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Broken Bones, Hypothermia and a Bee Sting

Wilderness First Aid

The most important thing you can bring on a hike is knowledge.


You and a buddy are hiking through the woods and you come across another hiker who’s lying on his back below a huge boulder and moaning. What should you do?

Backcountry Medical Assistance

You have a couple of options:

  • You could walk away because you don’t know what to do and you’re afraid of getting sued
  • You could try to call 911 for assistance, although rescuers might get there too late
  • You could quickly assess the hiker’s condition, immobilize them to prevent a possible back injury, and then seek assistance when you have a better idea of the type of help they require

Injuries both large and small are pretty common in the backcountry. The problem is when you’re unprepared for it and don’t know how to take care of your companions or yourself. A deep cut, a badly sprained ankle, or a bee sting can go from bad to critical very quickly in primitive conditions.

How to Make an Improvised Splint
How to Make an Improvised Splint

Wilderness First Aid

I spent two days last weekend in a Wilderness First Aid class learning how to assess and stabilize broken wrists, arms, legs, and backs, how to re-warm hypothermic patients, how to treat cuts, scrapes and puncture wounds, treat to ameliorate allergic reactions and anaphylactic shock, and dozens of other maladies that can affect backcountry travelers.

This is the third time I’ve been awarded a Wilderness First Aid certificate which is required by both of the organizations I guide and teach hiking with, the Appalachian Mountain Club and Andrew Skurka Adventures.

If you lead hikes for an organization or just for family and friends, I really recommend that you take an accredited Wilderness First Aid (abbreviated WFA) class. If a family member or someone in a hiking club, church group, or social club has an injury on a hike you are leading, they may need you to provide them with immediate medical assistance if they’re more then 4-7 minutes from a paramedic.

Self Sufficiency and Preparation

I also think there’s a lot that any hiker, whether they’re group leaders or not, can learn about Wilderness Medicine that will help make them more self sufficient and better prepared in the backcountry. I bring certain equipment on every hike I take, including day hikes, because I want to be prepared in an emergency situation that could threaten myself or others.

How to Rewarm a Hypothermic Patient
How to Rewarm a Hypothermic Patient

The simplest example is a foam pad. The ground is cold. In fact, it’s an average of 55 degrees Fahrenheit which means it can contribute to hypothermia if you have to sit or lay down on the ground for an extended period of time while you wait for a rescue. That’s why so many experienced hikers strap a Therm-a-Rest Z-lite folding sleeping pad to the outside of their backpacks. It’s not just for comfort at lunchtime, but to put an injured hiker onto if they’re immobile so they stay warm.

Recertification Woes

I know a lot of leaders and professional guides who complain about the need to take a Wilderness First Aid or Wilderness First Responder recertification class every few years to renew their certification. I’m not sympathetic. If you want the liability protection or other benefits provided by an organization that sponsors trip leaders like you, recertification makes sense to help protect your clients, yourself, and the organization you belong to.

Debreifing after a Role-Playing Exercise
Debriefing after a Role-Playing Exercise

If you don’t use your Wilderness Medicine skills frequently, you get rusty in how to apply them and make effective decisions. It’s just human nature. For me, it’s incredibly beneficial to review the assessment, treatment, leadership and judgment skills taught in a Wilderness Medicine class and to practice them with my peers in experiential role playing scenarios. I think it’s a fantastic learning experience, even if it means brushing up on skills you’ve learned previously.

I had fun in my WFA recertification course last weekend and felt it was a worthwhile use of my time, even if it meant missing two days of hiking.

The more knowledgeable you are, the better prepared you’ll be.


  1. This is something I’ve been thinking about for awhile. Thanks!

  2. I’ve been wanting to find a class like this in my area just haven’t had time but I think I will have to make the time. Being prepared for anything is such valuable knowledge. Last summer my wife got hypothermia after she got a bit wet from water spray. Luckily I knew what to do right away and get her warm and everything was fine. It could have been worse had I not even read and studied how to see the symptoms and how to treat them. A class would be even more valuable.

