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 medicine, case study, hydration, Wilderness First Responder

The Setting

You are a Search and Rescue (SAR) volunteer working with a team to sweep a trail in the central Rocky Mountains in response to a vague cell phone report of an ill person somewhere on the trail. Eight miles from the trailhead at 8,800 ft. (2,680 m) you find the patient sitting on a log. After introducing yourselves, and with the patient's permission, you and the SAR team members begin an assessment.

Topics: wilderness medicine, case study, first aid, Wilderness First Aid, altitude illness

Photo by Ashley Wise

THE SETTING

You’re leading a canoe trip for a group on the Rio Grande River in Big Bend National Park in Texas. It’s been a hot trip, with temperatures well over 90°F (32°C) day after day. Today, the group started off with a long morning hike up a side canyon, and now you’ve been paddling for several hours, floating lazily along, watching birds swoop around the limestone cliffs.

Suddenly, your observations are interrupted by yells for help downstream. You paddle quickly to a beached canoe and several people on shore. One of your participants is shouting something about a seizure.

Another participant is lying on their back in the sand. Their legs are quivering, but their arms seem to be moving normally. The other participant insists this is a seizure—you’re not so sure.

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

Photo by Jessie Long

The Setting

You are hiking with a friend through the Uinta Mountains in Utah, heading toward an 11,600-foot pass. Dark gray clouds are building in the west, hinting at an approaching thunderstorm. You ignore them: your itinerary does not allow for delays. As you move quickly up and over the pass, you and your friend are exposed to gusty winds, deep low rumbles of thunder, and occasional spits of rain. You speed your pace. On the other side of the pass is a broad alpine meadow—there are two miles of grass and wildflowers between you and a low forested area.

Topics: wilderness medicine, case study, Lightning Safety

The Setting

You and a friend have been rock climbing at the local limestone climbing area outside of Lander, Wyoming. While walking along the base of the cliff, your partner drops a piece of climbing gear and reaches to retrieve it. You hear a buzzing noise, a cry of surprise, and then your partner falls backward and tumbles down the sloped hill.

Topics: wilderness medicine, case study, Wilderness First Aid

Editor’s Note: This case study is based on a real-life incident from the early 1980’s.

The Setting

You and three friends are on an early winter ski trip. To shorten the route, the group decides to cut across a lake, despite previously agreeing to avoid the lakes due to thin ice.

Topics: wilderness medicine, hypothermia, winter, case study, NOLS Wilderness Medicine

Editor’s Note: We developed this hypothetical scenario to represent a common and plausible situation on winter backcountry trips.

Topics: wilderness medicine, case study, NOLS Wilderness Medicine, frostbite

Be honest—when was the last time you looked inside your first aid kit? Was it just last week, or was it long enough ago that you couldn’t confirm whether a family of packrats had made a home in it or not?

Topics: NOLS Wilderness Medicine, Wilderness First Aid, wilderness medicine, First Aid Kit

"When you find yourself in an emergency situation, is it better to resort to drinking unfiltered and possibly contaminated water or drinking no water at all?"

It’s a question, or as we like to say at NOLS, a judgment call, of which is the greater risk: dehydration or waterborne illness.

If this is an emergency, you need your wits and your health; both deteriorate when you are dehydrated. You need to consider how well hydrated you were at the start of this emergency, how fast you are losing fluids, how hard you are working, and how long you expect to be without a reliable water source. Perhaps you have the experience and self-awareness to anticipate how long you can function without fluid intake.

Topics: education, NOLS Wilderness Medicine, wilderness medicine, Wilderness Medicine

One of NOLS founder Paul Petzoldt’s endearing habits was challenging students to explain their choices and the principles behind their decisions and techniques. He wouldn’t settle on one best way to do something; he sought the practical and effective way.

Unfortunately, it’s not uncommon for students of first aid and pre-hospital medicine to be taught in absolutes; practices that supposedly work all the time, practices framed as being based on solid evidence but in reality often founded on bronze, not gold standard, science.

Topics: leadership, NOLS Wilderness Medicine Institute, wilderness medicine, Wilderness Medicine, WMI

Topics: backcountry, education, Expedition Prep, risk management, wilderness

The Setting

You're leading a team building day for a group of business people. Today's plan includes rappelling practice.

One participant, fearing the heights and exposure, is reluctant to participate. It took convincing from his co-workers to get him on the rappel over the cliff edge.

He is now 15 feet below the lip of cliff and looks awful. He's red, sweating, breathing hard, and says he is going to pass out. You engage the belay line to take control of his lowering, and try to get him to release the death grip he has on his brake line. This triggers drama: you hear swearing from below as he grabs the main line above his rappel device with both hands. Eventually he lets go and you lower him to the ground.

Topics: Backpacking, Wilderness Medicine, WMI, wilderness medicine, case study, psychological first aid

Adapted from the 2005 issue of The Leader.

Now that summer has officially arrived, we can enjoy the hot temperatures, lush wildflowers and rivers full with snowmelt. It brings to mind the need to stay hydrated.

Topics: backcountry, Backpacking, Wilderness Medicine, WMI

When the weather warms up, that means the reptiles are out of their winter dens and ready to enjoy some sunshine—just like you, your friends, dogs, and everyone in between.

Topics: backcountry, education, Wilderness Medicine

I once heard lightning expert Mary Ann Cooper, M.D. say that the primary risk factor in lightning danger is not the lightning itself; it's the inconvenience of risk mitigation, the unwillingness to change plans in the face of inopportune weather. I've heard altitude illness expert David Shlim, M.D. say that to prevent altitude illness, ambition and schedules must be tamed.

Topics: leadership, wilderness medicine, WMI, backcountry