Contents
List of Figures
Acknowledgments
Section I: Introduction
1. Wilderness Emergency Medical Care
First Response and Responsibility
A Brief History of Wilderness Medicine
Wilderness Medicine vs. Urban Medicine
Training
2. Legal Issues in Wilderness Medicine
Civil Law and the WFR
Negligence
Legal Considerations
Legal Protection
Section II: Patient Assessment and Initial Concerns
3. Patient Assessment
Stop! Size up the Scene
Stop! Assess the Patient for Immediate Threats to Life
Stop! Complete a Focused Exam and Patient History
Stop! Make a Problem List and a Plan
Stop! Monitor the Patient’s Condition
4. Airway and Breathing
Basic Anatomy of the Airway
Assessing the Airway
Foreign-Body Airway Obstruction: Conscious Adult
Rescue Breathing
Recovery Position
Evacuation Guidelines
5. Cardiopulmonary Resuscitation
Basic Anatomy of the Heart
Cardiac Arrest and CPR
Cardiopulmonary Resuscitation
Adult One-Rescuer CPR
Complications Caused by CPR
Criteria for Stopping CPR
Special Considerations for the Wilderness
Specific Wilderness Situations
Evacuation Guidelines
6. Bleeding
Types of Bleeding
Body Response to Bleeding
Control of External Bleeding
Internal Bleeding
Evacuation Guidelines
7. Shock
Basic Anatomy and Physiology of the Cardiovascular System
Shock
Types and Causes of Shock
Stages of Shock
Risk Factors
Management of Shock
Evacuation Guidelines
Section III: Traumatic Injuries
8. Spine Injuries
Basic Anatomy of the Spine
Mechanisms of Injury
Types of Spinal Cord Injuries
General Assessment of the Spine
Treatment for Suspected Spinal Injury
Lifting and Moving a Patient
Special Considerations for the Wilderness
The Focused Spine Assessment
Evacuation Guidelines
9. Head Injuries
Basic Anatomy of the Head
Types of Head Injuries
Levels of Head Injury
Treatment for Serious Head Injury
Evacuation Guidelines
10. Chest Injuries
Basic Anatomy of the Chest and Normal Breathing
Types of Chest Injuries
General Treatment Guidelines
Evacuation Guidelines
11. Abdominal Injuries
Basic Anatomy of the Abdomen
General Abdominal Trauma Assessment
Blunt Trauma Assessment and Treatment
Penetrating Trauma Assessment and Treatment
Evacuation Guidelines
12. Athletic Injuries
General Assessment of Athletic Injuries
General Treatment of Athletic Injuries
Specific Treatment for General Types of Athletic Injuries
Specific Treatment for Specific Athletic Injuries
Prevention of Athletic Injuries
Evacuation Guidelines
13. Fractures
Basic Anatomy of the Musculoskeletal System
Types of Fractures
General Assessment of a Fracture
General Principles of Fracture Treatment
Specific Treatment for Upper Body Fractures
Specific Treatment for Lower Body Fractures
Complicated Fractures
Evacuation Guidelines
14. Dislocations
General Assessment and Treatment of Dislocations
Specific Treatment for Upper Body Dislocations
Specific Treatment for Lower Body Dislocations
Long-Term Care for Dislocations
Evacuation Guidelines
15. Wilderness Wound Management
Basic Anatomy of the Skin
Types of Wounds
General Wound Management
Management of Specific Wounds
Evacuation Guidelines for Wounds
Wilderness Burn Management
Evacuation Guidelines for Burns
General Wound Infection Management
Evacuation Guidelines for Infected Wounds
Section IV: Environmental Emergencies
16. Cold-Induced Emergencies
Heat Production
Heat Loss
Hypothermia
Frostbite
Nonfreezing Cold Injury
Evacuation Guidelines
17. Heat-Induced Emergencies
Dehydration
Heat Cramps
Heat Exhaustion
Heatstroke
Hyponatremia
Prevention of Heat-Induced Emergencies
Evacuation Guidelines
18. Altitude Illnesses
Acclimatization
Acute Mountain Sickness
High-Altitude Cerebral Edema
