First aid for bushwalkers and ski tourers
- First aid in remote areas
- Leadership considerations
- Nursing care in remote areas
- Administering medication to others
- Trip planning
- Recording first-aid care
- First-aid kits
- Group supplies
- Individual first-aid kits
All bushwalking and ski touring leaders need to have a good, practical knowledge of first aid. A recognised basic first-aid course is a good start. Leaders venturing into areas remote from immediate medical assistance will benefit from training that focuses on specific requirements of remote-area first aid. Courses in both basic and remote-area first aid are available in all states, although remote-area first aid courses may be more difficult to access.
This chapter does not substitute for a first-aid manual. It simply highlights some aspects of first aid specifically relevant to situations in the bush. Best practice in these areas changes with advances in medical knowledge and understanding, and all readers should be aware that, while this information is believed to be the best available at the time of printing, changes in preferred practices and treatments will undoubtedly occur. To be able to render the best first aid requires ongoing effort to remain up-to-date.
First aid in remote areas
The practice of first aid in areas remote from quick medical assistance is far more demanding than that required in a suburban environment. Remoteness from medical aid is mostly determined by the time required for assistance to arrive, and could be influenced by:
- weather conditions, which may hamper or prevent travel out or help returning
- size and experience of the party, which could be too small or inexperienced to seek help safely
- rescue and evacuation facilities available in the area at the time.
Assistance could be several hours, or possibly several days, away.
In the event of a party member becoming ill or injured, the leader’s responsibilities are not confined to the treatment of the injury or illness. The leader, or a delegated party member, will need to:
- take control of the situation
- ensure a safe environment for all party members
- perform a primary assessment to identify life-threatening problems which will require an immediate response
- perform a secondary assessment to assess the injury or illness and determine the level of seriousness, and any required treatment
- assess management options, which could range from minor, where treatment is given and the trip continues, to major, where patient evacuation or external medical assistance is required
- provide ongoing nursing care.
The leader’s responsibility for first aid and nursing care must continue until the party member has either fully recovered or has reached medical aid. This may appear to be a very onerous set of responsibilities, but the leader can delegate any or all of these to better qualified, or other willing and able, party members. It does, of course, remain the leader’s responsibility to ensure that these delegated tasks are carried out appropriately.
Nursing care in remote areas
In the event of injury, illness or other circumstances which prevent a group member from caring totally for themselves, then the group, as directed by the leader, will need to assist. Care will be aimed at:
- prevention of further injury or aggravation of existing injuries
- protection from weather
- providing maximum comfort possible, given the equipment and aids available
- providing adequate food and nourishment
- attending to all washing, toilet and personal needs, if the patient cannot care for himself/herself
- providing companionship and reassurance.
Some aspects of nursing care are not easy (e.g. spoon feeding or cleaning the teeth of a person lying down) and some may be embarrassing (e.g. toiletting a person in splints in a tent). But in all cases a little planning and a confident, gentle and understanding approach will make your efforts both effective and appreciated with minimum difficulty or embarrassment. Many experienced first aiders say that accurate, but caring explanations of proposed actions help enormously in fostering the desired outcomes. The aim should always be to treat the whole person, not just the injury.
Administering medication to others
Administering medication to others is potentially dangerous and illegal unless you are medically qualified. Some generally accepted principles are:
- prescription medicines must only be taken or used by the person for whom they were prescribed
- assisting others to self-administer their own medication or over-the-counter preparations which appear appropriate to the circumstances is generally considered acceptable if the person asks for assistance
- always check whether the person has taken the preparation previously and whether they have any allergies before allowing or assisting in medication use
- check whether the medication is being taken in accordance with directions
- always check what other medications or drugs the person may be taking at the same time.
Through sound trip planning, the impact of many first-aid problems can be minimised, seriousness reduced, and in many cases they can be avoided entirely. In particular you should:
- identify escape routes
- ensure a good ratio of experienced to inexperienced party members
- match the fitness and abilities of party members to trip goals
- understand what weather extremes are possible and assess possible impacts
- ensure that party members are suitably prepared, clothed and equipped for the trip
- identify necessary group safety equipment
- carry a suitable group first-aid kit
- know the procedures for seeking help in the area of your planned trip
- be aware of and understand the implications of existing medical conditions in your party
- let someone know before you go—so that you can rely on help coming to you if you have not returned by the specified time.
