First Aid

First Aid is a skill of providing immediate help to someone in need in the event of injury or illness. It is a means to hopefully stabilize a victim so that further medical help can be administered at definitive care. It is usually never a substitute for trained medical help.

** The information on this page are the building blocks of first aid, discussing assessment but not treatment. Get the training ... it might just help another. **

Vocabulary

• ​Definitive care: Completed therapy; end point at which all treatment required at the time has occurred. Simplified, a hospital that can treat all or most needs for treating trauma or other injury. A family clinic or urgent care is typically not definitive care since during big incidents they transfer the patient to another facility for treatment - the location they transfer you to being the definitive care facility.
  • ​A hospital may map 15 miles away, but maybe there is road construction, a blizzard, or it takes an hour walk to get back to your car during a hike that suddenly puts that hospital 60 minutes away. Plan for it on your trips.
• Front country first aid: Providing simple first aid to a victim where transport of the victim is less than 60 minutes from Definitive care.
• Wilderness First Aid: Providing more advanced first aid to a victim where transport of a victim is more than 60 minutes from Definitive care.
• Mechanism for Injury (MOI). What caused the injury and is there a chance to neck or spine injury?
• Universal Precautions. Gloves, face shield, glasses, mask, gown. Outside of definitive care a provider may not have all of these item but should improvise (sunglasses, rain coat, etc) with as many as possible to prevent blood-borne pathogen transmission.
• Blood-borne pathogens: Any potential disease that is carried in blood that can be transferred to another host. Transfer is usually caused by blood entering a new host through cuts in the skin or through mucus membranes. Diseases could include HIV, AIDS, hepatitis B and C as well as others. Some carriers may not have symptoms or not be aware they are a carrier, so always take the precaution.
• SOAP: Subjective, Objective, Assessment, Plan. The SOAP notes are what you, as the first aid provider, writes that tells the story of how you provided care. Anyone that is trained certified needs to show that you did not provide care out of negligence and did not work outside your field of study/qualifications.

Good Samaritan Laws - Should I or do I have to provide help and am I protected if I do??

Also known as "volunteer protection laws," are state laws that are enacted to protect healthcare providers and other rescue personnel from being sued as a result of providing help to a victim during an emergency situation.

• To act as a good samaritan, you shall never take payment for your services - financial or material.
• If you decide to begin first aid, you must not stop until someone with higher training takes over for you or your patient revives, requiring you to only monitor to ensure there isn't a relapse. Failing to stop and render aid can be a very serious offense. States punish the offense as either a misdemeanor or a felony, depending on the situation surrounding the accident.​
• ​Good Samaritan Laws don't mean that you can't get sued, but it does mean that the likely hood of successfully getting sued is small.

Know your ​Good Samaritan Laws for your local state. This website may not be up to date so it is your responsibility to know the laws in your area. All states have Good Samaritan Laws, but some have a twist.

• In 2009 only ten states had laws that require people to at least notify law enforcement of and/or seek aid for strangers in peril under certain conditions (Duty to Rescue Laws): California, Florida, Hawaii, Massachusetts, Minnesota, Ohio, Rhode Island, Vermont, Washington, and Wisconsin.
• In most states, if a person is in danger or a victim to an incident, the general community can choose to help but is not required to help. The only state that requires a person to assist is Vermont (made law in 2016).
• As a Boy Scout leader and in other organizations, you are required by the organization to assist a scout during an emergency.
• Ask yourself the question: Can you live with the decision not help someone if they are in trouble? If you are not in the situation where you are required to act by law or by other obligation (as a Scout leader), this is the question you must ask and you must be fine with the consequences or results of that decision. That person may die, but you might ask act and the person might skill die or have long lasting deficits even after your help. Morality question for you....

​Planning

Before each event, plan for the worst and hope for the best. Ask yourself these questions (and others as applicable) and know the answers: Who, What, When, Where, Why and How. Are you following BSA safe guide to scouting guidelines? These guidelines are there to protect the scouts and adults.

• Who: Know who is coming on your trip? Any allergies or conditions that might need attention? Who have you told of your plans (time of return, where you are going, etc)?
• What: What are you doing? Do you need any special equipment to deal with the event (rock climbing, sailing, etc)? Different event pose different risks.
• When: Is it winter? Is it summer? Are there other environmental constraints that might need to be addressed? When are you coming back from the outing?
• Where: Where are you going? How far are you from help? Where is the nearest help and how can you get there?
• Why: Why are you doing this activity? Is it worth the potential danger?
• How: How can you get help? Is there cell phone signal there? How are you doing the activity and are there alternate ways to limit the risk?​​

Cardiopulmonary Resuscitation (CPR)

By definition, CPR is an emergency procedure that combines chest compression often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore blood circulation and breathing in a person who is in cardiac arrest.

CPR is the only way that a rescuer can provide aid to someone that is not breathing and has no heart beat. If you find someone that is you believe is having a cardiac arrest, you should follow the acronym R A B - C A B.

