Maintaining Resilience and Mental Health in the EMS Profession

By David Bullard September 26, 2023

Emergency Medicine

The suicide rate among emergency medical service (EMS) professionals rose a shocking 38 percent since 2009, according to a study published in the Western Journal of Emergency Medicine. But as shocking as that statistic is, it should come as no surprise.

As an emergency medical technician (EMT) or paramedic, you typically work a five-day rotation of 12-hour shifts (days or nights). You may start the week working Monday and Tuesday and then have Wednesday and Thursday off. You spend half your first day off catching up on sleep, doing chores, and running errands. You’re free the next day, but pretty much alone because everyone you know is at work or school or busy with other normal weekday obligations. 

EMS professional looking worn down with head in hands

As a result, you likely lack the social connections many of us rely on for emotional support and psychological well-being. Come Friday, Saturday, and Sunday — when your friends and family are off work — you’re back on the job, providing critical medical care in highly stressful situations involving people who don’t always treat you with the respect and appreciation you deserve. And you have to perform this service with a smile on your face, because you don’t want a complaint on your record.

To make matters worse, emergency medical care leaves no room for mistakes. Quality assurance (QA) and quality improvement (QI) programs ensure that Monday morning quarterbacks are always looking over your shoulder to spot mistakes and offer their criticism and sage advice from their comfortable seats along the sidelines.

It’s Getting Worse Instead of Better

Thanks to high healthcare costs and doctor shortages, many people don’t have access to a general practitioner, so guess who they call when they have nowhere else to turn, especially in the event of a mental health emergency? They pick up the phone and dial 911. And those types of emergencies are on the rise. 

Imagine being sent to the same location over and over again — essentially a “cry wolf” scenario — and having to remain on that scene while simultaneously hearing the dispatcher report a child choking in your district. Unfortunately, many of us in the profession don’t have to imagine these situations. We’ve experienced them.

So now, exhausted from your three-day weekend shift, you’re expected to leave everything you’ve seen, heard, and smelled back at the station and not take it home with you. Great advice, but how is that even possible?

What’s the solution? First off, every EMS agency should have a wellness and resilience program that includes a variety of mental health services that focus on both prevention and assistance to help individuals when they’re suffering from mental health or emotional problems.

In addition, we should all be working together to improve the situation for EMS professionals. In the following sections, I offer advice for EMTs and paramedics, their supervisors, and the public.

Self-Care Advice for EMTs and Paramedics

Caring for the health and well-being of others can negatively impact your health in several ways:

  • Irregular working hours can result in poor sleep.
  • Working in transit can result in poor diet and eating habits.
  • The highly emotional work environment can place you at a greater risk of depression, substance abuse, and suicidal thoughts.

Here are a few suggestions for self-care:

  • Adopt a sleep routine to regulate your sleep schedule as much as possible.
  • Pack a healthy lunch and snacks instead of eating out at fast food restaurants and convenience stores. Drink more water and less soda or energy drinks.

When you’re off the clock, focus on physical fitness, hobbies, family time, hanging out with friends — anything that takes you away from that ambulance and emergency department (ED) and puts you in a better frame of mind.

Advice for EMS Supervisors

Money, pizza parties, gifts, and other perks are all great for improving retention and resilience, but nothing is more effective than genuine expressions and demonstrations of appreciation and understanding. Acknowledge your employees regularly and spend time with them. Be generous with kudos and frugal with public criticism, and look for ways to make their jobs easier.

One of the things I did as a chief was work Christmas Eve and Christmas Day for two of my employees. I had older children at the time, and I enjoyed filling in for younger staffers so they could be with their children on the holidays. It cost my department nothing because I was a salaried employee; it helped me stay engaged with my field staff; it earned me respect for being back in the trenches; and it kept my finger on the pulse of my community. Eventually, my chief made me discontinue this practice because he felt that it made the other administrators look bad for not doing it. That’s one way to kill morale.

Administrators should visit where they were when they started in order to experience how conditions have change from those we experienced even 10 years ago. I strongly recommend occasionally working alongside your staff during holidays or whenever staffing is low. It’s a great way to build camaraderie, boost morale, earn respect, and keep abreast of changes in the field.

Finally, to all you administrators out there, if you’re sending your shift employees text or email messages reminding them to put their job behind them on their days off, stop it. That’s just another way of constantly putting their job in front of them. Respect their time off. It may be the only thing keeping them there!

Advice for the Public

Our society is experiencing a healthcare crisis, especially in relation to mental healthcare. We don’t have the space and resources to handle the overwhelming demand right now. People can’t get in to see a doctor, or they can’t afford it, so they call 911 for transport to the ED for healthcare issues that could be handled by a general practitioner or a psychiatrist or psychiatric nurse practitioner. EMS providers across the country are overrun with these types of calls, which impairs their ability to respond to life-threatening emergencies.

