Heat Illness strikes in Laos

On being alone

Bolivia Part 1

NO FIRST AID KIT - REALLY! !

Yesterday I was sent a link to a You Tube video that has me a little bit disturbed http://www.youtube.com/watch?v=VVonW8fBzPY. Normally I would just watch, enjoy or not and move on. In this case the video has been put out there by someone who I really respect as a bushman, hunter, survivalist and is one of the big names within the community. If there were only a few views on his site then I would create a fuss, but that is not the case. Lots of people are going to see this and because of who it is, will almost take his views as gospel, when in fact there is a lot within the content to dispute and at the very least discuss in open forum.

The point being made in the video is that a first aid kit is not required as part of your survival/bushcraft kit and that everything that you need can be improvised from the equipment within the pack. The thrust of the video appears on the face of it to have some valid points to those that have not much more than rudimentary first aid or medical training. The point is that you can do everything said in the video but, and here is the crux, should you? One has to be an expert in wilderness first aid or medicine with a lot of experience to effectively  put into practice what is being postulated, in such a way that does not increase mortality or morbidity.

Lets put it into context. Survivors are very often injured and people who travel, at least regularly in the wilderness are most likely to suffer from the effects of the environment or trauma or both in the first instance. Although people do have medical emergencies in wilderness areas it is less common. Primary care issues such as rashes, coughs, colds, gastro-intestinal illness etc, etc, are rarely life threatening although I accept that they may become so over time. The immediacy of traumatic and environmental emergencies means that interventions need to be quick, effective and maintainable. Wilderness environments pose particular problems in that equipment is often lacking, the evacuation times are longer, and the climate is a major factor in both the rescue and the victims physiology.

I don't want to critique every aspect of this video, however I will address the major issue that I have a problem with and the one which I think shows that the creator of the video is more an enthusiastic amateur with not much more than other peoples learned knowledge and not a large amount of practical first aid experience, which is a real shame because the guy is normally awesome.

Bleeding is one of those things that has turned the pre-hospital world on its head over the last 10 to 15 years. Indeed the usual ABCDE protocol for first aid treatments is now changing rapidly to C-ABCDE or even MARCH in some trauma assessment methodologies. Bleeding has three natures, capillary bleeding, venous bleeding and arterial bleeding. Treatment for bleeding is dependent on whether or not it is compressible or non-compressible. Indeed that is a really good classification. Compressible bleeding is found on limbs while non-compressible bleeding refers to bleeding within the torso or head where the first aider has no access.

Capillary bleeding is not usually life threatening except rarely, perhaps, in patients who are haemophiliacs. Venous bleeding can be serious but is low pressure in its nature and therefore if compressible and assuming that the victim is not suffering from haemophilia relatively easy to treat also. Arterial bleeding on the other hand can be rapidly life threatening to the point where you only have seconds to control the situation.

The approach to severe or catastrophic arterial bleeding is holistic and one needs a tool-box of techniques in order to stand any chance of effectively treating this at all in the presence of high pressure blood loss. The video suggests a very linear approach starting with direct pressure and suggests that if it doesn't work then move onto elevation and so on. In reality all tools in the haemorrhage control tool-box, including tourniquets, pressure points, elevation, packing, compression dressings, windlass control, haemostatic agents, and traction all feature, some in a linear fashion some simultaneously, for example direct pressure, haemostatics and elevation should all be used at the same time.

Now I could write a book on the control of bleeding, I really could. I have dealt with bleeding caused by penetrating trauma and blunt trauma, I have done it in hospital, in an ambulance, in a war zone, in the wilderness and many other places and one thing I can say with absolute certainty and that is that severe bleeding is anything but easy to treat. In fact it can be a right SOB and one has to work every trick in the book in order to achieve a good outcome.
First aid books often appear to make it sound as though its is easy to deliver first aid and the video seems to give that view credibility and in my experience it is rarely that way. Sure some things like airway management can be anything from the simple to the desperate, and that is the reality of first aid, it can be real easy, but it can also be real hard. To suggest that you can effectively carry out first aid skills using materials that are not designed for the job is leading people into a false sense of security. It can be done, I could do it and do it reasonably well, but the average person without specialist training would be hard pushed, and thats just dealing with the bleeding problem, it does not address all the other associated problems of being in a wild place.

The real problem is that putting a bandage on a severe bleed is probably not going to work very well. Ideally one must have specialised bandages such as those used by the military or their civilian equivalents such as Woundstop distributed in the UK and Europe by MDD http://www.mdd-europe.com/Produkt/firstcare-woundstop-pro-45m/ . The reason these bandages are so good is because they have been designed specifically to manage these injuries, in fact they are so specialised that in order to maximise their potential one must have appropriate training and the same is true with tourniquets and windlass application and haemostatics. All the items highlighted regarding bleeding in the video are simply not fit for purpose, with the sole exception of perhaps packing a wound cavity.

