Re: Wilderness First Aid ("Load and Go" saves lives in the wilderness)
Amick Robert (amick@spot.Colorado.EDU)
Mon, 12 May 1997 18:55:58 -0600 (MDT)
For those who are interested, I have addressed many of these questions in
a post which can be viewed through the courtesy of Gary Hendra at the
In addition to the above post, I will add a few thoughts concerning the
current discussion on wilderness first aid:
Essentially, there are several basic concepts involved in the question of
providing wilderness first aid. These are axiomatic to patient survival:
1. In serious injuries, the "golden hour" for trauma patients is defined
as the maximum time limit for optimal survival of a critically injured
patient. That is, from the time the injury occurs, until the patient is
in surgery at a level I or II trauma center, where highly trained and
experienced trauma surgeons, neurosurgeons, et al, are attending and
providing the best possible definitive care. Statistically, folks who are
critically injured that go beyond the "golden hour" begin losing the fight
for life at an almost exponential rate, and first aid measures are
minimally effective in reversing that progression. This concept was
initially discovered by the Military in Vietnam and Korea where rapid
helicopter evacuation from remote, isolated areas was largely responsible
for saving many critically injured soldiers.
2. All prehospital emergency medicine is being re-evaluated with the idea
that "load and go" is far more likely to minimize morbidity and mortality
of critically injured patients whether on main street, or in a remote
wilderness area, than any limited "first aid" or "wilderness first aid"
efforts can provide.
3. Thus, accessibility to rapid aeromedical helicopter or ground
evacuation of critically injured patients is highly dependent on
well-considered prior planning and failsafe resource development. You
have to carefully evaluate where you are going, what the evacuation and
rescue/pre-hospital EMS response resources are, how to quickly access
them, and how to anticipate and prepare for most potential hazards in the
4. There are lots of skills and talents you can bring to a field
situation with proper emergency medical training and preparation, which
can be initially life-saving, but you must remember that these only "buy
time" until the patient can be definitively treated in a high level trauma
center. A physician stated in another post, that no matter how well
trained you are, even an MD cannot perform neurosurgery effectively in the
field, because he has none of the tools, drugs and equipment required for
definitive treatment. Similarly, we can only "hold off" traumatic shock
for a short time, or temporarily relieve a pneumothorax, if authorized and
trained to do so, and CPR is marginally effective for the first few
minutes and becomes increasingly less effective as time goes on...
5. Certainly everyone participating in "high risk" wilderness experiences
should have as much training as they can before they go. However, bear
in mind that most Scouting trips to the Wilderness seldom have the luxury
of having a highly trained and more important, experienced, first
responder, EMT, Paramedic or physician as part of their crew. Those that
do are certainly in a better situation. And, you have to anticipate that
maybe your medic will become a victim and someone will have to know how to
treat their injuries or illness. So anticipate that by having more folks
Although most Scouts and leaders should take as much first aid training as
they can before they go on a "high risk" wilderness trip, they are still
going to have only limited knowledge and experience for dealing with
critical injuries or illness. However, no matter how much training
and experience you have in actually
treating critically injured patients, when the "golden hour" runs out, you
start fighting a losing battle for your patient.
The new Red Cross Emergency Response Class is probably one of the best
courses to train Scouts/Explorers and Leaders who plan to do wilderness
high adventure. It has been designed to provide the primary skills needed
for pre-hospital care, but also allows for modifications and additions
such as Wilderness first aid, and there is now a separate course text for
the wilderness module that can be appended onto the regular first
responder course. The whole course is about 50 hours and includes a CPR
for the Professional Rescuer certification (equivalent to AHA level C). I
teach this course to my Explorers, Older Scouts and Scout Leaders each
Spring and they are highly proficient with the training. It is a
Nationally recognized training course meeting DOT First Responder
standards and is approved by State EMS certification divisions throughout
6. So with this in mind, how do we approach the problem?
A. Make sure you have reliable communications equipment and know how to
use it. Have several levels of "failsafes" in the form of multiple "ham"
radios in the two-meter band, as well as multiple
spare batteries, cell phones, etc. If possible, take a pre-trip to the
area and confirm that the equipment works, or at least get in contact with
folks who know the area and verify with them what does and doesn't work.
B. Take several GPS receivers so you can verify the exact location where
rescue is needed, and precious time is not lost trying to "find you."
C. Take enough first aid gear to deal with most situations, as recommended
in Wilderness First Aid courses, or in Dr. William Forgey's excellent text
on Wilderness First Aid available at most mountaineering/outdoor stores.
D. Have Scouts/Explorers and Leaders take as much first aid training as
they can get before their trip.
E. Do a "tabletop" brainstorm on what the most likely hazards are, and
how you would deal with them, and involve everyone who is going on the
trip since they are the "first responders" who will be providing care.
Get input from local rangers or folks familiar with the trip area.
F. Remember that in spite of the best preparation, there are some things
that you cannot fully prepare for, or even worse, do a lot about; so
anticipate that "worst case scenario" as a possibility so if it does
happen, you are not totally devastated by the impact and can still draw on
reserves to respond as best you can.
G. Be sure to communicate with local rangers, EMS/Rescue providers,
inform them of your trip route, anticipated campsites, and as much about
your group as you can, so if something does happen, they are already up to
speed on where you are, what your resources are, and how to reach you
H. Emphasize injury/illness prevention: Scouting Safety procedures will
forestall nearly all injuries and illness if they are carefully followed.
For example:, folks who are bouldering need to be belayed and wear
helmets. Thus, no "closed head injuries" are likely to occur.
Folks who are on flowing water need to be in approved PFD's at all times.
NO EXCEPTIONS. On very rough water, helmets are a must.
Proper camping sanitation and water treatment prevents illness from
ruining an otherwise great outdoors experience...and so the list goes on.
And, as one poster so aptly stated, "Plan for the Worst, and Expect the
Best, and you will surely not be disappointed.." Have a great and safe
Bob Amick, EMT-B, Explorer Advisor, High Adventure Explorer Post 72,
Boulder, CO.; Red Cross Emergency Response Instructor