Wilderness Medicine | Patient Assessment



hi I'm Todd shimmelfinney I'm the curriculum director for the wilderness Medicine Institute of Knowles we're going to shoot an educational video here today to demonstrate our patient assessment system and then our focus spine assessment our tool for gathering information making a decision about whether we need to continue spinal immobilization and a patient who's got a spine mechanism of of injury we've got a beautiful day here at zero degrees Fahrenheit outside so we're going to be able to demonstrate how we do this manage the cold keep the patient in the sleeping bag zip and unzip layers deal with our hands and body substance isolation gloves in a real winter environment we hope you enjoy the video you can totally climb this no I can't do do it I bet you can't you climb hard in this all the time there's just like a five tree oh yeah you totally got it oh yeah go big go big they do it where's Charlie you okay I think so okay that was quite a fall I'm gonna go get home okay lay still don't move okay there's my buddy it's a lot of the tree up there he landed on his back from all the way up there like 10 15 feet yeah okay seen looks safe to me I just see him is there anybody else who's hurt no nobody else I have gloves in my pocket you have gloves as well love's in my pocket great hi Charlie I'm Sean I'm a wilderness EMT I'm a friend of Travis's can we help you yes great and you remember Travis yep what's your last name Charlie uh Manganiello and what happened to you I was up in the tree and I I just fell down can you open your mouth stick out your tongue did you bite your tongue do you feel like you have any broken teeth no any food or gum in your mouth no okay take a big deep breath for me is that painful or difficult no I'm gonna go ahead and just see if I can find a pulse here at your wrist oh you're nice and warm you have a nice strong pulse do you feel like you're bleeding anywhere no no no okay do you mind if I get underneath this waterproof layer and I double check good okay I'm just going to reach my hands and underneath these clothes okay no blood I'm just going to reach my hands down the side of your pants okay I'm not finding any obvious blood charlie we're just going to peel back your hat for a second so no obvious bleeding you took a pretty big fall Charlie so what we're going to do is keep you stabilized until we can do more assessment okay okay is there anything that's hurting you right now no okay Travis let's consider e expose in the environment he's not complaining of any injuries so there's nothing for us to expose and though it is cold outside the environment does not pose an immediate threat to life so we'll attend to getting them off the snow after we've completed a head-to-toe exam I'm just going to peek inside your ear nothing coming out no bruising back there go ahead and bite down does it hurt your jaw at all not at all okay great I'm gonna move your glasses for just a minute close your eyes open up your eyes pupils look round equal and reactive to light I'm going to unzip you one more time just take a look at your neck I don't see any obvious injury you don't wear any medical alert necklaces bracelets anklets do you know I'm gonna check your shoulders how's that feel what here good I'm gonna put my hands right up here and your armpits take a big deep breath any pain no second one do me a favor and point to your belly button all right I'm gonna press on your belly anything uncomfortable nope check your pelvis is there any reason I need to check your genitals did you injure them on the fall I don't think so legs feel good yep okay go ahead and push down on the gas pull up for me I'm going to go ahead and unlace and loosen up your boots so I can reach my fingers in there okay okay okay Charlie both of your feet feel warm to me do they feel warm to you yes okay can you tell me what side of your foot I'm touching the inner side or right side on which foot left foot okay how about here can you tell me what I'm pinching right Big Joe okay great so a good circulation sensation and motion in his feet I'm going to leave your shoes undone because eventually we're going to take those boots off and get you into a warm sleeping bag okay okay great finish up with your arms give my finger to squeeze good wiggle your fingers your hands feel nice and warm to me today feel warm to you yes okay nice strong pulse san feels warm as well yep to you also nice strong pulse okay so good circulation sensation motion in the hands as well so I think what I'd like to do Travis is let's roll him up on his side and check his back and we'll get him back down on a pad and a sleeping bag when we do that so Travis what I want to do is roll them up on his side let's make sure we roll them a little more than vertical so we can get all of this packaging underneath him I'm going to unzip your jacket Charlie so that I can feel along your spine I'm going to take your shoes off so that when we get you back down we can get your feet tucked into that sleeping bag okay I'll work for you okay so I'm going to unzip this one all the way and this one as well because I think I can feel through this fairly thin layer your job tries give yourself a big hug okay excellent and can you cross this right foot over your left leg okay we're gonna go on your capped go on my three one two three so Charlie I'm just gonna walk my fingers down your spine you tell me if I caused you any discomfort or if I'm not on your spine am I still on your spine yes okay no pain okay okay check the rest of your back good good can your account Travis one two three can you bend this knee for me Charlie actually been both of them great take this boot off go ahead and bend your knees a little bit more let's get your feet tucked in here and go ahead and rest your legs on this bag get him off the snow that comfortable for you yep all right so Travis son had to tell exam I didn't find any pain any obvious wounds or deformities how about vital signs his vitals look great at 112 he was awakened oriented to who he is where he is what time of day it is and what the events were leading up to to his fall his heart rate was 76 strong and regular his respiratory rate was a 16 regular and unlaid his skin was a little pale but warm and dry okay and his pearls were equal and reactive to light his pupils are equal round reactive light okay great so Charlie we have a couple more questions to ask you okay okay so do you have any a chief complaint right now is there anything that's hurting you no so you took a fall of about 15 feet that's what we understand okay is that what you understand it no okay so you have no complaints no symptoms that you're feeling you're not tired hungry nauseous headache anything like that none okay are you allergic to anything like medications let's just sell for drugs okay have you had any today no okay what happens when you take self address hives and rat are you allergic to any animals nope foods nope okay do you take any prescription medications no how about over-the-counter medications just advil when I have like a sore ankle or leg what if I hurt myself okay have you had any advil today no okay do you take any herbal medications or supplements nope okay how about any alcohol or drugs today no okay great so symptoms allergies medical missions past medical history do you have any problems with your heart no how about your breathing no how about belly stuff like ulcers no ever had a seizure no are you diabetic nope okay and have you ever hurt your spine or your head before from the fall never okay great so no pertinent medical history and what's the last thing you had to eat charlie I had a sandwich at lunch at lunch okay so right now it's about one o'clock so do you eat lunch at noon 11:00 right around noon okay how about um fluid intake today what have you had just coffee in the morning and glass of water with lunch okay how much exercise have you been doing today oh not much at all okay so is that a pretty typical amount of fluid for you hmm okay great and then urination today about mid-morning okay normal for you okay defecation same question uh no not yet okay normal though mm-hmm okay great so last ins and outs and events so we got the fact that you fell out of the tree did anything cause you to fall out of the tree do you get dizzy or did you slip I just slipped on the snow slipped on this note okay anything unusual in the last 24 hours we need to be aware of no okay great so sample history and any other questions you want to ask yeah that sounded good to me okay I do have one last question how old are you Charlie I'm 25 years old 25 Thanks okay so at this point we have a full physical exam we have a full set of vital signs and a good medical history and I have no evidence right now that he has any signs or symptoms of an injury to his spine if we were in town we would maintain spinal stabilization and wait for medical help to arrive however since we are in the wilderness it is appropriate for us to utilize the focus spine assessment to make a decision about immobilization you

