southbaytrek

Hacienda Entrance Gate Off Almaden Road

Ok, so it wasn’t Page 1…but we have to start somewhere.

Two and a half weeks ago in the Saturday paper, in a small feature called “3 Things to Do Today, 3 Things to Do Tomorrow” our Almaden Quicksilver Hike was posted.  Awesome!

Needless to say, the hits on the website were off the charts and the phone calls came in steadily (while we were out teaching Lifeguard Training of course).  We ended up with two fantastic hikers and some great exposure for our outdoor adventure company.

The Hike

Almaden Quicksilver is an incredible place to hike.  Although it can be crowded at times, I can’t pass up leading trips there because of the scenery, local history, and varied albeit challenging terrain.  I took out two avid hikers from Almaden into a section of the park they had not explored before.  We took in the views of the Diablo Range, Mt. Umunhum and the Almaden Air Force Base, as well as remnants of the English mining camp.

Our party of three tackled the 4.5 mile historic route faster than expected, which left us wanting more, so I promised a solid half- day next time.  (which by the way is the Upper Steven’s Creek trip in December)

We always love a small group on all of our trips for the social factor, but know that we rarely cancel–in fact, I’ve been known to hike by myself (or with my dogs or son) on an empty trip.  So…don’t be shy…come join us!

Remnants from a Mining Camp of 1800 People

Largest Mercury Mine in US in Our Backyard

Many thanks to Ravi, Evan, Melissa, Sue, Cathie, and Michael for a stellar Red Cross Lifeguard Training and Refresher Course!

We spent two weekends together at a high school pool in San Jose learning the finer points of keeping pool patrons protected.  It was a pleasure to have a small group of professionals in this late season class: one special ed teacher, one aspiring high school teacher, two facilities managers, one lifeguard, and one diligent uncle and husband of folks who enjoy the pool.

This was my third time teaching at a high school pool this summer and through battling the idiosyncrasies that come with this setting I have improved my teaching and the overall flow of the courses–in my humble opinion.  For example, we ran this last course under a small canopy on the pool deck under the blazing sun, moving and rotating it every 30 minutes to block the sun from our backs the projector screen.  As a trade off we got our run of the place and a huge, beautiful pool with a 13′ deep end!

Next season (January-June 2012) we hope to have agreements with at least 2 high schools, 1 athletic club, and possibly a municipal pool, and you can rest assured we have perfected our ability to teach in any environment.

Nothing to do with shock, other than you don't want to experience it here at 12,000'

I’m shocked!

No, not emotional shock.  Nor are we talking about electric shock.  This is a serious medical condition that affects the entire body and can be the result of almost any trauma or illness.  Which is why I’m writing about it :-) .

“Shock is inadequate perfusion, a condition that results when the brain and other body cells are not getting a sufficient flow of oxygenated blood.  It can occur from a great variety of injuries and illnesses, including blood loss, dehydration, a heart attack, spinal cord damage, and a severe allergic reaction.  Whatever the cause, most shock patients share similar signs and symptoms.”  (Tilton, Backcountry First Aid, 2007)

So, essentially the body is shutting itself down to keep oxygenated blood in the heart, lungs, and brain.

Here’s what to look for:

  • Change in level of consciousness
  • Rapid, weak pulse
  • Restlessness and irritability
  • Pale, cool, and clammy skin

Here’s what to do:

  • Get medical help!  Or begin your evacuation plan
  • Treat the cause (e.g. severe bleeding)
  • Calm the patient
  • Have them lie down and elevate their legs 6-12 inches if there is no sign of spinal injury
  • Keep them comfortable and monitor vitals continuously

If your patient slips into unconsciousness, decompensatory shock may be settling in, and a rapid evacuation is necessary.

Stay tuned for Part IV…

Part of the big picture is how you're going to get out of the woods

If Patient Assessment were a day at Disneyland, then the Primary Assessment would be the early morning run to all of the most crucial rides and attractions, and the Secondary Assessment would be the rest of your day.  In other words, Primary Assessment takes care of what is most urgent (immediate threats to life), and the Secondary Assessment addresses the entire picture and is an ongoing process.

You cannot move to the Secondary Assessment without first first conducting the Primary.  How would you feel spending a day hanging around It’s a Small World and Peter Pan knowing you missed your key opportunity to ride Indiana Jones?  But enough with the analogies…

Head to Toe Exam

Moving head to toe, press gently but firmly on major body parts while observing and asking questions.  Places to avoid: obvious injured areas (until to treat them), and genitals (unless that’s where the injury is.

