Wilderness First Aid

I took a WFA course a couple years back, but they didn't really specify what one should bring, outside of the first aid kit.
Obviously gear choices are conservative when first aid is a primary concern, i.e. full length zipper on sleeping bag to more easily cover an injured person, synthetic vs. down, basically the old NOLS philosophies.
Just like ultra-light backpacking requires creativity in use, so does wilderness first aid, so I think the thought process required for each are actually complementary.

Hmmm…I take most of those items even on a day hike: the ten essentials. (The SAM splint lives in the bigger first aid kit I bring with groups.) Perhaps your perspective depends on where you hike, who you hike with, and the risk of injury or weather danger. The lightweight perspective is generally to take not just lighter gear, but greater skills. If you choose not to carry any of that equipment and you are faced with an emergency situation, then you need to substitute your skills. A WFA course usually assumes that their students don't have serious backcountry skills (most don't). If you don't want to carry a SAM splint, then know how to make something equivalent and don't worry about it. Those "two most important things" are quite important, but neither are considered first aid. I think if my WFA course had covered all of those other topics in the same amount of time that the first aid training would have been much less comprehensive. (I'm looking forward to taking a WFR course in May.)

If you don't mind saying, which organization put on the course?

I have taken the course from three different instructors and organizations and the emphasis has always been on using materials available to you and how to improvise in the field.

Andy,
I have not taken the course, but want to. Thanks for the warning about the Traditional type curriculum. It sounds like they were suggesting you equip yourself to be one of the rescuers, not one of the rescued, no matter what the chance of needing that stuff is.

As a WFA I imagine you should carry SOME items you do not expect to use, but rather expect someone else to need. Otherwise, your help is limited to kind words of encouragement.. Just choose the lightest equipment which meet the requirements. For example, I always carry a bivy sack, even on day hikes; it is a 8oz zipperless goretex version. I also carry cordage, a decent first aid kit, SAM splint, in rugged terrain, an emergency rappel kit, etc.. My 'core' kit is light, so this unused gear is a couple pounds of peace of mind.

Lately I have been studying and taking notes from the "Accidents in North American Mountaineering" annual series. Each of the hundreds of stories is different, and educational; but a common thread in many of them is that the rescuees did not carry the "10 essentials" appropriate for the worst environmental conditions possible in that season.
Stabilizing the injuries, contacting rescuers by FRS/cellphone, and then staying stationary, is the most common sequence leading to a successful outcome, not getting out of the forest or building a shelter. Although those are more important the farther from civilization you are of course.

The challenge for someone willing to be a WFA and ULer, IMO, is to choose rescue/aid gear appropriate to the risks, then be willing to carry the extra weight.

Andy, that was very different from my experience in the American Red Cross WFA course that I took with our local BSA council. The emphasis in our course was on how to think through different situations. We analyzed a number of situations to consider what material we would have on hand and more importantly how to use the group's resources to address the problem. I could look but I don't recall any specific recommendations for a first aid kit.

BTW, the course instructor is a fellow that I've worked with on many different BSA health and safety courses. He does a great job. He and many of the participants in the class have backcountry experience. Not many of them use lightweight techniques but they also didn't assume that you would carry the resources of an emergency clinic on your back.

Starting in 2007 BSA requires the ARC WFA certification for an adult leader participating in a wilderness trek such as Philmont. The course is one of the most useful I've taken through BSA training.

I'm certified in WFA through NOLS. Some of the course did examine using what you had available, but mostly the course focused on using general first aid equipment. The course was only 16 hours so really didn't have time to show how you could cut gear by using substitutes. What it did was give me a solid foundation of backcountry injuries and standard aid – and that understanding will allow me to extrapolate and figure out substitutes on my own. It was the best first aid class I've ever taken.

Andy: Even with a course designed by good organizations like NOLS and WMI you will always get a taste of the instructor's biases.

Phil: I believe that the BSA WFA requirement has been pushed back to 2008 to give councils more time to ramp up training. But it's coming …. wish it'd come years ago.

Our council certainly has ramped up for this. We used to get one poorly promoted class per year. There have been two this year with a third starting next week. The instructor uses the class designed by WMI. The class materials and instructor were excellent. The last two hours of the course were devoted to treating the youngest member of the class as a victim of a hypothetical fall from the top of a high course (40 ft). We had not been told the scenario in advance but had been told to bring things you'd have on a backcountry trip that could be redeployed for first aid purposes. It was a great example of group dynamics and exercise in improvisation.

One subgroup improvised a litter using canoe paddles and a blue plastic tarp. Another splinted a femur fracture using SAM splints from the first aid kit and bandanas. Another made a torso length backboard using trekking poles, a ridgerest and thermorest. Yards and yards of duct tape were consumed.

