If you are injured exploring the wilderness there likely won’t be EMS available
Extended/Prolonged Field Care as a topic is extremely broad in nature, but simply being aware of Key/basic concepts will go a long way. As with anything starting at the ground floor and gaining a firm grasp on the fundamentals will give you a solid foundation to build upon. I’m going to touch on a couple of key points, by no means is this a comprehensive list. So I may not touch on certain points, but feel free to ask questions in the comments. So what are some good things to keep in mind with Extended Field Care:
Ask them questions –
If the patients LOC permits them to be a credible reporter of their condition, ask them how they’re doing. For the sake of establishing trends, you can compare their answer to how they were feeling before you started their treatment. Ask yourself “has there been an improvement or are they deteriorating, what’s the trend? Have you noticed any additional symptoms, has their pain radiated to a different area than before?
Fluids going in and fluids moving out-
I&Os should NEVER be overlooked, you must monitor the patients fluid intake and urine output stringently. It goes without saying hydration is incredibly important; it’s not unheard of for patients to die of dehydration post initial injury in remote environments. So traditionally most of us have been taught to adopt the mindset of not giving the patient/casualty anything to drink. The way I see it is unless we’re dealing with an instance where the patient is in hypovolemic shock that way of thinking should be ignored at all costs in remote environments. You as the provider will make the call as to what is needed:
⚠️ If the casualty is saying they are thirsty, they aren’t friggen lying to you, they’re thirsty, but you should encourage small sips at a time. No tippin it back like it’s a Friday night at happy hour.
⚠️ You give small sips to watch and see if the patient vomits, this is a clear indication their body is saying it doesn’t want it or simply can’t tolerate it.
Hydration status of patient –
As the care provider, ensure the patients’ hydration is maintained to produce a urine output of approximately 0.5-1ml / kg/hour. Hydrating with water will work but a rehydration solution is preferred by the World Health Organization and they recommend :
⚠️ 30g (approx. 6 teaspoons) sugar
⚠️ 2.5g (approx. half teaspoon) salt.
⚠️ 1 Litre clean water
So if your patient isn’t able to tolerate hydration by the oral route, you could always consider rehydration rectally unless contraindicated.
Risk/Signs for Infection-
Any and all wounds should be appropriately cleansed, properly dressed and monitored for signs of infection (which I’ll cover in detail next month), such as:
⚠️ expanding redness around the wound.
⚠️ yellow or greenish-colored pus or cloudy wound drainage.
⚠️ red streaking spreading from the wound.
⚠️ increased swelling, tenderness, or pain around the wound.
⚠️ fever.
Secure ALL equipment and continually reassess –
Some procedures, such as airways, IV tubes, catheters, chest drains or needle decompression, must be assessed frequently to ensure they are still patent, firmly fixed, and clean. Any of the aforementioned equipment should be taped to the patient to ensure they are not dislodged, especially in the event the patient needs to be transported
Analgesics and Pain relief –
Modalities of pain relief are more often than not thought of as drugs, but there are so many other, and effective, ways to help your patient achieve a degree of comfort, such as:
⚠️ Being present for emotional support and reassurance with an injured patient should NEVER be underestimated.
⚠️ Ensure that all dressings are assessed frequently and changed when they need to be
⚠️ Temperature modalities such as heat or cold can be utilized to treat sprains and strains
⚠️ You can unbeknownst to the patient distract them by continuously engaging the patient in their treatment. Be sure to splint injuries that require it, therefore, avoiding unnecessary movement.
⚠️ OTC medications can also provide some relief if accessible and not contraindicated
DOCUMENTING!!! –
Earlier I mentioned noticing “trends” in your patients’ condition. By documenting your initial findings; history, Signs & Symptoms, baseline vital signs and all of your interventions. A sharpie should be an essential carry item for you so you can continue to record your observations, assessments, and any interventions/treatments administered, you WILL forget and you will not be prepared for the end game.
Overall Sanitation Standards –
Hygiene practices such as hand washing, disinfecting if applicable, water collection and treatment, food storage, cooking and washing-up processes, waste disposal should be at the top of your priority list.
Be aware of the Elements and their Impact on the Patient-
The casualty must be protected from the environment. If they are immobile they will have reduced peripheral circulation. Any immobilized patient who’s on a stretcher will be more susceptible to heat or cold and should be they “packaged” appropriately. Something as simple as routine monitoring of the patients’ temperature in the armpit will go a long way. Remember don’t forget to document your findings, because if it isn’t documented, it never happened.
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