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The world of Search and Rescue (SAR) is often intertwined with wilderness medicine. In our wilderness medicine courses, we talk about SAR teams as a resource for evacuating a patient, so it’s important to understand the principles of SAR operations so we can communicate with and utilize them effectively should we need their assistance. As a trip leader and wilderness medicine provider, you also may find yourself in charge of an impromptu search or rescue for a lost student, client, or even someone from a less experienced group, in which case it can be very helpful to have an operational framework to reference as the scenario unfolds. In this three-part series, we’ll discuss the parts of a SAR response in the first article, “Foundations: What is Search and Rescue?” to provide a framework for executing any type of search and rescue, big or small. In the second article, “Applying concepts: A real-life example of a SAR incident in the Narrows,” we’ll go on a deep dive into a real story from my time working on an ambulance and SAR team in Zion National Park, where you’ll be able to apply the framework from article one to gain a better understanding of how and why the incident unfolded the way it did. Finally, the third article, “Lessons learned: Reflecting on the Narrows incident,” will debrief the story from article two, demonstrating the importance of debriefing incidents to find ways to continually improve search and rescue responses. By the end of the series, you’ll hopefully come away with an understanding of search and rescue processes and how they can be applied across a spectrum of situations, and how you as a wilderness medicine provider might fit into the SAR picture, whether you’re on a SAR team, requesting help from SAR while caring for a patient, or finding yourself leading an impromptu SAR mission.
Many years ago, I remember participating on a spring break backpacking trip with my college outdoor program. I was a first-year student and couldn’t get enough of these types of trips – I really wanted to be a trip leader and went on as many outings as I could cram into my busy college schedule. This particular trip was a five-day backpack through desert canyons outside of Hanksville, Utah. On the first day, as we packed up and prepared for the trip, the leaders reviewed some key safety policies – basic hygiene, traveling as a group, the planned route, and what to do if you become lost. That last point, which we discussed at the outset of every trip I had been on with the outdoor program, always struck me as a little funny, because weren’t we going to stick together the whole time? And weren’t we going to be on a pretty obvious trail, or walking through a confining desert canyon with no other paths? How could we become lost? The chances seemed infinitesimally slim, but nonetheless, I noted that the leaders advised that a lost person should stay put and make themselves obvious to help the group locate them. But the thoughts of getting lost soon drifted from my brain as we strode into a wash that afternoon, replaced by sunshine, red rocks, and a thin layer of desert sand crusting everything I owned. A few days into the trip, we stopped at a pothole holding good, clear water, so we dropped our packs, filled bottles, snacked and basked in the spring sunshine like lizards. After 20 minutes or so, the leaders urged us to get going again so we could make it to camp in the daylight. We were slow to leave our sunny watering hole, peeling ourselves off the warm sandstone sunbathing beds and putting on our crunchy desert shoes. As we waddled away under the weight of our packs, someone asked at the back of the line, “Where’s Amy?” Heads snapped up and eyeballs scanned. Where was Amy? And when had I last seen her? I suddenly took note of the twisting, rocky desert terrain and realized the canyon had split just behind us, where another fork joined. I wracked my brain…I know I saw Amy while we filled water, but did I notice her packing up? Had she slipped off to check something out or go pee around the corner? Amy was, at that moment, lost. The leaders quickly reacted to the erupting confusion and concern. They interviewed the group and determined that Amy had been with us at the watering hole, and that she must have gotten separated just as we were packing up and heading out, only about five minutes ago. No one had seen which direction she had gone, but the canyon walls were pretty steep, so she likely was somewhere nearby in the canyon or the other fork. They split us up into three groups - one would stay put to scan around the immediate area and make sure Amy didn’t accidentally pass us heading down the main canyon farther; one would go back to the watering hole and scan around there; the third would check out the other fork where it joined the main canyon. We would take no more than 15 minutes on this initial search before meeting back at the starting point – if we hadn’t found her by then, we’d need to come up with another plan and alert more resources. I was struck by how suddenly these events unfolded. In the course of just a few minutes, we went from an intact group to searching for a lost member. So THIS is how people get lost! Only a few minutes into our search plan, however, the two groups that searched up-canyon returned successful, Amy walking along with them. She’d gone off to change into shorts around the corner from the watering hole, got caught up checking out some cool rocks, and was surprised to see that the group had left upon return. The search teams found Amy at the confluence of the alternate fork and the main canyon, considering which way the group would have gone. After some collective sighs of relief, nervous giggles (“That could’ve been way worse!”), and a debrief of the situation from the leaders, our group, intact once again, happily carried on towards camp. For the rest of the trip, we stuck together like glue. This experience on the desert backpacking trip was a small, impromptu SAR incident — it took only a handful of minutes, and required no more resources than what our group already had, namely people, to be successful. But the process of the incident unfolded like any SAR incident would. The trip leaders functioned as the de facto incident command team (in formal settings, there is usually a single Incident Commander, or IC, assisted by a variety of section leaders such as Safety, Operations, Logistics, etc). Whether they knew it at the time or not, the leaders organized our response along the lines of a common SAR framework, referred to as P-LAST: Plan, Locate, Access, Stabilize, Transport. Each of these represents a distinct phase of a SAR incident, and when executed in order, results in an organized and efficient approach to finding and assisting a subject. The trip leaders’ first step was to make a Plan. This was composed of pulling together information, like where and when the lost person was last seen. If we hadn’t already spent days together, they might have also needed to gain more insight into Amy’s personality and psyche: Does she typically like to explore on her own? What are her interests? Has she done this before? How has she been feeling today? What are her skills and what resources does she have with her? Additionally, they needed to come up with a strategy for searching within the highest probability areas with the resources available, and quickly, to increase the chances of success before Amy had time to get even farther away from the group. Part of this strategy included identifying natural guardrails and funnels - in this case the canyon walls - that might hem the subject in. In other settings, natural features that can act as guardrails include large bodies of water, rivers, and cliffs. Terrain features that act as funnels are easy to travel along, like trails, roads, canyons, and ridgelines. Once the plan was made, the search, or Locate, phase began. Our small groups, which were functioning like hasty teams (small, self-sufficient teams that can quickly search high-probability areas), began searching in assigned zones based on where Amy was mostly likely to be found – near the point last seen (PLS) and at the potentially confusing junction where the canyon forked. The trip leaders thoughtfully left one group in place, stationed where we realized Amy was missing, to make sure she didn’t accidentally leave the search area; in SAR terminology, this is referred to as containment. Other tools that SAR teams use to locate subjects include tracking dogs, aircraft, GPS data, and even fine-toothed grid searching on foot. Luckily, our search teams were quickly successful. In any search, there is always some urgency in locating the subject quickly, because the less time they have to move away from the point last seen, the more easily they will be found. Amy had mere minutes to get separated, which meant the search area was small and likelihood was high that we’d find her. If she’d had hours, the search area would have expanded considerably. This is why it is usually easier to find a lost person if they stay put, and why our trip leaders encouraged us to do so while making our location as obvious as possible (you could shout or blow a whistle, use visual cues like smoke, bright colors, or reflectors, etc.) should we become lost during the trip. After the subject is located, they must be Accessed. In Amy’s case, there were no barriers to access – she was just standing in the canyon junction, and the searchers walked right up. But what if Amy had explored a little farther afield, and scrambled up a short but steep rock band and couldn’t figure out how to down climb it? Then we would have had a high angle rock access problem, and we might have needed to spot someone to climb up to Amy, or find an alternate route to reach her. Access problems usually intensify with water, snow, ice, rock or steep terrain. For example, rescuers may have to rappel down or climb up rock walls, ski down a snowy slope or avalanche debris, or navigate glaciers and crevasses. The Access phase may also involve rescuing the subject from immediate hazards, such as pulling someone to shore from swift water or removing them from unstable terrain like avalanches or rock slides. In a SAR incident where the subject is injured or sick, the next phase would be to Stabilize them by providing medical care and readying them for Transport. On the desert backpacking trip, there was no need for stabilization, because Amy was perfectly healthy, just a little lost. In other cases, the stabilization phase may involve treating immediate life threats, doing patient assessments, filling out a SOAP note, and devising a treatment and transport plan. Amy also didn’t need any transport assistance, so the transport phase of our mini-SAR was merely the process of walking her back to the designated meeting point, where we joyfully concluded the incident and carried on with our backpacking trip. If someone can’t transport themselves and needs to be evacuated (as is common for sick and injured patients), then the SAR team creates a transport plan based on the terrain and patient condition. This could include using vehicles like helicopters, UTVs, or boats to evacuate the subject. Or it could mean carrying them out in a litter (sturdy, human-shaped wire basket) on foot, hoisting them up or down steep terrain, or assisting them in other ways. Many SAR teams have specialized tools and equipment for dealing with transporting subjects in their unique service areas, and they spend a lot of time training on how to manage complex transports in their most challenging terrain. A SAR incident is only complete once the incident has been debriefed and all of the teams and gear required are returned and restored to their prepared state (rested, cleaned, organized, re-stocked, and ready to deploy). On our backpacking trip, the resources required were so minimal (just us humans looking for Amy for a couple minutes) that our group was ready to carry on with the trip after re-grouping at our designated meetup spot. The leaders debriefed the incident and reiterated the importance of letting people know when and where we’re going if we leave the group, and to remain stationary if we realize we’re lost. With that, we slung our heavy packs back on, and waddled down the canyon towards camp. That evening, under clear starry skies and gathered around a glowing headlamp-nalgene lantern, we reflected on our feelings from the day and what we learned. For my part, I thought about my new understanding of just how easy it can be to become lost, despite my disbelief at the beginning of the trip. I also marveled at the calmness of the leaders as they led us through the situation with Amy earlier in the day, and wondered if I’d have the skills to someday manage a group under stress so tactfully. I had no idea then that I’d go on to work professionally as a ski patroller, SAR team member, outdoor leader, and wilderness medicine instructor, and that this early experience would one day become a simple illustration of the phases of a search and rescue response. From this story, we can see how even the simplest incidents can follow the P-LAST framework, though some of the phases may be quite abbreviated in the absence of technical terrain or a sick or injured patient. Regardless of scale, following the stages of P-LAST helps organize resources and streamline a SAR response. To explore this process further, we’ll be going on a deep dive with the story of a professional SAR incident in the Narrows of Zion National Park in our next article, “Applying concepts: a real-life example of a SAR incident in the Narrows”. As you read this next story, you’ll now be able to identify the different parts of the SAR process, and perhaps reflect on what you might do if you were part of a SAR response. It’s an exciting story, involving an unreliable point last seen, navigating challenging terrain at night, a helicopter in a tight spot, and more. Stay tuned! If you have insight to share from your own experiences working with a SAR team, leave us a comment, we’d love to hear from you! About the author: Zoey is a licensed provider for WMTC and owner of Headwind Backcountry Medicine, LLC. She’s spent many seasons exploring outdoor education, recreation, and wilderness medicine from a variety of angles, and she’s excited to share pieces of her experiences here with you. Thanks for reading!
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Introduction A medical advisor who is an active member of your organization's risk management team can help prevent and reduce the severity of program-related injuries and illnesses. We recommend working with a medical advisor who is familiar with your program and an experienced outdoor person. A medical advisor can:
Standing Orders & Protocols Medical advisors use standing orders to authorize treatment and evacuation guidelines to meet an individual program's needs. For the purposes of this document, standing orders are written treatment and evacuation protocols—often in the form of algorithms—that authorize a wilderness medicine provider to complete specific clinical tasks usually reserved by law for licensed physicians (MD, DO, NP), physician assistants (PA), or nurse practitioners (NP) while in the backcountry. Standing orders may be specific to a patient or a condition and take two forms:
Best Practices Standing orders and protocols should:
Examples Examples of standing orders written for an outdoor program or guide service by their medical advisor include:
Interested in learnig more about wilderness medicine? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Wilderness travelers, outdoor instructors, guides, and Wilderness EMS personnel benefit from clear guidelines or protocols that address the unique circumstances encountered in the wilderness and remote settings regarding starting, withholding, and terminating resuscitation efforts for people in cardiac arrest. Because the chance of return of spontaneous circulation (ROSC) and survival with intact neurological function decreases exponentially with any delay or break in the AHA chain of survival, overall outcomes, universally poor in an urban context, are even worse in the wilderness. On-scene personnel may not have the medical, rescue, or outdoor training and experience to make an accurate risk-benefit analysis. For example, If a physician is present, they may not have the training or expertise to assess the hazards associated with a technical rescue or evacuation or know how to mitigate any environmental risks; the same holds for EMS professionals. Conversely, while many outdoor instructors and guides have the training and technical experience to assess and mitigate any risks associated with a rescue or technical evacuation, or adverse environmental conditions, they may not have the required medical training or experience to evaluate the patient’s likelihood of survival with neurological functioning intact. In addition, many outdoor programs and most recreationalists do not have timely or reliable communication with outside agencies that may be able to offer assistance. The following algorithm provides a data-driven template for a termination of resuscitation (TOR) protocol for recreationalists, outdoor trip leaders, guides, and wilderness EMS personnel; medical directors can modify the algorithm to align with regional laws and response times.  Click image to download a pdf file copy. Want to learn more about wilderness medicine? Take one of our courses. Guides and expedition leaders should consider taking our Wilderness First Responder course. Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Supplemental Reading 
 On August 9th the FDA approved a 2 mg epinephrine nasal spray (neffy®) for the treatment of anaphylaxis. A neffy prescription consists of two single-dose device that use a technology that temporarily loosens the spaces between the nasal cells to help epinephrine be absorbed rapidly into the bloodstream. Similar to epinephrine auto-injectors, a second dose should be given if there is no improvement in symptoms within five minutes or symptoms worsen. Interestingly, repeat dosing in the same nostril is more effective than dosing once in each nostril. Study results showed similar epinephrine levels between neffy and auto-injectors demonstrating similar increases in blood pressure and heart rate. A separate study in children weighing more than 66 pounds showed the amount of epinephrine in the blood was similar to adults who received neffy. Side effects were generally mild and short-lived in the clinical trials and similar to injectable epinephrine with the following exceptions related to the delivery method: throat irritation, nasal discomfort, a tingling or itchy nose, nasal congestion, or runny nose. No serious adverse events were reported. The spray is effective if you have nasal congestion or runny nose from a cold or seasonal allergy; however, people with nasal polyps or a history of nasal surgery may not receive a full dose and should stick with an injectable form of epinephrine. Caution: The spray will not work if frozen. Directions are simple: Insert the tip of the device fully into one nostril and firmly press the plunger. Avoid angling the tip towards inside or outside wall. Avoid sniffing during and after inhaling the drug. NOTE: While studies show the amount of epinephrine in the blood is the same for Neffy and injectable epinephrine, it has not been field tested — that will come with time. Want to know more about allergies and annaphylaxis? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.  Mnemonics in CPR and First Aid: A brief history & discussion A mnemonic is a learning technique that enhances information retention or retrieval by associating a concept or action with letters, words, or images. CPR and first aid commonly use letter mnemonics to describe the treatment order during your initial patient assessment; WMTC uses an image or visual mnemonic and builds it into a larger graphic that illustrates our complete patient assessment system. In 1957, Peter Safar, MD, a pioneer in resuscitation techniques, wrote the book ABC of Resuscitation. The ABC mnemonic—airway, breathing, circulation—and its associated techniques were described in a 1962 film, "The Pulse of Life," to promote and bring CPR training to the lay public. The film won six major awards, and the following year, in 1963, the American Heart Association [AHA] officially endorsed CPR; the ABC mnemonic became a standard part of their CPR training program in 1973. The mnemonic was later adopted by the first aid community and used during the initial assessment of an unconscious patient. Because the ABC mnemonic was easy to remember and reflected the order of action as determined by research at the time, it was widely adopted. As interest in outdoor recreational activities—rock climbing, mountaineering, backcountry skiing, white kayaking and rafting, canyoneering, hiking, etc.—grew, enthusiasts and guides alike found that urban first aid courses did not address the needs of remote travelers. With the emergence of wilderness medicine protocols and courses, other letters began to appear in the ABC mnemonic after the C: D for "disability" [referring to the cervical spine], E for "exposure" [to environmental insults], F for "fluids" [blood, cerebrospinal fluid, vomitus, etc.], and even G for "go" [evacuate]. The additional letters had three things in common:
Then, the research data changed the order of the letters in the ABC mnemonic. The AHA found (1) it was slightly more effective — on average roughly 20 seconds faster — to start chest compressions once a rescuer determined a patient was in cardiac arrest than to begin with rescue breathing, especially if a barrier device was used. They found that a person in cardiac arrest from a heart attack had enough residual oxygen in their lungs to oxygenate their brain for 4-6 minutes without rescue breaths if a bystander started pushing on the patient's chest. In 2010, the AHA changed the ABC mnemonic to CAB to reflect the change in treatment and the importance of initiating chest compressions before beginning rescue breathing during CPR when the arrest was due to a heart attack. Note that the ABC mnemonic accurately reflects the treatment order if the cardiac arrest was the result of a primary respiratory problem like drowning, snow burial, lightning, and overdoses where a lack of oxygen caused the arrest. In these cases, it is essential to begin rescue breathing ASAP. During the Middle Eastern wars, the US military found that the rapid application of extremity tourniquets saved lives; in fact, a lot of them. They also discovered that, in some cases, it was possible to apply a tourniquet and later remove it after packing the wound with hemostatic gauze and applying a pressure bandage; this practice saved limbs. Over time, EMS adopted a similar protocol, and instead of tourniquets being used as a last resort to stop severe bleeding, they became the first. To reflect the treatment change, the US military replaced ABC with X-ABC [eXsanguinate, Airway Breathing Circulation] or MARCH [massive hemorrhage, airway, respiration, circulation, head injury/hypothermia]; both of the new mnemonics supported the immediate application of tourniquets to address severe arterial bleeding, rather than the application of direct pressure followed by a pressure bandage with a tourniquet as a last resort. Fortunately, the new data and treatment protocols easily transfer to civilian applications; the mnemonics, however, not so much. Some mnemonics work better than others, depending on the individual, how their mind works, what mnemonic they were taught first, and the situation. Adding additional letters to a classic alphabet mnemonic is pretty easy to do; however, confusion and frustration can set in when a widely accepted alphabet mnemonic changes its letter order under certain situations — like when the AHA changed from ABC to CAB for heart attack patients in cardiac arrest and left ABC in place for arrests due to a primary respiratory problem forcing students to reorient their thinking choose the correct treatment order [and mnemonic].
So, is one mnemonic better than another? As usual, the answer is: It depends. The ABC alphabet mnemonic has been in use since 1957, and almost everyone is familiar with it. With two notable exceptions—cardiac arrest secondary to a heart attack and severe bleeding—it accurately reflects the order of treatment. If you can remember the exceptions, it works. The same is true for the extended alphabet mnemonics. The order of treatment expressed by X-ABC and MARCH works well for tactical situations and is easy for soldiers to remember, but it shares the same exceptions as the ABC alphabet mnemonics. Is WMTC's 3-triangle image mnemonic better? We think so because its ordered but non-linear structure encourages critical thinking and adapts to real-life scenarios and new research better than an entirely linear system. Will it work better for you? Take a course from us, and you decide! Ultimately, the best mnemonic is the one you can remember and use. 1 (2010). 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science. Circulation, 122(18).
