Full CPR in the back country is problematic. If someone's heart stops, they are going to need immediate professional medical care. CPR is great until the medics get there and defib and/or continue it on the way to the hospital, but you won't sustain someone for hours with CPR or "restart" their heart. Regardless, I would still administer CPR. Rescue breathing is different. I do agree that a mask is more of a convenience, particularly if someone isn't bleeding from the mouth.

Here is some interesting on CPR and EMS response from http://www.americanheart.org:

"Cardiopulmonary Resuscitation (CPR) Statistics

There are no reliable national statistics on CPR because no single agency collects information about how many people get CPR, how many don't get it who need it, how many people are trained, etc. Many studies have examined CPR in specific communities. While they show varying rates of success, all are consistent in showing benefits from early CPR.

These statements are fair generalizations:

Early CPR and defibrillation (de-fib"rih-LA'shun) within the first 3–5 minutes after collapse, plus early advanced care can result in high (greater than 50 percent) long-term survival rates for witnessed ventricular fibrillation (ven-TRIK'u-ler fib"rih-LA'shun).
The value of early CPR by bystanders is that it can "buy time" by maintaining some blood flow to the heart and brain during cardiac arrest. Early bystander CPR is less helpful if EMS personnel equipped with a defibrillator arrive later than 8–12 minutes after the collapse.
Sudden cardiac death (S.C.D.)

Sudden cardiac death from coronary heart disease occurs over 900 times per day in the United States. The risk in adults is estimated to be about 1 per 1,000 adults 35 years of age and older per year.
Sudden cardiac death in the young (people less than 35 years old) is much less common than in adults, occurring in only 0.5 to 1 child per 100,000 per year.
A review of published studies that report initial heart rhythms during cardiac arrest in children indicates that the majority (40–90 percent) have asystole (a-SIS'to-le) or pulseless electrical activity when first evaluated. However, ventricular fibrillation or ventricular tachycardia (ven-TRIK'u-ler tak"eh-KAR'de-ah) is found in about 7–14 percent of all children in cardiac arrest in the prehospital setting.
Automated external defibrillators (AEDs)

AEDs are computerized devices that are now about the size of a laptop computer. They can be used by healthcare providers (such as Emergency Medical Response providers) and by lay rescuers. They are attached to victims who are thought to be in cardiac arrest, and they provide voice and visual prompts to lead rescuers through the steps of operation. AEDs analyze the victim's heart rhythm, determine if a defibrillation shock is needed, then prompt the rescuer to "clear" the victim and deliver a shock.
Lay rescuer AED programs (also known as Public Access Defibrillation or PAD programs) train lay rescuers such as security guards, police and firefighters in CPR and use of an AED and equip the rescuers with automated external defibrillators (de-FIB'rih-la-torz).
The first out-of-hospital defibrillation device weighed 110 pounds; today they weigh less than 8 pounds.
Increased survival with CPR and AEDs

Studies have repeatedly shown the importance of immediate bystander CPR plus defibrillation within 3–5 minutes of collapse to improve survival from sudden VF cardiac arrest.
In cities such as Seattle, Washington, where CPR training is widespread and EMS response and time to defibrillation is short, the survival rate for witnessed VF cardiac arrest is about 30 percent.
In cities such as New York City, where few victiims receive bystander CPR and time to EMS response and defibrillation is longer, survival from sudden VF cardiac arrest averages 1–2 percent.
Some recent studies have documented the positive effect of lay rescuer AED programs in the community. These programs all ensure adequate training, and a planned response to ensure early recognition of cardiac arrest and EMS call, immediate bystander CPR, early defibrillation and early advanced care. Lay rescuer AED programs consisting of police in Rochester, Minn., security guards in Chicago's O'Hare and Midway airports, and security guards in Las Vegas casinos have achieved 50–74 percent survival for adults with sudden, witnessed, VF cardiac arrest. These programs are thought to be successful because rescuers are trained to respond efficiently and all survivors receive immediate bystander CPR plus defibrillation within 3–5 minutes"

"What do you plan to use to stabilize/support fractures and sprains?"

"Bandanas, clothing parts (long sleeves and legs from silkweight base layers are great), fleece, insulated vest, belts and pack straps, sleeping pads, trekking poles or tent poles, sticks, water bladders, duct tape and pack frame sheets.

Ditto.

At that level of response, especially for a solo backpacker going as light as possible, improvisation and multi-use of supplies is the name of the game.

I also occasionally carry (usually tied around my head or neck) an olive green military "tri-bandage" which is a large triangle of cloth what can be used for multiple purposes - however I find that to be a convinence mostly.

