When Help Is Hours Away: The Top 7 Essential Wilderness Medicine Skills

When we venture into the backcountry, whether it’s a day hike in a nearby forest or a multi-day expedition into remote terrain, we knowingly trade comfort and convenience for solitude, challenge, and a deeper connection with nature. 

This is a trade-off that comes with a conscious decision to expose ourselves to a higher-than-normal level of risk. Backcountry travel increases our chances of experiencing injury and illness while decreasing our accessibility to nearby basic or emergency medical care.

Mitigating this heightened risk requires improving our wilderness medicine knowledge and skills, something we help people do here at The National Center for Outdoor Adventure & Education (NCOAE). Our Wilderness Medicine and Emergency Medical Technician (EMT) courses cover everything from scene size-up and patient assessment to providing cardiopulmonary resuscitation (CPR), treating wounds and fractures, and successfully evacuating patients from remote wilderness areas.

As experts in the field of wilderness medicine, we often find ourselves discussing what we believe to be the most essential wilderness medicine skills. Here, we present our top seven, in no particular order. These are skills that we think all of our students should possess before venturing into the backcountry.

1. Scene Size-Up and Patient Evaluation

Every wilderness medicine event should start with a scene size-up and patient evaluation, which consists of the following three components:

• Safety: Identify and address anything posing a significant threat to your own health and safety and that of other members of your party. You don’t want to place yourself or others at serious risk to save someone else.
• Mechanism of Injury (MOI) / Nature of Injury (NOI): Prior to responding to a medical event, conduct a quick but thoughtful analysis to guide the plan design. Analysis may include the condition of the sick or injured party, the location, the terrain, weather conditions, and so on. In terms of MOI/NOI, you need to know whether you’re dealing with a physical injury from a fall, someone who’s exhausted, someone who’s ill, an allergic reaction, or something else.
• Resources: Take inventory of your resources. If necessary, lay out everything you have to work with — including communication tools — on a tarp. Knowing what you have at your disposal can help you make critical decisions, such as whether to begin search and rescue (SAR), provide medical care, or contact others in the area to request emergency services.

For more about assessing patients in the wilderness, including our ABCDE patient assessment protocol, see “The Role of Assessment in Wilderness Medicine.”

First Rule of Wilderness Medicine: The first rule of wilderness medicine is simple: Don’t create a second patient. Before jumping into action, take a moment to make sure that the scene is safe for you, your group, and the injured party.

2. Cardiopulmonary Resuscitation (CPR)

CPR is an emergency procedure used during cardiac or respiratory arrest that involves chest compressions, often combined with artificial ventilation. Chest compressions keep the blood flowing when the heart isn’t pumping, and artificial ventilation provides oxygen when the lungs aren’t breathing on their own.

CPR is covered in all NCOAE Wilderness Medicine programs in increasingly greater depth as the course length increases from Wilderness First Aid (WFA) to Wilderness First Responder (WFR) to Wilderness EMT (WEMT).

Chest compressions involve pressing down on the chest to squeeze the heart, manually pumping blood to the brain and other vital organs when the heart has stopped beating. Simply stated, chest compressions buy time. They don’t “restart” the heart on their own; they preserve brain and organ function long enough for defibrillation or other emergency care to work.

Breaths (ventilations) are provided to patients who are not breathing. You generally use your own breaths along with a barrier device of some sort to prevent exposure to the patient’s bodily fluids.

See “Understanding Wilderness CPR” for more information.

3. Bleeding Control

Cuts, scrapes, and punctures are among the most common backcountry injuries. If you’re traveling into the backcountry, it’s important to learn how to apply direct pressure, use a pressure dressing, and, if necessary, a tourniquet to control severe bleeding. Direct pressure involves using your hands to press gauze pads or similar sterile material against a bleeding wound. Pressure dressing involves applying tape to hold the gauze in place and maintain pressure, freeing your hands for other activities.

Wound Cleaning: Proper wound cleaning is as important as anything else when controlling bleeding. Dirt and bacteria can turn a small cut into a serious infection when you’re far from help. Here at NCOAE, we recommend that even novice day hikers carry a small irrigation syringe, antiseptic wipes, and sterile dressings.

4. Treating Severe Allergic Reactions

Insect stings, food reactions, and unknown allergens can trigger life-threatening anaphylaxis. You need to be able to recognize symptoms early, including swelling of the face or throat, difficulty breathing, or widespread hives, along with things that will calm the immune response.

If an epinephrine auto-injector, such as an EpiPen, is available, you may need to use it to administer the medication. You may also be able to administer epinephrine manually from a vial if local regulations allow for it. If epinephrine is unavailable, Benadryl may help calm the immune response to some degree, but it is no substitute for epinephrine.

About Epinephrine: Epinephrine (adrenaline) is a hormone created by the body. It stimulates the sympathetic (fight or flight) response. Boosting a patient’s epinephrine during anaphylaxis can be life-saving.

5. Hypothermia, Frostbite, and Other Cold Challenges

Technically speaking, hypothermia is a body temperature less than 95 degrees Fahrenheit (35 degrees Celsius). If not treated, it will ultimately cause the heart to become irritable, then stop pumping. Hypothermia can develop in cool, wet conditions and often begins subtly, with shivering and confusion. Like most everything else on this list, early recognition and intervention (which in the case of hypothermia includes removing wet clothing, insulating the person, and providing warm fluids, if possible), is key to managing it.

Frostbite is a serious injury that occurs when skin and underlying tissues freeze due to exposure to very cold temperatures, typically below 32 degrees Fahrenheit (zero degrees Celsius). It can cause symptoms such as numbness, tingling, and changes in skin color and may lead to permanent tissue damage if not treated promptly. Early intervention includes removing wet clothing and gently warming the affected area. In severe cases, surgery may be necessary to remove damaged tissue and prevent potentially lethal infection.

6. Cooling the Body/Heat Challenges

Heat exhaustion and heat stroke occur when the body overheats. Heat stroke is a life-threatening overheating of the body that ultimately results in cellular death, including brain cells. Treating someone who’s suffering from heat exhaustion or heat stroke involves moving the person to shade, cooling them with water or damp clothing, and promoting hydration. In severe cases, immediate evacuation may be necessary in order to obtain medical treatment for the patient.

7. Fracture and Sprain Management

In uneven terrain, it’s easy to trip and fall, resulting in a sprain or fracture. Knowing how to immobilize an injured limb using trekking poles, sleeping pads, or splints can prevent further injury and reduce pain. A triangular bandage or a large handkerchief can serve as a sling, while duct tape and a bit of creativity go a long way when you need to improvise.

As you can see, wilderness medicine covers a lot of ground and extends far beyond these seven essential skills, but by mastering these seven skills, you will be well on your way to protecting and preserving life and limb (your own and others) when you’re on wilderness excursions.

Need help getting up to speed with your wilderness medicine training? Consider taking a Wilderness Medicine training course such as those offered here at NCOAE.

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About the Author: Todd Mullenix is the Director of Wilderness Medicine Education at The National Center for Outdoor & Adventure Education in Wilmington, North Carolina.

Disclaimer: The information in this National Center for Outdoor & Adventure Education (NCOAE) blog post about essential medical skills for backcountry travel and wilderness expeditions is provided for general informational purposes only and may not reflect current medical thinking or practices. No information contained in this post should be construed as medical advice from the staff at NCOAE. No reader of this post should act or refrain from acting on the basis of any information included in, or accessible through, this post without seeking the appropriate medical advice on the particular facts and circumstances at issue from a licensed medical professional in the reader’s state, country, or other appropriate licensing jurisdiction.

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