  3. I took WFA last year and I gotta say, I’m looking forward to taking it again because I’m really not sure how much of it I remember. I hope that if something happens on a hike I’ll be able to remember in the moment, but I think that mastering this skill takes a lot more practice than what you get in one class.

    I know just about everyone in your photos, including the person in the black hat who’s face you can’t even see! What are the chances of that? (Where was your class?)

  4. Great reminder

    With all the technology in todays world many think that just pressing a button or calling on the cellphone and then the First Responders magically appear. Many of us try to avoid accidents, but sometimes they happen. Time is so critical in treating Shock, Airway, and Bleeding. I always make sure at least two in a group have this type of certification, and others to have at least a basic understanding on how not to freak out in case of accidents. Sometimes we need helpers to stabilize the patient.

    • Good information to have. I will definitely use these techniques in the future. Up ’till now, when someone in the group got injured, we usually just put ’em down with the .38

  5. I don’t hike far or have responsibility for a group but minor injuries can make your walk miserable if nothing else so I usually carry a simple first aid kit. Also, I have the British Red Cross first aid app on my phone, just in case of anything more serious.

    • Take a course. Your phone is not going to help you make decisions in an emergency.

      The WFA course was originally called “when help is delayed”. If you are in any situation where the professionals can’t show up in ten minutes, you need to know these skills. Earthquake, hurricane, Nor’easter, big power outage, whatever. A few years ago, wehad a major fiber cut in San Jose that took out 911 for a big chunk of the city.

      The course does not just teach first aid, it is triage, incident command, and decision-making. How are you going to keep someone alive for a day or more?

  6. I just took a one day survival course and it left me wanting to take a first aid class like this… too bad this organization doesn’t offer it in Minneapolis

    • Really? WFA courses are taught all over the country/ just search on “Wilderness First Aid”. REI also teaches the class – through a 3rd party provider.

      • Sorry. I meant the organization- SOLO- tat your post linked to. They offer in several states just not here. I jus found that Wilderness Inquiry has a schedule off offerings. Now I just need to wait until they offer one that fits my schedule

  7. A good WFA or WFR is some of the best money you’ll ever spend. More than the knowledge itself, the practice in decision making is invaluable.

    I would encourage anyone looking into a class to insist on getting the instructors CV before signing up. I’ve taken WFR twice. The first time with an experienced mountaineer who had been a Green Beret medic and Army FA instructor. To this day that remains the best class I’ve ever taken on any subject. Second time was with two experienced NOLS instructors with no particular teaching creds, and was a far less valuable experience.

    • Dave’s right. My last class was with a guy who’s been guiding in Alaska for the past 3 years and has an W-EMT. Amazing teacher although every other word he said was “awesome.” My other instructors were ok too, but not anything like this guy who made us do more stuff outside (drills + role play) than indoors. The decision making practice is really priceless.

      • Couldn’t agree more, my instructors were Ski Patrols, we read, we discussed, we roll played outside in mid December. The cold temps added an entirely different element vs inside where it’s warm. Everyone got to play the victim, different scenarios and groups leaders. Two of the best days I’ve spent in the outdoors and on two occasions I’ve applied what I learned.

  8. This is breaking news for me–pun totally intended. This post is pretty long. Philip has permission to edit it any way he thinks is necessary.

    Less than two weeks ago, I was hiking with a six year old granddaughter and nine year old grandson on Elk Mountain in the Wichita Mountains National Wildlife Refuge in Oklahoma. There wasn’t a cloud in the sky at the start of our hike and when we got to the top of the mountain, a small cloud morphed into a rumbling, snarling monster in minutes. We got hit with torrential rain, hail, and lightning. As we retreated the top, we encountered a couple with their two and four year old daughters who’d also gotten caught in the storm. The grandkids and I were wearing synthetics but the family we met were in cotton. They were cold and the girls were shivering. We fashioned a poncho for one of them from the plastic liner to my grandson’s GG Mariposa Plus and wrapped the other in my RailRiders Madison River shirt that I had in my pack and we worked our way down together.

