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Learning Wilderness First Aid

photo: Learning to improvise a leg splint
Learning to improvise a leg splint.

Imagine yourself kneeling next to a hiker who's slipped and broken a leg, or fallen and been knocked unconscious. What should you do?

If you're in a city, you'd probably call 911 and emergency medical services would arrive within 10 minutes. But if you're hiking on a trail or in a wilderness area without cell phone coverage, it may take hours or days for help to arrive. You might even have to hike out before you can call for help.

That's why knowing Wilderness First Aid (WFA, pronounced woofa) is so important. A victim's chances of survival are greatest if they receive care within a short period of time after a severe injury. For each quarter mile a victim is from a trailhead, it takes an additional 15 minutes for EMS to reach the scene. If your partner sustains a traumatic injury more than a mile or two from the road, you are their best chance for survival.

Wilderness First Aid teaches much more than how to bandage a blister or disinfect a cut, and many outdoor organizations require that camp counselors or trip leaders become certified before they can lead trips. Certification requires 16 hours of training, covering how to take control of an accident scene, assess a victim’s condition, and stabilize them. In addition, you learn how to splint broken bones, treat hypothermia and stop severe allergic reactions.

A Wilderness First Aid class is a surprisingly enjoyable experience, and taking it in a group setting is a lot of fun. In addition to lectures, you spend a lot of time in the field applying different techniques in staged scenarios. You’re taught how to improvise splints and cold injury treatments using gear and clothing that you have in your pack, as well as how to properly use the regular first aid supplies you bring with you when you go hiking.

Everybody should carry a basic first aid kit when they go hiking. But after you get your WFA certification, you’ll probably want to add a few extras like cloth cravats for making slings and splints, a large syringe for irrigating open wounds, and a pencil and notepad to keep track of vital signs.

For more information about Wilderness First Aid classes near you, contact NOLS Wilderness Medicine Institute, SOLO Wilderness Medicine School, or your local trail club.


Great article and important topic. I got my WFR (pronounced "woofer?") a many years ago.  I've used it on a number of occasions, and found it incredibly valuable.  If you hike regularly, it's well worth the investment of time and money to go for it.  I've also noticed that my WFR skills come in very handy in urban settings, though I am not protected by law unless I use them more than 1 hour from care.

I've been on wilderness SAR missions/evacs with paid EMTs and they were at a complete loss without SAM or air splints, cam straps, back boards, and the like. Guess that's why there is a Wilderness EMT supplement course, huh?

F_Klock, I too have been terrified watching urban EMT's work in the woods.  Recently, I saw a crew attempt to take a wheeled litter up a steep trail.  I helped them improvise a blanket litter and wondered what would have happened otherwise!

Among the outdoor organizations that sponsor WFA courses are Boy Scouts of America (BSA), Girl Scouts in the USA (GSUSA), Sierra Club, Seattle Mountaineers, and many more. Some of these use WMI (NOLS), and some use independent contractors. BSA runs its own courses, using a curriculum developed by a committee headed by Buck Tilton (of NOLS). American Red Cross also gives WFA courses (though I have been told by people who have been through it that it doesn't go much beyond their old "When Help is Delayed" course). BSA and the Sierra Club require a minimum of a WFA for their trip leaders.

I've never had to use the skills on trips I have led (except for "prevention is the best cure" planning and briefing before the hike). But I have had to use the skills for other groups. Two times, one of the victim's companions was a nurse, who had no first aid skills beyond "call 911". One of the nurses did not even know to stabilize the victim's head, although the victim had struck her head on a rock when falling off a boulder. Many medical personnel, who may be very proficient in their area of expertise, do not have first aid training.

The comment about help taking a long time even applies to our urban Open Space Reserves here in the SFBay Area. Castle Rock has no cell coverage at the climbing areas, most of which are at least 15 minutes from the trailhead. The Pinnacles NM climbing areas are at least 30 min from the trailhead. And the parks are often a half hour travel for the nearest ambulance, even though the straight-line distance may only be 5 miles (winding, steep mountain roads).

As Seth points out, the improvisation skills that are taught in the WFA and WFR courses are extremely useful and valuable.

