UKC

Hiya, I'm currently working with St John ambulance to improve defibrillator access for hikers and people in rural areas. I'm investigating hikers preparation for first aid when they go for a walk. It would be greatly appreciated if you could fill out this survey 

https://www.surveymonkey.co.uk/r/6BBV9ZX

or let me know what is most important for you when preparing first aid for a hike. 

TIA

I always alert the emergency services and local MRT whenever I may be out and about.

I rather think you've answered your own question in the survey.

For the vast majority of people, taking a defib kit would be too costly and bulky for the vanishingly small chance of needing it.

To put that into context, in all my decades of being out on the hills/climbing/kayaking/mountain biking - including instructing groups - I've never once needed one, nor (to my knowledge) has anyone else I know personally.

Your survey doesn't actually ask what level, if any, of first aid training people have - I suspect very little/none in most cases (everyone on this forum is, obviously, a fully trained remote area paramedic ), let alone any defib training. Yes, I know they are automatic these days, but you still need a modicum of knowledge to use them effectively. Yes, I'm trained to use one.

Agree with this. I am aware of one incident encountered by friends of mine involving a heart issue while walking.  Sadly a defib being there would have made absolutely no difference to the outcome. 

And even doing CPR can be a nightmare, as once you start you should not stop until relieved or the casualty recovers, which could be a very long time, MRT could be hours, no coastguard aircraft often due to low level cloud.  I done it with one other wearing body armour for 35 mins, restarted her heart twice, it was a very long time and hard work.

On the hill I mainly take a small pack for blisters, plasters, sling and a single field dressing for trauma. Regardless of the weather I always take my blizzard blanket, the 3 layer one and still only 400g and an emergency survival bag. Hypothermia is one of the biggest killers once you become immobile in a mountain environment.

I agree with earlier posts only MRT would have reason to carry a defib amongst other first aid kit.

Good luck with your ambitions.

Even if the AED was initially successful you're likely to be at least an hour away from hospital care and possibly much more, so I wonder how much difference they would make to survival rates anyway.

Our Parish Council decided to buy one. I was the only person who voted against it. We live in a very rural area. I did quite a lot of research on how likely it was to benefit our community. The only decent research I found was by Scottish Ambulance who concluded that they weren't worth having unless they were installed in a crowded area e.g. station or shop in a large town.

Our defib is installed outside the local pub. It cost around £2000. As an example, the money would have been better spent on helping locals who have problems such as mobility. 

Agree with this.

Defibrillator is just one part of the”chain of survival” starting with early effective CPR, through ASAP defib access, then proceeding to speedy transfer to definitive care. 

I also agree with the post about how hard continuous CPR is in the backcountry. It probably shouldn’t be started if it can’t be safely continued  with a large enough pool of people.

It’s exhausting, can lead to risk for the givers, and about a minute is the maximum effective period for compressions without a break (I was once involved with the unusual situation of doing CPR in someone who had real-time monitoring of their cardiac pressures, in theatre, showing immediate feedback of cardiac compression effectiveness: even the best of us, the burly cardiothoracic surgeon, was only able to maintain a perfusion pressure of 70-80 for about 45secs before a drastic drop off, a useful early lesson to switch frequently that has stayed with me.)

Since a sprained ankle in our party on Cadar Idris a few weeks back one thing I didn't have in my walking first aid kit, but which I will now always take is...a walking pole!  The jog down to the tree line was fine...the wade through hip deep bracken and bog to the downed tree about 50 metres of the path to snap off a branch for an impromptu crutch will live with me forever!

Bizarre question about the weight we carry.... loads of options for less than 2kg.... then only one for more than 2kg!

Warm layer + waterbottle + rucsac will be mote than 2kg....

Bizarre question about the weight we carry.... loads of options for less than 2kg.... then only one for more than 2kg!

Warm layer + waterbottle + snack + small rucsac will be more than 2kg....

Context.... A&E doctor here.... I would not automatically start CPR for cardiac arrest in a remote location.

And the implication in the question that we would carry the same load on every hike.

Why are you wasting your time?

Joins UKC to post one question

Doesn't reply to any response (even serious ones)

Look familiar?

