Sickness on the Hunt: When hunting in isolated places, knowing how to provide first aid in the event of Illness can make the difference between watching your hunting companion die and saving his life. Here you will find a guide with the procedures to be applied, based on the guidelines of the European Resuscitation Council.

Introduction

The need to evolve every activity that man intends to do always undergoes a radical change with the continuity of his practice to improve its quality and performance. The hunting practices falling among the most archaic activities that have undergone radical changes in history compare the first hominid who hunted with spear points made of flint, the modern hunter.

I have deliberately used this Aristotelian syllogism as an introduction to support my thinking. I have long argued that the hunters of the new millennium still need to evolve by further improving their range of technical skills, obtaining greater specialization for themselves and the whole category to protect it. It has been the case for years in central European countries.

The hunter in Europe is a folkloristic figure linked to the rural world who indeed suffers less negative pressures than our ones. He is considered a resource for the environment that can be used by administrations rather than a problem.

This difference between the two figures is not attributable to the Italian hunters, who are neither better nor worse than the Austrian or German ones. It is a general cultural diversity that I think depends on the technical quality. And so our foreign colleagues can put on the plate after decades of progress aiming to improve their image through the good deeds performed during hunting activities, in full compliance with the rules first of all and to appear as resources to protect the environment and not destroy it.

Basic Life Support – What It Is and Why Knowing How to Apply It Can Make a Difference?

By technical skills, I do not mean only those related to the mere act of hunting, but all the ancillary ones that accompany its normal execution. To better understand the idea, I would like you to think about the regulations related to law 81, “safety in the workplace,” because precisely this culture applied to hunting differentiates us from the rest of hunting Europe.

In the workplace, you are all used to, and I am no exception, to comply with an infinite number of rules to prevent accidents, and that’s not enough! Your employers also must train you in safety, directly concerning the role and job you hold. One of the essential building blocks on which your training is based is learning first aid procedures in the professional field. It is often indicated by the English acronym BLS that is Basic Life Support (in Italian, Basic Life Support), set techniques and procedures that allow one person to provide help to another in need, often saving her life.

The BLS upgrade is called BLSD Basic Life Support & +Defibrillation, the same procedures as the basic level with the automatic external defibrillator. What does the BLS consist of? BLS is a first aid maneuver that includes cardio/pulmonary resuscitation plus a sequence of basic life support operations. In light of what has been said, I believe that the BLS should be taught extensively to the entire population, as has been the case in the Scandinavian countries, which are now fully aware of cardiovascular diseases and traumas.

More than a dream, I consider this hope a mere utopia in this country. Still, slowly it will inevitably be achieved, if only by adapting to the rules of the European Union. These notions should be considered gold in all fields of application because they can make a difference, especially in the local hunting world, where the average age of Italian hunters is closer to 70 than you are 60 years old.

Unfortunately, it is not new that some hunters fall ill during a hunting trip and need help. Given that the geographical position in which the extraordinary event is often disadvantageous and challenging to reach because it is located in inaccessible areas, quick intervening gives the patient an extra chance to get away with it.

Suppose the companions intervene, applying the right maneuvers. In that case, the ill person gets revived, and the epilogue of the lousy situation comes with the arrival of the helpers who will take charge of the patient and transport him to a structure capable of treating him. There is also the possibility that despite the lightning-fast rescue, the epilogue is more unpleasant. In any case, the possible second conscience has been made, and nothing has been left unturned. In this case, there is nothing to reproach or fear.

The law protects the lay rescuer, i.e., non-professional, relieving him of any criminal or civil liability if the patient does not survive the situation. The legislator thought this to favor the spontaneous intervention of any person who is on the spot when the fact happens, dispelling doubts and perplexities in those who find themselves having to decide whether or not to intervene, wasting time, and hesitating.

