Call for ideas: Improvising in the field

Veneficus

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Why does it matter "how often" an improvisation is used?

Because charging students for a class, who do not know any better, to "teach" them something that isn't really what happens or what they can expect seems a bit dishonest to me.
 

MrJones

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Because charging students for a class, who do not know any better, to "teach" them something that isn't really what happens or what they can expect seems a bit dishonest to me.

Interesting. So, in your back country experience what really happens when a group is deep in the back country and one of them is seriously injured?
 

Veneficus

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Interesting. So, in your back country experience what really happens when a group is deep in the back country and one of them is seriously injured?

No, I think that based on my experience and speaking with people who are more active in providing medical aid in austere conditions that a lot of what is taught is generally BS.

Some of the advocates claim the purpose of teaching these interventions is to teach critical thinking skills. Which I definately do not buy into.

Making somebody reherse a skill is very different from teaching the basic principles required to understand and implement an intervention which will achieve the goal with some measure of success.

There is also the question of the practicality of some of the " core interventions" as they are taught.

I can teach you how to measure hematocrit using a ruler, a glass tube, and a needle mounted to a piece of wood. Not only because I was taught how to do it, but because I understand the principle behind it. (and I do'n even really need the ruler because I know the measurements of multiple paper currencies)

But the question becomes "what will this information add or change?" How much is going through this procedure going to be worth in terms of outcome?

Perhaps if you are in a a remote medical facility with broken equipment, but really nowhere else.

But it is definately not on the list of "things you should know before you travel."
 

MrJones

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No, I think that based on my experience and speaking with people who are more active in providing medical aid in austere conditions that a lot of what is taught is generally BS.

Some of the advocates claim the purpose of teaching these interventions is to teach critical thinking skills. Which I definately do not buy into.

Making somebody reherse a skill is very different from teaching the basic principles required to understand and implement an intervention which will achieve the goal with some measure of success.

There is also the question of the practicality of some of the " core interventions" as they are taught.

I can teach you how to measure hematocrit using a ruler, a glass tube, and a needle mounted to a piece of wood. Not only because I was taught how to do it, but because I understand the principle behind it. (and I do'n even really need the ruler because I know the measurements of multiple paper currencies)

But the question becomes "what will this information add or change?" How much is going through this procedure going to be worth in terms of outcome?

Perhaps if you are in a a remote medical facility with broken equipment, but really nowhere else.

But it is definately not on the list of "things you should know before you travel."

Again, interesting, but it didn't really answer the question. You stated that teaching "something that isn't really what happens...seems a bit dishonest...." and I asked you what really happens when a group is deep in the back country and one of them is seriously injured.
 

Veneficus

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Again, interesting, but it didn't really answer the question. You stated that teaching "something that isn't really what happens...seems a bit dishonest...." and I asked you what really happens when a group is deep in the back country and one of them is seriously injured.

That depends on where you are, what you have, and what you need to do.

It is quite a large topic, but I would propose the first part of the decision is "can you do anything for this person at all?"

You are then going to have to determine if you can be rescued, have to travel some distsance to make it possible, or self evacuate.

There are considerations of the capabilities of the rescuers and a bit of logistics with the materials available.

As a brief example, making a rope litter to carry somebody out may use up much needed rope, may not be feasible due to terrain, or you may not even have rope because it wasn't on your list of things to carry hiking through a desert or flatland.

Another good one, are you going to improvise a traction splint? If you have to self evacuate, how are you going to transport this person? Is the terrain conducive to carrying somebody in traction?

The list is endless, but to my knowledge, nobody ever died from not having a traction splint.

The femur is also not easily or effectively stabilized by many splinting techniques, so you might have an intervention that is doing nothing, or worse, making it harder to evacuate.

But I seriously doubt anyone is going to start a story with: "so there I was...When all of a sudden...When I remembered how to... that I learned in wilderness emt class... and the day was saved because I made a traction splint out of piece of fishing line and a stick."
 

