Remote & Wilderness Protocols Lesson Objectives Lesson Objectives Any Area Can Be Remote Response! Considerations For The Remote Wilderness Area

Transcription

1 Remote & Wilderness Protocols Lesson 23 Lesson Objectives 1. Explain what is different about first aid principles when help may be delayed. 2. Describe common situations when help is likely to be delayed. 3. List actions to take to be prepared for injury and illness emergencies in remote locations. 4. Describe methods by which EMS can be contacted from isolated areas. Lesson Objectives 5. Explain how to protect a victim until help arrives or how to safely transport a victim if help cannot reach the victim. 6. Describe special care for victims with common injuries and illnesses when help will be delayed. 7. Explain what to do in special wilderness emergencies such as avalanche or ice rescue, lightning strikes, wildfires, altitude sickness, and SCUBA diving illness. Any Area Can Be Remote Response! You don t have to be in the backwoods to be in a delayed response area There are special risks in rural or wilderness areas due to the environment, hazardous activities, or equipment Injury prevention is important Helicopter evacuation should be considered when you need quick access to advanced care Considerations For The Remote Wilderness Area C-A-B + bleeding/shock control may not be enough when care is delayed Environment may determine how care is provided (heat, cold, weather) and limit options Transport decisions critical Call for help or treat in place decisions critical Equipment is limited improvise! Helicopter evacuation, if available, more likely Medical responders may be a different group from the rescue response There may be communications challenges to call EMS Group: Know pre-existing conditions and medications. Preparation Is Key For Remote Area First Aid Good Things To Do In Remote Areas When EMS is Remote: Use remote protocols! Improvise! Improvise! Improvise! Use leadership skills with the victim, bystanders, and your group Know how to request help with multiple methods Protect victim until help arrives Insure safety and comfort of the entire group (including survival considerations) 466 Leadership Is Critcial Assess situation plus the victim s needs Have a plan for first aid, rescue, obtaining medical care, and taking care of the group Delegate responsibilities use helpers 1

2 Involve the group to participate in useful ways Continually reassess situation modify your plan if the situation changes Always maintain focus on the primary goal getting the victim to medical care Disasters Change The Rules First Aid Kits Bring the appropriate items and quantities. Consider trauma + illness + comfort. Everyone should bring their own personal prescription medications. Survival Essentials Water Food Warmth / Fire Shelter Survival techniques and equipment are specific to the area and the season. Survival techniques are not part of this presentation. Include Psychological Issues Outdoor environment adds stress of weather, temperature extremes, shortage of food or water Members of party may have different behaviors because of new environment Mental preparedness and leadership skills important to be ready to act effectively Emergencies can stress the group Mental Preparedness For The Emergency Stay confident and remember the basics of care Do not deny seriousness of emergencies Consider all equipment, supplies, resources improvise as necessary Stay focused on survival and treatment goals Help others in group stay calm and act productively Remain positive but realistic Calling For Help Communication failure is the most common cause that reduces wilderness medical outcomes Plan in advance and have appropriate equipment Three of anything is considered a distress signal (whistle, fires, lights, horn, etc ) Always know where you are Cell Phones Protect it from the environment Save the charge and/or spare battery pack for emergency use If there is no cell phone signal try to get to higher ground Text messages may still work in area of weak signal when voice connection does not work Will your cell phone show your location coordinates? Do you need to load an app? Do you know how to access coordinates? Communications Alternatives Satellite phones connect calls from anywhere in the world can be rented easily on the internet 2

