When have I actually applied it?

This past weekend I took my biannual wilderness first responder (WFR) and CPR re-certification courses. Between refreshes on the patient assessment system, conditions for a FSA, and rescue breaths, I thought concerning the situations over the past eight years when I’ve had to apply my coaching.

As a brand new WFR in 2011, I keep in mind being intimidated by the number of medical situations for which I’d been “trained” (with 80 hours of classroom-only instruction). For many who really feel similarly, or for many who are interested within the operations of a corporation like mine, I thought I would share my experiences from guiding 85 journeys with 625 shoppers.

For the sake of patient confidentiality, I have modified the shopper names.


The medical conditions I have encountered are partly a perform of my:

  • Position,
  • Clientele,
  • Journey length, and
  • Places.

I guide backpacking trips. My shoppers are typically 30- to 60-years-old and in above-average health, and skew male by a 2:1 margin. My journeys are Three to 7 days lengthy, and I run them principally within the Mountain West, and typically in Alaska and the japanese woodlands.

If you’ll be leading, say, month-long canoe journeys within the Boundary Waters with at-risk teenagers, your experiences will in all probability be totally different.

I supply Three- to 7-day backpacking journeys, principally in the Mountain West.


I don’t maintain a detailed report of each blister, sprain, and evacuation. Anecdotally, at the least, I assume our safely document has steadily improved, which I attribute principally to:

  • More stringent vetting of shoppers, to make sure that we have like-abled teams and that every shopper within reason qualified for their trip;
  • Extra expertise around shoppers, enabling us to recognize telltale warning signs and to know the bounds of our shoppers higher than they do; and,
  • Higher familiarity with the terrain, circumstances, hazards, and common itineraries of our go-to places.

What do these elements have in widespread? They’re all preventative. Unforgivably, for my part, the NOLS WFR curriculum omits any dialogue about methods through which medical situations may be prevented — it’s totally reactive.


I’ve had four medical evacuations, the final being in 2014.

Ethan strained his knee while crossing a wet rocky moraine in Alaska. We self-evacuated by packrafting down the Little Delta River.

Jennifer experienced an intestinal blockage, which had happened to her six months earlier, too. We slowly walked her out to a nearby trailhead, and her companion drove them to a close-by hospital.

Paul suffered a deep reduce on his heel when a nearby boulder shifted, wedging his foot. I assume I might see his Achilles tendon. He heroically self-evacuated, which involved a 25-mile hike with 5,000 vertical ft of achieve, after which drove himself to the hospital.

Finally, Vic (actual identify, with permission) severely strained his lateral collateral ligament (LCL) when he came upon a washed-out path and hyper-extended his knee. A helicopter evacuation was mandatory on account of his shock-inducing pain and our location within the higher Kern River, the place we have been separated from the closest trailhead by 20 miles and a 13,000-foot move.

Vic badly strained his LCL throughout a locate a washed-out path, and is my solely shopper who has needed a helicopter evac.

Run of the mill

The prospect of one other evacuation (or worse) makes me anxious, typically to the degree that I think about closing my program. Thankfully, they’re the exception, and most of our medical points are easily manageable.


The worst blisters I’ve seen belong to Guy. He developed scorching spots on the first afternoon, however we didn’t handle them until camp, the place I unveiled deep quarter-sized blisters on each forefeet. By no means again. Guy was remarkably robust, and nonetheless managed to complete a 7-day John Muir Trail thru-hike.

Maceration is widespread on moist journeys. Most shoppers are accustomed to my beneficial remedy, and guides are good about forcing shoppers to stay on prime of it.

Man developed dangerous forefoot blisters on Day 1. We should always have stopped to deal with them earlier, but as an alternative waited until camp.

Aches, pains, and overuse

Few of our shoppers arrive already trail-hardened. Most are professionals, have households, and are concerned of their group. Their coaching time is restricted, and thus principally restricted to short-but-intense train (e.g. operating, HIT workouts, yoga). They’re unaccustomed to spending lengthy days on their ft and carrying an in a single day package.

To stop and tackle ensuing aches and overuse accidents, we advocate a private provide of ibuprofen, and we average their effort early on so that they don’t disintegrate after the turnaround. Typically I additionally ask each shopper to specify their largest bodily grievance and to assign a ache score (out of 10), which gets better outcomes than simply asking, “How does everyone feel?”

