WFR - Wilderness First Responder Musculoskeletal and Spine Injuries Questions and Answers — Questions and Answers
Question 1: A hiker takes a tumbling fall 20 feet down a steep, rocky embankment. They are awake, alert, and complaining of severe neck pain. They are also shivering and their hands feel cold. According to WFR spinal injury management protocols, which of the following is the MOST appropriate immediate action?
- Apply a cervical collar and immediately begin a litter evacuation.
- Perform a focused spine assessment to determine if the spine can be cleared.
- Protect the spine from further trauma, treat for hypothermia, and then conduct a thorough assessment when the patient is stable. (Correct answer)
- Encourage the patient to sit up slowly to see if the pain increases with movement.
Correct answer: Protect the spine from further trauma, treat for hypothermia, and then conduct a thorough assessment when the patient is stable.
The mechanism of injury (a 20-foot fall) is significant, warranting spinal precautions. However, the patient's shivering and cold hands indicate potential hypothermia, which is an immediate life threat. The correct approach is to first protect the spine from further movement (manual stabilization), then address the immediate life threat (hypothermia) by insulating and warming the patient. A reliable focused spine assessment cannot be performed on a patient whose judgment may be clouded by another condition like hypothermia.
Question 2: When splinting a suspected fracture of the mid-shaft of the tibia in a wilderness setting, which of the following principles is most critical for a WFR to follow?
- Splinting the limb in the exact position it was found, regardless of deformity.
- Ensuring the splint is rigid enough to prevent all movement at the knee and ankle. (Correct answer)
- Wrapping the splint as tightly as possible to provide maximum compression.
- Checking Circulation, Sensation, and Motion (CSM) only once after the splint is applied.
Correct answer: Ensuring the splint is rigid enough to prevent all movement at the knee and ankle.
A key principle of splinting a long bone fracture is to immobilize the joints directly above and below the injury. For a mid-shaft tibia fracture, this means immobilizing both the knee and the ankle to prevent movement that could cause further damage, pain, or bleeding. While splinting in position of comfort is often done, significant deformities may be gently realigned. Splints should be snug, not overly tight, and CSM must be checked before and after splinting, and then monitored regularly.
Question 3: A member of your group dislocates their shoulder for the first time while scrambling. You are more than 24 hours from the trailhead. After a thorough patient assessment, you find good distal CSM. According to WFR protocols for simple dislocations, when is attempting a reduction appropriate?
- A reduction should never be attempted in the field by a WFR.
- Only if the patient has dislocated that same shoulder multiple times before.
- If there are signs of compromised circulation, such as a weak or absent radial pulse. (Correct answer)
- Immediately, to reduce pain and allow the patient to walk out.
Correct answer: If there are signs of compromised circulation, such as a weak or absent radial pulse.
Wilderness First Responder protocols generally allow for the reduction of simple dislocations (like an anterior shoulder) if there is a neurovascular compromise (impaired circulation or sensation) or if evacuation is significantly delayed and the rescuer is properly trained. A first-time dislocation carries a higher risk of an associated fracture, so reduction is not undertaken lightly. However, the loss of circulation to the limb is a more immediate threat, making a gentle reduction attempt necessary.
Question 4: Which of the following is a critical component of a focused spine assessment (FSA) used to 'clear' a spine in the wilderness?
- The patient must be able to walk at least 10 feet without assistance.
- The patient must be reliable, cooperative, sober, and alert. (Correct answer)
- The mechanism of injury must be minor, such as a ground-level fall.
- The patient reports a complete absence of any pain anywhere in their body.
Correct answer: The patient must be reliable, cooperative, sober, and alert.
A reliable patient is the cornerstone of a focused spine assessment. The patient must be able to understand questions, follow commands, and accurately report sensations. If a patient is altered (due to head injury, intoxication, extreme temperature, etc.), they cannot be considered reliable, and their spine cannot be cleared in the field. The assessment also checks for pain/tenderness on the spine and normal motor/sensory function, but reliability is the essential first step.
Question 5: You are treating a patient with a painful, swollen, and deformed ankle after they slipped on a wet log. Before and after applying a splint, you assess CSM. Which of these checks evaluates the 'Sensation' component?
- Feeling for a pedal pulse on the top of the foot.
- Asking the patient to wiggle their toes.
- Noting if the skin of the foot is pale and cool to the touch.
- Lightly touching a toe and asking the patient, 'Can you feel this?' (Correct answer)
Correct answer: Lightly touching a toe and asking the patient, 'Can you feel this?'
Assessing 'Sensation' involves checking for normal nerve function. This is typically done by lightly touching the skin distal to the injury and asking the patient if they can feel it, or if it feels the same as the uninjured side. Feeling for a pulse checks 'Circulation,' asking them to wiggle toes checks 'Motion,' and skin color/temperature is also part of the 'Circulation' assessment.
Question 6: A patient has a suspected closed fracture of their forearm. Which of the following describes the most appropriate improvised splinting technique?
- Tightly lashing a single, large tree branch to the top of the forearm.
- Using a rolled-up sleeping pad and two trekking poles to create a rigid 'sandwich' splint, secured with straps. (Correct answer)
- Placing the arm in a sling without any additional rigid support.
- Encasing the entire arm and hand in a thick layer of mud to create a natural cast.
Correct answer: Using a rolled-up sleeping pad and two trekking poles to create a rigid 'sandwich' splint, secured with straps.
A good improvised splint should be well-padded, rigid, and immobilize the joints above and below the injury. Using a sleeping pad for padding and two rigid trekking poles on either side of the forearm creates a strong 'sandwich' splint. A single branch provides poor immobilization. A sling alone is insufficient for a forearm fracture as it doesn't immobilize the wrist and elbow effectively. A mud cast would be ineffective and potentially harmful.
WFR - Wilderness First Responder Musculoskeletal and Spine Injuries Questions and Answers
A hiker takes a tumbling fall 20 feet down a steep, rocky embankment.
They are awake, alert, and complaining of severe neck pain.
They are also shivering and their hands feel cold.
According to WFR spinal injury management protocols, which of the following is the MOST appropriate immediate action?