3 SPOT Satellite Personal Tracker Amateur ( Ham ) Radio Satellite texting devices for cell phones Satellite phone in vehicles Four Key Questions For Wilderness Medicine 1. Should I call for help? 2. Do I wait for help or move the victim? 3. Can I provide care safely? 4. Are there safety or survival considerations? (bystanders, rest of the group, responders, etc ) Sheltering The Victim Protect victim from environment create an emergency shelter if needed Have items to construct an expedient shelter Emergency shelters can be constructed from natural and/or commercial items Evacuation of Victim It almost always better to wait for help than try to evacuate a seriously injured non-mobile victim Moving victim without the right equipment could worsen their condition Decision depends on factors such as: When help is expected Victim s condition and mobility Number of people available Environment Effectiveness of first aid Self-Transport Is this a smart option for your situation? Are you sure? A Trail Carry Technique If you have enough bearers for the trail carry you can move a victim a long distance without stopping. This is only an option if you have a stretcher, board, backboard, or basket. Trail Carry Air Evacuation More Than An Ambulance Air evacuation means fast transport to a trauma center with advanced medicine, specialized doctors, and surgical options. The aircrew on a medical evacuation helicopter are highly trained flight nurses or paramedics with some options, equipment, drugs, and techniques that are otherwise only found in the emergency room. Calling for Air Evacuation Air evacuation is appropriate when fast access to advanced care is needed. 3

4 Anyone can call for air evacuation. Helicopter activation will automatically alert EMS and fire. If you can be reached the local fire department will establish LZ. No one is charged unless a victim is transported even if the aircraft lands at your site. Don t let cost drive your decision for air evacuation. Landing Zone Safety Keep landing zone (LZ) clear Protect face and victim from flying debris Do not approach landed helicopter until signaled to do so by the crew members Don t approach from uphill side (rotor clearance issue) Tail Rotor Hazard The tail rotor is a significant safety hazard Volunteers may be recruited for both sides of the aircraft to keep bystanders clear of the aircraft Most modern aircraft do not require you to bend down under rotors if spinning follow the aircrew s guidance Landing Zone Protocols If fire and police can get to the LZ they will handle all the arrangements and preparation of the LZ Some counties have pre-selected landing zones and will use local resources to transport victim to helicopter If you are isolated you may have to set up the LZ yourself Self Preparation of Landing Zone 100 by 100 (minimum) hard flat surface with few obstructions Clear LZ of loose debris very important! Optionally mark corners of LZ (securely) At night never shine lights at aircraft and spotlight obstructions Give GPS coordinates if you have them, nearby major intersection, or geographical landmarks will also work they can see you from the air Identify surrounding obstructions to dispatcher Important LZ Protocols The aircraft has advanced night vision capability often they choose to land at night using night vision devices Earplugs are useful volunteers need a running aircraft work more safely and calmly when using earplugs Move vehicles away from the LZ Don t wave at aircraft this could be misinterpreted as the two handed abort landing hand signal Stand on the upwind side, facing the LZ, with both arms held up ( land here signal) Wait until signaled by crew to approach, or, usually they will come to you Who Do I Call? You can request air evacuation via 911, or call directly to air evacuation dispatcher. In the early stage of your response you can request a helicopter standby. They will go to a higher state of readiness and start researching your location for an LZ. You can call any medical evacuation company. Companies are interconnected with mutual 4

5 support agreements and will give you the nearest and most suitable aircraft/crew. But They Turned Me Down If any air evacuation dispatch says no aircraft is available (usually due to weather) don t bother calling another company they have shared that information and no one will send an aircraft. You will have to use ground based ambulance. Going For Help Sending Someone For Help If it is not possible to call for help then someone may need to go for help A difficult decision including who will go at least two should be in the group leaving Those who go for help must be able to accomplish this task so you must confirm they are capable The Go For Help Team Physically able to get to their destination Have sufficient clothing and equipment Clear idea of where you are, where they are, and how to get there and back! Able to survive if they get into trouble They have a plan for how to call for help Communication expectations with you (if possible) Know what they will do when the call is made Have discussed backup plans just in case Leaving the Victim Alone Consider this option only if: You are alone, and You cannot call for help, and Unlikely that anyone will pass by, and Medical condition warrants it Leaving the Victim Alone Prepare victim as well as possible before leaving Shelter, food, water Leave note with victim explaining when you anticipate returning With 2 or more responders don t leave a victim alone Leaving the Victim Alone Animal Attacks Know how to respond to animal attacks in your area Know animal behaviors that could signal an attack Treat bites with regular trauma techniques, and flush gently with water for 5+ minutes if bleeding allows Insure the area is safe to provide care (animal has departed) First Aid Techniques in the Wilderness Wilderness Wound Care 5

