal Airway (OPA)

Objective: To measure and insert an oral airway into an adult.

Check for airway patency by ventilating the patient.

Max Skill Copyright Scott Smith
Skill Points Demo

Initiate Standard Precautions. 1 (CPI)

Hold the adjunct against the side of the face with the flange adjacent to the 1 (CPI)
corner of the patient’s mouth. Size the airway by measuring from the
patient’s earlobe to the corner of the mouth or from the corner of the mouth
to the angle of the jaw.
Open the patient’s mouth with the cross-finger technique. Hold the airway 1 (CPI)
upside down with your other hand. Insert the airway with the tip facing the
roof of the mouth and slide it in until it is half way into the mouth.

Rotate the airway 180°. Insert the airway until the flange rests on the patient’s 1 (CPI)
lips. Insert the airway using the crossed-finger technique to open the
mouth.
Copyright Scott Smith
Must receive 4 out of 4 points.

Comments: __________________________________________
___________________________________________________________
Failure of any of the CPIs is an automatic failure.
Evaluator: ______________________________ NSP ID:______________________________________________________________
PASS FAIL
 164 SECTION 1 PREPARING TO BE AN OEC TECHNICIAN CHAPTER 5 MOVING, LIFTING, AND TRANSPORTING PATIENTS 165

4. Which of the following is not a backsmart tip?____________

a. Turn with your feet, not your hips. c. Keep objects close to your body.
b. Bend at your waist. d. Do not reach over your head.
5. All of the following are used by OEC Technicians to move, lift, or carry a patient except____________
a. a long spine board. c. rescue parallel bars.
b. an orthopedic stretcher. d. a short spine board.
6. What is the first principle of medicine?____________
The skills of lifting, moving, and transporting using good body dition. OEC Technicians must learn how to properly package pa- a. Use Standard Precautions. c. Help others who cannot help themselves.
mechanics must be mastered by every OEC Technician, because tients for transportation. b. Do no harm. d. Maintain scene safety.
an understanding of the techniques involved is essential for the The helicopter is an amazing rescue tool that can save lives 7. Which of the following is a long-axis drag?____________
care of the patient, and for the patient’s and the rescuers’ safety. due to its ability to bring both rescuers and equipment to the
a. blanket drag c. chair carry
On occasion, a patient will be located in an area that poses an im- scene rapidly, to extract patients from remote locations, and to
mediate threat to life and must be urgently moved to a safe loca- speed the transport of patients to definitive care. It is essential b. human crutch d. two-person assist
tion. These emergency moves are best accomplished by a that everyone on the scene have a basic understanding of landing
“long-axis drag,” which helps keep the patient’s spine in proper zone selection and procedures for operating in and around a hel- Matching
alignment. icopter. Toboggan transport of a patient in full arrest is difficult.
As part of their training, OEC Technicians must master the Decide the best method for your ski area, which will vary depend- Match each of the following patient conditions with the most common position for transport.
equipment and devices they will use in all conditions. Extreme ing on terrain. Practice this skill often so that when it is needed,
__________ 1. semi-Fowler position a. a patient who is experiencing breathing problems
care must be exercised with patients to avoid handling them you are prepared.
roughly or dropping them, which is likely to aggravate their con- __________ 2. high-Fowler position b. a patient with spinal injuries
__________ 3. supine position c. a patient with chest pain and a suspected heart attack
d. a patient in shock
__________ 4. Rothenberg position
e. a patient who is awake and for whom no spinal injury is
__________ 5. Trendelenburg position suspected
1. Back injuries may be prevented through exercise, weight 6. Used properly, equipment can facilitate a move or a lift.
maintenance, and good body mechanics. 7. A landing zone should be at least 100 feet by 100 feet. Short Answer
2. Plan each move carefully; get help when lifting. 8. Do not approach a helicopter unless instructed to do so by
3. Keep your back straight and lift with your legs. the pilot or a crew member; keep your head low. List six basic principles of helicopter safety.
4. Do not drop the patient. 9. Never approach a helicopter from the rear.
5. Urgent moves require preserving the long axis of the spine.

