National Outdoor Leadership School - Index

National Outdoor Leadership School - Summer2008 - Index

4
THE
Leader
WILD SIDE OF MEDICINE
Will hands-only CPR become all the rage? Though it has
its place in the urban environment, hands-only just isn’t
enough in the backcountry.
Don’t Hold Your
Breath: Hands-only
CPR Stays Frontcountry
BY TOD SCHMELPFENIG, WMI CURRICULUM DIRECTOR
The American Heart Association (AHA) recently
issued a press release on “hands-only” CPR
which caused a media splash. While it shocked some
folks like a runaway defibrillator, if you follow the
research trends it’s not a surprise.
Resuscitation science has questioned the value of
rescue breathing (mouth-to-mouth/mask) for people
WILDERNESS MEDICINE
PRACTICES & PROTOCOLS
Wilderness medicine for the
urban medical professional
• 3-day intensive module
• 18 hrs. of category I CME
• 24 hrs. of EMT CEUs
• Field-based scenarios
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Institute of NOLS
(866) 831-9001
wmi@nols.edu
www.nols.edu/wmi
WMI Archives
MEDICINE QUIZ
who suffer sudden cardiac arrest. The research trend
suggests chest compressions are more important, at
least for the first few minutes before the arrival of
advanced cardiac life support and while there is still
enough oxygen circulating in the blood to keep cells alive.
Hands-only CPR is easy to remember and removes
the stumbling block of fear of illness from mouth-tomouth/mask
breathing. In a “call to action,” the AHA
hopes these changes will foster more bystander CPR,
an essential link in the chain of survival.
This change is supported by several large
studies of CPR, none of which demonstrated a lower
survival rate when ventilations were omitted from the
bystanders’ actions.
Hands-only CPR should not be used for infants
or children, who tend to have cardiac arrests secondary
to hypoxia; for adults whose cardiac arrest is from
respiratory causes, e.g. drug overdose or drowning; or
for an unwitnessed cardiac arrest, where rescue breathing
may benefit the victim who has not taken a breath for
several minutes.
Hands-only CPR is designed for a witnessed
collapse, on an adult, when there is immediate access
to an emergency medical system. The key
points are to call 911 and start compressions (hard,
fast, uninterrupted).
The AHA isn’t abandoning rescue breathing with
compressions. Ideally, people are prepared to manage
all types of cardiac arrests, but for many urban scenarios
with 911 access, hands-only CPR is an effective technique.
More importantly, WMI doesn’t plan to change
our CPR curriculum. We will describe this technique
and its rationale and continue to teach rescue breathing
with compressions. Cardiac arrests in the wilderness
can be secondary to hypoxia, e.g. drowning or avalanche
burial. As well, access to 911, oxygen, and an AED are
not common in the wilderness, thus rescue breathing
is an important adjunct to chest compressions. For
our context, ventilation with compressions is an
important skill.
Which of the following is not a suggested means of avoiding heat illness? (Answer on page 8)
A. Hydrate well. C. Rest during the heat of the day.
B. Drink alcohol to vasodilate and sweat better. D. Give yourself time to acclimatize to heat stress.
ACCIDENTS HAPPEN.
GET READY.
Real Life Drama:
WMI Instructor Guiding
on Mount Rainier
At the Wilderness Medicine Institute of NOLS
(WMI), courses are designed to give you the
confidence and decision-making abilities to handle
medical emergencies in remote settings when they
happen for real. Here is a story from WMI instructor
and mountain guide David Conlan about putting his
wilderness medicine training into action while guiding
on Mount Rainier a few years ago.
“Our group left a break at 12,500 feet and everyone was
optimistic about reaching the summit—there was little
wind, a light chill, and decent conditions. As the last two
climbing teams headed up, we received a radio call from
another guide saying a climber was in a crevasse. Seeming
calm over the radio, we thought to ourselves, “Well, no big
deal, get ‘em out and let’s move on.” A couple minutes
passed, and then, “Uh, guys, we got a couple of people
in….yep, we have three in…” This is when we stopped,
anchored our clients in, and regrouped to provide assistance.
Another guide and I were first on scene. About 200
feet above us was a noticeable gouge in the glacier leading
down into the crevasse, the result of an unsuccessful
attempt by the team to arrest their fall. A lone ice axe lay
impaled in the glacier where hands once grasped the tool.
There were four patients—one guide and three
clients. A lot of blood stained the area in and around the
crevasse, reminding us to take precautions against cross
contamination. We triaged the scene and discovered two
critical patients with altered levels of responsiveness, bleeding,
and respiratory distress lying on a snow plug about 25
feet below the lip of the crevasse.
A team of five guides and two Park Service climbing
rangers, several trained by WMI, stabilized and extracted
patients from the crevasse and evacuated all four
to nearby definitive care (two via helicopters).
Injuries sustained by patients included facial fractures,
pnuemothorax, fractured cervical vertebra, ruptured
spleen, contusions, lacerations, hypovolemic shock, among
others. Thankfully, no lives were lost. Response and treatment
from the first radio call to the evacuation of the last
patient took an amazing five hours—all at 13,000 feet
on Mt. Rainier’s Ingraham and Emmons glaciers. It was
one of the largest and most successful rescues on that
mountain to date.”
If you spend any time in remote locations, you need wilderness medicine training.
For 17 years, the Wilderness Medicine Institute of NOLS (WMI) has defined the standards
in wilderness medicine training. With a wide range of course and certification opportunities,
our graduates head into the backcountry prepared to act with confidence, make complex
decisions and manage emergencies. To find a course near you, contact:
THE WILDERNESS MEDICINE INSTITUTE OF NOLS
www.nols.edu/wmi • (866) 831-9001