Ventura County Search & Rescue, Fillmore Mountain Rescue Team 1
 
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First Aid


Although at times SAR personnel are required to treat accident victims or disaster subjects, most of the patients to be treated will be located in the backcountry as the result of a search. In this case the assistance of an ambulance and other medical response personnel may be quite distant. For example, the injured subject found through a tedious search in snowy weather may require field care by the SAR team for 24 hours before the weather clears sufficiently for a successful evacuation. Also since an ambulance supplied with all the necessary gear will not be available, the SAR EMT must be able to improvise equipment and describe symptoms so they can be relayed via the radio to medical personnel. If required, and possible, the Command Post will arrange to transport Advanced Life Support personnel once the subject has been located. Since SAR personnel may be dispatched to large disasters, the SAR member should be aware of proper triage requirements.  

When operating as a SAR EMT, the team member operates under the guidelines of the Ventura County Emergency Medical Services and Health Care Agency who govern all aspects of emergency response treatment in Ventura county. A copy of the current policies and procedures for ambulance response personnel should be available in the rescue room at all times.    

PERSONAL FIRST AID KIT

Each member is required to maintain a personal first aid kit to be available with his 24 hour gear. The equipment listed below constitutes a minimum guideline. If the individual member has a replacement item or additional item that he feels is more applicable to his personal skills, then he should use that item. Stock for the kits are available through the team equipment officer. Exotic equipment is rarely needed. The kit should be packed in such a way so that it may be opened easily on a steep slope in dark conditions without having items falling out of the pack. Also the bandages and first aid equipment should be protected from rain and wet conditions. The kit should be periodically inspected as time deteriorates some of the medical supplies. Since the first aid pack is only one item in the SAR pack one should keep the first aid pack simple and lightweight.

www.firstaidkits.org

First Aid (Minimum Mandatory Equipment)  

Item

Qty

Kling or Kerlex gauze bandage

4 rolls  

Adhesive tape (1")   

1 roll  

Dressings (4"x 4")

15  

Surgipads (ABD's)  

2  

Bandage scissors (6")  

  1  

Tweezers (4")  

1

Band-Aids  

10

Antiseptic vials or swabs  

4

Vaseline Gauze pads  

2

Triangular bandage (or equivalent)

1

Penlight  

1

Aspirin (or equivalent)  

12

Patient Assessment Form  

 2

Pen or Pencil  

1

Rubber gloves  

2 pair

Optional Equipment:

Blood pressure cuff       

Extra Rubber gloves        

Stethoscope

Chapstick

Airways (#6-#4-ped's) Nox-a-sting ampules

Thermometer (Hypothermia type)

Suction Bulb    

Ivarest cream

Sunscreen

Hemostats

SAM / Wire Splints

Contact Case              

Personal Medications

Plastic Bag    

 

Team Trauma Packs:    

Each vehicle is similarly equipped with regards to trauma equipment. The contents of the traumas packs (general first aid gear) is identical in all vehicles. The main trauma pack and splint pack contents are given below. In addition each vehicle carries at least one replacement "C" size O2 bottle and at least one litter for transportation

Item

Qty

Rigid "C" Collar  

1

BP Cuff and Stethoscope

1

Ambu Bag and Adult Mask  

1

Oral Pharyngeal Airways  

3

Hot Pack  

3

Space Blanket  

1

Band-Aids

20

Kerlex Roller Gauze 4 inch  

6

4x4's  

20

Abdominal Pads  

8

Oxygen Tank (Size "C") and Regulator

1

Roll 3-inch Tape  

6

Roll 4 inch Tape  

1

Bandage Shears  

1

Triangular Bandage  

3

Sting Relief Package

3

Ivarest Package

3

Pair Rubber Gloves

3

V-Vac (Manufacturer name)  Manual Suction Device (Replacement Tips)

1

Full O2 Mask  

1

Non-rebreathing O2 Mask  

1

Ambu - O2 Tubing

1

Nasal Canula  

2

SAMS Splints  

2

Cardboard Splints  

4

 

The Patient Pack: 
(Bought with each litter in the field)

Item

Qty

Sleeping Bag  

1

50 ft of "Tie In" Line  

1

(1" webbing)  

1

Paper KED Blanket

1

Pair of Goggles  

1

Patient Helmet  

1

Splint Pack 
(Kept near the Trauma Pack)

Item

Qty

Seger Splint (One legged traction splint)  

1  

Soft Extrication Device

1

Long Board Straps  

1

 

 

In addition to the above listed equipment the vehicles have litters assigned to them based on the vehicles space constraints to carry the device. Break down litter (litters which fold in two pieces) are kept in the smaller vehicles. The utility vehicle, contains a Stokes litter and a Ferno Washington (or equivalent) plastic litter. Stokes litters should be used if any technical evacuation is expected or the Stokes Wheel (figure-1) is intended to be used. The plastic smooth bottomed litters are designed for use in snow and brush. Each vehicle also has a short spine board.  Team vehicles also carry Miller boards.  

