Wilderness First Responder

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…)

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…)

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…)

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…)

“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…)

It may surprise you to learn that drownings — along with heart attacks and falls — are among the leading causes of death for those who venture into the wilderness for recreation or education in the United States.

Statistics show that there are nearly 4,000 fatal drownings each year in the United States, with a little more than 8,000 nonfatal drownings. These figures include boating-related drownings. In fact, the threat of drowning is so prevalent that the first edition of the NCOAE Wilderness Medicine Field Guide devotes an entire section to Environmental Submersion and Drowning Injury.

Of course, it’s during the spring and summer that most outdoor explorers are on the water, including those participating in backcountry expeditions. Lakes, rivers and streams provide much-needed relief in the backcountry on a hot August afternoon and are sought-after destinations for many outdoor enthusiasts.

For those training to become Wilderness First Responders (WFR) and those participating in Wilderness First Aid (WFA) training, a major consideration is assisting with medical emergencies that occur on or near the water.  (more…)

There is no shortage of wilderness medicine education providers in this country. From organizations that offer education and training for Wilderness First Responder (WFR) and Wilderness First Aid (WFA) certifications to those that offer train-the-trainer programs, a simple online search reveals a ton of options — especially when the search is focused on a specific geographical region.

What’s striking about all the wilderness medicine training and certification taking place is that none of it is nationally regulated. None of it adheres to commonly accepted industry standards that govern what’s being taught or how wilderness medicine education and training are being delivered. On the other hand, the training and certification EMTs receive is regulated on a state-by-state level and must meet minimum requirements as set by the National Highway Traffic Safety Administration (NHTSA).

Wilderness medicine training, while loosely adhering to a similar curriculum, is officially overseen by, well, no one. That being said, standardization and oversight aren’t completely absent. Several organizations have attempted to fill the void with a variety of education programs, courses, guidelines, accreditations, and oversight committees.

A Mismash in the Making

Historically speaking, first on the list is the Wilderness Medical Society (WMS) — a nonprofit founded in the early 1980s to encourage, foster, support, and conduct activities that improve the scientific knowledge of human health activities in a wilderness environment. WMS offers three types of advanced wilderness medicine-related certification that have a “continuing education” focus and accreditation connection. The organization’s Fellowship in the Academy of Wilderness Medicine (FAWM), Diploma in Mountain Medicine (DiMM), and Diploma in Diving and Marine Medicine (DiDMM) are all provided in accordance with standards set in part by the Accreditation Council for Continuing Medical Education (ACCME).

There’s also the fledgling Wilderness Medicine Education Collaborative (WMEC) — an ad hoc group of medical educators whose interest in providing guidance on content for wilderness medicine courses has resulted in the creation of minimum guidelines and scope of practice (SOP) documentation for Wilderness First Aid (WFA), Wilderness Advanced First Aid / Advanced Wilderness First Aid(WAFA/AWFA), and Wilderness First Responder (WFR) training. While the work of the collaborative (whose members include leaders from SOLO Wilderness Medicine, Wilderness Medical Associates International, and NOLS Wilderness Medicine, among others) has resulted in a robust set of SOPs, its influence is nonexistent outside those of us who actively choose to look beyond ourselves for best practices. In other words, without accreditation, there’s no real motivation for anyone offering wilderness medicine education to seek out the WMEC. And without a formal structure and an administrative arm, the WMEC has no enforceable authority or meaningful influence.

Speaking of accreditation, closer to home for those us in outdoor and experiential education, following a rapid increase in the number of adventure programs in the late 1980s and early 1990s, it became imperative that outdoor experiential education programs develop standards of program quality, professional behavior, and appropriate risk management. Enter the Association for Experiential Education (AEE), which responded to that need in the early 1990s by developing comprehensive standards for common practices in the adventure education industry, becoming the nation’s first recognized accreditation provider focused on outdoor and adventure-based experiential education programming.

(more…)

For those interested in a career as an outdoor experiential educator, The National Center for Outdoor & Adventure Education wants to help you get onboard that particular ship.

