We could send one more patient out on a helicopter. The rest would either have to walk out on their own or be carried in what I had recently learned was called a litter. Michael, our elected incident commander, waved a few of us over to a patient lying on the ground. It was Thomas, who had suffered from fictional drowning and who despite our textbook rescue efforts, was not yet breathing easily. “Pulmonary edema?” Someone asked, a bit unsure, and we all nodded in agreement. Thomas’s condition warranted a level 1 evacuation, the most serious, so the final helicopter ride would go to him.
I looked around the river bank. First aid kits were scattered alongside trekking poles and backpacks. A group of three sat on a log, bandaged and covering themselves with sleeping bags. Others were running supplies to each other, or taking the pulse and counting the breaths of patients who were not yet stable, some still in the shallow frigid water where we had found them. A few folks waited off to the side, their conditions less serious, waiting for broken and sprained limbs to be attended to.
We were working through the final simulation of our Wilderness First Responder course. Successful completion would mean that we would be Wilderness First Responder certified, or have our “Woofer” as the outdoor community sometimes refers to it as. The certification lies somewhere between advanced first aid and emergency medical technician training, and is geared toward backcountry guides, ski patrollers, and those of us who venture into remote places to climb, camp, or hike where help isn’t an easy call away.
“Thomas! No!” Braydon cried. He had been playing the inept river guide who’s trip had gone awry when each of the rafts in his fleet had capsized upon entering a treacherous part of the river. I had found a tricky arterial bleed while performing a blood check on Braydon just a few minutes ago and had patched him up with a maxi pad (WFR tip!) and pressure bandage before moving on to Jukes, an onlooker who had been stung by a bee and was experiencing anaphylaxis (“administer .3 cc epinephrine up to three times, monitor for a rebound reaction”). We sent Thomas away on the fake life flight and turned to assess the next most critical patient at the scene.
I had spent the last few months studying anatomy, physiology, and biochemistry and working through lessons on practical skills such as how to perform a focused spine assessment or determine whether a particular stomach pain warranted immediate evacuation or could be waited out. The current situation at the river was one of many we had worked through in the last five days, taking turns playing patient and rescuer—as patients, dousing ourselves in fake blood and blue pigment to indicate wounds and bruising; and as rescuers, rushing to our patients’ sides to diagnose concussions, dress wounds, and wrap the injured in sleeping bag burritos to prevent hypothermia.
A typical WFR course is nine days of in-person instruction and group simulations. The course I enrolled in was a hybrid—requiring my cohort to learn the pathophysiology of traumatic, environmental, and medical injuries and illnesses on our own and to pass a series of tests before participating in the live group simulations. Many WFR courses take place on college campuses or in outdoorsy towns like Moab or Boulder. They focus on basic life support (CPR, stopping bleeds, helping with medication), using an assessment system to treat any current problems from an injury or illness, and working through a diagnostic tool called a SOAP note to manage the ongoing care of a patient.
I had wanted to get my WFR certification for years—having always looked up to my friends who had passed and were able to swap stories about the experience and talk with authority about ways to treat a snake bite. I finally took the course during the pandemic. It was August of 2021 and while I had been vaccinated for months, Idaho, my home state was going through a surge—cases of patients affected by Covid-19 were flooding the local hospitals to the point where some were being sent to emergency care in neighboring states. Once an avid climber and hiker, I had limited my backcountry exploits the last few years, not wanting to take up medical resources for a sprained ankle when so many people in my local community were getting sick or hurt doing more essential activities. Becoming WFR certified seemed like a good strategy for learning how to help myself or others out of most situations I would encounter.
Having sent Thomas off on that final life flight, we gathered around Grace, who was now unresponsive, but breathing. Her pulse was a little elevated, but not high enough to indicate any sort of internal bleeding, and her respirations were normal. Before she had lost consciousness, her rescuer had splinted her leg, which she had complained might be broken, in the manner we had learned to do so that week, practicing on one another and getting feedback from our course instructor. (“Keep things neat,” Cam would warn us. “And check that the patient still has circulation!”) We gently rolled Grace into a litter and surrounded her—three rescuers on each side and someone near her feet. We picked up the basket-like stretcher and started to hike up the bank toward the “front country” where in a real situation, more help would ideally be ready to take over Grace’s care. “Lift her over that stump,” Cam demanded, not letting us take an established trail and instead forcing us to find our way through the overgrown cottonwood trees that lined the river. Over an hour later, we had only moved a third of a mile, switching out rescuers to carry Grace every few paces as people tired. At last we reached our destination, the offices of the outdoor program at the university hosting the course, and after another hour of debriefing the rescue, we received our certifications and Cam sent us on our way, new skills and a few blank SOAP notes in hand.
Wilderness medicine was all I thought about in the weeks following the course and I was diagnosing and assessing everyone and anyone complaining of a paper cut. There was the snowboarder who fell to the ground and started seizing in the ski lodge (“turn him on his side and give him space”), the friend who visited town and developed a systemic infection from an animal bite (“clean like a high risk wound and obtain antibiotics”), my grandmother’s stomach ache (“can’t rule out diverticulitis”), and my cousin’s stomach ache (“can’t rule out appendicitis”). I debriefed mountain bike accidents on dates (“did they monitor you for a severe concussion?”) and identified my own gall bladder to be the source of some abdominal pain (“maybe don’t eat as much full fat whipped cream after dinner”).
Another thing that happened in the weeks following the course—the Omicron variant was discovered and another surge overwhelmed Idaho hospitals soon after. With the pandemic now into its third year, we have seen many try to take charge of their own healthcare, sometimes turning to potentially dangerous treatments like hydroxychloroquine or ivermectin that later become punchlines; sometimes turning to what seems like folklore—UV light, or a combination of essential oils. While generally being on the side of science and reason, I can understand these attempts, my own version being the WFR course I sought out to try cure what makes us feel so out of control.