“You will know how to deal with everything from a tension pneumothorax to torsion of the testes.”
April 17, 2012 5:38 PM   Subscribe

First, Do A Little Less Harm: "As Mark Jenkins knows, wilderness first aid can hurt. (Just ask his patients.) So he finally did what everyone should do: he took a class from real experts."

Previously on Metafilter: Where There Is No Doctor
posted by the man of twists and turns (48 comments total) 61 users marked this as a favorite

 
I started out as a WFR and moved up to Wilderness Emergency Medical Technician about ten years ago... One of the best things I've ever done.
posted by blaneyphoto at 5:40 PM on April 17, 2012 [1 favorite]


I have taken both WFR and WEMT courses as well. It's really deeply fascinating stuff and I learned a ton.
posted by Scientist at 5:43 PM on April 17, 2012 [1 favorite]


Also, in addition to NOLS, SOLO is an excellent school for Wilderness EMS . I'm going to do my next recert through NOLS though, because my state only recognizes them for the CEUs we're required to earn every 3 years.
posted by blaneyphoto at 5:45 PM on April 17, 2012 [1 favorite]


Yes! SOLO is where I did my WEMT. They were great. Good people, great instruction. I did my WFR with NOLS when I was out in California, they're great too. Sadly my certifications are expired, but I don't regret the classes at all and would love to get a refresher when I get a chance.
posted by Scientist at 5:52 PM on April 17, 2012


I'm surprised that this guy did as much as he did without any formal medical training. I guess he was doing a lot of it back when there wasn't as much formal wilderness medical training to go around, so he can probably be forgiven for at least some of it.

But seriously, if you think you're going to be spending a lot of time out where there aren't any park rangers or EMTs or anyone else who can whisk you off to a hospital, you really ought to get your WFR certification if not your WEMT. They cover some pretty essential stuff in those courses, and the courses themselves are fun and full of great people. It's absolutely worth it for anybody who wants to spend a lot of time out back of beyond.
posted by Scientist at 6:02 PM on April 17, 2012


Oh, and my favorite bit of wisdom from wilderness medicine, which I think is something that actually comes from emergency medicine in general:

"Air goes in and out. Blood goes round and round. Any variation on this is a Bad Thing."
posted by Scientist at 6:04 PM on April 17, 2012 [15 favorites]


Gardner, wry and fit, throws out a Mark Twain quote to set the tone: “One man alone can be pretty dumb sometimes, but for real bona fide stupidity, there ain’t nothing can beat teamwork.”

This sounded familiar, but not by Twain. Apparently it's Edward Abbey.
posted by zamboni at 6:16 PM on April 17, 2012 [5 favorites]


That's a great intro to the whys and wherefores of the WFR. I got my WFR with NOLS many years ago and although I've never had to put most of that knowledge to use it's been very comforting to have; I wish more people would take at least the Wilderness First Aid course before heading off into the backcountry. Re-taking the course (I'm well past the refresher deadline) is high on my to do list in the next year or two.

I can sympathize with those who do activities hours or days away from medical care and have never taken a full WFR or WEMT. It's surprisingly easy to get yourself into those situations, and a week (or a month for the WEMT) of vacation to take the course instead of going out into the backcountry can be hard to justify if you only get two weeks of vacation a year.

Also, if you're taking one of these courses, ask the instructors to add safe full-face helmet removal to the things they show you. It's not part of the standard WFR, but it's quick to learn, handy to have, and the life you save might be mine.
posted by hackwolf at 6:16 PM on April 17, 2012 [2 favorites]


Hackwolf, full face helmet removal was a standard part of the course at SOLO when I did it. It was the standard street EMT course plus all the wilderness stuff.
posted by blaneyphoto at 6:21 PM on April 17, 2012


IANAD, but have had EMT training and served as a medical "officer" on a couple of development expeditions in Cameroon (jungle and desert). I once impersonated a physician to stop a train in France so a lady having a tetanus seizure could get medical attention. Living and working out in the wilderness overseas can be a real grind. It wasn't long before I realized the one amenity I missed over all others was solid (i.e., non-dirt) floors and clean water. It's amazing the toll that take on you.

