Many people have done a first aid course in the past. But afterwards it’s easy to let the knowledge slip. But just what are the basics of first aid that every climber should know?
From that distant course you might remember the ‘ABC’ priorities (Airway, Breathing and Circulation) and a few procedures, but applying them under extreme stress can become a very different matter. Let’s take a look at a few of the basic skills and how to apply them.
You can’t save everyone
There are two extremes of casualty; those who will live despite you inflicting your worst first aid upon them, and those who will still die despite the efforts of a full A&E resuscitation team. But in the middle are the third group - those who will be saved by their mate opening their airway or successfully stopping catastrophic bleeding.
Simple as ‘ABC’
Most first aid courses follow this mnemonic so you can remember what to do under stress – like when you’ve watched your partner crater. ‘A’ stands for Airway, but it can also stand for Assess. Assessing the situation for danger is your first priority – there’s no point in getting killed before you can offer help. Then turn to the casualty. If they’re screaming their head off you can breathe a sigh of relief, they’re conscious and breathing - all you need to worry about is them bleeding to death.
Coming up for air
The silent casualty is a situation to dread, as you need to start diagnosing some pretty vital stuff without any help. First open their airway. This is really easy and involves carefully tilting the head back, opening the mouth and pulling the chin forward. Look inside the mouth to make sure there are no broken bits in the way and then listen for breathing. An unconscious casualty may not have the muscle tone to keep their tongue from blocking their airway and this simple manoeuvre has saved lives countless times. “But what if they have a broken neck?” is a common question. Well, one sure way to die from a broken neck is if you can’t breathe at the same time. If you can’t detect any breathing then it’s possible that either you’ve missed it or they’ve had a heart attack. The only thing that can revive a heart attack victim is a defibrillator and some pretty advanced drugs. CPR may help keep the person alive for a limited amount of time but must be started as soon as possible.
Stopping the flow
Conscious or not, the next priority is bleeding. Massive external bleeding is not only easy to see but can be relatively easy to stop. Apply direct pressure with a pad (a NATO First Field Dressing is the best thing) but check the wound first to make sure you don’t drive anything deeper into the wound. Arterial bleeding is difficult to stop - you have to press really hard in exactly the right spot. Internal bleeding from the chest, belly, pelvis or thigh is just as serious but more difficult to diagnose and impossible to stop without surgery. If the casualty is going into shock (rapid weak pulse, rapid breathing, cold and clammy) then suspect internal bleeding. Treat for shock (raise the legs and keep warm) and seek evacuation as soon as possible.
A common climbing injury that often looks worse than it is. A wound to the scalp bleeds profusely but may not be too serious. As with other bleeding, check the wound site and apply direct pressure. A fractured skull is far more serious and may also involve a compression injury to the brain. Either way there’s not much you can do apart from to monitor their vital signs (pulse rate, breathing rate and size of pupils) as a record of this will really help when they get to hospital. Protect the casualty from the environment and get a rescue team in as soon as possible.
Leaving the casualty
With the possibility of fractures to the spine and pelvis in any climbing fall, the casualty should only be moved if absolutely necessary. But if you’re leaving an unconscious casualty to fetch help you must leave them in a safe airway position. Some call this the recovery position but it doesn’t really matter what the position is, so long as any vomit or mucus produced by the casualty drains out of their mouth rather than going back down their throat. Get them in this position as carefully as you can without twisting or bending their spine (a cushion or rolled up fleece under the head helps) and make sure they won’t roll when you leave them.
Do a first aid course if you’ve not done one in the past, they can even be quite fun! And if it happens for real, remember that you can only do your best. And the best thing you may be able to do is to keep that airway open.
Nick Arding is an AMI member and a trainer and assessor with Adventure First Aid. Having spent much of the past 30 years in the mountains he has plenty of first hand experience at applying sticking plaster to other broken climbers.
Q. What’s the best way to cope with the stress of a real life situation?
A. Stress is manageable if you have a system to guide you through the incident. Mountain and Cave Rescue use the ABCDE system, others use DR(s)ABC and some use ABC. All are correct and the best advice is to take five seconds when you reach an incident to take stock, think through your system and act positively and safely.
Q. What should you have in a climbing first aid kit?
A. It depends. Think about what commonly happens and what you need to deal with a more serious injury. Take enough for the number of people in your party but you don’t need to carry an ambulance. Keep it simple. I use an ABCDE system for packing a first aid kit. A – Universal protection (gloves, waste bags etc), B – Pocket Shield for CPR and something to seal an open chest wound (tape and a plastic bag), C – Nato First Field Dressing for a major bleed, plasters, blister kit & medi wipes, D – Triangular bandages x 3 for immobilising fractures and some duct tape. E – Everything else like warmth, shelter, light, sugar etc. For remote locations consider drugs, fluids, sutures and advanced second aid equipment. But if you carry it, you should know how to use it.
Q. Is there really any point in doing CPR in a remote situation?
A. In an urban environment CPR slows down the process of dying, giving time for definitive care to reach the casualty. In a remote environment, the question is whether to start or not. I’d say yes. At the very least it will ensure that you feel like you attempted everything possible, you may just get a result (highly unlikely), and the helicopter might be near that day. How long to go on for is a more difficult question, be aware that hypothermia and lightning strike casualties have been successfully resuscitated after literally hours of continuous CPR.
Q. How do you decide whether to move a casualty?
A. Each situation is different. But if you have to move them into safety or into a safe airway position prior to leaving them then do so. Just be very careful.
Q. Can you be held liable if something goes wrong?
A. Yes and no. This is civil law, judged on existing cases and the circumstances of each situation. However, you will not be judged against what an expert would have done – if you’ve been acting with the best intention of saving a life you should be OK. You must gain the consent of a conscious casualty first as they do have a legal choice as to whether to accept your help.
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