As of Spring 2023, my medical training had been limited to watching the occasional hospital show that I am certain provides an entirely accurate picture of medical practice. “He has an infection in his right ear stat, cut off his left foot stat.” At least they say stat a lot, which sounds professional.
With this background, I walked into the NOLS Wilderness First Aid training not sure what to expect other than that I would hear stat a lot. After two days I walked away with a very different picture of medicine. The classes were about building basic competence by following an algorithmic approach to field evaluations and by developing practical skills. Our teachers were excellent.
The concepts were logical and ordered using an ABC paradigm: Airway, Breathing, Circulation. We first have to be sure that our patient can breathe. Then, if the person suffered a fall, we check for pooling of blood that the patient may not yet be aware of. Throughout this early evaluation we keep the head from moving to protect the spine from (further) injury. “Protect the spine” was a mantra not unlike stat on the tv shows but one that is vitally important.
Expose injuries to the skin level, follow a simple assessment procedure to ascertain if you missed anything. Take vital signs. Talk to the patient. Are they lucid? Do your best to exude confidence and inquire about the patient’s history. Why did this happen? Has it happened before? Are you on meds? Search your brain for relevant lines of inquiry so as to be as helpful as possible. We went through multiple scenarios to help us to develop these abilities.
We were also taught to splint breaks, to use traction-in-line to put compound fractures back in alignment, to reset a dislocated shoulder. We got some background on shock, and on wounds, infections, frostbite and burns. In each case there is procedure, an algorithm to go through in your mind, interactions with the patient and an assessment to be made. The question that hung over all of this was “Is your patient well enough to make their way out of the wilderness, possibly with your assistance, or do you need to call for help.” Maybe to bring in someone with more skills and equipment than yourself, or maybe a helicopter or other form of evacuation is indicated.
We weren’t expected to be able to perform miracles with our limited training and the even more limited gear that many of us carry into the backcountry. Instead, in addition to basic competence our teachers hoped to instill a realization that we needed to know more. At least that’s how I came away feeling.
I have been making trips into the wilderness for decades and I could relate to many of the topics. Yeah, that happened to me in ’04, that happened to a buddy in ’07, etc. Each time we had made it out under our own power, but some of them were close calls. I could suddenly see the value of training in helping to make those calls, and training to provide aid.
The hardest hurdle for me going forward is accepting that I need to carry first aid supplies into the backcountry to at least deal with wounds and breaks. Like many backpackers, I have spent years moving in an ultra-light direction. The thought that I need to carry something, anything, more is hard to swallow. I expect that my decision on this will be like so many other things in life; once we learn something, it becomes the new standard. To disregard this training, is to be negligent. Time to assemble a first aid kit, stat.
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