How do I self-assess my physical condition after a fall in the backcountry?

Question

Background: The weather that day, as well as the week before, had been dry and warm. At about nine pm on August 2, 2014, I fell off of a log onto rocks. The fall was roughly twenty feet. The rocks were jagged and each larger than my torso. The nearest person was about 75 yards away (at the group campsite) and it was getting dark.

I remember losing my balance (read: the tree's bark giving way) and falling. I do not remember the impact with the ground. I awoke to find myself nestled between several large rocks and felt a little chilled. I yelled a few times and was quickly found. I ended up a broken wrist, and a variety of minor injuries. All told, I feel pretty darn lucky.

How do I self-assess my physical condition, including mechanical injury, trauma, contusions, lacerations, etc, after a fall in the backcountry?

(Note: I can supply additional information about the incident and its circumstances upon request via the comments.)

Answer 1

Self-assessment is difficult because your level of consciousness (LOC) may be impaired. Unfortunately, one's own state of mind is also very difficult to self-assess. I'll list here a brief overview of some of the "self-checks" you can do, but (as I'm sure you're already aware), getting a second person to check you out as soon as possible will help ensure you haven't missed anything. In situations where there may be nobody else nearby at all, it might not be a bad idea to carry a small checklist card with you, which you could refer back to and check things off as you assess yourself to make sure you don't forget anything if your LOC is reduced.

In wilderness medicine we use the concept of the Patient Assessment System (PAS) as a standard way to check a patient and systematically identify possible problems. The full PAS could take a whole post of its own, or indeed most of an entire course. If this stuff is interesting to you, consider taking a wilderness first air or wilderness first responder course to really learn it in detail.

The first step is to assess your immediate physical safety, i.e. a scene survey. In a self-assessment situation, the main thing you need to get out of a scene survey is whether or not it's safe to stay where you are. Just fell off some rocks? Are you at risk for further rockfall coming down on top of you, or is your current position at risk for falling further down the slope? If you need to move to eliminate possible life-threatening hazards (and you are physically capable of doing so), you should try to do so as soon as possible.

After doing what you can to prevent any further injury, you go into a primary assessment, which can be remembered by the acronym ABCDE. The first two are less relevant in a self-assessment, but I'm including them because these go in order of priority, and it's good to know. If any issue is identified during the primary assessment, that's a "stop-and-fix" problem – you deal with that before moving on to the next step.

• Airway: Is anything blocking your airway? In a self-assessment, this should be very obvious.

• Breathing: Again, obvious. If you aren't breathing, you probably aren't going to be assessing yourself in the first place.

• Circulation: Is your heart working? If you're checking yourself, probably. This is also the time to check for any major bleeding. Do a quick blood sweep – run your hands over your body, checking to see if any blood appears. Sometimes serious wounds may not even hurt at first when you have adrenaline pumping and other injuries may be distracting you from the pain. Physically running your hands over your head, neck, arms, back, chest, legs, etc. and checking to see if any blood shows up is a good way to make sure you aren't missing something major. This step is very important in a self-assessment, because you can't see every inch of your body yourself.

• Deformity/disability: Is anything deformed or out of place? Are you at risk for permanent disability from a spinal injury? In considering whether a spinal injury may be a problem, there are various possible mechanisms of injury (MOI) which would lead one to suspect a possible spinal injury until proven otherwise. This includes a fall from >3x your body height (which occurred in your example), tumbling falls, sudden changes in movement (e.g. falling off a bike, crashing while skiing), falls directly onto the head or neck, and a variety of other causes. Standard procedure is to immobilize the spinal column when there's an MOI for a spinal injury, but it's near-impossible to keep your own neck still while inspecting yourself. If you do have to move your neck, make sure to do so very slowly, and if you meet any kind of resistance or pain when turning your head/neck, stop that motion.

  Regarding "deformity", this is where you do a "chunk-check" to see if anything else is out of place on your body. This part is a bit more difficult to do on yourself than to do on somebody else, but you can do it. The basic idea is to use your hands to quickly feel your body from head to toe (and finger), feeling for anything which is sticking out where it shouldn't be, or not sticking out where it should be. If something feels kinda weird, you can compare to the other side of your body to see if it's generally symmetrical or not. If you find any pain anywhere, try to take a closer look – that's a spot where you may need to deal with something. Note that minor injuries found during the chunk-check don't need to be dealt with immediately. If you can, write them down so you don't forget. If it's an immediate threat to life, then you should stop-and-fix.