Because they are persecuted by the thought of the possible legal consequences deriving from their actions in this regard, if you do not know the correct maneuvers, you can carry out the rescue even with just a phone call. It will be the reluctant, the fake skeptics who will pretend nothing happens, if ever, who will be heavily and criminally accused of failure to help.

So, after explaining my point of view to you with the possible and discounted benefits that hunting can derive from it. I list the maneuvers of the BLS broadly, trying to explain them. It is understood that to be trained in these practices. I believe “D’obligation to Attend Courses at Training Centers Recognized and Accredited by the Ministry of Public Health.” Here you will find highly qualified personnel who will guide you in learning, providing you with medical training aids and aids to learn the practice and the theory.

When and Why Apply BLS Procedures?

First, when do these maneuvers apply? When faced with an unconscious person suffering from syncope, a person with a mechanical blockage of the airways due to drowning, suffocation, or cardiac arrest.

The purpose of this maneuver is to ensure oxygen to the heart muscle and brain, ensuring, through compressive thrusts on the chest, a minimum of blood circulation. The risk that the patient runs in the absence of an emergency intervention, about 1 minute after the event, to be clear, is that of causing anoxic brain damage.

The timeliness of the intervention at this juncture is fundamental. Because, from the beginning of the cardio / circulatory arrest, the chances of survival are reduced by 10% after every minute. It is rare to hope for brain damage recovery. Especially after the absence of cardiopulmonary resuscitation for 9-10 minutes. The first serious damage to the brain is found, in fact, already after the first 4 minutes of lack of oxygen.

How to Intervene: the Chain of Survival

The survival percentage of a human being to a physical event of this entity is not concentrated in a simple or single maneuver. Still, it is subordinated to a series of essential interventions, metaphorically considered a “chain” precisely to explain the importance of sequence in which you must perform these maneuvers and explain that skipping one of the planned phases reduces the chances of drastically getting out of it acceptably.

This chain, known as the “Survival Chain,” is made up of 4 links:

1. Emergency call
2. Application of Basic Life Support (BLS) procedures
3. Defibrillation (if in possession of an AED)
4. Start of intensive health treatment

Emergency Call, the First Thing to Do

It is the call to a single simplified telephone number if a person finds himself in danger of life or sees others in difficulty.

The single European emergency number (NUE) is 112, in the whole of the European Union in the face of a need for help, dial 112 on the mobile phone to get help, it will be the switchboard’s task to take action by alarming the most suitable services for the case.

In Emilia Romagna, Tuscany, Veneto, Marche, Calabria, Molise, Abruzzo, Campania, and some areas of Sicily and Sardinia, this issue is exclusively dedicated to the Carabinieri, except for recent changes of which I have no news. However, the NUE is active in Lombardy, Liguria, Piedmont, the Province of Rome, and other areas scattered throughout Lazio, Friuli Venezia Giulia, the Province of Trento, the Province of Bolzano, and south-eastern Sicily. In the more or less near future, it will be an extended service to the whole national territory.

This call is used to obtain immediate help but allows us to maintain contact with the medical operator alerted by 112. He can help us manage the situation by giving us orders on how to intervene. Therefore, if a person is forced to operate by applying the BLS maneuvers, he can place the telephone on the ground by activating the speakerphone and remain listening or ask someone else to get in touch with help and stay online with the operator. Doctor, making the latter hold the phone, always with the speakerphone inserted, thus finding himself in a position to have his hands free to intervene and in any case to take advantage of the skills of a professional.

The operator with whom you will interface will respect a precise procedure by quickly addressing some specific questions that you must answer clearly without hesitating. Those questions are a procedure designed to provide rescuers, traveling to reach you, essential information to prepare them in advance for what they will have to face when they arrive on the spot and to give them the opportunity, during the approach, to prepare the necessary equipment to face the ’emergency.

It is useless to get off the vehicle to reach the place where the event took place on foot along a mule track with a positive difference in the height of 300 meters in one kilometer with the resuscitation equipment if it is a bit fracture of the finger of the left foot. Forgive me if I have emphasized giving you an example. Still, I want the concept to pass that you risk slowing down help or even invalidating it if you are not precise.