R A B - C A B

R - Responsiveness. Is the victim responsive? Do they respond to questioning or physical stimulation? Are they breathing and do they have a pulse?

A - Activate. Call 9-1-1. Assign a person to go get help. "You in the red coat, what's your name? XXX, go call 9-1-1. On your way back bring an AED."

B - Breath. Check for breathing. If breathing, place the victim in the recovery position and move into the physical exam and monitory for changing conditions. If not breathing, move into providing compressions.

C - Circulation. Begin chest compression. 30 compression shall be provided to the victim. Adults and children shall have compression given two fingers above the check bone. For infants you provide compression with two (2) fingers better the nipples.

A - Airway. Tilt back the head to open the airway. This is in preparation to provide rescue breaths. In front country first aid, you will usually only do compression only CPR, making the A and B not relevant for providing aid.

B - Breathing. Provide 2 breaths to the victim. For infants, this involves completely covering both the mouth and nose with the face mask or your mouth.

Some CPR manuals use RAP-CAB instead, with the only difference being P: Position - placing the victim into the recovery position if breathing or flat on their back on a stable surface if preparing for compressions.

If you start CPR, the only time you can stop is if 1) you are revealed by someone of a higher training/certification, 2) you are so exhausted that you cannot continue, 3) the victim begins breathing and has a heart beat. If an AED becomes available for your uses as at any point, you storm CPR to begin the use of the AED as the success rate of reviving someone with an AED substantially increases over employing just CPR.

Basic First Aid and introduction to Wilderness First Aid

Do you enter the Scene of a situation unless you ask these questions and can respond accordingly. You don't want to create two victums by entering an unsafe situation.

1. I'm number one!!! Never enter a situation where you put yourself at risk, making for two victims.
2. What's Wrong with you? Looks at the scene and determine what might have happened. Cause of injury?
3. None on me. Before you enter the scene to provide help, remember your universal precautions.
4. Are there any more? Triage. Is there more than one victim? If so, who is worse off and who can be saved?
5. Dead or alive? Do I (as the rescuer) help? Make the decision to help or walk away. You may have to help if state law says its required, otherwise it is a morality question for you as the rescuer. As a registered Boy Scout Leader, you MUST help a scout in need.
   • If you start first aid, you must continue first aid until you are relieved by someone of equal or higher certification, you cannot physically continue, or your patient can no longer benifit for your help. For some people, this might be a reason for not beginning first aid on a stranger, because it could spell the end of your camping trip.

Enter the Scene - Introduce yourself and ask if you can help. If they say "no" then watch them but do not perform services. If they are unconscious or lose consciousness and are unresponsive, rescuer can provide services if believed that if he/she does nothing, victims well being is in jeopardy.

If you enter the scene to help, you start with the Primary Assessment - looking for the A, B, C, D, E symptoms first. At any time you come on a situation that affects these, treat them first as they are life threatening. The A, B, C's are generally in the order of severity. Example: during your assessment, if they have an airway blockage, treat that first before treating breathing, circulation, disability, or exposure.

Primary Assessment

A - Airway. Is there something in their airway that prevents breath?

B - Breathing. Are they breathing?

C - Circulation. Are they bleeding? Is there something wrong with the heart?

D - Disability. Is there a MOI? Decide if you need to immobilize the neck and/or spine.

E - Exposure/Environment: Protect them from cold/heat and environmental situations.​ Extraction?

After patient is stabilized, proceed into Secondary Assessment to get more information. If you have two providers, this can happen at the same time as the Primary Assessment is being done by the first provider.

Secondary Assessment - D.O.T.S. , C.S.M's , S.A.M.P.L.E. and vitals

D - Deformities

O - Open Wounds

T - Tenderness

S - Swelling

CSM's - Testing to see if they have sensation and mobility in their extremities. Example: "Can you move your toes? Can you feel...." If you push on their nail beds, do they return to color?

C - Circulation

S - Sensation

​M - Movement/Motion

SAMPLE is determining the medical history of the victim.

S - Symptons

A - Allergies

M - Medications

​P - Previous medical history

L - Last in's and out's. When was the last time you used the bathroom (color and consistency)? When did you eat and drink last?

​E - Events leading to injury. What happened?

***When you perform first aid, keep records of what you do. SOAP notes are those records. ***

First Aid Kits

Training

Everyone should have CPR training as a basic skill. Boy Scouts of America requires at least one person to have WFA training on an outdoor campout/hike/event when not within 60 minutes of definitive care. Philmont Scout Ranch and other high adventure BSA activities require all adults attending to have the WFA training.

• CPR
• Wilderness First Aid (WFA) - 16 hours
• Wilderness Advanced First Aid (WAFA) - 36 to 40 hours
• Wilderness First Responder (WFR) - 80 hours​​
• ​Wilderness EMT (WEMT)
• Wilderness Advanced Life Support (WALS)