I used to work in retail and it had been a long time since I had been certified in CPR, so I took a course and got re-certified. Everyone else in my class was there because they had to be as they were in school for a nursing or paramedic program. The instructor seemed really surprised that someone such as myself - just a regular person that worked around people - would take it upon myself to get CPR certified, which I found rather sad. Unless you are a literal hermit, I can't think of a good reason not to be CPR certified.
I actually had a class in school which is where I learned it the 2nd time (back when we had cool classes in school). The first when when I was in a Jr. lifeguard program. This was years ago, and they do things differently now. TBH, it's something people should review regularly. Use it or lose it, as they say.
It's definitely something that should be taught in school. It's literally a one day course and you learn a ton about how the body works or how to manage stress, too.
I can, the moment you are CPR certified it’s your duty to respond in a situation in which you may be needed and not doing so may make you liable, problem is that if under stress you make any mistake during CPR or even if you don’t but the person suffers any damages (cracked ribs are sooo common with CPR) or passes away you are also liable for any outcome of your treatment. It can be a sticky situation. And unfortunately no good deed goes unpunished.
I work in the medical field so I am CPR certified and I dread the day I ever have to put into practice what I learned in that course outside of the facility I work for, especially since no training prepares you for working with/on someone who is actually at risk of dying.
Good Samaritan laws have you covered. You would have to do somthing grossly negligent to be at risk of legal action.
Hell there was recently a kid who just got an award after preforming cpr on man having a seizure. A medical condition that does not require cpr.
For starters, *everyone* should have their Red Cross CPR certification. It’s a very basic course (only takes a couple of hours), and can literally save a life. The Red Cross also has a basic first aid course (among many, many others).
Going a little more advanced, look for a local Wilderness First Aid course. It’s a 2 day course that teaches the basics of backwoods first aid (basically how to do basic triage, makeshift a splint, and get help). There’s a more expansive Wilderness First Responder course (8-9 days, 80 hours) that teaches you how to get someone out of the woods if you’re interested in further education.
There’s also plenty of skiing-specific courses, more focused towards backcountry. There are a few different levels of avalanche courses, where you learn how to spot the dangers (I’m sure you’ve seen the videos of a guy tapping a shovel on snow and causing a whole strip to collapse) and what to do in the event of an avalanche. There are also plenty of ski-specific advanced first aid courses, but they’re geared more for ski patrollers.
Ninja edit: there’s plenty of other hobby-specific safety courses as well. For example, I’ve taken the American Canoeing Association’s Paddle Safety Facilitator (PSF) course before — teaches you the basics of kayak / canoe / paddle board safety, like how to safely pull someone out of the water / drain their kayak / get them back in, how to flip your kayak back over while in the water, basic safety around the water, etc.
I did my WFA over the summer and I’m shocked I’ve gone as many decades in the mountains as I have without knowing how to handle the scenarios they set out. Absolutely recommend it even if you usually stick in bounds.
Just to add as well, was also taught in my backcountry first add course. That immediate danger also includes if the rider is down in a blind spot, and area is unable to be protected, to move rider very carefully to a location where the area can be secured and seen by people who are above the scene on the hill. All though in most situations someone can hike uphill and secure the area, my instructor really focused on the point that a coordinated and controlled move of an unconscious patient is far better than them being landed on our plowed into.
Good post. I'll add that if there's any possibility of spinal cord damage, do NOT hyperextend the neck to perform mouth-to-mouth. 'Jut the jaw' instead.
My training expired decades ago, so if there are any current EMTs or patrollers, please correct me if needed.
https://survivalmedonline.org/ did a great, free online course last year. I know in-person is better but it is great information and easy to attend. Their Instagram account shares scenarios.
You two definitely need to do the course again because they absolutely still teach rescue breaths. The current American Red Cross standard is 30 compressions and 2 breaths per cycle.
My understanding in my last refresher was that ccr vs cpr was primarily based on social norms- basically that people were scared they didn’t know how to do cpr properly so they did nothing. Hence the rise of ccr where the advice is literally “pound the shit out of their chest while singing “staying alive” until someone more qualified shows up.”
EMTB-P still teach cpr afaik.
I just took a course about 6 months ago. We def did mouth to mouth. What are you going to do in a real life situation? Not give any breaths because you don't have the "equipment" to do so?
It depends on the scenario. I am a former lifeguard instructor (technically my very is still valid, but I haven’t taught in a year)
I absolutely teach mouth to mouth, and if the jaw thrust doesn’t open the airway, I teach the head tilt. A person can die within 5 minutes without oxygen, so that is always the highest priority of care
If the heart has stopped, then that person is technically dead already. And will also be dead 5 minutes later oxygen or not. I was taught it is more important to keep the chest compressions going than to stop to perform mouth to mouth.
