Consider this: when you post a job announcement for an outdoor instructor you undoubtedly seek an individual with solid outdoor skills, actual experience leading groups and wilderness medicine training. Note the difference. It’s easier to find people with outdoor leadership experience and medical training than with both outdoor leadership and medical experience. Yet we know that experience is vital to judgment and that wilderness instructors not only treat blisters and headaches, they also make complex medical decisions in remote environments. How do we prepare them to make good decisions in this situation?
Take for instance abdominal pain, a common medical complaint. Most of the time our participants simply experience gastrointestinal discomfort. Some of the time they have a more serious problem such as appendicitis. A poor or delayed decision to evacuate someone with a serious abdominal problem can result in a more significant illness.
The diagnosis of abdominal pain is challenging for trained physicians, yet we expect our staff to make good decisions about when and how fast to evacuate a patient with a bellyache.
In the complex world of space flight NASA uses “mission rules,” pre-planned decisions triggered by circumstances. For example, there are mission rules governing weather conditions for launching and landing the shuttle. We’ve found the same concept helpful in guiding wilderness leaders through medical decisions. With our medical protocols we provide our staff with guidance in making medical decisions.
These protocols are based on the NOLS Field Incident Database, which for 22 years has gathered data on the injuries and illness on NOLS courses. We believe it’s the largest continuous dataset on wilderness expeditions. It tells us what decisions our staff makes in the field. Our protocols also use the lessons we have learned listening to generations of NOLS staff describe how they made decisions and what the sticking points were for them. And, it uses the expertise of WMI’s faculty and medical advisory panel.
NOLS Instructors carry a set of written medical protocols and evacuation guidelines in the field. These are developed in consultation with our medical advisor for the context in which we make medical decisions — remote wilderness expeditions, unreliable radio, cell or satellite communications and Wilderness First Responder trained staff. To help other outdoor programs support their staff’s medical decisions, WMI’s Shana Tarter developed a Wilderness Medicine Protocol Package. This valuable resource summarizes treatment and evacuation guidelines for the injuries and illnesses we anticipate seeing in the field, including unique wilderness medicine practices. In addition, it provides advice on working with a physician medical advisor, templates for documentation and “drug cards” to carry in the field for common medications. Organizations can customize this document to reflect their level of staff medical training, the remoteness of their trips and the preferences of their medical advisor.
As you prepare for your operating season this spring, consider adding this resource to support your staff.
For more information and to purchase your Wilderness Medicine Protocol Package, please visit the NOLS online store at www.nols.edu/store