When a patient arrives in the emergency room, the main objective is to keep oxygen moving into the lungs and blood circulating to the organs using the ABCs: airway, breathing, circulation. These principles are more important in the wilderness, as it takes time to transport a victim to the hospital from the accident site. As a climber and emergency medicine doctor, I carry a first aid kit to bridge the gap between first contact by a pre-hospital healthcare provider and delivery to definitive care (a hospital). Below is a list of essential gear and tips on planning for an emergency in the field.
Note: These techniques are relatively advanced and require medical training, like a wilderness first responder or EMT course.
First Aid Kit
The quality of treatment a sick or injured patient gets is determined by training, supplies, and the time it takes to reach medical transport and then definitive care. All team members should discuss medical supplies to be brought on the trip beforehand to ensure team members know how, why, and when to use them. Variables like high altitude, extreme temperatures, availability of water, and distance to roads, people, or rescue services will determine which supplies and medications you bring. Climbers may encounter head injuries, penetrating trauma resulting in shock or internal bleeding, fractures or dislocations, altitude sickness, hypothermia or frostbite, electrolyte abnormalities, and common medical issues like heart attack, stroke, seizure, allergic reaction, infection, etc. Consider the space in your packs, weight you can carry, and the likelihood of injuries based on personal medical histories and your intended objective. Store your first aid kits in an accessible place, like the top of your pack.
Barriers from bodily fluids
Gloves and a mask provide simple protection from bodily fluids while treating patients. Saliva or blood can harbor infectious organisms. Personal well-being and safety are always the priority in a rescue operation.
Shears or a (belay) knife to remove clothes
In a trauma setting, you may need to remove someone’s clothing to treat an injury. Also, consider the weather, as it might be difficult to keep the patient warm.
Pressure dressing or spare clothing
Apply these to wounds to control bleeding. You can wrap and tie square knots over the wound to apply pressure. Additionally, you can use a tourniquet to stop arterial bleeding that does not respond to direct pressure. Apply it three inches closer to the center of the body than the site of bleeding; ratchet until the bleeding stops. Record when it was applied, as potential for limb loss increases with time spent in a tourniquet.
Aluminum Foam Splint
This is a padded aluminum splint that can be used for fractures or dislocations, SAM splint being the most common. Though bulky, these provide quick and comfortable splinting of an extremity and can be used to make a cervical collar for neck stabilization. You can also improvise splints from trekking poles, sleeping pads, clothes, and branches.
Oral Rehydration Solution
Prevent or alleviate dehydration with a solution of three tablespoons sugar and a half teaspoon of salt per one liter of water. Sports drinks are decent substitutes in a pinch, though their sugar/salt ratio is less ideal for rehydration.
This is the standardized form of communication that medical providers use to relay patient information in transfer of care. It delivers concise information during patient transfer.
- Subjective (What are the situation and symptoms?)
- Objective (What are the physical-exam findings?)
- Assessment (What are the problems in order of importance?)
- Plan (What is the best course of action?)
When planning a big objective or expedition, you should know the medical history of everyone on your team. Find out the following:
- What medical conditions does each member have?
- What medicines do they take on a daily basis?
- What medicines will they need in an emergency?
- If they are packing meds, where are they and how are they administered?
- Any allergies to either food or medications?
Take a Class
Backcountry climbing demands a foundation in first aid. Start with a CPR class and then move on to a wilderness first responder course. Check out class listings from these providers: Wilderness Medicine Association; SOLO; NOLS Wilderness Medicine Institute.
Alex Charmoz is an emergency medicine doctor in Hartford, Connecticut. He is training to be an expedition doctor in remote climbing areas. His climbing roots are in the granite of the Northeast.