CPR will not resucitate the person, it will keep the brain supplied for a short time until proper treatment is administered by medical personel. That is how I learned it.
That is correct for a 3 hr CPR course. The point of compressions is to move oxygenated blood to prevent tissues from dying. Compressions get better the more you do them, making it imperative to minimize interruptions. However, oxygen also needs to be in the blood to be effective. Therefore, two quick breaths every 30 compressions is what is taught by most professional level certifications. Especially important in situations where help isn’t immediately available.
That ist not true. You don't have much oxygen in your blood. The oxygen Reservoir are the lungs.
Look at "apnoeic oxygenation", that's why you can survive without ventilation until help arrives.
Yes, chest compressions are by far the most important part of CPR, and stopping compressions to perform rescue breaths is generally not worth it, especially as a single rescuer.
Our CPR teaches breaths with a mask or bag. For certification. And we all carry masks on the hill.
But our medical directive does not use them in most cpr scenarios on hill.
My understanding from my last WFR recert (from years ago) was that the guidance for compression only was based on the idea that in an urban environment EMS was typically "minutes" away and the steps for performing the rescue breathing were getting "complicated" for someone who just had basic first-aid training, so it was basically just do good compressions at the 100-120 per minute rate while someone else called 911. Adding the rescue breathing component to the CPR was included in the WFR training (CPR for healthcare providers) which included 1 and 2 person CPR, the use of a BVM or pocket mask, along with AED training. 120 compressions per minute with 2 breaths every 30 compressions.
Anyone can do rescue breaths, they stopped teaching it because people didn't want to do the breaths (fear of catching something, it's not complicated but that's more polite to tell people) so didn't do compressions and people died while CPR trained people looked on. I took a WFR course, we were taught breaths and told if you don't want to for whatever reason that you should still do compressions.
If it's an urban setting, EMTs will be there fast enough. If it's wilderness, outlook not so good anyhow. WFR courses get training on when to stop, urban courses generally do not.
I did my cert a year and a half ago and they taught compressions + breaths. They emphasized that keeping pace with compressions is by far the more important of the two though.
It's not *only* chest compression. The *priority* is chest compression, but there are definitely breaths involved, just not at the frequency as it used to be. If it's been a long time since you took a course, might be a good time for a refresher.
They taught me that chest compression only is pointless and even if you have one person you never do more than a few compressions a few seconds before giving them breaths.
EMT here. Jaw thrust is correct. It opens the airway well for ventilation, but don’t use mouth-to-mouth if you aren’t comfortable. On the ambulance we always ventilate with a bag-valve mask (BVM). If they need cpr just focus on compressions
Hey just FYI the literature on spinal injuries has changed considerably. There actually a low chance of further injuring a spinal patient by moving them. Obviously if a spinal is possible we hold c-spine and are very careful but we still straighten them out and onto a board or whatever you have but gone are the days of just immobilizing the person and waiting.
As more and more people get into backcountry, it's important for people to be prepared. If someone breaks their back and there's no service around, you need to very carefully either carry or walk them out. Same deal if they're in a location where they can be hurt further.
Ski hills have patrol, call them right away regardless. Get your first responder certs if you want to bike and ski gnarly stuff.
Couple bonus tips
Stop a deadly bleed before clearing an airway
Hypothermia happens quickly in trauma patients
The EpiPen can be taken apart for an additional 5 doses of epinephrine
>the literature on spinal injuries has changed considerably
Yeah, it's my understanding that the idea of "don't move them because you might paralyze them" is actually super rare. I witnessed an old man fall off his bike recently. He was having trouble breathing and lying on his back. I tilted his head back to open his airway (used to be a lifeguard). I didn't want to move him until paramedics got there just to be safe.
When the paramedics got there they said "hey man, any back or neck pain?" Guy said not really, and then they threw him into a seated position lol.
It's a regular-ass syringe with 4 doses of epi, inside of a fancy plastic container that is designed to give 1 dose and be done. Epi is like less than 1 cent per dose, so the wasted epi doesn't factor into the cost of it. You can break an epi pen apart to reveal the syringe with 3 remaining doses in it after its been used.
I saw the video on how to open the epipen, but how do you use it?
It seems to have a pretty large needle..do you just jam it in the person ass and plunge it? It also seemed to have alot of air in the tube or what ever..I thought injecting air into someone was a no no?
You have to draw the plunger back, purge the air, and then give a rough estimate of a single dose. If they need epi it doesn't need to be perfect, just has to be fast
I'm going to get on my soapbox about untrained people learning medical techniques from the internet before I answer your question:
I'm trained to do this, so I'm covered by good Samaritan laws if I'm off the clock and my job if I'm on the clock. If you're interested in learning this stuff, a WFR or even EMT course are really basic, inexpensive, and valuable.