6 Direct pressure is the best technique to control bleeding anywhere Use soap and water to clean the wound flush if appropriate Use cleanest water and materials available Add an extra layer over bandages Antibiotic Ointment Soap and water is more important for cleaning wounds than just using antibiotic ointment For extended trips use antibiotic if appropriate and continue use for 3+ days (not one time) Antibiotic ointment will also act as a barrier for future contamination Frequent dressing changes are appropriate in remote care settings Sutures It should be possible to use the correct bandage with direct pressure in the field will stop blood loss until evacuation to a medical facility. Not generally recommended for the first aid volunteer. If sutures are not applied within a few hours after the injury then they should not be attempted because of swelling. Also, improper stitching can cause additional tissue damage, scarring, and retard healing. Legally sutures are not prohibited. But, volunteers are usually not trained or equipped to suture. Emergency Sutures Emergency sutures might be used if: The situation is appropriate for sutures You have the right equipment You have the experience/training EMS is significantly delayed Bleeding can t be controlled by direct pressure Use the simple chain suture or the simple interrupted suture Staples Sutures and Staples Medical Adhesive Medical adhesive is not recommended for volunteers. Pressure bandages and techniques should be enough. Medical Adhesive Hemostatic Agents Delivered by a powder or an agent-impregnated pad. Use for very large wounds or significant bleeding. Pour/insert powder or gauze pad in wound or puncture. Can be used by volunteers if you have been trained and understand their effects. Quick Application Tourniquet Commercial models are more effective, easier to apply, and do less damage than expedients. Gradually tighten until hemorrhage stops. Can apply for brief time to get and apply a pressure dressing. 6

7 If used to gain time to apply a pressure dressing it should be used no longer than 30 minutes. For amputation/near amputation leave the tourniquet on. It is no longer tourniquet last...it is tourniquet first for severe hemorrhage. Triangular Bandages as Tourniquet Expedient tourniquets are more difficult to apply than commercial tourniquet and may do more tissue damage than the QAT Keep folds 2-3 inches wide Follow the same application rules as QAT Mark skin with T and time of application Water Soap and water, or just water, is the best way to wash wounds in the outdoors Victim (and you) must have water to survive Use the cleanest available even if from natural sources Saline Wound wash, eye wash, and contact lens saline solution are effectively the same solution It is a near-sterile solution for washing, flushing, cleaning Don t improvise homemade salty water use cleanest plain water available if you don t have pre-mixed saline Shock In a rapid response area a shock victim is not to be given anything to drink In remote response area give water, clear fluid, or rehydration fluid in small drinks, frequently but as tolerated if victim is responsive and can swallow Expedite access to EMS all shock victims should be under medical care Splinters and Cactus Needles Quick removal and thorough cleaning will reduce irritation and swelling Splinters or cactus spines in the genitals, lips, and around the eyes are more appropriate to remove at a medical facility If they are deeply embedded, next to a large blood vessel, or in nervous tissue the victim should be transported to a medical facility On an extended trip monitor for subsequent infection Splinter Removal Clean the area plus clean the instruments before and after use! Tweezers (use sharp tweezers for splinters, blunt for cactus) pull out along entry path Sharp tweezers inserted under top layer of skin to reach superficial splinter or needle Small superficial cut to access end of diagonal/vertical entry (scalpel is best) Cactus Needle Inflammation Cactus needles usually have fungus on their spines, resulting in a subsequent inflammation If large areas of the body are involved monitor for a full-body allergic reaction The resulting inflammation can help you locate cactus needles for removal 7

