Wilderness First Responder
Detailed Course Outline
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DAY 1: Saturday 8:30 AM Registration completion and collection of fees. Introduction to the Training: Housekeeping Wilderness First Responder vs. First Responder -Principles of long-term patient care -Backcountry "Big Four" -Extended Care: Nine Principles of "2nd Aid" -(Skill station: the Recovery Position) Medical-Legal Issues Evolution of EMS and Wilderness Medicine Certification, Licensure, and Protocols Standards of Care Good Samaritan Laws Duty to Act Liability & Negligence Patients' Rights Civil Rights: -false imprisonment -consent -right to refuse -legal aspects of documentation Learning Objectives: Competency: upon completion of this section, students will demonstrate comprehension of the legal concepts above, and relate their interpretation to patient care. Anatomy & Physiology -Macrosystems: major systems and organs -Orienteering: a language for communicating about the human body. -Microsystems: activity at the cellular level Learning Objectives: Competency: students will have begun to demonstrate a working professional vocabulary for communicating their patient assessment and care with other responders. Infection Control -Conditions for Transmission of Disease -Body Substance isolation (BSI) -Communicable diseases -(Skill Station: gloving up / de-gloving; hand washing) Learning Objectives: Competency: students will demonstrate skill at gloving and de-gloving, and describe the techniques of body substance isolation. Seven Steps In Responding: "Maintaining the Flow: creating order out of Chaos in the Field." Creating and controlling the field of experience. Patient Assessment System (the PAS) 1.Scene Size-up: safety, MOI, backup, and getting a General Impression. The unsafe, unstable scene: hasty moves, lifts, carries, BEAMing (Skill Station: lifts, carries, BEAM-ing, drags, teamwork and communication) 2.Primary Survey (Initial Assessment) AABCDE: Awake, Airway, Breathing, Circulation, Disability, Exposure (Skill Station: ABC's) (Scenarios: Primary Surveys) (Skill station: stopping a major bleed-out: WADP and the Tourniquet) 3. Secondary Survey (Focused Exam): Vital Signs, History, Head-to-Toe Exam (Scenarios: Primary, with Secondary Surveys) Learning Objectives: Competency: students will have memorized all the fundamental components of the PAS, can demonstrate rudimentary execution of a Scene size-up, Primary Survey, and Secondary Survey, assessing and managing the scene for safety; demonstrate rapid, effective moves out of harm's way, application, management and defence of the tourniquet, verbalize a General Impression, assess the ABC's, and effect interventions, obtain multiple sets of vitals signs, a patient history and a thorough head-to-toe physical exam.* (Unless stated otherwise, the asterisk "*" at the end of the Learning Objectives section shall mean "provide long-term care and make evacuation decisions".) DAY 2: Sunday (Quiz) Field Documentation: the SOAP Note Principles: organizing your response recording your data reporting to others The "Bullet" - the verbal report Learning Objectives: Competency: students will demonstrate a basic skill in making SOAP notes, making Bullet reports.* Pathogens & the Immune Response Definitions, and the nature of Pathogens Dynamics of introduction and response Immunity and Immunizations Learning Objectives: Competency: students will be able to describe the introduction of pathogens into the body, and the body's inflammation responses. Respiratory System Physiology and Anatomy Our Approach: Five Components: Generic Assessment and Treatments. Classic vital sign pattern System-specific assessment and treatment: 1. Upper airway (obstruction) 2. Lower airway (constriction: asthma, infection, burns...) 3. Lung tissue (HAPE, near drowning, burns, infection...) 4. Chest Wall (trauma: assessing stable v. unstable: closed and penetrating) Types of chest wall trauma: Fractured ribs and Flail chest Pneumo / hemo-thorax Tension pneumothorax 5. Nervous Drive DAY 3: Monday (Quiz) Respiratory Emergencies: arrest, obstruction, and rescue breathing. (Scenarios: respiratory arrest, obstructions, etc.) (Skill stations: Rescue breathing, obstructions, patent airway management.) Respiratory Adjuncts: Airways, Improvisations, Oxygen delivery, pocket masks, Bag-valve masks, . (Skill stations: respiratory adjuncts) Learning Objectives: Competency: students will be able to accurately assess and manage oxygen delivery, airway interventions and management, the BVM.