For the benefit of the OP. Few walkers / climbers will carry packs <2kg

If possible ask a few MRT how often they use a defib compared to using other kit of comparable weight and which they would prioritise.

I think anyone who goes out playing in the hills accepts that, due to being in a remote location, there is increased risk of fatality due to illness or injury.

Carrying a defibrillator is disproportionate. The likelihood of needing it is slim, but having used it you would need to know that help was going to arrive *very* quickly.  That's simply not a realistic expectation.

So, just like I wouldn't start CPR in a remote location (because there's no way I could keep going for long enough), I wouldn't use a defibrillator.

I've posted on this repeatedly.  I routinely carry poles now since I dislocated my ankle coming back from soloing Pinnacle Ridge of Sgurr nan Gillean uneventfully.  I was still a couple of miles back out from the road and nearly vomited with the initial pain (my foot noisily popped out of position and slipped back in after about 20 seconds.

If I hadn't had the poles it would have been a rescue job (I had a weighty pack with rope harness etc) even though Akroyd and party sniggered as they passed at the state of me.

Getting back under my own steam became a matter of pride even though it took me twice as long as usual.  When I told the nurse at Penrith how I'd ended up with an ankle big enough to carve a Halloween lamp from she told me off for my efforts but I think a pair of poles is a prime piece of first-aid/self rescue kit.

Hi Chris, in case you come back to look at the responses.  I have completed the questionnaire, but perhaps a few of the questions could be tweaked a bit if you intend to circulate it elsewhere.  See elsewhere for helpful comments, plus what is considered to be first aid kit - just what is in the green pouch or more?  Emergency shelter, survival bag, spare clothing, trekking pole, gaffer tape around the water bottle, water.......

Working with a well known national organisation is all well and good, but the St. Johns are not usually the go to organisation for outdoor people in relation to their first aid needs.  Specialists like ITC First or REC would be a better bet.

Whilst it would be great to get more AEDs out in the community and have ways of getting them to remote places, e.g. drones, the back up of having a properly funded health service with good ambulance back in rural areas would make a massive difference.  I'm sure £350m a week would do it, but I've no idea how the government might find that sort of money just sloshing around in its coffers waiting to be used.

Good luck

Filled in the survey, giving you the benefit of the doubt that it has honest intentions.

Agree with others in that as great an organisation as St John Ambulance are, collaborating with the multiple MR teams across the country will likely be of far more use when it comes to what you seem to be trying to achieve, you may know differently of course.

My own first aid kit consists of a few bandages and sterile dressings, micropore tape, tuff cuts, triangular bandage, gloves etc and after being schooled in how to properly, properly use them for ankle injuries by a ski patroller, a Sam Splint. Basically kit to to get someone with minor injuries/breaks back to the road. I refuse to carry plasters, if it's big enough to worry about, I have bandages and dressings (i.e. suck it up and deal with it ;p)

My own opinion on this is that any money would be far better put into education, first aid training, how to look after yourself in the mountains.

Just to clarify, I support public defibs completely.

This is a question also for anyone else on the thread who knows what they're on about.  (Particularly nickinscottishmountains I guess.)

Would choosing not to start be an acknowledgement that the CPR is futile and that the casualty is not going to survive with or without it?  Or is it possible that starting CPR and subsequently being unable to continue after a while might actually be counterproductive in some way (from the casualty's point of view) and further reduce their chances of survival?

We've seen so many of those dodgy posters over the last year or so, but it would be quite unusual for one to include a link to a survey.  It's also pretty common for a genuine student to post a survey and not bother to respond, often as not they've registered on several forums to post the link but were never really interested in engaging with any of them besides trying to get a few clicks.

Either way, I don't think nickinscottishmountains or anyone else offering a serious reply is wasting their time even if the OP is a 'bot' of some kind - they're still interesting reading for the rest of us.

We discussed this at some length on the first REC outdoor first aid course I attended.  The instructor's advice was to carry out CPR for as long as you were able.  It almost certainly wouldn't help the casualty, but you would know that you had done your best for them. If you just stood around instead of attempting something, however futile, you could have lifelong regrets that you hadn't done more.