Observe for DOTS: Deformities, Open Injuries, Tenderness, and Swelling.  Ask about pain.  If you find an injury, expose it but take into consideration the environment and outside temperature.

Check the eyes, pupils, ears, nose, jawbone, scalp, nose, and cheekbones.  CAREFULLY check the neck, including the top 7 (cervical) vertebrae.  Press on each shoulder.  Squeeze the upper ribcage and lower, each time asking the patient to inhale deeply.  Press on the sternum.  Move down to the abdomen and GENTLY press on each quadrant, noting any tenderness, distention, or guarding/wincing.  Press downward on the two pelvis crests, then inward.  Check each arm and leg independently.  Check for Circulation, Sensation, and Movement (CSM) in each hand and foot.  Checking the back is an important step which is better explained in a classroom setting.  (Here’s where you sign up for class)

Taking Vitals

Check vitals early, often, and document them.  Start with the time they are taken and then note: the patient’s level of responsiveness, respiratory rate, heart rate, and the skins color, temperature, and moisture.

Patient History

Here is where you get to hear from the patient, in their own words.  Use the mnemonic SAMPLE to guide you through your interview, but don’t be afraid to ask additional questions.

S- signs and symptoms.  What hurts?  How bad does it hurt?  Can you describe the pain?

A- allergies.  Are you allergic to anything (drugs, food, bites/stings)?  Have you come in contact with that allergen today?

M- medications.  What are you currently on (prescription, over-the-counter, recreational)?

P- pertinent history.  Have you hurt this foot in the past?

L- last “ins and outs.”  What have you had to eat and drink today?  Have you have normal bathroom trips?

E- events leading up to illness/injury.  Can you tell me again what happened?  What were you doing right before you started feeling this way?

Getting the Big Picture

Once again, the purpose of the Secondary Assessment is to identify everything that is wrong and start thinking about a long-term solution.  While taking one set of vitals provides a snapshot of the patient’s condition, 10 sets provides a movie.  Check vitals every 5 minutes for an unstable patient and every 15 for a stable patient.  Continue to provide compassion and support to the person who is injured or ill.  Monitor your surroundings: is it getting dark?  Is weather moving in?  Is the tide or current changing?

Stay tuned for the “Arts and Crafts” of wilderness first aid…wilderness first aid kits!

Practicing a full patient check on the flanks of Mt. Shasta

A hiker falls down in the woods…

Pre-Assessment

“Is the scene safe?”

That’s the mantra repeated many dozens of times in any Red Cross course and Wilderness and Remote First Aid is no different.  The subsequent steps include checking the patient, calling for help (if available), and providing care—thus forming the Red Cross emergency action steps: CHECK—CALL—CARE.

The Wilderness Medicine Institute recommends a slightly different, yet valuable a five step process, recently documented in Backpacker Magazine.  The best part is it rhymes!  To remember the steps, you need to put your hand up to your forehead as if viewing something from a distance. This signifies keeping a safe space between you and the potentially dangerous situation, and it also reminds you of the five steps (one for each finger on your forehead.)

Here are the steps to run through mentally—or out loud if you’re so inclined:

#1: I’m Number 1!  (Protect yourself first)

#2: What happened to you? (look for the mechanism of injury)

#3: No germs on me! (Put your gloves on!)

#4: Are there any more? (Patients, that is)

#5: Are you dead or alive?(Get a general impression of the patient.  E.g. are you about to perform CPR or put a band-aid on them?)

Paul Peltzoldt, founder of the National Outdoor Leadership School has some additional advice: “sit down and smoke a cigarette if you get in a tough situation, and that’s pretty darn good counsel for any situation where things come flying at you quickly.”  (Tom Reed, NOLS)  Bear in mind that he said this in the sixties and neither I nor NOLS are encouraging smoking—but you get the concept: calm down, slow down, and think.

