Most people think of wilderness medicine as providing medical care in a remote setting where access to conventional healthcare resources is limited or unavailable. They imagine someone treating a wound, applying a tourniquet, performing CPR, or fashioning a splint out of sticks and a bandana enabling a hiker with a broken leg to hobble to safety. 

Few rarely consider the role of wilderness medicine in mass casualty events such as earthquakes, flash floods, wildfires, and other natural and manufactured disasters. These incidences result in multiple injuries that can overwhelm the resources available to treat the injured.

In the context of a mass casualty event, wilderness medicine providers fill all their traditional roles — caring for the injured and improvising to overcome the lack of medical equipment and supplies. However, their role often expands in scope as they face the challenges of assisting multiple patients at the same time suffering from diverse injuries. 

Meeting this challenge requires knowledge of the system and resources available, along with an ability think and act quickly and rationally in order to triage patients. That means  sorting and prioritizing patients on larger scale, based on the severity and urgency of their medical needs — again in the context of available resources.

Defining “Mass Casualty Incident”

A mass casualty incident (MCI) is any (more…)

The year 2024 was another great one for The National Center for Outdoor & Adventure Education (NCOAE). From groundbreaking program launches to prestigious accreditations, we’ve continued to grow, innovate, and strengthen our commitment to education and adventure. Here’s a look at our top milestones from 2024:

Celebrating 15 Years of Excellence

In 2024, we celebrated a major milestone: our 15th anniversary. Over the past decade and a half, NCOAE has grown from a vision into a leading outdoor education and adventure programming organization, impacting thousands of lives through our innovative programs. This achievement reflects the passion, dedication, and trust of our community, as well as the vision of our founders and faculty and staff that continue to buy into the NCOAE educational framework. 

Here’s to the next 15 years of adventure and growth!

Cognia Accreditation

This year, we learned that our accreditation from Cognia — an esteemed global organization representing the largest network of accredited institutions — is in its final stage of approval. Cognia is (more…)

Finding a local EMT certification course provider and fitting the training into a busy schedule may seem like an insurmountable obstacle, especially if you’re still in school, working a full-time job — or both. 

The solution? The National Center for Outdoor and Adventure Education’s (NCOAE’s) Intensive Self-paced EMT Certification Course, which gives you the freedom to learn at your own pace, from anywhere. 

This flexible EMT certification in Oregon and North Carolina is designed for people who are passionate about emergency response, the Intensive Self-paced EMT Certification Course offers a comprehensive, hands-on approach to learning that combines in-depth coursework with practical, real-world applications.

With expert instructors, engaging online content, and field training opportunities, this flexible EMT course is tailored to meet the needs of busy learners. Ready to dive in? In this post, we share most of what you need to know about this unique course offering from NCOAE, point you to sources where you can find additional details and provide the many benefits of Self-paced EMT Training.

About the Intensive Self-Paced EMT Certification Course

Our team designed this 240-hour self-paced EMT training course to be comprehensive, practical, and efficient. The curriculum is divided into two phases: (more…)

If you’re considering a career in the field of outdoor education and adventure programming that involves leading groups through remote wilderness areas, your career path will come to a fork in the road where you will face an important choice: Do you want to become a backcountry guide or an outdoor educator?

At first glance, these two roles may appear to be too similar to matter, but they serve distinct purposes. While both require expertise in risk management, their focus and approach differ considerably. In general, the differences boil down to the following:

• A backcountry guide is primarily responsible for leading groups safely through remote, rugged environments, with a focus on navigation, logistics, health, and safety.
• An outdoor educator or field instructor does everything a backcountry guide does but with the added responsibilities of teaching wilderness skills, fostering environmental stewardship, and creating opportunities for individual and group personal growth and learning. 

In this post, we explore the key similarities and differences between these two roles and what each brings to the outdoor experience.

Recognizing the Similarities

Backcountry guides and outdoor educators (field instructors) are more alike than they are similar. They both have a passion for nature and human-powered outdoor recreation and adventure, and they both share their technical outdoor knowledge and skills freely with others. More specifically, backcountry guides and outdoor educators share the following qualities: (more…)

Emergency medical technicians (EMTs) play a vital role in the modern healthcare system, providing immediate, life-saving assistance to people experiencing acute medical conditions or traumatic injuries. By rapidly assessing and treating patients in critical situations, EMTs improve survival rates, minimize complications, and optimize treatment outcomes. 

Training, testing, and certification ensure all EMTs have the skills needed to respond to life-threatening emergencies. In this post, we explore the history of EMT training and certification, bring you up to speed on its current state, and look ahead to its future. Why this matters to us here at The National Center for Outdoor & Adventure Education (NCOAE) is because we offer such training for EMTs throughout the U.S.