    The trail crosses many areas of bare rock and is intersected with numerous game trails and we lost the hiking trail in the storm and continued our descent cross country. We came to a series of slanted rock ledges on a steep slope and as I prepared to jump from one ledge to another, I started slipping. Hoping to prevent an out of control fall, I leaped immediately, however, because my feet had already started to slide they didn’t contact the intended landing zone and hit a place that the rain had washed mud onto. My feet squirted out like I’d landed on ball bearings and I crashed down hard on my right wrist, breaking it in multiple places and also receiving several punctures where rocks were driven into my palm.

    From there on down, it was uneventful (thankfully) and the gentleman we helped was a therapist and had an Ace bandage in his car. I had a SAM splint and we splinted it. The grandkids and I finished our camping trip the next day and a couple days later I got in for X-rays and a couple days after that I saw an orthopedist and am now sporting a stylish blue cast. The orthopedic said in thirty years of practice he’s never seen a fracture of the nature I have and he’s consulting with other specialists to determine if surgery is necessary.

    This isn’t the first injury I’ve received or encountered in the back country. I also broke the same bone in1987 when I fell on Ward Mountain in Big Bend while hiking alone off trail by several miles. I was descending a steep problematic section and stepped on an ice covered rock. Knowing I was about to take a bad fall, I launched to another spot, hoping to avoid an uncontrolled tumble. I ended up with a broken and punctured wrist. Any of this sound familiar? When I started to slip on Elk Mountain last week and jumped prematurely to try to avoid the coming out of control fall, I had a flashback to 1987 and thought, “I hope this turns out better than Ward Mountain.” And guess what? It was déjà SPLAT.

    That trip to Big Bend in 1987 was marked by three medical emergencies in a week. My sister wiped out on a mountain bike and received a concussion and the next day a group of us was hiking a desert canyon when one person in the group stepped off a rock down onto some gravel a foot below. Her foot slipped and she snapped both bones in her lower leg. My brother, another friend, and I carried her three miles on our backs to the trailhead and then 90 miles to the nearest hospital. At one point, one of her sons came up and said, “Mommy. Put these pretty rocks in your pocket.” I said, “Wait a minute! If I’m carrying your mother, it’s not with rocks in her pocket!”

    Nine years earlier, when hiking in another desert canyon in Big Bend, one person in our party slipped and fell 22′, breaking her back in three places. I left her husband to tend to her and went to get the rangers. We returned and carried her on a back board for a mile, then it was five miles on a quasi 4WD road to the highway and 130 miles to the hospital. Fortunately, she made a full recovery but hasn’t been interested in returning to the park. Perhaps it was that “I had a spine tingling experience in Big Bend” shirt her husband ordered for her.

    Bad things do happen in the back country. Preparedness is needed not only for your group but also to assist someone you may meet who needs help.

    In retrospect, there are a few positive and negative aspects of my readiness on last week’s incident.

    We wore synthetic clothing. Although we were soaked, they didn’t sop up water like jeans and cause chafing and chilling.

    I didn’t bring a couple extra trash bags for emergency ponchos (that will never happen again on a day hike) but I did use the liner from my grandson’s Gossamer Gear Mariposa Plus as a poncho. The liners are plastic bags that fit the pack perfectly and are available from GG for $5 a pair. Repurposing the liner did utilize what was on hand, however, if I’d have been better prepared initially, my grandson would still have a liner for his pack. I also left my rain shell in the car at the trailhead since the sky was clear when we started (that won’t happen again either).

    While we’re on GG products, I always have a SitLight pad with me–it’s light and great to sit or kneel on. My grandson’s Mariposa Plus has their NightLight pad for a frame. Those things, plus the foam back on my GoLite Pinnacle will serve to insulate from cold ground, if needed in the future.

    Although I instantly knew my wrist was broken, we didn’t try to splint it on the mountain–we were concentrating on getting down. I could have rigged something with the SitLight and duct tape or cord, however, keeping my right hand in the grip of the PacerPole helped considerably. It gave the hand support in just the right position to keep the pain manageable. PacerPoles are awesome!