My worst experience was a friend's son who had a high fever and went non-responsive. I'll tell you, the first time you have an infant go into febrile seizure, it causes a kind of dread that starts in the pit of your stomach and threatens to engulf you entirely. The mom's fear becomes palpable. It's generally pretty easy treatment (paracetamol), but Jebus does it feel like the world is ending right then.

Anyway, two quick comments RE the cool article. One, CPR guidelines have recently shifted to "compressions-only" for most cases. Two, I don't know how many times I've run across folks who still believe that sucking the toxin out of a snakebit is the best way to handle it. Yipes!
posted by darkstar at 6:26 PM on April 17, 2012 [4 favorites]


I did the NOLS Wilderness First Aid course several years ago, before I went to nursing school. Medical stuff was a complete mystery to me. It was an incredibly intense 2 days of training, and I learned a lot, but definitely did not get to the point of feeling comfortable or calm in an emergency situation. Within maybe 3 months after the course, I'd probably forgotten 95% of what I learned. But at least my first aid kit was in a lot better shape. I remember being paired up with somebody who had done the course many times (I think the refresher was somehow enmeshed with the full course), and he was so much more calm than me as we assessed our fake patient. It definitely made me want to get more experience and practice with wilderness first aid -- I've been meaning to take some time off and do the WFR course since then.

Of all the useless things to remember, I do recall being amazed at how quickly they can give you fake bruises and cuts that look really realistic. It really adds to your sense of panic, when you're one of the responders in a scenario, even though you know that technically that person isn't really hurt. I forgot to wash the "bruise" off the back of my arm one day, and hanging out with friends that night somebody asked if I had been in a car accident.
posted by vytae at 6:33 PM on April 17, 2012 [1 favorite]


blaneyphoto, was that the WEMT, or the WFR? The WFR at NOLS didn't cover it back in '06, but is a much shorter course. Although the curriculum might have changed in response to increased ORV usage too; at least one of the other students in my course was interested in helmet removal because they volunteered with the SAR group that worked a popular local ORV area.
posted by hackwolf at 6:39 PM on April 17, 2012


Oh yes, sorry - that was the WEMT that had the helmet removal. I can definitely see it being useful in the WFR course though. Lots of people in both my original WFR and my later WEMT were ski patrollers and with helmets being more common in lots of sports (aside from motorcycles) its a good thing to know how to do.
posted by blaneyphoto at 7:04 PM on April 17, 2012


Any physicians out there who've taken the WFR or WEMT courses? This sounds cool, but i just wonder how useful it is to someone already practicing medicine.
posted by i less than three nsima at 7:16 PM on April 17, 2012


Any physicians out there who've taken the WFR or WEMT courses? This sounds cool, but i just wonder how useful it is to someone already practicing medicine.
posted by i less than three nsima


I hate to nitpick, but in the case of the WEMT, its entirely possible that someone with that training could be putting it to use in a professional capacity. Professional medical care isn't strictly the realm of RNs and MDs! Its actually more likely that a working EMT/Paramedic might put these skills to use more often than an MD, unless that MD is working in remote areas or on expeditions, etc. The hospital based MD isn't likely to need to improvise care - but as an EMT in an urban location, I've seen that happen numerous times. Sure can't hurt to have those doctors trained in this stuff though - even if for no other reason than to give them a greater appreciation for the role EMS plays... lots of them forget about that.
posted by blaneyphoto at 7:28 PM on April 17, 2012


Is there an equally rigorous book on the topic?
posted by Foci for Analysis at 8:00 PM on April 17, 2012


I took a SOLO Wilderness First Aid course with my wife back in 2003. It was great. My wife liked it so much she became an EMT and by the time she was finishing EMT school she'd applied to a Physician's Assistant program. She's been working in an ER for about 5 years now. I should probably retake the course again one of these days. It's reassuring to know that you have some idea what to do when something goes horribly wrong and help (or my wife) is far away.
posted by Drab_Parts at 8:09 PM on April 17, 2012


I've never taken the WFR course so I can't compare, but I've found this one fairly useful. Nothing like hands on training though.
posted by Manjusri at 8:11 PM on April 17, 2012


Even in something like a State Park, a few miles from a trailhead, it can take a LONG time for help and evacuation of an injured person to come. This seems like a really good idea for anyone who goes into anything resembling back country.
posted by thelonius at 8:16 PM on April 17, 2012 [1 favorite]


Even in something like a State Park, a few miles from a trailhead, it can take a LONG time for help and evacuation of an injured person to come.
posted by thelonius


Absolutely true. Consider that if you're a few miles from the trailhead and have an injury, even if you're with someone your rescue time will go something like:
Friend gives you whatever care they can - maybe minutes to hours
Friend goes for help or sends someone who comes along - maybe hours to reach the trailhead.
Is there cell reception? Can 911 even be called? Not in many places! So, that person who went for help might have to find and drive to a house, firestation etc before even activating a rescue process.
Once in place, a rescue team needs to be assembled - and this is nowhere near the process of sending out the local volunteer fire squad for sure.
Once assembled, the rescue team needs to reach the patient. This could also be hours depending on the terrain and location. Did the patient fall off a cliff from an easily accessible area? Did they have a heart attack in on a remote trail? All factors that'll influence how soon rescuers can GET TO the patient.
On site care - assessment of the patient and packaging for transport takes time. Its truly rare that you're going to get plucked out of the wilderness by a National Guard helicoptor. More likely, you're gonna get delicately walked out of the wilderness by a large team of guys with a huge amount of patience... but you could still very well die in the process.

Long story short, if you get hurt in the outdoors be prepared to spend a long time waiting for help. Better yet, just Be Prepared.
posted by blaneyphoto at 8:32 PM on April 17, 2012 [4 favorites]


You know, I hear they're training some rescue cats...
posted by darkstar at 8:35 PM on April 17, 2012 [3 favorites]


You might be surprised about the availability of helicopter evacs. A lot of Sheriff Depts. have helicopters these days, and many rescues that would have been a big ground operation a decade ago are now a simple chopper pickoff.
posted by Manjusri at 9:02 PM on April 17, 2012


Agree with previous commenters. I got my WFR through Aerie Backcountry Medicine (Montana). We were taught to be able to handle injuries well enough to stabilize someone to wait for help or hike them out if possible. I found it incredibly useful not only for my job, but also recreational camping and hiking. You can never be too prepared!
posted by Etta Hollis at 9:15 PM on April 17, 2012


many rescues that would have been a big ground operation a decade ago are now a simple chopper pickoff.
posted by Manjusri


There's no such thing, as a "simple chopper pickoff", particularly in the wilderness but its a nice idea. Even the mainstream, suburban heli evacs I've been on scene for aren't a simple thing. Plucking someone off a cliff in the outback is a whole other thing. Aside from that, the cost is astounding - and its one of the reasons I'm a huge proponent of policies such as those which exist in New Hampshire which require the patient to foot the bill for the rescue if found to be negligent/responsible for requiring rescue. That six figure bill should be incentive enough to make sure everyone in your party (because you're not dumb enough to head out alone, are you?) has some wilderness first aid training.
posted by blaneyphoto at 9:17 PM on April 17, 2012 [2 favorites]


Even in something like a State Park, a few miles from a trailhead, it can take a LONG time for help and evacuation of an injured person to come.

Hell, a month or so ago, I was travelling on I-35 around midnight when I saw the tailights of the car a couple miles ahead of me dance and flash in the air. The woman was crawling out of her upside down SUV and onto the highway as I rolled to a stop on the shoulder.

My truck is reasonably well equipped with a basic first aid kit, but in the 20 minutes it took for the ambulance to arrive the thing I missed most - gloves. The woman had a pretty severe concussion and it was real work to keep her corralled on the tailgate of my pickup and not wandering off into traffic. She had several severe lacerations and without gloves I wasn't going to touch her - so she she bled onto my tailgate; I was happy to keep her from getting demolished by a semi, but I could have been more effective if I had some basic bio-hazard protection.

And why did she roll her SUV into the ditch in the middle of nowhere at midnight on a Tuesday ? Her ipod played a song she didn't like and she couldn't find one she did.

Anyway - you never know when you'll need to know a bit of basic first aid because it can take forever and ever sometimes for decent care to get to where the bad thing happened.
posted by Pogo_Fuzzybutt at 9:43 PM on April 17, 2012 [3 favorites]


She had several severe lacerations and without gloves I wasn't going to touch her

Perfectly reasonable. In a case like this - if you can and the patient is cooperative (which might not have been the case here) you can definitely just give instructions - "I need you to take this bandage/tshirt/wad of paper towels/etc and put it over the lac on your arm and push real hard to try to stop the bleeding..." In the case of a laceration like that you could safely have the patient applying direct pressure to the wound while you slow the flow from another point or further assess them or do any number of other things to help them out. Employ the patient in their own care, if you can and need to and they're capable of doing so. But yeah, also always carry gloves. I don't leave home without them.
posted by blaneyphoto at 9:56 PM on April 17, 2012


I keep nitrile gloves stashed everywhere for exactly that reason, and they're handy for an enormous number of things. Also, I can do a "two by two, hands of blue" routine on demand.

There's no such thing, as a "simple chopper pickoff"

I know of only one (apocryphal, badly remembered, second hand, I'm probably getting it wrong) case where this wasn't strictly true; happened in one of my friend's parks. There was a mountain biker having problems (I can't remember if it was a heart attack or something else) somewhere way the hell out in the foothills on single track who called it in on his cell phone. This is only marginally wilderness, because it's close to a major metro area, but the guy was still a long way from help. Everybody starts to mobilize, but there's no easy road into the part of the park where this guy is, so they're gearing up for a long evening. If I remember the story right, the helicopter was sent up to try and locate him before dark, but they spot this guy right on the edge of a perfect clearing to land in. They swoop down, backboard him, and he's at the hospital soon thereafter. All that's left for my friend and the other rangers to do is hike in for an hour or two to get the guy's bike, which he picks up a few days later after he's discharged. My friend said it was the easiest medical he's ever done, and if the helicopter crew hadn't picked up the guy when they did it might have been a body recovery instead. Sometimes you just get lucky. Most of the time? Yeah, totally doesn't work like that.
posted by hackwolf at 10:14 PM on April 17, 2012


darkstar pointed out that the CPR recommendation has shifted to "compressions only" but that should probably be clarified: for those untrained in CPR, attempting to give rescue breaths as well as compressions will probably be less helpful than simply doing compressions at the tempo of "Stayin' Alive" or "Another One Bites the Dust" depending on your mood.

Those trained in CPR recently shouldn't be concerned that the rug has been pulled out from under them. Continue to give CPR as you were instructed.
posted by Picklegnome at 10:32 PM on April 17, 2012 [1 favorite]


Continue to give CPR as you were instructed.
posted by Picklegnome


This applies regardless of who you are, really. The standards for CPR change (frustratingly often, recently) and there are different types of instruction for different audiences. Standard CPR for the everyday person is a different process than those for the Healthcare Provider or Professional Rescuer. Anything you do is likely to be better than nothing, for sure.

posted by blaneyphoto at 10:42 PM on April 17, 2012


> Is there cell reception? Can 911 even be called? Not in many places!

Ham radio will get you what you need, quite likely, in most of those places.
posted by hank at 11:02 PM on April 17, 2012


> Is there cell reception? Can 911 even be called? Not in many places!