You can help to conserve ambulatory resources for true emergencies by calling 911 only when necessary. Those instances include the following:

  • The person’s condition appears to be life-threatening — for example, the person is unconscious, bleeding profusely, choking, not breathing, or experiencing a severe allergic reaction.
  • The person’s condition may become life-threatening on the way to the hospital.
  • Moving the person could cause further harm or injury.
  • The person needs the skills or equipment used by paramedics or EMTs.
  • Driving would cause significant delay getting to the hospital.

In all other cases, call your primary care physician or head to an immediate care facility. If needed, contact a friend, neighbor, or family member for a ride.

If you must call 911, be respectful and appreciative of the EMS personnel who show up to help you. Stay out of their way, answer their questions, and do what they tell you to do. Let them do their jobs.

Keep in mind that we need to use our available emergency resources wisely to ensure that everyone has the services during their time of need, and this includes our most valuable resources of all — our highly skilled human resources. Working together in an atmosphere of mutual respect and appreciation is the best way to ensure that our EMS professionals have the emotional support they need to stay healthy and perform their best to preserve and protect our health and safety.

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About the Author: David Bullard is the Director of Emergency Medicine Education at The National Center for Outdoor & Adventure Education (NCOAE) in Wilmington, North Carolina.

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2023 Outdoor Industry Conferences for Outdoor Educators

By NCOAE Headquarters September 13, 2023


As we do each year, we are once again taking advantage of this space to inform you about opportunities for you, your staff, and your organization to participate in professional development, networking, and business growth and development available at upcoming outdoor industry conferences.

In this edition, we are spotlighting nine events taking place between now and the end of this year, as well as bringing to your attention six more events scheduled for the first part of 2024 that might be worthwhile marking on your calendar.

Sept. 18-21, 2023 | Cherokee, North Carolina

Why you should attend: This in-person, multi-day event is designed to foster intentional connections among stakeholders across the outdoor economy, igniting collaborations and catalyzing meaningful actions.

Why your company or organization should exhibit: Whether you’re a conference sponsor with booth space included in your sponsorship package or an independent exhibitor, conference organizers have curated a dynamic program that allows you and your staff to engage with the attendees while respecting the event’s other scheduled activities.

Sept. 24-26, 2023 | Boise, Idaho

Why you should attend: Outdoor Media Summit is where some of the brightest minds in outdoor media and marketing gather to share their tips, tricks, strategies, and warnings. If you are a marketer at an outdoor industry brand or an editor, freelancer, podcaster, or other content creator, this may be the conference for you.

Oct, 18-20, 2023 | Portland, Oregon

Why you should attend: Attend the Wilderness Risk Management Conference in order to gain practical risk management skills, network with others in the outdoor education and adventure programming industry, share field and administrative techniques, and help develop risk management standards for the outdoor adventure and education industries.

Why your company or organization should exhibit: Connect with more than (more…)

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Meet the Staff: Kate Javes, NCOAE EMT Instructor, Clinical Coordinator and AHA Training Site Coordinator

By Office Admin August 23, 2023

Meet the Team

Kate Javes has been a huge part of NCOAE’s continued success for a number of years, most recently as our EMS program director. Recently, Kate has decided to step back from that leadership role following three years of developing our Hybrid EMT training program

In addition, Kate oversaw all of our EMT and AEMT courses as well as instructed students, helped author the first editions of the NCOAE Wilderness Medicine Field Guide and the NCOAE EMT Program Manual, and played a pivotal part in helping our organization navigate the health pandemic caused by the virus named “SARS-CoV-2” and the disease it causes, named coronavirus disease 2019 (COVID-19).

A 2003 graduate of the U.S. Naval Academy who also attended Rutgers (The State University of New Jersey) where she played Division I soccer, Kate is now taking on the duties of an NCOAE EMT instructor, teaching hybrid and in-person 21-day EMT courses, both in North Carolina and in Oregon. In addition, Kate is our clinical coordinator, working with local hospitals and EMS agencies to schedule required clinical hours for the courses in both states.

Kate Javes headshot.

And she’s also our American Heart Association (AHA) training site coordinator. As such, she is the point of contact for the Southern Regional American Heart Education Center regarding all of our AHA courses, responsible for maintaining and submitting documentation for these courses. This is primarily for our BLS (basic life support) for Healthcare Providers courses taught as part of our EMT curriculum. It also includes HeartSaver CPR and First Aid courses as well as instructor certification and recertification. 

Before joining NCOAE in 2013, this Maryland native was a paramedic for the New Hanover (NC) Regional EMS for eight years. Prior to that, she was a paramedic and firefighter for a summer for the Antarctic Fire Department. And while serving in the U.S. Marine Corps, Kate was a (more…)

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Why Clinical Experience Matters in EMT Training

By Kate Javes August 2, 2023

Emergency Medicine

In the world of emergency medical services (EMS), future EMTs and paramedics accept the reality that their immediate future includes hundreds of hours of lectures, extensive bookwork, and plenty of written tests. 

