Wilderness Medical Field Protocols:
An Overview
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Wilderness Medicine is not a new concept. It was practiced for tens of thousands of years before modern civilization developed. The healers of centuries past were limited by circumstance to generic diagnoses and simple and adaptable equipment and treatments.
A patient’s medical problem was just a small part of a much larger picture that included weather, terrain, hazards, predators, mobility, and limited supplies of food and water.
Only in the past two centuries or so has civilized medicine been able to eliminate the environmental obstacles to providing care, allowing healers to focus on the medical problems before them. Aside from the occasional disaster situation, a hospital emergency department is free of wind, rain, rocks, and slope angle. The lights are always on and the temperature is ideal, and the patient’s medical problem is the only issue the staff needs to worry about.
This freedom from wants and fear led to an explosion of medical knowledge and technology. The dramatic influence on morbidity and mortality is evident almost everywhere in the world. In one of the most effective medical developments of the 20th century, Emergency Medical Services systems have extended some of these sophisticated technologies and procedures to communities far removed from the hospital.
However, while emergency medicine has changed dramatically in recent history, the wilderness has not. In truly wild places, the wind, rain, snow, and rock present just as much of a challenge to the medical provider as it did ten- thousand years ago. The patient’s medical problem remains just a small part of a much larger environmental picture. The same can be said of urban disasters, combat, and high angle rescue situations in which access to definitive medical care is delayed.
In some cases, helicopters are able to pluck people from peril and deliver them intact to the hospital. In most cases, it is the medical officer on the ground or rock face that is required to deliver care, sometimes for hours or days. The professionals and volunteers who are expected to provide this service need a scope of practice, standard of care, and regimen of training that works in a context of delayed access, difficult evacuations, and limited diagnostic and treatment resources. The re-emergence of the art of wilderness medicine has gone a long way toward providing that framework.
As the field grows, wilderness medical providers need to be free of the expectation that the techniques and equipment available and appropriate to the ambulance are going to be equally useful in the wilderness.
On the other hand, they also need to be free to apply techniques and principles that may not be allowed or appropriate for use by street EMS providers. The development and use of Wilderness Medical Protocols defines a scope of practice and standard of care in specific cases where the needs of wilderness and disaster rescue teams differ from the current practice and protocols of street EMS.
Who Uses Protocols, Anyway?
Acceptance of the concept by the medical and EMS establishment in the United States has been variable and sometimes controversial. This is understandable, considering that the protocols authorize basic level field providers to use techniques and medications typically reserved for licensed medical practitioners. A Wilderness First Responder, for example, may be allowed to reduce dislocations and “clear” spines where the paramedic or EMT on-scene cannot.
However, the use of such protocols has increased significantly in recent years. Large organizations like Outward Bound have been using wilderness protocols for over two decades with good results, as have Wilderness Medical Associates as well as CWS.
These protocols wield unconventional power and allow for specialized techniques and medications to save lives in places where time is of the essence, and help isn’t coming anytime soon.
A number of state and federal agencies have adopted and used wilderness protocols as well. The experience from the field indicates that well-trained providers at the WFR and WEMT level can safely and effectively use these techniques.
Conventional First Aid and EMT curricula are designed for an urban environment and assume the availability of 911 communications as well as rapid transport to a hospital. Backcountry outfitters and experiential educators have found the conventional medical protocols do not address the specialized wilderness context of delayed rescue transport in remote areas, prolonged exposure to severe environments, and the limited availability of medical equipment.