Guide to Wilderness Medicine for Outdoor Professionals and First Responders

An image of a group of hikers on a trail in the wilderness

The wilderness can be a harsh environment. Relatively common injuries can turn into infections without immediate access to proper treatment. Meanwhile, dehydration and shock are both serious threats if you aren’t prepared for your time outdoors. Additionally, there is the possibility of an animal attack while hiking on a trail.

Advanced care might be hours or even days away. This is when a minor injury can become severe and major trauma can take a turn for the worse, which is why it’s essential to take the appropriate steps in stopping (or minimizing) any injury progression. The need for accessible primary care during this time is becoming a concern — especially for those in remote and rural areas.

To change the outcome of medical events in rural, remote and backcountry areas, the general public will need to know how to immediately provide first aid care.

This necessity is creating a demand for those with a DNP degree to serve as an intermediary — allowing clinical and hospital nurses to administer wilderness medicine and advanced care their patients need. To do this, understanding wilderness medicine should be of interest to anyone residing in rural areas.

Wilderness Medicine

Both outdoor professionals and first responders should practice wilderness medicine, especially since they will be working in remote or rural settings. Outdoor enthusiasts, medical professionals and average people who know wilderness medicine practices will be able to provide critical emergency care in remote settings including:

  • Climbing
  • Rafting/kayaking
  • Hiking/backpacking
  • Hunting
  • Fishing
  • Skiing

Wilderness medicine includes evaluating and prioritizing the situation and providing preliminary care in a large variety of climates and environments. Those in this field should have a background of medical knowledge and/or wilderness first aid. Additionally, they should always keep a wilderness first aid kit prepared to minimize the damage while waiting for further help.

Wilderness medicine is broad and includes elements of emergency medicine — urgent intervention, stabilization, prehospital care and transportation. Therefore, a wilderness medicine professional — even adequately prepared — will need to be judicious in unpredictable scenarios and understand facets of the environment around them.

Environmental and Other Potential Hazards

The risks involved in backcountry activities are abundant, and can be fatal, if outdoor enthusiasts and medical professionals are not prepared for handling both the physical and environmental hazards that come with the territory.

People may choose a desert, mountain, tropical or marine setting for their outdoor activities. It is imperative to understand and respect the type of environment you are operating in — including the weather forecast, altitudes, hazardous terrain and wildlife.

Additionally, those who enjoy outdoor activities need to take into account their level of experience, pre-existing conditions and any unique preparation they may need for the specific environment they will be in. This can help maximize their chances of preventing injury or illness.

Preventive Actions

In addition to knowledge of first aid, some basic outdoor safety tips include:

  • Travel with company. If injury or illness happens when you are alone, you may not be able to provide yourself the care you need. Travel companions may also go for help, navigate if you get disoriented or injured, and defend yourselves from an animal attack.
  • Wear appropriate clothing. Make yourself comfortable with clothing including the proper inner layers, outer layers and footwear. Always bring extra, warm clothing in the event that the weather turns or you wind up unexpectedly staying the night.
  • Leave a copy of your itinerary. This can help a friend or family member better understand where you will be and how long you will be gone. If for any reason you aren’t back in time, they can alert the authorities.
  • Bring a first aid kit. Antiseptic, pain relievers, tweezers, insect repellent and a snake bite kit are all things you may include. Your first aid kit may be tailored to the environment you will be in (such as a snake bite kit for a desert).
  • Pack emergency supplies. This includes a first aid kit, but also a compass and/or map, flashlight, shelter, a satellite phone to call out for search and rescue, bear spray, a knife, and anything else specific to your trip. Additionally, pack nutritious, high-energy food and water.
  • Prepare for an attack. It is important to know that if you are attacked by an animal aggressively, fight back. In this scenario, using weapons, rocks and sticks while aiming for the face (eyes, nose, etc.) may be your only and best defense.

Wilderness Medicine Areas of Interest

As mentioned above, wilderness medicine is a multifaceted field of medical practice. Areas of interest pertaining to wilderness medicine include, but are not limited to:

  • Altitude illness. High-altitude activities, such as skiing and mountaineering, can lead to altitude sickness. The wilderness medicine focus is education and treatment of the life-threatening risks of high-altitude travel and activities, including administering oxygen and preventing high-altitude pulmonary edema
  • Cold-and-heat related illnesses. Hypothermia- and hyperthermia-related ailments are relatively common when exposed to the elements for extended periods. Wilderness medical professionals can specialize in lowering/raising core temperatures and providing further treatment in extreme conditions.
  • Diving (hyperbaric) medicine. This focus is concerned with the treatment, prevention and diagnosis of injuries and illnesses related to underwater environments. This includes marine hazards, decompression safety and overall diver education.
  • Envenomation. Insects and plants in remote areas can be venomous and extremely dangerous. This area of interest focuses on the treatment of injury by venomous creatures and education on what to do if you are stung or bitten by a spider, scorpion, snake or any marine life.
  • Expedition and disaster medicine. This interest is specific to the practice of medicine in remote environments. The emphasis of expedition and disaster medicine is in pre-departure planning and providing care and education for the adventurers.
  • Search and rescue. This area may include volunteer citizens and law enforcement. It aims to provide them with the medical training to go on missions for missing children, those with cognitive disabilities and outdoor enthusiasts.
  • Wild animal attacks. The objective of this wilderness medicine emphasis is to educate recreationists on preventing an animal attack, and what to do if you come across a hostile animal.
  • Wilderness trauma. In severe cases, trauma can occur from a high fall during rock climbing, hiking and more. This area of focus is concerned with educating professionals on treating minor to major trauma in these situations.

