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The Weekend I Learned That Everything Is a Potential Tourniquet - Wilderness First Aid Training · Off You Pop!

• 0:14
  SPEAKER_00: This is Off You Pop, the podcast for hikers and adventurers who want to be epic in just one day.
• 0:21
  SPEAKER_00: Most of us head into the outdoors with a backpack full of gear and a head full of optimism, and absolutely no idea what to do if things actually go wrong.
• 0:31
  SPEAKER_00: A few weeks ago I spent a weekend in Coloma, California with Sierra Rescue, learning Wilderness First Aid, and it's changed how I move through the mountains.
• 0:41
  SPEAKER_00: Not because I'm suddenly an expert, or because I now wander around diagnosing strangers like some sort of trailside doctor, but because I finally understand how little you need to know to make a massive difference when someone gets hurt.
• 0:55
  SPEAKER_00: This episode isn't a lesson, it's not a tutorial, it's not me pretending to be bear grills, it's a nudge, a friendly shove really, to get you to take the course yourself.
• 1:05
  SPEAKER_00: Because if you hike, climb, paddle, camp, or just wander around places without sell service, wilderness first aid might be the most valuable outdoor skill you ever pick up.
• 1:16
  SPEAKER_00: This is Wilderness First Aid and this is Off You Pop.
• 1:21
  SPEAKER_00: I decided to do a first aid certificate because I am increasingly spending more time outdoors by myself in remote locations, and I'm aware that if I get injured, I'm alone and I may need to self-rescue.
• 1:37
  SPEAKER_00: I'm also increasingly spending time with other people who have various levels of hiking skills and competence.
• 1:44
  SPEAKER_00: I'm getting increasingly concerned that one day somebody's going to get injured and I might need to be there to step in and help them.
• 1:52
  SPEAKER_00: And so this course that I signed up for was a two-day course down in Coloma, California, and it comes with a certificate in both CPR, AD, Epinephrine, and Wilderness First Aid.
• 2:06
  SPEAKER_00: And I thought it would be at least something different and something useful that I could take with me in the mountains.
• 2:13
  SPEAKER_00: Early in the course, you get thrown into a scenario.
• 2:16
  SPEAKER_00: They don't warn you, they don't ease you in.
• 2:18
  SPEAKER_00: One minute you're standing there holding a coffee, and the next minute someone's screaming on the ground and the instructor is yelling, you two go.
• 2:26
  SPEAKER_00: And in that moment I realize something very important.
• 2:29
  SPEAKER_00: I had absolutely no idea what I was doing.
• 2:32
  SPEAKER_00: None.
• 2:33
  SPEAKER_00: I've climbed mountains, trekked ridges, crossed rivers, but faced with a pretend injured person, my brain just quietly packed its bags and left the building.
• 2:43
  SPEAKER_00: The scenario was a deep laceration to the forearm and the patient was bleeding out.
• 2:47
  SPEAKER_00: The critical decision point was to apply pressure and then a tourniquet.
• 2:51
  SPEAKER_00: How many of us have actually applied a tourniquet?
• 2:54
  SPEAKER_00: I bet mostly no.
• 2:55
  SPEAKER_00: I also think that most of us don't know when to use it, or how long to keep it on, or how to manage the blood flow, and when to release it.
• 3:04
  SPEAKER_00: Suddenly I realized my old stick twisted around a twig knowledge wasn't going to cut it.
• 3:10
  SPEAKER_00: I didn't take this course because I'm preparing for a major trick, or am planning a serious life change to become a first responder.
• 3:18
  SPEAKER_00: I took it because I'm increasingly in the wilderness, not just alone, but also with others.
• 3:23
  SPEAKER_00: The simple truth is that the outdoors is beautiful, but it doesn't care how experienced you think you are.
• 3:29
  SPEAKER_00: I know that injury is inevitable.
• 3:31
  SPEAKER_00: One day I or someone I'm hiking with will have a mechanical injury, a cut, a bite, dehydration or hypothermia, and I can do something to be prepared for that before it happens.