* Lightning Physics of lightning Assessing and managing lightning injuries Prevention: conduct in storms, and lightning protocols (Scenario) Learning Objectives: Competencies: students will recognize the potential danger of thunderstorms, respond appropriately to an approaching storm, assess and manage related injuries*. Drowning and Near Drowning Physiology of drowning--the submersion incident Recognition and management of drowning, and near-drowning victims Learning Objectives: Competencies: students can describe the management of submersion incident casualties. Circulatory System Physiology and Anatomy Three major components, function, problems: Vessels Blood Heart Shock: the dynamics, assessment, management Lymph System : Physiology and Anatomy Comparative vital sign patterns. Learning Objectives: Competency: students will be able to describe and demonstrate the assessment and management of shock.* Cardiac Emergencies Physiology and Anatomy of the Heart The Heart Attack: risk factors, assessing, Myocardial Infarctions, Angina Pectoris... Cardiopulmonary Resuscitation (CPR) (Skills stations: CPR) CPR testing. Considerations for the backcountry. Learning Objectives: Competencies: students will be able to assess and manage chest pain, satisfactorily and appropriately perform CPR, and know the backcountry protocols for initiating and stopping CPR.* Pharmacology Why prescription medicines are controlled Legal considerations Why you should know about medications Care and documentation Recommended prescription and non-prescrition medications. Learning Objectives: Competencies: students communicate a degree of confidence in carefully approaching the study and use of medications. Water, Sanitation, and Camp Hygiene Healthy camping: hygiene, and food handling Pathologies of food-and-water-borne pathogens: recognition and treatment Water disinfection techniques Learning Objective: Competencies:students can communicate, the responsibility of the WFR in public health matters (water, food handling, and hygiene)*. DAY 4: Tuesday (Quiz) Toxins, North American Bites and Stings Modes of intoxication; prevention Generic Treatment - RADSAT Recognition and management of envenomation by: snakes scorpions, spiders ticks, and their related diseases wasps, hornets, and bees animal bites and rabies Allergic reaction and anaphyaxis management. Epinephrine injection training. Prevention of bites and stings. Learning Objectives: Competencies: students can prevent, recognize and manage intoxication, envenomations, and allergic reactions, provide wound care. Students can assess, measure, and administer 0.3ml volume intramuscularly*. Neurological System Physiology and Anatomy of the Nervous System Central (problems: decrease in LOC, inc. ICP, Strokes, seizures, ASR, intoxication) Peripheral (problems: interruptions) Head Injuries: assessing and treating 3 levels: head wounds, concussion, head injury Presentation and dynamics of ICP Comparative vital sign patterns Strokes, Seizures, Intoxication Assessing interruptions Learning Objectives: Competencies: students will demonstrate command of assessing and managing the three levels of injuries to the head, provide long-term care.* Spinal Column and Spinal Cord Injuries Physiology and Anatomy Assessment criteria Physical exam: Clearing the spine Spinal Precautions Improvising the Cervical Collar (Skill stations: Lifts, moves, rolls--alone, and with others) Learning Objectives: Competencies: students will demonstrate command of the assessment criteria, conduct a thorough physical exam for cord injury ("clear" the spine), improvise a C-collar, and demonstrate correct rolls, moves, and lifts with spinal precautions.