The Importance of Self Rescue vs Professional Rescue

As a member of a SAR team I know the importance of getting a professional rescue... but I also know the difficulty involved... sometimes SAR is busy with another mission. Sometimes it is too risky to deploy a team. Sometimes you are are beyond the ability of SAR to reach you easily. You should be prepared to effect as much self rescue as reasonably possible. If your self extrication fails you need to be able to hold out and stabilize until rescue can be effected by oustide parties. How long until they even know? Do you have a radio or phone? Are you in communication range? Will rescue not come until you are overdue? (hopefully you left an itinerary and check in times).

With good communications and helicopter deployment here, a SAR medic can be to you in 30 minutes! Can you help stabilize a yourself/a critical pt until then? What about an hour? What about a lot longer?

Is My Kit Extra Large?
You’ll notice that several items in my kit are removed depending on the activity. My proclivity towards higher risk act ivies and my involvement with SAR is the major reason that I have a significant trauma component to my first aid kit. If all I did was class 2 and occasional class 3 summits and trails, I’d carry significantly less. That is all a lot of people do and they are happy and nay not need the beefier trauma compenent.

Trauma sheers are very rare… usually only come along for SAR, kayaking, maybe BC skiing.
Pocket mask/OPAs come along only for SAR, BC skiing, kayaking, extended trips above treeline in the summer.
SAM splints comes along only for activities where extremity injury is likely and improvisation would be troublesome: SAR, BC skiing with snowboarders present, longer treks with heavy packs, going solo.
Coban is so usefull and multipurpose... especially if you have to do wound care/check circulation on the immobilized area! It is also better than anything else for strengthening and supporting an ankle/knee/wrist/elbow while still leaving it mobile.

The rest of the trauma kit is multiuse and light probably even to a gram counter (I’m an ounce counter). I prefer not to improvise trauma dressings from my probably otherwise needed and often pricey clothing. However, I’ll be more than happy to tear up the patient’s clothing as needed.

Bandaids because infections suck and they reduce pain and further injury, speed healing, etc.

Meds/packets are extremely small and extremely light even to a gram counter… and then you consider the great relief and use they can deliver especially from such a small package.

As for the need for CPR/Barriers… rescue breathing

Here are just a few backcountry maladies off the top of my head that could require rescue breathing: progressive phase of most types of shock, closed head injuries, lighting strike victims, near drownings, near suffocations, severe asthma, severe anaphylaxis, severe hypothermia, certain c-spine injuries, some seizures, HAPE, HACE, severe smoke inhalation, temporary airway obstruction combined with unconsciousness, etc etc etc...

Those are some pretty darn good reasons to carry a CPR barrier. If I find you on the trail and you aren’t breathing, you probably aren’t going to get any more than two rescue breaths from me unless I have barrier or mask (unless I know you and like you a lot). If you already have blood/vomit on you, I might not give you 2 rescue breaths. I don’t intend to catch a life long, possibly fatal disease trying to save you. Also, the thought of someone puking down my throat while I breath for them is somewhat unappealing. So, I carry an extremely small/light barrier at all times. I carry a mask when the risks are higher.

You’ll want a barrier when you consider that without one, statistically, the chance of exposing yourself to disease is about equal to the chance of saving their life.

The same theory is behind having a pair of gloves. I'm not touching your blood/vomit/*BEEP*/urine with my bare hands.

Backcountry CPR
As for CPR in the backcountry, it all depends on what happened to them. Not all arrests are from blunt trauma (which has a near zero save rate). Most avalanche fatalities are suffocation/CO2 toxicity (then trauma, then hypothermia). I have a friend who performed CPR for 45 minutes on one of his friends who bought it in a slide. Most river deaths are drownings. Two weeks ago, we had a guy fall into a lake and drowned during an MI! I would imagine most mountaineering deaths are hypothermia and shock followed by massive blunt trauma. Backpacking? I have no stats but I’d wager MI, hypothermia, and shock are at the top. The Wilderness Medical Society protocol for wilderness CPR is 30 minutes, less if provider will be endangered.

Edited by Summit on 06/24/2006 20:35:37 MDT.

Well, sounds like you got your gear figured out in accordance with your likes and wants and needs.

Your talking plenty about stabalizing people and so on and so forth... but if someone is solo and not breathing, they are NOT going to be effecting "self rescue" anytime soon. If someone is bleeding so bad they cant wait 30 minutes for SAR to come pick them up, then they have bigger problems than keeping their t-shirts clean and in one piece. And theres lots of anti-biotics out there that you can slather between the cut and the wrap to get home. If your really worried about it after that, go get a shot of penicillian.

Summit CO wrote: "If I find you on the trail and you aren’t breathing, you probably aren’t going to get any more than two rescue breaths from me unless I have barrier or mask (unless I know you and like you a lot). If you already have blood/vomit on you, I might not give you 2 rescue breaths. I don’t intend to catch a life long, possibly fatal disease trying to save you. Also, the thought of someone puking down my throat while I breath for them is somewhat unappealing."