The Evolution of EMT Testing: Past to Present

EMT testing and certification have evolved over the course of nearly six decades. Formalized training didn’t begin until the late 1960s. It was initiated by the publication of a white paper in 1966 titled, “Accidental Death and Disability: The Neglected Disease of Modern Society.” The paper was in response to increasing trauma and death resulting from traffic accidents in the United States.

Up to that time, ambulance services generally consisted of team members with little to no formal training, with such services often relying on volunteers. And any formalized training and testing that was being done was administered locally by (more…)

The morning of September 26, 2024, saw the peaceful mountain towns of western North Carolina waking up to their usual weather notifications. Even though the area was accustomed to storms, information about Hurricane Helene caused worry because it was growing stronger at a faster pace than anticipated. 

The stronger the storm became, the greater the responsibilities of local Emergency Medical Technicians (EMTs). From organizing for the possibility of extensive evacuations to offering essential treatment in hazardous and uncertain settings, EMTs were at the ready.

Two recent hurricanes — Helene and Milton — serve as stark reminders that natural disasters can strike with little warning, leaving a trail of chaos and devastation in their wake. Saving lives and keeping people safe during a disaster, and cleaning up in its aftermath, requires the coordinated efforts of a diverse army of professionals, including doctors, police, members of the military, heavy-equipment operators, carpenters, electricians, plumbers, and more.

Also on the front lines are EMTs, such as the ones we train here at The National Center for Outdoor & Adventure Education, typically serving as part of the local rescue response. National emergency services, including the military and larger medical teams, are usually dispatched later. But they also require the dedication and expertise of EMTs.

In this post, I explore the indispensable contributions of EMTs during natural disasters, highlighting their training, the challenges they face, and the profound impact they have on (more…)

Imagine hiking with a small group of friends or family members in a dense, remote forest. You’re ascending a steep, rocky ravine, when suddenly a member of your group, a middle-aged man with a stout build, clutches his chest and collapses to the ground. Everyone rushes to his side, their voices rising in panic. They all reach for their phones to dial 911, but nobody can get a signal. The nearest medical facility is miles away.

The only hope is that someone in the group is trained in cardiopulmonary resuscitation (CPR). Unfortunately, most CPR training is provided in the context of urban settings, including the workplace, community gathering spaces, and our homes. In a remote wilderness environment, responding to a cardio event requires additional skills along with mental calmness and agility — skills and abilities developed and practiced as part of Wilderness First Aid with CPR training.

What Is Wilderness CPR?

Wilderness CPR involves providing life-saving care in remote settings with limited access to medication, medical gear, and emergency medical services. The First Aid component covers everything from assessing situations and injuries/illnesses to treating common injuries, such as cuts, bruises, sprains, broken bones, head trauma, and spinal injuries. It also covers life-threatening conditions that are common in wilderness adventure scenarios, such as hypothermia and dehydration. 

The CPR component covers the process of delivering a combination of rescue breathing and chest compressions to help someone whose breathing or heartbeat has stopped.

Wilderness Care Challenges

Providing first aid and CPR in a remote wilderness environment, as compared to an urban setting, presents some unique challenges, such as the following: (more…)

Here at The National Center for Outdoor & Adventure Education (NCOAE), we are known to be among the best in class among providers of outdoor education and wilderness-based adventures for youths and adults, and wilderness medical and EMT training for adults.

To that end, we are excited to announce that we are currently in the final stage of seeking accreditation with Cognia, a globally recognized nonprofit organization acknowledged by the U.S. Department of Education, that provides accreditation, certification, assessment, and professional learning services for continuous improvement to public, private, and independent postsecondary schools, among others.

NCOAE attributes its success to several qualities that set us apart from others who offer the same or similar services and experiences. These include our highly knowledgeable, experienced, and passionate leadership team and staff and our unique core curriculum, carefully crafted to positively impact each participant’s self-confidence, interpersonal relationships, and commitment to fulfilling their civic and environmental responsibilities.

But we don’t expect you to take our word for it. Several highly reputable, independent organizations have given us their seals of approval through their accreditation programs, including the Association for Experiential Education (AEE) and the Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE). Further boosting our street cred is that fact that both the North Carolina Office of Emergency Medical Services and the State of North Carolina have approved us to offer an intensive 21-day EMT-Basic training curriculum.

