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Thanks for your comments, Christopher. The structure portrayed in this video is consistent with that expected by the EMR licensing body here in British Columbia. I am not sure exactly what your complaint is around the use of pulse oximetry at this point in the call, but it is not examined until after ABCs have been verified. We certainly don't teach anyone to rely exclusively on the pulse oximeter when determining oxygen needs, but in this case, where there is no increased work of breathing, history of inhalation injury, and no injuries consistent with or other indications of shock, applying O2 based on pulse oximetry is entirely appropriate, and helps to target the right amount of oxygen to administer to achieve a target SpO2 greater than 99%. I appreciate your observation that at a fire scene, where there is a risk of CO poisoning or other inhalation injury, the SpO2 isn't a reliable indicator but... this scenario doesn't take place at a fire scene, so I'm not sure the criticism is relevant. A good idea for a future video, though!

Thanks for visiting! I know its been a while, but we have more being planned, and are looking forward to rolling them out in the next few months. I hope you enjoy!

Hello! Thanks for replying. You can't really see in this video, but the feet should be tied together so the toes are pointed up to prevent the lateral rotation of the legs that I think you are referring to. There is quite a bit of evidence to support the application of a commercial pelvic binder - for example a T-Pod or SAM Pelvic Sling - to someone who has evidence of a pelvic fracture. There is an overview from the BC Emergency Health Services treatment guidelines, available here: handbook.bcehs.ca/clinical-practice-guidelines/h-traumatic-injuries/h08-pelvic-trauma At the bottom, there is a link to the clinical evidence supporting these practices. The effectiveness of the improvised version presented here is going to be more dependent on the user - a great reason to get trained and maintain those skills through refreshers and recertifications! - but the principles, if proper tying and positioning are used, are much the same as the T-Pod style pelvic binder, and are very likely to help reduce further injury and mortality in an unstable pelvic injury.

Thanks for the comment. The video is not just to demonstrate the treatments, but also to help students prepare for the provincial licensing exam by demonstrating a structured approach to patient care, and ensuring that ABCs are taken care of. At the time the video was made, licensing guidelines here in British Columbia required the examinee to take the first set of vital signs themselves. That, fortunately, has changed, and delegation of vital signs in this situation be not just acceptable, but encouraged as the best way to manage resources in this situation. That being said, however, I hesitate to encourage responders to rush. A full set of vital signs does not take an inordinate amount of time, even without the ECG monitor and NIBP, which EMRs do not have access to in BC. Thanks again for commenting - have a great day!

Perhaps it's something that would have occurred in real life, but since they wanted everyone to be wearing a mask, they decided to ignore that for the scenario

@@roboticdreamer Yeah, I get that, but this is an instruction video on how EMS providers should approach patients. Realism should be a key factor in these videos, especially since many new EMTs are timid about exposing patients.

Hi Alistair - thanks for your comment! One of the great things about wilderness first aid is the improvisational nature of field. What else might you have that could work as padding on this splint? A tent fly or a sleeping bag would work great - or an inflatable sleeping mat would make for super comfy padding on this splint! Of course, you will still need to keep your injured subject warm... If no padding is available, or can be spared, you can still splint the leg - just be really careful about any irregularities in the surface that might cause pressure sores or discomfort while you are waiting for evacuation.

@@coastwildernessmedicaltrai4040 liking your videos.

Are you allowed to allign a suspected femoral fracture?

Hey Carter - as Quinn points out in the beginning of the video, this is for a non-weight bearing injury. So, although our volunteer's leg looks fine, you can imagine something that has a visible deformity, indicating that the area of the fracture is pushing outward towards the skin. (Not even the offer of extra pastries could convince Iona that we REALLY needed to make it more realistic!) With this type of injury, it is unlikely that any sort of splint could help our patient walk out. What we are really trying to do here is stabilize so the injured area doesn't move and worsen the damage, in preparation for extrication. Optimally, this would be a professional SAR extraction, but if there were enough people, and depending on distance, terrain and weather, a sturdy improvised carry device might suffice as well.

@@coastwildernessmedicaltrai4040 gotcha, makes sense and they secured the heck out of that leg, ive just been watching some videos thinking about " damm what would I do if im out in the back country and I slip and break my shin, ankle, femur, any of that..." My mind goes to worst situation but if i got a bone sticking out my skin and im by myself I guess I'm fucked😂

@@cbulldog22 Signaling options. Solo hiking carries risks but is just so very lovely! InReach and Spot devices are your best bet, but it is important that anyone venturing beyond the safe confines of the city (or their sofa) maintains an awareness that we can mitigate risk, but not eliminate it. Of course, that is part of the allure, isn't it!

@@coastwildernessmedicaltrai4040 absolutely my man, theres something special about tackling the mountains with nothing but yourself, that being said we always gotta mitigate the risk we take, so we can keep gettin after it 💪

We've taken a slight hiatus from videos, but that will definitely be on the top of the list when we are back to it! :)

Hi Sheriden When you do a log roll, the hand that is holding the trap (in this case the right) becomes your anchor, allowing your forearm to support the weight of the head. This is quite important, because you will no longer be anchoring your elbows on the ground for stability - having that solid forearm and locked wrist on the bottom allows you to maintain the alignment of the head and torso during the roll.

Thank you! We have some in the pipeline!

If there is any indication of alteration to mental status, I would agree with you - and I don't limit that to clinical findings of disorientation, or decreased GCS. If, for example, I have a patient whose family states that they are acting 'off,' I am probably going to include a blood glucose check in my assessment, even if they can answer my questions accurately. (Trust the people who know your patient!) Incidentally, in that case, I am probably going to do a BGL even the patient isn't diagnosed as diabetic - if I am investigating altered mental status, its a pertinent part of my assessment. However, if they are alert, oriented and acting normally, its difficult to see what I would be looking for with that blood glucose check. It isn't a comfortable thing to have done, and while the risks of an infection are very low, they do exist, especially in certain populations.

@@CoastWildernessMedicalTraining Thank you! Makes sense.

We call that being a hero.

Thoy

Yeah, absolutely - if you can get that information. I have found that few people know their normal heart rate. This is why comprehensive, thoughtful assessments, and repeat vitals to look for trends while they are under your care, is so much more important that focusing on one number.

Hi Frank, Great question! Triangular bandages are useful for a wide range of first aid scenarios. Splinting, multi-trauma, large wound care and a few others. Some of them can also pack down quite small, so I would recommend carrying at least a few. If not, then they can also be improvised by using non-stretchy clothing such as t-shirts and sweaters. It is more about the principal of binding a pelvis as opposed to the exact materials. Cheers, Coast Wilderness Medical Training