Wilderness First Aid: A backpacker’s view

[Paul Magnanti]

Wilderness First Aid is a basic certification for the assessing, treating and stabilizing of a person's injuries in the backcountry. But how does the (sometimes) gear and equipment focused backcountry medicine co-exist with a more minimalist view? Here is my own take.

Wilderness First Aid is a basic certification for the assessing, treating and stabilizing of a person's injuries in the backcountry.  But how does the (sometimes) gear and equipment focused backcountry medicine co-exist with a more minimalist view? Here is my own take.

 

In anticipation of assisting as  a guide, I earned both my Wilderness First Aid (WFA) and CPR certifications.   The CPR class was aimed towards an urban environment but was easy enough to apply to a wilderness setting.

The WFA class, as the name implies, is meant for the backcountry enthusiast to provide for assessment  and treatment of medical issues in the backcountry.  The class covered injuries and situations ranging from blisters to hypothermia to head trauma. Pretty extensive.

The class was over the course of a weekend.  The class itself comprised both classroom instruction and hands on practicals with scenarios simulating real life situations. 

As with all medical instruction, process was stressed (and rightfully so; with a process in place consistent care is provided along with the ability to convey accurate info to the appropriate personnel).

The class itself, and the situations, did reflect the majority of the people who took the class: People who lead day-use activities into the more accessible parts of the backcountry and may not go far.    A large portion of the class took place outdoors in weather that threatened to turn all weekend. I was bit surprised at the people in sandals, t-shirts and jeans and had no warmer clothing to change into for the outdoor portion of the class.

When I naively stated to a few people how carrying all this lightweight firs-aid gear would soon add up to 40 lbs, I was given a few different reactions….

The first reaction was invariably that 40 lbs is not heavy. ;)  Another one was "I'll just carry the gear."  

The personal challenge for me in this class was applying the new knowledge and skills for the further reaches of the backcountry. Where carrying extensive gear and supplies to cover all situations is not necessarily the best option.

I enjoy going further into the backcountry and believe that knowledge, not gear, is more important in the outdoors.  Because of this inclination, the best part of the class for me was how to take the knowledge given and improvise with normal gear.    Hiking poles and pads provide splints. A bandana helps make a sling. And the every handy duct tape does wonders for well, almost everything. :)

The class did show some equipment that I am now considering bringing for both myself and items to add when guiding.

Rather than buy a very expensive kit that has too much or too little depending, I'll just make my own.

So what am I going to  take?  Think I'll keep my normal first aid kit pretty minimal.

• Ibuprofen
• Gauze pads
• Band-aids
• Semi-permeable bandages (new for me…they do wonders!)

And of course make use of the normal items I carry such as Purel, duct tape, bandanas, clothing, poles, a foam pad and so on.

When I am assisting on a trip, I will be more cognizant it is not just me that I am taking care of and have more responsibilities.

I am not 100% sure of what I am going to take, but<span style=””> have </span>some ideas from these sites:

1. Sectionhiker.com DIY Ultralight First Aid Kit
2. Traditional Mountaineering First Aid Kit
3. Hikingdude.com Outdoor First Aid Kit

The tentative list is looking to be along these lines

• The basic solo kit mentioned earlier
• Naproxen for those with Ibuprofen allergies
• Antihistamine
• Alcohol wipes
• Irrigation syringe
• Latex gloves
• …and more knowledge thanks to the class

I feel that the additional medicine and items carried, along with acquired knowledge and experience, should cover a mix of situations until a person can be given more comprehensive care.

Thoughts?

[John S.]

If I was going to be liable for others in a commercial guide situation (getting paid for it), I'd take a Wilderness First Responder course. Some parks require it.

Remember, you will be expected to (and liable if you don't) have enough equipment to cover the entire group.

[Paul Magnanti]

…and that includes fear of lawsuit. :)

Not arguing with your logic per se, but what is the tipping point between enough and too much? Can we take the lightweight theory of utility and making gear do multiple uses any apply it to backcountry medical as well?

Certainly carrying more because there is responsibility but how much more is the question?

