The classroom is lined with bruised and bloodied students, oblivious of their apparent injuries, all sitting at attention ready to learn. Though the injuries may look severe or concerning (especially the occasional impaled object), everything here is purely superficial, the product of realistic special-effects make-up used in class scenarios. Although each student is cured of their ails at the end of each scenario, the special effects make-up stays on long afterwards, a constant reminder to the students about the nature of their studies.
This classroom scene is from a Wilderness First Responder (WFR) course. The WFR (verbalized as ‘Woofer’) students are here to learn the fundamentals of wilderness medicine. Over an intensive eight-day schedule, students go from learning about the critical systems of the human body to applying such knowledge in realistic scenarios of wilderness medical emergencies. The aim of the WFR course is to teach any interested person enough to be able to safely assess and evaluate any emergency situation and provide basic life support to each patient when in a wilderness setting—that is, when definitive medical care is at least two hours away. Medicine in the wilderness context is made more challenging by the lack of medical supplies and a setting that is often hostile to medical emergencies and the rescuers. Thus, WFR students are taught a holistic program of extended patient comfort and care in the wilderness and are encouraged to improvise tools from outdoor gear when medical devices are scarce.
A WFR course attracts an affable and often young group of similar-minded outdoor enthusiasts. Such personalities come with the terrain. Many enrolled in the course are burgeoning outdoor professionals—guides or instructors—but some also take the course for personal development. All share the general desire to help others in emergency situations in the wilderness. With a common interest in the outdoors and backcountry medicine, and with so much class-time spent together, a class group dynamic forms with its unique bond. Being comfortable with the other students in the course is essential too; as a very hands-on classroom setting, WFR students get close and personal in the process of learning: performing spinal palpations, simulating rescue breathing, backboarding, and much more. Having a WFR course taught at a roadless camp in the Boundary Waters Canoe Area also doesn’t hurt the sense of group formation. Classroom time is shared, but so are meals, lodging, and recreation time in this residential setting. The aura is one continually steeped in the learnings of backcountry medicine.
The WFR curriculum carries no pre-requisites. Class instruction takes the student from the ground-up and quickly builds upon newly acquired knowledge. Starting with the basics, students learn about the three critical life systems of the respiratory, circulatory, and neurologic systems in the patient primary assessment. A deficit in any of these three critical systems could entail death to the patient within minutes. Simple, early scenarios in the course cement the concepts of checking each patient for these critical systems to safeguard each life in immediate danger.
Once WFR students master the basics, they soon learn more about advanced topics—a wide variety of serious and not-so-serious medical conditions. Patients with intact critical systems get a thorough secondary assessment in the field that can uncover many other challenging problems. Discoveries made on the secondary patient assessment will lead to the decision of an urgent evacuation, non-urgent evacuation, or field treatment of the patient. A traumatically injured patient may soon go into shock and need to be evacuated immediately, whereas some simple joint dislocations can be reduced in the field allowing a trip to continue. All problems, from critical to superficial, become the territory of the well-trained WFR.
The apex of practical training in the WFR course comes towards the end, when students put their new skills and knowledge into practice in realistic full-scale simulations of medical emergencies. This is where the special-effects make-up really comes into play. The course instructor will set up a medical scenario in the woods—be it a storm during a canoe trip or a mass rock climbing fall—and use some students as patients. Student-patients get a list of injuries to act out in a scene; fake bruises and blood add to the realism. Other students in the course then serve as rescuers in the scenario, approaching student-patients with little prior knowledge of the scene. Using their newly acquired knowledge, student-rescuers need to perform patient assessments and treat injuries in the field as if it were a real emergency. Even after only eight days of training, the student-rescuers perform their job with a high degree of skill and knowledge. Mistakes are still made in these simulations, but class debriefings help both patients and rescuers understand what went well and what could be improved. Afterwards, student-patients and student-rescuers switch roles to practice additional medical scenarios. One can learn just as much about wilderness medicine by being a patient as by being a rescuer.
Certified WFRs are everywhere. We look just like any ordinary person. You may see us in a city or encounter us in the great outdoors. When the situation arises, we are trained and prepared for the emergency. And we may just be the ones who can save a life.