Multiple Choice
You receive a call to the tubing park to aid an injured party. Once on scene, you find a 30-year-old male whose right lower
Choose the correct answer. leg is wedged between two trees. The patient is responsive and alert but has slurred speech. He complains of severe pain to his
1. In what position would a patient with a lower extremity injury be transported off the hill?____________ lower right leg. The patient states he was “horsing around” with two friends while tubing down the slope. He tells you he
a. sitting on a snowmobile c. head uphill was “bumped,” which forced him off the lane and into the trees. His friends state that he hit the trees “feet first.” The
b. injury facing downhill d. head downhill patient denies striking his head, neck, or back and reports no pain in those areas. The friends admit to having been drinking.

2. In what position would a patient with an upper extremity injury be transported off the hill?____________ Assessment of the patient’s leg leads you to suspect a possible closed fracture of the right leg.
a. sitting on a snowmobile c. feet uphill 1. What type of move is needed for this extrication?____________
b. injury downhill d. feet downhill a. a nonurgent move c. a shoulder drag
3. Which of the following is not a basic LZ guideline?____________ b. an urgent move d. a fore and aft carry
a. The site must be free of overhead obstructions and wires. After closing the outside lane and securing the scene, you request assistance and equipment. Another OEC Technician arrives
b. The site should be well lit. and you formulate an extrication plan.
c. The site must be a minimum of 100 feet by 100 feet. 2. Most back injuries to rescuers are caused by____________
d. Point spotlights toward the aircraft. a. not enough rescuers. c. poor body mechanics.
b. adverse terrain. d. oversized patients.

Chapter Review 166 SECTION 1 PREPARING TO BE AN OEC TECHNICIAN

Included here are a Chapter Summary, Other rescuers arrive with the treatment and transport equipment. The patient is packaged and ready to load in the

Remember . . . , Chapter Questions, Scenario, toboggan. Due to intense pain, the patient is not able to assist in moving himself to the toboggan. You decide to cravat his legs
together and lift him. You have a total of four patrollers at the scene to help.

Suggested Reading, and Explore myNSPkit, an 3. Which of the following types of lift is appropriate for placing the patient into the toboggan?____________
a. Extremity lift c. Direct ground lift

online resource. b. BEAM lift d. BEAN lift

Lipke, Rick. 2009. Technical Rescue Riggers Guide, Second Edition, Conterra, Inc. Bellingham, WA.

Please go to www.myNSPkit.com. Under Student Resources, you will find

animations, videos, web links, and games related to this chapter—and much
more. Look for additional information on the lifts covered in this chapter.
Register your access code from the front of your book by going to
www.myNSPkit.com and selecting the appropriate links. If the in-cover
access code has been redeemed, go to www.myNSPkit.com and follow
links to Buy Access.
Photography
A completely new, dynamic, and visually appealing photo
program captures the spirit and skill of working in the outdoors.

myNSPkit
A one-stop shop for all online instructor and
student resources, including lesson plans, testing
program, and PowerPoints (for instructors), and
quizzes, animations, audio glossary, games,
and web links (for instructors and students).
This page intentionally left blank
 Introduction to
Outdoor
Emergency David Johe, MD

Care Warren Bowman, MD

Robert Scarlett, Esquire

+ OBJECTIVES
Upon completion of this chapter, the OEC Technician will be able to:

1-1 Describe the evolution and purpose of the National Ski Patrol’s OEC program.
1-2 Describe the history of the National Ski Patrol.
1-3 Identify the founder of the National Ski Patrol.
1-4 Describe the role of National Ski Patrol in the formation of the U.S. Army’s 10th Mountain
Division.
1-5 Compare and contrast the OEC textbook and OEC course/curriculum.
1-6 Describe the organization of the OEC worktext and its use during an OEC course or OEC
refresher course.
1-7 Describe the OEC certification and recertification processes.
1-8 Contrast the standard of training and standard of care.
continued

Chapter Overview
Society today has many varied outdoor activities, especially sporting ones, during
which injuries or illness may occur. Among the many winter sporting events, most
people enjoy either skiing or snowboarding. The National Ski Patrol (NSP) has
created a course called Outdoor Emergency Care to provide emergency medical
care for individuals injured outdoors. The Outdoor Emergency Care program is
the backbone of the National Ski Patrol’s medical training program. It is also the
standard of training for other organizations involved with outdoor recreation.
continued

HISTORICAL TIMELINE

Minnie Dole breaks his Frank Edson dies due to Minnie Dole publishes an
1/2/1936

3/1936

1936

ankle on ski slope in injuries suffered in a crash article in an annual American

Stowe, Vermont. His during ski race. ski publication summarizing
friend, Frank Edson, and ski accident causes and
others transport Dole down the slope prevention.
using a piece of corrugated tin roofing.
2 SECTION 1 PREPARING TO BE AN OEC TECHNICIAN

1-9 Define the following legal terms:

• abandonment • consent
• assault • duty to act
• battery • negligence
• breach of duty
1-10 Describe the following forms of consent:
• expressed consent • informed consent
• implied consent • minor consent
1-11 Describe the impact of Good Samaritan laws on volunteer rescuers.

