Wilderness First Responder: How to Recognize, Treat, and Prevent Emergencies in the Backcountry

by Buck Tilton

The Wilderness First Responder is a comprehensive text for the recognition, treatment, and prevention of wilderness emergencies. It's essential reading for wilderness educators, trip leaders, guides, search and rescue groups, and anyone who works or plays far from definitive medical care.

This invaluble resource includes expert, step-by-step instructions, clear illustrations, and "Signs and Symptoms" sidebars designed to help you provide care in the wilderness--whenever you are more than an hour away from an ambulance or a hospital. You'll learn how to conduct a patient assessment, improvise when ideal materials are not at handy, and decide whether or not to evacuate a patient.

Learn how to assess and airway obstructions, cardiac arrest, external and internal bleeding, shock, spine injuries, head injuries, chest injuries, abdominal injuries, fractures and dislocations, athletic injuries, soft-tissue injuries, cold- or heat-induced injuries, altitude sickness, insect bites and stings, diabetic emergencies, poisoning emergencies, allergic reactions and anaphylaxis, and much more.

Buck Tilton, co-founder of the Wilderness Medicine Institute of the National Outdoor Leadership School (NOLS), wrote this book with more than a dozen medical professionals. The book represents more than a century and a half of combined experience in wilderness medicine, rescue, and education. Thouroughly updated and revised, this classic first-ever teaching manual for the "Wilderness First Responder" course is a must-have for anyone venturing into the backcountry.

Genres: Reference, Nonfiction, Outdoors, Medical, Health, Wilderness, Medicine

320 pages, Paperback

First published July 1, 1998

Reviews

[Andrea · Rating 3 out of 5]

He defined wilderness as when you're an hour away from medical care. "Who stands beyond the one hour? Outdoor leaders and educators do, wilderness guides and enthusiasts, military personnel, remote researchers, field journalists, and many more. And they share the fact that hospitals and, usually, physicians are far enough away that the closest thing to anything definitively medical could be you."

Anticipating and preventing probs is as imp as recognizing and treating them. Planning and preparing to prevent emergencies from things like heat, cold, altitude, hygiene, and blisters is imp. How to travel, dress, eat and drink, and choose gear.

The EMT operates under the "golden hour," the goal to get the patient to the hospital in 60 mins. That term was familiar to me from watching a military show on a para-rescue team.

Wilderness medicine is different because it requires environmental factors, and treatment with limited and nonspecialized equipment that may need improvisation, and might have a lack of communication with outside world and an extended amount of time.

Injuries can get worse with changes, like open wounds leading to infection. Environmental extremes can increase stress and risk to patient and rescuer.

I was scared when it came to the chapter on legal issues and being sued. That in your career you might have a contract with someone who could sue you for your care of them. Whoa. It got serious at that point.

It was so nerve-wracking to read giving someone CPR and making sure they're breathing. When it came to internal bleeding, and brain and spine injuries, and abdominal injuries like intestines spilling out, I got a little dizzy. Definitely not my kind of thing and I'd never be able to treat much less look at an injury like those.

I thought they should have saved the most severe injuries for last and eased us into the most basic injuries first. It was jarring to read about the worst injuries the human body can suffer, those that there's really nothing you can do except get help because people are going to die quickly.
Fractures are the most common that WFRs have to deal with, including dislocations, and athletic injuries (sprains, strains, tendinitis).

Athletic injuries are one of the most common that require treatment. Muscles, tendons and ligaments experience over-use injuries or traumatic ones. "They are called "athletic injuries" not because the patients are necessarily athletes, but because the injuries often leave the patient, after adequate management (and sometimes without proper management), able to continue the wilderness journey, as athletes are often able to return soon to the game following a similar injury."