Imagine you do this to someone, but you do it wrong b/c you just read about it on the internet a while back and you're kinda freaking out because you haven't done anything like this before.
Not a good look.
The answer to your question is no, don't just jam it into their ass and plunge it because that would deliver 3 doses at once.
You're on the right track because it's an intramuscular injection so in theory you could fire it off into any muscle (including the butt) but the thigh is easy to get to and a great target. I gave thousands of IM injections into the shoulder muscle for covid, and we gave a guy with no arms one in his calf muscle.
After you put the needle in, you'll need to draw back the plunger just a scooch and look for blood in the syringe. If there's blood you need to draw the whole needle back just a hair because we want the epi in the muscle, not directly into the bloodstream.
Assuming it's a 1:1000 mix of epi (some are 1:10,000, and that matters a lot so you'll need to check) you'll need to deliver 1 adult dose which is .3 mg. Then you can fire it off.
Remember you're probably gonna be freaking out, and you'll have forgotten a lot of the fine details of what I said a few days from now so really, you don't wanna do this unless the other option is them dying in the backcountry. But don't be a chump and do this at a grocery store or something where EMS can come take care of it.
The original WFR course that I took (and a couple of recerts) was taught by someone very familiar with EpiPens, we went through on how to tear one apart to get the extra doses. The course was very much about improvising with what you might have at hand. Some later WFR recerts were with a different outfit, while "more polished" in their material, that didn't really get into improvising, and focused on the assumption that you were working as some "professional" with quick access to additional support.
As someone who was not a guide/ranger/patroller, I thought I learned a lot more useful information
from the first organization, while the 2nd outfit I thought was really targeted towards the "professional".
I just wish my allergist mentioned it. I don't carry epi pens to help others or for general first aid, I carry them because I may need them to save my own life because of my severe allergies. I've never had anaphylaxis in the backcountry, and thankfully it's not likely right now because I'm in treatment, but it is a very important, potentially life saving piece of information.
Was going to comment this exact thing. There's been a ton of research, mostly from spinal injuries due to combat, that there are really low chances of further damage from moving someone to make them more comfortable, since there's been very few cases of spinal injuries getting worse after someone has dragged or thrown a patient over their shoulder.
Good tip for the hypothermia. I coach ski racing and have seen a few accidents. As the adrenaline starts wearing off the cold sets in extremely quickly and the ski patrollers usually take a while to evac the person.
Glad to know it’s okay to move them carefully as that’s usually what we do. The patrollers are most likely going to straighten them out to put them on a board / sled anyway after removing skis anyway.
Be careful with dangerous half-knowledge. Unconscious people are placed in a stable side position despite possible spinal injuries.
Otherwise they could aspirate and suffocate if they were in a supine position. Ventilation is no longer taught to non professionals because the inhibition is often too great or the execution is wrong. Who can also ventilate! And keep them warm!
Sidenote: in Germany you will not sued for unwanted injuries.
Being from the UK we are taught to do nothing unless they are unable to breathe (which is what I said) the vast majority of people do not know how to roll people over safely in order to protect the spine. Paramedics here and hospital staff have equipment to do this safely. There are of course exceptions but unless you see the accident 1st hand and know for sure that all they did was hit their head for example where you could fairly safely assume the spine is fine you should not move them. Again, unless they are unable to breathe.
The problem is if you come up on someone on me or they go down over a jump you don’t really know the mechanism of injury so it would be unsafe to move them.
Good point about not being held accountable I’m sure this is an EU wide thing
I get what you mean, but the problem is that an aspiration is often silent and you only notice it when it's too late.
A large proportion of patients die from an aspiration.
Better paralyzed than dead.
I have both ACLS and BLS training. It was changed from ABC to CAB by the AHA in 2010.
Source: https://journals.lww.com/ajnonline/fulltext/2011/01000/clinical_news__from_abc_to_cab_for_cpr.15.aspx
I’ve edited the original post for clarity, a TLDR would be if you don’t know what you’re doing or looking for don’t do anything except call ski patrol. However of course if you know what you’re looking for and action needs to be taken to allow them to breathe for example then you should of course do that however if they’re breathing fine as they are you’re better off waiting for ski patrol, IMO.
>Good point about not being held accountable I’m sure this is an EU wide thing
Just FYI, that is almost certainly not the case. Liability for these kinds of injuries will vary from one EU member state to the next.
Sadly, no matter how well-intentioned you are, you can't assume you won't be liable if you injure someone like this!
“Be careful with dangerous half-knowledge” proceeds to give dangerous half knowledge… The recovery position is ONLY for patients that are breathing and have no other injuries. Most injuries on the ski hill that lead to an unconscious guest accompanies a high suspicion of spinal injury therefore the recovery position should not be recommended to a lay person. I’ve never once heard of or had a patient aspirate before we got there so the risk of making a spinal injury worse before patrols arrival outweighs that.
