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 inevitable and necessary. That which does not grow does not survive. Its future is uncertain, but just as with navigation, knowing where we came from can be helpful in figuring out where we are heading. This post looks back at the history of wilderness medicine from evidence of its earliest practice to modern times, and provides a peek into the future of the field.
Prehistory
The earliest evidence of wilderness medicine is anecdotal, and it strongly suggests that the history of medicine begins with wilderness medicine. In other words, medicine was practiced first in the wilderness; it is not something that emerged only after modern medicine was practiced in civilized, settled areas. The earliest humans were certainly engaged in treating injuries and illnesses as they pursued reliable sources of food, water, and shelter.
When the famous anthropologist Margaret Mead was asked about the origin of civilization, she described an early case of wilderness medicine in which a broken femur was restored to health. (The story about Mead discussing the healed femur appears to be based on anecdotal accounts and was popularized by Dr. Paul Brand in his books, including Pain: The Gift Nobody Wants.) According to Brand, Mead explained that the first sign of civilization was a mended femur, indicating that someone had cared for the injured person, enabling the individual’s recovery. This story has been repeated and spread widely, although Mead’s own writings or lectures contain no evidence to confirm that she made this statement.
Early Evidence Captured in World Literature
Ancient literature provides the first evidence of wilderness medicine appearing in writings. Two well-known sources are the Epic of Gilgamesh (written around 2000 BCE) and Homer’s Iliad (written around 750 BCE).
In the Epic of Gilgamesh, the protagonist performed a wilderness medicine assessment: “But Enkidu did not answer. Gilgamesh touched his heart, but it did not beat.” In the Iliad, a record of the Trojan War, “Jupiter sends Minerva to break the truce. She persuades Pandarus to aim an arrow at Menelaus, who is wounded, but cured by Machaon.”
Wilderness Medicine in the Military
Many records of military operations include references to wilderness medicine. During the Napoleonic wars (1803 to 1815), French surgeon and military doctor Dominique Jean Larrey invented the modern method of army surgery, field hospitals, and army ambulance corps, which gave rise to the ambulance volantes (flying ambulances). These were horse-drawn carriages designed to transport injured soldiers rapidly and safely across the battlefield. Nearly every EMS textbook describes Jean Larrey’s “flying ambulances.” He is also credited with the sorting of patients called “triage” — the preliminary assessment of patients or casualties to determine the urgency and nature of the treatment they require.
In Climb to Conquer: The Untold Story of WWII’s 10th Mountain Division (2003), author Peter Shelton documents the military exploits of the 10th Mountain Division, which began in 1941 as a crew of civilian athletes with a passion for mountains and snow. In this book, Shelton discusses the unique focus and tactics of this unique fighting unit, particularly their expertise in mountain warfare and medical care in such challenging environments. While Shelton praises the 82nd Airborne Division as the greatest infantry division, he expresses a special admiration for the 10th Mountain Division’s specialized training and operations in mountainous terrains.
Modern Wilderness Medicine
A case could be made that modern wilderness medicine started as early as 1948, when the American Alpine Club began publishing its annual Accidents in North American Mountaineering, which is now called Accidents in North American Climbing. It may be the most comprehensive study of wilderness accidents in existence.
In 1964, U.S. Congress passed the Wilderness Act, defining and protecting wilderness areas in this country and refining the scope of wilderness medicine.
In 1983, Dr. Paul S. Auerbach published the first edition of his Wilderness Medicine Book. Now in its seventh edition, it has become nearly as epic as the Epic of Gilgamesh and the Iliad, establishing fresh standards in wilderness medicine. It is with great sadness that we lost Dr. Auerbach in 2021.In that same year, the WMS was formed with its mission to “encourage, foster, support, or conduct activities to improve the scientific knowledge of the membership and general public in human health activities in a wilderness environment.”
The year 2010 marked the formation of the Wilderness Medicine Education Collaborative (WMEC) with the goal of establishing standards for wilderness medicine education and practice. To find out more about the WMEC, visit wildmededucationcollborative.org.
In 2018 Seth Hawkins and friends published Wilderness EMS, which brilliantly merged the emergency management system (EMT, Paramedic, Nursing and Physicians etc.) with more traditional wilderness medicine systems (WFA, WFR, etc.). This book is likely to continue to play a significant role in bringing together these often-disjointed communities.
In the 1990s and early 2000s, certification for wilderness paramedics became more formalized. The WP-C exam and resulting certification is now administered by the International Board of Specialty Certifications, and is a rare example of an organization outside of a provider of education setting a standard for wilderness medicine proficiency.
Looking Forward to the Future of Wilderness Medicine
As mentioned earlier in this post, wilderness medicine will continue to evolve. Here are several areas likely to drive significant development in the field:
- Portable diagnostic and therapeutic devices, such as ultrasound machines, compact ventilators, and wearable health monitors
- Telemedicine via satellite to enable real time consultations with trained medical personnel
- Artificial intelligence for diagnosing conditions, predicting patient outcomes, and supporting medical decisions
- Enhanced training programs that include virtual reality (VR) and augmented reality (AR) for more immersive and realistic training scenarios
- Interdisciplinary collaboration among practitioners of wilderness medicine, sports medicine, disaster medicine, and other medical fields to enhance training and improve patient outcomes
- The continued merging of education and practice guidelines to enhance response and care to wilderness medical incidents
As a leading provider of outdoor and adventure education and wilderness medicine education, we are looking forward to these and other developments in the future of the field.
– – – – – – –
About the Author: Todd Mullenix is the Director of Wilderness Medicine Education at The National Center for Outdoor & Adventure Education in Wilmington, North Carolina.
TALK TO US
Have any further questions about our courses, what you’ll learn, or what else to expect? Contact us, we’re here to help!
Leave a comment