Archive for the ‘wilderness medicine newsletter’ Category

New! From The Wilderness Medicine Newsletter

February 10, 2012

For decades the Wilderness Medicine Newsletter has provided up-to-date information to pre-hospital and definitive care providers. Since becoming an on-line journal, the readership of the WMN has become international. Now the WMN has it’s own web site: www.wildernessmedicinenewsletter.com

Subscribers pay the same $15 a year subscription rate but have access to more than 165 articles from back issues as well as current issues. You can search the site either by category, or by key words making the Wilderness Medicine Newsletter site a much more useful reference for everything from reviewing splinting to the prevention and treatment of tropical diseases.

Check it out!

Haiti

February 5, 2010

the  Major disasters in the last 10 years, 2000 – 2010:

2001 – Gujarat Earthquake, India                                20,000 Deaths

2003 – Bam Earthquake, Iran                                      30,000 Deaths

2004 – Indian Ocean Earthquake and Tsunami    230,000 Deaths

2005 – Kashmir Earthquake, Pakistan                       85,000 Deaths

2005 – Hurricane Katrina, USA                                       1,300 Deaths

2008 – Sichuan China Earthquake, Chine                 70,000 Deaths

2008 – Cyclone Nargis, Burma (Myanmar)              150,000 Deaths

2010 – Haitian Earthquake, Haiti                               170,000+ Deaths

These natural disasters have cost hundreds of thousands of lives, displaced and made homeless millions of people, mostly the poorest of the poor, cost billions upon billions of dollars, and their global impact has lasted for years.

There is no reason for us to expect that these moanings and groanings of our living planet will ever stop. Therefore, it is essential that we are prepared for the worst. First, we have to be prepared in our own home, then in our community, our state, our country, and finally the world.

The point of this brief article is to provide you with a list of the principles of being prepared to go, to help, and to unselfishly SERVE others in their time of need.

The Principles that will help you to prepare to go and to SERVE:
SAFETY
SHELTER
SUSTENANCE
SANITATION
STAYING WELL
STRESS

SAFETY

Safety is first and foremost is having a well-thought-out plan and sticking to it.
There is safety in numbers; always travel in a group, and try to work together as a group. Keep the team together.
When moving around, remember that traveling during the day is much safer than traveling at night.
Know where you are going, how you are going to get there, and who is going to meet you.
Find out well in advance if there are any local concerns for safety or if there are dangerous areas that you should avoid.
Ask questions. Don’t guess. Most people are more than glad to answer questions and be helpful.
Have an evacuation plan. You need to know what to do if someone in your group does become sick or injured. The plan should include how to evacuate them to home.
It is a very good idea to have some form of evacuation insurance from a group such as Global Rescue, the American Alpine Club, or Divers Alert Network to name a few.
If you do have evacuation insurance, make sure that you carry the details of the policy on your person with appropriate contact information and phone numbers. You do not want to leave it at home or back at base camp. It needs to be with you at the time of the crisis, so the plan can be easily and accurately activated.

SHELTER

When you go into areas of destruction, you cannot count on there being any housing.
You have to carry your own shelter, i.e. a tent, and in the tropical climates you have to be able to sleep under mosquito netting at night to avoid bug bites.
Warmth. Check the weather conditions and carry appropriate sleeping bag or bed roll for the anticipated climate conditions. Remember, in the tropics 60F is considered cold.
Know how to and be prepared to bivouac, to be able to make an emergency shelter from a sheet of plastic or tarp.

SUSTENANCE

Food and water:
Like shelter, you cannot assume that there will be potable water or adequate foods supplies. You do not want to use up the resources of the people whom you’ve come to help.
Food:
You have to carry enough food for your team. Preferably, food that does not take a lot of cooking time or preparation time.
Carry food that can be eaten without cooking, such as protein bars or food that cooks quickly in boiling water, such as macaroni and cheese, instant potato, rice, or premade meals.

Water:
You have to be prepared to purify all you water.
Techniques of water purification: BOIL, CHEMICAL, FILTER, UVC LIGHT
All these techniques are very effective.
Boil: Bring to a rolling boil to sterilize. You have to have a source of heat.
Chemical: Chlorine or iodine.
Use chlorine for large supplies of water for a group.
Use iodine for individual water supply, one water bottle at a time. Although iodine is inexpensive, and safe to use, it does give the water an unpleasant taste.
Filtration: You can use for a group, but usually used by individuals.
Use a filter that also contains iodine to kill the viruses that are too small too filter.
UVC or ultraviolet C light.
Steripen is used by individuals for their own water bottles.

