A Brief Discussion on Wilderness Medicine
by: Brandon Behymer
Let’s first discuss what differentiates wilderness medicine from urban medicine. In the urban world if you fall ill or have a trauma-based injury, help is usually 15-25 minutes away and you’ll be at a location that can provide definitive care in less than an hour. The people who show up to your bad day are professionals and have a hospital room on wheels that they roll up in. Modern emergency medicine is amazing. In a wilderness setting definitive care is over an hour away, anyone with thumbs can provide some level of care, and you may be your sole provider. Chances are that there will be limited resources and an extended amount of time to endure on your way to the trailhead, ambulance, or emergency department depending on the severity of the illness or injury.
Among the first questions someone asks about treating a patient in the backcountry is generally ‘can I get sued for doing, fill in the blank?’ The answer is yes to whatever you want to fill in the blank with. Use your imagination and be creative. The answer is still yes. The real question is whether or not what they are suing you for will hold up in court. Good Samaritan laws protect you from frivolous lawsuits so long as you act within your scope and if you have no scope, did you attempt to help? You will not get sued for breaking someone’s ribs while performing cpr. One, because there is a slim chance that they actually survive the ordeal and getting sued by a dead person seems like a lot to ask. Second, you tried to help, did you not? Showing up, even if at random, to someone having an emergency and doing nothing is an easy way to potentially have legal action taken against you, and at the very least, be an asshole.
Someone approaches you in the woods with beads of sweat dripping from their beet red face and in a panicked voice exclaims ‘HELP, something bad happened!’ What do you do? Step one is understand that it’s not your emergency. This isn’t to downplay the urgency of the situation. Someone is hurt or sick and needs help. YOU are now involved. The best thing you can do for that person is not panic and keep yourself safe. You are of no use to anyone if you freak out or become another victim that needs saving too. Think about what you have available in the way of resources. Do you have the requisite knowledge or training to care for a patient in the woods? Do you have medical supplies to help someone when you arrive on scene? The average person usually has neither, but they do have a cell phone, maybe a snack and some water. It’s not much but it may be the difference to someone.
Consider the amount of time it takes to walk a mile. For most relatively healthy adults this task will take 20-30 minutes. How long do you think it would take to travel the same distance while carrying a litter with a 200lb patient complaining about a compound fracture in the lower leg? With dozens of your closest friends it could take two to three hours depending on terrain. Throw in a longer distance, inclement weather and elevation change and you may be looking at 12+ hours of patient care. When you come upon a middle-aged male complaining of a sprained ankle and requesting to be carried off the hill by search and rescue keep those numbers in mind. His day will be better, and the injury treated sooner if he walked off the mountain with minimal assistance (it would be helpful if you wrapped and elevated the sprain for 20 or so minutes).
Education and training are the most important thing you can do to help yourself or someone else out of an emergency in the backcountry. There are many ways to educate yourself in the field of emergency medicine. Books written by doctors specializing in emergency medicine are the most reliable resource. However, reading the accounts of various rescues or talking to a friend who has experience in the field will provide insight as to signs of what to watch out for in the field. Read the accounts of incidents pertaining to the activity you’re taking part in or wish to support.
If you wish to take things to the application level of education there is a broad array of options to consider. First and foremost, due to accessibility, are the very straightforward ‘First Aid’ talks and ‘classes’ given at outfitters large and small across the country. These opportunities are very useful for the family camper or Boy Scout dad wanting more awareness in the field. Classroom time allows for the better communication of ideas from one person to another. One thing to consider of these first aid talks and presentations is the quality and experience of the presenter. Anyone can give a presentation on first aid and charge a few dollars for it so choose wisely or have a conversation with the presenter about the content if time permits. The next step beyond weekend first aid classes is to actually get certified. Many companies offer First Responder training and several offer Wilderness First Responder training. These courses are taught by someone with experience in the field and are certified themselves. Cost can vary depending on company. Having a certification means that, if something bad happens in the backcountry and you are ABLE to help, then you are RESPONSIBLE for helping. Being a First Responder will open some doors as far as getting on with a search and rescue team or being an asset to a local outdoor community. Going further than this step will require a more serious time and financial investment and is usually pursued by those wanting to make a living in the field of emergency medicine.
Some of the companies offering Wilderness First Responder training also offer Wilderness EMT training. SOLO based out of Conway, New Hampshire is where I went to get my certification. I felt that the campus was welcoming and comfortable and the curriculum and instructors were thorough and professional. NOLS also provides highly rated courses and is headquartered in Lander, Wyoming. Having spent time in both geographical locations I can attest that neither suck. This has hopefully helped point you in the right direction if you have ever been in the woods and wondered ‘what would happen if I tripped and broke my, fill in the blank?’.
Not everyone needs to know how to pull traction on a splintered femur or what Cushing’s Triad is, but everyone needs to ask themselves ‘when shit happens, who do I want to be?’
