Applying the SOAP NOTE format to Avalanche Safety:

by Fay Johnson

 

S: (Subjective Information)

When choosing to venture into avalanche prone areas, first do some homework.

Go online to to access Avalanche Forecast Centers that provide

critical information regarding past and present snowpack and weather information.

If you plan to travel to mountainous terrain that you are unfamiliar with, seek

data from local ski shops, friends and other backcountry users that have been

in that area recently.  Try to ascertain the following:

Has there been any new snow in the past 48hrs.

What have the winds been like in that area in the past 48hrs

Is there a know weak layer in the snowpack

Have there been reports of recent avalanches in the area in the past 48hrs.

 

O: (Objective Findings)

Once you are in the field, be a good observer and detective.  Look for signs of recent avalanche

activity on slopes of similar aspect and elevation to those you plan to play on.

Be observant of past, current and anticipated weather conditions.

Remember that the recipe for an avalanche includes:

A slope steep enough to slide (30-45 degrees)

A cohesive layer of snow (a slab)

A weak layer (within the snowpack)

A trigger (a skier, snowboarder, snowmobiler)

If you hear or see signs of instability (cracks in the snow radiating from your skis,

a “whomping” sound, recent avalanches etc) alter your travel plans to avoid crossing

or traveling under steep slopes.

Remember treed slopes are not always safe and seeing other ski tracks on a slope

does not guarantee safety either.

 

A: (Assessment)

Combine the subjective information you gathered before your adventure, along with the observations you make in the field and come up with an assessment of the potential hazards in the area where you plan to go.

 

P: (Plan)

Based on all the information you have obtained so far, come up with a “travel plan” for your day of recreating in avalanche terrain AND come up with a “rescue plan” if despite your best efforts, something bad happens.

Your “travel plan” might include things to AVOID such as:

Slopes steeper than 35 degrees that have had recent wind loading

Slopes that terminate in a gully or streambed (terrain trap if the slope slides)

Your “rescue plan” might include:

What is your easiest route out (not always the same way you went in).

Is there cell phone service where you are going?

Leave your “proposed itinerary” with someone at home.

Have a projected return time.

Know who to call for rescue help (local SAR, County Sheriff, 911 etc)

 

Remember, back up “your plan” by ALWAYS following the 3 rules for safe backcountry travel:

Everyone in the party should carry and know how to use avalanche rescue gear

(transceiver, shovel and probe)

Always travel one at a time when crossing or skiing avalanche terrain

Watch your partners from a safe location so you are ready to respond

immediately if a rescue is necessary.

 

 

 

 

When venturing into the backcountry, evaluating the avalanche hazard requires an understanding of the terrain, weather and snowpack of the area in which you intend to travel. Regardless of how much care is taken, it is possible that someone may be caught in an avalanche. Prior planning may help you or your partner survive.

Statistics indicate that a person found after being buried less than 15 minutes has a 90 percent chance of survival. Burial times of 30 minutes have a survival rate of 50 percent. (These statistics assume no traumatic injuries) Time is crucial. You or your companions provide the key to a successful rescue.

What Can You Do If Someone Is Caught and Buried in an Avalanche?

  1. Remember to breathe.
    Since you were standing in a safe spot and practicing safe travel techniques, only one person was exposed at a time. This resulted in only one unfortunate burial rather than multiple burials with no immediate rescuers.
  2. Remember to beep.
    Your partner was wearing an avalanche rescue beacon. You made certain your beacons were in good working order, and you practiced with them regularly. You and your partner were both wearing single-frequency 457 kHz transceivers turned to transmit when you left the car. This is when your practice will pay off. Now, turn your beacon to receive.
  3. Remember to look, listen and feel.
    If you are confident there is no immediate danger to you as the rescuer, proceed with a rapid primary beacon search, while looking for surface clues such as equipment or a hand sticking out of the snow. Once you pick up the signal from your partner’s beacon, continue your search until you can pinpoint his location. At this point an avalanche probe will help you determine the exact location.  Remember, never leave home without your beacon, probe and shovel. Now, start digging.

Written by Fay Johnson

IMG_0402 copy 2Coming up: 5-day WFR Course in Costa Rica

Join Boreal River for a week long Wilderness First Responder (WFR) course and paddling adventure on the Pacuare River in Costa Rica. Starting on February 19th 2017.

