Backcountry First Aid Preparedness

1:25 a.m. on March 28, 2012 (EDT)
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Someone in another forum posted this link so I took this quiz. I suspect most on here will ace it:

http://www.proprofs.com/quiz-school/story.php?title=Survival-First-Aid-Test-1

I got an 88% (14 correct out of 16) but don't feel good that I didn't get 100%. If something serious happens in the wilderness there's no margin for error. The thing we don't know can make the difference between a difficult situation and a disaster.

This worries me because I go solo. Sure I carry a SPOT transmitter but I don't count on it. I consider it to be a tool of last resort, except to send periodic "breadcrumbs" to my people while I hike. It's mostly for their piece of mind so they'll have a general sense of my whereabouts.

I guess all that Boy Scout first aid training 35 years ago helped, but it's time for an update.

I just signed up for a 2-day NOLS Wilderness Medicine class in April.

12:06 p.m. on March 28, 2012 (EDT)
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interesting survey.  i got 15/16 but disagree with some of the 'correct' answers on this one.  SPOILER ALERT - IF YOU PLAN TO TAKE THE TEST, DON'T READ FURTHER BECAUSE I TAKE ISSUE BELOW WITH SOME OF THE QUESTIONS.   

-when someone says 'i can't feel my feet,' it's a leap to conclude frostbite without more facts, like the appearance of the numb limb or digit.  this says the correct answer is warming feet with water.  that is the right way to deal with frostbite, as opposed to exposing feet to an open flame, but i have seen plenty of feet, including my own, that were numb but weren't frostbitten.  also, taking the leap to warming with water ignores a number of other steps one can (and most likely would) take for numb feet, like warming them against someone's body first; warming someone's core; and so on.  many times, you can do things to rewarm a person and their feet short of starting treatment for frostbite.

-administer painkillers when someone strikes their head and has fluid discharge from their nose or ear.  while that discharge might evidence a concussion, it might also evidence intracranial bleeding of some kind.  indiscriminately administering aspirin or motrin to someone with an internal bleed could complicate the situation.

-for a severe, spurting laceration in the backcountry, the 'right' answer is direct pressure and a tourniquet is 'wrong' because it can cause more damage.  it's more complicated than that.  direct pressure and elevating the wound (if possible) is the first and preferred option, but if it doesn't work, and if help is potentially hours away, a tourniquet will save someone's life.  it depends on the circumstances. 

-does everyone carry 'cold compresses' with them? i don't, though i guess i should, because a few of these answers say that's what you should use.  i'm much more likely to wrap a sprained ankle, or keep it firmly secure in a boot, when i turn my ankle. 

 

6:43 p.m. on March 28, 2012 (EDT)
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Nice quiz to test your basic knowledge..I wouls suggest to anyone to take a first aid class wether RED Cross or Nols..

7:05 p.m. on March 28, 2012 (EDT)
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No offense to the creator of that test, but there are some deficiencies in it.  Leadbelly did a fine job of pointing a few out.  Administering medication, of any nature, takes some very specific training and permissions to do that (e.g., permission of the individual or part of your MD's protocols).  

7:16 p.m. on March 28, 2012 (EDT)
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The quiz is amusing, but leaves a lot to be desired (I managed to get 16/16 correct, but only by guessing what answer they wanted). Some of the questions have NO correct answer listed (as leadbelly notes), some have partially correct answers. The very first question (CPR) is outdated, going by the most recent recommendations on CPR, hence no correct answer, though you can pick the recommendation of about 5 years ago and get scored as correct. The spurting laceration has a correct choice, but the explanation is in error (and contradicts the correct choice - it did score the correct choice as correct, but botched the explanation). The sprained ankle explanation is stated as "curing" the sprain, and says "in 24 hours". Unnmm, real sprains don't heal in 24 hours. Besides which, you can't really tell whether it is a fracture or a sprain.

The basic first aid course won't give you enough information if you are more than a 911 call from help. Take a real Wilderness First Aid course, like the WMI/NOLS course that Bill Heiser is taking.