Wilderness First Aid Kit Supplies

Since wilderness activities involve many different climates — and risk of injury associated with various terrains — first aid kits can be tailored for specific expeditions. For example, you would likely need different medical supplies for an ice fishing trip than you would for a summer backpacking trip in the mountains.

Outdoor enthusiasts can assemble their own kits or purchase pre-assembled kits with unique items customized for specific environments. While items may vary, essential items in any first aid kit include:

  • Antibiotic ointments
  • Antihistamine for allergic reactions
  • Antiseptics
  • Biodegradable soap
  • Blister treatment
  • Dressings, bandages, splints and wraps
  • Diarrhea medication
  • Gloves
  • Insect repellent and anti-itch ointment
  • Multi-tool with knife
  • Prescription medications
  • Pocket guide
  • Rescue mask
  • Safety pins
  • Sunscreen and sunburn relief

Wilderness Medicine for Outdoor Professionals

Wilderness medicine and preparedness is vital for recreationists. However, if you are looking to become a professional outdoorsman (hunting, backpacking, diving and/or river guide), it will be extremely beneficial to seek further training from other outdoor professionals. This includes obtaining certifications and even diplomas.

For instance, those interested in guiding or instructing underwater activities might earn their Diploma in Dive and Marine Medicine (DiDMM). Additionally, you can earn your Diploma in Mountain Medicine (DiMM) for leading hiking and backpacking tours. There are many organizations that offer diplomas and educational programs for the various areas of wilderness medicine.

Wilderness Medicine for Nursing and Medical Professionals

Nurses and other medical professionals can also learn some of the foundational elements of wilderness medicine as part of a . This includes the ability to demonstrate advanced levels of nursing practice, clinical judgment and accountability — all proficiencies needed for the assessment of injuries and provision of care in an unpredictable situation.

Additionally, the demand for nursing professionals with this degree reflects an effort to improve population health in rural (remote) populations. Individuals with a Post-Master’s Doctor of Nursing Practice degree can pursue careers administering primary care in hospitals, rehabilitation facilities, remote care clinics and other health systems.

Areas of Wilderness Medical Training and Certification

Alongside earning a degree, an outdoor enthusiast or medical professional can pursue wilderness medicine certifications. Organizations offer classes, training, experience in the field and certifications to prepare you to become a leader in the backcountry and remote areas.

Wilderness First Aid Certification

WFA) refers to “any training course that focuses on prevention, assessment, and treatment for an ill or injured person in a remote environment where definitive care by a physician and/or rapid transport is not readily available.” A WFA certification course is recommended for anyone 16 and older aspiring to adventure in remote areas and will take 16 to 20 hours to complete.

Wilderness Advanced First Aid

A wilderness advanced first aid (WAFA) certification is recommended for individuals 16 and older, and for those who are looking to travel to remote areas. Here, you will learn to treat, stabilize and make transportation decisions for patients injured in the outdoors. This course will be 40 hours long.

Wilderness First Responder

Wilderness first responder (WFR)is for those aiming to become guides, educators, professionals and part of search and rescue teams. Here, you will be in both a classroom and outdoor settings (no matter the weather) to learn how to provide wilderness care in any environment when help is not available for miles or days. A WFR certification is standard for outdoor professionals.

Bridge (WAFA to WFR)

WFR training will take 64 hours to complete — however, WAFA training and certification will be a prerequisite. The Bridge is a four-day course to advance your WAFA certification into a WFR.

Wilderness EMS Upgrade

Specifically for rural and remote environments, a Wilderness EMS Upgrade (WEMS) is for medical professionals such as pre-hospital EMS providers. WEMS training provides unique courses to educate and prepare these individuals so they can provide care in challenging and hazardous areas.

Wilderness Life Support CPR and AED for Adult, Child and Infant

This training is geared for providing CPR education for the administration of cardiopulmonary resuscitation in any occasion, to anyone. Generally, CPR certification courses take about three to five hours to complete.

Canine Wilderness First Aid and CPR

There are classes to understand how to treat a dog who has become ill or injured during your expedition. This includes treating wounds, restraining and transporting, and CPR to treat and stabilize your dog. Fees and course length may vary.

Wilderness medicine is invaluable knowledge to have in remote, backcountry and other outdoor areas. In many cases, it may be the only thing keeping someone alive until they can be safely transported to a facility to receive advanced care. It is a must for both medical professionals and outdoor enthusiasts.