Recording first-aid care
It is essential that all first-aid care is recorded. This is necessary to ensure: • ongoing monitoring of a patient’s condition
- any request for outside assistance has necessary information
- that in the unlikely case of later dispute, relevant records can be provided.
Written records should be clear, concise and factual, reflecting observations only, and not opinions. These records should be kept confidential and details should only be given to those persons who require it (e.g. when seeking medical assistance).
All groups should carry an effective first-aid kit. The contents and quantities will depend on the size and type of group, the type and length of trip, personal preferences and the first-aid training within the party. It is a good practice to have each party member carry a small personal kit and then have a group kit carried by one identifiable person, preferably the leader or an experienced first aider.
Some points to consider when assembling a group first-aid kit for your trip include:
- Medication should be kept to an absolute minimum. Only products available over the counter should be included in a general group kit. Prescribed drugs are the domain of a doctor and should only be used by the person for whom they have been prescribed.
- Be sure to check ‘use by’ dates, and replace out of date items before trips.
- Not all pain-relieving tablets are safe for everyone. It is advisable to limit your stock to paracetamol and combinations of paracetamol and codeine. Soluble paracetamol is easier to take. Before offering any medication, always check with the casualty whether the substance is safe for him/her to take (i.e. no history of previous sensitivity or other side effects).
- Some medications may require low-temperature storage conditions, which are impossible on a bushwalk. In some cases it is possible to obtain a comparable product with a formulation that is less sensitive to temperature. Discuss this matter with your doctor or pharmacist.
The group first-aid kit (Table 35.1) should be carried in one waterproof container by one person (preferably the group’s first aider or leader) in an accessible part of their pack. Others should know its location. This kit is an example only, and more appropriate kits should be prepared for the expected needs of a group on any particular trip. Some organisations, such as schools or youth groups, may have specific requirements for first-aid kits which should be observed.
Individual first-aid kits
Personal first-aid kits should be prepared for the individual’s potential requirements, and a suggested kit is listed in Table 35.2. Items from individual kits can be used to supplement the group kit if required. Some other important points include:
- Personal medications should be carried in a separate container, clearly labelled with the drug name, circumstances indicating use, dosage, any possible reactions and expiry date. The leader and the group first aider should be advised if any member is carrying such medication.
- For extended trips (more than 10 days) to very remote areas, your doctor may prescribe some drugs for allergic reactions, various infections, etc. which could be encountered on the trip. These will be for your personal use only.
- Blister treatment kits are fairly expensive and are best kept for personal use.
|Table 35.2 Suggested personal first-aid kits|
1996. First Aid—Responding to Emergencies, Australian Red Cross Society.
Australian First Aid, Authorised Manual of St John Ambulance Australia.
Australian Resuscitation Council Policy Statement, Australian Resuscitation Council.
Coleman J, Heine A, Taylor I, Webb S, 1990. Outdoor First Aid. Mountain Safety Manual No. 14, New Zealand Mountain Safety Council, Wellington, New Zealand.
First Aid Manual, Authorised Manual of Australian Red Cross Society.
Lentz M, 1991. Mountaineering First Aid, 3rd edn. The Mountaineers, Seattle, Washington.
Sutherland S. K. 1996. Venomous Creatures in Australia.
Wilkerson J. A. (Editor) 1992. Medicine for Mountaineering, 4th edn. The Mountaineers, Seattle, Washington.
Wilson B. 1992. First Aid in the Bush, 2nd edn. Wilderness Publications, Blackburn, Victoria, Australia.
This chapter is not intended to replace a good first aid manual, and so specific treatment protocols have not been included. Leaders of bushwalking and skiing trips should avail themselves of as much knowledge as possible of current best practice in assessment and treatment of illnesses and injuries which may be encountered on trips into areas remote from medical assistance.