Red Rose Cave and Pothole Club - Newsletter Vol 6 No 3 - July 1969
Principles
of First Aid for Cavers A series. - Part 1
1. Assessment of the injured person.
First Aid as generally taught assumes that
an efficient ambulance service is readily available to move the casualty to
medical care. Underground this cannot apply and the man on the spot is on his own until the Cave Rescue
team arrives. All prudent. cavers are recommended to take a recognised course of instruction is fist aid but
the following remarks describe general principles of relevance to underground
incidents
In the assessment of a situation careful
details of the incident must be sought if anyone has fallen twenty feet or more They must be treated with the greatest care. despite exhortations that they are well and unharmed. Obviously
smaller falls can also cause major trauma in an apparently minor accident an
early decision is whether to let the casualty get out of the cave with what
assistance is available or whether to summon the Cave Rescue Organisation. The
decision must rest upon the individual circumstances that if there are long
pitches, awkward climbs or exposure to heights involved on the way be the
surface think hard before moving him without help. Allow for deterioration of
an injured caver on the way out in particularly that he is prone to suffer heat
loss and develop exposure! Also realise that an injured person will often
minimize his discomfort in the state of apprehension which follows injury in an
attempt to reassure himself that all is well and before he has fully appreciated what has happened. If one decides to move the patient he may
well roach the surface earlier and avoid a long wait in uncomfortable
conditions. The risk involved (apart from worsening specific injuries) is that
further effort may cause exhaustion which may worsen shook or exposure. If the
patient has a head injury and has been unconscious or even drowsy for any time,
however brief it should be unwise to allow him to make his own way out of all
but the shortest and easiest of caves. Anyone with chest, back or abdominal
injuries should be brought out by stretcher as should all hut minor lower limb injuries.
The most experienced first aider should
stay with the casualty throughout and not allow himself to be diverted to other
jobs. The strength, determination and experience of the casualty will have a
bearing on how easy it will prove to extract him. If a decision has been made
to move an injureed person unaided and this is
proving more difficult than was anticipated then make him rest and summon the
Cave Rescue Organisation.
On reaching an injured person the
assessments to be made in order of priority are:- l. Breathing 2. bleeding 3.
Specific injuries 4. if breathing is inadequate the "airway” must be kept
open by pulling the jaw upwards and forwards to prevent the tongue falling back
and turning unconscious patients into a face down position so as to prevent
choking with vomit or saliva, lf after these measures have been taken breathing is not adequate, artificial
respiration by the kiss of life
technique should be started (unless this technique is not possible (eg.
facial injuries) it renders all other methods of artificial respiration
obsolete acid should be used on all occasions) 2. Bleeding from lacerations can
almost invariably. be stopped by firm direct pressure onto the bleeding part
with the cleanest object to hand. Keep this up f or several minutes if necessary.
Tourniquets are almost never needed if this technique is used. Look out for
bleeding concealed under neoprene suits. 3. Treat specific injuries as necessary. Improvised bandages can be obtained
by tearing lengths of fabric from the legs of trousers and boiler suits, Sweaters etc , can be used for dressings. Bootlaces
and belts can hold these in position.
All
injured persons need reassurance. If you are worried don't let it show. Your demeanor is important to your patient. Warmth is paramount and caves are difficult places to achieve this but do your best for your
patient. Do not remove any clothing unless you consider it essential. Unless internal injuries are suspected food and drink will help your patient face the journey to
the surface but never give anything by mouth to an unconscious or semi-unconscious person.
Count the pulse rate (someone wears a
waterproof watch in moss parties these days) and check this three or four times per hour. If the pulse rate is increasing the casualty is worsening and look for any further bleeding. If he is unconscious
or drowsy more periodic assessment of of his level of consciousness e.g. will he obey simple
commands, a gently pinching the skin or
a painful pinching of the skin.. If his level of consciousness is deepening tell the CRO to hurry up, watch, his rate or breathing and be prepared to carry out
artificial respiration. Shock and exposure must always be considered and will be dealt with later in more detail, as will the
treatment of fractures.
J. C. Frankland