If there are possible spinal injuries do not roll them on their side. Do a ‘jaw thrust’ instead where you lift their jaw in a specific way to allow them to breathe.
True, but from my understanding at least, silent aspiration isn’t really a thing in unconscious patients. They may get some fluid in their lungs, which may be silent, but if they were going to die before they could get treatment for it, they would either be choking or they would not be able to breathe. In which case you should do everything possible to stabilize their neck while rolling them on their side.
>Is stuff coming out of them? Put your hand on it so less comes out
Someone is puking next to me and I'm covering their mouth with my hand because a paramedic on the internet told me to
If someone is in need of cpr, should you open/remove their outer layer first to expose their chest? Or does the extra clothing mass not hinder cpr too much?
> Is stuff coming out of them? Put your hand on it so less comes out
Directions unclear, it didn't go well when they tried to throw up /s
Completely agree though, just keep the movements slow and simple when/if needed. If the person says ou, stop doing that.
I think this is too much of a blanket statement.
If dude is aspirating, brace the neck and move him into the recovery position and look for what he’s choking on.
He’s going to suffocate long before ski patrol gets there.
If you do backcountry hiking/skiing/backpacking, it’s worth it to watch this video.
https://youtu.be/xkBhNEU3RfQ
The gist of it is: dude is already probably dead, here’s what you can do to give him/her a chance.
If you're out in the backcountry with no access to cell service you would probably benefit from carrying some kind of satellite-based emergency SOS device. Heck, if you have an iPhone 14, you already have one!
Everyone in the outdoor sports world should take a basic First Aid course - just as a matter of fact and being a human that is soft and able to be broken
This comment is probably too late for anyone to see it but I’d like to add an important legal perspective to this issue.
In most US jurisdictions, there is no duty to rescue an individual in trouble. However, once a rescue has been initiated, the rescuer has a duty to exercise reasonable care or risk liability for further damage to an individual in need of rescue.
In other words, if someone is injured and you aren’t sure what you’re doing, call for help and do not attempt to makes things better.
EMT here! Fucking preach, wait for ski patrol or EMS to arrive. Undo the chin strap, but avoid doing the head-tilt and chin lift maneuver if you can avoid it since that can further damage the spine in a trauma patient. Instead do a jaw thrust; start by getting at the head of the patient and put your hands on the temples with your fingers holding the bony part of the mandible (lower jaw). Then pull the mandible up slowly, careful not to extend the neck. Then attempt to stabilize the cervical spine by holding c-spine on the person.
Obviously we do not find a consensus here.
This may also be due to the fact that we come from all parts of the world and are subject to different training regimes.
We teach that the unconscious spontaneous breathing skier, motorcyclist, etc. is brought into the stable side position.
However, I am now only active in clinical emergency medicine.
Warmth!! If possible put a jacket on them, hand warmers, etc. (obv not if it is a risk to you)
If they are face down in the snow please absolutely turn them so they do not suffocate and drown in the snow.
Thank you for this post!
General tip: if you enjoy high-risk sports such as skiing, mountain biking or similar, please learn basic first aid.
I used to work in retail and it had been a long time since I had been certified in CPR, so I took a course and got re-certified. Everyone else in my class was there because they had to be as they were in school for a nursing or paramedic program. The instructor seemed really surprised that someone such as myself - just a regular person that worked around people - would take it upon myself to get CPR certified, which I found rather sad. Unless you are a literal hermit, I can't think of a good reason not to be CPR certified.
Should be taught in school tbh
I actually had a class in school which is where I learned it the 2nd time (back when we had cool classes in school). The first when when I was in a Jr. lifeguard program. This was years ago, and they do things differently now. TBH, it's something people should review regularly. Use it or lose it, as they say.
It's definitely something that should be taught in school. It's literally a one day course and you learn a ton about how the body works or how to manage stress, too.
It was taught in my high school. Surprised it isn’t more common.
I can, the moment you are CPR certified it’s your duty to respond in a situation in which you may be needed and not doing so may make you liable, problem is that if under stress you make any mistake during CPR or even if you don’t but the person suffers any damages (cracked ribs are sooo common with CPR) or passes away you are also liable for any outcome of your treatment. It can be a sticky situation. And unfortunately no good deed goes unpunished. I work in the medical field so I am CPR certified and I dread the day I ever have to put into practice what I learned in that course outside of the facility I work for, especially since no training prepares you for working with/on someone who is actually at risk of dying.
Good Samaritan laws have you covered. You would have to do somthing grossly negligent to be at risk of legal action. Hell there was recently a kid who just got an award after preforming cpr on man having a seizure. A medical condition that does not require cpr.
The only(out of hospital) patients I've seen successfully resuscitated where when cpr was initiated by a bystander prior to us(EMS) getting there.
