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Scenario: It is a sunny summer afternoon. You and your partner are 3 miles into a day hike on the AT in the Smoky Mountains.  They trip on a root and tumble down a few feet off the trail.  There is a deep cut on their palm and blood is running down their arm. Their foot looks like it is twisted to the side.  What is your biggest concern and what are your next three steps?

Barrett’s take on this scenario:

My biggest immediate concern is stopping the bleeding.  After that, it becomes evacuation.  With an ankle injury, I’m worried my partner might not be able to walk themselves out and we may end up stuck waiting a long time for a rescue team to arrive.  We could find ourselves there after dark without the layers to stay warm.  I want to do everything I can to get them mobile again (wrap, crutches, supported walk, etc.) to avoid a carry out.

My next steps:

1 – Get gloves on and stop the bleeding.

2 – Get through the rest of my primary assessment.

3 – Physical assessment with a detailed examination of the injured foot and ankle. There could be a fracture or dislocation that may impair perfusion of the foot.  I will need to get the shoe off and may have to cut it (and the sock) to do a thorough assessment.

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