At times, the evacuation of a patient may be necessary for their further assessment, definitive treatment, and/or simply additional recovery time. All evacuations in a wilderness environment carry some inherent risk to members of the rescue party and the decision to evacuate a patient should NOT be taken lightly. The need for evacuation depends on the severity of the patient’s injury or illness and your resources. The type of evacuation depends on the mobility of the patient, the size of your party and its resources, the difficulty of terrain, the weather and the distance involved.

Any evacuation, regardless of the type—self, assisted, simple carry, litter, vehicle—should not endanger either you or your patient beyond your capacity to deal effectively with the risk presented during the evacuation. In most cases, your field treatment for minor non life-threatening injuries will be effective and rapid evacuation will not be necessary. By contrast, your field treatment for most life threatening illnesses or injuries may simply buy you and your patient some time. In these situations, focus on a quick accurate assessment and fast evacuation. The “medical window” for life-threatening problems is often specific to the particular illness or injury. If an emergency evacuation is not possible, your field treatment will usually be limited to treating the patient’s signs & symptoms and supporting their critical systems; this is often ineffective and your patient may die. In general, any problem that causes a change in the patient’s level of consciousness is very serious. If a patient reaches definitive medical care (major hospital) while they are still awake they have a reasonable chance for complete recovery. If they reach definitive care with a significantly decreased level of consciousness (voice responsive, pain responsive, or unresponsive) their chances for a complete recovery, or a recovery at all are respectively reduced.

In today’s world of rapid communication via cell or satellite phones, it may be possible to consult with medical or rescue professionals prior to initiating an evacuation. This type of consult should be encouraged and part of any emergency action plan (EAP). When in doubt, it’s always better to seek a consult sooner rather than later. A thorough patient assessment is required prior to any medical consult and the use of a detailed patient SOAP note will facilitate both accurate patient assessment and communication. At minimum, your location (GPS coordinates), party resources, and the current weather are required for a rescue consult. Conserve your batteries and set a communication schedule prior to signing off.

When you are uncertain if a evacuation is necessary and a consult is unavailable, the following general evacuation guideline may be useful: any problem that is persistent, uncomfortable, is not relieved by your treatment—or cannot be effectively treated in the field—requires an evacuation. The speed of the evacuation depends on the degree of involvement, or potential involvement, of any critical system(s). The greater the degree or potential, the faster the evacuation.

The following definitions for levels of evacuation are correlated to the severity of the patient’s injury or illness and hence the urgency and speed of their evacuation. Every effort should be made to accurately diagnose the patient’s current and anticipated problems since an incorrect diagnosis may lead to a false sense of urgency and a willingness on the part of the rescuers to accept more risk than the situation warrants. In general, rescuers should ONLY be willing to accept a level of risk they believe they can safely manage based on their skill and the foreseeable problems. Unfortunately, not all problems are foreseeable and the amount of risk any given rescuer is willing to accept tends to rise with the severity of the patient’s injury or illness. Since it is impossible to legislate judgment, rescuers, when in doubt, must base their decisions on the “worst realistic case” situation both in diagnosing the patient and evaluating the risk associated with the evacuation. That said, the risk of a minor injury or illness to a rescuer is generally present during most evacuations and unavoidable under the circumstances.

WMTC Urgent Evacuation Levels

Level 1
The patient’s injury or illness is immediately life threatening and the patient may die without rapid hospital intervention, e.g.: increased ICP, volume shock, severe respiratory distress, respiratory distress in a near drowning patient, advanced disease, moderate to severe hypothermia, HAPE/HACE etc. All VPU patients require a Level 1 Evacuation.

Level 2
The patient’s injury or illness is potentially life threatening or will result in a permanent disability; the patient may develop a life threatening problem that requires hospital intervention, e.g.: concussion that is getting worse, systemic infection, spine & cord injuries, near drowning (no respiratory distress), etc.

WMTC Non-urgent Evacuation Levels

Level 3
The patient’s injury or illness is NOT life threatening, has little or no potential to become life threatening, and may be successfully treated in the field with no permanent disability; however, the patient is unable to resume normal activity within a reasonable length of time and/or requires advanced assessment. (E.g.: concussion that is getting better, unstable injuries with good CSM, reduced shoulder (dislocation) with good CSM, etc.)