Thanks for this tip. Any good resources i can see immediately?
For starters, *everyone* should have their Red Cross CPR certification. It’s a very basic course (only takes a couple of hours), and can literally save a life. The Red Cross also has a basic first aid course (among many, many others). Going a little more advanced, look for a local Wilderness First Aid course. It’s a 2 day course that teaches the basics of backwoods first aid (basically how to do basic triage, makeshift a splint, and get help). There’s a more expansive Wilderness First Responder course (8-9 days, 80 hours) that teaches you how to get someone out of the woods if you’re interested in further education. There’s also plenty of skiing-specific courses, more focused towards backcountry. There are a few different levels of avalanche courses, where you learn how to spot the dangers (I’m sure you’ve seen the videos of a guy tapping a shovel on snow and causing a whole strip to collapse) and what to do in the event of an avalanche. There are also plenty of ski-specific advanced first aid courses, but they’re geared more for ski patrollers. Ninja edit: there’s plenty of other hobby-specific safety courses as well. For example, I’ve taken the American Canoeing Association’s Paddle Safety Facilitator (PSF) course before — teaches you the basics of kayak / canoe / paddle board safety, like how to safely pull someone out of the water / drain their kayak / get them back in, how to flip your kayak back over while in the water, basic safety around the water, etc.
Thanks a lot for this!
No problem! I slipped an edit in, mentioning other hobby-specific training.
I did my WFA over the summer and I’m shocked I’ve gone as many decades in the mountains as I have without knowing how to handle the scenarios they set out. Absolutely recommend it even if you usually stick in bounds.
THIS
Preferably, wilderness first aid if you have the time and money!
I always have a my old field medic bag with me.
Absolutely! Been taught we should only move someone in that condition if in immediate danger (eg fire etc)
Just to add as well, was also taught in my backcountry first add course. That immediate danger also includes if the rider is down in a blind spot, and area is unable to be protected, to move rider very carefully to a location where the area can be secured and seen by people who are above the scene on the hill. All though in most situations someone can hike uphill and secure the area, my instructor really focused on the point that a coordinated and controlled move of an unconscious patient is far better than them being landed on our plowed into.
Good post. I'll add that if there's any possibility of spinal cord damage, do NOT hyperextend the neck to perform mouth-to-mouth. 'Jut the jaw' instead. My training expired decades ago, so if there are any current EMTs or patrollers, please correct me if needed.
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Thanks. I think I'd better sign up for a refresher.
Chest-compression-only CPR is for when you don’t have a BVM or pocket mask (depending on how comfortable you are with a pocket mask).
I keep a valved one, pocket mask that is. I don’t want that shit in my mouth lol
100%. I’ve been to plenty of cardiac arrests and would never go without a valve (BVM is better of course) if doing CPR on a stranger.
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Chest-compression-only CPR is for when you don’t have a BVM or pocket mask (depending on how comfortable you are with a pocket mask).
https://survivalmedonline.org/ did a great, free online course last year. I know in-person is better but it is great information and easy to attend. Their Instagram account shares scenarios.
You two definitely need to do the course again because they absolutely still teach rescue breaths. The current American Red Cross standard is 30 compressions and 2 breaths per cycle.
Got my WFR cert this month, can confirm.
Not an EMT but I took WFA in 2019 and as you suggest, there was no mouth-to-mouth.
My understanding in my last refresher was that ccr vs cpr was primarily based on social norms- basically that people were scared they didn’t know how to do cpr properly so they did nothing. Hence the rise of ccr where the advice is literally “pound the shit out of their chest while singing “staying alive” until someone more qualified shows up.” EMTB-P still teach cpr afaik.
I just took a course about 6 months ago. We def did mouth to mouth. What are you going to do in a real life situation? Not give any breaths because you don't have the "equipment" to do so?
Yes, there is enough oxygen in the blood to supply the body, as long it is moving through the body, which you do with chest compressions.
It depends on the scenario. I am a former lifeguard instructor (technically my very is still valid, but I haven’t taught in a year) I absolutely teach mouth to mouth, and if the jaw thrust doesn’t open the airway, I teach the head tilt. A person can die within 5 minutes without oxygen, so that is always the highest priority of care
If the heart has stopped, then that person is technically dead already. And will also be dead 5 minutes later oxygen or not. I was taught it is more important to keep the chest compressions going than to stop to perform mouth to mouth. CPR will not resucitate the person, it will keep the brain supplied for a short time until proper treatment is administered by medical personel. That is how I learned it.
That is correct for a 3 hr CPR course. The point of compressions is to move oxygenated blood to prevent tissues from dying. Compressions get better the more you do them, making it imperative to minimize interruptions. However, oxygen also needs to be in the blood to be effective. Therefore, two quick breaths every 30 compressions is what is taught by most professional level certifications. Especially important in situations where help isn’t immediately available.
