By Eric Billingsley
Albuquerque Journal
ALBUQUERQUE, NM — A hiker recently injured his knee in the Sandia Mountains and did what most people think is appropriate: wait for help.
By the time help arrived, the temperature had dropped, and hypothermia had set in.
The hiker survived. But if he had known how to treat the injury he could have walked out, says Jason Williams, a wilderness first aid instructor in Albuquerque. Painful, yes. But the move likely would not have increased the severity of the injury.
Accidents happen. And if they happen far from medical care, knowing how to administer first aid, improvise and get oneself or the injured person to safety can literally mean the difference between life and death.
Enter wilderness medicine.
“The main purpose of wilderness medicine is to teach people how to treat medical and traumatic injuries in adverse environments where there is delayed transport time,” says Marc Beverly, a certified mountain guide and wilderness EMT in Albuquerque. “It entails creativity on behalf of the care provider.”
A handful of instructors in Albuquerque offer classes in wilderness medicine, ranging from those for the average outdoor enthusiast to those designed for medical and search-andrescue professionals. The University of New Mexico also conducts wilderness medicine training classes for physicians, residents and medical students.
“Accidents happen all the time, and knowing how to deal with it appropriately is imperative,” says Williams, who is also a paramedic and president of Albuquerque Mountain Rescue. “If people get caught on La Luz trail and dial 911 for help, it can take hours for that help to arrive.”
Training is generally broken into three levels: basic wilderness first aid, which is often a twoto three-day, 16-hour certification course; wilderness first responder, a 72-plus-hour certification course; and wilderness EMT, which is 128 hours.
Costs can range from $150 for basic wilderness first aid to $3,100 for wilderness EMT courses.
Strike Rescue, owned by Beverly, offers training in how to extricate an injured person from hard-to-reach areas (such as using ropes and a litter to evacuate somebody from a cliff or gully). He says the course is designed for searchand-rescue professionals and people with medical backgrounds.
“I have seen all kinds of bad trauma in the wilderness, from collapsed lungs, to broken femurs and severe head injuries,” Beverly says.
Williams teaches a twoday wilderness first aid course a few times a year in Albuquerque. He says anybody spending time in the backcountry, such as hikers, hunters and skiers, should take this type of entry-level training.
“The most common types of injuries in the wilderness range from a blister, which can be debilitating, to a broken leg that’s bleeding,” Williams says. “The training also teaches people how to deal with medical emergencies such as chest pains and severe allergic reactions.”
The first day of the course includes an introduction to wilderness medicine, learning how to conduct a patient assessment in a wilderness context, how to treat shock, and how to deal with wilderness trauma and wounds.
The second day involves a half day of learning about altitude sickness, lightning injuries, splinting, heat and cold illnesses and medical conditions, and a half day in a wilderness setting. Two medical doctors from Albuquerque lecture during the training.
“What it really is, is taking your basic community first-aid course and transferring it to a wilderness context,” Williams says.
He adds that more and more people are getting out into the wilderness, which makes this type of training even more important. “An interesting trend is that the older generation is being encouraged to get out and be active,” Williams says, “so we have many people going into the wilderness with chronic medical conditions.”
The next level of training is wilderness first responder. The Wilderness Medicine Institute’s 80-hour, 10-day course touches on standards for urban and extended care situations. The Wyomingbased organization, part of the National Outdoor Leadership School, offers courses throughout the U.S.
“Wilderness first responder is for people who can imagine themselves in a remote area and having to administer care to somebody for anywhere from a half day to a few days,” says Shana Tarter, assistant director of the institute.
The curriculum includes wound management and infection, realigning fractures and dislocations, improvised splinting techniques, patient monitoring and long-term management problems, up-to-date information on all environmental emergencies, and advice on drug therapies.
The course emphasizes prevention and decisionmaking, not memorizing lists, says the organization’s Web site. It is designed to provide people with tools to make critical medical and evacuation decisions in remote locations.
The institute also offers wilderness first aid, advanced first aid, wilderness EMT training and programs for medical professionals. The EMT course blends first responder training with standard urban EMT education.
Tarter says an increasing number of medical schools throughout the world are also offering wilderness medicine education. “Medical training may not have prepared these professionals for making split-second decisions in remote locations with little or no access to medical equipment,” she says.
UNM’s Department of Emergency Medicine is one such school.
It offers a monthlong wilderness medicine course in March for physicians, residents and medical students. Weeklong courses in high-altitude and underwater (diving) medicine, survival and certification courses are available. And the school offers a disaster and remote medicine course in October.
“What I teach is leadership, self-sufficiency and when the chips are down, how to handle those situations,” says Dr. Darryl Macias, associate professor in the Department of Emergency Medicine and director of the school’s wilderness medicine program. “Even in my own experiences (in the wilderness) I have encountered situations.”
The program’s Web site says many people believe the challenge of wilderness medicine lies in preventing and managing injury and illness in a wilderness recreational setting. But it’s applicable beyond those settings.
“By definition, wilderness medicine takes place where medical technology is minimal, by way of limited facilities, equipment or long destinations to areas that are more medically sophisticated,” the Web site says. “Thus, it is imperative that the physician be able to improvise the medical care according to the environment and setting.”