Why Cognia Accreditation Matters

Since 1895, Cognia, most well-known as the Southern Association of Colleges and Schools-Council on Accreditation and School Improvement (SACS/CASI) rebranded about five years ago, offers research-based performance standards that are created with one end in mind — to ensure high-quality learning. They define the practices that are essential for (more…)

Within three weeks of graduating from the Intensive Hybrid EMT course offered by us here at The National Center for Outdoor and Adventure Education’s (NCOAE), Robert Fox had obtained his national and state emergency medical technician (EMT) licenses and had a job offer in hand at a local ambulance service.

Today, this Athens, Georgia, native works full time as an EMT. In addition — and in short order — Robert in on track to attend school to become an advanced emergency medical technician (AEMT) this fall. Advanced emergency medical techs provide basic and limited advanced emergency medical care and transportation for critical and emergent patients. 

These advanced technicians possess the knowledge and skills necessary to provide patient care and transportation. And after that schooling? Robert is thinking about starting a paramedic program at a local community college.

So, what prompted such inspiration for our young graduate? Robert began his career as a senior wilderness guide, working in the field from 2007 to 2013. It was while taking a course to maintain his Wilderness First Responder certification that he became interested in more advanced emergency medical services (EMS). 

But, sharing that the timing wasn’t right, Robert decided to work in behavioral health and criminal justice for (more…)

Look, listen, and feel. 

If you’ve been around wilderness medicine long enough, you may remember when this was the standard teaching for determining breathing status. You place your hand on the injured party’s stomach (feel), your ear to their mouth (listen), and watch (look) to see whether their chest is rising and falling.  

This method remains a foundation for assessing breathing, and its application has been expanded to cover a wider range of injuries and illnesses common in wilderness scenarios.

Look, Listen, and Feel

Look, listen, and feel is still a great way to remember that much of the assessment process (arguably the most important) comes in the form of look (visually inspect), listen (auscultate), and feel (palpate). These three actions are like the bumps on a key that align with tumblers to open a lock. In the context of emergency medicine, they form the key that unlocks the door to assessing the patient’s condition and developing treatment and evacuation plans.

NCOAE’s Patient Assessment Process

“Assessment” is the process of determining the nature, quality, or ability of something. In the context of medical assessment, it refers to determining the realities of the patient’s condition and environment factors in order to provide appropriate care and make well-informed evacuation decisions. 

In order to most accurately determine these realities, it is important to use a system of assessment that is easy to remember yet sophisticated enough to avoid overlooking vital data.

While assessment varies depending on the patient’s condition, environmental factors, and the wilderness medicine provider’s level of training and experience, The National Center for Outdoor & Adventure Education (NCOAE) patient assessment process is a wonderful example of a (more…)

Bethany Smith’s journey with The National center for Outdoor & Adventure Education (NCOAE) is one marked by passion, adventure, and a deep commitment to outdoor and experiential education. 

Joining our team in 2022, Bethany quickly became an important member of our field operations. After taking a brief break in 2023 to explore the world, we were thrilled to welcome her back for another season. Whether she’s navigating whitewater rapids or guiding students through challenging backcountry terrain, Bethany’s enthusiasm and expertise shine through in everything she does.

As you’ll learn, Bethany’s love for the outdoors started unexpectedly and has grown into a lifelong passion. From her early days as a raft guide to her current role as Lead Field Instructor & Raft Guide, she’s dedicated herself to helping students achieve their objectives in the outdoor classrooms offered in the backcountry. We recently sat down with Bethany to learn more about her journey, experiences, and what she loves most about working at NCOAE. Here’s what she had to say:

NCOAE: Where are you from originally, and when you’re not working in the backcountry, where do you call home? 

Bethany: I was born in (more…)

When next you find yourself in a wilderness area, whether that be at a national park in another state or a local or state park closer to home, take a moment to look at the folks around you while you’re enjoying the flora, fauna and pristine views.

What you’re likely to notice is a lack of diversity. That’s because the majority of those who spend time in wilderness and the backcountry participating in human-powered outdoor recreational pursuits are predominately white. 

Fact is, statistics collected by the U.S. Forest Service, National Park Service, and Fish and Wildlife Service show that while people of color make up nearly 40 percent of the total U.S. population, close to 70 percent of those who visit national forests, national wildlife refuges, and national parks are white. And Blacks remain the most dramatically underrepresented group in all of these spaces.

It’s not that people of color and other underrepresented groups don’t appreciate and enjoy the outdoors. Visit an urban park — especially on a weekend — and you’re likely to see more people and activity at parks located in black and Hispanic sections of town than at parks in predominantly white neighborhoods.

The question is why? What’s keeping state and federal parks and other wilderness areas from reflecting the diversity of the overall population in this country? A good follow-up question might be what can be done to make these areas and their associated outdoor activities attractive to a more diverse population?

