NCOAE Blog

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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In the Outdoor Industry, Affordable Housing for Outdoor Educators Remains Elusive

By NCOAE Headquarters December 5, 2022

Outdoor Education

One of the major “perks” of working as a field instructor, guide, or senior staff in the outdoor education and adventure-based programming sector of the outdoor industry used to be an offer of free or low-cost housing. Today, that incentive is more elusive, both for employees at our peer organizations and the staff we hire here at The National Center for Outdoor & Adventure Education (NCOAE).

Affordable staff housing — or the lack thereof — tops the list of major financial issues facing those of us who oversee the experiential education programs we run at NCOAE. Our instructors and staff come from around the globe to teach and facilitate our outdoor adventure and education programs. And for us, it has always been important that when they arrive on campus, we attempt to make sure the stress of basic needs does not overshadow the joy of the work.

Image © Camp Echo Lake (sourced from OccupationWild.com)

Carolina Beach, North Carolina, is the closest residential area to NCOAE headquarters, featuring rents that average $1,500 a month. That’s not outrageous if you’re earning $50,000 a year and you consider 30 percent of income for rent as the gold standard for conservative budget management.

But ours is a seasonal business, and part of the problem our sector of the outdoor industry faces is that our staffers don’t make 50 grand a year. In addition, most outdoor education facilities are located in beautiful areas near state and national parks, mountains, beaches, lakes, and other open recreational spaces. Obviously, real estate and rental accommodations are much more costly in such places. 

Outdoor Educators Consistently Lack Affordable Housing Options

Fortunately, NCOAE is not located in an area where rent and income gaps are so disparate that staff must move to other locations to survive. However, at the end of the day we are (more…)

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Gaining the Clinical Experience to Get into Med School: EMT Training and Direct Patient Care

By NCOAE Headquarters November 21, 2022

EMT Training

Experience is among the biggest hurdles you need to clear in order to enter any competitive profession. However, clearing this hurdle can be especially challenging for those entering the medical field because it’s unlikely you can get into medical school without some experience under your belt.

Unlike other professions, the field of medicine offers internship opportunities only upon graduation from medical school. So, the question for many high school and college students aspiring to become doctors is this: How do I get the patient care experience I need to get into medical school if I’m not a doctor?

Our solution? Perhaps the best clinical experience for pre-med can be obtained by training for and working as an emergency medical technician (EMT). As an EMT, you get diverse hands-on patient care experience in a fast-paced, high-intensity treatment environment while working closely with firefighters, police officers, doctors, and other emergency-response and medical professionals. And you gain exposure and experience with patients who have a variety of medical conditions in a broad range of emergency response scenarios.

Discover  efficient and effective paths to medical school, and ways to get the clinical experience needed to increase your chances of being accepted.

The Path to Medical School

According to the Association of American Medical Colleges (AAMC), the recommended approach to getting into medical school includes:

  1. Explore your medical career options.
  2. Get some experience.
  3. Stay on track for medical school.
  4. Get more experience and explore resources.
  5. Team up with your advisor to build a game plan.
  6. Register and prepare for the Medical College Admission Test (MCAT).
  7. Prepare for med school interviews.
  8. Receive letters of acceptance or rejection.
  9. Prepare for medical school.

Steps 2 and 4 call for gaining experience — hands-on patient care experience. The people who run medical schools are only looking for serious candidates — intelligent individuals who are passionate about the field. They seek those committed to completing a rigorous and prolonged education and training program.

They don’t want to fill their limited openings with candidates who are likely to drop out after their first encounter with a cadaver. Nor do they want to discover later that a (more…)

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Meet the EMT Students: Colleen and Justin

By NCOAE Headquarters November 14, 2022

EMT Training

There’s good reason why we precede our three-week Hybrid EMT course with the word “Intensive.”

