First Aid References

In taking stock of my preparedness skills, I have come to realize that my first aid skills are horribly out of date. My intention is to take a Red Cross First Aid/CPR class as soon as possible, as I believe doing it is more important than reading about it, but the classes in my area are a bit pricey, and while I scrape together the cash, I was wondering what First Aid resources you can scrounge up on the net. Have some useful links to pdfs, websites, or just favorite books that I can check out of the library?

Thanks,

C. Rowe

Take a look at "Where There Is No Doctor," available for (legal) free download at http://50.57.140.88/wp-content/uploads/pdf/en_wtnd_2010/en_wtnd_2010_whole_book.pdf . Lots of good stuff that goes well beyond basic first aid.

For back country use, I like "Medicine for Mountaineering," by James Wilkerson. The latest edition I have is the Fourth, but there may be a more recent update. Red Cross First Aid is great, but it is quite basic and generally assumes a normally functioning urban environment, which may not always be the case.

My personal favorite for a reference/textbook for First Aid is NOLS Wilderness First Aid or for a more advanced book NOLS Wilderness Medicine.

Good Wilderness First Aid classes are harder to find than basic First Aid classes, but are well worth it.

Another FREE resource that is decent is ARC's Wilderness and Remote First Aid guide.

Some great books mentioned so far.

I always recommend people learn anatomy. You can go a long way on sites like http://www.innerbody.com Not only does it help you provide better first aid, it's also important that you be able to communicate accurately with health care professionals when you finally make contact with them. You might find yourself someday on the radio asking for advice from a doctor and it's much better to say "My friend has a broken Ulna" instead of just saying "My friend has a broken arm". You'll save valuable minutes if you are more concise.

Furthering that theme, it's also advantageous to learn some basic anatomical location terminology. Words like anterior, posterior, distal, and even simple terms like left and right that are easily mixed up and can have adverse effects if you get it wrong. So, furthering our example above, you might say on the radio "My friend has a compound fracture of the ulna with bone visible at the anterior distal area of the forearm". You get the idea.

This also works the other way as well. It helps to understand these terms if you get advice from a doctor over a radio or cellphone. If a doctor tells you to apply a tourniquet on the proximal area around the humerus, would you know where he's talking about?

A good place to start learning anatomical location terminology is at http://en.wikipedia.org/wiki/Anatomical_terms_of_location

Another helpful learning tool is to have a subject to practice on. If you have a girlfriend or boyfriend it's nice to be able to probe and feel around their body to get to know how things are supposed to feel when all is normal and well. Your other half may not like you poking and probing all their rib bones, but you can learn a lot snooping around a healthy body with just your fingers.

Furthering the theme of practicing on a healthy person - it's good to have a grasp of what a normal person's vital signs are. You should have a fairly good grasp of what a normal temperature, normal respiration rate, normal perspiration rate, normal pulse rate, etc. Then when things go wrong you can begin to make better assumptions about their condition. Of course we all know what a person's temperature is, but do you know how a normal person's pupils react to light? Shining a flashlight quickly into one eye of a healthy patient will cause the pupil to rapidly contract. If one pupil is non reactive you might be looking at a brain injury. Again, knowing how a healthy patient responds will help you when you encounter a casualty.

Part of first aid education I think is instruction on when not to do what's in books Crowe - to do no harm. Simple wounds are just that, basic first aid will treat them, and really simple wounds require no real assistance - apply pressure, keep things clean everything should turn out ok. More complex medical assistance requires certified training, and without some basic training you won't really know when you have gone over the edge into a more complex, potentially life-threatening scenario. The decision to give first aid to another human being is a serious one, applying all your training and experience and fraught with general and specific personal liability for your actions. Without some instruction, you'll be reading the book when you should be applying pressure, or giving aid. Without a certified course in first aid, your response to anyone that asks if you have any first aid experience (employers, volunteer organizations, CERTs, friends, a patient lying on the ground with a compound fracture, etc), is "no." Anyone for whom it really matters does not want to be treated by the guy who slept the previous night in a Holiday Inn, so he must miraculously be transformed into a neurosurgeon. Once you have taken a course, you can say "Yes, I'm trained in [Wilderness First Aid], can I help you," and generally get right to work.

