As part of their ongoing monthly Sheriff’s Posse training activities, 11 Navajo County Search and Rescue, Inc volunteers became certified in Wilderness First Aid through SOLO recently. By far, the most valuable part of the training was the hands-on training and personal attention paid to the students by Instructor Mike Englund, sans a single PowerPoint slide!. Mike’s vast experience with Central Arizona Mountain Rescue Association (CAMRA) provided real-life scenarios with complex injuries and challenging evacuation logistics. CAMRA’s field of operations includes technical rock rescues, alpine snow conditions, swift-water and flooding situations, helicopter support, cave and mine extractions, wilderness emergency medical services and wilderness search and rescue. CAMRA is prepared to respond to almost any search and rescue incident in Arizona.

Wilderness first aid courses designed for people with little to no previous first aid training are offered regularly by CAMRA at the North Mountain Visitor Center in Phoenix. Visit Mountainrescue,org for more details. The following information is just a brief summary of information presented in this course, without the 100-page detailed spiral bound “Field Guide to Wilderness First Aid” or the Wilderness First Aid fold-out “map” with pictures showing how to treat various injuries with splints, bandages and other treatments. The map also includes handy checklists to use when stress and panic can scramble anybody’s semblance of organized thinking.  

The Navajo County Search and Rescue “ground pounders” were taught the first thing to do when approaching an injured person is to make sure the scene is safe for responders to help out the injured person. A rockslide may not be done sliding, flood waters may be getting stronger or a hive of stinging insects could be deadly if you are allergic. Surveying the scene can often reveal to you the mechanism of injury (MOI), or what happened and is it safe to approach the injured person.

When approaching an injured person who is unresponsive or looks unconscious, it is most important to check the ABCs immediately. A stands for Airway which should be clear and unobstructed. B stands for Breathing that is not irregular or abnormally noisy. And C stands for circulation sufficient to create a pulse and only minor, if any, bleeding. The SOLO course also added a couple of Ds and Es to assess, with Deformity and Disability potential from a neck or back injury included with Environmental conditions and consideration for Everyone Else’s safety. At this point, the idea is to treat the life- threatening situations such as lack of breathing, no pulse or heavy bleeding before moving on to anything else.

Sometimes, it is more dangerous to leave the injured person in place than it is to move them carefully, depending on the existing conditions. If a person has to be moved, the volunteers learned to wrap the neck so the chin does not move towards the chest or turn to the side and to keep the shoulders always aligned with the hips.

If the person is breathing okay -- without any serious bleeding -- the first responder can move on to the secondary survey where you can take more time to try and figure out what happened and more details on the condition of the injured person. These details include repeated monitoring of vital signs such as the breathing and heart rate and conducting a “chunk check” which is a physical examination of small chunks of the body to isolate injuries. The secondary survey should also include a judgement of the injured person’s level of consciousness, by asking them their name, where they are and what time and day it is. These answers can become worse with head injuries so should be monitored and noted.

A person’s past medical history might also help identify and treat the problem so search and rescue personnel are taught to use the AMPLE history when interviewing the person. AMPLE is another acronym intended to make it easier to remember important clue words to ask about. A stands for Allergies (to food, medications, insects, plants, etc). M is for Medications they are taking, both prescription and over the counter ones such as blood-thinning aspirin and other NSAIDS. P is for Previous injury or illness that might be causing or contributing to the current situation. L is for Last Input and Output of water and food along with urine and bowel movements. And E is for Events leading up to this problem, such as a strenuous hike without eating or drinking.

The condition that kills the most people in the backwoods is shock, where not enough blood is circulated to all parts and organs of the body, starving them of oxygen. Our bodies respond to stress, heavy bleeding or a heart attack by shunting any available blood away from our arms and legs and less important organs and pushing it all towards the brain which is first in line with the biggest appetite to get dwindling oxygen supplies carried by the blood. This works fine for short periods if the blood flow can be returned to the tissues that have been starved after first aid procedures stop the bleeding or get the heart started again through CPR. But sometimes the body can over-react such as in an allergic reaction to a bee sting so sensitive people should carry their “antidote” or Epi-pen with them all the time.

Probably the most common injury in the backwoods is a sprained or broken ankle which can usually be differentiated by the extreme point tenderness of a fracture compared to the more diffuse pain of a sprain. Both injuries could prevent walking out and may require an improvised splint to prevent additional movement of the limb and subsequent tissue damage. The recommended treatment for a sprain is another acronym, RICE: R = rest; I = ice; C = compression and E = elevation. A fracture will require professional care at an urgent care or emergency room.

An ankle or long bone sometimes fractures and becomes misaligned so wilderness first responders were trained to reposition the limb, preventing the veins and arteries from getting pinched and allowing oxygenated blood to be circulated through all parts of the limb. It is always important to check circulation, sensation and motion of the toes or fingers if they swell or a splint is used. SOLO recommends splints that are BUFF (B = big, U = ugly, F = fat and F = fluffy).  

Neck and back injuries in the wilderness are especially challenging to deal with since further injury during evacuation is always a danger. Search and rescue volunteers were trained how to stabilize an injured person’s spine and sometimes even how to “de-crumple” a victim so they can comfortably lie on their back or their side in a recovery position.

Problems caused by excessive heat or cold are obviously common in the back country so first responders in the Wilderness First Aid course were taught how to treat the most severe cases. Extreme hypothermia can be treated by turning the subject into a “human burrito,” using wind and waterproof tarps or space blankets as the outer wrap enclosing the person within a lining of dry and warm insulation. When layered and wrapped securely with hot water bottles or heating pads, this burrito may not be delicious but it could be a life saver. Hypothermia can be completely avoided with the proper clothing, staying dry, eating and drinking regularly and not over-exerting yourself and draining your internal batteries.

This is an incomplete list of topics covered in the CAMRA course. The Navajo County Search and Rescue personnel were also trained in using tourniquets, treating snakebites and insect stings, wrapping bandages for any occasion, and building emergency shelters using survival skills. So, this article won’t prepare you for all injuries in the wilderness but taking the Wilderness First Aid or other EMT courses from CAMRA at MountainRescue.org just might. Check them out.