Everybody has a story, that time they went out for a simple day hike and their friend fell, or a storm rolled in, or someone just did something plan stupid, and you were all the way in the backcountry and you didn't know what to do. I like to call those "oh crap" moments. Luckily, the injury wasn't too bad, or you had good gear, or help wasn't too far away. But, you can't stop thinking how much worse it could have been. And not to be scary, or all doom and gloom or anything, but if you have been hiking long enough you've definitely had at least one oh crap moment, it just comes with the territory.
I've had many oh crap moments. One of my last ones was on one of my favorite day hikes, Arroyo Seco, a river hike in the Central Valley. My friends and I have done it several times and it's always a super fun, but long day. Last year, I went with a group of super hard core outdoorsy people and one of my best friends, who is also subsequently the most badass adventure girl I know. She wasn't feeling very well but she decided to go anyway because, well, it was our annual Arroyo Second hike and it's awesome.
As the day went on, with the sun beating down on us, I progressively started seeing my friend get weaker and weaker. By late afternoon she finally caved and whispered to me she didn't want to go any further. And when this girl tells you she can't keep on, you know something is really wrong. So we broke of from the group and made our way back to the car.
Now this hike is not necessarily easy, you are constantly climbing slippery rocks and navigating through a river. On one particular portion I saw her take a wrong step, and I swear in slow motion I saw her fall in a horrible position right on her femur and wrist. All I could think was, oh crap, she definitely just broke something. Quickly, my mind started racing on how I was going to get her out of this steep canyon, nobody around, the sun setting, and with a broken wrist, or worse yet broken femur. I started going over the food I had in my bag, extra clothing (because we were soaked), ways to make a sling or even a litter to carry her out. My mind was going to the worst places.
Luckily, after a few tears, and a few curse words, she was able to stand and miraculously hadn't broken anything. We walked out, a little anxious and a little bruised, but no worse for the wear. We both knew we had gotten lucky.
My point is, you can be the most badass adventure girl out there, you can be tough, know the terrain, and have all the experience in the world, but even the most skilled hikers still have oh crap moments.
So how do you prepare for these oh crap moments? Well, that's where the Wilderness First Responder (WFR for short) comes in. The WFR certification is a 9-10 day certification that goes over everything you need to know for emergency situations in the backcountry. From how to assess a situation and do a thorough physical exam, provide emergency care, and make crucial evacuation decision.
What I Learned
The curriculum offered covers everything from wound management, to different types of trauma injuries (head, spine, chest, abdomen), to medical emergencies (cardiac arrest, allergies, gastro), to specific environmental emergencies (snakebites, head and cold emergencies, altitude, drowning)...yeah it was a lot and this is the short list. I won't get too much into the specifics of what I learned (as I am not a medical expert and definitely not qualified to teach the material) but I will share with you my top 6 take home messages.
1. Don't ignore the signs.
There is an old saying that bad luck comes in threes. Well I'm not so sure that is totally correct, but definitely I have noticed that there are signs leading up to an emergency or a series of unfortunate events culminating in one really bad situation. So pay close attention to what's going on around you, signs for change in weather, a change in attitude, or just a general shift in energy. Often people may start to feel sick or tired and won't say anything because they are embarrassed. The small things can really add up, and often one mistake or injury is followed by another, and another. So just pay attention and be observant, and if your start to get a bad feeling, trust your gut.
2. Secure your air-mask first.
You know how on an airplane when they are going over the emergency procedure and they always say that in case of an emergency the air-mask's will fall and you should secure you own before you help somebody else with their's? Well same goes here. It can be counter intuitive to check the scene before approaching somebody in danger, but your really no help if you injure yourself trying to get to, or help, somebody else. So always stop and take a moment to assess the scene, is the person under falling rocks, or on the beach and a large wave is coming in, or maybe on the side of a busy road, say in a car accident. Stop and make sure you are not putting yourself in unsafe situation first, and if you are, figure out how you can make the situation safe by either moving the patient out of the area or by some other means. For example, you may have a lookout if you are on a bike path where fast moving bikes could come zipping around a corner. Same goes for the people you are with, make sure they are safe as well, before you try helping others.
3. Slow and Steady Wins the Race.
Like I said before, during your WFR one thing you will do is a lot of is scenarios. One of the scenarios I faced was while I was hiking I came across a camp in a Redwood Grove after a storm, large limbs had fallen from the trees and there there were multiple people down. One person was aimlessly walking around either in shock or from a concussion, one had even had on fake make-up making it look like there bone was popping out of their skin, and one was one the ground face down with a large tree branch laying on them, unresponsive. Yeah it was intense, and even knowing full well that it was fake, I got super flustered and my heart started pumping. Once I started getting stressed out I started rushing through the assessment and missing vital questions or information. So I learned quickly to stay calm and steady. Also, a lot of injuries can get worse if the patient gets anxious, such as snakebites or anxiety attacks. The worst thing you can do is come running up to a scene, start barking orders, or bombarding the patient with questions. So make sure you remain calm, steady, and approach the scene with intention.
