Guide training: volunteer preparation

Study plan

• 3 min: Read the purpose and safety rules
• 2 min: Save the material and prepare your notes
• 5 min: Review your experience and write down questions

During the practical day we will work in small teams. You will rotate through caring for a simulated patient, playing the patient and observing with a simple checklist. There will be brief demonstrations, practice time, specific feedback and another chance to try. Each guide is not expected to deliver a formal presentation or arrive knowing every answer.

Have these ready

• Your phone with the document saved, paper and a pencil.
• A clean towel or cloth and a pillow to imagine supports or hand placement; you do not need to buy equipment.
• A quiet place to read, think and explain your decisions aloud.
• Your own first-aid kit, if available, just to identify equipment. Do not open sterile products or use medications during study.

If using a pillow, limit yourself to pointing out where the hands would go, explaining the sequence or counting a rhythm. This does not reproduce chest resistance or assess compression depth. Do not confuse verbal rehearsal with a skill assessment.

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Study plan

• 10 min: Read and explain the sequence
• 8 min: Work through the riverbank case
• 8 min: Rehearse SAMPLE and a call for help
• 4 min: Review your answers

In a remote setting, definitive treatment may be far away and the patient's condition may change while waiting. Assessment therefore happens more than once. Observe, act on urgent problems, call for help, reassess and communicate changes. Before touching someone who can respond, introduce yourself, explain what you want to do and ask permission. Protect your skin and eyes from blood exposure where possible; wear gloves and wash your hands afterward.

A sequence to remember

1. Check the scene: current, surf, slippery rocks and trails, falling branches, traffic, electricity, animals and storms. At a canopy site, a suspended person or platform access requires the operator’s rescue team; do not improvise a vertical extraction. Count patients. Do not enter a hazard your team cannot control.
2. Look for immediate threats: are they responsive, breathing normally, or bleeding heavily? Call for help and address these threats before a long interview.
3. Once urgent problems are addressed, ask what happened and the main complaint. Take a SAMPLE history and perform an examination appropriate to the injury.
4. Record observations and times. Reassess breathing, responsiveness, bleeding, pain and treatment results. If the patient worsens, return to the initial assessment.
5. Arrange evacuation and give the next team a clear report. Do not wait for a perfect diagnosis before requesting help.

Someone speaking normally has an open airway at that moment, but this can change. If unresponsive, quickly check whether they are breathing normally. Isolated gasps or agonal breaths are not normal breathing. For an unresponsive adult who is not breathing normally, activate help and begin CPR; do not waste time trying to find a pulse. The drowning sequence is explained in the next module.

SAMPLE: a short interview

• S: signs and symptoms. What do they feel? What do you observe? Since when?
• A: known allergies, particularly severe reactions.
• M: medications used and what they have taken today.
• P: relevant past medical history: illnesses, injuries or similar episodes.
• L: last food or drink intake.
• E: events: what happened before the problem and how it has changed since.

The secondary examination looks for additional injuries, pain, wounds, deformity or swelling. Explain what you are doing, protect privacy and avoid painful movements. Do not manipulate a bone to see whether it is broken. Observe responsiveness: alert, responds to your voice, or unresponsive. AVDI is the Spanish equivalent of AVPU found in earlier resources; it is not an instruction to apply pain to a partner during practice. DADH is the Spanish reminder for deformities, open wounds, pain and swelling.

Record trends in clear words: for example, 'At 10:05 they were talking; at 10:15 they are confused and breathing faster.' A single measurement or apparently normal skin does not rule out an emergency. Reassess frequently and immediately after a change or intervention; as a course reference, about every 5 minutes if unstable and every 15 if stable, while continuing to observe during the wait.

