You are the trip leader for a two-week high school snowshoe trip in the Adirondack mountains of New York state. It's day four. There was six inches of new snow on the forest road at the beginning of the trip. Last night it snowed three feet and it is still snowing hard. Looking closely at your map you realize that your original route crosses a few potential avalanche paths. After talking it over with your co-leader and considering the ever-increasing snowfall, you decide to reverse your route and head back. You have no satellite or cell phone reception during the storm.

After a day of struggling through the deepening snow, everyone is exhausted and wet from either sweat or snow when you reach your evening camp. You notice that two 16 year-old girls are particularly tired and shivering.

What are your concerns and what should you do? Click here to find out.

You are a trip leader on a five-day winter break backpacking trip in Linville Gorge, NC. It's day three of the trip when the gorge is hit unexpectedly with 14 hours of freezing rain. The rocks, trails, and trees are covered with an inch of ice; numerous trees have fallen, leaving the trails littered with trees and tree limbs, further increasing the difficulty of foot travel.

You are camped at the bottom of the gorge and scheduled to be picked up at 10 AM on the fifth day. To reach the pick-up at the scheduled time, you need to hike most, if not all, of the day.

What are your concerns and what should you do? Click here to find out.

You are a new administrator for a municipal outdoor recreation program. After assuming the position and reviewing the trip calendar, you decide to accompany a kayak touring trip to a local lake as an observer and assistant trip leader (the scheduled assistant canceled the previous day). While not an advanced paddler, you have led numerous multi-day kayak tours and the trip is marketed for beginning/new paddlers. It's early April and while the previous week has been unseasonably warm, the day of the trip is cool with a storm threatening. On arrival at the put-in you see the lake, long and narrow, stretch out before you. There is a light wind blowing down the lake at your back; you can see white caps on the horizon. The air temperature is 42º F; the water is 38º F. The lake is beautiful with vertical rock walls falling into the water on both sides. The clients arrive dressed—as requested in the pre-course literature—in long underwear, pile jackets, rain gear, wool beanies, and sneakers. After unloading the kayaks, the guide, a young man in his early twenties, pulled a drysuit over a light pile layer and donned neoprene booties. There were three doubles and three singles for nine people, including the guide; no spray skirts were provided. After a brief safety talk that focused on keeping the group together, everyone put on lifejackets, picked up paddles, chose their boat, and in six cases, their partners. The plan was to paddle down the length of the nine-mile lake, eat lunch, and return by 3 pm; it was no 10:30 am.

Watching launch preparations for the trip unfold at the put-in, you are extremely uncomfortable. While you are in overall charge of the tripping program, you are not the guide's immediate supervisor and you are here as an observer only.

What are your concerns and what should you do? Click here to find out.

Don't know where to begin or what to do? Take our Effective Outdoor Program Design & Management workshop and one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

Looking for a reliable medical 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.

You are a trip leader for a winter ski program. It's the second day of a week long (7-day) tour. Your route is point-to-point through rolling, heavily forested terrain where dead wood is readily available and fires are permitted. The entire route follows old forest service roads with excellent camping along the way; there is no avalanche danger. Halfway through the dinner on the second day it begins to snow heavily. The flakes are HUGE and very wet. Snow accumulates quickly at a rate of 2-3 inches per hour. It's necessary to wake every few hours throughout the night to knock snow from your tents to keep them from collapsing. By morning the snow has stopped and your campsite is buried beneath three feet of new snow. It seems to take forever to make breakfast and get out of camp. Breaking trail in the deep snow is hard work. By mid-afternoon everyone is wet from a combination of falling down and sweating. You decide to stop at the next available spot to dry out and camp for the night. A couple of your students are completely exhausted by the time camp is set-up. One, Katie, disappears into her tent and sleeping bag as other prepare dinner, look for wood, and start a fire. When dinner is ready, you send one of the students to wake Katie. The student returns saying she is in her bag and wants to sleep. You let her.

The temperature drops to -15º F during the night and everyone is slow to wake again the following day. Katie does not appear for breakfast. You go to check on her and can't fully awaken her. In the process, you notice that she appears to have slept in her wet clothes and much of her sleeping bag is frozen.

What is Katie's current problem, what should you do about it, and how could you have prevented it? Click here to find out.

Don't know where to begin or what to do? Take our Effective Outdoor Program Design & Management workshop and one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

Looking for a reliable medical 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.

Spring came early and warm temperatures precipitated an early run-off. Streams and rivers in the program area rose quickly. An instructor team with 10 college-age students were en route to their course end pick-up and were unexpectedly stopped by a flooded stream. The instructors were new to the course area and had no training in Swiftwater Rescue or high-water stream crossings; no emergency communication is available. After spending the night next to the swollen stream, they noticed that, although still quite high, the water level had fallen somewhat during the night and elected to attempt a crossing. During the attempt, one student was swept off her feet, into a fallen tree, and trapped under water against its branches. The rescue, although poorly conceived and extremely risky, was ultimately successful; however, the victim was recovered unresponsive with no pulse or respirations; and, her gear was lost. CPR was initiated and also successful; the patient recovered consciousness after 15 minutes with no memory of the event. One hour after the event she was warm, awake and alert with normal pulse and respiratory ratess, no spine pain or tenderness, and normal motor and sensor exams.

What were the administrative and site management errors, if any, that contributed to this incident? What are the patient's current and anticipated problems and what level of evacuation, if any, should be initiated? Click here to find out.

Don't know where to begin or what to do? Take our Effective Outdoor Program Design & Management workshop and one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

Looking for a reliable field reference for expedition medical problems? 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.