By Michael Morse

People have different thresholds for coping with things that frighten, confuse, or worry them. Objectivity is imperative at an emotional scene; people need somebody to take charge and lead them out of the jungle that has invaded their space.

An emergency scene can be returned to order simply by not participating in the nuttiness. The trick is to calmly, and non-judgmentally try to make things better by finding out what is wrong, solving the problem and getting the right resources to the scene.

Here are five scenes that could easily get out of control, and how to handle them: Read the rest of this entry »

Sterling, VA – The Center for Wilderness Safety (CWS), a nationally recognized program offering wilderness and remote medical training as well as American Red Cross health and safety training, will be a contributing sponsor for the 2010 Mid-Atlantic Student Wilderness Medicine Conference in Philadelphia, PA. The Conference is an exciting opportunity for medical students and health care professionals to learn about and gain hands-on experience treating patients in extreme environments.

The two-day conference in April will consist of lectures and workshops lead by nationally recognized physicians and experts on a variety of topics. Demonstrations featuring some of the latest technology being used in the field will also be offered. Students are invited to submit abstracts from their own research in wilderness or disaster medicine for poster presentations. This is an excellent opportunity for both students and health professionals to expand their knowledge and network with other like-minded professionals in the field.

Four members of the CWS staff, including Sean Keener, the new program director of CWS, will be attending the 2010 Conference. Sean has attended many similar wilderness medicine and risk management conferences around the US and is looking forward to getting a different prospective on what students are interested in learning and what new programs CWS can develop to bridge the gap between medical students, health-care professionals, and the relatively new field of wilderness & remote medicine.

Stay tuned for updates from our staff as more information becomes available. You can follow CWS on Twitter at (@CWSonline) and the Wilderness Medicine Conference at (@phillywildmed).

More information is available at http://www.phillywildernessconference.org.

Chewable aspirin is absorbed faster and is more effective than regular aspirin that is either swallowed whole or chewed and then swallowed, a new study shows. This “seemingly quite simple finding” could lead to improvements in the care of heart attack patients, researchers say.

Sean Nordt, MD, of the University of California, San Diego, and colleagues, gave three different types of aspirin to 14 people between ages of 20 and 61. One group was given regular solid aspirin tablets and told to swallow the pills whole. Another was given regular aspirin tablets and told to chew the pills before swallowing. A third group was given chewable aspirin tablets, and swallowing occurred during chewing.

The researchers then measured levels of aspirin in the blood; researchers say the chewable aspirin consistently showed the greatest and fastest absorption rates. The findings are being presented at the annual meeting of the Society for Academic Medicine in New Orleans. Researchers say the study was done because current guidelines recommend chewing to increase absorption, but evidence that that’s best is scant.

Thirteen of the 14 participants were men; the mean age was 31. Over the course of the study, each participant ingested each form of aspirin; 1,950 milligrams of aspirin (the equivalent of six regular aspirin tablets) was administered every time. Measurements of blood showed clearly that aspirin was absorbed fastest when administered in chewable form and swallowed. “This supports the recommendation to use chewable [aspirin] formulation in the treatment of ACS,” the researchers say. ACS refers to “acute coronary syndrome,” the general medical term meaning heart attack or sudden onset of angina.

Current guidelines call for giving heart attack patients one aspirin tablet and for them to chew it to speed up its anti-blood-clotting properties.

Aspirin works within 15 minutes to prevent the formation of blood clots in people with known coronary artery disease. One adult-strength aspirin contains 325 milligrams. The current study suggests that 325 milligrams of chewable aspirin would be preferred in the setting of a heart attack or sudden onset of angina ( chest pain). However, aspirin should still be taken under these circumstances if the chewable form is unavailable.

Aspirin use in patients with heart disease is common. People with known coronary disease often are told to take a “baby” aspirin (81 milligrams) daily to reduce their risk of heart attack of stroke.

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Want to learn more? Take a Red Cross CPR class and learn to save a life!
Visit the Center for Wilderness Safety’s website at www.WildSafe.com
and sign up for an American Red Cross course today!

At many blood donor services, you can choose to donate whole blood or just specific blood components. All donations are greatly needed and appreciated.