8 517 Joint Injuries and Fractures Musculoskeletal Injuries Splinting fractures is probably the best option due to the time needed to access EMS Splinting materials may need to be improvised Padding and patient comfort important as splint may be improvised and worn for extended time Monitor swelling frequently and adjust splint as needed Improvised Splinting Use any materials, natural or man-made, that will provide stability to the fracture Femur Fracture A commercial traction splint may be the best splint for femur fractures The commercial models are a better than an improvised splint Pulls bones back to normal position and protects soft tissues Make sure responders know how to deploy the splint before using it on the victim Improvised Traction Splint SAM Splints Easy to carry, lightweight, versatile Can be used to make a cervical collar Shape before you apply to the victim Reduction of Fracture In rare cases: Extremity fracture or dislocation can cut off circulation below injury Attempt to straighten extremity, reduce dislocation, or apply traction Do not straighten if this will increase uncontrolled bleeding Do not straighten if victim will receive medical care within 30 minutes Joint Manipulation If necessary, joints can be manipulated to improve splinting due to the needs of field transport. Do this only if necessary as an option of last resort. Movement should be slow, deliberate, and controlled If pain is intolerable then stop the movement Move only one joint at a time Move the joint only in a natural direction Support the injured area at all times Have patient assist with support or movement Dislocation Reduction Methods Dislocation and Fracture Reduction Is It A Spinal Injury? In a remote situation you may rule out a spinal injury if: Victim is alert, sober, cooperative There is no neck or back tenderness when you press with fingers along spine There are no other injuries that may distract from feeling pain or tenderness of spinal injury 8

9 Normal function in all 4 limbs Spinal Injuries May be difficult to keep spine immobilized in a remote care situation Self-evacuation is usually your last choice In remote response areas gently move victim to the normal anatomic position with head straight and eyes forward Assess for the specific location of the spinal injury Concussion A victim with a mild concussion may be able to continue remote activity Watch for symptoms in the first hours Monitor victim closely wake and check every few hours when sleeping in first 24 hours Emergency evacuation is recommended if the initial loss of consciousness is more than a minute, or, there are other concussion symptoms Abdominal Injury Abdominal injury is either internal or penetrating Abdominal injury may progress to shock Abdominal pain in lower right may be sign of appendicitis Evacuate any open abdominal trauma Evacuate a closed injury if there is shock, diminished consciousness, point tenderness, hard lumps in abdomen, vomiting blood, blood in stool, or pain Burns A conscious victim who is alert should be given water or clear fluids if tolerated Burn prevention is important in remote areas since access to medical care is delayed Include victim s level of discomfort and pain as a criteria for evacuation For extended care twice daily cleaning and bandage change is appropriate Diabetic Emergencies On any extended remote trip the diabetic should inform others of their condition Diabetics should monitor blood sugar levels and teach others the signs and symptoms of high/low blood sugar Partner with the diabetic victim to decide best treatment for high and low sugar situations Diabetic Emergencies Insulin that is frozen or allowed to heat above degrees should be discarded. Some insulins are over-the-counter, so these can be shared between victims Discuss with the victim what happened and how to prevent a reoccurrence on an extended activity For extreme symptoms, loss of consciousness, or shock activate EMS Anaphylactic Shock Others in group should know if someone has potential severe allergic reactions Victims should carry prescribed doses of emergency epinephrine Be sure others know where their emergency epinephrine is and how to use it Activate EMS if the airway swells, there is difficulty breathing, or there is loss of consciousness Anaphylactic Shock 9

