Adventure Safety & First Aid in the Canadian Rockies

Drinking Water

Our mountain streams are not as pure as they used to be. A parasitic protozoa named Giardia lamblia has contaminated much of our surface water. The common name for this illness is beaver fever. Victims experience diarrhea, gas, and acute stomach pains. Because it can take10 days or more for symptoms to appear, someone who has contracted the disease is most likely going to be out of the mountains by the time they feel ill. Treating drinking water with chemicals may not work. Water purifiers with a ceramic filter will separate the parasite. Boiling water will kill Giardia. Incidents of beaver fever have decreased, but it is wise to be careful. If planning a long backcountry trip it may be worth contacting a doctor to obtain the drugs necessary to treat the disease.

Whenever travelling carry a first aid kit. In the backcountry help may be hours or even days away. Severe weather or a difficult location can hamper the best rescue. The patients initial care may be critical to his or her survival. Always carry a first aid kit, know how to use it, and never expose yourself to unreasonable danger. A good basic first aid kit should include:

• 2 triangular bandages
• 1 roll 2" roller gauze
• 1 roll 1" or 2" adhesive tape
• 4 4x4 sterile dressings
• 1 large compress or sanitary napkin
• assorted bandaids
• any prescription medicines
• 1 resealable plastic bag
• rubber or surgical gloves
• sunscreen
• lip guard
• knife
• several safety pins
• matches in a waterproof container
• fire starter

In the event of an accident your first priority is your own safety. Taking risks to assist someone else will make a bad situation worse.

FIRST Assess the situation Is it safe to approach the patient? If there is a danger to the rescuer decide whether or not it is an acceptable risk. If possible remove the patient from further hazard or the hazard from the patient

SECOND Initial Evaluation The initial evaluation determines whether there are any immediate life threatening injuries. Remember ABCD.

A Airway- is the airway clear and unobstructed? If not clear it.

B Breathing- is the patient breathing? If not begin artificial respiration if you are properly trained.

C Circulation- is there a pulse? If not begin CPR only if you are qualified to do so.

D Deadly bleeding- is there any severe bleeding? if so apply direct pressure at or above the wound site and elevate the injury if possible.

In the above situations the patient may be moved as necessary to alleviate a condition, but for less severe injuries do not move the patient until first aid has been completed. Once the initial evaluation is complete begin a secondary evaluation. Starting from the head work your way down to the feet palpating (feeling) the entire body. Look for cuts, abrasions, deformities, and swelling. Feel for any instability along the bones, and crepitis (a creaking crunching sensation). Watch the patients face for signs of pain or tenderness. Even if the injury appears obvious do a complete secondary survey. Other more serious injuries can be masked by the pain of an obvious injury. Check for any medic alert bracelets, and ask the patient about his/her medical history i.e. previous injuries, medical conditions, medications, etc. With the secondary survey complete you can treat the injuries.

Bleeding Before treating an open bleed always wear gloves to prevent the transmission of infectious bacteria. Clean the wound site and apply a sterile dressing. Use roller gauze to hold the dressing in place and to apply pressure on the bleed. If the dressing becomes soaked with blood and continues to bleed, apply a second pressure dressing over top of the existing dressing. A sanitary napkin can be used as packing on the second dressing to help absorb excess blood. Do not remove dressings, this will only increase the rate of blood loss. If possible elevate the wound site. Penetrating wounds with an imbedded object or open fractures ( a fractured bone has broken through the skin ) require direct pressure around the wound site but not on it. Cover the wound with a sterile dressing to prevent further contamination.

Shock Shock occurs when the body lacks the ability to provide all the major organs with oxygen and nutrients. There are several types of shock but the most common type is hypovolemic; loss of blood through excessive bleeding. Bleeding can be visible or internal. Patients going into shock become anxious, breathing may be faster and shallower, the skin becomes pale or ashen in colour, and the pulse may become faster and weaker.

Unless treated the patient can deteriorate rapidly and possibly die. Control bleeding, have the patient lie down and remain still, elevate the legs, keep them warm, and reassure. These simple steps will slow the advance or stop the progression of shock. Treat for shock at its' earliest signs as it is much easier to prevent then to reverse. If the patient continues to deteriorate begin a second examination of the patient with a primary survey and then a full secondary survey to determine if any injuries may have been missed.

Head Injuries Any strong blow to the head is potentially very serious. Immobilize the head and neck with clothing, or by kneeling at the patients head and cradling the head between your legs. Neck injuries (spinal injuries) are often associated with a head injury. Observe the patients level of consciousness. Do not move the patient unless absolutely necessary.

Fractures (broken bones) Deformity of a limb, point tenderness, or swelling can indicate a broken bone. Immobilize the injury by splinting in the position found. Moving or manipulating the injury should be avoided unless you are properly trained. Metal rods from an internal pack frame, an ice axe, paddles, stiff foam sleeping pads, tent poles, and blankets can all be used to splint fractures. Applying ice or cold water to the injury (using the plastic bag) will reduce swelling and help ease the pain.

Dislocations These injuries are very similar to fractures in signs and symptoms, and are treated the same.

