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34-405: A wilderness medical emergency is a medical emergency that takes place in a wilderness or remote setting affinitive care ( hospital , clinic, etc.). Such an emergency can require specialized skills, treatment techniques, and knowledge in order to manage the patient for an extended period of time before and during evacuation. Few programs teach psychological first aid , although mental distress

68-406: A "reasonable person" in the same situation would act. The concept of implied consent can protect first responders in emergency situations. A first responder may not legally touch a patient without the patient's consent. However, consent may be either expressed or implied : Usually, once care has begun, a first responder or first aid provider may not leave the patient or terminate care until

102-469: A WFR certification. A number of fellowships are available for emergency medicine graduates including prehospital medicine ( emergency medical services ), hospice and palliative care, research, undersea and hyperbaric medicine, sports medicine, ultrasound, pediatric emergency medicine, disaster medicine, wilderness medicine, toxicology, and Critical Care Medicine. Medical emergency Any response to an emergency medical situation will depend strongly on

136-415: A long time to arrive. Locating the victim precedes assessment and intervention and in the case of wilderness response is often a difficult matter. Specialists in white water rescue , mountain rescue , mine disaster response and other fields are often employed. In some cases, emergency extrication procedures at incidents such as automobile accidents are required before assessment is possible. Only once

170-597: A number of boards and societies which have been formed in recent years to attempt to establish normalized standards for wilderness first aid certification and wilderness medicine in general. Currently, there are no national standards for wilderness medicine, however one of the most popularly followed curricula is the "National Practice Guidelines for Wilderness Emergency Care" published by the Wilderness Medical Society in 2010. The American Red Cross Wilderness & Remote First Aid (r.2010) certification

204-420: A process called triage in order to make the most of their limited resources. Transporting an injured person out of the wilderness on a stretcher can be a difficult exercise requiring considerable manpower. It is advised that at least one person stay with an injured party and that no one attempt to seek help by travelling alone over inhospitable terrain. In emergency medicine , some advocates assert that there

238-412: A responder of equal or higher training (such as an emergency medical technician ) assumes care. This can constitute abandonment of the patient and may subject the responder to legal liability. Care must be continued until the patient is transferred to a higher level of care; the situation becomes too unsafe to continue; or the responder is physically unable to continue due to exhaustion or hazards. Unless

272-461: A scientific basis. Dr. Bryan Bledsoe, an outspoken critic of the golden hour and other EMS "myths" like critical incident stress management , has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients. Wilderness first aid ( WFA ) is the specific discipline of first aid which relates to care in remote areas, where emergency medical services will be difficult to obtain or will take

306-578: A time-dependent reduction in the mortality and morbidity . Wilderness First Responder Wilderness first responders are individuals who are trained to respond to emergency situations in remote locations. They are part of a wide variety of wilderness medical providers who deal with medical emergencies that occur in wilderness settings. While wilderness first responder can generically refer to anyone providing first response, this term typically refers to individuals trained and certified with specific Wilderness First Responder (WFR) certification. Near

340-437: Is a golden hour which refers to a time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. While most medical professionals agree that delays in definitive care are undesirable, recent peer reviewed literature casts doubt on the validity of the 'golden hour' as it appears to lack

374-619: Is commonly encountered by wilderness guides and outdoor athletes. A mass casualty incident (MCI) is a situation in which the number or severity of casualties overwhelms the available medical resources and service providers. Wilderness MCIs may include blizzards , earthquakes , avalanches , landslides , floods and forest fire , but they need not be natural disasters. Mass casualties have also been caused by human error in parties of climbers or explorers, with or without complications from inclement weather. In mass casualty incidents, emergency service providers must prioritize their patients using

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408-489: Is generally present to deal with the average emergency situation. Emergency medicine physicians and anaesthesiologists have training to deal with most medical emergencies, and maintain CPR and Advanced Cardiac Life Support (ACLS) certifications. In disasters or complex emergencies, most hospitals have protocols to summon on-site and off-site staff rapidly. Both emergency department and inpatient medical emergencies follow