• 3:41
  SPEAKER_00: I often hike with people who are inexperienced, and when something goes wrong, I know someone has to be the grown-up in the room.
• 3:48
  SPEAKER_00: I can't rely on my hiking buddies, who are too busy trying to man up or stand helplessly by while we push someone deeper into the wilderness who really needs to be evacuated.
• 3:58
  SPEAKER_00: Kaloma felt like the perfect place to learn.
• 4:01
  SPEAKER_00: The Motherlode River Centre is one of the number of rafting companies that guide parties down the American River.
• 4:07
  SPEAKER_00: The course was held riverside amongst the bustle of rafters, campers, and outdoor adventurers.
• 4:12
  SPEAKER_00: It was attended by scout leaders, SAR teams, river guides, hiking guides, all who needed to be certified, then a handful of people like me who just wanted the knowledge because they love being outdoors.
• 4:23
  SPEAKER_00: So the biggest thing you learn is the patient assessment system.
• 4:27
  SPEAKER_00: There's a structure, a rhythm, a way to slow your brain down so you can actually help instead of panicking.
• 4:33
  SPEAKER_00: It's like someone hands you a mental checklist and says, follow this and you'll be fine, and suddenly you are.
• 4:40
  SPEAKER_00: The course teaches you how to assess the scene, the patient's reliability, perform a blood check, and a full body assessment.
• 4:48
  SPEAKER_00: You're moving through the patient assessment in an orderly manner to diagnose and treat the patient in the most effective manner possible.
• 4:56
  SPEAKER_00: You're not floundering around incompetently guessing about the problem and listening to the chaos of group think.
• 5:02
  SPEAKER_00: You take charge, you make an assessment, and you take action.
• 5:06
  SPEAKER_00: I've seen this scene play out numerous times in the wilderness.
• 5:09
  SPEAKER_00: Something is wrong with your friend, but you don't know what or how to treat it.
• 5:13
  SPEAKER_00: Usually you just tell them to suck it up, not knowing how close they might be from turning from feeling a little off to a critical condition.
• 5:21
  SPEAKER_00: You see many of these types of conditions on the mountain, hypoglycemia, heat-related illnesses, and dehydration, which can quickly escalate into critical conditions if they're not caught early, but could be treated with an early intervention that prevents a quick rest becoming a full-scale rescue.
• 5:38
  SPEAKER_00: I always thought treating bleeding would be complicated.
• 5:41
  SPEAKER_00: Turns out it's mostly pressure.
• 5:43
  SPEAKER_00: Pressure and calm, and calm is the hard part.
• 5:47
  SPEAKER_00: Ultimately you're trying to stop the bleed and get the body to clot.
• 5:51
  SPEAKER_00: We learn first to apply pressure to stop the bleed using gauze and ace bandages.
• 5:56
  SPEAKER_00: Interestingly, I never carried any of these in my cheap Amazon first aid kit.
• 6:01
  SPEAKER_00: They're sturdier, more elastic, and have velcro at the ends.
• 6:04
  SPEAKER_00: If that fails, you then apply the tourniquet.
• 6:07
  SPEAKER_00: But here's the bit most people don't know.
• 6:10
  SPEAKER_00: Once you apply it, you better keep it on until you make it to the emergency room and let a trained professional manage the release.
• 6:17
  SPEAKER_00: In the final mass casualty scenario, I was playing a patient with hypoglycemia who had a moulaged arm wound, bleeding but not squirting.
• 6:25
  SPEAKER_00: The team that came to save me skipped entirely the pressure bandage and jumped straight to a tourniquet.
• 6:31
  SPEAKER_00: Guess I would be taking a trip to the fake hospital.
• 6:34
  SPEAKER_00: As it turns out they only needed to apply pressure, but in applying the tourniquet, they pretty much guaranteed that I would need to go to the hospital.
• 6:42
  SPEAKER_00: It just goes to show you that it's challenging, even when you're acting, to assess the scene and apply the correct treatment.