How to Apply the Basic Life Support Procedures

These maneuvers require specific training carried out by suitable personnel as they are very invasive and must be practiced only and exclusively in real need. It is no coincidence that the training courses are carried out by practicing massage on special mannequins. It is common for a BLS maneuver to cause the fracture of one or more ribs. For this reason, a didactic tool is used that reproduces the human body and which in some cases, is equipped with special sensors connected to a PC that is used to help evaluate and possibly correct the maneuvers performed by the student.

That said, the procedures described below are based on the guidelines of the European Resuscitation Council, explicitly created to be used by anyone, even non-healthcare personnel. To this end, they do not require medical skills or the use of special aids. For this reason, it is defined as secular BLS. The procedure involves using medical devices such as Ambu bag, Pharyngeal or Nasopharyngeal canula, Combitube, pax needle, etc. On the other hand, it was created for medical nursing staff and certified and qualified rescuers.

• Make Sure That the Scene of the Incident Is Free of Imminent Danger

The first step to take when witnessing the fortuitous event is to make sure that the scene is free of imminent dangers for those in need of help and those who will have to intervene. For example, suppose a hunting companion slips and falls into a gully while trying to drag a freshly picked boar. In that case, it is useless to intervene to retrieve it, simply because you are not trained to do so and expose yourself to such a risk only serves to multiply the number of emergencies, which rescuers will have to remedy.

So the only thing you can do is call the Alpine and Speleological Rescuewho has the necessary skills to resolve emergency response. On the other hand, if the hunting companion is crossing a road where cars can circulate and faints, the first thing the rescuer friend will have to do is drag the sick person to the side of the road, avoiding him being hit by a vehicle. And start with the emergency maneuvers.

If you cannot intervene because you are not trained in these procedures or at risk of safety, promptly notify the NUE and list the various difficulties encountered and the dangers that prevent you from intervening.

• Evaluation of the Injured Person

When and if action is taken, the first step after alerting the emergency services is evaluating the injured person. It is known to those who have attended BLS training courses that the procedures to be applied are two slightly different. One treats Illness, including drowning, the second trauma. When you can’t understand the type of problem you are facing, by convention, you apply the treatment reserved for victims of “suspected trauma, “and you act as if the trauma happened.

We approach the patient’s extended body to complete the first summary assessment, and tests based on the 5-senses are carried out. The first test consists in shaking the body slightly by grabbing it by the shoulders, being careful not to move the neck abruptly, and calling it aloud. The double physical/vocal control (touch and hearing are used in this test) serves to overcome the problem of deafness in some people that increases with age. If there is no reaction, the person is called unconscious. It is useless to continue with other tests.

• ABC Maneuvers

The patient is unconscious, help is on alert, and is arriving. The switchboard operator on the phone is waiting to receive further information on the patient’s status. All that remains is to proceed with the ABC, Airway, Breathing, Circulation maneuvers, i.e., airways, breath, blood circulation.

The patient is positioned on the bare ground to have the ground as a sufficiently rigid surface, the limbs and the head are aligned in the supine position, then belly up, and the thorax is uncovered. Always consider the patient suffering from cervical spine trauma.

• Airway

The first danger faced by an unconscious person is the obstruction of the airways. There is a tangible possibility that the tongue will turn back due to the temporary loss of muscle tone and thus prevent the passage of air. The maneuver to open his mouth and check that the tongue is not out of place is called a “purse maneuver,” in a nutshell, thumb and index finger are used, making the same movement to open a purse. If the tongue is in its place at the visual check and no other objects obstruct the airways, you can move on to the next maneuver.

If the tongue or a foreign body is blocking the airways, try to remove them without ever putting your fingers in the mouth patient and being careful not to push the foreign body deeper. It does not change if obstructing the respiratory tract rather than an object is liquid, biological, or external. It is necessary to tilt the head sideways to make it come out. Since the suspicion of cervical trauma is still present, we will rotate the whole patient on his side instead of rotating the head, taking care to move the neck as little as possible.

