NOLS-WMI-WFA
National Outdoor Leadership School - Wilderness Medicine Institute - Wilderness First Aid
Jan 23/24 2016
Cedar Falls IA
Hosted by University Northern Iowa - Outdoor Recreation office
From NOLS website,
“The Wilderness First Aid (WFA) course will help you prepare for the unexpected. This fast paced, hands-on training is designed to meet the needs of trip leaders, camp staff, outdoor enthusiasts and individuals working in remote locations. It will introduce you to caring for people who become ill or injured far from definitive medical care. Classroom lectures and demonstrations are combined with realistic scenarios where mock patients will challenge you to integrate your learning. At the end of the course, you’ll have the knowledge, skills and ability to make sound decisions in emergency situations.”
Background
I have previously taken a DARK Angel Medical class in Aug. of 2015. My goal with this class was a refresher of skills and to learn more about injuries that I have to care for beyond an urban EMS response as well as become more familiar with environmental injuries.
Course Outline
The class was taught by two instructors, with 30 students present. Students ranged from very little first aid training to using this class as a re-cert for the Wilderness First Responder. Of note, some students were required to take this class to lead outdoor trips for the university. I was not required and attended for reasons above. Generally, we would be presented with a topic, EX. Patient assessment, and given a demonstration if applicable. Then we would divide into groups of 3, with one person being injured, the other two as rescuers. As we worked through the scenarios, the instructors walked among us and critiqued or offered tips. Scenarios took place outdoors because that is where wilderness medicine happens, and also because the classroom was too small.
Day 1
Weather
Morning was overcast, medium wind with temp in the low 20s. Hard packed snow on the ground and some wind barrier with buildings. The sun came up in the afternoon and it got up to about 30 with slightly less wind.
Main Lessons
The day was mainly spent on Patient Assessments and establishing some info to pass onto to advanced care. Starting with scene safety, moving to the ABCDE eval, a head to toe check, vitals, and then a SAMPLE report.
Scene Safety - We were taught a dorky lil rhyme that I find super useful and handy.
1. I’m number one (Don’t be a casualty)
2. What happened to you
3. Not on me (Body fluid protection measures)
4. Who’s on the floor ( I think, either way it means who are you dealing with)
5. Dead or Alive (Signs of Life, Triage)
ABCDE Eval
Airway - do they have one, is it in danger?
Breathing - Are they doing it, is it normal?
Circulation - Pulse, blood check
Disability - Do we have a spine injury, maintain neck support?
Expose - Find the chief complaint, or obvious injury and get to skin level
The other portions of this exercise are pretty self explanatory, SAMPLE is just their acronym for establishing issues and history. With the ABCDEs, at each step if you hit something that isn't right stop and fix it. Any injuries you turn up during the Head to Toe are dealt with after we get the other info and a plan. Those injuries aren’t killing them RIGHT NOW.
We also covered rolling a patient over with possible spine injury, shock, and major bleeds. Concerning shock, the focus was not on shock due to blood loss, but dehydration and exhaustion. On major bleeding, the instructors were not anti-TQ, just saw no need for one in their application. We were given a brief demonstration on applying a CAT TQ to another person, but thats all. Also while wound packing was mentioned for deep wounds, their was no mention of hemostatic gauze. We did learn quite a bit on wound cleaning, in this aspect, you could have to deal with a patient for 72 hours before advanced care reaches you. At this level, the strongest thing I’m carrying is anti-biotic cream, so keeping wounds clean was hit on heavily.
Day 2
Weather
Pretty much the same as Day 1, but 5 degrees warmer, as it cooled back off in the afternoon, a thin layer of ice developed and scenarios began a lil more cautionary.
Main Lessons
Started off with burns and heat injuries. Dealing with burns can be tricky, we were shown an example of someone who had spilled boiling cooking water into his boot. It sucked. Plus it removes hiking out as an evac. option.
A large portion of the day was learning to splint bones, brace joints, and tape feet. Not much to say here. We also learned to fix dislocations of the finger, patella and shoulder. With the shoulder we were taught to use a passive tension method to tire out the muscle.
The afternoon was spent on hypothermia, altitude sickness, and lightning concerns. Most beneficial was the hypothermia treatment of building and using a hypo-wrap to help the patient re warm as rapidly as possible.
After throwing in scenarios of the different injuries we spent class room time on learning the questions to ask a patient that just doesn't feel good, as well as the general “red flags” that are signs for evac. Following this we ran a scenario on an unresponsive patient, the main trick was there was something in the airway, and drugs on the body. A couple teams did not open the mouth, oops. One missed a pill bottle labeled poison. Double oops.