Combine training with travel in the tropics

The 5-day WFR format lets you prepare for the course at your leisure prior to the trip. This way we can spend more time on simulations and hands on skill building. The week is an action-packed adventure where you’ll gain skills, confidence and certification.
After meeting in San Jose and travelling through beautiful countryside by road, the true adventure begins at the riverbank. You will join your instructors, and professional guide team from Coast to Coast Adventures – our local hosts with over 20 years of experience running trips, courses, and adventure races in the region; everything is packed into dry bags and loaded the rafts. Your group paddles and floats 6 miles of the Rio Pacuare through fun rapids and jungle clad gorges to reach the first eco-camp, El Nido Del Tigre.
Later in the week, after 3 course days at and around camp, you’ll raft the next section of the river. Your group will pass through the deep and spectacular ‘Huacas’ and ‘Dos Montanas’ canyons paddling rapids and drifting by pounding waterfalls that spray wind and mist and by untouched rainforest buzzing with surrounding sounds. The descent on this day includes medical simulations along the way, allowing students to put knowledge and skills to practice in a remarkable wilderness setting.

Lodgings and the Jungle Classroom

With great fresh food, spacious lounging areas with hammocks, platform tents, bathrooms, and showers – all well maintained, sustainably built, and looked after by caring local staff – the camps make for very special course locations and homes. Toucans glide between towering trees trees while giant blue butterflies, sloths, and orchids are spotted amidst lush greenery. Students find that staying at the camps is a highlight of their experience in Costa Rica.

New Life for the River
 Nov25,WoR 021.jpg copyThe Pacuare is considered one of the best rafting trips on the planet. Yet, despite its world-class status, the river remains unprotected and threatened by development projects. Last year, after rafting the river, Costa Rica’s president Luis Guillermo Solís signed a decree banning dams from the Pacuare for 25 years. Thanks to the locals who have been fighting for the river for years, this is an important event and hopefully a step on the path to permanent and full protection.

 

Details

Dates

February 19-25, 2017

Enrollment Deadline

February 5, 2017

Price

$1,399 USD

Who’s this course for?

This course is for anybody aged 18 and up who is in good physical condition. No previous medical or river experience is necessary. It is important to have the discipline and learning style to complete the independent study component prior to arrival. The course is taught in English.

What’s included?IMG_0651 copy 2
Lodging, meals, return transport from San Jose, guided rafting, tuition, text books, and all training equipment.

What’s not included?
Flights to and from Costa Rica, travel and medical insurance, personal items and clothing

Details and Request to Book
  18. Raft copy

From WMA Instructor Greg Hren:

I love being part of the WMA family. Having taken my first WFR class over a decade ago, its amazing to appreciate how much one eight-day period can change a life.

First and foremost, what I love about teaching is the people we get to meet and the places we get to visit. From my fellow instructors, to class participants, to the sponsors running a course, it never ceases to amaze just how interesting individuals can be.

Splint

Fundamentally, it seems that the pursuit of backcountry medical knowledge draws the most amazing folks from all corners of the globe, and if you’re patient and listen carefully, it soon becomes clear that everyone has a story.

This story however doesn’t end with individuals, but continues into the environment where the learning takes place. Fellow instructors Eric Duffy, Andy Hagan, and myself are up in Wiscassett, ME at The Chewonki Foundation this week teaching a WFR Bridge course. Beyond the evolving stories and the developing friendships, what has struck me as particularly touching this year is the sustainable farm here on the grounds.

Sim

Lying just on the periphery of our experience here at Chewonki, is what seems to be a very magical place. We hear it through the trees while conducting our simulations; we smell the freshness of the livestock while walking the trails; and best of all, enjoy the stories from the farmers while we eat fresh greens from the garden, milk, butter and yogurt from the cows, and grass-fed meats on our table.

If you have the chance to visit, or partake of one of the summer programs, or are lucky enough to take a WMA course here at the Foundation, I hope your experience is as inspiring as mine has been.

Thank you Chewonki for a wonderful week!

Greg Hren

 

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Check out WMA’s Instagram feed for more of Greg’s images from the Chewonki WFR course.




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When venturing into the backcountry, evaluating the avalanche hazard requires an understanding of the terrain, weather and snowpack of the area in which you intend to travel. Regardless of how much care is taken, it is possible that someone may be caught in an avalanche. Prior planning may help you or your partner survive.

Statistics indicate that a person found after being buried less than 15 minutes has a 90 percent chance of survival. Burial times of 30 minutes have a survival rate of 50 percent. (These statistics assume no traumatic injuries) Time is crucial. You or your companions provide the key to a successful rescue.

What Can You Do If Someone Is Caught and Buried in an Avalanche?

  1. Remember to breathe.
    Since you were standing in a safe spot and practicing safe travel techniques, only one person was exposed at a time. This resulted in only one unfortunate burial rather than multiple burials with no immediate rescuers.
  2. Remember to beep.
    Your partner was wearing an avalanche rescue beacon. You made certain your beacons were in good working order, and you practiced with them regularly. You and your partner were both wearing single-frequency 457 kHz transceivers turned to transmit when you left the car. This is when your practice will pay off. Now, turn your beacon to receive.
  3. Remember to look, listen and feel.
    If you are confident there is no immediate danger to you as the rescuer, proceed with a rapid primary beacon search, while looking for surface clues such as equipment or a hand sticking out of the snow. Once you pick up the signal from your partner’s beacon, continue your search until you can pinpoint his location. At this point an avalanche probe will help you determine the exact location.  Remember, never leave home without your beacon, probe and shovel. Now, start digging.