Reporting Vitals and Patient Status

Once a missing subject is located in the field, the subject must be assessed for any injury that may have taken place. The command post needs to keep a record of the field findings for legal reasons and for any relay of information to waiting hospitals or other attendants. A patient assessment form should be maintained in the field. Reports must be completed with as much information as possible even under adverse weather conditions. If immediate transportation is required and the transportation is available, the following course of action should take place.  

Perform the Primary Patient Assessment:  This should include Airway opening with C-spine control, verification of breathing, check of circulation, check of motor-neuro responses, and exposing the complete torso to visually check for additional injuries. For major trauma subjects this should happen quickly as the best treatment will be definitive care in a hospital not in the field.  

Request transportation as is available from the command post:  Never assume that the command post knows what is needed. If available the command post will arrange for the necessary equipment and transportation. The team in the field should consider alternate plans in the event the equipment or transportation requested is not available.  

If transportation becomes immediately available, the patient should be loaded into the transporting vehicle. The secondary survey or additional treatment will be started in route to the hospital or medical station. Control of the patient will be passed to the highest trained medical person responding.  

If transportation is delayed, (i.e. subject is found in the Los Padres Forest, it may take time for an airship to arrive on scene) or a technical evacuation or long litter carry is anticipated, the secondary survey and proper patient treatment and packaging must occur prior to the evacuation. Since the transportation is delayed, the support team will periodically monitor vitals and then tend to the necessary injuries in accordance with the EMT training.  

If possible the command post will arrange for a separate radio channel for communication of patient information to and from the field. On some calls the command post has had medical personnel present (Medical Unit Leader) to control treatment remotely.   

If transportation is to be delayed a considerable delay, the support team monitoring the subject must make provisions for shelter, warmth, patient excretion, and overall patient protection. Proper handling and treatment is required with the equipment available for whatever time it takes to get the necessary evacuation equipment. It may be necessary for personnel in the support team to take sleep shifts to accommodate 24 hour a day monitoring. In this case the command post will have a medical unit leader to help.  

Litter Carries:

If it is not possible to fly an injured subject, the next choice is to carry the subject to a SAR vehicle, and then use the SAR truck to transport the subject to an awaiting ambulance. SAR vehicles are capable of transporting full litters in a closed vehicle.  

When it is necessary to carry the litter down a trail, utilize 6 members (if available) on the litter at a time. Switch positions often, and rotate in rested members to maintain a good rate of travel. If necessary abandon personal gear to be picked up later. Figure-2 depicts a smooth rotating cycle that allows the litter team to switch arms periodically. This is very difficult if CPR is required. Use of the Stokes wheel is suggested for trail or clear terrain use only. If used in brush, mud, or snow, it will hang up and make travel much more difficult.  



 

In a provisionary mode of operation, if a rigid litter is not required for evacuation an improvised litter can be formed from a standard length of rescue rope (200 ft) as is shown in figure-3. The rope litter can be improved by placing wooden staffs formed from tree limbs if such items are available. During all litter evacuations the subject should be secured into the litter for safety reasons. Belays should be utilized for any sloped conditions. Be especially careful that the patient is maintaining the proper temperature. It is not sufficient to place the subject in a sleeping bag and assume that he is warm. Litter carries can make a subject nauseous so be sure to monitor the patient carefully.  

APPLICATION OF THE SEGER SPLINT  

Many EMT courses do not include the Seger Splint as it is inferior to the Hare Traction splint in capabilities but is far more compatible with transportation into the back country. As is with other traction splints, the Seger is intended for use on subjects that have suffered midshaft femur fractures. The guidelines for application of the Seger Splint are as follows:

  • Expose the fracture sight, apply dressing if required.  
      

  • Verify distal sensation, movement, and pulse (Pedal)
      

  • Remove the Shoe and Sock.
      

  • Prepare the splint and splint wraps.
      

  • Place splint along the medial (inside) aspect of the thigh with the pad even with the buttocks.
      

  • Fasten the groin strap. 
      

  • Set length with pulley 2 inches past the sole of the foot.
      

  • Apply ankle hitch snugly above the medial and lateral malleoli.
      

  • Apply traction by releasing the shaft lock and pulling the inner shaft. Applied traction as is indicated on the tension wheel guide should equal 10 percent of the subject's body weight. Initially the tension may need to be set slightly higher to allow the splint to settle.
      