12:02 p.m. on March 29, 2012 (EDT)
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That's interesting feedback from everyone (I would expect no less from this group :-D).  Anyway, that quiz may be flawed. But ya know what?  It gave at least one person a wake-up call & triggered an immediate registration for a WMI/NOLS First Aid class!.

So I'd say the quiz served its purpose :).

1:53 p.m. on March 29, 2012 (EDT)
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Has anyone who has certifications thought about starting a thread like that quiz?  Ask a question with enough info so it's not to ambiguous, provide  multiple choice answers,  then give the correct answer(s) in a day or two? 

5:23 p.m. on March 29, 2012 (EDT)
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Not sure I have the time to write up mini quizzes right now.  But, I am always happy to answer questions that individuals may have!

7:09 p.m. on March 29, 2012 (EDT)
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Oh good, I am glad to see that I'm not the only one frustrated with the quiz choices.  Some of those aren't the either or thing-- or combos therein.

I suspect those 88% scores are the same two for each of us...  and for the rest...if people don't know most of those answers, they should consider staying home wrapped in bubble wrap...

11:26 p.m. on March 30, 2012 (EDT)
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> does everyone carry 'cold compresses' with > them? i don't, though i guess i should, > because a few of these answers say that's > does everyone carry 'cold compresses' with > them? i don't, though i guess i should, > because a few of these answers say that's > what you should use.  what you should use. 

Great question do people really carry cold compresses in the backcountry ?

8:07 p.m. on March 31, 2012 (EDT)
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The test is flawed.

I'm Red-Cross certified, and there are anomalies in the "answers".

Does anyone remember (?) a bumper-sticker (from the 1960s) that stated:

                    Question Authority

I've been doing that my entire life.   It's good advice.    It comes natural, I suppose ... being somewhat a 4 ... an 8 ... and a 9, on the Enneagram scale.

_____________________________________________

                               ~ r2 ~

                      a dubious brother

4:40 p.m. on April 1, 2012 (EDT)
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A really good read

5:01 p.m. on April 2, 2012 (EDT)
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The quiz, as posted, seem to be more a marketing tool for the company providing the training. If everyone who tried it got all the 'right' answers, no one would sign up. But if everybody gets a couple wrong, they'll start to doubt their knowledge and abilities, and hopefully take some training.

5:24 p.m. on April 2, 2012 (EDT)
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-for a severe, spurting laceration in the backcountry, the 'right' answer is direct pressure and a tourniquet is 'wrong' because it can cause more damage.

The 'best' answer if you're in the backcountry is QuikClot. Ask your military or paramedical types.

Direct pressure is better than a tourniquet, but a "spurting" wound suggests a ruptured artery and the person might may bleed out anyway. Direct pressure is very hard to maintain while humping a badly injured person all the way down a mountain, or 15 miles down a rugged trail.

10:10 p.m. on April 2, 2012 (EDT)
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peter1955 said:

-for a severe, spurting laceration in the backcountry, the 'right' answer is direct pressure and a tourniquet is 'wrong' because it can cause more damage.

The 'best' answer if you're in the backcountry is QuikClot. Ask your military or paramedical types.

 As with any kind of backcountry scenario, there is never a "best" answer.  

A couple of cautions on the use of Quikclot... remind your friends of this as well:

  • Quikclot is a chemical.  And, therefore, MUST be in your protocols if you are part of a EMS or other medical team.  If you are not, you assume the liability of applying it.  A person can have a reaction to quikclot.
  • Quikclot reduces bleeding through an exothermic reaction with fluids.  This means it produces heat.  A little quikclot... a little heat.  A large wound and a lot of quikclot... you have the real possibility of burning your patient.
  •  Since it reacts to fluids, Quikclot has to be handled carefully.  You don't want an exothermic reaction going on in your eye or nose or mouth... :)
  • Quikclot does nothing for infection.  If you are a couple of days from frontcountry care and you have a dirty wound (try cleaning a spurting wound) packed with Quikclot, you have an increased risk of infection.

