In the context of wilderness medicine, soap and SOAP are both indispensable. An explanation is in order. We’re all familiar with lower-case soap. This noun refers to a substance that’s added to water to remove dirt, grease, grime, and germs from various surfaces, including skin, hair, clothing, pots and pans, and so on.
Soap In The Wilderness
Traditional soap works in two ways — as a surfactant to break water tension, improving water’s ability to penetrate surfaces, and as a molecule that has a love-hate relationship with water. Soap molecules have two ends, one that’s hydrophilic (loves water) and the other that’s hydrophobic (hates water). The hydrophilic end binds to water, while the hydrophobic end binds to anything other than water — dirt, grease, grime, germs. Imagine soap molecules as tiny carabiners that shackle dirt molecules to water molecules to enable the water molecules to usher them away.
In backcountry and wilderness settings, soap plays a vital role in preventing infection and transmission of disease. In fact, scrubbing vigorously with soap and water may be among the most important risk-management technique you practice during your time in the wilderness.
SOAP (Subjective, Objective, Assessment, Plan)
Now let’s move on to the other SOAP — all uppercase — which is an acronym for Subjective, Objective, Assessment, and Plan. As an outdoor educator, field instructor, or wilderness guide, this note-taking procedure is nearly as important as scrubbing your hands regularly with soap and water. This is especially true when you’re dealing with a client injury or illness in a remote setting.
SOAP Notes, which I’ll be covering in this post, separate important information from the chaos and fog of emotion in order to provide clean, uncluttered details for making informed medical decisions and emergency response plans.
With SOAP Notes in hand, field instructors and outdoor educators trained in wilderness medicine, as well as backcountry guides, are better prepared to respond to a medical emergency. They do this by:
- Following an organized, methodical process
- Tracking changes in a patient’s health status
- Keeping a record of assessments, anticipated problems, and any interventions already provided
- Communicating with emergency responders
- Ensuring a seamless transfer of patient care to next-level healthcare providers
- Documenting cases and care for improving organizational outcomes
Here at The National Center of Outdoor Adventure and Education (NCOAE), we developed the SOAP Note form shown below.
Our SOAP Note’s Form
Our SOAP Note form consists of the following seven sections:
- General information: Date, time, location, treatment providers, patient information, weather conditions, nature or mechanism of the injury/illness
- Basic life support: Problems (such as bleeding or not breathing) and treatments provided (such as CPR and pressure bandages)
- Subjective: What the patient tells you about their medical history, pain level, and other relevant health/medical details
- Objective: Vital signs, including heart rhythm, respiration rate, oxygen saturation level, and blood pressure
- Assessment: Diagnostic details, such as whether the patient is suffering from a spinal injury, heat stroke, anaphylaxis, hypothermia, respiratory illness, or some other condition, along with concerns about any anticipated problems
- Treatment plan: Any treatments provided, such as cleaning and bandaging a wound, providing medication, rehydrating a patient, and so on
- Evacuation plan: Urgency of making an evacuation decision and the means of evacuation, such as self-evacuation, carrying the patient, calling in a helicopter, or getting assistance from a search and rescue team
As you can see, SOAP Notes facilitate the gathering, documentation, and communication of crucial information. For example, suppose you and your co-field instructors are leading a backcountry course of 12 participants on a 10-day backpacking trip in the remote wilderness. On the seventh day, a member of your party slips on and injures her ankle. Creating a SOAP Note can help you decide how to proceed.
Following our SOAP Note format, you might gather the following information about a 21-year-old student who slipped and injured her ankle during a guided backcountry expedition:
– Patient Name: Skyler Jones
– Age: 21 years
– Sex: Female”
– Mechanism of injury: Slipped on rock
– Environment: Dusk, 40 degrees Fahrenheit
Basic Life Support
-Severe pain and difficulty bearing weight on right ankle. Pain is sharp and localized to the lateral sspect of the right ankle. No reported loss of consciousness, numbness, tingling, or other associated symptoms
– Swelling and bruising present on the lateral aspect of the right ankle
– Limited range of motion
– Tenderness and localized pain over lateral malleolus
– No signs of deformity
– No signs of neurovascular compromise
– Skyler likely sustained a right ankle sprain
– Further imagining, such as x-ray, may be warranted in order to rule out possible fracture
– Rest. Ice. Compression. Elevation (RICE) to reduce pain and swelling
– Splint ankle for stability and to minimize movement
– Analgesic to alleviate pain
– Assess the feasibility of Skyler walking to pick-up point to obtain more advanced medical treatment
– Communicate with local emergency services to discuss potential evacuation options, considering the remote location
The above data entered in a SOAP Note provides essential information for planning your next move. Given Skyler’s lack of mobility and the fact that the temperature is only slightly above freezing and is likely to start dropping as the sun sets, you may decide that hiking out would be too risky. In addition, you would need to seek ways to keep members of your group warm while working with local emergency services to execute your evacuation plan.
When you create a SOAP Note, you’re following best practices of medical professionals — even those who conduct patient assessments numerous times over the course of a lengthy shift. SOAP Notes enhance efficiency, minimize mistakes, document findings and recommendations, and ensure the best possible outcomes for the sick and injured. They also serve as an important resource when debriefing a backcountry course and evaluating your organization’s future backcountry medical protocols and approaches to wilderness-based risk management.
The benefits of following an organized path through the chaos of an emergency are invaluable and may even save a life. That’s why we insist on preparing SOAP Notes as part of our emergency response scenarios during every NCOAE Wilderness First Aid course and Wilderness First Responder course.
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About the Author: Todd Mullenix is the Director of Wilderness Medicine Education at The National Center for Outdoor & Adventure Education in Wilmington, North Carolina.