Q: The new medical advisor of our guiding company has advised us not to distribute over-the-counter medication to our clients. What is your opinion?

Technically, one could argue that giving medication under these circumstances (paid guide giving to a client, non-family member) could be considered practicing medicine without a license.  Many school nurses are prohibited from dispensing over-the-counter (OTC) medications, let alone specifically prescribed medication to students.

There are some good reasons not to routinely include OTCs in all first aid kits.  First, aside from pain medication, antihistamines (for allergic reactions and motion sickness), and maybe some of the gastrointestinal (GI) products for heartburn and diarrhea, most other OTCs have little real value.  If we focus on acute problems, you can usually toss out the GI.  Symptomatic relief for coughs and runny noses certainly do not change the course of an illness.  Second, you should not be dispensing OTC medications without training. To treat, you have to make a diagnosis and then have a realistic expectation of improvement.  OTC medications are not innocuous.   For example, not only will giving an antihistamine for a cold be useless, it could also cause complications.  And third, aside from acute pain from an injury, many of the conditions for which these would be used are either predictable or recurrent.  If either of these is true, clients can bring their own.

Each guiding company has its own unique challenges and capabilities.  Do you have standardized first aid kits and uniform care protocols?  Many have neither.  Are all of your trips the same?  For a group that could be hours from help, I would expect uniform first aid kits and training that would cover their contents and use.  The list of meds would be limited and focused, varying by the environment and duration.  A more comprehensive kit makes sense for longer and more remote trips.

Bottom Line

Routinely carrying OTCs often makes no sense.  Don’t feel compelled to have them included and don’t think badly of your medical advisors if, based on experience and knowledge of your company’s program, they don’t want you to dispense OTCs.  At the very least ensure your guiding service has a clear set of medical protocols and standardized first aid kits that are suited for your adventures. When developing these protocols, take into account liability issues to protect your company.

 

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By: Dollie Chase

“Well-behaved women seldom make history.”
Laurel Thatcher Ulrich

Thirty women made history in Freeport, Maine the weekend of May 18-19 when L.L. Bean’s Outdoor Discovery School sponsored Wilderness Medical Associates’ first ever Women’s-Only WFA course. Five years in the making, this course was the brainchild of , a former Flight Medic in Iraq and Combat Medic in Afghanistan. Sawyer taught the course along with , a full-time Firefighter and the only female in her squadron.

I consider myself lucky to have had the opportunity to take this course alongside my new coworkers, Renee and Carrie. We were all a bit nervous the week prior to the course, as we were going to spend our weekend doing “outdoor stuff” that none of us had ever done before, and we were going to be tested!

We had a basic understanding of the course because we all work in the WMA office. Renee picks all the paperwork, books, and gear. I put together all the fastpacks (first aid gear), purchase all the textbooks and medical supplies; while Carrie boxes everything up and ships it to the course location. We all answer emails and phone calls from students, sponsors, and instructors regarding course content and preparation. However, we don’t do a whole lot of outdoor activities other than some gardening or going to the beach.

On the morning of the course, I was impressed as soon as I walked into the L.L. Bean facility. Everything was well-organized and they had put out a very nice spread of scones, bagels, fruit, coffee, and tea. Within a few minutes I’d met a middle-school science teacher, a Bowdoin college student, and a Paterson, NJ Police K-9 Rescue Officer. I realized it was a very diverse group, so I began to relax.

Within the first hour, all nervousness had vanished. Sawyer and Michelle, both expert instructors, put us all at ease. They taught with just the right amount of real-life experience, lecture points, and my personal favorite – emergency simulations. I thoroughly enjoyed the simulations because although the subject matter was serious, it was a lot like role-playing. We had to devise a strategy and then see how well we could carry it out.

I don’t think I could have had as much fun or had such a high level of comfort if it hadn’t been a women-only class. There was a lot of laughter, as well as skill-building, teamwork, cooperation, fearlessness, and finally, a sense of empowerment and accomplishment at the end of the course. I drove home exhausted, but with a great big smile on my face.

I would highly recommend a WMA Wilderness First Aid course to anybody, male or female, who wants to boost their confidence and learn some valuable new skills. If you spend a lot of time outdoors, especially in remote areas, this knowledge would be important to have.

