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First Aid – generic tools

A practical guide to useful first aid techniques

Take some time to learn first aid and CPR. It saves lives, and it works. Bobby Sherman

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.

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

  • DRABCD
  • Shock
  • Wound cleaning
  • Anaphylactic shock

DRSABCD The 7 steps to manage any first aid scenario

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 First aid for shock

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.

Wound care First aid for wounds

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.

Allergy and Anaphylaxis First aid for Allergy and Anaphylaxis

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.

Navigation

Navigating in the bush

Navigation is the art of getting from one place to another. It’s about making a plan around how to get from place A to place B, and then actually getting from A to B.

While navigation may seem like a big and scary topic, everyone can navigate! Think about it: every morning you get up, navigate from the bedroom to the bathroom and then out the front door. Navigating in the bush is the same, it’s just a little more complex. Learning to navigate around your house just means learning a few routes and remembering them. But in the bush, navigation involves working out and following a new route each time, and the landmarks are unfamiliar. There’s also more pressure to get it right on a bushwalk because getting lost in the bush is a bigger deal than getting lost in your hallway!

Navigation is a skill acquired by experience, study, and observation. It takes a long time to master. When starting out, it’s easy to be wrong. Unfortunately, the only way to get better is to persevere and keep on going! Navigation is a fun skill to learn, and many bushwalkers find that learning to navigate gives them a whole new appreciation of the landscape.

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Walk Grading System

A guide to understand how walks are graded

Walk grading is a bit of a contentious issue among the bushwalking community given the high level of subjectivity involved. We have adopted to use the guidelines of our peak Bushwalking NSW body. These are based on the Australian Standard for walking track classification.

A grade is a helpful bit of information but needs to be considered in the context of other bits of information such as the walk description and potential hazards.

Here is a breakdown of the grades.

Grade 1 Well-marked and even tracks or footpaths, some steps.

Grade 1 – Opportunity for a large number of walkers, including those with reduced walking ability to walk on well marked and even tracks. Tracks are man-made and may have a few steps. Should not be steep. Suitable for beginners. Distance should not exceed about 10km.

Grade 2 Mostly on well-marked and not very steep tracks

Grade 2 – Mostly on tracks of low gradient. Opportunity to walk easily in natural environments on well-marked tracks. Tracks should not be steep. Distance should not exceed about 15km.

Grade 3 Some rough and hilly sections, suitable for beginners

Grade 3 – A walk with some hilly sections and/or rougher terrain. Opportunity to walk on defined and distinct tracks with some steep sections requiring a moderate level of fitness. Suitable for fit beginners. Distance should not exceed about 20 km.

Grade 4 Steep and rough tracks, may be some off-track, need some experience.

Grade 4 – Steeper, rougher terrain and may have off-track sections (no more than one-quarter of the walk) or a longer distance track walk. Opportunity to explore and discover relatively undisturbed natural environments mostly along defined and distinct tracks. Tracks can be steep. There may be short sections of rock scrambling involved. Leaders should have map reading abilities and/or ability to use a compass. Distance depending on circumstances. Not suitable for most beginners.

Grade 5 Mostly off-track, some rock scrambles, for experienced bushwalkers

Grade 5 – Off-track or difficult terrain. Opportunity for walkers with advanced outdoor knowledge and skills to find their own way along often in distinct tracks or off track in remote locations. May include steep sections of unmodified surfaces. There may be rock scrambling, creek walking and crossing involved. Distance should not exceed 30 km, but may be short and difficult. Not suitable for beginners.

Grade 6 Off track and hard going, for very experienced bushwalkers

Grade 6 – Strenuous off-track walk or very long distance. Opportunity for highly experienced walkers to explore remote and challenging natural areas without reliance on managed tracks. Terrain may be steep, uneven and no track. There may be rock scrambling, creek walking and crossing involved. Distance covered is unlimited, but may be short and difficult. Only for experienced walkers and not suitable for beginners.

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