Erin Genereux, FNP-BC Garrett Genereux, WEMT While death in the backcountry is pretty rare, accidents happen. If the unthinkable occurs and you’re left with the seemingly impossible task of telling the rest of the group or those at home that their friend or loved one has died, the way you deliver the information will affect how it is received. While there is no perfect way to say someone has been severely injured or died, there is language you should avoid. Consider using these talking points:
When notifying or treating expedition members in the field following the delivery of another member's injury or death:
As Kenneth Iserson writes, “No one likes to deliver the news of a sudden, unexpected death to others; it is an emotional blow, precipitating life crises and forever altering their world.” The surviving victim(s) just wants the person telling them the news to show that they care. To show empathy that someone that they loved and cared for has died. If you do your best, you will accomplish what is necessary. Introduction Numerous articles, podcasts, and letters have recently argued for regulating wilderness medicine certifications. At its root, regulation is about control—someone always benefits, and there are always associated costs. This article discusses the various forms of regulation that apply to wilderness medicine certifications and attempts to identify who benefits and at what cost. Once they are known, we can run a cost/benefit analysis and see where it leads us in the near and distant future. Three types of regulation apply to wilderness medicine: economic regulation, government regulation, and self-regulation. Economic Regulation Economics currently regulates the field of wilderness medicine; it's a problematic market-driven, buyer-beware scenario. The Boy Scouts of America, the American Camping Association, and numerous college recreation programs require tripping staff to be certified in Wilderness First Aid. And the outdoor industry recognizes Wilderness First Responder certification as the industry standard for guides and outdoor instructors. Interestingly, course curricula, hours, format, delivery strategies, instructor training, and student assessment and evaluation for both courses vary greatly depending on the provider. Without industry-wide certification standards, potential students, sponsors, employers, and land management agencies have no easy or reliable way to evaluate course curricula or quality. Beneficiaries
Government Regulation Governments enact laws (policies) to control the practice of medicine. In the United States, the Emergency Medical Services (EMS) act of 1973—part of the Public Health Service Act—allocated funds to develop regional EMS systems. States are responsible for training and licensing four levels of first responders: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), and Paramedic. Other countries have similar, but not identical, EMS systems. While numerous schools teach Wilderness EMT (WEMT) or Wilderness EMS (WEMS) courses, wilderness EMS is essentially unregulated on a national or international level. If a country regulated wilderness medicine certifications, it would likely roll the curricula and standards into its existing EMS system. Beneficiaries
Good Samaritan laws protect people who provide first aid at the scene of an accident, act in good faith for the patient's benefit, within their training, and do not receive payment for their services. First aid training addresses the specific needs of a workplace, and the course curriculum tends to vary with the organization; sometimes, this requires advanced training. Graduates of WFA, WAFA, and WFR courses work in remote environments, under challenging conditions, with minimal resources, and in places where traditional EMS is not readily available. Depending on the country and region, some treatment skills taught in wilderness medicine courses may not be considered first aid by local authorities, but practicing medicine and, as such, require a license. Again, depending on the region, a licensed medical advisor with prescribing authority may—or may not—be able to authorize trained staff to administer prescription medications or follow advanced protocols. Self-regulation Two potential self-regulatory options exist—accreditation or industry acceptance of scope of practice documents that set standards for WFA, WAFA, and WFR certifications. Accreditation Accreditation is typically the form of self-regulation that initially jumps to mind. If a wilderness medicine school is accredited, an external body has reviewed and approved its curricula, delivery strategies, topics, scope of practice, assessment requirements, instructor hiring, and instructor training guidelines according to a previously agreed-upon set of standards. Accreditation is not a panacea; it does not guarantee quality but indicates an organization has gone through an evaluation process that may improve its operations. Seeking accreditation is voluntary, and the process generally requires a rigorous, often costly, evaluation of the organization's pedagogy with a focus on educational quality. The accrediting body is typically a non-profit organization comprised of widely recognized experts in the field. At present, there is no accrediting body for wilderness medicine schools. Beneficiaries