Quikclot can be used effectively in many different scenarios.  However, it is far from a "best" answer, particularly to those who are responsible to a Medical Director (e.g., medics).

10:15 p.m. on April 2, 2012 (EDT)
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peter1955 said:

Direct pressure is better than a tourniquet, but a "spurting" wound suggests a ruptured artery and the person might may bleed out anyway. Direct pressure is very hard to maintain while humping a badly injured person all the way down a mountain, or 15 miles down a rugged trail.

 Direct pressure in these situations does not mean "hand on wound."  You should escalate quickly from "hand on wound" to a compression wrap over gauze with a wound of that severity.  Compression wraps tend to stay put well during transport.  

They do, however, have the downside of needing constant supervision to ensure they are not doing damage to the person's "down stream" tissues... which you check by noting the patient's CSM's (color, sensation, and movement) below the wound (distal).

Sorry to take exception with both of your statements, but there are some serious gaps there.  I welcome any questions on either quikclot or bleeding management.  People need to be better informed about wound management.

10:00 a.m. on April 3, 2012 (EDT)
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Perhaps 'best' was a poor choice of words, but you agree that Quikclot would be a valuable addition to an emergency kit.

Like any treatment method, Quikclot should be handled properly, and any first responder should have the ability to assess which is the 'best' method to use to handle a wound. But regardless of how well-trained a person is, Quikclot still works in an emergency situation.

And like any treatment method, Quikclot has its good pints and its bad points.

  • If you're a few hours away from help, and you're dealing with a severed artery, Quickclot will stop them from bleeding out.
  • The potential for a burn is there, but a minor burn won't kill the victim. Major blood loss will.
  • Infection is not an issue in that case - the Quikclot has to be removed by a professional and the wound can be properly dressed at that time. It is only a temporary fix meant to get the victim to somewhere they can be helped, but it does that job well. Same as direct pressure.
  • In terms of preventing blood loss, Quikclot works, whether the artery is cut or torn apart. Direct pressure certainly works if done properly, but under difficult conditions, it is hard to maintain and blood loss can still occur. 

There are reasons Quikclot is in a battle kit. It can be applied quickly under difficult situations and can be easily taped or tied into place, and the victim can be transported to treatment. And it can stop them from bleeding out before they get there. 

I notice that you've made points about concerns that one might have while using Quikclot, but haven't really challenged the main issue. As I read the postings, that would be whether it works to save lives in the case of a wound that is 'spurting blood'. It does.

10:44 a.m. on April 3, 2012 (EDT)
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Cleric said:

Quikclot can be used effectively in many different scenarios. 

 No disputing that it is an effective means of wound control.  I want people be be cautious employing it.  It has been pushed as a wonderful "quick fix" on many online forums to many untrained individuals.  It sounds like you have the knowledge necessary to employ it.  Others won't... and I don't think it is wise to push it as a universal tool for severe wound management.

Good points!  I love a good discussion on this stuff!

5:47 p.m. on April 3, 2012 (EDT)
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speaking of chemicals, i regrettably admit that i carry a small container of superglue for bad cuts.  once you clean and sterilize a decent-sized cut, i think it works better all around than bandages or butterflies. 

9:13 p.m. on April 3, 2012 (EDT)
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You can get medically approved "superglue". It usually has a blue dye for easy identification when you get the victim to a real ER or other medical facility. It is a lot easier to use in the field than trying to thread a needle with dental floss and sew someone back together (no, don't use dental floss to sew an arm back on, though many of us use it for sewing clothes and tents back together in the field)

12:22 a.m. on April 4, 2012 (EDT)
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I just pulled this off the Z-Medica's site.  Explains how it works.  Apparently it no longer causes burns. 

1. What is the active ingredient in QuikClot® gauze dressings? The active ingredient found in QuikClot is a naturally occurring inert mineral called kaolin, which has been known for decades to clot blood. Kaolin does not contain animal or human proteins or botanicals.

