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

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

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

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: Lightning Safety, wilderness medicine, case study

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, Wilderness First Aid, case study

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, case study, winter, NOLS Wilderness Medicine, hypothermia

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

"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: wilderness medicine, education, NOLS 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: wilderness medicine, WMI, leadership, NOLS Wilderness Medicine Institute, Wilderness Medicine