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Study plan

• 12 min: Read the sequences and their differences
• 8 min: Rehearse aloud and assign roles
• 10 min: Work through both cases
• 5 min: Review the critical points

Drowning is respiratory impairment caused by immersion or submersion in liquid. The important problem is lack of oxygen. Someone may need rescue breaths and CPR even without striking a rock. First ensure a safe rescue: from a safe location, use the techniques, equipment and support for which you are trained. Being a healthcare professional or knowing how to swim does not mean you are trained for swiftwater rescue. It can happen during rafting, in a waterfall pool, at a beach or while snorkeling. Currents, surf, slippery rock and difficult access require a site-specific plan and equipment; this course does not certify water rescue.

Adult after drowning: already out of the water

1. Once out of the water, place the person face-up on firm, flat support. Give a specific request: 'You, call 9-1-1 and activate the local plan; bring the AED.' Observe responsiveness without delaying initial actions.
2. If responsive only to pain or unresponsive—P/U on AVPU, D/I on Spanish AVDI—open the airway with head tilt and chin lift and give 5 initial rescue breaths. Do not wait for a pulse check, oxygen or a mask.
3. Each breath takes about 1 second, only until the chest visibly rises. Never force breaths against coughing, resistance or effective spontaneous breathing. Airway opening and ventilation will be practised on a manikin under supervision.
4. After the initial breaths, assess normal breathing and signs of life without checking a pulse. If still unresponsive and not breathing normally or only gasping, begin cycles of 30 compressions and 2 breaths. If breathing normally, protect the airway, monitor and await help.
5. Compress in the centre of the chest over the lower half of the sternum, at 100–120 per minute. In an adult, compress at least 5 cm while avoiding depths beyond 6 cm; allow full recoil and minimize pauses.
6. Begin CPR before applying the AED; another helper can prepare it in parallel. Follow its prompts, with nobody touching the patient during analysis or shock, and resume CPR immediately when instructed. Change rescuers about every 2 minutes with the least possible interruption.

This is the BRAM adult drowning approach, informed by WMS 2024 and ILS medical position statements. Five initial breaths are BRAM’s selected teaching sequence; those sources do not universally mandate an exact five-count. Guides do not check a pulse. After the breaths, if still unresponsive and not breathing normally, continue with 30 compressions and 2 breaths: 30:2. With normal breathing, maintain the airway and monitor, without forced breaths or unnecessary compressions. For an adult collapse unrelated to drowning, start with compressions when unresponsive and not breathing normally. If you cannot give breaths to an unresponsive person who is not breathing normally, start compressions while calling for help; do not wait without acting.

To use the AED, remove the patient from the water and expose the chest. Quickly dry the areas where the pads will attach and follow the device's diagrams and instructions. Nobody should touch the patient during analysis or a shock. Resume compressions as soon as the device instructs. The team will explain the actual model during practice.

Do not use abdominal thrusts to remove water or waste time turning the person head-down. If they vomit, briefly and carefully turn them to allow drainage, remove only visible material and reassess breathing and the need for CPR. Do not perform blind finger sweeps. Continue resuscitation until signs of life return, another team takes over, medical authority directs you to stop, you cannot continue, or the scene becomes unsafe. Do not use an automatic 30-minute limit learned from the old appendix. If movement or recovery appears, quickly reassess breathing. Gasps are not normal breathing and do not justify stopping CPR.

If breathing normally but unresponsive, maintain the airway and monitor continuously. If a side-lying position is needed to protect the airway, turn carefully and minimize unnecessary movement; protecting breathing takes priority. Keep the person warm, remove or cover wet clothing as conditions allow, and arrange care. Persistent cough, shortness of breath, confusion or a need for resuscitation after submersion requires urgent medical evaluation. Do not allow temporary improvement to replace reassessment.

Choking is a different problem

Choking means an object is blocking the airway. If an adult is coughing strongly, encourage continued coughing and observe. If unable to speak, breathe or cough effectively, activate help and alternate 5 back blows with 5 abdominal thrusts. In advanced pregnancy or when you cannot encircle the abdomen, use chest thrusts instead. If they become unresponsive, begin CPR and remove only visible objects when opening the mouth. We will practise the technique only on training equipment, without force on people.

