Wilderness Advanced First Aid Course

It's been nearly two weeks since I've last posted, mainly because it's been pretty hectic here. I'm going to split the time since my last post, the first talking about my time in Pucón and the second about the rest of the time. So here goes.

Pucón, with the volcano smoking away in the background.

From Tuesday 25th to Saturday 29th I was based in Pucón in the south of Chile, I decided to take an Advanced Wilderness First Aid course to better prepare me for various kayaking trips I'm planning here and to be able to work in Pucón over the summer. The course, WAFA for short, is a 40hr course designed for outdoor instructors to give them an advanced level of first aid training to be able to operate in remote areas safely. The main difference between wilderness and urban first aid is that in urban first aid you are likely to be supported by paramedics or clinical practitioners within an hour or two, whereas in the wilderness environment first-aiders may have to wait anywhere from hours to days till they get help and may have to evacuate patients themselves. For this reason, the course is designed to give participants more training in detailed patient assessment, prolonged patient care and evacuation. The reality in Chile is that in some places, help is quite far away and calling mountain rescue or a helicopter isn't free, in fact the minimum amount a patient will pay for helicopter support is over £1,500 so the guides out here often have to evacuate casualties themselves.

The idea is to use what you have and improvise

I travelled down to Pucón on Tuesday evening and we started at 9am on Wednesday, I was pleased to find out that all 18 of the participants were raft guides because this meant the course would be very specific to the whitewater environment. The majority of the first two days was spent in the classroom studying the theoretical side of physiology and medical emergencies as well as looking at in-depth primary and secondary surveys. We spent 9am-9pm on day 1 and 9am-5pm on day 2 on this stuff, and although boring, it's pretty vital stuff. Luckily I'd done first aid courses before and was familiar with most of the content so it wasn't too hard. At around 5pm on day 2 we started to look at some practical components of the course. We looked at immobilising spinal injuries, fractures and reducing dislocations. Something that I found very useful about the instructor's approach to the course was that all the material we used to immobilise these injuries was equipment we carry on the river. There's no point me learning to use a complicated leg splint when it won't fit in the back of my kayak, instead we used paddles, slings, rope and rollmats to complete the tasks. We also learnt how to build improvised stretchers which is something that would come in handy for practical scenarios across the next few days.

On day 3 we spent the morning looking at altitude sickness, shock and evacuation plans in the classroom, followed by a practical session on CPR and the use of airway adjuncts and defibrillators, safe to say that the CPR mannequins were the most stylish I've seen. After lunch we worked for a few hours on spinal cases. This was a complex topic because we had to learn how to immobilise patients, safely roll and lift patients, secure them to improvised backboards and evaluating the spinal column to rule out spinal injuries before evacuation. We then spent until 8pm practising with various scenarios, basically one of the participants being given a role and a medical history and the rest of us turning up to deal with what we found, we were confronted with around 20 different cases of medical cases, trauma and environmental cases. I really enjoyed the hands on stuff and found it kind of like problem-solving to figure out what was wrong with the patient in some cases, treat the issue and form an evacuation plan. Some of these scenarios also involved building the stretchers to evacuate the patient and moving the patients through tricky terrain.

Teamwork was imperative

Not sure how many babies I'll take kayaking, but good practice all the same

Using defibs and airway adjuncts

The coolest mannequins in Chile

Night rescue was challenging

At 8pm we were told to go and grab dinner and meet back at the centre at 9pm, mysterious... At 9pm we were told that the 18 of us were going to take part in a scenario, myself leading one team of 9 and another guy leading the other half. We spent half an hour gathering and organising our equipment and suddenly received a call on the emergency phone from a distressed and incoherent guy telling us he and a friend needed help on the beach, we couldn't get any more information from him. We headed off the beach and split up, my team went right and the other team left. The unfortunate thing was that the beach is very long, being pitch black we had to thoroughly search the beach and the forest that lined it. After 30mins of searching my team found the two casualties, a kilometre from the entry point. Both casualties we on the waters edge and soaked through, supposedly kayakers that had entered into difficulties. As team leader I quickly called for the other team's support and we evaluated the patients. One patient had an open head wound, penetration wound to the chest, no feeling in his legs (suggesting spinal injuries) and severe hypothermia, the other was also very cold and wet, had an open fracture to the leg and was in shock. The instructors were the scenario 'gods' and provided the information on things like pulse, temperature etc when we asked for it, I must say the situation was very realistic and since it was dark it was made even more realistic. We stabilised both patients with our improvised kayaking/rafting equipment and began the evacuation. Unfortunately for us it wasn't going to be that easy, both patients vomited multiple times (tricky to deal with when they're strapped on their backs to spine boards) and stopped breathing more times than I can count. In total, both teams did around 35mins of CPR in the freezing cold. We finally managed to reach the evacuation point and do a patient handover and debrief, at 12pm over 3hrs later... It was great to be able to practise a serious situation and we were told that the next day would hold even more scenarios, this time for our evaluations.

The final day was almost all practical based, it was also evaluation day and we had to do our practical and written exams. My practical scenario was hard to believe when I reached the scene. The instructors had put a victim underneath a bus, face down and screaming in pain. There was almost no space under the bus and rolling the victim over and extracting here, all whilst trying to keep her spine immobilised was a difficult task. I then had to make an immediate treatment plan for her multiple fractures and bleeding, and then give my plan for a three-hour evacuation, all within 10mins (luckily we didn't have to carry out the 3hr evac!). We also went to the lake, where I was asked to teach a lifeguarding lesson to the course, sharing various towing strategies in the water and we did our CPR and defib evaluation on the beach. Note to self: If you try to do 10mins of CPR in shorts, on a beach full of vicious volcanic rocks, your knees will start to bleed... The final thing we learnt that day was how to inject drugs subcutaneously, which mean we all had to inject somebody else as well as ourselves. The needles were only small but I have to admit that it was a weird sensation sticking a needle into yourself, you'll all be glad to hear that it's not something I'll be making a habit of.

We finished the day by doing the final written exam which everyone was a bit nervous about. The main thing that worried me was that the exam, as well as the whole course, was in Spanish, so with some technical medical vocab I was just praying I'd understand it all. Thankfully I did and I passed with the highest practical and theoretical marks of the course! I now feel much more prepared to work in remote areas and be able to provide an appropriate level of first aid cover for the friends and/or clients that I paddle with. I was going to say that I look forward to putting the skills I learnt into practise, but in this case it's probably not appropriate!

Perhaps slightly oversized...