23 comments

  1. Please consider redoing this video. It’s not realistic. You should of had the patient say he injured or is in pain somewhere on his body.

  2. Why doesn’t the EMT ask how he landed first?? The video shows feet first then a roll onto his right hip. It would have helped if his friend gave more details. And why didn’t the EMT ask if he’s in pain?? She took a minute to ask if he feels like he’s bleeding anywhere! By the time she got to the body check he could of gone into shock. You don’t need to reply, I’m taking the course end of October.

  3. No need for C-spine this is not how this works..did he indicate he had spine back or neck pain ,,,NO .he has no injury WTF people..man hard to watch…

  4. At least make a injury to work around. Nothing is hurting him. Hard to watch as a WFR…. the key word is pertinent patient history you talked about tons of non pertinent history. The guy would get up and walk away WFR would never show up. .please make a bit more real.

  5. This is painful to watch. I get the teaching but this is so unrealistic it is actually a challenge to learning. He has no pain.

  6. This is just an educational video. One of the better ones out there. Regardless in there being an injury that warrants C-Spine or not they are simply going through the steps. Good vid.

  7. In the United States, where are there places of employment for being a wilderness EMT? Rocky Mountains, anywhere in New Hampshire, Connecticut? Do you stay in a station during a shift like a regular fire/ems company? I'm really interested in becoming a wilderness EMT

  8. Forgive the dumb question, but why would a short fall like this, expecially with zero evidence of injury of any kind, necessitate further stabilization and eventual evacuation. Is it simply judged by someone who saw the fall and their judgment as to whether they think it was accident causing? Or are we simply assuming here, for the video demonstration's sake, that an injury was likely? Thanks.

  9. I took an equivalent of a St-John's Ambulance First Aid/responder and CPR (Canada) course (private company) many years ago. I witnessed a horrible collision between a car and a cyclist where the cyclist was thrown violently from his bike. He was squirming uncontrollably on the road. There was no other traffic so I approached him and asked him not to move, and mentioned how dangerous it was but wouldn't stop squirming. Another person came in on the scene and told me to beat it while I was speaking to him. I didn't touch him. What does one do!? I was mortified. Felt so helpless.

  10. This is an educational video, hence they have to do everything by the book.

    Its' like how EMT/Medic school has to teach NREMT standard despite no one does exactly that way on the street.

  11. It is extremely interesting how the PAS system changes over just a few years. I am taking my wilderness first responder course and there are about half a dozen things either missing or different from what I am learning now.

  12. Not sure whether it's just for clarity but mentioning bleeding and blood in front of a patient isn’t especially good to keeping them calm.

  13. Great video, only addition I would do that I don't think was included was asking the pt or bystanders if there was any loss of consciousness during the fall.

  14. She didn't approach from the feet this is a possible spine/neck injury you should always approach from the feet so the person sees you coming and does not move their neck or head to see you… also and she asked a possible spine/neck injury patient to move his own leg? video was okay, I learned differently and we did not ask so many questions on our primary assessment

  15. Excellent training video! WFR recert. tomorrow–this is fantastic. I agree with binkerboo; video on any WMI processes or skills is awesome.

  16. Thanks NOLS for posting this. I watched this a few times as a great refresher before and during my WFR recert. Keep these great videos coming…

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