* DAY 5: Wednesday (Quiz) Cold Injuries Environmental Challenge: P & A of the Thermoregulatory System Assessing and managing; Hypothermia Frostbite Non-freezing cold injuries Prevention of cold-related injuries Learning Objectives: Competencies: students will demonstrate recall of prevention, assessment, and management of hypothermia, frostbite, non-freezing cold injuries*. Heat Injuries P & A of the Thermoregulatory system Assessment and Management of : Dehydration Heat Exhaustion Heat Stroke Heat cramps Sunburn Prevention of heat-related injuries Learning Objectives: Competencies: students will be able to prevent, recognize, and manage dehydration, heat exhaustion, heat stroke,heat cramps, sunburn*. Altitude Medicine Physiology and Anatomy of the body ascending to altitude Acute Mountain Sickness High altitude pulmonary edema (HAPE) High altitude cerebral edema (HACE) Assessing and treating AMS Prevention and Acclimatization "Big Net" management Learning Objectives: Competencies: students will be able to prevent, recognize, and manage high altitude problems*. Lifts, Moves, and Carries Single-rescuer carries: pacstrap, split-coil, piggyback, backpack, fireman's... Two-person carries 2-person rope coil Learning Objectives: Competencies: students will demonstrate competence at safely conducting these carries. Packaging the Patient - the Hypowrap Hypowrap: manageable, comfortable, protective. (Skill station: the Hypowrap) (scenarios) Learning Objectives: Competencies: students can fabricate a manageable, comfortable, and protective Hypowrap. Packaging the Patient - the Stokes Litter The role and availability of the backboard in evacuations the Stokes litter FOAMing the patient Litter carrying organization, techniques, and protocols (Skill stations: packaging the patient, transportation over rough terrain, obstacles) (Scenario) Learning Objectives: Competencies: students can demonstrate correct packaging, organization, communication, and carrying skills with the stokes litter. Low-angle Litter Belay Being part of the rescue solution Techniques, knots, anchors, friction, safety, communication protocols Staying warm on a rescue Rigging the Stokes (Field Exercise: low-angle litter belay) Learning Objectives: Competencies: students are familiar with the fundamental principles and operations of a technical rescue, can safely tie-in, and demonstrate rudimentary team skills with communicating, anchoring, belaying, lowering and raising a low-angle-configured rescue litter. DAY 6: Thursday (Quiz) Survival: Pact To Act Individual "Essential" items First things First! Preparation and Training (Pack-and-gear layout and demo) Learning Objectives: Competencies: students are familiar with "essential" items, search-victim care items, and radio conduct. Trek Planning Responsibilities and authorities Why and how to plan Learning Objectives: Competencies: students have discussed and can relate the purpose, principles, and parameters for trek planning.. Search and Rescue Anatomy of a Rescue Types of Searches Conducting a search Evacuation modalities Helicopter protocols (Scenario) Learning Objectives: Competencies: students can relate the principles and conduct of SAR operations, the considerations for evacuation options, and conduct around helicopters. Soft-tissue Injuries Physiology and Anatomy of the Integumentary System Types of wounds and concerns Natural wound healing Principles of wound management Assessing Wounds Closed v. Open wounds Wound management and closing, and dressing techniques: Cleaning and debriding: instruments and methods Closing: suturing, stapling, glue, tape, improvising Dressing: ointments, gauze, occlusives, non-adhering, Tegaderm Managing the Tidy, Low-risk wound (Skill Station: Open, Tidy, Low-risk) Managing the Untidy, High-Risk wound (Skill station: Untidy, High-risk wounds) Other types of wounds. Infection assessment and treatment Evacuation considerations Learning Objectives: Competencies: students can demonstrate proper management of open wounds, describe infection assessment and care*. Injuries Peculiar to Hunting Safety and Prevention Missile-caused wounds Fundamentals and dynamics Low- vs. high-velocity Anatomical distribution Assessment and Field Treatment Arrow / Spear wounds Learning Objectives: Competencies: students can relate the dynamics of missile wounds, the assessment criteria for evacuation, and expedient field treatment for missile, and arrow / spear injuries. Thermal Burns Mechanism Assessing: degree, depth, extent, and location Treatment Long-term care considerations: dressing changes, managing airway, hypothermia, shock. Learning Objectives: Competencies: students will be able to describe evaluation and management techniques of burn injuries*. Friction Blisters Demonstration