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New Web Site & Shop is Live

After working on an update of the website and new shop it is now live.  Expect more updates and products over the next few weeks especially after we return from the Outdoors Trade Show.

It is amazing what you can get done when you are 8000 miles from the real world.

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Wilderness First Aid – Scope of Practice

In our last post on the Patient Assessment Process we said our next post would be about a Scope of Practice for Wilderness/Outdoor First Aid.  If you are following our posts you will by now have realised that we believe strongly that Urban and Wilderness First Aid are different.


Survival & Medical Services
Survival & Medical Services

People who live, work, travel and enjoy the outdoors have First Aid training needs not met by traditional first aid programs. They care for patients in remote locations, in challenging weather, with questionable communication and support, limited equipment and the need to make independent decisions on patient care and transport.
Despite a multitude of First Aid courses being advertised under a multitude of titles there is to this date no defined Scope of Practice for Wilderness First Aid providers or for their training.  If fact there is no laid down Scope of Practice for First Aid in the UK at all.  Now that the HSE have changed their regulations to state that ‘it is the responsibility of an employer to endure that First Aid training and provision is suitable’, the closest there is to a Scope of Practice is the Voluntary Aid Societies Fist Aid Manual.  Unfortunately, for those heading away from the car park or to remote areas, the First Aid Manual is designed for the Urban environment, moreover these courses are often taught by professional Health & Safety or First Aid Instructors who have little or no experience of patient care let alone care in a Wilderness environment.

There are strong opinions that these programs are best taught by skilled and experienced outdoors Stour Estuary Bushcraft FA8people, who have experience for providing Emergency Aid in Wilderness situations, using hands-on practice, case studies, and realistic simulations as the prominent educational styles; we echo this belief that the most suitable instructors are not those with the highest Medical or Pre-Hospital qualifications rather those with experience in a Wilderness Field.  There are distinct differences between the Urban and Wilderness environment that support this.

Why have a Scope of Practice?

Almost anybody can put together a course on any subject, give it some flashy title and pay an awarding body to include it on the NQF (National Qualifications Framework) at a particular level however that does not mean it is Fit for Purpose.  It just means that the course is delivered at a particular educational level for a particular length of time.
Some responsible companies and organisations have added caveats to the training they require but it is insufficient to say that a course should be a minimum of 16hrs based on the outdoors, or that it should follow EFAW with the inclusion of 3 additional topics.
However this post is not intended to question organisational accreditation or instructor training or qualifications but we feel that First Aid training should not be about collecting NQF certificates but about learning something that is Fit for Purpose.

What is a Scope of Practice?

In simple terms it states what someone within a given context should be trained and able to do.  It is not a license to practice, rathersplint_inuse_ems guidance on what should be trained but most importantly it is evidence informed.

Is there a Scope of Practice for those who require to provide First Aid off the beaten track?

Yes there is! and as the only evidence informed document of its kind we feel that the Scope of Practice Document supported by the Wilderness Medical Association in the USA, with minor amendments, should be used as a Standard for such training in the UK.

Survival and Medical Services have adapted the WMA Wilderness First Aid Scope of Practice to meet not only a UK & European environment but also the differences in accepted medical procedures in UK and EU.

What follows is an outline précis of the Scope of Practice which we base our courses on.  We are happy to share a fuller copy on request.




Wilderness is subjective as is the concept of remoteness, within the concept of Wilderness First Aid it relates to any area beyond immediate access by road where the response by professional responders is likely to be delayed by distance or terrain but where that response could reasonably be expected within 8 hours.

First Aid:

First aid is the assistance given to any person suffering a sudden illness or injury, with care provided to:

  • Preserve life
  • Prevent the condition from worsening
  • And/or Promote recovery

It can be provided by lay persons within the bounds of their skills and training and is the aid provided by medical professionals when they do not have access to the normal facilities of their profession.

Wilderness Activity:

A Wilderness Activity is any activity or pastime that takes place in the Wilderness as defined above.  It can include country walks, bird watching and photography through camping and bush-crafting to kayaking, mountaineering and overland travel.

Who is Wilderness First Aid Aimed At?