That sounds like grounds for a negligence lawsuit to me. Also keep in mind that if you begin to provide care you are legally required to continue...ie if the patient starts vomiting during CPR you can't just stop. Sounds like a good case for carrying a CPR barrier, right?

Interestingly, the national EMT-B textbook states "there are no documented cases of disease transmission to rescuers as a result of performing unprotected mouth-to-mouth resuscitation on a patient with an infection".

I consider a CPR barrier invaluable in any situation requiring rescue breaths, but the chances of actually needing one in the wilderness is practically zero. What are the odds of having to perform CPR on some one in your day to day life...one in a million? How about on the trail, when you see much fewer people (potential victims) than in the city...one in a billion?

Sure if you're on a SAR call you'd better bring BSI equipment, but otherwise it's only there for your mental comfort...to satisfy the "what if..?" part of your brain.

you can only be sued if you are on duty. Otherwise you have no required duty to act. You can initiate care and terminate care if continuing care puts you in danger, be it real or perceived. I would never do mouth to mouth w/o a barrier. That doesn't make me a bad or negligent person.

Along the same lines I'd probably never do CPR in the backcountry because I realize its not going to do anything.

Yes, most states have aGood Samaritan law, so you might get sued, but they probably won't win.

99% of my hiking is with family and that tends to change your perspective.

As to SAR response, they do a great job and the services in my area are great, but you need to be in radio/phone contact to be effective; otherwise someone has to hoof it out to call for help. If my heart stops, I would think I would be pretty dead. If I fell in cold water and drowned and was out for a couple minutes, I would appreciate a few jump-start breaths.

If someone is really bleeding and propulsive vomitting, you're gonna get some on you. Most parents have been there and have the (stained) tee shirt. With a medical professional who is being exposed on a daily basis, it is aw that they protect themselves and the law of averages says they should too.

"Your talking plenty about stabalizing people and so on and so forth... If someone is bleeding so bad they cant wait 30 minutes for SAR to come pick them up, then they have bigger problems than keeping their t-shirts clean and in one piece."

If you think you can call SAR on your cellphone, and they can get there and start providing care all within 30 minutes, or even an hour of the accident, I posit that you are extremely close to civilization and/or (probably and) are in an area blessed with helicopters (and the whether is right/they aren't busy) and a very very good SAR team as well as cellphone coverage (and not in a valley). (I'm lucky, about 50% of my regular play area has excellent radio/cell coverage served by the best SAR team and helicopter service I know of)

However, a little bit of tools in your kit and you can really make a difference in bleeding control. I can do a lot more to save someone (or myself) with hemostatic bandages, 3x3s, or pressure bandages than with a down jacket or a polypro top (which I/they might need for warmth). Proper technique is key, of course (pressure points, elevation, etc).

But then weigh the likelihood of such trauma... are you scrambling/climbing and traveling through exposure or is the biggest danger tripping over a log, cutting yourself, or a freak animal attack?

As you said, my kit is oriented toward my higher trauma risk activies.

"if someone is solo and not breathing, they are NOT going to be effecting "self rescue" anytime soon."

Yes, that is because they are dead. :-P

All BSI is solely for protecting one's self while providing care to others.

----------

I think all the other points were effectively addressed by others.

Edited by Summit on 07/04/2006 01:34:11 MDT.

This might be slightly off topic. I was listening to a podcast with Shana Tarter of the Wilderness Medicine Institute. Towards the end, she listed the five items she would carry in a first aid kit, if she were limited to 5. I will listed them here:

Gloves
1.5" or 2" Athletic Tape
Tylenol, or Ibuprofin
Needle Nose Irrigation Syringe
Micro-thin dressing (OpSite, TegaDerm)

I am sure her first aid kit is more extensive than 5 items. My current store bought kit only has 2 items on her list, the athletic tape and the drugs. It got me thinking that I should put a lot more thought into my kit. By the way, there are a lot of great podcasts at www.practicalbackpacking.com

Edited by ericnoble on 07/05/2006 09:03:59 MDT.

You seem to miss the point Summit.

I was being factious by saying 30 minutes.
Hell, I would be factious if I said 30 hours for some locales.

My point was more directed to the fact that if your "first aid" has degenerated to the point that you must call SAR to rescue you, you have bigger problems than an ULTRALIGHT first aid kit can handle, and in that sort of situation, the solution is to sacrifice a little comfort and press non-FAK items into FAK roles.

I dont quite get where you made the illogical leap from cutting the leg off of some long underwear, or a strip of shirt material off the hem, and using it for an improvised bandaged... and somehow turned that into "a down jacket" or an entire polypro top... but whatever, maybe thats what you got?

