Wilderness First Responder

For the past ten days I’ve been engaged in something nearly as grueling as an ultramarathon: school. The Wilderness Medicine Institute confined me to ten days and 80 hours of backcountry medicine, all for the coveted title of “WFR”. And you know what? It was totally worth it. The skills I learned in that class will help me for the rest of my life, which could be considerably longer now that I know the basics of wilderness patient stabilization and evacuation. But what they didn’t teach us was the history of wilderness medicine itself. So I did some research and came up with the following:

"Wilderness Medicine" predates civilization. If the concept denotes the absence of definitive care, then just about all medicine practiced up to the modern age could be considered wilderness medicine. A good example of this is Otzi the Iceman, a 5300-year-old mummy found in a glacier in northern Italy in 1991. His body featured more than 50 tattoos, many of which were strategically placed over acupuncture points. His possessions also included a type of fungus known to have antibacterial properties, indicating that he was at least aware of the existence of intestinal microbes. This shows that he had a rudimentary knowledge of the body and its properties, and he was not alone. Evidence of this kind of basic medical knowledge can be found in some form in nearly all ancient civilizations. The Maya used human hair to stitch lacerations and performed dental and brain surgery with obsidian knives. Ancient Egyptian prostheses have been found that show continued wear by the patient for several years. Clearly ancient man was greatly skilled given the circumstances.

What created a rise in medicine more than anything else was war. Militaries needed people who could save injured soldiers on the battlefield and so doctors were in high demand along warfronts. As a result many of the greatest innovations in medical science came from war. Ambroise Pare was a 16th-century French "Barber-Surgeon" who, among other things, revolutionized the treatment of bullet wounds. The standard practice of the day was to cauterize them with boiling oil, but when he ran out of oil during the siege of Turin he went rogue and started bandaging wounds with regular dressings and ointment. He immediately saw a marked increase in survival and published his findings. He also promoted "the ligature of blood vessels to prevent hemorrhage during amputations" (Biography). His findings transformed medicine forever. Napoleon's Surgeon-General Dominique Jean Larrey was among the first to teach large audiences the basics of improvised injury stabilization in preparation for the mass casualties of war. He began the practice of Triage, which is the concept of prioritizing wounds and treating the most urgent first. He also was widely known for creating "flying ambulances" which would sweep the injured off the battlefield in less than twenty minutes during battle. These men and countless others not only pioneered the practice of medicine in general, but particularly the last-resort improvisation methods we use in the backcountry today.

According to Wikipedia: "By the dawn of the 20th Century additional organizations such as the Boy Scouts and the American Red Cross began teaching first aid to lay people. Over the years, these organizations trained hundreds of thousands of people in the elements of providing assistance until definitive care could be arranged." Over time people began to realize that with the rise in popularity of outdoors-based activities, new criteria needed to be developed to allow for longer time frames before the patient could see a doctor. The Mountaineers of Seattle were among the first to address this issue, forming classes that grounded climbers in the basics of wilderness medicine. After passing the National Traffic and Motor Vehicle Safety Act, the U.S. Dept. of Transportation created an Emergency Medical Services (EMS) system that standardized curriculum for Emergency Medical Technicians (EMT). From there the field grew and in 1977 Stonehearth Open Learning Opportunities (SOLO) held the first ever Wilderness First Responder (WFR) course.

Nowadays a WFR is required for most work in the outdoors industry, and is extremely helpful for anyone who spends a lot of time removed from definitive care. Several companies hold WFR courses, but perhaps the most well known company is the Wilderness Medicine Institute (WMI) of NOLS. These courses are 80-hours long and incorporate every conceivable problem that could arise, from broken bones to allergies, snakebites to diabetes. My experience was enough to show me that to this point I've been almost irresponsibly unprepared. I’m now prepared to handle an accident. Although WFR's are in no way a substitute for definitive care they are at least able to assess the situation and adequately stabilize the patient. In most cases that will be enough.

The conclusion? Get your WFR. It's worth it.