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 expeditions?

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.

Common Problems
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 tired.

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 To You
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 pads.
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.