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Study plan

• 9 min: Read the procedures
• 5 min: Organize equipment and explain its use
• 7 min: Work through the case and compare decisions
• 4 min: Review the essentials

Bleeding that flows in large amounts, pools, rapidly soaks clothing or continues despite firm pressure may be life-threatening. Address it before cleaning the wound or finishing the interview. Use a barrier, expose enough to find the source and apply firm, continuous direct pressure with gauze or clean cloth. Call for help. Do not repeatedly lift the cloth to see whether bleeding has stopped.

A commercial tourniquet may be needed for life-threatening arm or leg bleeding not controlled by pressure. The course will teach placement and tightening with a training device. Position it about 5–7 cm above the wound, not over a joint, and tighten until bleeding stops. Record the time and keep it visible. Do not loosen or remove it yourself: inform the medical team. If bleeding continues, a second device may be needed as taught. Do not use a tourniquet for snakebite.

Minor wound with bleeding controlled

1. Wash your hands, wear gloves and remove accessible surface dirt without probing deeply.
2. Irrigate with plenty of drinking-quality water. River water is not drinking-quality water; do not pour alcohol, hydrogen peroxide or irritating products into the wound.
3. Cover with a clean dressing. The dressing contacts and protects the wound; the bandage holds it in place.
4. Check sensation, movement and circulation beyond the bandage. Cold, pale or numb fingers or toes, or increasing pain, require checking whether an ordinary bandage is too tight.
5. Keep the covering clean and dry, replace anything soiled or wet, and monitor progress.

Deep wounds, bites, embedded objects, loss of function, open fractures and heavily contaminated wounds require medical assessment. Do not suture or glue a deep or dirty wound in the field. Do not remove a large embedded object: stabilize it and control bleeding around it. Increasing pain, warmth, spreading redness, pus or fever suggest infection. Tetanus vaccination status should also be reviewed with a healthcare professional.

For a thermal burn, stop the source without exposing yourself. Cool the area with cool running water for about 20 minutes when possible; do not use ice. Remove rings and tight objects before swelling increases, but do not pull away clothing stuck to skin. Then cover with a clean, non-adherent dressing and protect the rest of the body from cooling. Do not break blisters. Extensive or deep burns, or burns of the face or airway, hands, feet, genitals or around a limb, require urgent evaluation. Electricity may cause internal injury even when little skin damage is visible.

Treat a friction blister before it prevents walking: reduce friction, dry and protect the area with an appropriate covering. Do not routinely puncture blisters or remove skin during pre-learning or the basic course. Seek evaluation for pus, increasing pain, spreading redness or difficulty walking. For prevention, check footwear, rubbing areas and wet feet during breaks. On wet walks, check feet early, change wet socks when possible and adjust footwear before pain alters walking. At a beach, waterfall or river, natural water does not replace drinking-quality water for cleaning a wound.

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Study plan

• 18 min: Read assessment, support and Davos selection
• 10 min: Explain unloaded posture and checks
• 12 min: Work through ankle and shoulder cases
• 5 min: Reassess and explain decisions

You cannot always distinguish a sprain from a fracture. Pain, swelling, deformity, an open wound or inability to use a limb indicate a need to protect it. Do not ask someone to walk or force a joint to prove it is 'not broken.' Address breathing, severe bleeding and overall condition first; an ankle injury must not distract from confusion, cold exposure or breathing difficulty.

Before and after support

1. Ask how it happened and where it hurts. Look without forcing movement. Check for wounds, deformity and swelling.
2. Check circulation, sensation and movement below the injury: colour and temperature, sensation in fingers or toes, and gentle movement the person can make without forcing.
3. Support in a comfortable position, pad and apply the support or splint you have learned. Avoid pressure on wounds and bony prominences.
4. Secure without restricting circulation. For a long-bone injury, support usually limits movement at nearby joints; the instructor will demonstrate with available equipment.
5. Repeat the distal check and overall assessment. Record changes and adapt the plan if pain, numbness or swelling increases.