  • Fasten leg support straps (thigh, knee, and ankle)
      

  • Recheck for distal sensation, movement, and pulse

Guidelines for Patient Assessment:  

Although the EMT course will prepare the SAR member for field assessments, the following is included as a helpful reminder of the type of signs that are to be observed during a secondary survey. The initial survey will take less than 15 seconds and will detect any immediate life threatening conditions. The secondary survey will take longer (5 to 10 minutes) and is designed to be detailed. This information is often necessary for a medical team at the command post to make a proper decision on whether to delay transportation or attempt a dangerous extrication. Since the required treatment for many major trauma injuries is to stabilize and transport, do not delay transportation to complete a secondary transportation if transportation is available.  

Posterior Neck Area:  Check C7 upward for deformity, tenderness, or mushiness. Note the condition of the neck muscles (rigid, swollen, imbalanced). Check for any subcutaneous emphysema, bruising, or deformity.  

Head:  Check Scalp from back to front and sides for bruising, wounds, bleeding, deformity, or tenderness. Check mastoids for battle signs. Note any fluid loss from the ears.  

Face:  Note Skin color, skin temperature (cool, hot, clammy). Check forehead, temples, maxilla, mandible, zygomatic arches, and superciliary ridges for wounds, bleeding, deformity, or tenderness. Note any eyelid discoloration, pupillary reaction to light, conjunctiva condition. Note any injury to or fluid from the nose. Check for breath odors, jaw or mouth pain, blood or vomit, broken teeth or dentures. Note any difficulty in masseter operation.  

Anterior Neck Area:  Check for distended neck veins, trachea position (midline or not), presence of a stoma or medical alert tag.  

Shoulder Area:  Note if accessory muscles are being use to aid respiration. Check the clavicle, scapula, shoulder joint, on each side of the body for pain, bruising, wounds, bleeding, deformity, or tenderness. Check again for subcutaneous emphysema.  

Arms:  Check from the Shoulder to the wrist one arm at a time for bruising, wounds, bleeding, deformity, or tenderness. Note any medical alert tags. Check the pulse. (strength regularity)  Note skin temperature and moisture of the arms. Check arm movement and relative strength of each grip. Compare bilateral pulses.  

Chest Area:  Using compression tests from the head down note any irregularity in the chest structure. Note flail chest, sucking wounds, bruising, bleeding, deformity, or tenderness. Note energy required for inhalation and exhalation. Check for pain during a deep breath. Check again for subcutaneous emphysema. If the thoracic spine is available check for deformity.  

Abdomen:  Overall press lightly in all four quadrants for bruising, wounds, deformity, or tenderness. Note if flat, rigid, solid, or soft. Press deep to note guarding and the presence of any rebound tenderness. Check the lumbar spine for tenderness, and deformity.  

Pelvis:  Check the Iliac crest side to side and downward to check for fractures or pain. Likewise palpate the hip joint for the same reason. Note any priapism if applicable and any incontinence.  

Legs:  Check the femoral arteries for a detectable pulse. Check each leg one at a time from the hip to the foot for bruising, wounds, deformity, or tenderness. At the foot check color, temperature, bilateral pedal pulses, movement, and sensation. Note leg rotation and ability to control leg posture and squeeze together.

Back:  Using a log roll to stabilize the subject, the back should be investigated for any injury or deformity not already noted.  

Quantitative Readings:  The blood pressure, Level of Consciousness (LOC), respirations, and pulse should be noted at periodic rates. Every 5 minutes for the critical patient to achieve a baseline, and then every 15 to 60 minutes there after. Skin color, movement, location of pain, sensation, pupillary response, verbal skills, skin temperature, and skin color should also be periodically noted. Vital profile information should  be transmitted to the command post and should be recorded in the field. The field report should remain with the patient when the patient is transferred. The Ventura County Medical Field Report should be established for each patient.  

Presumption of Death:  

In accordance with county policy and procedures, the EMT (SAR member) shall instigate CPR and other required life maintenance procedures in patients in full arrest unless any of the following conditions exist:  Decapitation, Massive crushing, and or penetrating injury with evisceration of the heart, lung or brain, Incineration, or Decomposition. If the EMT is not absolutely positive of the presence of the above conditions, CPR must be initiated and maintained until instructed to discontinue.  

Medical Problems of High Altitude:    

Although Ventura county is limited to approximately 8800 ft elevation (Mt Pinos Area), complications due to quick travel to altitude are common in the SAR community. In addition since SAR Teams will respond to calls in the Sierra's, travel to 14,000 ft is possible. Altitude effects result from the lower oxygen content of the air, and not from the lower barometric pressure. At 18,000 ft only half the amount of oxygen is available compared to what is available at sea level. Acclimatization to altitude occurs at different rates in individuals and can differ in the same individual from one trip to the next. Typically one who is prone to altitude problems will experience problems more often. Physical fitness does not protect one from experiencing altitude problems however poor health will aggravate the effects of the problems making travel even more difficult. Drugs have not proven to be effective. Some members find it helpful to take a prophylactic aspirin and antacid just prior to or upon arrival at altitude to help combat some of the effects of altitude. Each person must know what works for him.  