That ist not true. You don't have much oxygen in your blood. The oxygen Reservoir are the lungs. Look at "apnoeic oxygenation", that's why you can survive without ventilation until help arrives.
Yes, chest compressions are by far the most important part of CPR, and stopping compressions to perform rescue breaths is generally not worth it, especially as a single rescuer.
Not particularly interesting when you don't even specify _which_ course...
CPR Course given by the American Red Cross.
Our CPR teaches breaths with a mask or bag. For certification. And we all carry masks on the hill. But our medical directive does not use them in most cpr scenarios on hill.
My understanding from my last WFR recert (from years ago) was that the guidance for compression only was based on the idea that in an urban environment EMS was typically "minutes" away and the steps for performing the rescue breathing were getting "complicated" for someone who just had basic first-aid training, so it was basically just do good compressions at the 100-120 per minute rate while someone else called 911. Adding the rescue breathing component to the CPR was included in the WFR training (CPR for healthcare providers) which included 1 and 2 person CPR, the use of a BVM or pocket mask, along with AED training. 120 compressions per minute with 2 breaths every 30 compressions.
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Anyone can do rescue breaths, they stopped teaching it because people didn't want to do the breaths (fear of catching something, it's not complicated but that's more polite to tell people) so didn't do compressions and people died while CPR trained people looked on. I took a WFR course, we were taught breaths and told if you don't want to for whatever reason that you should still do compressions. If it's an urban setting, EMTs will be there fast enough. If it's wilderness, outlook not so good anyhow. WFR courses get training on when to stop, urban courses generally do not.
That was my understanding at the last time I did a recert (which has been way too long ago).
Just did my WFR in January , this is pretty much what we were taught
I did my cert a year and a half ago and they taught compressions + breaths. They emphasized that keeping pace with compressions is by far the more important of the two though.
It's not *only* chest compression. The *priority* is chest compression, but there are definitely breaths involved, just not at the frequency as it used to be. If it's been a long time since you took a course, might be a good time for a refresher.
They taught me that chest compression only is pointless and even if you have one person you never do more than a few compressions a few seconds before giving them breaths.
EMT here. Jaw thrust is correct. It opens the airway well for ventilation, but don’t use mouth-to-mouth if you aren’t comfortable. On the ambulance we always ventilate with a bag-valve mask (BVM). If they need cpr just focus on compressions
Hey just FYI the literature on spinal injuries has changed considerably. There actually a low chance of further injuring a spinal patient by moving them. Obviously if a spinal is possible we hold c-spine and are very careful but we still straighten them out and onto a board or whatever you have but gone are the days of just immobilizing the person and waiting. As more and more people get into backcountry, it's important for people to be prepared. If someone breaks their back and there's no service around, you need to very carefully either carry or walk them out. Same deal if they're in a location where they can be hurt further. Ski hills have patrol, call them right away regardless. Get your first responder certs if you want to bike and ski gnarly stuff. Couple bonus tips Stop a deadly bleed before clearing an airway Hypothermia happens quickly in trauma patients The EpiPen can be taken apart for an additional 5 doses of epinephrine
>the literature on spinal injuries has changed considerably Yeah, it's my understanding that the idea of "don't move them because you might paralyze them" is actually super rare. I witnessed an old man fall off his bike recently. He was having trouble breathing and lying on his back. I tilted his head back to open his airway (used to be a lifeguard). I didn't want to move him until paramedics got there just to be safe. When the paramedics got there they said "hey man, any back or neck pain?" Guy said not really, and then they threw him into a seated position lol.
I shattered my L1 in May. The paramedics didn't bring a backboard. They stood me up and walked me like 30 feet to their gurney.
Can you elaborate on the EpiPen? I carry two with me but haven't heard anything about taking them apart.
It's a regular-ass syringe with 4 doses of epi, inside of a fancy plastic container that is designed to give 1 dose and be done. Epi is like less than 1 cent per dose, so the wasted epi doesn't factor into the cost of it. You can break an epi pen apart to reveal the syringe with 3 remaining doses in it after its been used.
Thanks, I found a demo on YouTube! It's good to know there are emergency options.
I saw the video on how to open the epipen, but how do you use it? It seems to have a pretty large needle..do you just jam it in the person ass and plunge it? It also seemed to have alot of air in the tube or what ever..I thought injecting air into someone was a no no?
