SAR Files:When the Unexpected Happens

August-September 1998

This is an article from WaveLength Magazine, available in print in North America and globally on the web.

by Lee Dixon

Some accidents happen and no amount of prevention short of living in a bubble can stop them. The question is what to do once they occur.

Consider this scenario. A party of 13 people in three canoes were on a wilderness trip. The perils of the passage were past. The camp had been set up and dinner enjoyed by all. A 70-year old woman (God grant that we're all out exploring in our seventies and beyond) was washing the dishes when bump, a passing contact with her husband unsettled her balance and over she went, arms extended to break her fall. Her wrist was broken instead. A colles fracture acquired in textbook fashion.

Attempts to radio for help proved futile, as the signal wasn't strong enough. No boats were in visual range so a message couldn't be relayed. The group was on their own.

Among their provisions was what was reportedly a very good first aid kit, but it would seem that first aid knowledge was sketchy. The lady's arm was immobilized but not splinted.

The next morning after what was undoubtedly an uncomfortable night a pleasure craft was spotted. The party was able to contact the boat and a radio message was relayed to the coast guard that a medical evacuation was needed. As no helicopters were available the injured woman was loaded onto the pleasure boat which set off to rendezvous with a fast response coast guard boat. When coast guard received the woman into their care they splinted her wrist and then transported her to a waiting ambulance in Bella Bella.

Although this was hardly a life-threatening situation, it does raise a number of issues including:

• Radio troubleshooting

• First Aid for fractures and Priority of transport

• Requirements for landing a helicopter

• Marine Law.

• First Aid Kit

TROUBLESHOOTING YOUR VHF

First you need to check your radio. Is there still life in the batteries? Is your antenna connected properly? Have you adjusted the squelch? Check other stations to see if you can transmit or receive. If your radio is in working order then it's most likely a signal problem.

BC's mountains, although an unending source of beauty, play havoc with radio communications by blocking signals. Trying a different location can put you into an area where the signal can be received. Walking down the beach, paddling out further into the bay (sea state permitting) or gaining altitude by climbing up the offending obstruction (without putting yourself into a precarious position) can all put you back into the range of a signal. Marine VHF signals work basically on line of sight. If all else fails, relay message via another vessel that is in your range of communication.

FIRST AID FOR A FRACTURED WRIST

I look at first aid from the perspective of common sense vs. rote protocol. Rote protocol says splint and transport. That's good advice if you're in downtown Vancouver and minutes away from a hospital. If you're off in the wilderness a more common sense approach is required. You'll be surprised at how much you know even if you've never had any formal first aid training, if you take the time to piece things out. The human body is a beautifully logical bit of creation.

Basically a fracture is a soft tissue injury complicated by a broken bone. The question is - what complications are there? The sharp ends of a broken bone can sever blood vessels, nerves or tissue. They can puncture the skin opening the injury to infection. If the skin is intact and no circulatory or nerve damage is present, treatment can be delayed by several hours. If circulation or nerve damage is present then immediate treatment is required. To determine this, an examination is in order.

First look at the injured limb. Is it displaced at some weird angle? Is the limb shortened or deformed? If yes, it's broken. The other sign of a broken bone is the sound of crepitus, although please do not go grinding at a broken bone in an effort to elicit that particular response. The primary rule of first aid is not to inflict further injury.

Next you'll want to know if any blood vessels or nerves are injured. What we are concerned about is permanent injury to the area beyond or 'distal' to the break (opposite side of the injury from the heart). That is the area that will be affected by loss of blood flow or impairment of any nerves. Check the pulse at the injured wrist, (swelling may obscure the pulse). Look at the colour and warmth of the affected fingers compared to the uninjured side. Blood supplies oxygen and warmth amongst other things. If blood flow is impaired, an area will no longer be toasty warm and pink. Capillary refill is the other test done to insure that circulation is not compromised. (Capillaries are the blood vessels responsible for gas exchange). Pressing down on the skin and then releasing it will leave a white mark that should immediately return to the normal skin colour. What you are doing is momentarily occluding the capillaries and then allowing them to refill when you release pressure. Compare capillary refill between the injured and uninjured side.