2. What are QuikClot hemostatic dressings? QuikClot products have evolved over several years. There are zeolite-based products on the market for pre-hospital and military use. The kaolin-based, gauze products for hospital use (QuikClot Emergency Dressing, QuikClot 4x4, QuikClot Hemostatic Formula, QuikClot 2x2, QuikClot Combat Gauze, and QuikClot Interventional (QCI) and QuikClot Trauma Pad), represent the third and latest generation of technology in the QuikClot family of products for hemostasis. The active ingredient, kaolin is bonded to the surface of nonwoven polyester/rayon gauze for easy and familiar application.

3. How are QuikClot dressings different from surgical gauze? Although QuikClot dressings look like and are as intuitive to use as surgical dressings, they are impregnated with kaolin, an inert mineral that has been known for centuries to initiate the clotting cascade. While surgical gauze and manual pressure more often than not initiate the clotting cascade, this process is sped up in the presence of kaolin.

4. Do QuikClot dressings work on the clotting cascade?

YES. Contact between kaolin and blood immediately initiates the clotting process by activating Factor XII.

    • This reaction leads to the transformation of Factor XII, Factor XI and prekallikrein to their activated forms

    • In addition, Factor XII can activate prekallikrein even without kaolin, but kaolin presence markedly enhanced the rate of activation.

    • The activation of both Factor XI and Factor XII leads to the rest of the coagulation cascade.

5. Does it work? YES. In independent studies performed by both the US Navy and US Army comparing multiple hemostatic agents, QuikClot Combat Gauze emerged overall number one in safety and effectiveness and is now recommended as the first line of treatment for life-threatening hemorrhage on the battlefield within every branch of the US armed forces. Anecdotal reports of use so far within the hospital have been overwhelmingly positive.

6. Is it safe? YES. Because kaolin is an inert mineral, there are no known contraindications.

7. Does it burn? NO. The first generation of the QuikClot granular product, made from non-hydrated zeolite, was discontinued in 2008 when the hemostatic gauze formulation based on kaolin was introduced.  That earlier granular product could cause exothermic reactions if not used properly.

8. Are there any allergic reactions with the use of QuikClot dressings? Because the active ingredient in QuikClot dressings is kaolin, a naturally occurring inert mineral and not a drug, animal, or human protein there are no known contraindications.

9. What if the wound bleeds through the QuikClot dressing? More severe and traumatic wounds may require additional dressings, in which case, multiple QuikClot dressings may be used. However it is suggested that the first dressing used remains in place while a second is applied over the first. You don’t want to disturb the clot that is forming under the first pad. Under no circumstance should a dressing be used a second time.

10. How long can I leave QuikClot dressings on the wound? Although hemostasis is typically achieved 3- 5 minutes, sometimes it is necessary to leave the dressing in place for an extended period of time. The dressings may be left on the wound site for up to 24 hours if needed.  QuikClotdressings are non-absorbable and indicated for external use only. 

11. How easy are QuikClot dressings to remove? QuikClot dressings are extremely easy to remove and will not rip when removed.  Irrigation is not normally required, however if you feel more comfortable it may be utilized.

12. What are the indications for use?

  • QuikClot dressings are intended for temporary external use to control traumatic bleeding. 

  • QuikClot Interventional (QCI) Hemostatic Bandage is applied topically as an adjunct to manual compression and is indicated for the local management and control of surface bleeding from vascular access sites, percutaneous catheters or tubes utilizing introducer sheaths up to 12Fr.

13. How should QuikClot dressings be stored? QuikClot can be stored as you would store any other surgical dressings. Kaolin will remain stable in varying temperatures and in extreme heat or cold.

14. Is the active ingredient in QuikClot dressings a drug or biologic? NO. Unlike other commonly used hemostatic agents, QuikClot dressings do not contain animal or human proteins, such as chitosan or thrombin - which can cause allergic reactions. The active ingredient in QuikClot dressings is a naturally occurring inert mineral called kaolin, which has been known for more than half a century to clot blood.