A splint reduces movement and pain; do not forcibly straighten a deformity. Do not reduce fractures or improvise traction. The workshop includes Davos for an anterior shoulder selected by the medical lead, demonstrated on a model with unloaded posture on healthy people. Reading this document does not authorize reduction in an actual patient. A cold, pale or numb limb, open fracture or severe pain needs medical help and urgent evacuation. Cover an open fracture with clean material; do not push bone back through the skin.

Shoulder injury and medically directed Davos

A shoulder dislocation is not the same as a fracture or a collarbone/AC-joint separation. In this BRAM workshop, a qualified medical lead selects an alert, cooperative adult with a likely uncomplicated ANTERIOR dislocation, particularly a familiar recurrent episode after low-energy indirect force. Ask about prior dislocations, mechanism, time and other injuries. A first episode or uncertain diagnosis needs medical assessment; it is not automatic permission for a guide-led attempt. A direct blow/high-energy fall, bony tenderness/crepitus, open wound/skin tenting, major swelling, suspected fracture or posterior dislocation, altered responsiveness or another serious injury means support the arm and escalate. Do not provoke crepitus or force range of motion. A cold/pale hand, absent pulse or new numbness/weakness requires urgent medical-lead action and evacuation; it is not a routine Davos practice case.

Before and after any attempt, and again after sling/support: compare radial pulse, skin colour/warmth and capillary refill; light touch and finger/wrist movement; and sensation over the outer shoulder (axillary-nerve territory). Document findings and time. Do not force painful shoulder abduction to test the deltoid. Repeat during evacuation. Any deterioration means stop and escalate immediately. A palpable pulse does not rule out all associated injury.

Davos sequence to explain using the model

1. The medical lead confirms selection, explains the patient-controlled method and obtains consent; record the baseline neurovascular examination.
2. Seat the patient on stable dry ground/a firm surface, supported against a fall. Bend the knee on the injured side about 90 degrees, with that foot flat; the patient interlocks fingers around that knee. Do not use this posture with a relevant neck, back, hip or knee injury.
3. The patient relaxes, gently rolls the shoulders forward and SLOWLY leans backward, allowing the arms to straighten and the head to look upward comfortably. The patient controls the movement; the coach does not pull, twist or lever the arm. Do not force neck extension.
4. Stop for increasing pain, resistance, inability to follow instructions or any new neurovascular symptom. No jerking, body-slamming, foot in the armpit, hanging weights or improvised sedation/alcohol. The medical lead decides any further attempt or alternative.
5. After apparent reduction, stop the manoeuvre, repeat neurovascular checks and support in a comfortable sling/swath. Reassess after support and arrange medical evaluation, imaging when available and follow-up. Do not return to paddling or strenuous guiding that day.

Increasing pain/resistance or a new sensory, motor or perfusion change: STOP, support and urgently involve the medical lead. Suspected fracture, posterior dislocation, high-energy injury or uncertain diagnosis: do not start routine Davos; arrange appropriate clinical care. A trained clinician may need urgent reduction for threatened circulation, so this is a guide escalation rule, not a ban on expert emergency treatment. Failed reduction or persistent neurovascular abnormality needs urgent evacuation; apparent success still needs documented reassessment, sling/support and medical review/imaging. No forced repeat attempts or same-day return to risk.

Suspect a spinal injury when the mechanism, neck or back pain, altered responsiveness, tingling or weakness suggest it. Ask the person to avoid unnecessary movement and provide calm support. Do not declare the spine 'cleared' after an improvised test. Nor should concern about the spine prevent opening an airway or removing someone from immediate danger. The priority is protecting the spinal cord by reducing unwanted movement while preserving life.

