A fit, healthy climber stands on an icy mountainside, preparing to tie into a rope for a last push toward the summit. A moment later, he is sliding down the mountain, out of control, picking up speed, and hitting rocks, trees, and chunks of ice as he cartwheels down the slope. He finally stops 200 feet below when his body hits a log that is frozen into the ice. He has a fractured skull, a broken neck, broken ribs, and lacerations on his face. The injured man needs a neurosurgeon, an orthopedic surgeon, and a hospital, but he is on the side of a 4,600-foot mountain. It is getting dark, and it is cold—very, very cold.
This was the situation last December on Nippletop Mountain in the Adirondack Mountains of New York. The only person who could provide care for the victim during the next 11.5 hours would be a climbing partner who rappelled down to him right after the accident. Two other climbers then ran the equivalent of a winter duathlon by summiting the mountain (hoping to get a cell phone signal to call for help, which they did not) and then hiking another eight miles down the mountain through wintry conditions in the dark to a phone. All of this activity followed an already physically demanding day of scaling the mountain.
Backcountry emergencies need a response from well-trained, physically fit, outdoor specialists in order to avoid becoming backcountry disasters. Although a victim might need the services of paramedics and, ultimately, nurses and doctors in the hospital, these people are typically not going to make it to the injured person on a mountainside, in a desert canyon, or out on the high seas. Even when they do, a paramedic without his ambulance or a doctor without her hospital can provide little more than basic first aid in the backcountry. What injured victims in the backcountry need is a person who is familiar enough with the environment in order to find them, skilled enough on the terrain to gain access to them, strong enough to carry them, and educated enough about medicine to do all of this without causing further injury. That is where wilderness medicine comes in.
Wilderness medicine is a sub-specialty of pre-hospital emergency care, which is normally the domain of EMTs and paramedics. Proper training can prepare ordinary people to manage emergencies like professionals in places where resources are limited and the challenge of the environment is fierce. Organizations such as Wilderness Medical Associates* and Wilderness Medical Institute provide first-aid training with a larger skills set and with a greater focus on anatomy and physiology than one would get in any standard first aid class. The greater depth of knowledge of anatomy and physiology gives rescuers the ability to make critical decisions as situations evolve, instead of just following a training algorithm. The greater skills set includes things such as removing impaled objects, reducing dislocated shoulders, and administering medications. It also includes how to improvise equipment for treating the patient and how to carry someone out of the backcountry. Some of these skills would normally be left for doctors to perform in a hospital, but the ability to perform them in the field can have a tremendous advantage to the victims of accidents during the crucial hours before the hospital.
People who take wilderness medical courses include outdoor professionals such as mountain guides, raft guides, park rangers, and military special forces, as well as scout troop leaders and weekend outdoor enthusiasts. These are the people who are going to be there, in the field, where the accident happens. They are physically fit and skilled in the environment. They are able to reach the side of an injured climber on a cliff face, run sugar to a struggling diabetic, or bring an inhaler to an asthmatic who is miles down a trail. If you are lying in the snow, broken and bleeding after a bad fall while skiing, you may want to see a doctor, a paramedic, or even your mother. If you look up and see the weather-wizened face of a ski-patroller and notice a WFR (Wilderness First Responder) pin on the collar of his or her jacket, be assured that you are in good hands.
These are the kinds of faces who greet the aforementioned injured climber at 3:30 the next morning. It is a group of backcountry rangers from the New York State Department of Environmental Conservation, who are trained as EMTs and have specialized wilderness training, making them WEMTs. Even this team of experienced rangers would be unable to do anything for the patient if his friend had not kept him alive and warm through the night, during which temperatures had dropped to the single digits. There is also a physician’s assistant with this group who is part of a backcountry rescue team and will be the highest level care provider to treat the man for the next 14 hours.
The remainder of the rescue is a dangerous, grueling slog that includes the use of ropes to lower the victim down the steep mountainside and the use of axes and chain saws to produce a suitable route through the forest. Once at the bottom, they are able to employ the first labor-saving technology in the form of pack frames designed specifically for New York ranger teams to help carry litters over rough terrain. By the time they reach the road, the team has increased in number to over 30 members. In the backcountry, the primary qualification to help save someone’s life is having a level of fitness that allows you to go the miles and to carry the gear. Some of these rescuers have been on the go continuously for over 24 hours. At least one rescuer had already spent the day skiing before he got the call and hiked through the night to reach the victim.
Once they reach a road, the climber is transported to the hospital by ambulance where doctors, nurses, and family members are able to play their role in his recovery. Meanwhile, the people who helped rescue him from the mountain are undoubtedly back out hiking on the trails, skiing on the slopes, and climbing on the cliffs. They are staying in shape and sharpening their skills, because that is what they do. Whether they know it or not, they are already training for their next wilderness rescue.