Each of these students has an objective in mind for taking EMT training courses, and their reasons are many. Some are looking to start careers in the EMS profession. Others plan to use their EMT certification as a stepping stone to medical school or physician assistant (PA) school. And there are those who are uncertain about what direction their future might take, so they’re exploring their options. 

Regardless of the reason why,  there are a number of things that simply can’t be “taught” in the classroom. Equally important as “book learning,” and perhaps more vital, is clinical and field experience. What is clinical experience? In the real world, clinical settings feature healthcare providers conducting actual exams and procedures on real patients. Physical examples might be a bustling hospital emergency department, a crowded local health clinic, or finding yourself hovering directly over an (more…)

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Frazzled by Eco-anxiety? Find Respite in the Backcountry

By Stephen Mullaney July 12, 2023

Outdoor Education

As you’ve probably heard or read, last month was the hottest June our planet has ever experienced — topping a prior record set in 2019. In fact, according to the European Union’s Copernicus Climate Change Service, the nine hottest Junes ever occurred over the past nine years.

In addition, extreme heat creates crispy conditions, and last month’s torrid temps were all the kindling needed to promote the one of the worst wildfire season in Canadian and North American history. Add to that a record-breaking cyclone in southeast Africa, heatwaves across Asia, and extreme flooding throughout the world. Oh, and this just in: June sea ice levels in Antarctic were at their lowest level since scientists began keeping records.

All of this highlights what many of us have sensed and now know for certain: Climate change is upon us — and that’s a scary situation for those of us who work in the outdoor industry. The cumulative effect of all of these climate catastrophes has created what the American Psychology Association (APA) calls “eco-anxiety.” 

According to the American Psychology Association, eco-anxiety is “the chronic fear of environmental cataclysm that comes from observing the seemingly irrevocable impact of climate change, and the associated concern for one’s future and that of next generations.”

Media coverage adds to the angst

This fear is evident across our land, with hand-painted yard signs and a variety of bumper stickers on vehicles, all advocating that “Science is Real.” Newspaper editorials push for “immediate action,” or ask, “Are We Too Late?” Such articles often crowd out other headlines and newscast bulletins, which only increases our angst.

These conversations about our planet’s future — most of them based on science — have had an effect on most everyone’s emotional state. Words have weight, words plant ideas. And ideas spread faster than anything else, for good or bad. 

Some people pay attention, some don’t notice, and some dismiss the science out of hand, pushing the notion aside without realizing they are being affected at a cellular level by the emotions that are under the surface. This is what is happening, and sometimes we see it, sometimes we miss it, but in the end we’re all going to feel it personally, or collectively. (more…)

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Why Learn Map and Compass Skills in the Age of GPS and Digital Tools?

By Cam Francisco June 28, 2023

Outdoor Education

Undoubtedly, you’re either reading this on a smartphone or you’ve got a smartphone in your pocket or sitting on the table or desk in front of you. Most likely, that device features a compass. In fact, the digital app version of one of the most ancient navigational tools in the world comes standard with most cell phones and other mobile devices these days. 

Toss in Google Maps, Pacer, Apple Maps, MapMyWalk, Waze, and other directional apps that rely on GPS technology and you’ve got to ask yourself, “Why the heck should I bother using unwieldy paper maps and a handheld compass to explore the backcountry?” 

Of course, there are plenty of good reasons to master traditional map and compass skills, the most obvious being, “Damn, I got no signal.” 

Here at The National Center for Outdoor and Adventure Education (NCOAE), we include lessons in basic map and compass skills on every expedition we lead. In fact, it’s part of our “First 48” programming, which teaches students important technical skills they’ll need to know within the first two days of any NCOAE backcountry expedition. 

During the Fist 48, NCOAE course participants learn the basics of a baseplate compass, as well as how to (more…)

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What’s the Difference Between NOLS, Outward Bound, and Other Outdoor Programs?

By NCOAE Headquarters June 16, 2023

NOLS and Outward Bound

As an accredited outdoor and adventure education provider, we here at The National Center for Outdoor & Adventure Education (NCOAE) know that people are diligently doing their homework in their search to find the best guided wilderness trips for their children or for themselves.

And topping their list of questions is this query: What makes NCOAE different from programs like Outward Bound, programs like NOLS, and even traditional summer camps? How do you make a well-informed choice between our outdoor education company’s offerings and those offered by a summer camp, tour operator, GAP semester provider, or an unaccredited outdoor adventure programming company?