A Wilderness First Aid (WFA) Course is intended for non-medical professionals:

  • For whom first aid delivery is a secondary responsibility
  • People acting as a second rescuer for a more highly trained person,
  • People with the outdoor skills needed to participate and/or lead the trip and who have an effective emergency action plan,
  • Individuals traveling alone, with family, and/or friends.

In the context of:

  • Locations where evacuations will primarily be walkout or stretcher carry with the assistance of local resources or might require Helicopter evacuation
  • Where local Ambulance or Rescue access is expected in a timely manner (< 8 hours, > 1 hour)
  • Short trips relatively close to help
  • Day trips/camps
  • Stationary wilderness camps,
  • Weekend family activities
  • Country outdoor recreation.

Wilderness First Aid Course Outline

Focus and Content Overview

The WFA is commonly taught as a 16-20 hour course with an emphasis on practical skills and drills. This is the minimum amount of time needed to cover the core topics.

Focus is on:

Performing a basic physical exam to identify obvious injuries or abnormalities, assessing basic and obvious signs, symptoms, and vital sign patterns, along with obtaining a simple relevant medical history,

Prevention of medical problems anticipated by the activity and environment,  treatment focused on stabilization of emergencies, initiation of specific and appropriate medical treatments (basic splints, wound care, spine immobilization, managing heat and cold) and assistance to patients utilizing their personal medications.

Conservative decisions on the need for, urgency of and appropriate type of evacuation and for interventions appropriate for this level of training.

Not Included

The WFA Scope of Practice does not include:

Traction splints

Wound closing with sutures

Use of prescription medications other than epinephrine by auto-injector for anaphylaxis

Needle decompression

Invasive or mechanical airway adjuncts

Releasing tourniquets in the field

Complex medical assessment or diagnosis

Core Skills

  • Patient Assessment and BLS
    • Evaluate the scene.
    • Perform a Primary Survey (Identify and treat life threats)
    • Perform a Secondary Survey
    • Plan and conduct evacuation or contact with outside resources.
  • Circulatory System
  • Respiratory System
  • Nervous System
  • Spine Injury
  • Wounds
  • Burns
  • Musculoskeletal Injuries
  • Allergic Reactions
  • Heat Illness
  • Hypothermia
  • Lightning
  • Submersion/Drowning
  • Common Medical Problems
  • Poisoning

Optional Topics

Optional skills after additional training. (These may be included in a Wilderness Advanced First Aid Course specific to need)

Options are supplemental program, activity and environmentally relevant topics; local cold injury, altitude, snakebite, marine toxins, arthropod venom, dislocation reduction and spine injury management, or additional practice time on assessment and practical skills that may meet the needs of specific audiences.

  • Dislocations (4 hrs)
  • Spine Injury Management (4 hrs)
  • Local Cold Injury (Frostbite and Non-Freezing Cold Injury) (2 hrs)
  • Altitude (2 hrs)
  • Toxins: Land (2 hrs)
  • Toxins: Marine (2 hrs)

If you would like a full copy of our SoP Document or want to discuss Wilderness First Aid or First Responder Training further please contact us.

If you are interested in training please complete this form.

reg now



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Remote First Aid 3

logo_RET2In this our third and final look at initial patient assessment we will look at the Secondary Survey.  We have already assessed the scene to rule out hazards and provide us with an overview picture of what has happened and we have conducted a Primary Survey to ascertain if there are any life threatening injuries, and to treat them there and then.  The Secondary Survey gives us a fuller picture of all the patients injuries or complaints, a base line of vital signs to start a monitoring process and a full patient history.


Secondary Survey

Once any and all life threatening injuries it is time to complete a full focused Examination of the patient and to gather a patient history and vital signs to discover any ailments that might affect the patient and to record a start point for the vital signs.  This process is often referred to as the Secondary Survey.

In an urban environment it is normal if the patient has any life threatening injuries, or if the Mechanism of injury (MoI) suggests serious underlying problems or if your intuition tells you that there is more going on than you are prepared to handle the patient would be on the way to hospital.  The Secondary Survey would then be completed during transport or on arrival at the receiving hospital.  Rapid evacuation is rarely possible in a remote environment even by helicopter, which means 2 things: firstly critically injured patients have a higher mortality rate in the wilderness and secondly you will have time to carry out a Secondary Survey on patients who you are not treating for a life-threatening injury.

