Posted by: scintillatingspeck | January 26, 2009

Wilderness First Responder training.

For nine days, I took part in a Wilderness First Responder course offered by SOLO at Amherst College. This was no small task for me. Bear in mind that this was an 80-hour intensive. Also bear in mind that I am still nursing a toddler. I was terribly nervous about spending most of my waking hours apart from Lily for nine days, worried about how she would fare, worried about how Tom would fare with the brunt of child care upon him during the daytime, and worried that I would discover that my brain had atrophied since the last time I studied so intensively, or that the demands on my body would be too great in terms of sleep deprivation and physical activity. However, I am immensely proud to say that I am now a certified WFR (pronounced “woofer”). The course was fantastic and we all came out alive.

Why did I decide to pursue Wilderness First Responder training? Let me start by explaining what it means. The course essentially focuses on backcountry emergency medicine. (See here for a full run-down of what was included in my studies.)  There are certain key differences between wilderness and urban emergency medicine: wilderness emergency medicine assumes that you won’t be getting to a hospital very quickly, and it relies much more upon improvised materials.  There are also differences regarding decision-making and standards of care; for example, an urban first responder might not be overly concerned about environmental threats such as hypothermia, whereas a wilderness first responder would be extremely concerned.  These elements– the assumption that hospital care is not around the corner, the reliance on skill and improvisation rather than lots of technology and equipment, and an emphasis on backcountry issues–are what drew me to WFR training as an important skill set both for immediate use and for a future threatened by economic recession and resource depletion.

WFR training tends to be the province of wilderness guides and leaders, adventurers, backpackers, hikers, paddlers, and the like.  I am as enamored of such activities as they are, and look forward to introducing Lily to hikes on nearby Mt. Tom and Mt. Norwottuck and such, and as she gets older, to longer and more challenging hikes in the Green Mountains and White Mountains.  She is still only 21 months old, but I can dream, right?  I want her to experience the peace of the mountains, the camaraderie of the trail, the satisfaction of physical movement and self-reliance, the delight of immersion in the natural world.  But it was not my love of mountain hikes that drew me to becoming a WFR, although I am very glad to have the skills for that setting.

No, I became a WFR because it seemed like the logical path to follow due to my concern about the economic/environmental/energy conundrum we are facing as a species. 

For starters, I wanted to leverage my existing knowledge and skills in the field of health care.  It started when I was a child, pestering my dad, a physician, for tales of patient care.  It continued with a few jobs working in physician’s offices (a cardiologist, who taught me how to take blood pressure and hook up patients to EKGs; and a pediatrician).  Then I had my own adventures as a patient in the health care system in the early 1990s and learned a great deal that way.  Subsequently I decided to major in nursing, and although the course material fascinated me, I decided that the actual business of nursing was not so appealing.  However, I darted in and out of involvement in the health care field in various ways– as a research assistant on gender and health; on a research team focusing on gerontology and end-of-life issues; and as a health librarian for the Holyoke Consumer Health Library, when I would train folks on how to use MedlinePlus as well as set up my roving librarian tent at the Holyoke Farmer’s Market (see pictures here).  Currently, in my position at Living Routes, one of my tasks is to review student medical forms for anything that needs follow-up.

All of this exposure to the world of health care has made me very aware of how utterly vulnerable the modern American health care system is to the vagaries of economic recession and resource depletion, in particular depletion of oil.  Not only do we rely almost exclusively on oil for transport (think ambulances, commuting health care workers, people traveling to see their doctors, equipment and medications being transported, etc.) but a lot of medical equipment and pharmaceuticals are manufactured using petroleum.  Think of the energy it takes to provide electricity to a hospital, or to heat and cool it.  Think of the energy it takes to power an MRI machine or any of a multitude of high-tech tools.  There is a growing international consensus that we are at or near the peak of oil production worldwide (see the Energy Bulletin Peak Oil Primer for a quick summary of what this is about).  Combine this with the reality that we are perhaps entering the Second Great Depression, and it becomes apparent that even if we keep some of this health care infrastructure running, a whole lot of people won’t be able to afford to use any of it.

I am lucky to live in the Commonwealth of Massachusetts, which is the first state to mandate universal health care access (and is also fabulous for being the first state to legalize gay marriage, but that’s another story).  As a result, my family is able to afford health insurance through Commonwealth Care, despite our severe underemployment.  However, I am concerned about the state’s fiscal woes and have to wonder how long this arrangement is going to last.  The health care system in this country as a whole is not financially sound and is not meeting basic needs.  This is a problem that can only be exacerbated by further economic turmoil and lack of resources.

