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.
When you start looking for a good school you soon discover that the field of wilderness medicine is fairly broad. In fact, it's grown tremendously over the last 20 years. Advances in knowledge, treatment, and instruction have been steady, but so have the number of ill-equipped schools. The problem, says Vanderwege, is a lack of standards and accreditation. "No government agency has stepped in and created a standard for wilderness medicine programs or instructors. There are large schools and small schools offering high-quality instruction, but it's still a 'buyer beware' market."
That's why you should consider SOLO, the Wilderness Medicine Institute, or Wilderness Medical Associates. These are the three largest, most widely respected schools, and when you consider their well-deserved reputations, it's safe to assume you won't go wrong if you choose any one of them.
But what if you can't journey to where these three schools are based? What if you need a course closer to home? As Vanderwege says, buyer beware. A little investigating will go a long way toward ensuring you enroll in the right class.
For instance, ask about the school's history. Who founded it and why? What's the school's philosophy about dealing with the injured? If they offer hands-on practice for a variety of injuries, that's good; if they merely provide "Band-Aid" advice designed to make the wounded comfortable as you wait for medical personnel to arrive, then pass.
How long has the school been in business? Avoid fly-by-nights. If the institution has been around a while, it means the school turns out happy, well-trained graduates and hasn't been shut down by lawsuits. Is the curriculum reviewed by a board of advisors that includes licensed physicians? Can you get recertified there, or must you go to another school in a distant state? How many recertification courses does it offer each year? If only one or two, that means to stay certified you have to work around the school's schedule. What's the wilderness and medical experience of the instructors? If they are certified paramedics, that's a good starting point. Those teaching the classes should also have plenty of on-the-trail backcountry experience and know about the conditions and complications that can arise when hikers are deep in the boonies.
After picking a school, the next step is determining the level of training that's right for you. There are generally four types of courses available, though the number of hours and course curriculum may differ slightly from school to school. Costs can vary dramatically, depending on where the course is offered. Price has no relation to quality of instruction, by the way.
- Wilderness First-Aid: 16 hours (two days); $100 to $200. This is the standard introduction to backcountry medicine: patient assessment, trauma, environmental concerns, some wilderness rescue, and equipment improvisation. "You get the concepts, but not much practice time," says Forgey. This one's a must for anyone who goes into the woods-even dayhikers. Backpackers who go on extended trips or are responsible for groups-church, Scout, or hiking clubs, for example-should add one of the longer courses, Forgey says. You'll learn, among other things, how to clean and close wounds (something "frontcountry" EMTs aren't taught), straighten fractures, reduce dislocations, tape ankles, improvise splints, monitor vital signs, head-off environmental illnesses like hypothermia and heat stroke, and deal with such backcountry threats as snakes, insects, and allergic reactions. You'll also learn how and when to evacuate an injured person. Generally, advanced skills fall under the following three headings:
- Advanced Wilderness First-Aid: 36 hours (four days); $200 to $400. This course builds on the WFA class, with more time spent practicing. You'll be involved in plenty of hands-on scenarios (lots of fake blood and makeup) that help you put the instruction to practical use.
- Wilderness First Responder: 80 hours (10 days); $400 to $750. This one addresses patient assessment and treatment skills in much greater detail. More time is devoted to simulations and organizing/leading rescues. The WFR course is the standard certification required for wilderness guides and outdoor leaders who work for organizations such as the National Outdoor Leadership School and Outward Bound.
- Wilderness EMT: 180 hours (about three to four weeks); $1,500 to $1,800. Instruction is aimed at rescue-team members, backcountry rangers, and medical professionals who work in remote settings. Approved programs have met U.S. Department of Transportation requirements for an EMT license. The next step would be medical school.
Regardless of which type of training you take, there's one highly important thing everyone learns, according to Melissa Gray, director of operations for the Wilderness Medicine Institute in Pitkin, Colorado: how to avoid becoming a victim of what she calls the most unfortunate of backcountry situations. "I've been at hundreds of rescues, and the most tragic ones are always those where loved ones are standing there saying, 'I didn't know what to do...I wish I'd known what to do.'"
SOLO, P.O. Box 3150, Conway, NH 03818; (888) SOLO-MED; http://www. stonehearth.com.
Wilderness Medicine Institute, P.O. Box 9, Pitkin, CO 81241; (970) 641-3572; http://www.wildernessmed.com.
Wilderness Medical Associates, 189 Dudley Rd. #2, Bryant Pond, ME 04219; (888) WILD-MED; http://www. wildmed.com.
National Safety Council, 1121 Spring Lake Dr., Itasca, IL 60143; (800) 621-7619; http://www.nsc.org. The NSC is a new player in the field of wilderness medicine, but with its curriculum-developed by the Wilderness Medical Society-and sheer size, the organization will likely reach a lot of backcountry users.
Wilderness Medical Society, P.O. Box 2463, Indianapolis, IN 46206; (800) 967-7494. WMS is a member-supported, nonprofit organization that is devoted to handling the issues of medical problems in the backcountry. While the organization doesn't offer hands-on, instructional classes, if you give them a call, the folks there will certainly help you find one in your area.