SANITATION
Sanitation is more than just good hand washing. It involves:
Wear gloves when examining and treating patients. It is essential that you bring lots of gloves.
Having a plan to properly dispose of human waist, urine and feces.
Choices: digging a pit and making an outhouse for the group to use or you can use commercially available potties or toilet bags with proper disposal. You want to avoid fecal contamination of the local water supply.
Staying clean. Keep the perineal area clean to avoid rashes and a painful butt. Applying a thin layer of Vasoline to the area around the rectum will help to stay clean and avoid chafing.
Bring lots of toilet paper and personal wipes.
Women need to bring sanitary napkins or pads.
You have to know how to bathe in a bucket of water, and do so daily.
Rinse out clothing every day with soap and water, i.e. the skill of hand washing.
Check your skin several days for ticks, bug bites, and rashes.

STAYING WELL

Immunizations/vaccinations:
Go to the CDC.gov website, travel advice, for information on travel vaccines and common diseases in the area you are going to.
Usual childhood vaccinations plus; Hepatitis A and B, IPV poliovaccine, Typhoid, make sure tetanus and diptheria are up-to-date, consider yellow fever and meningiococcal.
Antimalarials:
If you are going into an area where there is malaria, take an antimalarial daily such as doxycycline or Malarone. Remember that malaria is treatable, but not necessarily curable; therefore, malaria porphylaxis is common sense.
Know the modes of transmission of disease and practice good body substance isolation.
Insect repellants and insecticides. Do every thing that you can to avoid being bitten by insects – mosquitoes, black flies, ticks, sand flies, etc. Use insect repellants, wear appropriate clothing, and sleep under mosquito netting.

STRESS

Post Traumatic Stress Disorder:
One of the most difficult tasks is trying to determine who is emotionally prepared to face all the destruction and human suffering that you may be confronted with.
During the deployment, try to get your group together several times daily to share in their ongoing experiences, expectations, concerns, and to pray together if appropriate.
Have a follow-up plan for after everyone has returned home. PTSD can be prevented and is treated by talking about the tough work, the difficult things that you saw and did, and the sense of disappointment or even failure that can haunt you once you are back home, safe and secure.

We have to consider the whole human being; the body, the mind, and spirit. One cannot exist well without the others and they have powerful influences over one another. Being mature, having a wide variety of human experiences, a desire to serve as well as being well grounded in faith can be very helpful and important.

This post is an excerpt from the current special edition of the Wilderness Medicine Newsletter and is reprinted here with the permission of the editors.

Improvised Pelvic Splint

July 30, 2008

In keeping with the other video demonstrations that we have posted on this site, below you will find a video of an improvised splint for a possible fractured pelvis….

IX. Patient Assessment System – Checklist

April 29, 2008

Part 9 of 9: PATIENT ASSESSMENT CHECK LIST:

SCENE SURVEY:
Is the SCENE SAFE?
Is the PATIENT SAFE?

PRIMARY SURVEY: 
Are they CONSCIOUS?
Do they have an OPEN AIRWAY?
How is their BREATHING?
Do they have a PULSE? 
Are they BLEEDING?
Are there any serious injuries on the CHUNK CHECK?
Is their neck and spine STABLE?
Do they need to be MOVED?
Do we need to protect them from the ENVIRONMENT?
How is everyone else DOING?

SECONDARY SURVEY – VITAL SIGNS:
What is their RESPIRATORY RATE & EFFORT?
What is their HEART RATE & EFFORT?
What is their LEVEL OF CONSCIOUSNESS?
What is their SKIN COLOR, TEMPERATURE, & COLOR?

SECONDARY SURVEY – PATIENT EXAM:
HEAD  – scalp, face, eyes, nose, mouth.
NECK  – spine, trachea.
CHEST – clavicles, shoulders, ribs.
ABDOMEN – compress the abdomen.
PELVIS – compress the pelvis anterior/posterior and lateral.
LEGS  – circulation, sensation, and motion.
ARMS  – circulation, sensation, and motion.
BACK  – log roll and palpate the length of the spine.

SECONDARY SURVEY – AMPLE HISTORY:
ALLERGY – allergy to drugs, foods, insects, etc. 
MEDS  – prescription and non-prescription drugs.
PREVIOUS – significant past medical history, surgeries, etc.
LAST   – last intake & last output.
” EVENT – events leading up to this crisis.

SOAPnote:
Putting it all together and creating a treatment plan.

RESCUE PLAN:
” Looking at all factors and creating a rescue or evacuation plan.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

VIII. Patient Assessment System – Rescue Plan

April 22, 2008

Part 8 of 9: PAS – STOP – RESCUE SURVEY: Do we need help?

Are we staying or going?
What is our plan to get help?
Who is going to go to get help?
What do we do to protect the patient while waiting for help to arrive?
What do we do to protect ourselves while waiting for help to arrive?
Is the scene safe?