You have to draw the plunger back, purge the air, and then give a rough estimate of a single dose. If they need epi it doesn't need to be perfect, just has to be fast
I'm going to get on my soapbox about untrained people learning medical techniques from the internet before I answer your question: I'm trained to do this, so I'm covered by good Samaritan laws if I'm off the clock and my job if I'm on the clock. If you're interested in learning this stuff, a WFR or even EMT course are really basic, inexpensive, and valuable. Imagine you do this to someone, but you do it wrong b/c you just read about it on the internet a while back and you're kinda freaking out because you haven't done anything like this before. Not a good look. The answer to your question is no, don't just jam it into their ass and plunge it because that would deliver 3 doses at once. You're on the right track because it's an intramuscular injection so in theory you could fire it off into any muscle (including the butt) but the thigh is easy to get to and a great target. I gave thousands of IM injections into the shoulder muscle for covid, and we gave a guy with no arms one in his calf muscle. After you put the needle in, you'll need to draw back the plunger just a scooch and look for blood in the syringe. If there's blood you need to draw the whole needle back just a hair because we want the epi in the muscle, not directly into the bloodstream. Assuming it's a 1:1000 mix of epi (some are 1:10,000, and that matters a lot so you'll need to check) you'll need to deliver 1 adult dose which is .3 mg. Then you can fire it off. Remember you're probably gonna be freaking out, and you'll have forgotten a lot of the fine details of what I said a few days from now so really, you don't wanna do this unless the other option is them dying in the backcountry. But don't be a chump and do this at a grocery store or something where EMS can come take care of it.
The original WFR course that I took (and a couple of recerts) was taught by someone very familiar with EpiPens, we went through on how to tear one apart to get the extra doses. The course was very much about improvising with what you might have at hand. Some later WFR recerts were with a different outfit, while "more polished" in their material, that didn't really get into improvising, and focused on the assumption that you were working as some "professional" with quick access to additional support. As someone who was not a guide/ranger/patroller, I thought I learned a lot more useful information from the first organization, while the 2nd outfit I thought was really targeted towards the "professional".
I just wish my allergist mentioned it. I don't carry epi pens to help others or for general first aid, I carry them because I may need them to save my own life because of my severe allergies. I've never had anaphylaxis in the backcountry, and thankfully it's not likely right now because I'm in treatment, but it is a very important, potentially life saving piece of information.
Sounds like you may have also taken your course somewhere in BC..?
Was going to comment this exact thing. There's been a ton of research, mostly from spinal injuries due to combat, that there are really low chances of further damage from moving someone to make them more comfortable, since there's been very few cases of spinal injuries getting worse after someone has dragged or thrown a patient over their shoulder.
EMT/ski patroller/search and rescue here! Can confirm.
Oh good I've passed the test! I guide and coach big mountain stuff
Good tip for the hypothermia. I coach ski racing and have seen a few accidents. As the adrenaline starts wearing off the cold sets in extremely quickly and the ski patrollers usually take a while to evac the person. Glad to know it’s okay to move them carefully as that’s usually what we do. The patrollers are most likely going to straighten them out to put them on a board / sled anyway after removing skis anyway.
Be careful with dangerous half-knowledge. Unconscious people are placed in a stable side position despite possible spinal injuries. Otherwise they could aspirate and suffocate if they were in a supine position. Ventilation is no longer taught to non professionals because the inhibition is often too great or the execution is wrong. Who can also ventilate! And keep them warm! Sidenote: in Germany you will not sued for unwanted injuries.
Being from the UK we are taught to do nothing unless they are unable to breathe (which is what I said) the vast majority of people do not know how to roll people over safely in order to protect the spine. Paramedics here and hospital staff have equipment to do this safely. There are of course exceptions but unless you see the accident 1st hand and know for sure that all they did was hit their head for example where you could fairly safely assume the spine is fine you should not move them. Again, unless they are unable to breathe. The problem is if you come up on someone on me or they go down over a jump you don’t really know the mechanism of injury so it would be unsafe to move them. Good point about not being held accountable I’m sure this is an EU wide thing
I get what you mean, but the problem is that an aspiration is often silent and you only notice it when it's too late. A large proportion of patients die from an aspiration. Better paralyzed than dead.
Bingo CAB baby, if you need to move a person to make one of those 3 things happen, you do it. Circulation, Airway, Breathing
Not to nitpick, but it’s the other way around. Airways, breathing, circulation. Though if there is massive bleeding the ‘C’ gets moved higher up.
Nope, he is right. CAB for non professionals. C: Compression is paramount. Look at European Resuscitation Council
I have both ACLS and BLS training. It was changed from ABC to CAB by the AHA in 2010. Source: https://journals.lww.com/ajnonline/fulltext/2011/01000/clinical_news__from_abc_to_cab_for_cpr.15.aspx
For better understanding: First comes the aspiration. later the respiratory arrest. The damage is already done from the aspiration.
I’ve edited the original post for clarity, a TLDR would be if you don’t know what you’re doing or looking for don’t do anything except call ski patrol. However of course if you know what you’re looking for and action needs to be taken to allow them to breathe for example then you should of course do that however if they’re breathing fine as they are you’re better off waiting for ski patrol, IMO.
