Learning Objectives
By the end of this lesson, you will be able to:
- Define the role of a Wilderness First Aider and understand your scope of practice
- Apply Standard Precautions using available PPE in wilderness settings
- Conduct a scene size-up to identify hazards before approaching any patient
- Apply the principles of informed and implied consent when helping patients
- Understand Good Samaritan legal protections and documentation requirements
What is Wilderness First Aid?
Wilderness First Aid (WFA) training prepares individuals to recognize and manage medical emergencies in remote or austere environments — places where the arrival of advanced medical care may be delayed by 30 minutes to several days.
🏥 Urban EMS
- ALS backup minutes away
- Stabilize and hand off
- Full equipment available
- Protocols followed strictly
- Transport < 20 minutes
🏔 Wilderness First Aid
- Help may be hours/days away
- Must assess and treat fully
- Improvise with available gear
- Judgment-based decisions
- Monitor over extended time
Your Role as a WFA Provider
Understanding your scope of practice protects both you and your patients. Wilderness medicine training exists on a spectrum:
| Training Level | Hours | Key Capabilities |
|---|---|---|
| WFA | 16–20 hrs | Basic assessment, hemorrhage control, splinting, environmental emergencies, evacuation decisions |
| WFR | 70–80 hrs | All WFA + medication administration, spine clearing, advanced improvisation, extended care |
| WEMT | 120+ hrs | All WFR + EMT skills integrated for wilderness context |
| Wilderness MD | Medical degree + training | Full scope of medical practice in remote settings |
Standard Precautions
Standard Precautions is the current term for treating all blood and body fluids as potentially infectious — you may also hear the older term Body Substance Isolation (BSI). In the wilderness, you may have limited PPE — use what you have.
🧤 Gloves (Essential)
Always the first priority. Non-latex nitrile gloves are preferred. If unavailable, use plastic bags, extra clothing, or any barrier between you and body fluids.
👓 Eye Protection
Sunglasses can serve as protective eyewear when splashes are possible. Most important when controlling arterial bleeding.
😷 Face Protection
A commercial CPR face shield or pocket mask with a one-way valve is the real barrier option — clothing or fabric is NOT a fluid barrier. If you have no barrier and are unwilling or unable to give breaths, compression-only CPR is acceptable (AHA).
Removing Gloves
- Grasp the outside of one glove at the wrist — peel off turning inside-out
- Hold the removed glove in your gloved hand
- Slide two fingers inside the remaining glove — peel off turning inside-out over the first glove
- Dispose of both gloves together in a waste bag
- Wash hands thoroughly or use hand sanitizer (min. 60% alcohol)
Scene Size-Up
Before approaching ANY patient, perform a rapid scene size-up. This takes 5–15 seconds and could save your life.
Size-up is continuous, not a one-time act — keep reassessing throughout the response, because hazards change and the number of patients can grow.
The Scene Size-Up Checklist
Types of Scene Hazards
⚡ Environmental
- Lightning (ongoing storm)
- Avalanche zones
- Swift water
- Unstable terrain
- Extreme heat or cold
🐻 Wildlife
- Animal still present at scene
- Venomous snake near patient
- Agitated wildlife
- Bee/wasp nest vicinity
👥 Human Factors
- Unstable group members
- Hostile bystanders
- Fire or toxic smoke
- Moving vehicles/boats
⬆️ Structural
- Falling rocks or debris
- Unstable structures
- Vertical exposure
- Anchor instability
Mechanism of Injury (MOI)
MOI tells you what forces acted on the patient's body and helps predict hidden injuries. High-energy MOI requires a more thorough assessment.
| High-Energy MOI | Low-Energy MOI |
|---|---|
| Fall >3× patient's height | Simple trip and fall |
| High-speed vehicle crash | Low-speed ground-level fall |
| Direct high-force impact | Overuse/repetitive injury |
| Diving into water | Minor blunt force |
| Explosive blast | Gradual onset symptoms |
Documentation: The SOAP Note
The SOAP note is the standard format for documenting patient information in wilderness medicine. You'll practice this throughout the course.
SOAP Note Format
Consent in Emergency Care
Before treating any patient, you must obtain consent. Treating someone without consent may be considered assault and/or battery depending on the jurisdiction.
📢 Informed Consent
Who: Conscious, alert adults capable of making decisions
How: Identify yourself, your training, what you intend to do, and ask permission: "My name is Alex, I'm a Wilderness First Aider. I'd like to assess your injury. Is that okay?"
What: Patient must understand the situation and agree to treatment
🔇 Implied Consent
Who: Unconscious patients, patients with severely altered mental status
How: The law assumes that a reasonable person in this situation WOULD consent to life-saving treatment
What: Proceed with necessary interventions without explicit verbal agreement
👶 Pediatric Consent
Who: Patients under 18 (minors, in most states)
How: Ideally, consent from parent or guardian. If unavailable in emergent situation, implied consent applies.