A course that gives you hands on experience in treating wounds, immobilizing fractures, assessing and evacuating patients has been best in my experience. For general preparedness, save up $175-200, and take a Wilderness First Aid course from NOLS / (Wilderness Medical Institute) or the American Red Cross. The 2 day course is legit, and gives you some very valuable first aid skills that you will apply in life or in your planned preparedness activities. The certified training expires every 2 years, so if you want to keep it up you should similarly save up and re-take the course, like medicine the curriculum changes often enough to justify the cost. Plus they give you a decent, small medical reference that covers what you learn.

Once you have certified training, you will have a better sense of what first aid book references will be useful to you.

Also I think it is the price of admission to a civilized society and marks you as a civilized man/woman, that you take a CPR / AED course - not all courses are free, but generally speaking you can qualify for a free one though school, or an employer, or by volunteering with certain agencies (although even the Red Cross doesn't provide free CPR training anymore except for its actual employees). And check with your local emergency management agency or fire district, they often hold CPR fairs or other ways to learn and be certified (there's that word again) in CPR.

Last, practice - find out who provides the first aid station at local 5K and half marathons, and see if you can sign up to assist. That may get you into their required first aid training, and it will give you some hands on experience in doing real life first aid. Learning from those with more experience is always good, and frankly I've lived my whole life by that rule. If you look hard enough you may find other volunteer opportunities to learn and apply your first aid skills.

Book learned first aid folks might be relied on to hold a bandage on a wound, but not to assist with providing actual first aid. Get trained, you'll be more prepared to help real people.

Hello!

Great stuff! I'm a strong advocate of people learning everything they can.
I'd like to add that some municipalities offer classes for a localized CD. Also some Fire Departments will do it and even the Red Cross has.

Harv

Your intention to brush up first aid skills is an excellent idea. Unfortunately, the system in the USA is not geared to doing a good job of teaching these kinds of skills.

You will probably find that the Red Cross class actually involves 90% instruction on CPR, and 10% instruction on first aid. Too bad, since the text they actually have on First Aid is quite a good book. In reality, their whole class should be turned around. They should focus 90% on first aid, and 10% on CPR. Except for special circumstances, CPR is often not going to be effective on people who have lost their pulse and breathing (exceptions being drowning, electrocution, choking incidents, and maybe de-fib [which requires a defibrillator and isn't taught in the intro class). So in other words, the curriculum doesn't really make sense.

Next step up is EMT training. This is definitely better in terms of taking more time to teach anatomy, illnesses, wounds, patient assessment etc. However, the whole EMT thing is also not really designed to make you an effective first aid provider. That's because the US medical system doesn't want you practicing medicine, even if it's just first aid. So the EMT course winds up teaching you how to get ready to throw somebody in an ambulance. My wife's joke - while I was taking various EMT classes - is that the correct answer to any problem boiled down to ... "oxygen and transport".

It's more likely that the military teaches effective first aid. They have to. And probably a number of other countries around the world havemuch better first aid classes than America does. Check for first aid manuals from places like Israel, Switzerland, Cuba etc.

Good luck.
It shouldn't have to be this hard.

Pete2

I don't mean to hijack this thread but some of your points Pete are interesting but seem to require a response of sorts, as I tend to disagree with some of them:

CPR / First Aid split: I agree that the current split in most combined curriculums (Red Cross and American Heart Assn, I've taken both) is a little out of whack, not enough time is given to adequate first aid instruction, in fact in 2 recent courses FA was mostly an after thought, "you should read the manual" type of topic. Nowadays we add AED deployment to CPR / First Aid instruction, and the general CPR mechanism has been simplified down to compression only, so maybe there's an opportunity for a better time alignment with priorities: deploy available AEDs for maximum survivability, compression CPR until and AED or medics arrive for a chance at survival, and a decent level of first aid instruction, enough to apply pressure, immobilize patients when necessary, and wait for the cavalry / medical assistance.

