What is Wilderness Medicine?

by Morgan Matthews RN, CEN

People often ask what I do for a living. Most understand what it means when I say that I am an emergency room nurse. However, when I tell them that I also teach wilderness medicine courses, the response is usually “Oh, you teach survival skills?” They assume it means that I teach how to build fires, which berries are edible, and how to live primitively. Although those skills are useful, It is essential to distinguish between survival skills and wilderness medicine.

Have you ever seen the show Naked And Afraid? If you haven’t, that’s ok. T.V is terrible for you. If you have, it’s a great example of the implementation of survival skills or bush-craft, minus the cameras. Survival skills consist of living off the land in a natural environment or an environment that is built. It is the use of techniques that provide the necessities of life such as water, food, and shelter and learning how to interact with plants and animals to sustain life. In survival courses, students may learn how to live just as our ancestors have done for thousands of years sans modern technology. You might even learn how to successfully kill an animal for food and dry the hide for a sweet jacket. Who knows, by the end of one of these courses, you may be ready to be on T.V., battling someone for the last torch standing, in true Survivor mode.

Wilderness medicine is different. It is a branch of medicine that trains folks to respond to illnesses and injuries that occur in remote backcountry settings of at least 1 hour or more from an ambulance rescue or transport to a hospital. It is the implementation of a primary assessment, triaging or prioritization, initial treatment and the possibility of an emergency evacuation. Wilderness medicine is undoubtedly becoming more popular in response to an increase in remote outdoor recreation.

Let’s think about this. You are hiking with your buddy up to Mt. Sneffels, a 14,000 ft peak in Colorado, and they misstep sending them down a scree pile a couple of hundred yards. When they finally come to a stop, they are unresponsive. You can tell that they are breathing, but they are bleeding from a cut on their head. Now what? Oh, and there is no cell phone reception. This fall took place in a remote, dynamic, and austere environment that can make for difficult or dangerous patient access, with limited equipment and unreliable communication. A medical emergency in this environment requires critical thinking, collaborative care, and strong assessment skills to keep your backcountry buddy safe and alive over the course of an evacuation. In this case, an evacuation to definitive care could average eight hours or more. Conversely, urban responders can dial 911 to get a rapid delivery time to definitive care of approximately 15 minutes. Patients can deteriorate over time, which is why these courses are so important.

Wilderness medicine courses utilize evidence-based data and technology to teach the latest innovations to direct remote medical care. There are courses of varying lengths and certifications. All of them do incorporate basic CPR as well as many hands-on medical skills such as how to correctly apply a tourniquet, administer epinephrine for anaphylaxis, splint broken bones, stop bleeding and prevent a myriad of illnesses common to backcountry travel. Although it is crucial to have both survival and wilderness medical skills before venturing on a remote backcountry trip, it is essential to know the difference and how they can benefit you and your buddies in the event of an emergency.