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SC seagoat
Trad climber
Santa Cruz, or In What Time Zone Am I?
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Mar 25, 2015 - 09:15am PT
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NOLS Wilderness First Responder
Medical Off Shore Training (when you are 3 weeks from the nearest landfall you have to be prepared for a lot of potential emergencies). So far haven't had to do any major medical stuff (except self stitching) off shore, but the thought of a major bleed or break so far from help is intimidating.
Susan
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Patrick Sawyer
climber
Originally California now Ireland
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Mar 25, 2015 - 09:31am PT
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Former EMT 1 mid-1970s.
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perswig
climber
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Mar 25, 2015 - 09:33am PT
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About the only thing I remember how to do, is the "Sucking Chest Wound" where someone is shot straight through the lungs. Prolly not gonna see that.
Dude, you're not spending enough time over on the gun debate sandbox thread!
Those skillz will be in high demand as soon as the gub'mint starts trying to take back our ARs...
WFR plus recert, for me. Would consider that a minimum for at least one member of a climbing/whitewater/ski group to have when venturing afield.
Dale
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kev
climber
A pile of dirt.
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Mar 25, 2015 - 09:34am PT
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I'm a CGTP - Certified Gorilla Tape Provider
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HighTraverse
Trad climber
Bay Area
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Mar 25, 2015 - 09:49am PT
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Additional thoughts on chest compression CPR.
Indeed it's not often successful. I was told something like 8%.
However, that largely depends on the patient's health.
People with serious heart disease, COPD, extreme obesity......yada yada yada......are not going to come back as often.
Without warning my heart completely stopped. Or at least I had no pulse.
There were four keys to my survival:
Good overall health
No general heart disease
I kept breathing (yes, this happens)
Immediate chest compression CPR.
I came back in something like 2 1/2 - 4 minutes.
And yes, it HURTS. 7 weeks later and I've still got two tender spots in my ribs. Thank you DK, VERY much!
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apogee
climber
Technically expert, safe belayer, can lead if easy
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Mar 25, 2015 - 09:55am PT
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HT, pre-existing health condition is a key factor.
How long before BLS/CPR was initiated on you?
Was an AED applied?
How long before an ALS (Paramedic) provider arrived?
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HighTraverse
Trad climber
Bay Area
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Mar 25, 2015 - 10:14am PT
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CPR started: not more than 2 minutes later. Probably less. No one was keeping time at that point.
I came around completely in about 4 minutes. My mind was clear as a bell. I thought I had only fainted. Wanted to get up and keep hiking.
NO artificial stimulation. This was in the "back country". No AED. Nuttin'
Truckee Fire SAR arrived about 40 mins later. Put in a port, pulled a Troponin sample, gave me O2 just in case, put me on ECG. They packaged me for the chopper flight to Renown in Reno. I was wide awake and alternately helping and joking all the time.
2 1/2 hours from falling over to the ER. Exactly 24 hrs from falling over to open heart surgery.
How likely is anyone to need chest compression CPR? Not very likely. When you need it away from an AED nothing else will do.
Will an AED even work for total cardiac arrest? It's largely a de-fibrillator.
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apogee
climber
Technically expert, safe belayer, can lead if easy
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Mar 25, 2015 - 10:22am PT
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I know you described this in an earlier thread, but who provided your BLS? As it was backcountry, they obviously palpated for the presence of a pulse....correct?
A Defibrillator of any kind will not be useful when cardiac arrest progresses to asystole and an AED would not function, as asystole (or normal rhythm) are not 'shockable rhythms'. If defibrillation is to have any benefit, it needs to be applied as soon as possible (assuming there is actual fibrillation at the time).
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HighTraverse
Trad climber
Bay Area
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Mar 25, 2015 - 10:46am PT
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I was resuscitated by an Anesthesiologist who happened to be in my group. He found no pulse at my wrist. He didn't take the time to check my carotid but started chest compression CPR immediately. He had stopped by the time I awoke, after my pulse had returned. The subsequent medical tests confirmed my heart had stopped.
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Guernica
climber
dark places
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Mar 25, 2015 - 11:11am PT
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Lapsed EMT-B. Never did work professionally but had amazing training and ambulance ride-alongs where I witnessed some semi-legit stuff, but nothing too truly crazy or PTSD-inducing.
Was lucky enough to observe 6 autopsies though, 2 of which were homicide victims... one of those a "decomp". That was wild, though obviously nothing that demanded actual medical care (6 months too late to do anything in that case.)
Total respect for our medical professionals out there!
(edit: did get to use some of the training shortly after the course when a woman collapsed in a sushi restaurant in vancouver. Once the medics left with the patient the manager comped me & my gf's meal [incl. sake] for the help we provided :) )
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johnboy
Trad climber
Can't get here from there
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Mar 25, 2015 - 11:19am PT
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I've read a lot here can't handle the trauma.
I was on a volunteer fire department for 20 years before I got my EMT-B cert and the things I saw in the field made me numb to it. Car accidents when they lived were some of the worst I've witnessed. The will to live is strong, even when unconscious.
On the topic of AED's, almost all of them currently in service in schools, stadiums, airports, ambulences and such will monitor a pulse and automaticaly let you know if it's a shockable rhythm or not.
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apogee
climber
Technically expert, safe belayer, can lead if easy
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Mar 25, 2015 - 11:33am PT
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A true Automated External Defibrillator doesn't require anything of the user except to attach it properly- the device will determine whether the rhythm is shockable or not, and will automatically shock as necessary.
