The Setting

You and your climbing partner are enjoying an exceptional climbing vacation. This morning your partner has the lead on the first pitch and is approximately 30 feet off the deck and 6 feet above his last piece of protection working over a roof.

At this point you notice him struggling with his foot placement and brace for a fall. He comes off the route and swings into the rock about 12 feet below his high point. His feet impacted first. He grabs his right ankle.

Topics: first-aid, wilderness-medicine, case-study, NOLS Wilderness Medicine, wounds

The Setting

You are searching, as part of your local SAR team, for an overdue snowmobiler. You know that the overdue person is a 62-year-old male with a history of risk factors for heart disease, but no actual heart attacks. He is described as an experienced snowmobiler and knowledgeable of the local trails. He planned a short ride this morning, due home by noon.

Topics: first-aid, wilderness-medicine, case-study, NOLS Wilderness Medicine

The Setting

You’re the trip leader for a group of teenagers on a nine-day backpack in the Bitterroot Mountains of Montana. The rivers are up and every crossing has been wet. A late spring snowstorm dropped several inches of new snow and brought cooler temperatures. 

You’ve encouraged daily foot checks, changing socks and staying as warm and as dry as possible—all relative to the reality of these conditions. At today’s midday rest break you realize no one has dry socks and one of the participants says his feet hurt.

Topics: first-aid, wilderness-medicine, case-study, NOLS Wilderness Medicine

The Setting

You are hiking with a group of friends deep in a wilderness area. It’s lunch and everyone’s stomach is rumbling, but no one wants to stop long term.

Luckily, you have trail mix within arm’s reach. You feel comfortable passing it amongst your hungry group members because it doesn’t contain nuts.

However, soon after one of your friends becomes acutely ill. With a tingly and tight throat, your friend seems to be having an allergic reaction.

Topics: first-aid, summer, wilderness-medicine, case-study, heat illness

You’re out for a hike, enjoying a beautiful day in the mountains. Pausing to take a sip from your water bottle, you survey your surroundings—and suddenly notice the fallen hiker up ahead. You put your water bottle away and start walking toward the crumpled figure beside the trail.

Topics: patient assessment, first-aid, wilderness-medicine, Wilderness First Aid, NOLS Wilderness Medicine

Your weekend adventure in the mountains takes an unexpected turn when you spot a fallen hiker beside the trail. Fortunately, after a brief moment of panic, your wilderness medicine training kicks in and you complete a thorough scene size-up.

Topics: patient assessment, first-aid, wilderness-medicine, NOLS Wilderness Medicine

The Setting

You’re the supervisor for several crews doing volunteer trail maintenance in a local national forest.

Since your crew leaders are new, you decide to head out to their work sites to check on their work. (Plus, it’s a good reason to get out of the office, away from email, and enjoy a hike in the hills.)

The weather has been unusually hot and humid, with daytime temperatures in the 90s °F (30s °C).

You find one of your crews around lunchtime resting under a few trees. They look lethargic and tired.

One crew member is lying on his back with his feet elevated and a wet bandanna on his forehead. Your crew leader gives you a SOAP report on the patient.

Topics: first-aid, summer, wilderness-medicine, case-study, heat illness

The Setting

You’re a biologist working out of a remote ranch on the sagebrush plains of southern Idaho. It’s early May. You ride and walk daily to survey herds of pronghorn as part of a research program. One of your classmates goes to bed feeling lousy—achy, nauseous—and wakes up feeling worse.

Knowing you have training as a Wilderness First Responder (WFR), your colleagues ask you to take a look at this poor fellow.

Topics: Wilderness First Responder, first-aid, wilderness-medicine, case-study, NOLS Wilderness Medicine, flu-like illness

The Setting

You and a companion, both proud and confident Wilderness First Responders (WFR), are hiking a wilderness trail when you are passed by a horse pack string led by a young cowboy. You exchange pleasantries and fishing tips.

Suddenly, one horse nips at another, a horse kicks, and then horses seem to be going everywhere. The rider’s horse rears and bucks; he falls off and lands on his head and shoulder.

Topics: decision making, Wilderness First Responder, first-aid, wilderness-medicine, case-study

The Setting

You are on a Search and Rescue (SAR) team whose members are Wilderness First Responders (WFRs). You and your team members hike on a rugged trail into Wyoming’s Wind River Range, responding to a vague report that came in at midnight of a “very sick person” camped “near the trail near tree line.” Your team’s role is to sweep the trail in the dark in the hopes of finding out exactly what is going on. A second SAR group is gathering to hike up the trail later in support.

Topics: Wilderness First Responder, first-aid, wilderness-medicine, case-study

The Setting

You are the leader of a hiking group at a summer day camp. Today, you allowed some of your campers with good navigation skills and expedition behavior to walk 3 miles back to your camp on a well-marked trail without a camp leader present.

When the campers arrive, you notice one of them has a bandage on their forehead. You learn that about an hour ago and a mile back on the trail this camper tripped, fell, and knocked their head.

Topics: Wilderness First Responder, first-aid, wilderness-medicine, case-study, NOLS Wilderness Medicine

This is a tale from the early 1980s. Reagan was President, the internet and cell phones only a dream, and disco thankfully on its last legs. Two friends and I had recently learned wilderness medicine skills through an advanced first aid course, which was an early generation of the Wilderness First Responder (WFR).

Read along to see how you would react to a similar first aid situation today.

Topics: Wilderness First Responder, first-aid, wilderness-medicine, altitude illness, case-study, NOLS Wilderness Medicine

The Setting

You’ve been leading an outdoor skills course for young adults, most of it taught indoors or on day hikes. This weekend is the culminating overnight snowshoe trip where you plan to sleep in hollowed-out snow shelters, called quinzhees.

The snowshoe hike went according to plan and you and your group arrive at your planned campsite. Everyone appears weary, happy, and healthy. You note that it is much colder than any previous trip you’ve led, with temperatures hovering near 0°F (-18°C).

Topics: Wilderness First Responder, first-aid, wilderness-medicine, case-study, winter, frostbite

Photo by Brian Fabel.

Editor’s Note: This case study is based on an actual incident that NOLS Wilderness First Responder and Wilderness First Aid graduates responded to.

Topics: Wilderness EMT, Wilderness First Responder, first-aid, wilderness-medicine, case-study, winter

The Setting

You and three friends are hiking through a sandy wash in the desert. Even though it is fall, daytime high temperatures have been 100°F (37.7°C) with no clouds in the sky.

Your group encounters another party of two hikers, one of whom is lying on the ground under the only small juniper in the area. The other hiker seems worried. You ask if everything is ok. One hiker is fine but asks if you can help with the patient, who he worries is dehydrated or having a “heat stroke.”

Topics: Wilderness First Responder, first-aid, wilderness-medicine, case-study, hydration