442-400: Is taught in an EMR course, but with the additional hours spent putting it in a wilderness context. Wilderness first responder training courses focus on teaching the students to assess a situation, improvise solutions using available resources to stabilize the patient, and identify the best way to get the patient to definitive medical treatment. In many courses, students are encouraged to develop

476-595: Is valid for 2 years. In Canada the first WFA courses were taught in the mid-1980s and the first organization to adopt standards was the Wilderness First Aid and Safety Association of BC (defunct since 1998). In the Republic of Ireland and the United Kingdom various Wilderness First Aid courses and certifications are facilitated by WEMSI International who have bench marked their standards from

510-609: The Wilderness Medical Society published minimum topics for courses claiming to grant WFR certification. In 2016, the Wilderness Medicine Education Consortium, an industry-led collaborative from multiple wilderness medicine schools, published a recommended scope of practice for WFRs. The EMR portion of WEMR is regulated by state rules and law, and by federal EMS recommendations and policies. The wilderness portion of WEMR

544-666: The 1950s, organizations such as The Mountaineers began developing training programs that addressed these special needs. In 1966, the US Government, through the National Traffic and Motor Vehicle Safety Act , gave the Department of Transportation (DOT) responsibility for creating a national Emergency Management System (EMS). From this program came the standardized curriculum for the position of emergency medical technician (EMT) and later First Responder, which in

578-890: The 21st century as described below became emergency medical responder . The first formal wilderness medical responder class beyond first aid was taught by Carl Weil of Wilderness Medicine Outfitters, a variant of Advanced Wilderness First Aid for ski patrollers at Colorado State University in 1967. From this beginning a number of courses for wilderness responders beyond first aid appeared, including Wilderness Emergency Medical Technician , Advanced Wilderness First Aid, Wilderness Advanced First Aid, and others. Notable early schools and programs teaching such programming included Stonehearth Open Learning Opportunities , Wilderness Medicine Outfitters, and Outward Bound (Outward Bound courses were often run with Peter Goth, who went on to found Wilderness Medical Associates). The first of these classes to specifically grant Wilderness First Responder certification

612-465: The US based WEMS A Wilderness First Responder (72- to 80-hour course) certification is both a higher certification than a Wilderness First Aid or (16- to 20-hour course) certification, and may also be used to upgrade an Emergency Medical Technician to a Wilderness Emergency Medical Technician . Outdoor Emergency Care is a National Ski Patrol certification, but it doesn't fully meet the requirements for

646-446: The appropriate local emergency telephone number , such as 999 , 911 , 111 , 112 or 000 . After determining that the incident is a medical emergency (as opposed to, for example, a police call), the emergency dispatchers will generally run through a questioning system such as AMPDS in order to assess the priority level of the call, along with the caller's name and location. Those who are trained to perform first aid can act within

680-496: The basic protocol of Advanced Cardiac Life Support. Irrespective of the nature of the emergency, adequate blood pressure and oxygenation are required before the cause of the emergency can be eliminated. Possible exceptions include the clamping of arteries in severe hemorrhage . While the golden hour is a trauma treatment concept, two emergency medical conditions have well-documented time-critical treatment considerations: stroke and myocardial infarction (heart attack). In

714-410: The bounds of the knowledge they have, whilst awaiting the next level of definitive care. Those who are not able to perform first aid can also assist by remaining calm and staying with the injured or ill person. A common complaint of emergency service personnel is the propensity of people to crowd around the scene of a victim, as it is generally unhelpful, making the patient more stressed, and obstructing

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748-401: The case of stroke, there is a window of three hours within which the benefit of thrombolytic drugs outweighs the risk of major bleeding. In the case of a heart attack, rapid stabilization of fatal arrhythmias can prevent sudden cardiac arrest. In addition, there is a direct relationship between time-to-treatment and the success of reperfusion (restoration of blood flow to the heart), including

