Alphabet Soup: WFA and the AT
If you like alphabet soup, Wilderness First Aid (WFA) offers a titanium pot full. Not only is there WFA but also WMI, SOLO, PAS, MOI, BSI, ABCDE, CSM, LOR, HR, RR, SCTOM, SAMPLE, and SOAP. There are also WFA’s siblings WAFA, WFR and WEMT. Let me spell it all out for you.
WMI stands for Wilderness Medicine Institute, or sometimes NOLS Wilderness Medicine Institute or the Wilderness Medicine Institute at NOLS. According to the WMI website, WMI was founded as an independent entity in 1990 but nine years later was folded into the National Outdoor Leadership School. From its beginning, WMI has been a leader in wilderness medicine. WMI and NOLS are in the process of rebranding, thus the various ways of referring to them. Look for more consistency in nomenclature after the first of the year (2017).
PAS refers to the five step Patient Assessment System in which a person trained in Wilderness Medicine surveys the scene for hazards, determines the MOI, or Mechanism of Injury, practices BSI, or Body Substance Isolation, determines the number of patients, and forms a general impression of the patient.
After the PAS is completed, a WFA would then identify themselves and their level of training, obtain consent, ask the patient’s name and what happened, establish responsiveness, and survey the patient for immediate threats to life, including ABDCE, which stands for Airway, Breathing, Circulation, Decision on Disability, and Expose any injuries.
Next, it is time to complete a physical exam, take vital signs, and gather patient history. CSM refers to the checking of Circulation, Sensation and Motion in all four extremities. LOR stands for the Level Of Responsiveness. HR refers to Heart Rate and RR to Respiratory Rate. SCTM refers to the patient’s Skin Color, Temperature, and Moisture.
When gathering the patient history, it is imperative to note the chief complaint, person’s age, and obtain other information. SAMPLE is the abbreviation used to help remember to determine and note Symptoms, Allergies, Medications, Pertinent medical history, Last fluid/food intake and Last urine/bowel output, and Events related to the accident or event.
Once all the above has been completed and the patient attended to, a SOAP note should be prepared to send with the patient if they are being evacuated. SOAP is an acronym for Subjective, Objective, Assessment, and Plan, a standard in the medical field.
The most basic wilderness emergency medicine training is WFA, or Wilderness First Aid. The next level is WAFA, or Wilderness First Aid. WFR is the next highest level and refers to Wilderness First Responder, sometimes pronounced “woofer”. The highest level is WEMT, or Wilderness Emergency Medical Technician.
My first exposure to emergency medicine was an American Red Cross (ARC) Multimedia First Aid Course I took at my summer job site between my freshman and sophomore year of college. I followed that up with an ARC Advanced First Aid Course I took as a physical education course my junior year of college. During my senior year of college, I took a not for credit EMT course and went on to serve with as a volunteer EMT with a couple of rescue squads in addition to working as a full time EMT for nine months.
Graduate school and work got in the way of keeping my certifications current but I never forgot most of what I learned. Unfortunately, what I learned was more for “around the workplace”, “around the home” and “never more than a few minutes from a hospital” environments rather than the “hours or days from professional medical attention” environments I sometimes put and found myself in. That is why I wanted to obtain WFA training even though I had once been an EMT.
Three years ago, when the opportunity presented itself for me to take a WFA course through SOLO (Stonehearth Open Learning Opportunities) and hosted by the Mountain Institute at its Spruce Knob, WV campus, just four hours from my home, I seized the opportunity. Work prevented me from recertifying through SOLO and the Mountain Institute two years later, so when I had the chance to take a WFA course through WMI offered by REI at the Frick Environmental Center in nearby Pittsburgh, PA, about an hour from home, I once again took advantage of it.
There is some debate about who offers the better instruction, SOLO or WMI. I found their WFA courses similar, but there were also some differences. Both were two day courses, but SOLO offered the option to add CPR the evening before at a small additional cost. WMI did not. My SOLO course was offered in an alpine and almost wilderness environment during rain and windblown snow. My WMI course was offered in a more urban environment during which it rained only part of the time. SOLO required that participants pass a written test to be certified while WMI did not. Neither organization required participants to pass practical test but instructors from both organizations observed and critiqued participants during practice sessions. I imagine your experience would be affected by location, weather, and instructors.
Some sections of the AT are not far from immediate medical assistance while other sections are more remote, hours or even days from immediate help. WFA training provides you with the knowledge and practice to help any injured backpacker you encounter along the AT. It also helps you monitor and care for your own health and possibly avoid medical emergencies while in the backcountry. If more people using the AT, from day hikers to thru hikers, had WFA training, the AT would be a safer trail for all to travel.
For other perspectives on WFA, check out Rachel’s Bleeding, Broken, and Bruised: Wilderness First Aid and Dennis Plato’s Wilderness First Aid: The Gift That Keeps On Giving.
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