Exploring the Possible Reasons for the Lack of Diversity in the Backcountry

Several factors may be contributing to the lack of diversity in human-powered outdoor adventure and recreation activities. These factors can be broken down into (more…)

Wilderness medicine has been broadly defined as the provision of medical care when environmental conditions play a stronger role in decision making and interventions than the established systems of care.

It’s something we take quite seriously here at The National Center for Outdoor & Adventure Education (NCOAE). We also ensure that all of our field instructors, course directors, and other NCOAE staff hold current certifications in wilderness medicine. On top of that, we teach wilderness medicine courses ourselves.

Editor’s Note: See “What is Wilderness Medicine” here on the NCOAE Blog for a deep dive into defining wilderness medicine. 

The history of wilderness medicine as we know it today, is generally traced back to the 1980s and the emergence of the Wilderness Medical Society (WMS) in 1983. However, it has been in practice centuries earlier than that. In respect to Western Civilization, caring for the sick and injured in the field has its origin in early Greek and Roman societies. It has certainly been in practice for as long as human beings have been sailing the seas, exploring the world, and engaging in military operations.

Experts in the field of wilderness medicine universally agree that its continued evolution is (more…)

Like many podcasts that host informal chats with founders of businesses, organizations, and charities, Zac and Celine Adair recently offered listeners a glimpse into the heart and soul of their “baby,” The National Center for Outdoor & Adventure Education (NCOAE).

Zac and Celine, NCOAE’s co-founders, are showcased in Episode 15 of “It’s In the Experience,” presented by the Association for Experiential Education (AEE) and hosted by Sherry Bagley, AEE’s executive director. To listen to the 45-minute episode, which is titled Overcoming Challenges: Creating Positive Experiences in Experiential Education, subscribe to “It’s In the Experience” on Apple Podcasts, Spotify, Podcast App, or wherever you listen to podcasts. 

Or, you can listen to Overcoming Challenges: Creating Positive Experiences in Experiential Education by clicking on the audio file below:

Episode Highlights

Here’s a high-level overview of what’s featured in the episode, which was published by AEE in mid-June of this year: (more…)

Here at The National Center for Outdoor & Adventure Education (NCOAE) we like to take backcountry cooking to the next level, and that means teaching students how to prepare gourmet meals while on backcountry expeditions.

Whether it’s starting your day with a hearty breakfast, making a quick lunch wrap on the run, or preparing a veggie-filled dinner at the end of a long day hike, climb, or paddle, this post includes three backcountry recipes that might inspire you for the meals you’ll prepare and enjoy on your next adventure.

Cooking in the backcountry doesn’t mean you have to sacrifice flavor or nutrition. In fact, with a little planning and creativity you can enjoy delicious, nutritious, and satisfying meals that fuel your human-powered outdoor activities. Our field instructors have crafted these recipes to be both easy to prepare and incredibly tasty, ensuring that your time in the backcountry is complemented by great food.

Heard, Chef! When you’re in the wild, having a variety of meals that are quick and simple to prepare can make a big difference in your attitude and overall experience. The three recipes below are designed to maximize flavor while minimizing cooking time and cleanup, allowing you to spend more time enjoying the great outdoors.

At NCOAE, we believe that good food is an essential part — in fact, a highlight — of any outdoor adventure. Not only does it provide the energy needed for strenuous activities, but it also brings people together, creating memorable experiences around the campfire. So, whether you’re a seasoned outdoor chef or a beginner, give these recipes a try.

Note: The following recipes are meant for groups of 12. Do the math and adjust for the size of the group for whom you’re cooking.

Backcountry Recipe 1 – Breakfast

Breakfast Burritos with Hash Browns

Ingredients

• 3 Cups Scrambled Egg powder or 24 Eggs
• 4 Cups Hashbrowns (dried)
• Onion, diced
• Bell Pepper, diced
• 12 Tortillas
• 1 Cup Salsa
• 2 Cups Cheese
• Salt & Pepper, to taste
• Bacon Bits, optional
• Ketchup packets, optional
• Butter / oil

Directions | Instructions | Serves 12 (more…)

In addition to working for The National Center for Outdoor & Adventure Education (NCOAE), I’ve had the good fortune to assist public, private, and charter schools in setting up outdoor education programs for the past 25 years. During that time, I’ve developed a few winning strategies for educators embarking on such adventures.

Some of my more successful programs have included launching a learning farm for a public school system with 32,000 students, transforming schools into outdoor learning labs as a model for a school district, and even helping former inmates return to the world beyond bars by diving deep into outdoor experiences. (You can learn more about some my school-related work by reading “Taking Learning Outdoors: Merrick-Moore Elementary” on The Great Trails State Coalition website.)