Had exactly the same discussion on my ML training some years back. The group I was with came to the same conclusion,  although how much that is really in the casualties best interests was probably the major part of the conversation. 

During one my defib training courses we were shown a graph of survival times with and without various levels of intervention.  Even with a defib, the chances of survival were low unless the casualty could be got to hospital very quickly.  The purpose of a portable defib or even just CPR is to try to keep the casualty going for those crucial few minutes until an ambulance can get there.  In a remote location, that just isn't going to happen in time to make a difference.

The needs of hikers and of people who live in rural areas are very different.  My village has three defibs, and if someone were to need one in the village itself they might make a difference as an ambulance could get to them fairly quickly.  If the casualty was on top of the nearby hill it would probably take too long for help to arrive and to evacuate them to hospital.

That's a good point, and actually with that in mind I'm not sure how I would actually respond if someone collapsed.  Having done CPR, for real I know how hard it is to keep going for any length of time (see mention of 40 seconds upthread).  I hope I'd be able to be objective enough about it to be comfortable (if that's the word) with choosing not to start it in the first place.  But I might not be the only person there, and what they need (for their own peace of mind) would have to be considered too.

I don't think you're alone. The stark reality of cardiac arrest was brought up in one of the many FAK threads that have appeared on UKC over the years...

https://www.ukclimbing.com/forums/gear/first_aid_kit-502873?v=1#x6848042

https://www.ukclimbing.com/forums/info/search.php?forum=11&dates=1&...

I still think I'd like to think I had 'tried my best'.

Tbh I'm not sure professionals that deal with this kind of thing regularly (including me) giving advice is all that helpful when it comes to CPR as a bystander and probably just muddies the waters.

There's so many factors that you don't need to be thinking about at BLS level, especially in a stressful situation (chances are you will be flapping the first time you do CPR, especially if it's a loved one-it's completely natural). 

Just do your best, as you've been trained, if the outcome is poor then you've done all you can.

Edit to add: I really hope that didn't come across as patronising- it wasn't meant to! If I went in to the ins and outs of out of hospital cardiac arrest it probably wouldn't be very helpful! Nick will be able to take it to a far higher level than me of course.

,.........

I've done my last few first aid courses with the ambulance service and this is very much what they told us. Don't worry about getting it perfectly right, just do your best but most importantly do something. 

I know that I'm out of my depth in debating this with a healthcare professional, but I have to disagree. 

I'm aware that a casualty has very little chance of survival if CPR is required in a remote location, but isn't this better than no chance at all?

Not if it impacts upon your own chances of survival.

After five minutes of decreasingly effective cpr, you're going to be absolutely, utterly exhausted and dripping in sweat.  If help is still an hour away then all you've done is put yourself into trouble too.

I'm sure, in this scenario, I'd try.  But in the back of my head I would be watching my own levels of exhaustion carefully, and trying to give myself permission to stop in reasonable time.

I think you'll find that Llefram, the OP, is Chris Marfell, the lead author of this study - which is probably for an MEng dissertation/project. Admittedly, I was forced to use ingenious techniques of deduction to realise this. I'm sure they'll be back eventually, but, being new, doesn't realise the etiquette of UKC-dom. Most of the comments were addressed to some extent in the survey questions. Either way, it seems to be a genuine and reasonable request, if you can be bothered to give 3 mins of your time.

Out of interest, what would you do? Help is realistically 2 hrs or more away, unless a SAR helicopter is on its way. They're not breathing and seem to have gone into cardiac arrest.

Your scenario assumes that you're alone and dismisses the possibility of another passer-by or 2 coming around the corner to take over.

Agreed - me too.

Not at all and I appreciate the advice, but I wasn't really asking for advice I meant the question quite literally.  (You're quite right that the ins and outs of hospital cardiac arrest wouldn't be helpful, I basically know nothing so I'd struggle to keep up with anything at all technical.)

I was pretty sure I understood what "I wouldn't start CPR" means, but it is somewhat euphemistic so I was just looking for brutal clarity - that's because the casualty stands no chance of surviving and therefore CPR would be futile, right?