High-Altitude Pulmonary Edema
Prevention of Altitude Illnesses
Evacuation Guidelines
19. Immersion and Submersion Incidents
Immersion
Drowning
Near-Drowning
Prevention
Evacuation Guidelines
20. Lightning Injuries
Mechanisms of Injury
Types of Injuries
Management of the Patient
Prevention of Lightning Injuries
Evacuation Guidelines
21. North American Bites and Stings
Reptiles
Spiders
Scorpions
Zoonoses
Hymenoptera
Centipedes
Bears
Dangerous Marine Life
Evacuation Guidelines
22. Diving Emergencies
Physical Principles of Diving
Types of Barotrauma
Other Diving Disorders
Prevention of Diving Emergencies
Evacuation Guidelines
Section V: Medical Emergencies
23. Cardiac Emergencies
Types of Cardiac Emergencies
General Treatment for Cardiac Emergencies
Evacuation Guidelines
24. Respiratory Emergencies
Types of Respiratory Emergencies
Evacuation Guidelines
25. Neurological Emergencies
Basic Anatomy of the Brain
Unconscious States
Types of Neurological Emergencies
Evacuation Guidelines
26. Diabetic Emergencies
Normal Physiology
Diabetic Physiology
Hyperglycemia
Hypoglycemia
Diabetics in the Wilderness
Prevention of Diabetic Emergencies
Evacuation Guidelines
27. Poisoning Emergencies
Ingested Poisons
Treatment for Ingested Poisons
Inhaled Poisons
Treatment for Inhaled Poisons
Absorbed Poisons
Injected Poisons
General Treatment Guidelines for Poisonings
Evacuation Guidelines
28. Allergic Reactions and Anaphylaxis
Allergic Reactions
Anaphylaxis
Evacuation Guidelines
29. Abdominal Illnesses
General Abdominal Illness Assessment
Some Types of Abdominal Illnesses
General Treatment for Abdominal Illnesses
Evacuation Guidelines
30. Communicable Diseases and Camp Hygiene
Agents of Infection
Communication of Disease
Some Specific Communicable Diseases
Camp Hygiene
Principles of Camp Hygiene
Section VI: Special Emergencies
31. Common Wilderness Medical Problems
Headaches
Eye Injuries
Ear Injuries
Nose Injuries
Skin Damage
Gastrointestinal Problems
Flulike Illnesses
Solar Radiation Problems
Motion Sickness
Dental Problems
Other Mouth Problems
32. Urinary and Reproductive Emergencies
General Assessment Guidelines for Urinary and Reproductive Emergencies
Basic Anatomy of Biological Male Genitalia
Specific Emergencies for Persons with a Penis
Basic Anatomy of Biological Female Genitalia
Specific Emergencies for Persons with a Vagina
33. Obstetrical Emergencies
Basic Anatomy and Physiology of Pregnancy
Obstetrical Emergencies
Normal Childbirth
Complications of Delivery
Evacuation Guidelines
34. Psychological and Behavioral Emergencies
Normal Responses to Crisis
Critical-Incident Stress
Basic Psychological Impairment
Evacuation Guidelines
Section VII: Special Concerns
35. Emergency Procedures for Outdoor Groups
Trip Plans
Evacuation Organization
Managing a Lost Person Incident
Summary
36. Wilderness Transportation of the Sick or Injured
Walk-Out/Ski-Out
One-Rescuer Carries
Two-Rescuer Carries
Litters
Horse Transports
Vehicle Transports
Summary
37. Wilderness Medical Kits
General Guidelines for Wilderness Medical Kits
Specific Considerations for Wilderness Medical Kits
Final Thoughts on Kits
Appendixes
A. Oxygen and Mechanical Aids to Breathing
Oxygen and Respiration
Supplemental Oxygen Safety
The Tank
The Regulator
Oxygen Therapy
Airway Maintenance
Passive Delivery
Positive Pressure Delivery
Suction
B. Automated External Defibrillation
The AED
Operational Procedures
C. Basic Life Support for Healthcare Providers
Adult Two-Rescuer CPR
Child and Infant CPR
Foreign-Body Airway Obstructions
Rescue Breathing for Children and Infants
Glossary
Bibliography
Index
About the Author