Do we carry enough to cover every specific situation? Or enough to improvise if we have to?

The discussion goes to the heart of lightweight backpacking IMO as well.

Seems like all aspects of the outdoors is equipment focused as opposed to knowledge focused and wondering what a good balance may be.

Just food for thought with no right or wrong opinion. Honestly curious.

(On a side note, WFA is needded to be the assistant as opposed to the jefe IIRC )

[Bob Gross]

"Do we carry enough to cover every specific situation? Or enough to improvise if we have to?"

That is always the question.

Many backpackers carry lots of the small items that they expect to use. Those are convenient, but they may not be that important. Other backpackers carry virtually nothing of the small items, and they only carry the big or important items to be used for a serious injury. Of course the first group never carries those big items, and they say that they will just wait to be evacuated.

So, it all kind of comes down to (1) how remotely will you be traveling, (2) what are the chances of help finding you spontaneously, (3) what are the chances of getting help from the authorities?

I'm always reminded of the off-duty U.S. Marine who was solo hiking without any gear. He fell off the trail down into a stream bed with both legs broken. What did he do? He just survived there on stream water until he had gathered enough strength to crawl back up the hill and back out on the trail. It took him a long time.

–B.G.–

[Gerry Volpe]

Skill is definately most important for WFA and backpacking as well, though gear can be fun and convenient. When leading trips for my previous employer the FAK mandated by policy was huge and heavier than many solo lightweight gear kits in there entirety. The people who made the lists did a one size fits all for canoeing, car camping, and backpacking. Liability wise I was taking a risk everytime I took a backpack trip out with my unapproved FAK so I still carried more than I wanted but it was a more reasonable weight. Having taken (and let lapse unfortunately) both WFA and WFR I am comfortable improvising most of what might be needed in the backcountry. It is nice to have some basic bandaging supplies and over the counter meds(depending on organization policy) and I feel that it is worth taking a couple epi-pens if I am responsible for a group of people in an official capacity but it doesn't have to weigh much. On a personal trip I take very little in the way of a FAK and hardly ever use anything beyond duct tape, tp, and hand sanitizer. Like you said knowledge is much more important and there is a lot to improvise with on a backpack trip. The one thing I tell myself I should always(not just backpacking) have but rarely seem to is gloves and cpr mask but that is another story. There are plenty of sources of irrigation out there such as water bladders and plastic bags so I wouldn't carry one unless required by the organization.

[Mary D]

Some observations based on the above and on my own experience with WFA:

The WFA (or the equivalent) classes I've taken (four of them over my lifetime) emphasized improvisation with materials normally on hand in the backcountry. In the last hour of my most recent class we discussed first aid kits, and the question of weight was most definitely considered. So were the principles of risk assessment–i.e. what are the statistical chances of actually encountering a given problem?

The size of the first aid kit really depends on the size of the party. I take quite a bit more when taking along my grandchildren than I do when going solo, simply because the more people in the party, the greater the chances of something happening. As every parent knows, young children are forever skinning knees and elbows! I don't take an irrigation syringe when going solo (I'll poke a tiny hole in a plastic bag if I need it), but I do take one when going with the kids, along with more extra-large bandages. For a larger group, the leader should have a group first-aid kit to supplement items taken by individuals, which would probably include an irrigation syringe and a SAM splint. It isn't necessary for each individual to carry the kitchen sink.

I was also taught that in many states it is illegal to dispense medicines, even OTC stuff, to another person if not licensed to do so. I therefore will not give anyone else my medications. In the case of my grandchildren, I take along medications furnished by their parents.

When going solo, I frankly do not prepare for the less than 1% chance of my encountering someone with a serious problem along the trail. I know that coming upon the unexpected is a favorite scenario in WFA classes, but in 70 years of extensive backcountry travel, I've never encountered one. Any injuries I've actually encountered (which included one of my own, BTW) were within my group. Should the unexpected encounter happen, I will improvise using mostly whatever the other person brought along.

Finally, it was stressed in my classes, particularly the most recent ones, that the very first thing to assess in such a situation is the safety of the person rendering assistance. While this sounds selfish, ignoring this vital step will only create more victims! I took an abbreviated "call 911" type first aid session given along with my last CPR class, in which the same thing was stressed–environmental hazards can be even more of a problem in common situations like traffic accidents.

Keeping calm and doing your best to keep everyone else calm was also stressed. IMHO, this was the most difficult part of the various scenarios in my classes (we had some really good actors!). I'm sure it's even more difficult in an actual situation!

If I were going to be leading groups (meetup groups or clubs), I would definitely take more than a class in WFA–at least Wilderness First Responder. If I were leading groups commercially, I'd take Wilderness EMT. Either way, I'd make extra sure my certification stayed up to date.

I'm fortunate to have a son-in-law who is both an ER physician and a backpacker. He's my source for keeping up on the latest protocols. Every spring I reread my WFA text and notes and ask him about anything of which I'm unsure.

[Jake D]

Have not taken WFA/R but as an athletic trainer a lot of it is the same.

i have bandaids, gauze, 1/2 section of steri strips, duct tape, half roll of 1" tape, triangle bandage, emergency blanket, advil and benadryl.

[John S.]

This is a good discussion Paul. After I responded to your post I saw you were helping Andy and thought it might be fine if the assistant was WFA only with the main leader being WFR. Andy is a smart guy who will surely do his research on what first aid materials are required in the guide industry for the given group size.

Regarding the latex gloves, some people are allergic and you may not know until you see a reaction. Nitrile gloves should be considered.

[Michael Ray]

Andrew says in his book that he took an 80-hour course which greatly increased the weight of his FAK. I thought that rather ironic since most people's FAK get much smaller after WFA, but he didn't include the context that it was for group trips he was leading (and thus liable for). I can understand it in that context.

[John S.]

Here is a list from Dr. Paul Auerbach that can help with choices for a group FAK.

http://www.healthline.com/health-blogs/outdoor-medicine/rescue-essentials-gear

[Bill Law]

Coincidentally, I just read this article. I was going to look at updating my minimal FAK accordingly. I need to see how NOLS recommends taping a sprained ankle, as that's the most likely "serious", self-treatable affliction I'm apt to experience.

[Paul Magnanti]

John, thanks for the kind words.
Just some ideas rattling around in my head since taking the class and curious what other people may think. :) Very pleased at all the discussion people are having (and a civil one at that!).

As a person who is minimalist in not just backpacking but in general, it is interesting to balance gear vs knowledge; preparedness vs taking too much.

Of course, it does not hurt to do some thinking for myself too once in a while.. ;)

[Rex Sanders]

I've been certified in WFR for about 20 years, the last 10 years through NOLS-WMI. I've been on 21-day Grand Canyon rafting trips that took several large Pelican boxes full of first aid supplies; and I've backpacked solo with kits in a small Ziploc. I've been on trips with helicopter evacs, and one or two that should have had one. I've probably fixed up as many strangers found in the back country as myself or friends. And I've had more than a few personal medical emergencies.

So here's my 2 cents.

– Take WFR, not just WFA. You learn a lot more about how bodies work and break. You'll learn how to improvise, and what you can't improvise. You'll learn when you need to evac, and when you can stay and play. You get lots of critical hands-on experience, and most people have fun.

– Before you grouse about the time and expense – how much have you spent on gear? How long did it take you to learn to backpack super-extra-ultra-mega-lite?

– Stay certified in WFR, which usually means a 3-day recert course every two years. The repetition really helps the lessons stick, your skills stay fresh, you stay calmer when bad stuff happens, and you stay up-to-date on the best practices.

– Before you decide "I can improvise X by doing Y" – try it and see if it works. Ever tried to clean a wound by poking a hole in a plastic bag? How well did that work, compared to a 9 gram syringe? Tried taping an ankle with 2 feet of duct tape? Tried stopping major bleeding by hacking up dirty clothing that you really need since that storm is still raging?

– Think about what you really can't improvise in the back country for relatively common and/or life-threatening situations. On my short list is Benadryl for anaphylactic shock; aspirin for heart attack; Imodium for diarrhea; prescription painkiller for pain so bad you can't hike out without it.