BTW, I didnt say anything about your "higher trauma risk activities". Maybe thats what you read, but thats not what I said. Risk is subjective. Solo changes dynamics. Hike your own hike.

This might seem mean but my 1st Aid Kit is for my needs not yours.

I am not out in the woods to play doctor. If I come upon you hurt on the trail I will get out your 1st Aid Kit and do everything I can to help you. If you happen to be bleeding a lot I will use some part of you cloths or other stuff to stop or control your bleeding, I know how to do that.

If you die in my care I will check out your gear to see if you have anything good and help myself to it (house calls in the woods cost a lot). After all the local animals will just chew it up if I don't take it. I will wrap you up in your stuff (what ever is left) and mark the spot and report it next time I see the right person or whenever I get to the next town. I don't drag dead bodies out of the woods.

So how much of this is the way I really feel. The true part is that my 1st Aid Kit is for my needs not yours. If you don't take the responsibly for your 1st Aid needs don't expect me to give you mine.

This all changes if we are on a planned hike together or I am a hike leader. The 1st Aid Kit then is something (we/group) needs and what we take needs to be decided as a group even if it is just two of us. I have been on large group hikes where we even had one or more doctors along. That was nice as they even checked everyones feet each day for the first sign of problems.

Edited by bfornshell on 07/04/2006 11:43:27 MDT.

In case some missed it in all the banter, CPR
is very useful for some situations such
as cold water drownings and lightening strikes.
There is a decent probability you can save a
life.

I have had one friend brought back after
a strike hit a party climbing on a tower in Utah,
and also a high school teacher who brought back
a drowning person with back compressions
while floating on a log raft.

A local ER doc who does winter SAR with us
summed it up- most times CPR won't help
so don't feel bad if it doesn't work, but in
select situations it can be a wonderful tool.

I would add, at least get the A (open the airway)
in the ABC's if you do nothing else.

Edited by oware on 07/04/2006 16:28:52 MDT.

I dont think anyone doubts the usefulness of CPR, and really, some of those thin barriers are too light not to at least consider carrying them...

Here's what one paramedic suggests.

Eric - Nice find there with that link! Thank you! To think, all the times I put tegaderm on my IV start sites I never really thought about it. That podcast is definately going to have me looking into it. Light bandages that last longer and need to be changed less means I need to carry less bandaids and blister control!

Chris - I think that site has a nice list for a FAK!

JR - I'm not trying to be disrespectfull. In fact, I don't actually disagree with you on much except for the posibility of having the right (light) tools in your kit can, in many situations, really make a difference in stabilizing a patient until SAR can arrive, especially with a bleeder. For example actcel hemostatic 4x4s, though pricy at $12ea (4x2s $6), really can make a difference in stopping real bleeding far more quickly than pressure dressings/gauze alone, much less improvised bandages from clothing. In truth my trauma bandaging section of my kit is only about .7oz (minus the coban).

"I don't drag dead bodies out of the woods."



First Hiker: "Is he dead?"
Second Hiker: "Sure looks like it"
First hiker: "Roll him over and we'll take the air mattress.
Second hiker: "Okay, but I get the shoes..."

Edited by dwambaugh on 07/05/2006 10:16:53 MDT.

Summit, You have a real nice list, but Holy Cow! A box of 20 4x4 ActCel Hemostatic Gauze costs $240 and a box of 20 2x4 ActCel Hemostatic Gauze costs $180! I like that it expands to 3-4 times its original size when coming into contact with the blood and that converts to a gel that dissolves into glucose and saline over a 1-2 week period, but dang… those are some expensive FAK components.

Edited by mikes on 07/08/2006 08:50:16 MDT.

Yes, ActCels are very expensive. It is possible to buy $12 singles from some online stores. Nobody needs to buy a $240 box unless it is a groub buy! The shelf life of these things is 5years.

Their purpose isn't for every scrape and cut. They are for helping to rapidly stopping bad bleeds, and in a light kit, stopping bleeds that are sufficiently bad that it might use up most or all of your other gauze/bandaging produces when using conventional bleeding control methods.

Other products that can be considered are the QuickClot Sponge and TraumaDex, but I believe the ActCel is far easier to use, requires essentially no training, and has virtually no risk of complications. The HemCon Bandage is very similar to the ActCel. It is what the US Military uses. However, they are $150 PER BANDAGE. Makes the ActCel seem like a good deal... Still certainly not cheap.

I actually tried to use a modified slit-in-a-finger-exam-glove as a barrier device on a CPR dummy in ACLS class, it didn't work for me. The wrist portion of the glove didn't have a wide enough opening and well... it just didn't work that well

Joseph, thanks for trying this and reporting back.