Using Wilderness Medicine Training as a Recipe for Decision-Making

One of NOLS founder Paul Petzoldt’s endearing habits was challenging students to explain their choices and the principles behind their decisions and techniques. He wouldn’t settle on one best way to do something; he sought the practical and effective way.

Unfortunately, it’s not uncommon for students of first aid and pre-hospital medicine to be taught in absolutes; practices that supposedly work all the time, practices framed as being based on solid evidence but in reality often founded on bronze, not gold standard, science.

In both urban pre-hospital and wilderness medicine, experts argue best practices. The value of IVs, lights and sirens and air transport are only a few of the urban ambulance practices that are taken for granted, yet are controversial. On the wilderness side, we debate the efficacy of traction splints, pressure immobilization bandages, evacuation guidelines and whether we should “clear a spine,” reduce a dislocation or straighten a fracture.

This uncertainty can cause anxiety in the Wilderness First Responder (WFR) whose patient doesn’t quite fit the profile presented in class or whose teammate insists, with absolute certainty and confidence, that their way is the only way. Everybody knows people who are dogmatic preachers – confident and passionate that their technique or knowledge is the final word. Yet, a wise NOLS instructor once said, “If you step in dogma, your shoes stink.”

Petzoldt’s aspiration was to develop leaders with judgment; the ability to reason when challenged by missing data or conflicting information, when we’re at the edge of our experience and training. He helped young outdoor leaders make decisions by guiding them with principles; take care of people first, then the gear, then the environment.

An effective first aid education is also grounded in principles; stop if you’re hurting the patient, move people gently and carefully, make a sound patient assessment, attend to the ABCs, etc.

There is a place for practices we know are helpful; for example, chest compressions in CPR and direct pressure in bleeding. But there are also scenarios where there can be many ways to solve a problem, many of them workable, none perfect. In these scenarios novices need cookbooks, with treatment principles that are sound recipes.

Wilderness medicine training shows students recipes that work while helping them to be thinking cooks and use judgement along with their cookbooks.

Learn more about certifying or re-certifying in wilderness medicine.

Editor’s note: Published 06/2008, revised 07/2015 and 05/2018