Ham radio will get you what you need, quite likely, in most of those places.
posted by hank

Is that something else I've got to carry in my pack? Is this something that I can call EMS/Police/Fire with from the trailhead? Its actually a bit hard to tell from what you've linked to what it is that you're suggesting, but cell phones are pretty common. If you're suggesting that people carry specialized gear for rescue, then I'd go with a locater beacon instead.
posted by blaneyphoto at 11:31 PM on April 17, 2012


The SPOT emergency beacon works pretty much everywhere and is quite affordable. The new version also has an "OK" feature which you can use to check in periodically (with a transmitted GPS position).
posted by Harald74 at 12:46 AM on April 18, 2012 [1 favorite]


You're not going to be able to 'buy a ham radio', stuff it in your backpack like a mobile phone, and expect it to be any use to you. The right equipment at the right time used in the right way will save your backside, but you'll need to know what all that means first and how it applies to your particular (planned and actual) situation.

Mostly, these days, cell/sat phones and beacons will be more appropriate. If you want to learn how, then ham radio is an excellent back-up and can be an invaluable primary communications system during an emergency. In the spirit of this thread, though, it is a technical skill that must be learned (and practised) before it becomes useful.
posted by Devonian at 1:48 AM on April 18, 2012


Is there an equally rigorous book on the topic?

Sure, but what's the chances of someone getting badly hurt in a library?
posted by yerfatma at 5:54 AM on April 18, 2012 [1 favorite]


"two by two, hands of blue"

According to Google, that is a Firefly reference. What does it mean in this context?
posted by Kirth Gerson at 6:08 AM on April 18, 2012


If you are interested in becoming proficient in outdoor emergency care, it's hard to beat joining a volunteer ski patrol. The training is called OEC. It's similar to WFR except it's geared toward the ski resort environment. The huge benefit to this route is that you actually use the skills frequently. I volunteer once a month. Broken bones, head injuries, and medical cases happen just about every shift. When stuff has happened outside of a patrol shift--several car accidents, lady collapsed on the sidewalk, severe laceration at a restaurant, my wife's ultrafast labor--my OEC training and patroller experience has kicked in and kept me calm, clear-headed and focused when previously I likely would not have been.

When I meet people with WFR training, I recruit them for the patrol by asking if they'd actually like to put those skills to use because they likely haven't yet.
posted by nonmyopicdave at 6:19 AM on April 18, 2012


"When the bleeding finally stopped, it was obvious he needed stitches..."

Someone correct me if I'm wrong, but I've read that you never stitch in a first aid scenario-- it increases the risk of infection and you can't change stitches like a bandage. Stitching should only be done once you're in a sterile environment.
posted by justkevin at 6:50 AM on April 18, 2012


According to Google, that is a Firefly reference. What does it mean in this context?

I think the FIREFLY reference is the one hackwolf was making (i.e., "I can use the gloves for emergencies, or I can pretend I'm on FIREFLY if I get bored").
posted by EmpressCallipygos at 7:14 AM on April 18, 2012


Is that something else I've got to carry in my pack? Is this something that I can call EMS/Police/Fire with from the trailhead? Its actually a bit hard to tell from what you've linked to what it is that you're suggesting, but cell phones are pretty common. If you're suggesting that people carry specialized gear for rescue, then I'd go with a locater beacon instead.

Sort of. SPOT and sat phones are advantageous because there are no testing/license requirements and are pretty easy to use. But they are expensive and have their limitations, as well.

HAM is nice because a big chunk of America is within range of a 2m repeater. A reliable handheld and a little bit of knowledge can get you in touch with someone and doesn't cost that much. Longer wavelengths (20m, etc.) have even better range - hundreds or thousands of miles in some cases - but are more complicated to use.

There are other features, such as APRS - basically, your handheld can act as a beacon. And you can listen to NOAA weather broadcasts, emergency services dispatch, and so on.

