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