I remember NOLS founder Paul Petzoldt speaking to
our Wind River Wilderness course about the importance
of expedition planning. His captivating expedition
stories stressed planning your expedition carefully.
Echoing this theme, what health and
medical problems should we anticipate on wilderness
Many folks have answers to these questions,
but few are based on more than anecdotal experience.
Many outdoor programs don’t report into a common
database, or share their risk management data. Outdoor
recreation data comes from many sources and is hard
to interpret. The few studies published in medical
journals tend to focus on the results of serious accidents,
and not day to day expedition medical experience.
NOLS has kept a risk management database
continuously since 1984. It is specific to our courses,
and may not be applicable to every expedition, but
it does present a consistent and large perspective
on what happens in the field. The data has been published
twice in medical journals. It shows that a wilderness
leader on a NOLS course earns their pay every day
preventing serious injury and illness, which are rare,
and most often manages blisters, sprains and strains,
gastrointestinal and flu-like illness.
There are over two million person-days of experience
in the database. Athletic injuries (strains, sprains
and tendinitis) to the knees, ankles and back account
for half of all injuries. Falls and slips around camp,
or while hiking, are the leading contributing factor
to these injuries. Be prepared to assess an athletic
injury and decide if it’s usable and treatable
on your expedition, or needs to be evacuated. RICE
(rest, ice, compression and elevation) therapy and
ankle taping are critical skills. Prevention, the
best medicine, includes careful gear selection to
keep pack weight manageable, fitness, stretching,
hydration, nutrition, careful walking, helping each
other over obstacles and stopping before you’re
Wounds (cuts and bruises) are consistently
a third of reported field incidents at NOLS and other
outdoor programs. Leaders are commonly treating lacerations,
abrasions, avulsions and burns.
A wound we may ignore in town, where hot water and
daily bathing are taken for granted, is at risk for
infection in the wilderness, where good hygiene is
more difficult. Wound infections are less frequent
when leaders approach wounds with greater awareness
and cleaning skills. An irrigation syringe, antibiotic
ointment and good dressing and bandage material belong
in your first aid kit.
Blisters can be an everyday occurrence.
Moleskin, molefoam, 2nd Skin®, antibiotic ointment
and athletic tape are tried and true materials for
your kit. On the shelf of the bandage section of your
local pharmacy, you are likely to find many new blister
dressings that pad and protect. Any blister can be
tough to manage in the field. Proper socks, boots
and walking technique, with the good habit of stopping
and treating early, are foundations of prevention.
The most common illnesses are gastrointestinal
symptoms (nausea, vomiting and diarrhea) and all flu-like
illnesses (flu symptoms and respiratory symptoms).
Be prepared to disinfect your water with chemicals,
by filtering or boiling. Good kitchen and personal
hygiene practices are essential as well. We believe
most of these illnesses are primarily related to bathroom
and kitchen hygiene. Why spoil your long awaited trip
with a preventable illness? Wash your hands. Waterless
soaps can be helpful when water is scarce.
Clearly, what we might experience as
a wilderness medical problem will depend on the activity,
and where we’re going. River travelers must
be prepared for hypothermia, drowning and dislocated
shoulders. Climbers worry about trauma from falls
or rock fall. Winter campers are attuned to frostbite
and hypothermia, and if you’re climbing Denali,
altitude illness, crevasse falls and avalanche might
be high on your list. Ask the locals about common
diseases, animal or plant hazards.
It Can Happen
Medical problems that happen in the city happen in
the wilderness, too. Abdominal pain, respiratory problems,
headaches and other illnesses don’t take a vacation
just because we’re in the backcountry. This
is why in the WMI Wilderness First Responder curriculum
we cover a variety of medical topics ranging from
allergies to anaphylaxis, chest pain to pneumonia,
diabetes to seizures. Speaking of anaphylaxis, an
Anakit® or EpiPen®, while rarely needed, is
one thing we can’t improvise in the field.
We also need to be prepared for fractures,
dislocations, chest, head and spine injury. Thankfully,
these are rare. You might want to include a pre-made
splint or cervical collar in your kit, or rely, as
I do, on improvising these out of clothing and sleeping
Expedition planning has always been a fundamental
NOLS skill. With a sense of what you might see in
the field, you can supply your first aid kit, and
refresh your medical knowledge. Add an evacuation
plan, and you’ll be set to go.