I've never done WFA but I imagine it is FA with an emphasis on extended care and evacuation. What did you expect in 15 hours?

If you take a WFR course (80hr) you will learn a lot more about improvised care with available and natural means because they have time to teach it to you!

What you need is about where you go, when you go, how long you, what you do, and who you do it with.

Three people on an 8 day backpacking trip above treeline in class III terrain probably need a different kit than a pair of folks doing an overnight in the foothils.

I've become convinced that a short length of 1 or 1/2" webbing, a crevat (triangular bandage, a clothes pin, and an adjustable length trekking pole wrapped with duct tape are the bare minimum critical pieces for improvising splints/slings/traction splints (a length of 3" coban is pretty critical too). Cordellete isn't a bad idea. There are so many things you can improvize into splints: trekking poles, platypus/camelback, pack stays, sticks, ice axes, paddles, skis, tripods, potty trowels, etc etc etc. Nevertheless, I often carry a SAM. You don't have to. If you don't do you really carry the equipment necessary to improvise and do you really practice enough to be confident that you can improvise? For example, I know that right now I can quickly and effectively build a femur traction splint with:
1 crevat
1 length of webbing
1 extendable trekking pole
1 of any of the following: a shirt, long johns, webbing, crevat, roller gauze, cordelette

Without some webbing or cordelette, I'd pretty much guarantee that you aren't carrying enough duct tape to improvise a litter. Maybe you don't need to because you don't have enough people or a slope/rope to move one. If you do, the litter can mean being able to move your buddy to a safer drier warmer more managable shelter to await rescue (or can mean the difference between self rescue and no self rescue for your group).

My medical/survival/repair kit all together weighs in around 1 pound and it is essentially what I carry as my personal kit on SAR missions too. That is not going to suit someone with a 5lbs base pack weight. Than again, someone who has a 5lbs base pack weight is *most* likely not doing the terrain/activities that I am. That's OK. I carry it because I know that the extra weight means that I can effect extra care and survival that are more likely in my AO. That's what I need.

Nobody is suggesting that you carry 5lbs of medical gear.

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"I felt like the two most important things were left out of the course: 1) learning how to get out of the woods if you're lost and 2) learning how to make shelter with no/minimal materials."

-That is in the realm of a survival or orienteering course, not a first aid course. They didn't even have time to teach you much improvised care.

To answer some questions first, the course I took was WFA through SOLO (Stonehearth…) and is the 16hr course. The instructor was WEMT and does backcountry rescues regularly in the Whites of NH and did seem very knowledgable, but just made the scenarios unrealistic by having so many materials available in most cases. This course did NOT cover femur traction, severe spinal injuries, or litters. I have friends that took the WFR 80hr course with him and said those were covered.

I'm sure there's posts on here with recommendations of what a first aid kit would have, but over time I've found I never used most things, and realized that most of them were overkill (for example most store bought kits have 10-30 bandaids, I've never needed more than 1 or 2 at a time, so I carry 3.) I don't carry duct tape anymore since I just never used it, so making a litter with a roll of duct tape is not something I would be considering. I figure if needed, I could make all the things we used in the course with other gear I carry, except for having a tarp and sleeping bag on day hikes, so everything they suggested to carry was not something I would need.

I guess I was just dissapointed with the course in general. It's good knowledge to have, but nothing too special came form it. I've taken courses before that covered all sorts of backcountry skills, and those were more helpful than WFA was. I need the certification to run outing programs through my college, and fortunately they covered the cost, otherwise it was $90 for the re-certification. WFR was $100-something last time they had it here, and I was told it's normally $600-$900 otherwise.

You didn't reveal until now that this was so that you could guide college students on wilderness outings!

"This course did NOT cover femur traction, severe spinal injuries, or litters."

My bad. Now that I think about it, traction splints and full spinal immobilization are NOT in the scope of a lay rescuer. Thus, you wouldn't be taught nor may you perform said skills especially while in the employ of some organization.

"made the scenarios unrealistic by having so many materials available in most cases."

You need to know how to use the real tools before you start improvising and trying shortcuts! As was stated, there simply isn't time in 16 hours to cover the basics and then go back over it all with all forms of improvisation. Take the WFR course if you want to be taught those skills (<$200 is an incredible steal!) or read and practice on your own. Also, since this particular minimal course was aimed at people who will be guiding groups, maybe you are expected to have some materials.

"what a first aid kit would have, but over time I've found I never used most things, and realized that most of them were overkill (for example most store bought kits have 10-30 bandaids, I've never needed more than 1 or 2 at a time, so I carry 3.)"

That's your decision but just realize that, while you usually do not need extra gear, should a less than regular incident occur, 3 bandainds and no duct tape may not be enough for the emergency. That is acceptable if it is just you and you understand the risks. If you are guiding others, your charges (and supervisors) might be a tad miffed if they need (for example) 10 bandaids you only have 3 bandaids because you are trying to be completely SUL… unless you are making them carry the gear.

"I figure if needed, I could make all the things we used in the course with other gear I carry, except for having a tarp and sleeping bag on day hikes, so everything they suggested to carry was not something I would need."

Don't figure. Practice. Know.

"I guess I was just dissapointed with the course in general. It's good knowledge to have, but nothing too special came form it. I've taken courses before that covered all sorts of backcountry skills, and those were more helpful than WFA was. I need the certification to run outing programs through my college, and fortunately they covered the cost"

You are annoyed because they didn't teach you non-WFA things in a WFA course that you didn't have to pay for?

You are annoyed because they were doing worst case scenarios and actually using rescue gear to train you to effect care and rescue on a guided outing?

You are annoyed because they are recommending some extra gear but you don't even want to carry duct tape and 4x4s when you are apparently going to be responsible for other people as a guide or an assistant on outings?

I have to be honest: your attitude stinks.

>I need the certification to run outing programs through my college

You should carry more of a first aid kit than you think if you're going to be responsible for students. To offset liability you must not be negligent, and perhaps lacking basic first aid gear (even if you can improvise) may not sufficiently demonstrate that you are being responsible. The last time I was on an outing with grad students and faculty (thank goodness I was not responsible) I was amazed at the lack of common sense. When we stopped for a water break, some of the students began trundling rocks off the trail, and that soon turned into a rock throwing contest. This was on forested switchbacks! When we reached the summit and stopped for lunch, I walked over to a nearby peak. When I came back, I saw several tracks from where everybody was sitting to the very edge of a cornice (over a 1000-foot drop). One student had a bad ankle and declined to climb the last stretch up to the summit. She said that after she rested a bit she would slowly head down the trail. We expected to meet her on the way down, but we met another part of our group coming up and she wasn't between us. Some of us immediately headed back up, searching for a body at the bottom of the steep slopes. We eventually found her hobbling along the trail. Turns out she had been taking care of some personal business when we came down from the summit, and was embarassed to hail us. Then she was adamant that she could make it out on her own and that we should just hike out. Some of us absolutely refused and she couldn't stop us from accompanying her out. It was nearly dark when everybody got off the trail, thankfully in one piece.

This article is about an accident that occurred during a student outing on Mt. Adams. The boulder was dislodged by another student climbing above her. They were climbing the rock ridge because they didn't have basic mountain gear…

http://nl.newsbank.com/nl-search/we/Archives?p_product=YHRB&p_theme=yhrb&p_action=search&p_topdoc=1&p_text_direct-0=0FDC1448A261E1E2&p_field_direct-0=document_id

Good luck!

Don't take my words the wrong way… I said I need the certification for the trips I run, but that in no way means that I carry the same first aid equipment on trips I lead and trips with my hiking friends. I was speaking from the perspective of my regular hikes, and mentioned that I run trips, not the other way around.

I disagree. Most times doing nothing is better than doing something half-assed. For instance, if you try and put a traction splint on me rigged from a treking pole to evacuate me I'm not going to let you do it unless I'm unconcious. In fact I'm probably going to use my treking poles to keep you away. Sager and other comercial splints are friggin uncomfortable as the devil (I dare you to wear one for and hour or two) and you're telling me you want to jam a hiking pole in my crotch w/a good bit of tension and then cary me over rough terrain in an improvised litter…out of your gord. Keep me still, warm, and hydrated then wait for people w/the right equipment. A tradesman's most valuable tool is his knowledge and his ability to remain calm in an emergency. Your focus is on the idea that you have to do something. I contend in nearly all instances its better to do nothing and send someone out who can move quicker for people far better equipped than yourself. I'm a former EMS guy, but sometimes EMS guys know just enough to be dangerous.

I certainly agree with you that the best tool is knowledge.

"sometimes EMS guys know just enough to be dangerous."

I'd think that you were referring to me if you hadn't described yourself so aptly when it comes to the subject of improvised care in the wilderness, a subject you don't seem to understand even as a "former EMS guy". (and you seem to be misinterpreting my posts):

"Your focus is on the idea that you have to do something. I contend in nearly all instances its better to do nothing"

Of course there are times where you don't want to take every action you can think of! I am not advocating otherwise. Of course you shouldn't do something unless you you can carry out the action so that it benefits the patient rather than causing harm. I wouldn't advocate moving someone on an improvised litter unless it was a necessary action required by situations such as:

1. outside help is not sufficiently available (ever been outside the US in a 3rd world country where help isn't going to come and there is no way to call anyways? or in a situation where help will refuse to come?)
2. patient cannot remain in current location (unalterably and (soon to be) dangerously exposed)

i.e. when the cost benefit of waiting for a professional 3rd party to come save the day isn't as good as the cost benefit of improvising, it may be time to improvise!

I would always rather have SAR, but there are times and places where doing nothing is not the best option because SAR is going to be too slow or just plain absent.

You apparently don't know much about improvised splints or litters nor have you apparently ever tried to build or use one (the right way). You can make a really crappy one or you can make a really good one. Of course they are rarely quite as good as a manufactured product. Are they better than nothing? Yes, if done properly. The traction splint I described (which derided after, based on your response, imagining it entirely incorrectly in your mind) functions almost exactly like a Kendrik Traction Device if done right. You can also build Hare or Sager equivelents with more gear.

Of course you can always refuse care if you are still alert.

But have you seen many femur breaks in N Texas? They are not that rare in the Colorado mountains. Traction splints are uncomfy and not without potential for complications… improvised traction splints are less comfy… but if done right they are a far cry better than doing nothing for a midshaft femur fracture that has spasming muscles shoving the jagged bone ends slicing up muscles, vasculatur, and nerves! I'd definately improvise a good traction splint for my buddy so he wouldn't suffer worse injuries and pain while waiting for SAR and a few hour extrication. Like you said, knowledge is key: Am I going to superpad the thing? Yes. Am I going to take advantage of hard shell mountaineering or ski boots? Yes. Will I monitor closely? Yes. In the summer with a guy with no big boots, am I going to try and use skin traction to augment an ankle hitch? Yes. Am I going to apply the device if the extrication will take days? Probably not. Etc.

You've got to be pretty ignorant to contend that improvised care (as taught by NOLS, WMI, DMM, etc etc) is usually worse than no care. Following your logic, nobody should ever make a wrist splint with pack stays, a camel back, webbing and an extra shirt (and then possibly walk themselves out 5 hours) because it wouldn't be as comfortable or safe (according to your illogic) as waiting 6 hours for SAR to show up with a vacuum splint, and then walking out for 5 hours with them (11 hours total). Only an extremely closed minded urban provider would make such a dubious claim. The wilderness is not a downtown street corner where Fire/EMS is <8 minutes away and the level I trauma center is 10 minutes away.

(for the record I am a WEMT and on a MRA certified SAR team and a member of the WMS)

PS It might surprise you to know that the WMS has recommended guidelines to taught to WEMTs (and I believe WFRs as well) covering the circumstances where one could perform skills such as clearing c-spine, packing certain wounds, closing certain wounds and reducing certain types of dislocations. Don't have a cow, man. ;)

"First do nothing half-assed"

The new Hippocritic Oath..lol…probably true in alot of ways.

Whoa, it wasn't a personal attack on you or your improvised splint. If you'll re-read I even mentioned commercial devices are uncomfortable. Sorry I hurt your feelings. I guess everyone reads what they want to. I didn't think anyone would read what I wrote as implying you should wait for SAR to deal with all injuries and that all improvised care is bad, so I appreciate the opportunity to clarify. Thats not the poit I was trying to make. I'm not implying anyone should stand around and watch their buddy bleed to death. I also have no problem with splinting. My point was that people don't need to take pounds of stuff into the woods as the things they regularly take will be adequate to deal with injuries that they are likely to encounter and that can safely be dealt with. There's a time and a place, I just don't think most people will ever be at either. Please realize not everyone has the training you do. I still think if someone is serriously enough injured to require evacuation they are better served by being kept comfortable and removed safely than by being removed sooner. Of course there are always exceptions. Auerbach puts it nicely in Wilderness Medicine "A group of 25 climbers in the Himalayas with physician support and a field hospital at base camp will have very different criteria for evacuating an injured person than will a family of four spending a week hiking in the Rockies. In all cases, party leaders should have a plan for contacting evacuation support teams if a serious injury occurs." I hardly see how that is ignorant, demonstrative of a lack of logic, or close minded.

Which reminds me… I don't appreciate being called ignorant, illogic, or close minded. I know a thing or two about EMS and medicine in general and I have traveled outside the city I live in (shocker) and I've seen many, many femur fractures in my career. I've never seen any while backpacking though, and I bet if you surveyed everyone here you'd be hard pressed to find many people that have.