+ KEY TERMS
abandonment, p. 17 expressed content, p. 21 National OEC Refresher Committee,
assault, p. 23 Good Samaritan laws, p. 15 p. 12
battery, p. 23 Health Insurance Portability and National Ski Patrol System, Inc.
Accountability Act (HIPAA), p. 25 (NSP), p. 4
breach of duty, p. 18
informed consent, p. 21 negligence, p. 18
Charles Minot “Minnie” Dole, p. 4
implied consent, p. 22 Outdoor Emergency Care (OEC), p. 1
confidentiality, p. 3
minor consent, p. 21 prehospital care, p. 3
consent, p. 21
National Medical Advisor, p. 6 refresher, p. 12
doctrine of public reliance, p. 17
National Medical Committee, p. 11 scenario, p. 9
duty to act, p. 18
National OEC Program Committee, standard of care, p. 21
Emergency Medical Responder
(EMR), p. 20 p. 11 standard of training, p. 21
ethics, p. 15 National OEC Program Director, p. 12

Outdoor Emergency Care
(OEC) a course of medical instruction
developed and taught by National Ski
Patrol.
Outdoor Emergency Care, is the primary resource for a student who wants to be-
come a ski patroller or an OEC Technician, but it also has value for other outdoor en-
thusiasts (Figure 1-1䊏). National Ski Patrol OEC Technicians, people who are
enjoying the outdoors, or other rescuers can use this text as an educational tool. It
bridges the gap between medical responders with access to an ambulance and ad-
vanced equipment, and wilderness search-and-rescue personnel who are several
hours from advanced care. No other comprehensive medical textbook covers this

Figure 1-1 These covers show the

evolution of the Outdoor Emergency Care
texts, which teach intermediate care to
outdoor enthusiasts. The textbook has
progressed from the American Red Cross
First Aid to this Fifth Edition.
Copyright Caleb Hund
 CHAPTER 1 INTRODUCTION TO OUTDOOR EMERGENCY CARE 3

You are ski patrolling alone for the first time after having completed all of your OEC training. You receive a call to
respond to an accident in the parking lot of a condominium complex next to the resort. Although this condominium
is not part of the ski resort, your management has an agreement to provide medical coverage to adjacent proper-
ties such as this because most guests staying there are also guests of the resort.
The call involves an eight-year-old girl who apparently was hit by a car that has left the scene. Upon your arrival,
you find the child lying on the ground holding her leg. She is crying and asks repeatedly for her parents. An adult
man says he was walking by and found the child. He states that he is not related to the child and has never met her.

What should you do?

niche of prehospital care. River rafters, cavers, park rangers, mountain bike race per- prehospital care any medical care
sonnel, search-and-rescue personnel, rescuers at large sporting events, cruise-ship rendered by trained personnel prior to
medical personnel, and medical rescuers at large outdoor concerts will find the infor- arrival at a hospital.
mation in this text invaluable when providing care for patients.
The prospective OEC Technician will learn how to function with minimal equip- 1-1 Describe the evolution and
ment in outdoor environments while assessing and caring for the sick and injured. As purpose of the National Ski
Patrol’s OEC program.
important as medical knowledge is the demeanor of the OEC Technician in dealing
with patients, the public, and other emergency personnel. This text emphasizes the
OEC Technician’s ability to interact well with patients and their families, the public, 1-2 Describe the history of the
peers, management, and other medical personnel (Figure 1-2䊏). National Ski Patrol.
This chapter opens with a brief history of the National Ski Patrol and Charles
Minot “Minnie” Dole, its founder. It also includes the history of OEC and of 1-3 Identify the founder of the
Dr. Warren Bowman, the man who is credited with its inception. The last portion of National Ski Patrol.
the chapter gives a brief overview of the medical-legal issues that OEC Technicians
confidentiality the nondisclosure
may encounter. We will review ethical considerations, reporting requirements,
of personal information except to an
confidentiality, negligence, and abandonment.
authorized person with the need to
know.