During the secondary survey it is likely that the patient will have to be partially undressed to expose and investigate injuries etc, in urban protocols this is often expressed as E – for Expose but in the wilderness we must think of E – as Environment and before we start further investigations protect our patient from that Environment.

The Secondary Survey comprises of 3 elements:

Physical Examination
Patient History
Vital Signs Recording

The order that these are completed is not didactic.  With an ill patient it may make sense to get a History and Vital Signs before a physical Examination whereas with a confused trauma patient it would make sense to discover the sum of the injuries first.

Physical ExaminationScreen Shot 2014-10-27 at 09.05.49

Before starting a physical examination it is good practise to ask the patient what the main problem is. Knowing the chief complaint will give you a primary clue to your final decision making.

The Physical Examination is a head to toe survey of the body where you:
Look for bruises or discolourations, bleeding, swelling and other deformities, or anything else that is out of the ordinary. Look for any pain responses from a patient with any altered level of consciousness.Screen Shot 2014-10-27 at 09.08.42

Ask about pain, tenderness and sensations.

Feel for unusual hardness, softness, rigidity, discontinuity, angulation of limbs, heat and cold.

Listen for unusual breathing sounds, and grunts or groans when feeling for injury.

Smell for unusual body odours, breath, and clothing and any odours in the environment.

Remember to look and feel inside clothing, most medical care needs to be done at skin level; Outdoor clothing is often bulky which can mask injuries and/or waterproof so that bleeding is hidden inside it.

Patient History

A full Primary and Secondary survey is required for all critically illness and injury treatments however the majority of non-trauma patients do not need the same level of rapid interventions and head to to examination.  A quick review of ABCD’s, protection from the Environment are needed but the examination can be guided by the history and be more focussed.

The art of questioning and obtaining a good history is one of the keys to patient assessment.  An experienced Wilderness practitioner will often quickly come to a working diagnosis from questioning.
Always ask open questions and seek clarification from the patient, it is also important to seek answers to the questions from the patient themselves, not from a parent or partner.

For example if you ask “Is it a crushing pain” the patient will often assume that you know best and agree with you;  where as asking “Describe your pain” which may result in a more verbose answer, will give you a clearer indication of what the patient is experiencing.

A commonly used and understood mnemonic for gathering a patient history is SAMPLE

S – Symptoms are what the patient complains about – the sensations they feel – Pain, numbness, heat, cold. (not to be confused with Signs, which is what you can see)
A – Allergies – Is the patient allergic to anything and are any of those allergies severe enough to provoke anaphylaxis.
M – Medications, prescription or over the counter is the casualty taking. Have they taken alcohol or recreational drugs, have they missed a medication dose or taken too much.
P –  Past medical history – Is there anything that is possibly relevant, has something like this happened before, are they seeing a Doctor for anything,
L –  Last Intake of food and last toilet functions.  What and when was the last meal and fluid intake.  When did they last urinate and what was the colour, when did they last defacate and was it normal.
E – Events – What caused or led up to the injury or illness, has this been a slow or rapid onset?

SAMPLE is used for all patients to gather a history for patients complaining of an illness or non-traumatic pain further history taking by using OPQRST is helpful.

O – Onset: What initiated the chief complaint – Slow or Sudden onset
P –  Provokes: What changes the complaint, for example does changing position or taking a deep breath improve or make the condition worse.
Q – Quality “Describe the pain” sharp or dull, constant or intermitent
R – Radiate: Does the pain radiate, if so from where to where or is it targeted in a specific position.  Ask the patient to point.
S – Severity: How bad is the pain on a scale of 1-10 with 10 being the worst imaginable.
T – Time: How long has the problem been an issue, when did it start.