Moving someone requires a reason and a plan: scene danger, care that cannot be provided in the current position, or organized evacuation. Choose a leader to give commands, explain the movement to the patient and ensure enough people and equipment. Agreeing on 'ready, move, stop' prevents helpers acting at different moments. Check the route, ground, obstacles, rain and the team's actual capability. Do not pull on the head, neck or arms or improvise a difficult carry without training. A narrow trail, canopy platform or surf zone may require technical rescue for safe access: stop the activity and request trained support. Do not improvise rope descents or force someone to walk when unsafe. While help comes, support, warmth and monitoring remain treatment.

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Study plan

• 10 min: Read and compare heat illness and heat loss
• 5 min: Map shelter and resources
• 15 min: Work through heat and wet-cold cases
• 5 min: Review decisions and prevention

Heat, humidity, exertion, time without rest and clothing affect cooling. Prevention is more than 'drink more water': it also requires a reasonable pace, shade, breaks, food and looking out for one another. Sweat loses water and salts. Someone can develop a serious problem even while sweating or when physically fit. A coastal walk in sun, a canopy tour in a harness and a humid rainforest route may need different pacing, breaks and water access. Plan around the people and actual route, rather than the advertised duration alone.

Heat exhaustion may cause dizziness, weakness, headache, nausea and difficulty continuing, while mental responsiveness remains normal. Stop exertion, move to a safe cool place, remove excess clothing and cool the person. If alert, able to swallow and not persistently vomiting, offer fluids in tolerable amounts. Prepare commercial oral rehydration solution exactly as directed on the packet; do not improvise concentrated salt mixtures. Reassess and escalate if the person does not improve, worsens or cannot drink.

Cold-water immersion is highly effective when a safe system, supervision and continuous airway support are available. Do not put a confused person into the river. Without a safe facility, wet skin and clothing, fan and use available cold resources while arranging transport. Keep access to the face and monitor breathing and responsiveness. Do not give aspirin or paracetamol/acetaminophen to treat heat stroke, or oral fluids to someone who cannot swallow safely.

Stop heat loss while arranging help

1. Find a safe place protected from rain and wind. A roof or tarp can block rain but is not equivalent to lightning-safe shelter. Insulate underneath with a mat, pack or other dry material.
2. Replace wet clothing with dry layers when you can do so sheltered from the environment and preserving privacy. Without dry clothing, reduce rain and wind with a cover and add available insulation; do not leave the person exposed while arranging a change.
3. Insulate the torso, head and neck without covering the face. Wrap any heat source to prevent burns; do not rub limbs or apply intense heat directly to skin. Handle gently and do not force a clumsy or confused person to walk.
4. Observe responsiveness and breathing and record changes. Activate early evacuation for deterioration, altered responsiveness or inability to warm up. Do not wait for shivering to stop before deciding.
5. A warm sweet drink is an option only when fully alert and swallowing safely. Do not force hot drinks or give food, drink or gel to someone confused, drowsy or unable to swallow safely. Never use alcohol for warming.

When thunder or a storm occurs, follow the activity suspension plan. No outdoor location is completely safe. Seek an enclosed building or hard-topped vehicle if you can reach one safely; an isolated tree, tent or small open shelter does not provide the same protection. The local team must know shelters and exit decisions. A lightning victim does not retain electrical charge and can be touched once the scene permits. If unresponsive and not breathing normally, activate help and begin CPR; also check for fall injuries.

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Study plan

• 9 min: Read about the three main problems
• 6 min: Order the actions and discard myths
• 6 min: Work through the allergic-reaction case
• 4 min: Review and note questions

Prevention includes watching where you place hands and feet, using light at night, checking equipment and not handling wildlife. After a bite or sting, move away from danger, assess breathing and responsiveness, and observe whether symptoms remain local or affect the body. Do not try to capture, kill or transport the snake or other animal for identification. Do not delay care to take a photo. In forest, look before placing hands in vegetation or on logs; do not handle snakes, bats or other animals for a photograph. At the coast or while snorkeling, avoid touching marine life and seek species-specific local advice; first leave the water safely. Do not automatically transfer one sting treatment to another species or improvise vinegar or other products without identifying the problem and local protocol.

