Learning Objectives
By the end of this lesson, you'll be able to:
- Describe what a Wilderness First Aider does, and where your scope of practice ends
- Use Standard Precautions with whatever PPE you've got in the backcountry
- Size up a scene for hazards before you go near any patient
- Get informed consent, and know when implied consent applies
- Know what Good Samaritan laws protect, and what you need to write down
What is Wilderness First Aid?
Wilderness First Aid (WFA) is first aid for places where advanced medical care can be 30 minutes to several days away. You recognize the problem, manage it, and keep managing it for as long as that takes.
Urban EMS
- ALS backup minutes away
- Stabilize and hand off
- Full equipment on hand
- Strict protocols
- Transport < 20 minutes
Wilderness First Aid
- Help may be hours or days away
- You assess and treat, start to finish
- Improvise with what's in the packs
- Decisions run on judgment
- Long stretches of monitoring
Your Role as a WFA Provider
Staying inside your scope of practice protects you and your patient. Wilderness medicine training comes in these levels:
| Training Level | Hours | Key Capabilities |
|---|---|---|
| WFA | 16–20 hrs | Basic assessment, bleeding control, splinting, environmental emergencies, evacuation decisions |
| WFR | 70–80 hrs | Everything in WFA, plus giving medications, focused spine assessment, advanced improvisation, extended care |
| WEMT | 120+ hrs | Everything in WFR, plus EMT skills adapted to the wilderness |
| Wilderness MD | Medical degree + training | Full scope of medical practice in remote settings |
Standard Precautions
Standard Precautions means treating all blood and body fluids as potentially infectious. That's the current name. Older courses called it Body Substance Isolation (BSI), and you'll still hear it. Out here you'll have whatever PPE is in the packs, so use what you have.
Gloves
Gloves go on first, every time. Use nitrile, not latex. No gloves? Put a plastic bag over each hand, or have an alert patient press on their own wound. Clothing isn't a barrier. Blood soaks straight through it.
Eye protection
If anything might splash, your sunglasses will do. You'll want them most when you're controlling arterial bleeding.
Face protection
For rescue breaths, the barrier is a commercial CPR face shield or a pocket mask with a one-way valve. A bandana or a shirt is not a barrier. If you have no barrier and can't or won't give breaths, compression-only CPR beats no CPR for an adult who suddenly collapses (AHA). It isn't enough for drowning or any other arrest caused by lack of oxygen. Those patients need breaths first (Lesson 3).
Taking gloves off
- Grasp the outside of one glove at the wrist and peel it off, turning it inside out
- Hold that glove in your still-gloved hand
- Slide two fingers inside the other glove and peel it off inside out, over the first one
- Put both gloves together in a waste bag
- Wash your hands well, or use hand sanitizer (at least 60% alcohol)
Scene Size-Up
Before you approach any patient, stop and size up the scene. It takes 5–15 seconds, and it can save your life.
The size-up doesn't end when you reach the patient. Hazards change and more patients can turn up, so keep looking around for as long as you're on scene.
The scene size-up checklist
Types of Scene Hazards
Environmental
- Lightning (ongoing storm)
- Avalanche zones
- Swift water
- Unstable terrain
- Extreme heat or cold
Wildlife
- The animal is still there
- A venomous snake near the patient
- Agitated wildlife
- A bee or wasp nest nearby
Human factors
- Unstable group members
- Hostile bystanders
- Fire or toxic smoke
- Moving vehicles or boats
⬆️ Structural
- Falling rocks or debris
- Unstable structures
- Vertical exposure
- Anchors that might not hold
Mechanism of Injury (MOI)
The mechanism of injury is what happened to the body: how far they fell, what hit them, how hard. It tells you which injuries to look for before they show. A high-energy MOI calls for a more thorough assessment.
| High-Energy MOI | Low-Energy MOI |
|---|---|
| Fall of more than about 10 feet (roughly one story, or about twice their height); lower for older adults or anyone who lands on their head | Simple trip and fall |
| High-speed vehicle crash | Low-speed ground-level fall |
| Direct high-force impact | Overuse or repetitive injury |
| Diving into water | Minor blunt force |
| Explosive blast | Symptoms that came on gradually |
Coming in under the fall cutoff doesn't make a fall safe. A shorter fall, especially onto rock or onto the head, can still injure the spine. If you're not sure, treat it as high energy.
Documentation: The SOAP Note
The SOAP note is how wilderness medicine writes up a patient, and it's what the next rescuer reads when you hand off. You'll use it all through the course.
SOAP note format
Consent in Emergency Care
You need consent before you treat anyone. Depending on the jurisdiction, treating someone without it can count as assault, battery, or both.
Informed consent
Who: Conscious, alert adults who can make their own decisions
How: Say who you are, your training, and what you want to do, then ask permission: "My name is Alex, I'm a Wilderness First Aider. I'd like to assess your injury. Is that okay?"
What: They have to understand what's going on and agree to treatment
Implied consent
Who: Unconscious patients, and patients whose mental status is severely altered
How: The law assumes a reasonable person in their situation would consent to life-saving treatment
What: Go ahead with the care they need, without a spoken yes
Pediatric consent
Who: Patients under 18 (minors, in most states)
How: Ideally, a parent or guardian consents. If you can't reach one in an emergency, implied consent applies.