Whole blood
The main components that make up blood are red cells, platelets, plasma, and white cells. When most people give blood, they give a pint of “whole blood” which means a donation containing all four blood components. Each donation of whole blood is taken to the testing lab where the white cells are filtered out. The unit is then separated into the remaining components: platelets, plasma, and red blood cells.

If you donate through Inova Blood Donor Services or the American Red Cross, every donation is thoroughly tested, properly labeled, and carefully delivered to local hospitals.

Whole blood donors are eligible to give blood every 56 days.

ABC (automated blood collection) donation
Making an automated or “apheresis” donation means that you provide a particular blood component or set of components such as red blood cells, plasma and/or platelets. This technology enables us to collect specific components and return the uncollected components safely back to the donor via the automated process.

During the automated blood collection process, blood flows through single-use sterile tubing into a centrifuge chamber that “spins” your blood and separates the whole blood into various components. Each component is collected into a waiting bag. Component procedures take a little longer, but they are safe for you and highly efficient for patients. Each blood component is unique and important:

Platelets
One platelet donation yields as many platelets as normally present in six whole blood donations. Platelets are given to help stop bleeding in patients recovering from cancer, leukemia, open-heart surgery, and transplant surgery. A platelet donation typically takes 90 minutes. You can donate platelets every 14 days.

Plasma
One plasma donation yields as much plasma as three whole blood donations. Plasma carries clotting factors and nutrients. It is often given to trauma patients, organ transplant recipients, newborns, and patients with clotting disorders.

Red blood cells
One red cell donation yields as many red blood cells as two whole blood donations. Red blood cells carry oxygen and are often given to surgery and trauma patients and those with blood disorders such as anemia and sickle cell anemia. A red blood cell donation typically takes one to two hours. You can donate red cells every 56 days. You may also be eligible to donate double red cells. In this case, you are eligible t o donate every 112 days.

All blood types are needed for components. Component donations are safe for donors and make transfusions even more efficient and safe for patients.

Autologous blood donations
In rare instances, such as when someone has a unique set of markers or antigens in their blood or are about to undergo a highly complex surgical procedure, a physician may recommend that an individual have his or her blood drawn and reserved for the upcoming surgery.

In these cases, most blood donor services can draw and transfer blood to the hospital performing the surgery. If you are interested i autologous blood donation, please talk with your physician.

Blood that is drawn autologously and is not used during surgery is immediately and properly disposed of. The nature of autologous donations does not require that the donated unit(s) go through the same rigorous testing as blood donated for use by the general patient population.

To learn more, contact the American Red Cross (http://www.givelife.org) or Inova Blood Donor Services (http://www.inova.org/get-involved/blood-donor-services).

It has occured to me that a lot of emphasis is put on “macguyvering” or using whatever you have to self-evacuate a patient to definitive care. Don’t get me wrong, many wilderness first aid classes that I’ve seen have done a really great job of making some very creative (and sometimes even effictive) make-shift spine boards with which to evacuate a patient. However there’s a new train of thought that we teach in wilderness first responder which I think is important to relay to WFA students and alumni which is:

In a wilderness rescue situation where you find yourself in need of evacuating a patient with a severe life-threatening condition, there’s a very strong likelihood of NOT doing a self rescue, but rather an assisted rescue where professional services are utilized. Many folks seem to want to get the patient to definitive care as quickly as possible; which is not entirely faulty – the issue is that with wilderness medicine, the goal is to stabilize the patient and stay with them until either help arrives or you can stabilize them and make them as highly visible as possible while you go get help. Your goal as a wilderness medicine provider (WFA or WFR) is NOT primarily to evacuate the patient; hence why two major teaching points of both courses are extended patient care and evacuation decision making.

WFA and WFR courses should train using professional rescue devices such as actual spine-boards, Reeves stretchers and Stokes basket litters for example.

I just felt that this is a clarification that should be made since so many students have asked the question of “when should we evacuate a patient and how would one go about doing so”. I will also answer that saying ‘it really depends on the situation.’ Remember though your primary goal: stabilizing the patient and if at all possible, sending for help.

Since this topic has now come up several times in greater detail than I had anticipated in going into during CPR & Wilderness First Aid classes, I figured that I would pass this information on to you all regarding the American Red Cross’s stance on Do Not Resuscitate orders and what you as a lay-responder should do if you encounter one.

