Anyone who has spent even a moment on a tree care work site, regardless of knowledge and experience, can easily recognize it as a fairly dangerous environment. You’ve got large motorized machinery running at full bore, pieces of woody debris falling at varying speeds and individuals dangling from ropes while using sharp implements.

And all that is just on the surface. A more experienced bystander may note hazards such as pockets of decay in the trunk of a tree, the subtle yet large hornet’s nest on a branch, or the hidden hole left by the springer spaniel at ankle-breaking depth right next to the feed table of the chipper.

The risks and hazards of tree care cannot be completely eliminated, but they certainly can be better managed through safe work practices/techniques and the use of required personal protective equipment. In addition, the outcomes of accidents and injuries can be improved through preparation and better knowledge and training of emergency medical care at the moment of an incident.

You have to get to them before you can assess or treat them.PHOTOS: MICHAEL (HOUSE) TAIN

Treat ’em high or treat ’em low

The majority of what is thought of as “emergency response” in the tree care industry revolves around the types of aerial rescue. While this obviously is a component, it should not be the sole focus, particularly for emergency medicine.

Getting to the patient and assessing them is key, whether they are in the corner of the backyard or 45 feet up in a tulip poplar, but once assessed, bringing them immediately to the ground might not be the best option. Movement to the ground certainly could be undertaken, but only if their condition demands it, or the rescuer has enough emergency medical knowledge and training. The best option in many cases may be to “stabilize” the patient in place, whether in the canopy or next to the back fence, and await the arrival of emergency medical services.

What’s goin’ on?

The key component, and obvious first step, of any emergency medicine is assessment — figuring out what is going on with the injured person. As with an aerial rescue or electrical hazard situation, the would-be rescuer should assure scene safety prior to rushing in to “save the day” as a second victim is never helpful. Assessment is important because it dictates what should, and, perhaps more importantly, what should not happen next. As an example, moving a patient with a neck injury or cervical fracture is an excellent way to put them in a scooter chair for life. If the cause of injury is unknown — meaning the rescuer finds the climber hanging, unmoving — assessment is key along with some deductive reasoning on what might have happened. Any number of assessment tools and acronyms are available, but users need to be trained in what to look for when using them. Two that are fairly common are the ABCs of standard first aid and MARCH of military trauma care.

ABCs: These extend all the way through a number of letters in the alphabet, but for tree care emergency medicine the focus should primarily be on Airway, Breathing, Circulation and, possibly, Deformity. While the order changes in the event of cardiac arrest — CAB (circulation, airway, breathing) — meaning in a cardiac arrest, immediate chest compressions are first priority for a single rescuer, tree folk getting hit or cut will be better served by ABC.

MARCH: This is a relatively new acronym that has been developed by the U.S. military for more effective and timely assessment and treatment of combat trauma injuries than the standard ABCs. The acronym consists of Massive hemorrhaging, Airway, Respiration, Circulation and Hypothermia.

Stability also key

The complexity of a first-aid kit needs to complement the crew’s training and education. Regardless of the first-aid kit contents, the goal in an injury situation is to keep the victim stable until EMS arrives. The first step in this process is calling EMS. While this might seem obvious, it does require some thought and planning. Issues such as cell phone coverage, radio availability and location/condition of victim are all items of importance, along with having a person designated to call in the first place and even guiding EMS in to the site. Stabilization of the patient will depend on the training, knowledge and equipment available to the crew. Remember to stop obvious bleeding, keep the airway clear, monitor respiration and not move the injured unless absolutely necessary.

Positive Pressure: An example of maintaining the all-important “breathing” or “respiration” in training with a bag valve mask.

Taking inventory

Training and knowledge of crew members will dictate which items to include in the first-aid kit. Some useful items include:

Blood stoppers/compression bandages: The Band-Aid and small gauze pads in a basic first-aid kit are not going to be very helpful when confronted with a large chain-saw-induced laceration on a foot versus chipper/stump grinder incident. Compact, lightweight compression bandages can not only be in the first-aid kit, but are small enough to slide into the pocket of a pair of chaps or chain saw pants. Examples include the Cederroth blood stopper, the Israeli bandage and the H bandage. All allow for a great deal of compression to be put on a bleeding wound to stem the flow. Users should keep in mind that if their first effort hasn’t stopped the bleeding, do not remove it: and Add more layers and more pressure. Removing the initial effort will disturb whatever clotting has occurred and reinvigorate blood flow.

Nasal airway: Preparing to insert a nasal airway on a conscious patient in training.PHOTOS: JOSH MARTIN

Folding c-collars: These can be quite handy in a neck/cervical damage injury. Proper training is needed for proper application, but the availability of folding adjustable cervical collars means that a victim’s c-spine can be protected even when injured aloft.

Trauma shears/scissors: Often the first problem confronted by a rescuer is getting at the injury or source of blood. A set of trauma shears can simplify this process.

Read more: 3 First-Aid Kit Essentials