None of these projects were easy, but they can be done. In this post, I offer insights on how to start an outdoor education or adventure program for your classroom or school. Let’s begin with planning and dreaming.

Have a Dream, Plan Your Work, and Work Your Plan

To successfully launch an outdoor education program, it’s important to start with a clear vision and follow a structured plan. Here’s an approach I’ve developed based on both my experiences and the wisdom of my mentors (more…)

In wilderness medicine, the traditional response to a potential spinal injury has emphasized immobilizing the patient to prevent further injury. To this end, emergency responders have been trained to use advanced immobilization techniques and equipment, such as rigid cervical collars and spinal boards in conjunction with manual stabilization. 

And while nobody educated in emergency medicine would argue against the importance of motion restriction, the priority is shifting as doctors and emergency personnel consider it in the larger context of overall patient health and safety.

Given the importance of the spine in a person’s overall health, the focus on immobilizing patients with suspected spinal injury is no surprise. The spine protects the spinal cord, which functions like a fiber-optic network to carry signals throughout the body to and from the brain. Interruptions in the continuity of the spinal cord can dramatically impact a person’s ability to move and to interpret and interact with the world.

However, over the last few decades, the medical community has acquired a vast body of evidence concerning care for a person with an obvious or potential spinal injury. As a result, recent years have seen a significant shift in thinking on this subject. The conversation regarding the extent to which a spinal injury is impacted by subsequent treatment and transport has evolved into a rather heated debate that’s (more…)

Shortly after graduating from The National Center for Outdoor and Adventure Education’s Intensive Hybrid EMT course, Will Newman began working for Pender EMS and Fire in Burgaw, North Carolina, as an EMT. He recently completed orientation and is eager to serve the rural communities of Pender County as a medical provider.

Will credits his instructors at NCOAE for their ongoing commitment to his success after graduation, highlighting one instructor in particular for their continued communication and help in securing employment at an EMS agency. He noted that the dedication of our instructors to their students’ success is what makes our EMT training programs so unique.

Additionally, this North Carolina native continues to volunteer at the emergency department in nearby Scott’s Hill, where he has applied many of his new EMT skills. Will’s long-term goal is to attend medical school, and he plans to apply during the next application cycle. (more…)

When some hear the term “wilderness medicine,” they think of those rusty out-of-date First Aid kits that they used to carry with them on a personal hiking or camping trip. “As if that thing is going to do any good in an emergency.”  

In fact, to the average summer weekend outdoor enthusiast, wilderness medicine is limited to treating minor cuts, scrapes, bruises, sprains, bites and poison ivy. A major tragedy would be the occasional broken bone. But it has always been much more than that. 

To realize just how broad wilderness medicine really is, all you need to do is travel back to Antarctica in 1961. That’s when Russian explorer Leonid Rogozov suffered a severe case of appendicitis. Being the only medical doctor on site, he had to perform his own appendectomy. That’s among the extremes of what wilderness medicine is all about.

More recently, the Thailand cave rescue shined the spotlight on wilderness medicine. Thousands of rescue workers and medical personnel, including Thai Navy Seals, the national police, doctors, and nurses, rallied to save 12 teenagers and their soccer coach, all trapped in a complex cave system by floodwaters during a heavy rain. Rescuers had to locate and extract 13 people, some of whom couldn’t swim, from a flooded, two and a half mile stretch of caves. 

The rescue tested experienced divers who struggled to navigate currents and squeeze through the narrow passages. Rescuers had to (more…)

When you’re planning a backcountry-based experiential educational experience for yourself or a child/teen, you want to be sure that the people leading the outdoor program know their stuff. Few things are scarier in life — or potentially deadlier — than being ill-prepared in the wilderness. 

To ensure safety and an enjoyable, fulfilling experience, outdoor educators and field instructors must be highly skilled in many facets of outdoor and adventure education, including the following:

• Wilderness medicine
• Map and compass navigation
• Environmental stewardship principles and practices
• Backpacking planning and packing
• Wilderness shelters
• Backcountry cooking, water purification, and food safety
• Paddling techniques and boat safety (canoe, kayak, or raft)
• Climbing
• Leadership

One of the reasons we here at The National Center for Outdoor Adventure and Education (NCOAE) excel at delivering safe, enjoyable, and transformative outdoor adventures is that we educate our educators. We provide our field instructors with the training and opportunities to pursue the certifications they need to achieve best-in-class status.

Field Instructors and Guides: There IS a Big Difference

NCOAE outdoor educators and field instructors are not just “guides.” They are experienced outdoor educators with a broad range of responsibilities that include the following: (more…)