4. Don't be afraid to ask the hard questions.
Hard questions (i.e. when was the last time you pooped) just comes with the territory, so own it. I found starting a good rapport with the person by making eye contact and letting them know you are actually listening to what they are saying can make it much easier. In one of my scenarios, I was assessing a girl who had collapsed on the trail and was short of breath, pretty serious whenever am already is involved in the backcountry. I started having a conversation with her about what she was doing out there etc. And came to find out she had been out partying all night and had just broken up with her boyfriend. She was having a panic attack, but she never would have revealed to me all that personal stuff if she didn't trust me. Establishing that initial relationship really helps in the long run.
5. Do a thorough physical exam, and then do it again.
The injury that you see may not be the most critical. That bleeding coming from a person's head from a fall could be distracting you from the internal bleeding they are experiencing in their abdomen. So make sure you do a through physical exam before you start treating somebody's injuries and keep doing the physical exam as well as continually monitor their vitals the whole time you are with them. Because things can go from ok to bad really quickly.
6. Use all the resources around you to your fullest advantage.
Backcountry medicine is all about improvising with the resources you have. Many times when you are so far back there, you have a minimal first aid kit and you may have minimal items in you pack (if you are a light backpacker) so it is important to use your imagination and use the resources you have to your fullest advantage. It actually can be kind of fun. For instance, you can make a sling by ripping a strip off a cotton shirt, or even just pinning the bottom of the persons sweatshirt up around the arm. You can make a litter to extricate an injured person with your tent rainfly, sweatshirts, or a couple of backpacks and two larger branches. You can make a shelter using branches, or you trekking poles and a tarp. Honestly its amazing how much I can make now with just some branches, duct tape, a tarp, and a bobby pin.
My WRF Class & Review
I thought about getting my WFR for years, but in the last year I have really started hiking a lot more solo and also my goal is to start guiding in the backcountry, so I finally bit the bullet and signed up. There are a lot of companies that offer the WFR certification. NOLS being one of the biggest and most common. But, I was lucky enough to take my WFR is Big Sur with Backcountry Medical Guides. I'm not going to lie the course was not easy. Since I do not come from a medical background the course was a little overwhelming for me, learning both the anatomy and physiology of the body, and then drilling down deeper and learning special injuries and treatments for the backcountry, was a lot to say the least. I hadn't had to memorize that much information in such a short time frame since graduate school. We even had a few 10+ hour days to make sure we hit all the curriculum. But my teachers at Backcountry Medical Guides were patient with my never ending stream of questions, you could tell they really cared that I learned the information. They were also super knowledgeable and answered all my questions, the questions they couldn't answer right away they looked up and made sure to get back to me on the answer. I was even more lucky because I had an extremely awesome group with me, and everybody was super supportive and motivated to learn the materiel.
Other than super amazing teachers, the other cool thing about doing my certification with Backcountry Medical Guides was we were able to use Big Sur as our classroom, like legit one of our session was in a hot springs. One thing you will do a lot of are running through scenarios, where people will act out an emergency situation and you have to go through all the steps of assessing the situation and treating the patient. By having the class outdoors, rather than in a classroom setting, the scenarios definitely felt more real. I would highly recommend Backcountry Medical Guides and will definitely be doing my re-certification through them (the WFR certification is good for 2 years then you have to go back for a refresher to keep it current).
Personally, the course was extremely eye opening, I honestly can't believe I was hiking in the backcountry without it. I learned so much it's crazy, and I feel extremely proud that if something were to go wrong in the backcountry, either to a friend or a stranger I came across or even myself, that I would be able to provide skilled and knowledgeable care that could potentially save a life.
One thing I may have done a little differently is it would have been nice to take my Wilderness First Aid, first. Like I mentioned above, the course was a little overwhelming to me since all the content was new, the Wilderness First Aid would have been a good pre-requisite, making the course feel a little less rushed. Also, the Wilderness first aid is a good idea if you can't do the full 9-10 day course, as it is only a weekend long course. From what I heard the Wilderness first aid goes over a lot of the same information, it is just more condensed into one weekend and not as extensive of a training.
Bottom line, it wasn't an easy course and it was a lot of hard work but I am so happy I did it. I would highly recommend this course to anybody who either plans on hiking in the backcountry, traveling internationally, hiking solo, or if you plan on leaving or guiding a trip outside of an urban center. I feel so much safer now being out there.