Family Medicine Vital Signs

By Sean McNamara, MD

This article contains broad and over simplified medical recommendations and should not be interpreted as definitive medical management. The right thing to do in ALL scenarios is seek professional emergency assistance. 

 

Many Utah transplants live here for one reason:  beer. Not. It’s the mountains. Skiing, hiking, biking, fishing, off-roading, camping, no matter the activity, people who choose to move here love the mountains. All mountain activity comes with risks and unfortunately high consequence. This summer there has been an uptick in the number of search and rescue calls statewide and unfortunately a few deaths. This was also a particularly bad avalanche winter.

 

Salt Lake County Sheriff’s office runs the search and rescue operations for the greater Wasatch, and they average 1-2 calls per week with about one of every three requiring use of helicopter support. This June they had twice the number of calls compared to last June.

 

The busiest search and rescue operation in Utah is Grand County Search and Rescue which services all of Moab, Arches National Park, a portion of Canyonlands, and sometimes assists the National Park Service and neighboring San Juan County. They average about 100 calls per year, but had 137 calls in 2015 and already 92 in 2016 through the first week of July. 5-8% of calls require helicopter support.

 

Everyone enjoying the mountains has a duty to have some basic knowledge about wilderness medicine. If not for yourself, at least for your family and friends who may be out there with you. The focus needs to be on prevention. Staying out of danger is much easier than a complex rescue with others’ lives at risk. Keep this in mind as you read and please be thinking about ways to avoid these situations. Accidents are preventable!

 

What to do:

 

The scene must be safe for you to render care, do not put yourself in danger, this only creates more victims. Get help.

 

Every patient needs to be thoroughly assessed and FIRST comes pulse. If the victim does not have a carotid pulse, start CPR. Chest compressions should be at least 2 inches deep to the tune of Bee Gees Stayin’ Alive. (100 compressions per minute). Keep doing this with a ratio of 30 compressions and two breaths. 30:2 continues until help arrives or a pulse returns and the victim begins breathing on their own. If the victim has a pulse but is not breathing, breathe for them by blowing into their mouth (must be sealed) while plugging their nose. Give one breath every 5 seconds; you should see their chest rise. Keep doing this until they are breathing on their own or help arrives. Although this is very basic CPR, its A LOT better than doing nothing. You will not kill someone by giving CPR when they don’t need it, but NOT doing CPR on someone who needs it means sure death. So when in doubt, do CPR.

 

Trauma:

-Prevented by being careful, smart, and sober

-Call for Help

-CPR as needed

-Stop massive bleeding with tourniquet if the person is going to bleed to death

-Stop non-massive bleeding with firm and direct pressure right on the source. Push hard for at least 3 minutes. Use the cleanest thing you have. Keep pressure as long as needed, you can wrap tightly to hold pressure.

-Stabilize obvious fractures or painful limbs with whatever you can find. If moving the injury hurts, make it so the injury can’t move (i.e. a sling).

-If you suspect internal bleeding (blunt force trauma to chest or abdomen like a fall from height) provide CPR as needed and make sure help is on way

-Evacuation from wilderness as soon as safely possible. This means having enough people and skill to get the victim out without risking further injury to them or any rescuers.

 

Burns: 

-Prevented by fire safety

-Clean gently with cool water

-Apply thin layer antibacterial ointment

-Cover with non-adhesive/ non-dry dressing. Ideally a sterile dressing, may use damp fabric until obtained

-High risk for infection

-Evacuate safely any significant burn to face/hands/genitals or large body area.

 

Acute Mountain Sickness (Altitude sickness): 

-Prevented by SLOW ascent.

-Cured by FAST descent

-If mild symptoms begin such as headache, do not go any higher until resolved. It will only get worse.

-Can happen within hours to days at elevations as low as 6000 ft

-Life threatening complications from high altitude exposure include lungs filling with fluid and brain swelling. Go down fast.

 

Avalanche:

-Prevented by not being there, this is not a joke. Avalanche deaths are 100% preventable. It is a choice to be located where there is risk of avalanche. Do not take this risk.

-If you must take this risk, take avalanche safety courses, check local reports, purchase all avalanche safety equipment, go with experienced partners

-If caught, call for help

-Survival directly related to time buried. Know how to use equipment, finding someone fast is difference between life and death

-Provide CPR as needed

 

Heat related illness:

-Prevented by hydration, heat dissipation and acclimatization

-May require over one liter of fluid per hour, if over 2 hours may require salt as well

-Appropriate clothing, limit sun exposure, cool skin with water

-May take one week to acclimatize to hot environment.

-Treatment includes cooling the victim as soon as possible, think ice bath, get as close as possible to this given what you have including fanning.

-Rehydrate

-Evacuate safely

 

Frostbite:

-Prevented by being appropriately dressed/ carrying additional clothing and stay dry

-Treatment is rapid rewarming

-Do not rewarm if risk of refreezing.

-Do not rewarm by rubbing/ friction

-Ideally, place in warm clean water, think hot tub temperature for 15-30 min

-Do not risk burning by placing too close to fire (body part will be numb)

-Evacuate

 

Lightning: 

-Prevented by seeking shelter

-Do not go out with lighting in forecast

-Do not be tallest object around

-Do not be near tallest object around (current goes through ground)

-Find lower ground, squat down with feet together, elbows on knees, head down between forearms.

-Hope for good luck

-Provide CPR as needed; strike victims do better with CPR than heart attacks, so don’t give up!

-Evacuate

 

Drowning:

-Prevented by watching small children EVERY second near water, wear personal flotation device, stay sober

-LIFE jackets only work when worn. Drowning deaths are preventable.

-In Utah water can be VERY cold and even advanced swimmers can drown in a short time

-Call for help

-Provide CPR as needed, longer duration than usual

-No special trick for getting water out of lungs, just focus on getting the breaths in.

 

Snake Bites:

-Prevented by watching out for snakes!

-Two families of venomous snakes in U.S., pit vipers (rattlers, copperhead, cottonmouth) and coral snakes.

-Pit vipers have triangular shaped head compared to oval shaped.

-Call for help, evacuate victim immediately

-Do not apply tourniquet

-Do not try to extract and venom

-Do not incise the area

-Put all time and energy in to evacuation.

-The need for antivenom will be determined by the hospital

 

 

These are only a few common scenarios and hopefully provide you with a taste of the exciting world of wilderness medicine. Please use this as encouragement to learn more about how you can provide care to friends, family, and all those who enjoy the beautiful mountains of Utah! There are many formal wilderness medicine courses, one of which is designed for healthcare professionals, created at the University of Utah called Advanced Wilderness Life Support. For more information, visit www.awls.org.

Sean McNamara is a second year family medicine resident at the University of Utah School of Medicine.