HAM radio has a lot of utility - but it does require a fair amount of training and knowledge. I wouldn't travel in the backcountry without one or the other, personally.
posted by Pogo_Fuzzybutt at 8:03 AM on April 18, 2012


I spend a lot of time doing stupid shit in the backcountry. I have a SPOT messenger and carry it when it's appropriate, but it is no replacement for first aid training. At a minimum you need to keep your mishap victim alive until the cavalry arrives, or you'll have to move your victim to where the cavalry can get to him.

I've had regular Red Cross First Aid and CPR, and some additional motorcyclist-specific training (chest compressions can be a Bad Idea following an impact to the torso, plus helmet removal and scene management.) Next up is WFR. This is a great roundup - thanks for the post!
posted by workerant at 8:29 AM on April 18, 2012


many rescues that would have been a big ground operation a decade ago are now a simple chopper pickoff.

Manjusri, not to pile on your comment, but this embodies the very attitude that contributes heavily to wilderness emergencies.

"I live in civilization, and am taking what I need with me. What could go wrong? I'm only going x miles from the nearest town..."

You don't have everything you need with you.
You won't be close enough for rapid medical support.
You aren't just going for a simple hike.

If you believe any of those fallacies, you oughtn't be hiking without a more experienced support group.

People die in the wilderness, because they make terrible decisions. A lot of emergency preparedness is simply learning not to make terrible decisions that seem sensible at first, and to take the time to react more carefully.
posted by IAmBroom at 9:15 AM on April 18, 2012 [1 favorite]


Someone correct me if I'm wrong, but I've read that you never stitch in a first aid scenario-- it increases the risk of infection and you can't change stitches like a bandage. Stitching should only be done once you're in a sterile environment.

justkevin, that's a good point. My wilderness first-aid info is dated.

Can anyone speak to the usefulness of superglue as a wound closure in the woods? Yes, I know: it's not medical grade, but that can be obtained... and it's preferable to open wounds tearing & bleeding profusely, surely?
posted by IAmBroom at 9:41 AM on April 18, 2012


I haven't tried superglue for wounds, but I don't think it will stick to bloody surfaces. I have tried Celox, and it works to stop bleeding and cover wounds. Might be a better thing to take along.
posted by Kirth Gerson at 9:55 AM on April 18, 2012


Oh, damn, good point. I have tried it on bleeding wounds, and it doesn't stick. Never mind.
posted by IAmBroom at 9:56 AM on April 18, 2012


anyone speak to the usefulness of superglue as a wound closure in the woods?

I think the same logic that applies to stitching applies here. You're not in a sterile environment, and you're not going to be able the clean and disinfect the wound enough to avoid sealing a bunch of bacteria inside the wound. The really bad bacteria that you can get with a wound (like C. perfringens, the cause of gangrene) doesn't grow well if there's oxygen present, but if you seal it up under the skin where no air can get at it, it'll grow quite happily. And, incidentally, C. perfringens quite common in soil, rotting leaves, basically every square inch of the backcountry.

Stitching or gluing doesn't really stop the bleeding, anyway. Getting the blood to slow down enough in that area to clot is what you need, hence pressure and elevation. Once it's stopped bleeding, you want to keep the area protected so nothing disturbs the new clot. A person will probably end up with a nasty scar if the wound is left open (vs. stitching/gluing shut), but that's better than having a limb amputated due to gangrene.
posted by vytae at 10:34 AM on April 18, 2012 [2 favorites]


Kirth Gerson: In this context, it means I'm an easily amused dork who likes Firefly.
posted by hackwolf at 11:07 AM on April 18, 2012


Thanks, vytae. All really good points.
posted by IAmBroom at 12:15 PM on April 18, 2012


Okay, I'm a casual hiker. My boyfriend and I drive my truck out to trailheads, hike for a few hours on marked trails, and wander back, stopping in whatever little town is nearby for dinner. I take a small first aid kit with me, with a larger one in my truck; I bring a GPS unit, map and compass, and I'm pretty careful overall.

After reading that article and this thread, I never want to go outside again. Ever. Screw that, I'll play Skyrim.
posted by MrVisible at 1:01 PM on April 18, 2012


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