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Wilderness Accident Handling Steps

Accidents cause confusion. People panic, or don't think logically. Bandaging a wound without first checking to see if the victim is breathing might lead to a very nicely bandaged dead person. Following a well-defined set of steps ensures that things are done in the right order, and that nothing is missed. Knowing how to perform these steps requires instruction, and this page is not meant as instruction. After the instruction, remembering these steps amid all the panic and confusion requires practice. However, a nice mnemonic (memory jogger) never hurt!

Therefore, here is my home-made mnemonic for remembering the steps in accident handling. Just remember that "accident handling is like a 12 step AA program". There are 12 alphabetical steps, starting with "AA".

12 Step Program for Accident Handling

AA Approach & Assess: The objective of step AA is to first deal with those things that could kill many people at once. Remember to assess the accident scene and determine whether it is safe to approach. Consider the risk to rescuers and victim of attempting first aid at the scene. If the scene presents high objective hazards, weigh the risk of death to multiple persons if you attempt a lengthy first aid procedure at the scene vs. the risk of further injury to the victim if you move him to a safer location before administering first aid. If the mechanism of injury suggests a neck injury, remember to assign someone to lie face down on the ground and use their arms to stabilize the neck immediately.
A Airway: The objective of steps A,B,C,D are to deal with those things that could kill the victim within minutes.
Remember to open/unblock the airway of an unconscious or choking victim.
B Breathing: Remember to check that an unconscious victim is breathing, and if not, perform artificial respiration (while checking for circulation). If the victim is having difficulty breathing (ie a life-threatening chest injury) stabilize the injury.
C Circulation: Remember to check that an unconscious victim has a pulse (circulation), and if not, perform CPR. Despite what you see on TV, it is unlikely that the victim's heart will start beating again within a few minutes of giving CPR. You may be at it for a long time, until help arrives or until exhaustion or environmental conditions threaten the life of the rescuer(s) (after 30 minutes resuscitation is extremely unlikely).
D Deadly bleeding: Remember to do a deadly bleeding check & rapid body survey in the position found. This means putting your hands inside the Gore-Tex and checking all places where blood would be pooling (ie under the victim). If bleeding is discovered which is causing blood to pool, expose the wound and apply firm pressure over the wound to control the bleeding.
E Early prevention of shock: The objective of steps E,F,G are to deal with those things that could kill the victim within hours.
Early prevention of shock means protecting the victim from the elements and alleviating pain. Without moving the patient, remember to cover him to keep him warm, protect him from wind/rain/snow, and apply traction, stabilization, or a cold water bottle for quick relief of obvious pain. Remember that once traction is applied, it cannot be released.
F Full head-to-toe examination: Remember to perform a full head-to-toe examination of the patient to determine the full extent of his injuries. Expose and examine each injury (pelvic fractures are an exception; do not expose a pelvic fracture). Remember to keep eye contact and watch for flinching, and remember to check and record circulation and sensation distal to each injury, and to remove all jewelry.
G onGoing prevention of shock: After the full extent of the injuries is known, the extent to which victim can be moved is known, and further (onGoing) steps can be taken to prevent shock. Remember to insulate the victim from the ground, elevate uninjured legs, construct a shelter against wind/rain/snow, and provide more warmth and pain relief. Remember to plan ahead so that the victim only needs to be moved once to achieve all these things.
H History, vitals, records: The objective of steps H-K are to deal with those things that are not life-threatening, but could become a threat if not monitored.
Remember to record the victim's history (remember the acronym "AMPLE TLC"), record a baseline set of vitals, and record the events leading up to the incident (ie "broke his ankle" is not as informative as "was feeling increasingly dizzy and disoriented over the preceding 6 hours of climbing under the blazing sun, had stumbled several times in the minutes preceding the accident, didn't respond when others asked if he was OK, then finally collapsed, tumbled, and broke his ankle"). This additional information would probably affect your plan!
I Investigate options & make a plan: It's not time to go for help yet. First remember to investigate your options and make your rescue plan. Are you going to back-carry the victim out? Is the terrain technical? Can you transport the victim to a medical facility yourself (ie can he be seatbelted) or will you need to be met at the trailhead by an ambulance? Will you need a physician flown in, or a spine board, or a stretcher and oxygen? Do you need a cervical collar built from a rolled-up jacket? Do you need to build a splint from tree branches or ski poles? Does the injury indicate altitude restrictions? How many rescuers do you have? How many do you need? Do you have enough leaders to ensure the safety of the group? Can the victim be given anything by mouth? Do you have enough daylight left to begin the evacuation now, or should you find a safe place to spend the night first?
Do you know your location?
Ask these questions, investigate your options, and make your plan.
J Jump to it: Having made your primary and backup plan, jump to it. Make the splints, make the rope-stretcher, triangulate your position, clear the landing area, build the anchors, set up the belay system, build a camp for the night... whatever your plan dictates. If you decide to send out for help, this is the point at which you send for it; only after you have all the information needed to decide who is going to go for help, how long will it take them to reach help, what equipment needs to be brought back, what skills need to be brought back, how much muscle-power needs to be brought, how fast you need it, where you are now, where you will meet the rescue team, whether the evacuation will be on foot or by air, what level of medical facility you need to evacuate to, what's your backup if something goes wrong, etc.
K Keep on it: Remember to keep monitoring the injury (bleeding, immobilization, traction, etc), the condition of the victim (vital signs, LOC, CNS condition, etc), the condition of the rescuers, and the condition of the remainder of the group, over time. Take appropriate action to prevent further injury or injury aggravation.

Remember this page is just a mnemonic, not an instruction manual.