First, what does “wilderness first aid” mean? Typically, it refers to any medical treatment performed in the backcountry. A general rule for this is whether or not you can get the patient to a hospital in the “Golden Hour” urban EMS typically refers to. Although it is not a hard and fast rule and common sense is always your best guide, taking longer than that “Golden Hour” in the backcountry usually places you firmly in the wilderness first aid category. This has a few implications that anyone providing wilderness medical care needs to be aware of:
The easiest emergency situations to handle are the ones that never happen. There’s a reason Paul Petzoldt titled The New Wilderness Handbook’s chapter on survival “Avoiding Survival Situations.” Like undoing damage to a wilderness area, it is far easier to manage the potential difficulty before it becomes a crisis. Backcountry first aid is unique in the medical world in that you don’t have a network of urban EMS to count on in an emergency, you need to have done your own research on potential hazards, learned the necessary skills, and made the appropriate arrangements to keep you and your group safe. More than that, it is imperative that you keep planning ahead when an emergency arises. How long will it take you to evacuate the person? Are you even able to do that with the resources you have on hand? If the patient’s condition deteriorates overnight, what will you do? Is it better to start the evacuation now, in case they deteriorate overnight? Because patient movement and care is frequently hampered by rugged terrain and weather, it is important to keep these factors in mind when determining how you will care for someone.
Protect yourself from the environment.
This is a step that often gets overlooked by inexperienced backcountry first aid providers. In typical medical treatment, people frequently use the mnemonic “ABC” to remind them about the top three priorities of treatment, airway, breathing and circulation. Sometimes people even throw in a “D” for disability (broken bones, dislocations, etc.). In backcountry medicine, we go all the way to “E”, because it encourages people not to overlook a critical link the chain of survival, environmental factors. Plan to have protection from the environment for your patient, and don’t overlook this just because you are comfortable. Injured people are frequently less able to compensate for environmental factors because their bodies are already under stress. Even if you are not planning on being gone overnight, it is prudent to bring something, even if it’s just a contractor garbage bag and an extra warm layer, for protection from the environment.
This is one of the most critical skills you can possess in backcountry first aid. In urban EMS, it is common to have a bag weighing 10-15 pounds that gets carried to every patient’s side with you, containing all the gear you might need for any emergency that could arise. In the backcountry, we don’t have that luxury. We measure our first aid kits in ounces, not pounds. So choose your gear carefully, and make sure that the items you do include can be used for more than one purpose. And now the important part: know how to use them in all those different ways! A fleece with an elastic waist is not just a fleece, it’s a makeshift sling and swathe. A small strip of duct tape can also be used for wound closure. Safety pins can be used in an emergency to secure a flap of skin that will need stitches when you are able to get the patient to the hospital. Povidone-Iodine is not just a wound cleanser, it’s emergency water purification. A plastic bag for waterproofing can be used for wound irrigation in the absence of an irrigation syringe. Knowing the full potential of everything you are carrying means more than a lighter pack, it may save someone’s life someday
Kevin Morris is a former U.S. Marine Corps Combat Lifesaver, and is currently an EMT-Paramedic and a Wilderness EMT. He teaches a wilderness first aid course, and is the assistant director of Outdoor Transformations and Paddle-N-More, in the Finger Lakes region of New York.
***This information is not intended to replace medical training by qualified instructors. Professional instruction should always be sought before attempting medical treatment.***