10 Use SAMPLE to help with the decision to call EMS Life threatening reactions can happen on a first exposure (such as stings) The faster significant symptoms can indicate a more severe overall reaction Benadryl should be given, even if an Epi-Pen was also administered The body will break down the allergen over time, so we are trying to maintain the airway through the most severe time of the anaphylaxis Glucometer Inexpensive and easy to use Don t forget to enter the calibration number shown on the test strips Nice to have available for a diabetic victim to use Use for a high vs. low sugar decision Requires knowledge of blood sugar levels Heat Emergencies Prevent heat emergencies much better than having to treat it! For heat exhaustion or heatstroke cool victim as soon as possible If victim alert and not vomiting give fluid a little at a time Heat Emergencies Victim of heat exhaustion may be able to travel after cooling and resting but walking out in heat may renew problem Heat injury recovery takes time (dehydration and fatigue) Cool heatstroke victim fast and evacuate if possible Snakebites Assess if the snake is poisonous, or assume a poisonous snakebite if otherwise unknown Diamond shaped head is a good way to identify pit vipers from a distance Don t capture the snake or bring it to the medical facility (yes, there are folks who do this) Envenomation is variable effects on victims are different, so evaluate signs and symptoms Snakebites Use lightly wrapped elastic bandage on entire limb to slow venom spread to body core Extremely important to keep the victim still. Physical exertion will spread the venom faster. This is usually a carry out if away from a vehicle. Keep area at or below heart if possible Monitor fingers and toes for circulation Access EMS CPR If victim is far from medical care and is clearly lifeless after 30 minutes you can choose to stop except for victims of: Hypothermia Drowning Lightning strike Poisoning Oxygen and CPR Generally, we don t use supplemental O2 during CPR. 10

11 If you have the ability to measure PO2: Use supplemental oxygen is PO2 (at sea level) is less than 92-95%, or, there are signs of poor perfusion (blueness) Oxygen for COPD For rapid response areas use high flow oxygen. For remote response areas use victim s cannula and prescribed flow rates. If you have a Pulse Oximeter you can increase oxygen flow to bring percentage above 90 percent. Nasal Airways in the Wilderness NPAs are more expensive than OPAs, so purchasing a full set of diameters of lengths is not a likely option for field kits Field application: Carry only a few diameters in longer lengths Get the length adjusting type or trim to correct length after measuring Also, you can use two if you have them Avalanches Chances of survival diminish quickly, so call for help immediately Begin searching don t wait for help Start where victim last seen and work down slope Use ski poles or branches to probe snow You may face hypothermia + obstructed airway + cardiac arrest issues + trauma Snow Blindness Burn caused by intense sunlight reflected from snow Prevent with UV eye protection Eyes first are sensitive, headache may develop, eventually vision lost Bandage eyes to prevent further exposure Cold compresses may relieve pain Recovery usually within hours Lightning Strikes Two thirds of direct lightning strike victims may survive Immediate CPR critical Continue CPR past 30 minutes Lightning Strikes Direct strike - can be fatal Contact injury - when the person was touching an object that was struck Side splash - when current jumped from a nearby object to the victim Ground strike - current passing from a strike through the ground into a nearby victim. Blast injuries - hearing damage or blunt trauma by being thrown to the ground. Lightning Fatalities Colorado ranks high for lightning fatalities despite fewer lightning strikes than other states. (NOAA) Lightning Injury Prevention Stay indoors during storm If caught in open, crouch, squat, or sit with feet together, stay 15 feet away from others Stay away from doors and windows 11

12 Do not use electrical appliances (even indoors) Keep away from telephone lines and plumbing fixtures The only thing predictable about lightning is unpredictability! Avoiding Lightning Strikes Seek shelter if you hear thunder soon after lightning strike Get out of water immediately or off boat Try not to be tallest object Stay away from metal objects Closed motor vehicle safer than being in open Sheltering From Lightning Lightning is always unpredictable Inside buildings (away from metal) is the best shelter In forests don t stand next to or lean on tree trunks Lightning usually strikes higher objects 45 degree rule: Hypothermia Issues Temperature? Victim temperatures can be useful if you are in a remote area and EMS response is delayed. High temperatures can indicate the possibility of: - Fever from illness - Fever from infection - Hyperthermia (heat injury) Low temperatures can indicate the possibility of: - Hypothermia (cold injury) - Shock How Far Do I Go? Oral temperatures are easy to take. It is a useful capability for the advanced first aid volunteer in remote areas. Rectal temperatures can be useful when the core body temperature is less than 95 and you have a hypothermic thermometer. This is in a remote location, EMS is significantly delayed, and you are dealing with severe hypothermia. Otherwise, oral temperatures should be adequate. Thermometers Glass thermometers have advantages for field use: No batteries to get cold or old No liquid crystal display you can t read if very cold Glass thermometers have highest accuracy Disadvantages of glass thermometers: Can burst if left in high heat too long Need some training to use and read correctly Need a hard case to prevent breakage Not readily available at retail stores Why Glass Thermometers? Glass thermometers fell into disuse because of the mercury ban. They are now made with a 12

