Wilderness Medicine: Accounting for Challenging Terrain

Todd Mullenix

May 08, 2024

When some hear the term “wilderness medicine,” they think of those rusty out-of-date First Aid kits that they used to carry with them on a personal hiking or camping trip.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.

Rescuers in the Thailand cave rescue from 2018

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 pump water out of the cave, transport food and medicine in, stash oxygen tanks along the escape route, and sedate the teens to prevent them from panicking during their evacuation. The entire operation took more than two weeks, but all 13 victims survived. One diver, 38-year-old Saman Gunan, died.

With that as our backdrop, this blog post addresses the evolving definition of “wilderness medicine” and explores specifically the impact that differences in terrain have had on our understanding of what wilderness medicine entails.

Defining “Wilderness Medicine”

Current discussion surrounding the definition of wilderness medicine suggests the environment plays a larger role than traditional concepts give credit. As the definition of wilderness medicine evolves, it is expanding our awareness of the health and safety challenges we face in extreme conditions, and how those challenges impact our decisions and actions in the field. 

To fully appreciate the scope of the topic, consider the broad range of environments in which wilderness medicine is practiced — categories that include the following:

  • Military medicine
  • Mountain medicine
  • Maritime medicine
  • Outer space medicine

Within these categories are terrain challenges that go well beyond the fact that none of these environments is characterized by the quiet, well-lit, climate-controlled conditions we commonly associate with traditional in-town medical treatment facilities.

Four Challenging Terrains

As if practicing wilderness medicine were not difficult enough, all of the categories mentioned above, with the exception of outer space medicine, pose additional hazards due to the terrain, specifically, the following four categories of challenging real estate:

  • Slick and slippery: Mud, ice, snow, and even the slightest change of moisture over an otherwise level and grippy surface can quickly change the human position from upright and sure-footed to flat and broken on the ground. Moisture increases the risk of a fall even on flat ground. A slippery surface also increases the risk of losing or damaging equipment. Slick areas can be managed by slowing the pace, testing next-foot placement, using a walking pole or mountain axe, and donning crampons or micro spikes.
  • Steep: Steep terrain doesn’t need to be slick in order to be deadly. A simple miscalculation of distance or a slight navigation error can result in the angle of the earth changing from horizontal to vertical, resulting in a fall. In glaciated terrain, the “ground” under our feet can give way. Purposely moving through steep terrain often requires the use of a rope to manage the risk of a fall. Ropework is an extensive area of study and includes rope ties (knots, hitches, etc.) anchors, and systems combining them.
  • Soupy: Watery terrain, such as creeks, rivers, swamps, lakes, and oceans pose unique risks — from slipping and falling on rocks, docks, boat decks, and other hard surfaces to drowning beneath the surface. We are drawn to the flow of creeks and rivers and the majesty of waterfalls, but they can be as deadly as they are beautiful. Likewise, we are awed by the vast expanses of oceans, while their tides, currents, and waves can transform a pleasant day at the beach into a nightmare. We can significantly curtail the risks of soupy terrains by practicing water safety, making smart use of watercraft and personal floatation devices, and improving our skills at swimming and wading.
  • Sharp: Rocks and vegetation can snag, cut, and poke us when we move into them without due caution. Sharp terrain can dramatically slow movement and cause injury via puncture or laceration. Proper clothing, footwear, gloves, eye protection, and other personal protective gear should be considered carefully when moving into challenging terrain for recreation and rescue.

Aiming for Healthier and Safer in Challenging Environments

As human beings, safety is not always our No. 1 priority. However, living is. We all want to live fully and as safely as possible in order to enjoy another day with life and limbs intact. Each of us decides the level of risk we are willing to expose ourselves to, and we make life choices accordingly when related to work, play, exercise, and even what we eat and drink. Nothing we do in pursuit of prosperity and joy comes without some risk. We simply decide what we engage in based on what we deem “safe enough,” according to our own risk-versus-reward calculations.

Developing a deeper understanding of specific terrain challenges and reasonable ways to reduce their associated risks can help you expand your options and live a more vibrant, fulfilling life without unnecessary risk to life or limb.

If you’d like professional advice that can empower you to manage health and safety risks more effectively as you explore and enjoy the most stunning environments on Earth and beyond, consider enrolling in an NCOAE Wilderness Medicine course.

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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.

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