Beyond First Aid Levels of Consciousness

Wilderness Medical Associates put on an excellent Wilderness First Aid class last weekend at Idyllwild. Instructor Josh Jackson knows that stuff so well it's ridiculous, and he's got an entertaining delivery too. First aid and medical experience is so valuable, and even though I've only needed it rarely, the times I have needed and used it make me glad 1000x over that I've taken these classes over the years. But throughout the class I was thinking of how my objectives in climbing and mountaineering have evolved, and I'm no longer so concerned with succeeding at specific goals, summits, or routes. What brought that out is the AVPU consciousness scale.

A key skill to know in First Aid situations, and any guiding really, is assessing the LOC of your patient, the Level of Consciousness. Wilderness protocols use the AVPU scale to suggest the degree of brain function in a patient. It's an acronym of descending awareness, starting at Alert and then going down through the 3 grimmer levels of unalert consciousness: V, the patient is "out of it" but responds to Voice; P, only responds to a Pain stimulus, or is Unresponsive, ie. unconscious.

Well, I kept wondering, the problem with this system is having "A" as the top of the scale. All "Alert" basically means is that you can function fine. You can hear, and speak coherently, and, for instance, write a check for your rescue. If that's the highest consciousness we humans can hope for, well then what's the point? I started daydreaming about how the scale should also go above A, to, perhaps L, C, and E. L for love, C for compassion, E for enlightened. The ECLAVPU scale. The fun part about this idea is that it brings into one spectrum the concept of our mental, physical and spiritual state. The challenge, naturally, is that we can objectively identify Voice, Pain, and Unresponsive states, but we're not so practiced at identifying higher levels of consciousness. But I bet if we started trying to identify them, we would start to succeed. And of course for V, P, and U you have medical options to try to revive the patient back to A. To extend us up into L, C, or E, well, I suppose that's what meditation and faith and spiritual practice are supposed to do. And maybe a great climb with a great partner sometimes can help too.