Figure 1-2 An OEC Technician giving emergency care to a mountain biker.

Copyright Mike Halloran
 4 SECTION 1 PREPARING TO BE AN OEC TECHNICIAN

National Ski Patrol’s Early Years

Charles Minot “Minnie” In 1936, Charles Minot “Minnie” Dole, a 36-year-old insurance broker from Green-
Dole the founder and creator of the wich, Connecticut, realized the need for emergency care and rescue services for in-
National Ski Patrol. jured skiers following a personal mishap while skiing. Dole was skiing at Stowe,
Vermont, with his wife, Jane, and their friends Frank and Jean Edson, when he heard
a bone snap in his ankle, fell, and lay helpless in the snow. Frank stayed with Minnie
while Jane and Jean skied down the mountain for help.
The first person they met was a local farmer who told the women
The National Ski Patrol’s Mission that people who were foolish enough to ski deserved whatever fate
and Vision Statement (2009) they met and then went on his way. Jane and Jean finally located two
N people who hauled Minnie off the hill two and half hours later on a
The National Ski Patrol (NSP) is a member-driven makeshift toboggan improvised from a piece of corrugated tin roof-
O
T professional organization of registered ski patrols ing from an old shed. No splint was available to immobilize his an-
E striving to be recognized as the premier provider of
kle, and the resulting ride down the hill was quite painful. X-rays
training and educational programs for emergency
later showed the injury to be a severely displaced ankle fracture. Dur-
rescuers serving the outdoor recreational community.
ing the 1930s, such injuries were difficult to treat, and Dole’s doctor
To meet that goal and promote the safe enjoyment of
snow sport enthusiasts, the NSP supports its members told him he might never walk again, let alone ski. He was determined
through accredited education and training in to recover, and from this incident came the seed for the National Ski
leadership, outdoor emergency care, safety programs, Patrol.
and transportation services. Two months later while still in a cast, Dole received word that his
friend Frank Edson had been killed in a ski race. Dole was determined
to develop a rescue program for skiers. Following a suggestion by the
president of the Amateur Ski Club of New York, Roland Palmedo, Minnie was put in
charge of a ski safety committee for the club. In March 1938, Dole organized a volun-
teer “ski patrol” for the National Downhill Races at Stowe, Vermont. Roger Langley,
president of the National Ski Association (NSA)—now the United States Ski Associa-
tion (USSA)—was so impressed with this patrol that he asked Dole to organize a national
patrol. This marked the birth of the National Ski Patrol, which originated as a subcom-
National Ski Patrol System, Inc. mittee of the NSA. Minnie Dole continued to chair the National Ski Patrol System, Inc.
(NSP) the largest winter rescue group (NSP), as it was then known, until 1950 (Figure 1-3a䊏 and Figure 1-3b䊏).
in the world, as recognized by the The NSP separated from the NSA in 1953, incorporating in Colorado and becom-
United States Congress under Title 36 of ing an independent organization. Thanks to a distinguished legacy of altruistic service,
the United States Code; is the premier the National Ski Patrol was recognized with a federal charter by the U. S. Congress in
snow sports rescue organization in the 1980. This is a coveted endorsement that only a few other U. S. institutions have
United States.
earned, including the American Red Cross, the YMCA, and the Boy Scouts. Accord-
ingly, the NSP annually reports directly to Congress.
As a leading authority of recreational outdoor safety and patient care, especially
for ski areas, the NSP is dedicated to serving the public and the outdoor recreation
industry by providing education and accreditation to emergency-care and safety-
service providers. The organization is made up of more than 26,000 members, in-
cluding alpine, nordic, and auxiliary OEC Technicians, who serve on over 600 ski
patrols. NSP’s members work on behalf of local ski and snowboard areas to improve
the overall experience for outdoor recreation guests (Figure 1-4䊏).

The National Ski Patrol Goes to War

By 1942, the United States was at war with both Germany and Japan. During this
time, there were 180 registered patrols with more than 4,000 medically trained per-
sonnel, which included women for the first time. Also in 1942, the National Ski Pa-
trol System (NSPS) initiated the first Air Force Search and Rescue units in
collaboration with Second and Fourth Air Force Groups. The Ski Patrolmen com-
pleted 52 missions and saved at least eight lives. Still at the forefront of the NSP, Min-
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN