What is Wilderness Medicine, how does it differ from first aid, what is its history?
Definition; Wilderness Medicine is the care given to the patient of an accident or illness who is far away [usually more than 4 hours] from urban hospital care and highly skilled physicians. It is what some would refer to as frontier or improvisational medical care. It is not primitive care as the most current or recent knowledge and techniques are used by the care giver involving the best equipment on hand with improvised aspects of what is not available. The key words are “on hand”, “improvised”, “current knowledge”. Training in current knowledge and improvisation are essential. Those trained are often more prepared with some supplies always on hand.
Wilderness care involves doing more advanced care standard first aid. Wilderness care requires training usually put in at least the following categories: Wilderness First aid [intro 8 hrs, basic 16 hrs, intermediate 24 hrs, advanced 32 to 48 hrs], Wilderness First Responder [72 to 80 hrs are common], Wilderness EMT module [this is in addition to a 120 hr minimum EMT course and adds 48 to 76 hrs additional hrs commonly], Wilderness Advanced Life Support [this can be as little as a short WFR class of 24 hrs or a course utilizing cadavers and advanced techniques such as Tracheotomy’s, Cricotheroatomys, IVs,Suturing, Chest needle decompressions, Root canals and fillings normally taking at least 5 days.
The real difference of wilderness medicine compared to emergency medicine is the time period being over 1 hour and as many would say over 4 hrs to definitive formal medical help. Emergency Medical Services try to get the patient to the hospital in 10 minutes [referred to as platinum 10] or at least with in the first hour [referred to as golden hour] using an ambulance often costing 250,000 for car and equipment staffed with 2 EMTs. WM is done usually out of a back pack of 100 of equipment with most everything being improvised. What t little med equip must be economized and utilized to the highest possible extent as it may be days for re supply and to get patient to definitive care. The practicioner is often a WFR of 70 + hrs training vs.the 200 hr +- EMT. Yet the WFR usually has a much broader knowledge base and can have a wider range of authority from their controlling Doctor. The preferred level for out door guides is WFR not EMT. EMTS are tightly restricted by regulations in their scope of practice and often not allowed to have their scope expanded except by the state board of medical examiners. This tight regulation is not seen with WFRs and they can easily have their sop expanded by their control physician.
So when would having taken a wilderness medicine course be handy? Examples: You are stuck in the snow and you frost bite your hands digging out. What is the best way to thaw them with the least amount of long term damage? Your hiking partner falls and breaks their upper leg bone [femur]. [This could kill them] What do you do? You get a bad case of diarrhea. What do you do? There is a terrorist attack and only 3 of you are un hurt and 40 are hurt. What do you do? A WFR is trained to handle all these problems.
All of the courses are based on the premise that there will be need of treatment with no physician available. The trained wilderness person with the highest skill should prevail but care is only given to the level of need to help the pt until physician care becomes available if at all.
One of the first wilderness or improvisational medical classes was held at Colorado State University in 1967. A teaching team of Sandy Long, Allan Duckworth, and Carl Weil taught an advanced first aid course with wilderness aspects to ski patrollers of the area which included St Marys glacier, Geneva Basin, other long closed ski hills andEldora,. Carl continued to teach following mainly arc until 1974 after which he went on his own doing specialty instruction for outdoor groups. In the late 1980 he was teaching fairly regular and felt he should learn more so he took a WEMT class with Peter Goth who had founded a group in Maine nearly 10 years after Carl had taught his first class. Carl also joined the wilderness medical society which was 7 years old as member 172. WMS current membership numbers are in the 2000 range. He continued to teach becoming full time around 1992 when his company changed its name from white mesa outfitters to Wilderness Medicine Outfitters both were abbreviated as WMO.
There are close to two dozen schools offering wilderness medicine courses ranging from small to large. Costs and course content vary noticeably. There is no licensure. There is no national or state regulation. There is a professional organization: Professional Outdoor Medical Educators.
The Wilderness Medical Society [WMS] was started in 1973 by a small group of doctors interested in remote outdoor activities. Non physicians soon joined and now comprise a sizable percentage of membership. WMS holds conferences with short 1 or 2 hour seminars. WMS is not a teaching school offering classes described in this article. In 1999 a educational program was started called the Academy of Wilderness Medicine. A lengthy program of a minimum of 60 short classes and various professional work was established leading to a credential called a Fellow of Wilderness Medicine. A number of these short course are offered by many sources. Carl was in the first group awarded the Fellow designation. As of 2011 approximately 800 people mostly doctors are enrolled in the program with approximately 150having earned and been awarded the coveted Fellowship designation.
WildernessMedicine.com has many pages of WMOs class descriptions including two Distance learning courses and a lot of supplies for sale, WMOs free short videos “Medical Moments” as well as photos of the only wilderness medicine school with over 25 years off the power grid and operated on a land conservancy can be viewed there.
Carl Weil, Director , Wilderness Medicine Outfitters©1-11-11
Fellow of the Academy of Wilderness Medicine
2477 co rd 132, Elizabeth , CO 80107