Many organizations like ours seek to set themselves apart from the top two standard bearers, namely, The National Outdoor Leadership School (NOLS) and Outward Bound (OB). Truth be told, NCOAE’s similarities to those organizations far surpass our differences. In fact, like so many other organizations, we trace our pedigree back to programs like Outward Bound and NOLS.

NOLS and OB are leaders in the field, and for very good reason. They’ve been around longer than most every other outdoor education and adventure programming organization out there. Both brands are highly recognizable and trusted, and each has trained hundreds of thousands of people — many of whom have gone on to found outdoor recreation companies of their own.

In addition, these two organizations play leading roles within the outdoor education industry, from convening the annual Wilderness Risk Management Conference each fall to publishing industry-leading research. They’re also refreshingly upfront and transparent about reporting their in-field near misses and fatalities.

We share that transparency with both organizations, including other attributes, such as accreditation by the Association for Experiential Education (AEE). And like NOLS and OB, we have our own curriculum. We hire, train, and retain only the best instructors; we place an emphasis on our staff’s professional development and continuing education; we participate in annual in-person industry educational and networking events; we offer courses in unique and challenging destinations; and we have our own policies and guidelines according to how and where we operate.

But rather than comparing and contrasting ourselves to organizations like NOLS and Outward Bound, we think it’s most helpful for prospective students and their parents to compare what we offer to other options, such as:

  • Residential summer camps
  • Tour operators
  • GAP programs
  • Semester programs
  • Urban summer programs
  • Other outdoor and adventure-based schools

What we’d like to do in the sections that follow is outline what sets NCOAE apart from other forms of experiences that you or your child may be considering, starting with residential summer camps.

Residential Summer Camps
Residential summer camps are supervised by professional adults, college students, and counselors in training (CITs) to foster personal growth for children by providing them with fun educational and recreational programs in a safe environment.

Residential summer camps generally share the following characteristics:

  • Living units of 12–50 students, often divided into smaller groups for specific activities
  • A wide array of activities such as arts & crafts, sports, outdoor activities, and environmental pursuits
  • Opportunities for students to try new things and be somewhat in charge of new responsibilities, such as cleaning the bathhouse
  • Limited backcountry activities in which campers have the option, but not the obligation, to participate
  • Meals mostly prepared by camp kitchen staff and served in the dining hall with limited opportunities for campers to cook meals for themselves and their campmates
  • Centralized lodging, meals, and bathhouse facilities
  • Routine environment and activities coordinated from a central home base

NCOAE programs offer outdoor and adventure education experiences that promote personal growth the acquisition of technical outdoor skills, and stewardship in communities and in nature. Our outdoor and experiential education programs are characterized by the following:

  • Small groups with a 1:6 instructor-to-student ratio
  • Programs for individuals, school groups, university groups, nonprofit groups, and others
  • Outcome-focused curriculum
  • Activities chosen carefully to optimize experiential education outcomes
  • Opportunities to try new things and develop higher levels of responsibility and leadership
  • Backcountry meal prep with participants largely in charge of meal preparation
  • Group participation in most activities, followed by expertly facilitated end-of-day discussions about what was experienced and learned
  • Wilderness environment — most activities/adventures are conducted on unique wilderness land and water wilderness environments
  • Backpacking — participants working together, participants carry everything they need to live in the backcountry
  • Smaller, more cohesive groups that enable instructors and guides to support the development of the group dynamic more effectively

Tour Operators
Tour operators focus on delivering fun recreational activities that may also be, tangentially, educational. They often share the following characteristics:

  • A specific activity or package of activities, such as kayaking, whitewater rafting, or bird watching
  • An emphasis on fun and recreation
  • Limited education focused on a narrow skill set such as paddle techniques, water safety, local flora and fauna, or local/regional history
  • Highly regimented — participants follow instructions with little so no opportunity to take on leadership roles
  • Full-service guided tours in which participants primarily play a passive role, mostly as sightseers

NCOAE’s outdoor and adventure education experiences are designed so students may be fully engaged. In contrast to a tour guide experience, participants can look forward to the following:

  • A custom array of educational and recreational opportunities, with human-powered outdoor recreation activity serving as the vehicle used to drive personal growth, group dynamics, and leadership development
  • Active engagement in a range of educational lessons/activities, focused on technical skill development, leadership development, and environmental sciences
  • Opportunities for students to learn and grow — and then lead
  • Experiential education for developing the technical outdoor skills to live comfortably and safely in the backcountry
  • A highly customized personal, interpersonal, and leadership development curriculum

Gap and Semester Programs
Gap and semester programs are generally travel educational experiences that students take as a break from more formal classroom studies — usually before enrolling in a college, university, or trade school. These programs are generally characterized by the following:

  • International travel
  • Duration of three to six months
  • High-school, college, and adult offerings
  • Cultural and foreign language immersion opportunities
  • Limited backcountry experiences (not part of most gap and semester programs)
  • Remote locations for some programs