Semi-Automatic External Defibrillators require the user to attach it, and if determined necessary by the device, for the user to provide the shock via a pushbutton.
These days, most people refer to either type as an 'AED'. Neither of these types of devices typically have a cardiac monitor that graphically illustrates cardiac rhythms, or the presence of a pulse.
Manual Defibrillators do have a monitor, and the user can interpret it and adjust joule rates accordingly, and shock as they deem necessary. These types of defibrillators are most commonly utilized by ALS providers.
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SC seagoat
Trad climber
Santa Cruz, or In What Time Zone Am I?
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Mar 25, 2015 - 11:51am PT
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We've been contemplating getting an AED on our boat, given our age, and since we can be weeks from shore or days from a passing ship rescue.
This thread has given me a lot of food for thought.
Susan
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mucci
Trad climber
The pitch of Bagalaar above you
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Mar 25, 2015 - 12:04pm PT
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I had WFR and O2 administration certs.
Having had the basic life saving training saved the life of one partner, and expedited the critical care for another.
I would recommend at least the above to anyone doing anything in the mountains.
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Easy Wind
Trad climber
Oakland, California
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Mar 25, 2015 - 12:24pm PT
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CPR and First Aid certified since the Boy Scout days.
Just finished a 7-week EMT course a few weeks ago. Currently doing ambulance ride-alongs and studying for the NREMT. Planning to work as an EMT-B as I apply for nursing school.
A few years back I took a fall, pulled a piece, and was knocked unconscious when my head hit the wall. No helmet. Concussion and laceration. Two friends in the group had medical experience; one was an EMT, the other a WFR. They took care of me and hung in there until the paramedic unit arrived and transported me to the hospital, which luckily wasn't very far from the crag. I was grateful that my friends had training and could handle the situation. Sh#t happens. I think it makes sense to have a basic level of medical training to be able to help out.
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darkmagus
Mountain climber
San Diego, CA
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Mar 25, 2015 - 12:37pm PT
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I'm a Doctor of Chiropractic (D.C.).
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Clint Cummins
Trad climber
SF Bay area, CA
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Mar 25, 2015 - 12:47pm PT
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Zero certs lifetime and holding.
Have had informal training, so I can do basics on wounds, broken bones, spinal, CPR.
I understand the attraction of maybe being able to save a life, and being more self-sufficient.
I feel that getting certs/renewals would not significantly increase the chances of me saving lives/limbs.
Mainly because the frequency of accidents I've witnessed over 40 years has been low.
Good subject for thought and discussion, though.
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Vegasclimber
Trad climber
Las Vegas, NV.
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Topic Author's Reply - Mar 25, 2015 - 12:55pm PT
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Nice to see some great discussions in the thread! Thanks for all the input, and for keeping the thread on topic gang.
HT, that is some scary shyte. Glad he got you back so fast.
I tend to follow local protocols, but my general opinion on compression-only CPR is that in most cases, you will or will not get a pulse back before oxygen loss leads to brain damage. A lot of it is situation-dependent, but I can understand the concept that taking out rescue breaths helps a rescuer avoid contact without a mask. As a general rule, I keep a basic film mask in my pack at all times, but I only have a full mask when I have my BLS bag with me, which stays in the truck. With my BLS bag, I have a lot of O2 options so I probably wouldn't be using a mask then either.
I don't have an AED in my bag, as even the cheap ones are pretty damned expensive. If you do choose to purchase an AED Seagoat, I would do some research before buying.
I usually self-review all my training annually and recert as needed, mainly because protocols such as compression-only CPR can and do change, and I like to keep up with current techniques.
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WyoRockMan
climber
Flank of the Big Horns
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Mar 25, 2015 - 01:05pm PT
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EMT-B (now lapsed) as part of volunteer FD/Ambulance crew in Montana.
Moved to WY where they don't recognize NREMT certs. I started studying up for the WY tests, but was unable to find a volunteer service. I live about 1/4 mile outside of the local volunteer services responder "limit". This is a rural community with only 3-4 EMTs. I tried to sell the model that we used in MT, where we equipped our EMT's outside of the zone with jump kits/O2 to provide a wider range of rapid coverage. The idea was, and works well, is that the nearest responder can get there quickly while the wagon is en-route.
Pretty bummed to have to give it up. I still keep current FA/CPR.
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apogee
climber
Technically expert, safe belayer, can lead if easy
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Mar 25, 2015 - 01:31pm PT
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Compression-only CPR is being taught these days in light of research that suggests that acute onset cardiac arrest will likely have relatively good blood oxygenation, and therefore BLS time is better spent (at least initially) in attempting to perfuse the brain with that blood, rather than wasting time oxygenating it. In the case of cardiac arrest mechanisms that are more hypoxic in nature...many of which are more likely to be encountered in active outdoor people (i.e. drowning, avalanche burial)...compression-only CPR may not be as beneficial.
The other, more practical implementation of compression-only CPR comes in training laypersons, who are skittish about doing ventilations on a patient, &/or do not have Personal Protective Equipment (or comfort with it's use) available to them.
In any case, discriminating between mechanisms & adjusting one's technique is probably more relevant to someone with extensive training &/or experience. Bottom line with CPR: DO SOMETHING. No effort = 100% mortality rate.
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