Renee, Carrie, and I agreed that a WMA course would be an awesome team-building getaway weekend for any group. We all enjoyed the opportunity to get to know each other better. We were also impressed with the instructors, who really cared about our learning process and ensured that we were able to absorb the concepts of wilderness medicine.

We all enjoyed being part of the Women’s-Only class. We met a lot of interesting, intelligent, self-driven women – not unlike ourselves! If women request more classes like this, I believe they will become more commonplace.

The three of us all feel more comfortable at work now, as we don’t just know the courses from the office standpoint anymore. We had a chance to experience one, so our customer service skills have improved as well.
We all feel stronger today and yes, a bit special, too. We did it and we helped make WMA history in the process.

“The question isn’t who’s going to let me; it’s who is going to stop me.”
Ayn Rand

FREEPORT, ME – L.L. Bean has partnered with Wilderness Medical Associates to offer a Wilderness First Aid (WFA) course. This course, unlike the standard Wilderness First Aid, is available exclusively for women. WFA training is imperative for people who are looking to experience outdoor adventure, safely, giving you the knowledge and confidence to assess and manage medical emergencies when there is no help nearby. Wilderness First Aid will expand your awareness of potential hazards in the backcountry.

May 18 & 19, 2013
Freeport, ME
Cost: $205 (including textbooks)

fosters a dynamic and supportive learning environment. This training will provide a rare opportunity to share the unique perspectives and knowledge base of other women who also enjoy outdoor recreation. Come propose or share new ideas and see if “mom’s old remedies” are still the best medicine. Feel confident in adventuring into the outdoors while enjoying the camaraderie and diverse experiences of other women in this empowering course. Course topics include:

  • Anaphylaxis
  • CPR
  • Wound and burns
  • Fractures and dislocations
  • Patient assessment and management
  • Environmental topics (i.e. lightning, hypothermia, frostbite)
  • Splinting

Wilderness Medical Associates teaches over 8,000 students every year, across the globe. Their cutting-edge curriculum is continuously overseen by a team of medical practitioners who are active in the field, doing what they teach. The course will be led by , who is a member of the Vermont National Guard and adjunct faculty at Johnson State College. This is the first time WMA has offered a Women’s-Only course.

As you may know, a number of people from a variety of wilderness training organization wrote a Scope of Practice (SOP) document in 2010 for .  The intent was to clearly articulate what we believe to be the intended audience of such a course and what a graduate of a 16 hour WFA should be trained to recognize and address when in the field.  We did this in part to respond to what I believe have been unsatisfactory efforts by other groups and to answer the suggestion that there is no standard.  This document is not binding to anyone, and is not considered as a WFA curriculum as such.

The list of the SOP authors represents organizations that have taught literally tens of thousands of students across North America and on every other continent for more than 30 years.  In turn, their instructors are actively engaged in outdoor pursuits and have some level of medical responsibility.  Some of the authors are also involved in a parallel effort to publish a paper that lays out the scientific evidence that underpins this information.

The WFA Scope of Practice was revised in 2012 as part of an ongoing process of review and upgrade.  Please to review the latest version of the Wilderness First Aid Scope of Practice, released December 14, 2012.

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is hosting a through Wilderness Medical Associates (WMA) International. The unique course will take place over 6 days on a rafting trip on the Snake River through Hells Canyon, September 4 – 9, 2013.

The WALS course is WMA International’s most advanced level course for medical professionals. This 6-day, 36-hour course is open to certified or licensed advanced level medical practitioners involved in rescue, mass casualty, and remote outdoor environments or urban areas in disaster or crisis. This constantly-evolving course is highlighted by discussions of new and innovative ideas and the appropriate application of technologies. Physicians, physician assistants, and other ALS certified professionals may receive up to 36 hours of AMA PRA Category I Credit through the Wilderness Medical Society. The learning environment on a river trip will be challenging, stimulating, and fun. ().

– Multiple scenario opportunities, both on and off the water
– Group is immersed in the experience (no cell phones, computers, or other distractions)
– Discussion opportunities will extend beyond the 36 hours in class
– Group bonding and networking opportunities

 

Course Details

Where: Snake River through Hells Canyon
Course Length: 6 days and 6 nights
Dates: September 4 – 9 (arrival is on the evening of Sept 3rd)
Participants: physicians, residents, and other advanced care medical practitioners
Instructors: Jeff Isaacs, PA-C & Dr. Kaare Tingelstad, DO
(Jeff Isaac is WMA’s Curriculum Director and author of WMA’s standard WFR & WALS textbook, Wilderness and Rescue Medicine. Dr. Tingelstad is a practicing emergency room physician in Wisconsin.)
Cost: MD/DO ($1,995), PA/NP ($1,885), Other ($1,840)
Course Size: Limited to 18 participants
Registration Deadline: June 1, 2013