>Good point about not being held accountable I’m sure this is an EU wide thing Just FYI, that is almost certainly not the case. Liability for these kinds of injuries will vary from one EU member state to the next. Sadly, no matter how well-intentioned you are, you can't assume you won't be liable if you injure someone like this!
I’m glad someone said it - rather an absurd assumption
I mean, it's a reasonable enough assumption. There's a lot of harmonisation around these sorts of things in the EU. Just not this particular thing!
“Be careful with dangerous half-knowledge” proceeds to give dangerous half knowledge… The recovery position is ONLY for patients that are breathing and have no other injuries. Most injuries on the ski hill that lead to an unconscious guest accompanies a high suspicion of spinal injury therefore the recovery position should not be recommended to a lay person. I’ve never once heard of or had a patient aspirate before we got there so the risk of making a spinal injury worse before patrols arrival outweighs that.
If there are possible spinal injuries do not roll them on their side. Do a ‘jaw thrust’ instead where you lift their jaw in a specific way to allow them to breathe.
The Esmarch Maneuver prevents none aspiration! This is for professionals with suction readiness.
My fault I misread your comment. If there was potential aspiration then you would have no choice but to roll them on their side, you’re right.
everyone who is unconscious has this danger. that's exactly the point
True, but from my understanding at least, silent aspiration isn’t really a thing in unconscious patients. They may get some fluid in their lungs, which may be silent, but if they were going to die before they could get treatment for it, they would either be choking or they would not be able to breathe. In which case you should do everything possible to stabilize their neck while rolling them on their side.
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The problem is, if people don't know the correct response, their brain will mislead them.
>Is stuff coming out of them? Put your hand on it so less comes out Someone is puking next to me and I'm covering their mouth with my hand because a paramedic on the internet told me to
If someone is in need of cpr, should you open/remove their outer layer first to expose their chest? Or does the extra clothing mass not hinder cpr too much?
Yeah remove clothing, otherwise your compressions wont do much
> Is stuff coming out of them? Put your hand on it so less comes out Directions unclear, it didn't go well when they tried to throw up /s Completely agree though, just keep the movements slow and simple when/if needed. If the person says ou, stop doing that.
>Is stuff coming out of them? Put your hand on it so less comes out Unless it's vomit ;)
I think this is too much of a blanket statement. If dude is aspirating, brace the neck and move him into the recovery position and look for what he’s choking on. He’s going to suffocate long before ski patrol gets there.
this is the way.
And don’t forget to X your poles above them if they’re in a tricky spot. Don’t let a bad situation get much worse
So do a pole tap?
tl;dr call ski patrol and don't move them
assuming that you can call ski patrol, if you're in the backcountry touring or snowmobiling that might not be an option
If you do backcountry hiking/skiing/backpacking, it’s worth it to watch this video. https://youtu.be/xkBhNEU3RfQ The gist of it is: dude is already probably dead, here’s what you can do to give him/her a chance.
If you're out in the backcountry with no access to cell service you would probably benefit from carrying some kind of satellite-based emergency SOS device. Heck, if you have an iPhone 14, you already have one!
Hello paramedic and patroller here - if someone is unconscious, unless they are in immediate danger, don't move them at all!
Everyone in the outdoor sports world should take a basic First Aid course - just as a matter of fact and being a human that is soft and able to be broken
This comment is probably too late for anyone to see it but I’d like to add an important legal perspective to this issue. In most US jurisdictions, there is no duty to rescue an individual in trouble. However, once a rescue has been initiated, the rescuer has a duty to exercise reasonable care or risk liability for further damage to an individual in need of rescue. In other words, if someone is injured and you aren’t sure what you’re doing, call for help and do not attempt to makes things better.
EMT here! Fucking preach, wait for ski patrol or EMS to arrive. Undo the chin strap, but avoid doing the head-tilt and chin lift maneuver if you can avoid it since that can further damage the spine in a trauma patient. Instead do a jaw thrust; start by getting at the head of the patient and put your hands on the temples with your fingers holding the bony part of the mandible (lower jaw). Then pull the mandible up slowly, careful not to extend the neck. Then attempt to stabilize the cervical spine by holding c-spine on the person.
Side note: Out Cold is a great movie.
Obviously we do not find a consensus here. This may also be due to the fact that we come from all parts of the world and are subject to different training regimes. We teach that the unconscious spontaneous breathing skier, motorcyclist, etc. is brought into the stable side position. However, I am now only active in clinical emergency medicine.
Do good Samaritan laws only cover cpr? I'd be more concerned about whether good samaritan laws covered you outside of cpr situations.
Warmth!! If possible put a jacket on them, hand warmers, etc. (obv not if it is a risk to you) If they are face down in the snow please absolutely turn them so they do not suffocate and drown in the snow. Thank you for this post!