Take a Wilderness First Aid Course: Someone’s Life Could Depend On It

TRIGGER WARNING: The following story contains events of Paul Classen’s (Grandmaster’s) fall from McAfee’s Knob. My deepest condolences go to his family and friends. This article is for informational purposes only. Photos of medical procedures (leg splints, patient transportation, etc.) are of practice wilderness first aid sessions.

Last May, I realized how naive and unprepared I was in a wilderness setting. 

I was backpacking the Virginia Triple Crown with some friends. It was the same as the last twenty times I had hiked that familiar stretch of trails. I’d hiked them in the dark, the rain, the snow, the heat, the cold — I knew them. At least I thought I did. Their familiarity had lulled me into a complacent comfort. That weekend it was sunny, eighty degrees: the perfect summer backpacking trip. My friends and I were out giving chocolate and beef jerky to thru-hikers we met; we must have passed at least twenty on our first day. 

We camped at the base of McAfee’s Knob, and in the morning, packed up quickly to catch the sunrise. The crimson sun began to pierce through the trees, urging us to hike faster. We arrived at the top, sweaty and exhilarated. The sky blazed with the start of a radiant sunrise. Tinker’s Cliffs formed a deep blue ridgeline in the distance. It was beautiful. I was panting at the edge of the pine trees, hands on my hips, smiling at the thru hikers sharing coffee and oatmeal out on the cliff. They cheered as the sun came up. I thought about how excited I was to be one of them this March. I admired their camaraderie and toughness for making it the 700 miles to McAfee’s. I unzipped my waist pocket, about to reach in to grab my phone to take a photo of the picturesque scene and —

The unthinkable happened. A hiker fell. I could feel the sound through the rock. I stood there, dumbstruck, as the scene unfolded into chaos around me. My friend stood next to me, shaking her head, wide-eyed, murmuring, that did not just happen. The hikers sprang back from the edge and yelled for someone to call 911. Friends we had shared whiskey and stories with just the night before staggered back towards us from the edge, pale and shocked. Speechless. I stood there with my phone out, the three numbers dialed in and my finger hovering above the call button. I couldn’t press it. One of the thru hikers called first. I remember looking at the numbers on my phone, and looking up towards the thru hikers, as if one of them were going to say their friend was okay, and there was no need. There were no words. Everything had gone so wrong, so quickly. The rescue squad wouldn’t be there for over an hour. He needed help now. And I was frozen.

I was on a stretch of trail I knew better than my own backyard, and yet I have never felt as though I was in a stranger place. All I wanted to do was help, and I didn’t even know CPR. A thru hiker, one year older than myself, was dying just past the cliff where I stood, and despite my college degree, despite all the times I’d been out on these trails, despite how much I wanted to — none of my experience mattered. I didn’t have the knowledge to help him. I have never felt a worse feeling.

Months later, I decided to take a wilderness first aid course to educate myself on how to help others before I begin my thru hike. Wilderness first aid is not to be confused with a wilderness first responder class: A wilderness first aid course is a more general overview of best first-aid practices, while a wilderness first responder course is the standard for most outdoor education and guiding programs. (Though that might be in my future!) Wilderness first aid courses are typically 16-20 hours long while a wilderness first responder course can be 80 hours long. Some popular wilderness medicine schools that offer these courses include MEDIC SOLO, National Outdoor Leadership School (NOLS) and REI. Below is a table comparing price and time commitment between wilderness first aid courses.

School	Price	Time Commitment
MEDIC SOLO	$115 – 245	7 to 20 hours (in person and online options)
SOLO	$200	17 hours
NOLS	$195 – $575 (Depending on location)	16 hours
REI + NOLS	$335 – $350	16 hours
Wilderness Medical Associates	$189 – $500 (Depending on location)	Not specified

I took MEDIC SOLO’s Wilderness First Aid Class. I was worried the course might trigger some memories, but the thought of having the knowledge and skills to aid someone in a health emergency instead of being frozen made me determined to take it. This course has been the best investment I have made in my future hike. It taught me hands-on skills through mock scenarios with my classmates and made me realize that I do have the ability to help someone in an emergency situation — in fact anyone does. And, in my experience, it’s knowledge worth having.

Q&A with MEDIC Solo Wilderness First Aid Instructor Mateo Rosefsky

I interviewed Mateo Rosefsky, an instructor/trainer at MEDIC SOLO. I asked him about tips he has for anyone about to begin a hike. Rosefsky has been teaching wilderness medicine since 2007, has led anywhere from 500 – 1,000 outdoor adventures and has been utilizing his wilderness first responder skills since he was first trained in 2004. You can find a video on hiking safety here and what he carries in his first aid kit on trail here.

Q: What is the most common mistake that people in wilderness first aid make?