13 non-mercury fluid. Inexpensive digital types can be 1+ degrees off not as accurate Tympanic thermometers and forehead strips do not accurately represent core body temperature in the outdoors. Thermometers Fever Thermometer Must be shaken down before use Made as Oral or Rectal type Measures degrees Keeps temperature after removal Leave in for 3-5 minutes Oral vs. Rectal Type? Rectal has a blunt, shorter, stronger tip Field Tip: Carry Rectal type fever thermometers in field kits they resist bursting if they overheat much better than the Oral type. They can be used orally! Human Temperature Some folks do run slightly higher or lower ask them what is normal for them! Oral 98.6 F Axial (armpit) 97.6 F (1 degree lower) Rectal 99.6 F (1 degree higher) Reading a Glass Thermometer 1. Hold by stem end minutes oral and rectal 7-8 minutes axial 3. Rotate to see fluid in shaft and numbers (some have longer tick at 98.6 degrees) 4. Each tick mark is.2 degrees 5. Be as accurate as possible to nearest.1 degrees 6. Clean before and after use Hypothermia Thermometer For rectal use use a lubricant in the field you can use antibiotic ointment insert gently to avoid damage to rectal wall leave in 3-5 minutes Measures a lower temperature range 86 F 100 F for glass type 86 F 108 F for digital type Glass thermometer measures current temperature with no shake down required different from fever thermometer Use lubricant (in the field try antibiotic ointment) Insert gently to avoid damage to rectal wall Read immediately upon removal for accurate temperature Glass type becoming difficult to find you may have to purchase digital models Hypothermia Stages Mild (Stage 1) Symptoms may be vague, such as shivering, hypertension, and possible blood sugar issues. Core temperature is 95 F-98.6 F. Field rewarming should be possible. Moderate (Stage 2) 13

14 Lethargy, full body uncontrollable shivering, or, reduced shivering (lower core temp), coordination difficulties, stumbling, confusion, pale or blue skin. Core temperature is 91 F F. Field rewarming should be possible. Severe (Stage 3) Lower heart rate, no shivering, lower respiration, low blood pressure, difficulty speaking, confusion, poor coordination, irrational behavior, eventually coma and death. Core temperature below 90 F. Begin modified rewarming and call EMS. Mild to Moderate Hypothermia The victim is responsive with body temperature more than 90 F can usually recover with adequate warming even in the field With sufficient rest and warming, mild victim may be able to walk out Move recovered moderate hypothermia victim to a warm environment. Re-Warming With Immersion For mild to moderate hypothermia re-warm with immersion (if practical) water temperature no more than 104 F. Monitor victim for level of consciousness and airway. Severe Hypothermia Usually, do not try to evacuate if hypothermia is severe you need help quickly. Begin modified re-warming efforts as soon as possible. Avoid rough handling (because of cardiac irritability) Severe Hypothermia Modified Re-Warming Heating pads or hot water bottles beside neck, armpits, groin no immersion. Remove/replace all wet clothing. Alternative: Put victim between two dressed responders in pre-warmed sleeping bag(s). Monitor warmers for hypothermia. No naked helpers and victims in the bag! Paradoxical Undressing % of hypothermia deaths are associated with paradoxical undressing. This typically occurs during moderate to severe hypothermia. The person becomes disoriented, confused, and possibly combative. They may begin discarding their clothing, which, in turn, increases the rate of heat loss. Terminal Burrowing A self-protective behavior known as terminal burrowing, or hide-and-die syndrome, occurs in the final stages of hypothermia. The victim will enter small, enclosed spaces, such as underneath logs, between rocks, under beds or in closets. It is often associated with paradoxical undressing. Severe Hypothermia and CPR Victim may appear to be dead with skin cold/blue, signs of breathing very faint, unresponsive Internal temperature could be less than 85 F CPR can lead to life-threatening dysrhythmia if heartbeat is present Assess victim carefully victim may be breathing only once every 30 seconds or so check pulse for 1 minute+ Re-warm victim and provide CPR if needed 14

