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Wilderness Medical Associates® provides the highest quality medical training to people who work or play in remote areas. Our practical teaching methods and treatment principles equip students with the skills and confidence needed to act in emergency medical situations.


We teach over 350 courses in wilderness and rescue medicine year-round, throughout the U.S.and abroad, for individuals at all skill levels.


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Category:

Education

Tags:

• wilderness
• medical
• associates
• medicine
• outdoor
• first
• aid
• responder
• emt
• wemt
• wfr
• training

[climbermedic]

interesting conversation about impaled objects. I have a question: how easy would it be to stabilize and impaled object that is 4ft long and 6 inches in diameter during a long evacuation? How well can you clean the wound with the object still in place? Here's a better question: Can you control bleeding? If external bleeding can't be controlled, maybe we need to rethink trying to treat the patient in the first place. Tourniquet anyone? They are "en vogue" again with poper training.

[SenseiX55]

Wilderness Medical Associates 2nd Protocol: Wound Management: Impaled Objects states,

"Remove all impaled objects unless doing so would cause further harm. Exceptions include impaled objects in the globe of the eye or when removal would result in severe pain or bleeding. Remove objects that interfere with safe transport or will cause more damage if left in place. After removal, treat as an open wound."

[SenseiX55]

The key piece you are missing is the length of time we are dealing with in the wilderness, a long transport for you is what... An hour... Two? We're looking at upwards of days and weeks. It's a very different set of circumstances and as such there are a different set of protocols.

[hagakuru]

Well in my State: AZ, a State certified and NREMT has a higher level of training and SOP, than a WFR. Accordingly, the training that I received expressly states that an impaled object is to be removed ONLY if one of the two above situations presents, or if you are under direct order from Medical Control to do so, or in the rare case you have standing orders to do so.

I would like for you to present where it is said that it is the "Standard" of care without meeting one of the 2 above criteria?

[chilkootangler]

This is why it is called wilderness medicine and not wilderness first aid. You leave that impaled object in for any length of time and you will invite sepsis and/or osteomylitis.

[avpu1]

Actually, removing an impaled object IS the standard of care in a remote setting because leaving it in place increases the probablity of an infection. They only times that you would not are if 1.) it is in the globe of the eye or 2.)it would result in tissue destruction, bleeding that could not be controlled or unmanageable pain.

[hagakuru]

No way they should of removed that impaled object like that. They should of stabilized/imbolized the object and transported. Only time you should remove an object is if it is restricting the airway or the ability to potentially resusciate the Pt.