But a couple points on which we differ: CPR classes now instruct on AED / defibrillators, not just advanced ones - AEDs give the greatest chance of survivability, so the focus is on rapid deployment, and you want some training on that; and CPR only effectiveness isn't as dismal as you portray, particularly when followed by an AED and/or rapid medical response. I agree, there are plenty of scenarios where CPR won't revive a patient, but studies also show that in regions where CPR training is backed by rapid response, survivability is better. And doing CPR while someone comes running with an AED gives you a decent chance at living. The Seattle area is recognized for better survival stats, and that's attributed to early CPR from more knowledgeable lay persons, and faster medical response - plus I'm positive that the availability of AEDs in public places and from law enforcement etc will begin to factor into those stats too. Personally I'm 2 for 3, and the one deceased was out of region, where medical response was approx. 15 minutes from assisting. In 2 successful CPRs medical assistance was 4-5 minutes away, and both patients are still alive and kicking. But small numbers shouldn't convince anyone. Your heart stops and the odds will rapidly fall off in minutes, why not give them the best chance of rejoining the living - train everyone on CPR and AEDs. And support your local medic one levies...

I do agree though you have to look a little harder to find effective first aid training, but wilderness first aid has evolved to be a decent preparedness tool, since the concept that you are going to be responsible for your patients for 24-72 hours in wilderness settings (and need to set your treatment expectations appropriately) dovetails nicely with typical disaster scenarios, where paramedics won't be available. The 'problem' with traditional first aid training is the availability of medical response, and the likelihood that 99.99% of people won't encounter more serious trauma and be expected to deal with it. That's a good problem to have, but I'd like more people to have WFA training for non-wilderness situations. It is becoming more mainstream through organizations like the Red Cross, and I think eventually folks like the Boy Scouts will start to train future generations according to WFA principles. Be prepared etc.

It is hard to get into these courses in some states due to the ride-along requirements. I, too, just wanted to do the classroom; but having to be associated with an EMS squad made it a non-player.

Back a million years ago when I was in the Air Force in Alaska, we had our aircraft maintenance ancillary training dudes go to the Army base and take the "Combat First-Aid" course. They loved it. They did saline IM injections. We incorporated many of the things they learned.

There is also the 56hr (iirc) 'First Responder' level of training which sits between the FA/CPR and EMT-B levels.

Almost any formal emergency medical training is better than none, in my opinion. How much training, and which class to take depends on your situation, time, and budget.

Regarding EMT training, keep in mind that it is primarily oriented towards urban settings where the patient will be quickly transported to a hospital. In my opinion, a better option for survival situations is one of the "Wilderness" oriented classes. The reason being that these classes assume you might not be able to reach definitive care for many hours or days. They also stress improvisation, how to make do with what you have (not what might be found in a well equipped ambulance or clinic). Finally (and very important in my opinion) they usually give some guidelines about when to seek rapid evacuation, and when you might consider postponing a call for a helicopter (until the weather improves or until daylight, etc etc).

Within this context there are several options. There are various Wilderness First Aid classes that run about 16 hours, which are OK. A better choice if you can manage it would be a Wilderness First Responder (aka "WFR" or "woofer"). These run about 70-80 hours and cost $500-$600. Two good outfits offering excellent WFR classes that I can vouch for from personal experience are Wilderness Medical Associates ( http://www.wildmed.com/ )and WMI of NOLS ( http://www.nols.edu/wmi/ ). They offer classes in various regions of the country.