In contrast, NCOAE’s outdoor and adventure education experiences involve both domestic and international travel — mostly in a backcountry environment:

  • Domestic and international travel; for example, from New Hampshire to Oregon to Ecuador
  • Shorter duration — 42-day and 60-day programs
  • Travel that is split into different legs/segments
  • Cultural immersion opportunities
  • Backcountry activities
  • NCOAE’s core experiential learning and personal, interpersonal, and leadership development curriculum
  • Course offerings tailored to domestic and international locations
  • Programming for 18-plus aged participants exclusively

Urban Summer Programs & Day Camps
Urban summer programs are typically day camps for keeping young children physically and mentally active and engaged with one another in a community setting when they are not in school or home from a break in their community’s academic offerings. Characteristics of urban summer programs include the following:

  • Mostly day camp programming
  • Primarily based in urban areas
  • Broad array of activities such as dance, sports, skateboarding, and crafts
  • Supplemental outdoor activities such as archery and pool activities
  • Less defined curriculum
  • Local community input on program design
  • Short trips to natural environments, but primarily focused on activities/experiences in urban settings

NCOAE’s outdoor education and adventure experiences are uniquely different. We offer:

  • Primarily outdoor-based programs with limited time in any urban settings
  • Primarily overnight, multi-day programming with limited (if any) day programs
  • Backcountry wilderness environments
  • Development of technical outdoor skills
  • Personal, interpersonal, and leadership development curriculum in small-group settings in a wilderness environment to improve group dynamics and an understanding and appreciation of one’s individual and collective impact in a community

Other Outdoor and Adventure-Based Schools
Many providers of outdoor education and adventure programming are more limited in scope than we are and less flexible in their programming:

  • Focus primarily on outdoor skill development
  • Less focus on personal and interpersonal reflection and growth and on leadership development
  • Inability to customize programming
  • Limited to a few course areas and unable to roll out new ones to address changes in student needs and demands
  • Limited flexibility to pivot in response to client or staff feedback when warranted
  • More focus on allowing the environment and the physical experience of an expedition dictate the individual student’s learning and experience
  • Unaccredited by the Association for Experiential Education (AEE)

Here at NCOAE, we pride ourselves on delivering personalized outdoor education and adventure experiences that meet the unique needs of every individual and group that participates in our programs. We offer:

  • A well-rounded experience, with time for learning and challenge but also for relaxation and reflection, enabling participants to generalize and internalize so they can apply their learning when they return to their home or school communities
  • Outdoor activities that extend beyond participation to meet the outcomes defined in our unique core curriculum
  • Customized experiences for each partner organization and each class/year of students
  • Flexibility and passion for continuously improving our programs
  • The ability to pivot as needed to meet the school/organization/individual group needs
  • A careful balance of technical outdoor skill and leadership development
  • Sensitivity and flexibility regarding the pace of learning to ensure that participants are not pushed too hard or too far into a place of anxiety and frustration
  • Optimization of group dynamics and group bonding to reinforce the application of personal and leadership development and skills in a community setting
  • Bound by the Association for Experiential Education’s (AEE’s) strict standards of accreditation for program governance and administration, risk management, participant transportation, backcountry equipment and nutrition, and more

Choosing Between Outward Bound, NOLS, and NCOAE
We, at The National Center for Outdoor & Adventure Education, possess expertise not only in the principles and curriculum that drive our unique approach to outdoor education and adventure programming but also in the theories that guide outdoor experiential education itself. By staying informed about alternative programs available to you or your child and actively engaging in networking and educational opportunities provided by our industry membership and trade associations, we are confident in our ability to assist you in making an informed choice regarding the matters discussed in this blog post.

We encourage you as an informed consumer to continue your research and ask numerous questions. If we can be of additional assistance, please reach out to us by calling our headquarters at (910) 399-8090 or emailing us at

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Meet the Team: Wes Hawkins, NCOAE Director of Course Management and Logistics

By NCOAE Headquarters May 26, 2023

Meet the Team

As The National Center for Outdoor & Adventure Education (NCOAE) has grown, so have the skills and knowledge of our expertly trained and credentialed staff members. Take Wesley Hawkins, WFR, for example; a young man who grew up in the Southeast and eventually landed in Georgia where he attended Georgia College and State University.

Majoring in outdoor education with a minor in business administration, Wesley was given a class assignment that brought him to NCOAE for a site visit back in 2014. That trip resulted in Wes becoming an NCOAE intern, assisting with our outdoor programming, and eventually working his way up to lead instructor.

Fast forward to 2023. Wes is now our Director of Course Management and Logistics. He’s responsible for managing all course-related needs, such as transportation, gear, and food, and he makes sure our staff and students are prepared before heading out on their expeditions. He also supervises and assists staff on our backcountry wilderness courses as needed.