• 6:49
  SPEAKER_00: We built splints out of trekking poles, jackets and sleeping bags, basically everything except the kitchen scent.
• 6:56
  SPEAKER_00: I've never actually applied a splint, and I thought it would be instinctive.
• 7:00
  SPEAKER_00: First we applied a splint to the arm and figured out how to manage the sling and the swath.
• 7:04
  SPEAKER_00: We used a SAM splint, which I immediately purchased after the event.
• 7:09
  SPEAKER_00: Then we improvised a leg sprint from a broken oar.
• 7:11
  SPEAKER_00: My teammate was a real life river guide, so it was apropos.
• 7:15
  SPEAKER_00: Turns out we didn't apply enough ties to keep the leg rigid.
• 7:20
  SPEAKER_00: Heat, cold, dehydration, and altitude.
• 7:23
  SPEAKER_00: I've personally done all of these things wrong, at least once.
• 7:27
  SPEAKER_00: Now I understand what was happening in my body and instead of just thinking, huh, I feel a little weird.
• 7:34
  SPEAKER_00: These are all the things that happen in degrees.
• 7:37
  SPEAKER_00: You can usually see them coming on slowly, and most of us are probably somewhere on the scale of suffering from environmental issues if we've been in the mountain for a long day.
• 7:46
  SPEAKER_00: The interesting thing is how you tell low blood sugar from diabetes.
• 7:51
  SPEAKER_00: How do you warm someone up in the wilderness?
• 7:53
  SPEAKER_00: How do you spot the onset of heat exhaustion?
• 7:55
  SPEAKER_00: And what about altitude mountain sickness?
• 7:58
  SPEAKER_00: I think about the times on the trail, where my hiking buddies are out there making bad decisions.
• 8:03
  SPEAKER_00: These are likely caused by early dehydration, low blood sugar.
• 8:08
  SPEAKER_00: Not just them being assholes.
• 8:10
  SPEAKER_00: We had a trip where myself and Jason were in the Grand Canyon in July.
• 8:14
  SPEAKER_00: We were both very much suffering from the heat and getting grumpy and grouchy and more confused and more tired.
• 8:20
  SPEAKER_00: When we were climbing out of the canyon, the heat was in the high nineties, and the reality was that we were both reaching the upper ends of heat exhaustion, breathing heavily, moving slowly, and starting to get confused.
• 8:32
  SPEAKER_00: If it wasn't for the tap spigots calling us off, it's likely it would have got much more serious, much more quickly, and in hindsight we were both lucky to have made it out.
• 8:42
  SPEAKER_00: The scenarios are where it gets real.
• 8:44
  SPEAKER_00: Fake blood, screaming classmates, instructors who appear out of the bushes like woodland spirits of chaos.
• 8:50
  SPEAKER_00: And suddenly you're doing it.
• 8:52
  SPEAKER_00: You're helping, you're thinking, you're not panicking.
• 8:55
  SPEAKER_00: You know how to approach the scene, you know how to assess the patient, and you choose a course of action.
• 9:02
  SPEAKER_00: At one point we went around and diagnosed five patients one after the other, and to my surprise, I got them all right.
• 9:09
  SPEAKER_00: Even the burrito-eating lady with backache, who it turned out was having a heart attack, and the asthma attack from a smoke fire, and the person going to anaphylaxis due to a besti.
• 9:19
  SPEAKER_00: Even better, we knew what to do to stabilize the patient and get them safely off the mountain.
• 9:24
  SPEAKER_00: The training kicked in, and suddenly I realized I was no longer completely incompetent.
• 9:30
  SPEAKER_00: The biggest challenge wasn't the skills, it was the feeling, the confidence of knowing what to do in the first few minutes, the act of calm, slowing down instead of spiraling out of control.
• 9:43
  SPEAKER_00: The responsibility of taking charge of the scene and becoming the adult in the room.
• 9:48
  SPEAKER_00: I always think one of the biggest challenges of hiking with other people is trying to manage other people.