I can't speak for a professional like Nick, but I think that's something you'll never really know until it happens for real.

Realistically CPR is only to keep someones brain and tissues supplied with oxygen until serious medical attention arises. If that's hours away then it's futile.

Slightly off topic, but perhaps relevant, is a 'battlefield first aid' flip book I have from the 90’s. It's basically a flow chart, and goes like this:

Is casualty breathing? > No > Casualty is dead.

That's probably changed a bit with the use of MERT helicopters etc, but illustrates CPR is of limited use without rapid paramedic/hospital treatment. Psychologically it probably helps the person doing CPR feel a bit better at having tried.

Perhaps you missed the “automatically” part?

Dependent on circumstances, starting CPR in every instance may well be more assaulting a corpse rather than giving the casualty a fighting chance.

Admittedly, the ability to make such a call would be highly dependent on training and presence of mind.

If that's the case then I take back my trolling suspicion. There just seem to be so many very similar looking bad-faith contributors around these threads. I won't enquire into your 'ingenious techniques of deduction'! Although, it might be useful for checking bona fides if it's legal ...

I was in Chile, in the mountains, when there was a local who’d fallen in a river, and we did CPR for almost 2 hours, for pretty much this reason. We also had a very large pool of people to call on, and we also kept getting told that the army paramedics were “just 15 mins away”, and I much preferred that local medics called it, than some foreigners “let him die.”
It wasn’t a usual hills casualty situation, but I think that trying for so long may have helped those that assisted, and the young family that were in attendance.

It is a difficult decision not to start CPR, when remote, and I imagine it feels hard to look on, not doing it. I guess the important thing is not to throw all your remaining energy into a forlorn attempt and cause an unjustifiable risk to the rest when there’s little chance of benefit. 

Perhaps you missed the "out of my depth" part. 

I think that you should bear in mind that most people reading and contributing to this thread are lay people and lack the experience necessary to call whether or not they're "assaulting a corpse". 

No, I read it, it immediately preceded the part where you wrote “but I have to disagree”. Since you were debating the point with an A&E doctor, the latter statement rather wipes out the supposed intent of the former. 

So you didn’t get to the end of my own post before replying then?

Yes, I did. I even gave you a like for it. 

What message do you have for the non medical professionals reading this thread - CPR on a non breathing casualty, yes or no?

OK, fair enough. 

I'll not put words in the doc's mouth, so I'll let him tell you what he meant.

But otherwise yes, there are situations where CPR would be considered completely futile (such as injuries incompatible with life and others without delving too deeply into various guidelines).

Again, I don't want to overcomplicate BLS and first aid, thinking about all these different things when you don't deal with it professionally isn't helpful, as long as you've done your best it's all anyone can ask.

It’s not that simple: what’s the cause of the arrest? How long down? Any medical history for the casualty? How old are they? Who’s attending? How far away is help/definitive treatment? What’s the weather? Is it day or night? What’s the terrain? I could go on. 

Very broad strokes advice? Give it a go, after all what’s the worst that could happen? They’re already dead.

But bear in mind that you’ll be stopping at some point and happy endings are a rarity (but they do happen).

Thank you for that. It's hard not to get into arguments on here sometimes and I was trying to encourage lay people like myself to have a go as think I'm right in saying that they probably won't make things worse.

Disagreeing with an A&E doctor on a medical matter probably wasn't the smartest thing I've done today but I ran into the very scenario that we're discussing here a few weeks ago. There were three of us taking it in turns for 25 minutes and I believe that we could have continued much longer had MR not turned up. The ending was not a happy one so it's taken a while to process it but I'm sure of one thing: if someone found one of my loved ones in a heap at the side of the road, I'd really like them to have a go at giving CPR.

My apologies also. I know I have a tendency to come across as a bit ‘gruff’ but in my defence, I usually post in snatched moments and ‘gruff’ is usually just a result of trying to compress everything I’d actually like to say.

edit: also, take care to look after yourself. The sort of scenario you were involved in can have an emotional impact that can just creep up on you

My ingenious technique: Marfelllleframarfellllefram. Oh... also, I clicked the link

Sorry to hear about your recent experience, it sounds like you did your best and that is all that anyone can ask of you. Most importantly you didn't do anything that could have had a negative impact on the outcome.

