On the 4 hour drive up from Boston to Orono, Maine, I thought I had a pretty good sense of what was in store for my upcoming Wilderness First Responder (WFR) class. I’d be staying in a motel down the road, and car pooling in to class with some new friends every day.
I figured we’d talk about injuries and illnesses, common treatments and wilderness considerations. We’d practice things a few times and then head home, ready to practice some basic medicine in the backcountry.
And while we did learn a ton about the body, what can go wrong and how to fix it, there were some arguably much more important lessons that I took away from my experience becoming a WFR.
1. Your First Aid Kit is Insufficient, and That's Okay
One of my goals going into the class was to learn all about building the ideal first aid kit. I wanted to catalog every piece of gear I could possibly need and add it to my kit to be prepared for any emergency.
Over the course of the week, I realized that there are a dizzying number of things that can go wrong in the backcountry. While striving to “be prepared” is a worthy goal, it’s impossible to carry everything.
Backpacking is the art of knowing what not to take. Ultimately, first aid knowledge weighs nothing, and the ability to improvise based on the resources you have on hand is more important than trying to carry a specialized tool or drug for every situation.
2. Understanding Concepts is More Important than Memorizing Techniques
There’s no such thing as an “ideal” backcountry emergency situation. You always have to face the reality of what you find, and the resources at your disposal.
It may be dark, windy and rainy. You may have dropped your first aid kit somewhere back along the trail. You may be hiking alone and come across a large, multi-patient situation.
Wilderness medicine requires a lot of improvisation, but in order to do that effectively, you have to understand the core principles about what’s wrong with the patient and what your prioritized treatment plan looks like.
If someone fell off a ledge and was temporarily knocked unconscious, it would be “ideal” to get them on a backboard and wait for a litter team to help carry them out.
But if you’re on an exposed ridge with a blizzard moving in and insufficient gear to weather the storm, you may have to make a decision about hiking your patient out instead.
Don’t expect you’ll always be able to stick with the script you learned in the classroom. Specific treatments & techniques may not always make sense in every situation, but understanding the core principles of wilderness medicine will allow you to weigh the tradeoffs and improvise effectively.
3. Wilderness Medical Protocols Can be Very Different from Urban Hospital Settings
The goal of anyone working in a medical role is to do the best they can for a patient given the constraints they’re operating under.
There are often competing ideas about what the “right” course of action is for a patient, given the environment they’re in. Protocols you learn for wilderness contexts may be considered wrong or even harmful in urban environments.
A big one that we learned is to stop giving CPR to a pulse-less patient after 30 minutes (under certain circumstances). In an urban environment, an ambulance ride might put the patient on the table in front of a cardiac surgeon in a few minute’s time.
But if that same patient is several hours out from a trailhead, their outcome is more grim. It doesn’t make sense to exhaust rescuers and potentially expose others to risk by continuing CPR indefinitely.
4. The Profound Importance of Scene Management & Incident Command
One of the benefits of taking a WFR course in central Maine during the month of January is that we got first-hand experience about how important is to manage a scene.
There were several big storms that dropped more than a few inches of snow on us during the week we were there, and our instructors made sure we spent plenty of time outside, running simulations in those conditions.
During the first few simulations we lost gear in the snow, our poorly constructed tarp shelters blew over, and any ungloved hands got cold quickly. I realized that effectively managing a scene isn’t just about the medical care you provide.
Incident command is an extremely important part of any backcountry emergency situation. You should try to delegate tasks like setting up shelters, heating up warm water and cataloging useful gear like sleeping pads, clothing and first aid kits. Make sure nothing blows away or gets lost in the chaos.
It’s also important to keep an eye on your fellow rescuers, reminding them to take breaks, drink water, eat snacks and stay warm as best they can.
If you get tunnel vision and focus in on the loud, or obviously injured patients, you’ll miss the more insidious risks to the group from things like exposure, hunger or thirst. Be sure to take a step back and reevaluate as conditions change.
5. The Nuances of Higher Level Care
If you ever find yourself in a situation where you need to call for help, it’s important to know what options are at your disposal. Before you decide to put out a cry for help, it’s important to know what you’re actually requesting.
If it’s going to take a lot of cost and effort to reach you, make sure you’re clear about who should come, and what resources they should bring with them.
You need to decide whether the situation is dire enough to warrant a helicopter evacuation, and you also need to have a reasonable understanding of whether the current conditions will allow one to reach you in time.
Do you need to request an Advanced Life Support intercept that can administer drugs and provide critical care en route to the hospital? Does the patient need to be taken to a specialized treatment center like a burn or trauma center?
If the patient is stable enough to be able to wait for a litter team to hike in, describe the approach and let dispatch know if they need to prioritize sending “fit” rescuers over heavy-set ones, so as not to create new patients in the process.
As a First Responder, your emergency communication plan should be more detailed than simply “call 911.”
6. The Importance of Radio Communication
Have you ever felt awkward leaving a voicemail? Try communicating with a dispatcher or ranger over a spotty radio connection.