    On future day hikes, I’ll bring the SAM splint material, rather than leaving it in the car. I’ll also carry several lightweight trash bags because I might need to help not only my group, but someone else we meet. I’ll also bring my lightweight and compact SOL escape bivy, just in case someone may be incapacitated for a period of time awaiting help.

    I love paper maps but didn’t have one on this hike, relying on the phone/GPS and downloaded satellite photos and topography. When the rain started, I put my Galaxy S3 in a waterproof pocket on my chest strap. Those things only work when you zip them up! When we got off trail and were debating the best route down the mountain, I reached for my GPS and found it swimming in the pocket and my device hasn’t worked since. Fortunately, the Elk Mountain area is relatively compact and it’s easy to find the trailhead, but there are places that the non functioning electronics could have become a real safety issue if there was no backup.

    I also think it’s time I take a Wilderness First Aid course.

    • Wow, Grandpa, those are some incredible stories. Seems like you’ve done okay without any WFA but maybe you just got lucky? Anyway, thanks for sharing.

    • Grandpa – Sounds like it’s time for a WFA, at least. Sounds like you did all the right things without it, but it can only help. And heal up soon!

  9. Maybe it would be easier if I just quit trying to hike and chew gum at the same time…

  10. The Dallas REI is offering a class this weekend. I emailed and asked for the curriculum vitae of the instructors. It will be hard clearing the schedule and budgeting the funds on such short notice but I’m quite interested. My present condition makes note taking and some activities very hard to do right now so I asked if it would make the training too difficult. They also offer the course a couple times in Austin the next few months which may work out better physically but the location would much less convenient for me since the Dallas REI is only a few miles away.

  11. For the record, I require medical creds for my guides because it is a requirement where I run trips. But as far as I am concerned, if you have to apply what you learned in a med course as a guide, you probably already did something wrong, and i would rather have instructors who have the sense to avoid problems preemptively. If you are a ranger or ski patrol, that is a different role, ie you are not there to ensure that a person or group makes good decisions, and in fact it seems that usually you arrive to pick up the pieces after bad decisions, eg taking on too much risk, not knowing personal limits, being ill prepared, etc

    Is wilderness med training important? Absolutely. Is it any more important than say, navigation, gear selection, food planning, leadership, etc? Absolutely not. So I therefore disagree with the requirement passed down by land managers that guides have med certs yet nothing more. Either create a robust guide standard, or require nothing and let prospective clients and students decide what qualifications are important.

    • In a perfect world. Participants on my AMC hikes omit details about their medical history and the drugs they take all the time, not to mention the undiagnosed medical conditions they suffer from like blocked arteries, diabetes, etc. I am a very good screener for who is eligible for my trips but there are always surprises. As a leader I also can’t completely control what participants do on my hikes. If one falls on scree and gashes a knee or sprains an ankle, there’s very little I can do ahead of time to prevent that especially if they screened through based on past experience and the fact that I hike with them all of the time!

      I think what land managers require is irrelevant. Planning and all of the other backpacking skills you cite are obviously crucial, but you can’t control people enough (unless it’s just you) to anticipate all events on a hike.

  12. Andrew,

    You make a great point. As I look back on my fall, I was worried about that route and specifically that spot but when I saw how easily all the others made it down that place I set my trepidation aside. I should have listened to my gut and insisted on the other route that we ended up taking. Actually, I should have listened to the mother of the two girls because she was the one with the most misgivings about it although she made it through there just fine ahead of me.

    “Picking up the pieces after bad decisions.” I think that describes it exactly.

  13. I’m signed up for recertification in May. The BSA requires recert every two years, which is a good idea, but hard to keep up with.

    This will be my fourth time through the course. My indelible memory from the first course was a sort of retroactive terror that I had been on so many outings, responsible for Scouts, without knowing this stuff. Yikes.

    As a guide, WFR is a better choice than WFA, because you get so much more hands-on time for mostly the same material.

    If you are in Northern California, I highly recommend the courses from Paratus Institute.

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