15 Resuscitation may occur even after significant time in cold water Altitude Issues Common High Altitude Effects Headache Fatigue or Physical Exhaustion Disturbed Sleep Nausea and/or Vomiting Digestive Disorders Agitation Vertigo Altitude Sickness Sometimes called High Altitude Syndrome (HAS) Brought on with three to five thousand feet or more of altitude gain, usually above 5000 feet Acclimatization Take Time As you acclimatize: You breathe faster and deeper. You experience shortness of breath with exertion. You will exhibit a different breathing pattern as you sleep. You will awaken more frequently at night. Your body's hematocrit (an enzyme) will increase and more red blood cells are produced helps the transport of oxygen to the body tissues. Increased urination is normal. Oxygen and Water Oxygen is to treat poor profusion issues Oxygen may make a victim with HAS feel better, but, does not cure altitude sickness. Once oxygen is discontinued symptoms will return. Symptoms of high altitude sickness may look like dehydration. Evaluate hydration by judging urination. Don t hyper hydrate the victim. It is not a cure Acute Mountain Sickness AMS is a severe version of HAS, where the victim has difficulty performing routine tasks Acute mountain sickness (AMS) includes headache, dizziness, fatigue, shortness of breath, nausea, lack of appetite, general malaise As AMS worsens there will be shortness of breath at rest, decreasing mental status, and inability to walk Treatment is to descend to lower altitude For extended activities treat the symptoms and do not allow victim to gain altitude High Altitude Pulmonary Edema (HAPE) HAPE symptoms start gradually within the first 2-4 days at altitude. Symptoms: Shortness of breath, tightness in chest, significant fatigue and weakness, persistent coughing, confusion, irrational behavior Treatment: Activate EMS and descend to lower altitude and administer oxygen 15

16 577 High Altitude Cerebral Edema (HACE) HACE is an extension of AMS, often subsequent to HAPE Rare in Colorado, usually only happens higher than 13,000 feet. Symptoms: Disorientation, lethargy/fatigue, nausea, headache, loss of coordination, memory loss, possible hallucinations, psychotic confusion, coma. Transition from AMS to HACE can be fuzzy. Treatment: Descend to lower altitude and administer oxygen Pulse Oximeter Measures pulse and percentage of oxygen saturation in the blood Inexpensive (shop smart) Can help with a judgment regarding poor perfusion Remember that perfusion can read lower at altitude 90% at 10,000 feet is a normal perfusion Pulse Oximeter At sea level, typical saturation values are 97 to 99 percent in healthy people. At 5,000 feet it can be 95 percent and at around 10,000 feet it may be 90 percent. Above 10,000 feet there is a larger change rate and oxygen saturation can drop to 80 percent or below. For field first aid volunteers up to 10,000 feet: Below 90 percent start oxygen and treatment for high altitude sickness descend. SCUBA Accidents Call EMS for: Breathing difficulty Pain in joints or extremities Feelings of tingling, numbness Paralysis Significant fatigue and generalized weakness Convulsions, coma, unresponsiveness Decompression treatment may be needed SCUBA Accidents Scuba issues include: Barotraumas (expansion injury) Decompression Sickness (DCS nitrogen bubbles in the blood and joints Marine cuts, stings, and bites Any other conventional illness or injury Use oxygen for scuba issues (DCS) and advise EMS this is a scuba accident (for access to hyperbaric chamber) SCUBA Accident Symptoms SCUBA Diving Stings and Cuts There are some special techniques for cuts and stings from coral and marine animals divers should know them Apply standard first aid techniques. Take advice from divers on special solutions for washing and cleaning wounds. 16