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Wilderness First Aid and Backcountry Emergency Care

“I never felt so helpless,” said a doctor friend of mine as we discussed the mock accident scenarios we practiced during a Wilderness First Aid certification course I took recently. “I’m used to having medical tests, and instruments, and nurses around me when patients come to the Emergency Room. We never see them at an accident site.”

That pretty much sums up the difference between hospital medicine and first responder care for me and why I’d rather be treated by an EMT than some random doctor at an accident scene. The contrast is even more stark in a Wilderness setting where you are hours and perhaps days from Wilderness EMTs or Search and Rescue and the only medical aids and treatments you can carry are in your pack, what you can MacGyver from backcountry resources, and in your head.

Which is why I recommend that all hikers, backpackers, and hiking leaders take the 16 hour Wilderness First Aid certification class. In addition to self-diagnosis and self-care, understanding how to assess a patient and stabilize them in the Wilderness until help can arrive can make a huge difference in whether an injured hiker lives or dies, or retains full bodily function after an incident.

Wilderness First Aid classes are available from REI, the Wilderness Medicine Institute, The Boy Scouts, NOLS, SOLO and many other regional outdoor groups. The classes combine classroom lectures and scenario-based practice sessions where you can apply the hands-on assessment skills you learn in class in mock accident scenes. It’s very useful training and will make you more self sufficient and self reliant on hiking and backpacking trips, whether you’re hiking solo or in a group.

Wilderness First Aid Training
Wilderness First Aid Training – Practicing How to Splint and Wrap an Arm Injury

Having a Wilderness First Aid certification is often the minimum requirement for any kind of outdoor job and having it has helped me land some guiding jobs, so it’s worth the investment in time and money. Course prices vary depending on where you take it, ranging from $120 when subsidized  by an outdoor organization like the Appalachian Mountain Club to $225 from a commercial entity, but it’s definitely worth every penny you pay.

“Have you ever had to use your Wilderness First Aid training,” asked another friend of mine. “Yes, many times,” I replied, with surprising frequency, to treat everything from a heart attack to dehydration, bee stings, blisters, puncture wounds, sprains, and more. I can’t imagine what I would have done without this training.

But your patients aren’t the only people who benefit when you take a Wilderness First Aid training course. You also benefit personally by building your Wilderness skill set and the increased certainty and confidence that comes from it.

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  1. You can use urine to sterilize cuts.

  2. What a Great Informational Post you got here…. I am a licensed Health Care person and hold a Lifetime State Certified License as a Nurses Assistant,,not an Aide, but Assistant. In some States there is a huge difference in duties. I could do everything but give out Medications, going back to 1973. For years, well since Teddy Roosevelt I believe was responsible for the Boy Scouts being trained in First Aid should the Country experience a disaster going back to the 30’s, many of the Local Hospitals and the Red Cross at Fire Houses and even some High Schools all had classes on First Aid. During the Kennedy Cold War’s and test of Nuclear Air Raid Sirens in the 60’s the Government worked with the Red Cross to get thousands of people Trained… The problem became Lawyers chasing Ambulances and Suing well intentioned Good Samaritians, Some States have Good Samartian Laws so you need to Check your State Laws to see if your protected…… and then the Insurance Companies jumped in, So many good things in our country have been destoryed because of Lawyers and Insurance Companies…. And by the way Urine is sterile to a point because it contains Ammonia but never should be used to sterilize Open gaping Wounds of any kind like deep cuts. Urine is also very salty so should never be used as fluid replacement. The Ammonia in Urine can be used to neutralize the Toxin in Jellyfish and Man of War stings and Bee and Wasp Stings in emergencies and has been for over a hundred or more years.. There are a number of small Paperback Backpack sized Instruction Manuals on the Market. The one you choose should be written by a Doctor not a Outdoor Instructor unless the Doctor is the Outdoor Instructor… After you buy it sit down and read it from cover to cover at least Four times making notes of areas you have questions in and Put your First Aid kit together from what you read in the Book. Most First Aid kits carry a lot of useless stuff. Campmor and REI have good ones which you should modify for meet your particual needs.. For example, I always carry a knee Brace do to a Backpacking accident in 1988. .Do not rely on the Manual when the accident happens, it will be too late then…Only use it as a quick reference on the Trail and to refresh your knowledge…. A good source of individual packets of OTC Medications as well as Salves, Balms and anti-bacterial jels is I have been buying from them for over 10 years to replenish my First Aid Kit…. Also talk with your Doctor about Medications you may need. My Doctor in San Diego was a Backpacker, so he was able to prescribe a number of Medications for me for Pain, Diarrahea, and Viral and Bacterial, issues..