• 9:55
  SPEAKER_00: And an emergency situation that becomes even more critical.
• 9:59
  SPEAKER_00: It was evident when the group scenarios were happening that you needed to really assign people with tasks, otherwise, they just spiral out of control and just do random things.
• 10:12
  SPEAKER_00: Everybody has an opinion about what to do, but it's relevant and bets to understand that not everybody really knows what to do.
• 10:20
  SPEAKER_00: And so it was really interesting that they taught this sort of instant command process where you have different people having different tasks.
• 10:27
  SPEAKER_00: Somebody takes instant command, somebody is acting as a rescuer, or somebody treating the patient directly.
• 10:33
  SPEAKER_00: There's somebody who's in charge of communications, you know, within the group, but also externally to, you know, SAR teams or other emergency personnel.
• 10:42
  SPEAKER_00: Somebody's making sure that's uh everything's happening safely, there's no other dangers around.
• 10:47
  SPEAKER_00: And so once you assign those tasks to people, it sort of gives them something to do and stops the group spiraling.
• 10:54
  SPEAKER_00: And with one person in charge, you can really start to appropriately manage manage the situation and the scenario.
• 11:01
  SPEAKER_00: And I don't think that happens if you're out with three or four of your buddies or even with strangers.
• 11:05
  SPEAKER_00: That doesn't sort of naturally occur to people that there's a lot going on in an emergency situation, and it's best if you give people something to do rather than letting everybody sort of mill around and chaotically become involved or not involved in what's going on.
• 11:21
  SPEAKER_00: And that was a really useful leadership skill, not just a wilderness emergency scenario management skill, is people behave best when they're given a task, and that helps you manage a situation much more, much more better than you know, leaving people to their own devices and creating chaos.
• 11:42
  SPEAKER_00: And I think that's an important lesson that I'm going to take away from the from the course, is that when you do encounter these types of situations, you really need to take charge and need to make sure that you're able to manage what could potentially be an emotionally driven and highly stressful situation for everybody involved.
• 11:59
  SPEAKER_00: And the only way to do that is to really assign people to do things, even if it's going to fetch some water, you know, something, some simple task to keep their mind occupied, and really to keep you able to focus on the real emergency, on the on the on the individual who's really suffering and sick and he's needs the attention.
• 12:17
  SPEAKER_00: So that was a valuable lesson from the course.
• 12:20
  SPEAKER_00: Competence is a kind of kindness to yourself, to your friends, and to strangers you might meet on the trail.
• 12:27
  SPEAKER_00: My first hike after the course was on a mountain.
• 12:31
  SPEAKER_00: We ran a gnarly ridgeline off trail in the middle of the Nevada desert.
• 12:35
  SPEAKER_00: And as I'm coming off the mountain, the heat of the day starts beating down on me.
• 12:39
  SPEAKER_00: I can tell I'm slowly drifting into overheating and dehydration.
• 12:44
  SPEAKER_00: We are in the desert after all.
• 12:46
  SPEAKER_00: But I felt more confident because I was aware of the danger.
• 12:49
  SPEAKER_00: I stayed much more hydrated, drinking more electrolytes than usual, and taking deliberate rest in the shade to cool off, and moving more slowly to prevent the inevitable spiral into heat exhaustion.
• 13:00
  SPEAKER_00: I feel more confident now because I am prepared.
• 13:04
  SPEAKER_00: I look at my upcoming adventures differently.
• 13:06
  SPEAKER_00: I don't feel invincible, I just feel prepared, and that's a much better feeling.
• 13:11
  SPEAKER_00: I've also purchased a completely new first aid kit from Knowles with truly the right quality kit in it.
• 13:17
  SPEAKER_00: I also added a tourniquet, ace bandages, and a SAM splint.
• 13:21
  SPEAKER_00: It added some bulk to my kit, but I have much more confidence that I can help myself or others when I'm on the mountain.
• 13:28
  SPEAKER_00: This course isn't a medical school.