• Environment: The last part of the primary survey is to take note of your environment and protect yourself from the elements. Once you get too cold, it's very difficult – especially when injured – to warm back up. It's always a good idea to sit on a pad if you have one handy, put on some jackets and a hat, or if it's hot go sit in the shade. You need to take care of any environmental risks before proceeding to treat non-life-threatening problems such as sprains or small fractures. If you have some kind of portable shelter like a tarp or bivvy sack, now is a good time to get that out. If you fell into water, get dry before you develop hypothermia. Environmental emergencies like hypothermia and heat stroke are very preventable yet frequently complicate wilderness emergencies because it's easy to neglect. You should also take a moment to take care of your other bodily needs – drink some water, eat a snack, and make sure all your bodily systems can run as well as possible, so you can focus on fixing any injuries.

At this point you've completed the primary assessment. Standard procedure is to proceed into the secondary assessment, which consists of collecting vital signs, patient medical information, and performing a more detailed patient exam. At this point things get more complicated and more difficult to self-assess, so I would suggest looking at more detailed wilderness medicine resources if you're interested.

^{Note: This information is based on my training as a wilderness first responder and the accompanying textbooks and practice. Reading medical advice on the internet is no substitute for proper medical training. This information is provided as-is, with no guarantee of correctness or effectiveness. You alone are responsible for ensuring an appropriate level of training for the activities you engage in, including administering first aid to yourself and others. Neither Stack Exchange, the author, nor any other party shall be responsible for any harm that comes to you or others by following any advice in this post.}

Answer 2

Due to the nature of many injuries your awareness and ability to treat yourself may be impaired. Therefore, extra care should be taken. Don't do anything rash or hastily as that will probably just make things worse. Take a few moments to collect yourself and get an initial impression of how you feel.

Your first concern is to prevent further injury and get yourself into a safe position. What this involves will depend on the state of your injuries and your current position. You want to move to somewhere where there is no further risk of slipping/falling/getting hit by rocks etc. However, you are probably not feeling the most agile right now and don't want to cause further injury so think carefully about if you should move and do so carefully. If help/other people are nearby now is the time to try and contact them, they will be in a much better situation to assess the dangers and help you.

Once you are safe you should assess your injuries. The good news is you are conscious (or you wouldn't be assessing yourself) so you are not dying immediately. However, you may still have life threatening injuries that need immediate treatment. Unfortunately, most of the more serious injuries lead lower levels of consciousness and awareness making them difficult to self assess. Again, contact help if possible. In roughly decreasing level of seriousness some major things to check for are:

Head injuries: Head injuries can lead to concussion and/or internal bleeding both of which can be very serious. Check for any bleeding or swelling around the head. Can also lead to lower levels of consciousness, confusion and vomiting. If you suspect severe head injuries or conditions worsen you should get professional help as soon as possible. Direct treatment in the wilderness is limited - apply ice or cool any swelling and stop further bleeding.

Severe bleeding and shock: Severe bleeding can lead to large loss of blood, resulting in shock and loss of consciousness. Your first concern is to prevent further blood loss. Check your body for any bleeding. Treatment for bleeding is to apply pressure and then bandage. If there is a large object stuck/impaled in the wound do not move it as this may make the bleeding worse.

Shock can be caused by large amounts of blood loss and can result in confusion/dizziness leading to unconsciousness. This can make it hard to self assess. Treatment is to stop any further blood loss and if possible raise the legs to increase blood flow to the heart.

Hypo/hyperthermia: Depending on the weather conditions and how long you have been out in them you may be at risk due to exposure. The symptoms of these are quite well known but should be they also lead to confusion and lower levels of consciousness again making self-diagnosis hard. Try and protect yourself from the weather and heat/cool your body as appropriate.

Breaks and sprains: While brakes and sprains are not generally immediately life threatening, if they prevent you moving that can become a major issue in a wilderness situation. Learn how to splint the most commonly injured areas. I like to carry a SAM splint in my first aid kit as they are very flexible, light and easy to use, but sticks and walking poles also make good splinting materials.

I'll focus on lower body injuries. Upper body break can be very painful and should generally be splinted and or immobilized, but generally won't stop you walking to safety. For femur (thigh) or pelvis breaks your are probably screwed without assistance. The force required to break these and the amount of blood vessels in these areas will result in severe internal bleeding. Your should try and minimise this. For pelvis injuries you want to make/apply a pelvis splint. This basically pressurizes the pelvis to minimize further bleeding. For femur injuries a traction splint can be applied. These can be rigged up using a hiking pole. However, they are quiet difficult to apply correctly. In either case you aren't going to be walking out so need to be able to contact help.

For lower leg injuries the area between the knee and ankle should be immobilized. Sticks or walking poles can be used to do this although sleeping pads also work well. Depending on the severity of the break you will probably be able to walk out although it may be very painful. For ankle injuries either splint the ankle or just bind tightly with a bandage. Again painful but probably walkable.