Primary Assessment
This should be similar to what you have learned in CPR

Greet the patient, identify yourself and your level of training, and gain consent to help them.  Have another responder stabilize the patient’s head/spine while you continue.  If the patient can speak, find out their chief complaint.  The ABCDE steps in the Primary Assessment are designed to check for life-threatening conditions.  If at any time you find one of such conditions, stop and treat it.  Here are the Red Cross steps:

  • A–Check airway.  A patient who can speak has an open airway, is breathing and has a pulse
  • B–Assess breathing.  If the patient is not breathing, immediately begin rescue breathing or CPR
  • C–Assess circulation.  Check for a pulse in a child.  Then, for an adult  and child, perform a quick scan for severe bleeding.  If you find severe bleeding, immediately expose the wound and use direct pressure to control the bleeding.
  • D–Look for disability as a result of damage to the spinal cord.  If you suspect a spinal injury, keep a hand on the patient’s head or ask someone else to take control of the patient’s head and tell the patient to remain still.
  • E–Assess the threat of the environment and expose any injuries.  Look for exposure to extreme environmental conditions but, if necessary, you may expose part of the patient’s skin to assess the damage and to give care.
  • If there are no life-threats, continue with the secondary assessment and SAMPLE history.

Stay tuned for secondary assessment…

Last weekend I spent three days in the beautiful Marin Headlands learning how to save lives..no big deal.

Specifically, I took the Wilderness First Responder (WFR)-Refresher course—affectionately known as the “Woofer.” This course is put on by the Wilderness Medicine Institute (WMI), which is part of the National Outdoor Leadership School (NOLS).

WFR, WMI, NOLS…it’s difficult to keep the three-letter acronyms (TLA) straight, let alone pass the course. Anyway, the Woofer is the industry standard for wilderness guides and outdoor educators as far as first aid goes. The initial course is 80 hours and every two years you must take a 24 hour refresher.

Sound heinous? You won’t think so when your guide needs to give you a little TLA treatment such as CPR (cardiopulmonary resuscitation), AED (automated external defibrillation), or PAS (patient assessment system). In actuality, the Red Cross says that these skills start to perish after only 3 months!
In one month, I will be offering a condensed version of the Woofer, known as the Woofa, WFA, or Wilderness First Aid presented by the Red Cross. The course is two days and will be in the San Jose area (Los Gatos Creek County Park in Campbell to be exact.)

To get you (and me) pumped up for the upcoming course, I will be reporting on WFA topics which will be covered in the course for the next few weeks. Stay tuned for Part I: Patient Assessment

This weekend I began a host of new online marketing strategies–beginning with a needs assessment of our participants.  The results so far are informative and will play a big role in the way we, South Bay Trekking Company continue to expand, plan new trips and activities, and ultimately be a one-stop-shop for outdoor recreation in San Jose.

I posted the link to the survey, please take it!  We started with 31 company t-shirts to give away, and are down to a few left, and will then send out some Black Diamond carabiner keychains.

Survey aside, we love receiving feedback from our participants at any time.  Let us know how we can get you outdoors!  A few things you’ll see from us in the not-too-distant future will be outdoors programs for kids and families.  Speaking of which, here’s a picture of my four month old Assistant Guide, Stuart…

Happy Trails!

Last Sunday I taught a course rarely requested, but one with excellent information and certainly invaluable for folks who supervise youth aquatic activities.

This course is Red Cross Safety Training for Swim Coaches.  Ordinarily an 8 hour course, if you have taken it before or have been in the aquatic industry awhile, you can opt for the “Fast Track” which is a FREE online self-study, then 4-hour course with an instructor.

Sunday was a beautiful day in San Jose and at the Pioneer High School pool.  The course was filled with water polo coaches from Pioneer, Evergreen Valley, and Independence High Schools.  We spend about 45 minutes learning about injury prevention, aquatic emergency plans, and the basics of rescues.  Then we hopped in the pool to perfect the rescues for the next couple of hours.  Not a bad way to spend a Sunday morning!

I learned that while East Side Union High School District in San Jose requires this training, San Jose Unified does not.  Although it could be conceived as “yet another” certification that teachers/coaches need to obtain, this one, I feel is well worth it as it prevents injuries and is valid for three years.

I’m adding a link to the USA Swimming site which has more information on this course, as well as our own Safety Training for Swim Coaches site.

Cheers!

It was a warm one on this Father’s Day hike at Pinnacles–but crystal clear and no crowds–score!

Beautiful Sunday at Henry Coe State Park!  This area is great for early-season hiking before the daytime temps crank up.  We got in about 6 miles, from park headquarters to China Hole, toured around a bit, then headed back.

© 2012 The Trek Report Suffusion theme by Sayontan Sinha