BASIC MEDICAL CARE - Medicine for Mountaineering and Other Wilderness Activities - page 8

CHAPTER 2
BASIC MEDICAL CARE
James A. Wilkerson, M.D.
Principal Contributor
Most individuals injured in accidents or contracting an illness in the wilderness are evac-
uated within hours or, at the most, one to two days. Occasionally, however, bad weather,
difficult terrain, distance from a hospital or transportation—particularly on an expedi-
tion—insufficient personnel for evacuation, or other problems may force an individual to
remain in a remote situation. Some persons may not need evacuation if they are expected to
recover enough to walk out or resume activity within a relatively short time.
NURSING CARE
Anyone confined to bed (or sleeping bag) by illness or injury has certain needs that require
attention. Ministering to those needs is most readily identifiable as “nursing care.” The ob-
jective of this care is simple: to allow the body to heal itself.
Comfort and Understanding
Comfortandunderstanding—theessenceofnursing—areneededbyall,regardlessofthe
nature or severity of the medical problem. Some have a greater need than others; some, par-
ticularly young men, try to deny their need. Regardless of the situation, the medical sup-
plies on hand, or the sophistication of available medical knowledge, interest and concern,
sympathy and understanding can always be shown; comfort and reassurance can always be
provided. All are essential.
Rest
Rest promotes healing in several ways. Exertional and emotional stress are reduced. Ad-
ditional injury to damaged tissues is avoided. Rest can allow opportunity for improved nu-
trition, and the nutrients can be used for healing instead of muscular effort. Individuals with
heart or lung disease, and individuals with severe injuries, particularly fractures, may need
to be immobilized, but most do not need such confinement. Often, remaining in camp rather
than hiking or climbing is all that is required to hasten recovery.
Sedation
In the absence of brain injury or disease, medications that promote sleep may be given
at altitudes below 10,000 feet (3000 m). At higher elevations, sleeping medications should
not be administered because they reduce blood oxygenation during sleep, which often ag-
gravatessymptomsofaltitudesickness.Thesleeplessnessandirregularbreathingassociated