Vital Signs Recording

Vital Signs do not tell you what is wrong with your patient! they may give you some additional clues as to what s wrong with your patient but their most useful function when recorded with a time is to give you a reference point.  From an initial set of Vital Signs we can refer any subsequent measurements back to ascertain if our patients general condition is stable, improving or getting worse.  Circumstances will dictate how often Vital Signs are measured as a rule of thumb they should be monitored every 5-10 minutes initially and continue at they frequency for all patients who have abnormal Vital Signs that are not improving.  Vital Signs are viewed as a complete set and individual measurements cannot be viewed in isolation.

The Vital Signs that are measured are:

LOR – Level of Response using AVPU (A– Alert, V – Responds to voice, P – Responds to painful stimulus, U – Unresponsive) Alert can be subdivided 4-1, (how many questions can the patient answer about person, place, time/date, event)
HR – Heart Rate (Pulse) Measure rate, rhythm and quality noting the position the pulse was measured (preferably a distal site)
RR – Respiratory Rate Measure Rate, Rhythm and Quality
SCTM – Skin, Colour, Temperature & Moisture
BP –  Blood Pressure (If Sphygmomanometer available)
SpO2 – Oxygen Saturation (If monitor available – SpO2 monitors are unreliable in the cold)
P –  Pupils: Are both Pupils Equal Round and Reacting to Light (PERRL)
T – Temperature of Patients Core (if equipment available).

Screen Shot 2014-10-27 at 09.02.28

You now, finally, should have enough information to make a plan for how you are going to manage this patient. And if you have got this far you have ruled out or stabilised any Life Threatening Injuries.

The plan will include considerations of treatment, evacuation, care and monitoring.

Whilst in an urban environment it is normal to dial 999/112 as early as possible and have the patient transported to a medical facility as fast as possible.  This quick transportation option may not be available to us in the wilderness.  Therefore it is important that we have as much available information before making our Plan.  Unless you discover a life threatening injury that is not immediately resolved it is best to gather all the facts and consider your options before calling 999/112/911.


The final stage of the Patient Assessment Process is to make a decision based on what you know about the patient, the environment, distance from help.

Rapid Evacuation

Treatment & Rapid Evacuation

Treatment, Monitoring & Slow or Delayed Evacuation

Treatment, Monitoring and Continue Activities

Patient Assessment Process

The Patient Assessment Process is sequential, depending on the scene and the patients condition, some of the elements may only take a second to confirm in your mind whilst in other situations the process could take longer.  It is important that all the steps are considered and for your safety and that of the casualty they are considered in order.

Scene Safety

Primary Survey
Life Threatening Injury


Secondary Survey
Head to Toe / Vital Signs / History

Problem List & Plan

Call or Care
+/- Evacuation

We are hopeful that the past 3 posts following a Patient Assessment Process will help you should you need to treat anybody for an injury or illness in the field.  These posts cannot replace proper training but our hope is that they will provoke thought to support any previous training you may have.
If you are interested in taking part in a First Aid Course based on Remote Environments or the Wilderness please complete the following form to register or contact us directly by e-mail.  If you want to know what course will be best for you our next posts will look at the Scope of Practice for Wilderness First Air Providers.



All images in this post are courtesy of NOLS Wilderness First Aid Guide.

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Remote First Aid 2

logo_RET2In the last post we looked at the initial approach to a casualty needing First Aid and why there is a need to consider many factors before we even touch a casualty.  Next we look at the process of a Primary Survey our Initial patient assessment where we are looking for any Life Threatening Conditions and treating them immediately before moving on.  We will see that this follows a sequential approach so that the highest priority conditions are treated first.



Perform a Primary Survey.

The goal of the primary survey is to find and treat any immediate threats to the patients life.  During this sequence any condition that is Immediately Life Threatening you treat it straight away.  It is a Stop and Fix survey.  If there are more than one responders a second responder can find treatment while the person doing the Primary Survey continues.  It is good practice that a single person performs the Primary Survey to ensure completeness even if they are directing others to provide treatment.

Our Primary Survey is:

C – Catastrophic Bleeding
A – Airway with Cervical-Spine Control if indicated
B – Breathing
C – Circulation
D – Disability

Even though the Primary Survey is presented in a systematic way of C-ABCD and is designed for trauma patients it can be equally applied to severely ill patients.  Likewise it can be completed within seconds by asking simple questions.