I have always been told you should continue CPR until either a medical professional tells you to stop (either taking over, or because with their expert knowledge and equipment they deem it to be futile) or you are too exhausted to continue. I have never previously considered the value of CPR when a long way from help and logically I can see the argument that its unlikely to be beneficial to the patient, but as a non-medical person I'd sooner give it a go than live with the nagging doubt that I could have made a difference.

Hiya, thanks everyone for your responses, I will admit I have struggled to get back on to reply, hence the delay. But not looking to troll anyone, otherwise I wouldn't put back in contact details in the survey. 

Survey is not my finest hour, especially due to the fact I am a runner and kit I carry is a lot lighter generally and the free software doesn't allow branched questions.

I appreciate the responses, has been very useful understanding how large a part the CPR itself is post AED being applied. We have been given a very narrow brief hence the focus on AED specifically and exploring feasibility. And I think you guys have helped me answer that: with although it would be great, the reality is it is too hard to keep someone alive until professional help comes just due to physical limitations and time of response.

It's interesting seeing both points of view from medical professionals and avid hikers and how the main source of the problem is not the first aid itself, but getting help to you in the first place.

Thanks

What are your views on mask wearing and Scottish independence?

Asking for a friend .

Not so much for hillwalking but in a scenario where an AED might be accessible, I've always thought a "public trauma bag" - dressings for heavy bleeding, BVM, airway management etc and more PPE would be great to have somewhere.  There's plenty of folk about with more than basic training.  No idea how such provision could work in reality...

As a first aid trainer (usually around 20 - 25 outdoor based courses each year), whether or not to attempt CPR in remote places is something that I discuss on OFA courses.  The answer, like for so many questions, is "it depends".  Knowing some of the factors "it depends" on can help to form a vague game plan if the worst happens, but inevitably raises more questions than it answers. 

Potential situations first aiders might find themselves in can be as varied as finding a stranger in the middle of winter in a location with no phone signal likely for a long period of time, to being with one of your own family members, to being responsible for a group of cold, wet, tired teenagers finding a stranger, to being with a group of elderly walkers one of whose number has collapsed and their partner is with them, to being with a group of young fit members of a university club who have prior first aid training.  It could be that the casualty has been found wet and next to a water course with a suggestion that it is a drowning incident and maybe CPR alone could fix it.  Maybe mountain rescue team is already in the vicinity out training.  Maybe a helicopter is already in the area.  Or maybe not.

Some people tell me that life is sacrosanct and they will do whatever it takes.  Others are aware of their Duty of Care responsibilities over those who they are with.  People often have responsibilities to others at home who they need to get home to at the end of the day.

As stated above, it raises more questions than answers.   Always an interesting discussion.

The answer to this question would surely be answered a much bigger question about size, portability and cost of defibs in general, regardless of the environment they are being used in. If they were small, compact and cost less than £100 then most houses would have them, especially in villages and rural areas.

Small, compact defibs are available on the market which would be easily carried in a rucksack. The downside of this is they cost around £3000. Larger, heavier models are available for a lower cost (you can buy defibs from about £900)  but they come with drawbacks around weight, bulk and longer-term cost of ownership.

In my strong opinion, carrying a defib on a very remote hike is pointless. Carrying a defib when you're leading a walking club for retired lonely old dears on a wander around your local footpaths may be more appropriate. As always it very much depends on the situation

(written from a multitude of perspectives, former outdoor instructor, outdoor first aid trainer and now training as a technician with the ambulance service)

I think you need extra / improved questions, one of which should be 'should defibrillators be installed in the mountains?'.  I think it would be sensible to put them in places like mountain huts and bothies, and possibly also summits, path junctions or other places people stop / congregate.  People will be spending lots of time (relatively) at mountain huts/bothies compared to other places on the hill, and as such the likelihood of a collapse there is higher.

I think you could make an argument for the CIC, but not bothies - similar issue with response times and could be a bit of as pig for the MBA to look after/ensure not tampered with.