Wilderness First Aid for Himachal Mountain Guides

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Report by Dr. Jeph Mathias
2 day residential course for GHNP guides and porters run at Sairopa training center.
Instructors: Dr. Jeph Mathias, Mr. Padam Singh and Mr. Jock Barges from Jibhi CHAI

Participants:22 Guides, Porters and others organized through SAHARA.

Format: Theory plus lots of practice using role plays and models aimed at forcing guides and porters to make decisions about management of common and serious illnesses that might occur with clients in the park. The aim was not to make doctors out of participants but rather to give them good theoretical and contextual grounds for making decisions.

Content: The key message of the course came in the first session where we defined first aid as the initial response to illness or injury. Outdoor first aid was defined as sensible management imgp0871.JPG decisions from integrating an understanding of anatomy and physiology into an analysis of the context and an appreciation of resources available for rescue/treatment. On our hierarchy of responsibilities patient’s life and permanent handicap only come second and third after group safety. Every scenario stressed context analysis first and only then assessing the patient. We also introduced the idea that serious outcomes rarely result from a single error, instead they usually come from a cascade of mistakes. If each successive mistake is a lemon one should be very wary about “lining up the lemons”…
After general discussions we dealt with human anatomy, a system for taking history and examining patients, cardio-respiratory physiology, respiratory illness and circulatory compromise. Day two included thermal injuries, soft tissue and bony injuries, head injuries, infections, allergy, and surgical and non-surgical abdomen. Teaching was predominantly case based. In the final session guides thought back over cases and built up their own medical kit of essential items to deal with what they had seen.
It was a good course that guides thought would be useful in their professional work.

Post Course Suggestions:

  • Dr Mathias to write a pre-trip questionnaire for tourists to identify possible medical problems before they arise and send to GHNP management.
  • Dr. Mathias to compile the list of medications that guides think will be useful in the field and send to GHNP management.
  • GHNP identifies one person to screen pre-trip questionnaires and talk to relevant person before each booked trip.
  • A single-day training for guides to look at the medical kit once made.
  • Follow-up training with guides regarding outdoor skills and rescue techniques.
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