A rationale for wilderness medical education for outdoor leaders.

The importance of stressing safety measures and practices in all phases of adventure programming has acquired much greater significance in the past decade. The issue of ensuring the safety and well-being of clients while providing a progressive and attractive program of outdoor activities is a critical element in the responsibilities assigned to leaders in the field and program administrators. Furthermore, group leaders are often charged with a tremendous undertaking in caring for active and enthusiastic clients in an environment which is not always located within the normal range of emergency medical services and practices.

A wilderness environment may be defined as any area located outside the normal range of ambulance services and medical facilities. This may include a local hiking trail, canoe route or a multi-day expedition into remote areas. Unlike urban centers where help is minutes away, leaders in the wilderness may be required to make crucial, life-saving decisions in an emergency situation. Making these critical decisions requires specialized knowledge, skills and experience that instill confidence in dealing with such medical emergencies.

Urban based first aid training programs while widely available across Canada do not address the extreme limitations encountered in remote areas. Most of this training is focused on short term management of common illnesses and injuries where professional emergency services and medical facilities are only a phone call away. In this respect traditional urban based first programs are grossly inadequate for the group leaders and wilderness travellers.

In an urban environment the implementation of basic first aid is founded upon:

1. Rapid access to ambulance and medical services in virtually every populated area of Canada.
2. Short term management of illness and injury.

The Wilderness Medical Society has identified a number variables that identifies the non-urban environment. In the context of First Aid or Prehospital Emergency Care (PHEC) a wilderness environment may be defined as any area not located within the normal range and scope of ambulance services and medical facilities.

• It is provided outdoors where definitive medical care may be hours or days delayed.
• Illnesses and injuries that are not commonly seen in the urban environment may occur in the outdoors.
• Common illnesses and injuries may require different approaches.
• Advanced medical rescue techniques such as reduction of dislocations, wound cleansing, injections may be required.
• Urban protocols that rely upon rapid transport to a medical facility and radio communication with a control physician may be impossible to follow.
• The amount of first aid equipment that can be carried by a group or a rescue team will be limited.
• Wilderness care givers must be realistic about their abilities to manage serious injuries and illnesses.

Wilderness Prehospital Emergency Care usually denotes a response to sudden trauma, illness or injury. However, the most dangerous and debilitating disorders encountered on program are too often the product of poor planning, the neglect for basic needs and mismanagement of principles essential to normal body functioning.

Group leaders must be familiar with modalities of prevention and care prior to and during a program which include:

• Level of physical activity which is commensurate with participant's fitness capacity.
• Client medical information and emergency phone numbers.
• Adequate nutrition.
• Adequate hydration.
• Replenishing essential electrolytes.
• Quantity and quality of rest and sleep.
• Proper equipment and clothing.
• Adequate provision for shelter from the elements.
• Hazard evaluation and risk management skills.
• Condition and treatment of water.
• Camp locations and alternatives.
• Emergency procedures and exits.
• A clear understanding of emergency and rescue systems in the region and mechanisms for mobilizing such aid.

Responsibility rests on group leaders and outdoor professionals to acquire adequate first aid training which includes specific skills, knowledge and experience suited to the type of activity engaged in, as well as the environment encountered.

Dealing with environmental conditions and learning how to prevent injuries and accidents are important components of effective wilderness first aid training and are a central theme in all Sirius Wilderness Medicine programs.

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