Wilderness First Aid: Ready for the Worst

Keeping healthy and following basic safety measures help avoid tragedies on the trail, but when accidents do occur, specialized first-aid skills can make all the difference.

You’re two miles in on a rocky, wooded trail at dusk; lengthening shadows make every step a challenge for tired feet. Your youngest Scout trips on a tree root, goes over a ledge and crashes to the ground far below, fracturing his femur. As his blood spurts into the air, the others start to panic. The nearest hospital is hours away. Like it or not, you’re “It,” perhaps the one chance this Scout has for survival. Are you prepared to save his life?

Scouters across the country who have taken a course in wilderness first aid (WFA) are discovering that a weekend spent in intensive study and practice of the specialized first-aid methods used in backcountry rescue can make all the difference between an accident and a tragedy.

PREVENTION FIRST

Of course, most accidents don’t have to happen, explains David Bates, the BSA’s director of camping and conservation. “You can do so many preventive things to avoid problems before they occur.”

Simply stressing, for example, that Scouts drink water regularly on hikes can help keep them in good physical and mental condition throughout their camping adventure.

“One of our doctors studied this phenomenon at Philmont,” Bates explained. “Virtually everyone who came into the health lodge had dehydration to one degree or another, even if the problem ostensibly was a sprained ankle.” By encouraging your hikers to drink every 20 minutes—or, better yet, by modeling the behavior yourself—stumbling, falling, and poor decision making are much less likely to happen.

Christopher Tate, director of the Wilderness Safety Council based in Alexandria, Va., agrees. In his weekend courses throughout the mid-Atlantic region, Tate emphasizes prevention and leadership skills. For example, to prevent blisters, he advises Scouters to teach good foot care during a hike, to “treat hot spots we don’t have.”

THE ‘SANDWICH PRINCIPLE’

Scouters should know and practice BSA safety standards, such as those outlined in “Safe Swim Defense” (BSA No. 34370A) and “Climb On Safely” (No. 20-099). “Trouble will occur, though, if the campers ignore these techniques,” warns Dr. William Forgey, president of the Wilderness Medical Society (www.wms.org) and a member of the BSA Health and Safety Committee.

To prevent trouble, Dr. Forgey encourages Scouters to use the “sandwich principle: a foundation of discipline, where Scouts respect and follow their leaders; effective trained leadership on the part of the adults; and, sandwiched in between, the knowledge, or technique, with which everyone needs to be familiar.”

“You really can’t teach Scouts anything if you overlook safety,” says Bill Wilson, of Troop 1966, Fairfax, Va., one of Christopher Tate’s students. Wilson, who serves as Advisor for Venturing Crew 1966, requires at least one WFA-trained adult to attend all crew activities. “We’ve gone to the Pan American Jamboree in Bolivia; we go to the Grand Tetons; we have to be able to take care of ourselves.”

WILDERNESS VS. ‘URBAN’ SKILLS

The skills taught in WFA courses differ from those in standard “street emergency” first-aid courses offered by organizations such as the American Red Cross. (However, the Red Cross now offers a 16-hour Wilderness First Aid Basics course that the BSA recommends.)

According to the Wilderness Safety Council, there are three major differences between backwoods and street emergencies:

• transit—backwoods accidents occur more than an hour from the hospital
• resources—wilderness rescuers must improvise a response from what is in their backpack, their experience, and their knowledge
• environment—proper sanitation, lighting, and temperature regulation do not exist in the great outdoors.

Unlike standard “urban” first-aid classes, a weekend WFA course is “a comprehensive lesson in how to react, respond, and save life in remote, life-threatening situations,” says Tate.

Allan Osborn, assistant Scoutmaster of Troop 1853, Springfield, Va., took the course in February 2001. “We’re sending two crews to Philmont this year,” he said at the time. “We haven’t gone in about five years, so we’re using this class to prepare as well as we can.”

Philmont expeditions and similar backcountry high adventure treks offer strong incentive to take a WFA course, and many Scouters and Scouts appreciate the more complete level of training. Eagle Scout Matt Sherburne, a high school junior from Burke, Va., took the class in March 2000 in order to serve as first aider with his Philmont crew four months later.

“What I used most at Philmont was how to deal with dehydration and acute mountain sickness,” Matt said. “In our part of Virginia, the elevation is only 400 feet,” he noted. In contrast, his crew reached 13,161 feet in its climb up Wheeler Peak, the highest peak in New Mexico.

AVAILABLE TRAINING

For most volunteer Scouters, an entry-level WFA weekend program is the most feasible. There are many reputable groups offering WFA throughout the country, and protocols have been established in the Wilderness Medical Society to teach commonly accepted methods, Dr. Forgey notes.