Brandon O

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Wrappers from various supplies can be reused on scene if containers are needed in a pinch. For example, I used a couple of wrappers slipped over a pair of bloody trauma shears and taped in place to keep the blood from being smeared around until we could clean the shears. I've also used wrappers to contain smaller bits of rubbish to minimize the amount of cleanup on scene when a waste basket isn't readily available.

Gloves are good for this. Don, grab items, peel off glove around rubbish -- self-contained rubberized junk ball.
 

AK_SAR

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Jelly Roll splint for leg

Take two ensolite pads, put under leg, adjust overlap to fit leg length. Best to put something under knee so it is flexed slightly. Roll in from each side, secure with webbing, cravats or whatever. It works kind of like a ski patrol quickie splint. Just as good, or even better in some situations. It effectively immobilized the leg, pads, insulates, is comfortable for the patient and easy to adjust for swelling. I learned it in a WFR class.

And yes, I have seen it used in the field. A young woman blew her knee on a back pack in a remote area in the Talkeetna Mtns. The rest of the group splinted her up and took her pack. She was able to slowly hobble out to a lake where they were already planning to be met by float plane. A nice self rescue, in a situation where it would have otherwise required a helicopter to get her out.

That's why I always carry an old school ensolite pad when I'm out in the backcountry, rather than thermarest or other types. They are extremely versatile. You can do lots of great improv with them.
 
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MrJones

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That depends on where you are, what you have, and what you need to do.

It is quite a large topic, but I would propose the first part of the decision is "can you do anything for this person at all?"

You are then going to have to determine if you can be rescued, have to travel some distsance to make it possible, or self evacuate.

There are considerations of the capabilities of the rescuers and a bit of logistics with the materials available.

Exactly. But then you go off the rails....

As a brief example, making a rope litter to carry somebody out may use up much needed rope, may not be feasible due to terrain, or you may not even have rope because it wasn't on your list of things to carry hiking through a desert or flatland. Don't have enough rope? There are other ways to improvise a litter. Not feasible due to terrain? Shelter in place and send for help or, if there's not enough people available to do that, shelter in place and take appropriate steps to make it as easy as possible for the search effort to find you

Another good one, are you going to improvise a traction splint? If you have to self evacuate, how are you going to transport this person? Is the terrain conducive to carrying somebody in traction? The issue for self-evacuation isn't the traction splint (they're actually quite easy to build in such as way as to make evacuation possible), but the number of personnel available to bear the litter. As is true for any back-country injury that requires a litter evacuation.

The list is endless, but to my knowledge, nobody ever died from not having a traction splint. Actually, prior to the advent of the Thomas Splint in the early 1900s the mortality rate from femur fractures was quite high.

The femur is also not easily or effectively stabilized by many splinting techniques, so you might have an intervention that is doing nothing, or worse, making it harder to evacuate.You're correct, it's not easy; that's why learning to do it properly and effectively is so important. And remember - self evacuation is not always the best course of action.

But I seriously doubt anyone is going to start a story with: "so there I was...When all of a sudden...When I remembered how to... that I learned in wilderness emt class... and the day was saved because I made a traction splint out of piece of fishing line and a stick." I also doubt it, because no wilderness medical class that I'm aware of teaches using fishing line for a traction splint
 
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medictinysc

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Improvising

In one of your hands on portions of the class, ask a couple of the members of the class to imbolize a patient with only these items

  1. 2 1000cc bags of NACL
  2. 1 LSB
  3. 2 towels
  4. 1 short roll of duct tape
  5. 3 triangular bandages

Stand back and watch them scratch thier heads.... make it more interesting offer a bonus if they can do it NREMT style (and pass)
 

Brandon O

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In one of your hands on portions of the class, ask a couple of the members of the class to imbolize a patient with only these items