I guess I feel frustrated with the redundancy of these First Aid programs. I have my Red Cross First Aid certification and my Red Cross CPR certification, and they get renewed each year.


The only difference between those and wilderness first aid is the ability to use what's in your pack, the ability to prepare for it by having what you need with you, and the ability to use ingenuity when you don't have what you need, aka improvising.


Once the basic knowledge and skills are there, anyone with survival knowledge and hiking, climbing, and backpacking experience can improvise devices or procedures to fit the circumstances.


In fact, you have to do that in ANY emergency situation. It's not like a FA or CPR class hands out notes of every possible situation and how to react to it. The key difference here is knowing your tools and surroundings and how to use them in improvisation for emergency situations. I feel like with the amount of information I've read, practiced, and with my current trainings, I could teach the freakin course myself. Yet because I haven't shelled out stupid amounts of money, I'm not "certified" to do CPR in the wild.


Funny though, that I trust my own life and well being to my knowledge and skills, and so do my friends and beginners to the sport who come with me.


These classes in my mind are ways for companies to carve a narrow niche, to make more money, and serve no real purpose.


Same goes for Guide Certification. I know people that have hiked and climbed in areas for so many years, they know the area better than anyone else you could rouse up. Yet some young 20 year old guy can legally bring groups of people out into that wilderness and charge for it because he is "certified", even though he's only hiked in that region for a few years.

iClimb said:

I guess I feel frustrated with the redundancy of these First Aid programs...

The only difference between those and wilderness first aid is the ability to use.. ..ingenuity...

..These classes in my mind are ways for companies to carve a narrow niche, to make more money, and serve no real purpose.

Same goes for Guide Certification...  (for example) ..some young 20 year old guy can legally bring groups of people out into that wilderness and charge for it because he is "certified", even though he's only hiked in that region for a few years.

You are correct in your observations to a degree.

It has been awhile since I took a first aide course, but I don’t remember city side courses teaching how to deal with things like moving victims off steep inclines, over icy surfaces, using signal fires or other means to help rescuers locate you from the air, and other situations considered unique to the back country. 

I must say it gave me a chuckle to read the musing of a 26 year old climber as he doubts the experience of “some young 20 year old guy” to guide.  Perhaps it is funny only to codgers over 60s. lol  But I am sure that 20 year old has put in the hours, it is mandated.

As for guide certification, local knowledge is only one part of why one hires a guide.  If “expert” knowledge of a locale was the principal criteria to guide certification, that would pretty much negate certifying anyone to guide oodles of treks, such as Mt St. Elias, (Saint Elias range, Alaska) Tranago Towers (Karackoram range, India), or Mt Fitzroy (Southern Andes range, Argentia), just to touch each compass point, because few climb these peaks and fewer still ever make repeat ascents.  In any case the overriding concern I have in a guide is confidence the stranger I paid to share my rope doesn’t increase my exposure to risk; something the certification deal supposedly addresses.  That aside, the only reason I’ve hired guides was to handle the mundane logistics of the trek, and secondarily for the collective knowledge of the community in advising what special considerations are required gear-wise – my guide may not have climbed Fitzroy, but the tour company can find someone who has and pick their brains for specifics.  At least that is part of what the good companies do.


I got my WFA and WFR some years ago and recertify every two years. I think it important to keep the procedures fresh and in line with current teaching. Remote Medical is a company that does a great job and they often teach through REI. The Red Cross First Aid courses are certainly helpful, but don't go into the details of wilderness first aid procedures, per the 911 nurse in the post above. An interesting note is that if help is more than an hour away, that can roughly be considered a "wilderness" situation. An important aspect that hasn't been mentioned is the liability/legal issues, which are or should be taught in any WFA course. These can be hard to follow if the person has clearly suffered a traumatic injury, yet refuses medical attention. 

I recertified this year for a WFA and the procedures for clearing a spine had completely changed. I think it is important to keep up to date with the changes; wilderness medicine evolves and it really helped me practice the procedures with a group again because I've never had to use them in an emergency in the field.

ed - lol, yes as a 26 year old I'm criticizing the "young" 20 year old.

My reasoning for that is that I know my limits, and even with a "certificate" to guide, I know some of the "un-certified" could and should be doing it better than myself.

and in terms of what a city 1st aid course may not teach, I understand this, but again for someone who is experienced, well read, and self-trained, none of those things you mentioned about steep incline rescue, icy rescue, etc, are beyond common sense and improvising.

My intent behind the young versus old guide dilemma was this - it's not just about local knowledge, but experience as well. Again, the individual I know who is more qualified than most young "certified" guides, has been to the top of Mt Washington in the winter season ALONE almost 50 times. He has also done all of the 48 mountains over 4,000 feet many times over, all in winter and other seasons. He has done them to a point where the young buck wouldn't even have enough years to catch up even if the young buck hiked daily.

He has also done the most difficult routes many times over, many times he was alone for these routes.

My point is that he is beyond "certified" but doesn't carry the title, proving that these classes and titles are essentially meaningless. He has acted as my "guide" many times, and I would trust him with my safety and would trust my ability to learn from him more than any other guide company in the area.

I remember watching once in our ascent of Mt Washington in winter, as a "guide" younger than myself led two clients up the trail past us as we rested. The man I know and myself tried to chit chat with them, trying to be friendly. 

The "guide" took on a pompous "I'm better than you" attitude with his answers and his rehearsed "experience" rant. I watched in amazement as the man I was with, who had 6 times the experience and 35 years on the "guide" simply compliment his accomplishments in complete humility.

This is a good reminder that I'm well beyond due to refresh my WFA or to find the time to do a WFR.

Several years ago I did a 3-day WFA in the White Mountains, in what is now the Wild River Wilderness. We backpacked in a couple miles and set up class at a forest service campsite. Our first afternoon we did a number of scenarios; in one of them, the "victim" had been trampled by a moose.

Not long after that particular scenario, we were sitting in camp doing a recap of the day's lessons, when we heard a low, steady drumbeat from up the trail, where we'd done the moose scenario. As we listened, the drumbeat got louder, and louder, and louder.

All eyes were on the trail as a young moose came trotting into camp. Seeing ten or so people staring at it, the moose skidded to a halt in a rather comical manner, then quickly turned 90 degrees and crashed off into the woods.

Had the moose not taken that turn, we would have been dealing with a repeat of the scenario we'd just practiced.

iClimb, I certainly agree that there is no substitute for experience and I understand your disappointing encounter with a certified and yet inexperienced guide. I would advocate that in terms of WFA and WFR, all methods of gaining useful knowledge are important. As you say, experience counts. Also courses taught by experienced professionals, reading, and basic common sense are all factors in being able to quickly and competently deal with a medical emergency in the bush. It is certainly one thing to read about, or even practice a procedure, but quite something else when you are trying to assess and stabilize a victim with multiple injuries, on a wet dark night. Many of us go years or even decades without being thrust into such situations. That is why the courses are important. While they can't replace actual experience, they nonetheless establish protocols that are easy to follow. When it really happens, it is very reassuring to have such procedures. Most serious accidents in the bush often involve multiple injuries, and trying to deal with a victim who is incoherent and has suffered multiple traumatic injuries is a place where all your knowledge gained from every source, is important. Having many sources, means that your climbing partner might live to climb again.

An interesting sidebar to this discussion, is that, beyond simple band aids, one of the most needed items in a WFR's kit is a an EPI Pen.

NATIONAL SKI PATROL OUTDOOR EMERGENCY CARE manual is what I use (being a patroller, natch)


This course is open to anyone for $40. and another $50. for the big manual. It's the equivalent of an EMT level I course with winter FA included. It's a 40 hour course, so make the time. You'll be welcomed.

300 where is this course?

The Ski Patrol course is given at many commercial ski areas.  There are is a backcountry version given by various Nordic Ski Patrol groups.

You can order the OEC book directly on line. The rescue book is here.

I Climb,


Any ski patrol  (alpine or Nordic patrol) has this course beginning in late September or early October for their new candidates.

Wilderness Medical Associates International also provides Wilderness First Aid training across the globe, along with more advanced first courses (Wilderness First Responder, Wilderness EMT, etc). We train over 8,000 students a year. Check out our full schedule and learn what to do when 911 isn't an option.

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