First Aid Skill: PRICE

In any kind of wilderness medical training course, whether it is geared towards the lay provider or the professional one, I have often found that students are most interested in, and most focused on, learning how to treat dramatic injuries.  So topics that include broken extremities, wild animal attacks, tension pneumothorax, dysentery, and cholera, amongst a long list of others, tend to get the most attention and session time.  Not that I am inadvertently casting stones … Heck, my favorite lesson lately was about the field-expedient amputation and disarticulation.  But the simple fact of the matter is that in a wilderness setting, it is the “boring” injuries and illnesses that are the most common.  For this reasons, then, most of my time and effort is spent continuing to learn about and refresh my skills concerning the basics.

Since research consistently shows that in the out of doors sprains and strains are among the most common of injuries, I spent part of my shift yesterday reading about how to best control pain and spur healing after an acute soft tissue injury.

When it comes to such injuries, many of us are already familiar with RICE (rest, ice, compression, elevation).  The basis of this approach is to control swelling, which can not only be painful, but impair the healing of the tissue.  But the variation of this acronym to first include the letter “P” (protection) is the preferred approach of the Wilderness Medical Society (WMS) as outlined in its journal, Wilderness & Environmental Medicine (Practice Guidelines for Acute Pain, pp. 41-49).

So how can you help to manage your patient’s pain following a sprain or strain?

• Protection from further injury and providing stability in the form of tape, bracing, or splinting.
• Rest helps to reduce inflammation and pain (But keep in mind that this doesn’t mean that the patient shouldn’t be encouraged to self-ambulate during evacuation whenever appropriate).
• Ice, if available, can decrease skin temperature to the point where it inhibits nerve conduction, thus decreasing pain.  Plus it reduces swelling.  This should be done in 10-minute intervals (when practical) for the first 24-48 hours after the injury.
• Compression with an elastic bandage helps to reduce any swelling secondary to the initial injury.  The bandage should be close fitting, but without either cutting off the circulation to the injured extremity or preventing its muscles from expanding.  Be sure to periodically check the limb and dressing for signs of overcompression.
• Elevation of the injured extremity above heart level helps to reduce swelling and remove waste products.

And don’t forget about empathy!  Providers at all levels, even professional ones, often forget that simple techniques, like using a patient’s name, or using the patient as a “partner” in the treatment process, goes a long way towards controlling pain and anxiety, especially when pain medications are not available.  And this isn’t based on anecdote: the WMS points out in this article that one research study found that a patient’s heart rate responses to pain was lower when not alone, and that their pain levels were lower in the presence of an “empathetic” provider.