Certification Standards Voluntary adherence to scope of the Wilderness Education Medicine Collaborative's (WMEC) certification standards documents is another form of self-regulation and a reasonable alternative to accreditation. The documents include a list of topics, skills, and the scope of practice (SOP) required for WFA, WAFA, and WFR graduates. Medically, scope of practice (SOP) documents define the assessment and treatment skills graduates can perform, while curriculum refers to content, delivery, and assessment strategies. Scope of practice, curricula, and certification are related and often overlap. For example, the scope of practice for a ________ graduates may require them be able to recognize and treat _______ As a result, _______ becomes part of the course curriculum; however, the SOP generally will not specify how a school must teach _______. While the WMEC certification standards documents may specify the minimum hours required to teach core material and in-person skill labs and simulations, they typically leave the curriculum details, delivery methods, and assessment strategies to the individual school. The Wilderness Medicine Education Collaborative (WMEC) formed in 2010 to provide a forum for discussing trends and issues in wilderness medicine and to develop consensus-driven scope of practice documents for WFA, WAFA, and WFR certifications. In 2022, they expanded their work to include related white papers and position statements. Collectively, the WMEC schools* have over two hundred years of experience teaching wilderness medicine and have trained over 750,000 students in the past four decades. Decisions regarding the content of the WMEC SOPs and papers are made based on emerging research and technology, peer-reviewed articles, and best practices. The WMEC SOP documents provide a basis for certification and curriculum development and are available for public use on the WMEC website. For the WMEC SOP documents to solve the wilderness medicine regulatory problem, international outdoor education and recreation associations must formally recognize them as the industry standard. Examples of industry-wide associations include the Association of Outdoor Recreation and Education (AORE), the Association of Experiential Education (AEE), and the Wilderness Education Association (WEA). Beneficiaries
Conclusion The United States EMS system will likely develop a Wilderness EMS (WEMS) certification in the coming years; however, licensing WFA, WAFA, and WFR certifications appear unlikely. That said, there is the possibility that state regulators may push for standardized exams, and if that occurs, the exams will have the potential to impact WFA, WAFA, and WFR course curricula. Creating an accreditation body also seems unlikely due to the expense and resistance from established WFA, WAFA, and WFR schools. Adopting the WMEC certification standards as industry standard for WFA, WAFA, and WFR courses seems the best option now, and into the foreseeable future. Don't know where to begin or what to do? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. All outdoor trips incur risk. Trip planners must balance the severity of a potential injury or illness with the expedition members' outdoor skills, equipment choices, and the availability of outside assistance. The planner must accurately assess each member's skills and other factors with:
 Program managers and trip planners often require a deeper understanding of preventative wilderness medicine strategies than most WFR or WEMT graduates possess. A medical advisor who is intimately familiar with the program or trip can recognize clinical conditions for specific medical problems and aid in developing effective mitigation strategies. Let's take a closer look at each risk category: Hazardous Weather Events Due to global warming, hazardous weather events are increasing worldwide, making a trip-related prediction of potential weather-related injuries challenging. In addition to injuries directly associated with weather events, changing microclimates are expanding disease and fauna boundaries, often increasing the range of infectious diseases and venomous creatures. Managers and trip leaders need to:
Inherent Activity- and Terrain-associated Risks Most activity- and terrain-associated hazards are well known within the outdoor industry. Nationally and internationally recognized professional organizations offer training and certification in numerous outdoor pursuits designed to promote best practices within the industry. Both professionals and non-professionals can benefit from these courses and certifications. Training in activity-specific rescue techniques and wilderness medicine, especially Wilderness First Responder, helps expedition members understand potential consequences should things go wrong and imbibe a conservative approach to risk and site management. Infectious Disease Outbreaks Each pathogen, animal vector, and host has an optimal climate in which they thrive, with warm, moist temperate, subtropical, and tropical environments being the best. Global warming has increased and will continue to increase, both temperature and precipitation worldwide, leading to the proliferation of many infectious diseases. While this trend is predictable, the exact type and location of an emerging disease are not, and exposure to and contracting an infectious disease in an area without historical data is increasingly common. To this end, expedition members should protect themselves by treating their water, ensuring good personal and expedition hygiene, taking aggressive precautions against insect-borne diseases, and avoiding potentially infectious animals and their habitat. Avoidance equals prevention, and there are no reliable field treatments for most infectious diseases. Do your research:
Evacuation-associated Injuries The ability—or lack thereof—to rapidly evacuate an injured or ill expedition member to definitive care may directly affect their outcome. Since the inherent risk of injury to rescue party members tends to increase with the severity of the patient's injury or illness, it is critical to diagnose the patient's current and anticipated problems accurately. In some cases, an accurate assessment may require more medical experience than expedition members possess, and a physician consult may be necessary. Any evacuation, regardless of the type or urgency, should not endanger members of the evacuation team or the patient beyond the team's capacity to manage the risk effectively. Interested in Wilderness Medicine? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available. Introduction Trip medical forms can reduce program liability and help administrators and field staff prevent injuries and illnesses. In most cases, prevention is accomplished through appropriate screening of participants and modifying the structure of a trip by adjusting the trip’s activities and routes to accommodate individual medical conditions or concerns. The type and format of a trip medical form affects the quality of information received and the ability of program administrators and field staff to prevent and treat injuries and illness in the field. Why require medical forms for trips?
How is client medical information collected? Medical information may be collected orally from the client or via a written medical form. Collection is more effective if all involved—client, guide/instructor, healthcare provider, etc.—know why the information is important and how it will be used. There are two basic types of written medical forms: Those completed by a health care professional (physician, PA, or nurse), and those completed by the client (self-reporting). Medical forms completed by a health care professional—especially if they are the client's personal physician—tend to be the most accurate. Those completed by professionals with little or no previous knowledge of the client—college or university clinics, for example—can miss some conditions if the providers rely heavily on patient self-reporting. Self-reporting may be oral or written. Oral self-reporting typically takes place the day of the trip, often as clients are ready to embark on the trip. The accuracy of oral self-reporting is questionable as it's easy for clients to forget something important or simply not mention it for fear they will not be permitted to go on the trip. Clearly written self-reporting forms are better than oral self-reports. Written forms—regardless of whether completed by a healthcare professional or by the client—tend to be more effective when a combination of check boxes and open-ended questions are used. For example, here's a question with Yes/No checkbox followed by a series of open-ended questions asking for more information: "Are you taking any prescription medications?" (Yes/No) "If you answered "yes" to the above question please:
If client medical information is so important, why don't all outdoor programs collect it?
Looking for a reliable field reference? Consider consider purchasing one of our print or digital handbooks; our digital handbook apps are available in English, Spanish, and Japanese. Updates are free for life. A digital SOAP note app is also available.
(What are they and should I join one?) With the worldwide increase in natural disasters, wilderness medicine graduates are uniquely poised to help their neighbors in the event of a local disaster. Communities in all 50 states have organized Community Emergency Response Teams (CERT). CERT members are volunteers, and teams are structured so that local managers have the flexibility to adapt the program and their training to the specific needs of their community. The concept originated with the Los Angeles City Fire Department in 1985 and went national through the Federal Emergency Management Agency (FEMA) in 1993. Contact your local fire, police, or sheriff department for more information or visit the CERT website.
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