I think that most people that have taken the time to find a site like ETS, and even more so those dedicated enough to want to discuss these topics view the topic of "First Aid" as something more than what it really is.

First Aid can be expanded to include anything and everything done to care for a patient prior to that patient reaching and receiving the definitive care for their medical emergency. Sometimes that definitive care is simply wound cleaning and bandaging and other times it is a trauma surgeon. By this definition, First Aid is only as simple or complicated as the situation presented. This definition is where I believe many members of this Forum focus is. Most, if not all, understand that they can never be prepared for every medical emergency but they want to be as prepared as they can be within reasonable preparation time and financial limits.

The definition of First Aid in the previous paragraph does not fit what the common definition of First Aid is today. This second definition of First Aid can be best summed up as the minimum amount of training to save savable lives. In essence, provide for the ABCs (airway, breathing and circulation). This is why many basic first aid courses are heavy in CPR and add bleeding control, basic shock management, a few other topics and that is about it. I also believe that this is the most appropriate way to teach basic first aid and I think that every adult should take a basic first aid course. I also think that a basic first aid course is inadequate from a survival/preparedness point of view if you every plan on leaving urbania.

Wilderness First Aid (WFA) would be a much better basic course. If you take a WFA course from an organization like NOLS or Wilderness Medical Associates (WMA) you will really be attending an entry level EMS course.



These courses will probably be all that most need with some added research on specific topics of interest. Those that are looking for more should look into the First Responder Level courses like MarkO mentioned. I would also recommend NOLS and WMA for their Wilderness First Responder courses. The reality is that First Responder curriculum covers almost all the most important parts of the Basic EMT curriculum. This varies from state to state of course, but if you aren’t going to work or volunteer as an EMS provider a first responder level class will be more than adequate.

One last thing about CPR, I have heard a lot of comments about the new simpler CPR (positive and negative). I have been watching AHA catch up to the CPR being done in various regions by both EMS and ED and AHA is taking baby steps… there are more changes coming. So much of what we did for cardiac arrest patients was based off of theory with little to no supporting science for so long. In the past 5-10 years that has changed… and the guidelines for CPR reflect that. Granted some of those studies have proven some of the theories. In other cases the science has proven that some of those concepts were not quite right or completely wrong all together. While the experts are arguing what most of this means, there has been one irrefutable concept that has come out of all of this: effective, continuous chest compressions with limited interruption works… it has even been proven to make AEDs more effective if used after a few minutes of effective compressions.

Opps, I guess my response was a longer winded repeat of yours.
You response wasn't up when I started mine... dang distraction.

I've got EMT-I('85) and WEMT (via SOLO), plus some years working on the ambulance for a large 911-only system.

I agree with Alan that the ideal course path would be wilderness based. But there is a practical economic factor that might sway that decision for you. In some locales the cost for a wilderness based class can be very high in both time and money; travel and vacation time are often required. Meanwhile, the state or your employer may subsidize First Responder or EMT-Basic training at a local college where you can do the classroom work in the evenings. The state paid about 80% of the cost for my EMT-Basic and EMT-Intermediate training, and I took the classes at night.

Ride-alongs are usually required but the number of them is very minimal for EMT-Basic, and you are just riding along, you are not committing to any ongoing service in EMS.

It still amazes me that some training programs don't arrange vehiculars (ride-a-longs) or clinicals for their students. I don't know of a training program in Arizona that requires students to arrange their own, at least at the Basic Level. EMT basic classes have gotten expensive, up to the $700-800 range in AZ.

Another good thing about EMT student ride-alongs (as opposed to "interested citizen" rides) is that you get to actually work with the patient and do things. Our system sponsored "interested citizen" rides but the rider was not allowed to do or touch anything. As an EMT student if you show the crew that you are motivated and willing to jump in with both feet, you'd be amazed at what a confident paramedic will let you do (with full supervision, of course).

We expect our student ride-a-longs to be involved. It is a waste of both their time and ours if they aren't.