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Backpacker Magazine – October 1998

Wilderness First-Aid Courses

Take an advanced wilderness first-aid course and you'll never have to say "I didn't know what to do" to the next-of-kin.

by: Dennis Lewon

The scene looks like a grizzly with a mouthful of bees just came through, leaving a whole lot of injured hikers sprawled across the forest floor. One rolls and moans and clutches a badly broken leg. Another has blood dripping from a nasty head wound. Others lie silent and still as death. There's no time to think. You must act fast.

If you're like most hikers, you probably know how to patch a blister and deal with minor injuries, and being conscientious, you never leave home without a well-stocked first-aid kit. But what about the emergency situtation? This is the wilds, you know, where things aren't planned and there are no rules to govern what's fair and what isn't.

Fortunately, in this case the "injuries" are part of a wilderness first-aid class. The blood is fake, the bruises paint, and the "victims" healthy as horses. But as the would-be rescuers approached their make-believe patients, the question on all our minds-we later learned when comparing notes-was, "What if this were real?"

Two things will get you through a backcountry emergency: luck and wilderness-medicine training that goes beyond the basics. Granted, there's nothing wrong with taking a one-size-fits-all first-aid course at the local YMCA. It's better than nothing. But what you learn may not be enough to help you cope with a wilderness emergency, which unfortunately can happen to anyone.

"The assumption in most first-aid classes is

that you're just holding on until help finally arrives," says David Vanderwege, deputy executive director of the nonprofit Wilderness Medical Society, based in Indianapolis. "In the wilderness just the opposite situation is true. Help could be hours or even days away. Questions arise that never get asked when 911 is an option, and the wrong answers may cause more problems than the injury itself."

A 1975 situation involving the "wrong answers" ultimately gave rise to the modern-day field of wilderness medicine. A paramedic named Frank Hubbell was helping rescue an injured boy from Mt. Washington in New Hampshire. The boy's arm was so severely fractured he had lost circulation to his hand. By the time Hubbell and the others transported him to the hospital, it was too late to save the hand. The accident became even more tragic when the emergency-room doctor said the hand could have been saved if the boy's arm had been straightened in the field. Hubbell, sensing a need, went on to found Stonehearth Open Learning Opportunities (better known as SOLO), the nation's first wilderness-medicine school. (He also eventually coauthored Medicine for the Backcountry, with Backpacker Contributing Editor Buck Tilton.)

"We have what's called the 'golden hour' in trauma care," says Dr. William Forgey, author of Wilderness Medicine and

a Wilderness Medical Society board member. "If a patient is not treated adequately within an hour of the accident, there's a significant difference in survival rate and effects of the injury. In a wilderness setting, what you do makes all the difference for patients who miss the golden hour."

If you want to play it safe, you could restrict yourself to short hikes so you never venture beyond the golden hour, which isn't too appealing since many of the best spots are hours off the beaten path.

Or you could invest some time and money in a wilderness first-aid course. This specialized form of instruction revolves around three fundamental differences that separate backcountry medicine from traditional, or "frontcountry," first aid.

  • The time/distance relationship between the accident and a hospital-dealing with the fact that you're a long way from professional care.
  • The severity of the environment, such as extremes in temperature, weather, terrain, or shortage of food and water.
  • The lack of specialized equipment, which forces you to improvise.

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