15. How do I apply QuikClot Interventional (QCI)?

QuikClot Interventional product page
QuikClot Interventional Training video

16. How do I know which QuikClot dressing is right for me? There are a variety of QuikClot dressings available for the hospital market to suit your needs.
More Information is available in our healthcare professionals specialties section and our healthcare professionals productssection

17. If kaolin comes off the dressing, are there any adverse effects?

The active ingredient in QuikClot dressings kaolin, is bonded to the nonwoven delivery material, greatly reducing the chance of any unbonded material getting into the wound.  However it is possible that following intense manipulation, some kaolin could come off the gauze.

Several studies have been performed to assess the safety of the kaolin-based gauze with specific interest in addressing the potential impact of kaolin on soft tissues, vascular and nervous structures. Including standard biocompatibility studies, more than 10 studies have shown that kaolin is safe and has no negative effect on tissues and organs. Furthermore, kaolin is safe even when it comes in contact with an open vessel and no evidence of local or distal damage or thrombosis was ever discovered during pre-clinical testing. These results are well described in a recent contribution to the literature (
The Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 68, Number 2, February 2010) where the kaolin gauze was found to be as safe as standard surgical gauze. 

For further clarification, healthcare professionals are invited to contact our Chief Medical Officer, Dr Basadonna.

Ask Dr. Basadonna

Giacomo Basadonna, MD, PhD, FACS

Professor of  Surgery
UMass Medical School

18. Can I save an unused portion of QuikClot dressings for later use? No. Once the package has been opened QuikClot loses sterility and should be used immediately. Reuse will cause risk of infection and loss of efficacy.

19. Are QuikClot dressings cleared by FDA?

Yes. Z-Medica Corporation has received 510(k) clearance to market QuikClot for hospital use (prescription) in October of 2007. The 510(k) number is k072474. The FDA decision can be viewed at the website below by plugging in the 510(k) number.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm

20. What is the shelf-life of QuikClot dressings and are there any special storage instructions?  An unopened package of QuikClot has a shelf life of three years. The only storage direction is to not leave a pack of QuikClot in direct sunlight for extended periods of time. QuikClot can also be stored in very high or low temperatures (below freezing).

11:21 a.m. on April 4, 2012 (EDT)
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Superglue is handy for fixing a cut and works better than stitches, IMHO. I didn't know you could get a medically approved version.

I carry a tube, and I've also used it to fix broken dentures and glue together a ripped jacket on the trail. Handy stuff!

2:09 a.m. on April 13, 2012 (EDT)
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Yay, it looks like the rain will end just in time for us to lie on the ground to practice Wilderness First Aid this weekend :)

10:14 p.m. on April 14, 2012 (EDT)
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I recently re-certified with the Red Cross in CPR/First Aid. I was amazed at how much the First Aid course had changed. They teach very little now. It all assumes that you have phone access and can call EMS. We teach our Boy Scouts more first aid on their way to their 2nd Class and 1st Class ranks, not to mention the First Aid merit badge. I guess with Scouts we assume that we are out in the boonies and EMS is not readily available. I was disappointed in the Red Cross class, although the teacher did a good job of teaching it. Maybe a wilderness first aid class would be a better investment of my time. I had to take the Red Cross class for work, and they paid for it, so no big deal I guess.

2:57 p.m. on April 15, 2012 (EDT)
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Robert Rowe said:

The test is flawed.

I'm Red-Cross certified, and there are anomalies in the "answers".

Does anyone remember (?) a bumper-sticker (from the 1960s) that stated:

                    Question Authority

I've been doing that my entire life.   It's good advice.    It comes natural, I suppose ... being somewhat a 4 ... an 8 ... and a 9, on the Enneagram scale.

_____________________________________________

                               ~ r2 ~

                      a dubious brother

 I fully agree

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