Following this we went over anaphylaxis and building a medkit. We all got some swag and headed home.
Gear
We were told to expect to be outside, in the snow, and then back in a heated classroom and back again. I wore my normal winter boots, Danners with full Gortex, jeans, t-shirt, and a fleece. During simulations I put on Frogg Togg rain paints and a Arcteryx Atom Lt (possibly the best jacket on this planet), a skull cap, and light gloves. With the exception of the rain pants, all pretty much normal wear. I got a little chilled laying on the ground being the patient, but not awful, and had no issues moving around being the rescuer. Water bottle, coffee cup, notes, and the stuff normally in my pockets was in a small pack. This was on campus so no firearms, and it would probably freak people out in the Head to Toe anyway.
Observations
Day 1
For me there were three big things I learned.
-Most importantly, after you confirm ABCDEs, slow it down, we have plenty of time to work through issues, going fast and missing something is a lot worse than taking an extra few minutes. Plus you appear more in control.
-Second, there is no right way, wrong way to do anything, the situation sucks, deal with it make the best call you can.
-On a smaller note, working in winter clothing requires some planning and changes. Blood sweeps, pulse, Head to Toe, all work differently with 5 layers on. Not to mention not letting your patient go hypothermic.
-Gear note - NOLS sells a wound closure kit with Steri strips, a clear dressing and some benzoin tincture, which serves to help the strips stay adhered. Pretty neat lil kit for 5 bucks.
Day 2
-Working with improvised slings and splints was really beneficial, both instructors had lots of insight on the best ways to immobilize different body parts.
-Hypothermia treatments were interesting, building a hypo-wrap for rapid rewarmth was a great skill to learn.
-Overall I felt that my scenarios were a lot smoother, I did try out the NOLS SOAP note iPhone App, its not perfect, but it makes sure you get all of the info. Plus it has a built in timer for heart rate and respirations.
Points of Interest / Conclusion
I really enjoyed learning this stuff from a new perspective and picking up some extended care techniques. The more simulations I run, the better I am prepared to deal with it in real life.
National Outdoor Leadership School - Wilderness Medicine Institute - Wilderness First Aid
Jan 23/24 2016
Cedar Falls IA
Hosted by University Northern Iowa - Outdoor Recreation office
From NOLS website,
“The Wilderness First Aid (WFA) course will help you prepare for the unexpected. This fast paced, hands-on training is designed to meet the needs of trip leaders, camp staff, outdoor enthusiasts and individuals working in remote locations. It will introduce you to caring for people who become ill or injured far from definitive medical care. Classroom lectures and demonstrations are combined with realistic scenarios where mock patients will challenge you to integrate your learning. At the end of the course, you’ll have the knowledge, skills and ability to make sound decisions in emergency situations.”
Background
I have previously taken a DARK Angel Medical class in Aug. of 2015. My goal with this class was a refresher of skills and to learn more about injuries that I have to care for beyond an urban EMS response as well as become more familiar with environmental injuries.
Course Outline
The class was taught by two instructors, with 30 students present. Students ranged from very little first aid training to using this class as a re-cert for the Wilderness First Responder. Of note, some students were required to take this class to lead outdoor trips for the university. I was not required and attended for reasons above. Generally, we would be presented with a topic, EX. Patient assessment, and given a demonstration if applicable. Then we would divide into groups of 3, with one person being injured, the other two as rescuers. As we worked through the scenarios, the instructors walked among us and critiqued or offered tips. Scenarios took place outdoors because that is where wilderness medicine happens, and also because the classroom was too small.
Day 1
Weather
Morning was overcast, medium wind with temp in the low 20s. Hard packed snow on the ground and some wind barrier with buildings. The sun came up in the afternoon and it got up to about 30 with slightly less wind.
Main Lessons
The day was mainly spent on Patient Assessments and establishing some info to pass onto to advanced care. Starting with scene safety, moving to the ABCDE eval, a head to toe check, vitals, and then a SAMPLE report.
Scene Safety - We were taught a dorky lil rhyme that I find super useful and handy.
1. I’m number one (Don’t be a casualty)
2. What happened to you
3. Not on me (Body fluid protection measures)
4. Who’s on the floor ( I think, either way it means who are you dealing with)
5. Dead or Alive (Signs of Life, Triage)
ABCDE Eval
Airway - do they have one, is it in danger?
Breathing - Are they doing it, is it normal?
Circulation - Pulse, blood check
Disability - Do we have a spine injury, maintain neck support?
Expose - Find the chief complaint, or obvious injury and get to skin level
The other portions of this exercise are pretty self explanatory, SAMPLE is just their acronym for establishing issues and history. With the ABCDEs, at each step if you hit something that isn't right stop and fix it. Any injuries you turn up during the Head to Toe are dealt with after we get the other info and a plan. Those injuries aren’t killing them RIGHT NOW.