I recall only one shopper, Tanner, who developed debilitating tendentious alongside his IT band. This happened before I discovered to reign in teams for the primary few days — once they’re recent they need to charge exhausting, and not everyone is sweet about checking their egos on the door.

Hydration & vitamin

I have no notable tales about dehydration. My greatest prevention tactic is periodically asking shoppers once they last peed. When seven shoppers report peeing at lunch or even more lately, and one shopper stories last peeing at the trailhead, it’s clear who needs to drink extra.

Vitamin appears greatest managed by waiting for modifications in a shopper’s character or performance. A scarcity of energy might clarify why, say, a normally pleasant shopper appears slightly agitated, or why a front-of-the-pack shopper gets dropped on a climb.

Two shoppers have tried to comply with strict keto diets, and each Sam and Sawyer bonked onerous after a number of days. It appeared as if their bodies lacked the required gasoline for full performance, in order that they have been shadows of themselves. The solution was having them trade their jerky and pork rinds for the chocolate and Fritos that other shoppers had.


Heavy mosquito strain has been a non-issue as a result of we:

  • Researched the circumstances beforehand and knew what to expect;
  • Wore headnets and full-coverage permethrin-treated clothes;
  • Hiked and camped where the bugs have been much less dangerous, like atop ridges and on open gravel bars.

Five years ago Bob, Samantha, and Adam all contracted Lyme disease after a Might trip within the Blue Ridge Mountains, and thankfully have been shortly handled. On our newer West Virginia trips, we alerted shoppers to the danger, beneficial precautions (e.g. repellents and permethrin-treated clothes), and tried to avoid tick-infested areas like meadows. I can’t say if these measures made a distinction — it was unseasonably chilly and moist, and we didn’t discover a single tick.

Alan warms himself over our campfire in Alaska. We’d intentionally camped on the open gravel braids, where the wind stored the mosquitoes at bay.

Strains, sprains, breaks, and cuts

Rhett hyper-extended his knee slightly on Stanton Cross, which we pushed over earlier than dinner on Day 2. To additional illustrate our erred judgement, an hour later Bill scraped his shin on sharp talus, chopping by means of a lot of the skin. We should always have simply saved the move for the subsequent morning, once we wouldn’t have been tired.

On an off-trail descent Matt badly sprained his ankle, which we taped for additional help. Apparently, the incident occurred after probably the most troublesome part. I remorse not stopping the group after that part and forcing them to refocus.

Thirty-six hours after Matt sprained his ankle on an off-trail descent, it had turn into very bruised. With supportive tape and caution, he finished the trip.

After Paul was badly injured (mentioned above, certainly one of our evacs), the group was shaken and in a light panic — it seemed pressing to get Paul out shortly. We divided up Paul’s gear and commenced descending rapidly down a decent canyon that involved a number of crossings of a small creek. One shopper, Bill, was carrying his personal backpack and Paul’s close to empty pack, which made for an unwieldy load. He slipped throughout considered one of these crossings and landed arduous on his hand. We splinted it later that day, when it turned clear to Bill that he could not just merely walk off the ache. A post-trip X-ray revealed that he’d damaged two or three metatarsal bones. Lesson: After an emergency, examine your degree of panic and that of the group, and convey it again to near-normal to avoid a subsequent emergency.


At our Mountain West places, the trailheads are at 7,000 to 8,500 ft, and all the trails climb greater. I discovered shortly that shoppers would wish to acclimate more cautiously, especially in the event that they lived at sea degree. In two out of my three journeys in 2011, shoppers developed acute mountain illness:

  • Ben from Missouri threw up his dinner on the primary night time,
  • David from Oklahoma was nauseous for a lot of the second day, and
  • Kayree from Ohio was a walking zombie after we hit 10,000 ft.

The number of altitude-related issues has declined, because most shoppers now arrive at the least two days early, giving them full days to acclimate and work by means of the initial symptoms (e.g. headache, fatigue, restless sleep). However they nonetheless happen — last yr, Rick from Seattle responded badly and had to be walked out, despite acclimating correctly.

Giardia and GI misery

The guides carry a gaggle provide of Aquamira drops, which in my program has achieved wonderful results. Solely 5 shoppers have developed giardiasis, all the time after returning residence and all the time after admittedly consuming unpurified water, intentionally or by chance.

Katie and Elizabeth developed flu-like symptoms (e.g. muscle aches, weak spot, diarrhea, fatigue), presumably contracted from another shopper or from one other traveler. The answer was over-the-counter drugs and relaxation, and a day-hike for everybody else.

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