Level 4 (no evacuation)
The patient’s injury or illness is NOT life threatening, may be successfully treated in the field with no permanent disability, and the patient is able to resume normal activity within a reasonable length of time, e.g.: minor wounds, minor stable injuries, minor environmental injuries, etc.

There is typically little or no difference in the how a urgent evacuation is conducted. The difference lies in the mental preparedness and realistic expectations of the rescuers. If rescuers are not prepared for a patient death—as in a Level 1 Evacuation—research has shown that they will likely require more time to recover from post traumatic stress (PTSD) than those who recognize and accept that a patient’s death is a real possibility.

For the purpose of this document “Wilderness Protocols” are defined as any protocols outside the traditional EMS curriculum but supported by practice guidelines published by the Wilderness Medical Society (WMS), the National Association of EMS Physicians (NAEMSP), and the American Heart Association (AHA), and the Scope of Practice documents published by the Wilderness Medicine Education Collaborative (WMEC). They will likely include but are not limited to:

• Use of prescription drugs, herbs, and OTC drugs.
• Field management and clearing of spine injuries.
  
• Wound cleaning.
• Treatment of impaled objects.
• Field management and evacuation guidelines for specific environmental injuries.
• Field management and evacuation guidelines for specific traumatic injuries.
• Field management and evacuation guidelines for specific medical problems.
• CPR protocols.
• Specific treatment of preexisting conditions (e.g.: asthma, diabetes, etc.).

In conjunction with their physician advisor, each institution should establish written wilderness medicine protocols to act as guidelines for the field management of trauma, environmental, and medical problems. The protocols should define when they should be used based on the timeliness of conventional EMS response. Wilderness Medicine Protocols are usually in effect when a group is longer than one hour from definitive care (with the exception of immediately life-threatening situations: e.g.: severe asthma, anaphylaxis, etc.) Institutions should also develop a first aid kit designed to support their guidelines and staff should be trained in the use of the kit contents on a regular basis. The use of weatherproof Patient SOAP Notes for documentation is highly encouraged.

We recommend that institutions and their physician advisors review the NAEMSP position papers, WMS practice guidelines, and the WMEC Scope of Practice Documents before amending them to the needs of their program(s). Institutions should consider adopting the following general guidelines for staff trained to the Wilderness First Responder Level (WFR):

• Administer 0.3 cc 1/1000 epinephrine by SQ/IM injection (Rx) and subsequent oral H1 ± H2 antihistamine at the first sign of a anaphylaxis in an adult (standard pediatric dose is 0.15 cc or 0.01 mg/kg). Subsequent injections are indicated if: the S/Sx increase after the last injection or do not resolve within 5-15 minutes of the last injection. Oral antihistamines should be kept current for 24 hours. Consider 10-50 mg of oral prednisone—typically administered for a maximum of two doses—if evacuation to definitive care is greater than 8 hours; for those who tolerate it, it is good insurance. (Some patients may be allergic to prednisone, others, especially children and teens, may have adverse side-effects.) Clearly define evacuation guidelines.
• Clear potential spine injuries in the field using one of the following focused spine assessment (FSA) protocols: NEXUS or modified NEXUS, Canadian C-spine Rule, or WMS guideline. Clearly define how patients who fail the FSA are to be handled during their evacuation. Rigid cervical collars and full spinal immobilization are dangerous and should be avoided. Obtunded patients should be evacuated in a commercial or improvised litter with their spinal cord protected from abrupt or gross movement using a vacuum mattress or soft padding.
• Aggressively pressure flush full thickness wounds with “drinkable” water and protect with an appropriate dressing. Wounds at high risk of developing an infection may also be flushed with a antimicrobial solution depending on physician advisor preferences. Deep, highly contaminated  wounds  may  be  wet  packed  with  the  same  solution,  splinted,  and  evacuated; do NOT close high risk wounds in the field. Evacuate all wounds with underlying damage to deep structures (bone, tendons, ligaments, cartilage).
• Remove impaled objects in the field if they interfere with safe transport or are likely to cause additional damage if left in place. Removal should be easy and not cause undue additional damage. Clean the wound as described above.
• Attempt to reduce simple dislocations of the shoulder, patella, and digits (resulting from indirect trauma).
• Discontinue CPR if the patient remains pulseless for 30 minutes. CPR hypothermia protocols should be clearly spelled out.
• Treat severe asthma with 0.3 cc 1/1000 epinephrine by SQ/IM injection (Rx); repeat prn q 15-20 minutes for a total of three doses. Administer 40-60 mg oral prednisone.

Authorization should be in the form of a written document that clearly identifies:

1. The sponsoring organization (e.g.: outfitter, schools, institution, club, etc. name).
2. A brief summary of the purpose: standard EMS training is based on immediate access, assessment, and transport via 911 communications. This level of training and subsequent scope of practice does not address the special considerations required in a wilderness/remote environment where delayed  transport,  prolonged  exposure  to  severe  environments,  and  limited  medical  equipment are the norm.
3. Who is authorized to use the protocols (currently certified WEMT, WFR, WAFA, etc.).
4. Each individual protocol—acute allergic reactions, spine clearing,  etc.—should  briefly identify the problem and specify signs, symptoms, and treatment (including evacuation). Ideally the protocols should be referenced to the providers original course text, handbook, etc.
5. The medical director/consulting physician who is authorizing the treatment, their license number, and date.

The completed document should be signed and dated by the institution's medical director.

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.

Cardiopulmonary resuscitation (CPR) and cardiocerebrial resuscitation (CCR) are valuable first aid skills and we should all master them. That said, their effectiveness is severely limited in a wilderness environment. Cardiopulmonary resuscitation uses a combination of chest compressions and rescue breathing to delay brain death and extend the resuscitation window while cardiocerebral resuscitation utilizes chest compressions only; both are potentially life-saving techniques. It takes approximately 10-12 chest compressions to build enough intrathoracic pressure to start circulating blood. The same intrathoracic pressure that circulates the patient’s blood also brings in a small amount of fresh air and oxygen. If there is residual air and oxygen in the lungs—as occurs in cardiac arrest caused by a heart attack—chest compressions alone are more effective in delaying the onset of brain death than when combined with rescue breathing because they maintain a consistent intrathoracic pressure. Conversely, a combination of chest compressions and rescue breathing (CPR) is more effective than CCR for patients whose arrest stems from a primary respiratory problem and lack of available oxygen as occurs in near drowning, lightning, complete snow burial, etc. The effect of both techniques decreases rapidly over time and cannot save or prolong the life of a pulseless patient for greater than 20 minutes and neither CPR or CCR work with major trauma patients whose arrest stems from increased ICP, significant lung damage, or volume shock.

For CPR or CCR to be effective the patient’s circulatory system must be intact and their core temperature above 90º F (32º C); your chest compressions must be hard and fast (ideally at least 100 per minute) and delivered in the lower third of the patient’s sternum; your weight must be directly over the patient and the patient’s chest must be allowed to fully recoil between compressions; the recoil is as important as the compression. If rescue breathing is indicated, ventilate until the patient’s chest begins to rise; do not over-inflate—over-inflation forces air into the patient’s stomach and increases the chance or frequency of vomiting.

In settings where rapid defibrillation, advanced cardiac life support, and rapid transport to a major hospital are not possible, the overwhelming majority of patients in cardiac arrest will die. It is important that all rescuers understand the limits of CPR and CCR and when it is appropriate to start and stop.

When teaching chest compressions in our wilderness medicine courses we often tell students to compress at the rate of the beat in the Bee Gee's disco tune "Staying Alive" or Queen's "Another One Bites the Dust" depending on whether a student views the glass as half full or half empty.... (Yes, humor is important in the medical field.)

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
In 2007 we piloted our first hybrid course in wilderness medicine; in 2008 we opened them to the general public. Overall they were—and are—hugely successful. Our hybrid course curriculum is continually evaluated and our delivery systems updated annually. Each of our medical courses has a hybrid option.

Your time and money are important; so is your education. We've written this article to explain—as thoroughly as possible—what you are getting into when you register for one of our hybrid courses. It's important to understand that the Wilderness Medicine Training Center International is both a business and an educational entity. We take our educational responsibility very seriously. That said, because our hybrid courses require a significant financial investment on our part to maintain and deliver, once you have registered and paid for a hybrid course there are no refunds. Please read this article carefully and contact our office if you have any questions before you register and pay for a course.

Our hybrid courses are divided into two distinct parts, you must complete both parts within a year to receive certification.

Part 1
​Independent Study
​Learn the wilderness medicine curriculum online and at your own pace through multimedia presentations, the Wilderness Medicine Handbook, case studies, SOAP Notes, and testing. 

The Independent Study section provides the foundation for the Practical Session and is presented entirely online with minimal or no instructor contact. Students can complete the Independent Study from wherever they can access the course website. 

The Independent Study section requires a high degree of initiative and self-direction. Students who prefer to learn completely under the direction of an instructor may be challenged to move through Independent Study effectively.


Part 2
Practical Session
The Practical Session is facilitated by expert instructors who clarify and reinforce the Independent Study information with skill labs, simulations, and case study reviews. 

Because there may be a large gap between the time you finish Part 1 and begin Part 2, you will need to take an online Review test two weeks before the start of your practical session. The review test is designed to refresh key concepts learned during the Independent Study. You can also review your original tests and you will still have access to the course website.

You may register for for any Practical Session offered by any WMTC sponsor after you complete the Independent Study. 

The Independent Study section and the Practical Session both contain technical terminology as well as complex explanations of concepts. Students who are English language learners or who have certain learning disorders sometimes find this aspect of the curriculum challenging. Please contact the WMTC office before you register for a hybrid course if this might be a concern for you.

Part 1
Independent Study Details

Online Test Details
Content Tests
Content tests are fundamentally a practice test; they are easier than the Application tests and may only be taken once. You will receive answers to the Content test questions immediately after submitting them, and while the test is scored, the score doesn’t count. That said, your score will give you an idea of how well you understand the basic material.

Application Tests
The Application test questions are all scenario-based and WFR, WAFA, and WEMT students need to score ≥ 80% to pass; WFA students must score 75% to pass. You will be able to study for, take, and retake each Application test multiple times. (Some application tests have a 2-4 hour mandatory study/wait period before you can take the test again. We’ve found that students who take back-to-back tests without studying between them tend to fail the next test.) That said, there is a limit to the number of times you may retake a given test. If you reach the test limit, please contact the WMTC office where one of our senior instructors will review your last test, send you detailed written feedback via email, and give you one final opportunity to take that test. You will have the opportunity to review the feedback and ask the instructor questions before taking the test again. If you fail the same Application test again, you may not continue with the course, attend the practical session, or receive a refund for the course; it’s important that you know this. Keep in mind that historically 99% of the students who failed an Application test, received instructor feedback, and go on to take that test again, have passed that test.

While we provide a time range for completing the home study portion of each course, it’s a rough estimate: You may require more or less time. To that end, it’s important that you plan and schedule more time than the high end of the estimate to help ensure you can complete the home study portion in time to register and attend a practical session.

Scoring
Scoring for the online tests is complex as the answers are weighted: Correct answers are awarded 1-3 points while 0-3 points are subtracted for incorrect answers; the sum total is the score for that question, however, the lowest score anyone can receive for an individual question is 0 points. If you fail a test, you are not told the answers or given an explanation; it's left up to you to research the test question and answers using the course materials. This means that you cannot guess answers and will need to problem solve; details are important. 

Hybrid Course Websites
The hybrid course websites are essentially an online textbook with text, animations, and videos. Because there is no direct instructor interaction during the home study portion of the course (unless you fail an application test three times), the sites include case studies (and follow-up discussion) to check your understanding prior to taking the online tests. Keep in mind that the online tests are both an educational tool as well as an evaluative tool. As such, they are challenging and few students pass on their first attempt. There are two types of online tests: Content & Application tests; you can review tests you have already taken at any time.

Please visit the hybrid course website you are interested in to see how it is organized and get a rough estimate on how much time you should plan in order to complete the home study portion of the course; plan for more time than you think you will need. Thoroughly read the information on the Splash page and view the Lightning presentation to make sure the course meets your needs; the actual site is password protected, and entered via the button titled “Registered Students.” The website password together with login information to our online testing site and a link to the course study guide are sent to students upon registration.

    Hybrid Wilderness First Aid website
    Hybrid Wilderness Advanced First Aid website
    Hybrid Wilderness First Responder website
    Hybrid Wilderness EMT website
    Hybrid Recertification website

Part 2
Practical Session Details

There are no formal lectures during the practical session. Instead, the practical session focuses on the practical application of the independent study information: skills labs (splinting, wound cleaning, reducing dislocations, assessing and managing potentially spine-injuried patients, etc.), simulations, and case study reviews in order to prepare you to respond effectively to real-life injuries and illnesses. The time you spend away from home or work is significantly less than that required by our standard courses. Serious students can actually learn MORE via hybrid course because their they can process the information according to their learning style and in their own time.

Because there may be a large gap between the time you finish Part 1 and begin Part 2, you will need to take an online Review test two weeks before the start of your practical session. The review test is designed to refresh key concepts learned during the Independent Study. While the review test is scored so you can self-evaluate, there is no pass or fail;. however, you are responsible for knowing the information in order to pass Part 2 practical session. You will still have access to the course website and can look back through your original independent study tests to refresh your memory of key concepts.

Standard vs. Hybrid ~ Which one should I choose?

Both courses cover the same material using slightly different pedagogy. Tuition for both courses includes our weather-proof Wilderness Medicine Handbook and our Patient SOAP Notes. For some people, the primary decision-making factor is time away from home or work; for others, it has to do with their learning style, and still others it has to do with location or dates; for most, it's a combination. The tabbed information below should help you make a decision. Remember, you can always call our office and discuss the course type or format with one of our staff.

More thoughts on whether or not YOU should take a hybrid course
If you like studying by yourself, are intrinsically interested in wilderness medicine, have good study habits and discipline, like problem solving, have enough time to study, have a computer or tablet with a fast processor (Smartphones do work, but the screens are so very small....) and high speed internet access, and would like to spend as little time away from home or work as possible, consider taking one of our hybrid wilderness medicine courses.

If you are seeking to recertify your current WAFA, WFR, or WEMT certification our hybrid Recertification course is likely to be extremely attractive. As a graduate of an approved WAFA, WFR, or WEMT course, you already have a grasp of the didactic information and there is little need for you to sit through a lecture on material you could easily review on your own. Our hybrid WFR & WEMT  Recertification course allows you to spend only the you need to brush up on your anatomy, physiology, and pathophysiology by using the Recertification website, case studies, and the on-line test to focus your study. You maximize the your time away from home practicing skills and participating in as many simulations and case study reviews as possible to get the rust off. That's EXACTLY what our Review & Recertification course does. (Graduates from other wilderness medicine schools should keep in mind that our courses may require a deeper understanding of anatomy, physiology, and pathophysiology than your original course or use slightly different medical terminology. If so, you may require more time to complete the home study portion of the course than is advertised on the individual course website.)

If your WFR or WEMT certification has expired or you are looking for a more in-depth practice than a Recertification course can provide, our hybrid WFR or WEMT course will meet your needs without wasting any of your precious time. Similar to students seeking normal recertification, you already have a grasp of the didactic material and have little need to sit through basic lectures. You need to brush up on your skills, renew your certification, deepen you knowledge of wilderness medicine, and maximize your time spent away from home or work. That's EXACTLY what our hybrid WFR and WEMT courses do.

If you are a current EMT or medical professional seeking knowledge and certification in wilderness medicine you already have a working knowledge of normal anatomy, physiology, and pathophysiology you'll appreciate our hybrid WEMT module. While the practice of medicine in a wilderness setting is MUCH different than its urban counterpart, your background and experience will likely permit you to rapidly move through the home study portion of the course and, as mentioned above, maximize your time spent away from home or work.

There are people who should NOT take one of our hybrid courses.
Are you one of them?
Yes, we admit it: Our hybrid courses are not right for everyone. There are definitely some people who should probably think twice, or three times, or four times, or more before registering for the Part 1 Independent study portion of one of hybrid courses. Here are a few clues to help you decide if you are one of them or not.