RESCUE PLAN: Do we need help?

Group’s condition:
How well is each individual in the group doing?
How well prepared is the group to stay put and bivouac?

Decisions:
Do we need to evacuate the patient or can we all go on?
If evacuation is needed, send for help.
While waiting for rescue – build a bivouac.

Sending for help:
Send two to get help if possible.
Send out a SOAPnote on the patient.
Send out a list of the rest in the group and how well prepared you are to bivouac.
Send out a map with your exact location and time marked on it.

While waiting for help to arrive:
Know where everyone is; pair people up to massage each other’s feet, etc.
Keep everyone busy.
Create shelter for everyone.
Get water or melt snow and make something warm to drink.
If food available, make a meal & eat.
Keep spirits up, be positive, reassure, make sure everyone has something to do.
Create light and warmth; build a fire.
Make yourselves big, easy to find.
Continuously monitor your patient.
Continuously monitor everyone else in the group.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

VII. PAS – Secondary Survey – SOAPnote:

April 15, 2008

Part 7 of 9: PAS – SOAP note: What is our patient care plan? 

The SOAP note is organized into the Subjective date, Objective date, the Assessment, and the Plan.

Subjective:
The subjective date is their age, sex, the mechanism of injury (MOI), and the chief complaint (C/C), i.e., what they are complaining of.

Objective: 
The objective date consist of their vital signs, the patient exam, and the AMPLE history.

Vital signs: 
Time the vitals signs are taken:   
RR & Effort    
HR & Effort(BP)    
LOC    
Skin: C/T/M    

Patient exam:  Describe locations of pain, tenderness & injuries.
                                                                                                                                               
AMPLE history:
Allergies:           
Medications:             
Past pertinent medical history:         
Last intake & output:           
Events leading up to accident:         

A – Assessment:  (problem list)
1.                                                                                                                                                  
2.                                                                                                                                                   

P – Plan:  (plan for each problem on the problem list)
1.                                                                                                                                                   
2.                                                                                                                                                  
3.  MONITOR - reSOAP your patient every 5 – 15 minutes.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

VI. PAS – Secondary Survey – AMPLE History:

April 8, 2008

Part 6 0f 9: PAS – AMPLE History: What is their past medical history?

ACTION:
Talk with your patient or others to determine the following information:

A – Allergies:
Are they allergic to any medications, foods, insects, etc.? 
If they are what happens and how is it treated?

M – Medications:
What medications are they taking, both prescription and over-the-counter?
If they are taking medications, how often and how much do they take and have they taken their meds today?

P – Previous Injury or Illness:
Is there any recent or past injury or illness that could contribute to the current problem?
Have they ever been hospitalized over night for any medical problems, is so what?

L – Last Input and Output:
When was the last time they had anything to eat or drink?
What did they eat and drink?
When was the last they voided or had a bowel movement?

E – Events leading up to the crisis:
What lead up to or occurred just prior to the critical event?

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

V. PAS – Secondary Survey – Patient Exam:

April 1, 2008

Part 5 of 6: PAS – PATIENT EXAM: What are their injuries?

PRINCIPLES OF THE PATIENT EXAM:
You are trying to discover all possible injuries by:
LOOK:
Inspect:  Is there any bleeding, wounds, impaled objects, or deformities?
Compare:  Are their body parts symmetrical?
LISTEN:
Complaints: Are they complaining of pain or tenderness, if so, isolate where it hurts?
FEEL:
Palpation: Is there tenderness in muscles, bones, or joints?
Circulation:   Are there pulses in all four extremities?
Sensation:   Is there normal sensation in all four extremities?
Motion:   Is there normal range of motion is all four extremities?

ACTION:
Keeping the above principles in mind do a hands on head-to-toe exam:
HEAD:  scalp, face, eyes, ears, nose, mouth.
NECK: cervical spine, trachea.
CHEST: clavicles, gently compress the rib cage.
ABDOMEN: compress the abdomen in all four quadrants.
PELVIS: compress the pelvis front to back and laterally.
ARMS: palpate the muscles and flex the joints.
LEGS: palpate the muscles and flex the joints.
BACK: palpate the length of the back.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

IV. PAS – Secondary Survey – Vital Signs:

March 25, 2008

Part 4 of 9: Patient Assessment System – Vital Signs:

STOP – SECONDARY SURVEY: How hurt are they?
The Secondary Survey consist of:
How well are they? Vital Signs
What are their injuries? Patient Exam
What is their past medical history? AMPLE History
What is our patient care plan?  SOAPnote

VITAL SIGNS: How well are they doing? 