What: Write down every attempt you make to reach a guardian
Refusal of care
A conscious, competent adult has the right to refuse treatment. If they do:
- Make sure they understand the risks
- Document the refusal
- Make sure they aren't altered by drugs or a head injury
- Keep monitoring them if it's safe to
Good Samaritan Laws
Most jurisdictions have laws that protect lay rescuers who give emergency care in good faith. The protection generally depends on four things:
- You act in good faith to help someone in an emergency
- You don't act with gross negligence or willful misconduct
- You act within your level of training
- You don't take payment for the care
A separate legal rule sits alongside Good Samaritan protection. Once you start care, you have to stay and help until someone of equal or higher training takes over, or the patient is in better hands. Leaving before that is abandonment (more below). You can stop sooner if the scene turns dangerous for you or you're physically unable to keep going.
Duty to Act & Abandonment
If you're out there on your own time, your duty to help is generally moral, not legal. That changes if your job or role requires it, as it does for a guide. Once you start caring for a patient, though, you must not abandon them. Abandonment is when:
- You leave a patient worse off than you found them, or no better
- You stop care without handing off to someone of equal or greater training
- You leave without the patient's informed consent to stop care
Clinical Scenarios
Two wilderness situations to work through. Read each one, decide what you'd do, then open the discussion.
Setting: You're hiking a steep trail when someone cries out for help. A hiker is lying 30 feet off the trail at the bottom of a rocky slope, with loose rock above. They look conscious, and they're holding their leg. No one else is around.
Questions to consider:
- What do you do first, before you approach the patient?
- What hazards do you see?
- What BSI precautions can you take with what's in your day pack?
- What do you need to know to decide whether to call for help now?
1. Size up the scene first. Before you take a step toward the patient, stop and look at the slope above. Is there more loose rock up there? Could more come down where the patient is lying? Find the most sheltered way in.
2. Hazards. Loose rock above that can still come down, unstable ground on the way in, the chance you fall and get hurt crossing it, and the fact that nobody else is around to help.
3. BSI. Gloves on from your pack. No gloves? A plastic bag over each hand is a real barrier. A bandana isn't, because blood soaks through fabric. If they can, have the patient hold pressure on their own wound.
4. Calling for help. Weigh how bad the injury looks (can they walk?), the distance to the trailhead, how much daylight is left, what the group has, and whether you have a device to call out on. If the mechanism looks significant, like a fall of more than about 10 feet (roughly one story, or about twice their height) onto rock, call sooner rather than later. A tumble down a rocky slope is also a spine mechanism, so keep them still until you've asked the spine questions (Lesson 7).
Look up before you go in. Everyone's first instinct is to run straight to the patient. Under loose rock, that instinct can put you on the ground next to them.
Setting: You're a camp counselor. A 15-year-old camper has a significant cut (laceration) on their arm from a sharp rock. It's bleeding steadily, but pressure is controlling it. The camper says, "I'm fine, leave me alone, don't touch me." They're alert. They seem upset, but not confused.
Questions to consider:
- Is this refusal valid? Can they legally refuse care?
- What do you do next?
- When would implied consent apply here?
A minor's refusal. A 15-year-old is a minor in virtually every jurisdiction. Respect how they feel and don't get forceful, but a minor generally can't refuse medical care on their own. That call usually belongs to their parents or guardians. Rules vary by state, and in some places emancipated or "mature minors" are exceptions. Organized programs like camps and guided trips usually keep parental consent-to-treat forms on file, so know what your program's policy says before the trip.
What to do:
- Stay calm and kind. Ask, "Can you tell me why you don't want me to help?"
- Contact the parents or guardians and the camp director right away
- Offer gauze so they can hold pressure on it themselves. That's care they may accept.
- Document what the patient says and what you do
- If the bleeding becomes uncontrolled or the patient loses consciousness, implied consent lets you treat
- Never use force. Get the adults in charge involved.
When implied consent kicks in. If the camper becomes unconscious or severely altered, or the injury turns immediately life-threatening, you treat under implied consent while you get help.
Knowledge Check
10 questions. Pick an answer to get immediate feedback. Answer order is shuffled each attempt, and your best score is saved on this device.
The short version
- Your safety comes first, every time. Never enter an unsafe scene.
- Standard Precautions (formerly BSI): treat all blood and body fluids as potentially infectious, and use whatever barriers you have.
- Scene size-up: Safety, Scene, Mechanism, Help needed, Protection (PPE). Then keep reassessing.
- A high-energy MOI predicts hidden injuries, so do a thorough assessment even when the patient looks fine.
- Get informed consent from conscious adults. Implied consent covers patients who are unconscious.
- Once you start care, you can't abandon the patient.
- Document everything in a SOAP note.
Glossary
- Standard Precautions
- Precautions against exposure to any patient's blood and body fluids, on the assumption that all of it is potentially infectious. You'll also hear the older term, Body Substance Isolation (BSI).
- Scene Size-Up
- A quick look before you approach a patient. You spot the hazards, count the patients, work out the mechanism of injury, and make sure you're safe.
- Informed Consent
- A conscious, competent adult agreeing to treatment after you've told them who you are, your training level, and what you plan to do.
- Implied Consent
- The legal assumption that an unconscious or severely impaired patient would consent to life-saving care if they could.
- Good Samaritan Law
- Legal protection for lay rescuers who give emergency care in good faith, without gross negligence, and without expecting payment.
- MOI (Mechanism of Injury)
- The forces and circumstances behind a patient's injury. You use it to predict injuries that haven't shown up yet.
- SOAP Note
- The standard format for writing up a patient: Subjective, Objective, Assessment, Plan. It records what you found and what you did.
- Abandonment
- Stopping care without handing the patient to someone of equal or higher training, or without the patient's informed agreement. It's illegal.