• If you don’t like studying on your own.
• If you are not fluent in the language the course is offered in.
• If you are not disciplined.
• If you can’t schedule more than the maximum amount of recommended study time as listed on each course website. (If you plan for more time than you actually need, you’re golden.)
• If you are not familiar with and easily frustrated by technology.
• If you want a certification but aren’t really interested in the material and aren’t willing to work hard.

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.

This is an excellent practical question! Since students remember the skills and information they use on a regular basis, skill retention is shared by the wilderness medicine provider, their employer(s), and the graduate.

1. Wilderness medicine providers are responsible for:

• delivering the course material in a practical hands-on manner with as many skill labs and simulations as possible so students are able to grasp the required concepts and skills.
• providing on-going case studies and updates via blogs, newsletters, and other media to aid a graduate's knowledge retention.
• providing a field handbook and/or app that gives graduates access to assessment and treatment data.
• providing training and training options to a graduate's employers so they can run effective simulations and training sessions for their staff on a regular basis.

   
2. Employers of wilderness medicine graduates are responsible for:

• taking advantage of the training opportunities and strategies offered by the wilderness medicine providers.
• providing on-going simulation training, case study review, and discussion of possible problems—including their assessment and treatment—that their trips may encounter to their employees.

   
3. Graduates are responsible for:

• taking advantage of the opportunities offered by the wilderness medicine providers and their employers.
• taking a recertification course when they think their skills are becoming inadequate even if the course is before their certification expires.

Follow-up questions include (and will be addressed in later blog articles):

1. What are the most effective delivery strategies for providers?
2. What are the most effective strategies for employers to use to maintain their employees' assessment and treatment skills?
3. What kind of medical training do outdoor program administrators and directors need so they can make preemptive program design changes and on-going training decisions for their programs? This is especially true when it comes to preparing staff to deal with environmental problems. For example, program directors need to understand heat acclimatization in order to design training sessions and protocols for trips where the heat challenge may suddenly increase. They need to understand the physics behind lightning to train staff how to manage a rapid descent from an exposed ridge when an unexpected lightning storm approaches. Etc.
   

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.

I think everyone benefits from a basic understanding of how the body works and how to take care of it; after all, we've each got one. From this perspective, everyone should take our Wilderness First Responder course. Like everything else associated with education, you need an effective curriculum, well-written study and reference materials, realistic training supplies (first aid kits, an full-sized anatomical torso, a full-sized skeleton, litters, backboards, etc.) trained teachers, and, ideally, intrinsically motivated students. We supply everything but the last component.

Unfortunately, most people are busy and taking time to learn about their bodies and first aid falls pretty low on their "to do" list. Enter extrinsic motivation: college or professional credit, job requirement, being involved in—or hearing about—an accident or incident that "could have happened to you" and not knowing what to do, etc. Once extrinsic motivation enters the picture, it defines the course parameters. For example, if you want to be a trip leader for ________ college and they require a Wilderness First Aid course, then it's likely that you will take the course they sponsor or recommend. At the same time, it's doubtful that you will seek out and take a more intensive Wilderness First Responder course; after all, a WFR is longer, more expensive, and will require a greater investment on your part.

See how complicated the answer is to this apparently simple question?

Moving on....
One way of looking at the answer to the above question is rephrasing it to mean "what skills will I REALLY use on a trip?" Well, that too, depends....

If you are on a day hike in moderate terrain in a neutral environment with young healthy people and have cell phone coverage (and you bring a fully-charged phone), you probably don't need to know a whole lot of first aid or bring a much with you in terms of first aid supplies. You'll probably benefit from knowing how to—and carrying supplies to—prevent and treat blisters and treat minor wounds, headaches, and pain. If you are untrained and reading this article, you probably already have some idea how to do all this, along with what to carry: a few band-aids®, some water, mole skin® or tape, and ibuprofen. If it's more complicated than that, you can always call for help. Right? Maybe.

The problem with this way of thinking lies in the variables. If the terrain is dangerous (lightning, avalanche, rock fall, big rapids, etc.) it's likely that an accident will be more serious and require more training and supplies than you have to address. If the environment is too hot, cold, wet, dry, etc., you'll need more training, and perhaps more supplies to prevent (ideally) and treat (hopefully) any environmental problems that arise. If you have kids, older adults, or people with health issues, you may not have the knowledge or supplies to help them.