Respiratory Rate and Effort:
Respiratory rate and effort shows us how well the Respiratory System, the airway and lungs, is doing at oxygen exchange and in particular, in supplying the brain with O2.
LOOK – Do they look like they are having difficulty breathing?
LISTEN – Are they complaining of shortness of breath or difficulty breathing?
FEEL - Is the chest moving properly with breathing?

Heart Rate and Effort (blood pressure):
The heart rate and effort, blood pressure, tells us how well the Circulatory System, the heart and blood vessels, are doing.
LOOK – Do they look shocky?
LISTEN – What is there heart rate, beats per minute.
FEEL – Take a blood pressure by palpation (systolic), if you do not have a BP cuff.

Level of Consciousness:
Level of consciousness tells us how well the Central Nervous System, the brain and spinal cord, are doing.

Action:
Level of Consciousness (LOC) is determined using the AVPU scale:
Awake, Verbal, Painful, Unresponsive.

Conscious: “The lights are on, is anyone home?”
Awake, their eyes are open but, are they alert oriented times 3, person, place, and time?
Person, do they know who they are?
Place, do they know where they are?
Time, to they know the day, week, and year?

Unconscious: If their eyes are closed they are unconscious, but how responsive are they?
Verbal stimuli, “Hello, anyone in there?”
Speak to them, do they react to hearing their name?
Do they follow simple commands?
Painful stimuli, “That’s got to hurt.”
A knuckle rubbed on their sternum?
Is it an appropriate response to pain?
Unresponsive, “Speak to me; say something.”
No response to verbal or painful stimuli.

Skin color, temperature, and moisture:
Skin color varies by individual and race.
Look – What is their skin color, pale, ashen, cyanotic?
Listen – Are they complaining about feeling hot or cold?
Feel – Is their skin dry, moist, clammy, hot, or cold?

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

III. Patient Assessment System – Primary Survey

March 18, 2008

Part 3 of 9: Patient Assessment System – Primary Survey

STOP – PRIMARY SURVEY: Are they alive, and are they going to stay alive?

A: Approach and Assess – Are they conscious and can they speak?
A: Airway – Do they have an open airway?
B: Breathing – Are they breathing?
B: Breathing – How well are they breathing? 
C: Circulation – Do they have a pulse? 
C: Circulation – Are they bleeding?
D: Deformity – Are there any obvious deformities?
D: Disability – Is their neck or back at risk of injury?
E: Environment – Can they stay where they are?
E: Everyone Else – How is everyone else in the group doing?

A: Approach and Assess – status of the central nervous system
Are they conscious and can they speak?
Look – Are they awake; are their eyes open; what position are they lying in?
Listen – Speak to them. Do they speak back?
Feel – What is your general impression of the situation?

A: Airway – status of the respiratory system
Do they have an open airway?
Look – Is there anything in their airway?
Listen – Can you hear air moving in and out of the airway?
Feel - Can you feel air moving in and out of the airway?

B: Breathing – status of the respiratory system
Are they breathing?
Look - Is their chest wall moving as they breathe?
Listen – Can you hear any adventitious breath sounds indicating a partially occluded airway, such as wheezing, gurgling, or snoring?
Feel - Is the chest wall moving appropriately with respirations?

B: Breathing – status of the respiratory system
How well are they breathing?
Look – Is their chest wall moving as they breathe?
Listen – Can you hear any adventitious breath sounds indicating a partially occluded airway, such as wheezing, gurgling, or snoring?
Feel – Is the chest wall moving appropriately with respirations?

C: Circulation – status of the circulatory system
Do they have a pulse?
Look – Is there any bleeding?
Listen - Can you hear a heartbeat?
Feel - Can you feel a carotid pulse?

C: Circulation – status of the circulatory system
Are they bleeding?
Look – Is there any bleeding?
Listen – Can you hear a heartbeat?
Feel – Can you feel a carotid pulse?

D: Deformity
Do they have any obvious injuries or deformities?
Look – Do you see any obvious injuries or deformities?
Listen - Where are they complaining of pain?
Feel - Where does it hurt? As you touch them, where can you cause pain?

D: Disability
Is their neck or back at risk of injury?
Look - What was the mechanism of injury (MOI)? Can they move their extremities?
Listen - Are they complaining of any neck or back pain?
Feel - Do they have normal sensation in their extremities?

E: Environment
Can they stay where they are?
Look - Where are they lying?
Listen – Are they complaining about being hot, cold, or wet?
Feel – Is their skin warm, dry, cold, or wet?

E: Everyone Else
How is everyone else in the group doing?
Look – How does the rest of the group look?
Listen – Is anyone complaining of being cold, wet, hungry, or thirsty?
Feel – What is the emotional status of the group?

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.


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