You’ve never met them, and you don’t know what their level of training is or what they’ll understand, or even if they’ve heard what you just said.
Messages may get lost or garbled and things will likely be misunderstood at some point. It’s imperative that you’re able to communicate clearly and effectively.
In order to get the assistance you and the patient need, you need to practice distilling down the chaos of a scene to a simple, clear radio report.
Start by stating your location, in case batteries die or the rest of your communication is dropped. Then communicate the most important pieces including the patient’s status and your specific requests for help.
It’s definitely awkward the first few times you do it, but that’s why we practice.
7. The Biggest Thing People are Scared of in the Backcountry is Looking Weak
Many patients assume that their tender ankle or growing dizziness or uncontrolled shivering is something they’re supposed to just soldier through.
They may think of the hike as something they’re supposed to “tough out” and not realize that they should actually stop and ask for help.
They don’t want to be seen as weak or “complainers” in front of the group and may falsely assume that everyone else is as miserable as they are.
You can’t necessarily rely on patients to tell you that something is wrong – you need to keep an eye out and anticipate problems. This is especially true if you’re out with children or leading a group of first-time hikers.
Make sure that people are staying hydrated and well fed, and wearing appropriate layers. If you see someone lagging behind or looking a bit out of it, pull them aside and find out what’s going on.
Ideally you can intercept small issues and stop them from becoming full-blown emergencies.
8. You Can't Save Them All
Even if you’re the world’s top surgeon, sometimes humpty-dumpty is just too broken to be put back together again. Even if the patient is still alive now, there may be nothing you or anyone can do for them in time.
One of our scenarios was a climbing accident where both climbers had been struck in the head by falling rocks.
One had short-term amnesia, a broken lower leg and a few cuts and scrapes. The other one had signs of a severe skull fracture, and then started vomiting and quickly lost consciousness while we were doing our secondary assessments.
When we called into “dispatch” and asked for ALS and a helicopter to pick up the second climber, we were told that the conditions were too windy and that they’d be sending a ground team instead – and that they would take about 6 hours to reach our location to begin carrying him out.
At that point I knew we were going to “lose” our second patient and there wasn’t much we could realistically do for him with the resources we had. We turned our attention to splinting and packaging our first patient to keep him warm and stable as best we could.
It’s an extremely tough call, but when you have limited resources to direct towards caring for all of your patients, sometimes it’s a necessary one to make.
9. Wilderness First Responders Do Save Lives
At one point in the class we were reviewing case studies and going through “what would you do” scenarios. One case sounded particularly dire:
Three guides – all WFRs – were several days into an intense ski mountaineering adventure in a remote section of Alaska. A big winter storm had blown in and limited their visibility to only a few meters in front of their faces.
Wanting to test their winter navigation skills, they set out for the day and made it a ways before one of them inadvertently skied off a cliff, falling dozens of meters and breaking some vertebrae in his back. They knew conditions wouldn’t let a helicopter reach their location, and they were many miles from a trailhead or civilization.
As a class, we spent a while talking about what we’d do if we found ourselves in that situation. We were pretty split on whether we’d try to hunker down, let the storm pass and call for help, or whether we’d attempt a two-person evacuation over the crevasse fields. Some even suggested leaving the patient so that one or both of the other guides could run out and fetch help.
Eventually, our instructor revealed that the case study was actually his own story. He had been the one who skied off the cliff and was rescued by the two guides he was out with. He had been their WFR instructor and they ended up evacuating him on a makeshift sled made out of skis and webbing.
His own WFR students ended up saving his life. He ended up making a full recovery and still climbs and skis (and teachers WFR classes!) to this day.
10. Professionalism and Appearances Matter
Being a calming presence on a scene can have tremendous impact on those around you. Putting a firm hand on a panicked person’s shoulder and speaking in a calm, reassuring voice can go a long way towards lowering their heart rate and slowing their breathing.
Sometimes, that may be all it takes to bring someone out of an Acute Stress Reaction or otherwise help them control their breathing. It may be the only treatment required.
It’s also important that you instill confidence and get buy-in from other bystanders or fellow rescuers on scene as you’re working. You need to be able to lead a group of untrained people without coming off as bossy, rude or curt.
Professionalism can also help protect you and your organization from negligence lawsuits down the line. If you say something glib or make light of a patient’s situation under your breath or to another rescuer, your comments might not seem as funny to other bystanders or the patient’s parents.
Take your work, and yourself, seriously. It can have a big impact on the patient’s outcome, as well as your own.
11. There Are a Lot of Really Awesome, Smart People in the Backcountry
Taking a Wilderness Medicine classes is one of the best ways that I’ve found to meet other smart, motivated backcountry adventurers.
The kinds of people that take these classes are caring and conscientious, and I made some great friends during my course in Maine.
If you’re looking to meet people that share your passion for the backcountry and concern for others, I’d highly recommend taking a class.
I’ve trained with both
and would highly recommend both of their programs and instructors.