I liked the part on lower back strain because my lower back gets hurts so easily. He advised rest in the beginning, lay on your side or back with padding under knees. Too much rest is a bad thing because it can lead to weak muscles. As soon as you can handle exercise, exercise to your tolerance level. Start with easy walking and then exercise the back by lying flat on it, knees raised and feet on the ground, and raise head and shoulders and press the lower back into the ground. This abdominal crunch stretches the lower back and strengthens abdominal muscles, which helps prevent lower back injury.

Ice the pain several times a day for several days, and gently massage several times a day. Hydration and ibuprofen are recommended.

I liked the practical advice not just for a WFR when they find a patient in the wild, but for anyone who exercises. The best way to prevent an athletic injury is to get and stay in shape. People with weak joints should learn exercises specific to that joint.

Boots that provide sufficient ankle support also provide better support for the knee and lower back. Replace worn-out footwear before it injures your ankle. Low-quality boots can cause pain as well as boots that are too stiff or too tightly laced. Warm up muscles before exercise because tight muscles are more likely to strain.

Wounds are one of the most common medical problems in the wilderness, and wounds and their complications make up 1/3 of wilderness medical problems severe enough to prevent engaging in activities. Burns, such as from hot water and fires, are a large % of wilderness incidents. During wilderness travel even small wounds can get infected. The objective is to prevent complications and attain optimal functional and cosmetic results.

I really liked the It Could Happen to You sections at the beginning of each chapter, because they set up a scenario with some humorous and unique wording that engaged me. And at the end you knew they'd pick back up and resolve it based on the skills we learned. One thing I noticed was that all the scenarios thru ch. 14 were never as bad as I first thought, like the injuries that went on to be described in the chapter were; they always ended up being the least serious injury, one that didn't require much. But for ch.16 on Cold-Induced Injuries, all of a sudden the injury was for us instead of another person. All the examples happened to other people and the reader was the WFR but this time we were the one injured as we lagged behind, didn't drink and didn't wear enough clothes and got hypothermia.

I was surprised to learn that someone with mild to moderate hypothermia wouldn't really warm up from a fire. I naturally think a fire would warm someone up quickly, but it really doesn't do much aside from psychological comfort. Also, another person doesn't warm them up. In tests the rate of warming didn't increase. I was surprised again that being naked versus lightly clothed is controversial. Skin to skin contact transfers heat faster, but light clothing limits the transfer of moisture. Hot water bottled and heat packs increase warm-up rate a little. Heat packs should be on the chest, hands and feet, but not directly on cold skin because it can damage. "A mildly hypothermic patient may be encouraged to exercise once he or she has donned dry clothing. A moderately hypothermic patient typically has too little coordination to be exercised safely, although he or she may be able to perform simple exercises, such as sit-ups within a sleeping bag."

This book busted a lot of myths about cold injuries. For frostbite, the freezing phase is when blood clots form in blood vessels and circulation decreases, which causes more destruction. What was surprising was that the thawing phase causes more damage than freezing. It's bad to massage the cold body part or put it near a strong heat source. You can warm by submerging in warm water. The best method is to have contact with warm skin. Ibuprofen will help take away some pain during the warming and decrease damage.

You can't over thaw, but you can under thaw. Test temp of water with elbow if you don't have a thermometer. If it's comfortably warm and not hot it's probably ok.

As the body's core temp rises, excess heat is absorbed by the blood. As the brain detects the increase in blood temp it causes blood vessels to open. This increases blood flow to the skin. The brain stimulates sweat glands to produce sweat to increase heat loss from skin. When sweat evaporates from the skin it increases the rate of cooling. If sweating fails or sweat can't evaporate, cooling off fails and overheating results. Loss of water and electrolytes from sweating + dehydration forms = heat illnesses.

Mild dehydration: dry lips and mouth, normal pulse, darkened urine &mild thirst
Moderate: very dry mucous membranes, rapid&weak pulse, darker urine &thirst.
Eat salty foods as well as staying hydrated when exercising in the heat.
Stay hydrated to prevent heat-induced emergencies. Drink before you get thirsty, and if you get thirsty, drink until thirst is quenched.