The airways have been checked, and if necessary, freed, now you can perform the hyperextension maneuver of the head. This maneuver is carried out by placing one hand on the forehead, which will move the patient’s head back and two fingers under the chin to lift it. This operation must be delicate but done with the decision. It must be excluded if there is the only suspicion of cervical trauma, in which case only the purse maneuver is provided.

• Breathing

Now that you are sure that the airways are clear, you need to understand breathing. The best method (covid-19 permitting) is to bring a cheek to the patient’s mouth at a distance of about 4 cm to perceive the movement of air. It is beneficial to observe if you discovered a chest movement in advance in the very first phase. Freeing the chest from clothing also serves for this. This maneuver is called GAS.

I look, listen, feel, because you look at the movement of the chest, listen to the breath, feel the air on the cheek. This observation must last for at least 10 seconds while counting aloud. However, we must not confuse panting and gurgling from respiratory arrest for good breathing.

• Circulation

This control usually takes place, looking for the arterial carotid pulse because it is located near the heart and is perceptible even if the systolic (maximum) is about 50 mmHg. The search for tangible signs of blood circulation must not cause excessive waste of time, so if you cannot find the pulse, you must consider absent and act as such. In light of the objective difficulties in this operation, especially if you are not an expert, you can still deduce that the circulation is in operation from the presence of MO.TO.RE. (Movements, TOsse, REspiro).

Lateral Safety Position

Suppose breathing and blood circulation are present and the patient is unconscious, and no trauma to the cervical spine or spinal column is suspected. In that case, he should be placed in a lateral safety position. This position avoids the risk of suffocation due to obstruction of the respiratory tract, prevents the tongue from turning backward for muscle relaxation as described above, fills the oral cavity with biological fluids from the stomach, and facilitates rescuers in loading the unconscious patient on the spinal stretcher.

This position is obtained by following 4- steps in which the patient’s limbs move safely to pass from the initial standing position, prone with the belly up, to the lateral one on the side. The first phase consists in extending the rescuer’s arm outwards, leaving the elbow flexed. The arm and the chest must form a 90 ° angle on the ground. The second-hand arm is placed on the opposite shoulder crossing it on the chest in the second phase.

The correct position of the hand is between the shoulder and the face. The third phase involves bending the knee opposite the rescuer in a not too accentuated vertical angle. The last stage will see the rescuer simultaneously grasp the knee flexed upwards in phase 3 and the patient’s body by pulling towards himself until the patient is lying on one side with his head resting on the hand of phase 2, both resting on the arm of the patient.

• Cardiopulmonary Resuscitation

This procedure, also known as “heart massage,” is, in fact, the primary maneuver of the BLS. It is the life-saving maneuver, the only weapon, the only practical thing that simple hunters can perform as early as possible in the field while waiting for the arrival of help. I take it for granted that when you go out to serve, alone or accompanied, no one owns an IFAK, Individual first aid kit, even the military is during their operations. “Hunters are not military,” “we have never needed it,” “we have never seen it done,” “it is not our culture,” “we are not educated in these practices.

Up to now, perhaps 95% of the category has never even thought it could be helpful to know the first aid procedures to practice hunting activities. Knowing this maneuver that you can perform with only the hands is the only real possibility to make a difference in a health emergency on the hunting ground.

It is necessary to make a synthesis of how oxygenation of the human body occurs. A few simple notions of anatomy make it possible to explain this maneuver’s effect if performed correctly. Breathing is signaled by the continuous and visible rise and fall of the rib cage. It is one of the most critical vital functions of the human body and is an automatic function that does not require the rational will to be exercised.

It depends on the expansion and emptying of the lungs. . Through the airways, oxygen is introduced into the lungs, which work the air by synthesizing oxygen to enter the blood through the alveoli, this is the first phase called inhalation, the second phase is called exhalation and serves to expel the anhydride carbonic.

