In the summer of 2008, I took a Wilderness First Aid course and part of the course covered what to do when help is delayed.

Below is my summary of the booklet offered by the American Red Cross: First Aid - When Help is Delayed. While I have taken training classes in first aid, I am not a certified EMT or medical person. So, use your best judgement and common sense. If you don't understand something or have additional question, ask a qualified person.

These notes are for general discussion purposes.


Types of Delayed-Help Situations

Delayed-Help definition: Emergency help is more than 30 minutes away.
a. No easy way to call for help
b. No easy way for emergency personnel to reach the victim
c. No easy way to transport the victim to medical care

Three Types of Delayed-Help Situations

Rural areas - usually involve equipment, animals, electricity, falls, fires, overturned vehicles, chemicals or pesticides and agricultural machinery.

This is my personal situation, 12 miles from the nearest medical facility. Our local volunteer fire department is the first responder unit.

Wilderness - need to consider how to get help and what care to give. This will be discussed more in-depth since this is what this site is all about.

Other Delayed-help Environments
Natural and man-made disasters - hurricanes, earthquakes, tornados, terrorist acts and some boating activities.

Applying the Emergency Action Steps: Check-Call-Care

Check: scene, victim, resources

Check the scene - check the whole scene to get an idea of what happened and look for potential dangers that threaten your safety or that of the victim (e.g. falling rocks, tree limbs, unsafe equipment). If you see any dangers, do not approach the victim until you have carefully planned how to avoid or eliminate the danger. Also note any impending dangers such as bad weather.

Check the victim - approach carefully and continue by checking for life-threatening conditions (airway, breathing, circulation). If the victim has fallen or if you don't know how the injury occurred, assume they have a head injury. BE VERY CAREFUL. If you are not trained in how to move someone, then don't. STABILIZE the victim and get help.
Check for any other problems that are not immediately life threatening but may become so over time. Make sure you have all the information about the victim's condition in order to make a plan for getting help. Whenever possible, perform a head-to-toe check. Write down the information. If you have nothing to write with, try to remember the most important or unusual observations.

Check for available resources - gather information needed for planning how and when to get help. Check the surrounding environment for conditions or developing conditions that could endanger your or the victim during the time it will take to get help (e.g. weather, insects, etc.) Note any conditions that will make it difficult to get help. Consider whether you may have to move the victim and how.
Resources include: people available to help, communication equipment or signaling devices, food and water, shelter, first aid supplies and means of transportation.

Call: making a plan, executing the plan

Making a Plan - four choices
Stay where you are and call, radio or signal for help (do you have a means to do so?)
Send someone to get help or leave the victim alone to get help
Transport the victim to help (is it even possible?)
Care for the victim where you are until the victim has recovered enough to travel on their own (what type of care needed and how long?)

You may discover there is no "best" plan. You may have to compromise.

Executing the Plan
Calling - If you have some means of two-way communication (e.g. radio or telephone), make sure you have gathered all necessary information about the victim's condition and your location. This reduces potential confusion and improves the likelihood that the correct help will be sent to the right location. Make the first contact count. Later attempts may fail. Know your landmarks (or if you have a gps - know your coordinates). Some may be visible in the daylight but not at night. Don't use flares in a heavily wooded or dry area that might ignite a forest fire. You may need to send someone to meet the SAR personnel at a main road or easy-to-identify location.
Signals in Threes - a series or set of three is the universal signal for help - three shots, three flashes of light, three blasts on a whistle.
Ground-to-Air signals - mark a large X on the ground in a large, open area. Make sure the X stands out against its background and is at least 20 feet across.

Sending for help - make sure the person doesn't leave without certain information: victim's condition, a map indicating the location of the victim, a list of other members in the group and available resources, weather, terrain and access routes. Needs to be in writing in case something happens to the person or they get lost.

The safety of the messenger is extremely important. Send enough people to ensure the safety of the messenger. Do not send people who are not prepared to overcome hazards or challenges.
Make sure the person going for help can lead the SAR team back, if necessary.

Care
Remain calm, provide support and reassurance to the victim.
Monitor the victim - continously monitor the breathing victim who is unconscious or has an altered level of consciousness (e.g. hyper/hypo thermia). Check them every 15 minutes.
Watch for changes in skin appearance, temperature and level of consciousness. Keep a written record and note any changes, the time they occured and the care provided.

Obtain training for serious injuries such as:
Fractures and Dislocations
Severe Bleeding
Burns
Sudden Illness (e.g. diabetic emergency, allergic reactions, etc.)
Shock
Head,Neck and Back injuries
CPR
Rescue Breathing
Heimlich manuever

Protection from the Weather
Protect the victim from heat and/or cold
Construct shelter if needed, keep it simple, use resources on hand

Remember - CHECK, CALL, CARE

All of this assumes you are not hiking solo. If you do, that opens up a whole different discussion. But, you may come upon someone that has been injured and needs assistance.

So, let's discuss!

Tango61