I think most commonly people purely go for whatever the patient is complaining of and do their best to treat that — which is cool — but don’t do their best to check the rest of them out.

For example, a common injury, crossing a stream, a person slipped, fell and came down on some rocks in the stream. The injured person complained of wrist pain, because they caught their fall with their hand. The person who went up and helped them was trained in some kind of first aid, which was great! The caregiver went up and assessed their wrist, determined it was fractured, and treated it as such, which was correct — but that’s all the caregiver checked out, nothing else. Since it was broken, the injured person went to higher medical care, and it turned out that person had a broken elbow too. 

You just never know, on three levels: 

1. What else is injured but is less painful. 

The patient might not even realize it until you fully check out the patient and push on it. 

2. You may come across something that the patient hurt earlier that day.

For example, yes, it’s their wrist, but maybe they sprained their ankle earlier and they won’t remember to tell you about that until you fully check them out and you push on their ankle and they say Ow, oh yeah I turned my ankle earlier. And you say, Oh, you know what — I’m going to treat that too.

3. You just never know what else is in the picture that is completely unrelated.

I treated a person for heat illness and at first glance it seemed all of her symptoms were lining up with heat exhaustion. There was one symptom upon doing the full body check that just did not line up with heat illness. When we pressed deeply into one quadrant of her belly, there was some pain. She had been completely unaware of this until we pushed deeply on her abdomen. And I said, Well, everything else lined up with your heat exhaustion and we’ve treated that. You’re feeling better with all of those things — except for this one item that does not line up with heat exhaustion. And there are 2,000 different documented reasons for belly pain. I don’t know what it is; I think you ought to get checked out. And she did. She had an ectopic pregnancy. Ectopic pregnancy can kill the mother and fetus, so that saved her life. And that completely had nothing to do with the illness at hand. 

The most important thing in wilderness medicine is the patient assessment system… To me, the patient assessment system checklist brings order to chaos, quite simply. 

The most important thing in wilderness medicine is the patient assessment system. It’s a checklist that one learns to go through on every patient and then you don’t miss anything. To me, the patient assessment system checklist brings order to chaos, quite simply. 

Q: What injuries or illnesses do you think thru hikers are most likely to experience on trail and what’s your advice on preventing and treating them?

First, I’ll just generally propose to anyone going out there for a long hike backpacking is to figure out what’s the longest amount of time that you will be out on the trail without resupply, and go do a practice run before your long trek of that many days and nights if you can work that into your schedule. This will help you to figure out what of your gear is working for you and what is not. Injuries or overuse things can happen during that longer period of time which don’t make an appearance in a day hike or in a weekend backpacking trip. 

Injuries or overuse things happen during that longer period of time which don’t make an appearance in a day hike or in a weekend backpacking trip. 

I learned this from gradually increasing my backpacking from a weekend to the longest unsupported trek I did which was ten days until resupply. A pair of boots that I thought were worn in, and I thought didn’t cause me blisters — when I put them to the test for more than just a weekend, they did give me blisters and then life sucked. So testing things out for that whole period of time will bring some issues to light and then you can figure out how to be prepared for those. 

You’ll realize some of those common injuries such as chafing, “Oh, after X number of days I do start to get some redness here,” so you can be prepared to handle that with some Glide or some baby powder. With blisters, learn how to recognize that pre-blister hot spot, and having what you need to slap onto that so the rubbing happens on some tape instead of your foot. This prevents it in the first place. Possibly figuring out how to tighten your shoelaces differently. Or perhaps needing to get a different pair of shoes or boots. 

Overuse injuries of different muscle groups can make an appearance. A physical therapist will be the best for that one. Part of it is proper footwear, how much weight is in your pack, but there’s only so much one can do to prevent overuse injuries. As unhappy as it may be, going sooner rather than later to a physical therapist will arrive at exercises and answers that one wouldn’t have thought of. That may get you back on the trail sooner. 

Sprains and strains certainly are common — consider trekking poles. I know my trekking poles have saved me from so many sprains and falls. When I step wrong and I feel my ankle starting to twist, I instinctively slam my weight into my poles. That stops the fall and the rest of the twisting process. And then I have no injury. Poles can do more than that too. I used to get knee pain from backpacking and I learned it was from going downhill where there’s a fairly large step. I would slam down pretty hard which slams pressure into the knees. Someone recommended to me, try trekking poles. It was inconvenient at first but now when I step down, I put my weight onto the poles and go down softly — I never have knee pain. That was decades ago, otherwise I’d still be having it. 

Gastrointestinal illnesses. A lot of times, sadly, that’s just from Being Nice. Folks say Hey, I’ve got this really tasty trail mix, would you like to try it? Then the other person digs their hand into the trail mix bag. It’s hard to stay perfectly sanitary after you poop in the woods, so their hand wasn’t perfectly clean and now those pathogens are in your food and you get sick from Being Nice. If you’re going to share food, pour it into someone’s hand. Use hand sanitizer before you eat and after you go to the bathroom. 