What about the unexpected? What happens if someone gets stung by a bee, has a life-threatening allergic reaction, can't breathe, and you don't know how to treat them or don't have the materials (epinephrine auto-injector)? They will likely die before help arrives. I guess this might extrinsically motivate you to take a course but it won't help your friend....

The bottom line is that you don't know what you don't know. We have spent years and years as guides, outdoor instructors, rescue team members, and wilderness medicine instructors. We work very hard to develop a curriculum, delivery methods, materials, and instructor training program that remains unparalleled in the industry. And, we continue to research and improve every day. Take a tour of our website. Look at our individual medical courses and materials, think about our mission, vision and educational philosophy, take a look at the faces and experience of our instructors, visit our online store and see how our curriculum influences the design of our first aid packs, first aid kits, and the supplies we sell, and then come take a course from us. If you are interested in your wilderness medicine education, you'll be happy you did.

Okay. So what course should I take?

1. If you are—or want to be—a guide or outdoor instructor, take our Wilderness First Responder course.
2. If you are intrinsically motivated, take our Wilderness First Responder course.
3. If you want to take a course but don't know which one to take, take our Wilderness First Aid course. Our WFA course will help you define both your needs and your motivation. Many students go on to take our Wilderness First Responder course months or years later.
4. If you want to take a Wilderness Advanced First Aid course, take our Wilderness First Responder course UNLESS you are complete extrinsically motivated by a very specific job requirement.
5. If you already have an urban EMT certification (or are a physician, physician assistant, nurse, or medical student) and want to further your knowledge, take our Wilderness EMT Module. An urban EMT course, or advanced medical training in an urban setting, DOES NOT prepare you for preventing or assessing and treating problems in a remote setting.
6. If you work—or want to work—in remote areas as part of a rescue or relief team take either our Wilderness First Responder course or, if you are already a medical professional (EMT, physician, physician assistant, nurse, etc.), take our Wilderness EMT Module.

There are a lot of wilderness medicine providers. Does everyone teach the same course? In other words, does it matter who I take a course from as long as I take one?

1. Yes, there are a lot of people and companies offering courses in wilderness medicine; a web search will reveal the ones with the best marketing....
2. No, not everyone teaches the same material in the same way. Not all WFA, WAFA, WFR, or WEMT courses cover the same material using the same—or even similar—delivery methods and materials. In fact, there can be a LOT of difference between companies. Click to read an article on how to choose a wilderness medicine provider (or simply take a course from us!).
   

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.

Children are physiologically and psychologically different from adults. You must take these differences into account, and act accordingly, when you bring your children into the outdoors. Below are a few things to think about before you head outside with kids.

Small children live completely in the present and are easily distracted; this makes it difficult for them to remember and follow the new and unfamiliar rules that accompany outdoor activities. In addition, the hazards presented by outdoor living and adventure sports are different than those most children are accustomed to. Young children and children new to a specific outdoor activity must be closely monitored at all times. When you decide to bring a child into the outdoors, the trip must focus on the child's needs rather than your own; get your enjoyment by watching them explore, grow, and have fun.

Keep in mind that children are individuals and will not respond in the same way physiologically and psychologically. Common problems and solutions are discussed according to their mechanism below.

The American Red Cross offers a Wilderness & Remote First Aid Course based on the curriculum developed by the Boy Scouts of America. While the Red Cross has a long history in teaching urban first aid, their Wilderness and Remote First Aid course leaves much to be desired when compared to the Wilderness First Aid courses offered by most of the professional providers. If you are considering taking the ARC course—or becoming an instructor for one—below is a list of pros and cons.

Introduction
Spending time outside for work or play is part of human history, both past and present. Interest in the outdoors is constantly growing with new human-powered and motorized activities/sports emerging on a regular basis. The development of more sophisticated equipment allows access to more challenging terrain and environments...and greater risk. Use permits, once unheard of, are now the rule—and are increasingly difficult to procure for both individuals and organizations. Wilderness ethics are changing as use increases and "leave no trace" has become a mantra for many. In short, the outdoors has become a thriving industry.