Sunday, February 03, 2008

Wilderness First Aid: Arlington County, VA Feb 2-3, 2008

I took a Wilderness First Aid class over the weekend. Why? Well, it has been a long time since I did outdoors activities with people who knew more than I did, and I like to make a practice of learning from others. And there were times in Afghanistan where I was designated medic, because I was the most highly trained and I was judged as having the attitude that the convoy commander figured I would act appropriately if needed. My 10-year expired EMT certificate and Red Cross first-aid really were not the things I would have thought as being quite the right set of qualifications. But these are folks who are quite serious when the judge people, and are generally good at it.

Wilderness First Aid is very different than standard first aid taught around the country. The big difference is the level of self-reliance. The expectation in most of suburban and urban United States is professional emergency response is available within 10 minutes, and hospital transport is within 15 minutes (or so). In wilderness, these times are measured in hours, so the medical protocol reflects that. So this is something that is more on par with first responder training then first aid training. Many organizations that work in the backcountry require this as a safety measure, because their activities can be hours away from outside help. Some organizations use this as a proxy for trained personnel that is lower then EMT, but higher then first aid, because they need personnel of a certain competence. And some organizations that operate in the third world like it, because they also are hours away from medical assistance.

It is a different attitude than most people in the U.S. The focus here is on leadership that can watches the people around them, and teaches them to avoid disaster. I've been in organizations that resist people watching after each others safety (or anything else). The students here were mostly people who would go on to lead Boy Scouts outings, or camp counselors in outdoor settings, teaching self-reliance and the ability to watch for each other and survive to others. Which a contrast to people who have told me that we don't do anything, just trust authority. (which is not very fun if authority is far away and someone would be dead before authority could do anything.)

Things we learn (1) do not create a second victim (2) always think, "what will kill the patient first. Lots of thinking about priorities. And especially, leadership in prevention of problem situations. How to look at a group, identify the signs of problems build, and take precautions before there is a problem. How to demonstrate leadership, in many different forms and switch as needed. Medical folks will appreciate this one: how to ignore a patient. Realizing that you did not get this great training so the patient can self-diagnose a problem. That is your job. And how to communicate, to communicate problems in a way that many hours later, someone can hear the message, and respond in a way that helps in a place where resources and carrying capacity is limited.

It is an honest class. A couple of other students and I were joking that we hoped all the real outdoors people in the class did not mind us amateurs taking up space. We talked about the issues we faced in the places we worked and volunteered in. And the challenges of working with the populations that we do this with. And we talked in a straightforward way, what can kill a person. And how to overcome the psychological and social barriers that would prevent us from giving care that makes the difference between someone living and dying that day.

The goal is to live. And live well. It was a great group of people, and I would put my life in any of their hands. I have known people that probably would not want anything to do any of us out of principle. That is their loss.

What is this for? Yes, some of it is because if I am expected to be the group medic, it helps if I have competent and recent training. But also, I have a philosophy that I should be involved with things that I am not good at. And with people who are good. This was one of those places.
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