Hello and welcome back to the blog for the Chamois Mountaineering Club, in this blog I though it would be helpful for any prospective club members or anyone interested in outdoor and wilderness first aid to read about a course we recently ran at our centre in North Wales for our members. The article below is by one of our club members who attended the course:

Just back from wilderness first aid course at the chamois mountaineering club North Wales the course which was ran by the club and delivered by one of the members Chris Harling, Everest Mountaineer and Outdoor expert who is leaving for Nepal on Saturday to climb more Himalayan Mountains.

The course ran over two days/16 hours and is very comprehensive for those of us who live and work in the Outdoors. A brand-new learning for some of the members and a refresher of skills fade for others. The course covers Primary and Secondary surveys of individuals who may have had an accident in the outdoors, Urban or Mountainous terrain, CPR resuscitation, Heart conditions, Head injuries, common medical conditions, what to do with Hypo  and hyperthermia and Mountain Rescue. Chris is a former member of ‘Keswick Mountain rescue’ so could relay first hand rescue scenarios.

The emphasis is on repetition and participation over the two days we enacted numerous scenarios which ensured that we wired in the key actions we need to take when approaching an accident scene.

First you undergo a ‘Primary Survey’

D – Check for danger as you approach the scene, at no point put yourself in danger

R- Response Is the casualty responsive to your voice or a gentle touch on the head or shoulder.

S – Send for Help  Dial 999/112, none of us are Doctors and expert help even when called immediately, can take time to arrive. Always make sure you have signal, it may mean moving to a signal area with the phone, and remaining stationery until you receive the confirmation call back.

A – Check that the airways open, this is important and slightly tilting the chin back whilst supporting the head, can help achieve this  

B – Is the casualty breathing, placing an ear next to the mouth for at least 10 seconds and watching to see if the Chest/diaphragm is rising and falling can show if this is the case

C – Circulation -Is there any obvious blood lost scan the body to check, being mindful of Waterproof clothing ensuring that you check inside for any pooling of blood

All the above should be completed as quickly as possible.

If the casualty is unresponsive then CPR will be required, this is achieved by ensuring the patient is lying flat, moving them if necessary to an area that allows you good access, kneeling away from the casualty and placing the heal of the hand on the Sternum with the other hand over the top and pushing down quickly and strongly for 30 times or roughly 2 x a second. This is then followed by two rescue breaths, ensuring clean air is drawn in and a light breath is blown into the patient, all the time watching to see if there is a rise and fall in the abdomen or chest. The thing that we all noticed was how quickly you tire, and a relay system is required to maintain the rhythm until the emergency services arrive on the scene. We all  imagined how exhausting but vital this would be to maintain on your own. At this stage you would update the Emergency services that CPR had started.

If the casualty is breathing OK, you would quickly continue with

Secondary surveys

Chris described this as think about a ‘laser’ moving down the body checking each part, which is a great analogy and one that is easy to visualise

First does the casualty have any history of medical conditions they can verbalise, have on their wrist or in their rucksack, for instance ‘Epilepsy’ they may carry an epi pen and wear a wrist band, Diabetes again wrist bands or Medi tags around the neck may give you a clue.

Head check for any unusual lumps or bumps, anything at the back of the head/neck,  eyes, are the pupils normal or dilated, this may indicate head injury, any fluid from the ears, blood or clear? Again, a sign of head injury., is the nose how it should be? Lips swollen, discoloured or normal? Anything out of the norm with the windpipe and oesophagus? If its slightly off centre this could be due to lung issues. What are the conditions of the collar bones, different heights could mean dislocation. Feel the torso, anything amiss with the ribs any reaction could mean a possible broken rib? Does the abdomen feel soft or is it slightly hardened in parts – which could mean internal bleeding. How does the small of the back feel? Is the pelvis symmetrical , check the thighs firmly are they the same size is their symmetry in the knees, what do the shins look like any swelling? Do the ankles fall to the side normally or is one at an angle? Anything strange about the feet, remove boots if necessary.

Moving down from the shoulders check the arms check for anything abnormal there.

The more information you can gather, the more you are able to share with the teams when they arrive, and if epileptic or diabetic you may be able to help them with their medication that they have with them. Double check pockets ,Rucksacks,  wrists, and Neck for any clues

Scenarios included all the above things, repeating until we automatically ran thru DRS ABC’s, like a well learnt mantra, when we arrived at the scene of the accident.

Some scenarios, had several things going on some one in deep shock, could have a more acute injury that is life threatening. I showed how important being methodical and working thru DRS ABC’s as a vital checklist tool

Watching one of your team enacting an Angina attack  Tightness in the Chest and  pains ,shortness of breath,  grey pallor , often triggered by exercise but seeing how they recover after the wonder drug GTN and being placed in an upright seated W position was  was nothing short of an Oscar nomination-

Seeing a heart Attack being enacted and how quickly you need to act, or a stoke, and again knowing how to recognise the signs was easy to remember

F- Face may have dropped to one side, and they may not be able to smile

A – Arms they may not be able to lift both arms simultaneously and keep them raised

S – Speech, may be slurred or garbled or they may not be able to talk

T – Time is the essence Seeing any of these signs its vital to ring 999/112 .

One of the other distressing things to see is some one going into ‘Epileptic Fit’, it’s an incredibly physical thing and the  the recovery can leave them tired and exhausted, so its worth knowing if you are out on the hill when someone has one, then be prepared to get them evacuated off as soon as you can.

One of the things I am always conscious of when leading a group is having contact details for next of kin, its easy to forget to collect them but in an emergency situation it makes you realise how important it is to have that name and phone number to hand, its also a good idea to have some instructions that you share with your group should any misfortune happen to you.

One of the things I am always aware of is dehydration, its often ignored by individuals who just do not read the signs of fat fingers, not needing the loo, and being so busy walking, they forget to drink. Whilst we may all be hardened Mountaineers, climbers, or walkers, we all know how quickly performance is affected by dehydration too.  

The body is a fine well-balanced machine with a core temperature of 37C any fluctuations in this temperature will lead to Hyperthermia if too cold mild hyperthermia sets in from 36-31C, and Hypothermia occurs when the body gets too hot, mild Hypothermia can occur from 38-40C and is often referred to as Heat exhaustion.

In cases of Hypothermia, it is vital to get the individuals moving, put on extra layers and eat and drink to create energy for the body to warm up the core, the limbs start to feel cold and often result in cold hands and feet as the blood flow is restricted to the core organs.

In cases of Hyperthermia the person needs to drink copiously, cover up so that the dun cannot burn them or continue to heat up the skin, seek shade and rest whilst the body recovers its normal temperature

Knowing how to bandage wounds, correctly and with minimum fuss or need for safety pins was a great learning for all of us too, and did provide a sense of amusement to see head bandages, slings and bandaging around objects protruding from the body, however this soon became a knowledgeable skill, that everyone felt comfortable with.

We play acted scenarios, watched video clips, and discussed vast amounts of content over the two days, but its also great to know we have nine freshly genned-up Wilderness First aiders in the club, who will be happy to support you should you have the misfortune to become a casualty.

Key learning Its never a wrong decision to call for help, if the casualty recovers they will check them anyway – Definitely worth that ‘Peace of mind’

Huge thanks to the Meets team for organising , for the Chamois members who made it fun, and Chris for working thru a precious weekend pre-expedition.