I have been influenced by the writings of Dan Bednarz, who examines the impacts of energy decline on public health and medicine.  See for example his essay Energy, Climate Change, and Complexity in Health Care available on his blog, Health after Oil.  Bednarz tends to focus on the big picture, the policy implications, and I appreciate that.  However, I am impelled to translate those implications into the immediate, mundane realities of everyday life.  So, while I continue to look at these issues from an intellectual standpoint, I also feel an enormous urgency to take action, say, by knowing what to do if someone has a mid-shaft femur fracture and there is no ambulance in sight.  Or knowing how to perform CPR.  Or knowing how to prevent certain accidents or illnesses from occurring.  Or knowing how to stride into the midst of a crisis and take the lead.  I have a deep need to balance these macro and micro levels of knowledge and skill.

Enter the stupendous WFR course I just took.  I was one of 11 students: 9 college students, the Amherst College outdoor coordinator, and me, the oldest person in the room at the ripe age of 36.  Lovely bunch of bright, motivated folks.  We were taught by Jon, a guy who clearly knows his stuff and loves teaching, which was a pleasure.  Each day was a combination of classroom lecture and hands-on practice, complete with mock rescues, fake blood, fake bruise make-up, and one spectacular fake compound tibia fracture.  We also got to see some excellent slides that elicited strong reactions, like certain images of the effects of frostbite, trench foot, a de-gloved finger amputation, and brown recluse spider bite havoc.  By far the best parts of the course were the scenarios, when we took turns being patients and rescuers and quickly learned some crucial lessons: a.) be very precise and thorough in assessing your patient, in the exact order of priority (establishing scene safety, body substance isolation, airway, breathing, circulation etc…); b.) make sure you have the necessary materials at hand (sleeping pads, cravats, a long pole or stick for a traction splint, a SAM splint, etc); c.) don’t forget to ask all the questions required for proper documentation in a SOAPnote and to really get the whole story of what’s going on for a patient.  Most of our scenarios took place outdoors on the Amherst College campus, in the snow, in mostly frigid conditions.  I was exhausted a lot, particularly because Lily seemed to want to nurse half the night every night so as to make up for my absence during the day.  I pumped breastmilk at lunchtime each day for Lily to have the subsequent day.  Pumping is a pain in the butt, or rather, a pain in the boobs.  On top of that I was also pumping in the evening to give milk to a pair of twin babies in the neighborhood who otherwise lacked access to breastmilk. 

But I made it through nonetheless. (And Tom and Lily made it through as well, and Tom deserves endless thanks for his patience and awesome Daddy-ness.) I did really well on the final written exam and also built a kick-ass ankle splint out of a Thermarest sleeping pad, various bits of clothing for padding, and a bunch of well-placed, tightly knotted cravats, and wrote a great SOAPnote.  My classmates and I were all very pleased and justifiably proud to become certified WFRs.

Now that I am certified, I hope to continue expanding my knowledge of wilderness emergency medicine as well as exploring other health care fields that I think will be especially useful.  I would like to learn about herbalism but have not yet decided to what degree.  Time and expense are two limiting factors I’m confronting.  I was able to do the WFR course because it was a 9-day course.  It was still expensive for us, considering my family’s financial situation, but we considered it a priority for the future, so we allocated funds to it.  With herbalism, I’m not sure I could find something that would allow me to parent a toddler and work part-time as well as study, and I am worried about the cost.  I know there are correspondence courses, and maybe I will end up doing one of those, but I think there’s a tremendous amount of value in the hands-on approach and I worry that I would miss valuable sensory lessons.  I am also very interested in the use of food as medicine.  If anyone has any good suggestions for how to pursue studying herbalism in a way that I can manage, please leave a comment.  I also want to learn a lot more about managing chronic health conditions in backcountry settings.

I highly recommend the WFR certification as part of a comprehensive approach to preparedness for the future.  Are there others out there becoming WFRs for the same reasons as me?  I would love to know.

Meanwhile, I want to offer my classmates a hearty congratulations on a successful course.  I would be honored to be on a rescue team with any and all of you.  And I also want to thank Jon Clancy for his wonderful teaching.

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Responses

  1. Congrats to you on all that you accomplished – with the class, with your family, and with your spirit!

    That, and I will just love calling you “Woofergirl”! 🙂

  2. You can call me Woofergirl anyime. 🙂 The only point of confusion for some folks is that it sounds a lot like someone who participates in WWOOF (Willing Workers on Organic Farms). But I suspect there’s a decent amount of overlap with WFRs and WWOOFers.

  3. This post took Jen a long time to write amist exhaustion and baby-sleep-difficulties, but it was so important. I feel really good knowing that our family has these new skills and preparedness!

    As for watching Lily for nine days – I want to thank all the lovely people who have uploaded entire seasons of The Muppet Show on YouTube. For a family with no “TV”, that really helps in a pinch.

  4. Damn, woman! You’re amazing! I had no idea it was a nine day course and you went through all that. I am impressed!

    And, Tom, what a gift!

    Love to your family.

  5. Great post.I got many ideas from your post while reading.Thanks for your information!


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