Suspected snakebite in Costa Rica

1. Keep the person calm and at rest. Immediately activate transport to an appropriate healthcare facility.
2. Remove rings and objects that could become tight with swelling. Support and immobilize the limb without constriction.
3. Reduce movement and exertion; arrange assisted transport when safe rather than making the patient walk unnecessarily.
4. Monitor responsiveness and breathing, record times and changes, and give this information to the treating team.
5. Do not use a tourniquet, pressure bandage, cuts, suction, ice, alcohol or remedies. Antivenom belongs in the healthcare facility, not an improvised field treatment.

Do not be reassured just because swelling is minimal or you did not see the snake. Some symptoms appear later. Bite-mark patterns and colour bands do not allow a guide to rule out danger. A loose supporting splint differs from a bandage compressing the whole limb: this course follows local Instituto Clodomiro Picado guidance and does not teach pressure bandaging as a general response to snakebite.

Anaphylaxis is a severe allergic reaction. It may cause breathing difficulty, a sensation of throat closure, tongue swelling, fainting or rapid deterioration; hives, vomiting or abdominal pain may also occur. Do not necessarily wait for a rash before calling for help. Activate emergency services and assist with the person's epinephrine autoinjector if available and within your training and local procedure. An antihistamine does not replace epinephrine or evacuation.

Prevent the person from standing or walking. If they tolerate lying down, keep them there; if breathing is easier in another position, assist without making them stand. Monitor and prepare for CPR if they become unresponsive and are not breathing normally. Follow the autoinjector and emergency-service instructions. If they do not improve and help is delayed, a second dose may be needed after 5–10 minutes according to your training and protocol. Practice uses a trainer without a needle or medication.

A small local sting reaction may cause pain, itching and redness. Promptly remove a visible stinger without wasting time, wash and apply protected cold to relieve discomfort; continue watching for systemic symptoms. Do not apply substances to 'draw out the venom.' Progressive symptoms, difficulty breathing or swallowing, altered responsiveness, or intense pain with systemic symptoms require urgent care.

After a mammal bite, wash thoroughly with soap and water and seek prompt assessment for infection, tetanus and possible rabies. Do not wait for rabies symptoms. Avoid further animal contact and notify the appropriate people. For ticks, use fine-tipped tweezers close to the skin and pull steadily upward without twisting; if parts remain and do not come out easily, do not dig into the skin. Wash and seek advice for later symptoms. Prevent bites with clothing, mosquito nets and approved repellent used according to its label; permethrin is for equipment or clothing as directed, not skin.

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Study plan

• 8 min: Read the warning signs and initial care
• 8 min: Work through the case and write a report
• 4 min: Review your plan and local questions

Not every emergency begins with a fall. Chest pain, breathlessness, sudden weakness, seizures or confusion can occur during activity or at rest. Use the same initial assessment: safety, responsiveness, breathing, bleeding and help. A person with changed mental status is not simply 'tired' until someone establishes the cause. Request support early and do not let them continue the activity to see whether it passes.

Chest pain or pressure, particularly with breathlessness, sweating, nausea, fainting or pain spreading to the arm, back or jaw, needs urgent care. Stop exertion, help the person rest comfortably, activate emergency services and prepare the AED. Avoid making the patient walk to transport if possible. Do not give unfamiliar medication or delay help while deciding whether it is anxiety. If unresponsive and not breathing normally, begin CPR and use the AED.

During a seizure, remove hazards, protect the head and time the event. Do not restrain firmly, put anything in the mouth or give liquids before normal swallowing returns. When it ends, check breathing and help position the person to protect the airway. Request urgent help if it lasts 5 minutes or longer, repeats without recovery, is the first known seizure, causes injury, occurs during pregnancy or in water, or breathing or recovery are concerning. Continue observing: the person may be confused afterward.