There should have been better order. Ch. 16 was cold-induced emergencies, ch. 17 was heat-induced, ch. 18 was altitude illnesses and ch. 19 went back to immersion and submersion. Those words had been brought up during the cold emergencies, and this chapter mentioned hypothermia. This should have been ch. 17. I thought I was done with that topic and was glad to move ahead, only to be brought back to hypothermia. That didn't make sense.

"Few, if any, rescue scenes carry more risk for the rescuers than an immersion or submersion incident. The water threatening the life of your intended patient may suddenly threaten your life."

"Reach, throw, row, tow, go."
Reach to a struggling immersed person (someone with their head out of water who is breathing) from a secure place. If you can't reach with your arm or leg, extend reach with an item. If that isn't long enough, throw them something that floats. If that doesn't work, row to the person in a stable watercraft. You can also toss a line to the person and tow them to safety. Going to the person "is to risk your own life." Their panic will give them greater strength and going to the person should be done only if you’re trained and capable.

When it came to amputations, I was so upset! It was hard to read about body parts coming off and having to put it on ice, but not directly because it might be possible to reattach if it's soon enough. Just thinking about that was jarring.

I really didn't like reading about drowning victims and what they go through. It was morbid and very unpleasant to think about. People panicking and struggling while holding their breath, heart rate and blood pressure rising, involuntarily swallowing water. "The drive to breath becomes overpowering, and the person inhales water." Respiratory arrest and cardiac arrest happens. I was surprised that recovery is possible by breathing for them and giving CPR if heart stopped. It was very surprising to learn that the colder the water is the better it is for recovery.

It sucked to learn lightning myths. It does strike the same place twice, and more than twice. Lightning strikes vehicles and rubber tires don't do anything to protect you. The electricity stays on the outside of the metal, so staying inside the car with the windows rolled up will protect you.

I was shocked when they said covering ticks with petroleum jelly, nail polish, and gasoline or burning them with a match are ineffective and maybe dangerous. Who came up with this stuff?! It was disturbing that using fingers works, but you can crush the tick and cause its juices to go into you. Fine-pointed tweezers are the best method. Grasp it near the skin and gently pull. Don't twist, yank or squeeze. Scrub area gently with alcohol, antibiotic ointment or soap and water. If you want the tick tested, don't touch it with your hand and write down the time and location.

Wearing light-colored clothing lets you spot ticks better. Tucking pants into socks ensures you usually find them before they reach your skin. DEET is a good repellant, and permethrin. Lemon eucalyptus oil repels but has to be applied more often.

It's shocking that mosquitoes ruin wilderness activities more than anything. An estimated 1 out of 17 ppl die from a mosquito bite. Put ice on a bite in the first few mins to reduce swelling and itching. Use an antihistamine such as diphenhydramine for intense reactions. DEET with 30% concentration is the best repellent. Higher concentrations don't increase repellency but last longer. Should be washed off as soon as exposure to insects is over. Can be applied to clothing like collars and cuffs. Permethrin is applied to clothing and kills insects on contact. Can be put on tents, sleeping bags and window screens. Don't apply to skin. Loose clothing prevents some insects from biting through to skin. Smoke keeps some away. Mud put on skin keeps them from biting. Use tent with good insect netting. Make camp in high and dry place. Avoid low, wet areas.

The section on rabies was like a movie, very doom and gloom and so heavy. Listing all the symptoms and feelings, like the victims biting at ppl and drooling. "As the nervous system deteriorates, patients become paralyzed, slip into a coma, fail to breathe adequately, and die." So unsettling.

Aggressive washing of a bite can deactivate the rabies virus and does more than first-aid treatment.

If you come into contact with a bee or wasp, stay calm and back up slowly. Don't make rapid movements.

I was surprised that bears made an appearance. The great white polar bear (Ursus maritimus) and the black bear (Ursus americana). Grizzly (Ursus arctus horribilis). What a name!