Shortly after Wes settled in for the upcoming summer season, we pulled him away from his duties to answer a few questions for the latest post in our Meet the Team series. Here’s what he had to say: (more…)

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Trending: With Increased Participation Comes a Renewed Focus on Stewardship

By Stephen Mullaney May 17, 2023

Outdoor Education

This is the last post in our four-part series on trends to be aware of in outdoor and adventure-based experiential education. In Part 1, we covered DEI (diversity, equity, and inclusion). Part 2 focused on restorative practices. And Part 3 called attention to trauma-informed learning

Here in Part 4, we’re wrapping up the series with a call for action about stewardship.

According to research from Pennsylvania State University’s Department of Recreation, Park, and Tourism Management and the Leave No Trace Center for Outdoor Ethics, 13 percent of people who regularly participated in outdoor recreation activities prior to the COVID-19 pandemic, stopped doing so once nationwide lockdowns went into effect. 

At the same time, that 13 percent was offset by 20 percent more participation coming from people for whom the researchers say were likely entirely new to recreating in local, state, and national parks.

In New England alone, according to an article published in the journal for the International Association for Society and Natural Resources, overall recreation visitation increased by a whopping 61 percent during the summer of (more…)

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Opinion: Instilling an Operational Risk Management Mindset in EMS

By Kate Javes April 27, 2023

Emergency Medicine

In EMS (emergency medical services) education, generations of students have been taught to put safety first.  “Don’t enter a scene if it’s not safe,” is what all EMS students are told.  “Your safety is most important,” we say. “If you don’t feel safe, get out.”  

That being said, there’s another concept called “Safety Third” that’s become popular in recent years, claiming that it’s really up to the individual — not the institution — to ensure their safety on a continual basis. For more details about this, please read Safety is Third, Not First, and We All Know It Should Be in the Journal of Emergency Medical Services, written by our Medical Director, Dr. Christopher Davis, MD

But what is “safe” and why do we put so much emphasis on it?

Personally, I think even the notion of chatting about “safety” leads us down the wrong path. Instead, we should be discussing risk management and decision making. Let’s face it. Absolutely nothing in EMS is “safe.”  Emergency services personnel respond on a near-daily basis to situations that the regular population is unable (or unwilling) to handle.  Why, just the simple act of driving an ambulance can be unsafe.  Again, nobody becomes an EMT (Emergency Medical Technician) because they’re desperately seeking a safe career.

Most emergency healthcare providers will agree that “safety” is not really our focus. Whether they realize it or not, every EMT or paramedic who spends more than a few shifts in the field will develop their (more…)

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Managing Backcountry Rain by Adopting an Expedition Mentality

By Cam Francisco April 17, 2023

Outdoor Education

If you asked me to list the attributes that allowed Sir Ernest Shackleton’s Trans-Antarctic Expedition (1914-1917) to survive more than a year stranded in Antarctica, I point to characteristics like leadership, adaptability, teamwork, ingenuity, and perseverance. 

What Shackleton and his men employed was a mindset that intentionally embraced a set of values and behaviors that are essential for success and survival in extreme conditions. Here at The National Center for Outdoor & Adventure Education (NCOAE), we refer to that as having an expedition mentality (and I’ll have more to say about that later in today’s post).

If you’ve ever spent a full week backpacking in the Appalachian Mountains of western North Carolina between May and August, chances are you encountered some rain somewhere on the trail.

That’s because that region of the country — particularly in Pisgah National Forest — encompasses areas categorized as Appalachian temperate rainforest that traditionally receive more than 100 inches of rain per year. Generally, this rain is a (more…)

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Trending: Trauma-informed Learning in Outdoor-based Experiential Education

By Stephen Mullaney April 7, 2023

Outdoor Education

Why We Need Trauma-Informed Learning

Time warp yourself back to early-February of 2020. We were a month into a new decade when news broke that the U.S. Department of Homeland Security had directed all flights from China be routed through one of 11 airports in the United States for enhanced screening procedures and possible quarantine. 

A few months later, just as our nation’s students were preparing to end another school year, our country found itself in virtual lockdown. 

While students of all ages may experience loneliness, anxiousness, and uncertainty, the global health pandemic caused by the virus named “SARS-CoV-2” and the disease it causes — COVID-19 — had an unequivocal impact on school-age youth. 

From extreme levels of disengagement and isolation to the loss of school-based nutrition and healthcare programs, we’ve only recently begun to understand how bad it really was. As more children fall behind in terms of social and academic development, the more serious the case for trauma-informed learning and trauma-informed practices in education. (more…)

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Trending: Restorative Practices in Outdoor-based Experiential Education

By Stephen Mullaney March 22, 2023

Outdoor Education

A few weeks ago, we published Part 1 of this series, which covers what we here at The National Center for Outdoor & Adventure Education (NCOAE) view as the trending best practices to know about in outdoor and adventure-based experiential education

  • Here, in Part 2 of this series, we introduce you to Restorative Practices, and share how they’re incorporated in the programming here at NCOAE.
  • For Part 3, we will shift our attention to Trauma-Informed Learning.
  • And we’ll wrap up the series in Part 4 with a discussion on Stewardship.

