Wilderness Medicine for
Resident Outdoor School Teachers and Naturalists

Certifications

Certifications which include the "wilderness" appellation address situations in which the victim is more than two hours from definitive medical care (a hospital), in a severe environment, or when improvised equipment is required. Courses are listed by increasing length and value of the certificate, within the urban and wilderness categories.

Cardiopulmonary Resuscitation (CPR): American Heart Association offers an 8-hour Healthcare Provider course for 2-year certification while the American Red Cross offers similar 4-hour adult or 5-hour infant/child or 6.5-hour adult/infant/child or 9-hour CPR for the professional rescuer course, all for a one-year certification. The course covers basic life support - clearing an airway, breathing for a victim, and chest compression.

Urban

Community First Aid (FA): An American Red Cross 9-hour course for 3-year certification, covering basic first aid for urban situations and CPR. Many combinations of first aid and CPR training are available.

First Aid - Responding to Emergencies (similar to Advanced First Aid - AFA): An American Red Cross 24-hour course for 3-year certification, covering more advanced first aid and some assessment for urban situations.

Emergency Response: A 44-hour course for to train first responders to help sustain life, reduce pain, and minimize the consequences of injury or sudden illness until advanced medical help arrives.

Emergency Medical Technician (EMT): A training for ambulance and fire personnel, with hospital and ambulance observation.

Wilderness

Wilderness First Aid (WFA): A 16-hour course for 3-year certification, which builds on CPR and First Aid (though does not require them) by adding a patient assessment system and medical protocols appropriate for a wilderness setting. Topics include patient assessment, body systems, equipment improvisation, trauma, environmental medicine, toxins, backcountry medicine, and wilderness rescue. Also a refresher for WFR.

Wilderness Advanced First Aid (WAFA): A 36-hour course for 3-year certification, which builds on WFA by adding additional depth and simulations for patient assessment and wilderness protocols.

Wilderness First Responder (WFR, often pronounced "woofer"): A 72-hour course which covering the same topics as WFA, but with extensive practice and simulations, and information about advanced life support, movement and evacuation, and search and rescue, with CPR BLS level included.

Wilderness Emergency Medical Technician (WEMT): A 180-hour course for a 3-year certification. Can also be taken as a 54-hour add-on to an existing EMT certification. Includes hospital and ambulance observation as well as wilderness protocols including oxygen administration and automatic defibrillation.

Other specialty certifications are often available in fields such as ski patrol and search and rescue.

Common Requirements

The level of certification required for various outdoor recreation and education positions is not consistent, but there are some patterns. CPR and First Aid are usually required for any person working with children or adults in an outdoor environment, including residential outdoor schools. Wilderness First Aid is often required for any program that leaves the program site for trails or other outdoor environments, and university outdoor programs. Wilderness First Responder is almost always required for staff in multi-day or higher risk programs. WEMT is usually required for expedition leaders, search and rescue personnel, and Park Service backcountry rangers.

Recommendations for Residential Outdoor Schools

My recommendation for training and certification for residential outdoor school naturalists and teachers is:

• AHA Healthcare Provider CPR and Red Cross community first aid be the minimal level of training for all teaching staff at outdoor schools
• Wilderness First Aid should be required for programs which schedule all-day hikes or overnights, or provide higher risk activities such as ropes courses and climbing walls
• over time, long-term staff should obtain WFA and long-term staff in the all-day, overnight, and higher risk situations should obtain WAFA
• Wilderness First Responder is not normally needed in the residential outdoor school setting but might be appropriate for remote sites and could be very beneficial for staff in their off-season pursuits
• residential outdoor schools should require the minimal level of certification before hiring any staff position, but should support staff in reaching the next level of certification by offering tuition, per diem, and salary for these trainings

These are my ideas. What do you think? I'll be happy to include any responses as addendums to this article.

Sources of Training

Three companies, WMI, WMA, and SOLO, are recognized throughout the outdoor recreation and education field as providers of effective curriculum and hands-on teaching methods. Other companies may or may not provide the same quality of training.

• Wilderness Medicine Institute (WMI), PO Box 9, Pitkin CO 81241; 970-641-3572 / 970-641-0882 fax; ; http://www.wildernessmed.com/
• Wilderness Medical Associates (WMA), 189 Dudley Rd, Bryant Pond ME 04219; 1-888-WILD-MED (945-3633); ; http://www.wildmed.com/
• SOLO / Stonehearth Open Learning Opportunities, PO Box 3150 - Tasker Hill, Conway NH 03818; 603-447-6711 / 603-447-2310 fax; ; http://www.stonehearth.com/

American Red Cross; http://www.redcross.org/

American Heart Association; http://www.amhrt.org/

The Fall 1998 issue of The Outdoor Network Newsletter focused on wilderness medicine and was of help in writing this article. Information from the five web sites above was also used.

Publications

Outward Bound Wilderness First Aid Handbook

Wilderness Medical Associates Field Guide

Both can be obtained from Wilderness Medical Associates, above.