Wilderness first aid is not urban first aid and while I accept that in a true survival situation you would make do with what you have or can improvise, this should not be considered normal practice for vacation or leisure trips into the wild places of the world. So for those that consider this video in the same light as the other videos then I urge you to think again. Get specialist training for the wilderness and learn exactly how to use the equipment.

The uploader also talks about pain and using over the counter medications which is fine for mild perhaps even moderate pain, but pain is going to be a major factor in what you can and cannot do with a patient. It takes skill, patience and knowledge for a patient to become compliant. Trauma injuries by their nature are painful, often extremely so and even the safe limits of the over the counter medications is not going to make a real difference.

There is some good stuff in the video and quite practical however there is in my mind a disconnect between minor first aid conditions that can be treated easily with rudimentary equipment but to venture out routinely without the key items to deal with a major trauma injury is in my view simply folly. I am not suggesting that one needs to pack a full scale EMT or Paramedic pack, but just a bit of thought and some simple easily available items your ability to do so much more is enhanced greatly and the benefit to a patient may mean the difference between survival or not.

NO FIRST AID KIT - REALLY!!

I was sent a link on Twitter by a friend of mine entitled No First Aid Kit. The You Tube info clip was made by Dave Canterbury of the Pathfinder School in the US, a man who I have a very high regard for. Now I am hoping that this video is a survival video for one of those situations when you really do have an emergency and absolutely no equipment with which to treat any injuries and in many ways that would be fine. DC makes some interesting points that are valid but he also at the same times says some things which make me cringe and scream NO, NO. NO.

Medical emergencies in the wilderness are much more difficult to treat than injuries sustained in the city or urban areas in first world countries. They are characterised by lack of available equipment, long evacuation times, environmental factors, difficult access etc etc. Injuries sustained can be very much harder to treat and the approach taken by this video is far too simplistic and it is not based on very much practical experience.

I take particular issue with DC's section on bleeding and bandaging. Bleeding accounts for many deaths both internally and externally, with every drop of blood we lose the oxygen carrying capacity of the haemoglobin is reduced. Bleeding is either compressible or non-compressible in real terms and either severe or life threatening. The advice given in the video is to take a linear approach to the problem citing direct pressure and if that does not work using elevation and so on. This is just plain wrong and will, in the case of a severe life threatening bleed lead to the death of the victim. Bleeding control should be considered much more holistically and a tool-box approach taken to each situation. Compressible bleeding by its very nature occurs on arms and legs only. You cannot compress bleeding within the torso or head, therefore in victims in which bleeding can be compressed one needs to incorporate bleeding control techniques appropriate to the type and severity of the bleeding.

The environment takes its toll on the health of people, however in the wilderness situation it is much more devastating. Medical experience obtained by the worlds military medical services has shown that there is a Lethal Triad of Death at cellular level and advances in the treatment of war victims in hospital aims to treat not only the visible and obvious injuries using the well established C, A, B, C, D, E formula, but also contributing factors such as the effect of cold on clotting for example. Other factors are the acidosis caused by reduced oxygen supply to cells, and the ability of the blood to coagulate.

Severe injury reduces the threshold for hypothermia from the established 35 degrees C to 36 degree C. Hypothermia comes on earlier in the presence if severe injury. Hypothermia interferes with cellular metabolic oxygenation and blood coagulation. Delays in stopping blood loss or poor bleeding control skills also lead to reduced cellular oxygenation and increased acidity of the the internal environment, earlier onset of hypothermia and the consequent effect on coagulation. Stopping bleeding therefore is a multi faceted approach and one needs at the very least some good equipment or a very good training course and ideally both.

Now I am not saying that this cannot be done without equipment, but what I am saying is that if you do not have this equipment, you need to have the knowledge and skill set to do the job properly and this is poorly addressed or conveyed in the video. It is advice that people will take up for no other reason other than the fact that it is Dave Canterbury saying it. I truly believe that Dave Canterbury does a valuable service to his followers, but in this respect the consequences of his advice are potentially dangerous and misguided individuals, faced with a serious casualty will find that putting the bleeding element in particular into practice will be much more difficult and may well lead to a very poor outcome.

Some readers of this blog will ask what my credentials are. Up to now I have never put my head above the parapet but I need to justify this blog and give it some professional weight. I was a Combat Medic for 22 years and for a period of that time I was the Chief Medical Instructor to UK Special Forces and post military I co-founded Exmed UK one of the worlds leading remote area medical life support companies. I continue to provide medical support while pursuing a life of adventure, survival and safety so in that respect I have learned, seen and experienced a lot of wilderness type injuries as well as the usual combat related trauma.