To Summarize:
1) As the Lay Responder (Red Cross CPR/First Aid certified only), one does not have to acknowledge the DNR Order.
2) If you are Wilderness First Aid certified or higher (WFR, FR, EMT, etc.), you are to look at the document and may “accept it’s conditions” to not perform CPR in the event of a cardiac or respiratory arrest only if the following conditions exist:
a. The document MUST be the ORIGINAL (copies and verbal statements do NOT count in a court of law).
b. The document MUST be SIGNED by the correct people (person’s personal physician; and the patient or power of attorney).
c. The document is only valid for ONE YEAR from the date signed by the physician. After which it is no longer valid.
3) If you are a lay responder (American Red Cross certified only) then take the document and give it to the paramedics upon their arrival.
4) If the patient has a Living Will, it is NOT THE SAME and therefore you are to perform CPR as needed according to your initial assessment.
5) A DNR order can be revoked by the patient (or power of attorney) destroying the document (ripping it in half is sufficient) and cutting of their DNR bracelet (if they have one).
6) A TATOO which says “Do Not Resuscitate” is NOT A LEGAL DNR and must be ignored.

This information is specific for Virginia, Maryland and the District of Columbia. If you live in another state, check their laws regarding DNR orders (it’s fairly easy to find on Google). I hope that answers any questions that you may have had regarding Do Not Resuscitate orders! If you’ve got more questions, please feel free to call us at (703) 444-9468.

This is what prompted me to renew my cert almost a year early:

Yesterday our kids were out riding motorcycles in the neighbor’s backyard on the small motocross course they have set up. One of the neighbor boys, Marshall, overshot the tabletop and crashed, went over the handlebars, and landed on his head. Garrett knew I had first aid training and came home to get me. I rushed to the scene and held c-spine on Marshall until the paramedics arrived. Marshall was altered and barely breathing, in very serious condition. They had to airlift him out to Fairfax. Later the EMT thanked me – he said that when they arrived I had done everything right and had control of the scene. Funny thing is, despite being a little rusty it all came naturally.

Marshall is in the Pediatric ICU today. He has a lacerated liver and some bleeding on the brain. Last we heard he was scheduled for a CAT scan, but that there were no signs of brain damage.

Thanks for a great course. “It’s not your emergency” was key to keeping focused. Everything else seemed to happen naturally.

Mike

PS. All of the boys wear full gear, but sometimes it just doesn’t prevent injury. The motocross track is now slated for demolition per every mom in attendance. Marshall’s career motocross racing has also ended – he is officially retired, also per his mom.

The following article was written by Michael M. and Adam S. of Herndon, VA who did a case study of the effects of how different individuals deal with coming across a patient who is already deceased, as opposed to one to passes away while under their care. These two gentlemen are still in High School – and did a fantastic job with this study!

Wilderness First Aid: Psychosocial Development and the Five Stages of Grief

by Michael M.

Throughout life, people change. Whether it is psychological or physiological, this change will always happen. Although many disagree about whether people change in stages or in one continuous movement, it is unanimous that people develop.

For our 10 hours of community service, Adam S. and I volunteered at a course called Wilderness First Aid (WFA), taught by the Center for Wilderness Safety. WFA is a 25-hour long course that is open to all people 14 and older. It teaches how to prevent, recognize, and treat common wilderness first aid problems when definitive medical help is more than one hour away. Along with becoming “victims” for them, we also taught a session of the course called “Death and Dying,” in which we taught about Kubler-Ross’ Five Stages of Grief. Read the rest of this entry »

With bones, we have only 1 basic thing that can happen: fractures. Fractures can be either simple (broken or cracked – but still under the skin) – or compound (an obvious break; usually showing through the skin). Either way, we need to make certain that the patient is comfortable, and that we stabilize the fracture and prevent movement of the injured area; thus, preventing further damage or harm to the patient.

How we achieve this goal, is to apply a splint.

Read the rest of this entry »

fcpa_logoWe’re very excited about our new partnership between the Center for Wilderness Safety and Lake Fairfax Park in Reston, VA!  We will now be offering a number of course available to the public starting in February of 2009. Those courses will include many American Red Cross and Wilderness Medicine courses that will be offered not only to the public, but also to Fairfax County Park Authority employees over the coming months.

Read the rest of this entry »

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