What: Always document your attempts to contact guardians
🚫 Refusal of Care
A conscious, competent adult has the RIGHT to refuse treatment. If a patient refuses:
- Ensure they understand the risks
- Document the refusal
- Ensure they are not altered (drugs, head injury)
- Continue to monitor if safe to do so
Good Samaritan Laws
Most jurisdictions have laws protecting lay rescuers who provide emergency care in good faith. Good Samaritan protections generally require:
- You act in good faith to help someone in an emergency
- You do not act with gross negligence or willful misconduct
- You act within your level of training
- You do not accept payment for the care
A related but separate legal concept: once you begin care, you must stay and help until relieved by someone of equal or higher training or the patient is in better hands — leaving before that is abandonment, covered below.
Duty to Act & Abandonment
As a WFA provider without a professional role, you generally have a moral but not legal duty to respond (unless your employer or role requires it, e.g., a guide). However, once you begin caring for a patient, you MUST NOT abandon them. Abandonment occurs when:
- You leave a patient in a worse or no-better situation than you found them
- You stop care without transferring to someone of equal or greater training
- You leave without the patient's informed consent to discontinue
Clinical Scenarios
Apply what you've learned to these realistic wilderness situations. Read each scenario, form your response, then reveal the discussion.
Setting: You're hiking a steep trail when you hear a cry for help. You see a hiker lying 30 feet off the trail at the base of a rocky slope. There are loose rocks above. The patient appears conscious and is holding their leg. There are no other group members around.
Questions to consider:
- What is your FIRST action before approaching the patient?
- What specific hazards do you identify?
- What BSI precautions will you take with the supplies in your day pack?
- What information do you need to determine if you call for help now?
1. Scene Size-Up First: Before moving toward the patient, stop and assess the slope above. Are there more loose rocks? Is the patient in a position where more rocks could fall? Look for the most sheltered approach path.
2. Hazards identified: Loose rocks on the slope above (ongoing hazard), unstable terrain to approach, possible additional injury from falling while you traverse, isolation (no other rescuers on scene).
3. BSI: Put on gloves from your pack. If you don't have gloves, you could use a clean bandana or plastic bag over your hands for initial contact — but any substantial wound care requires a barrier.
4. Decision to call for help: Factors include: apparent severity of injury (can they walk?), distance from trailhead, available daylight, group resources, communication device availability. If the mechanism looks significant (fall of 10+ feet onto rock), call for help sooner rather than later.
Key takeaway: Rushing to the patient is the most natural impulse — and the most dangerous. The scene size-up is non-negotiable.
Setting: You're a camp counselor and a 15-year-old camper has a significant laceration on their arm from a sharp rock. The wound is bleeding steadily but is controlled with pressure. The camper says "I'm fine, leave me alone, don't touch me." They are alert and appear upset but not confused.
Questions to consider:
- Is this patient's refusal valid? Can they legally refuse care?
- What steps do you take next?
- When would implied consent apply here?
Refusal by a minor: A 15-year-old is considered a minor in virtually all jurisdictions. While you should respect their emotions and not be forceful, a minor generally cannot refuse medical care on their own — that authority typically rests with their parents or guardians — though rules vary by state, and emancipated or "mature minors" are exceptions in some places. Note that organized programs (camps, guided trips) typically have parental consent-to-treat forms on file — know your program's policies.
Steps to take:
- Remain calm and empathetic. Ask "Can you tell me why you don't want me to help?"
- Contact parents/guardians and camp director immediately
- Document the patient's statements and your actions
- If the bleeding becomes uncontrolled or the patient loses consciousness, implied consent allows you to treat
- Never use force — get adult authorities involved
Implied consent trigger: If the patient becomes unconscious, severely altered, or the injury becomes immediately life-threatening, treat under implied consent while getting help.
Knowledge Check
10 questions. Pick an answer to get immediate feedback. Answer order is shuffled each attempt, and your best score is saved on this device.
🎯 Key Takeaways
- Your safety ALWAYS comes first — never enter an unsafe scene
- Standard Precautions (formerly BSI): treat all blood and body fluids as potentially infectious; use available barriers
- Scene size-up: assess for Safety, Scene, Mechanism, Help needed, Protection (PPE) — and keep reassessing
- High-energy MOI predicts hidden injuries — always perform a thorough assessment
- Obtain informed consent from conscious adults; implied consent applies to the unconscious
- Once you start care, you cannot abandon the patient
- Document everything using SOAP note format
Glossary
- Standard Precautions
- A set of precautions taken to prevent exposure to blood and body fluids from any patient, assuming all are potentially infectious. You may also hear the older term Body Substance Isolation (BSI).
- Scene Size-Up
- A rapid assessment performed before approaching a patient to identify hazards, determine the number of patients, understand the mechanism of injury, and ensure personal safety.
- Informed Consent
- A conscious, competent adult's agreement to receive medical treatment after being informed of who you are, your training level, and what you plan to do.
- Implied Consent
- The legal assumption that an unconscious or severely impaired patient would consent to life-saving care if they were able to do so.
- Good Samaritan Law
- Legal protection afforded to lay rescuers who provide emergency care in good faith, without negligence, and without expectation of compensation.
- MOI (Mechanism of Injury)
- The forces and circumstances that caused a patient's injury, used to predict potential injuries even when not yet apparent.
- SOAP Note
- A standardized documentation format: Subjective, Objective, Assessment, Plan — used to record patient information and treatment.
- Abandonment
- The illegal act of stopping care for a patient without transferring responsibility to an equal or higher-level provider, or without the patient's informed agreement.