Learning wilderness first aid basics could be the difference between life and death.

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This article originally posted in January, 2015

As someone who does his fair share of hiking, camping and backcountry exploring, I like to think I'm well prepared.

In the summer, I take plenty of water. In the winter, I've got the right layers. No matter what time of year it is there's always a small first aid kit in my pack.

But about 10 seconds into my first attempt at figuring out how to help someone who had fallen off the roof of a remote ski hut, I realized how wrong my assumption had been.

Fortunately, the injury was fake. It was a simulation created as part of a wilderness first aid course organized by the Tahoe Rim Trail Association and conducted by the National Outdoor Leadership School and one of five initial certification courses by the Wilderness Medicine Institute.

If it had been a real injury it could have been bad news for the victim, a classmate playing the role of the hut caretaker. Myself and my partner for the exercise managed to work our way through the steps to identify the problem and stabilize the victim. But it was clumsy, we had to reference our notes and we might have missed a step or two.

The point? When someone is sick or injured in a remote setting, there's no ambulance to call or nearby urgent care center. And if the people in position to help don't have a smart system to diagnose problems, implement solutions and execute an evacuation strategy they're likely to make the problem worse.

"You need to have a system to follow otherwise it is just chaos," instructor Jen Latham told the group of about 30 students. "Stay or go? Fast or slow? That is what it boils down to."

The two-day, $275 course had just 16 hours of instruction and is meant as an introductory class for people who don't have previous wilderness medicine experience.

Day one covered patient assessment, evacuation plans, coping with head or spine injuries, wound management and shock. Day two included more wound management, bone injuries, heat illness, cold injury, lightning, altitude sickness, medical problems and anaphylaxis.

Latham and her fellow instructor, Brandon Howlett, acknowledged they were just scratching the surface of wilderness medicine in the first aid course. Still, the opportunity to put the technical knowledge they did cover into the context of a wilderness first aid system could be of immense value on the trail.

That's because one of the tenets of wilderness medicine is to take a systematic approach to identifying and managing problems. A basic understanding of the steps to take in a wilderness emergency makes it easier for people to prioritize life safety issues over dangerous distractions and improve communication.

"The more training you get, the more you can add to the system, but it is still the same system," Latham said.

The emphasis on a systematic approach to first aid is evident beginning in the first few minutes of class and lasts the entire course.

Nearly every topic the instructors tackle is broken up into steps, often packaged into acronyms or numerical lists.

For example, early on day one, instructors explained a five-step patient assessment system that students are expected to deploy at the outset of any scenario.

Each of the five steps, one for each finger, came with a rhyme or easy-to-recall phrase. Step one, for example, is about assessing the scene of an incident before approaching the victim in order to prevent hurting yourself while trying to help another.

The mnemonic device for step one? "Number one, I'm number one."

A would-be first aid provider then moves through two more mini-systems; an A, B, C, D, E system for assessing the patient and a system that uses the letters SAMPLE to ensure all the right medical questions are asked and the responses recorded properly.

All the lists and acronyms do more than make it easier for people to remember the steps. They make it easier to communicate to a potential victim, who could be a stranger, disoriented or simply stressed out by the circumstances.

"A patient in the loop is going to be more cooperative," Howlett said. "The patient is a human, not an object you are trying to fix."

Latham added that the systematic approach is a good way to gather information because it relies on checking objective signals, such as heart and respiratory rates, and reduces the chances of being distracted by more confusing signals, such as a patient's possibly flawed recollection of how they got hurt.

"The thing I like about vital signs is they don't lie," Latham said. "Our patients can tell us anything."

Since the methods instructors used to help people in the class take in all that information worked so well, I'll deliver my observations from the two-day course in the form of a three-item list.

One: Gaining a greater appreciation for the seriousness of what we might consider a minor injury in town, like a sprained ankle, in the wilderness makes me much more interested in being alert, aware and cautious about potential hazards in order to avoid ever getting into a first aid situation.

Two: The more you learn, the more you realize how much you don't know which makes you want to get more training.

Three: After interacting with people from different cultural backgrounds or beliefs in an intimate setting where you are concerned with breathing, vital signs and level of orientation, you gain appreciation for how alike we are as fragile humans who can need or be in position to give life-saving assistance.

Those differences people assign each other based on superficial assumptions are of zero significance in a wilderness first aid situation.

Vital signs and life- or limb-threatening injuries are the same for everyone, no matter their race, creed, cultural background or personal politics. Composure, competence, communication and compassion are really all that matter when it comes to getting a distressed person to safety.

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