• 13:30
  SPEAKER_00: It's just two days.
• 13:32
  SPEAKER_00: Two days that make you more useful, more confident, and more aware.
• 13:36
  SPEAKER_00: It's surprisingly fun, it's community building, and honestly, it's one of the most empowering things you can do if you spend any time outdoors.
• 13:44
  SPEAKER_00: Wilderness first aid isn't about being heroic, it's really about preparation.
• 13:50
  SPEAKER_00: It's about showing up for your people, it's about making sure the adventure doesn't end on a bad day, and knowing how to evacuate people.
• 13:58
  SPEAKER_00: Perhaps my favorite part of this course is really that decision of point between when is it okay to stay on the mountain and when should you evacuate somebody?
• 14:08
  SPEAKER_00: And that's really difficult to tell if you don't have the knowledge or understanding of what's actually happening to somebody.
• 14:14
  SPEAKER_00: This could mean the critical difference between life and death.
• 14:18
  SPEAKER_00: You may think it's okay to stabilize a limb and then allow the person to carry on, assuming they've just twisted an ankle and they can tough it out.
• 14:27
  SPEAKER_00: In reality, they may have a serious ankle break, and you should be working to evacuate them.
• 14:34
  SPEAKER_00: And so trying to better understand when is the go time and when is not the go time is really important because you may be putting somebody's life in danger.
• 14:44
  SPEAKER_00: And that's what I really took away from this course as a major benefit was knowing what is the best way to identify when the trip is over and when can you safely carry on.
• 14:56
  SPEAKER_00: And I think most of us, particularly men who go out hiking together, tend to favor this idea that it's just a twist, it's just a break, you're just feeling down.
• 15:07
  SPEAKER_00: Suck it up, man, let's keep going.
• 15:10
  SPEAKER_00: And that's really not the right way or the right approach at all, because you could be putting your friend in even more danger and making it even more difficult for rescuers to come and get you if you drive more deeply into the wilderness.
• 15:22
  SPEAKER_00: Imagine, for example, somebody who is suffering from heat exhaustion.
• 15:27
  SPEAKER_00: At this moment, it may be okay.
• 15:29
  SPEAKER_00: They may just be hot.
• 15:30
  SPEAKER_00: You may be able to cool them down by putting them in the shade, you may be able to cool them down by applying water to them and cooling down their core temperature, enabling them to fully recover and continue the hike.
• 15:42
  SPEAKER_00: Or you may push through and continue, not realizing that they were spiraling into a dramatic death situation where they were on the verge of heat stroke and can very quickly expire.
• 15:53
  SPEAKER_00: I can think of countless times where we've done this, where we've been hot and overheated, and we just pushed on and pushed on and pushed on.
• 16:00
  SPEAKER_00: And that is a major mistake.
• 16:03
  SPEAKER_00: The other exciting thing I thought I took from this course was understanding exactly how to evacuate people.
• 16:10
  SPEAKER_00: Now you don't think about this when you're on the mountain.
• 16:13
  SPEAKER_00: How do I actually help somebody off the mountain and in which way?
• 16:17
  SPEAKER_00: And so we practiced a number of different scenarios.
• 16:20
  SPEAKER_00: A one-man carry, a two-man chair carry, and my favorite of all, the tarpaulin burrito, where we basically tuck somebody up like a burrito and carried them off of the mountain.
• 16:35
  SPEAKER_00: And we used this in our final scenario where we basically took one of actors who had a serious issue, wrapped them up in a tarpaulin appropriately, and then carried them off of the fake scene.
• 16:49
  SPEAKER_00: One of the most important things we learned during the course was CPR and the use of an AED.
• 16:56
  SPEAKER_00: I've done CPR courses before, but it's been four or five years, so it was useful to have a quick reminder.
• 17:03
  SPEAKER_00: And so I wouldn't say there was anything substantially different about learning CPR for the wilderness as compared to a normal CPR class.
