Wilderness Medicine

Perils and Pearls

Dwight Parker MD
Mountain bike fall
 Call 911 when you get service!

Will route you to Salt Lake Sheriff's Office and local search and rescue.
Suggested Reading

Backcountry rescues tend to take a long time so

patients tend to be stable if they are alive.
Bear Attack

How I survived
How to properly use bear spray
Ski touring up Butler Fork in Big Cottonwood Canyon. Wanted to get up to
Gobbler's Raymond Saddle.
In the aspen grove about 2 hours up you find a lone skier facing downslope, leaning
into a tree. He seems to be breathing but has some blood coming out of his mouth.

Case
 1. Scene Safety
2. Massive hemorrhage
a. Can't replace blood or volume in the backcountry
trauma setting.
Primary Survey: b. No blood means hypovolemic shock, organ failure,
hypothermia, incapacitated and potentially
immobilized patient
Level of Responsiveness
Alertness c. Can only be evacuated with a helicopter/flight team
[A+O x4 person, place, time, event] 3. Airway with C-spine stabilization. Is airway already open?
Verbal Able to maintain airway? Trap squeeze stabilizing method
Pain 4. Respiration. Rescue breaths if needed
Unresponsive
5. Circulation. Assess for non-massive hemorrhage. Blood
sweep. Full head to toe check for blood, wet clothing,
swelling, other signs of bleeding. Mention sand and snow.
Sand the blood fades away. Snow looks like a massacre.
6. Hike vs. Helicopter—Hypo and Hyperthermia.
CPR guidelines
in the backcountry
⁻ CPR is exhausting.
⁻ Gauge the feasibility for yourself
and your party.
⁻ Hypothermic patients are not
dead until "warm and dead"
unless they died before onset of
hypothermia, died and cooled
in a 70 degree lake (for
example). Need to assess pulse
for 30-60 seconds in cold
settings/cold drownings.
• Even in urban settings, CPR with
delayed defibrillation has success
rates 1-6%.
• European Rescue Council
recommends 5 breaths at beginning
of CPR for drowning rather than the 2
breaths recommended by AHA.
• Prioritize rescue breathing in:
• Lightning strike victims
• Drownings
• Snow burials
Secondary Survey Physical exam
full palpation and inspection
Altered mental status check:
• Allergy/Altitude/Anaphylaxis
S.A.M.P.L.E. history
• Environment (hyper or hypothermia) Signs and symptoms
• Infection (sepsis, meningitis)
Allergies
• Overdose (drugs, toxins)
• Underdose
Medications
• Trauma Pertinent medical history
• Insulin/Diabetes Last ins and outs
• Psych Events
• Seizure/Stroke
 • Always bring a space blanket or folded up huge
garbage bag
• Things you can't improvise in the backcountry
• Duct tape
• Syringe for irrigation
• Tweezers
Pearls • You can't replace blood in the wilderness
• Best chance of survival usually relies on
being able to get yourself out
• If you have severe bleeding or a severe LE
fracture this likely won't be possible
• Build a Wilderness First Aid Kit
“The clearest way into the Universe is
through a forest wilderness.”
― John Muir