782-450: The delay of life-saving aid from bystanders, many states of the USA have " Good Samaritan laws " which protect civilian responders who choose to assist in an emergency. In many situations, the general public may delay giving care due to fear of liability should they accidentally cause harm. Good Samaritan laws often protect responders who act within the scope of their knowledge and training, as

816-405: The elements of providing assistance until definitive care could be arranged. The training in these courses assumed that definitive care was nearby and could be delivered quickly. Eventually it was realized that this training, while valuable, needed to be supplemented and/or revised to deal with the extended time and limited resources inherent when a medical crisis occurs in a wilderness setting. In

850-529: The end of the 19th century, volunteer organizations such as St. John Ambulance began teaching the principles of first aid at mining sites and near large railway centers. By the dawn of the 20th century, additional organizations such as the Boy Scouts and the American Red Cross began teaching first aid to lay people. Over the years, these organizations trained hundreds of thousands of people in

884-545: The habit of systematically thinking through and documenting their assessment decisions/plans using a SOAP note . Topics covered usually include, but are not limited to, the following principles: WFR is an unregulated certification. With the abandonment by the Department of Transportation of the First Responder nomenclature in the 21st century, it now also has no linkage to EMS operations or certifications. In 1999

918-420: The location of the victim has been determined, a trained responder has been dispatched and successfully reached the victim, can the ordinary first aid process begin. Assessment is then enabled and it follows carefully specified protocols which have been refined through a long process of evaluation. Wilderness First Aid is a relatively new field compared to regular or 'urban' first aid. For this reason, there are

952-423: The outdoors and students may take courses from numerous nationally recognized providers (see below). In the mid-2000s, the Department of Transportation (which oversees EMS nomenclature and operations) mandated a national name change removing the formal "First Responder" certification and replacing it with "Emergency Medical Responder". With this action, a new category of Wilderness Emergency Medical Responder (WEMR)

986-464: The situation is particularly hazardous and is likely to further endanger the patient, evacuating an injured victim requires special skills, and should be left to the professionals of the emergency medical and fire service. During a medical emergency in which a patient is no longer breathing and does not have a pulse , survival is predicated on adherence to the chain of survival , which has four components: Within hospital settings, an adequate staff

1020-443: The situation, the patient involved, and availability of resources to help them. It will also vary depending on whether the emergency occurs whilst in hospital under medical care, or outside medical care (for instance, in the street or alone at home). For emergencies starting outside medical care, a key component of providing proper care is to summon the emergency medical services (usually an ambulance ), by calling for help using

1054-428: The smooth working of the emergency services. If possible, first responders should designate a specific person to ensure that the emergency services are called. Another bystander should be sent to wait for their arrival and direct them to the proper location. Additional bystanders can be helpful in ensuring that crowds are moved away from the ill or injured patient, allowing the responder adequate space to work. To prevent

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1088-574: The wilderness. The training is principally geared towards lay providers, with little to no actual medical experience, though they are often already professionals in other aspects of the outdoors industry, like park rangers, climbing instructors, and guides. A standard Department of Transportation defined emergency medical responder (EMR) course, which focuses on urban medical emergencies, requires approximately 60 hours of training, while its backcountry counterpart, wilderness first responder course, typically involves 80 hours of training, covering much of what

1122-429: Was born, and the differentiation between the wilderness medicine certification of WFR (primarily for guides, oudoorspeople, and others not formally involved in a response system, and unregulated) and the wilderness EMS certification of WEMR (primarily for formal responders to wilderness emergencies in a regulated system) began. A wilderness first responder is trained to deal with many situations that may be encountered in

1156-514: Was taught in 1985 by Frank Hubbell of SOLO and Peter Goth of Wilderness Medical Associates in the Florida S.T.E.P. (Short Term Elective Program) basecamp of Hurricane Island Outward Bound School. The purpose of creating the course was to provide rangers, outdoor leaders, and guides the necessary knowledge to provide care in crises in the wilderness. Today, WFR certification is frequently a prerequisite for professional positions that involve work in

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