  3. Wow, this topic got me thinking. Urine does contain bacteria.

    Clinical medical care givers are out of their element when presented with a medical


    If you are going to get injured, do it in a national park the bigger the better so as to get

    a helicopter ride out.

    I’ve met two women (different times and locations) hiking who fell and broke their arms

    doing the John Muir Trail.

    Carry a light pack (under 30 #s), use comfortable hiking shoes, and use a staff or hiking

    poles. Blisters are the #1 reason people quit hiking on the JMT.

    And thanks Phil for your informative articles.

  4. Wilderness first aid sounds similar to combat first aid we had in the Army, although there was a huge emphasis on gunshot wounds, sucking chest wounds and 3rd degree burns, which one is unlikely to be exposed to in the wilderness. Treating for shock, recognizing cold weather and heat related injuries, immobilizing broken limbs and reassuring the patient can all be applied to wilderness first aid.

  5. Great information Philip, thanks!

  6. For UK readers, I can strongly recommend the outdoor first aid courses offered by the National Mountain Centre at Plas – y-Brenin. Not cheap, but amazingly thorough and very well taught. Even after 17 yrs MR experience, I learned stuff on the course I attended that I’d never come across before.

  7. I took the class 3 years ago before going to Philmont Scout Ranch for 10 days of backpacking. Will be taking it again in 2016 before we go back in the summer. I highly recommend the class for anyone spending any time far away from the first responders we are all use to in the USA.

  8. AAC membership is also a good idea to enroll in so you don’t bankrupt if you ever do need med help from the authorities.

  9. One can be a fatalist and decide that “serious” injury is simply beyond one’s capacity to treat, while non-serious injury isn’t really worth much worry. Moreover, the outdoors may well be safer than “ordinary” life: less exposure to auto traffic and other machinery, while potential activities are often limited to walking. I took a WFA course in ’74 or ’75 from guy from N.Conway. I learned you can tape a popped-out eyeball to somebody’s cheek using a Dixie Cup (cut slot for nerves). Also that litter-carries require lots of people, are hard and potentially chaotic. As it happened, none of the information ever became useful to me.

  10. Life happens – be prepared.

    Having participated as a medevac corpsman in the rescue of hundreds of injured civilians from the wilderness, I observed that it’s as important for first-responders to know what not to do as it is what to do. Basic first aid training many times made the difference between life or death until EMS could make it to the scene – which was a lot longer than people are comfortable with. Knowing current first-aid techniques allows that first-responder to make the difference in an emergency situation. It’s not possible to save everyone, but it is possible to try and certainly not to make things worse. The helpless bystander gets to endure that special regret from ignorance. I recommend the training. Your choice.

  11. Hi Philip,
    What is the recommended response to being bitten by a venomous snake while in a remote backcountry area? I hike mainly in New Jersey, Pennsylvania, New York, and Maine, so the venomous snake bite would be either from a timber rattlesnake or a northern copperhead. I always hike alone. I don’t know if I should call for help and wait or try to hike back to the car (which may be a full day’s hike or two away).

    • First off – you can avoid these encounters if you’re aware of snake habitat. That’s the best option.
      Second – a large percentage of “bites” don’t involve the injection of venom and are called dry bites.
      Third – evacuation is always the safest course. First immobilize the wound by splinting or bandaging it so it moves less. If you’re not near a vehicle, request external assistance.
      I suggest taking a Wilderness First Aid class so you can take care of yourself or others.

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