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.
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 people, 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, rather 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 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.
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.
The WFA Scope of Practice does not include:
Wound closing with sutures
Use of prescription medications other than epinephrine by auto-injector for anaphylaxis
Invasive or mechanical airway adjuncts
Releasing tourniquets in the field
Complex medical assessment or diagnosis
- 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
- Musculoskeletal Injuries
- Allergic Reactions
- Heat Illness
- Common Medical Problems
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.