And that’s because our 21-Day “Intensive” Hybrid EMT course enables students to satisfy eligibility requirements for the National Registry of Emergency Medical Technicians (NREMT) and North Carolina State EMT examinations in an expeditious manner. Our course includes 10 days of virtual, instructor-led training, followed by 11 days of hands-on, practical skills training.

Today in this post, we’re highlighting a couple of students who completed our EMT training and received their certifications. As you’ll see, neither of them rested on their laurels, instead immediately following their training with additional education. First up is Colleen Kenedy.

Meet Colleen Kenedy

The first student we’re highlighting is Colleen Kenedy, who completed our Hybrid EMT training course in December of 2021. She signed up for the program in order to gain hands-on medical experience in a short amount of time. The objective was to help her when she was accepted to Physician Assistant (PA) school. And Colleen did just that.

Shortly after completing her EMT course and passing her NREMT exam, Colleen was accepted for admissions to the PA Program at the University of Washington’s MEDEX Northwest campus in Anchorage, Alaska, where she is now completing her didactic year. She received her (more…)

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Hybrid EMT Training Available in Oregon and North Carolina

By NCOAE Headquarters October 31, 2022

EMT Training

Long touted for offering hybrid EMT instruction in North Carolina, The National Center for Outdoor & Adventure Education (NCOAE) also offers Hybrid EMT training in Oregon

This highly effective 21-day EMT training includes 10 days of virtual instruction delivered online, followed by 11 days of hands-on, practical training in Oregon’s Tygh Valley. The program offers an ideal format for college students, premed students, working professionals, and anyone else who appreciates the flexibility of learning in a fast-paced hybrid format.

Whether you choose a hybrid EMT training program that features in-person, hands-on skills training in Oregon or North Carolina, your NCOAE training and experience will include the following:

Before your course begins: We’ll ask you to complete up to 30 hours of asynchronous web-based training using our online eLearning platform. The benefit to this approach is (more…)

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8 Alternative Jobs to Pursue with an EMT Certification

By NCOAE Headquarters October 14, 2022

EMT Training

Just obtaining an Emergency Medical Technician (EMT) license opens a world of career possibilities both inside and out of the medical field. Sure, you have to put in the effort, but the opportunities are as diverse as our EMT students here at The National Center for Outdoor & Adventure Education (NCOAE).

Fact is, we receive applications from students from all walks and stages of life, who successfully complete our EMT training program and go on to use that EMT training for a variety of opportunities. Some become full- or part-time EMTs, others use this outstanding training and education as a steppingstone for medical or nursing school. And then there are the outdoor enthusiasts who use this EMT training to become Ski Patrollers or members of Search and Rescue crews, or to add an additional layer of medical expertise when guiding groups on mountaineering and backcountry expeditions.

Maybe you’ve been an EMT for a while and are looking for a change, Or maybe you’re thinking about obtaining your EMT certification and then consider your options. While the most popular career trajectory for EMTs is to become a Paramedic, there are a number of jobs that you can obtain with just an EMT certification, keeping mind that some may require additional training. 

Here are eight such opportunities: (more…)

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Heat Illness: Symptoms, Prevention, and Treatment

By Kate Javes October 3, 2022

Medical Training

Nobody likes to be hot and sweaty on the trail. But when things turn from being uncomfortable to becoming downright dangerous, it’s time for quick, on-the-spot emergency action. 

Heat illness is a range of medical conditions that result from the body’s inability to cope with an elevated heat load. When that occurs, it is more commonly referred to as “heat strain.” And whether you’re inactive in a warm, humid environment or participating in strenuous physical activity in the fall or winter, you are at an increased risk of heat illness.

For people who engage in backcountry adventures, heat illness and heat strain are among the many potential health and safety risks. That’s why our instructors at The National Center for Outdoor Adventure Education (NCOAE) include it in our Wilderness Medicine courses. In this post, we bring you up to speed on the basics, including the symptoms to watch for, preventive measures, and treatments to cool an overheated body.