You can immediately anticipate that CPR is a very invasive maneuver. It must be performed with full knowledge of the facts; for this reason, you should remember that a course with certified instructors who can train you effectively and profitably must be attended. It must be carried out mainly in case of the absence of signs of breathing or blood circulation, chronologically during the checks and the “ABC maneuvers.” CPR is performed in adults with chest compressions (thrusts on the chest in the solar plexus area with both hands crossed) between 5 and 6 cm deep with a 100-120 bpm frequency.

These compressions create an artificial heart motion and are assisted by insufflations through the oral cavity. For carrying out an insufflation, it is necessary to close the patient’s nose with the index finger and thumb (the pinch gesture). So that the blown air does not escape but enters the lungs, with the index and middle fingers of the other hand a light pressure on the chin to keep the jaw open by opening the mouth completely wide, in this condition, it is possible to blow air into the oral cavity.

If the oral cavity is occluded, air can be blown through the nose as an alternative. These maneuvers make it possible to reproduce breathing artificially. The ratio of chest compressions to respiratory insufflations is 30 to 2 in adults, 30 massages, and 2- insufflations.

Video Explaining the Basic Life Support process

In the following video, you can see an example of the Basic Life Support process, developed by the European Resuscitation Council.

Defibrillation – How to Use an Automated External Defibrillator

The Automatic External Defibrillator (AED), defined as automatic by convention, is, in fact, a semi-automatic defibrillator because it requires an initial pose and start-up by a rescuer. In practice, it is a Personal Computer, aesthetically similar to the boosters that car repairers use to start a vehicle that has broken down due to the exhausted electric battery. In addition to the shapes, paradoxically, the AED shares its purpose: both are used to restart stopped motors with an electrical impulse.

These semi-automatic defibrillators allow lay staff to perform early defibrillation. For a long time, those who live in the city have seen columns containing the AED. The relative signs scattered everywhere indicating its position appear in public places such as stations, schools, administrative buildings, stadiums, gyms, etc. With the great awareness campaigns on cardiovascular diseases, it has been concluded that it is essential to counter these disorders once they have occurred.

For doing this, the necessary equipment must be made easily available, the use of which must be as simple as possible and within reach of all. The AED statistically increases the chances of being saved by up to 75%. They are produced with a very simple graphical interface, and there are only 2-buttons. One of the power on/off the other is the button to launch the impulse, also called discharge or shock.

As I wrote earlier, the chances of saving a person in cardio-respiratory arrest, with consequent brain damage, drop by 10% every minute that passes. By acting on a patient in cardiac arrest, two minutes after the heart has stopped, the patient has an 80% chance of being saved. After three minutes, 70% and so on. The primary purpose of BLS is to maintain heart massage and, with mouth-to-mouth, mouth-to-nose ventilation (in case you encounter problems in blowing through the mouth), a constant and sufficiently good supply of oxygenated blood to the brain. After 4 minutes without oxygen, the brain undergoes severe brain damage.

In many cases, however reversible, from 6 minutes onwards, the damage becomes irreversible and can cause motor deficits, lexicons, or heavily affect the person’s state of consciousness. Victims in a vegetative state are an example. I doubt that the managers of a wild boar hunting team, the only true association of hunters in pursuit of their hunting activity permitted by law, can budget for an expense of 500 or 600 euros for an automatic external defibrillator. It is a matter of pure utopia. But I am not a natural skeptic nor a chronic pessimist.

So I want to hope, going against the tide, that soon, among the 1000 new useless and counterproductive regulations continuously promulgated at the European level on the subject of hunting. One will come up with one that will introduce the AED as an accessory tool to be carried on the hunting leader’s vehicle and guarantee its presence where the number of people is substantial, such as hunting wildlife reserves, where customers are often numerous.