• 17:13
  SPEAKER_00: Of course, the difference is the scenarios that may cause a person to require CPR, and then the amount of time it's going to take to extract somebody.
• 17:23
  SPEAKER_00: And so the reality is in the wilderness, the types of things that may cause somebody to require CPR are uh drowning and lightning.
• 17:31
  SPEAKER_00: And in both of those cases, it may be possible to restart the heart or to use CPR to allow somebody to eject the water in their throat.
• 17:41
  SPEAKER_00: When you drown, what you don't realize is that somebody's the body's natural reaction is for the throat to close.
• 17:46
  SPEAKER_00: And it may be possible with a few quick rescue breaths to get their body to open up the lungs and spit out the water and start breathing again.
• 17:55
  SPEAKER_00: With lightning as well, it's highly possible that you could potentially shock the heart back into rhythm.
• 18:01
  SPEAKER_00: The reality is though that we have to face that CPR most of the time is not effective, it's just keeping the oxygen running around the person's body in the hopes that somebody can bring an AED device to the scene.
• 18:13
  SPEAKER_00: And most of the time, we're not going to be carrying AEDs with us into the wilderness.
• 18:17
  SPEAKER_00: And so it's going to be a challenging situation if you ever needed to use CPR in the wilderness.
• 18:23
  SPEAKER_00: The second skill I learned was how to apply and use epinephrine.
• 18:31
  SPEAKER_00: And so my wife has serious allergies and carries epinephrine.
• 18:35
  SPEAKER_00: And if anything ever happened to her, I absolutely don't know what to do, or at least I didn't before this course.
• 18:41
  SPEAKER_00: But the course taught us how to use epinephrine, how to inject it.
• 18:46
  SPEAKER_00: Not that complicated and not that difficult.
• 18:49
  SPEAKER_00: But what was useful was trying to understand when you would use it in the wilderness, how often you can use it and apply it.
• 18:56
  SPEAKER_00: And in learning the appropriate requirements for using epinephrine and getting a certificate, I can now carry epinephrine into the wilderness, which is it's useful.
• 19:07
  SPEAKER_00: Maybe a little expensive, but it's useful to have that in your medical kit, particularly if you're with other people.
• 19:13
  SPEAKER_00: I would imagine that most people who have severe allergic reactions will be carrying an epipen with them.
• 19:18
  SPEAKER_00: But legally, uh only that person is supposed to be able to inject themselves with the epinephrine.
• 19:24
  SPEAKER_00: But it's it's likely that there could be a situation where that person's unable to do so.
• 19:28
  SPEAKER_00: And so being able to administer that and having the knowledge of when and how to use it is is useful.
• 19:34
  SPEAKER_00: Then finally, the wilderness first aid certificate itself, and that was the bulk of the two days.
• 19:40
  SPEAKER_00: And at the end of the of the course, got presented with these three certificates.
• 19:46
  SPEAKER_00: One of them, the CPR AED, the one, the epinephrine certificate, and then the wilderness first aid certificate.
• 19:53
  SPEAKER_00: And it feels like I've now got a greater responsibility to others when I'm in the wilderness now that I have the certificate.
• 20:00
  SPEAKER_00: And I feel like I'm much more competent at being able to use it.
• 20:05
  SPEAKER_00: Now, the real test is if anything ever happens in the wilderness, will I respond appropriately?
• 20:10
  SPEAKER_00: And if you don't use it very often, then how much is that knowledge that I've learned over two days going to degrade?
• 20:17
  SPEAKER_00: So I probably have a responsibility now that I have the certificate to continue sort of referring and refreshing my knowledge as I get further and further away from the two-day event to make sure that if anything does happen, I sort of remember what to do and have that knowledge ingrained in me moving forward.
• 20:34
  SPEAKER_00: So if you love the great outdoors, you should go take this course because ultimately it might save your life.
• 20:41
  SPEAKER_00: And it's only two days, it's a bit of fun, but absolutely worth every single penny.
• 20:46
  SPEAKER_00: Now off you pop.