To lessen chances of encountering bears, avoid trails with bear tracks and scat, salmon streams, and berry patches and through dense brush and thick forest, especially at night. Move away from places that smell of decaying meat; bears lightly cover what they don't eat and finish later. Camp in the open. Cook food at least 100 yds from camp. If at river, sleep upriver from cooking site. Cleanly camp. Don't wipe hands with food residue on clothes. Don't spill food on ground. Don't cook fish or greasy food. Pack food and products that smell, like toothpaste and soap, in a separate bag from clothing. Hang food up at night off the ground and away from tree trunk. Food residue should be packed with food, not burned.
Travel with the wind and make noise. If the bear doesn't run, speak calmly and quietly. Back away slowly, don't run. “Running encourages bears to play chase, a game bears win." Stay in a group of 4 or more. Stand close together, raise your arms and speak loudly.

Threatened bears turn to the side to display their size, and usually woof aggressively. They might charge and then stop. This is a signal for you to retreat slowly. Humans without backpacks can turn to the side while backing off to show your smaller size. Avoid eye contact.

If a black bear attacks, counterattack. If it's a grizzly, adopt least-threatening posture like playing dead. Curl up to guard vital parts and clasp hands behind the neck. Play dead until the bear is well away. "There seems to be no reasonable response to a polar bear's attack." Nice!

Sharks: Swim in groups. Wear bright colors to avoid being mistaken for prey. Don't swim at dusk or night. Don't thrash or splash. If a shark comes near, face it and swim away slowly. If it charges, curl into a ball. If it wants to take a bite, kick and punch at the eyes, nose and gills.

I was surprised that you're not supposed to hold your breath at all during scuba diving, and holding your breath causes diving injuries.

Aspirin acts faster if it's chewed before swallowing.

By ch. 21 I just wanted to get done. From bites and stings, it went to diving, cardiac, respiratory, neurological and diabetic emergencies to ch. 26 and I enjoyed those the least.

Native Americans used Dutura, Jimsonweed, to treat venomous snakebites, insect and spider bites, asthma, sore throat, nasal congestion and bruises.

He described the makings of a cat hole in the chapter: dig several inches in soil, where the decomposing microorganisms live abundantly, and after going to the bathroom stir the waste into the soil and cover with a couple inches of soil.

If debris gets into the eye, don't rub and immediately wash out with a lot of clean water. Lie down and pour a steady stream of water on the bridge of the nose. Blink rapidly which will help flush it out. It's okay to remove large objects from eye, but never use force. Don't try to remove anything that is stuck to the surface of the cornea.

I thought this book would be more about things like poison ivy and common wilderness dangers like that, which he got to in ch. 31. And I was delighted that he had a little section on fish hooks because that's something I've always wondered how to remove. That's a handy little piece of advice.

"There are three ways to remove an embedded fishhook: the good, the bad, and the ugly."

Cool, overcast summer days are dangerous. UVR goes through the densest cloud cover. Even tho it feels cool, you can get sunburned and need to put on protection.

UV light damages the eyes; cataracts can form from forester exposure. Wear sunglasses that absorb or reflect 100% of UV light, and that wrap-around of have side shields that block reflected UVR.
Make sure sunscreen blocks UVA and UVB. Works best when on warm skin and soaks in skin for 30 mins before exposure. Sensitive skin can do better with opaque substance like zinc oxide. "All tanning should be considered visible evidence of toxic injury."

Motion sickness: Focus eyes on a distant point, preferably something in horizon line like mountain or tree. Fixed point gives brain reference point to help sort conflicting messages. Don't go below ship: lack of reference point worsens sickness. Stay still at center of boat.

I noticed that in the later chapters that covered even more of a variety of related topics, the It Could Happen to You segments only covered only one scenario, because they could only cover one. But I wish there had been scenarios for more of those injuries, and by the time I read, I had learned so many different ones that I couldn't remember what the accident had been about and had to go back and look. There were some other emergencies I wish the example had been about.

