First Aid

Here we go through some of the common procedures that can help when an emergency situation arises in the bush. We strongly recommend that you do a practical first aid course (e.g. BWRS to learn these techniques. This content on Bushwalking101 is a helpful refresher to those that have done a first aid course recently or an introduction for those planning to do one soon.

You’ll also need a good first aid kit.

The four first aid procedures that we’ll cover here are:

• DRABCD
• Shock
• Wound cleaning
• Anaphylactic shock

For every first aid scenario, we follow a simple acronym developed by St John’s Ambulance: DRSABCD. By following each letter, we know the steps to take to ensure that we’re safe, and doing the best we can do under a stressful situation.

DRSABCD stands for:
DANGER: Ensure the area is safe for yourself, others and the patient
RESPONSE: Check for response—ask name—squeeze shoulders. If there’s response, make comfortable, check for injuries and monitor response. If there’s no response:

SEND FOR HELP: If in phone reception, call Triple Zero (000) for an ambulance or ask another person to make the call. If not in phone reception, trigger PLB.

AIRWAY: Check the airway isn’t blocked. Open mouth—if foreign material is present, place in the recovery position and clear airway with fingers. Open airway by tilting head with chin lift.

BREATHING: Check for breathing, look, listen and feel. If breathing is normal, place in recovery position, monitor breathing, manage injuries and treat for shock. If not normal breathing, start CPR.

CPR: Start CPR. Chest compressions are the most important part of CPR. The Australian and New Zealand Committee on Resuscitation (ANZCOR) make the following recommendations:
1. All rescuers should perform chest compressions for all persons who are unresponsive and not breathing normally.
2. Interruptions to chest compressions should be minimised.
3. Those who are trained and willing to give rescue breaths do so for all persons who are unresponsive and not breathing normally.

If you are alone, start chest compressions as soon as possible after calling for help, and aim for 30 compressions (almost two compressions per second) followed by two rescue breaths. Continue until help arrives.

DEFIBRILLATION: Apply defibrillator if available and follow voice prompts (unlikely to be available in the bush).

Shock is the body’s reaction to any kind of stressful situation. This could be triggered by a physical injury or an emotional state. Often, the exact way that stress presents is different from patient to patient, and scenario to scenario.

Immediately after injury, there may be little evidence of shock, but it may develop with time, depending on how severe the injury is and how quickly medical services can respond.

The signs and symptoms of shock include:

• Weak, rapid pulse;
• Cold, clammy skin;
• Rapid breathing;
• Faintness/dizziness;
• Nausea;
• Pale face, fingernails, lips.

St John’s Ambulance suggest the following protocol for dealing with stress:

1. Follow DRSABCD and manage injuries such as severe bleeding.
2. Reassure the patient.
3. Raise the patient’s legs (unless fractured or a snake bite) above the level of the heart, with head flat on the floor.
4. Treat any other wounds or burns, and immobilise fractures.
5. Loosen tight clothing around neck, chest and waist.
6. Maintain the patient’s body warmth with a blanket or similar. DO NOT use any source of direct heat.
7. Give small, frequent amounts of water to the conscious patient who does not have abdominal trauma and who is unlikely to require an operation in the immediate future.
8. Monitor and record breathing, pulse and skin colour at regular intervals.
9. Place the patient in the recovery position:
   • If there is difficulty breathing;
   • If patient becomes unconscious;
   • If patient is likely to vomit.

Wounds can occur in many different ways: bites from animals, injury from objects, falls, scratches, lacerations and so on. In all cases, wound care by first aiders is about primarily stopping blood loss and secondarily preventing infection. Blood loss is the most important thing to sort first, preventing infection comes with longer term management of the wound.

For a serious wound, St John’s Ambulance makes the following recommendations:

1. DRSABCD
2. Lie casualty down if the bleeding is severe.
3. Remove or cut clothing to expose the wound.
4. Apply firm direct pressure or instruct casualty to do so if possible.
5. If casualty is unable to apply pressure, apply pressure using a pad or your hands (use gloves if available).
6. Raise and rest the injured part when possible.
7. Apply a pad over the wound if not already in place and secure with bandage – ensure pad remains over the wound.
8. If bleeding continues, leave initial pad in place and apply a second pad over the first and secure with a bandage.
9. If bleeding continues replace second pad only.
10. Seek medical aid. Doctors should examine open wounds for tetanus or other serious infections.

For minor wounds (e.g. grazes), to minimise the risk of infection, minor wounds they should be cleaned. St John’s Ambulance makes the following recommendations for cleaning a minor wound:

1. Create a clean area in which to work e.g. a clean paper towel. Wash your hands and put on gloves. Wet the gauze swabs with the normal saline and clean the wound. There are three separate actions in cleaning the wound:
• With a wet gauze, wipe the furthest section of the wound from you from top to bottom once only and discard used gauze into rubbish bag.
• With the second wet gauze, clean the middle section using the same method.
• Then with the third gauze swab, wipe the portion nearest to you, again, using the same method.
2. Apply a non adherent dressing covering the whole wound. Discard gloves into rubbish bag.
3. Then with the third gauze swab, wipe the portion nearest to you, again, using the same method.

Even if the wound is cleaned well, there is still a risk of infection as the wound heals. Patients should continue to change the dressing regularly (once per day) and if it gets dirty or wet and monitor for infection. Signs and symptoms of infection include localised pain, redness, swelling, offensive discharge, and the wound not healing. In these cases, seek medical attention.

An allergy is a reaction that the body has against certain substances like pollen, gluten and peanuts. An allergy can be as mild as a slight swelling or discolouration of the skin, right through to the patient having difficulty breathing. In the case of the later, an allergy can be life threatening.

Anaphylaxis is the term used to describe a severe allergic reaction, which must always be treated as a medical emergency.

Signs and symptoms of a mild to moderate allergic reaction (may precede anaphylaxis) may include:

• Swelling of the lips, face, eyes;
• Hives or welts;
• Tingling mouth;
• Abdominal pain and vomiting.

Any one of these signs and symptoms may indicate anaphylaxis:

• Difficulty and/or noisy breathing;
• Swelling of the tongue;
• Swelling/tightness of the throat;
• Difficulty talking and/or hoarse voice;
• Wheezing and/or coughing;
• Persistent dizziness or collapse;
• Young children may be pale and floppy.

St John’s Ambulance recommend the following management for anaphylaxis:
For an unconscious patient:

1. Follow DRSABCD.
2. Immediately administer the adrenaline autoinjector, if available.

For a conscious patient:

1. Follow DRSABCD.
2. Help patient to sit or lie in a position that assists breathing.
3. If the patient is carrying an auto-injector (e.g. Epipen®, AnaPen®), it should be used at once. Let the patient administer the auto-injector themselves, or ask if they require assistance.
4. Keep the patient in a lying or sitting position. Observe and record pulse and breathing.
5. If no response after 5 minutes, further adrenaline may be given.