Q. What happened?
A. I fell over that log and think I have broken my leg! I cannot walk!
Q. Apart from your leg do you have any other injuries?
A. No but I feel a bit cold.

From the above we know that there is no catastrophic bleeding, the airway is ok and that they are breathing and therefore have circulation, because they are talking coherently have no neurological deficit.  They have not identified other injuries but feel cold.

Catastrophic Bleeding

Any patient who has active arterial (spurting bright red) or major venous (actively flowing darker red) bleeding we can immediately assume that the lungs and heart are working and that the airway is partially open.  Life threatening bleeding must be stopped immediately; in the early stages of such blood loss the ability of the blood to transport oxygen to the body tissues is impaired and quickly deteriorates to life threatening situation and irreversible shock resulting in death!
Be aware that waterproof clothing, immersion suits and very heavy clothing can hide severe blood loss until it is too late.

Airway with C-Spine Control if indicated

Your assessment of the MOI (Mechanism of Injury) and scene will have provided an indication as to whether you should suspect a C-Spine injury.  If you consider there to be a C-Spine injury take immediate manual control of the patients head to prevent movement.  However remember that airway maintenance is always more important than immobilisation but it is possible to achieve both at the same time.

Check the airway for blockages, vomit, damage and that the trachea is central.  If the airway is not open use a head-tilt/chin-lift manoeuvre or a jaw-thrust if spinal damage is suspected.


Assess the adequacy of breathing.  With a conscious patient ask them to take a large deep breath, if they can do this without difficulty there is no need to expose the chest to look for other injuries.

If the casualty is unconscious it is important to look, listen and feel for any signs of respiration – if there is none you may consider CPR.

Expose the chest (be aware of inducing Hypothermia) and fully assess to expose or discover and treat any life threatening injuries.  Also note whether the breathing is Normal; Deep; Shallow; Laboured; Fast or Slow.


Life threatening bleeding has already been dealt with however we need to make an assessment of the circulating blood to provide any so far indication of hidden life threatening injury.

Check for a pulse, by the time we get to C we know our patient is breathing otherwise we would be doing CPR so the best pulse to check is the radial pulse at the wrist.  If one arm is injured check the pulse in the uninjured one.

When checking the radial pulse we are checking:

That it exists – if you cannot find it try the carotid pulse (A radial pulse suggests that the casualty has a Blood Pressure of at least 80 Systolic);  The Rate (how fast); Rhythm (regular or irregular); Quality (strong & bounding or weak & thready).


In a  patient we need to assess if there are any neurological deficits.
We check their level of response either using AVPU or the Glasgow Coma Score (The GCS is important in the assessment of head injuries but can be completed during the secondary survey with the help of a crib sheet)


Is the patient A– Alert, responsive to V – Voice, P – Pain or totally U– Unresponsive.

Check the Pupils, do they both react to light?  are both pupils equal? are they round?

Skin tissue colour and capillary refill time.

Look at the colour of the skin, lips and tongue, are they pale, ashen or grey/blue.  Capillary refill is a good indication of perfusion to the tissues of the body.  Depressing the nail bed on the fingers or the palm of the hand will blanch the colour, when the pressure is released the skin or nail bed should return its colour in 2 seconds in healthy persons (This is unreliable in cold patients or those with a previously compromised circulatory problems).

Now it is time to move on to a Secondary Survey to discover what other injuries or complaints the patient has.
Remember the Primary Survey was a Stop & Fix for Life Threatening Injuries only.  Any other injuries or complaints you have found should be left to this next stage.
Also remember that a Primary Survey can be completed without touching a conscious conversant patient whereas you may not get passed A with an unconscious patient who cannot maintain their own Airway.


In our next post we will look at a focused examination of the patient and history taking to diagnose any injuries or illnesses so that we can build our treatment plan and long term care or evacuation plan. These posts cannot replace proper training but our hope is that they will provoke thought to support any previous training you may have.
If you are interested in taking part in a First Aid Course based on Remote Environments or the Wilderness please complete the following form to register or contact us directly by e-mail.