For gender-specific emergencies, find a private place to talk. Make eye contact, be straightforward, respectful and nonjudgmental. Use medicinal terminology and terms they understand. Don't make jokes or use slang. A member of the patient's sex should be present if possible. You can explain the physical exam needed and let them perform it if patient is opposite gender.

Menstruation pain can be reduced with yoga and massaging lower back or abdomen and applying heat. Increase B vitamins-peanuts, rice, sunflower seeds and whole grains and decrease salt. Engage in strenuous exercise.

The psychological and behavioral emergencies chapter was one I never would have thought of. "A crisis is an unstable period when people have to respond and adapt to unusual and possibly critical changes in the state of affairs." "People generally have strong emotions and high expectations when their worlds are altered by unexpected events." Many people don't know how to act in a crisis. It was amusing that he said "They may have preconceived notions of what to do, but sometimes these are based on the unreality of television and cinema, not on good judgment and common sense."

I especially liked the suggestions for what to pack in a wilderness medical kit. There are commercial wilderness medical kits that save money and time. He stressed that it isn't the kit that saves lives but the brain and what knowledge you have of what to do for the sick or injured. The kit is mostly to ease pain, speed healing, and prevent more injury. That would have been a nice point to end on, but I was disappointed to see it went on to breathing. 3 chapters on breathing and by this time I was trying to hurry and finish.

I really liked that each scenario was set in a different place. It took us all over the world, mostly in the U.S., with a diff scene and situation. It kept it so fresh and I couldn't wait to find out what happened. A well-written, engaging, very informative book with humor along the way.
highlights from It Could Happen to You:
"Only the rocks know what happened, and maybe a couple of trees, but they aren't talking."
"..with a sigh, you realize you've got to excuse yourself for a trip to the bushes. Into your cat hole goes the first of what will be numerous explosive bowel movements."
"You’ve been as busy as a homeless beaver teaching these kids to pitch tents, cook meals, and Leave No Trace."
"The message carried by the pain could be as insignificant as "slow down and rest" or as critical as "you will soon be dropping pack forever in that Great Campsite in the Sky."

[Erin · Rating 5 out of 5]

Fantastic resource. Nice to have a little humor mixed in with the seriousness. Bookending each chapter with a scenario is great to "apply" the skills reviewed. Will definitely be taking this book along on future trips, though I hope to never need it for more than blisters and small events!

[Michael · Rating 5 out of 5]

Great text book and content! Super easy to understand and well written.
It is literally a life saver :P

[Gulo · Rating 5 out of 5]

An extraordinarily useful guide for wilderness first aid. The book is broken into short chapters (2 - 5 pages for the most part) that can be quickly referenced. For study or otherwise pre-event learning, there are scenarios posed on the first page and a “solution” posed on the last page of each chapter - which made reading the book much more enjoyable. Overall, a fantastic book that could be an ideal supplement to a wilderness first responder course.

My one takeaway quote:
“Your ability to adequately manage an emergency is rooted in your ability to properly assess the scene and patient… 1) size up the scene, 2) an initial assessment, 3) a focused exam and history of the patient, 4) documenting and reporting the event, 5) monitoring the patient’s condition.”

[Reading · Rating 3 out of 5]

Get the new edition. Fair number of changes. Although this book has valuable information the real value is in the workbook and most importantly the practical experience you get when you take the Wilderness First Responder class - no substitute.

[Luis Brito · Rating 5 out of 5]

A no frills to the point resource to develop the skills necessary to respond to emergencies while out in the wilderness. It is very thorough, yet to the point, striking a good balance between application and theory.

[Elena]

Send thoughts and prayers for me for the final next week

[Mike Smelser]

Reviewing for the upcoming WFR Recertification up in SF. If anyone's wandering by Crissy Field in a couple of weeks and sees a bunch of folks with life threatening injuries (aka scenarios), "Stay Calm and Carry On" as they say.

[Robert Reed · Rating 5 out of 5]

our textbook during Wilderness EMT-B in 2000 at Pitkin, CO