From Bad to Worse on the Heat Illness Spectrum

Heat illness, heat strain, and related injuries occur when the core body temperature becomes elevated, stressing or surpassing the body’s ability to cool itself. Like a nuclear power plant, the human body can suffer serious and potentially fatal damage when its core becomes overheated.

The severity of the condition is on a spectrum generally divided into the following three levels: (more…)

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Adult Education Courses & Adventure Vacations

By NCOAE Headquarters September 23, 2022

Adult Courses

Taking a well-deserved adult vacation offers joyful predictability. There’s time off to do what you want, visit places that you’ve maybe never seen before, and return home with some great photos of friends and family. Then, for most of us, it’s back to a predictable grind. By mid-week, we’re back to being the same employee or boss that we were when we packed up and headed out for vacation. 

What The National Center for Outdoor & Adventure Education (NCOAE) offers outdoor enthusiasts — including adults who are curious about backcountry travel — is an alternative to your typical adult vacation. We prepare, set up, and guide life changing adventure-based adult education courses for anyone looking to learn new skills — or those sharpening existing skills in the outdoors, enabling them to return to daily life with new insights into leadership and how to protect our natural resources. 

We can even help you pitch your trip as a benefit to your employer. Who knows? Adventure-based education may be the future for your organization’s workplace employee engagement. (more…)

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Concussion Recognition and Treatment in the Backcountry

By Kate Javes September 9, 2022

Wilderness Medicine Training

Concussion recognition and treatment has gotten a lot of attention over the last decade, mostly in the context of youth and professional sports such as tackle football and soccer. It’s even a topic for those who serve in our armed forces. However, confusion over its prevention, diagnosis, and treatment remains widespread. 

In an interview with a reporter from the Chicago Sun Times, former National Football League quarterback Brett Favre, who was knocked out cold only once in his 20-year career, claimed that “probably 90 percent” of the tackles he endured left him with a concussion.

He’s most likely correct in that estimation. After all, the definition of “concussion” is broad: “A concussion is a brain injury, a disturbance in brain function induced by traumatic forces, either from a direct blow to the head or a transmitted force from a blow to the body.” It disrupts brain function at the cellular metabolic level but does not result in major structural damage. Conventional MRI or CT scanning will not show evidence of a concussion.

So, how do you know if you or someone else has suffered a concussion while in the backcountry? And, after having made that determination, what should be done? Having clear answers to these two questions is essential for successful recovery and to prevent long-term cognitive and psychological complications. This is true no matter where the concussion takes place, but especially in the backcountry where medical treatment from a full-time team is unavailable. (more…)

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Avoiding Target Fixations and Incident Pits in the Backcountry

By Stephen Mullaney August 29, 2022

Risk Management

“Look where you want to go!” 

I have conveyed this message to wilderness course participants countless times, shouting, screaming, and using hand signals when necessary. Sometimes I’m yelling above the roar of a set of rapids or the sound of an adjacent waterfall. 

“Look where you want to go!”

I emphatically issue the same advice while watching climbers rappelling down a cliff, or verbally guiding a student on a mountain bike through a sketchy section of trail. In each case, the point of my shouting is to get the students to stop looking at the obstacle. 

“Look where you want to go” really translates as “Stop looking at the obstacle! Don’t fixate on the hazard!”

And it doesn’t matter if you’re a Wilderness First Responder approaching the scene of a backcountry incident, or a student on a wilderness course attempting to navigate a perceived hazard or obstacle, looking too closely at a hazard you want to avoid can be very dangerous.

At first glance — no pun intended — you might think it wise to actually look closely at the hazard you want to avoid. No argument there. You absolutely need to identify obstacles, especially in the backcountry and other places considered Wilderness. In fact, identifying an obstacle is a key factor in remaining safe. 

But here’s the thing: (more…)

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Have any further questions about our courses, what you’ll learn, or what else to expect? Contact us, we’re here to help!