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Remote First Aid 1


In the last post we looked at the differences between Wilderness First Aid and Urban First Aid and why there is a need for a different approach.  In the next few posts we will address the initial steps in dealing with a casualty in remote area’s.  It need not be said but in remote area’s there are many more or certainly different considerations that need to be made.  We need to draw on all our experience of our chosen environment to ensure both our own safety and that of the casualty and others around you.  In this post we look at the initial considerations when approaching any casualty.

Approaching casualties.

The ability to effectively manage an First Aid Emergency situation has its foundation in being able to properly assess the situation, to be able to, in your own mind, create a complete picture of what has happened to the casualty and then to be able to act upon it.  It must take account of any dangers that exist, an understanding of what happened leading up to the incident, an initial assessment of the casualties condition followed by a focused examination for all other injuries, monitoring of the casualty and formulating a treatment and evacuation plan.

With a conscious compliant casualty this can be a very simple process started by asking the casualty pertinent questions however discovering an unconscious patient it can be like a ‘CSI’ or a ‘Morse’ episode on TV where you have to be the investigator.

The key steps in Situation Management are:

Scene Safety and Environmental considerations
Initial Patient Assessment for Immediately Life Threatening Conditions
A full examination and history taking to identify all other injuries or conditions
Treatment and Evacuation Plan

Those who are best at managing first aid emergency situations are those who are excellent at managing relationships, with patient and others who may be of help.  Thinkers, Planners and Communicators!
Those who rush at a situation like a bull at a gate, who let natural adrenaline take over, are likely to put their own safety and that of others at risk.
Two words that characterise good incident managers are Competence and Confidence, both gained through proper training and practice in the operating environment.

Scene Safety and Environmental Conditions

Before you approach the casualty STOP and THINK!

Are there any further hazards which may affect the patient further and more importantly you or those helping you.  In a remote setting creating a second casualty is not only tragic but a massive draw on resources and potentially threaten further the safety of others in the group.
Hazards might be the obvious such as cliff edges, steep slopes, rivers, rock fall, fallen branches or thin ice amongst others; they might also be less obvious like Carbon Monoxide build up in a tent or poisonous insects or animals in the area.
The Environment also provides a risk, in the cold or wet a rescue party who rush to a casualty will cool down faster and potential start to suffer hypothermia while treating a casualty, in a similar way in the heat rescuers may suffer Hyperthermia and de-hydration.
Hazards must be eliminated or at least identified and minimised before approaching the casualty.

Having the initial scene to manage may be difficult but creating additional casualties through poor scene management is not only unfortunate but a massive drain on the resources available.

Part of the scene safety assessment is looking at the mechanism of injury (MoI).  Creating a mental picture of how the accident happened.  Did they fall, if so; how far, what did they land on, were they using any safety equipment.  Were they injured by something, if so was it; sharp or blunt, long or short.  Any information you collect on the MoI will help in your initial assessment and allow you to anticipate future changes in the casualties condition.

Very often your assessment of Scene Safety and Environmental Conditions can be done on the approach to the casualty, as can an assessment of the MoI.

Patient Assessment

Up until now you have not touched the patient, it is always good practice to wherever possible and available to wear protective gloves, all First Aid kits and Medical Packs should contain them, make sure they are replaced if used.
In the 60 seconds it takes to put on a pair of gloves you can do an ‘end of bed’ assessment.

What is your initial general impression – Hurt or not Hurt? Sick or not Sick?
How do they look – Pale, Sweaty, Shaking, Anxious
How are they positioned – holding or supporting an injury
Are they conscious – talking, moving, looking
Do they appear to be struggling to breath – gasping, short sentences, wheezing
Are they talking – openly, responding to voice

If your initial impression is that the patient is critically injures or ill you are prepared for a rapid assessment, rapid treatment and rapid evacuation, bearing in mind that rapid evacuation in a wilderness setting might be more wishful thinking than anything else, but it will grossly affect your planing and thinking.
If however your initial assessment is that this patient is less seriously hurt you can prepare for a less rushed assessment and treatment and time to plan evacuation or in-field treatment plan.

