Wilderness Medicine

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…)

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…)

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…)

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…)

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…)

In wilderness or the backcountry, bad things can happen to even the most experienced of adventurers. Truth is, most illnesses and injuries on the trail can be managed by the adventurer, or with the assistance of someone possessing some training in wilderness medicine. 

Of course, some injuries and illnesses do pose a threat to life or limb, and in other cases, the person — who for our purposes we’ll call our “patient” — may not even survive without professional medical intervention. It’s those situations in the grey area that leave many outdoor adventurers wondering, Do we call for help or not? You maybe conflicted for several reasons: pride or overconfidence, embarrassment or reluctance to admit weakness, misjudging the severity of the situation, concerns over medical costs, or perhaps you lack an effective means to contact emergency services.

As the ancient adage suggests: “He who hesitates is lost,” and the objective of this post is to equip you with the knowledge and insight needed to arrive at the right decision faster. Here, you will learn when to call for help, the type of help to call for, and the various means of communication you can use to call for help.

Important! Before embarking on any wilderness or backcountry adventure, leave your itinerary with a trusted individual, along with instructions to contact emergency personnel in the event that you fail to return or call on the scheduled date of your return. If you need a visual on how important this is, watch the 2010 film 127 Hours, which vividly illustrates the torment suffered by Aron Ralston, the rock climber who was forced to amputate part of his own right arm after it was pinned between rocks in an isolated canyon in Utah.

Deciding When to Call for Help In The Wilderness

When you or someone in your group suffers a serious illness or injury, toss your emotions aside and focus on the following factors in deciding whether or not to call for help: (more…)

When it comes to emergency medicine — whether in an urban setting or the backcountry — swift and accurate assessments play a pivotal role in determining the severity and progression of an injury and deciding the best course of action. 

The decisions you make regarding treatment, evacuation, and transportation in cases of non-obvious threats to life and limb can determine not only whether someone lives or dies, but also their quality of life should they survive the emergency. After all, quality of life is a huge part of being alive. And a beating heart with minimal brain activity doesn’t always meet a person’s definition of “living.”

The National Center for Outdoor and Adventure Education (NCOAE) is a leading provider of wilderness medicine education and certification, and in this post, we’re taking the time to introduce you to the process of evaluating neurovascular function to determine the extent and progression of an injury. By doing so, you can make well-informed treatment, evacuation, and transportation decisions when responding to a medical emergency, no matter the origins of the incident.

Understanding What a Neurovascular Assessment Entails

A neurovascular assessment is a collection of tests used by medical clinicians, including emergency medical personnel such as Wilderness First Responders and Wilderness EMTs, to determine whether someone is suffering nerve damage or impaired blood flow. Neuro refers to anything related to the body’s nervous system, and vascular refers to anything related to the body’s blood vessels. Neurovascular function encompasses the interplay between the brain, spinal cord, peripheral nerves, and blood vessels that supply oxygen and other vital nutrients to organs, limbs, and tissues. Any disruption of this intricate balance can lead to severe consequences ranging from impaired cognition to more severe conditions such as stroke or the loss of a limb.

Neurovascular status can be determined by simple tests of the following three functions: (more…)

When the average person encounters the term “wilderness medicine,” they typically assume it is referring to the practice of medicine in a remote or harsh environment with little to no access to medical equipment or supplies. 

They may imagine a scenario of providing CPR to someone who suffered cardiac arrest during a whitewater rafting adventure or creating a splint out of a branch and a few strands of twine to help a hiker with a sprained ankle become ambulatory. 

While these notions of wilderness medicine aren’t far off the mark, they are limited. In other words, close but no cigar. It’s all the above and more, which makes it a challenge to come up with a clear and comprehensive definition. 

Teaching Wilderness Medicine at NCOAE

Here at The National Center for Outdoor Adventure and Education (NCOAE), our wilderness medicine courses begin with a discussion of what wilderness medicine is, as well as what each student hopes to learn from the course. Often, these discussions elicit points of discussion that require an even broader definition of the term.

While there’s no universally agreed upon definition of wilderness medicine, certain components set it apart from non-wilderness medicine. For the purpose of this blog post, let’s begin with the following definition:

Wilderness Medicine is provision of medical care when environmental conditions play a stronger role in decision making and interventions than the established systems of care. 

Wilderness Medicine encompasses not only the treatment of injuries and illnesses in these settings but also includes preventive measures, survival skills, and the management of environmental hazards such as extreme weather, hazardous terrain, and wildlife encounters.

Wilderness medicine skills and techniques can be applied in a variety of setting, including but not limited to: (more…)

In the context of wilderness medicine, soap and SOAP are both indispensable. An explanation is in order. We’re all familiar with lower-case soap. This noun refers to a substance that’s added to water to remove dirt, grease, grime, and germs from various surfaces, including skin, hair, clothing, pots and pans, and so on.

Soap In The Wilderness

Traditional soap works in two ways — as a surfactant to break water tension, improving water’s ability to penetrate surfaces, and as a molecule that has a love-hate relationship with water. Soap molecules have two ends, one that’s hydrophilic (loves water) and the other that’s hydrophobic (hates water). The hydrophilic end binds to water, while the hydrophobic end binds to anything other than water — dirt, grease, grime, germs. Imagine soap molecules as tiny carabiners that shackle dirt molecules to water molecules to enable the water molecules to usher them away.

In backcountry and wilderness settings, soap plays a vital role in preventing infection and transmission of disease. In fact, scrubbing vigorously with soap and water may be among the most important risk-management technique you practice during your time in the wilderness.

SOAP (Subjective, Objective, Assessment, Plan)

Now let’s move on to the other SOAP — all uppercase — which is an acronym for Subjective, Objective, Assessment, and Plan. As an outdoor educator, field instructor, or wilderness guide, this note-taking procedure is nearly as important as scrubbing your hands regularly with soap and water. This is especially true when you’re dealing with a client injury or illness in a remote setting. 

SOAP Notes, which I’ll be covering in this post, separate important information from the chaos and fog of emotion in order to provide clean, uncluttered details for making informed medical decisions and emergency response plans. 

With SOAP Notes in hand, field instructors and outdoor educators trained in wilderness medicine, as well as backcountry guides, are better prepared to respond to a medical emergency. They do this by:

• Following an organized, methodical process
• Tracking changes in a patient’s health status
• Keeping a record of assessments, anticipated problems, and any interventions already provided
• Communicating with emergency responders
• Ensuring a seamless transfer of patient care to next-level healthcare providers
• Documenting cases and care for improving organizational outcomes

Here at The National Center of Outdoor Adventure and Education (NCOAE), we developed the SOAP Note form shown below.

Our SOAP Note’s Form

Our SOAP Note form consists of the following seven sections (more…)

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…)