At NCOAE we recognize the power of the outdoors and how it can shape the lives of those who participate in our outdoor education courses and wilderness medicine  trainings. Take a backcountry teen expedition for example. By experiencing hiking, climbing and paddling, we see physical obstacles turn into (more…)

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Benefits To Leadership-Based Summer Camp for Teens

By NCOAE Headquarters March 9, 2023

Summer Camp

Outdoor and adventure-based summer camps for teens provide a life-enriching and world-changing experience for those who participate in them. These experiences, offered by accredited adventure-based experiential and outdoor education providers like The National Center for Outdoor & Adventure Education (NCOAE), offer a unique opportunity for teens to develop personal competencies in the following four areas, as well as technical outdoor skills that will last a lifetime:

  • Self
  • Community
  • Action
  • Impact

Or, as we here at NCOAE prefer to present it:

Self + Community + Action = Impact

This formula for personal growth, development, and leadership sets us apart from a traditional summer camp, where backcountry experiences are electives and not the backdrop for everything that’s offered.

Parents of teens who choose to participate in our adventure-based summer camps often tell us their teens return home with much more than campfire-building skills. These parents report an increase in caring and empathy on the part of their teens, and a better understanding of the importance of sharing and giving. They also exhibit a greater willingness to stand up for what they believe in, taking responsibility for their actions instead of shifting the blame elsewhere. These teens have discovered that such qualities are essential for building a progressive society and making a positive impact on the world.

Outdoor and adventure-based summer camps experiences that take place in the backcountry create a sense of community and provide opportunities for intergenerational relationships. They help teens develop (more…)

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Trending: 4 Best Practices in Outdoor and Adventure-based Experiential Education

By Stephen Mullaney March 2, 2023

Outdoor Education

A little more than three decades ago, two educators and researchers from Canada partnered with the Association for Experiential Education (AEE) on a groundbreaking book titled Safety Practices in Adventure Programming

Simon Priest, Ph.D., and Tim Dixon, M.Ed., regarded at the time as among only a handful of leading experts in outdoor adventure education and leadership, penned what some argue was the first widely-published best practices for the outdoor education and adventure programming industry. 

Known as the Red Book, due to its bright red cover, their work coincided with AEE’s foray into accreditation, inspiring outdoor education program administrators across the globe to adopt common approaches to the safety and well-being of their clients and staff while facilitating adventure-based programs. 

And while it likely isn’t fair to suggest that best practices didn’t exist within our sector of the outdoor industry before Priest and Dixon’s Red Book, the publication of that forward-looking guidance saw the rapid adoption of such practices for our sector like no other. Fast-forward 33 years, and we find most all outdoor education or adventure-based programming operations pay close attention to best practices in the realm of safety and risk management. 

In today’s post, I’m pleased to call attention to four areas with associated best practices for which all outdoor educators and adventure-based organizations should be aware. After hearing from college and university outdoor program managers, organizational leaders, and by performing research of our own, four themes rise to the top as trends and best practices in outdoor education and adventure programming to follow over the next year: (more…)

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Opinion: There’s Nothing “Basic” About an EMT

By Kate Javes February 20, 2023

Emergency Medicine

It’s been more than a decade since the National Registry of Emergency Medical Technicians (NREMT) stopped using the certification designations EMT-B and EMT-Basic. 

The change from EMT-B to EMT was not just in title. It was accompanied by an expanded set of knowledge and skill expectations for emergency medical technicians (EMTs). There is nothing “basic” about what an EMT learns or the skills he or she can perform. And they’re certainly not “Ambulance Drivers.”

(Photo Credit: RODNAE Productions | Sourced from Pexels)

Most states have made the transition to the new title, but many emergency medical service (EMS) providers continue to refer to some EMTs as “Basics.” Maybe it’s out of ignorance, or just an antiquated habit, but we need that to stop. It’s much more than just an inaccurate designation — it’s misleading to the public and gives the wrong impression regarding care and capabilities.

Looking Back at EMT Designations

The early terminology came from a haphazard system of state-by-state naming conventions. The NREMT itself started out with an “EMT-Ambulance” or “EMT-A,” later adding an “EMT-Non-Ambulance” designation. As a result of this confusing (more…)

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What Outdoor Industry Pros Recommend You Keep in Your First-Aid Kit

By Kate Javes February 6, 2023

Wilderness Medicine

Having a first aid kit handy is always a good idea, but what should it contain? The answer to this question really depends on what you plan to be doing. There are different considerations for a kit that you carry in your car versus one that you grab up for a mountain bike ride or take with you on an overnight or multi-day backcountry expedition. 