clinic in options for cleaning and managing hotspots and friction blisters of the foot. DAY 7: Friday (Quiz) Musculo-Skeletal Injuries: Sprains and Strains P & A of the M/S System Assessing and Managing (Skills station: taping ankles) Learning Objectives: Competencies: students will be able to describe the steps and technique for assessing and managing the sprained ankle. Students will demonstrate effective taping of the ankle*. M/S Injuries: Fractures P&A of the M/S System Assessing and managing fractures Splinting and improvisations Long-term care and evacuation (Skill stations: splinting) Traction splinting and improvisation. (Skill station: improvised traction splinting) earning Objectives: Competencies: students will be able to demonstrate assessment and management of fractures; improvise stabilizing and traction splints*. M/S Injuries: Dislocations P & A of joints Assessing and managing dislocations (Skills stations: reducing shoulder, patella, digits, jaw, elbow, radius, hip) Learning Objectives: Competencies: students can assess and manage dislocations, can demonstrate skills to relocate the shoulder, patella, and digits, and forearm*. Trauma Survey Multiple systems injuries Teamwork (Scenarios: trauma surveys) Learning Objectives: Competencies: students will have demonstrated effective teamwork in managing patients with insults to multiple primary systems.* Triage &Incident Command System Principles and fundamentals of command Organizing response to multiple casualties Triage (sorting and prioritizing) Teamwork in multi-system trauma Scenario: multiple patients, multi-system trauma) Learning Objectives: Competencies: students will have exercised organizing and managing a response to a multiple casualty scene, rapidly sorting, prioritizing, and managing patients for critical care and evacuation*. DAY 8: Saturday (Quiz) Ear, Eye, Nose and Throat (EENT) Emergencies Ear Problems Injuries Barotrauma, sinusitis Ear infections: external and middle Foreign bodies in ear Eye Problems Conjunctivitis Foreign Bodies Sunburn Nose Problems Nosebleeds: anterior v. posterior Throat Problems Dry-climate sore throat Viral pharyngitis Strep throat Dental Problems Facial trauma Teeth: broken, missing, loose Toothache Mouth wounds Learning Objectives: Competencies: students will be able to describe the assessment and management of common EENT problems*. First Aid Kits, Equipment and Supplies The myth of the "Perfect Kit" How to plan and pack Equipment, supplies, and sources Demonstration of a variety of kit configurations. Assessing Medical Emergencies "Bedside manner": the patient Hx and vital signs. "OPQRST" shows its great value. (Scenarios: assessing the medical patient) Learning Objectives: Competencies: students will demonstrate thorough, courteous technique in assessing the "medical" patient. Gastrointestinal System and the Belly Etiologies of abdominal pain Physiology and Anatomy of the GI system Four general pathologies The "Acute Abdomen": "Red Flags" Generic treatment Assessment methods, "best tests", and differential diagnoses of the abdomen (Scenarios: GI problems) Abdominal Injuries: blunt and penetrating Learning Objectives: Competencies: students will be able to assess and manage abdominal problems, demonstrate improving skills in getting a medical history, and demonstrate knowing when to evacuate the patient*. Diabetes Physiology of Diabetes Recognition and management of diabetic emergencies Hyperglycemia Hypoglycemia Learning Objectives: Competencies: students will be able to describe assessing for, and managing diabetic emergencies*. Genito-Urinary System, Injuries and Illnesses "We all gotta..." Urinary Tract Infections Problems gender-specific to women Problems gender-specific to men Learning Objectives: Competencies: students will be able to relate the assessment and management of common GU illnesses, and the instruction others in hygiene and prevention in the backcountry*. DAY 9: Sunday Lectures Wrap-up Backcountry Rescue and Casualty Management Exercise (Backcountry field exercise with multiple patients) CISD: Critical Incident Stress Debriefing Stress and the Rescuer Signs and symptoms of stress reaction Managing stress in the field, and the after-action debriefing. Exercise No-fault Critique and Evaluation Final Written Examination - Essay Question Format |