US GUN CONTROL

I have just been reading about US gun control and the arguments surrounding the issues on both sides of the debate and it seems to me that the pro-gun control lobby is pretty good at shooting itself in the foot by coming out with some quite ridiculous comments. Just for the record and so there is no doubt where my feelings lay, I am in support of some gun control measures as a casual observer sitting here in the UK, but not completely against gun ownership. In my view the majority of people who own legitimate weapons are doing so for sporting and recreational purposes and pose a minimal threat to others.
It is reasonable to state the statistic that there is less violence in areas that allow guns to be carried than in states where it is banned. Any reasonable person who is not clouded by the emotion of the subject can take that statistic as evidence and use it to support the case. However, statements by certain sections of the pro-gun control sector just seem to beggar belief and surely cannot be taken with any seriousness. Take this example from Senator Dianne Feinstein (D- California), who came out with this extraordinary statement at a Senate Judiciary Committee hearing on gun-control ''We have federal regulations and state laws that prohibit the hunting of ducks with more than three rounds. And yet it's legal to hunt humans with 15-round, 30-round and even 150-round magazines.'' Her supporters must have ground their teeth in anguish at this statement.
But she is not the only one, Danny Glover of Lethal Weapon fame (does anyone else see the irony here) told students at a Texas University that the rights created by the Second Amendment was for no reason other than to enslave black people and kill native Americans!
There are really powerful arguments to support gun control and one of the best website for this is http://theprogressivecynic.com/debunking-right-wing-talking-points/refuting-gun-enthusiasts-anti-gun-control-arguments/
But the message that this website should send out is diluted by heavy duty politicians, celebrities and others through their emotional and rash statements. If they lose the battle they will only have themselves to blame.

A SHORT LONG WALK

I tend to wake up most days in spring and summer with the sunrise accompanied by the dawn chorus which is wonderful because I have a few hours just to do stuff I sometimes find difficulty with during the distractions of the working day and today was no exception. I am I admit quite excited as tomorrow I fly to Copenhagen and then off to an as yet unnamed place to begin a new episode of a new survival reality show with my good friends Myke and Ruth. I needed to get some things from our local 7/11 or for UK readers the Co-Op and so took a walk from the new house in the direction of said shop. The route follows a main road or there is the option of cutting across a meadow known locally as the Lugg Flats so for me the choice was really no choice at all and so I hopped over the fence following the course of the Lugg River upstream. Now this place is not really a wild place as it is so close to the ancient town of Hereford and you never quite get away from the roaring traffic that thunders along the road bordering this space, but, there is a sense of jumping into nature and at this time of the year with the early spring bluebells dying off and being replaced by the late spring meadow plants. To my discredit I have never wandered on this place before even though I have known about it for as long as I have lived in this part of the world. It has always been a place that I believed the teenagers ran rampant and where they came to indulge in under age boozing and getting up to mischief and maybe they do sometimes, but not in the early hours of this morning.

Its one of those experiences that you wish you could capture and the few pictures I took on my pathetic mobile phone didn't do the place any justice. I would have loved a professional outdoor photographer to capture the vista and those little things that you see that thrills you whenever you walk in nature, but even then it would not have been enough. As soon as you step onto the meadow the colours are in your face, bright yellow buttercups, small white umbillifers as yet to be identified (but not cow parsley), and purple clover. But a photographer wouldn't have been enough because there is so much other sensory stuff going on, the perfume and the sounds, traffic aside, that have to be processed and go toward creating the whole experience. And this is what being in nature does, if you allow it to it will draw you in, if you pass through wild places and slow down and force yourself to not only see but to open up all your senses then you start to understand the wonder of nature and realise that anything we humans create in this world in nothing to what nature can achieve, and here is the thing..... you do not need to know what the plants are called or the birds or indeed anything.... you just have to open up and experience and surely you will be moved.

Lugg Flats ancient Norman pasture nature reserve, Hereford UK

Purple flower Comfrey a survival medicine reputedly a
medicine good for healing bone fractures which has now
been confirmed by modern science. 

Of course if you do know something about nature then pleasures of discovery abound in places like this. As I entered this space I read the board describing this reserve and its history and what can be found there. It is centuries old and goes back to the Norman era when Hereford Cathedral was being built (now famous for housing what is reputably one of the oldest maps in the world, the Mappa Mundi). With this little bit of information my exploration of this place took a whole new meaning and I was looking at how life would have been sustained here and at that moment the meadow and the flats and all the resources within it opened up and I could clearly see how one would have been able to not only survive, but flourish on this lush pasture land, with its abundance of resources that has apparently changed very little since then.

The short walk I took to the shop, should have only taken no more than 45 minutes round trip, 2 hours later I arrived home!