Sprains A sprain has many of the same symptoms as a fracture. If in doubt treat for the more serious injury. Apply ice, or soak the injury in cold water to reduce swelling. A tensor bandage may be useful. If you have to walk out on a sprained ankle lighten your load as much as possible, walk no more than absolutely necessary, take frequent rests, and soak the injury in cold water every chance you get. If you can afford the time it is best to wait a day or two before walking out.

Blisters While Blisters are a minor injury, they can be extremely painful and even somewhat debilitating. Preventing blisters is much more effective than treating them. As soon as a rubbing or hot spot is felt stop immediately. Check socks for wrinkles, boots for a loose fit, and if necessary protect the area with mole skin, or second skin. If blisters develop, don't lance them unless there is no other way you can walk. Try building up the area around the blister with 4x4 dressings and roller gauze. Keep the blister clean, and never apply any adhesive directly over it, or much of the surrounding skin will tear when the tape is removed.

For more serious injury or illness once the patient has been stabilized you must decide if he/she can continue to travel. If the injury is relatively minor you may continue. When the patient is unable to travel, camp must be established as close to the patient as possible. Assess your resources, the people available, their experience, and all equipment. Choose a campsite that is safe from objective hazards, and accessible to a rescue. Most patients are transported out of the area by helicopter, consider a suitable landing site for a rescue helicopter and make the camp visible from the air. Make the patient comfortable, keep him/her warm, and be careful not to exhaust the energy of the rest of the party in caring for the patient.

After establishing a camp, reassess the situation, and decide if a rescue may be needed. Consider the location, distance to the nearest assistance, severity of the injury, the experience of each person, and their present physical state. If it is late in the day it may be wise to wait until morning before seeking help if the group is tired, the weather is bad similarly it may be best to wait until the weather improves. At this point, another accident could be catastrophic, therefore extra care must be taken with all decisions.

When the decision is made to go for help, safe travel is more important than fast travel. Write down all relevant information about the accident for the rescue party: location of patient, time of accident, patients chief complaint, a history of the accident, assessment of the injuries, treatment, medical history (medications, medical conditions, previous illnesses or injuries), and the number of people in the party. Any additional information considered important should be included.

Hypothermia

Hypothermia kills. In the Canadian Rockies there is no time of the year in which you are safe from it. Staying warm is an essential element in back country survival, particularly once a person has sustained an injury. . Hypothermia begins with heat loss.

Heat Loss

Heat is never really lost, but transferred or altered in some way. Heat can be transferred in three ways:

1. Conduction - physical contact. If you stick your hand in snow, the snow gets warmer; your hand colder.
2. Convection - continuous movement of air or water transferring heat. Wind or rain against bare skin.
3. Radiant Energy - heat radiating outward from a direct source. Sunshine is a source of radiant energy.

Body heat is lost by all three methods. Staying warm and dry is essential.

Hypothermia is the lowering of the body's core temperature. Heat Loss is caused by conduction, convection, evaporation, and radiation. Water, snow, and the cold ground conduct heat from the body. Wind and rain convect heat. Evaporation dries sweat and wet clothes robbing the body of heat. Radiation is for all practical purposes unstoppable.

Signs and Symptoms

Mild Hypothermia

• feels cold
• shivers
• have a desire to warm-up
• lose interest in the hike/climb etc.
• become physically awkward.

Profound Hypothermia:

• core body temperature drops below 32 degrees Celsius
• personality changes
• loses coordination
• skin is cold to the touch
• breath has fruity acetone smell/taste
• clothing can be urine soaked

Mild Hypothermia

Patients with mild hypothermia need only to be protected from further injury and be rewarmed by any convenient means.

Profound Hypothermia

The survival rate for an unconscious hypothermic patient is between 20 - 50%. Handle the patient as gently as possible, rough handling can cause death. Stabilize, and prevent any further injury to the patient. Do not attempt to rewarm patient, as they have survived hours and even days in a hypothermic state. Send someone out for help, and prepare for the arrival of a rescue party. Attempt rewarming only as a last resort with the understanding that the chance of survival is low. Apply very gentle heat to the trunk and attempt a gradual rewarming.

Proper clothing is essential when traveling in the backcountry. Everyone handles cold a little differently. Body fat, blood circulation, physical health, and even smoking affect how we stay warm. Body temperature must be maintained within very narrow parameters to function properly. Hypothermia is the lowering of the bodies core temperature. Easily overlooked or ignored, it is a serious threat to outdoor enthusiasts; often a contributing factor in injuries, and a leading cause of death. As the body loses heat, blood is shunted from the arms and legs to reduce further loss. As a result fingers and toes become cold. The body also shivers to produce more heat. If heat loss to the head and chest is not stopped, judgment becomes impaired and the victim may not even know that he or she is in danger

The body does not lose heat evenly. The head is notoriously bad, while it makes up only 9% the body's surface area, we lose almost half our body heat from it. While it may not be fashionable the head and chest are the most vital areas of the body to insulate. Fingers and toes are much more likely to stay warm if the head is properly covered.

For our article Clothing and Equipment - providing information about the best methods of staying warm, please click here. .