Of course, you could purchase pre-stocked first-aid kits for a variety of purposes. Retailers and companies like REI, Adventure Medical Kits, and even Amazon and Target all sell first aid kits that may be right for your purposes. These can be convenient, and many are vacuum sealed to save space. However, they can be expensive and may contain less useful items for your purposes.

Putting together your own first aid kit lets you decide how many and what kinds of things you want. It also gets you thinking about what you’ll have on hand should a backcountry emergency occur. 

Pro Tip: Make sure your backcountry first aid kit is waterproofed and check it regularly to make sure things haven’t been damaged or have expired. 

Here are some things to consider when creating your own backcountry first aid kit:

What injuries/situations are likely to occur? (more…)

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Let’s Add Humble to the 5 ‘Umbles’ of Hypothermia

By Todd Mullenix January 23, 2023

Risk Management

Hypothermia is deadly. There, I said it! This potentially dangerous drop in body temperature is commonly defined as a core body temperature below 95 degrees Fahrenheit (35 degrees Celsius) after dropping from a healthy temperature of about 98.6 degrees Fahrenheit or 37 degrees Celsius.

The slightest variance from the “normal” range can disrupt the body’s ideal operating conditions, known as homeostasis. The negative impact of hypothermia on homeostasis is dramatic and therefore should not be underestimated. Hypothermic progression follows a path, moving first more slowly, then more rapidly toward non-movement and when properly treated, onto death.

The author, NCOAE Director of Wilderness Medicine Education Todd Mullenix, moving and staying warm.

Movement is life. Living things grow, evolve, learn and work to improve their circumstances. Non-living things hold fast to current circumstances unless acted upon by an outside force. As we’ve all experience, movement generates warmth, and this case, it combats hypothermia. A creature that has the appropriate amounts of items necessary for movement will generally maintain a body temperature conducive for life. 

These items required for movement include nutrients, health, fitness, clothing, and sometimes technical outdoor tools such as an ice axe and crampons. A breakdown of these items leads to decreased movement and reduced temperature. In this post, we will look at the hypothermic process using the five umbles: (more…)

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Hands-on Training is the Key to a Career in the Outdoor Industry

By Liz Shirley January 9, 2023

Outdoor Industry

For anyone interested in a career in the outdoor education, adventure programming, and guiding sectors of the outdoor industry, there are many trails to reach your destination. Among these are university recreation programs, internships, seasonal employment and more. 

Not all pathways in this wide and diverse industry necessarily require a recreation-specific degree. However, an associate’s or bachelor’s degree offers job seekers a leg up when it comes to qualifying for an administrative position, as well as positions in environmental education or academia. 

And while a college degree is helpful and even required in some sectors of this great outdoor industry of ours, what this industry truly values most is hands-on experience. That experience — in combination with holding the relevant certifications — is the key to successful advancement in outdoor education and adventure programming employment. 

Gaining real-world experience is essential, whether you’re pursuing a college degree or not. And one of the best ways to jump start your outdoor industry career is to find seasonal employment working in the field. Taking a part-time or summer job offers a great opportunity to start gaining the needed experience. 

Types of Outdoor Industry Organization

Seasonal opportunities abound, including through the following types of organizations: (more…)

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New Thinking about How to Handle Spinal Injuries in Remote Wilderness Settings

By Kate Javes December 12, 2022

Wilderness Medicine Training

Best practices for evaluating and transporting patients with potential spinal fractures or spinal cord injuries is a hot topic in emergency medicine. And it’s no wonder. All of us who work in the adventure programming and emergency medical services field fervently want to avoid causing or worsening a potentially catastrophic injury to someone’s spinal cord. 

As such, and for many decades, EMS officials dogmatically insisted that “immobilizing” patients with potential spine injuries was the best protection from further harm. Protocol demanded rigid backboards, cervical collars, head blocks, and yards of tape and straps to prevent someone who is injured from moving. However, new research suggests this is not only ineffective, but quite likely harmful.

Immobilization Dismissed as the Tool of Choice for Patient Transport 

Anyone suffering a spinal injury could have a spinal fracture. And that fracture could be unstable. So, if your client (i.e., patient in this case) moved even a little bit (like turning their head), that unstable spinal fracture could slide around and cause spinal cord injury. And that spinal cord injury could cause them to be paralyzed forever.

The Old School solution was to prevent them from moving on their own. Only let trained first responders (including outdoor educators, field instructors, and guides who are certified in wilderness medicine) lift/move the injured patient. Immobilize them to a rigid device — essentially a full-body splint — and get them out of the backcountry and to a hospital. 

Upon what was this edict based? Essentially nothing. A few case reports that, on closer scrutiny, don’t indicate any (more…)

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