– Everyone will make different weight/hassle tradeoffs, but you should think it through. For me, 5 wound closure strips in sterile packaging at 3 grams is not worth the hassle of making them, not-sterile, in stressful situations.

– Some stuff is not worth taking, like antibiotics. You almost always will use them when you don't need to (which can cause serious problems); and not use them when you should. If someone's that sick, you need to evac anyway. I have.

– Take a small first-aid pamphlet with you. You simply can't keep it all in your head, you'll forget under stress, and you don't want to get it wrong. NOLS-WMI sells an 8 gram pocket guide to remind you of all the essential stuff, AFTER you've taken WFR.

– WFRs often do better in emergencies than city-trained EMTs and ER docs. They aren't trained to diagnose and treat with almost nothing in the way of modern medical equipment.

– However long you think Search-And-Rescue will take to get to you and get you out – you are probably way wrong. Think many, many hours, if not days.

– And if you think it can't happen to you, you are wrong. Sooner or later, stuff happens to everyone.

So I carry an 11 ounce first aid kit for backpacking, I work on making it better and lighter, and worry that it's not enough.

Sorry for the long rant, but I'm tired of the "I carry two aspirin and some duct tape" messages I see from people with no training and even less real-life first aid experience.

[Justin Baker]

I have always been interested in primitive first aid techniques. Simple things like pine sap can help close up wounds and is a mild antispectic. Some mosses/lichens also have mild antiseptic properties and can be used as wound dressing. I have used both of those things many times when I cut myself with my knife. There are also a bazillion different plants that have medicinal properties. It's worth looking into this stuff. Knowledge weighs nothing.

[David Thomas]

+1 on knowledge. I guess no one argues with that, we just debate the relative value of FAK equipment. If knowledge is +1, than gear is between +0.01 and +0.2, depending on the gear and the trip.

I find it very helpful to review, "if there was a trauma / broken leg / heat stroke / heart attack / etc, what would I do with the gear I have?" That typically sways me towards a deeper stock of multi-purpose supplies like cordage, tape, and maybe an extra clothing layer that could be a dressing or a sling. A very few pills of a very few drugs (aspirin, benadryl, OTC NSAIDs) plus, for a longer trip / larger group, professional samples (1 to 2 gram tubes) of a steroid cream, an anti-fungal, etc.

I find it even more helpful to imagine and practice emergency response using the gear you typically travel with. Thermarests and pack stays as splints, rigging a traction splint from ski poles, dealing with hypothermia in an immobile victim, etc.

Further, reviewing possible first aid needs makes me more cautious about taking risks and not just rock climbing sorts of risks. Managing one's hydration and exertion so as to avoid hypothermia or heat exhaustion/stroke would save more lives than responding perfectly to all outdoor trauma cases.

>"There are also a bazillion different plants that have medicinal properties."

We landed in a grizzly-infested camp (Brook's Camp, Katmai National Park) with our 5-month old, but without our gear (delayed bags). Everyone was very friendly, helpful, and loaned us almost everything we needed. Except diapers. We were seriously considering the absorbtive capacity of sphagnum moss when our gear arriving on the next day's plane.

[Eric Blumensaadt]

I'm ski patrol trained in OEC (Outdoor Emergency Care)

It's a 50 plus hour course with a lot of on-the-hill training in addition. Basically it's EMT 1 plus winter first aid. More than most need for backpacking but I use a lot of it at the resort every year. So I have the advantage of actual practice on real patients which "instills the skills" like nothing else. And then summer comes and I forget half of it! Thus our annual fall refresher for OEC.

In addition I'm the Sierra Club Chapter Outings chair for Nevada so I have to remind all the outings leaders yearly to check their first aid kits against those listed in the Sierra Club "Clubhouse" site's online recommended 1st aid gear AND MODIFY ACCORDING TO THE TRIP. And to toss out expired gear.

That's what we all do, modify our kit according to the trip. But always remember, your best gear are your skills. Constantly re-train or they will decay.

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