Having it available would greatly facilitate the task of the poor hunter forced to intervene. So while waiting for the relative legislation, let’s assume that we have one with us in the car during a wild boar hunt. However, it must be known how to use it. The mere fact of having it makes no difference with not having it!

The first precaution to be taken is a quick check of the place: the purpose of the AED is to launch an electrical impulse, it should never, I never repeat, be used if the patient is near water basins, if he is above a puddle, or if the victim is wet because you fished him out of a river, a stream, a lake or if he is soaked in the rain.

A wet body causes an enormous dispersion of the electrical impulse, significantly attenuating the effect on the heart. Furthermore, the rescuer would risk taking a shock by conduction. In these cases, therefore, the first rule of the BLS applies: The victim must be “secured” in a dry place, and if necessary, we must undress the victim, trying to dry him as best as possible.

Once the feasibility of the intervention has been ascertained, the case is opened.  There is the AED with 2-adhesive electrodes, a pair of scissors to cut the clothes that cover the chest, a disposable razor to remove hair if present from the areas where it will go positioned the electrodes (the equipment depends on the model).

Once the chest has been freed with scissors, switched on the AED with the button. In new models, it turns on automatically when the lid is opened. One of the two electrodes is applied to the right breastplate. The remaining is just below the side on the left side. (see video below)

Once this operation has been carried out, you will wait for the instrument’s orders. While you are waiting for the response from the machine, you must “make sure” by removing any onlookers present from the range of action of the machine. If the machine decides that it must give the impulse, there must be no one around him. The correct mantra to be recited aloud, possibly shouting, is: “GO ME! ALL AWAY! ”

Once everyone present is safe, and you press the shock button. From the moment the AED is activated, it performs an ECG, an electrocardiogram, to detect the presence of abnormal heart currents. If the data collected by the victim’s analysis requires it, he will order you to launch the pulse. Suppose he believes that the victim does not need a charge because he detects sufficient and regular cardiac activity or does not detect any at all.

In that case, he will not intervene but will alert the rescuer of the need to intervene with the cardiopulmonary massage. A 30-2 is performed (30 thrusts and 2-insufflations)for two consecutive minutes until the machine repeats the procedure from the beginning, “GO ME! ALL AWAY!” and wait for the ECG result again for the machine order, and proceed accordingly. It continues until the rescuers arrive.

I also stress that each phase of its operational cycle is accompanied by a recorded vocal explanation, which will continuously update you on the current situation and on the measures it intends to take from time to time. I can guarantee that this recording helps considerably to manage psycho-physical stress for all phases of the rescue.

Early Start of Intensive Health Treatment

The last link in the “chain of survival” is the patient’s care by an equipped health facility. At these facilities, chosen based on the symptoms found during the intervention by professional rescuers, the patient will receive intensive treatment to stabilize his physical condition until he is considered out of danger of life.

Conclusions

I thought about writing this article after the loss of my mother on April 18, 2020, in a full covid-19 emergency. I thought of his last 30 years of life, made more difficult by his various forms of heart disease. Over the years, we have learned about cardiovascular disorders, everything that could have been useful in case of his default.

Perhaps, for this reason, 25 years ago, I unconsciously embarked on a professional path that favored me in training, making me a good professional in the private security sector. My mother, during our chats, always said that when you can help people, you should never back down. The best chance to sensitize as many people as possible about accidents and sudden illnesses is to attract interest in the correct procedures to counter them, contributing in a small way to save human lives indirectly.

Lives of people who are at the center of their tiny universe made up of affections, friendships, relationships, family, and passions, including hunting, a much-discussed world in which I believe every improvement in the image is essential to silence the voices of those who would like to turn it off with a click. The same click that a defibrillator button makes when it is turned on to save a life, and if after publishing this little vademecum on a page like this, one hunter out of all those who will read will do a BLSD course for me, it will already be a great one victory. One day, if this hunter will save another person’s life, it will be a bit as if he had saved my mother’s.

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