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Picture this: The tall hills, rugged terrain, jagged peaks staring in the horizon, a bunch of spirited outdoor enthusiasts who are steadily making their way up surviving on thin air and plentiful redemption — and you can easily conjure up a setting where nature and man are engaged in a challenging outdoors encounter; be it in the Andes, Alps, Himalayas or even closer home the Western Ghats.
Against the backdrop of that smooth sailing outdoor trip, jerk your head for a second and imagine, one of the participants falls down and breaks a bone; gasping for breath, he is in no shape to walk out. It’s a two-day trek to the nearest road-head and further one more day to hospital. You might have guessed by now that things have gone horribly wrong on that perfect trip.
The same ‘together’ team is now gripped with absolute pandemonium, virulent theories about patient care and the debate about the future course of action rages on — the team is in disarray, worried, eager and oozing adrenaline. What next?
Imagine a Wilderness First Responder (WFR) jumps in — equipped with training and knowledge about wilderness medicine that radically changed the way the entire episode played out. That would have made such a pretty movie script. But am afraid that did not happen in this case.
Most people journeying outdoors have been part of a similar situation at some point in time. But the Wilderness First Responder? I am not sure if too many among us have heard or are faimilar with, notwithstanding the issue of safety and medical help in the wild would have crossed most of our minds. How can we make this outdoor trip safer?
Will the camp have trained medical help? What medicines are you carrying in your first aid kit? We’ve heard these questions or we’ve asked them ourselves. Most often we have also got answers for the same. But wait a minute — do we actually know if there exists a medical protocol to follow in case of a mishap? What actually happens when somebody breaks their leg? Who does what, and how is the person handled till he/she reaches hospital? What happens between the scene of injury and the journey enroute to the hospital? Here you might ask — is there a time period we need to be worried about, after all we are getting to hospital? The answer is yes; considering that in the outdoors definitive medical care is never a stone’s throwaway. Contrary to urban medicine where this period is short, in a wilderness situation this period is crucial — unfortunately it is often ill defined and left to individual leadership, knowledge and discretion.
Here we enter the forte of wilderness medicine — medical response in the hinterlands.
What can we do in the middle of the forest for someone with a bleeding wound, how can we help a person who sprains an ankle, fractures a hand or has a skull fracture? Other than calling for help, can we do anything at all? The answers to all these lie in wilderness medicine.
Wilderness safety
Unheard of in India till recently, in the last couple of years with a surge in the population of children and adults seeking to explore, experience and learn from outdoor environments, wilderness medicine has assumed profound significance. While it is mandatory worldwide for outdoor practitioners and enthusiasts to have some level of wilderness medicine training, it remains virtually unregulated in our country. It is common sense though that knowledge about response to an emergency in the wild — be it a snake bite, a broken leg, or a bloody wound — would define the outcome of how one handles it. Thus emerges an increasing need to generate maximum awareness about wilderness safety and impart emergency medical training to outdoor programme leaders and outdoor enthusiasts about aspects of wilderness medicine.
In the West, this critical need (response to medical emergencies) has a systemic response. There are three levels of medical training that people on outdoor trips can possess — the wilderness first aid, wilderness first response (WFR) and the wilderness emergency medical technician (WEMT), in order of depth of training and competence.
There are many institutes who conduct courses, and the certification is valid for a fixed number of years — needs to be renewed periodically.
In fact, the roots of wilderness medicine can be traced back to the end of the 19th century and early 20th century in the United States of America when organisations like Boy Scouts, St Johns Ambulance and the American Red Cross started training workers and other commoners in aspects of first aid.
The training in these courses assumed that definitive care was nearby and quick to access. However, in the 1950s and 60s mountaineers and outdoor people across the world realised that their situation was a bit more peculiar as their access to definitive medical care varied from hours to weeks in some situations.
Two US outdoor organisations (NOLS & SOLO) took the lead and by the late 1970s offered wilderness first aid training to their instructors. Meanwhile, the US government took notice and developed an integrated curriculum for all first response staff (firemen, truck drivers, policemen etc) who would be faced with handling patients in the golden hour (within one hour of injury/accident) and thus was born the Wilderness First Response (WFR) curriculum.
An 80 hour hands-on curriculum taught over 10 days covers topics such as basic life support, responding to results of trauma, management of soft tissue injuries (burns, frost bites, wounds etc), treatment of infectious diseases, management of musculoskeletal injuries like fractures, sprains, dislocations, responding to sudden medical illness, spine and head injuries etc.
Owing to active media coverage, we now hear about accidents and deaths in the outdoors more often than before. Identifying the critical need to generate awareness and streamline response to wilderness emergencies, Wildcraft, the outdoor equipment brand, took the lead and hosted south India’s third wilderness first responder course in the outskirts of Bangalore recently. Conducted by the National Outdoor Leadership School’s (NOLS) wilderness medicine component, the Wilderness Medicine Institute (WMI), the WFR course held in August saw 15 more outdoor enthusiasts armed to handle emergency medical situations. “I think it is time we brought in some order and method to the way in which we handle emergency medical issues in outdoor areas,” says Dinesh K S, founder director of Wildcraft.
But what about the context you may ask. North American outdoors and the Indian outdoors — the conditions are dissimilar, so do such courses really make sense? “We teach people the context, the signs and symptoms, treatment, decision making for evacuation and management of medical issues where there are no doctors, hospitals or emergency services to rely on — wherever that might be,” says Renee Jenkinson, chief instructor of the WFR course here.
“It taught us how to assess a situation, use whatever we had from our backpack to stabilize the patient and streamlined our thinking in emergency situations,” shared Parineeta Chauhan, a budding mountaineer from Delhi. Shanti Rani Devi, a climbing professional from Bangalore, added, “It trained us to think calmly; we can now rely on a procedure and not only on our gut feeling.”
A famous native Indian quote rings in my ears “Nature is a gift we all have inherited — beautiful, pristine, and invaluable. By increasing ones knowledge base and providing tools to enhance safety, we will be able enjoy all that she has to offer to the fullest. Unprepared, she can be unforgiving and deserves our utmost respect. With that respect, nature will continue to give us solitude or companionship, beauty and sustenance, as well as oneness with all living things.” Be safe and enjoy the out doors.
(The author is an outdoor professional)