Whether your patient is conscious or un-conscious it is important to establish a relationship with your casualty.  Introduce yourself, try to elicit responses to questions, be professional.  When doing this it is important to get yourself, where possible, at the casualties level and establish eye contact.  Show compassion and empathy to your patient and be honest with them.
Touch is a universal way to provide comfort and reassurance; it is also a good way of checking a patients skin for temperature or to feel for a radial pulse in a conscious patient.
In unconscious patients or those with immediately life threatening injuries the process of establishing a relationship may have to wait however as the hearing is often one of the last senses to be lost it is important to continue to communicate with any casualty and explain what you are doing.


In our next post we will discuss the initial assessment of any patient to discover any life threatening injuries.  These posts cannot replace proper training but our hope is that they will provoke though to support any previous training you may have.
If you are interested in taking part in a First Aid Course based on Remote Environments or the Wilderness please complete the following form to register or contact us directly by e-mail.


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Why Remote First Aid

 logo_RET2First Aid in Remote Area’s

First Aid is the diagnosis and application of care to an injured or ill person in the period immediately post injury or illness onset and until appropriate medical care facilities are available.  First Aid is rendered within the capabilities knowledge and available equipment of the provider no matter what their qualification, medical or otherwise;  First Aid off the beaten track has many names from Remote & Hostile Area to Mountain First Aid or Wilderness First Aid, the titles do not matter the important thing is that the approach is different. The following text aims to explain why providing First Aid in remote area’s is different to an urban situation.


The world is unique and has much to offer us away from the humdrum of society, off the beaten track. There are woodlands, rivers, mountains and shorelines; further afield there are the vast oceans, deserts and underdeveloped lands. It can be hot or cold, wet or dry, dark or light, rushing with noise or silent; it can take hours to walk, a day of paddling, a week of driving or a month of sailing to get there.
In enjoying that greater world there is a responsibility on each and everyone to take some responsibility for not only their own health and well-being but also for those around them. When accidents happen or illnesses strike you need to be able to deal with it in an appropriate manner without all the support systems of communications, EMS or Ambulance Responders only 8-20 mins away and hospital treatment within the ‘Golden Hour’
Whether you have no training at all or are already trained as a First Aider, EMT, Paramedic, Nurse or Doctor there is a common thread that runs through Emergency Medical treatment ‘Off the Beaten Track’; there is going to be more than 1 hour between an injury or illness and definitive medical care resulting in extended contact time with a patient.
Your chosen activity could be Hiking, Bush Crafting, Mountaineering, Kayaking, Overland Travel or Sailing. You could be a group leader, teacher, enthusiast, outdoor photographer, field journalist, forester or anyone else enjoying or working in the outdoors, you all share the fact that Ambulances and Hospitals are far enough away that the closest thing to anything medical could be you!
The great outdoors can turn small emergencies into big ones and providing medical care or First Aid is often demanding and difficult requiring greater self-reliance and decision-making skills to provide the most appropriate care.
Taking responsibility for people in the wider outdoors you must be able to recognise, treat and where possible prevent problems created by and in the outdoors. Anticipating and preventing problems as well as managing risk are at least as important as recognising and treating injury and illness, and that risk to be managed is a continuous factor that extends from before injury through treatment and evacuation.
Traveling beyond the car park means you accept responsibility for not only your health and well-being but also for those who are with you.

Wilderness First Aid vs. Urban Response.

Wilderness First Aid, at whatever knowledge level, involves standard medical principles in a context that requires attention to extended contact time with the casualty, environmental extremes, and treatment with limited and non-specialised equipment including improvisation and the lack of robust communication.

Extended Contact Time

Patients needs change over time and problems may become worse and life or limb may become threatened. For example open wounds require little attention from an urban First Aider because they will be properly handled by a medical facility, typically within 1 hour, in the wild an open wound may lead to life threatening infection before evacuation to a medical facility can be completed.
Over hours, over night or sometimes for days a patient’s well-being has to be considered, including such things as urination, defecation, hydration, temperature control and physical comfort.
The patients’ injury in remote areas may merit a different approach to the urban environment to improve long-term outcome and evacuation. For example a dislocation in a remote location may merit an attempt at reduction to allow self-evacuation.