In addition to the programs offered throughout the mid-Atlantic states by the Wilderness Safety Council (www.wfa.net), other organizations, such as the Wilderness Medicine Institute (www.wildernessmed.com) in Pitkin, Colo., Stonehearth Open Learning Opportunities (www.stonehearth.com) in Conway, N.H., and Wilderness Medical Associates (www.wildmed.com) in Bryant Pond, Maine, offer weekend classes.

Of all the techniques, high-tech equipment, and structured methodologies, what’s the most important factor for a safe outing? Readiness, says Dr. Forgey, because Scouting is designed to be both adventurous and safe.

“Our job is to attempt to minimize the dangers while allowing people to have fun,” he says. “Have a knowledge of the environmental challenges of a trip. Be able to protect the weakest individual from environmental stress.

“Cold or heat injuries are common, after all, and most hypothermia cases occur in temperatures of 35 to 50 degrees Fahrenheit. These are basic Scout skills, but so important. Think ahead!” S

In the November-December 2001 Scouting magazine, contributing editor Cathleen Ann Steg wrote about the U.S. Naval Academy’s annual merit badge weekend.

A WEEKEND OF ‘VIGOROUS INSTRUCTION’ A typical two-day WFA class offered by the Wilderness Safety Council, such as the February 2001 program held at the Alexandria, Va., Coast Guard facility (pictured here), provides a mix of vigorous classroom instruction and outdoor scenarios. In outdoor sessions, students find “victims” (fellow trainees) and practice their newly acquired assessment and treatment skills, using only the equipment in their backpacks. Scouters quickly learn to improvise splints using Foamlite sleeping pads, socks, gloves, ski poles, even pieces of pack frames. In classroom lectures, Christopher Tate offers easy-to-remember phrases and acronyms to help wilderness first aiders respond without panic in an emergency. During role-playing scenarios on Day 1, however, the students tend to be self-conscious, awkward, and tentative. Sometimes a “patient” fails to survive, due to blatant rescuer error, an unsettling experience for the trainees. And yet, Scouters praise the challenging experience of the scenarios. “The role-playing is tremendous,” said Scoutmaster Bob Benedict of Troop 913 in Herndon, Va. “Everyone became far more confident by the second day.” And the final scenario on Day 2 is a dandy. The class breaks into two groups: victims of a major backwoods accident and a hiking party which encounters them. Rescuers must choose a leader, assess the seriousness of the injuries, begin patient care, and make a careful plan for getting help. “This is supposed to be wilderness first aid,” Tate explained, and weather conditions, good or bad, are part of every training scenario. That meant victims had to lie down in semi-frozen mud during the February course and in a pelting rainstorm for the session a month later. Students take the final role-play seriously indeed. Dealing with these feigned emergencies in ugly weather tends to help burn the lessons into the mind and muscle memory of all participants. A year after Matt Sherburne played the part of rescue team leader (and was one of the rare teenagers to take this grueling course), he remembered the lessons. “My mind has been opened to almost all possibilities that could occur on a backcountry trip,” said Sherburne. “I still have the knowledge there to use if and when needed.” —C.A.S.

RESOURCES FOR A SAFER OUTING Do you need to know the training requirements for a weekend camping trip? A two-week kayaking trek? How about a city bike ride? A great place to start is with these BSA publications: Passport to High Adventure (BSA No. 4310) Scoutmaster Handbook (No. 33009) Troop Committee Guidebook Guidelines (No. 34505B) Guide to Safe Scouting (No. 34416B). For a more in-depth discussion of wilderness first-aid practices and issues, see: Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care, edited by William W. Forgey, M.D. (The Globe Pequot Press) NOLS Wilderness First Aid, by Tod Schimelpfenig and Linda Lindsey (Stackpole Books) Outward Bound Wilderness First Aid Handbook, by Jeff Isaac and Peter Goth (The Lyons Press).

WHAT’S THE WORST THAT CAN HAPPEN? BSA Health and Safety records show the most frequent causes of death and serious health emergencies during Scout events are the following: vehicular accidents (at the top of the list mainly because each accident tends to include a number of Scouts and Scouters in the vehicle) cardiac emergencies (mainly among adults, and often involving guests at Scouting activities; an older visitor at summer camp, for example, who succumbs to heart failure, would be included in these statistics) falls lightning. In years past, aquatic events accounted for more deaths. However, drownings have decreased markedly, thanks in part to emphasizing the use of the BSA Safe Swim Defense plan and Safety Afloat standards.