The hunter is lying at the base of a steep rock slope, unconscious. His face is bloody, and one leg is bent at an unnatural angle, apparently broken. What should you do?
The natural urge especially if the hunter is a close friend or family member is to rush in, to give immediate aid. But this could be a dangerous mistake that only compounds the trouble. Rushing in violates the first rule of rescue, which is: Don’t become another casualty. You’ll only worsen the situation if you get hurt or killed in a blind hurry to help. Admittedly, this rule can be tough to follow when the injured person is a loved one. But in any accident or injury situation, it’s important to hold back for at least a few moments until you have an overview perspective of the scene.
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Overview of the Scene
Emergency professionals call this the “scene survey.” You stop, look around (literally: up, down, to either side of the victim, near and distant) and ask: “What here could hurt me?” Are rocks still sliding down the slope face? Is that huge boulder about to let loose and fall? Once you are sure of a safe approach–or have disabled the potential hazards–the next concern is to consider what might further hurt or threaten the victim. If danger is imminent, you might need to move the injured person (with all necessary caution and care) out of harm’s way before proceeding with your assessment and aid.
Of course to do any of these things effectively you need to maintain a reasonable calm–again, easier said than done in many cases. It helps, however, to act and sound calm even if you don’t feel that way inside. Accident scenes can be frantic, chaotic, and emotional. People rush around, shout uninformed advice, and get in the way. You might need to be the one who establishes rationality and brings order to the proceedings.
On the other hand, someone better trained or more knowledgeable may be available (or easily summoned) to take control of the scene. Once at a premier hunting lodge, I began to assess a guest who had suffered a bad fall from a horse, and who had sustained serious-looking head trauma. It occurred to me to ask: “Isn’t there a doctor hunting here at the lodge?” (There are always doctors at the premier lodges, it seems.) There were several, as it turned out, and two proved quickly available.
Although I had Wilderness First Responder certification I gladly handed the situation over to the docs, one of whom worked in an emergency room and knew precisely what to do (and not do). A relief, from my very limited skills perspective, and a reminder of two more rules of rescue: 1) Don’t attempt more than you know. And 2) When you’re out of your depth, get out of the way and let someone better qualified proceed.
But if you are the one who must attend an injured person (perhaps because you’re the only one around), then you have to do the best you can. The next step after having surveyed the scene and rendered it safe is to assess the victim’s condition. It’s important here to know the correct priorities. What appears most serious might be a lesser overall concern. The person’s scalp might be leaking blood; the leg might be obviously and grossly broken. But those problems have to wait. First, you must attend to the ABCD of emergency assessment, an acronym worth committing to memory.
“An” is for the airway. Is the airway clear? “B” is for breath. Is the victim breathing? Check to see if the chest is rising and falling; if necessary put your ear to the mouth and nostrils to listen or feel for breaths. “C” is for circulation. Is the heart pumping? Without a breath or circulating blood, the person will quickly die. You may need to do a finger swipe to clear an obstructed airway, or you might need to give several mouth-to-mouth rescue breaths to restore normal respiration.
In more severe cases it might require a longer cycle of all-out cardiopulmonary resuscitation (CPR) to regain normal functioning or to keep the person alive until professional help arrives. (CPR, especially the newer, simpler version, is easy to learn and master, as described in this column, October 2006.)
Do no Harm
If the primary rule of rescue is: Don’t become another casualty, the underlying rule of first aid is: Do no harm. That’s especially important to remember for the next priority, “D” for disability, which refers specifically to possible damage to the nervous system. Could the accident have fractured the person’s neck or spine? If someone has, for example, fallen a steep slope or tumbled from a horse, or been thrown or hit in the head during an ATV or auto accident, the answer is clearly yes. Following first aid’s “do no harm” dictum, this person must be handled with extreme caution.
Stabilize the head and neck by holding them firmly on both sides with your hands and forearms. (Where multiple aid-givers are present, one first-aider’s sole job might be keeping the head and neck stabilized while another attends to the ABC concerns and other injuries.) If a neck brace, such as an emergency Sam Splint, is available, it should be secured in place as soon as possible.
After breathing, heart, and spine have been addressed; it’s time to do a second assessment of the victim’s condition, starting at the head and moving slowly downward to the toes. However, don’t stop to treat each problem you find. Instead, complete the entire survey, listing all injuries and concerns. Then go back and treat each problem in the order of priority. Stop any bleeding by using constant direct pressure to the wound. Splint broken bones with whatever suitable rigid objects are available (branches, sticks, equipment poles, even a rifle stock) to immobilize them, which helps reduce movement, pain, and further damage. Obviously, the more you know about first aid–and an essential equipment you have packed in your first aid kit–, the better the quality of care you can give.
Note: Be aware of the possibility of communicable diseases that can be carried in the body fluids of another person. Use careful preventative hygiene, including disposable gloves and a one-way resuscitation mask (both of which should be carried in your first aid kit) to ensure your safety.
If you haven’t been able to send or call for help until the victim is stabilized, do so immediately. While you wait for help to arrive, watch for environmental factors that could endanger the victim’s health or comfort, such as hypothermia from wet or cold conditions, overheating or burn from direct sun, or dehydration. Do your best to provide the necessary antidotes, such as warmth, shade, drinking water.
If the victim is conscious, remember that the stress and trauma of injury are not only physical but has a psychological aspect too. The person is probably frightened, anxious, and very likely suffering from pain. Speak calmly and reassuringly. With a stranger, introduce yourself and use first names to establish a comfortable, assuring bond. Appropriate touching–a gentle pat on the arm or shoulder, or hand-holding if the person seeks it–can be comforting, especially during transport or the seemingly endless wait for professional help to arrive.