We also covered rolling a patient over with possible spine injury, shock, and major bleeds. Concerning shock, the focus was not on shock due to blood loss, but dehydration and exhaustion. On major bleeding, the instructors were not anti-TQ, just saw no need for one in their application. We were given a brief demonstration on applying a CAT TQ to another person, but thats all. Also while wound packing was mentioned for deep wounds, their was no mention of hemostatic gauze. We did learn quite a bit on wound cleaning, in this aspect, you could have to deal with a patient for 72 hours before advanced care reaches you. At this level, the strongest thing I’m carrying is anti-biotic cream, so keeping wounds clean was hit on heavily.
Day 2
Weather
Pretty much the same as Day 1, but 5 degrees warmer, as it cooled back off in the afternoon, a thin layer of ice developed and scenarios began a lil more cautionary.
Main Lessons
Started off with burns and heat injuries. Dealing with burns can be tricky, we were shown an example of someone who had spilled boiling cooking water into his boot. It sucked. Plus it removes hiking out as an evac. option.
A large portion of the day was learning to splint bones, brace joints, and tape feet. Not much to say here. We also learned to fix dislocations of the finger, patella and shoulder. With the shoulder we were taught to use a passive tension method to tire out the muscle.
The afternoon was spent on hypothermia, altitude sickness, and lightning concerns. Most beneficial was the hypothermia treatment of building and using a hypo-wrap to help the patient re warm as rapidly as possible.
After throwing in scenarios of the different injuries we spent class room time on learning the questions to ask a patient that just doesn't feel good, as well as the general “red flags” that are signs for evac. Following this we ran a scenario on an unresponsive patient, the main trick was there was something in the airway, and drugs on the body. A couple teams did not open the mouth, oops. One missed a pill bottle labeled poison. Double oops.
Following this we went over anaphylaxis and building a medkit. We all got some swag and headed home.
Gear
We were told to expect to be outside, in the snow, and then back in a heated classroom and back again. I wore my normal winter boots, Danners with full Gortex, jeans, t-shirt, and a fleece. During simulations I put on Frogg Togg rain paints and a Arcteryx Atom Lt (possibly the best jacket on this planet), a skull cap, and light gloves. With the exception of the rain pants, all pretty much normal wear. I got a little chilled laying on the ground being the patient, but not awful, and had no issues moving around being the rescuer. Water bottle, coffee cup, notes, and the stuff normally in my pockets was in a small pack. This was on campus so no firearms, and it would probably freak people out in the Head to Toe anyway.
Observations
Day 1
For me there were three big things I learned.
-Most importantly, after you confirm ABCDEs, slow it down, we have plenty of time to work through issues, going fast and missing something is a lot worse than taking an extra few minutes. Plus you appear more in control.
-Second, there is no right way, wrong way to do anything, the situation sucks, deal with it make the best call you can.
-On a smaller note, working in winter clothing requires some planning and changes. Blood sweeps, pulse, Head to Toe, all work differently with 5 layers on. Not to mention not letting your patient go hypothermic.
-Gear note - NOLS sells a wound closure kit with Steri strips, a clear dressing and some benzoin tincture, which serves to help the strips stay adhered. Pretty neat lil kit for 5 bucks.
Day 2
-Working with improvised slings and splints was really beneficial, both instructors had lots of insight on the best ways to immobilize different body parts.
-Hypothermia treatments were interesting, building a hypo-wrap for rapid rewarmth was a great skill to learn.
-Overall I felt that my scenarios were a lot smoother, I did try out the NOLS SOAP note iPhone App, its not perfect, but it makes sure you get all of the info. Plus it has a built in timer for heart rate and respirations.
Points of Interest / Conclusion
I really enjoyed learning this stuff from a new perspective and picking up some extended care techniques. The more simulations I run, the better I am prepared to deal with it in real life.
- I will still be carrying a TQ everyday, its no skin off my back and recent events show its a worthwhile thing
- I wish the classroom was bigger, with more tables, small bitch but it got cramped and disorganized
- The NOLS website has some awesome pricing on first aid kit items.
- The patient assessment system, hypothermia, and slinging hurt limbs were the best things I took away.
- Overall, I won’t be making any changes to my gear, a little consolidation and some higher tech dressings
- A good class to take overall, different from a TCCC style class, but meant for a difference audience
- No mention of NPAs I woulda put one in before leaving our unresponsive patient, would like to hear some thoughts on that.
- The patient assessment system is worth the class, it really helps to catch everything and calm you down.
Any questions let me know.