But as the late comedian Jonathan Winters suggested when he famously quipped “If your ship doesn’t come in, swim out to it,” that vessel isn’t necessarily going to snuggle up to the dock and pick you up. It’s up to you to do the basic footwork — or perhaps backstroke is a better analogy — in order to achieve your career objectives.

Many people ask us if a formal education is necessary for a career in outdoor and adventure education and we answer that question by posing another: Does a piece of paper make for a master educator? Then we answer our own question by saying, “It depends.”

In the end, it’s you who must decide what role you want to play in the outdoor industry. If your objective is to spend a few years going “wild” as a fledgling field instructor, then just head out and apply for a job. Or let’s say you want to become a leader in a specific area of the outdoor experiential education field. In this case, gobble up some on-the-job experience and a fistful of certificates and get to work.

However, if what you seek is a career as a lifelong experiential educator — with a comfortable salary and maybe some good health insurance — some formal education might be required. The secret is to find ways to get a good education without being (more…)

What are your plans for Thanksgiving? Here at The National Center for Outdoor & Adventure Education, we’re expanding our outdoor educator-training program on a global scale and announcing a month-long training expedition that culminates in a Thanksgiving celebration in Patagonia — a remote region at the southernmost end of South America that is shared by Argentina and Chile.

That’s a large leap from our outdoor educator training programs in North Carolina on the Eastern seaboard and Oregon and California out West. But we’re excited to be spreading our wings, and we’re even going a step further by planning a second overseas training expedition next spring — this time to Kenya for a 33-Day Outdoor Educator Instructor Training – East Africa.

But first, back to our Patagonia training. The 31-Day Outdoor Educator Instructor Training – Patagonia is co-ed and targets college students, classroom teachers and novice outdoor educators who are 18 years and older. Tuition is just $6,600. We fly from Houston, Tex., and land in Santiago, Chile, where our local team has already worked out an invigorating itinerary.

Chile is a land of extremes, from the snow-capped volcanoes of Patagonia and dizzying heights of the Andes, to the driest desert on earth and the extensive southern glacial fields. We’ll be exploring some of the most beautiful mountains and rivers in the world, and we’ll see it with fellow explorers who have the same enthusiasm and zeal for the outdoors and education that you do.

And when it comes to gaining the experience and knowledge to become an outdoor educator, there are few better “classrooms” than Patagonia and the (more…)

Working in remote settings has its challenges. From the lack of a quality connection to the Internet and having to find alternate ways to ‘go to the bathroom,’ to not being able to find a doctor precisely when you may need one, working remotely takes on all new meaning when you’re outdoor educator or backcountry wilderness guide. And while there’s nothing we can do for you here at the National Center for Outdoor & Adventure Education (NCOAE) about the Internet connectivity issue, we sure as heck can train and prepare you or your staff for medical emergencies that happen five or 500 miles away from the nearest hospital.

If you take a moment to really think about it, the practice of wilderness medicine has been around a lot longer than anyone really knows. We venture to say that its existence predates 1,800 BC, when the Code of Hammurabi first set out fees for surgeons and punishments for malpractice. Since the very first opportunity to provide lifesaving care in a remote setting, wilderness medicine has been a thing.

Of course, no one on the battlefields of Elam’s Invasion into Mesopotamia ever yelled for a ‘wilderness’ medic. Regardless, “the advancement of wilderness medicine has been closely connected to military exploration/operations throughout history, and not surprisingly, this remains in many ways as true today as it was a thousand years ago,” wrote George W. Rodway in a paper titled The Foundations of Wilderness Medicine: Some Historical Features.

Fast forward to 2015, and NCOAE — through its affiliation with the Wilderness Medicine Training Center — has emerged as a leading provider of wilderness medicine training in North Carolina (and as a custom training provider, anywhere in the world). More to the point, we’re the only provider to offer a Hybrid Wilderness First Responder (WFR) training and a Hybrid Wilderness First Aid (WFA) training, all under one roof. What’s this ‘hybrid’ thing we’re referring to? Good question. Read on, grasshopper.

For people interested in receiving training and certification in the administration of wilderness medicine but can’t get away from home or work for weeks at a time to participate in such trainings, hybrid training allows you to (more…)