If someone with diabetes develops shaking, sweating, weakness or confusion, ask about their plan and check glucose if equipment is available and you know how, without delaying care. If alert and swallowing safely, you may help them take glucose or rapidly absorbed sugar according to their plan and first-aid protocol; reassess and seek help if they do not improve. If poorly responsive, seizing or unable to swallow, do not put food, drink or gel into the mouth. Activate help, protect breathing and use only treatments for which you are trained and authorized. Do not give insulin to treat suspected low blood sugar.

A poisoned or substance-exposed person also needs safety and assessment. Do not enter a gas- or smoke-filled space to rescue without proper equipment. Do not induce vomiting or try to neutralize a product with another substance. Record what, how much and when, and seek urgent advice. Bring information or the container only if safe, without contaminating the team.

Communicate so the next team can act

• Exact location, route name and a known access point: trail or distance marker, canopy platform, waterfall access, beach or river point; do not say only “in the rainforest” or “on the river.”
• Number of patients, mechanism or problem and approximate onset time.
• Responsiveness, breathing, bleeding and changes you have observed.
• What you did, the result and the time; include epinephrine or tourniquet use.
• Hazards, route conditions, required resources and a way to re-establish contact.

In Costa Rica, 9-1-1 is the emergency number. In an area without signal, the plan needs another communication method and a coordinator. Confirm radio channels, access points, transport, receiving facility and who decides to suspend the activity with the local team. Do not invent these details or a fixed arrival time. While waiting, assign one person to the patient and another to communications/equipment; reassess, protect from the environment and document. In exercises, say 'simulation' and do not call 9-1-1.

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Study plan

• 10 min: Answer the 15 questions without looking at the answers
• 5 min: Compare, correct and prepare your questions

Complete the self-assessment first. Then review each explanation and return to the relevant module. The proposed target is at least 12 correct answers out of 15 and understanding every error; this is study guidance, not certification or the course's only criterion. If you do not meet that target, do not hide uncertainty: review and request extra practice.

The in-person session will check what you can do: initial assessment, communication, bleeding control, limb support, resuscitation and evacuation decisions. The team will observe actions, provide feedback and allow another attempt. Everyone must have a chance to act; playing the patient or watching a demonstration does not replace practising as the rescuer.

Review questions — answer before viewing the key

1. An injured person is across a current you cannot safely cross. What do you do first?

• A. Cross quickly because time is the only thing that matters.
• B. Assess hazards and request trained, equipped rescue support.
• C. Send an inexperienced person to test the depth.

2. During SAMPLE, the patient stops answering clearly. What is the next step?

• A. Finish every question before acting.
• B. Assume they need sleep.
• C. Reassess immediate threats and update urgent help.

3. After drowning, an adult out of the water is unresponsive and only gasping. What does the course sequence require?

• A. Activate help, give 5 initial breaths and continue 30:2 if still unresponsive and not breathing normally.
• B. Wait for a radial pulse before deciding.
• C. Use abdominal thrusts to remove water.

4. What is the adult CPR compression rate?

• A. 40–60 per minute.
• B. 100–120 per minute, allowing full recoil.
• C. As fast as possible regardless of depth.

5. An adult cannot speak or cough effectively because of an airway object. Which sequence is taught?

• A. Give water.
• B. Perform blind finger sweeps to remove the object.
• C. Alternate 5 back blows and 5 abdominal thrusts; use the chest-thrust alternative when appropriate.

6. A deep leg wound is bleeding heavily. What takes priority over cleaning?

• A. Firm direct pressure, help and appropriate escalation of bleeding control.
• B. Find river water and wash first.
• C. Lift the cloth every few seconds to look.

7. A commercial tourniquet controls life-threatening bleeding. What should the guide do?

• A. Loosen it every 10 minutes.
• B. Record the time, keep it visible and hand over to the medical team without loosening it independently.
• C. Remove it because it hurts.