Most EMT courses do not include mountaineering high altitude complications, so they are noted here. Altitude problems may occur year round but are more pronounced in the winter months as additional pack weight and colder temperatures aggravate the effects of lowered oxygen availability. The altitude problems are classified as Acute Mountain Sickness, High Altitude Pulmonary Edema (HAPE), and High Altitude Cerebral Edema (HACE).  

All altitude related problem are derived from the body's inability to acclimatize in the time provided. Some of the effects are temporary and not dangerous. Given time, if the body does not properly acclimatize, altitude problems can progress to life threatening ailments. The body's normal response to altitude will include:  An increased respiration rate and volume which will be most noticeable during periods of exertion. The pressure in the pulmonary arteries is elevated to allow better blood perfusion in the lungs. If exposure to altitude is extended the body will create additional red blood cells to carry additional oxygen and additional chemicals to help with the absorption and release of oxygen. According to "Medicine for Mountaineers" acclimatization is 80 to 90 percent complete in ten days. However since the SAR member is expected to respond from Ventura county to high altitude calls within hours, the member must learn to cope with the discomforts and be able to discern serious complications.  

In general the amount of exertion that one will be able to achieve at altitude is less than what is achievable at sea level. The amount of exertion is limited by the ability of the chest muscles and diaphragm to move air in and out of the lungs which protects the heart from over exertion. In cold temperatures when humidity drops to near zero, one must be careful to keep the body hydrated as the process of breathing can expel 1 quart of fluid in 8 hours while resting.

 Acute Mountain Sickness is a general term for severe conditions related to exposure to altitude. The onset is dependent on the rate of ascent and the altitude attained. The onset will normally occur within a few hours after arrival at altitudes above 8000 ft. Common symptoms include headache, dizziness, fatigue, shortness of breath, loss of appetite, nausea, and general lousy feeling. To help these symptoms reduce altitude if possible, reduce exertion, take aspirin for headache, eat high carbohydrate foods with high sugar content, and drink plenty of fluids to prevent dehydration. Avoid depressants or sedatives, alcohol, diuretics, and tobacco. If symptoms do not improve or worsen after 24 hours the subject must be brought to a lower elevation to increase the amount of oxygen. If elevation decrease is not available, supplemental oxygen should be given at low flow for a minimum of 15 minutes at a time until the patient positively responds.  

High Altitude Pulmonary Edema (HAPE) is a serious and life threatening complication of altitude that results from the alveoli (air sacs) of the lung becoming full with fluid from the blood stream. This is most likely (the exact cause has not yet been determined) due to the increased pulmonary arterial fluid pressure and the decreased atmospheric pressure. Since fluid filled alveolar sacs are not capable of transferring oxygen, as more of the sacs become full, a marked decrease in available oxygen to the body occurs. The symptoms appear similar to pneumonia. As HAPE progresses the patient will become cyanotic, confused and extremely lethargic and incapable of exertion. Symptoms usually occur after a minimum exposure of 24 hours. Other characteristic symptoms include: characterizing the pain as "Wrapped in Cellophane" indicating tightness in the chest, progressive productive cough from watery to frothy sputum, elevated pulse (110 to 160 per min), and the presence of bubbling or crackling heard in the chest cavity with a stethoscope. Treatment must include evacuation to lower altitude, high flow supplemental oxygen, and treatment at a hospital. If transporting a patient with suspected HAPE conditions, be sure to notify the hospital of the exact conditions in advance as soon as possible. The LOC of the patient is the best indicator of the effects of HAPE and should be monitored closely. Unconscious HAPE patients may die in 2 to 6 hours unless active intervention occurs. Medical follow up exams are required if HAPE was present, since the progressive effects of HAPE can continue in a subject even after returning to normal elevations.  

High Altitude Cerebral Edema, HACE, follows the same course as HAPE except that fluid is collecting in the brain region. HACE occurrences are prevalent at elevations above 14,000 ft., which makes them rare in the continental United States. Symptoms include intense headaches, nausea, and the occurrence of bloodshot eyes. Normal head trauma symptoms are to be expected in mature HACE episodes. With any suspected HACE patient, evacuation to a lower altitude, high flow oxygen, care for normal head trauma considerations, and hospital care is required.  

 

  
Ventura County Sheriff's Volunteer Search & Rescue  |  Fillmore Mountain Rescue  |  Team 1
Mailing Address:  P.O. Box 296 |  Fillmore, CA  93016
 
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2005 Ventura County Sheriff's Volunteer Search & Rescue, Fillmore Mountain Rescue, Team 1

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