The environment, and it does not have to be at its extremes, can increase stress on the body and risk for the patient and those providing treatment. In particular Heat, Cold and de-hydration can pose very high risk to every one, patient or otherwise.


In an urban situation generally there are no decisions to be made about transportation, either the patient is taken to hospital or they refuse transport. In the wild rescuers must make independent decisions not only about patient treatment but also whether to evacuate or not and how that will be achieved often without any communication support from the outside world.
The unique circumstances of the wilderness make a didactic ‘Recipe Book’ approach to treatment and decision making impossible. Responders require training and a ‘bucket load’ of common sense as a foundation to making the correct decisions.
Uniquely those decisions made and treatment provided might enable the patient to remain in the field and enjoy the rest of their experience – something that would rarely happen in an urban environment.


The first aid kit that saves lives prevents disability, and eases suffering is not found in a bag or on the shelf but largely in the brain of the rescuer. The best safety plan for any activity off the beaten track and away from accepted modern medical response is to be well trained in First Aid for the environment you may encounter. That training may have many different titles and be delivered in different forms but it must be influenced and driven by the concept that accepted modern access to pre-hospital and hospital care may not be readily available.


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Outdoors First Aid Courses

logo_RET2If you are interested in attending an Outdoors First Aid Course with Survival & Medical in the next 6 months please register your interest on the sign up form later in this post.  This will give us a start point for discussing locations and dates.

My thoughts are to run 1 or 2 courses for adults either side of Winter.

We have access to a camp ground in North Essex, with local accommodation if winter camping is not for you; we can also run the course at any campground you have access to, given sufficient numbers.


Please feel free to share this sign up with anybody else you think will be interested.

Stour Estuary Bushcraft FA8

Adult Courses

I am interested in attending or finding out more about an Outdoors First Aid Course in the next 6 months.

Children’s First Aid Courses

If you are also interested in First Aid Training for your Kids please complete the second form, this will be a course for the kids not how to treat kids.

Stour Estuary Kids 1

I am interested in my children receiving training in First Aid during the next 6 months.


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Stour Estuary Bushcraft Weekend


logo_RET2Survival & Medical Services will be joining  Bushcraft & European Bushtucker at their Bushcraft Weekend being held near Wrabness in Essex.  On the Saturday we will run some Survival First Aid Sessions for the youngsters and on Sunday Morning we will hold an Adult Session on First Aid in your Preparations for the Wilderness.

Information on the event is below or you can find out more from this LINK

A Bushcraft Weekend for all levels.

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17th to 19th October 2014

Arrival and welcome on the Friday Night whenever you can get there. – Networking and time around the camp fire.

Saturday Day – Either explore the woodlands and Estuary at your leisure or join in one of the master workshops being run by guest instructors – A nominal extra fee may be charged by the instructor for this. Sessions offered are wild food, fire lighting, spoon carving and Game Butchery.

Additionally included in the cost of the weekend I will be running a workshop on shelter building and principles of survival.

On the Saturday Evening you can either spend time around the camp fire of join in the survival exercise included in the cost. – It will be a lot of fun.

Sunday will be a relaxed morning of practicing your new skills, time for equipment trade – swop if you wish – Packing up at mid day.

There are no washing facilities
There is two chemical toilets and a urinal facility
There is one tap that will provide water.
There will be one large central fire-
You may use disposable BBQ’s

You will need to be able to carry your equipment as the camp site is accessed via a short woodland walk.

You will need to provide your own tent and food for the weekend. There will be the chance to purchase game for the weekend that will come gutted but in the skin if you wish.

Adults are £12 Children are £4.
Families are welcome – there will be a couple of Children’s Bushcraft activities too.

Anyone under the age of 16 will remain the responsibility of their adult.

Tickets are subject to availability – There is an extra charge of 63p per person for payments via pay – pal to cover their cost. You may contact me directly on
07449 – 621 314

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First Aid in your Preparation for Adventure

We would like to thank everybody who attended our lecture on First Aid in your Preparation for Adventure at the Adventure Overland Show.
From the link you can get a PDF Copy of the short slide set.

Adventure Overland