  1. 2 1000cc bags of NACL
  2. 1 LSB
  3. 2 towels
  4. 1 short roll of duct tape
  5. 3 triangular bandages

Stand back and watch them scratch thier heads.... make it more interesting offer a bonus if they can do it NREMT style (and pass)

Of course, ask a group of firefighter to do it, and you'll just end up with a patient cocooned to the board with the entire roll of tape :p
 

medictinysc

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Of course, ask a group of firefighter to do it, and you'll just end up with a patient cocooned to the board with the entire roll of tape :p

your right they might even forget the board HA HA just cocooned in tape LOL
 

Veneficus

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In one of your hands on portions of the class, ask a couple of the members of the class to imbolize a patient with only these items

  1. 2 1000cc bags of NACL
  2. 1 LSB
  3. 2 towels
  4. 1 short roll of duct tape
  5. 3 triangular bandages

Stand back and watch them scratch thier heads.... make it more interesting offer a bonus if they can do it NREMT style (and pass)

So after you immobilize this patient for spinal precautions, how do you deal with the inflammatory response that causes secondary damage?

Better still, how do you move them?
 
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AK_SAR

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You are then going to have to determine if you can be rescued, have to travel some distsance to make it possible, or self evacuate.

There are considerations of the capabilities of the rescuers and a bit of logistics with the materials available.
You have a marvelous grasp of the obvious.
 

Veneficus

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medictinysc

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I work for a medical director who has very clear spinal precautions. It's like tic tacs everyone gets em. I don't have a choice. I understand the train of thought that says LSB does more harm than good. But if I wish to continue work. I will LSB all trauma with mechanism regardless.
 

Veneficus

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I work for a medical director who has very clear spinal precautions. It's like tic tacs everyone gets em. I don't have a choice. I understand the train of thought that says LSB does more harm than good. But if I wish to continue work. I will LSB all trauma with mechanism regardless.

I am not suggesting you have a choice or that you shouldn't follow your protocols, but in the context of wilderness medicine, using what you described:

2 1000cc bags of NACL
1 LSB
2 towels
1 short roll of duct tape
3 triangular bandages

How do you move them or think this is helping?

You are not walking around the woods with a LSB surely?
 

mycrofft

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and how often do people really used improvised liters, make shift traction splints etc.

Ask around.

Preferably ask people who didn't sell you that class but really do it.

I spent weeks making a powerpoint about improvising litters (as well as other litter lore) and the truth is, in a disaster or a hurry or both, carrying someone is faster and more certain. Improvs can go bad. They are for long distances.
 

Veneficus

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I spent weeks making a powerpoint about improvising litters (as well as other litter lore) and the truth is, in a disaster or a hurry or both, carrying someone is faster and more certain. Improvs can go bad. They are for long distances.

That is what I was thinking.

About 5 years ago I actually saw an account of a group of 4 climbers from Japan (I forget where in the world they were climbing) where one broke her leg and they took turns carrying her back to civilization over a period of 2 days without making camp. They claimed to have no medical training and were worried the injury would get worse over time.

I thought that was an awesome feat of discipline and comraderie.
 

mycrofft

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As for how often it has been used, I even prefer "Show me". And before you try to show 'em you had better have done it. I've embarrassed myself a few times doing something I'd read about but when it came time to do it, didn't work. I've also caught folks who are spouting.

Again and again and again...truth and fact before rumors and dogma. Experience before armchairs.

NOTE: a quarter of my litter lecture was about how NOT to do stuff, such as lifting improv rolled fabric litters with the longerons (poles) over the fabric or rope litters without longerons or too few bearers without hand protection, etc.
 
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mycrofft

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And the nasal cannula for eyewash deal...seen it fail more times than not, takes time to set up, not enough liters per minute for serious eye exposure as initial treatment, and if there is toxic exposure to the face and head it doesn't help wash that off like sluicing with bottles of clean solution does. Sure looks great though.
 
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