There are both motor and sensory nerves running through the body. They must be tested separately. We can establish that motor (movement) nerves are intact if the fingers of the injured hand can be wiggled. The ability to detect hot/cold, pain and touch determine sensory nerves are functioning. Continue to check colour, motion and sensitivity periodically as swelling may complicate an injury. Remove any jewelery distal to the fracture. Swelling may cause rings to become tourniquets.

Fractures should be splinted in order to immobilize the fracture site so that those nasty little sharp bone ends can't do further injury. Splints should be padded for comfort and protection; they should also supply some compression over the fracture site but not so much as to impair circulation. Wrists should be splinted in a functional position, with the hand in a cupped position, not flat. Put a balled up sock in the injured hand first to maintain a functional position after splinting.

Splints can be improvised by using a sturdy piece of bark, driftwood etc. Belts or clothing can be used to tie the splint in place. Once the wrist is splinted apply a sling to support and limit movement. Ice the limb to limit swelling for twenty minutes at regular intervals for 48 hours. Since it's unlikely that you'll have ice with you improvise with ocean water in dry bags, ziplock baggies or what ever else comes to hand.

If circulation or nerves are compromised and the injured hand is cold and blue or no sensory or motor function is present, then further action is required and the situation is more critical. Ideally you'd want to evacuate this situation by helicopter since a limb is in jeopardy. The hand will be lost if not treated immediately. This fracture needs to be reduced (set). Reduction of a fracture at a joint is dangerous due to the intersection of so many blood vessels and nerves. There is a risk that reduction could result in further injury. But what do you do when you're between a rock and a hard place? If the circulation to the hand is cut off they will lose their hand if no medical intervention is available within a couple of hours. If you find yourself in the position of having to deal with a person who has a fractured hand that's turned blue and cold with help a night away your best choice is to try reducing the fracture yourself.

To reduce the wrist, grasp the injured hand as if you were going to shake hands then pull straight out with firm steady pressure until the deformity is corrected. Counter traction may be required. Once the circulation returns, splint in that corrected position.

Incidentally, if you find yourself in remote straits where help is likely to be days away and you need to cast a fractured limb, improvise using the sap of a tree such as a Douglas Fir that dries to a hard resin. A fire and a pot in which to boil the sap out of the bark and simmer it down, and strips of cloth are required. Please don't experiment on trees unless there is a real need. The method can be read about in Where There is no Doctor, an excellent reference book when travelling to remote spots especially tropical non-industrialized places.

If you suspect that your casualty is going to require surgery, avoid feeding them for 8 hours prior to the probable surgery time. Anesthetics and full stomachs don't go together.

HELICOPTER LANDING REQUIREMENTS

A Labrador helicopter requires 100 x 200-foot clearance to land and a Coast Guard helicopter requires 50 x 75-foot clearance. Level ground is needed for the skids. Try to clear that area of anything that could get turned into a projectile by the downdraft of the rotating blades. Always approach a helicopter so that the pilot can see you. Await his/her thumbs up signal before moving into the helicopter, approach bent over and take your hat off. If the landing site is not available, the helicopter may be able to hover.

MARINE LAW

Marine Law requires that mariners respond to calls for help. Whether it is the BC ferry or a pleasure boater, anyone hearing your distress call in the vicinity is required to respond, by law.

FIRST AID KITS

Personally I've yet to come across a pre-made first aid kit that meets my needs. First aid kits need to be tailored to your particular trip. The topic is more than an article in itself and one day I'll tackle it. Just as a reminder, anyone who takes occasional prescription drugs, such as nitroglycerin, needs to bring them along and to check the expiry date. Diabetics need to let their paddling partners know what hypo/hyperglycemia looks like and let them know what to do in case of an emergency.

Anticipating possibilities and preparing for them is the mark of a true outdoors person. Take a reputable first aid course and do some reading if you know that your first aid skills aren't up to handling a fractured bone.

Safe paddling!

Lee Dixon nursed for 15 years, predominantly emergency and OR, specializing in trauma. She now co-owns and operates Windrunner Ocean Adventures in Sidney, BC. Ph: 250/2162628.