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closeIn a backcountry setting, dealing with a broken bone is among those medical emergencies that require an immediate change in priorities.
Following a fall or other physically traumatic accident, victims must be stabilized and their breathing, heartbeat and level of con-sciousness checked. If vitals are positive, immediately scan for bleeding (treat external bleeding by applying gentle direct pressure on the wound with a clean compress). Responders then must make an inspection of the victim’s joints for dislocations and bones for frac-tures. Check for central nervous system continuity by touching or gently pinching toes on both feet and fingers on both hands. Unless first responders have advanced aid or medical treatment training, their roles should be limited to ensuring vital functions, stabilizing and protecting the victim from further injury or shock, making them as comfortable as possible and starting efforts to evacuate. Here are the steps in case of skeletal trauma.
1. Immobilize and assess
Unless the accident location is inherently unsafe for aiders and the injured person, immobilize the victim in place. Further movement could cause a fractured bone to sever an artery or vein and start bleeding or, in the case of neck and vertebral trauma, could cause damage to the spinal column. Move victims as little as possible to get them into a safe position, and keep the head aligned with the spinal column. Then begin a head-to-toe assessment first by observation and then using gentle finger pressure. For broken bones, look for bruising, protruding bones, deformation or misalignment of limbs. Use gentle finger pressure on limbs and ask conscious victims about pain at each touch point or movement. If necessary, cut rather than pull clothing off limbs if fractures are suspected. Start warm-ing the victim unless there is a potential for heat illness.
2. Stabilize and protect
If a fracture or dislocation is indicated or suspected, do not attempt to align (set) the bone sections or reduce (put the joint in place) the dislocation unless you have specific advanced medical training in how to safely accomplish the procedure. Always treat for swelling around fracture or joint by repeatedly applying cold compresses (snow, ice or stream water) wrapped in cloth or plastic. Trained first responders can immobilize the injured limb or joint with properly fitting and improvised splinting. Splints must prevent or restrict movement, but not constrict blood circulation. Other party members should rig or build shelter around and over the victim to avoid having to move them inside.
3. Support and evacuate
Only if the patient is in good enough condition (no head, spinal or other injuries), the terrain permits and the fracture or joint disloca-tion is an upper extremity (arm, fingers or hand) should they be allowed to evacuate under their own power. If direct communications with outside emergency aid is not possible and the party is big enough, dispatch two people to summon aid — make sure they have explicit details (route name, elevation, mileage distance) on the victim’s location. While waiting, maintain warmth, take the victim’s vitals (pulse and respiration) regularly, give them encouragement and updates, but don’t speculate on their injuries. If any painkillers have been administered, make note of the time and dose.
Training in advance is always a good idea. Rehearse basic how-to procedures of medical first aid and discuss and rehearse the priority of steps that must be taken in a variety of backcountry medical scenarios. There are a variety of training options available, from basic first responder training through the Red Cross to wilderness first aid, which usually gives more in-depth coverage of triage and treat-ments when transport and formal medical treatment are hours or days away.
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Caregivers
The Courtyard -
Accounts Receivable - Contracts Manager
Sicklesteel Cranes, Inc. -
Finance Director
WTA -
Research & Development Engineer
Samson Rope -
Contracts Assistant, Financial Services
WESTERN WASHINGTON UNIVERSITY
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