Are you prepared for an accident?

Photos by Josh Martin and Yao Yu Cheng.

Patient assessment in field simulation.

We have all read the articles, sat through the presentations, seen the pictures or videos and heard the stories. Unfortunately, far too many of us have also lived through the terrifying, pain-filled moments when we or a co-worker have been hurt or injured on the job. The statistics do not lie. More of us are being killed or getting hurt on the job than ever before, and to ignore such a fact or pretend it will never happen on our work site not only deceives ourselves and our co-workers or employees, but makes an already dangerous situation worse.

Northern Cairn Instructor Josh Martin demonstrating IV techniques and process.WEMTs do not give IVs, but are expected to assist.

We are all striving to be professionals, determined to use all required and appropriate personal protective equipment (PPE), carrying out necessary work site safety, evaluation and planning procedures, and using safe, efficient work methods and techniques with the proper gear and equipment. These are all steps that, when carefully carried out and adhered to, can prevent needless accidents and injuries. Yet, what are we doing to be prepared in the event of a serious injury?

We should have a first aid kit in the truck, equipped and fully stocked for the types of injuries we might face. But, what if we’re far from the truck, perhaps even in a tree, and the severity of the injury does not give us the survival time to reach the truck, let alone our first aid kit? A personal first aid kit or blood-stopper set small enough to fit in the pocket of our chaps or hang on our harness might help in some of the emergency medical situations we confront, but certainly not all of them. Then, assuming we do have the tools and equipment necessary to stabilize our own or our co-worker’s injuries until emergency medical services (EMS) arrive, do we know what to do? We may or may not have had American Heart Association or American Red Cross training in CPR and first aid, but maybe the lead climber with the training is the one injured, or, more likely, the nature of the injury is not one that was well-covered in the condensed training session.

We must be ready, equipped, informed, educated and trained for the situations, scenarios and injuries that we are going to confront, and we must carry out this preparation in a realistic way.

First aid kits should not only contain the minimum required to satisfy the appropriate regulations, they should also contain the supplies needed to deal with and treat the injuries our industry commonly experiences: those caused by vehicular accidents going to and from the work site; struck-bys in which ground crew members are hit by a tree, branch or other object; and severe lacerations from chain saws, chippers or stump grinders. A standard first aid kit may quickly be found lacking when confronted with the traumatic brain injuries, possible spinal involvement, broken bones with soft tissue damage, and severe bleeding associated with injuries in a tree care setting.

Along with being realistically equipped for the injuries and situations we may need to deal with, we need to be realistic about the setting they may take place in, and our proximity to assistance. Even when working on the ground, let alone aloft, we do not present as straightforward a situation to EMS teams as the homeowner having a heart attack in their living room. Whether in an urban, suburban or rural setting, our workplace presents unique challenges in treatment and patient movement, and we must be aware of this. We may have to treat or take care of ourselves for a longer period of time and more extensively than most EMS patients do. In the case of aerial injuries, we may need to assist the professionals in somehow reaching the patient.

Northern Cairn WEMT students at the completion of the final night simulation with one of their patients after evacuation to the road.

Now that we are appropriately equipped and realistically prepared, do we know what to do? First aid training is readily available in many shapes and forms, and certainly some basic training and knowledge is better than none at all, and there is emergency medical training available that is both realistic and appropriate to the setting/isolation we work in: wilderness medicine.

Students practicing the installation of a nasal airway on each other in the classroom.

Wilderness medicine is geared around patient care and management in isolated settings and extreme environments with limited equipment. Though we would rarely be as isolated as hikers on a backcountry trip or a mountaineering expedition, many of our work locations and injuries would be better dealt with and treated if done so within a wilderness medicine context. Wilderness Medical Associates (WMA), the world’s leading provider of wilderness and remote emergency medical training, has been teaching and training students from a wide variety of fields, industries and professions for 30 years, and conducts classes at locations all over the country, and the world.

One location is Northern Cairn Wilderness Training (www.northerncairn.com) in Petoskey, Mich. They not only offer the full line of Wilderness Medical Associates’ courses, but also will work with companies or groups on custom courses designed and developed for their individual needs. Existing courses for beginners with no prerequisites include Wilderness First Aid (two days), Wilderness Advanced First Aid (four days), and Wilderness First Responder (five days with pre-course work/eight days without) certifications. Additional courses are offered for medical professionals in Wilderness Emergency Medical Technician and Wilderness Advanced Life Support certifications. All these courses include certification/recertification in American Heart Association CPR/AED.

The instructors and curriculum, regardless of which course and location, are what make wilderness medicine and Wilderness Medical Associates the first aid/emergency medical training most appropriate and realistic for tree care operations. WMA instructors, and the instructors at Northern Cairn in particular, have a wide variety of emergency medical, patient care and backcountry experience, both as civilians and in the military, and include wilderness emergency medical technicians, paramedics, registered nurses and physician’s assistants. The curriculum is a mix of classroom and outdoor settings, with a great deal of realistic practice, scenarios and simulations. Students learn subjects such as patient assessment, critical systems and basic life support in the classroom, and then put the knowledge into use in real life, hands-on simulations that attempt to duplicate the stress of patient care and stabilization in a true field emergency situation. The liberal use of stage makeup, artificial blood/body fluids and plasticized wounds, along with enthusiastic “fake” patients who have been briefed on the signs and symptoms of their particular injury/illness create an atmosphere of realism, stress and urgency that could only be exceeded by an actual injury/illness. Students are required to perform the skills they have learned. Thus, treating and evacuating a patient with a possible spinal injury from a real vehicle or from beneath a fallen tree in the woods, treating a person found unconscious face down in the snow, or assessing and treating a patient with severe lacerations on a lake shore are all possible scenarios and settings. Additionally, patient assessment and treatment with limited equipment is stressed, particularly valuable to members of the tree care industry with limited space and budgets. Since the courses are geared to wilderness conditions, methods, strategies and techniques to deal with delayed emergency medical response in isolated settings are taught and practiced.

This level of training may seem far too in-depth to some, but it is the best fit and training available at the current time, and though some organizations are taking steps to rectify the lack of tree industry-specific first aid training, wilderness medicine is far more realistic and appropriate than any other first aid training available. We have to ask ourselves as individuals and as an industry, which we will regret more while we’re waiting to hear the wail of the approaching ambulance, too much training and knowledge, or too little?

Moving a patient with a severe neck laceration and possible spine injury at a lakeside simulation.

Michael (House) Tain is a contract climber, splicer, educator and writer associated with North American Training Solutions/Arbor Canada Training and Education, currently located in Lancaster, Ky.