8. What should you check before and after a splint or supporting bandage?

• A. Only that it looks neat.
• B. Whether you can forcibly straighten the joint.
• C. Distal circulation, sensation and movement, plus overall condition.

9. After exertion in heat, a person becomes confused and collapses. What do you do?

• A. Activate help and evacuation and begin safe rapid cooling without waiting for a thermometer.
• B. Wait until the skin stops sweating.
• C. Only offer water and allow continued activity if they say they feel better.

10. After a suspected snakebite in Costa Rica, which plan is appropriate?

• A. Cuts, suction and a tourniquet.
• B. Rest, non-constrictive support and urgent transport, without capturing the animal.
• C. Wait for swelling before calling for help.

11. Breathing difficulty and dizziness develop after a sting, without hives. Could this be anaphylaxis?

• A. No; hives are required.
• B. No; an antihistamine is enough.
• C. Yes; activate help and facilitate epinephrine according to training, availability and protocol.

12. Someone is having a seizure. What should you avoid?

• A. Putting objects or liquids in the mouth and restraining firmly.
• B. Removing nearby hazards and protecting the head.
• C. Timing the event and checking breathing afterward.

13. A person with diabetes is confused and cannot swallow safely. What is appropriate?

• A. Force a sugary drink.
• B. Call for help, protect breathing and give nothing by mouth.
• C. Guess an insulin dose.

14. Once the source is controlled, what should you do for a recent thermal burn?

• A. Apply ice directly and break blisters.
• B. Pull off stuck clothing.
• C. Cool with cool running water for about 20 minutes when possible, protect and assess severity.

15. What makes an evacuation message useful?

• A. Location and access, patient condition and changes, timed actions, hazards and a way to contact you again.
• B. Only saying 'we need help on the river.'
• C. Inventing a diagnosis to sound more precise.

Answers and explanations

1. B. Preventing more casualties is the first priority. A medical emergency does not remove the conditions needed for a safe rescue.

2. C. Changed responsiveness may indicate deterioration. The interview must not delay assessment of breathing and other threats.

3. A. Gasps are not normal breathing. BRAM’s teaching sequence starts with 5 breaths; if still unresponsive and not breathing normally, continue 30:2. The guide does not check a pulse or try to drain water. WMS 2024 and ILS inform the approach; five is BRAM’s selected initial count.

4. B. CPR requires the correct rate, adequate depth, recoil and few interruptions. These skills will be checked on a manikin.

5. C. Severe obstruction requires help and appropriate manoeuvres. If unresponsive, perform CPR; remove only a visible object. Do not practise forcefully on partners.

6. A. Severe bleeding can kill quickly. Irrigation of a minor wound is not the priority while dangerous bleeding continues.

7. B. A tourniquet controlling severe bleeding is not routinely loosened. It differs from an ordinary bandage that is too tight.

8. C. Support should reduce movement and pain without compromising circulation. It does not authorize reductions or traction by untrained people.

9. A. Heat with altered mental status suggests heat stroke. Do not delay cooling or force fluids on someone who cannot swallow safely.

10. B. Local guidance prioritizes calm, rest, immobilization without compression and urgent medical care. Initial absence of symptoms does not exclude danger.

11. C. Anaphylaxis can occur without skin signs. Do not wait for a rash or substitute antihistamines for epinephrine and evacuation.

12. A. Protect from injury, time the seizure and observe. Prolonged or repeated seizures, those in water or with recovery problems require urgent help.

13. B. Giving something by mouth in this situation can obstruct the airway. Treatment must match responsiveness, training and protocol.

14. C. Safe cooling and covering protect the injury. Avoid ice, breaking blisters and pulling off stuck material; seek care for significant burns.

15. A. Specific information helps determine resources and access. Say what you know, what changed and what still needs confirmation; a definitive diagnosis is not required to request help.

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