Q: What about serious ailments — like hypothermia?

I was on the Pacific Crest Trail with a buddy of mine, packing up camp and getting ready to hit the trail for the day. This was near mile marker 2,500, and two thru hikers made their way into our camp after having hiked uphill to get to where we were — and after having hiked 2,500 miles — so obviously they were extremely experienced. The guy said, Hey, my fiancée passed out earlier this morning and is about to pass out again. Can you help please?

So of course we did. She was quite hypothermic. We did everything you learned in your class, by the book. The hypowrap, we covered every square inch and were obsessive compulsive about getting it right. Did all of that. Pretty quickly, she got significantly better. 

I was monitoring her vitals, checking her skin temperature, color and moisture and within an hour, it had gone from pale and cold to, on her core, hot and sweaty. Oh wow! At that point I opened up her hypowrap so that she could get out. She could talk well and she shared that year she had heard of many cases of people being air-lifted off of the Appalachian Trail due to hypothermia. 

A: That’s awful. B: That’s crazy. It’s totally curable on the trail. But yes, if one is unresponsive they should go get checked out.

For this thru hiker on the PCT, they had hiked 2,500 miles; we were in Washington State in the Cascades. Up until that point, their trek had been mostly dry. Sure, of course there was some rain here and there — but the next day it would be sunny. They were super lightweight backpacking it, and they didn’t have all the rain gear to keep things light. They would just dry out the next day. Well, this whole section of trail was raining all day long, every single day. This was the first time that there wasn’t a sunny next day to dry out on. They were keeping their sleeping bags dry, which was excellent, and so she slept warm overnight — but she still had to put on her wet clothes the next morning. Despite the fact that she hiked uphill to get to where we were that morning, it didn’t create enough heat to get her warmed up. So we took her in and fixed her up and she didn’t need to evacuate — she just pulled a zero that day. 

Q: How do you stay calm in a crisis situation and give adequate care to the patient?

In a wilderness medicine class, wilderness first aid, wilderness first responder — one learns the Patient Assessment System. It’s a checklist to go down in order of life threats, to fully treat a patient. Some things are obvious, some things are not so obvious. The order in which to treat them is based on the system’s order of what is more life threatening and what is not so threatening. To me, that Patient Assessment System is the guiding light. It is my guiding light; it takes whatever chaos we’ve got and guides that into order. 

To me, that Patient Assessment System is the guiding light… it takes whatever chaos we’ve got and guides that into order. 

Several times during class I asked people to get into a Zen state of mind as I reviewed the Patient Assessment System and went down it. I have had many people over the years say, Hey, I got into this terrible chaotic situation on trail and I heard your voice running down the steps of the Patient Assessment System in my mind. For them, starting to go through the steps in their mind enabled them to not run over there, freak out and get deer-in-headlights syndrome, but instead, go over there and give help in the right order.

There’s this phrase: Slow is smooth, and smooth is fast. Being able to do exactly that, one ends up giving thorough care. For example, when Captain Sully and his co-pilot safely landed that plane when the engines were taken out by birds — safely landed it in the city of millions and didn’t kill anyone on ground and saved every life on board — they used a checklist. They went straight for their checklist book for dual engine failure and started going down those steps. That plus simulations training — he had never landed a big airplane in a river before, but his scenarios training and the checklist, enabled them to do exactly what they did and save every life. 

There’s this phrase: Slow is smooth and smooth is fast. Being able to do exactly that one ends up giving thorough care.

To me, taking a wilderness medical course and having not only the book knowledge of what this patient assessment is, plus how to treat the various injuries and illnesses that one may encounter, but also having that simulation practice before going out there — before encountering it — that leads to success. That leads to saving lives. I teach it, but I also use it. There have been many times where I’ve been facing chaos and it’s tempting to run over there, but I pause myself and I start thinking about those items on the checklist. Sometimes people will get out the physical checklist, their card, what have you, and that totally gets them into the right state of mind to put this chaos into order and give thorough treatment. 

Somewhere there’s a saying. I think it’s attributed to Benjamin Franklin, and it goes something like this: In failing to prepare, you are preparing to fail. I’ve always thought that to be helpful to keep in mind, and the Scout Motto. Be Prepared, as much as possible before diving into something. 

Take a wilderness first aid course before starting your trek. Whether it’s a day hike, a section hike, a thru hike — anything could happen. This course has helped me have peace of mind knowing that I can help another hiker in need. On the trail, all we have is each other for the first few hours (if not longer) in a medical emergency — and those hours can be the difference between life and death. Help your fellow hiker, and learn the skills necessary to assist in times of need — you just might save someone’s life.