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Wilderness First Aid Tips

This is the first of a mini series of articles designed to tackle first aid questions and problems that might crop up on the Bibbulmun Track. Of course, mostly things don’t go wrong, and we don’t want them to, but it’s best to be prepared. Which is exactly where we will start: with the 6 Ps.

Tip 1: Remember the 6 Ps

In over 30 years of outdoor activities in many parts of the world I’ve had relatively few experiences where I’ve had to put on my medical hat—and almost all of them have been in another group I’ve come across, rather than my own. Perhaps some of it was luck, but mostly it was adhering to the 6 Ps: prior preparation and planning prevents poor performance.

In our modern age of instant knowledge, we have perhaps forgotten some skills take time to learn—reading a map in the rain, interpreting weather patterns and packing the correct gear aren’t things that can be perfected by watching one You Tube tutorial.

For sure, the Bibbulmun Track isn’t Everest but you will avoid problems by planning properly. Think of your outdoor activities as an apprenticeship; start out simply and build up, where possible find experienced people who you can learn from. Even if you do have all the skills, get local knowledge. The Bibbulmun Track Foundation website is the obvious place to start, and attending the workshops held by the BTF is another.

Here is the framework I use – it can be used for everything from a road trip to Karijini to skiing across Greenland. Admittedly some of the headings can be left blank as you plan your Bibbulmun Track walk, but you’ll want to have something pencilled in under most of them.

Logistics: routes, regulations, transport, food and fuel, equipment, training needs, and budget.

Here is the framework I use – it can be used for everything from a road trip to Karijini to skiing across Greenland. Admittedly some of the headings can be left blank as you plan your Bibbulmun Track walk, but you’ll want to have something pencilled in under most of them.

Logistics: routes, regulations, transport, food and fuel, equipment, training needs, and budget.

Health and Medical: risk assessment, pre-travel screening, medical kits, team selection, vaccinations / anti-malarials and hygiene.

If the mention of risk assessment made you flinch – have a quick flick through Dom Hall’s Risk Management for Adventure and discover why dynamic risk assessment should become part of your outdoor activities.

Tip 2: Get past the myths and deal with the facts: antiseptics, blisters, hydration, dehydration and nutrition

Health, medicine, sport, and the outdoors are as much a playground for the commercial marketing menaces as any other aspect of modern life. So…

Myth one: you need antiseptics in your first aid kit to wash out those nasty wounds. Pointless, and worse still there is emerging evidence that antiseptics can interfere with wound healing. The simple truth is that water is all you need. If it’s good enough to drink, it’s good enough to wash a wound with. Take a look at: http://www.cochrane.org/CD003861/WOUNDS_the-effects-of-water-compared-with-other-solutions-for-wound-cleansing.

Myth two: you need to buy special blister kits to treat blisters. All you need is some tape – it doesn’t matter which type—my preference is Hypafix or Fixomull—stretchy, breathable sticky sheets that come in various widths and have a hundred and one uses. Stick it on with a generous margin so it doesn’t come off easily, and then leave it on until you have finished your hike— several days to a week is fine.

Myth three: you need special branded foods and sports drinks to perform properly and avoid fatigue and dehydration.

Walk into an outdoor store, sports shop or health food store and you get the impression that you need a heap of fancy powders, power bars and supplements. I had the good fortune a few years ago to listen to a lecture from the head nutritionist for the British Olympic and Team Sky cycling teams. These professional cyclists generally eat home-made rice bars and drink watered-down fruit juice when training, and drink milk in the recovery phase. They only use proprietary sports drinks, gels and bars because it provides them with income from sponsors.

Then there is a current fad about preventing dehydration. Of course dehydration is to be avoided, but there is no magic formula of how much to drink. The maxim is drink to thirst.

So, what should you drink? The answer is pretty much whatever you fancy. Isotonic sports drinks are illogical as sweat is hypotonic (a weaker solution) and research shows that they do not provide any benefit. The same can be said for ORS (e.g. Gastrolyte or Hydrolyte). However, if you like them, go ahead and drink them, just don’t expect anything magical.

Drinking too much (i.e. a forced hydration strategy) can actually be harmful – indeed even fatal—due to Exercise Associated Hyponatraemia—as has been reported a few times on the Kokoda Track in the past few years.

Find out more about EAH and get a full overview of exercise and hydration.

What about food? Same answer really. Eat pretty much what you want, with consideration of how much weight you are happy to carry. When we exercise, our bodies release various hormones that reduce blood flow to the digestive system, so it makes sense not to load ourselves up with big meals before or during exercise. My preference is for muesli bars, dried fruit and nuts; mainly because I’m too lazy to make nice rolls filed with tuna and mayo and tomato – but if you offer me one I’ll eat it happily. I keep a few bits handy and snack little and often.

Tip 3: Ask and answer the questions that actually matter

Ankle injuries are really common, and then everybody looks at the ankle and wonders if it’s broken or sprained.  This is the wrong question to ask. The question that always needs to be answered is “Can we keep going as planned, do we need to call it quits and get ourselves out to the nearest town, or do we need to call in some outside help?”

This is the same first question that you need to answer for all such incidents.  As a doctor, even with a set of x-rays in front me, it’s not always possible to tell if an ankle is broken or not, but it is always possible to make a treatment decision. Broken ankle doesn’t mean much—there are several bones, sometimes they dislocate as well, and sometimes there are additional soft tissue injuries. Some breaks need no more than a bit of Tubigrip for comfort, others need urgent surgery to prevent nerve or tissue damage. Some sprains are worse than a simple break.

Confused? You don’t need to be: Can your patient put any weight through the foot? If they can’t you need to get a good look, so get the boot off (and the other one to compare if you need to). Is there early swelling, as opposed to swelling building up by the end of the day or overnight? Can they wiggle their toes? Does the foot feel cold, compared with the other one? Can they feel you touching their foot?

If the patient is prepared and able to weight bear then let them, it will do no harm. If there is an option to hobble to some shelter or put up your tent and let time be the judge, then that is a reasonable approach in many cases. If there is inability to weight bear with early gross swelling, any deformity or change in skin sensation or temperature then you are looking at calling in outside help sooner rather than later. Injuries to other parts of the body—wrist, shoulder etc should be considered with the same approach.

Decision making can sometimes be difficult. On the Bibbulmun Track there is some network coverage, so you might be able to phone a friend, but there may be consecutive days where there is no signal at all. In WA the Royal Flying Doctor Service provide a free 24 hour a day service to rural and remote areas whereby a single phone call will put you in touch with an experienced doctor who is used to dealing with injuries over the phone.

With the capacity to text or email images directly from your phone or use Facetime or Skype, that doctor can even see what is going on. Just put 1800 625 800 into your phone contacts and share that decision making process with someone. If you are walking in areas that have no phone reception, carry some form of emergency beacon.

PLB’s can be hired from the Bibbulmun Track Foundation.

Edi Albert is a doctor with the RFDS based in the Kimberley, a senior lecturer in remote and polar medicine at the University of Tasmania and runs courses in expedition and wilderness medicine. Over the last 30 years his love of the outdoors has taken him all over the world either to work or play, or better still, both. He can be contacted on edi.albert@hotmail.com.